BMT & Cellular Immunotherapy Nurse Coordinator Huntsman Cancer Institute SANDY, Utah, United States
Introduction: Multiple myeloma (MM) commonly affects older adults, with a median diagnosis age of 69. Younger adults with MM (YA MM) face a shortened life expectancy along with significant impacts on career, fertility, and quality of life.Understanding and tailoring supportive care for this group is crucial to improving outcomes.Our insitute analyzed data from YA MM patients to identify areas for improvement.
Methods: Patient data was exported from the EHR and included patients under 50 diagnosed with MM or plasma cell leukemia.Patients diagnosed with amyloid,MGUS, or SMM were excluded.The presence of t(4;14), t(14;16), t(14;20), del(17p), p53 mutation, 1p deletion, or 1q21 defined high-risk cytogenetic disease. Data regarding referral to supportive care services were analyzed. Specifically, social work notes were reviewed for mentions of distress, financial toxicity, transportation needs, or survivorship support.
Results: We identified 155 YA MM patients, of which 37% were female. The majority (72%) were aged 41-49 years, with very few (2%) < 30 years. Most patients (59%) had standard-risk disease, 19% had high risk, and the rest were undefined. Nearly half (42%) sought social security disability. Referrals included: reproductive counseling (15%), fertility preservation (9%), pain specialists (23%), wellness center (17%), physical therapy (28%), nutrition counseling (5%), financial counseling (8%), sleep medicine (8%) and psychiatric care (2%). Social work referrals included counseling on Advance Directives (3%), depression, anxiety, or distress (7%), and transportation assistance (19%).
Conclusions: YA MM patients in our cohort are predominantly male and fall within the age range of 41-49 years, with a significant proportion having standard-risk disease. This aligns with existing literature on YA MM patients.Many patients sought disability services, underscoring the disease's severe impact on the daily functioning and financial stability in this population.In general, referrals for reproductive counseling, physical therapy, nutrition support, pain management, and psychiatric care were low. Areas of improvement for comprehensive care for the YA MM population include proactively assessing risks for impaired fertility, promoting the completion of medical power of attorney and living wills, and increasing awareness and referrals for psychiatric care and counseling services early on in the MM disease course, to more robustly address the psychological impacts of the disease. In addition, implementing referrals to AYA-specific support groups align with the NCCN AYA guidelines.This retrospective review may lead to missing information, potential selection bias, and possible data entry errors, which are limitations. YA MM patients encounter unique challenges that necessitate a multidisciplinary approach to care. Enhancing early awareness and timely referrals to appropriate support services can significantly improve this vulnerable cohort’s quality of life and overall well-being.
