Nurses’ Guide to Managing Symptoms of Myeloproliferative Neoplasms

Because of their clinical experience, oncology nurses can play a key role in conducting clinical research on the use of nonpharmacologic interventions for managing the symptoms associated with myeloproliferative neoplasms (MPNs), according to Canadian oncology nurse researchers. In a second of a 2-part series, Canadian nurse practitioners and specialized hematology/oncology nurses outline what are believed to be the best approaches for managing symptoms associated with the most common BCR-ABL1-negative MPNs. The authors write that that there is limited evidence on the use of nonpharmacologic interventions for treating the symptoms of MPNs.

Myeloproliferative neoplasms are rare, yet potentially life-threatening, disorders. They include essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). “The education hasn’t been great for the patients. They don’t know the symptoms they need to be looking for, and what is on the web is very general,” said study author Nancy Siddiq, RN, BScN, and clinical nurse specialist for MPNs at Princess Margaret Cancer Centre in Toronto, Ontario.

THE STUDY

The authors reviewed the most common symptoms and how to optimally manage patients. Research suggests that quality of life (QOL), functional status, activities of daily living, and work productivity are areas where nurses can help patients to adopt self-management strategies. Oncology nurses are well suited for identifying those patients who have unmet needs and could potentially benefit from a simple treatment modification. “Transfusion support and little small lifestyle changes can make a big difference,” Ms Siddiq said in an interview with Oncology Nurse Advisor.

The 10 most clinically relevant disease-related symptoms of MPNs are fatigue, concentration problems, early satiety, inactivity, night sweats, pruritus, bone pain, abdominal discomfort, weight loss, and fever. “Since patients with these MPNs can live for several years, thereby requiring long-term treatment and follow-up, nurses play an essential role in communicating with these patients, assessing their symptoms, and educating them on treatments and self-management strategies that can reduce their symptom burden,” write the authors.

Fatigue is multifactorial and may be due to a host of factors including impaired hematopoiesis, infection, thrombosis, and microvascular symptoms. The authors note that deconditioning, depression, and medication side effects may be involved in fatigue. Management can include treating the underlying factors contributing to the symptoms, such as antibiotics for an infection, red blood cell transfusions for anemia, and platelet transfusions for low platelet counts. Ms Siddiq said depression can be common in this patient population, and nurses need to query patients about problems with anxiety and depression.