Bowcock, S;
Atkin, C;
Iqbal, G;
Pratt, G;
Yong, K;
Neal, RD;
Planche, T;
Karunanithi, K;
Jenkins, S;
Stern, S;
et al.
Bowcock, S; Atkin, C; Iqbal, G; Pratt, G; Yong, K; Neal, RD; Planche, T; Karunanithi, K; Jenkins, S; Stern, S; Arnott, S; Toth, P; Wandroo, F; Dunn, J; Drayson, MT; TEAMM Trial Management Group and Trial Investigators
(2023)
Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial.
Cancers (Basel), 15 (13).
p. 3337.
ISSN 2072-6694
https://doi.org/10.3390/cancers15133337
SGUL Authors: Planche, Timothy David
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Abstract
Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of 'bone pain', simply 'pain'. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47-8.44]), bone disease (OR 3.71 [CI 1.88-7.32]) and age >65 years (OR 1.58 [CI 1.15-2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28-3.91]), age >65 years (OR 2.14 [CI1.28-3.91]) and absence of back pain (OR 0.44 [CI 0.29-0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of 'symptom-directed' screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures.
Item Type: | Article | |||||||||
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Additional Information: | © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). | |||||||||
Keywords: | MGUS, diagnosis, diagnostic delay, multiple myeloma, organ damage, precursor disorder, screening, smouldering myeloma, symptoms, TEAMM Trial Management Group and Trial Investigators, multiple myeloma, symptoms, organ damage, screening, precursor disorder, MGUS, smouldering myeloma, diagnosis, diagnostic delay, 1112 Oncology and Carcinogenesis | |||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | |||||||||
Journal or Publication Title: | Cancers (Basel) | |||||||||
ISSN: | 2072-6694 | |||||||||
Language: | eng | |||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution 4.0 | |||||||||
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PubMed ID: | 37444449 | |||||||||
Web of Science ID: | WOS:001030078100001 | |||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/115757 | |||||||||
Publisher's version: | https://doi.org/10.3390/cancers15133337 |
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