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Overview of Hodgkin Lymphoma

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This is a malignant lymphoma from the Reed-Sternberg cell found in the lymph nodes. Common sites of metastasis are the spleen, liver, and bone marrow. Clients are treated with combinations of radiation and chemotherapies. Although this type of lymphoma has a high cure rate, clients with a history of this condition may develop secondary cancers, long-term complications of cardiac diseases, and persistent fatigue.1,2 Clients who are long-term survivors of this condition may have limited endurance due to the cardiotoxicity effects of radiation and chemotherapies on the myocardium.

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Comorbidities to Consider

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  • Reduced activities and the effects of deconditioning limit clients' endurance.

  • Clients with a history of smoking, hypercholesterolemia, and obesity have greater risk for heart disease.

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Client Examination

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Keys to Examination of Clients

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  • During acute stages, determine if activities need to be limited or restricted by assessing their white and red blood cell counts and levels of hemoglobin and hematocrit.

  • Clients may undergo tests for heart and pulmonary function, including electrocardiogram, echocardiogram, stress testing, and spirometry.

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Recommended Baseline Testing of Fitness Levels

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  • Assess for aerobic fitness with a walking or cycle ergometry test using small increments when increasing intensity.3

  • Use strength and mobility tests to determine if clients will need to limit participation in exercise activities.4,5

  • Assess fatigue level using the fatigue severity score.6

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Exercise Prescription

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Type: Treadmill walking or cycle ergometry in a hospital setting

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Intensity: Start at 60% of maximum aerobic capacity3,4

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Duration: 15–20 minutes

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Frequency: Three times per week

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Getting Started

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Clients participating in a walking program can use low to moderate perceived exertion levels for 15 to 20 minutes with duration slowly progressed. Exercise parameters can be increased to 75% of maximum aerobic capacity for 45 minutes over a 2- to 3-month period.3,4 Clients should be counseled to participate in regular exercise four to five sessions per week, with a goal of increasing to 150 minutes of exercise per week.7 Long-term survivors of Hodgkin lymphomas may have heart and lung diseases and abnormal thyroid function that will limit their tolerance to exercise and limit their potential for improving physical function. Clients should be counseled to maintain a regular exercise program using different types of activities to maintain their adherence to and enjoyment of their program.

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References

1. +
Aleman  B, van Leeuwen  F. Are we improving the long-term burden of Hodgkin's lymphoma patients with modern treatment? Hematol/Oncol Clin North Am 21(5):961–997, 2007.
2. +
Hjermstad  MJ, Fosså  SD, Oldervoll  L,  et al. Fatigue in long-term Hodgkin's disease survivors: A follow-up study. J Clin ...

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