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Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit™.

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Medical Crossfire®: Management of Adverse Events Associated with Therapies for Hematological Disorders: Nurses' Perspective PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap



1 of 3

Multiple Myeloma: Recap of Case-Based Discussion

Medical Crossfire®: Management of Adverse Events Associated with Therapies for Hematological Disorders: Nurses' Perspective featured nationally recognized experts in the management of hematologic disorders. Program Chair Michael Mauro, MD; along with faculty, Ajai Chari, MD; Sandra Allen-Bard, NPc, MSN, ANCC, AOCNP; and Patrick Spencer, RN, OCN, discussed challenges encountered by clinicians treating patients with hematologic malignancies, exchanged perspectives on unmet needs in the field of treatment-associated toxicity management, offered suggestions for optimizing care, and review current and emerging standards of care in this setting.

The first of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on a panel discussion promoting awareness of adverse events associated with several different classes of treatments for hematologic malignancies. The faculty used a case presentation of a patient with multiple myeloma to address several commonly encountered treatment associated-toxicities, beginning with infusion reactions associated with monoclonal antibody therapies. The faculty offered several measures that could be taken to mitigate potential problems associated with an initial infusion of daratumumab.

The faculty also addressed adverse events seen with other classes of multiple myeloma therapies, including steroids, conventional chemotherapy, immunomodulatory drugs, proteasome inhibitors, and histone deacetylase inhibitors.

Steroids are very important in lymphoid and plasma cell malignancies, but require education regarding their effect on blood sugar, as well as the potential for sleep difficulties, gastritis, and other challenges.

Conventional cytotoxic chemotherapy approaches are still used for hematologic malignancies. Education regarding medication administration and side effects is important to optimize outcomes.

Immunomodulatory drugs are commonly used, and clinicians and patients alike need to be particularly mindful of potential for thrombosis, particularly when they are used in combination with steroids. There is also potential for myelosuppression, diarrhea, and neuropathy with these drugs.

Proteasome inhibitors carry challenges such as neuropathy, hypertension, cardiac toxicities, and gastrointestinal symptoms.

HDAC inhibitor therapy has significant nursing implications due to its association with emergence of grade 3/4 diarrhea. Prophylaxis can help to mitigate symptoms.

For more on this discussion, visit www.gotoper.com.



2 of 3
PER Pulse™ Recap

Medical Crossfire®: Management of Adverse Events Associated with Therapies for Hematological Disorders: Nurses' Perspective featured nationally recognized experts in the management of hematologic disorders. Program Chair Michael Mauro, MD; along with faculty, Ajai Chari, MD; Sandra Allen-Bard, NPc, MSN, ANCC, AOCNP; and Patrick Spencer, RN, OCN, discussed challenges encountered by clinicians treating patients with hematologic malignancies, exchanged perspectives on unmet needs in the field of treatment-associated toxicity management, offered suggestions for optimizing care, and reviewed current and emerging standards of care in this setting.

The second of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on a panel discussion of strategies to stay ahead of treatment-related adverse events, focusing on a patient with chronic myeloid who is treated with tyrosine kinase inhibitor (TKI) therapy. The faculty offered the following perspectives:

It is imperative for nurses to be able to prepare patients for potential toxicities associated with TKIs, even second and third generation TKIs. Cardiovascular toxicities are quite common, and familiarity with different TKIs and their individual toxicities can help to tailor therapy. Data from frontline and second-line setting studies, such as PACE and ENESTnd, have established the prevalence of cardiovascular toxicities. It is important for cardiovascular assessment to take place with TKI therapy.

Myelosuppression also needs to be addressed with TKI therapy, as does the potential for hepatotoxicity and pancreatic toxicity, as well as fluid retention. Careful monitoring is also essential to mitigate toxicities associated with other classes of therapy.

For more on this discussion, visit www.gotoper.com.


3 of 3
PER Pulse™ Recap

Medical Crossfire®: Management of Adverse Events Associated with Therapies for Hematological Disorders: Nurses' Perspective featured nationally recognized experts in the management of hematologic disorders. Program Chair Michael Mauro, MD; along with faculty Ajai Chari, MD; Sandra Allen-Bard, NPc, MSN, ANCC, AOCNP; and Patrick Spencer, RN, OCN, discussed challenges encountered by clinicians treating patients with hematologic malignancies, exchanged perspectives on unmet needs in the field of treatment-associated toxicity management, offered suggestions for optimizing care, and reviewed current and emerging standards of care in this setting.

The third of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on a panel discussion of management of treatment-related adverse events in special patient populations as well as the vital role that nurses play in patient education and multidisciplinary communication. The faculty offered the following perspectives:

Management of geriatric patients with hematologic malignancies may be challenging, and dose modifications of different treatments may be required. The logistics of patient travel and the ability of the patient to tolerate different treatments may also influence treatment adherence. Polypharmacy is an obstacle to achieving patient outcomes that must be addressed, and nurses play a vital role in helping to overcome this and other obstacles through support, communication, and education.

Younger patients may also have challenges with treatment adherence, and education can help to improve patient insight into the nature of their hematologic malignancies and the need for treatment. Supportive organizations for younger patients are also available.

A multidisciplinary approach can help to optimize outcomes and facilitate patient engagement in the treatment decision-making process. Nurses can help to assess patient needs and manage anxiety related to treatment challenges. Open communication regarding potential adverse events associated with treatments should take place. There are multiple barriers to optimal patient adherence to treatments for hematologic malignancies, which must be recognized and addressed by clinicians.

There are validated assessment tools that can help to enhance management of patient symptoms. Severity of patient-reported symptoms may not correlate with those recorded by clinicians, and adherence to treatment commonly may decline over time. Patient socioeconomic factors, including cultural differences, also need to be addressed. There are several resources that are available to share with patients who are being treated for hematologic malignancies.

For more on this discussion, visit www.gotoper.com.







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