Mian Owais, Puts Martine, McCurdy Arleigh, Wildes Tanya M, Fiala Mark A, Kang Matthew, Salib Mary, Alibhai Shabbir, Mian Hira
Department of Internal Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON, Canada.
Front Oncol. 2023 Jan 27;12:974038. doi: 10.3389/fonc.2022.974038. eCollection 2022.
A utologous stem cell transplant (ASCT) remains a standard of care among older adults (aged ≥65) with multiple myeloma (MM). However, heterogeneity in the eligibility and utilization of ASCT remains. We identified decision-making factors that influence ASCT eligibility and utilization among older adults with MM.
A qualitative study across two academic and two community centres in Ontario was conducted between July 2019-July 2020. Older adults with MM (newly diagnosed MM aged 65-75 in whom a decision had been made about ASCT in <12 months) and treating oncologists completed a baseline survey and a subsequent interview, which was analyzed using thematic analysis.
Eighteen patients completed the survey and 9 follow-up interviews were conducted. Patients were happy with their treatment decision with "trust in their oncologist" and "wanting the best treatment" as the most important to proceed with ASCT. "Afraid of side effects" was the most common reason for declining ASCT. Fifteen oncologists completed the survey and 10 follow-up interviews were conducted. Most relied on the 'eye-ball' test for ASCT eligibility over geriatric screening tools. The lack of both high-quality evidence and local guidelines impacted decision-making. Both oncologists and patients felt that chronological age alone should not affect ASCT eligibility.
While decision-making factors regarding ASCT can be variable, both oncologists and patients indicated that chronological age alone should not represent a barrier for ASCT among older adults. Future simplification and incorporation of ASCT eligibility geriatric assessment tools in studies as well as the inclusion of these tools in local guidelines may further improve ASCT decision-making.
自体干细胞移植（ASCT）仍是老年（≥65岁）多发性骨髓瘤（MM）患者的标准治疗方法。然而，ASCT在资格认定和应用方面仍存在异质性。我们确定了影响老年MM患者ASCT资格认定和应用的决策因素。
2019年7月至2020年7月在安大略省的两个学术中心和两个社区中心进行了一项定性研究。患有MM的老年人（新诊断为MM，年龄在65 - 75岁之间，且在<12个月内已就ASCT做出决定）和主治肿瘤学家完成了一项基线调查和随后的访谈，并使用主题分析法进行分析。
18名患者完成了调查，并进行了9次随访访谈。患者对他们的治疗决定感到满意，“信任他们的肿瘤学家”和“希望得到最佳治疗”是决定进行ASCT的最重要因素。“害怕副作用”是拒绝ASCT的最常见原因。15名肿瘤学家完成了调查，并进行了10次随访访谈。大多数人在ASCT资格认定上依赖“直观判断”而非老年筛查工具。缺乏高质量证据和当地指南影响了决策。肿瘤学家和患者都认为仅按年龄不应影响ASCT资格。
虽然关于ASCT的决策因素可能各不相同，但肿瘤学家和患者均表示，仅按年龄不应成为老年患者进行ASCT的障碍。未来简化并将ASCT资格老年评估工具纳入研究，以及将这些工具纳入当地指南，可能会进一步改善ASCT决策。
