Distress Score Could Shape Myeloma Treatment Interventions

While recent breakthroughs have led to more treatment options for multiple myeloma, patients are also experiencing new side effects, stressful financial issues and psychological burdens. In turn, recent research found that this increased distress may actually have negative implications for patient outcomes.

“This is a critical time to evaluate things on a global standpoint. We need to be concerned about the system as a whole, but we also need to get more granular and focus on what the deleterious effects seen on a patient-by-patient level are, in terms of financial burden,” Joshua R. Richter, M.D., a myeloma specialist at the John Theurer Cancer Center said in an interview with OncLive, a sister publication of CURE.

Richter and his team examined 239 patients with multiple myeloma who completed the Living With Cancer patient-reported outcomes tool — designed for patients to report on aspects such as distress, depression and financial burden.

Nearly half of the patients (48 percent) reported that they were concerned that could no longer do the activities that they wanted to do, while one-third (33 percent) reported a decrease in performance status. When asked about money, 44 percent of patients reported having financial toxicity.

Only 76 percent of patients who reported having higher distress scores experienced 12-month survival compared with 87 percent in those with low distress scores.

One finding that Richter found particularly surprising was regarding depression and anhedonia, or the inability to feel pleasure. While only 15 percent of patients reported depression, 41 percent reported anhedonia — a symptom that is highly connected with depression.

“It was interesting how patients report their symptoms,” he added. “Ultimately, we gained patient insight in terms of when they are ready to transition towards palliative care or cessation of chemotherapy.”

These findings could help physicians better understand issues their patients may be facing, and can open the door to patient-provider conversations about certain interventions, such as palliative care, hospice care or ending chemotherapy treatment.

“One of the things that this tool allows is a shift in paternalism, where the physician sits down and gives the power back to the patient,” Richter said. “That tool gives us an idea that they are ready for a transition. It puts the power in the hands of the patient to help guide their plan of care.”

Moving forward, Richter hopes to standardize the approach, as well as make it more universal. And while participants only completed the study once, Richter also mentioned that it would be valuable to track the patients’ responses over time, and to use the results to craft a model of the best times to implement interventions.

“It is important to explore the possibilities of establishing a standard,” Richter said. “Right now, especially in hematologic malignancies, it is difficult to know where the patient is in terms of the disease.”