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07-07-2016 | Multiple myeloma | Article

The impact of disease-related symptoms and palliative care concerns on health-related quality of life in multiple myeloma: a multi-centre study

Journal: BMC Cancer

Authors: Christina Ramsenthaler, Thomas R. Osborne, Wei Gao, Richard J. Siegert, Polly M. Edmonds, Stephen A. Schey, Irene J. Higginson

Publisher: BioMed Central

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Abstract

Background

Multiple myeloma, the second most common haematological cancer, remains incurable. Its incidence is rising due to population ageing. Despite the impact of the disease and its treatment, not much is known on who is most in need of supportive and palliative care.
This study aimed to (a) assess symptom severity, palliative care concerns and health-related quality of life (HRQOL) in patients with multiple myeloma, and (b) to determine which factors are associated with a lower quality of life. We further wanted to know (c) whether general symptom level has a stronger influence on HRQOL than disease characteristics.

Methods

This multi-centre cross-sectional study sampled two cohorts of patients with multiple myeloma from 18 haematological cancer centres in the UK. The Myeloma Patient Outcome Scale (MyPOS) was used to measure symptoms and concerns. Measures of quality of life included the EORTC QLQ-C30, its myeloma module and the EuroQoL EQ-5D. Data were collected on socio-demographic, disease and treatment characteristics and phase of illness. Point prevalence of symptoms and concerns was determined. Multiple regression models quantified relationships between independent factors and the MyPOS, EORTC global quality of life item and EQ5D Index.

Results

Five-hundred-fifty-seven patients, on average 3.5 years (SD: 3.4) post-diagnosis, were recruited. 18.2 % had newly diagnosed disease, 47.9 % were in a treatment-free interval and 32.7 % had relapsed/progressive disease phase. Patients reported a mean of 7.2 symptoms (SD: 3.3) out of 15 potential symptoms. The most common symptoms were pain (72 %), fatigue (88 %) and breathlessness (61 %). Those with relapsed/progressive disease reported the highest mean number of symptoms and the highest overall palliative care concerns (F = 9.56, p < 0.001). Factors associated with high palliative care concerns were a general high symptom level, presence of pain, anxiety, low physical function, younger age, and being in the advanced stages of disease.

Conclusion

Patients with multiple myeloma have a high symptom burden and low HRQOL, in the advanced and the earlier stages of disease. Identification of patients in need of supportive care should focus on assessing patient-reported outcomes such as symptoms and functioning regularly in clinical practice, complementary to traditional biomedical markers.
Literature
1.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.CrossRefPubMed
2.
Phekoo KJ, Schey SA, Richard MA, Bevan DH, Bell S, Gillett D, Moller H. A population study to define the incidence and survival of multiple myeloma in a National Health Service Region in UK. Br J Haematol. 2004;127:299–304.
3.
Pulte D, Gondos A, Brenner H. Improvement in survival of older adults with multiple myeloma: results of an updated period analysis of SEER data. Oncologist. 2011;16:1600–3.CrossRefPubMedPubMedCentral
4.
Kumar K, Rajkumar V, Dispenzieri A, Lacy MQ, Hayman R, Buadi FK, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2008;111:2516–20.CrossRefPubMedPubMedCentral
5.
Kyle RA, Rajkumar V. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009;23:3–9.CrossRefPubMed
6.
Acaster S, Gaugris S, Velikova G, et al. Impact of treatment-free interval on health-related quality of life in patients with multiple myeloma: a UK cross-sectional survey. Support Care Cancer. 2013;21:599–607.CrossRefPubMed
7.
Molassiotis A, Wilson B, Blair S, Howe T, Cavet J. Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psychooncology. 2011;20:88–97.CrossRefPubMed
8.
Delforge M, Minuk L, Eisenmann J-C, Arnulf B, Canepa L, Fragasso A, et al. Health-related quality-of-life in patients with newly diagnosed multiple myeloma in the FIRST trial: lenalidomide plus low-dose dexamethasone versus melphalan, prednisone, thalidomide. Haematologica. 2015;100:826–33.CrossRefPubMedPubMedCentral
9.
Johnsen AT, Tholstrup D, Petersen MA, Pedersen L, Groenvold M. Health related quality of life in a nationally representative sample of haematological patients. Eur J Haematol. 2009;83:139–48.CrossRefPubMedPubMedCentral
10.
Gulbrandsen N, Hjermstad M, Wisloff F, for the Nordic Myeloma Study Group. Interpretation of quality of life scores in multiple myeloma by comparison with a reference population and assessment of the clinical importance of score differences. Eur J Haematol. 2004;72:172–80.CrossRefPubMed
11.
Mols F, Oerlemans S, Vos AH, Koster A, Verelst S, Sonneveld P, et al. Health-related quality of life and disease-specific complaints among multiple myeloma patients up to 10 yr after diagnosis: results from a population-based study using the PROFILES registry. Eur J Haematol. 2012;89:311–9.CrossRefPubMed
12.
Jordan K, Proskorovsky I, Lewis P, Ishak J, Payne K, Lordan N, et al. Effect of general symptom level, specific adverse events, treatment patterns, and patient characteristics on health-related quality of life in patients with multiple myeloma: results of a European, multicenter cohort study. Support Care Cancer. 2014;22:417–26.CrossRefPubMed
13.
Sherman AC, Simonton S, Latif U, Plante TG, Anaissie EJ. Changes in quality-of-life and psychosocial adjustment among multiple myeloma patients treated with high-dose melphalan and autologous stem cell transplantation. Biol Blood Marrow Transplant. 2009;15:12–20.CrossRefPubMed
14.
Brenner H, Gondos A, Pulte D. Expected long-term survival of patients diagnosed with multiple myeloma in 2006–2010. Haematologica. 2009;94:270–5.CrossRefPubMedPubMedCentral
15.
Kvam AK, Fayers P, Hjermstad M, Gulbrandsen N, Wisloff F. Health-related quality of life assessment in randomised controlled trials in multiple myeloma: a critical review of methodology and impact on treatment recommendations. Eur J Haematol. 2009;83:279–89.CrossRefPubMed
16.
Sonneveld P, Verelst G, Lewis P, Gray-Schopfer V, Hutchings A, Nixon A, et al. Review of health-related quality of life data in multiple myeloma patients treated with novel agents. Leukemia. 2013;27:1959–69.CrossRefPubMedPubMedCentral
17.
Campagnaro E, Saliba R, Giralt A, Roden L, Mendoza F, Aleman A, et al. Symptom burden after autologous stem cell transplantation for multiple myeloma. Cancer. 2008;112:1617–24.CrossRefPubMed
18.
Bartley EJ, Edmond N, Wren AA, Somers TJ, Teo I, Zhou S, et al. Holding back moderates the association between health symptoms and social well-being in patients undergoing hematopoietic stem cell transplantation. J Pain Symptom Manage. 2014;48:374–84.CrossRefPubMed
19.
Anderson KO, Giralt A, Mendoza TR, Brown JO, Neumann JL, Mobley GM, et al. Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant. 2007;39:759–66.CrossRefPubMed
20.
Hung YC, Bauer J, Horsley P, Waterhouse M, Bashford J, Isenring E. Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation. Support Care Cancer. 2013;21:1579–86.CrossRefPubMed
21.
Sherman AC, Plante TG, Simonton S, Latif U, Anaissie EJ. Prospective study of religious coping among patients undergoing autologous stem cell transplantation. J Behav Med. 2009;32:118–28.CrossRefPubMed
22.
Wang XS, Shi Q, Williams LA, Shah ND, Mendoza TR, Cohen EN, et al. Longitudinal analysis of patient-reported symptoms post-autologous stem cell transplant and their relationship to inflammation in patients with multiple myeloma. Leuk Lymphoma. 2015;56:1335–41.CrossRefPubMed
23.
Boland E, Eise C, Ezayd Y, Greenfield DM, Ahmedzai H, Snowden JA. Living with advanced but stable multiple myeloma: a study of the symptom burden and cumulative effects of disease and intensive (hematopoietic stem cell transplant-based) treatment on health-related quality of life. J Pain Symptom Manage. 2013;46:671–80.CrossRefPubMed
24.
Molassiotis A, Wilson B, Blair S, Howe T, Cavet J. Living with multiple myeloma: experiences of patients and their informal caregivers. Supp Care Cancer. 2009;19:101–11.CrossRef
25.
Osborne TR, Ramsenthaler C, Siegert RJ, Edmonds PE, Schey SA, Higginson IJ. What issues matter most to people with multiple myeloma and how well are we measuring them? A systematic review of quality of life tools. Eur J Haematol. 2012;89:437–57.CrossRefPubMed
26.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.CrossRefPubMed
27.
The EuroQoL group. Euro-QoL–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef
28.
Stead ML, Brown JM, Velikova G, Kaasa S, Wisloff F, Child JA, et al. Development of an EORTC questionnaire module to be used in health-related quality-of-life assessment for patients with multiple myeloma. European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Br J Haematol. 1999;104:605–11.CrossRefPubMed
29.
Cocks K, Cohen D, Wisloff F, Sezer O, Lee S, Hippe E, et al. An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-MY20) in assessing the quality of life of patients with multiple myeloma. Eur J Cancer. 2007;43:1670–8.CrossRefPubMed
30.
Fayers P, Aaronson N, Bjordal M, Groenvold M, Curran D, Bottomley A. EORTC QLQ-C30 Scoring Manual. Brussels: EORTC; 1999.
31.
Osborne TR, Ramsenthaler C, Schey SA, Siegert RJ, Edmonds PE, Higginson IJ. Improving the assessment of quality of life in the clinical care of myeloma patients: the development and validation of the Myeloma Patient Outcome Scale (MyPOS). BMC Cancer. 2015;15:280.CrossRefPubMedPubMedCentral
32.
Hearn J, Higginson IJ. Development and validation of a core outcome measure for palliative care: the Palliative Care Outcome Scale. Palliative Care Core Audit Project Advisory Group. Qual Health Care. 1999;8:219–27.CrossRefPubMedPubMedCentral
33.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
34.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefPubMed
35.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.CrossRefPubMed
36.
Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Blade J, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23:3412–20.CrossRefPubMed
37.
Kvam AK, Fayers PM, Wisloff F. Responsiveness and minimal important score differences in quality-of-life questionnaires: a comparison of the EORTC QLQ-C30 cancer-specific questionnaire to the generic utility questionnaires EQ-5D and 15D in patients with multiple myeloma. Eur J Haematol. 2011;87:330–7.CrossRefPubMed
38.
Durie BG, Harousseau JL, Miguel JS, Blade J, Barlogie B, Anderson K, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20:1467–73.CrossRefPubMed
39.
Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson; 2007.
40.
Donders ART, van der Heijden GJ, Stijnen T, Moons KGM. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59:1087–91.CrossRefPubMed
41.
Ramsenthaler C, Kane P, Siegert RJ, Gao W, Edmonds PE, Schey SA, et al. Symptoms and biomedical factors show who is at risk of poor quality of life and high cost in multiple myeloma—a systematic review and meta-analysis. Qual Life Res. 2014;23:67.CrossRef
42.
Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Meth. 2007;39:175–91.CrossRef
43.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Erlbaum; 1988.
44.
Corporation IBM. IBM SPSS Statistics for Windows, Version 22.0. Armonk: IBM Corp; 2013.
45.
Armenian H, Sun C-L, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: Role in development of subsequent cardiovascular disease. Blood. 2012;120:4505–12.CrossRefPubMedPubMedCentral
46.
Curigliano G, Cardinale D, Suter T, Plataniotis G, de Azambuja E, Sandri MT, et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO clinical practice guidelines. Ann Oncol. 2012;23:vii155–66.CrossRefPubMed
47.
Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC. Multiple myeloma. Lancet. 2009;374:324–39.CrossRefPubMed
48.
Dimopoulos MA, Palumbo A, Hajek R, Kropff M, Petrucci MT, Lewis P, et al. Factors that influence health-related quality of life in newly diagnosed patients with multiple myeloma aged/= 65 years treated with melphalan, prednisone and lenalidomide followed by lenalidomide maintenance: results of a randomized trial. Leuk Lymphoma. 2014;55:1489–97.CrossRefPubMed
49.
Joske D, McGrath P. Palliative care in haematology. Intern Med J. 2007;37:589–90.CrossRefPubMed
50.
Howell DA, Wang H-I, Smith AG, Howard MR, Patmore RD, Roman E. Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death. BMC Palliat Care. 2013;12:42.CrossRefPubMedPubMedCentral
51.
Howell DA, Roman E, Cox H, Smith AG, Patmore R, Garry AC, et al. Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy. BMC Palliat Care. 2010;9:9.CrossRefPubMedPubMedCentral
52.
Smith A, Roman E, Howell D, Jones R, Patmore R, Jack A. The Haematological Malignancy Research Network (HMRN): a new information strategy for population based epidemiology and health service research. Br J Haematol. 2010;148:739–53.CrossRefPubMed
53.
Efficace F, Cartoni C, Niscola P, Tendas A, Meloni E, Scaramucci L, et al. Predicting survival in advanced hematologic malignancies: do patient-reported symptoms matter. Eur J Haematol. 2012;89:410–6.CrossRefPubMed
54.
Kripp M, Willer A, Schmidt C, Pilz LR, Gencer D, Buchheidt D, et al. Patients with malignant hematological disorders treated on a palliative care unit: prognostic impact of clinical factors. Ann Hematol. 2014;93:317–25.CrossRefPubMed
55.
Dubois D, Dhawan R, van de Velde H, Esseltine D, Gupta S, Viala M, et al. Descriptive and prognostic value of patient-reported outcomes: the bortezomib experience in relapsed and refractory multiple myeloma. J Clin Oncol. 2006;24:976–82.CrossRefPubMed
56.
Efficace F, Bottomley A, Smit EF, Lianes P, Legrand C, Debruyne C, et al. Is a patient’s self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975. Ann Oncol. 2006;17:1698–704.CrossRefPubMed
57.
Strasser-Weippl K, Ludwig H. Psychosocial QOL is an independent predictor of overall survival in newly diagnosed patients with multiple myeloma. Eur J Haematol. 2008;81:374–9.PubMed
58.
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. JAMA. 1995;273:59–65.CrossRefPubMed
59.
McCann L, Maguire R, Miller M, Kearney N. Patients’ perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity. Eur J Cancer Care. 2009;18:156–64.CrossRef
60.
Basch E, Artz D, Dulko D, Scher K, Sabbatini P, Hensley M, et al. Patient online self-reporting of toxicity symptoms during chemotherapy. J Clin Oncol. 2005;23:3552–61.CrossRefPubMed