By Nichole Fisher, RN, BSN, Lead Registered Nurse and Clinical Research Coordinator, Willamette Valley Cancer Institute and Research Center
Eleven years ago, my world was turned upside down when my dad was diagnosed with stage four colon cancer. I was working on my master’s degree in mental health counseling at the time, but quickly decided to switch career paths after witnessing the work of an oncology care team firsthand.
Nursing isn’t like every other job; it’s a career you have to be passionate about, as patients are at their most vulnerable when they’re with us. During my training, I was lucky to have been taken under the wing of an emergency department nurse who quickly became my mentor. She showed me by example how to be caring and compassionate with patients, and handle the different situations thrown at you with grace.
In my current role as the nursing team lead for my oncology research department, I work primarily with blood cancer patients, including those living with chronic lymphocytic leukemia, or CLL, the most common type of leukemia in adults.1 There are many different paths CLL patients take and multiple stages through their disease, each with different requirements. One of my main responsibilities is educating patients on their disease as well as treatment options and potential side effects.
In CLL, patients have a few different treatment options available to choose from based on where they are in their disease. Educating patients throughout their experience is vital in ensuring they feel comfortable to make the right decision for them. For many patients with CLL, symptoms don’t show right away, in which case we’d recommend a “watch and wait” or “active surveillance” period until treatment becomes necessary.1,2,3 If a patient starts experiencing severe symptoms that interfere with daily life, such as drenching night sweats, fatigue or thrombocytopenia, that’s when we may decide to put them on treatment.3,4 Not surprisingly, patients often have concerns about waiting, so it’s important to help them understand why this is a standard approach for CLL. We know that making these types of decisions in a doctor’s office can be quite overwhelming for the patient, their family and loved ones. As part of these discussions, we also share reputable resources to turn to if they want to do their own research on different treatment options.
When it comes to determining the right treatment for a patient, age is one of the first considerations for medical professionals.3 For a disease like CLL, where patients are typically over 70 years old and may suffer from other health issues, the side effects of treatment and their impact on a patient’s quality of life are critical to understand.5 We also consider the patient’s distance from a cancer center, which could make it difficult to visit regularly for treatment. Over the course of a patient’s treatment, I become their main point of contact, helping manage the ups and downs of a cancer diagnosis, treatment and treatment-related side effects. It’s my job to support them through their experience.
Even though there are several effective FDA-approved treatment options for CLL, there are also times when we would suggest a patient enroll in a clinical trial for a potential new therapy.3,6 Over the past few years, I supported patients on a clinical trial called ELEVATE TN evaluating the potential of CALQUENCE® (acalabrutinib) for the treatment of patients with previously untreated CLL.7 ELEVATE TN demonstrated that CALQUENCE reduced the risk of disease progression or death, and supported the US FDA approval of the medication in this setting.8,9,10 The study also showed that CALQUENCE had a favorable safety profile.8 In my experience, side effects can often be a predominant reason why patients do not stay on or switch medications, and these findings show a low discontinuation rate of CALQUENCE due to side effects — an important consideration for a patient living with a chronic disease like CLL who is typically on treatment for years.8,11
In the current climate with COVID-19, I’ve never felt more privileged to be a nurse than I do now. I’m not only a member of my patients’ care team, but also the friendly face to help give them ease and confidence in the next phase of their journey. While I miss giving my patients a hug and having their family members with them during visits, I’m grateful to be able to make their day just a bit better and share a connection in fighting their disease. That’s why I’m here and love what I do.
For more information about CLL, visit www.CALQUENCE.com/cll.html.
What is CALQUENCE?
CALQUENCE is a prescription medicine used to treat adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
It is not known if CALQUENCE is safe and effective in children.
Important Safety Information About CALQUENCE® (acalabrutinib) capsules
Before taking CALQUENCE, tell your healthcare provider about all of your medical conditions,
including if you:
- have had recent surgery or plan to have surgery. Your healthcare provider may stop CALQUENCE for any planned medical, surgical, or dental procedure.
- have bleeding problems.
- have or had heart rhythm problems.
- have an infection.
- have or had liver problems, including hepatitis B virus (HBV) infection.
are pregnant or plan to become pregnant. CALQUENCE may harm your unborn baby and cause problems during childbirth (dystocia).
- If you are able to become pregnant, your healthcare provider may do a pregnancy test before you start treatment with CALQUENCE
- Females who are able to become pregnant should use effective birth control (contraception) during treatment with CALQUENCE and for at least 1 week after the last dose of CALQUENCE
- are breastfeeding or plan to breastfeed. It is not known if CALQUENCE passes into your breast milk. Do not breastfeed during treatment with CALQUENCE and for at least 2 weeks after your final dose of CALQUENCE.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking CALQUENCE with certain other medications may affect how CALQUENCE works and can cause side effects. Especially tell your healthcare provider if you take a blood thinner medicine.
How should I take CALQUENCE?
- Take CALQUENCE exactly as your healthcare provider tells you to take it.
- Do not change your dose or stop taking CALQUENCE unless your healthcare provider tells you to.
- Your healthcare provider may tell you to decrease your dose, temporarily stop, or completely stop taking CALQUENCE if you develop certain side effects.
- Take CALQUENCE 2 times a day (about 12 hours apart).
- Take CALQUENCE with or without food.
- Swallow CALQUENCE capsules whole with a glass of water. Do not open, break, or chew capsules.
- If you need to take an antacid medicine, take it either 2 hours before or 2 hours after you take CALQUENCE.
- If you need to take certain other medicines called acid reducers (H2-receptor blockers), take CALQUENCE 2 hours before the acid reducer medicine.
- If you miss a dose of CALQUENCE, take it as soon as you remember. If it is more than 3 hours past your usual dosing time, skip the missed dose and take your next dose of CALQUENCE at your regularly scheduled time. Do not take an extra dose to make up for a missed dose.
What are the possible side effects of CALQUENCE?
CALQUENCE may cause serious side effects, including:
- Serious infections can happen during treatment with CALQUENCE and may lead to death. Your healthcare provider may prescribe certain medicines if you have an increased risk of getting infections. Tell your healthcare provider right away if you have any signs or symptoms of an infection, including fever, chills, or flu-like symptoms.
- Bleeding problems (hemorrhage) can happen during treatment with CALQUENCE and can be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs or symptoms of bleeding, including blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding or bleeding that is severe or you cannot control, vomit blood or vomit that looks like coffee grounds, cough up blood or blood clots, dizziness, weakness, confusion, changes in your speech, headache that lasts a long time, or bruising or red or purple skin marks
- Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with CALQUENCE, but can also be severe. Your healthcare provider should do blood tests to check your blood counts regularly during treatment with CALQUENCE.
- Second primary cancers. New cancers have happened in people during treatment with CALQUENCE, including cancers of the skin or other organs. Your healthcare provider will check you for skin cancers during treatment with CALQUENCE. Use sun protection when you are outside in sunlight.
- Heart rhythm problems (atrial fibrillation and atrial flutter) have happened in people treated with CALQUENCE. Tell your healthcare provider if you have any of the following signs or symptoms: fast or irregular heartbeat, dizziness, feeling faint, chest discomfort, or shortness of breath
The most common side effects of CALQUENCE include headache, diarrhea, muscle and joint pain, upper respiratory tract infection, and bruising.
These are not all the possible side effects of CALQUENCE. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
1 American Cancer Society. What is Chronic Lymphocytic Leukemia? Accessed August 2020.
2 Cancer.Net. Leukemia – Chronic Lymphocytic – CLL: Types of Treatment. Accessed August 2020.
3 National Cancer Institute. Chronic Lymphocytic Leukemia Treatment (PDQ®)–Patient Version. Accessed August 2020.
4 American Cancer Society. Signs and Symptoms of Chronic Lymphocytic Leukemia. Accessed August 2020.
5 American Cancer Society. Key Statistics for Chronic Lymphocytic Leukemia. Accessed August 2020.
6 National Cancer Institute. Drugs Approved for Leukemia. Accessed July 2020.
7 Acerta Pharma BV. Elevate CLL TN: Study of Obinutuzumab + Chlorambucil, Acalabrutinib (ACP-196) + Obinutuzumab, and Acalabrutinib in Subjects With Previously Untreated CLL. NLM Identifier: NCT02475681. Accessed August 2020.
8 Sharman JP, Egyed M, Jurczak W, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzumab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial [published correction appears in Lancet. 2020;395(10238):1694]. Lancet. 2020;395(10232):1278‐1291.
9 S. Food and Drug Administration. Project Orbis: FDA approves acalabrutinib for CLL and SLL; November 21, 2019. Accessed August 2020.
10 US Food and Drug Administration. Project Orbis. Available online. Accessed August 2020.
11 American Cancer Society. Typical Treatment of Chronic Lymphocytic Leukemia. Accessed August2020.
CALQUENCE is a registered trademark of the AstraZeneca group of companies.
©2020 AstraZeneca. All rights reserved.
US-43241 Last Updated 8/20