Multiple Myeloma Care: Innovative Nursing Strategies and Patient Support

The landscape of multiple myeloma treatment is shifting rapidly with the introduction of quadruplet regimens, bispecific antibodies, and CAR T-cell therapies. Amidst these clinical advancements, the role of the oncology nurse remains a cornerstone of patient safety and operational success.

Reflecting on her participation in a recent Oncology Nursing News Case-Based Roundtable, Czarina Cecilio, BSN, RN, Clinical Nurse Manager at the Weill Cornell Medicine Multiple Myeloma Center, shared critical insights into how nursing interventions can optimize both clinical outcomes and the patient experience.

A career rooted in specialized care

Cecilio’s perspective is shaped by over a decade of experience within the hematology-oncology division. Starting her journey in 2013 as a medical assistant, she worked across various specialties, including lymphoma and solid tumors, before specializing in multiple myeloma. After advancing her education to become a registered nurse, she returned to Weill Cornell, eventually rising to the position of Clinical Nurse Manager. In this role, she bridges the gap between direct clinical care in the infusion area and the operational oversight required to manage referrals and administrative workflows.

Innovative injection techniques: The butterfly needle

One of the most discussed takeaways from the roundtable involved the practical administration of daratumumab and hyaluronidase-fihj (Darzalex Faspro).

Cecilio highlighted a technique used at her center that initially sparked a healthy dialogue among staff: the use of a butterfly needle for subcutaneous administration.

While many clinicians use a straight needle, Cecilio explained that utilizing the tubing length of a butterfly needle provides significant benefits for both the patient and the nurse. For the patient, it offers a sense of security; one patient noted that the tubing allowed him to react to the initial injection or move slightly without the risk of hurting the nurse or dislodging the needle. For the nurse, the technique is more ergonomic, particularly when administering the large 15-cc volume required for the drug.

This revelation was an "eye-opening" moment for other roundtable participants, illustrating the value of sharing institutional "pearls" to improve daily practice.

Proactive management of treatment toxicities

As therapeutic regimens become more intensive, managing treatment-related toxicities is paramount. Cecilio detailed the specific protocols employed at Weill Cornell to mitigate both immediate and delayed reactions. To manage pulmonary effects such as shortness of breath, patients are instructed to take montelukast 90 minutes prior to their appointment.

Furthermore, to address the possibility of delayed reactions following the first injection of daratumumab and hyaluronidase-fihj, the center has implemented a prophylactic regimen of low-dose steroids given the day after and two days after treatment. While standard premedications — including diphenhydramine, dexamethasone, and acetaminophen — are strictly used during the initial cycles, Cecilio noted that physicians often taper these once a patient has demonstrated stability over several cycles.

Operational harmony and nurse wellness

The transition of complex therapies to the outpatient setting introduces significant operational challenges. Cecilio emphasized that while inpatient settings handle the initial step-up dosing for bispecifics to monitor for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), the outpatient team must be prepared for high patient turnaround and complex scheduling.

The key to success, according to Cecilio, is a collective focus on patient safety and the prevention of nurse burnout. "We want to make sure our nurses aren't being burned out. ... We also need to make sure our nurses are fully aware of what they're doing," she stated. This requires a multidisciplinary alignment where every team member is on the same page regarding patient load and safety protocols.

The power of education and empathy

Because multiple myeloma is currently an incurable disease requiring long-term management, the relationship between the nurse and patient is uniquely enduring. Cecilio believes that education for both the nurse and the patient is the most effective tool for managing the anxiety associated with transitioning from frontline therapy to maintenance or managing a relapse.

She encourages nurses to provide patients with a vision of the future, reminding them that while the initial schedule is intensive, the goal is to reach a point where they can live their lives, go on vacation, and see their care team only once a month. Family involvement and support groups also play a vital role in providing the emotional support necessary for these long-term journeys.

Advice for the next generation

For novice oncology nurses entering the field of hematologic malignancies, Cecilio’s advice is simple: move beyond the checklist. "You can’t just become a nurse and just follow everything that’s on the screen," she remarked. She urges new clinicians to be "outside the box," combining technical knowledge with deep empathy to recognize patient needs that a computer screen might miss. By constantly seeking to educate themselves and understanding the "why" behind their practice, nurses can evolve from novices to true clinical experts.