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Letters to the Editor
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Figure 1. Trajectory of symptom burden in patients with newly diagnosed multiple myeloma. Proportion of the cohort reporting moderate-to-severe Edmonton Symptom Assessment System (ESAS) scores ≥4 for (A) tiredness, well-being, pain, drowsiness and loss of appetite and (B) anxiety, shortness of breath, depres- sion and nausea, by month following diagnosis.
the most prevalent and nausea being the least prevalent (13%). Most symptoms decreased over the first year, with the largest decline happening in the first 3 months. One year following diagnosis, there continued to be a substantial burden of symptoms, with over 25% of the cohort reporting moderate-severe levels of each of the following symptoms: tiredness, impaired well-being, pain, drowsiness and loss of appetite. Additionally, whereas physical symptoms such as pain improved over time, psychosocial symptoms of anxiety/depression showed minimal improvement with generally flat scores.
The odds of reporting moderate to severe symptoms during the first year are listed in Table 2 with a higher odds ratio for a co-variate being ‘worse’ for each specified symptom. Increasing age was associated with a slightly lower burden of pain, depression and nausea with an odds ratio that was borderline at 0.98. Female sex was associated with a 1.19 to 1.59 higher odds of reporting moderate to severe symptoms for all categories except shortness of breath. An urban geographic location was
associated with higher anxiety and nausea. Socioeconomic status did not have an impact on most symptoms except for tiredness. Increased co-morbidity status did not show any clear correlation with increased symptoms. A more recent year of diagnosis was associat- ed with slightly lower odds of pain, loss of appetite and nausea. Receiving treatment at a non-teaching hospital was associated with higher odds of reporting pain and depression. Myeloma-related end-organ damage, specifi- cally bone disease, was associated with higher symptom burden; the effect size ranging from 1.52 to 2.65 times for impaired well-being and pain respectively.
In summary, our study demonstrates that transplant- ineligible patients with NDMM experience a substantial burden of symptoms following diagnosis. From a patient’s perspective, knowledge of these symptoms and how they change over time may enhance communication regarding expected trajectory and informed shared deci- sion-making. From the oncology team’s perspective, understanding the considerable burden of symptoms
haematologica | 2021; 106(7)