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McCaughan D, Roman E, Sheridan R, Hewison A, Smith AG, Patmore R, Howell DA. Patient perspectives of 'Watch and Wait' for chronic haematological cancers: Findings from a qualitative study. Eur J Oncol Nurs 2023; 65:102349. [PMID: 37331194 DOI: 10.1016/j.ejon.2023.102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Chronic blood cancers are incurable, and characterised by unpredictable, remitting-relapsing pathways. Management often involves periods of observation prior to treatment (if required), and post-treatment, in an approach known as 'Watch and Wait'. This study aimed to explore patient experiences of 'Watch and Wait'. METHODS In-depth interviews with 35 patients (10 accompanied by relatives) with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma. Data were analysed using descriptive qualitative techniques. RESULTS Patient views of Watch and Wait ranged along a continuum, from immediate acceptance, to concern about treatment deferral. Significant ongoing anxiety and distress were described by some, due to the uncertain pathways associated with Watch and Wait. Infrequent contact with clinical staff was said to exacerbate this, as there was limited opportunity to ask questions and seek reassurance. Patients indicated that the impact of their malignancy could be underestimated by clinicians; possibly due to them comparing chronic and acute subtypes. Most patients lacked knowledge of blood cancers. Support from clinicians was considered greater among treated patients, possibly due to increased contact, and many drew on relatives for aid. Most patients were satisfied with their time-allocation with haematology staff, although experiences could be improved by greater access to clinical nurse specialists, counselling services, and community-based facilities. CONCLUSION Experiences varied. Anxiety about unpredictable futures could be more distressing than any physical symptoms and have a greater impact on quality of life. Ongoing assessment could facilitate identification of difficulties, and is particularly important among individuals without supportive networks.
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Affiliation(s)
- Dorothy McCaughan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Rebecca Sheridan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Ann Hewison
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Alexandra G Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, UK.
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
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Abstract
ABSTRACT In this article, we carry out an overview on the management options available for chronic lymphocytic leukemia (CLL) patients and discuss possible treatment decisions, taking into account the issue of sustainability and availability. Targeted agents have shown to be superior compared with chemoimmunotherapy (CIT) in terms of progression-free survival in high-risk CLL. In the majority of studies, however, continuous treatment was compared with fixed-duration CIT and no overall survival or progression-free survival-2 (time from randomization to second progression or death) advantage could be documented. Meanwhile, a substantial financial burden on both patients and payers has raised issues about affordability and adherence to treatment. Therefore, value-based pricing of new drugs has been used to set up price negotiation policies in several countries, and fixed-duration therapy has shown to be less costly than continuous treatment. Thus, CIT continues to have a role in the treatment of CLL patients with a favorable genetic profile, that is, with a mutated IGHV gene profile and a wild-type TP53. Targeted treatment represents the preferred choice in patients with an unmutated IGHV gene configuration and/or a TP53 disruption, provided that adherence to treatment is guaranteed and bearing in mind that should costly drugs not be available for frontline treatment, new agents can be very effective as first salvage treatment.
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Schetelig J, Chevallier P, van Gelder M, Hoek J, Hermine O, Chakraverty R, Browne P, Milpied N, Malagola M, Socié G, Delgado J, Deconinck E, Damaj G, Maury S, Beelen D, Quoc SN, Shankara P, Brecht A, Mayer J, Hunault-Berger M, Bittenbring J, Thieblemont C, Lepretre S, Baldauf H, de Wreede LC, Tournilhac O, Yakoub-Agha I, Kröger N, Dreger P. Idelalisib treatment prior to allogeneic stem cell transplantation for patients with chronic lymphocytic leukemia: a report from the EBMT chronic malignancies working party. Bone Marrow Transplant 2020; 56:605-613. [PMID: 33004942 PMCID: PMC8589680 DOI: 10.1038/s41409-020-01069-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/28/2023]
Abstract
No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible. Data on 72 patients (median age 58 years) were analyzed. Forty percent of patients had TP53mut/del CLL and 64% had failed on at least one PI. No primary graft failure occurred. Cumulative incidences of acute GVHD °II–IV and chronic GVHD were 51% and 39%, respectively. Estimates for 2-year overall survival (OS), progression-free survival (PFS), and cumulative incidences of relapse/progression (CIR) and non-relapse mortality NRM were 59%, 44%, 25%, and 31%. In univariate analysis, drug sensitivity was a strong risk factor. For patients who had failed neither PI treatment nor chemoimmunotherapy (CIT) the corresponding 2-year estimates were 73%, 65%, 15%, and 20%, respectively. In conclusion, idelalisib may be considered as an option for bridging therapy prior to alloHCT. Owing to the high risk for acute GVHD intensified clinical monitoring is warranted.
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Affiliation(s)
- Johannes Schetelig
- Medical Clinic I, University Hospital, Dresden, Germany. .,DKMS, Dresden, Germany.
| | | | | | | | - Olivier Hermine
- Department of Hematology, Necker Hospital and INSERM U1163 Imagine Institute, University of Paris, Paris, France
| | - Ronjon Chakraverty
- Cancer Institute and Institute of Immunity and Transplantation, University College London Hospital, London, UK
| | | | | | - Michele Malagola
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | | | - Ghandi Damaj
- Centre Hospitalier-Universitaire, Institut d'Hématologie, Normandie University, Caen, France
| | - Sebastian Maury
- Service d'Hématologie Clinique et de Thérapie Cellulaire Creteil, CHU Henri Mondor, Créteil, France
| | | | | | | | - Arne Brecht
- Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | | | | | - Stéphane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel, Normandie University, Rouen, France
| | | | - Liesbeth C de Wreede
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivier Tournilhac
- Service Therapie Cellulaire & Hematologie Cliniquer, Centre Hospitalier Universitaire, Clermont Ferrand, France
| | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France
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