Recording symptom burden and palliative care concerns in multiple myeloma patients

This study assessed symptom severity, quality of life and palliative care (treatment to relieve symptoms) concerns in multiple myeloma patients. Authors concluded that patients with multiple myeloma generally have a high symptom burden and low quality of life.

Multiple myeloma is the second most common type of blood cancer. Newer treatment options combined with stem cell transplantation have improved response and survival rates. However, many patients experience disease progression over time. Symptoms also often persist into treatment-free intervals, as well as treatment-related side effects. These can considerably affect quality of life. There is evidence suggesting that multiple myeloma patients suffer more symptoms and problems compared to other types of blood cancer. Common complaints include pain, fatigue, breathlessness, nausea, vomiting, and neuropathy (disease affecting the nerves). More studies are needed to help guide palliative care for multiple myeloma patients. Palliative care is given in order to lessen the problems caused by the disease or its treatment, and to improve quality of life. 

The aim of this study was to examine symptom severity, quality of life, and palliative care concerns in multiple myeloma patients.

557 multiple myeloma patients were included. The average time since diagnosis was 3.5 years. 18.2% of patients had newly diagnosed disease. 47.9% of patients were in a treatment-free interval. 32.7% of patients had relapsed or progressive disease. About half the patients (46.5%) were not on active or maintenance (long-term) treatment. Questionnaires were used to record quality of life, symptom burden, physical and mental health, and palliative care concerns.

On average, patients reported 7.2 separate symptoms (from a selection of 15). The most burdensome symptom was fatigue. 21.9% of patients scored fatigue as burdensome. This was followed by pain (13.8%) and tingling in the hands or feet (10.2%). Pain, fatigue, and breathlessness were present in 60 to 88% of patients. Poor memory, tingling in the hands or feet and poor mobility were present in 50 to 70%. Less common were constipation, dry mouth, anxiety, nausea, diarrhea, depression, and vomiting (occurring in 10.1 to 38.3% of patients).

The frequency and severity of symptoms differed depending on disease phase. Those with relapsed or progressive disease had the highest average number of symptoms compared to those in a treatment-free interval or with newly diagnosed disease. They were significantly more likely to report shortness of breath, constipation, dry mouth, and tingling in the hands or feet.

Number of symptoms, pain, low physical function, younger age, and advanced disease stage all increased palliative care concerns. Patients with relapsed or progressive disease showed the highest overall palliative care concerns.

Quality of life was significantly associated with a higher pain level, higher fatigue level, more mobility problems, and higher anxiety and depression scores. Overall, patients in a treatment-free interval experienced better quality of life.

Authors concluded that patients with multiple myeloma have a high symptom burden and low quality of life across all disease stages. Monitoring symptom burden could help select patients for appropriate palliative care regimens.