Non-Hodgkin's Lymphoma, Part 2 — Possible Medication Side Effects, Restrictions, and Implications for School

Possible medication side effects

Chemotherapy can cause a variety of side effects. Many drugs affect the bone marrow, and decrease the number of functioning white blood cells, red blood cells or platelets. These symptoms include:

  • fevers or night sweats
  • frequent infections
  • feeling week or tired
  • bleeding and bruising easily (e.g.,bleeding gums, purplish patches in the skin, tiny red spots under the skin)

Other side effects of chemotherapy include:

  • nausea and vomiting
  • weight change
  • diarrhea and constipation
  • mouth sores
  • fever
  • pain
  • temporary hair loss
  • depression and anxiety

The side effects of radiation therapy include nausea, fatigue, dry mouth and skin reactions over the treatment area. Most of the side effects of radiation therapy are transient. Some side effects, such as bone-marrow suppression, might persist after the end of the course of treatment.

Physical, dietary and other restrictions

As a rule, non-Hodgkin's lymphoma does not impose any dietary or physical restrictions on the patient. However, an individual patient might have unique restrictions due to the precise location of the tumors. In consultation with the student, parents and school, the doctor will determine the need and nature of any specific restrictions.

Implications for school

Teaching peers about NHL.

The diagnosis of non-Hodgkin's lymphoma can create significant implications for the student, and its management at school can be complex. Educators must be aware of the physical, psychosocial, cognitive and educational issues involved to ensure the student's continued success at school.

Many physical aspects of non-Hodgkin's lymphoma will require accommodations or adaptations at school:

  • Fatigue is a common problem, and the child might need to rest during the school day. It is usually best to do this in the nurse's office or another location away from the other students to avoid increasing peers' feelings that the child is different or unfairly favored.
  • Restroom privileges should be flexible.
  • Exercise can benefit the child by increasing muscle strength. The child should be encouraged to participate in all physical activities at school. Occasionally, the child might be limited by the effects of the tumor or of the therapy, but should still participate to the extent that the healthcare provider allows. With input from the child and parents, the doctor can establish reasonable limits for strenuous activity, or set guidelines for ways to handle difficult days.
  • Physical stamina should be evaluated by the school nurse. Any modifications or accommodations that are indicated should be incorporated into the student's IEP.

Psychological and social concerns for the student can be significant. Due to the frequency of absences and infections, and the limitations on physical activity, a young person with non-Hodgkin's lymphoma likely will feel excluded from normal social interactions. This is a particularly difficult issue during high school. Students might feel abandoned or lost. To encourage healthy psychological, emotional and social adjustment, the school should consider:

  • With the consent of the child and the parents, the school could educate the child's peers about what it means to have non-Hodgkin's lymphoma. The hospital school teacher is an excellent resource for offering a presentation, suggesting materials, or assisting with the education of school personnel or other interested community members.
  • Encourage peers to stay in contact with their friend during the inevitable absences. Cards, letters and phone calls can bridge the gap between friends when they are apart.
  • This is a wonderful opportunity to teach peers about supporting a friend, showing compassion and other essential life lessons.
  • Study groups are essential.
  • Identify strong peers to mentor the student upon the return to school. Many students have said that having someone fill you in on what you missed while you were gone can make all the difference in providing a smooth re-entry to school.
  • Help the student find areas of expertise and ways to excel in the school environment. Mentoring support could be included even in the IEP to help the student develop confidence.
  • Include social work or counseling services as part of the IEP. Having someone at school in whom the student can confide, or who can act as an advocate for the student can be a significant asset. This would afford the student the opportunity to discuss worries about homework, fears about the future, social difficulties and problems with family members, all in a non-threatening setting.

For more information

Part 1 — Introduction, Symptoms and Treatment

The Leukemia and Lymphoma Society

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1311 Mamaroneck Ave.
White Plains, NY 10605
Phone: 914-949-5213
Fax: 914-949-6691
Non-Hodgkin's Lymphoma

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National Cancer Institute
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National Cancer Institute

Information Resources
Cancer Information Service (CIS)
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TTY 1-800-332-8615

Contributed by:

Robert Trueworthy, MD
Chief of Pediatric Hematology and Oncology
University of Kansas Medical Center

Lavonne Ridder, ARNP, CPON
Clinical Nurse Specialist
Pediatric Hematology and Oncology
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center