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Higher Distress Scores Linked With Lower Survival in Myeloma

Danielle Bucco
Published: Wednesday, Feb 07, 2018

John Richter, MD
Joshua R. Richter, MD
With several new agents entering the treatment landscape, patients with multiple myeloma are facing different toxicity, financial, and psychological burdens. As a chronic disease, additional attention is needed to address these issues and improve patients’ overall quality of life, according to Joshua R. Richter, MD.

In a patient-reported survey, 239 patients with multiple myeloma completed The Living with Cancer patient-reported outcomes (PROs) instrument. Of those, 48% were concerned that they were not able to do the activities they wanted to do, with 33% reporting decreased performance status. Financial toxicity was reported by 44% of patients. Depression was reported by 15% of patients and 41% of patients reported anhedonia.

The 12-month survival rates from the completion of this study were 76% for patients with high distress scores and 87% for patients with low distress scores.

In an interview with OncLive, Richter, a hematologist/oncologist specializing in multiple myeloma at John Theurer Cancer Center, discussed the findings form the self-reported symptom and psychological survey in patients with multiple myeloma.

OncLive: What is the incidence and survival impact of self-reported symptoms and psychological distress among patients with multiple myeloma?

Richter: The landscape of multiple myeloma is changing. There are many new developments. We are pushing the field forward in terms of how we treat the disease and we are improving outcomes in both the upfront and the relapsed/refractory settings. There are a lot of data that were presented recently that look at ways that we can maximize efficacy of different regimens in relapsed/refractory multiple myeloma. 

What has become more prevalent is understanding that there are other areas that need to be taken into consideration, including overall symptom management and a variety of different modalities on how the patient has to live with the disease on a daily basis. 

This has become an area that we are interested in and it has not been maximizing clinical outcomes in terms of response rates, but maximizing outcomes in terms of the total number of patients who have to live with cancer. 

A pilot study was developed to investigate PROs. This was validated across a variety of physicians giving them clinical scenarios of different statuses of patients to determine whether they would recommend either intervention by palliative care, hospice care, or cessation of chemotherapy. 

Once the tool was validated, a second study looked at over 1100 patients across a variety of different malignancies to evaluate where patients may benefit from transition to palliative care or hospice care. 

Subsequently, we looked at a subset of 239 patients with multiple myeloma. The PROs tool is a survey that involves 4 different domains of personhood. We look at performance status, burden, pain, and depression. We ask questions along the Likert Scale and then the patients individually weigh their responses in terms of how each of those modalities impact their life.

Can you discuss the significant findings with this study?

The survey turned out to give some surprising results. In terms of all cancers, we found people who had high distress scores and low distress scores. The whole survey, if you put the numbers together, gave a rank score somewhere between 0 and 112. It turns out that anything with 29 or greater was associated with decreased outcomes across all cancers. This was validated in a presentation at the 2017 ASCO Annual Meeting. In terms of multiple myeloma, we found some interesting facts. 

In terms of distress score correlating with outcomes, there is a trend suggesting that those with higher distress scores did have worse outcomes. However, that was not statistically significant as it had a P value of .66.

However, there were some interesting things that did come out of our study, including the depression modality. The way that we approach depression was by utilizing a 2-question screening for depression. It asks about feelings of depression and feelings of anhedonia. It turns out that although 15% of patients reported depression, 41% of patients reported anhedonia, which is highly consistent with depression as a larger scale. It was interesting how patients report their symptoms. Ultimately, we gained patient insight in terms of when they are ready to transition towards palliative care or cessation of chemotherapy.

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