Cancer Therapy Advisor: How important are social support networks for treatment adherence among older patients with multiple myeloma?

Dr Wildes: Many of the current treatment options for patients with myeloma are orally administered. While oral therapy is convenient and often preferred by patients, adherence to complex regimens can be challenging. This includes not only the cancer therapy, but required supportive care medications, such as VTE prophylaxis, varicella zoster prophylaxis, and vitamin D supplements.

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Depression, multi-morbidity, polypharmacy, and cognitive impairment are among the factors associated with poorer adherence to medications. Patients who are unmarried/unpartnered are at greater risk for nonadherence,19 underscoring the importance of social support in optimizing adherence. Simple interventions, such as using a weekly medication pill box, can improve patient satisfaction and were preferred for administration of oral anticancer treatment.20 In a patient who lives alone, home nursing can be employed to support adherence through assisting with medication setup.21

CTA: What should clinicians know about the timing of supportive/palliative care for older patients with myeloma?

Dr Wildes: The American Society of Clinical Oncology (ASCO) has called for earlier integration of palliative care into the overall care of patients with cancer.22 Yet unfortunately clinicians who treat hematologic malignancies perceive palliative care as being equivalent with end-of-life care.23

Oncologists who treat hematologic malignancies are more likely to recommend chemotherapy for patients with poor performance status and limited life expectancy than their colleagues focusing on solid tumors.24 Patients with hematologic malignancies referred for hospice have a significantly shorter length of stay on hospice and are more likely to die within 24 hours of hospice referral than patients with solid tumors.25

We also know that patients with multiple myeloma have among the worst quality of life of patients with cancer.26 Patient preferences are also an important component of decision-making; older patients, for example, are more likely to forego treatments that would render them more dependent or cognitively impaired and prioritize their independence over length of life.27,28

RELATED: Four New Drugs Approved for Multiple Myeloma Since 2015

Together, this suggests that there is a significant opportunity to improve the care of older adults with myeloma, both from the standpoint of attention to symptom management throughout the disease course, prioritization of treatment preferences, and addressing end-of-life needs earlier.


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