Patients with precursor disease exhibit similar psychological distress and mental HRQOL as patients with active myeloma
Authors: Imad Maatouk, Susanne He, Manuela Hummel, Stefan Hemmer, Michaela Hillengass, Hartmut Goldschmidt, Mechthild Hartmann, Wolfgang Herzog, Jens Hillengass
Journal: Blood Cancer Journal (2019)

Multiple myeloma (MM) is largely a disease of the elderly with a median age at first diagnosis of 69 years.MM accounts for 10% of hematologic malignancies, with an incidence of 5-8/100,000 individuals in the US 1 .Several studies have investigated the impact of MM on health-related quality of life (HRQOL), psychological distress (DT), and mental comorbidity 2 due to a variety of disease-and treatment-related events leading to impairment in terms of HRQOL and increased DT 3 .However, MM is consistently preceded by a monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) MM (SMM), which are premalignant stages of the disease with the presence of monoclonal plasma cells and/or monoclonal protein, but lacking so-called myeloma-defining events 4 .It is estimated that ~5% of the elderly population (aged ≥70 years) are diagnosed with MGUS.In individuals aged ≥85 years the prevalence of MGUS in men increases to 9%.Depending on clinical risk factors, MGUS and SMM require regular consultations, as the annual risk of progression is 1 and 10% for MGUS and SMM, respectively 5 .Clinicians and patients report that this period of watchful "waiting" characterized by repeated follow-up visits has a high psychosocial impact on patients' quality of life.Pilot data suggest similar or even higher levels of DT in patients with non-malignant hematologic entities 6,7 .Here, we aimed to compare HRQOL, DT, anxiety, and depression between patients with MGUS/SMM and patients with MM pre-and post-treatment.All patients who made the first appointment at our outpatient clinic between November 2014 and September 2017 received a letter prior to their appointment at the hospital.This letter included information on the survey and a psychosocial questionnaire package.Patients with a diagnosis of MM, SMM, or MGUS, and who also had sufficient skills in reading and writing German were eligible for study participation.Written, informed consent for analysis of patient data was obtained from all participants.Approval was obtained from the local ethics committee at the University Hospital of Heidelberg.HRQOL was measured using the Short Form General Health Survey (SF-12).The items were weighted and totaled to provide both a physical component score (PCS) and a mental component score (MCS) 8 .DT was measured using the National Comprehensive Cancer Network (NCCN) distress thermometer 9 .The nine-item patient health questionnaire (PHQ-9) and the seven-item general anxiety disease-screening instrument (GAD-7) were used to measure depression and anxiety symptoms, respectively 10 .Participants were classified into three groups based on the guidelines of the International Myeloma Working Group and according to time-point in the course of the disease as follows: new diagnosis of MM (pre-treatment), treated MM, and premalignant disease (MGUS or SMM) 4 .Group comparisons (Kruskal-Wallis tests) for the respective outcomes and multivariate regression analyses were performed, with HRQOL, DT, anxiety, and depression scores as outcome measures.Classification of a disease stage (Group 1: premalignant disease; reference, Group 2: new diagnosis of MM before treatment, and Group 3: treated MM) served as