Is Early Palliative Care Feasible in Patients With Multiple Myeloma?

J Pain Symptom Manage. 2017 Nov;54(5):692-700. doi: 10.1016/j.jpainsymman.2017.04.012. Epub 2017 Aug 12.


Context: Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies.

Objective: To assess the benefits of outpatient-based EPC for symptom control in patients with multiple myeloma.

Methods: Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1-December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated.

Results: About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end.

Conclusions: These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.

Keywords: Palliative care; hematology; multiple myeloma; neoplasms; pain; palliative medicine.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cost of Illness
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma / physiopathology
  • Multiple Myeloma / psychology
  • Multiple Myeloma / therapy*
  • Pain Management
  • Pain Measurement
  • Palliative Care / methods*
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors