How should I manage a patient with newly diagnosed leukaemia in terms of supportive care and symptom management?

Supportive care and symptom management for a patient with newly diagnosed leukaemia should include:

• Multidisciplinary team (MDT) involvement: The patient should be managed by a haemato-oncology MDT including haematologists, clinical nurse specialists, palliative care specialists, and other relevant professionals to ensure coordinated care and long-term support ¹.
• Infection prevention and management: Patients at risk of prolonged neutropenia (neutrophil count ≤0.5×10⁹/L for ≥7 days) should be cared for in appropriate isolation facilities with clean-air systems if possible, and have rapid access to blood counts and broad-spectrum antibiotics to promptly treat infections ¹.
• Symptom assessment and management: Regular, systematic assessment of physical symptoms such as fatigue, pain, bleeding, and infection signs should be performed at key points (diagnosis, treatment episodes, relapse, end of life). Symptoms should be proactively enquired about rather than waiting for patient report ².
• Symptom control: Persistent symptoms should be treated with regular prophylactic medication rather than as-needed dosing. Treatment goals should be discussed and agreed with the patient. For example, pain should be managed pragmatically, avoiding unnecessary or contraindicated medications ².
• Psychological support: Psychological state should be assessed regularly, with prompt referral to specialist psychological care if significant distress is identified. Psychological interventions should be delivered in a private, comfortable setting by trained staff ².
• Rapid management of complications: Facilities should be available for rapid assessment and treatment of life-threatening complications such as neutropenic sepsis or bleeding, including direct admission pathways to haematology wards ¹.
• Blood product support: Ensure rapid availability of blood components for transfusion to manage anaemia or thrombocytopenia ¹.
• Patient and family education: Provide information on disease process, symptom recognition, treatment side effects, and supportive care options to empower patients and carers ³.