How can you manage your energy after CAR T-cell therapy? Nurse practitioner Daniel Verina shares practical tips for combatting fatigue, including setting realistic goals and making time for healthy eating and physical activity as you recover from myeloma CAR T-cell therapy.
Daniel Verina is a nurse practitioner at the Center of Excellence for Multiple Myeloma at Mount Sinai Tisch Cancer Center in New York City.
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Transcript
Katherine Banwell:
Daniel, when it comes to recovery from CAR T-cell therapy, what should patients be aware of?
Daniel Verina:
I think one of the things that CAR T unfolds many phases of like, we have two things, the feeling of one and done sometimes is like, oh, I had my CAR T inpatient. What do I need to do? And there is an acute phase, which I think we need to understand that even after discharge from the hospital, patient’s blood counts, their white blood cell count, their platelets still need time to recovery. And they’re still kind of in this acute phase of flux. So, even though they may leave the hospital with a good white count, or a good platelet count, or red blood cells, what happens in CAR T is you have this, it’s kind of like a rollercoaster effect.
You have this wax and wane. They kind of go up, and then they slowly go back down. And then, eventually, maybe a month or two later, they come back up. Interesting enough, and I bring this point up because now that CAR T is so available, more a second line, many of our patients, I usually say, oh, it’s just like when you had a stem cell transplant.
But they are not getting stem cell transplants upfront anymore, so it’s hard to relate to the process. So, I kind of have to bring up the rollercoaster as my example for them. So, really, bringing it home that white count might be for a risk for infections. And patients even post CAR T two, three, four months later, still are at a high risk for just general infections alone.
Katherine Banwell:
What are some strategies for managing the fatigue following CAR T?
Daniel Verina:
Oh, I think fatigue, I mean, everybody has fatigue, but I think it’s one of those things that we have to say, what is the best way to get a patient – I think either patients walk in the door emotionally fatigued because of that fear of if I do this process, I’m going to have a relapse, and nobody wants to hear the relapse word again. I’m a big promoter, and most physicians are, it’s really getting them to keep activity, aerobic exercises, light weight training.
That is all under physical therapy. They should actually be evaluated by a physical therapist, which works with them to heal, even if they have other comorbidities. What is the safest way to do that? I’m big on energy conservation, so kind of knowing what you can do at certain periods of the day. Don’t always try to push through the day until you’re so exhausted, you collapse at the end of the day on your couch, kind of knowing your own body alone. Plan your activities around those. If you’re a morning person, get things done in the morning. And then, rest kind of in the afternoon.
We’re all attached to a phone. Everybody has the blue light, the tablet, the phones. So, it’s kind of breaking away from that and kind of doing more mindful, maybe do yoga, maybe having cognitive behavior, be able to do deep breathing and relaxation to allow our bodies to heal. We as humans, and everybody could disagree with me, but we as humans like to push through things.
I have to get it done. My body says I’m tired. I have to get through it. So, I’m big on yoga, relaxation, acupuncture if it’s really advised by their healthcare professional team. Massages, I think are one of the best ways to reconnect and recenter our bodies, but that’s more from the mind cycle social standpoint. But I also like to bring up maybe we have to investigate other reversable contributions. Maybe the thyroid function, it slightly needs to be adjusted, or they have anemia, or what is their nutrition? We always forget. When patients leave hospitals, we all think they have three meals a day at home, but what is their nutrition?
Do they have enough food at home to have these three meals at home. So, get the nutrition really involved in that. And sometimes, even leaving the hospital, we have depression or anxiety. And that can also add to the fatigue.
Is it depression because you had a whole care team around you for two weeks, and it was very supportive, and now you go back to home, and who do you have besides your care partner with you? So, I think it’s a multifactorial strategy to try to help with fatigue.