Seven month lag between MM symptom presentation and diagnosis

New research has revealed significant delays between multiple myeloma (MM) symptom presentation in primary care and diagnosis, impacting patients’ chances of survival and quality of life.

The population-based cohort study, published in BMJ Open, showed that almost half (48%) of patients with newly diagnosed multiple myeloma (NDMM) presented in primary care with bone pain (mainly affecting the back) around seven months before the condition was identified.

This delay to diagnosis not only has an impact on quality of life but could also have a significant impact on treatment outcomes, lead researcher Dr Karthik Ramasamy, a Consultant Haematologist at Oxford University Hospitals Trust, told the limbic.

“[It] leads to a more emergency presentation and we have data showing patients admitted through this route have a poorer survival,” he said.

Data from Myeloma UK released earlier this year showed that early diagnosis via GP referral was linked with improved overall survival; with a 62% one-year survival rate for patients diagnosed via the emergency route versus 88% for those diagnosed via GP referral. The researchers also noted 84% of patients with myeloma survive for more than five years if they are diagnosed at the earliest stage, compared with just 26% if diagnosed at advanced stage.

The study included NDMM patients over the age of 18 at diagnosis who were registered with GP practices across the UK and contributed to the UK Clinical Practice Research Datalink (CPRD) GOLD database, with 2,646 ultimately included in the analysis.

Its findings also revealed widespread failure to carry out assessment of all CRAB (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) criteria, with this being performed in just 19% of patients prior to MM diagnosis; investigations for serum calcium levels were used in only 36% of patients, haemoglobin levels in 66%, and renal function in 74%.

Also, advanced bone imaging investigation with MRI or CT scan, as recommended by IMWG and the National Institute for Health and Care Excellence, was undertaken in just 20% of symptomatic patients.

According to Dr Ramasamy, the best way to reduce the gap between symptom presentation in primary care and diagnosis is ensuring that GPs have “access to rapid diagnostic centres to investigate a likely myeloma with blood tests and imaging.” The authors have also proposed “a plethora of actions in different settings to be undertaken by both the patient and the GPs” to help speed up MM diagnoses.

The findings suggest that GPs “could have significant input in improving the time to diagnosis of MM,” the researchers said. “To reduce delays in the diagnosing of MM in primary care there is a need for improved diagnostic safety netting, that is, the process of managing diagnostic uncertainty during the GP consultation and communicating to patients when and how to follow-up on potential symptoms,” they concluded.

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