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Overview of Non-Hodgkin Lymphoma

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Non-Hodgkin lymphomas are a group of conditions that begin with the abnormal development of lymphocytes, resulting in solid tumors within the lymphatic system. Tumors usually arise in the lymph nodes, with malignant cells traveling via the lymphatic system to the thymus, spleen, and the gastrointestinal organs. Clients typically present with painless, enlarged lymph nodes, unexplained fever, and weight loss. Lymphomas may be aggressive or slow-growing. Treatment is with radiation and chemotherapies based on the staging of the disease, followed by a bone marrow transplant to reduce the size and activity of the lymphatic system tumors. Clients undergoing treatment for lymphomas typically have severe fatigue due to the disease process and the side effects of their treatment program.1

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Comorbidities to Consider

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  • Clients who have undergone chemotherapy for aggressive types of lymphomas may develop impaired cardiac function.2

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Client Examination

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Keys to Examination of Clients

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  • Determine if physical activities need to be limited or restricted based on assessments of blood cell counts and hemoglobin and hematocrit levels. Clients undergoing treatment for lymphomas may be restricted from exercise activities if their white blood cell count is <5000/mm3, hemoglobin is <8 g/dL, or if platelets are <20,000/mm3.

  • Clients receiving chemotherapy should have ongoing monitoring of their cardiac function during exercise testing.

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Recommended Baseline Testing of Fitness Levels

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  • Endurance can be assessed using a 6-minute or 10-meter walk test depending on the client's environment and tolerance to activities.

  • Examine clients for strength and mobility to determine if there will be activity limitations and if a type of exercise needs to be restricted.

  • Assess fatigue levels using the Fatigue Severity Score.3

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Exercise Prescription

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Type: Walking, standing exercises4

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Intensity: Start with low intensities

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Duration: 10–30 minutes, depending on tolerance

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Frequency: Three times per week

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Getting Started

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Clients should be encouraged to maintain some amount of standing and walking activities during treatment even though their fatigue level is persistent. After treatment, clients should be encouraged to participate in endurance activities to improve their cardiovascular health and quality of life.5,6,7 Most clients prefer walking programs so that they can assess intensity using perceived exertion levels with the duration slowly progressed.6 Clients should be counseled to participate in regular exercise in four to five sessions per week, with a goal of increasing to 150 minutes of moderate- to vigorous-level exercise per week.4 Clients who have completed treatment should be encouraged to increase their physical activity level, as this will influence their health-related quality-of-life measures.4

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References

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Wang  XS, Giralt  SA, Mendoza  TR,  et al. Clinical factors associated with cancer-related fatigue in patients being treated ...

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