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A non-Hodgkin lymphoma diagnosis can come with many uncertainties, especially for patients with subtypes that remain chronic and incurable. Patients may feel anxious about not knowing when their lymphoma may progress or how their treatment may impact their lives. As a result, more than one-third of survivors experience symptoms of post-traumatic stress disorder.

Those uncertainties can make navigating diagnosis and treatment emotionally crippling. But a doctor who acts as a partner in their lymphoma care—educating patients on therapeutic options and supporting them throughout their treatment—can make all the difference in building confidence in their patients.

With that in mind, the theme of this year’s World Lymphoma Awareness Day, recognized on September 15, was “Small Things Build Confidence.” In recognition of this campaign, Dr. Nathan Fowler, associate professor at MD Anderson Cancer Center, discusses why taking the time to ensure people with lymphoma understand their therapeutic options can go a long way in strengthening their confidence in their treatment decisions.

DR. NATHAN FOWLER FROM THE MD ANDERSON CANCER CENTER BELIEVES IT IS IMPORTANT THAT PATIENTS WITH LYMPHOMA BUILD A HEALTHY PARTNERSHIP WITH THEIR DOCTORS.

How does understanding of their therapeutic options help lymphoma patients build confidence in their treatment?

“When people living with lymphoma understand their treatment options, they are better prepared to navigate what’s best for them. Fortunately, patients have multiple treatment options for lymphoma, and their participation in the decision-making process is important. They should be aware of the risks and benefits of any treatment that they’re starting.

There’s also a psychological benefit of understanding the path ahead, the chances of success and having confidence in the treatment choices made. From my observations, patients who approach treatment with understanding and confidence are less stressed and are in a better place psychologically.”

How important is the doctor-patient relationship to addressing uncertainties and building confidence for lymphoma patients?

“It’s paramount that patients feel their doctor is going to be a partner in their care throughout their entire treatment journey. Today, many patients take it upon themselves to search the internet and learn all that they can about their disease. But, they should also feel comfortable coming to their doctor with questions when things just don’t make sense. They shouldn’t feel like they have to figure it out all alone.

I’ve grown quite close to many of the patients I have treated over the years; I know details about their families, their friends and their lives. In fact, the close relationship that I’ve forged with my patients is one of the rewarding parts of being an oncologist.”

What are some common questions that your patients with lymphoma ask you?

“The most common question I get asked is ‘am I going to die from this?’ Patients also have concerns about treatment side effects, insurance coverage of their treatment and how the disease will affect their work and their families.

The best way to address these concerns is to be very honest and discuss both the good and the bad. While survival rates for lymphoma are generally increasing with new treatment options, some subtypes of non-Hodgkin lymphoma have varying outcomes for patients and remain incurable.”

Why is it important for patients with lymphoma to know their subtype?

“The more we learn about the over 80 different subtypes of lymphoma, the more we learn how dramatically different they are from each other. These diseases behave differently and respond differently to various treatments, which is why patients should have a basic understanding of their subtype.

Knowing their subtype is critical to balancing the risks of therapy against the risk of the disease. This information needs to be factored into a patient’s decision for treatment.”

What are some of the concerns that patients have about their treatment options?

“Almost every patient I see in the clinic has concerns about their treatment. I spend a great deal of time talking about how each treatment works. When a patient feels like part of the decision-making process, they can be more confident when they start their cancer treatment.”

It’s paramount that patients feel their doctor is going to be a partner in their care throughout their entire treatment journey.

After a patient has been treated, how do you address their concerns about their cancer returning?

“When a patient finishes treatment, they still need to see their doctor frequently. Return visits not only allow many of our patients’ questions to be answered but also allows us to monitor their progress and determine if their disease may have returned. Regular follow-up visits help reassure patients that multiple options exist should their cancer return, which can help relieve a patient’s concerns while furthering the doctor-patient relationship.”

To learn more about advances in lymphoma treatment, read “The Many Faces of Lymphoma.”

Disclosure: Dr. Fowler has received research funding from and is on a scientific advisory board of Celgene.

Most patients diagnosed with lymphoma discuss the possibility of chemotherapy with a healthcare professional at some point. Chemotherapy is a standard of care for many forms of lymphoma, but most patients will experience multiple relapses.

Chemotherapy is a broad spectrum treatment that stops cell growth and division throughout the body, which can lead to side effects. Chemotherapies cannot differentiate between cancer cells and normal cells, so they also attack fast-growing but healthy cells, such as hair follicles and the cells lining the gut. That damage can lead to both short and long-term side effects, such as fatigue, nausea, a compromised immune system, fertility loss and an increased risk of infection or a second primary cancer.

While the benefits of chemotherapy often outweigh the risks, patients are eager for alternative solutions. Thankfully, research continues to look at different treatment pathways.

Meghan Gutierrez

MEGHAN GUTIERREZ, CHIEF EXECUTIVE OFFICER OF THE LYMPHOMA RESEARCH FOUNDATION (LRF), EXPLAINS WHY RESEARCHERS ARE EXPLORING CHEMOTHERAPY-FREE TREATMENTS

“We are learning a great deal about lymphoma subtypes and making progress in the discovery and development of new approaches that may improve quality of life,” Meghan Gutierrez, chief executive officer of the Lymphoma Research Foundation (LRF), said. “There is meaningful interest in exploring potential new treatments and combinations, many of which are chemotherapy-free.”

Lymphomas are caused by changes in immune cells called lymphocytes. In patients with lymphoma, the body makes many of these defective lymphoma cells that may not be detected by normal immune cells, which can properly fight infection and disease, including cancer. Restoring the immune system’s ability to fight cancer is a growing trend that has led to the development of immunomodulatory therapies, which can boost the tumor-killing cells of the immune system.

Investigators continue to explore new approaches focused on stimulating the immune system for patients with lymphoma.

The inherent ability of some types of immune cells to attack tumors relies on “tags” called antibodies on the surface of cancer cells. This killing process is known as antibody-dependent cell-mediated cytotoxicity (ADCC). In fact, several approved lymphoma therapies are antibodies that attach to cancer cells, leading the immune system to better identify and attack them. Researchers are now studying whether combining these antibody therapies with immunomodulatory therapies might further enhance cancer-killing ADCC, without the need for chemotherapy.

With further understanding of how both of these types of treatment work, separately and in combination, there is a potential to improve outcomes.

“Investigators continue to explore new approaches focused on stimulating the immune system for patients with lymphoma,” Gutierrez said. “It’s an incredibly exciting time as research is constantly evolving.”