Proactive Side Effect Management Underpins Curative Therapy for T-Cell Lymphomas

October 24, 2016
Allie Casey

Erin Kopp, NP, discusses the vital role that supportive care plays in oncology, especially for aggressive diseases such as lymphoma.

Erin Kopp, NP

At the National Comprehensive Cancer Network’s 11th Annual Congress for Hematologic Malignancies, Erin Kopp, NP, of City of Hope in Duarte, California, presented on supportive care and the management of T-cell lymphomas. While there, Kopp sat down with Oncology Nursing News for an interview and discussed some of the toxicities involved with T-cell lymphomas, as well as the general importance of supportive care in oncology.

What are some of the key takeaway points for oncology practitioners from your presentation?

In T-cell lymphoma, specifically in cutaneous T-cell lymphomas, there are a lot of disease- and management-related toxicities that patients are dealing with. It’s critical for me to have people understand that supportive care or management of symptoms really improves quality of life for the patients and allows them to get the therapy that they need. And, to differentiate between what we consider palliative care and supportive care: supportive care is really symptom management for improved quality of life and it goes hand-in-hand with aggressive curative therapy.

What are some of the toxicities patients being treated for T-cell lymphoma might face?

In cutaneous T-cell lymphoma, a lot of the toxicities tend to be skin-related: anything from dry, fissured, ulcerated skin that leads to infection risk to irritated skin from the medications. We use a lot of topical ointments, and nitrogen mustard gel, for instance, is an example that actually can cause skin irritation, so the appropriate use of the topical steroids is important, in addition to the treatments that we’re using.

Itching is probably the biggest issue that patients will express, both from the disease and from the management. The utilization of antihistamines doesn’t work very well for these patients, so really thinking outside of the box, using medications like gabapentin or selective serotonin reuptake inhibitors, is important.

Peripheral T-cell lymphoma involves therapy with cytotoxic agents, so patients experience the typical nausea, vomiting, pancytopenia, and, critically, infection risk, because these patients have T-cell lymphoma and they’re already immunosuppressed.

Clinicians should look at the level of nausea patients get, especially with a medication, for instance, like romidepsin (Istodax): managing nausea so patients can get the therapy that they need without delays, at the doses they need, so they can respond.

Do you feel that supportive care receives enough attention in oncology?

Supportive care is often overlooked, and if we think of it only as something to provide comfort to the patients, which should be a priority anyway, we tend to stop thinking of it when we’re focusing on the treatment regimen.

When treating an aggressive disease, or a disease that can become aggressive like lymphoma, T-cell or otherwise, you see providers really focusing on the treatments that we want to give, as opposed to what the patient will experience during treatment. But we have to remember that without supportive care, patients often fall out of treatment, because they can’t handle the toxicities, because the disease symptoms themselves are preventing the patient from showing up at the clinic, from taking the medications that we recommend. So supportive therapy will not only improve the patient’s quality of life and their desire to get better, but it will also give them the tools to show up and be able to do that.

What was your goal as a nurse speaking to this particular audience of mainly oncologists?

As a nurse practitioner focusing on T-cell lymphoma, I’m blessed to see a huge population of a relatively rare disease. And at our institution, we get to have a collegial, collaborative relationship between the nurse practitioner and the physician, so we’re able to work together and focus on both the treatment regimen as well as supportive care. But I know that doesn’t occur in every setting.

I wanted to bring to light, to the oncologists and hematologists who are treating in the community or at other academic institutions, the importance of incorporating supportive care into their daily routine when they’re discussing treatment regimens for T-cell lymphomas. Because they’re rare and you don’t see them as often, it’s not something that you’re thinking about necessarily, the very significant effects that these diseases have on the individuals that we’re treating. My goal is to get that message across, provide some practical tools, and hope to encourage an emphasis on supportive care in their day-to-day practice.