engleski

Determinants of quality of life in multiple myeloma patients: Croatian experience

Background: Multiple myeloma (MM) is incurable clonal plasma cell disorder leading to end- organ damage. It has been shown that patients suffering from MM have decreased quality of life (QoL) and are prone to various psychiatric comorbidities. Aims: The main aim of this study was to show psychosocial determinants of QoL in MM patients treated at single-center. Methods: We electronically reviewed the charts of MM patients being referred to, treated or observed at hematologic transplant center in 2018. All subjects were then contacted by mail to fill out various questionnaires. The questionnaires included general questionnaire about sociodemographic and medical data, EORTC QLQ- C30 version 3, general questionnaire measuring QoL in cancer patients, and EORTC QLQ-MY20, To assess depression, we use CESD-R. Anxiety was assessed by GAD. Association analyses between QLQ-C30 Score and other clinical and demographic variables were performed using general linear model framework (ANOVA and linear regression). Adjusted R2 was used as a measure of strength of association between QLQ- C30 Score and other variables. False discovery rate for both analyses was controlled using Benjamini-Hochberg procedure. Results: A total number of 235 possible subjects were contacted with response rate being 40% (N=95). Median age of respondents was 65 with median age at diagnosis being 59. Majority of subjects were retired (74, 74%) with average Croatian income. Most of the subjects were transplanted at some of the point of their disease course (65, 26%). At the time of the survey 70.54% received some kind of therapy. Concerning treatment-free interval (defined as at least 6 months not taking therapy), majority of subjects were not treatment-free (50, 53%).Median QLQ-C30 was estimated to be 72, 09 (Min= 36, 02, Max=100). CESD-R score was estimated to be 11 (Min=5, Max=79) with GAD score being 3 (Min=1, Max 7). Depression measured by CESD-R was the most robust predictor of QoL (R2=0.508, p adj.= 5, 52E-14). All CESD-R scales were significantly correlated with QLQ-C30 (data not shown). Anxiety as measured by GAD seems not to be such robust predictor (R2=0, 358, p adj.= 6, 64E- 11). Concerning QLQ-MY20 scales, only two scales were meaningful in explaining the variance of QLQ- C30. Disease Symptoms scale was one of the most robust predictor of QoL (R2= 0, 564, p adj.= 6, 38E-18) followed by Side Effects of Treatment scale (R2= 0, 415, p adj.= 5, 89E-13). Interestingly, Body Image and Future Perspective scales were significantly correlated but not clinically meaningful. Conclusion: To our knowledge this is a first study examining psychiatric comorbidities and QoL in Croatian MM patients. The major limitation is low response rate being 40% indicating that QoL related outcomes are novel in our population. Furthermore, the average age of participants was 65 signifying that the frail and elderly patients’ population was not captured in this study.We have demonstrated that in our study population QoL is moderately impaired. Although less prevalent, examining for and treating the psychiatric comorbidities should play an important role in every-day MM treatment. Concerning, MM specific QoL scales only disease and treatment burden have a meaningful effect on QoL. In conclusion, QoL- related outcomes are yet to be introduced in Croatian MM patients through patients’ education, patients’ NGO groups and multidisciplinary approach in order to receive the quality of care as in developed countries.

depression ; multiple myeloma ; quality of life

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