Disparities in Multiple Myeloma Distress Screenings May Point to Care Gaps

Women and patients with stage 2 multiple myeloma are more likely to report psychological distress at their initial consultations, a new report has found.¹ However, the study also identified disparities in terms of which patients complete a distress screening.

The results suggest patients who do not complete the screenings are less likely to receive high-intensity treatment and may be missing out on additional supportive services. The findings were reported in the European Journal of Haematology.

Patients with multiple myeloma who did not complete a distress screener were also less likely to receive autologous stem cell transplants. | Image credit: LIghtfieldStudios - stock.adobe.com

Psychological distress is common among people with cancer, noted corresponding author Anita D’Souza, MD, of the Medical College of Wisconsin, and colleagues. Previous reports suggest between 24% and 50% of people with cancer experience psychological distress. In 1997, the National Comprehensive Cancer Network developed the “Distress Thermometer” survey, which the network’s guidelines now recommend as a means to identify patients who may benefit from psychological referrals or other guidance.

One reason screening matters is that previous research indicates patient distress is linked with treatment delays. In breast cancer, for instance, a study found an association between patients who experienced a delay between their abnormal mammogram and core biopsies and those who reported emotional and health-related distress.²

In their new study, D’Souza and colleagues looked back at patients who had initial consultations between 2015 and 2022 at an academic cancer center with a high volume of patients with multiple myeloma to see how the Distress Thermometer was used.¹ All patients were given a paper copy of the survey to complete, and those who completed it had the paper scanned into their electronic health records.

Of a total of 1011 new patients, the investigators found that 683 patients (68%) completed the Distress Thermometer. The investigators found that non-Hispanic Black patients (adjusted odds ratio [AOR], 0.50; 95% CI, 0.32-0.79; P = .003), those who lived in socially vulnerable neighborhoods (AOR, 0.54; 95% CI, 0.39-0.76; P = .0004), and those with Karnofsky Performance Status scores below 90 (AOR, 0.60; 95% CI, 0.43-0.86; P = .005) were less likely to complete the screening. They also found that participation levels diminished in the more recent years of the study’s time frame.

D’Souza and colleagues said the finding that non-Hispanic Black patients were less likely to complete the screening highlights the need for more effective communication with patients and more tailored patient care with relation to quality-of-life issues.

Among those who completed the screenings, distress was associated with being female (AOR, 1.48; 95% CI, 1.07-2.04; P = .017) and having stage 2 vs stage 1 multiple myeloma (AOR, 1.76; 95% CI, 1.20-2.57; P = .004). Overall, 44% reported a moderate-to-high level of distress, the authors found, with 19% reporting high distress at the initial visit.

Yet, D’Souza and colleagues said important insights can be drawn from those 32% who did not complete the screening. The investigators found that these patients—who were already more likely to live in socially vulnerable neighborhoods—were also less likely to receive autologous stem cell transplantation (71% vs 79%; P < 0.01), a crucial part of the standard of care for eligible patients.

“Being more vulnerable, these patients may have benefited from additional support, thus highlighting the missed opportunity for identifying high-risk patients and suggesting the limitations of relying on a self-reported screening tool to assess unmet needs among patients with multiple myeloma,” the investigators wrote.

D’Souza and colleagues noted their data has limitations, including its retrospective nature and its focus on initial consultations only. Still, they said it shows that care teams need to pay careful attention to patients who do not complete distress screenings, as they may have vulnerabilities that might suggest the need for additional support.

References

1. Estrada-Merly N, Wu JF, Pezzin LE, Nataliansyah MM, D'Souza A. Completion of distress screening and correlates of distress score in patients with multiple myeloma at initial evaluation at a transplant center. Eur J Haematol. Published online February 16, 2025. doi:10.1111/ejh.14394
2. Yang JH, Huynh V, Leonard LD, et al. Are diagnostic delays associated with distress in breast cancer patients?. Breast Care (Basel). 2023;18(4):240-248. doi:10.1159/000529586