In this retrospective study, we analyzed the outcomes of 22 patients diagnosed with MM who were admitted to the PCU for comprehensive symptom management. Here, we present a detailed discussion of the results observed in this cohort.

Admission to PCU took place at various timepoints after MM diagnosis and ranged between a few months to over 20 years after initial diagnosis of MM.

The most common clinical symptom on admission to the PCU was nutritional problems (cachexia; loss of appetite; anorexia), followed by fatigue and pain. In a study by Pallotti et al. of 43 patients, the most common reason for PCU consultation was pain [17]; however, in their study, PCU consultation was mainly outpatient (74%), whereas in our study, we included only inpatient PCU patients. But it is important to highlight outpatient PC as well as it plays a crucial role in the continuum of support for MM patients. PC provides ongoing symptom management, psychological support, and coordination of care, enabling patients to maintain their quality of life at home. Integrating outpatient PC early in the treatment process ensures that patients receive comprehensive and consistent care, addressing a wide range of needs and potentially reducing the frequency of hospital admissions.

Fatigue emerged as a prominent symptom among the patients included in our study. Despite advances in the treatment of MM, fatigue remains a pervasive issue, significantly impacting patients’ quality of life [18]. Through tailored interventions focusing on energy conservation, activity pacing, and pharmacological management, we observed significant improvements in fatigue levels in the majority of patients. Multidisciplinary approaches, including physical and psychosocial therapy, have been instrumental in addressing the multifaceted nature of fatigue in MM [19, 20].

Nutritional problems represent an important aspect of supportive care in MM patients, with anorexia, cachexia and malnutrition being significant barriers to treatment tolerance and disease management. Through a comprehensive nutritional assessment and implementation of dietary interventions tailored to individual patient needs, we observed improvements in nutritional status and appetite in a subset of patients. Nutritional support, including oral supplements and enteral nutrition, played a pivotal role in improving malnutrition and enhancing treatment adherence [21, 22].

Pain, a hallmark symptom of MM, has a profound impact on patients’ well-being and functional status. Our findings highlighted the effectiveness of multimodal analgesic strategies, including pharmacological management, physiotherapeutic interventions, and multimodal therapies in achieving optimal pain control and improving QoL [23].

Our results show that admissions to the palliative care unit (PCU) were often necessitated by both tumor-related symptoms and treatment complications; however, it is often difficult to distinguish between treatment-related and disease-related symptoms, such as fatigue, weakness, and nutritional problems, as these symptoms are often non-specific. This highlights the dual role of PC in managing both the direct effects of the malignancy and the side effects associated with its treatment. By addressing these complex and intertwined issues, PC not only alleviates physical suffering but also may improve overall quality of life, highlighting its indispensable role in comprehensive cancer care. Integrating PC early into the treatment process can therefore provide holistic support and address a wide range of patient needs. Fig. 3 highlights practical implications, when MM-specialist should consider palliative care for their patients.

Practical implications—when to consider PC specialist

Patient survival after discharge from the PCU varied, with 45% of patients dying in the hospital and the remaining 55% having a median overall survival of 1.4 months, with a wide range from 1 day to over 3 years. These data show that even after a stay in the PCU, MM patients can have a long life ahead of them. This underlines the benefit of early integration for successful symptom relief and comprehensive, individualized treatment.

The fact that none of the patients had an advance care document highlights the importance of further measures to promote the concept of advance care planning (ACP). This is an essential approach to ensure that a person’s healthcare preferences and decisions are known and respected. Given the unpredictable nature of MM and its potential for progression, discussing and documenting patients’ preferences regarding their future healthcare decisions is of paramount importance for this patient cohort. The ACP involves open dialogue between patients, their families, and healthcare providers to clarify goals of care, explore treatment options, and address QoL concerns. These discussions may include preferences for pain management, resuscitation, hospice care, and end-of-life wishes. By engaging in ACP, MM patients and their environment can navigate the complexities of the disease with greater understanding and ensure that care is consistent with their values and preferences [24, 25].