Lymphoma follow-up pathway: A 10-year study to guide practice

Purpose: Lymphoma survivors who have received curative intent treatment are currently followed up at defined time points in medical and nurse-led clinics often indefinitely. The follow up protocol is often at the discretion of the treating physician. The aim of the study was to explore the clinical, biochemical and radiological presentation of patients with Diffuse Large B-cell Lymphoma (DLBCL) and Hodgkin Lymphoma (HL) treated with curative intent at the point of recurrence from first remission, and to understand if recurrence was detected at scheduled follow up. Methods: A cross-sectional study of patients with DLBCL & HL on surveillance was carried out. Statistical analysis was performed to describe the clinical, biochemical and radiological characteristics of patients with DLBCL and HL at recurrence and to estimate the time to reoccurrence using the Kaplan-Meier estimator. Results: There was a substantial number of patients with DLBCL & HL treated with curative intent on surveillance programmes (N = 226). Small numbers of this patient group relapsed (13%) with most of these occurring within 5 years of achieving remission (73%). In all cases relapse was detected at an unscheduled appointment, most often initiated by a patient reported symptom (97%). Conclusion: The evidence for a benefit of routine follow-up, particularly beyond 5 years, for detecting relapse is unsupported. However, the multiple survivorship benefits of routine follow-up visits must also be considered. A personalised follow up Lymphoma pathway with direct access, provision of an end of treatment care plan, and signposting to survivorship services is recommended.