Managing Early Satiety in MPNs

Early satiety is one of the symptoms faced by patients with myeloproliferative neoplasms (MPNs) — a set of blood cancers that cause the bone marrow to overproduce red or white blood cells or platelets. Polycythemia vera, essential thrombocythemia and myelofibrosis are all MPNs.

“Early satiety means that you feel full really soon after you start eating,” explained Amanda Smith, a registered nurse at the Huntsman Cancer Institute at the University of Utah. “There are a lot of implications for this. Nutrition is a really big deal, especially when you have a blood disorder or a cancer, so it's definitely something to be aware of.”

In an interview with Oncology Nursing News, Smith discussed the impact that early satiety can have on patients with MPNs and the role nurses playing in helping patients manage this symptom.

Oncology Nursing News: What kind of impact on quality of life and nutritional intake can this have on patients? And then how can both of those things affect patient outcomes overall?

Smith: If you are not able to eat, it can be really frustrating. Anyone who has ever had a short period of time where they have been unable to eat, knows how run down you can feel, and the lack of energy. You are not getting energy from food as you normally would. And so, it can compound with other things to make you feel just really extra run down. Nutrition is important for our immune systems and it can really have a spiraling effect if we cannot get it under control.

Part of the reason it happens in MPNs is because of splenomegaly, [which] is when your spleen is enlarged. That can happen for a few different reasons, but one of the jobs of the spleen is to filter the blood. When you have an MPN and you have too many platelets or other types of blood cells, then your spleen is — in the simplest terms— working so hard to try and filter all those cells, and it gets too big. Then there is just not room in your abdomen. There's not enough room in there. That is why it happens.

Patients with MPNs can go through long asymptomatic periods, which is one of the things that makes MPNs really tricky to diagnose and manage. Can this early fullness be a warning sign for patients?

Yes. I know that our providers ask about it every time, so if it's important enough that they are wanting to know if there have been any changes in that in that area, then yes. Some people can be very stable with this symptom for a long time. As with a lot of things in medicine, the important thing to watch out for is change. You can have a symptom, and it can be stable and may or may not be something to worry about. But if you've had an acute change—if something gets a lot worse—it's definitely something that we would want to know about.

How can nurses help patients manage this issue with things like maximizing their nutritional intake?

The higher calorie foods that you can get down, we would encourage that. We're also looking at electrolytes a lot, so we're wanting to make sure those are balanced. High-protein, high-fat types of things, but also just things that you are able to eat. So, it can be really tricky.

A lot of our medications can help shrink the spleen, so medication adherence is huge. Often people feel so much better that they don't need to be reminded, [but] it's so critical to stay on the regimen that the doctor prescribes.