Incorporating patient perspective during myeloma treatment

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Published: 2 May 2018
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Dr Karthik Ramasamy - Oxford University Hospital, Oxford, UK

Dr Ramasamy speaks with ecancer at the 2018 Myeloma Knowledge Exchange about the attitudes toward treatment of myeloma patients towards the end of their life.

His key message is about the responsibility of communication with patients, and understanding their history as well as co-morbidities.

Watch our interview with Erik Aerts for more on palliative care in myeloma.

ecancer's filming has been kindly supported by Amgen through the ECMS Foundation. ecancer is editorially independent and there is no influence over content.

It’s important to understand that myeloma now has a number of therapeutic options. We almost live in the golden age in myeloma therapy. Ten years ago we were practically working with steroids and some chemotherapeutic drugs, now we have at least four, if not five, classes of drugs to treat myeloma patients.

What I’m going to do is to try and bring forward to both the physicians and nurses is the importance of actually working with the patients during their treatment. It’s also important to incorporate their perspectives when we treat them during the myeloma journey. Myeloma treatment often starts at diagnosis and is now going to be continuous until unfortunately they pass away with the condition. Therefore it’s important that we take their perspectives whilst we plan their treatment.

What kind of challenges does working with elderly patients bring?

Myeloma is, you could say, a disease of the elderly. The average age at diagnosis is 70. A good 40-50% of patients are over 70 and often they have multiple different comorbidities – often they have hypertension, heart problems, lung problems, diabetes and so on. So when you have all these complications and then you introduce an additional variable of myeloma therapy often what you have is you introduce new complications and therefore difficulty in them managing their treatments. So it is important to understand that we take the patient as a whole and not just view myeloma separately in our patients and actually work with our patients to understand what therapies they need, how long do they need it for and how do we actually manage their side effects when they’re on treatment.

What’s a key message for clinicians?

The key message for clinicians is we all need to take responsibility in managing our myeloma patients. This is not just limited to looking at phase III trial data and saying, ‘This is the treatment combination, this gives better progression free survival and improved overall survival.’ What we need to understand is patients in front of us come with multiple different comorbidities that are elderly. Unfortunately myeloma remains an incurable illness. We need to recognise that we are going to treat them from diagnosis until they pass away with the illness. The choice of treatment has to be made very carefully and by working with the patient. What we need to understand is that we keep the patient informed, we take all the perspectives of the patient and run alongside them. We need to educate carers. We need to build a team of clinicians, nurses, allied health workers around the patient so they feel supported during their treatment. Alongside this if you can educate your patient well you can ask them to take more of an authoritative stance as to how they would like to manage their own condition.

All of this will mean that they are more compliant with their treatment, they understand what is happening with their myeloma and by doing this there is a good chance that we will achieve much better outcomes than we have. It’s not just the mere presence of more classes of drugs that we have, it’s about working with the patient is how we’re going to improve their outcomes.