Q&A: Transitioning Myeloma Care to the Community Level

Transitioning care to the local level requires coordination and communication, says Diane Moran, RN, MA, EdM.

The treatment of multiple myeloma has been an evolving area of oncology for decades, and with the range of new treatments emerging from clinical trials, the transfer of care from specialized clinics to local oncology centers needs to be streamlined with education and clear communication, says Diane Moran, RN, MA, EdM, the interim CEO and senior vice president of strategic planning at the International Myeloma Foundation.

The transition from one clinic to the other can create stress for both patients and providers. As Moran emphasized, nurses are an essential link between care centers, as they can help manage adverse effects (AEs) to make treatment more tolerable.

Additionally, she pointed out that clear communication between centers can create an environment where community providers are encouraged to interact with and learn about unfamiliar therapies when myeloma specialty clinics give explicit education on expectations for care.

Oncology Nursing News: How does the development of multiple myeloma care impact community practice providers?

Moran: [We are] making a lot of progress [in immunotherapies for multiple myeloma]. We do have the new therapies like CAR T-cell therapies, bispecific [antibodies] … or not-yet-approved trispecifics. Just like when the era of novel therapies came in the early 2000s, where we moved out of traditional chemotherapy into these options, we are moving into options that have different types of AEs: some long term, some short term.

We are looking also at the importance, based on capacity, of transitioning care more to the community. … [We] move the patients out of the [academic] centers to increase the opportunity for other patients, and get them back to their community oncologist. So those are really important things. Again, management of those AEs, helping them build the networks that allow them to have access.

What is the role of nurses in evolving myeloma care?

Moran: I don’t think [treating multiple myeloma is] different for the nurses than it is for the physician, because many of the nurses are seeing more patients than the physicians actually see. Everything from focusing on disparities and what that means in myeloma, when you have a disease where you know [a disproportionate percentage] of the patients who [are diagnosed with] it are African American, so focusing on the unique needs of those communities, to watching for the transitions of care [to community clinics], and how do you optimize that transition to make it successful? … Again, immunotherapy symptom management is so important. And then the trends coming out, there was a recent [FDA Oncology Drugs Advisory Committee] vote on smoldering [myeloma] and whether or not to treat high-risk patients. So all of these things are as important to the nurses as they are to the doctors. The nurses then turn this information to address [adverse effect] management, the opportunity to keep people on therapy so that the therapies can deliver the promise of the clinical trials. The trials can give you great data, but if then you can’t keep patients on therapy, then you will not see the promise of the clinical trial realized.

How should the transition be streamlined to make nurses in community clinics just as confident in providing care as those at specialty centers?

Moran: To optimize it, there has to be a formalization of communication. What you have to do in the community is help the community get over the anxiety of patients coming there [after receiving] new therapies. This has happened with all kinds of drugs, where when they come to the community, there’s the anxiety of “Are we prepared to handle this?” And many of the drugs that initially take a long time get into the community eventually are used routinely on a daily basis, but that takes a lot of work in terms of communication, education, willingness to support the community once the patients move out into the community, and the confidence to know the community can handle the patient when they get there. Those are some of the most important things: How do you create that dialogue and give the community the education and the support to take that patient back, knowing that there’s an open door if they have challenges?

How can communication be formalized to ease that change of hands in care?

Moran: It looks different in different places, but certainly it’s different tools that one makes, and that can be anything from written transition sheets to videos. One of the things my nurses often say is, among the most important things, getting on the phone and talking to the practitioner, building the confidence that you’re there for them, walking them through and making sure that they know how to use the therapies, what to watch for, helping them understand the difference between short-term and long-term AEs. There could be short-term AEs that people hear about in the community, and they worry about taking the patient, but by the time the patient transitions, they’re past that period. So again, a lot of education … [is] absolutely all vital to what this transition needs to look like.

This transcript has been edited for clarity and conciseness.