5 tips for chronic blood cancers

Taking care of patients with chronic blood cancer often comes down to good primary care practice, including ensuring appropriate immunization, cancer screening and mental health monitoring. Working with other specialists is also key.Here are five ways primary care physicians can help patients with chronic blood cancers manage their condition and overall health.1. Acknowledge the tricky psychosocial situationThe most common chronic blood cancer is chronic lymphocytic leukemia (CLL). The first-line treatment for early-stage, asymptomatic patients with CLL is to watch and wait. This can be difficult for patients to accept, explained Nadine Prevost, executive director of research and community support at the Leukemia and Lymphoma Society of Canada. The vocabulary around cancer is battle-laden, with words like conquering, fighting or combatting in frequent usage. Telling a patient that their condition won’t be initially treated—that the fight is on pause—may be difficult for them to accept, and some patients may seek a second opinion. The idea of a chronic cancer is also hard to process. Some patients may have trouble with their identity as a cancer patient, not sure where they fit in the cancer patient landscape as someone neither in treatment nor a survivor, Prevost said.“The reality is there are many people who are living with cancer, as opposed to those who are achieving what science and society have put out as a goal for cancer, which is cure,” said Dr. Versha Banerji, a hematologist and researcher with CancerCare Manitoba and associate professor of internal medicine at the Max Rady School of Medicine at the University of Manitoba. Patients with chronic blood cancers don’t often have a chance at a cure.Chronic blood cancer is often presented as a good diagnosis since, “It could be worse,” but physicians should understand that it’s still very stressful for the patient.“Yes, we want to reassure patients, but we also want to acknowledge that for them, this is really a big deal,” Dr. Banerji said. For example, every blood test brings a slate of worries and concerns that the cancer has worsened. Primary care physicians should actively monitor a patient’s mental health and provide counselling and support when needed.The Leukemia and Lymphoma Society of Canada has a number of resources on their website to help patients and their caregivers navigate the psychosocial aspects of living with chronic cancer.2. Get acquainted with newer treatmentsLike many conditions, treatment for chronic blood cancer has changed in recent years. There are Canadian treatment guidelines for CLL, both for first-line therapy and for relapsed or refractory patients, published in Leukemia Research in February and October 2023. Canada’s Drug Agency also has an algorithm for the sequence of funded treatments for CLL published on its website in January 2025. While it isn’t a treatment algorithm, it may provide an overview of some of the more recent available therapies.In the past, older patients might not get treatment because of the risk of adverse side-effects, but newer therapies are available that preserve quality of life. “We do have safer treatments that are less toxic and are available for all patients regardless of their age,” Dr. Banerji explained.In the CLL guidelines, the recommendations are based on the age and overall health of the patient. More than 80% of patients diagnosed with CLL have an early stage of disease without symptoms and don’t yet meet the criteria to require therapy, the guidelines note.When treatment is appropriate, it does depend on the molecular status of the patient, whether patients have a mutation in the immunoglobulin heavy light chain variable region (IGHV) or aberrations or mutations in TP53 (including deletion 17p). IGHV mutation status does not vary in time and patients only need to get the test once, but should get TP53 mutations testing before each treatment.Second-line treatment depends on what the patient received for first-line treatment, which varies because the present-day population of patients with chronic blood cancer includes those who have received various generations of therapies, depending on how long they have been living with the disease.3. Monitor for cancer symptoms and rule out other causesPrimary care physicians can monitor patients for cancer symptoms, including fever, chills, night sweats, nausea, vomiting or weight loss.Fatigue is the most common symptom for people living with chronic blood cancer. “If the primary care provider can help us attribute that it’s not depression and it’s not due to other medical conditions and it’s purely based on their cancer symptoms, that’s extremely helpful to us,” Dr. Banerji said. Alternative diagnosis for fatigue can include depression or sleep apnea, among others. Doing this work helps the specialist say that, “If I’m going to give a patient therapy for their symptoms, I’m actually going to make a difference in their quality of life,” she said.4. Provide good preventative carePatients living with chronic blood cancer are immunocompromised and should get all available vaccines. This includes immunization for influenza, COVID-19, RSV and shingles. If family members or friends ask how they can help, physicians can urge them to get their vaccinations as well.Living with chronic blood cancer also increases the risk of skin cancer and solid tumour cancers compared to the general population. Primary care physicians must follow routine age-appropriate cancer screening for all patients.Male patients should wear condoms if they’re on therapy in order to minimize exposure to their partner. There are not much data on the treatments in pregnancy and childbirth, so women of childbearing age receiving treatment should be on birth control.Primary care physicians can highlight the importance of a healthy lifestyle, with good nutrition, regular exercise and proper sleep hygiene. This is especially critical during the watch and wait phase. “The fitter patients are going into therapy, the better that they do,” Dr. Banerji said.5. Communicate with the specialistPrimary care providers and other specialists involved in the patient’s care should communicate with each other when there’s a change in the patient’s medication to ensure there are no drug-drug interactions.A lot of the medications used in chronic blood cancer cause cardiovascular complications, like atrial fibrillation, high blood pressure and bleeding, Dr. Banerji said. “We want to make sure (primary care physicians) are well-versed in those toxicities and so when they wonder if it is due to age or cancer treatment, they can connect with us to see if we can change management.”Physicians can also discuss hormone treatment with specialists for patients who are menopausal or perimenopausal. The risk of blood clots and other cancers can be weighed against benefits.Dr. Banerji noted that every case of chronic blood cancer is unique and primary care physicians should reach out to other specialists if they have any questions.Primary care physicians are critical and active participants in care for patients with chronic blood cancer. From preventative care to mental health counselling, a primary care practitioner’s support and guidance through the patient’s illness will have a major impact on their quality of life.

5 tips for chronic blood cancers

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