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.