Living With Advanced But Stable Multiple Myeloma: A Study of the Symptom Burden and Cumulative Effects of Disease and Intensive (Hematopoietic Stem Cell Transplant-Based) Treatment on Health-Related Quality of Life
Living With Advanced But Stable Multiple Myeloma: A Study of the Symptom Burden and Cumulative Effects of Disease and Intensive (Hematopoietic Stem Cell Transplant-Based) Treatment on Health-Related Quality of Life
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DOI：
10.1016/j.jpainsymman.2012.11.003
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发表时间：
2013-11-01
影响因子：
4.7
通讯作者：
Snowden, John A.
中科院分区：
文献类型：
--
作者：
Boland, Elaine;Eiser, Christine;Snowden, John A.
上下文。疾病和治疗相关因素对多发性骨髓瘤长期存活者健康相关生活质量(HRQOL)的累积影响尚不清楚。研究晚期强化治疗的骨髓瘤患者的HRQL和症状负担。我们对接受过造血干细胞移植并随后接受至少一次进展性疾病治疗的患者进行了详细的评估。排除活动性疾病的影响和治疗的急性毒性，患者处于平稳平台期。患者接受了HRQOL(简表-12，欧洲癌症研究和治疗组织生活质量问卷-CORE 30和多发性骨髓瘤模块)、疼痛(简明疼痛问卷-简表)、周围神经病变(利兹神经病变症状和体征自我报告)和担忧(根据担忧简介改编)的评估。检测血清IL-6和肿瘤坏死因子-α水平。共有32名患者入选，诊断时的中位年龄为55岁，评估时的中位年龄为60岁。在确诊和三次治疗的中位数5.5年后，身体功能显著受损(P<；0.001)，并与进行性工作残疾和对丧失独立性的担忧有关。疲劳和疼痛是主要症状，对身体功能有负面影响(P<；0.001)。在一半的患者中，疼痛主要是神经性的。血清IL-6水平与疼痛(P=0.003.0 3)、疼痛干扰(P=0.0 2)、失眠(P=0.0 2)、食欲不振(P=0.0 2)呈正相关，与身体功能呈负相关(P=0.0 3)。尽管疾病控制和支持性护理，强化治疗的长期骨髓瘤幸存者已经显著降低了与症状负担相关的HRQOL。即使在疾病活动稳定的情况下，系统评估也是晚期骨髓瘤的常规指征。进一步的研究应该调查介入策略的实用性以及细胞因子与症状的关系。(C)2013年美国癌症疼痛缓解委员会。爱思唯尔公司出版，版权所有。
Context. The cumulative impact of disease and treatment-related factors on health-related quality of life (HRQoL) in long-term survivors of multiple myeloma is poorly characterized.Objectives. To characterize HRQoL and symptom burden in advanced, intensively treated myeloma.Methods. We performed detailed assessments in patients who had undergone hematopoietic stem cell transplantation and subsequent treatment for at least one episode of progressive disease. To exclude the impact of active disease and acute toxicity of treatment, patients were in a stable plateau phase. Patients were assessed for HRQoL (Short Form-12, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and Multiple Myeloma Module), pain (Brief Pain Inventory-Short Form), peripheral neuropathy (self-report Leeds Assessment of Neuropathic Symptoms and Signs), and concerns (adapted from Profile of Concerns). Serum interleukin-6 and tumor necrosis factor-alpha were measured.Results. A total of 32 patients were enrolled, with a median age of 55 years at diagnosis and 60 years at assessment. After a median 5.5 years from diagnosis and three lines of treatment, physical functioning was significantly compromised (P < 0.001) and associated with progressive work disability and concerns regarding loss of independence. Fatigue and pain were the predominant symptoms, impacting negatively on physical functioning (P < 0.001). Pain was predominantly neuropathic in half the patients. Serum interleukin-6 levels positively correlated with pain (P = 0.03), pain interference (P = 0.003), insomnia (P = 0.02), and appetite loss (P = 0.02), and inversely correlated with physical functioning (P = 0.03).Conclusion. Despite disease control and supportive care, intensively treated long-term myeloma survivors have significantly compromised HRQoL related to symptom burden. Systematic assessment is routinely indicated in advanced phase myeloma, even when disease activity is stable. Further studies should investigate the utility of interventional strategies and the relationship of cytokines with symptoms. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.