8. Conclusion and recommendations

Late diagnosis and inadequate palliative care are the hallmarks of poor prognosis and overall survival outcome of MM in developing countries [3]. There is a need to educate the physicians, especially orthopedic surgeons, renal physicians, and gastroenterologists to exercise higher index of suspicion, as they are usually the first to see such patients [44].

The government, stakeholders in health institutions, and donor agencies who are passionate for MM have a role to play in its management toward improving the quality of life of people living with the disease. This is achievable by improved funding of MM research and treatment in developing countries. The public health system should as a matter of urgency provide health insurance coverage for the management of MM patients especially in LICs such as Nigeria where the over 62% of population lives on extreme poverty of less than two dollars per day [41].

There is also a need to build special centers designated for the treatment of MM where all relevant modern health-care facilities/equipments for diagnosis, risk assessments, and treatment of MM should be available, while taking into cognizance international best practices for the management of the disease.

Adequate access to radiation therapy is a crucial component of modern multidisciplinary cancer care including MM. There must be a strict adherence to the IAEA recommendation of one megavoltage machine per 400 new cancer patients in areas with excellent cancer registry or one per 250,000 population size in areas without excellent cancer registry. The implication is that in countries like Nigeria where there are barely five functioning radiotherapy machine, the number has to be scaled up between 260 and 840 megavoltage units taking into cognizance a population size of 210 million people (based on 2006 population census and average annual growth rate of 3.1%) [29].

Supportive care of people living with MM must take into cognizance psychosocial health of the individuals and their families. This is the only way forward in ensuring a holistic care and improved quality of life of these patients. Every component of palliative workforce including the social workers must be involved in realizing this goal.

There is a need to scale-up definitive treatment of MM in developing countries using stemcell transplantation. Autologous non-cryopreserved stem-cell transplantation avoids the cost of establishing and maintaining a cryopreservation facility, and this can be feasible in transplant centers in economic-constrained regions [45, 46]. Studies have shown that high-dose melphalan with autologous stem-cell support improves the survival rate for patients with myeloma. Also, when they are carefully selected for treatment with ASCT, they can be managed with a brief initial hospitalization and outpatient follow-up, with low morbidity and mortality [47–50].

Also, efforts should be intensified to set up excellent cancer (MM) registries in developing countries so as to improve on the statistics and epidemiology of MM and other cancer diseases. Each country is expected to formulate its own consensus guidelines that will best serve the patients using international best practices.
