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MGs Care Pathway
Monoclonal Gammopathies (MGs) are a diverse group of blood cancers, with Multiple Myeloma being the most common. This cancer is particularly challenging to detect in primary care because of non-specific symptoms. Symptoms can include back pain, bone pain, fatigue, and repeated infections, which can be mistaken for aging or more common conditions. These difficulties in early detection increase the risk of complications and impact the patient’s long-term quality of life.
Who is Impacted the Most?
Patients with MGs in rural, remote and First Nations and Métis communities in Northern Saskatchewan face additional challenges, because of geographic and financial barriers, inadequate local resources, and limited access to specialized care.
What is the Cancer Agency Doing?
The Saskatchewan MG Care Pathway aims to address these issues by establishing a dedicated MG Clinic, create a streamlined referral pathway, and raise awareness among primary care providers. Other supportive care components include a First Nations and Métis Patient Navigator to provide culturally sensitive support throughout the patient’s journey and will embed early palliative care and streamlined pain and symptom management for every patient.
Resources for Health-Care Providers
This course is designed for Primary Care Providers, who play a crucial role in the early diagnosis of Multiple Myeloma and its precursor conditions, such as Monoclonal Gammopathy of Undetermined Significance (MGUS). It helps Primary Care Providers recognize the signs and symptoms of Myeloma, understand the necessary investigations, know when to refer patients, and how to manage and monitor symptoms.
Developed in partnership with Myeloma Canada and Queen’s University, this interactive online course offers Continuing Medical Education (CME) credits and is available free of charge to the first 800 participants.
This guide from Myeloma UK HCP Hub assists in diagnosing MGs in primary care, providing information on the required tests, how to interpret results, and when to refer patients.
The Saskatoon and North Monoclonal Gammopathies Clinic
Primary Care Providers can refer patients to the MG Clinic if a monoclonal protein is identified in a blood test, such as serum protein electrophoresis and/or serum free light chain assay. A Hematologist at the clinic will then review the patient and perform further evaluation. The referral form to the MG Clinic is available here.
If there is evidence of a systemic hematologic malignancy, the clinic will then refer the patient to the Saskatoon Cancer Centre for further management.
If the patient has MGUS (there is no evidence of a systemic hematologic malignancy), the clinic will continue to assess the patient's risk for developing multiple myeloma or related conditions based on three risk factors:
1. Non-IgG monoclonal protein
2. M protein levels higher than 15g/L
3. Abnormal serum free light chain ratio
- All initial patients will be reassessed 6 months after their initial appointment to ensure that their risk factors remain stable.
- Low-risk patients (those with none of the risk factors) will be discharged back to their Primary Care Provider for yearly monitoring. If there is no primary care provider, the patient will be followed in the MG Clinic annually.
- Higher-risk patients (e.g., those with two or more risk factors) will have more frequent follow-up appointments and may require additional tests, such as bone marrow aspirates and biopsies and/or cross-sectional imaging for closer monitoring.
The goal of follow-up is to detect early progression to symptomatic Multiple Myeloma or related conditions, minimizing complications and improving survival with timely treatment.
Referral Form and Supporting Resources
- Please refer to the 2-page MG Referral Form and Pathway in the additional resources below. The second page, titled Referral Pathway, features a flowchart that guides when to order specific tests, make a routine referral to the MG Clinic, and initiate an urgent referral based on the included red flags.
- Please refer to the Think Myeloma Card in the additional resources for a quick guide on considering Multiple Myeloma as a differential diagnosis based on the symptoms and complications described, ordering necessary tests, and accessing the MG Referral Form if a referral is needed.
Contact
Please fax the MG Referral Form to 1-855-809-3068.
For urgent matters, call the MG Clinic 306-655-1483 or the SHA system flow 1-888-766-6050 and ask for the Hematologist on call.
