Many people beginning cancer treatment are filled with hope and anxiety as they try to understand their new regime and what to expect from their treatment. Ensuring that patients are fully informed of their cancer treatment and its associated side effects is crucial to their adherence to the treatment and overall well-being. Discussing BTK inhibitors before treatment begins will help to better prepare patients for their disease and the various side effects that they may encounter during their course of treatment.
Targeted therapies like BTK inhibitors need to be explained to patients before starting the treatment. Bruton’s tyrosine kinase (BTK) inhibitors are described in detail on the Web, but it is also important to understand that every single BTK inhibitor is different. Hence, the information provided to the patients regarding the treatment needs to be individualized.
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Explain How BTK Inhibitors Work
There are different drugs which are currently in use to treat various types of cancers like CLL, SLL, WM, and it is important to explain to the patients why they have been prescribed particular BTK inhibitor drugs and how they work. Patients need to be told that these drugs are different from the traditional type of chemotherapy that is used to treat cancer and work by targeting the cancer cells and the biological pathway that the cancer cells use to survive and multiply.
It is also helpful to explain why BTK inhibitors have been chosen to treat a certain disease and to describe the differences in treatment between individual patients. This form of therapy targets the signaling pathways involved in growth and survival of cancer cells. Patients should be informed that while the treatments are based upon similar methods, they are designed to destroy individual cancer cells. Therefore, patients may have different responses to the treatment, and it may take some time to see results.
Each patient’s response to treatment is monitored using the patient’s symptoms, physical examination, lab values, imaging studies and other measures to assess response to treatment for his/her specific type of cancer. Treatment response may vary among patients.
Discuss How and When to Take Medicine
Patients need to understand the dosage, frequency, and whether the treatment must be taken with or without food.
Healthcare professionals must explain to patients that it is crucial to adhere to the correct dosing of BTK inhibitors. Patients should be advised to consult with the healthcare team before changing the treatment dosage or stopping the treatment. They should also be advised what to do if they miss a dose of their cancer medicine.
Remind patients to inform their healthcare provider of all medications including prescription medicines, over-the-counter medicines, vitamins, supplements, and herbal products that they are taking before starting their cancer treatment. There are some medicines for bleeding as well as some medicines that affect heart rhythm that can interact with their BTK inhibitor therapy. In addition, some medicines as well as some supplements and herbal products can affect how their cancer medicine is metabolized (i.e., processed) by their liver, potentially causing higher or lower than intended levels of the medicine in their system.
Review of Potential Side Effects
Patients need to be able to tell the difference between expected, temporary side effects and a sign of serious problems. While many BTK inhibitors have similar side effects and their frequency can be similar for different drugs within a class, each individual drug can have different side effects with variable severity.
Many side effects experienced by patients with cancer, using targeted treatments, can cause a lot of discomfort but most will disappear on their own within a few days or a couple of weeks. It is essential to report persistent or unpleasant side effects to the cancer team as quickly as possible and not self-manage with other medicines as the effects of cancer treatments can be unpredictable.
To make patients aware of more serious side effects, such as increased risk of bleeding or infections, changes to heart rhythm, increase of blood pressure and cardiovascular problems, patients need to be informed about the potential risks of their BTK-inhibitor. Patients have to be made aware of possible side effects, but they should not panic once they have read about potential side effects.
Highlight Bleeding and Infection Precautions
The risk of bleeding is another important consideration. Patients should report any unusual bruising, bleeding, frequency of nosebleeds or unexpected bleeding or bloody discharge from wounds to their doctors before starting treatment. They should inform their doctors and dentists before any surgery, dental treatment or invasive medical treatment.
In addition to the symptoms of cancer and its treatment, the individual with a cancer treated with oral targeted cancer therapy needs to be aware of the increased risk of infection. Other symptoms which may indicate the onset of an infection include fever/chills, persistent cough, sore throat. In such cases the patient should be encouraged to promptly contact the healthcare team.
Discuss Other Medicines and Health Conditions
A complete list of all the patient’s current medicines (prescription and non-prescription) as well as any vitamins and supplements, and any herbal remedies should be obtained before starting with targeted cancer therapies.
Even over-the-counter medicines, like some kinds of pain relievers, should be discussed with the patient’s cancer therapy team. This includes all vitamins, herbal products and other supplements the patient currently takes or is thinking of adding to their daily regimen. Patients should remind their cancer therapy team of any newly prescribed, over the counter or other medicines, especially before taking them.
In addition to medications that a patient is taking for cancer, other existing medical conditions (e.g. cardiovascular disease, liver dysfunction, increased risk of infection) need to be considered when determining appropriate monitoring.
Explain Monitoring and Follow-Up
Depending on the specific circumstances, follow-up may include further treatment, more assessment of symptoms, blood counts, full chemistry panels and potentially a variety of other measures to assess treatment and detect any potential problems.
Healthcare professionals can describe the value of monitoring for patients. The purpose of monitoring the treatment team is to assess the effectiveness of therapy and to catch problems early. Patients must also know what to do if they develop a new or worsening symptom between appointments and who to contact.
Encourage Practical Adherence Strategies
There are ways that may help patients adhere to the medication. For example, taking the BTK inhibitor at the same time every day, using reminders, and keeping an updated list of all medications.
In addition, patients should be informed of the appropriate method of disposal of their medicines and told to keep their medicines out of children’s reach. Patients who develop swallowing difficulties or other adverse effects that make administration difficult should be advised to contact their healthcare team for advice on alternatives rather than trying to manage them themselves.
Support Shared Decision-Making
Adherence to long term cancer treatment needs to be discussed in terms of benefits vs risks of treatment, alternative treatments and how patients will be monitored on treatment. Patients should have the opportunity to ask any questions they have regarding their BTK inhibitor treatment. Acknowledge and review the patient’s understanding of key information by asking them to repeat back in their own words what they have been told about their treatment, in particular about their medicines and the side effects that they may get.
The discussion about BTK inhibitor drugs should be personalized to the individual patient’s disease, drug(s), other treatment(s), and specific patient circumstances including their lifestyle. Patients must be encouraged to discuss concerns with their healthcare team and understand the goals and potential risks of treatment.
Medical Disclaimer: The information provided in this article is intended for educational purposes only and should not be interpreted as medical advice, clinical guidelines, or a recommendation for any specific treatment.