Psychological distress and mental health-related quality of life is similar between patients with precursor disease and active myeloma

The development of multiple myeloma (MM) can be preceded by premalignant conditions such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Due to the risk of progression, both conditions are usually monitored with regular follow-up visits, which can have a detrimental psychosocial impact on a patient’s quality of life. Previous studies investigating health-related quality of life (HRQoL), psychological distress (DT) and mental comorbidity in patients with MM have shown impairment in HRQoL and increased DT associated with disease- and treatment-related events.^1,2 This study was carried out in Germany by Imad Maatouk, Medical University Hospital and National Center for Tumor Diseases, Heidelberg, and colleagues, and compared HRQoL, DT, anxiety and depression rates between patients with MGUS/SMM and patients with MM pre- and post-treatment.³

Patient Population and Study Design:

• Recruitment took place from November 2014 ­to September 2017
• Patients with diagnosed MM, SMM, or MGUS, who made their first appointment at the outpatient clinic were eligible for study participation
• All received information on the study survey and psychosocial questionnaire
• Enrolled patients: n = 552 (1066 patients were eligible; 51.8% response rate)
• Mean age: 62.1 years (30.7–87.5)
• Patients were stratified into three groups based on International Myeloma Working Group guidelines:⁴
  • Group 1: premalignant disease (MGUS or SMM): 27.9% (n = 148)
  • Group 2: new diagnosis of MM before treatment (pre-treatment): 35.8% (n = 190)
  • Group 3: treated MM: 36.4% (n = 193)
• HRQoL, DT, anxiety and depression were measured as per:
  • HRQoL: Short Form General Health Survey (SF-12) weighted to produce a physical component score (PCS) and mental component score (MCS)
  • DT: National Comprehensive Cancer Network (NCCN) distress thermometer
  • Anxiety: seven-item general anxiety disease-screening instrument (GAD-7)
  • Depression: nine-item patient health questionnaire (PHQ-9)

Key Findings:

All data are given as Group 1 (premalignant disease) vs Group 2 (new diagnosis) vs Group 3 (treated)

Entire cohort analysis:

• HRQoL (SF-12) mean scores:
  • MCS: 42.4 (11.5–68.9)
  • PCS: 39.1 (16.4–59.6)
• DT: 63.9% (n = 338) above threshold of ≥5
• Anxiety (GAD-7): moderate–severe anxiety: 12.4%
• Depression (PHQ-9): moderate–severe depressive symptoms: 21%

Subgroup analysis (mean scores):

• HRQoL (SF-12):
  • PCS: 43.6 vs 39.1 vs 35.7 (p < 0.001)
  • MCS: no significant difference: 43.1 vs 42.9 vs 41.3 (p = 0.18)
• Psychological Distress: 5.2 vs 5.7 vs 5.3 (p = 0.26)
  • No significant difference in multivariate analysis
• Anxiety symptoms (GAD-7): 4.1 vs 4.8 vs 4.6 (p = 0.21)
  • No significant difference in multivariate analysis
• Depression symptoms (PHQ-9): 4.9 vs 5.6 vs 6.9 (p < 0.001)
  • Significant difference between Group 3 and Group 1

Lower physical HRQoL scores and higher depression scores were observed in patients with MM compared with patients with precursor disease. This is likely due to the symptoms of active MM and treatment-related adverse events.

There was no significant difference between mental HRQoL, distress and severity in anxiety symptoms between the three groups. This aligns with previous reports from clinicians that screening and anticipation of cancer in patients with MGUS and SMM can cause a similar psychosocial burden to those patients with active MM.^1,2 The high DT score across all groups (~63%) highlights the need for psychosocial support in the majority of patients, including those with MGUS or SMM.