
More Early Palliative Care May Be Needed to Individualize Pain Management in MM
Investigators concluded that early palliative care may be needed for more patients with multiple myeloma (MM) as pain can manifest in different ways and severity levels depending on disease state, suggesting that a more individualized approach is critical for pain management.
The causes, types, and severity of pain in patients with
The retrospective single-center study,
“Our study suggests the usefulness of EPC to manage pain and symptoms in MM patients and to facilitate the decision-making process for the most appropriate end-of-life setting, thus reducing the need for intensive treatments or for access to emergency departments,” wrote the investigators.
Over two-thirds of patients with MM experience
New evidence has suggested that establishing timely and close collaboration between hematologists and PC specialists could help address pain, fatigue, anorexia, nausea, depression, and anxiety. EPC could also improve quality of life by enabling patients to manage symptoms more effectively and reducing the need for treatment discontinuation.
“It would provide much needed support for caregivers and could help to establish a relationship of trust between patients and PC clinicians, facilitating the development of advance care planning….For those in poorer clinical conditions or with a higher symptom burden, a PC homecare visit or hospice admission is proposed by a multidisciplinary team (physician, nurse, social worker, psychologist, and physiotherapist),” the investigators wrote.
For the present analysis, patients were identified through electronic medical records from 1 institute in Italy; they had to be at least 18 years old, have an MM diagnosis, and at least 1 PC consultation. Overall, 325 patients were followed between January 2017 and June 2020, of whom 43 (13.2%) were referred for a PC consultation, 23 (53.3%) were women, and the median age was 71 years.
The main reason that patients were referred for PC was pain management (n = 39; 90.7%). Of those referred for pain, 17 had somatic pain, 9 had neuropathic pain, and 13 had mixed pain. During the first PC clinic visit, 24 patients had MM bone disease–related pain, 6 had chemotherapy-induced neuropathic pain, 1 had postherpetic neuralgia, and 8 reported pain for other reasons.
A majority of patients had a median of 2 PC consultations and 3 were seen more often by the PC team.
After the consultations, 4 patients were assessed to identify the most appropriate PC settings for their individual needs, of whom 3 were referred to hospice care and 1 was assigned to home-based PC. Of the patients who were referred for pain management, 5 required evaluations for the best PC setting, of whom 3 were referred for hospice care and 2 for palliative homecare.
The study had some limitations, including that that data were collected with suboptimal completeness, with some minor symptoms potentially left out. Also, the small sample size from a single-center design limits the generalizability of the results.
“We consider our paper a starting point to encourage closer collaboration between hematologists and PC physicians in an effort to find the answers to the many open questions remaining in this area,” wrote the investigators.
Reference
Pallotti MC, Rossi R, Scarpi E, et al. Patients with multiple myeloma referred for palliative care consultation: from retrospective analysis to future directions to improve clinical outcomes. Support Care Cancer. 2021;30:2293-2298. doi:10.1007/s00520-021-06560-8
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.