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Multiple myeloma: routes to diagnosis, clinical characteristics and survival - findings from a UK population-based study.

ABSTRACT: Prompt cancer diagnosis may align UK survival with European averages. We examined the impact of route to diagnosis on survival for multiple myeloma patients diagnosed 2012-2013 using data from our population-based patient cohort that links to national death notifications and collects details on treatment and response (n = 441). Emergency presentation was associated with advanced disease and poorer outcomes, and was the commonest route to diagnosis (28·1%) followed by General Practitioner urgent (19·0%) and two-week wait (17·2%) referrals. CRAB (elevated Calcium, Renal failure, Anaemia, Bone lesions) distribution varied by route (P < 0·001), with patients with emergency presentations most likely to have ?2 features and significantly worse survival (log-rank test ?² = 13·8, P = 0·0002).

SUBMITTER: Howell D

PROVIDER: S-EPMC5396308 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Multiple myeloma: routes to diagnosis, clinical characteristics and survival - findings from a UK population-based study.

Howell Debra D Smith Alexandra A Appleton Simon S Bagguley Timothy T Macleod Una U Cook Gordon G Patmore Russell R Roman Eve E

British journal of haematology 20170201 1

Prompt cancer diagnosis may align UK survival with European averages. We examined the impact of route to diagnosis on survival for multiple myeloma patients diagnosed 2012-2013 using data from our population-based patient cohort that links to national death notifications and collects details on treatment and response (n = 441). Emergency presentation was associated with advanced disease and poorer outcomes, and was the commonest route to diagnosis (28·1%) followed by General Practitioner urgent ...[more]

PMID: 28146275

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Project description:ObjectivesPatients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. The aim of this study was to characterise the frequency and timing of clinical features in the primary care setting prior to MM diagnosis.DesignPopulation-based cohort study.SettingElectronic health records data of approximately 17 million patients (2006-2016) within the UK Clinical Practice Research Datalink.ParticipantsPatients aged ≥18 years with newly diagnosed MM (NDMM), no history of solid tumours and ≥2 years registration in a primary care practice prior to MM diagnosis.Main outcome measuresClinical features and symptoms including bone pain, skeletal-related events (SREs), investigation and confirmation of MM diagnostic CRAB criteria (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) during the 2 years prior to MM diagnosis; time between symptom manifestation and/or relevant investigation and diagnosis of MM.ResultsAmong 2646 patients with NDMM, 47.5% had a bone pain record during the 2-year period prior to MM diagnosis, mainly affecting the back. Regardless of baseline bone pain, investigations for serum calcium level were used in 36.4% of patients prior to MM diagnosis, followed by haemoglobin (65.6%) or renal function (74.1%). Median (Q1, Q3) time from first-recorded bone pain to MM diagnosis was 220 (80, 476) days. Median (Q1, Q3) time from first-recorded hypercalcaemia, renal impairment or anaemia to MM diagnosis was 23 (12, 46), 58 (17, 254) and 73 days (28, 232), respectively. An imaging investigation or referral for imaging was recorded for 60.0% of patients with bone pain/SRE and 32% without.ConclusionsNearly half of patients diagnosed with NDMM presented with bone pain approximately 7 months prior to MM diagnosis. Investigations to evaluate all CRAB criteria, including targeted imaging, were underused. Early recognition of myeloma clinical features and optimised use of investigations in primary care may potentially expedite MM diagnosis.

Dataset Information

Multiple myeloma: routes to diagnosis, clinical characteristics and survival - findings from a UK population-based study.

Publications

Multiple myeloma: routes to diagnosis, clinical characteristics and survival - findings from a UK population-based study.

Similar Datasets

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