Coping with induction therapy
Your first round of treatment for indolent non-Hodgkin’s lymphoma can be an emotionally and physically challenging time. But, regardless of whether your induction therapy will be immunotherapy plus chemotherapy together, or either one of them alone, there will be things that you can think about doing to help yourself cope with the treatment period.
Many people have heard a lot about the side effects of cancer treatments and they can often feel afraid of them. But it is important to bear in mind that not everyone experiences all the potential side effects, and many side effects can be eliminated or reduced.
Nevertheless, both immunotherapy and chemotherapy have potential side effects that you should be aware of, and exactly what you experience will depend on the specific drugs you are being prescribed. You should discuss all potential side effects in detail with your doctor before you begin treatment.
More information can also be found in the patient leaflets that come with your medication as well as in the immunotherapy and chemotherapy pages of Lymphoma Life.
Next, we’ll discuss some of the most common side effects of induction treatment, and how you can deal with them.
Possible side effects of immunotherapy for non-Hodgkin’s lymphoma and how to deal with them
Some side effects can occur when immunotherapy is being administered, but these are generally less severe than with chemotherapy and not everybody gets them
Side effects are sometimes experienced when you are receiving the immunotherapy infusion (usually through a drip) or for a few hours afterwards.
They occur most commonly during the first treatment session, and are usually milder with subsequent doses.
The most common immediate side effects are fevers, chills and other flu-like symptoms such as muscle aches, headaches and tiredness
These are usually experienced only during treatment and will pass quickly once the treatment session is over. Sometimes, patients have a sudden flushing and feeling of warmth in the face. This sensation is usually very brief.
Infections are more common in people receiving immunotherapy
Because immunotherapy targets your lymphocytes (part of your immune system), you may be more susceptible to infection after treatment. After your treatment, you should report any symptoms of an infection – such as fever or sore throat - to your healthcare team. Therapy with antibiotics might be necessary.
Nausea (feeling sick) or vomiting (being sick) can also occur
Your healthcare team will be able to give you anti-sickness (anti-emetic) medication if you need it. There are many different anti-emetics, and some kinds work better for some people than others. So, if one anti-emetic does not seem to work, you should ask if you can try another.
Managing nausea and vomiting: find out more
Sometimes, pain can occur in parts of the body where the lymphoma is located
The pain is usually mild and can be relieved by ordinary painkillers.
Immunotherapy can sometimes cause an allergic reaction
Symptoms can include:
- Itchiness or the sudden appearance of a rash
- Cough, wheezing or shortness of breath
- Swollen tongue or a feeling of swelling in the throat
- Swelling caused by excess fluid in the body tissues
Major allergic reactions to immunotherapy are rare, and patients are monitored throughout the treatment session for these symptoms. Patients should report any of these symptoms as soon as they occur.
Often, all that is needed is for the intravenous drip to be slowed down or stopped for a short while until the allergic reaction passes. Patients are usually given anti-histamines before the treatment session to help avoid or reduce these problems.
For more detailed information on side effects from immunotherapy, please read the patient information leaflet that you can get from your doctor.
Possible side effects of chemotherapy for non-Hodgkin’s lymphoma and how to deal with them
Nausea (feeling sick) or vomiting (being sick) can be quite common with chemotherapy
As mentioned for immunotherapy, it is often helpful to take an anti-emetic before treatment starts. If you find that the anti-emetic you have been given is not working for you, don’t be afraid to ask if you can try another one.
Managing nausea and vomiting: find out more
A sore mouth or throat and difficulty swallowing can be caused by chemotherapy affecting the lining of your throat and mouth
Washing your mouth with bicarbonate of soda mixed with warm water can often help. Also, make sure to clean your teeth, gently, after each meal to prevent infection. If you have dentures, it may be more comfortable to leave them out as much as possible. If swallowing is difficult, eating liquidised or semi-solid food will help.
You may also notice that some foods taste different from normal during treatment. If so, it might help to eat cold rather than hot foods and avoid foods with strong odours. Avoiding favourite foods might also be advisable, so that they don’t become associated with treatment.
Diarrhoea or constipation
If you are experiencing diarrhoea, you should drink plenty of fluids to make sure that you don’t get dehydrated. Speak to a member of your healthcare team about the best kind of drinks to have, or if you are finding diarrhoea or constipation a problem.
Hair loss
Not all chemotherapy drugs cause hair loss, but if it does occur many people can find it particularly upsetting. Your health care team will tell you if hair loss can be expected from the treatment they have selected. It is important to remember that it is only temporary and once chemotherapy is finished, your hair grows back, but you may want to think about wearing a wig, hat or scarf in the meantime. Your treatment nurse will be able to advise you on local wig-fitting services.
Managing hair loss: find out more
Tingling in the hands and feet (neuropathy)
You may experience tingling in the hands and feet if you are given some chemotherapies as part of your treatment.
There is no proven treatment for neuropathy, but simple remedies such as massage and comfortable footwear can help. Gentle bending and stretching of the fingers and toes every day can also help.
Dry or sore skin or nails
Using nail varnish and moisturising cream can often help with these problems.
Feeling tired and lethargic is also a common symptom of chemotherapy
It is important to have adequate rest. It might be necessary to take time off work and to adjust your daily schedule. Other people, however, find that they can continue as normal. Everyone is different.
Managing fatigue: find out more
Increased bleeding or bruising and risk of infections
Because your bone marrow – where your blood is produced – can sometimes be affected by chemotherapy, you might become more prone to infection, or start to bruise or bleed more easily than usual. You should report any unusual bleeding or bruising, or any symptoms of infection or fever, to your medical team.
Regular blood tests during the course of chemotherapy are used to check whether the blood cell count is falling too low. If it is, the next sessions of chemotherapy may be delayed, or the dose reduced to give the bone marrow a chance to recover.
It is advisable to try and minimise your risk of infections as much as possible. Following these simple guidelines can help:
- Always wash your hands well before preparing food
- Take care to avoid cuts and scratches by wearing gloves for gardening or housework
- Avoid large crowds and people with colds and flu, if possible
- Some doctors recommend that patients do not have dental treatment during a course of chemotherapy, as this can increase the risk of mouth infection
- Try not to go swimming, due to the risk of picking up an infection from the water or changing room
- If planning a holiday abroad, patients should check with their GP first, as some vaccines should be avoided. These include measles, mumps, rubella and MMR, oral polio vaccines, liquid typhoid, BCG, and yellow fever
These sorts of side effects are usually temporary and go away once the chemotherapy has stopped. But some side effects can be more serious…
Some side effects can be more permanent or serious and you should talk through these possibilities carefully with your doctor before you begin treatment
Some chemotherapy drugs affect fertility. For example, in women, menstrual periods may become irregular or stop, while, in men, the sperm count may decline. Although this may be temporary, infertility may be permanent with some treatments. If this is a possibility, you should discuss this with your doctor before beginning treatment. Men may be offered sperm banking in some cases.
Other possible permanent effects include long-term effects on the heart, on sensory nerves, and an increased risk of developing another cancer in later life. In all these cases, the long-term risks have to be weighed against the likely benefits of treatment. Your doctor will discuss these issues with you before you begin treatment.