Failure of Treatment in Lymphoma
Lymphoma is a group of neoplasms that derive from immune cells residing in the lymph system. The nosology used to differentiate these neoplasms has evolved hand-in-hand with the evolution of the understanding of the immune system and its malignancies. The key distinctions between types of lymphoma are based on cell type and rate of growth. According to the Revised European-American Lymphoma (REAL) classification, which encompasses all lymphoproliferative neoplasms, lymphomas are grouped into three main categories: B-cell neoplasms, T-cell neoplasms, and Hodgkin’s lymphoma. The National Cancer Institute has further divided the entities included in the REAL classification into indolent and aggressive lymphoma types, a more clinically useful distinction.
Treatment for non-Hodgkin’s lymphoma (NHL) depends on the type, location, grade, and stage of disease, as well as the patient’s age and overall health. If the patient is diagnosed with localized, slow-growing, early stage (Stages 1 or 2) NHL, radiation therapy is the main form of treatment.
If the patient has non-localized, slow-growing, late stage (Stages 3 or 4) NHL, the treatment plan is not so well defined. Because of the unhurried growth of such tumors, chemotherapy and radiotherapy – which selectively destroy rapidly-dividing cells – cannot eliminate all of the patient’s cancer cells. Therefore, these tumors usually are not “curable”. In spite of this, treatment options may include single agent chemotherapy, or combination chemotherapy, or chemotherapy plus radiation therapy.
In addition, some physicians and patients may choose to delay treatment until symptoms appear, especially with elderly patients or in those who have significant health problems. Yet, recent findings suggest that the patient’s survival is improved when treatment is begun soon after diagnosis.
There have been many instances when lymphoma treatments fail and the patient is left with no other viable options. This usually happens when the cancer has been discovered at a terminal stage or has recurred for a number of times and treatments could no longer suppress the abnormal cells. When the cancer management team discovers that treatment could no longer cure the patient, the difficult decision must be faced by the patient and his or her family as to whether to continue with more aggressive treatment or simply ask for medication to ease up the symptom while the patient waits.
Decisions to stop treatments are very tough to make. Many people who know that the treatment if continued would prove to be futile and would subject the patient to inhuman treatment would still opt to continue treatment in the hope that somehow it will work out. At this point, it is best to discuss the situation openly with patient. Many patients have an idea of the futility of the treatments so when the cancer management eventually discuss the situation, the information would not usually come as a shock to them.
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