Multiple Myeloma

Supportive Care

Advances in multiple myeloma treatment are enabling people with the disease to live longer. As a result, they are faced with maintaining the quality of life they desire while managing the long-term complications that accompany both the disease and its treatments. It can be challenging. Supportive care, however, may offer the strategies you need to manage the physical, emotional and spiritual challenges of living with multiple myeloma.

Supportive care can begin as soon as you are diagnosed, regardless of the stage of the disease. Certain effects may be prevented or minimized and it is important to talk with your health care team about the strategies they recommend. Some will be physician-led, and others can be tackled by you with help from clinical professionals trained to provide supportive care services. Most important, keep the lines of communication open so, together, you can address side effects or symptoms as soon as they begin.

Supportive care may include the following.

Antacids and/or acid reducers may be available over the counter or by prescription to prevent or treat gastrointestinal problems, which may be caused by steroids. These medicines work by neutralizing stomach acid to provide relief from heartburn or indigestion.

Antidepressants may be used to treat depression, anxiety, fatigue, chronic pain or neuropathic pain. Receiving a diagnosis of multiple myeloma can be a shock, which is normal. This medication can be prescribed to help you cope with the emotional impact of cancer. Antidepressants have also been used to treat chronic or neuropathic pain caused by either the disease or the treatments. Many types of antidepressants are available, and they may be used in combination with other medications.

Antimicrobials are medications that may be prescribed to prevent or treat bacterial, viral or fungal infections. Antimicrobials are antibiotics, antivirals or antifungals. Frequent infections are possible with this disease. A fever is a typical sign of infection. Ask your doctor what signs to watch for to determine when to contact your doctor.

Blood thinners are used when patients are at risk for developing blood clots. People taking certain immunomodulatory medications for multiple myeloma may need blood thinners to reduce the risk. These medications prevent blood clots from forming.

Bone-modifying agents increase bone density. These agents are often prescribed because myeloma cells may build up in the bones, which weakens them and increases the risk of fractures and pain. Bone that has been damaged with lesions may become brittle and may be painful. Common sites of fracture include spinal vertebrae, skull, hip bone, ribs and shoulders. Bone-modifying agents may also be used to slow bone loss or breakdown or to treat moderate to severe hypercalcemia.

Corticosteroids are often used along with chemotherapy for multiple myeloma. They have anti-inflammatory and anti-cancer effects. Some help reduce nausea and vomiting caused by chemotherapy.

Erythropoiesis-stimulating agents are approved to treat anemia, which may occur with multiple myeloma. These medications stimulate the bone marrow to produce more red blood cells.

Exercise is an important aspect of improving overall health in patients with multiple myeloma. Maintaining or improving physical strength and flexibility reduces the risk of falls or impaired mobility, and improves psychological and emotional health. Exercise also helps combat fatigue. It is important to talk with your doctor about the exercises, stretches or other activities that are appropriate for you. Considerations should be made to modify physical activity if symptoms worsen. For example, if neutropenia develops, avoid group exercise to reduce exposure to bacteria and viruses and consider doing less strenuous exercise until your blood cell counts return to a more normal level. Exercise may also be helpful to reduce the pain associated with peripheral neuropathy.

Hydration is the adequate intake of liquids. Staying hydrated is important to preserve kidney function, which may be affected by abnormal proteins accumulating in the kidney or by the cancer itself. Drinking plenty of fluids helps your kidneys function and flush out the abnormal proteins. In cases of dehydration due to nausea, vomiting, diarrhea or mild hypercalcemia, fluids may need to be given intravenously.

Integrative medicine, also known as complementary medicine, uses mind-body strategies to deal with stress, depression, anxiety and fatigue during cancer treatment. Examples include, but are not limited to, psychological and/or spiritual counseling, relaxation exercises, meditation, support groups, yoga, tai chi, massage, acupuncture, Reiki, humor and journaling. These strategies may help you cope with your diagnosis and its symptoms.

Intravenous immunoglobulin (IVIG) may be given to prevent or treat infections. Multiple myeloma cells can weaken the immune system by decreasing the level of normal antibodies. To strengthen it, you may be given an infusion of immunoglobulins (antibodies).

Kyphoplasty is a surgical procedure that may be used if a vertebra collapses. Your doctor will insert a balloon in the collapsed area to make room to inject bone cement to stabilize the vertebra. A vertebroplasty is a surgical procedure that inserts bone cement into a fractured vertebra. The goal is to stabilize the vertebra and prevent it from moving.

Nutrition helps give your body the nutrients it needs to stay healthy and fight the cancer. Eating a balanced diet of a variety of healthy foods is recommended. It can also help you keep up your strength and help tolerate side effects better. Ask your doctor what foods to eat and which to avoid. A registered dietician or nutritionist can help you make food choices. In some cases, intravenous nutrient therapy is needed if a patient is losing weight and can’t take in enough food and calories by mouth. In patients with acute GvHD, total parenteral nutrition (TPN), a type of intravenous feeding, may be needed to prevent malnutrition and maintain strength.

Pain management may be used to treat bone pain caused by the breakdown of bone, bone fractures, a compressed spine or peripheral neuropathy. Nonsteroidal anti-inflammatory drugs are not recommended for multiple myeloma patients because they may increase the risk of kidney damage. Your doctor may recommend over-the-counter pain medicines or may prescribe stronger drugs, such as analgesics, lidocaine patches and creams, or opioids. Another way to reduce pain is with a nerve block. A doctor injects drugs into or around a nerve or around the spinal cord. Surgery is also an option in some cases where rods and pins may need to be added to support bones.

Physical or occupational therapy helps keep muscle strength, improves balance and increases coordination. This therapy may be helpful with peripheral neuropathy or if physical activity and daily routines need to be modified due to pain or other limitations.

Plasmapheresis may be used to treat blood that has become too thick, which can occur when there are too many proteins in the blood. An abundance of proteins thickens the blood, slows down circulation and increases the risk for blood clots. This procedure removes the extra plasma and antibody proteins from the blood, which is sent through a machine. Normal blood cells are returned to the body and may contain donated plasma or a plasma replacement.

Radiation therapy may be helpful in treating bone pain caused by myeloma.

Transfusions inject blood, plasma or platelets into a person’s veins. A blood transfusion may be used in severe cases of anemia, which can occur when myeloma cells become so numerous that they disrupt the development of healthy blood cells. If thrombocytopenia develops, a platelet transfusion may be given to prevent heavy bleeding. Blood plasma may also be transfused to help treat bleeding problems.

White blood cell growth factors help your body make more white blood cells. These drugs may be needed if you develop neutropenia, which is a low white blood cell count that increases the risk of developing an infection.

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