Patient Preferences Should Be Considered for Treatment of Relapsed or Refractory Multiple Myeloma

As patient-reported outcomes and the patient voice continue to play a more integral role in cancer care, a new study is shedding light on and underscoring the importance of including patient preferences when deciding on treatment for relapsed or refractory multiple myeloma (RRMM).

After conducting qualitative interviews and focus groups among 32 patients with RRMM across Canada, researchers of the study came away with the understanding that patients prioritize treatments that could enhance life expectancy, mitigate side effects, and control financial burdens.

With previous research on patient preferences typically focusing on MM, the study offers a rare look at the preferences of patients with RRMM, who may have different priorities due to their longer-term experiences with the disease.

“Most research to date has focused on clinical prognostic factors and therapies to target the most complex pathogenesis of multiple myeloma,” wrote the researchers. “Relatively little attention has been paid to patients’ experiences of the disease in the published literature—still less so in the context of RRMM.”

The qualitative interviews entailed individual in-depth interviews to get an understanding of patients’ experiences with the disease and related issues.

During the interviews, patients indicated that fatigue, musculoskeletal pain, gastrointestinal symptoms, neuropathy, and neutropenia were common physical side effects. They also reported numerous cognitive side effects of treatments, including difficulty concentrating and memory lapses, as well as emotional and psychological side effects, such as mood swings. According to the researchers, these side effects often resulted in broader implications relating to quality of life, with patients reporting disruptions in social relations and their ability to work and pursue other valued activities.

Reflecting on these side effects, conversations from the focus groups provided a more comprehensive look at these experiences by identifying priorities related to treatments. These discussions resulted in a list of 10 priorities for patients when it came to their treatments. Falling behind the highest priorities, which address life expectancy, physical and cognitive side effects, and the financial impacts, patients also prioritized the following:

• The treatment does not require use of dexamethasone or requires limited use of the steroid
• The treatment does not preclude other treatments or make other treatment ineffective
• How the treatment is administered
• The treatment allows for down-time or off-treatment breaks during treatment periods
• Treatment side effects are predictable
• The treatment does not increase sleep disturbances or mood swings
• The treatment and the healthcare provider are accessibly located
• There is smooth and consistent access to medications

“Our study has important implications for cancer survivors: a clear articulation of their priorities can contribute to efforts to design treatment with patients’ concerns in mind, thereby promoting a more patient-centered approach to care," the authors wrote.

Reference

Parsons J, Greenspan N, Baker N, McKillop C, Hicks L, Chan O. Treatment preferences of patients with relapsed and refractory multiple myeloma: a qualitative study [published March 25, 2019]. BMC Cancer. doi: 10.1186/s12885-019-5467-x.