Review Article

Palliative Care in Multiple Myeloma

Tiffany Richards,(1) MS, ANP, AOCNP®, and Kevin Brigle,(2) PhD, NP, on behalf of the International Myeloma Foundation Nurse Leadership Board

1MD Anderson Cancer Center, Houston, Texas; 2Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia

Tiffany Richards, RN, MSN, ANP, AOCNP®, MD Anderson Cancer Center, Department of Lymphoma/Myeloma, 1515 Holcombe Boulevard, Houston, TX 77030.
E-mail: trichard@mdanderson.org

Authors’ disclosures of potential conflicts of interest are found at the end of this article.


J Adv Pract Oncol 2016;7:31–43 | doi: 10.6004/jadpro.2016.7.2.12 | © 2016 Harborside Press®


  

ABSTRACT

Abstract

With the advent of more effective treatments for multiple myeloma, many patients are maintained longer on chronic therapy and thus have greater need for palliative care to manage symptoms of the disease and side effects of therapy. Although some patients and health-care providers view palliative care as having a role only at the end of life, ideally this should begin at diagnosis and continue throughout the course of the disease. A majority of patients with multiple myeloma present with and experience acute or chronic pain, so ongoing pain assessment is required for effective management of symptoms by either pharmacologic approaches (e.g., opioid and non-opioid medications) or nonpharmacologic approaches (e.g., radiation therapy, vertebroplasty/kyphoplasty). Peripheral neuropathy can also occur in myeloma patients due to the disease or its treatment, and effective management is essential to maintaining the patient’s quality of life. Gastrointestinal side effects, postherpetic neuralgia, and renal failure also can arise as a result of the disease or therapy, and should be monitored and treated promptly. While not widely studied in multiple myeloma, many patients report cognitive impairment, often arising from treatment, which can adversely affect quality of life for patients and their caregivers. Fatigue is present in about 80% of patients with multiple myeloma and should be managed proactively. Finally, psychosocial care, including spiritual support and screening/treatment for distress and depression, can help maintain emotional and physical well-being. Advanced practitioners are in a position to address these needs with patients and their caregivers, provide education, monitor symptoms, and integrate supportive care throughout the disease continuum.




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