Assessment-Guided Interventions for Elderly Multiple Myeloma Patients Highlight Benefit of Oncology Pharmacists

Multiple myeloma (MM) is a rare form of cancer involving excessive production and dysfunction of plasma cells, a type of white blood cell found in the bone marrow. This malignant condition is different from solitary plasmacytoma, in which there are multiple tumors or the bone marrow has greater than 10% plasma cells. MM typically arises between the fourth and seventh decades of life, with a median age of 68 years at diagnosis.¹ The American Cancer Society estimates about 35,780 new cases and 12,540 deaths for MM in the United States in 2024.²

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Older adults are at an increased risk of developing MM and the prognoses for these elderly patients are highly variable.³ In this regard, health care providers and patients face complex treatment decision-making due to increased incidence of comorbid conditions, polypharmacy, and functional impairment.⁴ The comprehensive geriatric assessment (GA) has been employed in clinical practice and research settings to address this high individual variability in physical and psychosocial functioning. The comprehensive GA is a multidimensional approach and evaluates the individual’s functional ability, physical performance, nutrition, comorbidities, cognitive function, and psychosocial support.⁴

Researchers from the University of North Carolina at Chapel Hill conducted a study evaluating the feasibility of a GA-guided supportive care program for older adults treated for MM.⁴ The study used the university’s existing registry of adults with plasma cell disorders. The investigators offered referrals to supportive care resources at routine visits to MM patients 60 years of age or older with a GA-identified deficit in 1 or more problem areas.⁴

The identified problem areas were physical function deficits, polypharmacy, and anxiety or depression. Provision of supportive care service for a specific problem area included physical therapy (PT) for physical function deficits, oncology clinical pharmacy practitioner (CPP) involvement for polypharmacy, and a comprehensive cancer support program (CCSP) for mental health symptoms.⁴

Fifty-eight patients had at least 1 deficit on the GA, and PT (79%) was the most common resource identified followed by CPP visits (57%). The patient acceptance rate was 50% when offered referral(s) to at least 1 new supportive care service. Furthermore, the greatest referral acceptance rates were among patients recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%).⁴

At the study’s conclusion, patients most readily accepted physical interventions and referrals to CPPs. The low proportion of physical therapy referral acceptance suggests a need for a more tailored and personalized patient approach. More research is necessary to understand the feasibility and impact of supportive care referral programs for this patient population.⁴

References

1. Multiple myeloma. National Organization for Rare Disorders (NORD). Updated February 6, 2023. Accessed February 2, 2024. https://rarediseases.org/rare-diseases/multiple-myeloma/

2. Key statistics about multiple myeloma. American Cancer Society. Revised January 19, 2024. Accessed February 2, 2024. https://www.cancer.org/cancer/types/multiple-myeloma/about/key-statistics.html

3. Yao Y, Sui WW, Liao AJ, et al. Comprehensive geriatric assessment in newly diagnosed older myeloma patients: a multicentre, prospective, non-interventional study. Age Ageing. 2022;51(1):afab211.

4. Jensen CE, Deal AM, Nyrop KA, et al. Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study. J Geriatr Oncol. Published online December 16, 2023.