Interdisciplinary approach to multiple myeloma – time to diagnosis and warning signs

Abstract

Delayed diagnosis is a common challenge in the management of multiple myeloma (MM). This prospective interdisciplinary study evaluated symptoms and time to diagnosis (TTD) in 81/295 screened patients at our tertiary center, who were examined by an orthopedist prior to the MM diagnosis. The most frequent complaint was back pain (81%), mainly localized thoracic and/or lumbar. Pain was independent of movement in 85%, occurred at night in 69%, and at multiple localizations in 30% of patients. Notably, 63% patients with an orthopedic disease noticed substantial symptom change before the MM diagnosis was made. The median TTD was 7 months and did not differ significantly between patients with or without a preexisting skeletal disease. To avoid delayed diagnosis, physicians should consider MM as a differential diagnosis, whenever warning signs such as skeletal pain independent from movement, at night, at various localizations, and change in pain characteristics accompanied by fatigue, are reported.

Keywords:

• Multiple myeloma;
• symptoms;
• time to diagnosis;
• oncologist;
• orthopedist;
• warning signs

Acknowledgments

The authors would like to thank Chrissoula Kiote-Schmidt, M.D. and Christoph Miething, M.D., University Hospital of Freiburg, for their assistance in recruiting patients for this study. We thank Dr. Cristian Pasluosta for his very valuable help in editing the manuscript and Mrs. Lynn Leppla for her constructive comments on the ‘Study design and patient selection’ section. We are especially in debt to all MM patients who gladly and vividly engaged in this study.

Disclosure statement

Dr. Herget, F. Kälberer, Dr. Ihorst, Dr. Graziani, L. Klein, Dr. Rassner and Dr. Gehler have nothing to disclose. Dr. Jung reports grants from the Else Kroener Fresenius Stiftung, outside the submitted work. Dr. Schmal reports grants from Horizon 2020, Interreg, personal fees from speaker honorarium Arthrex, outside the submitted work. Dr. Wäsch reports grants from Pfizer, grants from Amgen, grants from Novartis, grants from Sanofi, grants from Janssen, grants from Celgene / BMS, grants from Gilead, outside the submitted work. Dr. Engelhardt reports grants and personal fees from Amgen, Janssen, BMS, Takeda, outside the submitted work.

Data availability statement

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.