Quality of Life Declines for Patients With Relapsed or Refractory MM Before Progression Appears

A recent study of patients with relapsed or refractory multiple myeloma examined quality of life (QOL) during induction and maintenance therapy with 8 cycles of ixazomib-thalidomide-dexamethasone, followed by 12 months of ixazomib maintenance therapy.

Whereas previous studies have focused on response rate, the quality of the response, progression-free survival (PFS), and overall survival (OS), increased attention is being paid to QOL issues, as patients live longer and there is a greater emphasis placed on shared decision making and a greater focus being placed on QOL data, noted the authors.

This median age of the 90 patients with relapsed/refractory MM in this study was 67 years; 41% were stage I, 33% were stage II, and 26% were stage III.

Researchers found significant impairment in health-related QOL, physical, role, and social functioning and several other dimensions, as well as more pain and fatigue, compared with the general population. Induction therapy resulted in significant improvement of pain and worsening of neuropathy, with no significant change in other categories. During maintenance treatment, health-related QOL, physical functioning, and pain improved, but neuropathy did not.

Time to deterioration (10 or more score points) of health-related QOL, physical functioning, pain, and neuropathy was distinctly shorter than time to progression. Health-related QOL and physical functioning at baseline correlated with OS.

Previous studies have shown that physicians often underestimate the impact of cancer-associated symptoms such as nausea, fatigue, or pain on patient’s well-being, and they presume that PFS and good QOL go hand-in-hand; that is, that as long as patients maintain their response without progressing, that they are enjoying a good QoL.

That is not supported by the evidence in this study, the researchers said, which showed that global health-status/QOL, physical functioning, fatigue, and pain begin to deteriorate 2 to 3 months before progression of the underlying malignant disease.

However, better health-related QOL was associated with increased PFS, and both higher health-related QOL and physical functioning were associated with prolonged survival. Patient-reported outcome assessments are vital for understanding "individual needs and impairments, for prognostication, and for elucidating the impact of therapy on the various dimensions of QOL," the authors said.

Reference

Ludwig H, Pönisch W, Knop S, et al. Quality of life in patients with relapsed/refractory multiple myeloma during ixazomib-thalidomide-dexamethasone induction and ixazomib maintenance therapy and comparison to the general population [published online September 26, 2019]. Leuk. Lymphoma. doi: 10.1080/10428194.2019.1666381.