Chemotherapy Versus Transplant: Comparing Quality of Life After Myeloma Treatment

A cancer diagnosis can be costly, but not just financially. Treatments such as chemotherapy and radiation can leave cognitive and motor impairments for patients, too.

However, according to preliminary pilot data, one method of cancer treatment — autologous stem cell transplantation – does not impair short-term cognition, function or symptoms for patients with newly-diagnosed myeloma.

Noa Biran, M.D., a physician in the Multiple Myeloma Division at the John Theurer Cancer Center, and colleagues assessed patients before and after ASCT. Outcomes were measured using the Patient Reported Outcomes Measurement Information System (PROMIS) — a 0 to 100 scale that examines cognitive function – and the Comprehensive Score for Financial Toxicity (COST).

Patient-reported outcomes focused on cognition, symptom extremity and financial toxicity following ASCT, which were assessed prior to and six months following treatment.

Overall, 22 patients showed improved symptoms over the course prior to and following transplant — including less anxiety, depression, fatigue and pain interference. In addition, they reported a higher incidence of satisfaction with participation in social roles and physical function, as well as less financial toxicity and improvements in cognitive function.

Biran said that one theory behind the improved quality of life after ASCT is that the procedure is vastly different than its alternative: chronic chemotherapy.

“What patients don’t understand is that the alternative to ASCT is chronic therapy. Patients are faced with a decision of continuing on chemotherapy for the rest of their lives, and that in itself has its own toxicity and can worsen over time,” Biran said in an interview with OncLive, a sister publication of CURE.

For many patients, chemotherapy often results in a declining cognitive function (commonly known as “chemo brain”) and other symptoms, such as chemotherapy-induced peripheral neuropathy (CIPN) and chemotherapy-induced nausea and vomiting (CINV), which can continually worsen a patient’s quality of life.

While transplantation may cause similar symptoms, patients will eventually get better and come back to baseline, Biran said.

Understanding these outcomes is important in planning treatments and mitigating the possibility of patients stopping their treatment.

“Patients often feel disease burden and treatment burden, so they’re not staying on therapy. In multiple myeloma, it’s very important to find regimens that are well-tolerated because it requires continuous therapy; it’s a chronic disease,” Biran said.

She added that financial toxicity is also a major factor in drug adherence. In particular, insurance companies may not fully approve coverage for oral medications or they could be associated with high copays for patients.

“Oftentimes, patients have to decide if they are going to get treatment or not. A lot of patients say, ‘I’d rather not get treatment. It’s too much money. I just want my family to have that money.’ Treatment is very important, but it’s often limiting,” Biran said.

Since some patients are not eligible for ASCT and are faced with the option of chronic chemotherapy, Biran noted that her team is currently investigating a mobile app that can track symptoms and help determine if a patient will stay on treatment.

“We know that the longer people stay on therapy, the longer they live. The only way to find out how to do that is to look at the quality of life,” she said.