scholarly journals Pharmacists’ Role in Managing Patients with Chronic Lymphocytic Leukemia

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 52 ◽  
Author(s):  
Kevin Y. Chen ◽  
Kelly M. Brunk ◽  
Bianka A. Patel ◽  
Kurtis J. Stocker ◽  
Jessica J. Auten ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Hematologic Malignancy ◽  
Vital Role ◽  
Lymphocytic Leukemia ◽  
Cancer Therapies ◽  
Oral Agents ◽  
Quality Of Patient Care ◽  
Adherence Counseling ◽  
Improve Patient

Chronic lymphocytic leukemia (CLL) is a hematologic malignancy that has seen significant advances in care over the last 5 years with the approval of oral agents such as ibrutinib and venetoclax for the treatment of this disease. As such, there has been a substantial shift away from the traditional chemotherapy infusions which have allowed patients greater autonomy with oral cancer therapies. This paradigm shift poses new challenges for the medical team, including drug–drug interactions, adherence counseling, and financial toxicity. Pharmacists are uniquely trained and equipped to help to manage the changing landscape of CLL care. From identifying common medications which may impair ibrutinib clearance to ensuring patients are on the appropriate anti-infective prophylaxis while receiving obinutuzumab, pharmacists can play a vital role in ensuring the highest quality of patient care. Furthermore, additional credentialing of clinical pharmacists in select states allows for independent visits with the pharmacists, allowing for greater involvement, particularly for initiation of venetoclax and management of ibrutinib-induced toxicities. Pharmacists are essential to both expanding and enhancing the care of patients with CLL and should be leveraged to improve patient outcomes whenever possible.

Patient activation measures, distress levels, and causes of distress in chronic lymphocytic leukemia.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 201-201 ◽  
Author(s):  
Karina I. Halilova ◽  
Emily Van Laar ◽  
Uma Borate ◽  
Bradford E. Jackson ◽  
Maria Pisu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Quality Improvement ◽  
Chronic Lymphocytic Leukemia ◽  
Patient Activation ◽  
Lymphocytic Leukemia ◽  
Knowledge Gaps ◽  
Activation Level ◽  
Psychosocial Concerns ◽  
Improve Patient

201 Background: Patients with chronic lymphocytic leukemia (CLL) reporting high levels of distress due to knowledge gaps and emotional concerns can have negative outcomes and suffer from lower quality of life. Understanding patients’ activation levels, causes of distress, knowledge gaps, and psychosocial needs are crucial in high quality care. Optimally activated, educated and empowered patients are better positioned to communicate effectively with providers regarding selection of, and adherence to, CLL treatment protocols and long-term care plans, and potentially improving quality of life. Methods: We recruited 44 adults with CLL from the University of Alabama at Birmingham Health System Cancer Community Network from April to July of 2015 as part of an educational and quality improvement initiative. Patient-reported distress assessments were collected to evaluate distress levels and causes of distress. The Patient Activation Measure (PAM 13) was used to evaluate patient activation (1-4 scale with 4 maximally activated). Results: The median participant age was 69 years old (range 50-89 years). Thirty percent had completed ≤ 12 years of education, 20% had some college education. Thirty-nine percent were on active treatment, 59% were in observation; 2% were uncertain of treatment. Fifty seven percent of participants were maximally activated (level 4); 11% had an activation level of 3; 20% had a level of 2; and 11% had the lowest level of activation (level 1). Twenty-five percent reported moderate distress (≥ 4) and 5% reported severe distress (≥ 8); 34% reported distress due to psychosocial concerns and 25% due to knowledge gaps. Conclusions: This project demonstrates a need to improve patient activation levels and minimize patient distress related to knowledge gaps and psychosocial concerns related to CLL. Well-designed, easily accessible educational interventions and multi-level quality improvement programs may be helpful in improving patient engagement by providing necessary knowledge to improve patient-provider communication and optimize patient outcomes.

Healthcare practitioner behaviours that influence unsafe use of hospital information systems

2019 ◽  
Vol 26 (1) ◽  
pp. 420-434 ◽  
Author(s):  
Lizawati Salahuddin ◽  
Zuraini Ismail ◽  
Ummi Rabaah Hashim ◽  
Nor Haslinda Ismail ◽  
Raja Rina Raja Ikram ◽  
...  
Keyword(s):  
Information Systems ◽  
Improve Patient Safety ◽  
Structured Interview ◽  
Hospital Information Systems ◽  
Healthcare Practitioner ◽  
Resultant Data ◽  
Quality Of Patient Care ◽  
Copy And Paste ◽  
Improve Patient

This study aims to investigate healthcare practitioner behaviour in adopting Health Information Systems which could affect patients’ safety and quality of health. A qualitative study was conducted based on a semi-structured interview protocol on 31 medical doctors in three Malaysian government hospitals implementing the Total Hospital Information Systems. The period of study was between March and May 2015. A thematic qualitative analysis was performed on the resultant data to categorize them into relevant themes. Four themes emerged as healthcare practitioners’ behaviours that influence the unsafe use of Hospital Information Systems. The themes include (1) carelessness, (2) workarounds, (3) noncompliance to procedure, and (4) copy and paste habit. By addressing these behaviours, the hospital management could further improve patient safety and the quality of patient care.

scholarly journals Improvements in Health-Related Quality of Life and Symptoms in Patients with Previously Untreated Chronic Lymphocytic Leukemia: Final Results from the Phase II GIBB Study of the Combination of Obinutuzumab and Bendamustine

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3491-3491 ◽  
Author(s):  
Alexey Danilov ◽  
Habte A Yimer ◽  
Michael Boxer ◽  
John M Burke ◽  
Sunil Babu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Chronic Lymphocytic Leukemia ◽  
Global Health ◽  
Research Funding ◽  
Lymphocytic Leukemia ◽  
Future Health ◽  
Equity Ownership

Introduction: Longitudinal changes in health-related quality of life (HRQoL) are important in patients with chronic lymphocytic leukemia (CLL). GIBB (NCT02320487) is an open-label, single-arm phase II study of obinutuzumab (GA101; G) in combination with bendamustine (G-Benda) in patients with previously untreated CLL. A previous report from the GIBB study demonstrated an investigator-assessed objective response rate of 89.2%, a complete response rate of 49.0%, and no unexpected safety signals with G-Benda (Sharman et al. J Clin Oncol 2017). Here we report the final HRQoL data over 3 years from the GIBB study. Methods: Enrolled patients received G-Benda by intravenous infusion over six 28-day cycles: G 100mg on Day (D)1, 900mg on D2, and 1000mg on D8 and D15 of Cycle (C)1, then 1000mg on D1 of C2-6; benda 90mg/m2 on D2-3 of C1, and on D1-2 of C2-6. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) includes a global health status measure, 5 functional scales (physical, emotional, cognitive, social, and role functioning), 8 symptom scales/items (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea), and an item on financial difficulties (Aaronson et al. J Natl Cancer Inst 1993). The EORTC Quality of Life Questionnaire-Chronic Lymphocytic Leukemia 16 (QLQ-CLL16) is a 16-item module, specific to CLL, containing 4 multi-item scales (fatigue, treatment side effects, disease symptoms, and infection) and 2 single items (social activities and future health worries). Both questionnaires were completed by patients on C1D1 (baseline), C3D1, and C6D1, at the end of induction (EOI) treatment (defined as +28 days from C6D1 or early treatment termination visit), at the response visit (defined as 2-3 months after the EOI treatment for all patients who received study treatment and had not experienced disease progression), and every 3 months thereafter at follow-up visits for up to 2 years. In total, there were 14 timepoints where data were collected. HRQoL scores were linear transformed to a 0-100-point scale. Mean baseline scores and mean score changes from baseline at each visit were evaluated. A threshold of ≥10-point change in score represents a clinically meaningful difference. For symptoms, negative change scores from baseline reflect an improvement in symptom burden. For global health status and functioning, positive change scores from baseline reflect improvements. Results: The trial enrolled 102 patients. Median age was 61 years and 68.4% of patients were male. Ninety-eight patients (96%) completed a questionnaire at baseline and at least 1 other questionnaire during a follow-up visit. Questionnaire completion rates at 14 time points ranged from 96% at baseline to 66% at 27 months follow-up (Table 1). According to the EORTC QLQ-C30 (Figure 1), improvements were observed for global health status at all follow-up visits, and clinically meaningful improvements were observed at the response visit, 3 months follow-up, and 27 months follow-up. Clinically meaningful improvements in role functioning were observed at EOI and persisted throughout the 27-month follow-up. For fatigue, clinically meaningful improvements were observed at every visit starting from the end of treatment (EOT) visit. Improvements were also observed for insomnia with mean reductions from baseline ≥10 points at various time points during follow-up. There was no worsening in other patient-reported symptoms or functional status over time. Similarly, with the EORTC QLQ-CLL16 (Figure 2), clinically meaningful improvements in symptoms were observed for fatigue, disease symptoms, and future health worries during treatment, at the EOT and/or throughout the follow-up. The largest improvement was observed for fatigue (-24.7) at the 24-month follow-up and future health worries (-25.4) at the 27-month follow-up. Conclusions: We previously reported that G-Benda is an effective regimen for first-line treatment of CLL with no unexpected safety signals. The HRQoL data from the GIBB trial suggest that G-Benda treatment consistently improved patient HRQoL over time. Several clinically meaningful improvements were observed in HRQoL, including global health status, functioning, symptoms, and future health worries. Disclosures Danilov: AstraZeneca: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; TG Therapeutics: Consultancy; MEI: Research Funding; Bristol-Meyers Squibb: Research Funding; Verastem Oncology: Consultancy, Other: Travel Reimbursement , Research Funding; Takeda Oncology: Research Funding; Genentech: Consultancy, Research Funding; Bristol-Meyers Squibb: Research Funding; Takeda Oncology: Research Funding; Aptose Biosciences: Research Funding; Aptose Biosciences: Research Funding; Janssen: Consultancy; Pharmacyclics: Consultancy; Bayer Oncology: Consultancy, Research Funding; Celgene: Consultancy; Pharmacyclics: Consultancy; Janssen: Consultancy; Curis: Consultancy; Seattle Genetics: Consultancy; Verastem Oncology: Consultancy, Other: Travel Reimbursement , Research Funding; Gilead Sciences: Consultancy, Research Funding; Bayer Oncology: Consultancy, Research Funding; Curis: Consultancy; Seattle Genetics: Consultancy; MEI: Research Funding; TG Therapeutics: Consultancy; Celgene: Consultancy; Gilead Sciences: Consultancy, Research Funding; AstraZeneca: Consultancy, Research Funding; Abbvie: Consultancy; Abbvie: Consultancy. Yimer:AstraZeneca: Speakers Bureau; Janssen: Speakers Bureau; Seattle Genetics: Honoraria; Celgene: Honoraria; Clovis Oncology: Equity Ownership; Puma Biotechnology: Equity Ownership; Amgen: Consultancy. Boxer:Gerson Lerman: Consultancy; Best Doctors: Consultancy; Takeda: Honoraria, Speakers Bureau; AbbVie: Honoraria, Speakers Bureau. Burke:Celgene: Consultancy; Gilead: Consultancy; Roche/Genentech: Consultancy. Babu:Genentech: Research Funding. Li:Genentech: Employment; Roche: Equity Ownership. Mun:Genentech: Employment, Equity Ownership. Trask:Genentech: Employment, Equity Ownership. Masaquel:Roche: Equity Ownership; Genentech: Employment. Sharman:Acerta: Consultancy, Honoraria, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; TG Therapeutics: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Research Funding. OffLabel Disclosure: GAZYVA (obinutuzumab) is a CD20-directed cytolytic antibody and is indicated: in combination with chlorambucil, for the treatment of patients with previously untreated chronic lymphocytic leukemia; in combination with bendamustine followed by GAZYVA monotherapy, for the treatment of patients with follicular lymphoma (FL) who relapsed after, or are refractory to, a rituximab-containing regimen

Diagnostic value of serum miR-145 and miR-185 as targeting of the APRIL oncogene in the B-cell chronic lymphocytic leukemia

2020 ◽  
Author(s):  
Malihe Bagheri ◽  
Behzad Khansarinejad ◽  
Ghasem Mosayebi ◽  
Alireza Moradabadi ◽  
Mahdieh Mondanizadeh
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Hematologic Malignancy ◽  
Rna Extraction ◽  
Diagnostic Value ◽  
Lymphocytic Leukemia ◽  
Pcr Analysis ◽  
Healthy Individuals ◽  
Potential Biomarker ◽  
New Biomarkers

Abstract Background: Chronic lymphocytic leukemia (CLL) is one of the most common hematologic malignancy in adults worldwide. This cancer has a poor prognosis at different stages. So, the identification of new biomarkers is important for early diagnosis of B-CLL. Considering the oncogenic role of APRIL molecule in this leukemia as well as the regulatory role of microRNAs (miRNAs) in different signaling pathways, the present study evaluated the miRNAs targeting APRIL gene in B-CLL.Methods: The miRNAs were predicted and selected using bioinformatics algorithms. A total of 80 plasma samples (40 samples of healthy individuals and 40 samples of B-CLL patients) were subjected to RNA extraction and synthesis of cDNA. The expressions levels of predicted miRNAs and APRIL gene in plasma of B-CLL patients and healthy individuals were assessed by Real time PCR analysis. ROC analysis was performed to investigate the role predicted miRNAs as novel biomarkers in diagnosis of B-CLL. Results: The results of the prediction showed that miR-145-5p and miR-185-5p target the APRIL gene. The expression level of APRIL gene was strikingly higher in plasma of B-CLL patients than in the healthy individuals (102, P= 0.001). On the other hand, expression levels of miR-145-5p and miR-185-5p were strikingly lower in B-CLL patients than in the healthy individuals (0.07, P= 0.001) (0.29, P= 0.001). Also, ROC curve analyses demonstrated that miR-145-5p and miR-185-5p are specific and sensitive and may serve as new biomarkers for the early detection of B-CLL. Conclusions: These data suggest that the study miRNAs may have a role in B-CLL development and progression. Moreover, miR-145-5p and miR-185-5p can be served as a novel and potential biomarker in the diagnosis of B-CLL.

scholarly journals Impact of Ibrutinib in Quality of Life (QoL) in Patients with Chronic Lymphocytic Leukemia (CLL): Preliminary Results of Real-World Experience

2018 ◽  
Vol 18 ◽  
pp. S218-S219
Author(s):  
Maria Jose Mela Osorio ◽  
Carolina Pavlovsky ◽  
Astrid Pavlovsky ◽  
Isolda Fernandez ◽  
Federico Sackmann Massa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Lymphocytic Leukemia ◽  
Real World ◽  
Lymphocytic Leukemia ◽  
Preliminary Results

Quality of life in patients of chronic lymphocytic leukemia using the EORTC QLQ‐C30 and QLQ‐CLL17 questionnaire

2020 ◽  
Vol 105 (6) ◽  
pp. 755-762
Author(s):  
Padma Youron ◽  
Charanpreet Singh ◽  
Nishant Jindal ◽  
Pankaj Malhotra ◽  
Alka Khadwal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

scholarly journals Impact of idelalisib on health-related quality of life in patients with relapsed chronic lymphocytic leukemia in a phase III randomized trial

Haematologica ◽  
2020 ◽  
Vol 105 (10) ◽  
pp. e519
Author(s):  
Paolo Ghia ◽  
Steven E. Coutre ◽  
Bruce D. Cheson ◽  
Jacqueline C. Barrientos ◽  
Peter Hillmen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Lymphocytic Leukemia ◽  
Randomized Trial ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Comprehensive Management of the CLL Patient: A Holistic Approach

Hematology ◽  
2007 ◽  
Vol 2007 (1) ◽  
pp. 324-331 ◽  
Author(s):  
Tait D. Shanafelt ◽  
Neil E. Kay
Keyword(s):  
Quality Of Life ◽  
Chronic Lymphocytic Leukemia ◽  
Holistic Approach ◽  
Lymphocytic Leukemia ◽  
Current Management ◽  
Comprehensive Management ◽  
Clinical Complications ◽  
Novel Treatment ◽  
History Of

The current management of B-chronic lymphocytic leukemia (CLL) is no longer straightforward for the practicing hematologist. Rapid advances in diagnostic precision, methods of predicting prognosis, understanding of natural history of CLL, recognition of clinical complications, clarification of the quality of life (QOL) issues facing the CLL patient, and the exciting array of novel treatment approaches have made the care of the CLL patient more demanding. This review is focused on summarizing these advances in order to provide a framework for integrating this knowledge into routine hematologic practice.

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