Oncology Nurses Play a Pivotal Role in Amyloidosis Management

Oncology Nurses Play a Pivotal Role in Amyloidosis Management

Although primary amyloidosis is rare, oncology nurses have a broad range of responsibilities in managing patients who develop this disorder, researchers said.

“Oncology nurses educate patients about dietary changes that help prevent edema as well as safety measures that help prevent falls and fractures and additionally teach them which medications to avoid that may cause renal deterioration,” Noel B. Mendez, RN-BC, OCN, clinical nurse in the lymphoma and myeloma inpatient unit at The University of Texas M. D. Anderson Cancer Center in Houston, pointed out.

Oncology nurses also monitor cardiac, pulmonary, and renal function and manage chemotherapy-related side effects. Although primary amyloidosis is not a type of cancer, most patients are treated with chemotherapy, he said.

There are three types of amyloidosis: primary, secondary, and hereditary, Mendez noted. Primary amyloidosis is the most common form in the western hemisphere, but only approximately 3000 patients in the United States develop the disorder each year.

Primary amyloidosis, which may occur in patients with multiple myeloma, is actually a plasma disorder that develops within bone marrow, he said. Bone marrow produces proteins to create protective antibodies against infection. Normally, the protein antibodies are broken down and reabsorb in the body. However in primary amyloidosis, the protein antibodies are not broken down and instead accumulate in the bloodstream, migrating into multiple organs and leading to an amyloid buildup.

Diagnosis is based on clinical symptoms and tissue biopsy. Criteria have been established for determining amyloid- related major organ involvement, Mendez said.

• Cardiac involvement is confirmed if an echocardiogram shows increased ventricular wall thickness and thickened valves in the absence of a history of hypertension or valvular disease. The patient with cardiac involvement also has unexplained low-voltage New York Heart Association class 2 or higher heart failure with or without ischemic heart disease.
• Kidney involvement is confirmed by a 24-hour proteinuria output greater than 500 mg.
• Peripheral nervous system involvement is confirmed by the presence of orthostatic hypotension, lower extremity sensory or polyneuropathy, chronic nausea, dysgeusia, early satiety, impotence, diarrhea, or constipation.

The primary goals of treatment are elimination of amyloid production in the bone marrow and control of symptoms, which usually involves chemotherapy, Mendez said. Besides chemotherapy, symptom management may also include treatment of underlying illness, such as infection and inflammation.

The key responsibilities of the oncology nurse are:

• Management of chemotherapy side effects, such as nausea and vomiting, infection, mucositis, pancytopenia, diarrhea and constipation, skin rash, and neuropathy
• Prevention and management of graft-versus-host disease after stem cell transplantation
• Patient education about dietary changes. Oncology nurses should make recommendations about diet with particular attention to fat, protein, and salt content depending on which organs are involved
• Safety promotion. Oncology nurses should instruct patients with peripheral nerve system involvement to avoid sudden movements that may cause dizziness due to orthostatic hypotension and to curb their salt intake. Because patients may also have amyloid deposits in their bones, physical therapy options should also be discussed
• Pain management. Oncology nurses should assess patients routinely for pain that may occur as a result of liver and spleen enlargement. Referral to a specialized pain service or palliative care service may also be necessary
• Support services. Oncology nurses should provide emotional and psychological support and should also encourage patients and their families and caregivers to ask questions. Social workers, case managers, chaplains, psychiatrists, and support groups may also be helpful.