Myeloma Survivorship Program: Findings and Future Steps

A survivorship intervention originally designed for cancer survivors was recently evaluated more specifically among individuals diagnosed with multiple myeloma, which is an incurable cancer.¹ Participants with multiple myeloma found the Living With Multiple Myeloma Group intervention to be feasible and acceptable, with advantages that include peer support and better well-being. However, they also thought future iterations of the intervention could be refined as they pertain to helping patients optimally deal with their fatigued and decreased quality of life (QOL).

The intervention, which was delivered virtually due to the COVID-19 pandemic, encompassed 6 weekly group sessions that each contained 45 minutes of physical exercise, 15 minutes of downtime, and 75 minutes of a structured psychosocial and self-management evaluation.

Investigators published their findings in a recent issue of Pilot and Feasibility Studies.²

Results for this intervention were mixed, with participants noting that future such interventions should be shorter and the physicial activity component individualized | Image Credit: Tom Merton/KOTO-stock.adobe.com

This mixed-method, repeated measures feasibility analysis was conducted in partnership with Galway University Hospital, which is 1 of only 9 designated cancer centers in Ireland. Data were collected from October 2021 through March 2022. To be included, all participants had to be 18 years or older, be diagnosed with multiple myeloma, be classified as able to participate in light exercise, be considered suitable for engaging in a group intervention, and be able to provide written informed consent. Total enrollment was 7 patients, which the authors preferred, as a small study population lent itself to easier data analysis.

Of the 7 participants, only 2 were female patients; 4 were in active treatment during the study. The overall mean (SD) patient age was 62.86 (10.07) years, and an average of just under 4 years had elapsed since diagnosis. The tools used to measure the intervention’s effectiveness were the 6-Minute Walk Test, Sit to Stand Test, Grip Strength Test, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), European Organisation for Research and Treatment of Cancer Multiple Myeloma module, Multidimensional Fatigue Inventory, Depression Anxiety and Stress Scale (DASS-21), and a Goal Setting and Rating Scale.

At baseline, the mean QLQ-C30 score was above average, at 79.76 (11.64). The study investigators noted that patients with multiple myeloma typically come in at 55.7 (22.8). No patients dropped out, and of the 42 total sessions for the survivorship intervention (6 for each patient), 37 sessions were attended.

The first domain evaluated was the intervention’s acceptability and appropriateness, with everyone thinking the program to be important, satisfying, engaging, essential, and important. However, the online presentation was difficult at times, with the program time commitment of 75 minutes being cited as a downside.

For the second domain of the program’s helpfulness, the relationships and peer support formed through participation were highlights, in particular, the group being an “open, safe, and confidential space.” Also, 6 of the 7 participants said they noticed bettered physical ability and/or improved well-being.

Potential group participation roadblocks comprised the third domain, with everyone noting they started the program with high uncertainty, but that these feelings improved with each session.

The fourth domain was future program recommendations, with all of the participants in agreement that peer support groups are important as treatment milestones are reached. However, 5 of the 7 patients also desired more family support, 6 thought the exercise program should be individualized with on-demand access and a blend of online/in-person components, and 4 of 7 said the group sessions needed adjusting.

The largest physical improvements were seen for the 6-minute walk (d = 1.95) and sit to stand tests (d = 1.01), and these improvements were maintained. Grip strength also improved from end of treatment through follow-up.

Quality of life was deemed improved for just 1 patient, decreased for 2, and not changed for 4. Between treatment and follow-up, 2 patients had additional improvement, 2 had worsened QOL, and 3 had unchanged QOL. In particular, fatigue only decreased for 1 patient following treatment. Per the DASS-21, levels of depression were considered normal, while for anxiety and stress levels, with 2 patients and 1 patient, respectively, saw increases after treatment, and 1 patient each continued at those higher levels after treatment.

The study authors believe that their findings both show the intervention to be positive and highlight, based on patient feedback, how it can be improved for future participants. There was an overall 54% participation rate—13 patients were originally referred by their hematologist—which the authors thought to be promising, and an 88% adherence rate. However, less than 30% of patients overall showed a “reliable improvement” after the intervention, despite expressing their appreciation for its multidisciplinary approach.

“The next phase of development will require a focus on the efficacy and effectiveness of the intervention,” they concluded, “as without clear evidence for the effectiveness, the relevance of the intervention in routine care remains unclear.”

References

1. Multiple myeloma. Cleveland Clinic. Updated May 4, 2022. Accessed July 17, 2024. https://my.clevelandclinic.org/health/diseases/6178-multiple-myeloma

2. Eilert N, Murphy NJ, Cummins H, Houlihan E, Krawczyk. A multidisciplinary group‑based survivorship intervention for those living with multiple myeloma: a feasibility study. Pilot Feasibility Stud. 2024;10(1):100. doi:10.1186/s40814-024-01524-1