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In the United States, approximately 1.63 million people are either living with or are in remission from blood cancers such as leukemia, lymphoma, myeloma, myelodysplastic syndromes (MDS), or myeloproliferative neoplasms (MPNs). An equal or greater number of individuals serve as care partners for these patients. Being a care partner is often motivated by deep affection, yet it can lead to significant stress.

As a care partner, you might experience stress symptoms such as feeling overwhelmed or anxious, fatigue, irritability, a loss of interest in previously enjoyed activities, or physical health issues. These issues typically arise from the challenges of balancing your loved one's needs with your own.

If you notice any of these stress indicators, consider the following advice from fellow blood cancer care partners on how to reduce burnout.

Eight Tips to Reduce Caregiver Burnout

Blood cancer care partners shared the following tips for how they reduce burnout while supporting their loved one.

Set boundaries with the patient around what they want help with. Even if it is out of love, be willing to let go of nagging them on areas they don’t want help with.
Get outside (weather permitting). Go for a walk, run, bike ride, garden, or just a break sitting outside and breathing in the fresh air.
Show yourself compassion about the learning curve. Don’t try to cram all the information in at once. If you get a specialist on your team, trust their input up front, and you can learn more about the cancer over time.
Give yourself the validation that it is okay to take frequent breaks from thinking about cancer. Spend time doing a hobby you would have enjoyed pre-diagnosis.
Keep up with your own health care. Putting your health first will help reduce resentment. Your well-being will also impact your ability to care for others.
Take a break from depressing social media posts. Also, when searching for information, seek it out from credible sources, such as specialists.
Even if you feel like you need to be strong for your loved one, you need to take time to feel your emotions. Otherwise, they will build up over time and negatively impact your health. Seek out a mental health professional to support you as needed.
Even though there are bad days, when the good moments come, give yourself permission to enjoy those too. It does not all have to be doom and gloom.

Conclusion

In summary, when supporting someone with blood cancer, it's important for care partners to actively manage their own stress and well-being. To reduce burnout, care partners suggested tips like setting clear boundaries, maintaining personal health, and allowing space for emotional processing. This enables you to not only preserve your own health but also enhance your ability to provide compassionate assistance to your loved one.

Connect to Other Caregivers!

Visit one of the links below to learn from and speak to other blood cancer care partners. HealthTree groups we have so far include:

If you would like to share your story or tips about being a blood cancer caregiver, please email info@healthtree.org.

Sources:

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Everyone should consider the importance of estate planning. Preparing for the distribution of your assets ensures that your financial and personal affairs are managed according to your wishes in case of incapacity. Taking these steps ahead of a crisis can provide both emotional and financial benefits.

It's important to consult with an attorney who specializes in estates, especially if your situation is complex, such as having a blended marriage or caring for a special needs individual.

Disclosure: I am only providing an overview of estate planning. Please consult with an attorney to address specific concerns you may have.

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What Is an Estate?

An estate, simply, is everything that you own that is in your name. Your estate is responsible for any debt owed at your death.

It is important to prepare well in advance. This planning will help you feel more secure about your future and confident that your loved ones will be taken care of after you pass.

Many people don’t understand that estate planning can assist you in tax mitigation before death.

Many of the issues that can be addressed in an estate plan are:

Providing for a spouse or children
Preserving assets for future generations
Supporting your favorite charity
Ensuring all of your assets that pass through a beneficiary designation will be distributed per your wishes
Minimize taxes and expenses
Ensuring the persons you name to handle your estate or make decisions on your behalf are put on record
Make sure your heirs can manage their wealth or have a resource to assist them in place
Ensure that anyone you are responsible for financially, such as those with special needs, is taken care of
Assure that anyone you want to leave assets to is assigned, including entities such as charities
Allow you to provide protection of assets from ex-spouse/s or creditors

An estate plan can help you understand and mitigate tax ramifications to your assets before and after your death. This specifically refers to Federal Gift taxes and Generation-skipping transfer taxes.

Common Documents and Descriptions for the Estate Plan

Here are the most common documents and descriptions of the documents used to help you carry out an Estate Plan:

Will: This is a legal document used to outline how you want your assets and property to be distributed after you die. It can also help you name guardians for your children, dependents, or pets, as well as the person (executor) who will handle these affairs after your death.
Durable Power of Attorney: Allows you to name someone (agent) to handle your financial affairs if you’re unable to do so.
Power of Attorney for Healthcare: It allows you to appoint a trusted family member or friend to make decisions about your medical care if you are unable to make them yourself.
Privacy Releases: These are documents that are offered to you when seeking medical attention. It gives permission for someone on your behalf to access information and documents necessary to represent you in healthcare matters. Many healthcare POAs have this included. Check with your healthcare providers, as they may have their own privacy waivers.
Living Will (Advanced Medical Directive): This document requires careful thought when naming someone to make decisions on your behalf with your healthcare providers as to how you are to be medically treated when you are unable to make the decisions yourself.
Trust: There are many types of trust to help you manage your assets. They are often used as part of an estate plan to help minimize or eliminate transfer taxes, as well as other opportunities unrelated to taxes to help solidify an estate plan.

What Happens If You Die Without Any of These Documents?

If you don’t have a will when you die, it is considered intestate. In this situation, the intestate laws of your resident state will determine how your estate will be distributed. This could be a concern if you have an ex-spouse or blended marriage with children.

Estate planning can also include Legacy Planning/Planned Gifts. You can include your desire to donate to your favorite charity in your estate plan. If you want to include gifting in your plan, careful consideration as to what, whom, and when you should give is very important.

Some gifts provide life-long income to the donor, while other gifts use estate and tax planning to provide for charity and heirs in ways that can maximize the gift and/or minimize its impact on the donor’s estate. Other planned gifts can be simple charitable gifts through a will or a trust.

There are three types of planned gifts:

Outright gifts that are given of appreciated assets, such as stocks as a substitute for cash
There are gifts that return income or other financial benefits to the donor in return for the contribution
Gifts that are donated after the death of the donor

Charitable gift annuities make fixed payments to the donor starting at either the time of the gift (immediate-payment gift annuity) or payments at a later date(deferred gift annuity). Depending on the organization to which these are donated, the funds can be pooled (comingling of donations) together with other donated funds and pay beneficiaries through the variable spending on the earnings of the fund. They generally operate very much like a charitable mutual fund.

Charitable remainder unitrust and annuity trust are individually managed trusts that pay beneficiaries either a fixed percentage of trust income or a fixed dollar amount.

A huge benefit of gifting is the tax benefits to the donor depending on the type of gift:

A donor can realize a charitable deduction for the real market value of the asset where the donor will not pay capital gains tax on the transfer of the appreciated asset, such as securities or property.
A tax benefit to the donor can be realized for donated life-income gifts. The donors will receive an income tax deduction for the full, fair market value of the assets contributed minus the present value of the income interest retained. If the gift is appreciated property, they pay no upfront capital gains tax on the transfer.
Bequests are gifts donated at the donor's death, such as a life insurance policy or a retirement account. They don’t generate a lifetime income tax deduction for the donor; however, they are exempt from estate tax.

You don’t have to be rich to give, but many people will donate vehicles, art, or other property as it enables them to give to the charity they have an emotional tie to more than they can otherwise give.

When considering estate planning and/or legacy planning, it is recommended that you work with your financial and tax professionals, as well as your estate attorney, to make sure you have all of the required documents needed to manage your affairs in the event you cannot while living and to manage the distribution of your estate the way you want it distributed after your death.

They will also help you manage the gifting and maximize the tax benefits while minimizing tax consequences.

Triage Cancer is a good place to start educating yourself and finding the resources you may need to start the process.

HealthTree has information to help you understand Estate and Legacy planning and provide you with opportunities to include the HealthTree Foundation in your planning. Learn more here: Legacy Giving

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Blood cancer care partners brainstormed ways their communities can support them in effective ways. Read their ideas below to learn how you can support blood cancer care partners and what to think twice about before doing so.

Caregivers, share this article with your loved ones so they know how they can help!

Ways to Help Blood Cancer Caregivers

Unspoken Simple Tasks

Sometimes, the most meaningful acts of service include simple actions that care partners weren't even aware they needed.

These could include:

Bringing in/out the trash or recycling bins on trash day
Shoveling snow
Bringing gift cards (or, when requested, food)
Treat drop-offs to let you know you were thinking of them
Mowing the lawn

Pre-Arranged Tasks

If you know of a loved one who is taking care of someone with blood cancer, consider offering to do one of these pre-arranged tasks.

Rides to treatment
Errands/chores
Sunshine basket (care baskets with crosswords, hygiene products, snacks, etc. for hospital stays)
Freezer/crockpot meals
Take care of pets
Pick up prescriptions
Sign up for UPS/FedEx deliveries requiring signatures
Make hotel and flight reservations
Negotiate price with airline due to \"medical flight\" status
Help resolve insurance issues

Perhaps one of the most important things that you can do for care partners is arrange time for them to take care of themselves. Ask if you can spend time with the patient so that they can participate in activities such as:

Nail appointments
Hair/spa appointments
Walks or other forms of exercise
Movie

Spiritual Check-ins

If appropriate and applicable, you might want to consider checking in with your friends and family who are care partners and ask how they are doing spiritually. Be careful not to come off as condescending, and be sensitive to the fact that some people might be going through a faith crisis after being diagnosed with cancer.

You could consider:

Checking in with people from your religious circle
Sharing you are praying for them and ask if there are any specific prayer requests they have
Share inspiring and comforting scriptures to remind them they are not alone

Mental Health Check-ins

Check in with your loved ones' care partners to make sure they are doing well mentally and emotionally. Even when the care partner has a positive attitude, the role can be lonely and draining. Knowing you have a strong support system who is checking in on you is very helpful.

Consider sharing the following:

Share encouraging words
Validation of emotions: Letting the caregiver know it's ok to feel the way they feel
Keep them included: Even if they're not available, keep inviting them to book clubs, parties, dinners, and get-togethers so they feel included
Care plan: Create checklists for them to ensure they are taking care of themselves. Supportively hold them accountable for their own health
Be an ear to vent to
Remember important days and “celebrate” or acknowledge them
Do a non-cancer activity together (stream a movie, craft, play games, etc.)
Shared caregiving responsibilities like loved ones taking “shifts” to care for patients in/out of the hospital

Think Twice Before Doing This for Caregivers

While we know that you have good intentions, you may want to think twice before doing the following when trying to help blood cancer care partners:

Pushing food or delivering food without asking
Sharing unwanted/unasked-for medical advice
Sharing doubt about diagnosis
Sharing horror stories about diagnosis or other sicknesses/cancers

When in doubt, ask the care partners you would like to help and what would be most helpful. Come up with ideas to help, and ask them if they would feel comfortable with that in their lives at this time.

While improving the quality of life of blood cancer patients is important, let's also work to improve the lives of blood cancer care partners.

Summary

Blood cancer care partners shared insightful ways their community can offer practical and emotional support to enhance their caregiving roles. Effective help can range from performing simple, often overlooked tasks like mowing the lawn or taking out the trash to more involved assistance such as managing errands, offering rides to treatment, or even arranging self-care opportunities for the care partners themselves.

Additionally, it's important to approach support with sensitivity, avoiding imposing food or unwanted advice and instead focusing on meaningful, consented assistance that respects the care partner's needs and preferences.

!AD!

Connect to Other Caregivers!

Visit one of the links below to learn from and speak to other blood cancer care partners. HealthTree groups we have so far include:

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Being a care partner to a blood cancer patient, no matter where they are in their journey, can be overwhelming. It adds more roles and responsibilities to your already busy schedule. You serve out of love, but there is no denying that wearing all of the hats that a caregiver brings can be exhausting at times.

Learn insights on managing this role.

How Can the Caregiver Role Change?

At the beginning of a blood cancer diagnosis, many caregivers wonder what their role will look like in the upcoming years. The truth is these roles can differ based on the age of the patient, the treatments that they receive, and the status of the cancer.

For example, older patients might require a ride to their treatment appointments, while younger patients can usually drive themselves. Younger patients might need several reminders to take their medication, while older patients remember to take it with their other daily medications. Many patients benefit from having someone to talk to or a shoulder to cry on.

Sometimes, your role as a caregiver can include being a walking/exercise partner. Other times, it can include being an appointment keeper or secretary at certain appointments.

It could be as simple as picking up the slack when the patient feels fatigued or helping them manage heightened emotional states caused by treatments. If you are noticing a significant change in your loved one’s emotional state as a result of treatment, talk with your cancer specialist about your concerns.

Tips for Managing the Caregiver Role

Maci Chance, a blood cancer care partner, shared the following advice for others in similar roles. Watch the video below or read the summary highlights to learn her advice:

Instead of focusing on balance, go where you are most needed. At different times in the cancer journey, you will be required to spend more time in some areas of your life than others. For example, Maci was a full-time working mom and partner to Tad. During Tad's stem cell transplant, she was able to take a sabbatical from work to concentrate on the mother and partner/caregiver roles in her life. She has since returned to work but emphasized the need not to try to search for balance but rather go where you are most needed. It requires sacrifice, but it is worth it not to burn out in all areas of your life.

Therapy can be a lifesaver. Having an uninvolved third party to talk about your frustrations and concerns can be incredibly helpful. This is a stressful time, and you deserve the chance to process your grief and worry with a trained professional who can help you. Ask the social worker at your center or your general practitioner for recommendations. You can also call your insurance to see who/what they cover within your network. You are worth finding a good, helpful therapist!

Don't be afraid to ask for help. It might be hard to let go of the \"control\" that you feel, but by asking for help, you are taking care of yourself. Perhaps someone else could take your mother to her treatment appointment, your neighbor can pick up her groceries, or your brother can take a turn sleeping over at her house after her stem cell transplant. Asking for help allows you to better serve in the future.

Summary

Being a care partner for a blood cancer patient involves adapting to changing roles and significant responsibilities that can vary depending on the patient’s age, treatment, and condition. Care partners are encouraged to manage their duties without seeking perfect balance but by prioritizing needs and making sacrifices where necessary. It’s crucial for caregivers to acknowledge the emotional toll of their role, seek professional support, and not hesitate to ask for help to maintain their well-being and effectiveness in caregiving.

!AD!

Connect to Other Caregivers!

Visit one of the links below to learn from and speak to other blood cancer care partners. HealthTree groups we have so far include:

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Many veterans miss out on valuable benefits available to them when they become disabled due to their military service, or if an illness worsens as a result of their active duty or training.

In this article, I will highlight available benefits even if you are not completely disabled. These benefits may also assist a child, a spouse, or parents.

If you were disabled during inactive duty training, the disability must be due to an injury, heart attack, or stroke. Additionally, your discharge from service cannot be dishonorable in order to qualify for the benefits listed.

Understanding Veteran Disability Compensation

Disability compensation is a tax-free benefit paid to veterans who are at least 10% disabled, with benefits corresponding to the level of disability. You can review the rate chart at www.vba.va.gov/bln/21/rates.

If you have dependents and a disability rating of 30% or higher, you may qualify for additional compensation. Keep in mind that your disability benefits may be offset by military retirement pay, disability severance pay, or separation incentive payments.

Available Benefits for Disabled Veterans

Disability Compensation

This tax-free monthly income is paid to veterans disabled by an injury or disease incurred or aggravated during active military duty. This includes physical conditions, such as chronic back or knee issues, as well as mental health conditions like post-traumatic stress disorder. For those on inactive duty training, the disability must result from an injury, heart attack, or stroke. Dependents may also qualify for benefits.

Special Monthly Compensation

You may receive additional compensation beyond the basic rate if your disability involves any of the following:

Loss of or loss of use of specific organs, sensory functions, or extremities.
Disabilities that confine you to your home or make you bedridden and in need of assistance.
Combinations of severe disabilities that significantly impact your ability to walk.
Independent disabilities or multiple conditions, each rated 50% or 100%.
Multiple disabilities that require special skilled assistance, without which you would be confined to a nursing home.

To apply for these benefits, ensure you have all necessary documents ready, including your discharge or separation paperwork (DD214), and medical records from military or private providers supporting your claim.

Open an eBenefits account at www.ebenefits.va.gov for easy access to benefits.

For more information on filing your claim, visit www.benefits.va.gov/transformation/fastclaims.

Presumptive Benefits

Many of you may already be aware of Presumptive Benefits, which apply to veterans with service-connected disabilities linked to certain conditions of service, including:

Former prisoners of war
Gulf War veterans with undiagnosed illnesses or medically unexplained chronic multisymptom illnesses
Veterans exposed to Agent Orange

Clothing Allowance

Veterans may be eligible for one or more annual clothing allowance payments if:

You use a prosthetic or orthopedic device due to a service-related disability.
You have a service-connected skin condition and use medication that causes irreparable damage to your outer clothing.

To receive payment, you must establish eligibility by August 1st of the year for which you are claiming. To apply, contact the prosthetic department representative at your VA center.

Automobile Allowance

If your military service has resulted in a disability that requires vehicle modifications for you to drive, you may be entitled to a one-time allowance paid directly to the seller of the vehicle. Your impairment must include one of the following:

Loss of or permanent loss of use of one or both feet or hands
Permanent vision impairment in both eyes that makes driving impossible, even with corrective lenses
Certain severe burns

You may also qualify to purchase adaptive equipment, such as adaptive steering, power brakes, power windows, or other modifications if you have mobility issues in the joints of one or both knees or hips.

To apply, contact your nearest VA regional office or center, or call 1-800-827-1000 for assistance.

Housing Grant

One of the most well-known benefits is the Housing Grant:

Specially Adapted Housing (SAH) Grant:
This grant helps service members and veterans with permanent and total service-connected disabilities to purchase, construct, or modify a home to accommodate their disability.
Special Housing Adaptation (SHA) Grant:
This grant assists qualifying veterans in adapting or purchasing a home to meet their needs.

Grant amounts are set by law but may be adjusted based on the construction cost index. The grant can be used up to three times, not exceeding the total aggregate amount.

For more information or to apply for adapting your home, purchasing a home that needs adaptation, or modifying a family member's home, visit www.ebenefits.va.gov or download the form (VA Form 26-4555) at www.va.gov/forms. You can also call 1-800-827-1000 or use TTY via the federal relay number at 771. For additional details on the SAH/SHA grant programs, please visit www.benefits.va.gov/homeloans.

Veterans’ Mortgage Life Insurance (VMLI)

Similar to regular mortgage insurance, Veterans’ Mortgage Life Insurance (VMLI) helps families pay off the mortgage after the death of the service member or veteran. There are certain prerequisites:

Eligibility:
VMLI is available to service members or veterans with severe service-connected disabilities who have:

Received a Specially Adapted Housing (SAH) Grant from the VA for building, remodeling, or purchasing an adapted home
Their name on the home title
A mortgage on the home
Applied for VMLI before their 70th birthday

How it Works:
VMLI is automatically issued after SAH approval, provided the necessary information is submitted to establish a premium, unless coverage is declined. Coverage ends automatically when the mortgage is paid off. If you sell the home, you can transfer VMLI to the mortgage of a new home.

Premiums vary based on your age, the outstanding mortgage balance at the time of application, and the remaining term of the mortgage. VMLI is a decreasing term life insurance policy, and all premiums are deducted monthly from your compensation.

Service-Disabled Veterans' Insurance (S-DVI)

Life insurance is available to veterans with a service-connected disability who are otherwise in good health. To qualify, you must meet the following criteria:

Have an honorable discharge on or after April 25, 1951
Receive a rating for a service-connected disability of 0% to 100%
Be in good health except for service-connected conditions
Apply within two years from the date you are notified by the VA about your new service-connected disability

The premium amount depends on your age, the type of insurance plan (term or permanent life), and the requested death benefit. Note: If you have basic Service-Disabled Veterans' Insurance (S-DVI) coverage and are rated 100% disabled, you may apply to have your premiums waived.

Additionally, you may qualify for Supplemental Insurance if you have a Supplemental Service-Disabled Veterans' Insurance (S-SVI) policy and your premiums are waived due to total disability. You must apply within one year of receiving the premium waiver notice and be under 65 years of age.

Vocational Rehabilitation and Employment (VR&E)

These benefits are designed for service members and veterans with service-connected illnesses and injuries. The VA evaluates your interests, aptitudes, and abilities, and assesses how your disability impacts your ability to work. This program offers career counseling and rehabilitation planning, including job training, job-seeking skills, resume development, and more. Additional benefits include on-the-job training, apprenticeships, and non-paid work experiences. For those severely disabled and not ready to work, independent living services are also available.

Eligibility Requirements:

You have a service-connected disability rating of at least 10% from the VA, or a pre-discharge disability rating of 20% or more.
You have received or will receive an other-than-dishonorable discharge.
If referred to a military Physical Evaluation Board or participating in the military/VA Integrated Disability Evaluation System process, you may qualify without a VA rating.

Generally, veterans must use all Vocational Rehabilitation and Employment (VR&E) services within 12 years from the later of the following dates:

The date of separation from active military service.
The date the VA first notified you of a qualifying service-connected disability rating.

Education Assistance

This program provides education benefits to Veterans to assist with obtaining a degree or pursuing other eligible education and training.

Dependents Educational Assistance (DEA): Assists survivors or dependents of Veterans to obtain a degree and pursue other eligible education and training.

Always Review Your Benefits

It's crucial for veterans to review their available options. Financial assistance can address various issues and concerns, significantly reducing financial uncertainty and distress.

Are you interested in exploring financial resources for blood cancer patients? HealthTree Foundation offers free connections with financial coaches who volunteer their time to answer questions about insurance, prescription coverage, and more. They also help connect patients and their loved ones to valuable resources. You can reach out to them using the contact information below:

Patrick Kelley- patrickkelley072@gmail.com
Dave Braucht- flatdog@earthlink.net
Ken Levy - kenplevy@sbcglobal.net
Diahanna Vallentine- myfinancialcoach@healthtree.org

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Blood cancers, a group of cancers affecting the blood and bone marrow, often present with subtle symptoms that can be easily overlooked. Early detection is key to improving outcomes and increasing treatment success rates. This Blood Cancer Awareness Month, we're empowering you with the knowledge to recognize potential warning signs and take proactive steps for your health.

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Common Symptoms to Watch For

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While blood cancers can manifest in various ways, some common symptoms include:

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Unexplained fatigue: Feeling unusually tired or weak, even after adequate rest.
Sudden weight loss: Losing a significant amount of weight without any changes in diet or exercise.
Frequent infections: Experiencing more infections than usual or taking longer to recover.
Easy bruising or bleeding: Noticing bruises or bleeding easily, even from minor injuries.
Swollen lymph nodes: Feeling enlarged lymph nodes in the neck, armpits, or groin.
Bone pain: Experiencing persistent pain in the bones, often in the back or ribs.
Changes in the skin, such as unexplained rashes, itchy skin, or a sore that does not seem to heal
Frequent fevers or experiencing night sweats on a regular basis
Persistent headaches, difficulty breathing, feeling faint or lightheaded, or noticing a rapid or irregular heartbeat

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Don't Ignore the Signs

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If you experience any of these symptoms, it's essential to consult your doctor promptly. While other conditions can cause these symptoms, it's crucial to rule out blood cancer as a possibility.

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Early diagnosis is crucial as it often allows for more treatment options and better outcomes. When blood cancers are detected at later stages, they may have already caused significant damage to the body, making treatment more complex and potentially less effective. In some cases, a delayed diagnosis can limit access to treatments like stem cell transplants, which are often most successful when performed earlier in the disease course.

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Taking Action: Knowledge is Power

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This September, join HealthTree Foundation for our upcoming "Innovation in Blood Cancer" webinar on September 30th. This informative session will feature a panel of experts in hematology who will discuss the latest advancements in blood cancer research, treatment, and care. The webinar is free and open to all patients and their loved ones.

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webinar registration

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By staying informed and proactive, we can work together to improve early detection rates and support those affected by blood cancer.

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HealthTree Foundation: Innovation that Saves Lives

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B-cell lymphomas are a type of blood cancer representing the majority (80-85%) of non-Hodgkin lymphomas (NHLs). NHLs are a diverse group of blood cancers that affect immune cells known as lymphocytes, with different symptom patterns and responses to treatment. NHL usually originates in lymphoid tissues like lymph nodes or spleen and can spread to other organs.

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How Can Lymphoma Alter Your Bloodwork?

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When diagnosed with lymphoma or facing a relapse, blood work is a crucial part of monitoring the overall health. Blood tests can provide information about the body's condition and how lymphoma affects the normal body functions. In this article you’ll learn the most common alterations in blood work that lymphoma patients might experience, what each value means, normal ranges, and why these values can be altered.

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Complete Blood Count (CBC)

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A Complete Blood Count (CBC) is a common blood test that provides important information about the different cells that constitute your blood. Blood cells are produced in the bone marrow. When lymphoma cells invade the bone marrow, they can crowd our healthy bone marrow cells, making it difficult for the normal production of blood cells to occur. This is why patients with lymphoma often experience altered blood cell counts in their test results.

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White Blood Cells (WBC)

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Normal range: 3.2-10.6 k/ul
What it means: White blood cells are crucial for fighting infection. Lymphocytes and neutrophils are types of white blood cells.
Why it’s altered: Lymphoma can either increase WBC counts due to the overproduction of abnormal lymphocytes (lymphocytosis) or decrease WBC counts if the disease affects the bone marrow’s normal function (neutropenia). Due to the essential role of these cells in the immune system’s defenses, altered counts will always be linked to an increased risk of infection or an active infection.

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Red Blood Cells and Hemoglobin (Hb)

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Normal range: 12.1-15.9 g/dL
What it means: Hemoglobin is the protein in red blood cells (erythrocytes) that carries oxygen throughout your body.
Why it’s altered: Lymphoma cells invading the bone marrow can decrease the production of red blood cells, leading to lower hemoglobin levels, which is commonly known as anemia.

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Platelets

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Normal range: 150 - 440 k/ul
What it means: Platelets are fragments of a cell called megakaryocyte that circulate in the blood and play a crucial role in blood clotting and wound healing.
Why it’s altered: If lymphoma affects the bone marrow, it can result in a low platelet count, known as thrombocytopenia, which can lead to an increased risk of bleeding and bruising.

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What is Other Blood Tests Can Detect Lymphoma?

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Lactate Dehydrogenase (LDH)

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Normal range: 100 - 253 or 300 - 600 U/L
What it means: LDH is an enzyme found in almost all body tissues, and high levels can indicate tissue damage. The range varies greatly in this lab value for many reasons: each laboratory has a different range for what's considered normal. Your lab report should show the range that your lab uses for each test. Another reason is that your doctor will look at your results and, based on age, health, and other factors, will make a full-picture interpretation of what might be happening in your body. A value that isn't in the normal range may still be normal for you.
Why it’s altered: Elevated LDH levels are common in lymphoma patients and can indicate the presence and extent of disease and be a marker of tumor burden.

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Erythrocyte Sedimentation Rate (ESR)

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Normal range: 0 to 22 mm/hr for men, 0 to 29 mm/hr for women, but it gradually increases with age.
What it means: ESR is a test that indirectly measures the amount of inflammation in the body. It measures the rate at which the red blood cells, or erythrocytes, fall to the bottom of a blood sample tube.
Why It’s altered: Elevated ESR can be seen in lymphoma due to the inflammatory response caused by the disease.

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Beta-2 Microglobulin (β2M)

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Normal range: 0.70 to 1.80 mg/L
What It means: Beta-2 microglobulin is a protein found on most cells' surfaces, but some, particularly lymphocytes, release it into the blood. β-2 microglobulin is usually elevated in some cancers, inflammation diseases, and kidney disease.
Why it’s altered: In lymphoma, high levels of β-2 microglobulin can indicate a higher number of lymphoma cells or tumor burden, making it a useful marker for diagnosis and prognosis.

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Liver Function Tests (LFTs)

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What they mean: These tests assess liver function.
Why they’re altered: Abnormal levels can indicate that lymphoma cells are invading the liver. Side effects from some treatments can also produce changes in liver function.

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Liver function tests measure the levels of enzymes and proteins in the blood produced by the liver. They are an indicator of the liver health status and they can also alert if there are obstructions in the biliary tract. The indicators for liver functions are:

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Alanine aminotransferase (ALT): is an enzyme that can be elevated when the liver is damaged by viral infection, fibrosis (cirrhosis), non-alcoholic steatohepatitis, also known as fatty liver, and drug toxicity. In rarer cases, it can also be elevated when there are muscle injuries from trauma or excessive exercise. \n\n\t
- Normal range: 7 to 56 units per liter
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Aspartate aminotransferase (AST): is also an enzyme used to measure liver health, however, it is less specific because it can be found in other tissues. \n\t
- Normal range: 10 to 40 units per liter
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Alkaline phosphatase (ALP): is an enzyme that also helps determine the functioning of the liver and gallbladder or identify concerns with the bones. Its function in the body is important in calcium metabolism. It can also be helpful as an infection or inflammation indicator.\n\t
- Normal range: 44 to 147 units per liter
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Bilirubin: It is the product of red blood cell metabolism, and it also helps break down food in the digestive system. It has a yellow color, and high bilirubin levels can alter the skin color and make it yellow. In more severe cases it can also tint the eyes yellow; this condition is called jaundice. When bilirubin levels are low, it can produce a rare condition called acholia, where the stool is white instead of brown, and choluria, when the urine color is black as a cola soda. This can happen when there is a bile tract obstruction.\n\t
- Normal range: 0.1 to 1.2 milligrams per deciliter
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Monitoring blood work is essential for managing lymphoma. Understanding these common alterations can help you navigate your health status and engage in more informed discussions with your healthcare team. Consult your healthcare provider to interpret your results and develop a personalized care plan.

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Take control of your care with HealthTree Cure Hub!

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With HealthTree, you can continue learning about lymphoma, discover treatment options, find a specialist or a clinical trial, and so much more! Sign up for a free patient account today to get started.

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CREATE MY FREE ACCOUNT

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Sources:

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https://emedicine.medscape.com/article/202677-overview#a2
https://healthtree.org/myeloma/community/resources
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It’s no secret that in the United States, a cancer diagnosis can translate into a significant financial burden for the patient and their family. Thankfully, action is being taken in the national legislature to decrease spending for Americans on Medicare.

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Many Americans add Medicare Part D to their standard Medicare Plan to cover prescription drug costs. Today, we will discuss the 2024/2025 Medicare Part D updates and how they can benefit blood cancer patients on Medicare.

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Review of Medicare Part D Stages and 2023 Medicare Part D Changes

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Thanks to the Inflation Reduction Act of 2022, significant changes to Medicare went into effect, including coverage updates to Medicare Part D.

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There are 4 parts to the Medicare Part D coverage in which drug costs are covered at varying levels by the enrollees themselves, drug manufacturers, Part D plans, and Medicare itself.

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Beginning in 2023, Part D Enrollees paid $505 for their deductible and 25% of total drug costs, up to the “Catastrophic Threshold”.

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You can see the four stages and the state of each phase in 2023 below.

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To understand the catastrophic phase, those enrolled in Part D reach the catastrophic threshold when their out-of-pocket amount, plus the value of the manufacturer discount on the price of brand-name drugs in the coverage gap stage, exceeds a certain dollar amount.

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This amount has changed historically, and further changes will be made in 2024/2025.

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In 2023, after enrollees reached the catastrophic threshold, the enrollees paid 5% coinsurance of their prescriptions.

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2024 Changes to Medicare Part D Coverage

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This year, changes to Medicare Part D coverage include eliminating the 5% coinsurance that enrollees had to take on after they had reached the catastrophic threshold in 2023.

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Instead, they will have a spending cap and not have to contribute anymore after reaching the catastrophic threshold of $8,000 (in 2024). With the value of the manufacturer price discount on brands factored in, this means that enrollee out-of-pocket costs would sit around $3,300.

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This will save thousands of dollars for blood cancer patients, who often pay exuberant out-of-pocket costs for treatments such as Revlimid (BMS, Celgene), Pomalyst (BMS), Imbruvica (AbbVie, Janssen Biotech), or Jakafi (Novartis).

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The table below, provided by KFF, the independent source for health policy research, polling, and news, shows the extreme savings this could give to patients paying for high-cost drugs/treatments.

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Other updates this year include an increase in Part D Plan contributions. Previously, they covered 15% of total drug costs in the catastrophic stage, but they will now cover 20%.

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2025 Changes to Medicare Part D Coverage

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There are more changes to come in 2025 to Medicare Part D plans and coverage including:

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A $2000 out-of-pocket maximum for enrollees
Getting rid of the coverage gap phase
A higher share of drug costs paid by the Part D plan in the catastrophic phase
New manufacturer price discount in the catastrophic phase
Changes to plan costs and manufacturer price discount in the initial coverage stage (after deductible)

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Because of the new $2000 out-of-pocket maximum, for a cancer patient usually paying around $3300 (as mentioned in the last section), this provides annual savings of at least $1300.

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As you might remember from above, the coverage gap stage was previously between the initial coverage stage (after the deductible) and before the catastrophic stage. Below is the image for reference again.

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In 2025, the coverage gap stage will no longer exist. This means that Part D enrollees will no longer be responsible for the cost of a given drug after they move from the initial coverage stage to the coverage gap stage. Interestingly enough, this is actually what occurs within most Part D plans today, but it’s nice to have it in writing.

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Other plan changes in 2025 include Part D plans and drug manufacturers paying a larger amount of costs for catastrophic coverage, with Medicare paying a smaller share.

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Action Steps

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Medicare can be frustrating and confusing. Our coaching program offers free 1:1 help from a financial coach.

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Are you a myeloma patient? Sign up for a free account and filter for “Health Insurance/Financial Resources”
If you or a loved one has a different blood cancer, email Diahanna Vallentine to receive help.

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Conclusion

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In conclusion, the upcoming changes to Medicare Part D in 2024 and 2025 offer significant financial relief for blood cancer patients and other Medicare beneficiaries. Eliminating the 5% coinsurance, introducing a spending cap, and removing the coverage gap represent monumental steps toward reducing the financial burden of prescription drugs.

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With these reforms, patients will have more predictable and manageable out-of-pocket costs, allowing them to focus on their health rather than the high cost of treatment. As these changes take effect, they mark a crucial turning point in making life-saving medications more accessible and affordable for those who need them most.

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Sources:

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Thank you to KFF for their excellent coverage of this topic and the excellent graphics throughout this article.

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Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

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I often receive questions about whether insurance will cover clinical trials, second opinions, and telehealth. I’ll break it down for you in this article.

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The first thing you need to do is know your insurance! I say this a lot, but it really is your foundation of care. Knowing your insurance every step of the way in your treatment journey is important so that you can be proactive and make changes to your insurance plan as needed.

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Understanding the Out-of-Pocket Costs for Clinical Trials

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If you want to participate in a clinical trial, work with your treating physician to find a local one you qualify for. Willing to travel? That may increase the cost, but you can look for clinical trials here: HealthTree Clinical Trial Finder (scroll down on the page to search for clinical trials for your type of cancer).

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After you’ve found a clinical trial, talk to the clinical trial coordinator to see what costs they cover. This will usually come through the clinical trial sponsor. Once you discover what they will pay for as part of the trial, determine what your insurance will pay for and what you will be responsible for prior to signing on the dotted line on the clinical trial contract.

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Steps for Understanding Coverage

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First, determine where the trial is being conducted. This will determine whether it is charged as in-network or out-of-network with your insurance. Be aware that some insurance plans do not cover out-of-network, so double check with both the trial hospital location and your insurance that coverage will apply.

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Estimate additional costs such as lodging, transportation, and food. Also, consider childcare costs if applicable.

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Be aware that insurance may not cover some lab tests, your co-pays, or deductibles while in the clinical trial. However, your insurance must cover medically necessary routine care costs in clinical trials.

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For a clinical trial to be approved, it must have a written protocol already approved by an Institutional Review Board. Sometimes to be covered, the trial must be for a life-threatening condition. Remember, this can be interpreted differently by insurance plans.

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There are Grandfathered insurance plans that may not cover trial participation. Grandfathered plans existed prior to the ACA enactment in March 2010.

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Some clinical trials are known as paid clinical trials. These are usually Phase I trials in which the potential treatments need to be better understood, and it might be the first time these treatments are used within humans. Dosaging and side effects may be undetermined. Therefore, paid clinical trials also usually involve more risks.

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Fortunately, these trials usually reimburse you for your trial or will pay for childcare and travel costs. Always check with the trial sponsor before signing up to know what your covered and uncovered costs will be.

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Tips for Getting Your Insurance to Cover Clinical Trial Costs

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Here are steps you can take ahead of time to possibly reduce problems later.

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Collect journal articles from prior studies that explain the potential benefit of the treatment.
Have your doctor submit a letter that explains the trial or why the trial is medically necessary for you.

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Give your insurance provider letters from any outside supporters of the trial, such as patient advocacy groups.

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So, will insurance cover clinical trials? It’s not an easy “yes or no,” but it is possible for them to cover the costs if they deem it necessary.

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Will Insurance Pay for Second Opinions?

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At some stage of your cancer journey, you might find it necessary or desirable to seek a second opinion from a different facility.

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Second opinions give you a fresh perspective and additional options so you can make a more informed decision regarding your treatment.

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Additionally, you may require a third opinion, particularly if there’s a huge difference between your first and second opinion. It is essentially a tiebreaker when the first two opinions are so different.

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If you have Medicare Part B (traditional Medicare), it will cover the second opinion at 80%. The remaining 20% is covered through a supplement plan if you have one. If you don’t have a supplemental plan, you are responsible for 20%. You do not need a referral from your doctor.

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If you’re covered under a Medicare Advantage Plan, you are also covered for second opinions. However, you may need to take additional steps to make this happen.

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You may need to get a referral from your doctor.
You may have to consult with a doctor in their designated network. (Sometimes second opinion doctors reside in the same practice). Be aware of your insurance provider's guidelines.

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There’s a good argument for getting a second opinion from an unaffiliated practice. Hospitals and practices can be uniform when it comes to treatment recommendations.

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You can either ask your doctor for an unaffiliated practice or search through Medicare’s Care Compare Tool at: Medicare.gov/care-compare.

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You can also search your plan's website for a second opinion to obtain a list of candidates.

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To prevent duplication of tests, make sure your second opinion doctor has your medical records ahead of time. No one wants to have extra biopsies. If your second opinion doctor requires additional tests, they will be covered by your insurance.

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Commercial insurance carriers will generally always pay for second and, if necessary, third opinions.

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Does Insurance Pay for Telehealth Services?

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Telehealth became very popular during the era of COVID-19 because you could have an appointment with your doctor without going into the office. It offers a wide range of medical care services, including primary care and urgent care.

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The cost of telehealth visits can vary, so it would be a good idea to check with your insurance company beforehand to avoid surprise billing. The costs also can vary depending on your health insurance coverage, health condition, and health care provider.

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The costs associated with a primary care telehealth provider will be less than a telehealth visit with a specialist. Also, a telehealth visit for general medical advice will probably be significantly less expensive than a telehealth visit with a cancer specialist.

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Your insurance may pay a portion of your telehealth visit or the entire visit cost. Your plan may or may not require you to pay co-pays, deductibles, or coinsurance. The point is to know your insurance, prior to using a service. You can always call the provider to ask about coverage.

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Medicaid has expanded in most states, but Medicaid reimbursements vary from state to state. To learn how your state has broadened telehealth coverage, go to: www.cchpca.org.

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What are some of the telehealth service providers that Medicare will cover?

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Doctors
Nurse Practitioners
Licensed Social Workers

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Again you may still be required to cover copays like you would do for regular office visits. Additionally, you will still be required to pay your Part B deductible. You may also still need prior authorization for the telehealth visit.

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Can You Save on Telehealth Visits?

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You can do cost comparison shopping via GoodRx Telehealth marketplace for common services across popular telemedicine apps.

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Because changes occur so often in the healthcare market, you need to keep abreast of possible changes for 2025.

\n\n

In 2024, you can get telehealth wherever you are located. You don't have to be at an originating site, where patients get physician or practitioner medical services.

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However, after December 2024:

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For non-behavioral or mental health, there may be originating site requirements and geographic location restrictions.
For behavioral or mental issues, all patients can continue to get telehealth wherever they’re located, with no originating site or geographic location requirements.

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Conclusion

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Know your insurance and understand your coverage as much as possible before making any decisions about clinical trials, second opinion visits, or telehealth appointments. Be proactive in your care. Take advantage of the resources that are available to you and ask the right questions of your healthcare team.

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If you would like to connect with me about financial resources for your blood cancer, you can email diahanna@healthtree.org. If you are a multiple myeloma patient, sign up for a free 1:1 visit with a financial coach by creating a profile at HealthTree Myeloma Coach and finding a coach that’s right for you.

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For those of you who are continuing to work at Medicare age, you may be confused as to how your employer insurance will continue to work when Medicare is on the table.

\n\n

It isn’t as simple as you may think, and you should contact your employer's benefits department to make sure you understand their requirements.

\n\n

Additionally, if your employer covers additional family members, you need to be aware of how the decisions you make might affect their coverage as well.

\n\n

Understanding Medicare Laws Based on Your Employer

\n\n

If you are 65 and older and still employed, you might ask yourself, “Can my employer force me to take Medicare?”

\n\n

The Omnibus Reconciliation Budget Act of 1980 created a Medicare Secondary Payer program to ensure that Medicare does not pay for items and services that other health insurance programs are responsible for.

\n\n

For this to be effective, they had to determine who paid for the service and items first. The primary payer is the insurance company responsible for paying the insurance claim first, up to its limits (the primary insurance).

\n\n

The secondary payer covers the remainder of the costs that the primary did not cover up to its limits. A company's number of employees determines who the primary and secondary insurance plan will be.

\n\n

How the Size of Your Company Affects Your Coverage

\n\n

Employers with 20 or more employees are considered large employers. They must offer the same primary insurance to their employees who are 65 years old or older and their spouses as offered to all their other employees. Under no circumstances can they offer any incentives to the older employees to terminate their coverage with them to force them to enroll in Medicare. So, employer-provided insurance is the primary insurance for people employed by companies with more than 20 employees.

\n\n

It then follows that an employer with 20 or fewer employees is considered a small employer, and the insurance for employees covered in the employer insurance plan is secondary to Medicare.

\n\n

Additionally, the employer can terminate the employee's insurance plan and require the employee to enroll in Medicare. It is totally up to the employer. They do not have to offer insurance to employees 65 years or older as they would to all other employees.

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According to the Age Discrimination in Employment Act, age-related discrimination is not considered when a small employee terminates the employer insurance coverage for a Medicare-eligible employee.

\n\n

This would only apply to private employers with 20 or more employees, state and local employers, employment agencies, labor organizations, and the federal government.

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Conclusion

\n\n

When considering your options, acquire accurate information from your employer's benefits department and Medicare.gov. Being prepared can prevent you and your family from a gap in insurance coverage.

\n\n

If you would like 1:1 support with financial resources, you can meet with a Financial Coach to learn more about what's available to you and your loved ones.

\n\n

If you have multiple myeloma, sign up for a free profile at HealthTree Myeloma Coach. Browse for your own coach and filter for "Health Insurance/Financial Resources"
If you have any other type of blood cancer, email our Financial Program Manager, Diahanna Vallentine, to get started.

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