Fast-Moving ALL Care Outpaces Guidelines: Emily K. Curran, MD

In this interview with The American Journal of Managed Care^®, Emily K. Curran, MD, associate professor of internal medicine at the University of Cincinnati College of Medicine, discussed 2 gaps in the American Society of Hematology’s 2026 guidelines for acute lymphoblastic leukemia, published in June: keeping pace with new evidence and meeting patients’ nonmedical needs.

On rapid obsolescence, Curran says oncology treatments are advancing faster than any published guideline can keep up, and she expects the problem to grow. But she calls this a good problem to have, since it reflects steadily improving therapies for patients. Rather than offering a formal threshold for departing from a living guideline, she advises treating it as a baseline that was accurate as of its publication date, noting that newer developments have likely emerged since. To stay current, she recommends attending scientific meetings, reading the literature, and consulting experts about the newest recommendations, because the field is moving very quickly. In her view, clinicians should not assume that any published recommendation still reflects the latest standard of care.

On psychosocial and financial toxicity, Curran calls the disruption a diagnosis causes in the lives of adolescents and young adults (AYAs) the hardest part of treating them. All of these needs matter, she says, but they can be very challenging to address. The guidelines’ good practice statements acknowledge fertility, financial toxicity, and psychosocial needs but give little implementation guidance. Some centers have dedicated AYA teams, Curran said. Her own team relies on social workers, nurses, a nurse practitioner, and pharmacists collaborating to address these issues. For smaller or less-resourced practices that cannot do everything, she advises pooling whatever resources are available, asking patients what matters most to them, and helping them prioritize. Focusing on that single most important concern, she says, is the best place to start, particularly when staff and time are limited.

“I think probably if you’re going to prioritize,” she emphasizes, “it’ss really asking the patient what is important to them and helping them prioritize.”