Study Evaluates Factors Related to HRQOL in Multiple Myeloma

A study published Monday of 70 patients being treated for multiple myeloma (MM) examined factors that influence health-related quality of life (HRQOL), with the authors concluding that regular assessments of patient reported outcomes (PROs) are important to deliver the best clinical care.

Authors of the study also say they are the first to document a link between participation in a clinical trial and improved HRQOL. However, they offer the caveat that restrictive inclusion criteria for trials could make it hard to compare MM patients who get to participate with those unable to do so.

Tracking long-term HRQOL in MM is important, the authors note, because advances in treatment for the blood cancer have offered patients new treatment options and greatly extended overall survival (OS). The 5-year OS rate is 55% and rises to 77% for those whose disease is caught early. Thus, the authors write, “HRQOL becomes more important in clinical decision making,” but physicians lacked a satisfactory study on this topic.

Patients in this prospective observational study were recruited between April 2013 and January 2015, prior to being treated at University Hospital Wuerzburg in Germany, “regardless of the individual time point of primary diagnosis.” Median age of the patients was 62 years; 44% were female and 56% were male. At the time of recruitment, more than half were “fully active,” with an Eastern Cooperative Oncology Group (ECOG) status of 0.

Investigators assessed patients prior to the start of therapy, and those receiving stem-cell transplant (SCT) were interviewed a second time after therapy—4 weeks after induction but before SCT. Well-known assessment tools were used—the “Quality of Life Questionnaire-Core 30” of the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) and the Multiple Myeloma Module (QLQ-MY20).

Also, the 4-item Patient Health Questionnaire, (PHQ-4), which screens for anxiety and depression, and a sociodemographic questionnaire were used during the first assessment.

Consistent with guidelines, 58.3% of patients were treated with tandem high-dose therapy and SCT; most relapsed patients received a novel agent without SCT (52.9%). Investigators found “no significant difference in anxiety and depression of patients with first-line or relapse treatment regarding severe (P = 0.358) or moderate psychological distress (P = 0.768).”

Results showed that compared with those with recurrent MM, patients with MM receiving first-line therapy reported significantly lower pain levels and better overall health status, and “even showed further improvement in these variables over time.”

By contrast, those with relapsed MM reported decreasing health status and increasing pain—and had reported a better over ability to function at baseline.

In the areas of body image, side effects, and cognitive function, all patients reported their HRQOL decreased significantly after chemotherapy began; of note, those receiving tandem SCT did not do worse than those without SCT.

“Participation in clinical trials was correlated to a better HRQOL in numerous parameters at all time points compared to non-study patients, which was particularly evident in first-line patients,” the authors found. The posited that this could be due to better information about the disease and treatment, and better connectivity to the treatment team.

Although the authors noted the possibility that trial exclusion criteria could affect this finding, they write, “Nevertheless, these results should be taken into consideration in the therapy setting of patients with chronic diseases, who don’t meet inclusion criteria or don’t want to take part in clinical trials.”

Finally, the authors recommend that instead of a single screening for anxiety and depression prior to treatment, multiple screenings throughout treatment would be recommended.

Reference

Fischer J, Knop S, Danhof S, Einsele H, Keller D, Löffler C. The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study. BMC Cancer. 2022;22:1032. https://doi.org/10.1186/s12885-022-10101-9