In a recent review published in the Blood Cancer Journal, Yael N. Shapiro of Massachusetts General Hospital in Boston, MA, and colleagues discussed lifestyle factors that may be related to quality of life (QOL) in patients treated for multiple myeloma (MM).

As the authors described in their report, patients with MM have experienced improved prognosis as treatments have advanced, and they may spend a longer time receiving treatment than in the past. These factors necessitate adjustments in supportive care to help patients maintain QOL and functioning.

Studies that have examined physical activity in patients with MM are limited, as the authors noted in their report. One concern clinicians and patients may have regarding exercise is the presence of lytic lesions in about 80% of patients with MM. “Fear of fractures is a widespread concern and causes many MM patients to give up sports and other leisure activities,” the authors reported.

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However, the authors indicated that physical activity may be associated with both physiological and psychological benefits, based on the results of studies that are available. The authors recommended a multidisciplinary strategy for developing exercise recommendations as well as consideration of bone-directed therapies to reduce skeletal-related risks. The authors also indicated that more randomized controlled trials should be conducted on the best use of exercise in patients with MM.

The authors noted that obesity may impact survival in patients with MM. While research appears sparse on impacts of weight gain on disease activity, and regarding nutritional guidance for patients with MM, the authors indicated that diet may be modified to reduce side effects of the disease or its treatment and that meal schedules may contribute to a healthy diet. They also recommended that studies be conducted to inform nutritional guidelines for patients with MM.

Sleep quality is an additional concern for patients with MM. “The heavy psychological burden associated with the diagnosis of an incurable cancer such as MM may have a profound impact on patients’ sleep and overall QOL,” the authors wrote.

Pain and treatment-related side effects may also impact sleep quality in patients with MM. Sleep impacts on the MM disease course reflect another area of limited research in MM, but the authors pointed out that general sleep hygiene practices and other nonpharmaceutical interventions may help with sleep. Taking agents such as corticosteroids in the morning may potentially help to reduce their impact on sleep, and other pharmacologic measures may be considered as appropriate.

The authors also recommended attention to issues related to possible substance use by patients, such as with drinking or smoking. However, studies examining relationships between substance use and disease activity have been limited.

“Lifestyle interventions, including tailored physical activity and nutrition interventions, may serve as valuable routes for MM patients to manage their health and perhaps improve their physical functioning, fatigue, QOL, psychological distress, and long-term health outcomes,” the authors concluded in their review. However, they noted that while guidelines exist for cancer more generally, research for MM-specific guidelines remains sparse.


Shapiro YN, Peppercorn JM, Yee AJ, Branagan AR, Raje NS, O’Donnell EK. Lifestyle considerations in multiple myeloma. Blood Cancer J. 2021;11(10):172. doi:10.1038/s41408-021-00560-x