Integrating supportive care in myeloma bone disease – lessons from the MySTIC model

Myeloma bone disease (MBD) is one of the most common and debilitating complications of myeloma, affecting around 80% of patients. It leads to skeletal-related events such as pathological fractures, spinal cord compression and severe bone pain. These complications often result in prolonged hospital stays, loss of function and poorer quality of life. In our centre, we recognised that people admitted with MBD often experienced fragmented care, delayed imaging and late access to rehabilitation. 

To address this, we established the Myeloma Supportive and Integrated Care (MySTIC) team at Singapore General Hospital – a multidisciplinary group focused on providing timely, coordinated support for people with MBD. The team is led by a Haematology Advanced Practice Nurse (APN) and brings together haematologists, palliative care specialists, radiation oncologists, interventional radiologists, orthopaedic surgeons and allied health professionals. Our goal is to ensure early diagnosis, prompt intervention and holistic care that meets the physical, emotional and practical needs of each patient. 

A nurse-led, multidisciplinary model 

Within the MySTIC model, the APN plays a pivotal role in coordinating care across specialties. We aim to expedite imaging and surgical assessment, optimise pain control and start rehabilitation as soon as clinically possible. The APN also chairs multidisciplinary discussions and supports communication between the healthcare team, patients and families. This approach helps to bridge service gaps and reduces variation in how supportive care is delivered.

To understand the impact of the model, we conducted a retrospective review of 30 patients with myeloma bone disease who were admitted under MySTIC between January and December 2024. Of the 30 patients, 21 were newly diagnosed, and 9 had relapsed. The median age was 72 years (range 51–86), and 67% were women. Before diagnosis or relapse, 90% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, but on admission this declined to ≥2 in 92%.

Key observations from practice

Spine involvement was common, seen in 60% of patients. Pain was the predominant symptom, with 80% reporting moderate to severe pain on admission. Vitamin D deficiency – defined as 25(OH)D < 30 ng/mL – was identified in 50% of patients. Supportive interventions included analgesia for all patients, bone augmentation or osteosynthesis procedures in 53% and radiotherapy in 7%. The average hospital stay was 30 days (range 0–112). 

Beyond physical symptoms, patients reported significant emotional distress, loss of mobility and challenges linked to financial burden and transport. These findings underline how MBD affects every aspect of daily life and why psychosocial support must be built into the care pathway. 

Putting learning into action

From our experience, the key to improving outcomes for people with MBD lies in early, integrated supportive care. This means introducing bone-targeted treatments and surgical or radiotherapy consultation as soon as possible, alongside correction of vitamin D deficiency and early physiotherapy. Addressing pain effectively and involving palliative care at an early stage are equally important. 

The APN’s role is central in maintaining continuity, ensuring interventions happen in the right sequence and that patients, carers and families receive consistent information. Having a single point of contact also helps identify psychosocial issues that might otherwise be missed.

Building stronger pathways

Our findings suggest that MBD remains a major cause of hospitalisation and symptom burden in people with myeloma, but outcomes can be improved through structured, multidisciplinary pathways. As healthcare systems evolve, incorporating supportive care from diagnosis rather than at crisis point will be essential. 

While MySTIC was developed in Singapore, the principles – early imaging, coordinated surgical and rehabilitation input, and nurse-led continuity – are transferable to any setting. For clinicians managing people with myeloma, supportive care should not be seen as an adjunct to treatment, but as a vital component that preserves function, independence and quality of life. 

What opportunities exist within UK services to introduce earlier, more coordinated supportive care for people experiencing complications of myeloma bone disease?