Earlier recognition of multiple myeloma in primary requires ‘connecting the dots’

March has been designated “Myeloma Action Month” by the International Myeloma Foundation to encourage health care professionals, patient advocates and caregivers to “take action to empower patients and arm them with knowledge.” Healio Family Medicine spoke with oncologists and primary care physicians about awareness of the malignancy in primary care and strategies for diagnosing the disease earlier.

Multiple myeloma is considered relatively rare in the United States, accounting for 1.8% of all anticipated new cancer cases in 2016, with an estimated 30,330 new cases and 12,650 deaths.

The prognosis for multiple myeloma has improved in recent years, due in large part to new therapeutic agents and the use of autologous hematopoietic stem cell transplant. Median survival rates vary by stage, but range from 62 months for patients with stage 1 disease to 29 months for patients with stage 3 disease.

Identifying patients with multiple myeloma can begin in the primary care setting, but the non-specific symptoms make diagnosis challenging and require greater recognition of symptom patterns and patients at increased risk.

The initial symptoms of multiple myeloma include pain, particularly of the back and bones, and fatigue, common complaints in primary care, according to Robert A. Vescio, MD, medical director of the multiple myeloma and amyloidosis program at Cedars-Sinai Medical Center in Los Angeles.

“Back pain and bone pain are the most common early symptoms that people present with,” Vescio said. “If the bone is weakened from a plasmacytoma, a tumor of malignant plasma cells, that can cause a compression fracture. People have back pain for many other reasons, so there is often a lag between symptom onset and diagnosis. In older patients, it may be assumed that they have compression fractures from osteoporosis.”

Healio Family Medicine spoke with Vescio and other clinicians about the initial symptoms of multiple myeloma and the steps that can be taken to increase earlier diagnosis in the primary care setting.

Importance of patient characteristics, related symptoms

In addition to pain and fatigue, early symptoms of multiple myeloma include anemia and renal insufficiency, which may not be recognized immediately as an indicator of multiple myeloma, according to Vescio.

“If the creatinine is rising in a patient who has a history of diabetes or hypertension, or there is another reason to explain why the kidneys are not functioning, a complete workup isn’t always done,” he said.

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