Geriatric assessment and quality of life changes in older adults with newly diagnosed multiple myeloma undergoing treatment

Mian, Hira; Pond, Gregory R.; Tuchman, Sascha A.; Fiala, Mark A.; Wildes, Tanya M.

doi:10.1016/j.jgo.2020.05.004

Cited by 11 publications

(11 citation statements)

References 43 publications

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“…Elderly patients in our study reported significantly more fatigue and constipation. Mian et al reported data from a cohort of 40 elderly patients (> 65 years), who underwent stem-cell transplantation and remained stable with regards to function and overall QoL whereas the mental health of the study participants had actually improved 6 months after the end of therapy [27]. If these observations were to be confirmed in larger studies, female and elderly patients might benefit from intensive and more specific supportive care in order to be able to better withstand intensive therapy concepts.…”

Section: Discussionmentioning

confidence: 99%

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study

Fischer

Knop²,

Danhof³

et al. 2022

BMC Cancer

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Background Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions. Methods In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy. Results In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL. Conclusion This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to develop an individualized, patient-centred, therapy concept.

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Section: Discussionmentioning

confidence: 99%

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study

Fischer

Knop²,

Danhof³

et al. 2022

BMC Cancer

View full text Add to dashboard Cite

show abstract

“…Elderly patients in our study reported signi cantly more fatigue and constipation. Mian et al reported data from a cohort of 40 elderly patients (>65 years), who underwent stem-cell transplantation and remained stable with regards to function and overall QoL whereas the mental health of the study participants had actually improved 6 months after the end of therapy (29). If these observations were to be con rmed in larger studies, female and elderly patients might bene t from intensive and more speci c supportive care in order to be able to better withstand intensive therapy concepts.…”

Section: Discussionmentioning

confidence: 99%

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: A prospective observational study

Fischer

Knop

Danhof

et al. 2022

Preprint

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Background Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions. Methods In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy. Results In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL. Conclusion This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to further an individualized, patient-centred, therapy concept.

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“…In the third study of 30 older patients with lung cancer [8], walk speed decreased from prior to through weeks 6 and 12 after chemotherapy administration. In the fourth study that evaluated for changes in PF in 32 patients with multiple myeloma at diagnosis and 6 months later [12], no differences in Timed-Up-and-Go test scores were found. In the fifth study of 49 patients who were recruited before or within 3 days of starting chemotherapy treatment for leukemia [11], compared to pretreatment scores, independent activities of daily living (ADL), Short Physical Performance Battery (SPPB) test scores, and grip strength declined at 8 weeks after hospital discharge.…”

Section: Introductionmentioning

confidence: 86%

“…However, recent findings suggest that subjective and objective measures of PF assess different dimensions of functional status [2]. Of ten longitudinal studies of PF in older patients undergoing chemotherapy [3][4][5][6][7][8][9][10][11][12], only five used objective measures and findings were inconsistent [8][9][10][11][12]. In one that evaluated for changes in grip strength, chair-stand, and 2-min walk tests, over 1 year, in 97 older patients with acute myeloid leukemia [10], grip strength showed an initial decline with subsequent recovery, the other two tests improved over time.…”

Section: Introductionmentioning

confidence: 99%

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

Torstveit

Miaskowski

Løyland

et al. 2022

Support Care Cancer

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Purpose Study purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF. Methods Balance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined. Results Gait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment. Conclusions Determination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.

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Geriatric assessment and quality of life changes in older adults with newly diagnosed multiple myeloma undergoing treatment

Cited by 11 publications

References 43 publications

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study

The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: A prospective observational study

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

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