Nicole Lamanna, M.D.: People always ask, are there lifestyle changes or things you can do to help with your disease? I don’t think this is generally specific to CLL or cancer, or even other medical problems. I think the more that someone can take care of their body in general—and that means moderation in your habits, some exercise, and eating well—that will hold longer than anything else. Because if you take care of yourself, your organs work better. As we age there will be fewer medical problems. You’re controlling those medical problems.
So if you have diabetes or you have heart disease, but you take medications to make sure they’re under control, that will preserve your organ function. Regarding therapies that your doctor looks for, they’re going to take into consideration how your organ function is, and that means your performance status and how fit you are. So the better you’re able to take care of your body, the more options patients have for treating their disease because they’re less frail. Hopefully, with some of these newer therapies, some of the data suggest even frailer individuals can take them, which is a good thing because that wasn’t what we had back in the days of chemoimmunotherapy.
I think that it’s always important to talk with your doctor if you’re going to take supplements. I think it’s always important that you need to discuss with your doctor what you’re taking, whatever you put in your body—whether it’s prescribed or it’s something you buy over the counter at a vitamin store—because they may have drug-drug interactions if you happen to be on therapy for your CLL, and that’s important because it may increase the toxicity or decrease the response to the therapy if there are drug interactions. Or they may cause a side effect from the supplement because the supplement may be increased and cause you toxicity. And we’re worried about preserving your organ function. So it’s always important to bring whatever other medications that you’re going to take or would like to take, that you bring those to the attention of your physician so they can review your medicines, whether prescribed or not prescribed, and make sure there aren’t interactions.
I think there’s obviously a lot when you look on the internet, which can be helpful, but it can be very dangerous. You can google a lot of different diets for patients with CLL or cancer in general. But I think that unfortunately there are limited data that we have currently. It doesn’t mean that living a healthy lifestyle is bad and that doctors don’t believe in this. It’s just that when we talk about what may be good for one cancer versus another, there have actually been some studies that have shown that some supplements have actually been harmful for certain cancers. And so we just lack data right now.
So I think moderation and making sure that your physician is aware of what you might be taking are important. And I think they’ll certainly be supportive if there are things you’d like to do, but they have to make sure you’re safe first. And there may be interactions if you’re on active therapy versus if you’re just on surveillance.
I think that it’s important as a CLL patient to make sure that you’re up-to-date with your other health care issues. Cancer screening for other cancers is important. We know that patients with CLL have a higher incidence of other cancers. And those other cancers are potentially curative, such as skin cancer. So make sure you’re going to the dermatologist once a year. Screening for colon cancer. Screening for breast cancer. These are all doable things because if they find those cancers early, they’re detectable; they’re cured. So we’re very, very pushy in my clinic about making sure your patients do all they need to do for cancer screening.
Another thing that patients also ask about routinely are vaccines. We know that with a lot of CLL patients, their immune systems are more compromised, and so certainly we’re looking to see if we decrease your risk of infection. I’m a proponent of vaccines. It doesn’t mean they work, right? So we can get the flu shot, and it may not be to the optimal strain that year and so you could still get the flu. But hopefully it’ll decrease the severity of the flu if you get it. And so I think that many of us are proponents of vaccines. We advocate dead vaccines only, so no live vaccines for individuals with CLL. We’re trying to reduce risk of patients having infectious issues or getting sick. It’s all about being proactive about your health care.
Transcript Edited for Clarity