Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care (Figure 3). They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Chronic lymphocytic leukaemias Working Group.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	Timeframe is not urgent unless severe symptoms of fever, night sweats or weight loss. In these cases, investigations should be started as soon as possible to exclude more aggressive disorders.
	Initial investigations initiated by GP	The GP should have results and review the patient within 2 weeks.
	Referral to specialist	In most cases referral to a specialist within 2 weeks is appropriate, but refer within 72 hours if severe thrombocytopenia, anaemia or bulky or locally compressive lymphadenopathy.
Diagnosis, staging and treatment planning	Diagnosis and staging	Most investigations should be done 2–4 weeks before starting treatment, but CT scans can be done up to 2 months prior, and FISH and marrow aspirate and biopsy can be done up to 12 months prior if therapy and disease course have not changed.
Diagnosis, staging and treatment planning	Multidisciplinary team meeting and treatment planning	Multidisciplinary meeting and treatment planning should occur before starting any disease-directed therapy.
Treatment	Systemic therapy	When systemic therapy is indicated, timing should align with patient preferences but not be delayed to the point where the condition worsens.
	Radiation therapy	If symptomatic/palliative goals, timing is guided by the severity of symptoms, but usually within 2 weeks. If organ preservation is the goal, begin within 72 hours

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral step

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing refractory, relapsed, residual or progressive disease

Step 7: End-of-life care

This pathway covers chronic lymphocytic leukaemia (CLL).

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) are two manifestations of the same disease process, which affects B lymphocytes. When the malignant cells are present in the blood, it’s referred to as CLL. When they occur exclusively in the lymph nodes or other tissue, it’s referred to as SLL. However, the treatment is the same in both cases, and there is evidence that one can change to the other. In this optimal care pathway, we generally refer to CLL, but the information applies to both forms.

CLL is a heterogeneous disease of B lymphocytes. It is the most common leukaemia in Australia, accounting for nearly half of all leukaemia diagnoses. In 2021, the yearly incidence rate of CLL in Australian adults was estimated to be 7.0 cases per 100,000, with a five-year relative survival rate of 84.9 per cent. The median age of diagnosis in Australia was estimated to be 71 years of age, with 83 per cent of all patients diagnosed being 60 or older. CLL is more common in males, with 9.4 cases per 100,000 compared with 5.0 cases per 100,000 in females (AIHW 2021).