Charise Gleason, MSN, NP-BC, AOCNP: The challenge for nurses caring for patients with myeloma is going to vary from centers. For instance, where I work, we see a couple thousand patients a year that only have myeloma. That’s what we do. But in the community, you might not see the same volume of patients. So, it’s hard to keep up with all the therapies and the side effects, and how to manage this for your patient.
Kathleen Colson, RN, BSN, BS: As far as challenges for the oncology nurse in multiple myeloma, I think we’re at a conundrum. We have so many therapies. I think I had mentioned earlier that because we have monoclonal antibodies that have a different side effect profile, we need to monitor patients for infusion-related reactions. Nurses need to know about these infusion-related reactions. They need to know how to treat for them, how to pre-treat, what medications to give them prior to their infusion, and educating patients what they need to know post infusion. And, again, most generally with the monoclonal antibodies, these can be mild infusion reactions, but we still need to watch out for severe ones. Generally, these always happen with the first infusion, and the patients do well thereafter.
To know how to carefully monitor patients with monoclonal antibodies, the oncology nurse needs to understand these new oral therapies, these classes of drugs, and mechanisms of action. They need to know how to manage the side effects for these patients and also talking to the patients about compliance and adherence, because patients are taking a lot of their therapies at home. Are they taking their therapies? So, we need to know about compliance. I think this all comes through education and really emphasizing to patients the importance of staying on track with their medications and not missing their therapies or not taking it because they’re going on vacation and they feel like they don’t need it. Because having oral therapies gives patients a sense of freedom that, “Well, if it’s oral, maybe I don’t need to be taking it,” and it’s very important to emphasize the importance of staying on track with their therapies.
Wendy Vogel, MSN, FNP, AOCNP: There continue to be challenges for the oncology nurse who’s caring for myeloma patients because of the disease process itself. Myeloma patients often present with pain, whether from fractures, bone disease, that sort of thing. So, I think that’s always going to be a challenge as we treat myeloma patients. I guess it’s a good thing for oncology nurses to have trouble dealing with keeping up with the drugs that are going to come out in myeloma therapy, and the new ones that we have, and how to educate those patients. That’s a good thing.
Charise Gleason, MSN, NP-BC, AOCNP: The Darzalex Protocol for Nurses is going to show nurses what they need to do for their patients—talking about the side effects, the premedications that are essential, and the fact that we can easily get these patients through these infusions. This is for nurses to not be intimidated by these drugs. They’re used to giving monoclonal antibodies, and this is a part of myeloma that is going to be used more frequently even now than what we are doing.
Wendy Vogel, MSN, FNP, AOCNP: I think what I’m most excited about, in things that are coming about for multiple myeloma, is the different targets that we have. If you look at the myeloma cell and you look at the different targets that are expressed there, like the CS1, CD30, CD20, we can look at the natural killer cells, or NK cells. There are so many different targets and so many exciting possibilities for new drugs to come out in the future, and so much is in clinical trials right now.
Charise Gleason, MSN, NP-BC, AOCNP: I’m excited that there are so many options for treatment now for patients. And we’ve got these amazing drugs that we can use. It hasn’t cured myeloma, but we have so many more options than what we used to. Monoclonal antibodies have made the patient experience much better. Patients are living longer, they’re responding to these therapies, and we have so many new drugs coming down right now that, in clinical trials, we’re just looking at a whole different way to treat myeloma than we used to. And we’re tailoring treatment more to the patient, especially after that induction therapy. Induction still pretty much remains the same unless we add an antibody on a clinical trial. But then after that, we’re really looking at the genetics of the disease and how we treat patients. These drugs just make such a huge difference.
Kathleen Colson, RN, BSN, BS: These are very exciting times in myeloma, especially all these new approaches to therapy. We have the monoclonal antibodies, we have the immunomodulatory drugs, and we’re looking at therapies for vaccines, different approaches with transplant, and CAR-T therapies. And so, right now with all these new approaches, we have so much yet to learn for our patients. But what I do know, and what I know is exciting, is that when I do meet with a patient, the therapies that they are going to receive are effective; there’s great efficacy. We see very good and rapid response rates with these patients. And, most importantly, I know that these therapies are manageable for the patients and they’re easily tolerated. So, these patients, again, have the freedom to know that they don’t have to be coming into clinic. They can have their oral therapies and take it home, in combination with coming in maybe once a week, every other week, or once a month. Because the monoclonal antibodies, in addition to their other therapies, help lead to better response rates for our patients. Myeloma is the hematological malignancy that remains incurable at this time, but we know that it’s very highly treatable. And with the rapid advancements in myeloma looking at new pathways for treating the disease, it certainly helps give encouragement to our patients and their families. And so, we see hope and renewed survival for myeloma.