Site Editors
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Posted: Wednesday, September 13, 2023
Frail adults face unique challenges in the management of multiple myeloma. In an extended abstract from the 2023 Society of Hematologic Oncology (SOHO) Annual Meeting (Abstract EXABS-201-MM), which was published in Clinical Lymphoma, Myeloma & Leukemia, Elizabeth O’Donnell, MD, of the Dana-Farber Cancer Institute, Boston, delved into the specific points of concern and discussed the importance of individualized therapeutic strategies in this population.
“Health-care providers must adopt a personalized, multidisciplinary approach that considers the individual’s frailty status, tailors treatment plans accordingly, and provides comprehensive support for pain management and psychosocial well-being,” Dr. O’Donnell stated. “By taking a personalized approach, we can enhance the quality of life…and improve overall outcomes.”
The decline in physical function often seen in frail adults may significantly impact their ability to tolerate cancer treatments. Although several comorbidity indexes have been used to predict mortality based on conditions such as frailty, it was only in recent years that the Myeloma Comorbidity Index, along with its revised version, was specifically developed for the assessment of patients with multiple myeloma. In clinical practice, the International Myeloma Working Group (IMWG) frailty scoring system finds broad application in guiding upfront dose modifications to mitigate side effects and promote long-term tolerability; frailty scores are now more commonly being incorporated into study designs.
Frail adults with multiple myeloma have been found to experience increased levels of anxiety and depression, according to Dr. O’Donnell. The emotional well-being and resilience of this population may be strengthened via psychological support, counseling services, and support groups. In addition, increased rates of infection have been observed; thus, Dr. O’Donnell advised close monitoring of these patients. Frail adults may also experience a reduced pain threshold and limited mobility, hindering their multiple myeloma–related pain management. Dr. O’Donnell recommends both pharmacologic and nonpharmacologic interventions to alleviate suffering and enhance overall comfort.
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