Dr Afsana Elanko
Senior Educationalist and Healthcare Leader
Dr Fenella Willis
Consultant Haematologist, St George’s University Hospitals, Trustee Myeloma UK
The pandemic brought uncertainty, delays and disruption in care/access to treatments for patients with a type of blood cancer — myeloma. During the pandemic, society became more aware of this vulnerable group. But as we have discarded our masks and restrictions — what does their future look like?
Myeloma is difficult to diagnose due to vague/common symptom presentation (eg. fatigue, back pain, infection).
Impact on diagnosis
During the pandemic, the entire cancer pathway was disrupted (GP access, diagnostic pathways, hospital services), which has had a significant impact on myeloma diagnosis. In 2020–2021, over 500 fewer patients were diagnosed, and patients presented late with irreversible life-changing complications (eg. spinal fractures, renal failure) resulting in increased morbidity and mortality.
Delays in diagnostic pathways resulted in a surge of activity after the lockdowns eased, increasing pressures on already overstretched NHS services. For myeloma patients, maintenance of strict infection control measures, streamlined care pathways and digital services have become the norm. Clinicians must challenge decisions on services provided to these vulnerable patients to reverse the negative impact of delayed diagnosis/treatment.
Ongoing infection risk
Myeloma patients have an eleven-fold increased infection risk and eighteen-fold risk of viral infection in the first year after diagnosis due to the immunosuppression both by the disease and treatment. Infection risk continues throughout the patient’s lifetime.
Prophylactic antibiotics used in the first 12 weeks of treatment significantly reduce the risk of febrile episodes and death from infection. Reduction in viral infection risk requires vaccination and antiviral treatments. Even with intervention, patients may not always respond optimally. Between January and March 2022, data from the Office of National Statistics showed that one in twenty-two patients who died with Covid-19 in England and Wales had blood cancer.
The clinician-patient conversations regarding easing restrictions and risks of infections with the ability to sustain a good quality of life are essential.
Priorities for patients
For blood cancer patients, it is paramount to ensure speedy vaccine rollout, timely access to Covid-19 treatments and rapid testing and fast approval of new drugs/treatments.
The clinician-patient conversations regarding easing restrictions and risks of infections with the ability to sustain a good quality of life are essential. Access to vaccination and treatments has helped, but careful consideration of potential risk and the use of masks in healthcare environments and crowded areas are also vital. Legislation for improved employment protection and development of safe-working environments remains essential for patients to remain healthy in working environments.
Impact on mental health
The last two years have seen significant increases in mental health disorders, and 72% of patients highlighted that myeloma had a moderate–high impact on their quality of life. Additionally, 30% reported a major impact on their mental health, rising to 40% when looking at the BAME (Black, Asian and Minority Ethnic) community. As services return to normal, these patients need enhanced psychological support and access to specialist medical and nursing support.