Transitioning to Community Care With Multiple Myeloma
Lisa Hwa Christenson, APRN, DNP, CNP, FAPO, outlines best practices for safely transitioning patients with multiple myeloma on bispecific antibodies to community care.
For patients with multiple myeloma receiving bispecific antibodies, transitioning care from an academic center to a community clinic requires careful coordination, according to Lisa Hwa Christenson, APRN, DNP, CNP, FAPO, a nurse practitioner and assistant professor at the Mayo Clinic College of Medicine in Rochester, Minnesota. In an interview with Oncology Nursing News following a Case-Based Roundtable discussion with advanced practice providers (APPs), many from community settings, Christenson shared strategies to ensure continuity and safety during these transitions.
Christenson explained that when patients with relapsed or refractory multiple myeloma are not eligible for or decline clinical trial participation, treatment options often include bispecific antibodies. For patients who live far from academic centers, initial step-up dosing is frequently completed at the academic center to monitor tolerability and manage early adverse events. Once stable, care is transitioned to local oncology providers, requiring consistent, direct communication between the academic and community teams.
Even after the transition, ongoing collaboration remains essential. Christenson noted that patients typically return to the academic center for follow-up every few cycles, or at minimum once per year, to reassess tolerance, response, and any need for dose adjustments.
Transcript
In my practice, I manage patients receiving bispecific antibody therapy. When I see a patient in the clinic who presents with relapse and refractory disease, if I see they may be eligible for any clinical trials we have, I always discuss the options of clinical trial vs standard care.
If patients are not eligible for or they are not interested in participating in clinical trials at the time, then I collaborate with the community oncology providers if patients would like to receive treatment closer to their home.
In our practice, most of the patients are not local. They require quite a bit commute, so some of the patients may choose to have a step-up dosing therapy at Mayo Clinic first, and if they are tolerating it OK, then we collaborate with their local provider, then transition their care to the local clinic.
That requires direct communication. In my practice, I contact patients’ local provider—either physicians or APPs—to report the updates of the patient’s treatment. How’s their situation, and what’s our recommendation for the next treatment plan?
Once patients transition back and receive treatment closer in their local clinic, we don’t just cut them loose. I talk to the patients—it depends on their commuting situations—and then I see them back. Normally, if I start a new therapy, I then say, “OK, we’ll schedule a follow-up with us after 2 to 3 cycles,” and just make sure they are tolerating it okay, [evaluate] if we need to do any dose modification and their response, and so forth.
For evaluation, once it is established that patients are tolerating treatment and responding well, we still see them periodically. It depends on patients’ comfort level, and some patients prefer to come back to us every 3 or 4 months for evaluation while getting treatment locally. Other patients may come back every 6 months, but I ask that patients return to us, at minimum, every year.
This transcript has been edited for clarity and conciseness.
