Abstract
Introduction: Multiple Myeloma (MM) treatment is undergoing rapid transformation. New agents and regimens create an increased need to proactively screen for, assess, and manage patient reported symptoms and concerns. The Carevive Care Planning System (CPS™) captures electronic patient-reported outcomes (ePRO) and clinical data to generate tailored, evidence-based symptom management and supportive care plans, promoting supported patient self-management. Description: 90 patients with MM will be enrolled at 3 sites in this pilot intervention study. Using a study-provided tablet in the waiting room prior to a clinic visit, MM patient engaged with the Carevive CPS to report symptoms and concerns resulting in an auto-generated care plan that is reviewed by the clinician, who approves or rejects recommendations at the point of care. The study’s primary aim is to examine provider use of evidence-based symptom care behaviors (education, recommended interventions) in study participants compared to historical controls. This analysis focuses on symptoms and concerns of intervention participants, as well as provider care behaviors for these individuals, determined by which evidenced-based recommendations were retained. Summary: To date, 38 MM patients on active treatment have enrolled. Patients ranged in age from 36-89 (mean age=60.4). 55.3% of patients (n=21) were on Dexamethasone, 42.1% (N=16) were on bortezomib (Velcade), and 39.5% (n=15) were on lenalidomide (Revlimid). Physical symptoms of fatigue, peripheral neuropathy (PN) and diarrhea were the most prevalent. 75% (n=27) of patients reported experiencing some level of tiredness/fatigue within the previous week, with 67% reporting a moderate to severe level (mean 4.7 (1-10 severity scale)). 60.5% (n=23) reported PN of whom, 69.6% (n=16) reported painful PN. 37% (n=14) reported diarrhea, of which 57% reported this symptom frequently-almost always. Patients reported being most concerned with: (1) making the right treatment decision (47.4%), (2) understanding (their) treatment plan (44.7%), and (3) managing fatigue (31.6%). 100% of care plan recommendations for patients experiencing moderate to severe levels of fatigue were accepted by providers and delivered to patients (i.e., consider starting a supervised exercise program), with 68% of the associated tasks being accepted and delivered (i.e., schedule an appointment with a physical/occupational therapist to develop an exercise plan). 92% of patients received a recommendation to learn about MM treatments and side effects with 100% acceptance and delivery. Conclusions: Physical symptoms were highly prevalent; largely of moderate to high severity. Providers instituted both evidence-based proactive and reactive symptom management strategies. Interestingly this included a high rate of acceptance for referrals to physical therapy to manage fatigue, highlighting the recognized role of cancer rehabilitation as a treatment strategy. Even with high symptom prevalence and severity, patient top concerns were predominantly understanding and making decisions about treatment; supporting the need to address treatment education and decision-making support with symptom management.
