Introduction
The majority of patients with myeloma experience complications that are directly related to their underlying disease. Most newly diagnosed patients will present with a complex array of symptoms. Given that myeloma primarily affects an older population the complex presentation can be further compromised by poor performance status and/or co-morbidities.
Controlling the disease with appropriate anti-myeloma treatment often leads to improvements in myeloma-related complications. However, all anti-myeloma treatments are associated with potential side effects and therefore treatment decisions should always consider both the toxicity profile of each drug and the patient’s performance status, including any comorbidities. Even with careful treatment selection, most patients will experience some degree of side effects.
Supportive care forms an essential part of the management of myeloma patients and addresses both myeloma complications and treatment toxicities. Alongside anti-myeloma treatment, supportive care strategies can significantly improve patients’ quality of life and improve outcomes.
Nurses have the difficult but important role of sensitively communicating to patients’ information about what to expect in terms of the disease complications and treatment side effects. Nurses also play a vital role in monitoring and managing disease complications and treatment toxicities by regularly assessing patients for symptoms and providing education on side effect management and symptom reporting. Holistic needs assessments (HNAs) carried out regularly e.g. at the start and end of a new line of treatment are critical in allowing space and written assessment of a patient’s overall needs and concerns, and to help develop a personalised care and support plan. These may be carried out as part of a nurse led clinic or by enlisting the help of support workers for example. The myeloma specific MyPOS tool and Macmillan HNA are those most often used for people living with myeloma.
The following sections cover the more common symptoms and complications associated with myeloma and its treatments, and what measures can be taken to prevent, identify, assess and manage them. For myeloma bone disease – go to Module 9.