A recently published statement by the International Myeloma Foundation Nursing Leadership Board seeks to aid nurses in recognizing and managing distress, fatigue, and sexual dysfunction in patients with multiple myeloma (MM).
“With complex cancer therapies moving away from inpatient to ambulatory settings, identifying psychiatric disorders has become more problematic,” the authors posited after citing that a staggering 47% of patients with cancer suffer from a psychiatric disorder.
“Untreated, these psychological needs may impair the patient’s ability to make decisions and adhere to treatment.”
The report starts by discussing distress, which is much harder to define than its closely related counterpart, stress, because it consists of “a collection of symptoms and not a specific diagnosis and is closely associated with many psychiatric disorders.” Distress is “emotional, mental, social, or spiritual suffering” that affects the patient’s ability to cope with the diagnosis or treatment. Symptoms and signs of distress are discussed, including emotional states like irritability and physical states, such as trembling or shaking. A lengthy symptom-management tip sheet is included in the report that can be provided to patients during assessment.
Cancer-related fatigue (CRF), as described in this report, is another major factor affecting the quality of life of patients with MM. It is similar to normal fatigue but tends to be “resistant to rest,” making it more severe and harder to assuage. Patients are often reluctant to bring up their CRF to health care providers as they may believe it is untreatable. As such, symptoms and assessment are discussed, and management options are suggested.
Finally, sexual dysfunction is discussed at length. Because patients are unlikely to communicate this dysfunction, which may be “caused by the disease, chemotherapeutic agents, surgical procedures, hormonal therapy, medications, and comorbid conditions,” providers are urged to ask patients about their sexual function routinely. The symptoms and treatments differ for men and women, and a discussion about both is included.
In conclusion, the report summarizes the deleterious effects of these 3 topics, warning, “If untreated, they may lead to unnecessary suffering, family burden, frequent visits to the healthcare provider, added stress on the healthcare team, and difficulties in treatment decision making and adherence.”
Distress, fatigue, and sexuality: understanding and treating concerns and symptoms in patients with multiple myeloma.