Many patients truly believe that if they can only practice true positive thinking, they will be rid of cancer, eventually.  For these folks disease progression carries the additional burden of sense of failure.  The Medscape article I review below is very worth reading –  for the sake of your mental health.

Even for the young at heart, age does make a difference.  This is of particular importance when we consider therapy options for elderly patients.  Here is a review of a “best practices” paper that discusses the special needs of elderly CLL patients.

That is the first question that pops into our brains, when we are first diagnosed with cancer.  CLL patients are no different in that respect.  So, what can early stage CLL  patients expect, by way of both quality and quantity of life?

The CLL guidelines formulated by the International Expert Working Group are the state-of-the-art guidance on how to diagnose, evaluate and treat our patients. Physicians who are not familiar with these guidelines are not likely to be your best bet.  This is stuff you and your oncologist should know in your sleep!

There is no doubt that bendamustine (in combination with the ever popular Rituxan) is trying to displace FCR as the modern day gold standard.  For a change, we have solid clinical trial results to look at.

It is generally accepted that cancerous stem cells can be at the root of several blood cancers.  But while the concept has been kicked around, there has not been formal consensus that there could be a malignant stem cell at the root of CLL in particular.  That may be changing.  And it has implications for therapy options.

Does it matter whether you see a local oncologist or one of the CLL experts?   Are your chances of survival better if you stick close to home with a community oncologist, or are you better off traveling to an expert center?  As always, devil is in the details.

Prognostic indicators have vastly increased our understanding of CLL and our ability to distinguish between high risk patients and lucky “smoldering” variety. Is this must have information? Should patients ‘encourage’ their physicians to do prognostic testing?  This is an important issue and one that impacts all patients.

Like it or not, majority of CLL patients tend to be older.  Are present day FCR style therapy options right for elderly patients? How well are older patients represented in clinical trials?  Here is an expert’s opinion on treating older CLL patients.

Almost a year ago I wrote with deep disappointment about the results of Campath consolidation.  Just published results now confirm my worst fears.  Topping up standard therapy regimens with Campath as a way of “improving” your results is not likely to increase your life span.