What types of conversations should patients have with their doctors? What questions should they be asking?

Well, you know, one of the most important conversations to be having is, you know, I mentioned some of our favorite new therapies, but really probably should at least give some acknowledgment to really our favorite favorite therapy. Our favorite therapy is no therapy because most patients, when they get diagnosed, actually do not need therapy in the beginning, and some of them don't need therapy for a very long time.

I was given permission by my grandma to reveal a medical fact about herself. She had CLL for 37 years. She never needed any therapy at all. And, you know, I think that's an important thing for patients to realize. CLL was a very common disease, is more than 100,000 people walking around America with CLL. Many of them probably don't even know they have it.

And a lot of times you don't need to know because if you have a small amount of this disease and it's not hurting you in any way, we're not really sure that you need therapy because some folks are like my grandma and can go for years or decades without needing therapy. So the most important conversation piece for the patient and the doctor is talking about, Do I need therapy?

What is sort of the indications for why I need therapy? The simple answer is patients need therapy if the CLL's harming them or going to harm them in the near future. But for many patients, really, the majority, when they get diagnosed, they don't need to start on therapy right away, and some of them not for years. So that's why the most critical conversation that patients should have with their doctors.

The first thing they should ask is to try to talk to the oncologist, especially for CLL is,

What kind of a disease they think it is to try to profile it as well as possible. The second thing they have to find out and talk to an oncologist is how fit they are physically, what their life goals are,

what they like to do, and what gives them happiness.

All those are important in these decisions. And then the third,

discussion that

patient can have is to really assess whether a disease really need to be totally cured of or if it is enough to just keep it away because some treatment options

are available, which can lead to a complete remission for at least certain time, but they are more toxic and that often takes a lot out of those patients.

On the other hand, there are other treatments which can control the disease for a substantial period of time, often for a very long period of time, without really affecting the patient's typical day-to-day life as much. And it is important to have those goals in front of you before deciding what is right.

The first decision is, is treatment indicated and when. And usually the thing about CLL is typically not every case, but usually if you're following with your doctor and you've been diagnosed with CLL, and you're on a program of observation. Usually, it's not such a quick change that

really, even over the course of several visits, you and your doctor can have a conversation about your nearing the need for treatment and start to talk about options then, because there's a lot of different

options.

I would say one of the things that I talk to patients about, if I see a little bit of change in the labs or their physical exam or their symptoms that tell me they may be nearing that need for treatment is making sure your other medical conditions, your preventative care is complete in terms of cancer screening. And that depending on the therapy that will be used, making sure that cardiac issues and other medical issues are kind of under control.

So you're going into the treatment kind of in the best medical condition possible.