Follow-Up Care for Survivors of Lymphoma Who Have Received Curative-Intent Treatment
by
J. Sussman
1,*, 
N.P. Varela
2,
M. Cheung
3,
L. Hicks
4,
D. Kraftcheck
5,
J. Mandel
6,
G. Fraser
7,
L. Jimenez-Juan
8,
A. Boudreau
8,
S. Sajkowski
9 and
R. McQuillan
9 1
Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON L8S 4L8, Canada
2
Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada
3
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
4
Division of Hematology/ Oncology, St. Michael’s Hospital, Toronto, ON, Canada
5
Provincial Primary Care and Cancer Network, Hamilton Niagara Haldimand Brant, Grimsby, ON, Canada
6
Department of Diagnostic Imaging and Nuclear Medicine, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada
7
Division of Malignant Hematology, Juravinski Cancer Centre, Hamilton, ON, Canada
8
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
9
Cancer Care Ontario Patient and Family Advisor, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2016, 23(5), 499-513; https://doi.org/10.3747/co.23.3265
Submission received: 6 July 2016
/
Revised: 3 August 2016
/
Accepted: 10 September 2016
/
Published: 1 October 2016
Simple Summary
Findings in the present study support the importance of improving awareness on the part of survivors and clinicians about the symptoms that might be associated with recurrence. The evidence does not support routine imaging for improving outcomes in this patient population.
Abstract
Objective: This evidence summary set out to assess the available evidence about the follow-up of asymptomatic survivors of lymphoma who have received curative-intent treatment. Methods: The MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews were searched for evidence published between 2000 and August 2015 relating to lymphoma survivorship follow-up. The evidence summary was developed by a Working Group at the request of the Cancer Care Ontario Survivorship and Cancer Imaging programs because of the absence of evidence-based practice documents in Ontario for the follow-up and surveillance of asymptomatic patients with lymphoma in complete remission. Results: Eleven retrospective studies met the inclusion criteria. The proportion of relapses initially detected by clinical manifestations ranged from 13% to 78%; for relapses initially detected by imaging, the proportion ranged from 8% to 46%. Median time for relapse detection ranged from 8.6 to 19 months for patients initially suspected because of imaging and from 8.6 to 33 months for those initially suspected because of clinical manifestations. Only one study reported significantly earlier relapse detection for patients initially suspected because of clinical manifestations (mean: 4.5 months vs. 6.0 months, p = 0.042). No benefit in terms of overall survival was observed for patients depending on whether their relapse was initially detected because of clinical manifestations or surveillance imaging. Findings in the present study support the importance of improving awareness on the part of survivors and clinicians about the symptoms that might be associated with recurrence. The evidence does not support routine imaging for improving outcomes in this patient population.
Keywords:
lymphoma; Hodgkin lymphoma; non-Hodgkin lymphoma; follow-up; relapse
