QJM Advance Access originally published online on September 10, 2007
QJM 2007 100(10):635-640; doi:10.1093/qjmed/hcm077
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Multiple myeloma: causes and consequences of delay in diagnosis
From the 1Department of Academic Haematology, Royal Free Hospital and University College Medical School, London, UK, and 2Department of Pathology, Colombo North Teaching Hospital, Ragama, Sri Lanka
Address correspondence to Dr A.B. Mehta, Department of Academic Haematology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK. email: atul.mehta{at}royalfree.nhs.uk
Received 8 March 2007 and in revised form 24 June 2007
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Abstract |
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Background: Myeloma is a serious and usually fatal haematological malignancy with reported mortality of 10–20% within the first 2 months of presentation. Symptoms are non-specific, and patients thus present to a range of medical practitioners.
Aim: To analyse the causes and consequences of a delay in diagnosis of myeloma.
Design: Retrospective case review.
Methods: The number and type of disease–related complications present at diagnosis of 92 patients with myeloma were categorized according to the medical practitioner to whom the patient initially presented, the time before diagnosis and the status of the patient at study end in 2006. Overall and disease-free survival were analysed.
Results: Duration of symptoms >6 months prior to diagnosis was seen in 40% of the patients, of whom >50% had initially consulted a general practitioner. The most common presenting symptom (67%) was bone pain. The most common complications present at diagnosis were anaemia (54%), bone disease (45%) and renal failure (36%), with the highest frequency of complications in the group experiencing symptoms for >6 months. All patients in this group had two or more complications, while 40% in the group with symptoms for <3 months had no complications. A prolonged time to diagnosis had a significant effect on disease-free survival from both onset of first symptoms (p = 0.043) and from diagnosis (p = 0.003), but not on overall survival.
Discussion: A prolonged delay before diagnosis is associated with a significant impact on the clinical course of multiple myeloma. There is a need to raise awareness of the presentation of this condition, especially among general practitioners.
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