Part of the IMF Patient Education Tools Series
Preventing Blood Clots and Thromboembolic Events
With Novel Agents for Multiple Myeloma
Patient Education Sheet: Preventing Blood Clots and Thromboembolic Events
With Novel Agents for Multiple Myeloma
KEY POINTS
TREATMENT
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TYPES OF THROMBOEMBOLIC EVENTS
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RISK FACTORS FOR CLOT FORMATION
SYMPTOMS OF DEEP VEIN THROMBOSIS
SYMPTOMS OF PULMONARY EMBOLUS
WAYS TO REDUCE CLOT RISK
SYMPTOMS OF STROKE
Note.
Note.
Reprint · June 2008 · Supplement to Volume 12, Number 3 · Clinical Journal of Oncology Nursing
Part of the IMF Patient Education Tools Series
Managing Steroid-Associated Side Effects
of Novel Agents for Multiple Myeloma
Patient Education Sheet: Managing Steroid-Associated Side Effects
of Novel Agents for Multiple Myeloma
KEY POINTS
Steroids have been an effective treatment for multiple my-
eloma, alone and in combination with other drugs, for many
years and still are used as an important part of treatment
with newer drugs known as novel therapies (thalidomide,
lenalidomide, and bortezomib). Steroids cause a wide
range of side effects, affecting nearly every system of the
body. Identifying the side effects early and managing them
quickly will contribute to successful treatment and ulti-
mately improve overall quality of life. Do not stop or adjust
STRATEGIES FOR CONTINUING TREATMENT
your medications without discussing it with your healthcare
provider.
Steroids should be taken with food.
Steroids commonly prescribed include dexamethasone, pred-
Steroids can cause sleeplessness and therefore should be
nisone, prednisolone, and solumedrol.
taken early in the morning.
POTENTIAL SIDE EFFECTS
of breath, and low blood pressure
medication to prevent gastrointestinal issues.
rash anywhere on the body; usually painful with or without
rash), and thrush (white coating on tongue, bad taste, and
painful swallowing) also may be prescribed.
Know the signs and symptoms of high and low blood sugar:
and frequent urination. If you have known diabetes, consult
with your endocrinologist or diabetes educator prior to start-
ing treatment with steroids.
they occur.
Note.
computer program to help patients and healthcare providers keep track of information and treatments.
Visit http://manager.myeloma.org to download the free software.
Note.
Reprint · June 2008 · Supplement to Volume 12, Number 3 · Clinical Journal of Oncology Nursing
Part of the IMF Patient Education Tools Series
Managing Myelosuppression From Novel Agents for Multiple Myeloma
Patient Education Sheet: Managing Myelosuppression From Novel Agents for Multiple Myeloma
The greatest concern with neutropenia is infection. Symptoms
KEY POINTS
can include fever of 100.5°F (38°C) or higher, shaking chills,
dizziness, fainting, redness at a wound site, difficulty breath-
Novel therapies used to treat multiple myeloma include
ing, cough, or sinus congestion.
thalidomide, lenalidomide, and bortezomib. The drugs can
cause myelosuppression, which is a decrease in bone mar-
If you experience fever or symptoms of infection, contact your
row activity, resulting in fewer red blood cells (anemia),
healthcare provider immediately.
white blood cells (neutropenia), and platelets (thrombocy-
topenia). The risk of side effects varies with each medica-
To reduce your risk of infection, wash your hands carefully
tion. Managing the side effects can reduce your discomfort,
and often, avoid crowds, and take antibiotics as prescribed by
prevent serious complications, and allow you to receive the
your healthcare provider.
best treatment for your myeloma. Your healthcare provider
may change your dose or schedule of medication to help
Your healthcare provider will check your blood counts regu-
manage your symptoms. Do not stop or adjust medications
larly based on your plan of care and may prescribe antibiotics
without discussing it with your healthcare provider.
to prevent infection and growth factors to stimulate white
blood cell growth. If necessary, changes may be made to
ANEMIA
medications you are taking.
Anemia is a decrease in red blood cells, or hemoglobin, which
THROMBOCYTOPENIA
carry oxygen in the blood. It may result from myeloma treat-
ment, decreased kidney function, myeloma disease, or other
Thrombocytopenia is a decrease in platelets that protect
medications.
against bleeding. It may result from myeloma treatment,
Symptoms of anemia can include fatigue, low energy level,
myeloma disease, or other medications. It may be associated
difficulty with normal daily activities, shortness of breath with
more frequently with lenalidomide and bortezomib.
activity, and chest pain with activity.
Symptoms of thrombocytopenia may include bruising, pink
If you experience symptoms of anemia, contact your health-
urine, nosebleeds, small red or purple spots on the body
care provider.
(petechiae), and bleeding that does not stop with pressure.
Try not to use too much energy in daily activities.
If you experience signs or symptoms of a low platelet count,
contact your healthcare provider immediately.
Your healthcare provider may prescribe a red blood cell
supplement such as iron, erythropoietin, or a red blood cell
To reduce your risk of bruising or bleeding, avoid taking as-
transfusion. If necessary, changes may be made in medica-
pirin, ibuprofen, or naproxen. Avoid activities that can cause
tions you are taking.
bruising or bleeding, such as contact sports, anal sex, and
heavy lifting. Participate in gentle exercise only.
NEUTROPENIA
Your healthcare provider will monitor blood counts regularly
Neutropenia is a decrease in white blood cells, which protect
based on your plan of care and may prescribe a platelet
against infection. It may result from myeloma treatment, my-
transfusion. If necessary, changes may be made in medica-
eloma disease, or other medications.
tions you are taking.
Note. For more information, please contact the International Myeloma Foundation (1-800-452-CURE; www.myeloma.org). The foundation offers the
Myeloma ManagerTM Personal Care AssistantTM computer program to help patients and healthcare providers keep track of information and treatments.
Visit http://manager.myeloma.org to download the free software.
Note. Patient education sheets were developed in June 2008 based on the International Myeloma Foundation Nurse Leadership Board's consensus
guidelines. They may be reproduced for noncommercial use.
Reprint · June 2008 · Supplement to Volume 12, Number 3 · Clinical Journal of Oncology Nursing
Part of the IMF Patient Education Tools Series
Preventing Peripheral Neuropathy From Novel Agents for Multiple Myeloma
Patient Education Sheet: Preventing Peripheral Neuropathy From Novel Agents for Multiple Myeloma
KEY POINTS
symptoms you should monitor and report to your healthcare
provider are as follows.
Peripheral neuropathy is a change in feeling in the arms,
hands, fingers, legs, feet, toes, or other body parts. It can
be a symptom of multiple myeloma or related to the use of
medications to treat myeloma, such as novel therapies tha-
lidomide and bortezomib. Managing peripheral neuropathy
can reduce pain and other symptoms and can allow you to
receive the best treatment for your myeloma. Your healthcare
Difficulty opening jars or feeling the shape of small
provider may change your dose or medication schedule to
objects in your hand
help manage your symptoms.
SYMPTOMS OF PERIPHERAL NEUROPATHY
MANAGING THE SYMPTOMS
You may have the following symptoms in toes and feet, fin-
gers and hands, or lips.
If symptoms become more severe, your healthcare provider
may recommend the following.
Always report symptoms early to your healthcare team.
You may have an examination before treatment and at vari-
ous times during treatment to see whether you have any
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you to move more easily and safely, carry out your daily ac-
ropathy affects your daily activities.
tivities, and prevent unnecessary pain and discomfort.
Note.
Myeloma Manager Personal Care Assistant
Note.
Reprint · June 2008 · Supplement to Volume 12, Number 3 · Clinical Journal of Oncology Nursing
Part of the IMF Patient Education Tools Series
Managing Gastrointestinal Side Effects of Novel Agents for Multiple Myeloma
Patient Education Sheet: Managing Gastrointestinal Side Effects of Novel Agents for Multiple Myeloma
KEY POINTS
Novel therapies used to treat multiple myeloma include thali-
immediately.
domide, lenalidomide, and bortezomib. Each of the drugs, alone
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or in combination, may be associated with gastrointestinal side
pitalization to assess fluid status and rule out bowel ob-
effects, including nausea, vomiting, diarrhea, and constipation.
Managing the side effects can reduce your discomfort and can
allow you to receive the best treatment for your myeloma. Your
healthcare provider may change your dose or schedule of medi-
International
cation to help manage your symptoms. Do not stop or adjust
MANAGEMENT OF CONSTIPATION
medications without discussing it with your healthcare provider.
ursing
TYPES OF GASTROINTESTINAL SYMPTOMS
nausea and vomiting, inability to urinate, confusion, and
N
diarrhea alternating with constipation.
-
M
tivity, and start stool softeners
ncology
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y
O
eloma
of
nied by discomfort and difficulty
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amount of fluid in the stool
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F
Journal
oundation
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MANAGEMENT OF NAUSEA
intestinal specialist may be arranged by a physician.
Clinical·3
episodes, upper abdominal pain, pain when swallowing,
·
umber
hiccups or heartburn, weight loss, dizziness on standing
citrate, lactulose, and bisacodyl
1-800-452-CURE
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up, and your medication history.
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MANAGEMENT OF DIARRHEA
12,
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syndrome, colitis, diverticulitis, and medications other
Volume
to
(2873)
upplementS·
increased or different medications and see your physician
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2008
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Reprint
eloma.org
considered for fluid replacement, a stool culture will be
MANAGEMENT OF VOMITING
ordered to see whether the diarrhea is the result of an
infection, and medications will be given to control fre-
whether digested or undigested, whether a "trigger" was
involved, whether it was new or different from other times.
stopped for a period of time, or the dose may be lowered.
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tinue medications for nausea.
Note.
Myeloma Manager
Note.