Do Diagnostic Pathways Determine Multiple Myeloma Severity?
Posted: Friday, September 25, 2020
Stella Bowcock, MBBS, MA, of King’s College Hospital, London, and colleagues used the TEAM trial to evaluate diagnostic pathways, time to diagnosis, and disease severity in patients with multiple myeloma. The article, which was published in the British Journal of Haematology, presents unique data on the relationship between end-organ damage and the route to diagnosis. They found that 51% of patients were referred from their general practitioner directly to hematology, 29% of patients were diagnosed through acute services, and 20% were referred via a secondary care specialty. They also found that those referred through acute services had a higher burden of end-organ damage.
“Delay in diagnosis remains a major problem in multiple myeloma. Patients are diagnosed through multiple pathways, with [the] route to diagnosis linked to [the] aggressiveness of [the] disease,” stated Dr. Bowcock and colleagues.
A total of 977 patients were recruited into the trial; however, diagnostic data were available for only 915. Data regarding diagnosis pathways were collected at initial trial recruitment, and International Staging System scores were used to determine the disease stage. Using the International Myeloma Working Group criteria for myeloma diagnosis, the investigators assessed end-organ damage.
Results revealed that patients referred via secondary care had the longest diagnostic interval (median, 120 days), whereas participants diagnosed via acute services had a poorer performance status (P < .0001) and a greater burden of end-organ damage (P < .0001). The 12-month survival for the three diagnostic routes was 91% for the direct pathway, 91% for the acute service pathway, and 86% for the secondary care pathway, suggesting no differences overall, (P = .07).
Based on their findings, Dr. Bowcock and colleagues concluded: “Those diagnosed through acute services…have a poorer performance status and [a] higher burden of end-organ damage, probably reflecting more aggressive disease.”
Disclosure: For full disclosure of the study authors, visit wiley.com.
