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A recent study found that higher side-effect bother was related to worse health-related quality of life in multiple myeloma patients. The study also found patient–physician discordance in reporting of side effects.

Multiple myeloma (MM) is the second most prevalent hematological malignancy in the United States. Evidence shows that physicians focus on survival outcomes when making MM treatment choices, while patients prioritize factors influencing health-related quality of life (HRQoL). 

A study published in the journal Supportive Care in Cancer outlined real-world patient-reported outcomes in MM treatment in the United States and evaluated the concordance between patient- and physician-reported side effects across lines of therapy (LOT).

Patient Characteristics

The study comprised 63 physicians. They completed patient record forms for 377 patients, of whom, 132 had matched physician-completed forms and patient self-completion questionnaires. Of these, 30% were receiving their first LOT (1L), 24% were at 2L, 24% were at 3L, and 22% were at 4L. The matched patient population was predominantly male (65%), retired (67%), White (70%), and had Medicare health insurance (60%). The median age was 70 years. The median time since diagnosis was 24.3 months.

Cancer Patients’ Quality of Life and Treatment Outcomes

Patients completed the European Organisation for the Research and Treatment of Cancer QoL Core Questionnaire (EORTC QLQ-C30) and the EORTC MM Module (EORTC QLQ-MY20). Global health status, functioning, and symptom scores were generally similar across LOTs. EORTC QLQ-C30 scores range from 0 to 100, with high scores indicating a high quality of life. The median EORTC QLQ-C30 global health status score ranged from 66.7 at 2L to 50 at 4L. 

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Clinically meaningful differences between at least two LOTs were noted in all other domains except fatigue, pain, and diarrhea. Patients on 3L and 4L+ were more likely to have a higher EORTC QLQ-MY20 body image score than 1L patients. Future perspective scores were lower in 1L and 4L vs. 2L and 3L. A clinically meaningful difference in side effects was observed between 2L and 4L.

Impact of Side-Effect Bother on Global Health Status and Functioning
Global health status and functioning EORTC QLQ-C30 scores were worse with higher levels of side-effect bother; clinically meaningful differences were observed between all bother levels, except between “somewhat” bothered and bothered “quite a bit”. Higher bother was noted with higher fatigue, nausea/vomiting, and pain severity. Clinically meaningful differences with higher bother levels were reported in all other domains.

Higher bother levels were related to higher symptoms and side effects on EORTC QLQ-MY20 scores, whereas they were inversely related to body image and future perspective scores. Clinically meaningful differences were observed between most side-effect bother levels.

Patient- and Physician-Reported Side Effects

Patient–physician concordance on the frequency of side effects ranged from poor to fair across all LOTs. Concordance analysis showed fair agreement for gastrointestinal and hematological side effects, slight agreement for neurological/psychological side effects, and poor agreement for dermatological side effects. Patients generally reported a higher incidence of gastrointestinal, neurological/psychological, and dermatological side effects incidence than physicians. Across all LOTs, gastrointestinal side effects were the most common category, while fatigue was the most common specific side effect reported by both physicians and patients.

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Ribbands, A., Boytsov, N., Bailey, A., Gorsh, B., Luke, E., & Lambert, A. (2023). Real-world patient-reported outcomes and concordance between patient and physician reporting of side effects across lines of therapy in multiple myeloma within the USA. Supportive Care in Cancer, 31(6). https://doi.org/10.1007/s00520-023-07836-x