Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses

“The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN^™, oncology clinical specialist at ONS, during a conversation about long-term multiple myeloma considerations for oncology nurses.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by March 6, 2027. Ann McNeill is on the speakers’ bureau for Pfizer. This financial relationship has been mitigated. All other planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to management of long-term side effects related to multiple myeloma and treatment.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast^™ episodes:
  • Episode 401: Multiple Myeloma Treatment Considerations for Oncology Nurses
  • Episode 398: An Overview of Multiple Myeloma for Oncology Nurses
  • Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer
  • Episode 201: Which Survivorship Care Model Is Right for Your Patient?
• ONS Voice articles:
  • Effective Care Transitions Are Essential for New Multiple Myeloma Treatments
  • Infection Prevention for Oncology Nurses
  • Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations
  • Nurse-Led Survivorship Programs
  • Sexual Considerations for Patients With Cancer
• Oncology Nursing Forum articles: 
  • A Qualitative Study of the Experiences of Living With Multiple Myeloma
  • Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study
• ONS book: Multiple Myeloma: A Textbook for Nurses (third edition)
• ONS Huddle Cards:
  • Pain Management
  • Sexuality
  • Survivorship Care Plan
• ONS Learning Libraries:
  • Hematology, Cellular Therapy, and Stem Cell Transplantation
  • Survivorship
• ONS Symptom Intervention resources:
  • Chronic Pain
  • Fatigue
  • Peripheral Neuropathy
• American Cancer Society: Living as a Multiple Myeloma Survivor
• Blood Cancer United: Resources for Healthcare Professionals
• International Myeloma Foundation: Resources and Support for the Myeloma Community
• Multiple Myeloma Research Foundation: Empower Patients and the Community

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“We do consider myeloma an incurable hematologic malignancy, even though we have had improvements in survival. But just like for any malignancy, our goal is to maximize survival. We want to eliminate as many myeloma cells as we possibly can. And subsequently, we want to improve the quality of life for these patients in the long term. So those are basically our treatment goals. That’s what we think of when we’re treating patients all throughout their treatment journey.” TS 1:39

“It is very typical for patients along their journey to have received several lines of therapy. I think it’s important to realize that the cells acquire new mutations, making them more resistant to these further subsequent lines of therapy. We see quicker, more aggressive relapses in those patients with multiple prior lines of therapy. We can see an increase in the CRAB symptoms, which are the calcium elevations, the renal dysfunction, profound anemia, and even bone disease. We can see a rapid rise in the monoclonal protein in the labs or even a very rapid rise in the involved light chain in that serum free light chain assay, so it’s important to monitor these labs.” TS 9:14

“All oncology nurses are focusing on these survivorship plans now. And I think that’s a great thing when you think about a diagnosis of cancer and a survivorship plan, because it means these patients are living a longer time. We still look at long-term health maintenance guidelines depending on the patient’s sex and their age. ... I think preventing infection is always going to be something absolutely on the forefront in our survivorship plan with myeloma. I mean, myeloma is an immune system malignancy. The treatments that we have given patients can sometimes, especially in later life therapies, further compromise the immune system. So, we’re always looking to prevent serious infection.” TS 12:46

“Patients get treatment, especially induction therapy. They may or may not get transplant. They may have been on a very minor maintenance schedule, depending on their age. And they feel really well. And then they decide not to return for their follow-up because they feel so good. I think nurses are critical in the communication aspect of the patient-provider aspect. So, nurses are really the key means of communication. The providers are absolutely important—the physicians, the nurse practitioners and every other member of the team—but I think the nurses have a really special rapport with patients. They’re usually the ones providing the education on the treatment regimens. They’re managing the toxicity profiles. They’re doing all the coordination of care between visits. They are really going to be the ones telling the patient, ‘Hey, you’re going to feel good and that’s a wonderful thing, but you still need to come once a month or once every six weeks or once every two months for your labs.’” TS 15:17 

“It has been amazing. The science, the research, the treatments, the approvals from the U.S. Food and Drug Administration. Survivorship has improved dramatically. Let’s take the first few years of the new century, right? The five-year survival rate was about 38%. If you then jump to 2015–2019, which is still seven plus years ago, it has doubled. So, we’re talking about anywhere from 60%–80% over a five-year survival. So that’s an amazing improvement in their five-year survival rate for myeloma.” TS 23:28

“Survivorship in myeloma begins at diagnosis, not just after treatment. And I think that because it is managed as a chronic, often relapsing disease, it does require lifelong evolving care. Patients should realize that they will know us for the rest of their lives. We will know everything about you. I always tell them, ‘I will know everything about your hobbies, your children, your grandchildren, what you love to do on the weekends.’ It’s very important that that point is made right at diagnosis, not just after so many lines of treatment. It’s very important that we are going to follow these patients throughout their journey.” TS 28:18