Comprehensive Nursing Care May Offer Better Outcomes for Patients With Myeloma and Cardiac Dysfunction

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Numerous renal and cardiac indices as well as quality-of-life measures were improved with a comprehensive vs routine nursing care model.

Patients with multiple myeloma and cardiac dysfunction who were treated with comprehensive care, defined as modern nursing practices that hinge on holistic concepts, experienced significantly improved cardiac and renal function, treatment compliance, self-care abilities, and quality of life, according to a study published in the American Journal of Translational Research.

The treatment compliance rate in the experimental comprehensive care group was 92.86% vs 68% in patients who received routine nursing care. Additionally, statistically significant differences in favor of comprehensive care were noted in levels of left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), glomerular filtration rate (GFR), serum creatinine, and uric acid (P <.05).

“Patients with [multiple myeloma] combined with cardiac dysfunction have poor prognosis, and more than half of them will die from cardiac failure or cardiac arrhythmia,” the authors wrote. “Therefore, the key task of care for patients with [multiple myeloma] is to encourage them to face life positively and improve negative emotions, treatment compliance, self-care ability, and the quality of life through personalized and comprehensive care.”

In total, 53 patients who meet International Myeloma Working Group criteria for multiple myeloma and had cardiac dysfunction who were admitted to the hospital from May 2019 through May 2020 were analyzed. Of those, 25 were treated in the control group and 28 were treated with comprehensive care. No significant differences between the 2 groups at baseline were noted. All patients received bortezomib (Velcade), thalidomide, and dexamethasone.

Routine nursing care included educating patients about necessary precautions, administering medications, and giving dietary guidance. Comprehensive care included everything comprised in routine care plus a dedicated multidisciplinary team to administered health education, psychological counseling, dietary guidance, and medication guidance.

Prior to intervention, no differences in LVEF, BNP, NT-proBNP, GFR, serum creatinine, or uric acid were noted. After intervention, LVEF was significantly improved in the experimental vs control group at 71.64% ± 12.38% and 56.22% ± 10.13%, respectively. Similarly, BNP (91.05 ± 4.38 ng/L vs 111.49 ± 4.96 ng/L), NT-proBNP (482.43 ± 12.94 ng/L vs 561.52 ± 11.15 ng/L), GFR (71.64 ± 12.38 ml/min vs 56.22 ± 10.13 ml/min), serum creatinine (94.31 ± 25.83 ummol/L vs 123.76 ± 35.24 ummol/L), and uric acid (300.58 ± 36.17 umol/L vs 362.74 ± 41.66 umol/L) were all improved with comprehensive care.

The exercise and self-care agency scale (ESCA scale) using a 5-point scale, ranging from 0 indicating completely inconsistent to 4 indicating very consistent self-care abilities, was used to evaluate patients before and after care. Notably improved scores were reported for patients treated with comprehensive care (P <.05). Looking at quality-of-life using the Generic Quality of Life Inventory-74 (GQOL-74) scale which measures physical, psychological, social, and material life before and after intervention indicated similarly improved outcomes with comprehensive care (P <.05).

“In conclusion, comprehensive care is worthy of clinical application. Instead of routine nursing care, the innovation of this study was to introduce comprehensive care model into the nursing work of patients with [multiple myeloma] combined with cardiac dysfunction, which emphasized on patient’s medication, physical, mental, and psychological status…to avoid careless omission that may lead to patients’ loss of confidence in treatment,” wrote the authors.

Limitations of this study included its small sample size, insufficient follow-up time, and incomplete monitoring of cardiac and renal function. To address this, the authors noted that a study with a larger sample size including multiple treatment regions and more comprehensive indices monitoring could provide more robust evidence in favor of comprehensive care for this patient subset.

References

Xu J, Bai R. Effects of comprehensive care in patients with multiple myeloma with cardiac dysfunction. Am J Transl Res. 2021;13(5):4844-4851.