Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with an increase in effective oral chemotherapy and continuous treatment. In line with the 2014-2019 cancer plan and its goals of improving oral chemotherapy safety and coordination, an innovative follow-up protocol by advanced practice nurse (APN) has been implemented at the ICLN (Institut de Cancérologie de la Loire Lucien Neuwirth). While the role of APN is well defined in North America, it is still in its infancy in France and new within haematology. This study aims to describe precisely the original management of MM patients treated with Revlimid Dexamethasone (Rd) and to evaluate the impact of advanced nursing practice on the patients' ambulatory care, regarding quality of life and safety.
Follow-up by an oncology APN was suggested for 42 MM patients who had recently been treated with Rd in the medical haematology department. Telephone calls as well as specific consultations were carried out in a complementary way, according to a predefined plan. There was a medical delegation of chemotherapy renewal and associated therapies, management of drug toxicities with dosage adjustment or discontinuation. For this retrospective qualitative study among APN intervention, data were collected between April 2017 and September 2020.
All calls and APN interventions were recorded, representing 1240 phone calls, and 162 consultations. All reasons for appeal were exhaustively analysed. Calls were more frequent in the first few months, with a high demand for information and reassurance. APN and stakeholders were on the front line, each with a direct line, enabling better coordination between the primary care team and the hospital. APN was able to manage multiple side effects, organizing hospitalizations and transfusions, saving full time in a physician job.
In order to respond to the high need for care pathway and safety improvement, we have initiated a new APN follow-up for MM patients treated with oral chemotherapy. This new profession in haematology is expected to grow and could be one of the answers to current and future health issues.
Clinical trial identification
Legal entity responsible for the study
Institut de Cancérologie Lucien Neuwirth.
Has not received any funding.
All authors have declared no conflicts of interest.