Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA.
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
BMC Cancer. 2023 Jan 19;23(1):65. doi: 10.1186/s12885-022-10458-x.
Advances in multiple myeloma treatment and a proliferation of treatment options have resulted in improved survival rates and periods of symptom-free remission for many multiple myeloma patients. As a result, health-related quality of life (HRQoL) concerns related to myeloma treatments have become increasingly salient for this patient population and represent an important consideration guiding patients' treatment choices. To gain an understanding of patients' experiences with choosing myeloma therapies and explore the HRQoL concerns that are most important to them, we interviewed a diverse sample of US-based multiple myeloma patients about their treatment considerations.
We conducted a qualitative descriptive study using in-depth interviews. Participants reflected on (1) the factors that were most important to them when thinking about multiple myeloma treatment and how these have changed over time, (2) how they might weigh the importance of treatment efficacy vs. side effects, (3) trade-offs they would be willing to make regarding efficacy vs. HRQoL, and (4) treatment changes they had experienced. Interviews were audio-recorded and transcribed, and narratives were analyzed using applied thematic analysis.
We interviewed 21 patients, heterogeneous in their disease trajectory and treatment experience. Participants were 36 to 78 years, 52% female, and 38% Black. Efficacy was named as the most important treatment consideration by almost two-thirds of participants, and over half also valued HRQoL aspects such as the ability to maintain daily functioning and enjoyment of life. Participants expressed concern about potential treatment side effects and preferred more convenient treatment options. Although participants stated largely trusting their clinicians' treatment recommendations, many said they would stop a clinician-recommended treatment if it negatively impacted their HRQoL. Participants also said that while they prioritized treatment efficacy, they would be willing to change to a less efficacious treatment if side effects became intolerable.
Our findings link to other reports reflecting considerations that are important to multiple myeloma patients, including the importance placed on increasing life expectancy and progression-free survival, but also the tension between treatment efficacy and quality of life. Our results extend these findings to a racially diverse US-based patient population at different stages in the disease trajectory.
多发性骨髓瘤治疗的进步和治疗选择的增多，使许多多发性骨髓瘤患者的生存率和无疾病缓解期得到提高。因此，与骨髓瘤治疗相关的健康相关生活质量（HRQoL）问题对这一患者群体变得越来越重要，这也是指导患者治疗选择的一个重要考虑因素。为了了解患者在选择骨髓瘤疗法时的体验，并探讨对他们最重要的 HRQoL 问题，我们对美国多发性骨髓瘤患者进行了一项关于他们治疗考虑因素的多样性样本的深入访谈。
我们使用深入访谈进行了定性描述性研究。参与者回顾了（1）他们在考虑多发性骨髓瘤治疗时最重要的因素，以及这些因素随时间的变化，（2）他们如何权衡治疗效果与副作用的重要性，（3）他们愿意在疗效与 HRQoL 之间做出的权衡，以及（4）他们经历过的治疗变化。访谈进行了录音和转录，并使用应用主题分析对叙述进行了分析。
我们采访了 21 名患者，他们在疾病轨迹和治疗经验方面各不相同。参与者年龄在 36 至 78 岁之间，52%为女性，38%为黑人。近三分之二的参与者将疗效列为最重要的治疗考虑因素，超过一半的人还重视 HRQoL 方面，如保持日常功能和享受生活的能力。参与者对潜在的治疗副作用表示担忧，并希望选择更方便的治疗方案。尽管参与者表示基本上信任他们的临床医生的治疗建议，但许多人表示，如果治疗对他们的 HRQoL 产生负面影响，他们会停止临床医生推荐的治疗。参与者还表示，虽然他们重视治疗效果，但如果副作用变得无法忍受，他们愿意更换为效果较差的治疗。
我们的研究结果与其他反映多发性骨髓瘤患者重要考虑因素的报告相联系，包括对延长预期寿命和无进展生存期的重视，但也包括治疗效果与生活质量之间的紧张关系。我们的研究结果将这些发现扩展到不同疾病轨迹阶段的美国种族多样化的患者群体。
