Introduction
Over the past few years, cancer care has shifted from treatment predominantly performed in hospitals to streamlined, patient-centered care. One aspect helping to facilitate this shift is the advent of oral oncology. The impact of this change is particularly pronounced in the care of patients with Chronic Lymphocytic Leukemia (CLL).
New CLL medications are increasing in oral form. This allows patients to manage their care from their homes.
Understanding Oral Oncology
Oral oncology is simply the practice of administering cancer treatment through the mouth, as opposed to through intravenously administered medications in a clinical setting. Oral oncology medications are developed to attack specific pathways that are involved in the growth of cancer.
This represents an alternative administration route compared with intravenous therapies. For patients with CLL, this approach has often replaced the need for chemotherapy and traditional hospital visits.
Key Features of Oral Oncology:
- Self-administered at home
- Targeted mechanisms of action
- Reduced need for hospital-based care
- Long-term treatment options
Evolution of Chronic Lymphocytic Leukemia treatment
CLL patients were historically required to undergo chemotherapy and countless infusion therapies, which meant they were subject to frequent hospital visits because of the side effects that were non-negotiable with such therapies. This approach was unsuitable for elderly and frail patients.
The introduction of targeted oral therapies has altered treatment approaches for chronic lymphocytic leukemia (CLL). The focus of these therapies is to fight disease while improving the quality of life of the patient.
Overview of Medications for CLL
Oral therapies for CLL include medications that target and block certain pathways that help cancer cells grow and divide. Some of these medications may be offered as monotherapy, while in other cases, may be offered in combination to create a multi-agent regimen.
Benefits of Treatment at Home
The transition to oral therapies has a lot of benefits for patients, caregivers, and the entire healthcare system. Due to the fact that these medications can be taken at home, patients with chronic lymphocytic leukemia can become more active in their treatment.
Transforming Healthcare System
The transformation that oral therapies have brought to patient experiences is also the transformation that oral therapies have brought to the entire healthcare system.
Healthcare providers have adapted to the use of increased remote patient monitoring, digital health, and patient instruction. This approach has allowed for more individualized care and kept provider-patient encounters under the pre-determined threshold.
Transformations include: This new model supports better communication and ongoing management. The first step in overcoming the barriers in treatment adherence is understanding its significance. While how medications are taken in the hospital vs at home is slightly different (hospital treatments are administered vs oral medications are taken at home), ultimately, the compliance to the treatment plan is the same.
Techniques for improving treatment adherence:
- Stick-to-it notes
- Pill boxes
- Journals
- Involvement of family, friends and caregivers
- Self-imposed, your healthcare provider, and peer accountability.
- Medication adherence to chronic lymphocytic leukemia is of the utmost importance in achieving treatment goals.
Side Effects of Home Oral Therapy
The side effects of oral therapies are generally milder and easier to tolerate than those of IV therapies; however, side effects are still common, and patients must be prepared to manage them.
Examples of side effects:
- Fatigue
- Diarrhea
- Infections
- Bruising
- Bleeding
Helpful Tips for Side Effects
- Eat well
- Drink well
- Contact your Dr.
- Follow instructions
Managing side effects is essential to the patient’s well-being, and the success of the therapy.
Oral oncology is not without its challenges, however, in spite of its many benefits.
Examples of challenges:
- Missing doses
- Little to no healthcare provider supervision
- Drug interactions
- Cost of long-term medications
A solid support system and effective communication between the patient and health care team is essential to overcoming the challenges.
Role of Family and Caregivers
The participation of family members and caregivers to support patients while undergoing treatment at home is vital. Their participation improves treatment adherence, emotional health, and overall prognosis.
Ways family members and caregivers help:
- Medication reminders
- Assistance in routine activities
- Emotional support
- Side effects management
- Participation in virtual or in person meetings
The presence of family supports the treatment of chronic lymphocytic leukemia medication, and the further family participation in this support system, the more effective the treatment.
Future Directives for Oral Oncology and CLL
The future for CLL treatment continues to improve and direct CLL treatment towards greater convenience and personalization for the patient, and better outcomes. Continuing discoveries and findings will improve existing oral therapies and discover more combinations to improve outcomes.
Current Themes Include:
- Developing the next generation of targeted therapy
- Combination therapies to improve treatment efficacy
- Development of individualized treatment plans using the patient’s genetic profile
- Digital health for patient monitoring and treatment adherence \
The continuing advances in oral therapies will complement the continuing advances in the treatment of cancers.
The evolution of cancer treatment has shifted towards oral oncology. The shift off of treatment in the CLL clinic, and towards the patient’s home, has provided CLL patients with more treatment access, greater flexibility in how and when to take their cancer therapy, and greater control of CLL treatment.
Medication adherence and routine monitoring are components of care that may influence patient outcomes. As cancer treatment options evolve, oral oncology will remain vital in bringing treatment home to the patient and enabling greater self-management.
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