Digital PROs May Identify Multiple Myeloma Subgroup Fit for Bortezomib

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Patients with multiple myeloma appear to feel confident in being able to report adverse effects associated with bortezomib independently via digital tools.

“We demonstrated that using our questionnaire and associated algorithm, we were able to identify patients physically fit for treatment,” according to study authors.

“We demonstrated that using our questionnaire and associated algorithm, we were able to identify patients physically fit for treatment,” according to study authors.

A digital questionnaire and algorithm demonstrated safety and feasibility with respect to determining patients with multiple myeloma who are physically fit to undergo treatment with bortezomib (Velcade), according to findings from a mixed method study published in European Journal of Oncology Nursing.

Across 318 questionnaires that were filled out via the “My Hospital” digital app, 81% (n = 257) of responses highlighted no adverse effects (AEs) that were not compatible with treatment. Of those who responded as such, treatment was administered to 98% (n = 253). Additionally, 19% (n = 61) of questionnaire responses indicated AEs that were incompatible with treatment, and 12 (4%) therapies were ultimately not given. The most common reasons for treatment not being administered included neuropathy (n = 1), neuropathy and other AEs (n = 1), fever and other AEs (n = 2), diarrhea (n = 3), diarrhea and constipation (n = 1), diarrhea and fever (n = 1), and other AEs (n = 3).

Collecting patient reported outcomes (PROs) with the digital app demonstrated a positive predictive value of 98% for identifying those who are eligible to receive bortezomib without further consultation. Additionally, patients reported that they felt confident and competent with having the freedom to report AEs independently. The app appeared to provide patients with more flexibility for reporting AEs than a phone call, and those in the workforce stated the concordance with the program.

Overall, 29 of 33 patients who received treatment responded to an evaluation form related to their experience using digital app; they generally expressed satisfaction with the ability to report AEs on their own. Additionally, 6 patients agreed and 23 strongly agreed that they would prefer to continue reporting AEs using “My Hospital” following the study’s conclusion.

“We demonstrated that using our questionnaire and associated algorithm, we were able to identify patients physically fit for treatment,” the study authors wrote. “The method proved to be both safe and feasible, and patients and health care professionals alike found it to be advantageous and flexible. However, as the questionnaire and the algorithm are specific to patients with M-component dyscrasia receiving treatment with bortezomib, further studies are required before applying the setup to other treatments.”

Investigators of this prospective, mixed-method study collected PRO data and time registrations from nurses at the outpatient clinic from May 2021 to November 2022 at the Department of Hematology of Odense University Hospital. The study included a questionnaire that patients could respond to using the “My Hospital” app, which pertained to AEs typically associated with bortezomib such as neuropathy, fever, diarrhea, and constipation. Upon exiting the study, patients were also eligible to describe their experience of self-reporting toxicity through a custom-built questionnaire.

Patients older than 18 years with M-component dyscrasias set to undergo treatment with bortezomib who were able to use a smartphone app for self-reporting AEs were included in the study. Additionally, the study included health care professionals—mainly nurses and physicians—with at least 2 years of hematological experience. Patients received bortezomib on days 1, 4, 8, and 15 at the outpatient clinic as part of 21-day cycles.

The study included 33 patients who had a mean age of 64.3 years (range, 47-82). Most patients were 64 years or younger (52%) and had IgG multiple myeloma (39%), were in their frontline therapy (64%), and had middle or long education (55%). Additionally, more than half of patients were female (52%) and retired (64%).

Nurses and patients alike initially expressed unfamiliarity with using “My Hospital” and suggested that a visual tutorial in addition to written guidelines may have been valuable for learning how to use the app. However, nurses eventually found that it was easy to check PRO data with the app; they set up the patient in “My Hospital” for a mean of 5.97 minutes (range, 1-30) and instructed patients for a mean of 6.13 minutes (range, 1-15).

Reference

Rosenberg T, Kirkegaard J, Tveden MG, et al. Making decisions for follow-up chemotherapy based on digital patient reported outcomes data in patients with multiple myeloma and other M protein diseases – A mixed method study. Eur J Oncol Nurs. 2024;68:102455. doi:10.1016/j.ejon.2023.102455

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