Clinical update on haematological cancers, including latest guidelines, signs and symptoms, advice on helping your patient, and expert comment.
Haematological malignancies are a diverse group of cancers that affect the blood, bone marrow and lymphatic systems. The main categories are lymphoma, leukaemia, myeloma, myelodysplastic syndromes and myeloproliferative neoplasms.
In addition, there are subtypes of lymphoma and leukaemia, as well as more rare haematological cancers that have their own categories.
There are also borderline conditions such as aplastic anaemia and other non‑malignant bone marrow failure syndromes.
The charity Bloodwise says about 38,000 people in Britain are diagnosed every year with blood cancer or a related disorder, making it the country’s fifth most common cancer.
In May, the National Institute for Health and Care Excellence (NICE) published updated guidance on haematological malignancies, with the aim of improving care for patients by promoting best practice in the organisation of specialist services.
Guidance has been updated from 2003 to reflect the increased complexity of care and new diagnostic techniques.
It includes recommendations on integrated diagnostic reporting, staffing, isolation facilities, ambulatory care and multidisciplinary teams (MDTs).
Haemato-oncology MDTs should include at least one clinical nurse specialist (CNS), says NICE. They should be the initial point of contact for patients who need help in coping with the disease, its treatment and consequences. Networking between nurses with different types of expertise should also be encouraged.
Categories vary in prevalence, incidence and survival rates. There are no known risks in lifestyle factors, and haematological cancers rarely run in families.
Anyone can be affected at any point in their life, although most types are more common in older people. For children and young adults, leukaemia and lymphoma account for 4 out of 10 childhood cancers.
Survival rates have improved dramatically. In 1960, barely 1 in 10 children survived the most common form of childhood cancer, acute lymphoblastic leukaemia. Now that has risen to 9 in 10, says Bloodwise.
While some forms of haematological cancer are highly aggressive, others are so benign that they are often only discovered by chance, says NICE.
Symptoms may include lumps caused by enlarged lymph nodes, characteristic of lymphomas. Other symptoms are bone fractures and kidney problems characteristic of myeloma. In addition, fatigue and vulnerability to infection and bleeding can be caused by most types of haematological cancer, but are particularly severe in acute leukaemia.
How to help your patient
Nurses can play a key role in supporting patients, especially in providing information about any tests they may need, diagnosis and treatment, including the pros and cons of different options. They can also direct patients to organisations that offer specialist support, whether emotional, medical, practical or financial.
Gill Stewart, lymphoma clinical nurse specialist at Leeds Teaching Hospitals NHS Trust
‘This new updated guidance clarifies a lot of the original recommendations from 2003. It’s a good document for all nurses to read, so they can gain insight into how decisions are made about patients’ treatment. It encourages thinking about a holistic approach to care.
‘More specifically, I welcome the emphasis on clinical nurse specialists being a key part of multidisciplinary teams (MDTs). Another useful recommendation is the inclusion of ward sisters from hospitals providing high-intensity chemotherapy in MDT meetings, as this will help improve their knowledge.
‘The guidelines say MDT members can attend remotely, which is welcome, as getting people together in person can be challenging. We do a lot of videoconferencing here and find it works well.’