Patients with relapsed and/or refractory (RR) multiple myeloma (MM) are exposed to many therapeutics over the course of their disease. Though survival has improved, exposure to these drugs for prolonged periods puts patients at risk for treatment-related toxicity. The disease can also have related morbidities, so the cumulative effect on these patients’ quality of life can be staggering.
One review published in Cancers discussed treating and preventing some of the biggest concerns in patients with RRMM, including renal insufficiency, anemia, bone disease, and infection. The article also discussed drug-specific non-hematological adverse events, such as peripheral neuropathy; venous thromboembolism; and cardio, gastrointestinal, and ocular toxicity.
“Research progress in MM is leading to a dramatic increase in the number of new drugs and the complexity of combination regimens, demanding constant updates on their indications, mechanisms of action, and safety profiles,” the review authors stated. They added, “optimal care of the disease and treatment-related complications has a pivotal role in MM, not only to improve health-related quality of life but also to prolong patients´ survival.”
Further complicating the course of RRMM is that many patients do not receive antiviral prophylaxis, bone-modifying agents, or even simple vaccines (eg, the influenza vaccination). Studies have also shown that organizational obstacles like care delivery in the community setting can complicate the disease course. The review article discusses the necessity of targeted interventions, “such as the integration of primary care providers and clinical decision support systems, are required to implement quality of care in MM.”
With the compounding effect of disease-related morbidity, treatment-related toxicity, and suboptimal adherence to prophylactic strategies, a sufficient quality of life can be difficult to achieve. The authors conclude that nurses should be aware of the current and emerging treatments for RRMM morbidities, toxicity profiles, and side effects.
“An awareness of drug toxicity allows for early diagnosis and intervention, thus supporting longer treatment exposure and better response rates,” the authors concluded.
Management of adverse events and supportive therapy in relapsed/refractory multiple myeloma