Functional Trajectories and Illness Experiences of Older Adults with Multiple Myeloma

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Multiple myeloma is a disease of aging, with a median age at diagnosis of almost 70 years. Most adults with this condition also have several other age-related health conditions, including multiple chronic conditions and cognitive and functional limitations. Furthermore, quality-of-life for patients with myeloma is much lower than for those with other blood cancers. In this respect, the needs of older adults with multiple myeloma differ in important ways from those of other cancer populations. With the increasing availability of new therapies to treat myeloma, there is a growing urgency to understand how the benefits and harms of these treatments shape functional capacity, quality-of-life, and the illness experience. Prior studies have failed to account for baseline (pretreatment) level of functioning and have generally focused on traditional disease-centric metrics such as survival and remission status and have not incorporated the range of outcomes that might be important to patients. While disease-specific endpoints remain highly relevant to older adults with myeloma, more global outcome measures addressing the impact of disease and treatment on the whole person are critical. Therefore evaluating measures of function and quality-of-life which are increasingly relevant to older adults is critical as these can profoundly shape the illness experience. To fill the existing knowledge gaps, I propose a pilot observational study leveraging an existing Registry NCT03717844 at the University of North Carolina, Lineberger Comprehensive Cancer Center. This proposed observational study will quantify the frequency and severity of decrements in cognitive and physical function and quality-of-life among older adults newly diagnosed with multiple myeloma (Aim1 ); identify predictors of these outcomes (Aim 2), and elicit the experiences and perspectives of older adults with myeloma and their care partners on illness and care received (Aim 3). Knowledge gained from this pilot observational study will inform the design of a larger observational study that will compare outcomes of different myeloma treatment regimens in older adults. This data would also inform the design of studies to develop and test interventions to support shared decision-making and a more individualized, person-centered approach to care for older adults with multiple myeloma. The proposed study is a transdisciplinary effort between the Divisions of Geriatrics, Hematology, and Oncology, and the Geriatric Oncology Program at the University of North Carolina. Hyman B. Muss MD (Geriatric Oncology) will serve as the Primary Mentor with additional mentorship provided by Jan Busby-Whitehead MD (Geriatrics), Dr. Tanya Wildes MD MSCI (Geriatric Hematology and Qualitative Research), Sascha Tuchman MD MHS (Multiple Myeloma), Timothy Ahles PhD (Neurocognition), Kirsten Nyrop PhD (Qualitative Research) and Allison Deal MS (Statistics).