4.1 Treatment intent
The natural history of MM is complex, and treatment aims may change throughout the disease course. It’s also important to note that MM is an incurable cancer, and nearly all patients will eventually relapse after each line of therapy.
The intent of treatment can be defined as one of the following. For MM:
- to obtain deep remission for durable disease control
- to improve quality of life and/or longevity without expectation of deep remission
- symptom
For solitary plasmacytoma:
- potential
The treatment intent should be established in a multidisciplinary setting, documented in the patient’s medical record and conveyed to the patient and carer as appropriate.
The potential benefits need to be balanced against the morbidity and risks of treatment.
The lead clinician should discuss the advantages, and disadvantages of each treatment and associated potential side effects with the patient and their carer or family before treatment consent is obtained and begins so the patient can make an informed decision. Supportive care services should also be considered during this decision-making process. Patients should be asked about their use of (current or intended) complementary therapies (see Appendix D).
Timeframes for starting treatment should be informed by evidence-based guidelines where they exist. The treatment team should recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients.
Initiate advance care planning discussions with patients before treatment begins (this could include appointing a substitute decision-maker and completing an advance care directive). Formally involving a palliative care team/service may benefit any patient, so it is important to know and respect each person’s preference (Australian Government Department of Health 2021a).