For stage II FL (non-contiguous lymph nodes, or not amenable to radiation therapy) and advanced stage FL (stages III and IV), the decision to start treatment is guided by symptoms and disease bulk. Approximately one-third of initial presentations occur in patients with low-volume disseminated disease. The importance of ‘watch and wait’ is true even in…

The patient’s general practitioner should consider an individualised supportive care assessment where appropriate to identify the needs of an individual, their carer and family. Refer to appropriate support services as required, keeping in mind the long duration with which patients live with low- grade lymphomas. See validated screening tools mentioned in Principle 4 ‘Supportive care’.…

The general practitioner is responsible for: providing patients with information that clearly describes to whom they are being referred, the reason for referral and the expected timeframes for appointments requesting that patients notify them if the specialist has not been in contact within the expected timeframe considering referral options for patients living rurally or remotely…

After receiving a referral for suspected lymphoma, the referral should be triaged accordingly, on the basis of presence of indicators of concern such as B symptoms or organ dysfunction. The timing of diagnostic investigations should be guided by the initial severity of symptoms. Staging (see 3.2 Staging and prognostic assessment) should be completed within four…

In discussion with the patient, the lead clinician should undertake the following: establish if the patient has a regular or preferred general practitioner and if the patient does not have one, then encourage them to find one provide written information appropriate to the health literacy of the patient about the diagnosis and treatment to the…

For patients with indicators of concern such as organ dysfunction or neurological involvement, urgent referral to a specialist centre is needed. Specialist healthcare providers should provide clear routes of rapid access to specialist evaluation to ensure patients with indicators of concern (outlined above) are contacted and reviewed urgently. Where lymphoma is identified by biopsy or…

The lead clinician has these communication responsibilities: involving the general practitioner from the point of diagnosis ensuring regular and timely communication with the general practitioner about the diagnosis, treatment plan and recommendations from MDMs and inviting them to participate in MDMs (consider using virtual mechanisms) supporting the role of general practice both during and after…

For patients who do not need a prompt referral to a specialist, all investigations should be completed, and a path of action decided, within four weeks of first presentation.

Presenting symptoms should be promptly and clinically triaged with a general practitioner.

See validated screening tools mentioned in Principle 4 ‘Supportive care’. A number of specific challenges and needs may arise for patients at this time: assistance for dealing with psychological and emotional distress while adjusting to the diagnosis; stigma; treatment phobias; existential concerns; stress; difficulties making treatment decisions; anxiety or depression or both; psychosexual issues such…