bh in Brief

Dr. Peter Anglin obtained his medical degree from Queens University at Kingston and followed this with clinical fellowships in internal medicine, haematology, and oncology. He has been in clinical practice for the last 15 years in the Greater Toronto Area, and is a clinical investigator with the National Cancer Institute of Canada. Dr. Anglin completed his MBA through the executive programs of the Rotman School of Management, University of Toronto, and he has served as a consultant for a number of health-related organizations.

Dr. Anglin has a particular interest in the process design and human resource issues associated with the out-patient delivery of oncology services. His clinical areas of expertise

include gastrointestinal and

haematolgic malignancies,

particularly myeloma and the

lymphoproliferative disorders.

1. What is chronic lymphocytic leukemia (CLL)? What are the symptoms? 

CLL is a low grade blood disorder that results from a slow-growing  malignancy of the white blood cells of the body. It is a tumour or cancer of the blood that manifests in patients as a rising white blood cell count and swelling of the lymph nodes. It leads to fatigue and anaemia and may cause people to be more susceptible to infection. It is called “chronic” because it can last for many years. For much of that time, patients can be relatively well and do not require therapy.

2. Who gets  CLL? How is it different from other forms of cancer?

CLL is a malignancy or disease that affects older people. It is most commonly diagnosed around age 70, although it can affect adults of working age as well. It differs from other forms of cancer because of its age of onset and its chronic nature. In fact, it is the most common leukemia of the western hemisphere but seems less common because of the patient demographics.

3. What are the treatment options? Are there new treatment options and if so, what are their benefits? 

There are many treatment options for patients with CLL. These treatments do not cure the disease but can put it into remission for several to many years. Physicians gauge treatment by the age and general health of the patient. Initial intravenous treatments that combine different drugs are quite well-tolerated overall, although there is variability – some patients don’t respond as well or are not in remission as long. Generally, however, 80%-90% of people respond to treatment and most have remissions that last for several years. 

The range of treatment options includes combinations of traditional chemotherapy drugs and targeted monoclonal antibody therapy.  There are, however, exciting new drugs that are revolutionizing the treatment of CLL and will provide physicians with excellent options. These are not yet first line choices but are coming on stream with the promise of controlling CLL for several years. These newer therapies are extremely well tolerated and allow people to return to normal activities, including activities at work. The best news, however, is that this continues to be an exciting area for drug development. Newer pharmaceuticals are currently being developed that will provide even better disease control. 

4. Some patients are diagnosed when they are still of working age. How does it impact their ability to work?  What are the challenges of diagnosis – for patients and their caregivers?

When CLL patients of working age are symptomatic, the negative effects of their disease, such as fatigue and weight loss, will be evident and affect their productivity at work.  Also, working while getting chemotherapy can be a challenge, although the new oral agents make it easier for patients to work during the treatment phase. Even now, most treatments, including chemotherapy, are administered on an out-patient basis, minimizing time lost from work. Still, absenteeism is an issue, not only for patients but also for their caregivers. Since CLL strikes older people, employees of all ages are likely to need time away from work to support and care for loved ones who are ill even if they are not active in the workplace.  

5. What can employers do to help patients and caregivers manage CLL more effectively and enjoy a better quality of life and, at the same time, increase productivity?

Employers can optimize opportunities for employees to access agents that control the disease and allow them to function normally. It is also important for employers to recognize that the disease process is  dynamic and can continue over many years. An employee who seems to be acutely ill can, in a relatively brief period of time, experience a remission and return to productivity. They should also understand that whenever the disease flares, an employee will need treatment but not always the same type of treatment. Over the course of the disease a patient may have three or four different types of treatment, each requiring a different workplace response.  In sum, the biggest issues are accessibility to drugs and sensitive, flexible return to work planning.