While advances in treatment of multiple myeloma (MM) have led to longer overall survival for patients, the increased life expectancy has brought concerns about chronic pain, bone health, and overall quality of life (QOL).
The International Myeloma Foundation Nurse Leadership Board reviewed the most recent research and issued an update to the current recommendations for managing bone health in patients with MM. Their statement discusses the management of pain and functional mobility and focuses on promoting QOL in MM survivors. The updated recommendations were published in the Clinical Journal of Oncology Nursing.
The authors first provide updated diagnostic criteria for active MM. For a person to be diagnosed with MM, they must “have at least 10% clonal bone marrow plasma cells, or biopsy-proven bone or soft tissue (extramedullary) plasmacytoma” in addition to one or more of the following myeloma-defining events: calcium elevation, renal insufficiency, anemia, or bone disease.
The statement then offers evidence-based recommendations for the management and maintenance of bone health before moving to a discussion on sources and types of pain. Management strategies include pharmacologic and non-pharmacologic interventions. Patient education tip sheets are provided on bone-health management and pain prevention. An additional health care provider tip sheet is included, which summarizes the sources of pain and assessment, prevention, and management information. It also provides tips and reminders for nurses during bone-pain patient visits.
The updated guidelines also discuss mobility and safety for patients with MM. This section includes multiple-level-of-evidence recommendations surrounding exercise, nutrition, alcohol consumption, and related factors. As with the other sections, a printable tip sheet highlights the key points.
Before closing, the report discusses the assessment of function and frailty in patients with MM, and finally, it delineates implementing an “activity plan of care.” This includes behavioral support interventions for considerations including health screening, sun safety, physical activity, weight management, and dietary habits.
The report concludes that “Oncology nurses can help improve outcomes for patients with MM by conducting assessments at every encounter, regardless of care setting; playing a role in symptom prevention; managing medication side effects; and implementing plans of care that promote safety, mobility, and QOL in conjunction with the healthcare team.”
Bone health, pain, and mobility: evidence-based recommendations for patients with multiple myeloma.