Stakeholders Profile: We visited Interbalkan Medical Center of Thessaloniki in order to examine the conditions under which patients with malignancies receive their intravenous treatments, to learn what conditions are taken into account when administering such therapies, and more generally to discuss CLL and the therapeutic strategies followed with Dr. Touroutoglou, who is an oncologist at this clinic. Dr. Touroutoglou is a hematologist-oncologist with extensive expertise and a Clinical Assistant Professor at the University of Nevada School of Medicine.
Discussion Summary: Chemotherapy administration follows a structured process beginning with medical evaluation and prescription of the appropriate therapeutic regimen. Before each cycle, patients must undergo laboratory testing to ensure adequate liver and kidney function, as well as sufficient hematologic parameters, particularly white blood cell counts, to minimize risk. If intravenous therapy is indicated, venous access is established either through standard venous catheterization or, in cases where repeated access is necessary or veins are fragile, through the placement of a port-a-cath, a subcutaneous long-term venous access device connected to large central veins such as the subclavian or jugular.
The frequency of chemotherapy cycles varies according to the type of malignancy, typically ranging from every 15 to 21 days, though flexibility is possible depending on patient condition and social needs. Treatment duration can span from a few hours to several days. Prior to chemotherapy administration, patients are routinely premedicated with antiemetics to prevent nausea and vomiting, as well as with drugs aimed at reducing the risk of hypersensitivity reactions, since allergic responses to chemotherapeutics can be severe or, in rare cases, fatal. Given the immunosuppression caused by these treatments, patients may also receive prophylactic antibiotics, particularly when therapy must be temporarily paused due to travel or personal events. While oral agents are generally preferred when effective, they pose challenges since side effects occur at home without immediate medical support, creating difficulties for patients until they learn to manage these toxicities independently.
Common adverse effects across regimens include arrhythmias, hypertension, bleeding, nausea, infections, and fatigue. In more advanced strategies, innovative therapies are being introduced, such as monoclonal antibody-drug conjugates and immunotherapies targeting CD28 or CD3 receptors, which directly attack malignant cells when appropriate antigens are expressed. Within the clinical environment, patients are treated in comfortable settings, with infusion chairs, meals, and access to first-aid stations for emergency reactions, while ongoing reassessment ensures therapeutic efficacy and allows modifications in case of resistance or intolerance.
Usually, there is no choice between intravenous and oral treatment. However, both types of treatment have an impact on patients' psychology. On the one hand, intravenous treatments involve unpleasant visits to healthcare facilities and the need to be pricked with a needle in order to receive the treatment. On the other hand, pill treatments cause anxiety as patients have to deal with side effects that are not insignificant without immediate medical assistance, which causes them discomfort due to the fact that it takes time for them to learn how to manage the side effects of their treatments, while the absence of immediate medical care can make the situation dangerous in the event of serious side effects.
Insights and Recommendations: The evidence suggests that supportive measures such as prophylactic medication, antiemetics, antibiotics, and growth factors to stimulate white blood cell production are essential in ensuring continuity of care and reducing the risk of life-threatening complications. Early planning for venous access through port-a-cath devices should be considered for patients undergoing multiple cycles, as this reduces venous trauma and patient discomfort. Furthermore, the psychological dimension is central to patient well-being and treatment adherence, and healthcare providers must actively support patients in maintaining emotional resilience throughout the therapeutic journey. Education on side-effect recognition and management at home is particularly critical for those receiving oral therapies, who may otherwise lack immediate access to medical assistance. Treatment decisions should also incorporate molecular profiling and antigen expression analysis to ensure the appropriate use of innovative targeted therapies, thus maximizing the therapeutic benefit while minimizing unnecessary toxicity. By combining physical, psychological, and molecular-level considerations, oncologists can achieve more precise, patient-centered, and effective outcomes.
Implementation: Through our visit and discussion with Mr. Tourutoglou, we learned about the medical practices used in the real world to combat malignancies. We learned about the challenges and difficulties that exist in each type of treatment, as well as the condition of patients in general, and we gained a more comprehensive picture through real clinical conditions of how a treatment should be applied and what factors are taken into account when choosing a treatment regimen, and the impact that treatment has on patients' psychology. Such actions enable us to adapt our work to the real needs of patients and, at the same time, to respond to the conditions of clinical reality. It is our team's firm belief that our work will be closely linked to scientists who are experts in our field of research, as well as to the latest developments and conditions prevailing in the fight against cancer, so that siREN is a responsible, effective, and practical solution for CLL.
