Visiting the clinic for induction therapy
You may have been to the specialist non-Hodgkin’s lymphoma (NHL) clinic several times for diagnostic tests, as well as consultations about your condition and the management options available to you.
If you have been on a ‘watch and wait’ treatment plan, you may also have been for several check-up visits. However, you will probably still feel quite nervous about going along for your first round of treatment.
This is understandable, as you will be going through a lot of new experiences and meeting some new staff who will be specialists in the treatment that you’ll be receiving.
Remember that everyone on your healthcare team is dedicated to helping you through your treatment, and they will always have time to talk to you about what to expect on your visits and to give you advice about how to cope with your treatment.
There are also several patient support groups for non-Hodgkin’s lymphoma who will be able to provide you with advice and information, and your healthcare team will be able to let you know of any local groups that you may like to contact.
Getting yourself ready in advance for your treatment visits can also help make things easier for you. Our section on Preparing for your first treatment for non-Hodgkin’s lymphoma will give you some tips on things to think about in advance, or what to ask your healthcare team.
How often will I need to visit the clinic for induction therapy for my non-Hodgkin’s lymphoma?
Induction therapy is usually given as a combination of immunotherapy plus chemotherapy
However, immunotherapy or chemotherapy can sometimes be given on their own.
Your doctor will have decided what kind of induction therapy is best for you based on your type of disease, as well as your personal health and circumstances. You will also need to visit the clinic for regular check ups after your induction therapy is complete.
What will happen at the clinic when I start induction therapy?
You will probably have a consultation with your doctor at the beginning of each of your treatment visits
Your doctor will want to know how you are feeling and assess your general health, and they will be able to talk to you about what to expect from your treatment. However, a specialist nurse from the lymphoma clinic will normally give you your treatment.
Immunotherapy and many types of chemotherapy are usually given intravenously (as an injection or drip)
This means the nurse will use either a needle or catheter (a small hollow tube) that is inserted through the skin to get the medication into a vein, usually in the arm. If the treatment is given as a drip, the medication will be injected into a bag of fluid that is allowed to slowly enter your body through the needle or catheter.
Sometimes, a device known as a central line is used. A central line is a long-lasting catheter or tube that is usually inserted into one of the veins at the top of the chest and can remain there throughout your treatment course. The advantage of a central line is that there is no need to insert a new needle every time intravenous medication has to be given. Central lines can also be used to draw blood samples.
Most people receiving induction treatment will need to have a combination of injections (or drips) and tablets at each visit
Although immunotherapy and chemotherapy medications are usually given as a drip or an injection, some types of chemotherapy and some of the drugs that can help with side effects can be taken as tablets (orally). These may also be given the day before the i.v. chemotherapy starts.
For your first round of induction treatment, you will probably need to stay in hospital overnight
This is usually so that your healthcare team can monitor you to see how you are responding to the medication. For example, if side effects occur while you’re being given any of the drugs, your nurse may be able to slow down the treatment to allow time for the side effects to pass.
After your first treatment, most induction therapy drugs can be given in an outpatient clinic
This means you’ll be able to go home the same day. However, for certain medications a short hospital stay might still be needed. But this will depend on exactly what medications you are being prescribed. Your doctor or specialist nurse will be able to advise you of what to expect from your treatment.
Immunotherapy for non-Hodgkin’s lymphoma
Immunotherapy is usually given once at the same time as chemotherapy
You may receive some other drugs at the same time as immunotherapy, such as paracetamol and antihistamines, to help prevent any reactions to the immunotherapy.
For your first treatment, you will either stay in hospital overnight or spend all day there before going home
If side effects occur while the drug is being given, the drip can be slowed or even stopped until the side effects pass. Subsequent treatments are likely to be much quicker and usually cause few side effects. Most people can be given these later treatments as outpatients, which will allow them to go home the same day.
Find out more about immunotherapy for non-Hodgkin’s lymphoma
Find out more about coping with induction therapy and its side effects
Chemotherapy
Usually, chemotherapy is given in cycles with time off between treatments
Although the length of chemotherapy cycles can vary widely from one lymphoma unit to the next as well as between regulatory areas and countries, one round of chemotherapy is usually given over a day. If you are taking steroids these are then given for 5 days after the administration of the chemotherapy. This completes one chemotherapy cycle, and there will be a rest period of around 3 weeks between cycles. Steroids can both alleviate the side effects caused by the chemotherapy and can cause tumour cells to shrink and die.
A course of chemotherapy typically takes several months, but the duration depends on many factors and will be different for everybody.
Find out more about coping with induction therapy
Who will give me the induction therapy?
Induction treatment is often planned by a haematologist – a doctor who specialises in diagnosing and treating diseases of the blood
You might be under the care of a haematologist, who is a specialist doctor who will decide on the best course of treatment for you. He or she will be involved in the planning of your induction therapy, including such things as which drugs should be given, what the doses should be, how often the drugs are given, and how long the course of treatment will be.
You may also see an oncologist – a doctor who specialises in treating cancers
You may find yourself under the care of an oncologist, either as well as, or instead of, a haematologist.
A specialised treatment nurse will give you your immunotherapy and chemotherapy
Treatment nurses have had special training in the use and administration of chemotherapy and immunotherapy, and they will be the ones to give you your medication. They will also be able to give advice about side effects of the therapy and about what to do if anything unusual happens during a course of treatment.
Clinical nurse specialist – a nurse who has specialised in NHL
Although they might not be directly involved in your induction therapy, the clinical nurse specialist is often your main point of contact at the clinic. They will be able to talk to you about your induction therapy and answer any questions that you might have.