A patient with CLL relies on their pharmacy team for support.
Patients diagnosed with chronic lymphocytic leukemia (CLL) should not be overlooked in any pharmacy setting. Many of these patients are in dire need of support, encouragement and coordination of care. They will go through a grueling process of dealing with diagnosis, treatment and, in the event of recovery, the fear of recurrence. All these stages will affect the patient emotionally and physically.
As the most accessible member of the healthcare team, the pharmacist can provide the information and support cancer patients need to get through what may be the most challenging period of their lives. Pharmacists’ willingness to help at this critical time demonstrates a concern and concern that patients will likely never forget.
Originally, EM entered the pharmacy with complaints of extreme fatigue. At the time, the pharmacist on duty told EM to contact his GP for an evaluation as the fatigue was unusual and not due to a lifestyle change.
During their conversation, the pharmacist also noticed that EM appeared to have lost a lot of weight, but his abdomen appeared enlarged compared to the rest of his body. After evaluation with his primary care provider, EM had lab work done, with the results showing EM had an enlarged spleen; this led to him being diagnosed with active CLL.
During the evaluation, EM admitted to having terrible night sweats and fever. He was repeatedly tested for COVID-19, under the assumption that he may have been infected. When his tests came back negative, he resorted to ignoring his symptoms before finally being diagnosed with CLL.
EM is a 68-year-old male who has CLL and is a regular in your health care system. CLL has been a burden in addition to its multiple co-morbidities. EM is constantly struggling to understand treatment options for CLL and is concerned about what this cancer means for his overall quality of life.
None of EM’s relatives have had cancer or blood disorders, so receiving a CLL diagnosis put an unexpected curve in his life. EM, a retired salesperson, has a limited support system because he is divorced and his adult children live out of state. To manage this disease, EM relies on its pharmacy team and other members of the hematology clinic.
Brown Bag Consult
Today, EM returns for follow-up after completing chemotherapy, and he’s asking you to top up some of his monthly medications. As you guys talk, he complains of worsening back pain to the point where he can’t stand up straight or walk properly. He also mentions that he is short of breath and still very tired.
If you look at the lab values on the papers that EM gave you, you can see that he has normal liver and kidney function, but his platelets and white blood cells are not good. You explain to him that the immune system of people with CLL may not work efficiently because it may make abnormal antibodies against its own red blood cells and/or platelets. These antibodies can then destroy the red blood cells, which can cause anemia, or low platelet count.
Antibodies that attack the body’s own red blood cells are called autoantibodies, and individuals with CLL can develop these autoantibodies at any time. However, the development of these autoantibodies is not necessarily related to the severity of the CLL. You stress EM not to panic about the numbers and offer to help him arrange a follow-up with his hematologist to get more clarity on their significance.
EM explains to you that he often wonders why he isn’t feeling better, is stressed because he needs more tests and treatments, and doesn’t understand the different types of leukemias. He also explains that he often worries about his future and has trouble falling asleep and getting up in the morning.
After listening to EM, encourage him to share these thoughts and feelings with his immediate healthcare team so they can better support his needs holistically. Based on what he has explained, it seems possible that EM is clinically depressed.
In this situation, as a pharmacist, you are not the first decision-maker in the care team. However, you can see many non-pharmacological ways you can help EM, and you can make recommendations to its health care providers based on your observations.
It is also important to remember that you are the most accessible source of EM. For this reason, make some time to talk to EM and explain the different types of CLL treatments. After finding out that he is not up to date on his vaccinations, encourage him to update and discuss with him the benefits of quitting smoking. EM tells you that he appreciates your patience and how you discuss things with him in a way that he can understand.
You also review EM’s “as needed” medications and realize he’s overusing his prescription anxiety, sleep, and pain medications. If you notice this, offer to contact EM’s healthcare team, address the issues and get him on a plan that can help have more lasting effects.
EM also explains that he doesn’t drink water, which means he is often dehydrated. In addition, he does not eat a balanced diet and does not get any exercise.
After hearing this, you notice that despite his weight loss due to the CLL, his most recent lipid panel is out of reach, so you take his blood pressure and notice it’s significantly elevated. EM does have documented dyslipidemia and hypertension, and he admits that he is no longer on the drugs for the chronic conditions. You express your concern about his heart health and suggest that he contact his healthcare team and resume his prescribed medications after evaluation.
As for exercise, you’re talking about a support group that advised EM’s son to look into his community because the group has a walking club. This kind of regular activity can be helpful, so tell EM that once his pain is better controlled, it may be easier for him to move around and go about his daily activities. This ease of movement could also help with his fatigue and mood.
Finally, note the importance of EM’s bone health and deep vein thrombosis prevention and encourage him to join the walking club. These small efforts may seem minimal, but you mention that they all help aid his fight against the disease and support improvements in his quality of life.
About the author
Jill Drury† PharmD† BCOPis a clinical pharmacy specialist based in Chicago, Illinois and Milwaukee, Wisconsin.