Abstract Topic: 35. Quality of life and palliative care
Background: Patients with MM and their clinicians face difficult choices between treatments that differ in their benefits, risks, and mode of administration. Patients have increased satisfaction and adherence when their preferences are considered as part of shared decision-making.
Aims: This study examines MM patients’ preferences to identify key treatment features impacting initiation and discontinuation of a therapy.
Methods: Semi-structured in-depth interviews were conducted in 2022 with MM patients in the US, who had not planned or received transplant and had received first or second line therapy. Topics included treatment benefits, risks, convenience, and reasons for initiation and discontinuation of treatment. Four scenarios comparing 2 hypothetical treatment regimens with varying life expectancy, severity of adverse events (AEs), mode of administration, and length of therapy were presented to understand trade-offs among various treatment attributes. Content analysis utilized dual coding and inter-coder analysis. The sample size of 20 patients was based on the principle of theme saturation while considering feasibility.
Results: The mean (±SD) age of patients was 60±6 years, of which 35% patients were African American and 35% were White; 45% were retired; 65% had commercial insurance; and 50% were within 1 year of their MM diagnosis. Percentage of inter-coder agreement was 100% in the final dataset.
The most desired treatment benefits were an increase in overall life expectancy (noted by 85% of the patients) and an improvement in quality of life (60%). Symptom improvements reported most frequently were fatigue (75%), weight/appetite loss (50%), and reduction in pain (30%). Majority (70%) reported some AEs after treatment. Patients were most concerned about the potential for severe AEs like heart problems (65%), blood clots (60%), kidney infection (45%) even though few experienced them. About 79% of those experiencing AEs, stated they would prefer to continue their treatment despite AEs, provided the treatment is still effective. In the hypothetical scenarios, improved life expectancy was the most valuable feature while the least important was the length of overall treatment. Among patients who received intravenous (IV) or subcutaneous (SC) treatments (n=18, 90%), almost all preferred oral options (94%) over IV or SC, while more than half (61%) disliked IV treatment. Over half (61%) considered travel time to clinics and frequency of treatment more bothersome than the time required at the clinic for administration for either IV or SC treatments.
Summary/Conclusion: Patients consider greater life expectancy as the most important aspect of MM treatments and are willing to trade-off greater risk of AEs, longer treatment duration, and more frequent administration, if the treatment confers longer life expectancy. These results highlight the importance of patient engagement in shared decision-making.
Keywords: Multiple myeloma, Patient, Myeloma, Quality of life