Dipti Patel-Donnelly, MD, discusses key factors to consider when selecting consolidation therapies in high-risk hematologic malignancies.

  Dr Patel-Donnelly on Factors Influencing Consolidation Therapy in Hematologic Malignancies

Dipti Patel-Donnelly, MD, oncologist, assistant professor, oncology, Johns Hopkins University, discusses key factors to consider when selecting an appropriate consolidation therapy for the management of high-risk hematologic malignancies in community practice.

For patients undergoing intensive treatment for hematologic malignancies, deciding on the optimal consolidation strategy is pivotal and requires careful consideration, Patel-Donnelly begins. After completing initial induction therapy, which often involves hospitalization and intensive care for complex cases, patients and their families work with the medical team to determine the most suitable approach for consolidation, she expands.

Factors influencing this decision include the patient's clinical course during induction therapy, Patel-Donnelly states. Patients who experience significant complications may be recommended for inpatient consolidation to ensure close monitoring and management of potential complications, she explains. Conversely, patients whose disease responded well to treatment with minimal complications and have strong family support may be considered for outpatient consolidation. Outpatient consolidation offers more flexibility, allowing patients to recover at home while still requiring frequent visits to the treatment center for follow-up and monitoring, Patel-Donnelly adds.

Logistics and accessibility also play a crucial role in the decision-making process, Patel-Donnelly continues, adding that patients must live within reasonable proximity to the treatment center and have reliable transportation to attend frequent follow-up appointments. Moreover, outpatient consolidation may be preferred to reduce the risk of hospital-acquired infections, which can often occur during prolonged hospital stays. Although outpatient consolidation provides patients with more freedom and comfort, it necessitates diligence in adhering to medication schedules, recognizing potential signs of complications, and promptly seeking medical attention when needed, Patel-Donnelly says.

Ultimately, the goal of consolidation therapy is to further treat the disease, reduce the risk of recurrence, and optimize patient comfort and outcomes, Patel-Donnelly emphasizes. The choice between inpatient and outpatient consolidation is tailored to individual patient circumstances, treatment response, and support structures available. This personalized approach ensures comprehensive care throughout a patient’s treatment, prioritizing effective approaches while minimizing risks and enhancing patient well-being, she concludes.

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Dipti Patel-Donnelly, MD, discusses key factors to consider when selecting consolidation therapies in high-risk hematologic malignancies.
 

Dr Patel-Donnelly on the Management of High-Risk Hematologic Malignancies in the Community

Dipti Patel-Donnelly, MD, oncologist, assistant professor, oncology, Johns Hopkins University, discusses the management of high-risk hematologic malignancies in community practice.

The management of complex hematologic malignancies, especially acute leukemias, traditionally falls within the purview of academic institutions due to their aggressive presentation and potential complications, Patel-Donnelly begins. These patients often present at a critical stage, requiring immediate attention to manage complications arising from conditions such as sepsis, high white blood cell counts, and hyper viscosity, she details. As the typical first point of contact, local oncologists face the challenge of handling rare cancers with acute complications that may be outside their routine scope of expertise, given the relative infrequency of hematologic malignancies compared with more common cancers, Patel-Donnelly states. However, community-based approaches can effectively address these challenges with the right infrastructure, she adds.

At Virginia Cancer Specialists, several strategies are utilized to manage the diversity of, and complications associated with, hematologic malignancies in the community setting, Patel-Donnelly continues. One key aspect is the establishment of a dedicated hematologic malignancies team comprising physicians specializing in leukemias, lymphomas, and multiple myeloma. This sub-specialization enhances their comfort level with such cancers, depth of knowledge, and ability to enroll patients in clinical trials, she explains.

Additionally, a collaborative team consisting of advanced practice providers, a nurse navigator, social workers, and nutritionists is employed, Patel-Donnelly says. This team works cohesively to provide comprehensive care, both in the outpatient and inpatient settings, she explains. The providers play a crucial role in day-to-day patient management, while the nurse navigator ensures coordinated care, Patel-Donnelly adds. Frequent visits are scheduled to manage complications associated with outpatient therapies, including supportive measures and monitoring.

Ancillary support systems, such as social workers and nutritionists, address psychosocial aspects and nutritional needs, respectively, Patel-Donnelly notes. Given the intensive chemotherapy regimens and extended follow-ups required for hematologic malignancies, this multidisciplinary team approach allows for personalized and intensive patient care in the community setting, she says. By sub-specializing, dedicating support teams, and integrating ancillary services, community-based management of hematologic malignancies becomes not only feasible but also comprehensive and effective, Patel-Donnelly concludes.

Dipti Patel-Donnelly, MD, discusses the management of high-risk hematologic malignancies in community practice.
 

Dipti Patel-Donnelly, MD

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Dr Patel-Donnelly on Factors Influencing Consolidation Therapy in Hematologic Malignancies

Dr Patel-Donnelly on the Management of High-Risk Hematologic Malignancies in the Community