Survival from multiple myeloma (MM) has improved, and more attention is required for symptom burden and psychological impact in the long-term management of this disease. Researchers assessed the incidence of self-reported pain, depression, financial and family burden, and impairment of performance status, as well as determined the correlation of total distress with survival. Joshua R. Richter, MD, at the John Theurer Cancer Center in Hackensack, NJ, discussed the findings at the ASH Annual Meeting.
The researchers included 239 patients with MM (median age = 67 years) receiving outpatient therapy at a tertiary cancer center. They used the Living With Cancer (LWC) patient-reported outcome (PRO) instrument, which evaluates distress from the point of view of the patient with advanced cancer. The seven-item, five-level Likert survey measures four domains: performance status, pain, burden (financial and family), and depression. The questions are weighted based on patient opinion of importance, for a total score ranging from 0–112. For individual survey items, a self-reported rating of 2–4 was considered a patient concern. Patients completed the LWC PRO between September 2015 and October 2016.
Almost half of patients (48%) were concerned that they could not do the things they wanted to, with 33% reporting decreased performance status. Financial toxicity concerns were self-reported by 44%, with family burden noted in 24%. Depression was reported by 15% of patients, and an additional 41% reported a lack of pleasure. Pain was reported as a concern in more than one-third of patients (36%).
After a median follow-up of 316 days since LWC completion, 13% of patients died.
A high total distress score (defined as greater than 28) was noted in 57 patients (24%) and was associated with a decreased survival rate compared to the 182 patients (76%) with a low total distress score (p < 0.05). Six-month survival rates from the completion of the LWC survey for patients with high and low distress scores were 86% and 96%, respectively, whereas 12-month survival rates were 76% and 87%, respectively.
“Despite dramatic improvements in survival among patients with MM, symptom, financial, and psychosocial concerns continue to plague patients,” the researchers concluded.