Follow-Ups Help Prevent ‘Dangerous’ Outcomes in Blood Cancer Survivors

For survivors of blood cancer, health-related complications may be frequent during the follow-up period of survivorship, which is why regularly attending follow-up appointments is crucial.

Now, testing to see whether diseases have a likelihood of returning has improved in recent years, explained Dr. Gwen Nichols, hematologist-oncologist and chief medical officer at The Leukemia & Lymphoma Society, during an interview with CURE®.

Through follow-up appointments with blood cancer survivors, detecting potential recurrence is key.

“If we see the cancer coming back, acting on that information early means so much to how long it will stay quiet and how safe the treatment is,” Nichols said. “Other health issues that we're looking for — and are ready for in follow-up — can prevent them from becoming really dangerous. We want to keep people safe and healthy, and that's why we continue to follow up.”

Some of the health-related complications blood cancer survivors may experience may include immunosuppression and secondary malignancies.

In the blood cancer space, many patients and survivors tend to be immunosuppressed, Nichols said, which could mean certain patients and survivors may be at “much higher risk of viral infections and complications [from] viruses.”

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Secondary malignancies among survivors of blood cancer may be common, mostly in the form of myelodysplastic syndrome (MDS), Nichols noted.

According to the National Cancer Institute, MDS is a type of cancer that occurs when the bone marrow is unable to produce enough healthy blood cells, including red blood cells, white blood cells and platelets. Abnormal cells are also present in the blood and bone marrow.

“Some chemotherapies can cause damage to healthy normal cells. Damage to normal stem cells, especially as [people] get older, we don't have as many good stem cells in the bone marrow, and as we age, we have fewer and fewer,” Nichols explained, “so [there’s] damage to those cells from chemotherapy or radiation.”

Proliferation may occur for some survivors because they don’t have as many normal cells to crowd out by the clone of damaged cells, Nichols said, which is a negative side effect caused by chemotherapies.

Other malignancies blood cancer survivors may experience include skin cancers. Regardless of cancer type, most cancer survivors are “at a higher risk than an age-matched control of [having] a second cancer,” Nichols stated.

“[For example,] even though you may be thinking about your lymphoma, we need to be thinking about all other possible complications of cancer. [It’s] another reason for doing follow-up but also to maintain all the screening — normal screening,” Nichols emphasized. “Just because you've had one cancer doesn't mean you [won’t] have a blood cancer; [it doesn’t mean] you still shouldn't get your mammograms and your colonoscopy.”

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Because of the heightened risk of health-related complications during follow-up for blood cancer survivors, their quality of life may also be affected.

“I think people find a balance and work with their caregivers and their physician to understand when they should [be wearing] a mask, hand washing, [avoiding] crowds, how to handle that and still be able to function,” Nichols noted.

Fear of recurrence is another factor that often affects survivors’ quality of life, she said.

“While it's easy for the physician to say, ‘Don't worry,’ that's easier said than done. And even if I could say ‘I have other treatments to give you if it comes back, we're ready,’ waiting for that other shoe to drop is just a really hard way to go forward in life.

“I just think we sometimes as practitioners and caregivers forget how hard that is, to kind of put it on the back burner in mental health is a really important part of good survivorship.”

Nichols recommended that survivors find a balance between being honest with their care teams about any new symptoms or changes they notice without becoming a hypochondriac — a person who is obsessively anxious about their health.

She also emphasized visiting The Leukemia & Lymphoma Society website for programs and additional information for survivors to speak with trained peer counselors.

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