Review Finds Time to Diagnosis for Multiple Myeloma Can Be Significantly Reduced

A review of studies found that the time from symptom onset to confirmation of diagnosis of multiple myeloma can be significantly reduced. Currently, many patients experience a more than 3-month delay until their diagnosis is confirmed.

A paper published in BMJ Open reviewed 9 studies that reported time intervals from symptom onset to diagnosis. Delays in diagnosis can cause complications to develop, such as pathological fractures and irreversible renal failure, they are linked to higher cancer stage and poorer survival, as well as a shorter disease-free survival and more complications following treatment.

“Quantifying the time intervals leading up to diagnosis is important as it will inform future interventions that aim to shorten the diagnostic process,” the authors explained.

Five of the studies reported intervals in various cancers, 3 reported only for multiple myeloma, and 1 for hematological malignancies. There was substantial diversity among the studies in the symptoms and the time points used to define intervals. Three of the studies didn’t even report the starting symptoms, and in total there were 19 different symptoms used to define the start of multiple myeloma.

The researchers found that patients experienced symptoms of the beginning of multiple myeloma for a median of 1 month before seeking help and 25% patients waited for longer than 3 months. After seeking care, the median time to diagnosis was 108.6 days, with 25% of patients waiting longer than 8 months.

The reasons for such long diagnostic intervals include the fact that symptoms like back pain are common; general practitioners have a hard time suspecting multiple myeloma when patients visit with symptoms since it is a rare disease; and there is no effective screening program.

Since this paper was not able to estimate the interval from referral to diagnosis care directly, the authors suggested that future studies estimate this duration and investigate the impact of 1 setting on the other.

“There is potential for meaningful reductions in the time to diagnosis especially for the diagnostic interval, which could improve patient outcomes, but more research is required in order to do that,” the authors concluded.

Reference

Koshiaris C, Oke J, Abel L, Nicholson BD, Ramasamy K, Van den Bruel A. Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis. BMJ Open. 2018;8:e019758. doi: 10.1136/bmjopen-2017-019758.