Article

Mobility and Safety in the Multiple Myeloma Survivor

Sandra Rome

Bonnie S. Jenkins

Kathryn E. Lilleby

the International Myeloma Foundation Nurse Leadership Board

survivorship care plan, multiple myeloma, physical activity, safety, survivors, cancer survivor, exercise
CJON 2011, 15(4), 41-52. DOI: 10.1188/11.S1.CJON.41-52

As in many other cancers, survivorship of multiple myeloma involves handling treatment, recovery from therapeutic interventions, the effects of the disease, and ongoing therapies. Although mobility challenges vary among survivors of multiple myeloma, these patients have an increased risk of impaired mobility because of side effects of therapy and the pathology of the disease, as well as other factors (e.g., increasing age). Health maintenance increasingly is becoming a part of the cancer control continuum, and nurses have the opportunity to help survivors of multiple myeloma optimize their functional mobility and safety, thereby preserving quality of life. The purpose of these practice recommendations is to provide the healthcare professional with information on mobility, fall risk, and planned activity as an integral part of the plan of care for patients with multiple myeloma. Tools for nurses and physicians for assessing and evaluating the newly diagnosed patient, the patient undergoing treatment, and the long-term survivor of multiple myeloma will be provided.

Jump to a section

    References

    American College of Sports Medicine. (2006). ASCMFitSociety® page. Retrieved from http://www.acsm.org/AM/Template.cfm?Section=About_ACSM&CONTENTID=6905&TEMPLATE=/CM/ContentDisplay.cfm
    Armoiry, X., Aulagner, G., & Facon, T. (2008). Lenalidomide in the treatment of multiple myeloma: A review. Journal of Clinical Pharmacology and Therapeutics, 33, 219-226.
    Asplund, R. (2005). Nocturia in relation to sleep, health and medical treatment in the elderly. British Journal of Urology International, 96(Suppl.), 15-21.
    Bartel, T.B., Haessler, J., Brown, T.L.Y., Shaughnessy, J.D., van Rhee, F., Anaissie, E., … Barlogie, B. (2009). F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood, 114, 2068-2076. doi:10.1182/blood-2009-03-213280
    Birmann, B.M., Giovannucci, E., Rosner, B., & Anderson, K.C. (2007). Body mass index, physical activity, and risk of multiple myeloma. Cancer Epidemiology Biomarkers and Prevention, 16, 1474-1477. doi:10.1158/1055-9965.EPI-07-0143
    Brenner, H., Gondos, A., & Pulte, D. (2009). Expected long-term survival of patients diagnosed with multiple myeloma in 2006-2010. Haematologica, 94, 270-275. doi:10.3324/haematol.13782
    Bux, R., Parzeller, M., & Bratzke, H. (2007). Causes and circumstances of fatal falls downstairs. Forensic Science International, 171(2-3), 122-126. doi:10.1016/j.forsciint.2006.10.010
    Cancer Therapy Evaluation Program. (2003). CTEP: Common terminology criteria for adverse events [version 3.0]. Retrieved from http://ctep.cancer.gov
    Carlson, L.E., Speca, M., Faris, P., & Patel, K.D. (2007). One year pre-post intervention follow-up of psychological, immune, endocrine, and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behavior and Immunity, 21, 1038-1049. doi:10.1016/j.bbi .2007.04.002
    Carson, J.W., Carson, K.M., Porter, L.S., Keefe, F.J., Shaw, H., & Miller, J.M. (2007). Yoga for women with metastatic breast cancer: Results from a pilot study. Journal of Pain and Symptom Management, 33, 331-341. doi:10.1016/j.jpainsymman.2006.08.009
    Celgene Corp. (2010a). Revlimid® (lenalidomide) [Product information]. Summit, NJ: Author.
    Celgene Corp. (2010b). Thalomid® (thalidomide) [Product information]. Summit, NJ: Author.
    Centers for Disease Control and Prevention. (2008). Self-reported falls and fall-related injuries among persons aged 65 years—United States, 2006. Morbidity and Mortality Weekly Reports, 57, 225-229.
    Centers for Disease Control and Prevention. (2010). Falls among older adults: An overview. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
    Christina, J.A., & Cavanagh, P.R. (2002). Ground reaction forces and frictional demands during stair descent: Effects of age and illumination. Gait and Posture, 15, 153-158. doi:10.1016/S0966-6362(01)00164-3
    Clark, M.M., Vickers, K.S., Hathaway, J.C., Smith, M., Looker, S.A., Petersen, L.R., … Loprinzi, C.L. (2007). Physical activity in patients with advanced-stage cancer actively receiving chemotherapy. Journal of Supportive Oncology, 5, 487-493.
    Cohen, M.H., & Eisenberg, D.M. (2002). Potential physician malpractice liability associated with complementary and integrative medical therapies. Annals of Internal Medicine, 136, 596-603.
    Coleman, E.A., Coon, S., Hall-Barrow, J., Richard, K., Gaylor, D., & Stewart, B. (2003). Feasibility of exercise during treatment for multiple myeloma. Cancer Nursing, 26, 410-419. doi:10.1097/00002820-200310000-00012
    Coleman, E.A., Coon, S.K., Kennedy, R.L., Lockhart, K.D., Stewart, C.B., Anaissie, E.J., & Barlogie, B. (2008). Effects of exercise in combination with epoietin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma [Online exclusive]. Oncology Nursing Forum, 35, E53-E61. doi:10.1188/08.ONF.E53-E61
    Coleman, E.A., Hall-Barrow, J., Coon, S.K., & Stewart, C.B. (2003). Facilitating exercise adherence for patients with multiple myeloma. Clinical Journal of Oncology Nursing, 7, 529-540. doi:10.1188/03.CJON.529-534
    Coon, S.K. & Coleman, E.A. (2004a). Exercise decisions within the context of multiple myeloma, transplant, and fatigue. Cancer Nursing, 27, 108-118. doi:10.1097/00002820-200403000-00003
    Coon, S.K., & Coleman, E.A. (2004b). Keep moving: Patients with myeloma talk about exercise and fatigue. Oncology Nursing Forum, 31, 1127-1135. doi:10.1188/04.ONF.1127-1135
    Courneya, K.S., & Friedenreich, C.M. (2007). Physical activity and cancer control. Seminars in Oncology Nursing, 23, 242-252. doi:10.1016/j.soncn.2007.08.002
    Culos-Reed, S.N., Carlson, L.E., Daroux, L.M., & Hately-Aldous, S. (2006). A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psycho-Oncology, 15, 891-897. doi:10.1002/pon.1021
    Dawson, J., Thorogood, M., Marks, S.A., Juszczak, E., Dodd, C., Lavis, G., & Fitzpatrick, R. (2002). The prevalence of foot problems in older women: A cause for concern. Journal of Public Health Medicine, 24, 77-84. doi:10.1093/pubmed/24.2.77
    DiStasio, S.A. (2008). Integrating yoga into cancer care. Clinical Journal of Oncology Nursing, 12, 125-129. doi:10.1188/08.CJON.125-130
    Doyle, C., Kushi, L.H., Byers, T., Courneya, K.S., Demark-Wahnefried, W., Grant, B., … the 2006 Nutrition, Physical Activity, and Cancer Survivorship Advisory Committee. (2006). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA: Cancer Journal for Clinicians, 56, 323-353. doi:10.3322/canjclin.56.6.323
    Everett, P. (2008). The prevalence of vitamin D deficiency and insufficiency in a hematology-oncology clinic. Clinical Journal of Oncology Nursing, 12, 33-35. doi:10.1188/08.CJON.33-35
    Faiman, B., Bilotti, E., Mangan, P.A., Rogers, K., & the International Myeloma Foundation Nurse Leadership Board. (2008). Steroid-associated side effects in patients with multiple myeloma: Consensus Statement of the IMF Nurse Leadership Board. Clinical Journal of Oncology Nursing, 12(3, Suppl.), 53-62. doi:10.1188/08.CJON.S1.53-62
    Ganz, D.A., Bao, Y., Shekelle, P.G., & Rubenstein, L.Z. (2007). Will my patient fall? JAMA, 297, 77-86. doi:10.1001/jama.297.1.77
    Gao, C., & Abeysekera, J. (2004). A systems perspective of slip and fall accidents on icy and snowy surfaces. Ergonomics, 47, 573-598. doi:10.1080/00140130410081658718
    Gupta, V., & Lipstiz, L.A. (2007). Orthostatic hypotension in the elderly: Diagnosis and treatment. American Journal of Medicine, 120, 841-847. doi:10.1016/j.amjmed.2007.02.023
    Hacker, E. (2009). Exercise and quality of life: Strengthening the connections. Clinical Journal of Oncology Nursing, 13, 31-39. doi:10.1188/09.CJON.31-39
    Haskell, W.L., Lee, I.M., Pate, R., Powell, K.E., Blair, S.N., Franklin, B.A., … Bauman, A. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39, 1423-1434. doi:10.1249/mss.0b013e3180616b27
    Hendrich, A. (2007). Predicting patient falls using the Henrich II Fall Risk Model in clinical practice. American Journal of Nursing, 107, 50-59.
    Hendrich, A., Nyhuuis, A., Kippenbrock, T., & Soja, M.E. (1995). Hospital falls: Development of predictive model for clinical practice. Applied Nursing Research, 8(3), 129-139. doi:10.1016/S0897-1897(95)80592-3
    Ingram, C., & Visovsky. C. (2007). Exercise intervention to modify physiologic risk factors in cancer survivors. Seminars in Oncology Nursing, 23, 275-284. doi:10.1016/j.soncn.2007.08.005
    Jones, L.W., Courneya, K.S., Vallance, J.K., Ladha, A.B., Mant, M.J., Belch, A.R., & Reiman, T. (2004). Association between exercise and quality of life in multiple myeloma cancer survivors. Supportive Care in Cancer, 12, 780-788. doi:10.1007/s00520-004-0668-4
    Jones, L.W., Courneya, K.S., Vallance, J.K., Ladha, A.B., Mant, M.J., Belch, A.R., & Reiman, T. (2006). Understanding the determinants of exercise intentions in multiple myeloma cancer survivors: An application of the theory of planned behavior. Cancer Nursing, 29(3), 167-175. doi:10.1097/00002820-200605000-00001
    Jones, L.W., & Demark-Wahnefried, W. (2006). Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncology, 7, 1017-1026. doi:10.1016/S1470-2045(06)70976-7
    Jones, L.W.Y., & Courneya, K.S. (2002). Exercise counseling and programming preferences of cancer survivors. Cancer Practice, 10(4), 208-215. doi:10.1046/j.1523-5394.2002.104003.x
    Kado, D.M., Huang, M.H., Nguyen, C.B., Barrett-Connor, E., & Greendale, G.A. (2007). Hyperkyphotic posture and risk of injurious falls in older persons: The Rancho Bernardo Study. Journal of Gerontology, 62, 652-657
    Kannus, P., Sievanen, H., Palvanen, M., Jarvinen, T., & Parkkari, J. (2005). Prevention of falls and consequent injuries in elderly people. Lancet, 366, 1885-1893, doi:10.1016/S0140-6736(05)67604-0
    Kerse, N., Butler, M., Robinson, E., & Todd, M. (2004). Wearing slippers, falls, and injury in residential care. Australia New Zealand Journal of Public Health, 28(2), 180-187.
    Kharicha, K., Iliffe, S., Harari, D., Swift, C., Gillmann, G., & Stuck, A.E. (2007). Health risk appraisal in older people. 1: Are older people living alone an "at risk" group? British Journal of General Practice, 57, 267-268.
    Kinney, J.M. (2004). Nutritional frailty, sarcopenia, and falls in the elderly. Current Opinions in Clinical Nutrition and Metabolic Care, 7, 15-20. doi:10.1097/00075197-200401000-00004
    Knobf, M.T., Musanti, R., & Dorward, J. (2007). Exercise and quality of life outcomes in patient with cancer. Seminars in Oncology Nursing, 23(4), 285-296. doi:10.1016/j.soncn.2007.08.007
    Lundin-Olsson, L., Nyberg, L., & Gustafson, Y. (1998). Attention, frailty, and falls: The effect of a manual task on basic mobility. Journal of the American Geriatrics Society, 46, 758-761.
    Maxwell, C. (2007). Role of the nurse in preserving patients' independence. European Journal of Oncology Nursing, 11(Suppl. 2), S38-S41. doi:10.1016/j.ejon.2007.07.004
    Melton, L.J., III, Rajkumar, S.V., Khosia, S., Achenbach, S.J., Oberg, A.L., & Kyle, R.A. (2004). Fracture risk in monoclonal gammopathy of undetermined significance. Journal of Bone and Mineral Research, 19, 25-30. doi:10.1359/jbmr.0301212
    Menz, H.B., & Lord, S.R. (1999). Footwear and postural stability in older people. Journal of the American Podiatric Medical Association, 89(7), 346-357.
    Menz, H.B., Morris, M.E., & Lord, S.R. (2006). Footwear characteristics and risk of indoor and outdoor falls in older people. Gerontology, 52(3), 174-180. doi:10.1159/000091827
    Miceli, T., Colson, K., Gavino, M., Lilleby, K., & the International Myeloma Foundation Nurse Leadership Board. (2008). Myelosuppression associated with novel therapies in patients with multiple myeloma. Clinical Journal of Oncology Nursing, 2(3, Suppl.), 13-19. doi:10.1188/08.CJON.S1.13-19
    Millennium: The Takeda Oncology Company. (2010). Velcade® (bortezomib) [Product information]. Cambridge, MA: Author.
    Moore, N.L., & Kiebzak, G.M. (2007). Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population. Journal of the American Academy of Nurse Practitioners, 19, 642-651.
    Morse, J.M., Morse, R., & Tylko, S. (1989). Development of a scale to identify the fall-prone patient. Canadian Journal of Aging, 8, 366-377. doi:10.1017/S0714980800008576
    Nau, K.C., & Lewis, W.D. (2008). Multiple myeloma: Diagnosis and treatment. American Family Physician, 78, 853-859.
    Oldervoll, L.M., Loge, J.H., Paltiel, H., Asp, M.B., Vidvei, U., Wiken, A.N., … Kaasa, S. (2006). The effect of a physical exercise program in palliative care: A phase II study. Journal of Pain and Symptom Management, 31, 421-430. doi:10.1016/j.jpainsymman.2005.10.004
    Overcash, J. (2007). Prediction of falls in older adults with cancer: A preliminary study. Oncology Nursing Forum, 34, 341-346. doi:10.1188/07.ONF.341-346
    Overcash, J. (2008). Vitamin D in older patients with cancer. Clinical Journal of Oncology Nursing, 12, 655-662. doi:10.1188/08.CJON.655-662
    Peel, N.M., Bartlett, H.P., & McClure, R.J. (2007). Healthy aging as an intervention to minimize injury from falls among older people. Annals of the New York Academy of Science, 1114, 162-169.
    Perell, K.L., Nelson, A., Goldman, R.L., Luther, S.L, Prieto-Lewis, N., & Rubenstein, L.Z. (2001). Fall risk assessment measures: An analytic review. Journal of Gerontology, 56A(12), M761-M766.
    Petit, W.A., Jr., & Upender, R.P. (2003). Medical evaluation and treatment of diabetic peripheral neuropathy. Clinical Podiatric Medicine and Surgery, 20, 671-688. doi:10.1016/S0891-8422(03)00068-5
    Podsiadlo, D., & Richardson, S. (1991). The timed "Up and Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148.
    Robbins, S., Waked, E., Allard, P., McClaran, J., & Krouglicof, N. (1997). Foot position awareness in younger and older men: The influence of footwear sole properties. Journal of the American Geriatrics Society, 45, 61-66.
    Rome, S.I. (2011). Nursing management: Hematologic problems. In S. Lewis, S.R. Dirksen, M.M. Heitkemper, L. Bucher, & I.M. Camera (Eds.), Medical-surgical nursing: Assessment and management of clinical problems (8th ed., pp. 661-713). St. Louis, MO: Mosby.
    Roodman, G.D. (2008). Skeletal imaging and management of bone disease. Hematology. American Society of Hematology Education Program, 313-319.
    Rubenstein, L.Z., & Josephson, K.R. (2006). Falls and their prevention in elderly people: What does the evidence show? Medical Clinics of North America, 90, 807-824.
    Schaap, L.A., Pluijm, S.M., Smit, J.H., van Schoor, N.M., Visser, M., Gooren, L.J., & Lips, P. (2005). The association of sex hormone levels with poor mobility, low muscle strength, and incidence of falls among older men and women. Clinical Endocrinology (Oxford), 63, 152-160. doi:10.1111/j.1365-2265.2005.02315.x
    Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Glavao, D.A., Pinto, B.M., … Schartz, A.L. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise, 4, 1409-1426. doi:10.1249/MSS.0b013e3181e0c112
    Schwartz, A.L. (2004). Cancer fitness: Exercise programs for patients and survivors. Emeryville, CA: Simon and Schuster.
    Schwartz, A.V., & Sellmeyer, D.E. (2007). Diabetes, fracture, and bone fragility. Current Osteoporosis Reports, 5, 105-111.
    Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the timed up and go test. Physical Therapy, 80, 896-903.
    Singh, M.A.F. (2002). Benefits of exercise and dietary measures to optimize shifts in body composition with age. Asia Pacific Journal of Clinical Nutrition, 11(Suppl. 3), S642-S652.
    Tariman, J.D., Love, G., McCullagh, E., Sandifer, S., & the International Myeloma Foundation Nurse Leadership Board. (2008). Peripheral neuropathy associated with novel therapies in patients with multiple myeloma. Clinical Journal of Oncology Nursing, 12(3, Suppl.), 29-36. doi:10.1188/08.CJON.S1.29-35
    Thurman, D.J., Stevens, J.A., & Rao, J.K. (2008). Practice parameter: Assessing patient in a neurology practice for risk of falls. Neurology, 70, 473-479. doi:10.1212/01.wnl.0000299085.18976.20
    Voukelatos, A., Cumming, R.G., Lord, S.R., & Rissel, C. (2007). A randomized controlled trial of tai chi for the prevention of falls: The Central Sydney Tai Chi Trial. Journal of the American Geriatrics Society, 55, 1185-1191. doi:10.1111/j.1532-5415.2007.01244.x
    Wilkins, K. (1999). Medications and fall-related fractures in the elderly. Health Reports, 11, 42-45.
    Wiseman, M. (2008). The Second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Proceedings of the Nutrition Society, 67, 253-256.
    Wisloff, F., Kvam, A.K., Hjorth, M., & Lenhoff, S. (2007). Serum calcium is an independent predictor of quality of life in multiple myeloma. European Journal of Hematology, 78, 29-34.
    Young-McCaughan, S., & Arzola, S.M. (2007). Exercise intervention research for patients with cancer on treatment. Seminars in Oncology Nursing, 23(4), 264-274. doi:10.1016/j.soncn.2007.08.004