Receiving a cancer diagnosis can be devastating, confusing, and overwhelming. It is important for oncologists to be thorough in explaining the treatment process to patients. In this interview with i3 Health, Carla Casulo, MD, Associate Professor at the University of Rochester Medical Center, gives advice on counseling patients diagnosed with follicular lymphoma.
What questions do you commonly encounter from patients or caregivers about their treatment, and how do you counsel them?
Carla Casulo, MD: That's a good question because when we meet follicular lymphoma patients at the time of their initial diagnosis, it's a very long consultation. It's a long consultation because we go into a lot of the natural history. You're likely to live a long time with this disease. It's an indolent disease, but it's also pretty heterogeneous. Some patients do less well than others, and there are different things that we can look at that can help to predict who falls into what category.
What patients ask me a lot is, "What's my prognosis? What are ways that we can refine my prognosis?" These questions lead you to assume that they're wondering: "How do you know how I'm going to do in the next few years?"
We have several different treatments to pick from. We have bendamustine. We have CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone). We have CVP (cyclophosphamide, vincristine, prednisone) which is not used as often anymore in the United States. We have lenalidomide. We have single-agent rituximab. We have two antibodies to select from: rituximab and obinutuzumab. There are lots of different treatments to pick from, and there are a lot of other drugs that are being developed to choose from at the time of diagnosis.
This is a similar issue to how you would approach someone in the relapse setting: how do you know who needs treatment? If we're treating everybody exactly the same and most patients are going to do well, then that would argue that we're probably over-treating a large proportion of patients. If we can refine the way that we approach them, if we can be more precise and more nuanced about, "Well, this group of patients should get this form of treatment and that group of patients should get that form of treatment," that will really significantly move the field forward.
That's what I tell patients, and that's what I tell my colleagues when I give talks on this disease: we need to refine our approach to follicular lymphoma. We should really try to be much more nuanced and a little bit more biologically driven. I think we're heading in that direction.
About Dr. Casulo
Carla Casulo, MD, is an Associate Professor of Medicine at the University of Rochester Medical Center. She has received numerous awards for her work, including the John W. Bracket Housestaff Teaching Award at Yale University School of Medicine, the Mortimer Latcher Fellowship Award from the Lymphoma Foundation, and the National Institutes of Health (NIH) John Calabresi Career Development Award, among others. Dr. Casulo's research interests include newly diagnosed and relapsed follicular lymphoma, Hodgkin lymphoma, peripheral T-cell lymphoma, and lymphomas affecting young adults.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.
Image Courtesy of University of Rochester Medical Center