Honoring Patient Wishes in Myeloma Treatment Journeys

Continuing our discussion with The Ohio State University Comprehensive Cancer Center’s Don M. Benson, MD, PhD, hematologist-oncologist, he explains how he navigates the intricacies of conversations with patients when quality-of-life preferences may conflict with treatment goals, always keeping patient preferences top of mind. One of Benson’s top priorities it to always deliver personalized patient care by taking into account their specific type of cancer and their desires and goals for treatment.

For parts 1 through 3 of our conversation with Benson, please click on the links below:

Part 1: Elevating Myeloma Care Amidst Complex Treatment Choices

Part 2: Balancing Life and Myeloma: A Patient-Centered Approach

Part 3: Unlocking Myeloma Outcomes: The Role of Immunity

This transcript has been lightly edited for clarity.

Transcript

When patients choose quality of life over continuing treatment, how do you navigate those conversations?

There was a wonderful study published a few years ago where they looked at patient expectations as a function of where they were in the journey of their myeloma disease. It's striking, because at diagnosis, their number 1 goal—in this paper anyway—was overall survival. Nothing else mattered. And in the relapse/refractory setting, the number 1 goal, by far and away, was survival. The reason it's such an interesting paper is that that middle, that in-between, when the disease is in remission, it's all about quality of life. It's energy, fatigue, pain, cognitive function, independence, freedom. Those metrics take on substantially more meaning and importance for patients overall and beyond survival.

Myeloma is not a sprint, it's a marathon. And I think as physicians, as specialists, we need to be sensitive to where patients are in the journey. When somebody is newly diagnosed, their risk tolerance is very different than when their disease is in remission and you're trying to cajole them into taking a maintenance pill that might cause diarrhea or it might cause a rash. This is what I mean by taking into account patients' desires and goals.

I'll give you another example. We had a patient last year who was diagnosed in the early part of the year, got induction treatment, got into remission, we collected his stem cells, and then his daughter got engaged. And she wanted to get married while dad was well. The wedding was in October, and he came in and said, “I want to walk my daughter down the aisle with a full head of hair and I want to dance at her reception with a full head of hair.” And so we delayed his transplant.

That's sort of what I mean by tailoring treatment to individuals. And he's doing great, by the way; he got a transplant, he's killing it, he's doing awesome.

I can tell you with great confidence that I've taken so much more from my patients than I could ever give them. When you're confronted with your mortality and being told you have an incurable cancer, I'm truly humbled to walk into… I hesitate to even call it work. It's just a privilege to come in and be with these people. And in some way, if I can help them, that's great. But they've taught me so much more about how to live and how to love and how to sacrifice and what life really means.