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Physical Well-Being

The physical effects of lymphoma and its treatments can be challenging for patients and their loved ones.  Be mindful of changes in your health and do not hesitate to call your doctor if you are concerned about side effects or other problems. Lymphoma may cause changes in cognitive function, sexuality, fertility and pregnancy. If you experience pain or fatigue, ask your doctor what you can do to relieve these symptoms. Also, consider asking your doctor about complementary or alternative therapies or changes in diet and exercise. Lastly, take an active role in your follow-up care and see your doctor regularly after completing treatment.

When to call the doctor

Inform your doctor if you experience any side effects, changes in your health status, or other problems during or after therapy. Contact your doctor immediately if you develop a fever, as it can be a sign of a serious underlying issue. Also, make sure your oncologist is aware of medications that have been prescribed to you by other doctors as well as any over-the-counter medications you are taking.

Alert your doctor if you experience any of the following:

  • Fever (greater than 100.5 F)
  • Any infection (such as cold, flu, or an abscessed tooth)
  • Constipation or diarrhea
  • Sores in your mouth or throat
  • Excessive coughing
  • Shortness of breath
  • Dizziness
  • Unusual fatigue
  • Unexpected weight gain or loss
  • Swelling of the legs
  • Tingling in your fingers and toes
  • Ringing in your ears
  • Bleeding or unusual bruising
  • Nausea/vomiting despite medication
  • Enlarged lymph nodes
  • Pain

Follow-up care

After your treatment for lymphoma is finished, your doctor will set up a schedule of follow-up visits, usually occurring every few months. Since there is the possibility of relapse with some types of lymphoma, it is very important to keep your follow-up appointments. In addition to a physical examination, follow-up visits generally include imaging, and blood, molecular diagnostic, or other laboratory tests. In some cases, these tests can detect unusual side effects of your treatment.

You can play an active role in maintaining your health after therapy by considering the following steps:

  • Get copies of your medical records and maintain a master file, in case you move or change doctors
  • Ask your doctor questions (click here for a list of suggested questions)
  • Tell your health care team about any new symptoms or changes in your health or lifestyle
  • Eat a balanced diet, get enough sleep, and exercise regularly
  • Do things you enjoy (hobbies, recreational activities, spending time with your family, arts and crafts, and the like)

Coping with pain

People living with lymphoma may experience pain as a result of lymphoma tumors pressing on bones, nerves, or body organs. Certain treatment regimens, procedures or tests, such as bone marrow biopsies, may also cause pain. Pain may be acute (severe and lasting for a short period of time) or chronic (severe or mild and lasting over a long period of time). If pain continues without treatment, it often leads to irritation, depression, and fatigue. It is important to know that you do not have to live in pain and your medical team can help control your pain.

Many medical advances have been made in the treatment of pain, including an improved understanding of how medication works to relieve pain. Complementary therapies such as relaxation, guided imagery, and biofeedback may also help relieve pain. Keeping a journal of when pain occurs, what it feels like (sharp, throbbing, dull, etc.), how strong it is, and how long it lasts will help you and your doctor develop a plan to treat your pain.

Diet and exercise

Good nutrition is vital. This is especially true during cancer treatment. It is important to remember, however, that according to the National Cancer Institute there is no evidence that any specific kind of diet or food alone can either cure cancer or keep it from coming back. A good approach is to eat a variety of healthful foods every day. Ask your doctor, nurse, or registered dietitian before changing your diet or taking any vitamin or mineral supplements. Your health care team can help you create an eating plan that is best for you.

People who exercise regularly are often better able to tolerate chemotherapy and radiation, and cope with fatigue related to treatment. Ask your doctor whether mild exercise such as walking, swimming, and stretching would be good for you. Although exercise may help you feel better, failure to exercise will not jeopardize your treatment. Listen to your body and do not push yourself too hard.

Complementary and alternative therapies

Complementary and alternative therapies are nonstandard therapies that some people feel help them live and cope with their disease. Such therapies may be a helpful addition to your treatment, but they should not be used as your only therapy. Complementary therapies such as meditation, prayer, guided imagery, exercise, diet, biofeedback, and relaxation techniques have the potential to improve physical and emotional comfort and may be beneficial when used in combination with standard medical treatments. Although the benefits of using acupuncture as a complementary therapy to standard lymphoma treatments are still under investigation, some patients opt to try the procedure. If you elect to try acupuncture, make sure the acupuncturist is certified and uses new, sterile needles.

Any therapy promoted for use instead of standard medical treatment is considered alternative. Advocates for alternative therapies, such as herbs and vitamins, often claim that they can cure your disease. However, no alternative therapy has been proven effective against lymphoma. The safety of these therapies is also not known and some of these substances can either cause harm or interfere with the effectiveness of chemotherapy or other treatments. It is important that you talk with your doctor before taking any substance that is not part of your prescribed therapy. Additional information on complementary and alternative medicines can be obtained by calling the National Center for Complementary and Alternative Medicine at 1-888-644-6226 or visiting their Web site at www.nccam.nih.gov.

Fatigue

Fatigue is one of the most common symptoms experienced by cancer patients. A study by the Fatigue Coalition found that while the majority of patients experience fatigue, it is one of the most overlooked and under-treated side effects of cancer. Many physical and emotional factors can cause fatigue, including the lymphoma itself, treatments, medications, pain, nutritional deficits, anxiety, and depression. In addition, lymphoma and its treatments can cause anemia, a decrease in the red blood cells, which leads to fatigue. For more information on fatigue, refer to the Fatigue Fact Sheet.

Cognitive changes

Many cancer patients report memory and cognitive changes during and/or after treatment. These changes or problems can be frustrating and frightening. A variety of factors can affect memory and cognitive function, including direct or indirect effects of the cancer itself, chemotherapy, medication, anemia, depression, stress, anxiety, fatigue, life demands, and other medical problems.

Memory and cognitive changes may have a negative impact on a patient's quality of life. Most commonly, patients report having difficulty with: memory (particularly learning and retaining new information), concentration, performing multiple tasks, verbal and mathematic skills, and difficulty following directions. These problems can range in severity and duration from patient to patient.

If you experience any changes to your memory or cognitive function, it is important to notify your doctor. The more your doctor knows about your particular situation, the more they might be able to do to help.
Some ways to optimize your functioning include:

  • Relaxation training (yoga, tai chi, meditation)
  • Memory exercises (reading, writing, doing puzzles, playing computer games)
  • Slowing down and focusing on one task at a time
  • Making lists and keeping a journal
  • Getting social support from loved ones and friends
  • General aerobic or weight-bearing exercise (as approved by your physician)
  • Eating well, getting plenty of sleep
  • Medications (in some cases)

Sexuality

Many people are embarrassed to talk to their doctor about sexual side effects. Sex and/or sexual desires are a part of life and need not be a source of embarrassment. Your healthcare provider may be able to offer you options to ease your concerns and side effects.

Fatigue and side effects of some cancer treatments often decrease sexual desire (libido) in lymphoma patients. Men may experience a decrease in their ability to function during sexual intercourse. It is common for women to experience vaginal discomfort, particularly during intercourse, because the therapies can cause vaginal dryness or soreness. Such sexual side effects are generally temporary. Sexual drive and function often return after treatment. The amount of time it takes for libido to return to normal varies from patient to patient.

Lymphoma is not passed through sexual intercourse. However, men undergoing treatment should wear condoms, as small quantities of chemotherapy may be found in semen. People undergoing bone marrow or stem cell transplants will also need to use condoms following transplant.

Fertility

If you are considering having children in the future, talk to your doctor about fertility concerns before you begin treatment for your lymphoma. Certain types of chemotherapy, particularly alkylating agents, are more likely to cause infertility than others. The dose and location of radiation therapy may also affect reproductive organs. Some people who lose fertility immediately following treatment may regain fertility, though this varies depending on the age of the patient, type of treatment, and several other factors. The Fertile Hope organization provides educational materials and resources for reduced cost fertility preservation services http://www.fertilehope.org.

Men may want to consider sperm banking as an option before beginning treatment. Infertility in men occurs when the testes stop producing sperm cells. Sperm cells can be obtained before treatment and frozen for later use. Some men who lose fertility immediately following treatment might regain fertility in the future, though the chance of regaining fertility decreases with the following factors: age (younger men are more likely to regain fertility), presence of fevers, and the higher doses of radiation/chemotherapy. Production of the male hormone, testosterone, is not usually affected to a major degree.

Cancer treatment may cause women to begin menopause early or may cause other damage that does not allow for a successful pregnancy. Several options exist for women planning to have children in the future. Eggs may be removed and frozen, usually either after being fertilized with sperm, or without fertilization, and stored for future use. Unfertilized egg storage is technically more difficult. If a partner or donor sperm is available, a procedure called embryo freezing may be done by removing eggs, fertilizing them using in-vitro fertilization, and freezing the embryo. Before beginning treatment, women of childbearing age should talk to their doctor about these options.

Pregnancy and breast-feeding

Women who are undergoing diagnostic procedures or receiving treatments for lymphoma should inform their doctor if there is any possibility that they may be pregnant. This is very important, and may allow the doctor to prescribe treatments that will minimize exposure to the fetus. Likewise, lymphoma that is discovered during pregnancy is challenging, but can often be handled by choosing drugs that are less likely to harm the fetus.

Woman who are undergoing treatment for lymphoma are generally advised not to breast-feed because of the possibility that chemotherapy may be passed to the child through the mother's milk. Women of childbearing age should discuss these issues and all possible options with their doctor.

Organizations and support programs, such as the Lymphoma Support Network and Pregnant with Cancer, can offer support and an opportunity to speak with other women who have also been in a similar situation.

For further support and information on physical well-being, contact the Lymphoma Research Foundation's Helpline at: 800-500-9976 or      e-mail helpline@lymphoma.org.