Multiple Myeloma Treatment Priorities Vary Among Patients, Clinicians, and Caregivers

Patients with multiple myeloma (MM) have various factors to consider when pondering treatment options. A new study says their priorities can differ significantly from the priorities of their caregivers and physicians.

The report, published in the journal BMC Cancer, shows that aside from survival, a number of other factors can weigh on patients’ decisions. Corresponding author Simon J. Fifer, PhD, of the Australia-based research group CaPPRe, and colleagues write that it is important for clinicians and policymakers to understand the preferences of patients and caregivers given that MM decision-making often involves complex trade-offs.

In order to better understand those preferences, Fifer and his team began by interviewing patients with MM, along with caregivers, hematologists, and nurses who had a special interest in MM. Using that research as a base, the investigators then created a survey using discrete choice experiments (DCEs), which offered participants the chance to evaluate generic treatment choices (such as treatment A or treatment B) that differed by a number of factors, including mode and frequency of administration, out-of-pocket costs, average overall survival, remission period, and side effects.

The final survey was given to 124 Australian patients with MM, 44 caregivers, 28 hematologists, and 34 nurses. Overall survival was the top concern of all groups, but beyond that, the results showed significant variance in preferences between the groups.

“In comparison to people living with MM, carers were less cost-sensitive and more concerned with quality of life (remission period),” Fifer and colleagues wrote. “Physicians and nurses were generally more concerned with overall survival and more cost sensitive than people living with MM.”

Among patients, the survey also found that oral therapies were preferred over other forms of administration, which the authors say appears to be linked with a relative dislike of injection or infusion therapies. However, the authors say the ability to self-administer a therapy at home also likely plays a role in the preference for oral therapies.

The survey further showed that caregivers are relatively less concerned with the cost of treatment. The authors suggest this might be due to concerns about the quality of life for both the patient and the caregiver.

“It is also speculated that carers may value remission periods more highly as it has a personal component — it represents a period of less intense care requirements, which may have important mental, physical and economic aspects that were not further investigated by this research study,” Fifer and colleagues report.

Notably, the authors found that even within cohorts, the preferences were not uniform. For instance, they reported that patients and caregivers could be divided into 2 groups, or “classes.” While each class had similar preferences, one distinct class appeared to value overall survival and remission more than the other class.

The investigators conclude that their survey shows patients and other stakeholders have a mix of complex preferences and concerns that stretch beyond survival rates.

“Overall, the findings demonstrate that while clinical treatment attributes are important, people living with MM and their care team also consider non-clinical treatment attributes to be important when making treatment decisions," they wrote.

Reference

Fifer SJ, Ho KA, Lybrand S, Axford LJ, Roach S. Alignment of preferences in the treatment of multiple myeloma - a discrete choice experiment of patient, carer, physician, and nurse preferences. BMC Cancer. 2020;20(1):546. doi:10.1186/s12885-020-07018-6