Division of Geriatrics, University of California, San Francisco, 4150 Clement St., San Francisco, CA, 94121, USA.
Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
Aging Clin Exp Res. 2020 Jun;32(6):1153-1160. doi: 10.1007/s40520-019-01465-3. Epub 2020 Jan 22.
Changes in well-being of patients with multiple myeloma (MM) before and after diagnosis have not been quantified.
Explore the use of secondary data to examine the changes in the well-being of older patients with MM.
We used the Health and Retirement Study (HRS), linked to Medicare claims to identify older MM patients. We compared patient-reported measures (PRM), including physical impairment, sensory impairment, and patient experience (significant pain, self-rated health, depression) in the interviews before and after MM diagnosis using McNemar's test. We propensity-matched each MM patient to five HRS participants without MM diagnosis based on baseline characteristics. We compared the change in PRM between the MM patients and their matches.
We identified 92 HRS patients with MM diagnosis (mean age = 74.6, SD = 8.4). Among the surviving patients, there was a decline in well-being across most measures, including ADL difficulty (23% to 40%, p value = 0.016), poor or fair self-rated health (38% to 61%, p value = 0.004), and depression (15% to 30%, p value = 0.021). Surviving patients reported worse health than participants without MM across most measures, including ADL difficulty (40% vs. 27%, p value = 0.04), significant pain (38% vs. 22%, p value = 0.01), and depression (29% vs. 11%, p value = 0.003).
Secondary data were used to identify patients with MM diagnosis, and examine changes across multiple measures of well-being. MM diagnosis negatively affects several aspects of patients' well-being, and these declines are larger than those experienced by similar participants without MM.
The results of this study are valuable addition to understanding the experience of patients with MM, despite several data limitations.
多发性骨髓瘤（MM）患者在诊断前后的健康状况变化尚未量化。
利用次级数据探讨老年 MM 患者健康状况的变化。
我们使用健康与退休研究（HRS），并与医疗保险索赔数据相关联，以确定老年 MM 患者。我们使用 McNemar 检验比较了 MM 诊断前后的患者报告指标（PRM），包括身体功能障碍、感觉障碍和患者体验（严重疼痛、自我报告的健康状况、抑郁）。我们根据基线特征，为每位 MM 患者匹配了 HRS 中没有 MM 诊断的 5 名参与者。我们比较了 MM 患者及其匹配者的 PRM 变化。
我们确定了 92 名 HRS 患者患有 MM 诊断（平均年龄=74.6，标准差=8.4）。在幸存患者中，大多数指标的健康状况都有所下降，包括日常生活活动困难（23%至 40%，p 值=0.016）、自我报告的健康状况较差或一般（38%至 61%，p 值=0.004）和抑郁（15%至 30%，p 值=0.021）。与没有 MM 的参与者相比，幸存患者在大多数指标上报告的健康状况更差，包括日常生活活动困难（40%比 27%，p 值=0.04）、严重疼痛（38%比 22%，p 值=0.01）和抑郁（29%比 11%，p 值=0.003）。
我们使用次级数据来识别 MM 诊断患者，并检查多个健康指标的变化。MM 诊断对患者的多个方面的健康状况产生负面影响，并且这些下降比没有 MM 的类似参与者经历的下降更大。
尽管存在一些数据限制，但本研究的结果对于了解 MM 患者的体验是有价值的补充。
