Episode 432: Long-Term Chronic Lymphocytic Leukemia Considerations for Oncology Nurses

“It’s a chronic disease. It never goes away for some people, and so therefore it has these periods of remission where it’s really quiet and well controlled. Then there can be periods of flares where you’re actively engaged in treatment or it’s impacting other pieces. There’s this feeling patients have of, ‘When am I going to have that flare?’ You know, this anticipatory anxiety of, ‘When are things going to be done differently?’ or ‘When do I need to change?’” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP^®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN^™, oncology clinical specialist at ONS, during a conversation about long-term chronic lymphocytic leukemia (CLL) considerations for oncology nurses.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD), including 15 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by September 11, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the nursing considerations of caring for people with long-term CLL.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
  • Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
  • Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses
  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications
  • Episode 201: Which Survivorship Care Model Is Right for Your Patient?
• ONS Voice articles:
  • Cardio-Oncology Program Monitors Heart Toxicities Throughout Survivorship
  • Fixed-Duration Therapy for CLL May Lower Cardiovascular Risks and Costs Less Than Continuous Treatment
  • Individuals With CLL Face Increased Risk for Skin Cancer
  • Patients With CLL Report Worse QoL and Other Factors
• Clinical Journal of Oncology Nursing articles: 
  • In Remission: A Patient’s Experience of Continued Care After Chronic Lymphocytic Leukemia
  • Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia
• ONS book: Site-Specific Cancer Series: Leukemia (first edition)
• ONS Learning Libraries:
  • Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library
  • Survivorship Learning Library
• ONS Symptom Management Resources: 
  • Prevention of Bleeding
  • Prevention of Infection: General
• CLL Society: Living With CLL
• Lymphoma Research Foundation: Remission and Long-Term Survivorship
• National Comprehensive Cancer Network

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“I think about the immunocompromised state that often comes from the CD20 monoclonal antibodies such as obinutuzumab, rituximab, and ofatumumab. All of those are agents that have been used in CLL, and they can lead to hypogammaglobulinemia. That is something that can be short-lived right after therapy, but can be prolonged or even a lifelong status after receiving these types of therapies. And then some of the other pieces that we think about are increased risk of basal cell carcinoma, routine skin exams, and maintaining some of those components of evaluation, monitoring, and preventative types of health care.” TS 1:57

“We think about how we comanage some of these comorbidities, especially cardiovascular. … The evolution of cardio-oncology programs has been incredibly valuable, specifically for a lot of agents that have such a significant impact on the risk of developing hypertension but also on the potential for atrial fibrillation. When we think about our aging population and common cardiovascular risks, cardio-oncology has been an incredible partner to be able to collaborate and effectively manage their cardiovascular health in a way that keeps that risk reduction strategy in place, but also allows us to maintain these really effective oncologic agents.” TS 4:50

“When we think about indefinite therapy, the consideration is that patients are on a therapeutic agent for as long as that agent is working, so there’s no set time that is indicated. We oftentimes talk about cycle length or a year of therapy or things like that. But when we think about indefinite treatment, it’s really a shift in the perspective of looking at CLL like a chronic disease that is continually being managed. I think this is when we partner and think about other comorbidities that we manage, such as hypertension. You have to take something every day to effectively manage this disease. And so this is what we think about with indefinite treatment—that the patient is going to be receiving treatment or engaged in taking these agents for as long as they’re working and it’s giving the patient the intended benefit.” TS 12:30

“CLL might not be something that requires an action plan. There’s a lot of active surveillance and routine monitoring, and there’s not really something the patient can do to say, ‘I’m kind of in the driver’s seat.’ I think this is one of those components that really ties together what we can advocate for our patients to be doing to reduce the risk of complications. I often talk about immunizations and vaccines and really staying up to date because that’s going to be the most effective way for them to reduce the risk of infections.” TS 15:01

“Everyone’s going to need different support, but there’s so much opportunity to really provide a meaningful quality of life. Whether patients are on active surveillance or have never needed therapy, if they need periods of treatment or are off therapy, or if they’re continuously on therapy, I think that there are a lot of things that we can do to advocate for them to have a really good quality of life and be able to live fully with this diagnosis.” TS 27:44