CLL Survivorship Begins at Diagnosis | Dr. Jackie Broadway-Duren

Jackie Broadway-Duren, APRN
Family Nurse Practitioner
The University of Texas MD Anderson Cancer Center

Dr. Jackie Broadway, a family nurse practitioner specializing in CLL, discusses the importance of survivorship care, emphasizing the necessity of managing one’s overall health after cancer.


Jackie Broadway-Duren: 

My name is Jackie Broadway-Duren, and I am a family nurse practitioner with a doctorate degree in nursing research.

I recently opened the first leukemia survivorship clinic in our department. And, at this time, my focus is CLL since that’s where my level of expertise lies within leukemia. The goal of the survivorship clinic is to manage all aspects of that patient’s care. So, these patients, generally, when they come to the survivorship, they’re in remission or they may have some minimal residual disease; however, they’re not requiring any treatment. They’re well. So, my goal as a survivorship – survivorship as a matter of fact begins at the time of diagnosis. So, people think you only become a survivor after you’ve been treated, but you’re a survivor from the day you are diagnosed.

So, survivorship is important because we look at every aspect of their lives. That includes screening for other cancers, which there’s a high incidence in CLL, particularly skin cancers. So, that is a daily mission of mine when I see patients in the regular leukemia clinic. I constantly remind them to get a dermatology evaluation because skin cancer is very prominent in CLL patients. So, it all just ties in together.

It starts in the regular clinic. But then, by the time the patient is just being monitored and they transfer it to survivorship, it’s a continuation of what we’ve already started. We focus on vaccinations for people who want to get vaccinations. But part of my role is educating the patients.

They need to be fully aware of every aspect of CLL. It’s not about just coming to clinic. I’m on this drug; I’m going to switch to this protocol. It’s all about, “How you doing at home?” When they walk into that clinic and I sit and talk to them, the very first question out of my mouth is, “How are you doing?” And you’d be surprised. Sometime people just need to vent a little bit, or sometimes that brings about emotions. They may have had a death in the family. They may just be having themselves a crisis.

So, sometimes you just need to sit and listen before you start talking. I make sure that all the patients who are going on any treatment protocols – they have research nurses there and we have the physicians, but I also make it a personal mission to make sure that these patients are fully aware of every aspect of their treatment and make them also aware that there’s always someone there for you.

Many of them come in; they’re overwhelmed. All they heard was, “I have cancer.” So, I often time find myself – and maybe I shouldn’t, but I tell patients all the time, “You have CLL. This is a good thing, not that you have CLL but it could be a different leukemia. So, we have really good treatments right now that are ongoing in this particular specialty.” I love the patients. I love the opportunity to intermesh with them frequently, and I’ve become a part of many of their families.  

So, it’s very important for the patient to walk through their survivorship process. From the day they walk into that clinic, they always need to know there’s somebody I can talk to. There’s somebody that can teach me and educate me on what I need to do. There’s Jackie Broadway that’s always saying, “Take your medicine every day. You don’t get to decide to skip a day.” So, those are the type of things that I do.

We strongly encourage patients to continue to have a primary care provider. Although many of them, when we get them, they think that’s it. We do everything, which many times we do.

But we want to encourage them to still get your mammograms, still get the prostate/PSA levels checked, all the things that you normally would do. And it’s also an important fact that sometimes people don’t think it may be important, particularly providers, because we’re always in that goal mindset. “Okay. We gotta get this, this, this, and this.”

There are patients who go into significant depressions and have emotional dysfunction. So, that’s part of what we do. Now, I’m not a psychologist, but I do know how to refer them to one. And there have been times when patients will like – wanted to give up, and I was like, “That’s not an option. Giving up is not an option. You have to fight.”

CLL is a chronic condition, meaning that it’s gonna – it has been going on long before you even received a diagnosis. You weren’t aware of it. But now that you are, this is a lifetime thing. So, it’s important for you to continue to live your life. Even patients who are on the newer therapies now, the oral therapies, the BTK inhibitors and BCL inhibitors, many of them once they get regulated on their doses, they go do life.

They go back to work, some of them. Many of our patients are older patients. So, you’re looking at retired persons in most cases, but we do see younger persons with CLL. So, you continue to live your life. Go get your nails done. Go do some yoga. Guys that have told me, “I was so exhausted.” And, once they started therapy – you know, people are playing golf again for the first time in two or three years. So, I always reiterate, “Life doesn’t stop because you were diagnosed with CLL. You still have a life to live. Do things with your family.”

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