Patients, when discussing multiple myeloma (MM), will want to know ways to mitigate the possibility of negative outcomes and improve their odds of survival. From 2012 to 2018, the 5-year survival rate for people diagnosed with MM was 57%.¹
A variety of factors can play a role in MM patients’ outcomes, and patients and health care professionals alike should be aware of these factors. Frailty, bone disease, cardiovascular disease, renal disease, and mood disorders can all affect outcomes and should be discussed with MM patients.
Since MM is more likely to affect older patients, conditions that have an impact on the health of geriatric patients should be considered. One example is frailty, which presents unique challenges when dealing with MM.
In a 2021 review in Current Opinion in Oncology, researchers examined the need for frailty scores for individualized MM treatment, noting that while overall survival in MM has improved, frail patients remain at risk of shorter overall survival and progression-free survival.² This is due, in large part, to their increased risk of experiencing adverse events, particularly when they are overtreated. Having a better understanding of a patient’s frailty can lead to a more targeted treatment regimen that accounts for their risk of adverse events.
2. Bone Disease
Bone disease is a common comorbidity to appear after MM develops. Per a 2022 study in Cells, nearly half of patients who experience bone disease in MM will have a skeletal-related event that can increase mortality risk by 20% to 40%.³ These skeletal-related events can include pathological fractures and spinal cord compression. Being vigilant in looking for bone disease can lead to early detection and treatment. Osteoclast inhibitors have shown the potential to lower the risk of adverse skeletal-related events and increase the likelihood of bone resorption.
3. Cardiovascular Disease
As patients with MM tend to be older, they are more likely to have existing comorbidities. One such comorbidity is cardiovascular disease, a condition that may affect outcomes if it exists prior to diagnosis and if it develops later on.
In 2022, a study was published in Annals of Hematology that examined comorbidities in patients diagnosed with MM in Finland. The investigators found cardiovascular disease to be a common comorbidity in these patients.⁴ When examining patients from 2005 to 2016, 27.9% of those with comorbidities presented with cardiovascular disease in the year prior to diagnosis, while 4.8% had experienced a major adverse cardiac event. At 2 years post-diagnosis, those numbers increased to 57.1% and 11.4%, respectively. The researchers also found that older male patients were at a higher risk of major cardiac events and mortality.
4. Renal Disease
Renal complications can also affect outcomes in MM. A 2017 study in Cancer Medicine, which included patients diagnosed with MM from 2005 to 2012, revealed an increased incidence of renal disease as a registered comorbidity.⁵ In patients with MM who were diagnosed with moderate and severe renal disease, the 5-year survival rate was just 24%.
5. Mood Disorders
Patients with MM have a heightened risk of mood disorders and psychiatric conditions. As a 2018 study in Blood Advances showed, an estimated one-third of patients with cancer experience mood disorders as a comorbidity.⁶ These mood disorders are often associated with worse outcomes and an increase in medical costs.
A large part of the risk with MM is that treatment often includes corticosteroids, which bring an increased risk of psychiatric complications. This, combined with the stress of dealing with a serious illness and the high existing costs of cancer treatments, can compound and increase the risk of mood disorders. Mental health is something health care professionals should focus on when working with patients.
1. Survival rates for multiple myeloma. American Cancer Society. https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/survival-rates.html. Updated March 2, 2023. Accessed March 9, 2023.
2. Möller MD, Gengenbach L, Graziani G, Greil C, Wäsch R, Engelhardt M. Geriatric assessments and frailty scores in multiple myeloma patients: a needed tool for individualized treatment? Curr Opin Oncol. 2021 Nov 1;33(6):648-657. doi: 10.1097/CCO.0000000000000792. PMID: 34534141; PMCID: PMC8528138.
3. Bernstein ZS, Kim EB, Raje N. Bone disease in multiple myeloma: Biologic and clinical implications. Cells. 2022 Jul 27;11(15):2308. doi: 10.3390/cells11152308. PMID: 35954151; PMCID: PMC9367243.
4. Toppila, I., Kysenius, K., Miettinen, T. et al. Comorbidity characteristics of multiple myeloma patients diagnosed in Finland 2005–2016. Ann Hematol 101, 2485–2495 (2022). https://doi.org/10.1007/s00277-022-04959-9
5. Gregersen H, Vangsted AJ, Abildgaard N, et al. The impact of comorbidity on mortality in multiple myeloma: A Danish nationwide population-based study. Cancer Medicine. 2017;6(7):1807-1816. doi:10.1002/cam4.1128
6. Niazi S, Frank RD, Sharma M, et al. Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma. Blood Advances. 2018;2(10):1120-1128. doi:10.1182/bloodadvances.2018016717