If treatment for non-Hodgkin lymphoma stops working
Non-Hodgkin lymphoma (NHL) is a diverse group of diseases, and the chance of progression or recurrence after treatment varies among types.
In many cases, NHL that comes back after treatment (recurs) will respond to new kinds of chemotherapy or other drugs. If a remission can be achieved with the second round of treatment, doctors often recommend high-dose chemo with a stem cell transplant or a low-dose, non-myeloablative transplant, if possible.
If several rounds of chemo have already been tried, the lymphoma is much less likely to respond to additional or new chemo. If the lymphoma does respond, the response may be shorter. Over time, chemo usually provides less benefit, although immunotherapy and other new approaches to treatment available through clinical trials may be effective.
For general information on dealing with a recurrence, see our document When Your Cancer Comes Back: Cancer Recurrence.
At some point, even newer treatments may no longer be effective. If this happens, it’s important to weigh the possible limited benefits of any new treatment against the possible downsides. Everyone has their own way of looking at this.
This is likely to be the hardest part of your battle with cancer – when you have been through many medical treatments and nothing’s working anymore. Your doctor may offer you new options, but at some point you may need to consider that treatment is not likely to improve your health or change your outcome or survival.
If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor may say that more chemo or radiation might have about a 1 in 100 chance of working. Some people are still tempted to try this. But it’s important to think about and understand your reasons for choosing this plan.
No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose – the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer. You can learn more about physical and emotional changes, as well as plans and preparations for yourself and your family, in our document Nearing the End of Life.
At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it’s given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn’t mean you can’t have treatment for the problems caused by the cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more in our document Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there’s still hope for good times with family and friends – times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you’ve always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.
Last Medical Review: 08/26/2014
Last Revised: 01/28/2015