OBJECTIVES

Although Multiple Myeloma (MM) is a rare cancer, it is the second most prevalent hematological malignancy. MM patients report high symptom burden and reduced health-related quality of life (HRQoL) yet prior reviews have generally focused on RRMM. The aim of this systematic literature review (SLR) was to summarize published evidence on the humanistic burden in newly diagnosed adult MM (NDMM) patients.

METHODS

An SLR identifying studies in English (randomized and non-randomized trials) published between 01/2005-11/2018 reporting humanistic burden of NDMM in adult patients was conducted. An electronic database search (Medline/Embase/CEA Registry/EconLit/Cochrane/PsycINFO/ScHARRHUD) and a hand-search of conferences (ASH/EHA/ASCO/ESMO/ISPOR) were performed. Only studies reporting on humanistic burden outcomes including patient reported outcomes, HRQoL, utilities and disutilities, functional ability, and symptoms were included. Case reports, non-systematic reviews and editorials/letters were excluded. Publication screening and extraction were performed by two independent

RESULTS

A total of 47 studies (including 16 RCTs) were identified (range: 7-7,778 patients, median: 335 patients). The most frequent measures of HRQoL were EORTC questionnaires and the EQ-5D. The most common symptoms were pain, fatigue, and dyspnea. EORTC pain scales were comparable between randomized and non-randomized studies (range: 35-53.4;37-50.1). Trial results showed that, regardless of treatment arm, EORTC QLQ-based measures improved over the treatment period. Non-randomized longitudinal studies reported similar improvements over periods of 12-18 months. Large proportion of the elderly patients meet criteria for moderate/severe frailty assessments, experience falls and geriatric syndromes limiting physical function.

In 8 studies comparing NDMM cases with healthy controls, NDMM patients presented with higher risk of suicide in one study (HR: 3.4; 95% CI: 2.3-5.0), while another study found nearly one-quarter of MM patients met established criteria for depression.

CONCLUSIONS

A new diagnosis of MM is associated with a significant humanistic burden due to pain, impact on physical function which limits patients in daily activities and psychological distress.