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Balancing Life and Myeloma: A Patient-Centered Approach

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In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.

In our ongoing discussion with Don M. Benson, MD, PHD, The Ohio State University Comprehensive Cancer Center, who moderated the multiple myeloma panel discussion at our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains what are his top priorities for his patients throughout their treatment journey for multiple myeloma and how caring for them is a true partnership.

As a hematologist-oncologist, Benson has cared for patients at James Cancer Hospital for 22 years, where he strives to enable his patients to live as long and as well as possible, he explains in this clip.

“We make it work,” he says, “and that's amazing because, again, we didn't do that 20 years ago."

The transcript has been lightly edited for clarity.

Transcript

What factors should guide the choice between traditional transplant options and newer immunotherapy approaches for newly diagnosed or relapsed disease?

When I meet somebody with myeloma, my goal is for them to live as long as possible and as well as possible. Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.

We’re blessed. We can achieve that now for the vast majority of people within a few months.The challenge really isn't getting the disease under control nowadays, it's doing it in a way to minimize toxicities, minimize side effects, even down to things like time. How long are you in the clinic? How long are you away from your life? These are things that we never would have thought of 20 years ago. So I think starting with principles and then moving forward, once the disease is in remission.

We talk a little bit about this shared decision-making model of, we have a panoply of options available. What makes sense for you with your myeloma right now? Realizing that that answer might be different 2 years from now or 5 years from now. But what can we do right now to stay on our true north, that I want you to live as long as possible and as well as possible. And for some people, that's a transplant.For some people, that's maybe a CAR [chimeric antigen receptor] T cell. For some people, that might be stopping treatment and just taking a maintenance drug.

What strategies can be implemented to support caregivers and enhance patient engagement throughout this journey?

I can speak to my perspective at a referral center that the vast majority of people with myeloma are receiving care in community settings. Oftentimes, when we get involved at a referral center, at an academic center, there's potentially a question about transplant eligibility, about eligibility for a BiTE [bispecific T-cell engager] or a CAR T cell. But just as often, these are referrals that are like grassroots referrals, and it's often an adult child who's driving care.It's not the patient who's maybe 75 or 80 years old, it's an adult child who's gotten on the internet, who's going to support groups, who's done his or her homework, and is saying, “Mom, I really think it's worth the drive to this center. Not that we are unhappy with our care, not that we disagree with our care, but this is a rare cancer. Maybe it would make sense to have somebody look at your case and meet you once, who does it for a living, who sees it every day.”

And I'm all about that. I think that's so important. Myeloma is a rare cancer, and I think the more that—the patient, obviously—but the patient's family, their loved ones, and most often it's the adult children—it's actually usually the oldest daughter for what it's worth, who's taking time off work, who's finding childcare, who's making sacrifices to make sure mom or dad is getting the best care possible. And I see that as a partnership, and I truly see it as a shared decision-making model, because things that we would do for one person… I've had patients come in and say, “I got 400 acres of corn I have to harvest.” And I've had other people come in and say, “We have nonrefundable tickets for a cruise around Greece.”

And so we make it work. And that's amazing because, again, we didn't do that 20 years ago.

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