Research Unit for General Practice, Aarhus, Denmark.
Department of Clinical Medicine, University Clinic for Innovative Patient Pathways, Aarhus University, Aarhus, Denmark.
BMC Cancer. 2024 Aug 12;24(1):998. doi: 10.1186/s12885-024-12706-8.
Multiple myeloma often presents with vague and non-specific symptoms. Many patients are diagnosed in unplanned rather than elective (planned) diagnostic pathways. This study investigates the diagnosis of multiple myeloma in unplanned pathways and the association with patient characteristics, disease profile, and survival.
We conducted a nationwide register-based study, including all patients diagnosed with multiple myeloma in Denmark in 2014-2018. Patients were categorised as diagnosed in an unplanned pathway if registered with an acute admission within 30 days prior to the multiple myeloma diagnosis and no other previously registered pathway to this diagnosis. Unplanned pathways were compared to all other pathways combined.
We included 2,213 patients diagnosed with multiple myeloma, hereof 32% diagnosed in an unplanned pathway. Comorbidity, no prior cancer diagnosis, a history of few visits to the general practitioner (GP), multiple myeloma complications at diagnosis, high-risk cytogenetics, and advanced cancer stage were associated with a higher probability of being diagnosed in an unplanned pathway. For example, 24.4% (95% confidence interval (CI): 21.8-27.0) of patients with low comorbidity (Charlson Comorbidity Index (CCI) score 0) were diagnosed in an unplanned pathway as were 50.9% (95% CI: 45.6-56.1) of patients with high comorbidity (CCI score 3+). For patients with dialysis need at the time of diagnosis the probability was 66.0% (95% CI 54.2-77.8) and 30.9% (95% CI: 28.9-32.9) for patients with no dialysis need. Patients diagnosed in an unplanned pathway had inferior survival (hazard ratio 1.44 (95% CI: 1.26-1.64)). However, this association was not seen in analyses restricted to patients surviving for more than three years.
High comorbidity level, few usual GP visits, advanced disease status at diagnosis, and complications were associated with diagnosis in an unplanned pathway. Further, patients diagnosed in an unplanned pathway had inferior survival. Promoting earlier diagnosis and preventing unplanned pathways may help improve survival in multiple myeloma.
多发性骨髓瘤常表现为模糊且非特异性的症状。许多患者是在非计划性（计划）诊断途径中被诊断出的。本研究调查了多发性骨髓瘤在非计划性途径中的诊断情况及其与患者特征、疾病特征和生存的关系。
我们进行了一项全国性的基于登记的研究，纳入了 2014 年至 2018 年期间在丹麦被诊断为多发性骨髓瘤的所有患者。如果患者在多发性骨髓瘤诊断前 30 天内有急性入院记录，且无其他先前登记的诊断途径，则将其归类为在非计划性途径中被诊断。将非计划性途径与所有其他途径相结合进行比较。
我们纳入了 2213 名被诊断为多发性骨髓瘤的患者，其中 32%在非计划性途径中被诊断。合并症、无先前癌症诊断、以往就诊次数较少、多发性骨髓瘤诊断时的并发症、高危细胞遗传学和晚期癌症分期与更高的非计划性途径诊断概率相关。例如，24.4%（95%置信区间（CI）：21.8-27.0）无合并症（Charlson 合并症指数（CCI）评分 0）的患者和 50.9%（95% CI：45.6-56.1）有合并症（CCI 评分 3+）的患者在非计划性途径中被诊断。对于诊断时需要透析的患者，概率为 66.0%（95%CI 54.2-77.8），而不需要透析的患者为 30.9%（95%CI：28.9-32.9）。在非计划性途径中被诊断的患者的生存情况较差（风险比 1.44（95%CI：1.26-1.64））。然而，在限制分析中，对于生存时间超过三年的患者，未观察到这种关联。
高合并症水平、以往就诊次数较少、诊断时疾病状态较晚和并发症与非计划性途径诊断相关。此外，在非计划性途径中被诊断的患者的生存情况较差。促进早期诊断和预防非计划性途径可能有助于改善多发性骨髓瘤的生存。
