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Due to new therapeutic options, patients with newly diagnosed and relapsed multiple myeloma are living longer than they did just one decade ago. Therefore, patients' general health must also be maintained throughout the course of their disease. Proper maintenance of pre-existing or co-morbid conditions can improve quality of life and extend survival.

The following is a description of additional health issues that multiple myeloma patients may face along with the screening recommendations for each.

Cardiovascular

 

Health Condition Diagnosis Screening Process  Prevention*
Hypertension (high blood pressure)

Determined upon the average of two or more properly measured readings at each of two or more office visits after an initial screening.

Hypertension blood pressure readings show a systolic of 140 mmHg or higher and diastolic of 90 mmHg or higher

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Frequency of Screening:

Normal: every 2 years

Prehypertension: every year Stage I Hypertension: Confirm within two months (systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-99 mmHg).


Stage II: Evaluate within one month (systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 100 mmHg or higher).


Hypertensive crisis: immediate attention required (higher than 180/110 mmHg)

 

 

 

 

 

 

 


 

 

Prevention:


Weight loss

Low sodium diet

Reduced alcohol consumption 

Increased physical activity  

 

 

 

 

 

 

 

 

 

 

 

 

Hyperlipidemia 
(high cholesterol)
 

 

 

 

Diagnosed by the results of a fasting lipoprotein profile including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol (HDL), and triglycerides.

 

 

 

Frequency of Screening; **
Men older than 35: every 5 years (if results are normal)

Men aged 20-35: every 5 years unless they are at increased risk for heart disease

Women older than 20: screen only if at an increased risk for heart disease


 

Prevention: 
Weight control 

Dietary changes

Regular physical activity

Smoking prevention or cessation

 

 

 

* Depending on a patient’s co-morbid conditions, the treatment of hypertension varies. Multiple myeloma patients who are diagnosed with hypertension should discuss the treatments they require with a cardiovascular specialist.

** The U.S. Preventative Services Task Force makes no recommendations for or against routine screening for lipid disorders in men ages 20-35 or in women ages 20 or older who are not at risk for coronary heart disease.

More information and guidelines can be found at:

•    American Heart Association
•    2017 Guideline by the American College of Cardiology/American Heart Association (ACC/AHA)
•    National Cholesterol Education Program [NCEP], 2002

Malignancies

Multiple myeloma patients should continue to be screened for other malignancies throughout the course of their disease, especially if they have a genetic predisposition to other cancers. Some patients do develop secondary cancers. Proper screening and preventative measures can treat these malignancies should they develop.

Health Condition Screening Process
Breast Cancer
(Over production of cells in the breast that develop into a cancerous tumor)
 
Women aged 40 and older should be checked using mammogram technology every 1 to 2 years 
Cervical Cancer
(Abnormal cells of the cervix -the canal between the uterus and vagina)
 
Initial Screening: 3 years after a woman becomes sexually active (but no later than 21 years old)
Frequency: every 3 years  
 

Skin Cancer
(Collection of abnormal skin cells. Usually found in moles or other spots on the skin)

 

 

 

 

 

 

 

 

 

Screening: 
Visual examination criteria: 

 A = asymmetry (one half of the mole does not match the other half).


B = border irregularity (edges of the mole are ragged, notched, or blurred).


C = color (pigmentation of the mole is not uniform, with varying degrees of tan, brown, or black)

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D = diameter of more than ¼ inch (about the size of a pencil eraser).


E = evolving (the mole is changing over time).

Colorectal Cancer
(Abnormal cells in the colon or rectum)
 

Stool Test: checks for the presence of blood in the stool

Colonoscopy: To check inside the colon and rectum for abnormalities

Flexible sigmoidoscopy: To check the lower colon for abnormalities

Multi-targeted stool DNA testing: stool sample that checks for DNA mutations and blood

CT colonography: Using X-rays to see images of the colon

Prostate Cancer
(Abnormal cells in the prostate)
 

Two types of screening: 

1.    Prostate-specific antigen (PSA) blood test: Checks for high amounts of PSA. However high PSA does not always indicate prostate cancer

2.    Digital rectal exam: doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for lumps or anything else unusual

More information and guidelines can be found at:

 

Endocrine Disorders

Health Condition What Is It? Screening Process

Diabetes Mellitus Type 2 

 

 

 

 

The pancreas struggles to produce enough insulin. 

Myeloma patients have increased blood sugar levels, especially those on a long-term steroid therapy treatment.

 

 

 

Various kinds of blood tests including:

A1C (reflects average blood sugar levels for the past 2-3 months)

Glucose tolerance test (determines how well your body processes sugar)

Fasting blood glucose

Thyroid Dysfunction The thyroid cannot make enough of the correct hormones Blood tests that measures the amount of TSH (Thyroid Stimulating  Hormone) in the blood. Also known as a serum TSH test. 

*Patients receiving treatment for multiple myeloma can have an increased incidence of hyperglycemia (high blood sugar) when dexamethasone is incorporated into their regimen. The incidence of high blood sugar is actually prevalent in all steroid users.

More information and guidelines can be found at:
•    USPSTF guidelines and recommendations for the screening of Type 2 Diabetes.
•    USPSTF guidelines and recommendations for the screening of Thyroid Dysfunction.
 

Sensory Health

Health Benefits What Is it? Screening Process
Vision issues Multiple myeloma patients with comorbidities such as diabetes, hypertension, or a family history of ocular disease, may be at greater risk for vision health issues.  Routine vision checks as advised by a healthcare professional 
Hearing issues Most patients with multiple myeloma are older adults with a median age at diagnosis between ages 68 to 70. Therefore, screening for hearing loss is essential.

Frequency: 

Before age 50, tests should be conducted every 10 years 

Patients 50 and older should be screened every 3 years


More information and guidelines can be found at:
•    National Eye Institute 
•    American Academy of Opthamology 
 

Addiction and Substance Abuse

Health Condition Screening Process How is it treated?

Smoking
Patients with myeloma are already at greater risk for shortness of breath (dyspnea) and smoking will worsen this condition

Can also cause other cancers

Increases the risk of pulmonary infections

 

Health care providers will ask if you are an active smoker

 

 

 

 

Counseling following guidelines to stop the use of tobacco in myeloma patients

 

 

 

 

Alcohol 

Contributes to increased risk for liver disease, high blood pressure, inflammation of the pancreas, cancer, and mental dysfunction

 

 

 

 

 

Health care providers will ask if you about your alcohol consumption

 

 

 

 

 

Counselling: 

Face-to-face sessions

Written self-help materials

Computer-based programs

Telephone counselling

During counseling, healthcare professionals work with patients on various strategies, such as action plans, drinking diaries, stress management, and problem-solving.

More information and guidelines can be found at:
•    USPSTF guidelines and recommendations for the screening of Alcohol Misuse.
 

Oral Hygiene

Type of Immunization Why It's Important for Myeloma Patients
Influenza Vaccine

For the general population, but also essential for immunocompromised (myeloma) patients. 

Should be offered in early autumn, however, can be offered year-round when an outbreak is detected in the community. 

Pneumococcal Vaccine

Immunocompromised patients with multiple myeloma are at risk for developing pneumococcal disease. 
There are two types of the vaccination: 

1. the pneumococcal polysaccharide vaccine

2. the pneumococcal conjugate vaccine

Tetanus Booster 

 

Recommended every 10 years

 

Post-transplantation vaccinations

After transplantation, a patient remains immunocompromised for 6-12 months. 

Immunizations such as polio, tetanus toxoid, diphtheria toxoid, pneumococcus, hepatitis B, haemophilus influenzae type B conjugate, and measles, mumps, and rubella, should be given to the patient as per the recommendations of the transplantation center.

Coronavirus Vaccine Learn more about COVID-19 Vaccinations and Myeloma Patients here

Oral Hygiene

Oral Hygiene Health Screening Risk Factors

General dental care includes brushing teeth twice daily, cleaning between the teeth daily with floss or an interdental cleaner, and seeing the dentist regularly for examinations (including X-rays, if warranted), and professional cleaning.

Minimum twice-yearly visits to the dentist is required to maintain good oral hygiene.

For myeloma patients there is risk of reduced blood flow to the bone in the jaw which can be prevented, diagnosed, and treated by an oral health care provider

Direct inspection and palpation (feeling with the fingers or hands) of the oral cavity is the most recommended method of screening for oral cancer, which can be completed by a dentist during routine visits.

 

 

 

 

Smoking: increases risk for oral cancer


Alcohol Combined with Smoking: increases risk of oral cancer 

More information and guidelines can be found at:


•    American Dental Association’s Oral Health Recommendations
 



The International Myeloma Foundation medical and editorial content team

Comprised of leading medical researchers, hematologists, oncologists, oncology-certified nurses, medical editors, and medical journalists, our team has extensive knowledge of the multiple myeloma treatment and care landscape. Additionally, Dr. Brian G.M. Durie reviews and approves all medical content on this website.

Last Medical Review: August 1, 2019

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