What is supportive care? What is the role of supportive care throughout relapsed and refractory myeloma management?
Supportive care is very, It's very important. And supportive care can be anything from treating the upfront complications the CRAB criteria then pain management of course is very very important. And that is both involving this part of care team to have an optional pain management regimen, maybe, having kyphoplastly if there are compression fractures, working with rehab medicine and physical therapy, those are really important, important patient, resources in order to enhance the quality of life.
Then other things are prophylaxis and treatment of infections, blood clots and other types of side effects, other things that are very important as well as are of course thinking and treating mental health issues. Some patients react very early on. Some patients have a delayed kind of reaction or it sinks in after a while. A lot of patients actually go through induction therapy and then transplant.
And then after that when you get to the maintenance and things come down a little bit, then you kind of react and then you need maybe more support. So both thinking about the actual both acute complications, pain management prophylaxis and and mental health.
Well, I mean, I think supportive care is obviously very, very important. And I think that that's kind of a broad question. Right. there's, myeloma is unfortunately a disease that affects the bones and can result in lytic lesions that lead to, pathologic fractures and pain and discomfort. so there's a, a we work with a multidisciplinary, group of physicians, including orthopedic surgeons, radiation oncologists, interventional radiologists that help with, a type of procedure called the like a cement augmentation procedure, where we try to manage, both bones structurally and from a pain perspective.
I think there are also, of course, the antiresorptive drugs. So like zometa, pomidronate, and denosumab that are should be used in patients with bone disease or to manage things like hypercalcemia. and then, you know, our patients are susceptible to infections. And so I think it's also important to keep in mind, you know, what are the immunoglobulin levels that, you know, patients have?
How frequent are infection events, upper respiratory infections or serious infections. And should one, you know, incorporate immunoglobulin replacement therapy or PJP prophylaxis, it's important that individuals are on appropriate antivirals. And then I think some of our medications can result in blood clot formation. So I think it's also very important to pay attention to that. You know patients need to be on aspirin or on low dose, doac drugs to help prevent, blood clots that can also be a major morbidity or a major you know, issue that can cause discomfort and illness.
What is the role of supportive care throughout relapsed and refractory myeloma management?
I think all of those things that I just, said to continue to remember that the patient needs this throughout. We have very set kind of treatment programs and treatment guidelines for supportive care when you're on specific treatments for infection prophylaxis, thrombosis prophylaxis. But to remember that pain management, physical therapy, rehab medicine, and also the counseling and psychiatry team are needed throughout.
Also to think about also for the caregivers to not forget about them because that also in the beginning tends to be survival mode. But after several years it affects everyone around you as well.
What suggestions do you have for caregivers?
I think speak to, your doctor or your loved ones doctor and speak to the whole team there. There is social work. We have, a case manager to see what's needed at home. And then, some centers can have counseling for caregivers with some you need to find that out in your own either through your primary care or other resources.
There's a lot in the patient organizations that I would say also, to have support groups and to be able to talk to other caregivers.
HealthTree • July 28, 2025
