Mastering Oral Therapies in CLL and MCL: Essential Strategies and Insights for Nurses Authors: Amy L. Goodrich, RN, MSN, CRNP-AC; Claudia Boglione, RN; Natacha Bolano

https://www.medscape.org/viewarticle/mastering-oral-therapies-cll-and-mcl-essential-strategies-2025a1000xko?page=1&sso=true&uac=148436CN&src=mkmcmr_reeng_recap_mscpedu_activity Thank you for your recent participation in the activity: Mastering Oral Therapies in CLL and MCL: Essential Strategies and Insights for Nurses Below are some key learning points to help reinforce the impact of this activity. ☑ Nonadherence is common and clinically significant: 20% to 40% of patients on oral anticancer therapies show some degree of nonadherence, with rates of 15% to 35% in CLL/MCL. Key barriers include complex regimens requiring self-management, treatment-related side effects, limited disease understanding, and practical challenges such as financial burden and transportation issues. ☑ Proactive management of BTK inhibitor toxicities: Monitor for bleeding (hold therapy 3 to7 days before/after procedures), atrial fibrillation (especially in males ≥ 65 with cardiovascular history), and treatment-emergent hypertension. Second-generation BTK inhibitors demonstrate improved selectivity with fewer off-target effects compared with first-generation agents. ☑ Tumor lysis syndrome prevention is critical with venetoclax: Implement 5-week dose ramp-up, ensure adequate hydration, administer antihyperuricemic agents, and monitor high-risk patients (high tumor burden, renal dysfunction, splenomegaly) with serial labs including potassium, uric acid, phosphorus, and calcium levels. ☑ The Lymphoma Coalition's patient survey showed that 95% and 90% of patients with MCL and CLL, respectively, experienced physical side effects from their treatment, especially fatigue (affecting 60% to 64%). However, only 25% discussed fatigue extensively with doctors and 40% received no support, highlighting critical communication gaps. ☑ Nurses play a pivotal role in optimizing adherence: Use motivational interviewing, teach-back methods, and open-ended questions to identify barriers early. Provide practical tools (pill organizers, medication diaries), create safe spaces for nonjudgmental discussions, and facilitate shared decision-making between patients, caregivers, and clinicians.