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Telehealth for MGUS/SMM
Telehealth for MGUS/SMM, the Pre-Myeloma patient, is certainly about pre-MM but also about your RISK. You Risk of progressing to full MM.
And most patients diagnosed with either MGUS or SMM will eventually undergo annual testing. While all testing is important, testing of the pre-MM patient is ideally suited for telehealth aka not in-person visits.
I am a long-term MM survivor. While “seeing” your doctor is important to some degree, I would be the first MM survivor to admit that many visits do not require a face to face appointment. The articles and video linked explain why face to face appointments can be avoided for telehealth appointments.
Email me at David.PeopleBeatingCancer@gmail.com with questions about Telehealth for pre-MM.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
New Patient Visits Via Telehealth Improve Management of Patients With MGUS at Increased Risk for Hematological Cancers
“Study results demonstrated that conducting new patient visits via telehealth with advanced practice providers allows for quicker identification, assessment, and surveillance of patients with monoclonal gammopathy of undetermined significance (MGUS), a pre-malignant plasma cell disorder, at increased risk of developing certain hematological cancers…
In this study, researchers crafted guidelines based on disease subtype and testing characteristics of patients with MGUS and enrolled 23 patients at risk of progression to
- multiple myeloma,
- amyloidosis,
- Waldenstrom macroglobulinemia,
- chronic lymphocytic leukemia,
- chronic lymphocytic lymphoma,
- and smoldering multiple myeloma.
Referrals were reviewed by a nurse navigator and patients underwent standard work up and testing, with certain patients additionally undergoing additional bone marrow biopsy with or without PET/CT scans if indicated.
A new patient visit was scheduled and completed with an APP via Telehealth or, if indicated for patients with smoldering or multiple myeloma, a doctor via telehealth. Follow-ups were requested, and the patient underwent further testing for the next appointment…
At the time of the new patient visit, patients were categorized by risk as
- ultra-low (n = 2),
- low (n = 2),
- low-intermediate (n = 7),
- intermediate (n = 6),
- high-intermediate (n = 4),
- smoldering multiple myeloma (n = 1),
- and lymphoma (n = 1)
and further categorized by subtype as lymphoma (n = 1), IgM lambda (n = 1), IgM kappa (n = 1), IgA lambda (n = 1), Kappa FLC (n = 2), IgC lambda (n = 2), IgA kappa (n = 3), or IgG kappa (n = 12).
After 12 months, the distribution of diagnoses reported 4% of patients with lymphoma, 9% of patients with smoldering multiple myeloma, and 87% of patients with MGUS…
Conducting new patient visits via telehealth allows for complete results to be obtained before the appointment, reducing the number of trips to the clinic for the patient. Additionally, O’Brien et al noted, “Brisk identification of newly diagnosed MGUS patients and risk stratification from diagnostic workup allows a surveillance plan to be formulated and prompt determination of progression and initiation of treatment when indicated…”
Monoclonal gammopathies: Electronic subspecialty consultation
“Importance: Electronic consultation (e-consult) is an important component of care for patients in the Veterans Health Administration who require subspecialty consultation but not urgent face-to-face evaluation. Monoclonal gammopathy of undetermined significance (MGUS) is a common reason for e-consult. While often benign, MGUS requires careful evaluation and persistent surveillance over time…
Methods: We performed a retrospective review of our e-consult database and identified a cohort of 152 MGUS patients triaged for e-consult over a 5-year period (2010-2014).
Results: The median time to completion of an e-consult was 2 days. Ninety-six percent of MGUS e-consults had a hemoglobin >10 g/dL, and 90% had a creatinine <2 mg/dL. While the majority of e-consults were low risk, paraprotein surveillance varied over time and tracked with consult utilization. With a median follow-up of 44 months, there were 6 documented progression events, representing a mean rate of progression of 1% per year.
Conclusions: E-consult is a helpful mechanism for the evaluation of MGUS, reducing the need for outpatient appointments. However, timely risk stratification and persistent surveillance over time are critical for e-consult to work well.
Telehealth for MGUS/SMM Telehealth for MGUS/SMM