Disease symptoms, as well as other health conditions, can have a major impact on the treatment plan for patients with myeloproliferative neoplasms.
Patient symptoms and other health issues can play a key role in determining the appropriate myeloproliferative neoplasm (MPN) treatment strategy, highlighting the importance of patient-provider communication, explained Julie Huynh-Lu.
“I just think it's so important that patients be very forthcoming with what they're experiencing, whether it's good or bad, and not be afraid to divulge that information,” Huynh-Lu, a physician assistant from The University of Texas MD Anderson Cancer Center in Houston, said in an interview with CURE®. “So, if we can change (treatment) for the better, then let's go do it.”
For example, a common symptom that patients with MPNs experience is spleen enlargement, or “splenomegaly.” Patients with splenomegaly may feel sensations of fullness after eating only small amounts, and it is essential that they bring this up with their cancer care team.
Huynh-Lu explained that a commonly used class of MPN medications called JAK inhibitors help to shrink the spleen. But if a patient does not have an enlarged spleen, they may not need to take this type of drug.
“That’s not saying that they can’t start (JAK inhibitors), but there might not be a reason to,” Huynh-Lu said. “(Spleen status) can also change the trajectory of whether or not we’re talking about splenectomy (surgical resection of the spleen) as an option. That’s not really our go-to, specifically here in our department at MD Anderson … but that can certainly lead to a conversation of whether surgery is an option.”
At every visit with Huynh-Lu and the MPN team, patients fill out the MPN10 questionnaire, which has patients rank 10 common MPN symptoms on a scale of 0 (nonexistent) to 10 (worst imaginable).
“In addition to having them fill that out, I obviously will ask them specific and pointed questions to tease out more information,” Huynh-Lu said. “A lot of times these patients may be very stable for a certain time. And they might say, ‘I'm a little bit short of breath, but not too bad.’ And then all of a sudden, six months down the line, that shortness of breath can worsen, or their spleen size can get larger. So instead, now they're saying, ‘I used to be able to eat three quarters of a hamburger, and now I'm only able to eat half of one.’ Then this can lead to the discussion of, should we change the treatment that they're on? And or are we on the right path? Do we need to make any other treatment options available to them?”
In addition to MPN-related symptoms, it is also important for patients to disclose other health complications before starting treatment.
“There are a lot of medications that can affect the kidney or liver and others that can also effect the heart, so there can be some contraindications for certain treatment options, especially for patients with an extensive cardiac history,” Huynh-Lu said.
Interferons, which are a type of drug that can be used to treat polycythemia vera (a subtype of MPN) may not be appropriate for patients who have a history of depression or autoimmune diseases.
Huynh-Lu noted that bringing along a family member or close friend may help patients ensure that all pertinent information is being communicated with the health care team.
“It’s nice to have a family member or friend who can remember certain things and maybe (the patient) didn’t remember to ask or forgot to jot down.”
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