Table 3 Adherence of the hematologists-oncologists to the recommended guidelines for monitoring patients with multiple myeloma

Monitoring vital signs, hematologic issues, kidney, and liver functions

1

Assess the vital signs at each encounter, measure, and document the body mass index at least once at the beginning of the treatment and whenever there is a change

[1, 10]

2

Order and evaluate complete blood count with differential to screen for hematologic issues including anemia, neutropenia, and thrombocytopenia before each chemotherapy session and for follow-up

[10, 16, 29,30,31,32]

3

Order and evaluate kidney function tests and liver function tests before each chemotherapy session and for follow-up

[10, 16, 29,30,31,32]

4

Counsel the patients about the alarming symptoms that require immediate medical help at the beginning of the treatment and whenever there is a need

[10, 16, 29, 30, 32]

Monitoring and maintaining bone health

1

Order and evaluate calcium, vitamin D, alkaline phosphatase, electrolytes, and phosphorus levels to monitor bone health at the beginning of the treatment and for follow-up

[6, 10, 37, 38]

2

Prescribe calcium and vitamin D supplements whenever there is a need

[10, 37]

3

Prescribe bisphosphonates at the beginning of the treatment, when there are no contraindications, and whenever there is a need

[10]

4

Screen for medication problems related to bone health during treatment and whenever the patient complains about issues

[14, 39]

5

Refer patients to orthopedic surgeons for vertebroplasty, kyphoplasty, or surgical fixation when there is a need

[10, 40, 41]

Monitoring and managing pain

1

Assess pain including neuropathy at the beginning of treatment, whenever the patient complains about pain, and whenever there is a need

[2, 3]

2

Order and evaluate the physical examination and radiologic imaging (i.e., x-ray, magnetic resonance imaging, positron-emission tomography, computed tomography, bone survey, and bone density tests) to evaluate any new pain and whenever there is a need

[16, 30,31,32]

3

Prescribe analgesics including narcotics to manage pain whenever there is a need

[4, 5]

4

Prescribe medications to reduce pain and anxiety before performing painful and stressful procedures whenever there is a need

[46]

Monitoring mobility, physical activity, mental health, and well-being

1

Asses physical activity habits and adherence to healthy behaviors at the beginning of treatment and whenever there is a need

[39, 42]

2

Asses alcohol and tobacco use at the beginning of treatment and whenever there is a need

[39]

3

Asses cardiovascular and pulmonary fitness at the beginning of treatment and whenever there is a need

[14, 16, 29, 30, 39]

4

Screen for fatigue and its contributing factors including endocrine, electrolyte, sleep, and other dysfunctions at the beginning of treatment and whenever there is a need

[39, 43]

5

Asses arthritis and musculoskeletal issues including steroid myopathy at the beginning of treatment, during treatment, and whenever the patient complains about issues

[16, 30, 32, 45]

6

Screen for emotional distress including depression and anxiety whenever the patient complains about issues and whenever there is a need

[44, 45]

7

Screen for nutritional deficits and refer patients to a nutritionist at the beginning of treatment, whenever the patient complains about issues, and whenever there is a need

[14, 39]

8

Prescribe a tailored physical activity plan to help maintain balance, strength, and fitness at the beginning of treatment and whenever there is a need

[39, 42, 43]

9

Recommend patients to use a cane or walker to help them with mobility whenever there is a need

[10]