Chemotherapy induced symptom burden in patients with multiple myeloma undergoing induction therapy

Seema Prasad, The University of Texas School of Public Health


BACKGROUND: Multiple myeloma (MM) is a plasma cell tumor characterized by bone destruction, end organ failure and immunodeficiency [8]. Introduction of proteasome inhibitor Bortezomib (BTZ) has substantially improved outcomes in MM patients [8]. MM disease burden along with treatment associated toxicity is known to increase morbidity, cause memory problems and even psychosis among patients. With the advancement in cancer treatment it is really important to understand patients’ experience of a treatment approach [8, 10]. Patient- reported outcomes on symptom severity and neurophysiological status can not only help increase understanding of disease status but also help build specific symptom management strategies in cancer treatment [30]. PURPOSE: To estimate the prevalence of major MM-related symptoms (bone pain and fatigue) and effects of BTZ on peripheral neuropathy and cognitive function during induction therapy. METHOD: In this longitudinal study, study participants (n=64) reported symptom severity and interferences to daily life activities on the MD Anderson Symptom Inventory MM module (MDASI-MM), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30), Neuropathy pain (ID pain) questionnaire and Treatment-Induced Neuropathy Assessment Scale (TNAS) during the first 6 months of BTZ induction therapy. Cognitive tests were conducted at the time of patient enrollment and at the end of the study. Group-based trajectory modelling (GBTM) was used to depict patients with MM who persistently reported symptom burden trend over time either in high and low symptom severity groups. Loess curves were used to demonstrate symptom severity. Mean neuropathy scores from MDASI-MM and TNAS were reviewed using Wilcoxon signed rank test. Paired t-test was used to determine cognitive change at the end of induction therapy. RESULTS: The prevalence of bone pain and fatigue was 32% and 31%, respectively, in the high symptom group of patients receiving induction therapy. BTZ was associated with high prevalence of numbness during the first 6 months of induction therapy (42%). A significant increase in Becks Depression Inventory (BDI) scores (p=.01) and a decline in motor functions were reported at the end of induction therapy (p=.02). CONCLUSION: Bone pain and fatigue are highly prevalent symptoms in newly diagnosed MM patients receiving induction therapy. BTZ induction therapy was associated with high incidence of numbness. Help in the form of symptom management and psychosocial therapy may be useful for patients with disabling symptoms.

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Recommended Citation

Prasad, Seema, "Chemotherapy induced symptom burden in patients with multiple myeloma undergoing induction therapy" (2015). Texas Medical Center Dissertations (via ProQuest). AAI10109680.