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Supportive care

Symptom control and supportive care

Supportive care aims to maximise the benefits of treatment by ensuring the patients with multiple myeloma maintain as high a quality of life as possible, despite incurable disease and the cumulative effects of disease and treatment

Elaine Cachia MD MRCP Sam Ahmedzai MBChB MRCP FRCPS FRCP Academic Unit of Supportive Care John Snowden MBChB MD FRCP FRCPath Haematology Department, Sheffield Teaching Hospitals, UK

Over the past decade, delivery of more intensive and directed treatment in multiple myeloma (MM), including haematopoietic stem cell transplantation (HSCT) and introduction of novel agents has resulted in major improvements in overall survival, with over half of patients under 50 years of age predicted to survive beyond a decade following diagnosis of the disease.1


generations of novel agents are likely to extend survival further and MM is increasingly being considered as a chronic disease state. These patients are therefore increasingly long-term survivors, living with both the burden of the disease and the side effects of treatments.

Supportive care plays an increasingly

significant role in the modern management of MM. Haematology teams responsible for patients with MM provide most aspects of supportive care, although multidisciplinary teamwork is often essential.

Guidelines written on behalf of the British Committee for Standards in Haematology (BCSH) and the UK Myeloma Forum (UKMF) summarise the current national consensus for supportive and symptomatic care in multiple myeloma.2

“Supportive care plays an increasingly significant role in the modern management of patients with multiple myeloma”

Pain and peripheral neuropathy Patients with MM commonly experience pain both at diagnosis and at subsequent relapse. Bone pain impacts on functional capacity and is associated with significant morbidity. A clinical assessment of pain should include history taking, examination and necessary investigations and should be carried out regularly. In

recent years, the understanding of the mechanisms of cancer pain and the action of analgesic drugs has significantly increased, thus patients with myeloma who develop pain should be controlled using a modern multi-modal approach, including evidence-based

pharmacological treatments, such as bisphosphonates, alongside non-drug 9

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