BACKGROUND: Myeloma is a serious and usually fatal haematological malignancy with reported mortality of 10-20% within the first 2 months of presentation. Symptoms are non-specific, and patients thus present to a range of medical practitioners. AIM: To analyse the causes and consequences of a delay in diagnosis of myeloma. DESIGN: Retrospective case review. METHODS: The number and type of disease-related complications present at diagnosis of 92 patients with myeloma were categorized according to the medical practitioner to whom the patient initially presented, the time before diagnosis and the status of the patient at study end in 2006. Overall and disease-free survival were analysed. RESULTS: Duration of symptoms >6 months prior to diagnosis was seen in 40% of the patients, of whom >50% had initially consulted a general practitioner. The most common presenting symptom (67%) was bone pain. The most common complications present at diagnosis were anaemia (54%), bone disease (45%) and renal failure (36%), with the highest frequency of complications in the group experiencing symptoms for >6 months. All patients in this group had two or more complications, while 40% in the group with symptoms for <3 months had no complications. A prolonged time to diagnosis had a significant effect on disease-free survival from both onset of first symptoms (p = 0.043) and from diagnosis (p = 0.003), but not on overall survival. DISCUSSION: A prolonged delay before diagnosis is associated with a significant impact on the clinical course of multiple myeloma. There is a need to raise awareness of the presentation of this condition, especially among general practitioners.
BACKGROUND:Myeloma is a serious and usually fatal haematological malignancy with reported mortality of 10-20% within the first 2 months of presentation. Symptoms are non-specific, and patients thus present to a range of medical practitioners. AIM: To analyse the causes and consequences of a delay in diagnosis of myeloma. DESIGN: Retrospective case review. METHODS: The number and type of disease-related complications present at diagnosis of 92 patients with myeloma were categorized according to the medical practitioner to whom the patient initially presented, the time before diagnosis and the status of the patient at study end in 2006. Overall and disease-free survival were analysed. RESULTS: Duration of symptoms >6 months prior to diagnosis was seen in 40% of the patients, of whom >50% had initially consulted a general practitioner. The most common presenting symptom (67%) was bone pain. The most common complications present at diagnosis were anaemia (54%), bone disease (45%) and renal failure (36%), with the highest frequency of complications in the group experiencing symptoms for >6 months. All patients in this group had two or more complications, while 40% in the group with symptoms for <3 months had no complications. A prolonged time to diagnosis had a significant effect on disease-free survival from both onset of first symptoms (p = 0.043) and from diagnosis (p = 0.003), but not on overall survival. DISCUSSION: A prolonged delay before diagnosis is associated with a significant impact on the clinical course of multiple myeloma. There is a need to raise awareness of the presentation of this condition, especially among general practitioners.
Authors: Mara M Epstein; George Divine; Chun R Chao; Karen E Wells; Heather Spencer Feigelson; Delia Scholes; Douglas Roblin; Marianne Ulcickas Yood; Lawrence S Engel; Andrew Taylor; Joan Fortuny; Laurel A Habel; Christine C Johnson Journal: Int J Cancer Date: 2017-05-15 Impact factor: 7.396
Authors: Christian Gerecke; Stephan Fuhrmann; Susanne Strifler; Martin Schmidt-Hieber; Hermann Einsele; Stefan Knop Journal: Dtsch Arztebl Int Date: 2016-07-11 Impact factor: 5.594
Authors: Antonieta Medina-Lara; Bogdan Grigore; Ruth Lewis; Jaime Peters; Sarah Price; Paolo Landa; Sophie Robinson; Richard Neal; William Hamilton; Anne E Spencer Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014