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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.

, 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. 

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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Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: 22nd Annual International Congress on Hematologic Malignancies®: Focus on Leukemias, Lymphomas and MyelomaMay 30, 20192.0
Online Medical Crossfire®: 5th Annual Miami Lung Cancer ConferenceMay 30, 20196.5
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