Exploring Interest in and Feasibility of a Lifestyle Intervention for Multiple Myeloma Patients
Authors: Kerschner Abigail , Hodge Allen , Williams Alexis , Sheean Patrica , Jensik Kathleen , Visotcky Alexis , Hari Parameswaran , Mohan Meera , Chhabra Saurabh , D'Souza Anita , Stolley Melinda 
Published: November 2021

Abstract
Introduction: Multiple Myeloma (MM) is the second most common hematologic malignancy in the U.S., with higher rates observed in older adults and Black individuals (Kazandjian, 2016). Owing to therapeutic advances and greater access to frontline therapy with autologous stem cell transplant (ASCT), more patients with MM now survive in excess of 5-10 years (Costa et al., 2017), with no difference in post-transplant outcomes by race/ethnicity (Hari, et al. BBMT 2010). Many survivors struggle with fatigue, bone pain, bone fractures, and kidney disease. Poor body composition may be partly responsible, as studies show that MM survivors have a high incidence of being overweight or obese (Greenfield, 2014). These collective factors highlight the value of developing evidence-based lifestyle interventions to meet the needs of this diverse group of survivors.
Typically, MM survivors treated with ASCT are not considered for lifestyle trials under the assumptions that: 1) there is limited interest, 2) exercise could be unsafe or pose additional burden, or 3) changes in physical activity and/or nutrition would have little impact on their disease trajectory. However, a few studies demonstrate that personalized exercise programs are not only safe, but also improve quality of life in MM survivors (Groeneveldt, 2013 & Smith, 2015). Less is known about dietary interventions or those that combine diet and physical activity, and no studies have intentionally included diverse patient populations. We report the results of an exploratory study aimed to inform the development of a lifestyle program tailored to meeting the needs of the diverse MM survivor community.
Methods: We recruited a convenience sample of MM survivors who were at least 100 days post-ASCT with ECOG status 0-1 through treating oncologists, with the goal of including equal representation of females/males and white/Black participants. Participants completed an online survey targeting diet using the validated Block Fat/Sugar/Fruit/Vegetable Screener, physical activity using the Godin Leisure Physical Activity Index, social support and quality of life (QOL) using the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS scores are reported using a common metric (T-score with a mean of 50 and a standard deviation of 10), which has been normalized to the US population. Higher scores represent more of that domain. Interviews focused on health behaviors, unmet needs, and preferences/interests regarding a lifestyle intervention program.
Results: 38 MM survivors (54% white, 46% Black, 54% female, 46% male) participated. Mean age was 60.37 ± 20.06years old, 74% married, 100% had health insurance. Education and income varied widely. Overall, participants, of which 76% had obesity, reported good QOL and high social support. However, QOL challenges included reduced physical function (43.85 ± 9.49), fatigue (52.61 ± 8.53), and pain (52.85 ± 10.77). Comparisons by race reflected no differences, but significant gender differences were evident for perceived emotional support (p = 0.026), informational support (p= 0.001), instrumental support (p = 0.011), and companionship (p = 0.048), with female participants reporting higher perceived support in these areas. The majority reported insufficiently or moderately active lifestyles and diets that did not meet guidelines. Qualitative data showed that most had not received lifestyle counseling from their healthcare team (55%), were not aware of the American Cancer Society guidelines (83%) and were interested in a lifestyle program (87%). Predominant themes regarding survivors' desires for the program included: 1) social support, 2) guided/personalized exercise, 3) meal preparation support, and 4) flexibility. Notably, participants also stated that mental health support, opportunities to mentor others, and disease management information would be helpful to them at this point in their survivorship.
Conclusions: This study demonstrates the substantive need for and interest in lifestyle change support among a diverse sample of MM survivors. In addition to providing structure for improved diet and exercise, a program of this kind has the potential to provide social and informational support for survivors. This could be particularly beneficial to male MM patients, who have lower perceived support in their survivorship compared to their female counterparts.

Disclosures
Hari: Millenium: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Adaptive Biotech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Celgene-BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Karyopharm: Consultancy; GSK: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau; Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Chhabra: GSK: Honoraria. D'Souza: Imbrium, Pfizer, BMS: Membership on an entity's Board of Directors or advisory committees; Janssen, Prothena: Consultancy; Sanofi, Takeda, Teneobio, CAELUM, Prothena: Research Funding.