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Common complaints, difficult diagnosis: Multiple myeloma


  • Colleen Dvorak RN, BSN, OCN

    (Graduate student, currently in the Acute Care Nurse Practitioner Program with a focus in oncology1 and Clinical Nurse), Corresponding author
    1. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
    2. Hematology/Oncology and Bone Marrow Transplant Division, University Hospital of Cleveland, Cleveland, Ohio
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Colleen Dvorak, RN, BSN, OCN, Hematology/Oncology and Bone Marrow Transplant Division, University Hospital of Cleveland, 6970 Carriage Hill Drive, #102, Brecksville, OH 44141. Tel: 440 717 1566; E-mail:


Purpose: To review the presenting signs and symptoms of multiple myeloma, its pathophysiology, diagnostic evaluation, and treatment options.

Data sources: A literature review of research articles and publications by oncology experts who specialize in multiple myeloma, supplemented by a case study.

Conclusions: Multiple myeloma is a cancer of the geriatric population, with the average age at diagnosis between 65 and 68 years. As the population of those over age 65 is predicted to double by the year 2050, the incidence of myeloma is expected to increase. Nurse practitioners (NPs) must become familiar with the signs, symptoms, and complications of myeloma for patients to be diagnosed and referred to specialists in a timely manner.

Implications for practice: Patients with multiple myeloma often present with vague, common symptoms such as back pain, bony pain, fatigue, and anemia. These symptoms may be treated as separate medical conditions if NPs fail to include multiple myeloma in their differential diagnosis. If NPs are educated on this malignancy, they will have the expertise to look for other signs of the disease such as hypercalcemia, pathological fractures, osteopenia, or renal failure. Without early recognition of multiple myeloma and referrals to oncology specialists, patients are left with a delayed diagnosis and poor symptom control.