Side Effects Understanding Cancer Multiple Myeloma

Getting Care for Symptoms & Side Effects

Multiple MyelomaMultiple myeloma and its treatment often cause side effects. In addition to providing treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting survivors with their physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting cancer survivors and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, people who receive both types of treatment often have less severe symptoms, experience better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. For people with myeloma, supportive care to reduce symptoms and complications may include the following:
• Antibiotics and intravenous immunoglobulins (a blood product given through an IV, and known as IVIG) are given to treat or prevent infections.
• Pain medications, or analgesics, are given to people who need help managing bone pain. They can include a wide range of drugs, from acetaminophen (Tylenol) to opiates. Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided.
• Antiviral medications may be given to treat or prevent viral infections, such as herpes zoster, particularly for those who are being treated with a proteasome inhibitor.

Drink an adequate amount of water to flush the kidneys and help them filter impurities from the blood.• A blood thinner may be recommended to help prevent blood clots in people who are being treated with a combination of an immunomodulatory agent and dexamethasone, which is a steroid.
• Antidepressants are frequently prescribed not only to help people cope with this normal reaction to a cancer diagnosis but also sometimes to treat painful neuropathy that can be caused by the myeloma itself or by treatments for myeloma.
• Antacids or proton pump inhibitors are frequently given to people who are taking steroids to prevent or treat gastrointestinal problems.
• Some people may undergo plasmapheresis, which is a procedure used to reduce the thickness of the blood and relieve the related symptoms. During this procedure, blood is taken from a vein. The plasma – or the liquid part of the blood – is then removed from the body after it is separated from the red and white blood cells. The blood cells are then mixed with a plasma substitute, usually an albumin solution, and placed back into the person. This procedure is often done using a blood cell separator.
• Bisphosphonates – drugs that increase bone density – are given to help with bone pain and reduce the risk of fractures. These drugs also prevent high levels of calcium in the blood, thereby reducing the effects of having too much calcium circulating in the blood.
• Exercise is recommended to maintain bone strength, reduce calcium loss, and help prevent fatigue.
• Drinking an adequate amount of water is very important, and people with multiple myeloma are encouraged to drink water and other healthy fluids so the body can flush the kidneys and help them filter impurities from the blood.
• A balanced diet that is high in calories and protein is recommended to help prevent fatigue and infection, as is getting plenty of rest and reducing stress.
• Emollient or moisturizing cream and supplements may be recommended to help with specific side effects, such as peripheral neuropathy.

You may also receive palliative treatments similar to those used to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. For example, surgery may be used to relieve pressure from a plasmacytoma on the spine or other organs. 

More recently, procedures to relieve pain, restore lost height due to a collapsing vertebra, and strengthen the spine have been investigated. One such procedure is kyphoplasty, in which doctors inflate a balloon between vertebrae to clear the space, then remove the balloon and inject bone cement to stabilize the spine. Another procedure is vertebroplasty, which involves injecting bone cement to stabilize fractures in the spine. 

Before treatment begins, talk with your healthcare team about the potential side effects of your specific treatment plan, as well as your palliative care options. Make sure to discuss the goals of each treatment in your palliative care plan. During and after treatment, be sure to tell your doctor or another healthcare team member if you are experiencing a problem so it can be addressed as quickly as possible. 

This article is an edited exerpt from Multiple Myeloma: Treatment Options from Cancer.Net. All rights reserved.

This article was published in Coping® with Cancer magazine, September/October 2017.