Editing Patient Pathways: Myeloma (section)

= Patient pathway =

Creating a comprehensive plan for myeloma treatment includes steps from initial presentation and diagnosis to treatment and follow-up. Below is a detailed plan:

<span id="diagnostics"></span>
== 1. Diagnostics ==

The patient presents with symptoms of decreased physical fitness, stiffness, fatigue, and less commonly loss of appetite, nausea, vomiting, or weight loss.

Consultation with a general practitioner (GP): The patient visits a general practitioner.

Medical history and physical examination: A detailed history of the patient’s illness.

Initial tests: gynecological examination, Pap test, HPV testing

'''Referral to a specialist'''

Referral to a radiologist and oncologist.

'''Diagnostic evaluation'''

''Physical examination ''Laboratory tests ''Hematological and biochemical tests, urine tests ''Imaging (CT, PET/CT) ''Computed tomography (CT) ''Magnetic resonance imaging (MR) ''Positron emission tomography (PET) ''Bone marrow biopsy ''Tests for monoclonal proteins ''Genetic molecular tests

<span id="treatment"></span>
== 2. Treatment ==

'''Multidisciplinary Team (MDT) meeting'''

'''MDT discussion:''' Review of diagnostic findings with specialists including endocrinologists, surgeons, oncologists, radiologists and pathologists.

'''Development of a treatment plan:''' Based on the stage of the myeloma and the patient’s general health.

'''Treatment options'''

'''Chemotherapy:''' Used to kill or slow the growth of cancer cells. It is usually used in combination with other medications for better results.

'''Immunotherapy:''' This method uses the patient’s own immune system to fight cancer. Drugs such as monoclonal antibodies or CAR-T cell therapy may be included in this approach.

'''Steroid therapy:''' Steroids such as dexamethasone can help control symptoms and reduce the number of tumor cells.

'''Biological therapy:''' This therapy uses substances that come from natural sources or are synthesized in the laboratory to help the body fight cancer. Examples include drugs like bortezomib or lenalidomide.

'''Stem cell transplantation:''' This procedure involves replacing damaged or diseased blood cells with healthy stem cells. Transplantation can be autologous (using the patient’s own stem cells) or allogeneic (using donor stem cells).

'''Radiation:''' It can be used to treat specific lesions or to control bone pain.

'''Support and symptomatic treatment:''' Includes treating symptoms such as pain, anemia, infections, and kidney problems.

<span id="after-treatment-follow-up-rehabilitation-and-survivorship"></span>
== 3. After treatment: follow-up, rehabilitation and survivorship ==

'''Follow-up'''

'''Regular checkups:''' patients will see their oncologist regularly to monitor their response to treatment and to identify any side effects or complications. Checks include physical exams, lab tests, and imaging.

'''Laboratory tests:''' Monitoring of blood protein levels, such as beta-2-microglobulin, and urinalysis to assess kidney function and detect any signs of relapse.

'''Immunological tests:''' Checking the number and function of plasma cells in the bone marrow to monitor disease progression.

'''Imaging tests:''' MRI, CT scans or PET scans can be used to monitor any changes in the bones or to identify new lesions.

'''Rehabilitation'''

'''Physical Rehabilitation:''' Physical rehabilitation programs can help maintain mobility, strengthen muscles, and reduce pain. Exercises are often tailored to the patient’s condition.

'''Psychological Support:''' Psychological help, such as therapy or support groups, can help patients cope with the emotional and mental challenges of the disease.

'''Nutritional Support:''' A nutritionist can help create meal plans that support bone health and overall well-being, and help prevent or treat side effects such as loss of appetite or nausea.

'''Symptom Control:''' Includes managing pain, anemia, and other symptoms caused by the disease or its treatment.

'''Survivorship'''

'''Monitoring long-term effects:''' Long-term survival may involve monitoring for any long-term effects of treatment, such as kidney problems, osteoporosis, or cardiovascular problems.

'''Planning for relapse:''' In case of recurrence of the disease, it is important to have a plan for re-treatment, which may include changing therapy or additional treatment methods.

'''Healthy lifestyle:''' Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding unhealthy habits, can help maintain overall health and prevent complications.

'''Support from family and friends:''' Involving loved ones can provide emotional and practical support, which can significantly improve quality of life.

<span id="palliative-care-if-applicable"></span>
== Palliative care (if applicable) ==

'''Palliative treatments:''' To relieve symptoms and improve quality of life in advanced cancer.

'''Pain management:''' Medications, nerve blocks.

'''Symptom control:''' Management of shortness of breath, pain, etc.

'''Hospice care:''' For end-of-life care when treatment is no longer an option, for skin and mucous membrane care.

<span id="challenges-myeloma-cancer-patients-face-during-their-treatment-journey"></span>