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.