NLB Guidelines for the Management of Side Effects of Novel Therapies
Written by the IMF Nurse Leadership Board, made up of experienced specialty oncology nurses, these are the first comprehensive guidelines for managing side effects from lenalidomide, thalidomide, and bortezomib used in the treatment of multiple myeloma. Published in the June 2008, Supplement to Volume 12, Number 3 of the Clinical Journal of Oncology Nursing. Use the links in each article to view either a PDF or html version.
To achieve the maximum potential of novel agents, healthcare professionals must adequately address day-to-day details of side effects. Oncology nurses are the interface between patients and treating physicians. These guidelines, developed by the dedicated team of oncology nurses serving as the Nurse Leadership Board of the International Myeloma Foundation, provide an invaluable tool for nurses positioned to intervene to help patients
The IMF believes that nurses play an essential role in managing patient care and recognizes the need for specific information concerning the use of novel antimyeloma agents as well as management of their associated side effects. To address the need, the foundation created a Nurse Leadership Board (NLB), which included 20 oncology nurses from leading cancer centers and community practices in the United States caring for patients with multiple myeloma.
Myelosuppression is a common and expected side effect of novel therapies for multiple myeloma. As a result of myelosuppression, patients may experience anemia, neutropenia, and thrombocytopenia. Depending on their severity, the side effects can have a negative impact on patients’ medical treatment and quality of life by interrupting or reducing therapy and causing life-threatening complications.
Thromboembolic events can produce life-altering complications, affecting physiologic functions such as breathing, cognition, and overall function, and should be considered medical emergencies. Thromboembolic events can permanently affect the lives of patients and their families. Impairment resulting from thromboembolic events can interfere with therapy, treatment options, drug combinations, and patient adherence. Patient education, focused nursing assessment, and proactive prophylaxis against thromboembolic events may increase positive patient outcomes.
The novel therapies thalidomide and bortezomib can cause peripheral neuropathy, a challenging adverse event that can affect quality of life and compromise optimal treatment for patients with multiple myeloma. Specific management strategies for peripheral neuropathy are based on the grade of severity and on signs and symptoms; strategies include dose and schedule modifications, pharmacologic interventions, nonpharmacologic approaches, and patient education.
The novel immunomodulatory drugs lenalidomide and thalidomide and the novel proteasome inhibitor bortezomib can cause gastrointestinal side effects, including constipation, diarrhea, nausea, and vomiting, which can have a deleterious effect on quality of life and interfere with optimal therapy. These side effects are manageable with appropriate medical interventions.
Steroids can cause a wide range of adverse events that affect almost every system of the body. In recognition of the need for specific recommendations on managing key side effects of steroid therapy for patients with myeloma, the International Myeloma Foundation’s Nurse Leadership Board developed this consensus statement for the management of steroid-associated side effects to be used by healthcare providers in any medical setting.