Abstract B141 Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center
Authors: Estrada-Merly Noel , Wu James F , D'Souza Anita 
Published: September 2024

Abstract
The National Comprehensive Cancer Network (NCCN) recommends screening all cancer patients for distress to facilitate psychosocial support and referrals. This distress is associated with treatment delays and other obstacles that may affect patient outcomes. The prevalence of distress in patients with multiple myeloma (MM) and its variation among underrepresented minorities and vulnerable groups is unknown. We hypothesized that patients with advanced disease, racial minorities, and vulnerable individuals would report higher distress levels. New patients with MM seen between 1/1/2015-12/31/2022 at a tertiary medical center were identified. All patients receive the NCCN Distress Thermometer (DT) survey for completion at initial consultation as standard of care. Baseline characteristics of patients who completed the survey were compared with those of patients who did not. Among those with survey data, DT score was categorized as &lt;4 (low), 4–6 (moderate), and &gt;6 (high). DT score was analyzed by sociodemographic and disease-related factors. The 2020 Social Vulnerability Index (SVI) at the county level was calculated using Zip codes and categorized as less vulnerable (score &lt;50) or more vulnerable (&gt;=50). Of 1,011 new MM patient consultations, 683 patients had an available DT survey at initial consultation. In patients without the survey (N=328), a higher proportion was older than 75 years (21% vs 16% P=0.04), non-Hispanic Black (NHB) [22% vs. 9%, P&lt;0.01], and with more advanced disease (ISS III 20% vs 14%, P&lt;0.01). There was lower autologous stem cell transplant utilization in the group with missing survey data (71% vs 79%, P&lt;0.01). Among those with DT survey, younger age, female sex, advanced stage, and shorter time from diagnosis to consult was associated with higher distress. In patients with DT survey data and SVI (N=683), the mean SVI was 0.37 (std dev 0.31) and 166 (28%) had more vulnerability. Younger age and NHB race were associated with more vulnerability. The more vulnerable group also had a shorter time from diagnosis to consult (1.2 vs 1.8 months, P&lt;0.01). In the more vulnerable group, high DT score was seen with younger age and NHB race. There was no difference in transplant utilization by SVI group. No significant differences were found in the proportion of patients reporting concerns for physical, practical, emotional, social concerns by vulnerability. In this tertiary referral center study, we observed the greatest disparity by the completion of the NCCN DT survey highlighting a missed opportunity to identify individuals who may benefit from additional services. Among those who completed the survey, patient-reported distress was influenced by age, sex, and MM stage. Younger age was associated with more vulnerability. This may be due to minority status as a theme in the SVI calculator and the known association of younger age at MM onset in NHB individuals. Next steps including an adjusted analysis will be shown in the final presentation.
Citation Format: Noel Estrada-Merly, James F Wu, Anita D'Souza. Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B141.