Cargando…

Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care

OBJECTIVES: Patients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. The aim of this study was to characterise the frequency and timing of clinical features in the primary care setting prior to MM diagnosis. DESIGN: Population-based cohort st...

Descripción completa

Detalles Bibliográficos
Autores principales: Seesaghur, Anouchka, Petruski-Ivleva, Natalia, Banks, Victoria Louise, Wang, Jocelyn Ruoyi, Abbasi, Ali, Neasham, David, Ramasamy, Karthik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496401/
https://www.ncbi.nlm.nih.gov/pubmed/34615682
http://dx.doi.org/10.1136/bmjopen-2021-052759
_version_ 1784579750667223040
author Seesaghur, Anouchka
Petruski-Ivleva, Natalia
Banks, Victoria Louise
Wang, Jocelyn Ruoyi
Abbasi, Ali
Neasham, David
Ramasamy, Karthik
author_facet Seesaghur, Anouchka
Petruski-Ivleva, Natalia
Banks, Victoria Louise
Wang, Jocelyn Ruoyi
Abbasi, Ali
Neasham, David
Ramasamy, Karthik
author_sort Seesaghur, Anouchka
collection PubMed
description OBJECTIVES: Patients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. The aim of this study was to characterise the frequency and timing of clinical features in the primary care setting prior to MM diagnosis. DESIGN: Population-based cohort study. SETTING: Electronic health records data of approximately 17 million patients (2006–2016) within the UK Clinical Practice Research Datalink. PARTICIPANTS: Patients aged ≥18 years with newly diagnosed MM (NDMM), no history of solid tumours and ≥2 years registration in a primary care practice prior to MM diagnosis. MAIN OUTCOME MEASURES: Clinical features and symptoms including bone pain, skeletal-related events (SREs), investigation and confirmation of MM diagnostic CRAB criteria (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) during the 2 years prior to MM diagnosis; time between symptom manifestation and/or relevant investigation and diagnosis of MM. RESULTS: Among 2646 patients with NDMM, 47.5% had a bone pain record during the 2-year period prior to MM diagnosis, mainly affecting the back. Regardless of baseline bone pain, investigations for serum calcium level were used in 36.4% of patients prior to MM diagnosis, followed by haemoglobin (65.6%) or renal function (74.1%). Median (Q1, Q3) time from first-recorded bone pain to MM diagnosis was 220 (80, 476) days. Median (Q1, Q3) time from first-recorded hypercalcaemia, renal impairment or anaemia to MM diagnosis was 23 (12, 46), 58 (17, 254) and 73 days (28, 232), respectively. An imaging investigation or referral for imaging was recorded for 60.0% of patients with bone pain/SRE and 32% without. CONCLUSIONS: Nearly half of patients diagnosed with NDMM presented with bone pain approximately 7 months prior to MM diagnosis. Investigations to evaluate all CRAB criteria, including targeted imaging, were underused. Early recognition of myeloma clinical features and optimised use of investigations in primary care may potentially expedite MM diagnosis.
format Online
Article
Text
id pubmed-8496401
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-84964012021-10-22 Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care Seesaghur, Anouchka Petruski-Ivleva, Natalia Banks, Victoria Louise Wang, Jocelyn Ruoyi Abbasi, Ali Neasham, David Ramasamy, Karthik BMJ Open Oncology OBJECTIVES: Patients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. The aim of this study was to characterise the frequency and timing of clinical features in the primary care setting prior to MM diagnosis. DESIGN: Population-based cohort study. SETTING: Electronic health records data of approximately 17 million patients (2006–2016) within the UK Clinical Practice Research Datalink. PARTICIPANTS: Patients aged ≥18 years with newly diagnosed MM (NDMM), no history of solid tumours and ≥2 years registration in a primary care practice prior to MM diagnosis. MAIN OUTCOME MEASURES: Clinical features and symptoms including bone pain, skeletal-related events (SREs), investigation and confirmation of MM diagnostic CRAB criteria (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) during the 2 years prior to MM diagnosis; time between symptom manifestation and/or relevant investigation and diagnosis of MM. RESULTS: Among 2646 patients with NDMM, 47.5% had a bone pain record during the 2-year period prior to MM diagnosis, mainly affecting the back. Regardless of baseline bone pain, investigations for serum calcium level were used in 36.4% of patients prior to MM diagnosis, followed by haemoglobin (65.6%) or renal function (74.1%). Median (Q1, Q3) time from first-recorded bone pain to MM diagnosis was 220 (80, 476) days. Median (Q1, Q3) time from first-recorded hypercalcaemia, renal impairment or anaemia to MM diagnosis was 23 (12, 46), 58 (17, 254) and 73 days (28, 232), respectively. An imaging investigation or referral for imaging was recorded for 60.0% of patients with bone pain/SRE and 32% without. CONCLUSIONS: Nearly half of patients diagnosed with NDMM presented with bone pain approximately 7 months prior to MM diagnosis. Investigations to evaluate all CRAB criteria, including targeted imaging, were underused. Early recognition of myeloma clinical features and optimised use of investigations in primary care may potentially expedite MM diagnosis. BMJ Publishing Group 2021-10-05 /pmc/articles/PMC8496401/ /pubmed/34615682 http://dx.doi.org/10.1136/bmjopen-2021-052759 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Oncology
Seesaghur, Anouchka
Petruski-Ivleva, Natalia
Banks, Victoria Louise
Wang, Jocelyn Ruoyi
Abbasi, Ali
Neasham, David
Ramasamy, Karthik
Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title_full Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title_fullStr Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title_full_unstemmed Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title_short Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
title_sort clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496401/
https://www.ncbi.nlm.nih.gov/pubmed/34615682
http://dx.doi.org/10.1136/bmjopen-2021-052759
work_keys_str_mv AT seesaghuranouchka clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT petruskiivlevanatalia clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT banksvictorialouise clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT wangjocelynruoyi clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT abbasiali clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT neashamdavid clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare
AT ramasamykarthik clinicalfeaturesanddiagnosisofmultiplemyelomaapopulationbasedcohortstudyinprimarycare