WHAT WAS LEARNED

In the treatment of MPNs, ruxolitinib has been shown to help cut fatigue symptoms by almost 50% compared with many standard therapies, such as hydroxyurea, interferon, pipobroman, anagrelide, and immunomodulators. Ruxolitinib can reduce spleen size, resulting in improved activity levels and helping to improve appetite. “Ruxolitinib has done really wonderfully for some patients,” said Ms Siddiq. “The majority of the patients respond very well to it, if they are presenting with symptoms. Sometimes we see improvement in symptoms in a month. In other patients, it does take a little bit longer time.”

Pruritus tends to be more common in patients with PV and the management of PV-associated pruritus is largely based on empirical evidence. Some treatments include interferon-alpha, selective serotonin reuptake inhibitors (SSRIs), and antihistamines. Other strategies include, avoidance of triggers, using emollients, and undergoing narrow band ultraviolet B (UVB) phototherapy. The authors write that some patients with MPNs may not recognize their symptoms and dismiss them as normal effects of aging. So, it is paramount that oncology nurses communicate regularly with patients to identify symptoms early. “They don’t present as sick as they think they should. So, some of it is being reassured by the nurses,” said Ms Siddiq.

The researchers recommend tracking disease progression with the MPN-10, formerly known as the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS). It is a validated instrument that quantitatively assesses the burden of symptoms in patients with MPNs. It can also help to determine response to treatment helping to improve disease management.

IMPLICATIONS FOR NURSES

The authors note that all patients with MPNs ideally should be managed in a shared-care model. This includes close collaboration between nurses, a community hematologist/oncologist, and a tertiary-care center with expertise in MPNs. Paula Grant, RN, a clinic nurse at the Rogel Cancer Center at the University of Michigan in Ann Arbor, said working closely with a pharmacist can be highly beneficial. “Having a pharmacist on board can help a lot. It can help with raising platelet counts and eating different foods that may help. The clinic pharmacists plays a key role and they can help look at the big picture,” said Ms Grant.

She has been managing patients with MPNs for more than 4 years and notes there is a lack of education when it comes to treating MPNs on both the part of the patients and nurses. “There doesn’t seem to be a lot of drug education about it. So, it is a little disappointing. The myeloma treatment plans are discussed, but they don’t talk about MPNs,” Ms Grant explained in an interview with Oncology Nurse Advisor.

She said patients are aware of a myriad of alternative treatments that they read about on the Internet. Many patients take supplements, and they hear about different products and diet issues. Knowing what patients are reading and how best to counsel them is important. “They go on the internet and they want to know if something works,” Ms Grant said. “The most important role for the oncology nurse is to anticipate and to be aware. It is a chronic condition and compliance can be an issue. I tend to go more in-depth with [these patients]. I review a lot with them on their medications and how they are tolerating them, and then I go over the side effects with them.”

Reference

1. Fowlkes S, Murray C, Fulford A, De Gelder T, Siddiq N. Myeloproliferative neoplasms (MPNs) – Part 2: a nursing guide to managing the symptom burden of MPNs. 2018;28(4):276-281.