At the Greater Los Angeles Oncology Nursing Society (GLAONS) Oncology Care Summit in Los Angeles, California, Oncology Data Advisor spoke with Tiffany Richards, PhD, ANP-BC, Advanced Practice Nurse at MD Anderson Cancer Center, about strategies for optimizing patient experiences during multiple myeloma treatment. Dr. Richards discusses the challenges of treating patients with multiple myeloma, particularly during the COVID-19 pandemic, and shares strategies for promoting adherence and optimizing treatment outcomes.
Dr. Richards, thank you so much for joining me today.
Tiffany Richards, PhD, ANP-BC: Thank you for having me speak with you.
What are some of the most challenging aspects of managing treatment for patients with multiple myeloma?
Dr. Richards: That's a great question. We just have so many various drugs. I think treating for induction is a lot easier right now because we've had so many randomized phase 3 studies, and we know that triplets are better than doublets. It looks like maybe having a four-drug regimen is going to be better than a three-drug regimen. The progression-free survival data has not yet been reported, so I think we'll have to wait to see what that data shows. When it gets to relapsed/refractory disease, that's where it becomes a little bit more complicated. We need to know which combinations to use, because so many triplets have shown benefit, such as elotuzumab in combination with lenalidomide/dexamethasone, ixazomib/lenalidomide/dexamethasone, carfilzomib/lenalidomide/dexamethasone, and daratumumab/lenalidomide/dexamethasone, compared with a doublet.
It gets to be a little bit tricky to know what the best treatment is, particularly for patients who may have a slow-growing relapse as opposed to a more aggressive relapse. It's pretty easy to use a daratumumab regimen at first relapse. I think there are still a lot of questions that remain unanswered as far as which drugs to use and when to use them.
Definitely. What are some of the factors that go into selection of therapy for patients with multiple myeloma?
Dr. Richards: We use a lot of different things. One involves looking at whether patients are fit or frail. With somebody who's frail, you're obviously going to treat them a little bit more gingerly than somebody who's fit. You're going to look at what other comorbid conditions they have. Do they have diabetes? Do they have pre-existing neuropathy? Have they had prior blood clots? You're going to look at patient preference. Do they prefer an oral regimen, or do they want to come to an infusion therapy center? Even though we don't like to talk about insurance copays, I think that's an important component of this discussion—particularly for patients who have Medicare, because they do have a high out-of-pocket copay for oral oncologic agents. If they can't afford the copayments and they can't get patient assistance, that can be prohibited for them.
We also obviously look at efficacy. we're going to at efficacy, and we also look at what types of social support systems patients have in place. Do they have somebody who can bring them to the infusion therapy center one or two times a week? We look at all those factors when trying to determine the best option for a patient.
What are some of the challenges that have been presented by the COVID-19 pandemic when it comes to treatment of multiple myeloma?
Dr. Richards: The biggest question that we all have is how we can keep our patients safe, while also trying to keep their disease under control. It doesn't do a patient any good if we try to keep them safe from COVID, but then their disease progresses during that time. We try to determine the best therapy to put patients on during this time in order to minimize the number of times they have to come to the center. That's been challenging. Another component is just the social isolation that our patients have been experiencing. Since the vaccines have been available, people have been able to start going out. We don't really know what kind of immune response our patients are going to have to the vaccine, so they still really need to still maintain 6 feet distancing and wear masks. That makes it more challenging because then our patients have to maintain social isolation, and that's challenging for them.
What are some of the questions that you encounter from patients with multiple myeloma, particularly in light of the pandemic, and how do you counsel them?
Dr. Richards: One of the questions is, "Can I see my grandchildren? Can I see them without my mask? Can I give them hugs now that I've been vaccinated?" I think that's really going to be dependent upon where patients live and what the mask mandates are. In Texas, for example, the governor prevented school districts from mandating masks. That becomes problematic for our patients, because they can't necessarily be around their grandchildren without masks, because there's a risk that the grandchildren could get COVID while they're at school.
Another question involves the timing of the COVID vaccine and now the booster, as well as knowing how to best manage treatment while they're getting ready to take their COVID vaccine. That has also been a question that we're working to address.
Finally, is there any advice you can share with oncology nurses who are treating patients with multiple myeloma?
Dr. Richards: I think the biggest thing is making sure that patients understand how to take their medications. That's going to promote adherence. Helping them manage their side effects is also going to promote adherence. In this day and age, where patients have oral oncolytics and intravenous (IV) agents, it becomes challenging for patients. Generally speaking, they're an older population. If they're a younger population, they're also trying to juggle kids and that sort of thing. Making sure that patients have been educated on side effects and how to manage those side effects will promote adherence and ensure that patients achieve the best response that they can get.
Well, thank you very much for sharing all this valuable information with us.
Dr. Richards: Thank you for asking me to talk with you today.
About Dr. Richards
Tiffany Richards, PhD, ANP-BC, is an Advanced Practice Nurse at the University of Texas MD Anderson Cancer Center. She specializes in the treatment of patients with multiple myeloma, and her research focuses on the development of targeted therapies for this disease. Dr. Richards serves as Co-Facilitator of the Multiple Myeloma Support Group and is an active member of the International Myeloma Foundation Nurse Leadership Board and the Oncology Nursing Society. She has authored or coauthored numerous peer-reviewed publications and book chapters focusing on novel therapeutics and treatment strategies to optimize the care of patients with multiple myeloma.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.