Abstract
IntroductionNew treatments have improved the overall survival of patients with multiple myeloma (MM). At diagnosis and during the course of the disease, patients often report pain and other symptoms. Given the long disease trajectory, psychological and social issues are also frequent. Recently, the potential usefulness of early palliative care (EPC) was hypothesized in the area of hematology. We conducted a retrospective analysis of patients with MM referred to our institute for a palliative care (PC) consultation between January 2017 and June 2020. Our aim was to evaluate the main reasons (pain or other clinical symptoms) for the referral for a first PC consultation.MethodsWe examined the main reasons for the first PC consultation, the number of PC consultations carried out, and the period of time between diagnosis, first and subsequent PC visits, and death. We also recorded information on the type of pain experienced and the treatments administered.ResultsOf the 325 patients with MM followed at our hematology unit during the study period, 43 were referred for a PC consultation (39 for pain management and 4 to determine the most appropriate care setting (hospice or palliative homecare service)). Nineteen (44.2%) of the 43 patients reported other symptoms in addition to pain. The median time between MM diagnosis and the first PC consultation was 473 days. Fifteen patients died, with a median 332 days between the first PC visit and death.ConclusionRandomized studies on MM involving larger patient populations with access to EPC are needed to identify an effective clinical model to improve the management of patients with MM.
Highlights
New treatments have improved the overall survival of patients with multiple myeloma (MM)
If bone pain is more frequent at diagnosis and relapse, pain from chemotherapy-induced peripheral neuropathy develops during MM treatment and can worsen over time from the prolonged use of these drugs
With regard to the clinical aspects, we reviewed the clinical notes in the electronic medical records and focused on the main reasons for the request of a first palliative care (PC) consultation
Summary
New treatments have improved the overall survival of patients with multiple myeloma (MM). At diagnosis and during the course of the disease, patients often report pain and other symptoms. Results Of the 325 patients with MM followed at our hematology unit during the study period, 43 were referred for a PC consultation (39 for pain management and 4 to determine the most appropriate care setting (hospice or palliative homecare service)). It is estimated that in 2020, there were 32,270 new cases and 12,830 deaths from this disease It is more frequent in males, and the median age at diagnosis for both sexes is 69 years [1]. More than two-thirds of patients at diagnosis and most during the course of the disease have myeloma bone damage and experience pain from osteolytic bone lesions, but different types of pain occur at different stages of the disease. Long survivors may experience late effects of treatments such as chronic pain, neuropathy, or asthenia, and may develop psychological symptoms such as depression and anxiety [2,3,4,5,6]
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