title: Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation.
abstract: Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.
authors.affiliation: Behavioral Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, 756, Little Rock, AR 72205, USA. ShermanAllenC@uams.edu
authors.forename: Allen C
authors.initials: AC
authors.lastname: Sherman
authors.forename: Elizabeth Ann
authors.initials: EA
authors.lastname: Coleman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Griffith
authors.forename: Stephanie
authors.initials: S
authors.lastname: Simonton
authors.forename: R Jean
authors.initials: RJ
authors.lastname: Hine
authors.forename: Jeana
authors.initials: J
authors.lastname: Cromer
authors.forename: Umaira
authors.initials: U
authors.lastname: Latif
authors.forename: Harriet
authors.initials: H
authors.lastname: Farley
authors.forename: Rowena
authors.initials: R
authors.lastname: Garcia
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Anaissie
mesh_terms: D000368:Aged; D001131:Arkansas; D005260:Female; D006304:Health Status; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000451:nursing* / Q000601:surgery; D010348:Patient Care Team / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D014182:Transplantation, Autologous