Developing a Symptom Toolkit for Adult Lymphoma Patients Receiving Chemotherapy in Malawi

Lymphoma is one of the most common cancers affecting young adults in Sub-Saharan Africa, yet survival outcomes lag far behind those in high-resource settings. A significant contributor to these disparities is treatment abandonment, driven by limited access to essential palliative care support and lack of symptom management medications. This study aimed to assess the feasibility and early uptake of a Symptom Toolkit intervention to support symptom recognition and self-management.

We designed and implemented a novel, low-cost, culturally appropriate Symptom Toolkit into an oncology clinic in Malawi. The toolkit included nurse-delivered patient education and take-home essential therapies targeting high-burden symptoms, including pain, nausea and vomiting, insomnia, gastritis, mucositis, and constipation, with pictorial labels and a journal to record use. Included therapies were selected based on local clinical guidelines and availability. At follow-up visits, a palliative care nurse completed survey assessments and distributed new Symptom Toolkits, noting both symptom occurrence and rates of medication use.

A total of 65 patients with lymphoma (median age 39) participated, including individuals with acute lymphoblastic leukemia, Burkitt lymphoma, diffuse large B-cell lymphoma, and Hodgkin's lymphoma. Across the 602 toolkit reports completed, use of symptom-directed medications increased over time, indicating improved uptake and engagement with the intervention.

This pilot intervention demonstrates the feasibility of a nurse-delivered Symptom Toolkit as a means to enhance symptom recognition and self-management in a low-resource oncology setting. Further evaluation of the Toolkit in future studies will assess its impact on symptom burden and quality of life.