Tag Archive for: support system

How Can Patients Overcome Noted Diffuse Large B-Cell Lymphoma Disparities?

How Can Patients Overcome Noted Diffuse Large B-Cell Lymphoma Disparities? from Patient Empowerment Network on Vimeo.

How can diffuse large B-cell lymphoma (DLBCL) patients overcome noted care disparities? Expert Dr. Nirav Shah from Medical College of Wisconsin explains some common factors that impact DLBCL care and how the gap in care can be bridged for more equitable care for all. 

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“..we all need to do a better job of educating our community, of making people aware that these options are available, and then also facilitating patients who have less money, patients who have less resources to be able to provide them what they need to be able to get the treatments that are best for them.”

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Related Resources:

How Do Different Diffuse Large B-Cell Lymphoma Subtypes Impact Treatment Options

How Do Different Diffuse Large B-Cell Lymphoma Subtypes Impact Treatment Options

Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients

Why Is Clinical Trial Participation Vital for Diffuse Large B-Cell Lymphoma Patients

Will Newer Therapies Be Curative for Diffuse Large B Cell Lymphoma Patients

Will Newer Therapies Be Curative for Diffuse Large B Cell Lymphoma Patients


Transcript:

Lisa Hatfield:

So what are the noted disparities that are seen in DLBCL? Sometimes we talk about clinical trials. Some people don’t have access to those clinical trials, what are other disparities, and how can patients overcome those to get the best outcome? 

Dr. Nirav N. Shah:

Yeah, absolutely. So I think that America is an incredibly large and diverse country. I think we know that by just watching the news with people of all walks and colors, and different opinions on how they view their world. And so I think one simple bias is I am a lymphoma specialist at an academic center. However, I live in a larger city, in the city of Milwaukee and covering a geographic area, even of the size of the state of Wisconsin, not everybody has access to this center. Some of my patients have to drive three, four, or five hours away to get complex treatments that aren’t even available in the community or even have the opportunity for clinical trials, which are most often centered in larger academic centers.

So I think that just simple geography is an issue that creates accessibility and impacts the type of care that a patient is able to get. I think beyond that, there are obviously economic factors that drive a patient’s ability to get specialized treatment. Do they have money to afford the gas to get to a larger center? Do they have the resources or the support system available to get a complex therapy where you would need those treatments, especially for relapsed disease? And then I think there are always going to be racial factors and accessibility issues that happen, where patients aren’t referred in time or patients aren’t getting necessarily the best care that they can.

So I know that in the world of diffuse large B-cell lymphoma, we have lots of great treatments, which is the exciting part for me. My biggest concern remains that not all of those treatments are accessible to all the patients that they need them, and I think we all need to do a better job of educating our community, of making people aware that these options are available, and then also facilitating patients who have less money, patients who have less resources to be able to provide them what they need to be able to get the treatments that are best for them.


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How Can Your Diffuse Large B-Cell Lymphoma Care Team Help in Treatment Decisions?

How Can Your Diffuse Large B-Cell Lymphoma Care Team Help in Treatment Decisions? from Patient Empowerment Network on Vimeo.

How can diffuse large B-cell lymphoma (DLBCL) treatment decisions be aided by your care team? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains key factors that help guide treatment decisions and how some patient characteristics may alter dosing and treatment approaches.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.

[ACT]IVATION TIP:

“..try to come up with an individualized treatment plan that meets the needs of your disease and your situation.”

See More from [ACT]IVATED DLBCL

Download Resource Guide

Download Resource Guide en español

Related Resources:

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient

How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

When Should CAR-T Therapy Be Considered for Relapsed_Refractory DLBCL Patients

When Should CAR-T Therapy Be Considered for Relapsed/Refractory DLBCL Patients

Is Stem Cell Transplantation Still a Treatment Option for Some DLBCL Patients

Is Stem Cell Transplantation Still a Treatment Option for Some DLBCL Patients


Transcript:

Lisa Hatfield: 

So, Dr. Shah, how do you work with your DLBCL patients in helping them make treatment decisions, and what should they consider when they are making their treatment decisions? 

Dr. Nirav N. Shah:

 It’s a great question, Lisa. I think that in the current area that we’re practicing, the term I use is one size doesn’t fit all. I really try to meet with the patient, understand number one, their disease, so the biology of their disease, what subtype or phenotype is it, what stage is it presenting in. Then I try to think about the actual patient characteristics, what are their goals of care, what is their age, and what are their comorbid conditions that may impact our ability to treat them and other factors, social factors. Do they have a support system? What is the distance that they’re driving to come here to be able to get treated here, and so I take all of this information together and try to come up with the best treatment option that is available for that patient.

Now again, the majority of people are going to get common regimen such as R-CHOP chemotherapy, which is one of the standard of care for diffuse large B-cell lymphoma, but even within them, there are different ways you can administer it if you’re a particularly older patient or have a lot of medical problems. And so I really believe in trying to individualize the treatment plan for the patient, because each one of us are different, and how we tolerate things and what our body has been through in the past is going to impact how we’re going to be able to handle a specific treatment. And so my activation tip to patients about this is to try to come up with an individualized treatment plan that meets the needs of your disease and your situation.


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Finding Your Support As a Newly Diagnosed Patient

From PEN-Powered Activity Guide VIII: Supporting Your Support System

Finding Your Support As a Newly Diagnosed Patient from Patient Empowerment Network on Vimeo.

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Transcript:

Lisa Hatfield

It’s hard to know how much to share, when to share, who to share with, when you have kids, when you have colleagues, when your friends and neighbors see that you’re maybe not doing so well, or know that you’re in the hospital, they want to know, but it really has to be a decision that is best for you and taking care of yourself during that time and your family at that time. So, one of the things that kind of that flows into another question is when friends and family hear that, people jump in and they want to try to help you get messages, phone calls, text. How can I help? What can I do? How are you feeling? For me anyway, I loved that kind of support, but it does get overwhelming, and I know for anyone who has gone maybe to have stem cells collected or staging, when you’re gone for several weeks at a time, it’s really difficult to keep up on those messages and everyone’s intentions are so good. And they really do want to help. So, we had actually set up a Caring Bridge page where I could communicate on my own time or my husband could communicate the information, so really, like you said, doing things on your own time and just disclosing as much information as you want to.

There was a patient who had asked me how to deal with a family member who as they were talking about their myeloma, as he was explaining it to her family, that person got very choked up, and so she said, I felt like I was trying to take care of them as I was dealing with my own diagnosis, so I didn’t really know exactly what to say other than just be sure to take care of yourself at that time, whatever I pray for you is going to be the best… Whatever is best for you is going to be the right thing for you, but the next question I had is when people do start asking, how can I help… Can I drive your appointment? Can I bring meals to you… Maybe you want them to help out, which is a pretty easy one, but what if you don’t want them to help out? Again, these are questions your doctors might not be able to answer, but they happen a lot with myeloma or cancer patients, how do you handle that when people are asking, either you don’t have the time to respond, or maybe you don’t want the help, have either of you have any of you had that experience with your friends and family network.

Sheri Baker:

Yeah, I had a lot of people jump in and offer meals or whatnot, in the beginning, I accepted. Especially in the beginning when I was starting to…Well, when I was in the hospital too, I was doing my treatment, I was learning how to do dialysis, so the first two to three months were kind of hectic, and I had a friend who offered. She’s like, every Wednesday, I’m going to bring you a meal.

And I accepted that up until about like Thanksgiving. And I called her and I said, I’m back on my feet. But I reserve the right next year when I have to have my stem cell transplant and be in the hospital again to ask you to help out again. And she says, definitely. And same thing with other friends, I was on a renal diet, so they want to know what can we make for you, so you just tell them, but there does come a point in time where you say, I’m doing good now, but down the road, can I call you and ask you to help out again with meals, and then after my stem cell transplant, before I came home from the hospital, a group of friends were like, We want to come to clean your house, and I said, Great.

So, they did come and clean my house, and that was, I have to say that’s uncomfortable because now they’re like all over your house, and you don’t know what kind of state your house is going to be in ’cause you’ve been in the hospital for almost three weeks, so you’re a little embarrassed about the dust bunnies and how bad the bathroom might look, but it was welcome help, even though you might be a little embarrassed about how dirty your house really is, but I think that it was.

For me, it was easier to say, I don’t need to help right now, but next year or in a couple of months, if I need some help, can I call you that and ask for help, so that’s maybe one way to… If you don’t want the help right now to still not totally shut them down, but say, I’d like to have some help in the future.

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Chronic Lymphocytic Leukemia: Shirley’s Clinical Trial Profile

Chronic Lymphocytic Leukemia: Shirley’s Clinical Trial Profile from Patient Empowerment Network on Vimeo

Chronic lymphocytic leukemia (CLL) patient Shirley felt she had a different experience not fitting the typical CLL patient demographic. Watch as she shares about her journey as a BIPOC patient, the value of clinical trials, and her advice to other patients for ensuring optimal outcomes.

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Deirdre’s Clinical Trial Profile


Transcript:

Shirley:

In my late 30s, I started feeling extremely fatigued, and I went to my GYN. She ran a couple of tests, and she has sent me over to a hematologist because she just determined that it was something that she was not knowledgeable about. Then I had a physician contact me after several blood tests, and they had told me that it was a form of cancer, and it was leukemia, and it was called CLL, which is chronic lymphocytic leukemia.

When I heard the word chronic, I immediately thought, “Oh my God, this means like death instantly.” But they had told me that, “No, it was aggressive, but it’s definitely slow-moving,” and I have a great chance of fighting it. I was concerned because I did not feel like I wanted to be a lab rat, because I was told that I did not fit the demographics for having CLL. Most of the individuals were male of Caucasian descent, and they were much, much older than I was possibly in the late 60 to 70s, so I got a lot of stares and it made me feel very uncomfortable. So, I just didn’t want to feel like they were just like, “Okay, this is a different case. We can make a name for.” I wanted to make sure I was getting the best treatment.

I didn’t tell too many people in the beginning because I really didn’t know what was going on, but a lot of people was able to tell because no matter how much the time of sleep I got…I was always tired. The fatigue is just overwhelming. I decided to just remain optimistic about my future, because I know whenever you’re trying to battle any kind of ailment your attitude means a lot, you have to really put it out there into existence that you’re going to get better and you believe it, you have to really believe it in order to put that energy into finding out about the treatments and so forth. My doctors, they gave me a booklet that was maybe about it, and they said to me, “Take this home, study hematology and learn about your disease, how we’re going to be trying to treat it, and you know what you’re going to be feeling and you need to tell us everything if your nose itches, your eyes burn. We need to know everything that happens.”

And I was just not a complaining type of person, so there were plenty of times where I was experiencing like pain on my side and I was just like, “Oh, it’s probably just gas from the medication,” and then later found out that the medication they were giving me was enlarging my spleen, so it was pushing against my stomach, which was causing me an enormous amount of discomfort. So the doctors had to then give me other types of medication to help treat that issue that I was having, so it was definitely a long journey. This was an unusual diagnosis for someone of my heritage. The doctors explained to me that there was no blueprint for my treatment, this was, they were going to be trying things, they had a team of individuals, maybe it was like 10 or 15 of them, and they’re actually studying my case on this big screen in this room.

So it was constant medication, it was constant them trying, running the blood test, you were always, always getting blood tests, they were always giving you observations. Someone was always in your room, at least every two hours, checking to see what was going on. I just remember some time sitting in the hospital was just feeling very overwhelmed and definitely feeling isolated alone. I remember one time I was in so much pain, like my bones were hurting me so bad that I literally was just losing my mind in the bed. So they gave me some morphine, which I’ve never taken before in my life, and I wind up throwing up the chemo medication that they gave me. it was just so bad. So, the nurses and I were really overwhelmed at that point. I remember contacting family members and telling them, “I need to get out of here, I feel like they’re just trying whatever they want to try on me, and I don’t think it’s working. I don’t feel this is the place for me, like I need to really get out of here.”

So my doctor who was actually giving a seminar in Switzerland was just like…he was really amazing. He said to me, he said, “You are my prize patient. I am working every day really hard trying to get you back to being your 100 percent yourself,” He said, “You’re always like a light of sunshine.” The women that he worked with are always looking in the patient portal, and they’re like, “Shirley is coming in,” like, “Oh my gosh, she’s coming today.” And they’re excited because I always maintained a great attitude, and I always came in there dressed up.

So my doctor also recommended it when my treatment, a hospital stay was over for me to practice on taking out walks and exercising, yoga was very good meditation, they told me to get all these apps on my phone and therapeutic massages, those have been like a savior for me. I think having a good support system around you is extremely important, people who understand. Never be afraid to tell people what exactly you are experiencing. The mental fatigue that you go through is really unpredictable, and it’s off because that was not something that they, that no one prepared you for. So my doctor and his colleagues, they were just one of the greatest teams that I have experienced, them being very transparent about what was going on with me, even when I was at one time being very stubborn, I got so upset that I pulled the IV out of my arm and I was like, “You know what, I’m not doing this, I’m tired. I’ve got to get out of this hospital. I can’t stay here.”

I mean, people were just so sick, and this is not me. And they had to assure me, “It is you. You are sick, and you do have a blood cancer, and the sooner you come to terms with that, the more calm you’re going to be in being susceptible to accepting treatment. We’re here to help you, but we need you to tell us if something is not working, you don’t feel good on what’s going on in your body, we need to know.” The blood tests don’t lie, they tell them exactly what’s happening, the doctors know if the treatment is working, they monitor the CLL extremely closely. They were way more advanced at honing in on the type of treatment that I needed, so I was really assured that you’re in the right hands, and after when I started feeling a little bit better, then my trust totally opened up in staff, because I saw that they were excited about my treatment working. They were giving me the three combinations of chemo, and they were like, “This combination is working for you now.”

They started a new trial which was bringing in venetoclax (Venclexta) along with the rituximab (Rituxan), and that is what really started sending me on a better path, getting better. And then once I came off of the rituximab, which was an IV-infused chemo treatment, they decided to just keep me on the pill form of venetoclax, I was able to go into the office, which I was ecstatic about.

Advice I like to give to patients who are considering a clinical trial is definitely ask a lot of questions. Don’t be afraid, don’t be shy or hesitant and don’t feel like you feel like you’re ignorant. And always address it with a positive attitude. Keep in mind that they are there for your best interests and trying to get your health back to normalcy. Just know that you’re not in it alone. And always find someone that you can always have a conversation with if you don’t feel comfortable. Never be afraid to ask questions and just even if you do look different as opposed to everyone else that… and just get that everyone else that is sick. Don’t feel like you’re in it alone, regardless of how you look for what your demographic background is, just know that the team that’s there that’s in place is always fighting for you, and you can always say no or get a second opinion. That’s very important to know that you have options.

So, never feel afraid to ask about the clinical trials and do your research, it’s important. It’s inspiring to see people on the leukemia organization website that are exercising, they go for runs right after they receive treatment, that inspired me to say, I’m going to out and take the dog out for a walk or go out for a run and help myself get better,” and it works. It works, it really does.