Living with hematologic cancer: Recommendations, solutions

Beth Faiman; Matthew Faiman

doi:10.3949/ccjm.84a.15159

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TABLE 1

Follow-up beyond routine screening

AFTER HODGKIN LYMPHOMA AND ACUTE LYMPHOBLASTIC OR MYELOGENOUS LEUKEMIA^5,30,33,36

Risks
Subsequent neoplasms and recurrence
Cardiac disease (after chest radiation)
Oral cancer, osteonecrosis (after azathioprine or radiation to the jaw)
Osteoporosis
Chronic pain, peripheral neuropathy, Raynaud phenomenon
Pulmonary fibrosis, interstitial pneumonitis (after mediastinal radiation and high doses of bleomycin)
Cataracts (after high doses of radiation to head)
Bladder fibrosis, hemorrhagic cystitis, impaired kidney function, bladder cancer (after abdominal radiation)
Esophageal strictures, gastroesophageal reflux disease, enterocolitis, bowel obstruction
Infections

Educate on sun exposure, signs of cancer, healthy high-fiber diet, avoidance of alcohol, smoking cessation, hand-washing, vaccination, avoidance of people with colds, need to report symptoms

Screen
For skin cancer every year
Mammography every 2 years for women age 50 to 74³⁷
Colonoscopy every 5 years after age 35, or 10 years after abdominal radiation
Echocardiography at baseline and periodically
Annual liver screening with aspartate aminotransferase, alanine aminotransferase, and bilirubin for patients who received ≥ 3,000 cGy to upper abdomen, or received methotrexate, mercaptopurine, or thioguanine
Dual-energy x-ray absorptiometry per World Health Organization recommendations

Vaccinate against pneumococcus (PCV 13 for immunocompromised individuals),³⁸ influenza (inactivated); live-attenuated virus vaccines (eg, herpes zoster, influenza) can be used with caution and in close contacts of cancer survivors; consider prompt antibiotics to cover gram-positive organisms in those with hypogammaglobulinemia, compromised immunity

Monitor for relapse: computed tomography (CT) to evaluate response, then chest radiography or CT every 6 to 12 months for 2 to 5 years

Specialist evaluation as appropriate

FOR OLDER PATIENTS with chronic lymphocytic leukemia, acute myelogenous leukemia, multiple myeloma and non-Hodgkin lymphoma^22,39

Risks
Early onset of diabetes (secondary to steroid use), hypertension (secondary to chemotherapy), osteoporosis (especially after multiple myeloma), cataracts (from steroids), and cardiovascular disease (especially with anthracycline and alkylating agent chemotherapy); reinforce healthy lifestyle, proper screening

AFTER ALL CANCERS^33,34

Address educational issues, emotional issues, financial issues, chronic pain, cognitive function, sleep disorders, immunizations, and healthy lifestyle (smoking cessation, weight management, diet, exercise)

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TABLE 2

Screening after hematopoietic cell transplant

Cardiovascular risk-factor assessment

Immune system
If on chronic graft-vs-host disease prevention: gram-positive encapsulated organism prophylaxis, Pneumocystis carinii pneumonia prophylaxis, cytomegalovirus testing
Revaccinate after stem cell transplant, yearly inactivated influenza vaccine

Ocular clinical symptom evaluation, ocular fundus examination if previously abnormal

Dental assessment

Pulmonary
Clinical pulmonary assessment
Smoking avoidance counseling
Pulmonary function testing if previously abnormal
Chest radiography if previously abnormal

Liver
Liver enzyme testing if previously abnormal
Serum ferritin testing if previously abnormal

Kidney
Blood pressure screening
Urine protein screening
Blood urea nitrogen and creatinine testing

Muscle and connective tissue
Evaluate for muscle weakness if on chronic graft-vs-host disease prevention
Physical activity counseling and routine exercise

Bone and spine
Bone density testing (adult women, all allogeneic transplant recipients and patients at high risk for bone loss), reassess if previously abnormal

Nervous system
Clinical neurologic evaluation
Evaluate for cognitive development

Endocrine system
Thyroid function testing
Growth velocity in children
Gonadal function assessment in prepubertal children and in adults if previously abnormal

Skin self-examination and sun exposure counseling

Gynecologic examination

Secondary cancers
Vigilance counseling and screening

Psychosocial, financial, and quality-of-life clinical assessment, sexual function assessment