Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation

Abstract

Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.

Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation

“…Conversely, emotional distress was the strongest concurrent predictor of compromised physical functioning. No causal conclusions are possible from these data, but findings are consistent with previous research indicating that deficits in one sphere of functioning (eg, depression) were associated with difficulties in multiple other areas as well (eg, nutrition, fatigue, pain), 24,38 highlighting the cascade of symptoms that some patients experience. This correspondence between emotional and physical symptoms may be less evident later in the course of treatment, however, because different aspects of functioning appear to have divergent trajectories of recovery.…”

“…These results are notable because these problems remain largely underdiagnosed, 41,55,56 and most would be expected to be exacerbated rather than diminished with the beginning of aggressive high-dose therapy and transplant regimens. 27,28,33 The prevalence rates found in the present investigation are even higher than those that emerged in our earlier pilot study of myeloma patients at a similar point in treatment; 24 taken together, these studies demonstrate that early psychosocial screening is feasible in a busy treatment center and that supportive care needs are extensive. On the SF-12, for example, 59% of patients in the current study exceeded cutoffs (1 s.d.)…”

“…Early, systematic screening appears to be an important and feasible component of patient care. 24,27,28 …”

“…Moreover, in many studies, the time frame for assessment has centered on the intermediate 19 or, more typically, the long-term post transplant period, 15,16,[20][21][22][23] with fewer studies examining the critical interval before transplantation. Levels of distress and psychosocial morbidity appear to be especially high during this period, 18,24,25 which warrants increased attention from investigators to help guide clinical services, inform patients about what to expect, and establish baselines to assess subsequent changes.…”

“…24 Common difficulties included nutritional deficits, fatigue, pain, disrupted physical functioning, and heightened distress. The current study focuses on adjustment and QOL in a separate, much larger sample of multiple myeloma patients evaluated early in the course of care.…”