Depressive Symptoms and Mental HRQOL Prior to Diagnosis Did Not Affect Survival in Older Population With Multiple Myeloma

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

A retrospective study did not find any associations between survival of older patients with multiple myeloma and pre-diagnosis depressive symptoms and mental health-related quality of life.

Depressive symptoms and lower mental health-related quality of life (HRQOL) before older patients were diagnosed with multiple myeloma did not appear to impact survival, according to results from a retrospective study published in Support Care Cancer.

Overall, pre-diagnosis depressive symptoms were not associated with either all-cause mortality (HR, 1.01; 95% CI, 0.79-1.29) or cancer-specific mortality (HR, 0.94; 95% CI, 0.69-1.28) for older patients with multiple myeloma.

“We found a high prevalence of pre-diagnosis depressive symptoms in older patients prior to diagnosis with first primary multiple myeloma,” the investigators wrote. “Patients with depressive symptoms reported a higher number of comorbidities and lower scores indicating worse general, mental, and physical HRQOL compared to patients without depressive symptoms.”

Patients who were aged 65 years or older at the time of the Surveillance, Epidemiology, and End Results (SEER) Medicare Health Outcomes Survey (MHOS) were eligible to participate in the study. Patients were also required to have received a diagnosis of first primary multiple myeloma between 1998 and 2014, and needed to have a minimum of 1 SEER-MHOS 5 years prior to diagnosis.

The primary end points of the study were cancer-specific mortality and all-cause mortality, as assessed by survival information from SEER registries.

A total of 522 patients diagnosed between 1998 and 2014 were included, with 30% reporting depressive symptoms prior to being diagnosed with multiple myeloma. The median patient age was 77 years, and 59% of patients were 75 years or older. Sixty percent of patients were White and 18% were Black. Moreover, patients reported having an average of 2.7 comorbid conditions, and 74% had at least 1 heart condition.

Although not statistically significant, patients who scored in the second mental component scores (MCS) tertile trended toward an increased risk of all-cause mortality (HR, 1.19; 95% CI, 0.91-1.55) and cancer-specific mortality (HR, 1.17; 95% CI, 0.86-1.60) compared with the highest tertile. When comparing the first and third MCS tertiles, no significant association was observed for all-cause mortality (HR, 1.07; 95% CI, 0.80-1.43) and cancer-specific mortality (HR, 0.98; 95% CI, 0.68-1.40).

In terms of limitations, investigators noted that variable response for certain patient characteristics was a potential limiting factor, as well as an inability to draw causal inference. Moreover, certain regions of the United States, including Florida and Minnesota, were not represented in the SEER registries, potentially limiting the generalizability of this data.

“Additional research is essential to understand the high prevalence of pre-diagnosis depressive symptoms and poor mental HRQOL and explore their impact on future risks of major depressive disorder, treatment acceptability and clinical decision-making following multiple myeloma diagnosis. Lastly, prospective studies and clinical trials should determine whether life-prolonging novel therapies also improve mental HRQOL,” the investigators concluded.

Reference

Alobaidi A, Nabulsi NA, Talon B, et al. Depressive symptoms, mental health-related quality of life, and survival among older patients with multiple myeloma. Support Care Cancer. 2020;28(9):4097-4106. doi:10.1007/s00520-019-05246-6