Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
Click the orange button to the right to learn more about what you can start doing today.
- You are here:
- Home »
- Blog »
- Multiple Myeloma »
- Considerations for Frail Myeloma Patients
Considerations for Frail Myeloma Patients
Considerations for frail myeloma patients focus more on quality of life then they quantity of life. While age is certainly an important indicator of frailty, my experience as a MM survivor points to “co-morbidities” more than age as being the key indicator of frailty. For example,
- Diabetes,
- Cardiovascular Disease
- Dementia
all are key considerations when thinking about considerations for frail myeloma patients.
Further, in general, considerations for frail myeloma patients focus more on how the MM patient functions on their own. Because aggressive MM treatment can really knock the patient down for an extended period of time, it is the caregiver who factors into the NDMM treatment plan more that it does for the average NDMM patient.
How does a frail patient deal with treatment for multiple myeloma?
1. Tailored Treatment Approach
- Dose Adjustments: Frail patients may require lower doses of chemotherapy or other medications to minimize side effects while still aiming for effective disease control.
- Less Intensive Regimens: Treatment regimens that are less aggressive but still effective may be chosen to reduce the burden on the patient’s body.
2. Supportive Care
- Nutritional Support: Ensuring the patient has adequate nutrition to maintain strength and support immune function is crucial. Nutritional supplements or interventions may be necessary.
- Pain Management: Multiple myeloma can cause significant pain, particularly in the bones. Effective pain management strategies, including medications and palliative care, are essential.
- Infection Prevention: Frail patients are at higher risk for infections. Prophylactic antibiotics, antivirals, and vaccinations might be considered, along with careful monitoring.
3. Monitoring and Adjustments
- Frequent Monitoring: Close monitoring of blood counts, kidney function, and other parameters is important to catch complications early.
- Adapting to Tolerance: Treatment plans should be flexible, with adjustments made based on how the patient tolerates therapy.
4. Physical and Emotional Support
- Physical Therapy: To help maintain mobility and strength, physical therapy can be beneficial. Even mild exercise can improve outcomes and quality of life.
- Psychosocial Support: Dealing with a chronic condition like multiple myeloma can be emotionally challenging. Counseling, support groups, or therapy might be helpful for coping with anxiety, depression, or fear.
5. Palliative Care
- Symptom Management: Palliative care focuses on improving quality of life by managing symptoms such as pain, fatigue, and emotional distress.
- Advanced Care Planning: Discussing goals of care, including the patient’s wishes regarding treatment intensity and end-of-life care, is important for aligning the treatment plan with their preferences.
6. Family and Caregiver Support
- Involving Caregivers: Family members and caregivers should be involved in the treatment plan, as they often provide essential support.
- Education: Educating the patient and their caregivers about the disease, treatment options, and potential side effects can empower them to make informed decisions and recognize complications early.
It is important to point out that it is the oncologist’s interpretation or judgement that decides when the newly diagnosed MM patient is “frail.” And because, in my experience, board-certified oncologists lean toward aggressive therapies, I have to caution reader about aggressive treatments.
Having said all of the above, I went to stress that treatment of the frail MM patient is less about chemo or radiation and more about how the patient will feel, and how the patient will function when treated.
If you are a frail MM patient or a caregiver for a frail MM patient and have any questions, email me at David.PeopleBeatingCancer@gmail.com
thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Clinical Frailty Scale
“Frailty is a multidimensional geriatric syndrome characterized by an increased vulnerability to various stressors. Frailty is strongly linked to adverse outcomes, including mortality, admission to nursing homes, falls, and delirium.
The Clinical Frailty Scale is a well-validated scale used to quantify the degree of disability from frailty. This activity reviews the clinical frailty of geriatric patients and highlights the role of the Clinical Frailty Scale for use by clinicians in evaluating a patient for frailty…”
Considerations for the treatment of frail multiple myeloma patients
“The optimal treatment of frail patients with myeloma is not easily derived from available clinical trials, including ones that purportedly included such patients. For example, the MAIA trial1 included 737 multiple myeloma (MM) patients, of whom many were considered as “frail”.
However, the data from the MAIA trial cannot be simply extrapolated to real-world patients, because many frail patients seen in daily and routine practice are not be the type of patients eligible for the MAIA trial (or other similar clinical trials).
In fact, only a small subset, even among the group of elderly MM patients, might have been eligible. Therefore, we cannot generalize regimens and outcomes without knowing what sort of patients were studied in many of the MM trials that included elderly and/or frail patients.
Even when trials have tried to include frail patients, inclusion and exclusion criteria permit enrolment of only patients with relatively good performance status, and most frail and very frail MM patients who need therapy are excluded.
In the absence of good data, the treatment of frail patients typically relies on a physician’s “clinical judgement” in the selection of the regimen, and adjustment of dose and schedule.
Importantly, if regimens used in clinical trials were generalized to truly frail patients without such adjustments, we could cause significant harm…
Future perspectives for frail MM patients
For the clinical trial-eligible frail patient (e.g. a frail patient aged >80 years who has no heart failure, and does not have performance status 3 or 4), the biologic MM risk has to be considered as a priority because often one needs to administer treatments differently, particularly for maintenance.
On the other hand, for very frail patients (performance status 3 or 4, or multiple comorbidities), we need to be careful in selecting the appropriate regimen, dose and schedule, and be willing to initiate therapy with doublet or even monotherapy until the clinical condition allows escalation if needed.
These patients will have to be studied in clinical trials based on frailty scores. An ongoing trial by ECOG (Eastern Cooperative Oncology Group) of patients who might not have qualified for the MAIA trial, is investigating VRd-lite versus DRd-lite.
The use of the simplified frailty index based on performance status, comorbidity index, and age, should be encouraged in routine clinical practice. The use of this score will help managing elderly patients not eligible to clinical trial regimens, especially if they cannot receive a triplet regimen.7″