Lifestyle Medicine in Myeloma Care: Treatment-Free Ways to Delay Progression

Dr. Besty O'Donnell, board-certified lifestyle medicine physician and multiple myeloma specialist, shared with the Boston Myeloma Round Table audience about possible treatment-free delays to multiple myeloma progression on September 16th. 

What is Lifestyle Medicine? 

Lifestyle medicine helps people adopt evidence-based lifestyle behaviors (such as healthy eating habits, regular exercise, managing stress, forming and maintaining healthy relationships with others, sleep hygiene, and avoidance of risky substances) to improve and maintain health as well as prevent disease. 

The benefits of participating in lifestyle medicine practices for multiple myeloma patients can be an improvement in: 

• quality of life 
• side effects from treatment 
• physical function 
• mood
• fatigue 
• cancer outcomes

The six pillars of Lifestyle medicine are as follows: 

1. Exercise 
2. Sleep 
3. Social Connections 
4. Stress Management 
5. Substance Use and
6. Nutrition

Although Dr. O'Donnell and her team have done their best to compile data from all of the six aforementioned pillars, the overall conclusion is that each of the pillars simply needs more research, and more evidence. 

Pillar One of Lifestyle Medicine: Exercise 

Exercise can benefit both myeloma patients and caregivers alike. 

Some of the researched ways that exercise can help myeloma patients specifically is: 

• improve quality of life 
• decrease cancer-related fatigue 
• decrease anxiety 
• improve emotional well-being
• improve libido 
• decrease sleep disturbance
• improve social functioning 

A critical question regarding exercise is whether it is safe and/or beneficial. 

Exercise is generally safe, but those with bone involvement need to be aware of where their bone lesions are and avoid activity that stresses those areas. Talk to your oncologist if you have lesions. Consider working with a cancer-specialized physical therapist when learning what moves are appropriate and which are not. 

The American College of Sports Medicine recommends exercising 150-300 minutes weekly. This includes resistance training (weight-bearing activities) at least twice weekly.  

There's a benefit to exercising 30 minutes three times a week to fit the requirement. You could even work out for 10 minutes three times a day if you are having a hard time scheduling a 30-minute free period within your day. 

When exercising, choose an activity you enjoy, not one that you lament doing. Start slowly and build up to 30 minutes of activity per day. Exercising at least every other day can be helpful.

Moderate-intensity exercise is recommended. That means you will likely be able to talk but not sing when you are performing the activity. 

Try classes to find something that interests you, such as core strength, yoga, zumba, pilates, etc.

Pillar Two of Lifestyle Medicine: Sleep

Sleep is an extremely important part of human health. 

Did you know? We spend up to a third of our lives asleep and need it to survive! Our brains are very active during sleep: circadian rhythm, neurotransmitters, growth, and rest all occur during this time. 

Sleep disorders are more common in people with cancer due to the physical changes caused by cancer, treatment side effects, and stress related to cancer.

Dexamethasone and other myeloma drugs can cause insomnia or the inability to sleep or fall asleep. The goal in myeloma treatment is continuous therapy, so ask your doctor if a lower dose or no dose of dexamethasone is right for you if you are experiencing insomnia. Make sure to take your dexamethasone in the morning with food! 

Practice proper sleep hygiene. Try establishing a routine. Don't eat close to bedtime or have screen time, making falling asleep harder. Consider participating in self-care practices like meditation, a warm bath, or reading a good book. 

Pillar Three of Lifestyle Medicine: Social Connections

Participating in social connections can dramatically improve your well-being. The COVID-19 pandemic was an isolating time, but we learned the importance of being around other people during that time. 

Strong social connections are the most important predictor of human happiness and longevity. Cancer can be physically and emotionally isolating, so work to find your tribe and stick by them. 

Pillar Four of Lifestyle Medicine: Stress Physiology

Fear affects every single system within your body. There are antidotes to stress that are worth exploring. Some of these include: 

• mind/body therapies 
• exercise
• balanced nutrition 
• positive emotions, humor, gratitude 
• support (relationships, social connectedness) 
• restorative sleep

Take advantage of the mind/body therapies such as counseling, acupuncture, exercise classes, dieticians, and more that your facility might offer.

Identify your stress signals and build your coping resources. Remember, self-care is a form of cancer care. 

Pillar Five of Lifestyle Medicine: Substance Use 

People often wonder if any amount of alcohol is appropriate with a diagnosis such as multiple myeloma. The more you drink, the more harmful it can be. 

Specific chemicals could interact badly with certain medications, so make sure you talk to your doctor to see if alcohol will cause any unwanted side effects or reduce the efficacy of any of your myeloma-related treatments. 

The recommended limit of alcohol per day is one serving for women and two for men. 

Medical cannabis has been used to help some patients with pain or anxiety; however, the risk of paranoia increases with the use of cannabis, so use them at your wisest discretion. Be aware that dosing can be tricky when taking edibles. 

Pillar Six of Lifestyle Medicine: Nutrition

Several patients are interested in nutrition-related research on understanding the relationship between myeloma progression and diet. 

Our research data so far supports healthy eating in terms of vegetables, fruits, plant-based proteins, and whole grains. 

Foods and drinks to limit include red and processed meats, sugar-sweetened, consumption of fast foods, and other higher-calorie processed foods. 

The American Cancer Society recommends having a community around eating and supporting healthier eating. 

Most importantly, be mindful of what you eat and when you eat. 

Dr. Betsy O'Donnell is very interested in this type of research and has open clinical trials to explore the microbiome and metabolic/gut health. 

Trial One: Role of Meal Timing

This trial is for MGUS/smoldering myeloma patients and will test the hypothesis that meal timing may affect metabolic health. They will also ask how the timing of meals affects the gut microbiome (healthy bacteria in your digestive system). 

Similar tests have been conducted in patients with breast cancer. Those who fasted for more than 13 hours were shown to have a lower risk of breast cancer reoccurrence.

Dr. O'Donnell and her team want to see if this becomes replicable in the early precursor myeloma stages. This trial will test the effects of a 14-hour prolonged fast in MGUS and smoldering myeloma patients.

There is growing evidence of the relationship between the microbiome and plasma cell dyscrasias (including multiple myeloma). Though data is limited, there is evidence for the role of the microbiome in disease progression and response to immunotherapy. The presence of certain gut bacteria has been associated with an MRD-negative test result. 

Trial Two: Interception of Multiple Myeloma Using Immune and Microbiome Signatures 

This Dana-Farber trial is recruiting 100 MGUS patients, 100 smoldering myeloma patients, and 50 active myeloma patients into their new study. They will be testing stool samples. it will help researchers amass the amount of data they need to understand the relationship between the status of the microbiome and myeloma progression. 

Trial Three: Dissecting the Role of the Gut Microbiome in Predicting Response to Immunotherapy in Patients with Plasma Cell Disorders 

Another ongoing study tests the hypothesis that gut microbiome improves immunotherapy treatment outcomes, such as CAR-T therapy. Trials of teclistimab and CAR-T in both smoldering and active myeloma, along with their gut microbiome, is being tested. 

If you are interested in participating in any of these studies and a patient at Dana Faber, please contact your physician to let them know of your interest.