Abstract
Introduction/Background: Because multiple myeloma (MM) typically occurs in patients over 70 years of age, many patients present with comorbidities. This can present a challenge for the care team who must consider multiple factors which prevent these patients from being able to tolerate standard treatment protocols without dose modifications and supportive therapy. As a result, MM therapy for older patients requires a tailored approach to treatment selection and supportive care. Materials and Methods: A web-based educational program designed as a roundtable discussion among nurses and tailored to a nursing audience was posted on Medscape Oncology in September 2014 (http://www.medscape.org/viewarticle/831381). The effect of nursing-centric education was assessed using a pre-assessment/post-assessment study design. This study design compared participants’ responses to questions before exposure to educational content (pre-assessment) with the same participants’ responses to identical questions placed after the educational content (post-assessment measurement). A paired 2-tailed t-test was used to assess whether the mean pre-assessment score was different from the mean post-assessment score. A Pearson’s ÷2 statistic was used to measure changes in responses to individual questions. Probability values (P values) were also calculated for both t-test and ÷2 statistics to determine significance level (á). Individual learners were defined as “Improved” (higher post education score) “Knowledge Reinforced” (answered both pre and post education questions correctly) or “Unaffected”(pre and post scores answered incorrectly). Between September 25, 2014 and January 7, 2015, more than 22,000 nurses participated in the activity, of which 1415 were assessed. Results: Compared with the baseline assessment, an overall medium effect size of 0.724 was seen among nurses (p <.05). Specifically:
• 82% improved/reinforced understanding appropriate nursing practice for a new diagnosed patient with MM undergoing first line treatment using lenalidomide/dexamethasone regimen and developing a side effect
(p <.05).
• 80% improved/reinforced knowledge on the benefit of the “air sandwich” technique as a strategy for reducing injection site reactions associated with subcutaneous administration of bortezomib (p <.05).
• 72% improved/reinforced knowledge related to proper carfilzomib dosing and relevant patient-caregiver communication (p <.05).
• 62% improved/reinforced knowledge related to the safety profiles of current treatments approved to treat patients with MM (p <.05).
Conclusions: This study demonstrated the success of a nursing-focused educational initiative designed by nurses to improve the care and management of elderly patients with MM. Remaining gaps include outlining best nursing practices that can minimize adverse events in MM patients and summarizing critical caregiving communication principles for MM patients.to lung cancer patients with COPD regarding I-O therapies. It is essential for patients to understand the mechanism of action of I-O therapies, the differences in side effects compared with traditional chemotherapy, and the importance of managing comorbid conditions to maintain underlying health and therapy administration. These patients should undergo pulmonary evaluation before initiation of therapy. Consistent follow-up and collaboration with both oncology and pulmonary teams is the key to optimizing therapy for patients with lung cancer and underlying COPD, particularly given the importance of differentiating I-O–related pneumonitis from infectious pneumonitis in this population. Collaboration across both teams on the use of oral steroids for any reason is critical. Summary: Comprehensive management of comorbid pulmonary conditions such as COPD is necessary for patients to fully benefit from I-O therapy. While nivolumab is the first I-O therapy available to patients with advanced-stage squamous non–small cell lung cancer, other promising I-O therapies for lung cancer patients are in development, making this a hopeful time for patients with metastatic lung cancer.
