Introduction
Multiple myeloma, a complex and incurable haematological cancer, has seen an increase in patient survival rates due to advances in therapy. Despite these advances, the disease trajectory often results in significant physical and psychological burden, with health-related quality of life (HRQoL) being profoundly impacted. In a recent study published in Palliative Medicine, researchers have attempted to shed light on the factors that predict a declining HRQoL in patients diagnosed with multiple myeloma.
Understanding the Study
The study, cited with a DOI of 10.1177/0269216319833588, was a prospective, longitudinal cohort analysis involving 238 patients with multiple myeloma from 14 hospitals in England. The research, led by Christina Ramsenthaler at the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, and colleagues, was designed to identify patients who would benefit from early integration into palliative care by analyzing HRQoL trajectories and determinants leading to decline or poor HRQoL.
Health-Related Quality of Life Trajectories in Multiple Myeloma
The research utilized latent mixture growth models to identify four distinct HRQoL trajectories in the patient population over an 8-month period. It was observed that two of these trajectories indicated either stable poor HRQoL or a significant decline in HRQoL.
The primary objective was to understand the predictive factors for poor HRQoL outcomes. The study revealed that general symptom levels, the presence of clinically relevant anxiety, and pain were significant predictors of poor HRQoL. Specifically, general symptom levels presented an odds ratio (OR) of 1.3, clinically relevant anxiety an OR of 1.2, and pain an OR of 1.02. These factors were found to be more predictive than demographic or clinical characteristics.
Palliative Care and Multiple Myeloma
The implications of these findings underscore the importance of early referral to palliative care services for multiple myeloma patients, a practice which is not yet standard. Palliative care focuses on improving the quality of life for patients with serious illnesses, addressing physical symptoms as well as emotional, social, and spiritual needs. Historically, many multiple myeloma patients have only received palliative care interventions late in their disease trajectory.
The study’s focus on patient-reported outcomes emphasizes the significance of healthcare professionals being attentive to symptoms and psychological well-being beyond clinical indicators. This approach can lead to the timely identification of those at risk of HRQoL deterioration, allowing for earlier palliative care interventions.
Recommendations and Clinical Implications
Based on the study, the authors recommend that multiple myeloma patients should be systematically screened for pain, symptoms, and anxiety to identify those who may benefit from palliative care at earlier stages. This strategy may mitigate declining HRQoL and support overall patient well-being.
Keywords
1. Multiple Myeloma Quality of Life
2. Palliative Care in Oncology
3. Myeloma-related Symptoms
4. Palliative Care Outcomes
5. Psychological Well-being Cancer
Conclusion
This study provides a crucial understanding that symptoms and anxiety are significant predictors of declining HRQoL in multiple myeloma patients. The findings argue for the integration of palliative care not as an end-of-life measure but as a concurrent practice during the oncological treatment of multiple myeloma. Early identification and intervention provide a path for improving patient outcomes and their experience of living with a chronic and incurable cancer. These insights lead to a more compassionate and responsive healthcare model for individuals facing the challenges of multiple myeloma.
References
1. Ramsenthaler, C., Gao, W., Siegert, R. J., Edmonds, P. M., Schey, S. A., & Higginson, I. J. (2019). Symptoms and anxiety predict declining health-related quality of life in multiple myeloma: A prospective, multi-centre longitudinal study. Palliative Medicine, 33(5), 541–551. https://doi.org/10.1177/0269216319833588
2. Myeloma UK. (2019). What is multiple myeloma? Retrieved from https://www.myeloma.org.uk/information/what-is-myeloma/
3. World Health Organization. (2021). WHO Definition of Palliative Care. Retrieved from https://www.who.int/cancer/palliative/definition/en/
4. National Comprehensive Cancer Network. (2021). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Palliative Care. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf
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