Aim of the lymphoma case study
This case study aims to facilitate the development of competencies that reflect the role of the Specialist Cancer Nurse (SCN) in providing a coordinated approach to care planning, implementation and evaluation for people affected by NHL across the cancer journey.
Non-Hodgkin lymphoma was the most common cancer affecting the blood and lymphatic system in Australia in 2011. Overall, it was the sixth most commonly diagnosed cancer and the seventh most common cause of cancer death.4
Lymphoma is more common in the older person. Older people diagnosed with cancer can have unique support needs, associated with co-morbidities, and changes in general health, functional status, and social circumstances.
This case study focuses on the SCN's role in the provision and coordination of care for people with NHL, as well as exploring issues associated with diagnosis of cancer in the older person.
There are many points along the cancer journey when SCNs can improve outcomes for people at risk or affected by NHL. These include:
Section 1: Reduce risk
The causes of most lymphomas, including NHL, are unknown, although identified risk factors include an underlying immunodeficiency condition, presence or history of specific infections, occupational risks and medical / co-morbidity risks.4
While many of the identified risks are difficult to avoid and there is limited practical benefit for prevention programs, the SCN can promote avoidance of risk factors and community education about these risks.
Section 2: Find the condition early
Many of the symptoms associated with lymphomas including NHL replicate common symptoms of influenza and common viruses which are frequently seen in primary health care settings.5
The SCN has an important role in educating primary care colleagues about the signs and symptoms of NHL to promote efficient referral to specialist services and timely commencement of treatment.
Section 3: Have the best treatment and support during active treatment
Treatment for NHL depends on a range of factors associated with the type and grade of the disease. The SCN can assist people affected by NHL to understand the rationale for treatments, and support them to make decisions congruent with their needs and wishes.
Antineoplastic agents are commonly used in the treatment of NHL,6 and this may be used in combination with radiotherapy and/or monoclonal antibodies. These treatments can be associated with significant effects and toxicities which require evidence based management.
Care of the older person with cancer raises unique challenges for the multidisciplinary team (MDT).7 The SCN has a role in ensuring that any barriers to optimal care are addressed, and that treatment and care of the older person with cancer is optimal.
Section 4: Have the best treatment and support between and after active treatment
While prognosis following treatment for NHL has improved, completion of treatment is often associated with significant fears about relapse as well as managing adverse effects of treatment. The care coordinator is a key member of the MDT, providing support for the person affected by lymphoma throughout the cancer journey.
Section 5: Have the best care at the end of life
Advance care planning is integral to the management of older people with life limiting conditions such as cancer.8 The SCN supports people affected by NHL to voice their wishes regarding individual care choices at end of life.
An evidence based multidisciplinary approach is required for management of symptoms associated with progressive disease.9 The SCN acts as a resource to colleagues in other settings regarding strategies for effective symptom management.
Carers of people with cancer face a range of competing demands, and caregiving can negatively impact on the carer's health.10 SCNs play an important role in supporting carers and facilitating access to carer support services.