Enhancing Treatment and Patient-Care Proficiency in Multiple Myeloma
i3 Health has provided a nursing continuing professional development (NCPD)–approved activity, Multiple Myeloma: Enhancing Treatment Tolerability, Adherence, and Patient-Centered Care, during which the health care team was challenged to address knowledge gaps experienced in this field.
Multiple myeloma (MM) is a B-cell neoplasm characterized by aberrant expansion of plasma cells within the bone marrow and extramedullary sites. The American Cancer Society approximates 35,730 new cases of MM to be diagnosed in the United States this year and 12,590 deaths from the disease. Although the tumor cells remain primarily within the bone marrow, they can cause several complications, including localized bone destruction, anemia, decreased immunity to infection, and kidney damage. Multiple myeloma is primarily considered a disease of older adults, with a median age at diagnosis of 69 years. From 1975 to 2007, the incidence increased by 11.4%, and is expected to continue to rise in conjunction with the aging population. Early diagnosis is difficult because symptoms often do not appear until the malignancy is in advanced stages. The 5-year survival rate remains only 58%. Due to this, it is imperative that the health care team remain proficient in understanding the evolving treatment landscape and adhere to patient-centered care.
To address the knowledge gaps experienced by nurses regarding treatment tolerability, adherence, and patient-centered care in MM, i3 Health provided educational opportunities through a series of 16 live meetings held between April 1, 2020, and July 21, 2022. The activity was also made available on i3 Health's website as well for on-demand learning from May 19, 2020, until May 18, 2021. Three faculty who specialize in treatment of MM led the activity; Beth Faiman, PhD, CNP, Chairperson, Nurse Practitioner in the Department of Hematologic Oncology at Cleveland Clinic Taussig Cancer Institute; Tiffany Richards, PhD, ANP-BC, Advanced Practice Nurse in the Department of Lymphoma/Myeloma at MD Anderson Cancer Center; and Charise Gleason, MSN, NP-BC, AOCNP®, an Advanced Practice Provider Chief at Winship Cancer Institute of Emory University.
Between the live meeting series and the online activity, a total of 840 learners participated in the activity, with 791 on them moving on to complete the activity for credit. Most participants were registered nurses, followed by nurse practitioners, clinical nurse specialists, and other advanced practice nurses. Amongst participants, the average number of patients seen with MM per month was 13, and the average number of years in practice was 22.
The baseline data collected revealed knowledge gaps in the following areas: identifying predictive and prognostic markers that can tailor treatment selection and goals to individual patients with MM; evaluating the efficacy and safety profiles of novel therapeutic strategies for newly diagnosed and relapsed/refractory MM; and assessing strategies to manage treatment-related adverse events, promote adherence to therapy, and ensure patient-centered MM care.
Participants were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest revealed that only 15% of participants successfully identified stage III as the disease stage under the Revised International Staging System (R-ISS) for a patient with immunoglobulin G (IgG) kappa MM, a β2-M level of 5.9 mg/L, serum lactate dehydrogenase (LDH) within normal range, and t(14;16) by fluorescence in situ hybridization (FISH); 27% successfully identified KRd (carfilzomib/lenalidomide/dexamethasone) as the best induction therapy for a transplant-eligible patient with with R-ISS stage III MM and del(17p); 18% successfully identified DVMP (daratumumab/bortezomib/melphalan/prednisone) as the best initial treatment for a transplant-ineligible patient with newly diagnosed R-ISS stage 3 MM; 91% successfully understood that a patient with R-ISS stage 3 MM now being treated with isatuximab/pomalidomide/dexamethasone as a third-line regimen should be counseled to avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs); and 24% successfully understood that the next step for a patient with relapsed MM, being treated with selinexor who is experiencing a platelet count drop to 40,000/µL and bleeding, would be to interrupt the selinexor and restart it at 1 dose level lower after the bleeding resolves.
The posttest assessment revealed significant knowledge gains for each learning outcome: an increase of 51% of participants (66% total) successfully understood staging of newly diagnosed MM; 46% more (73% total) successfully understood KRd efficacy for high-risk transplant-eligible MM; 40% more (58% total) successfully understood DVMP efficacy for newly diagnosed transplant-ineligible MM; 4% more (95% total) successfully understood the need to avoid NSAIDs during treatment with pomalidomide; and 36% more (60% total) successfully understood management of selinexor-related bleeding.
Upon completion of the activity, 85% of participants reported feeling more confident with treating their patients with MM, and 86% felt that the material presented would be used to improve the outcomes of their patients.
The data revealed by the posttest assessment affirm the effectiveness of online educational content pertaining to the topics of tolerability, adherence, and patient outcomes in MM. Based on these data, i3 Health has determined that the multidisciplinary team may benefit from NCPD activities that provide MM education on predictive and prognostic markers to tailor treatment selection and goals, efficacy and safety profiles of novel therapies, strategies to manage treatment-related adverse events, promote adherence to therapy, and ensure patient-centered care.
i3 Health (2021). Multiple myeloma: enhancing treatment tolerability, adherence, and patient-centered care: activity outcomes report. Data on file.