Methods for reducing delays in the diagnosis of multiple myeloma.

Abstract

Multiple myeloma & diagnostic delays Myeloma is a hematological malignancy that starts in the bone marrow and mainly affects the elderly population with a median diagnosis age of 70 years old [1]. A systematic review has shown that patients with multiple myeloma experience long diagnostic intervals, with 50% of patients having waiting times longer than 3 months [2]. Myeloma patients also experience many consultations as 50% visit their primary care physician more than three times before they get referred to specialist services [3]. Longer time to diagnosis has been associated with more complications and worse disease-free survival [4]. Approximately 30% of myeloma patients are being diagnosed through emergency services and these patients have worse survival compared with patients being diagnosed through other routes [5,6]. More timely diagnosis could have a positive impact on myeloma patients both in terms of treatment options and subsequent survival and quality of life. Myeloma has been classified as one of the hardest cancers to diagnose and no single reason is responsible for the delays observed in diagnosis [7]. It is usually a combination of multiple factors which together form a very complex diagnostic picture. One of them is the rarity of the disease; in the UK, the yearly incidence is approximately nine per 100,000 population and it accounts for 2% of all cancer cases diagnosed every year [8]. A full-time primary care practitioner in the UK will diagnose on average one myeloma case every 5 years. The other main factor is the nonspecific nature of the symptoms that can include back pain, bone pain, fatigue and repeated infections [9]. These symptoms are also common in many other conditions of varying severity that makes it difficult to suspect myeloma as the underlying cause. Patients with comorbidities are also more likely to experience diagnostic delays as multiple comorbidities can mask myeloma-related symptoms [10].