An approach to anxiety during watch-and-wait for Chronic Lymphocytic Leukemia: Monitor and move on

Nanette Cox-Kennett


Chronic Lymphocytic Leukemia (CLL) is the most frequently diagnosed hematologic malignancy with the majority of patients at diagnosis in the “watch and wait” stage of treatment – language that gives the perception of an axe waiting to fall, belying the fact that up to 30% of patients will never need treatment in their lifetime. While receiving active surveillance, patients report anxiety, distress, and depression, yet there is little research capturing the experience of this patient population, nor describing interventions to improve their experience (Damen, 2022). In an effort to “do something,” patients may turn to often expensive and unproven alternative therapies. At each clinic visit, there is an opportunity to provide relevant and understandable information, resources to address anxiety, and response to unmet needs to increase the patient’s experience of shared decision making. Reframing the experience to a more proactive perspective such as ‘Monitor and Move On’ versus “Watch and Wait’ may empower patients with CLL along their trajectory.

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Association Community Cancer Centers. (2022). Are we speaking the same language: Insight from a patient and provider survey on CLL.

Baron, B. W., Thirman, M. J., Giurcanu, M. C., & Baron, J. M. (2018). Quercetin therapy for selected patients with PIM1 kinase-positive chronic lymphocytic leukemia/small lymphocytic lymphoma: A pilot study. Acta Haematologica, 139 (2), 132–139.

Binet, JL., Auquier, A., Dighiero, G., Chastang, C., Piguest, H., Goasguen, J., Vaugier, G., Potrin, G., Colona, P., Oberling, F., Thomas, M., Tcherina, G., Jacquillat, C., Boivin, P., Lesty, C., Duault, M. T., Monconduit, M., Belabbes, S., & Gremy, F. (1981). A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer, 48(1), 198–206.;2-v

Da Cunha-Bang, C., Simonsen, J., Rostgaard, K., Geisler, C., Hjalgrim, H., & Niemann, C. U. (2016). Improved survival for patients diagnosed with chronic lymphocytic leukemia in the era of chemo-immunotherapy: A Danish population – based study of 10455 patients. Blood Cancer, 6(11), e499.

Damen, M. D. C., Westerweel, P. E., Levin, M. D., & Pelle, A. J. (2022). Unmet supportive care needs, anxiety and depression in haematology patients during watch-and-wait. Psychooncology, 31(2), 176–184.

D’Arena, G., Laurenti, L., Coscia, M., Cortelezzi, A., Chiarenza, A., Pozzato, G., Vigliotti, M. L., Nunziata, G., Fragasso, A., Villa, M. R., Grossi, A., Selleri, C., Deaglio, S., La Sala, A., Del Poeta, G., Simeon, V., Aliberti, L., De Martino, L., Giudice, A., Musto, P., De Feo, V. (2014). Complementary and alternative medicine use in patients with chronic lymphocytic leukemia: an Italian multicentric survey. Leukemia & Lymphoma, 55(4), 841–847.

Eichhorst, B., Niemann, C. U., Kater, A. P., Furstenau, M., von Tresckow, J., Zhang, C., Robrecht, S., Gregor, M., Juliusson, G., Thornton, P., Staber, P. B., Tadmor, T., Lindstrom, V., da Cunha-Bang, C., Schneider, C., Poulsen, C. B., Illmer, T., Schottker, B., Nosslinger, T., … & Hallek, M. (2023). First-line venetoclax combinations in chronic lymphocytic leukemia. The New England Journal of Medicine, 388, 1739-1754.

Fischer, K., Bahlo, J., Fink, A. M., Goede, V., Herling, C. D., Cramer, P., Langerbeins, P., von Tresckow, J., Engelke, A., Maurer, C., Kovacs, G., Herling, M., Tausch, E., Kreuzer, K.-A., Eichhorst, B., Böttcher, S., Seymour, J. F., Ghia, P., Marlton, P., … & Hallek, M. (2016). Long- term remission after FCR chemoimmunotherapy in previously untreated patients with CLL: Updated results of the CLL8 trail. Blood, 127(2), 208–215.

Ghia, P., Owen, C., Barrientos, J. C., Barr, P. M., Mato, A. R., Shi, C., Szoke, A., Abbazio, C., Krigsfeld, G. S., & Burger, J. A. (2022). Initiating first-line (1L) Ibrutinib (Ibr) in patients (pts) with chronic lymphocytic leukemia (CLL) improves overall survival (OS), outcomes to rates approximating an age-matched population of ≥ 65 years. Blood, 140(1), 4159-4161.

Golombick, T., Diamond, T. H., Manoharan, A., & Ramakrishna, R. (2015). The effect of curcumin (as Meriva) on absolute lymphocyte count (ALC), NK cells and T cell populations in patients with stage 0/1 chronic lymphocytic leukemia. Journal of Cancer Therapy, 6 (7), 566–571.

Government of Canada. (2017, November 15). Summary of safety review- green tea extract – containing natural health products – assessing the potential risk of liver injury (hepatotoxicity).

Guieze, R., & Wu, C. J. (2015). Genomic and epigenomic heterogeneity in chronic lymphocytic leukemia. Blood, 126(4), 445–453.

Hallek, M., Cheson, B. D., Catovsky, D., Caligaris-Cappio, F., Dighiero, G., Döhner, H., Hillmen, P., Keating, M., Montserrat, E., Chiorazzi, N., Stilgenbauer, S., Rai, K. R., Byrd, J. C., Eichhorst, B., O’Brien, S., Robak, T., Seymour, J. F., & Kipps, T. J. (2018). iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood, 131(25), 2745–2760.

Kleinstern, G., O’Brein, D. R., Li, X., Tian, S., Kabat, B. F., Rabe, K. G., Norman, A. D., Yan, H., Vachon, C. M., Boddicker, N. J., Call, T. G., Parikh, S. A., Bruins, L., de Campos, C. B., Leis, J. F., Shanafelt, T. D., Ding, W., Cerhan, J. R., Kay, N. E., … & Braggio, E. (2020). Tumor mutational load predicts time to first treatment in chronic lymphocytic leukemia (CLL) and monoclonal B-cell lymphocytosis beyond the CLL international prognostic index. American Journal of Hematology, 95(8), 906–917.

Molica, S., Shanafelt, T. D., Giannarelli, D., Gentile, M., Mirabelli, R., Cutrona, G., Levato, L., Renzo, N. D., Raimondo, F. D., Musolino, C., Angrilli, F., Famà, A., Recchia, A. G., Chaffee, K. G., Neri, A., Kay, N. E., Ferrarini, M., & Morabito, F. (2016). The chronic lymphocytic leukemia international prognostic index predicts time of first treatment in early CLL: Independent validation in a prospective cohort of early stage patients. American Journal of Hematology, 91(11), 1090-1095.

Owen, C., Gerrie, A. S., Banerji, V., Assouline, S., Chen, C., Robinson, K. S., Lye, E., & Fraser, G. (2018). Canadian evidence-based guidelines for the first-line treatment of chronic lymphocytic leukemia. Current Oncology, 25(5), 461–474.

Parikh, A. S., Rabe, K. G., Kay, N. E., Call, T. G., Ding, W., Leis, J. F., Kenderian, S. S., Muchtar, E., Wang, Y., Koehler, A. B., Schwager, S. M., Lesnick, C. E., Klienstern, G., Dyke, D. V., Hanson, C. A., Braggio, E., Slager, S. L., & Shanafelt, T. D. (2021). The CLL international prognostic index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL. Blood, 138(2), 149-159.

Rai, K. R., Sawitsky, A., Cronkite, E. P., Chanana, A. D., Levy, R. N., & Pasternack, B. S. (1975). Clinical staging of chronic lymphocytic leukemia. Blood, 46(2), 219-234.

Rassenti, L. Z., Jain, S., Keating, M. J., Wierda, W. G., Grever, M. R., Byrd, J. C., Kay, N. E., Brown, J. R., Gribben, J. G., Neuberg, D. S., He, F., Greaves, A. W., Rai, K. R., & Kipps, T., J. (2008). Relative value of ZAP-70, CD38, and immunoglobin mutation status in predicting aggressive disease in chronic lymphocytic leukemia. Blood, 112(5), 1923–1930.

Rocque, G., Williams, C., Halilova, K., Borate, U., Jackson, B., Van Laar, E., Pisu, B., Butler, T., Davis, R., Mehta, A., Knight, S., & Safford, M. (2018). Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education. Translational Behavioral Medicine, 8(2), 175–182. https//

Rojas-Gil, A. P., Kodonis, I., Ioannidis, A., Nomikos, T., Dimopoulos, I., Kosmidis, G., Katsa, M. E., Melliou, E., & Magiatis P. (2022). The effect of dietary intervention with high-oleocanthal and oleacein olive oil in patients with early-stage chronic lymphocytic leukemia: A pilot randomized trial. Frontiers in Oncology, 11, 810249.

Sfeir, J. G., Drake, M. T., LaPlant, B. R., Maurer, M. J., Link, B. K., Berndt, T. J., Shanafelt, T. D., Cerhan, J. R., Habermann, T. M., Feldman, A. L., & Witzig, T. (2017). Validation of a vitamin D replacement strategy in vitamin D-insufficient patients with lymphoma or chronic lymphocytic leukemia. Blood Cancer Journal, 7(2), e526.

Shanafelt, T. D., Bowen, D., Venkat, C., Slager, S. L., Zent, C. S., Kay, N. E., Reinalda, M., Sloan, J. A., & Call, T. G. (2007). Quality of life in chronic lymphocytic leukemia: A international survey of 1482 patients. British Journal of Hematology, 139(2), 255–264.

Shanafelt, T. D., Call, T. G., Zent, C. S., Leis, J. F., Laplant, B., Bowen, D. A., Roos, M., Laumann, K., Ghosh, A. K., Lesnick, C., Lee, M. J., Yang, C. S., Jelinek, D. F., Erlichman, C., & Kay, N. E. (2013). Phase 2 trial of daily, oral polyphenon e in patients with asymptomatic, Rai stage 0 to II chronic lymphocytic leukemia. Cancer, 119(2), 363–370.

Sharman, J. P., Egyed, M., Jurczak, W., Skarbnik, A., Pagel, J. M., Flinn, I. W., Kamdar, M., Munir, T., Walewska, R., Corbett, G., Fogliatto, L. M., Herishanu, Y., Banjeri, V., Coutre, S., Follows, G., Walker, P., Karlsson, K., Chia, P., Janssens, A., … & Byrd, J. C. (2022). Efficacy and safety in a 4-year-follow-up of the ELEVATE-TN study comparing acalabrutinib with or without Obinutuzumab versus Obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia. Leukemia, 36(4), 1171–1175.

Statistics Canada. (2023, May 16). Number and rates of new cases of primary cancer, by cancer type, age group and sex.


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