Understanding the Patient Experience in Blood Cancer Treatment

This information is intended for US healthcare professionals only.

The treatment landscape for hematologic malignancies has changed drastically in recent years, with targeted therapies, including biologic therapies, potentially providing a tailored approach for those patients who live with diverse and complex blood cancers.1-2 Even so, a commitment to transforming the hematologic cancer care experience goes beyond the development of novel therapies. Evolving from a purely disease-focused approach to one that addresses the holistic experience of patients can enable physicians to have a meaningful impact on the patient experience.

Burdens and unmet need in blood cancers

Specific challenges for patients and unmet needs for the heterogeneous range of blood cancers can add significant burden to the patient experience. For example, patients may require regular health center appointments to receive treatments via intravenous (IV) infusion. Travel time to appointments, time spent in waiting rooms and the duration of IV infusions could all contribute to the cumulative burden of time lost to receiving treatment, a concept referred to as “time toxicity.”3-4 Further, the pain and discomfort of frequent cannulations5 and the potential for difficulties with venous access6 may add to the burden associated with administering IV treatments for some patients.

It is also important to address challenging clinical unmet needs. While significant improvements in disease management may have been achieved in certain blood cancers,7 physicians may face the challenge of tackling other blood cancers due to limited therapeutic options. For example, historically, chemoimmunotherapy has been used as a first-line treatment in blood cancers such as mantle cell lymphoma (MCL),1,8 chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma and other B-cell lymphomas.9-10 Older patients may find it more challenging to tolerate intensive chemotherapy or allogeneic stem cell transplantation (allo-SCT) often offered as a first-line treatment to younger patients.11 In most cancers, including MCL and CLL, new therapeutic options are much needed to improve the outlook for patients.12

Addressing the varied burdens and unmet needs in blood cancers has proved to be both complex and challenging. The ongoing collaboration between hematology researchers and the blood cancer community is essential if all burdens and unmet needs are to be fully resolved.

Understanding patient preferences

Greater involvement of patients in key decisions made throughout their entire cancer journey may help to optimize the patient experience. When making shared decisions about the treatment plan, a number of important factors should be considered, including – but not limited to – patient preferences for specific types and duration of therapy. In addition to understanding safety profiles, patients with blood cancers may prefer fixed-duration over continuous treatment until disease progression or unacceptable toxicity.13-14 Fixed-duration treatment provides patients with the freedom from ongoing therapy, reduced exposure to side effects after treatment completion, and offers the convenience of fewer travel requirements for appointments.13 Once fixed-duration treatment is completed, patients may have reduced healthcare appointments depending on their clinical presentation, helping to minimize time toxicity,3 which may allow patients to return to their normal routine as much as possible.13 The reduction of budget and anticipated expenses is crucial as it significantly contributes to the overall patient experience.15

Patients may also express a preference for how they receive their cancer treatment. For example, research has shown that patients with CLL may prefer oral administration rather than IV infusions.14 Generally, convenience and being able to receive oral medications at home resonates in patients with cancer.16 Oral anti-cancer medications also offer resource and cost benefits with the bonus of a reduced carbon footprint.17 Nevertheless, adherence could be challenging as some patients may not take their medications as prescribed, potentially impacting their clinical outcomes.18

A patient-centric approach to blood cancer treatment

The therapeutic landscape in blood cancers has already evolved considerably, and with the promise of more innovations on the horizon, patients with blood cancers can have renewed hope about their future care. At AstraZeneca, we are focused on understanding and addressing the complexities of the blood cancer journey, and that starts by placing the patient at the center of everything we do. We design and deliver patient-centric clinical trials with clearly defined endpoints to fully capture the complete burden of disease and support clinical
decision-making. We gather patient and physician feedback, and we prioritize delivering advanced treatments that meet patients’ needs. This patient-centric approach enables us to get the right medicines to the right patients, as we aim to potentially improve the lives of those with blood cancers.

References

1. Thomas CJ, Carvajal V, Barta SK. Targeted therapies in the treatment of Mantle Cell Lymphoma. Cancers (Basel). 2024;16(10):1937.
2. Hampel PJ, Parikh SA. Chronic lymphocytic leukemia treatment algorithm 2022. Blood Cancer J. 2022;12(11):161.
3. Johnson WV, Blaes AH, Booth CM, Ganguli I, Gupta A. The unequal burden of time toxicity. Trends Cancer. 2023;9(5):373–375.
4. Gupta A, Eisenhauer EA, Booth CM. The time toxicity of cancer treatment. J Clin Oncol. 2022;40(15):1611–1615.
5. Blandford A, Furniss D, Galal-Edeen GH, et al. Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study. Southampton (UK): NIHR Journals Library; 2020 Feb. (Health Services and Delivery Research, No. 8.7.) Chapter 6, Phase 2: patient perspectives on infusion administration. Accessed November 2024. https://www.ncbi.nlm.nih.gov/books/NBK553517/
6. Armenteros-Yeguas V, Gárate-Echenique L, Tomás-López MA, et al. Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients. J Clin Nurs. 2017;26(23-24):4267–4275.
7. Skånland SS, Mato AR. Overcoming resistance to targeted therapies in chronic lymphocytic leukemia. Blood Adv. 2021;5(1):334–343.
8. Kumar A, Eyre TA, Lewis KL, Thompson MC, Cheah CY. New directions for Mantle Cell Lymphoma in 2022. Am Soc Clin Oncol Educ Book. 2022;42:1–15.
9. Ryan CE, Davids MS. Practical management of Richter Transformation in 2023 and beyond. Am Soc Clin Oncol Educ Book. 2023;43:e390804.
10. Douglas M. Richter transformation: Clinical manifestations, evaluation, and management. J Adv Pract Oncol. 2022;13(5):525-534.
11. Alnassfan T, Cox-Pridmore MJ, Taktak A, Till KJ. Mantle cell lymphoma treatment options for elderly/unfit patients: A systematic review. eJHaem. 2021;3(1):276-290.
12. Husain A, Keqin Q, Zhu A. Attrition rates and treatment outcomes during successive lines of therapy in patients with Mantle Cell Lymphoma in the US. Poster presented at: ISPOR 2022 In-Person and Virtual Conference; May 15-18, 2022; National Harbor, MD. Abstract ID 116548.
13. Ravelo A, Myers K, Ervin C, et al. Patient preferences for fixed versus treat-to-progression therapies in Chronic Lymphocytic Leukemia. Blood. 2023;142:3706–3708.
14. Ravelo A, Myers K, Brumble R, et al. Patient preferences for chronic lymphocytic leukemia treatments: a discrete-choice experiment. Future Oncol. 2024;20(28):2059–2070.
15. Fifer S, Godsell J, Opat S, et al. Understanding the experience, treatment preferences and goals of people living with chronic lymphocytic leukemia (CLL) in Australia. BMC Cancer. 2024;24(1):831.
16. Eek D, Krohe M, Mazar I, et al. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. Patient Prefer Adherence. 2016;10:1609–1621.
17. Eii MN, Walpole S, Aldridge C. Sustainable practice: Prescribing oral over intravenous medications. BMJ. 2023 Nov 6;383:e075297.
18. Greer JA, Amoyal N, Nisotel L, et al. A systematic review of adherence to oral antineoplastic therapies. Oncologist. 2016;21(3):354–376.