Non-Hodgkin lymphoma (NHL) is one of the most common cancers, comprising 4% of all cancers in the United States. Although non-Hodgkin lymphoma can occur at any age, more than half of all patients are 65 years old or older. Efforts are ongoing to find new and better ways to treat non-Hodgkin lymphoma. In this interview, Maria Badillo, MSN, RN, OCN®, CCRP, a Research Nurse Manager at The University of Texas MD Anderson Cancer Center, talks about the challenges and strategies involving the nursing management of patients with aggressive non-Hodgkin lymphoma.
What led you to become a research nurse studying non-Hodgkin lymphoma?
Maria R. Badillo, MSN, RN, OCN®, CCRP: Nursing is my second career. Right after nursing school, I worked in the lymphoma/myeloma inpatient department and was an inpatient nurse. I had to leave my position and came back because my passion is to work with oncology patients. Oncology is very close to my heart. Unfortunately, I do have a lot of family members that had a history of cancer. So when I got a chance to work again at MD Anderson Cancer Center, they had an opening for a research nurse position in the same department. I've been working in the same research department for 13 years and I love it. Now that I'm leading one of the best teams, every single time we have a new clinical trial that we are going to open, I feel it gives hope to patients, especially those patients that are relapsing and needing new trials and new treatments.
What are the biggest challenges when caring for patients with aggressive non-Hodgkin lymphoma?
Ms. Badillo: One of the biggest challenges when caring for patients with aggressive NHL is ensuring that our patients are well educated about their disease, including how to manage their side effects and be compliant with their treatments, especially if they are on oral medication. Since patients are taking their treatments at home, nurses need to ensure that our patients are adhering to their oral regimen, as well as knowing how to manage these symptoms at home. Some patients will just stop the drug without letting their care team know. Our patients also need to be educated about when to hold and when to resume their drug. We need to provide numbers to call in case they have questions while they are taking treatment at home.
Another challenge that I see when caring for our patients is when we see them relapsing from their disease. That's why I love what we do in clinical research. At least we know that there are options for our patients other than the standard-of-care treatments.
What advances in the field have changed the nursing management of non-Hodgkin lymphoma?
Ms. Badillo: Recently, there have been multiple FDA-approved treatments for NHL. They are not only intravenous (IV) treatments but also quite a number of oral drugs. There are also multiple chimeric antigen receptor (CAR) T-cell therapies, as well as bispecific therapies. Nurses need to be prepared and educated with these types of treatments so that they know how to manage their patients. Understanding cytokine release syndrome (CRS), neurotoxicity, and tumor lysis syndrome (TLS) will help the nurses identify these side effects in order to know what and when to report to the physicians. Also, as mentioned previously, most of our treatments are in oral form. Nurses now rely on patients to self-administer their drugs—or the nurses rely on the patient's family in assisting with the drug intake. Some patients stay on these drugs for many years. Again, drug compliance is important because we have seen drug resistance, disease progression, or increase in mortality if our patients are not consistently taking their prescribed oral treatments.
What are the most common questions that you get from patients with non-Hodgkin lymphoma? How do you counsel those patients?
Ms. Badillo: The most common questions we get from our patients are what to expect if they are on a certain type of treatment. Our patients would like to know the most common side effects—nausea, vomiting, diarrhea, alopecia, and others. Secondly, since we get patients from around the country and sometimes outside the United States, they also want to know their schedules. Some patients still work and have little kids. They want to know how long they need to be off work and when they can return to work or if they have someone to look after their kids. Our elderly patients also want to know if their treatment can be given as an outpatient or an inpatient. Some of our elderly patients rely on their children to drive them back and forth to the Center. Another important question that our patients always ask is the cost of the treatment—if the treatment will be billed through their insurance or how much out of pocket they need to prepare for in case their insurance will not fully cover the treatment.
Counseling and educating our patients are very important. As a nurse, whether you do research or you are seeing a standard-of-care patient, you need to make sure that you educate the patients about all the possible side effects that they will encounter whenever they're receiving treatment. Also, it's not only about educating them about the possible side effects, but it's also about how to manage those side effects. Counseling starts when the patient signs their informed consent. We talk about the logistics, side effects, and cost. One important thing about counseling and educating our patients is that we need to make sure that we do follow-up teaching, especially to those who are newly diagnosed. For example, if a patient starts a new therapy, call the patient the week after to check if they have side effects and if they are tolerating the treatment. However, for some patients for whom we know we need to do follow-up telephone calls, we call them 2-3 days after they start the treatment.
What is your advice to oncology nurses for managing adverse events in patients with aggressive non-Hodgkin lymphoma?
Ms. Badillo: With newer treatments to learn, oncology nursing is challenging, but very rewarding. In clinical research, we get to see and experience the cutting-edge cancer therapies for NHL. I would advise oncology nurses to learn about the new treatments available to our patients, such as CAR T, bispecific, and newer targeted therapies. Once they know these treatments, it is easier for them to discuss with their patients the expected side effects, as well as how to manage them. Again, teaching our patients doesn't only happen on the initial encounter. We also need to provide some education tools that patients can go back to in case they have questions about their treatments. In addition, we need to expand our teaching not only to the patients, but to their family members, as well.
About Ms. Badillo
Maria R. Badillo, MSN, RN, OCN®, CCRP, is the Research Nurse Manager in the Mantle Cell Lymphoma/Myeloma Department at The University of Texas MD Anderson Cancer Center in Houston, Texas. As a clinical trial manager, she develops research strategies and programs, manages protocol design and implementation, and coordinates patient participation in phase 1, 2, and 3 clinical trials. Her research focuses on the development of novel therapeutics for patients with hematologic malignancies and the management of adverse events to optimize treatment outcomes.
For More Information
American Cancer Society (2021). What's new in non-Hodgkin lymphoma research and treatment? Available at: https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/new-research.html
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.