The Significant Contribution of Pain in Determining the Health Status of Patients with Multiple Myeloma

Conference Correspondent - TON - ASH 2015 - Multiple Myeloma

Bone lesions and bone pain are relatively common in patients with multiple myeloma (MM). Pain can be debilitating; therefore, patient-reported outcomes may provide useful information in determining the impact of this condition. This study assessed health status using the EQ-5D, a commonly used tool to measure health utility scores. It also evaluated the predictive information provided by the Brief Pain Inventory (BPI), a self-report pain assessment tool designed to capture pain severity and interference in patients.

Eligible patients had histologically confirmed advanced cancers, radiographic evidence of ≥1 bone metastasis, an Eastern Cooperative Oncology Group status score of ≥2, and adequate organ function. These patients completed the EQ-5D and BPI at baseline. Using data from 168 patients, researchers summarized information about the patients’ health-related quality of life and utility scores. The investigators also analyzed the same data from several (N = 5500) groups of patients with cancer, including breast and prostate cancers, to determine whether patients with MM have experiences similar to patients with other types of cancer.

Of the 5 dimensions measured by the EQ-5D, patients with some/moderate or extreme MM-related pain (80%) scored the highest (higher score denotes greater severity), followed by usual activities (68%), mobility (64%), anxiety/depression (50%), and self-care (36%). The order was similar for patients with other cancers, but with slightly lower percentages for most items: pain (79%), usual activities (58%), mobility (55%), anxiety/depression (58%), and self-care (26%). When the BPI was used as a surrogate marker, there was considerable concordance with EQ-5D scores. Concordance index scores were 86% for mobility, 80% for self-care, 83% for usual activities, 90% for pain, and 78% for anxiety/depression, where 100% represented total concordance and 0% represented no concordance. Three BPI pain severity items—pain at its worst, average pain, and pain now—in addition to interference with activity and interference with work significantly predicted the EQ-5D pain item.

In conclusion, researchers reported that a majority of the patients reported moderate to extreme problems in all EQ-5D dimensions except self-care. Consistent results were seen across tumor types, including breast and prostate. Concordant results with the EQ-5D indicated that use of the BPI had utility for treatment planning and health status evaluation in patients with MM.

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Last modified: December 8, 2015