Top tips – Introduction

A multidisciplinary approach to care: Top tips for the management of patients with multiple myeloma (MM) undergoing autologous stem cell transplant (ASCT)

Professor Diana Greenfield

Over recent years, the number of treatment options for MM has expanded markedly, resulting in improvements in overall survival.1,2 Although this is a cause for celebration, these survival increases do not describe how well people are living with this treatable yet incurable condition;3 good survival rates do not necessarily equate to ‘good survival’.4 Optimising patient health-related quality of life through the provision of appropriate supportive care is crucial for managing the overall burden of disease.5 As the incidence of MM is rising,6 consideration must be given to how we match the successes of modern medical management with improved quality of survival.

Historically, conventional management of MM has focused primarily on medical disease management; the concept of rehabilitation has rarely been considered in this setting. A multidisciplinary approach to care is increasingly becoming recognised as a vital way of optimising the health of those living with long-term MM and in managing the cumulative side effects of treatments.5,7 This approach begins at initial treatment so that interventions can be effective from the outset (known as prehabilitation) and continues through treatment and beyond (restorative and/or palliative care supportive rehabilitation).8

This series of ‘top tips’ for healthcare professionals (HCPs) has been developed in collaboration with a dietitian, clinical psychologist and physiotherapist and provides recommendations for a holistic approach to optimising outcomes for patients undergoing an ASCT. Recommendations for each of the three disciplines are given at three time points (before, during and after ASCT) and provide comprehensive assessment, management and monitoring advice for HCPs.

Integrating these recommendations into routine practice within existing services will require change and a novel way of delivering care on the basis of best practice and using published evidence, where it exists. Anticipated benefits for patients with MM undergoing ASCT include promoting personal empowerment, building and maintaining physical and emotional resilience, and promoting positive behaviour change to impact on long-term health.

Please note: Recommendations provided in this series are based on the combination of subjective expert practice and experience of the authors and published evidence, where it exists. There is a lack of published evidence in this clinical field and further investigations are required.

Professor Diana Greenfield

Consultant Nurse, Multidisciplinary Team Lead & NIHR Senior Nurse Research Leader, Sheffield Teaching Hospitals NHS

Professor Diana Greenfield is a consultant nurse in late effects at Sheffield Teaching Hospitals NHS Foundation Trust, the first post of its kind in the UK. Professor Greenfield also holds a faculty position of honorary professor in cancer survivorship in the Department of Clinical Oncology and Metabolism at the University of Sheffield since 2015. Professor Greenfield is also the first practicing clinical nurse to be conferred Honorary Professor at Sheffield Teaching Hospitals. These reflect her research and collegiate activities at local, regional, national and international level. Additionally, Professor Greenfield is a senior nurse research leader for the National Institute for Health Research.

As an NHS consultant nurse and honorary professor, Professor Greenfield’s key roles and responsibilities include expert clinical practice and leadership, learning and development, research, audit and collegiate activities, and service innovation and improvement. These responsibilities are all focused in the relatively new clinical field of long-term and late consequences of cancer and its treatment.

Diana Greenfield

1. Goldschmidt H et al. Ann Hematol 2019;98:1–18; 2. Quaresma M et al. Lancet 2015;28:1206–1218; 3. Ravi P et al. Blood Cancer J 2018;28:26; 4. Sonneveld P et al. Leukemia 2013;27:1959–1969; 5. Snowden JA et al. Br J Haematol 2011;154:76–103; 6. Cancer Research UK. Myeloma statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/myeloma#heading-Zero (accessed December 2019); 7. Snowden JA et al. Br J Haematol 2017;176:888–907; 8. Macmillan Cancer Support. Available at: https://www.macmillan.org.uk/assets/prehabilitation-guidance-for-people-with-cancer.pdf (accessed December 2019).

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