Patricia Mangan, RN, MSN, APRN-BC, from Abramson Cancer Center, University of Pennsylvania
Patricia Mangan, RN, MSN, APRN-BC, from Abramson Cancer Center, University of Pennsylvania, covers essential components of a survivorship care plan to maintain optimal health in patients with multiple myeloma.
Hello, I’m Patricia Mangan, and welcome to the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Health Maintenance. In this video, we will present a general overview of survivorship care plans for patients with multiple myeloma.
In 2014, it is estimated that more than 24,000 people will be diagnosed with multiple myeloma.2 The median age at which a patient receives a diagnosis of multiple myeloma is 69—this means that many of these patients in your practice may also suffer from comorbid conditions.3
Mortality from multiple myeloma peaked in the 1990s but has fallen in recent years.4 Because more people are living longer with the disease, there is an increased need for multiple myeloma survivorship care plans.4
Many survivors do not receive a coordinated long-term care plan.
According to the Institute of Medicine, essential elements of a cancer survivorship care plan should include:
• Cancer type, treatments received, and potential consequences
• Specific information on timing and content of recommended follow up
• Recommendations on preventive practices and how to maintain health and well-being
• Information on legal protections regarding employment and access to health insurance, and
• Availability of psychosocial services in the community5,6
In addition, a survivorship care plan for patients with multiple myeloma that aims to maintain the health of patients should address screening and care for the common comorbidities and illnesses for which this population is at risk.1,6
Survivorship care plans for patients with multiple myeloma should be centered on evidence-based practice and include screening for:
• Cardiovascular disease (such as hypertension and hyperlipidemia)
• Other malignancies (such as prostate, breast, and colon cancers, often found in older persons)
• Endocrine disorders, including type 2 diabetes mellitus and thyroid dysfunction
• Bone health
• Sensory changes, such as vision and hearing deficits
• Psychosocial issues
• Addiction and substance abuse, such as tobacco and alcohol
• Nutrition
• Other important conditions, such as infection, immunization scheduling, and oral hygiene6,7
There are specific systems that require assessment, and preventative measure can be taken for patients with multiple myeloma to help improve their overall health and survivorship.
Alterations in skeletal integrity are a common consequence of multiple myeloma.8 Fractured bones are a common problem in patients with multiple myeloma.8
Therefore, the management of bone disease in patients with multiple myeloma is an integral part of the care plan. Healthcare professionals should assess and recognize those patients at risk and recommend preventive and therapeutic interventions such as bone monitoring with X-rays and scans, bisphosphonates, surgical procedures, and exercise promotion to minimize the risk of developing skeletal-related events.8-10
Skeletal events in patients with multiple myeloma can affect mobility and safety. Weakened bones can add to an already heightened risk of falls present in people of the typical diagnosis age. More than one-third of older adults fall each year, and those that fall once are 2 to 3 times more likely to fall again.10,11 Falls can reduce independence and quality of life.10,11 Assessment of risk and fall prevention are integral components of the multiple myeloma survivorship care plan.10,12
Sexual dysfunction in patients living with multiple myeloma may result as a consequence of treatment, nerve root compression, or other comorbidities such as hypertension, diabetes, or coronary artery disease.1,13 In addition, patients may develop body image disturbance or have pain as a result of their disease, which may affect their sexuality.1,13 A survivorship care plan includes a focus on defining sexual dysfunction, discussing risk factors for the development of sexual dysfunction, providing tools for sexual assessment, and describing interventions for patients and their partners who may be experiencing a disruption of their sexual response cycle.1
Kidney dysfunction is one of the common clinical features of symptomatic multiple myeloma and one of the CRAB criteria for diagnosis.14 Renal failure affects about 1 in 5 patients with multiple myeloma.15
Managing the effects of multiple myeloma on the kidneys is an essential part of the multiple myeloma survivorship care plan. Assessing patient risk for renal failure and intervening is necessary to prevent progression to end-stage renal disease.1,16
For more detailed information related to survivorship care plans for patients with multiple myeloma, view the additional Survivorship Care Plan videos on this website. The videos cover detailed recommendations for survivorship care plans addressing bone health, safety and mobility, sexual dysfunction, and renal health.
The International Myeloma Foundation Nurse Leadership Board recommends follow-up screening for patients with multiple myeloma across a wide range of body systems.
This concludes the Multiple Myeloma Center for Nurses Survivorship Care Plan for Health Maintenance video. To find out more on this and other topics related to multiple myeloma, please see additional videos and resources on this site. Here you will find a number of educational tools to help you discuss these topics with your patients, answers to common questions, and other downloadable materials.
Thank you.
References
1. Bilotti E, Faiman BM, Richards TA, Tariman JD, Miceli TS, Rome SI; International Myeloma Foundation Nurse Leadership Board. Survivorship care guidelines for patients living with multiple myeloma: consensus statements of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs. 2011;15(suppl 4):5-8.
2. American Cancer Society. Cancer Facts & Figures 2014. Atlanta, Georgia: American Cancer Society; 2014.
3. National Cancer Institute. SEER cancer statistics review 1975-2015. https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed July 1, 2019.
4. National Cancer Institute. A snapshot of multiple myeloma. http://www.cancer.gov/researchfunding/snapshots/myeloma. Accessed November 24, 2014.
5. National Cancer Institute. A tough transition: cancer survivorship plans slow to take hold.
6. Kurtin S. Living with multiple myeloma. A continuum-based approach to cancer survivorship. Semin Oncol Nurs. 2017;33(3):348-361.
7. Bilotti E, Gleason CL, McNeill A; International Myeloma Foundation Nurse Leadership Board. Routine health maintenance in patients with multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs. 2011;15(suppl 4):25-40.
8. American Cancer Society. Multiple myeloma. www.cancer.org/acs/groups/cid/documents/webcontent/003121-pdf.pdf. Revised June 16, 2014. Accessed November 24, 2014.
9. American Cancer Society. Multiple myeloma. https://www.cancer.org/content/dam/CRC/PDF/Public/8741.00.pdf. Last Medical Review: February 28, 2018. Revised February 28, 2018. Accessed September 5, 2019.
10. Rome S, Noonan K, Bertolotti P, et al. for the International Myeloma Nurse Leadership Board. Bone health, pain and mobility evidence-based recommendations for patients with multiple myeloma. Clin J Nurs Oncol. 2017;21(5)(suppl):47-59.
11. Stevens JA, Burns E. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2015.
12. Rome SI, Jenkins BS, Lilleby KE, and the International Myeloma Foundation Nurse Leadership Board. Mobility and safety in the multiple myeloma survivor. Clin J Oncol Nurs. 2011;15(4)(suppl):41-53.
13. Catamero D, Noonan K, Richards T, et al. and the International Myeloma Foundation Nurse Leadership Board. Distress, fatigue and sexuality understanding and treating concerns and symptoms in patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5)(suppl):7-19.
14. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538-e548.
15. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009;23:3-9.
16. Faiman B, Doss D, Colson K, et al and the International Myeloma Foundation Nurse Leadership Board. Renal, GI, and peripheral nerves Evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. 2017;21(6)(suppl):19-36.
