Symptoms and quality of life in multiple myeloma – a longitudinal study of predictive factors

Christina Ramsenthaler1,Caty Pannell1,Paramjote Kaler1,Wei Gao1,Richard Siegert2,Polly Edmonds3,Steve A. Schey4,Irene J. Higginson1

1Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK,2School of Public Health and Social Studies and School of Rehabilitation, University of Auckland, Auckland, New Zealand,3Department of Palliative Care, King’s College Hospital, London, UK,4Department of Haematological Medicine, King’s College Hospital, London, UK

Presenting date: Monday 2 November
Presenting time: 16.50-17.05

Background

Multiple myeloma remains an incurable cancer with evidence that patients suffer more symptoms than in other haematological conditions. Palliative care services are rarely involved. We aimed to determine how symptom prevalence, severity and quality of life as well as cost/health care utilisation change over time, and what demographic, clinical and social factors predict changes.

Method

We recruited patients into a 14-site multicentre, longitudinal observational study, consenting patients at various stages of their illness (newly diagnosed, stable and progressive/relapsed disease). At baseline and then on up to 4 occasions over eight months, patients completed self reported demographic, clinical, symptom, palliative, quality of life and service use questionnaires. Clinical details were abstracted from medical records. We used myeloma-specific and generic, validated scales, including the Myeloma Patient Outcome Scale (MyPOS), a quality-of-life questionnaire specifically developed for multiple myeloma. We tested for predictors using multivariable analysis, adjusting for confounders.

Results

257 patients with multiple myeloma with a median age of 69 years (range: 34-92) and on average 2.5 years post-diagnosis participated. 18.2% were newly diagnosed, 47.9% had stable disease and 32.7% had relapsed disease or were in the advanced, palliative phase of illness. Patients reported a mean of 7.1 (SD=3.4) symptoms. Over 70% had pain, 88.7% fatigue and 61.1% breathlessness. The most burdensome symptoms in the advanced stages were fatigue, poor mobility, pain, and tingling in the hand/feet. Over the eight months, patients showed distinct trajectories according to whether they were in an early or advanced treatment-interval or in an early or advanced treatment-free interval. Trajectories of physical functioning did not follow other domains of quality of life. The strongest predictors of higher levels of symptoms and health care service use at the end of follow-up were initial scores on MyPOS, type of myeloma, performance status and co-morbid conditions.

Conclusion

Burden of symptoms in multiple myeloma is high and symptoms are not resolved even during the treatment-free intervals. Those with a high symptom burden and with light chain disease are at increased risk for poor HRQOL, should be monitored and could potentially be considered for early referral to palliative care services.