Supportive Care

The management of myeloma bone disease requires a coordinated multidisciplinary approach. Often led by clinical nurse specialists liaising with other teams such as orthopaedics, physiotherapy, pain and palliative care specialists, the main aims are to minimise patients’ symptoms, improve physical function and help limit disability and prevent further complications to give a good quality of life.

Patients also form part of this team and need to be educated to know what to look out for and how to act, particularly for worsening pain or symptoms. They should be encouraged to report on any new or changing symptoms e.g. through regular holistic needs assessments, quality of life assessments and assessment of Activities of Daily Living. Referrals to community nursing and occupational therapists should be made to help support patients when home.

Patients should be encouraged by all members of the hospital and community healthcare teams to maintain physical function where possible, to maintain muscle strength, prevent complications such as thromboembolic events and improve quality of life. For patients who require social support as a result of their myeloma bone disease, the nursing and supportive care teams should help with or make appropriate referrals e.g. for benefits advice, Blue Badge Scheme.

A number of non-medical interventions may help to relieve pain which members of the nursing and occupational therapy teams are well placed to advise patients of:

• Application of hot and cold compression packs
• Relaxation techniques such as meditation, visualisation, relaxation or a combination of these
• Transcutaneous electrical nerve stimulation (TENS), acupuncture, acupressure
• Orthopaedic bracing
• Correct positioning
• Gentle massage, if permitted

Together with the treatment and management options discussed in this Chapter, arming patients with therapies they can try at home gives some control and a feeling that their care does not stop in hospital.