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Maryland Gov. Larry Hogan speaks during a news conference about his cancer diagnoses in Annapolis on Monday. Hogan has "very advanced" and "very aggressive" cancer of the lymph nodes, but he said Monday he will continue to work as the state's chief elected official. (Algerina Perna/The Baltimore Sun via AP)

Many lymphoma patients take chemo in stride

As Gov. Larry Hogan undergoes chemotherapy in the coming months, he could face a slew of side effects including nausea, hair

 Dr. Robert Brookland (GBMC Submitted photo)

Dr. Robert Brookland (GBMC Submitted photo)

loss, lack of appetite and general fatigue.

But that doesn’t mean he’ll face a serious disruption in his ability to govern; many patients facing the same medical challenges manage the side effects and maintain a relatively normal schedule, said Dr. Robert K. Brookland, chair of radiation oncology at Greater Baltimore Medical Center.

“We’ve all had patients that work full-time during a regiment of chemotherapy,” Brookland said, adding that it would not be surprising if Hogan “was able to pace himself and still work during treatment.”

Hogan announced Monday that he was recently diagnosed with an “aggressive” B-cell non-Hodgkin lymphoma — a cancer that originates in the body’s immune system — and would soon begin an 18-week regimen of chemotherapy to treat the disease.

Patients undergoing chemotherapy usually receive an infusion of drugs over the course of several hours and are then given a few weeks to recover before being infused again; lymphoma patients are commonly given six infusions, one every three weeks, Brookland said.

The most common side effects of the treatment are nausea and a decrease in white blood cells, which can leave the patient more vulnerable than normal to infection. But if the need arises, doctors can give patients medicine that increases the blood cell count very quickly, Brookland said.

Some patients also receive anti-nausea medications mixed with their chemotherapy infusions and don’t become very symptomatic, he said.

“We have very effective medicines these days compared to when many of us [doctors] were in our training,” Brookland said.

Patients may also lose their hair and experience a diminished appetite that can lead to weight loss, both of which Hogan said Monday might happen to him, but are not likely to experience much pain or difficulty concentrating, Brookland said.

“Most folks, from a memory and concentration standpoint, do just fine,” he said.

Many patients also adjust their routines to the rhythm of treatment, arranging for their “weekend” time to coincide with the days they are being infused and are likely to feel the side effects most acutely, Brookland said.

After five years, 70 percent of patients treated for non-Hodgkin lymphoma remain free of the disease, said Dr. Kevin Cullen, director of the Greenbaum Cancer Center at the University of Maryland Medical Center.

Since the disease is considered particularly aggressive, patients who show no signs of recurrence after five years can be very optimistic about remaining free of the disease, Brookland said.

Hogan told reporters Monday that he would be hospitalized for four days of chemotherapy at the start of his treatment, then a day at a time over the course of the treatment.

“I’m going to miss a few meetings, but I’m still going to be constantly involved,” Hogan said. “There’s probably two, maybe three days … every three weeks that I’m not going to be feeling so well, so we’ll see how that goes. The rest of that time I’ll be working.”

Lt. Gov. Boyd K. Rutherford would be stepping up to fill in as needed, such as presiding over biweekly meetings of the Board of Public Works, Hogan said.

As governor, Hogan is effectively on-call 24 hours a day, seven days a week and does not earn or report leave, according to Eric Shirk, a spokesman for the state Department of Budget and Management.

But a typical state employee, even one who has been on the job for five months, like Hogan, would likely be able to take as much as 31 days of paid leave to accommodate such a treatment, according to Shirk.

State employees earn 15 sick days a year and are entitled to six days of personal leave per year that can be pro-rated to new employees. After six months of employment – Hogan will reach that next month – state employees are eligible for annual leave, or vacation time, starting at 10 days per year, according to the Department of Budget and Management.

State employees can also transfer leave time to employees who have none left because of a prolonged illness, according to the department.

Hogan’s announcement came one day before the Montgomery County Council unanimously approved a bill requiring county businesses to provide paid sick-leave to employees. Councilwoman Nancy Floreen said Hogan’s announcement underscored the importance of the legislation.

“It’s very difficult for small businesses to proceed, frankly, with a very ill employee,” she said. If the governor was in a different was line of work, “he might have very limited options.”

Daily Record writer Katelyn Newman contributed to this report.

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