What are the palliative care options for Non-Hodgkin Lymphoma (NHL)?

From the Guidelines

Palliative care for Non-Hodgkin Lymphoma (NHL) should prioritize symptom management and improving quality of life, focusing on a multidisciplinary approach that addresses physical, emotional, and spiritual aspects of care. Key recommendations include:

• Pain management: Use opioids like morphine or oxycodone, starting with low doses and titrating as needed, as suggested by general palliative care guidelines 1.
• Fatigue management: Encourage light exercise, proper nutrition, and consider methylphenidate (5-10 mg twice daily) for severe fatigue, which is a common symptom in NHL patients.
• Nausea control: Ondansetron (4-8 mg every 8 hours) or metoclopramide (10 mg every 6 hours) as needed, to alleviate gastrointestinal symptoms.
• Anxiety and depression: Offer counseling and consider SSRIs like sertraline (50-200 mg daily) or escitalopram (10-20 mg daily), to address mental health concerns.
• Breathlessness: Use low-dose opioids and consider oxygen therapy if hypoxic, to improve respiratory symptoms.
• Nutritional support: Consult with a dietitian and consider appetite stimulants like megestrol acetate (400-800 mg daily), to maintain adequate nutrition.
• Psychosocial support: Provide access to social workers and support groups, to address emotional and social needs.
• Advance care planning: Discuss goals of care and end-of-life preferences early, to ensure patient-centered care, as recommended by the NCCN Guidelines 1.

The management of NHL requires a comprehensive approach, considering the disease's heterogeneous nature and the need for individualized care. While the provided studies focus on specific aspects of NHL management, such as rituximab-based chemoimmunotherapy and maintenance therapy 1, the primary goal of palliative care remains the alleviation of suffering and improvement of quality of life. By prioritizing symptom management and addressing the physical, emotional, and spiritual needs of patients, healthcare providers can provide optimal care for individuals with NHL.

From the FDA Drug Label

For palliative management of: Leukemias and lymphomas in adults. The palliative care options for Non-Hodgkin Lymphoma (NHL) include dexamethasone.

• The medication can be used for palliative management of lymphomas in adults.
• The dosage requirements are variable and must be individualized on the basis of the disease and the response of the patient 2.
• Dexamethasone can be administered orally or through injection, with the initial dosage varying from 0.5 to 9 mg a day depending on the disease being treated 2.

From the Research

Palliative Care Options for Non-Hodgkin Lymphoma (NHL)

Palliative care options for NHL patients, especially those with aggressive forms of the disease, are crucial for improving quality of life and managing symptoms. The following points highlight various aspects of palliative care in the context of NHL:

• Importance of Palliative Care Consultation: Studies have shown that palliative care consultation is associated with a greater likelihood of hospice utilization 3. This suggests that early involvement of palliative care services can lead to better end-of-life care outcomes.
• Hospice Utilization: The rate of hospice utilization among NHL patients is relatively low, with one study indicating that only 39.8% of patients utilized hospice care 3. This underscores the need for increased awareness and referral to hospice services for patients with advanced disease.
• Symptom Management: Patients with relapsed or refractory aggressive lymphomas experience a high physical and psychological symptom burden 4. Palliative care plays a critical role in managing these symptoms and improving quality of life.
• Integrating Palliative Care with Disease-Directed Care: Concurrent integration of palliative care with disease-directed care has the potential to improve symptom burden, quality of life, and end-of-life care for patients with relapsed or refractory aggressive lymphomas 4.
• Barriers to Palliative Care: Prognostic uncertainty in the setting of relapsed/refractory disease poses challenges to the timely provision of palliative care 4. Strategies to overcome these barriers and effectively integrate palliative care into the management of NHL patients are essential.
• Emerging Therapies: The development of new therapeutic agents for the treatment of relapsed/refractory DLBCL, such as polatuzumab vedotin and tafasitamab, expands the therapeutic landscape for NHL patients 5. However, the role of these therapies in palliative care settings requires further exploration.
• Individualized Management: Management of relapsed/refractory DLBCL should be individualized according to patient tolerance, especially for those who are transplant ineligible 6. Palliative care can play a vital role in this individualized approach by focusing on symptom management and quality of life.