**Quality of Life Issues of Patients with Multiple Myeloma**

Klára Gadó and Gyula Domján

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/55625

**1. Introduction**

The great advance in the field of anti-myeloma therapy in the last few decades has resulted in a huge improvement of overall and disease-free survival. Nevertheless, multiple myeloma (MM) is still an incurable disease.

There are two issues emerging. On one hand, the patient lives together with the illness for a long time, and on the other hand, the thought of incurable illness hangs over their head like the sword of Damocles for a longer time. Quality of life (QoL) issues are coming into focus because of the longer survival times.

Problems related to the disease such as pain, fatigue, bone fracture-induced inconveniences, complications such as infections, neuropathy, thrombosis, osteonecrosis of the jaw, mucositis, as well as invasive interventions emphasize the importance of supportive care.

The social and economic environment of the patients, their participation in the world of labor, financial resources, changes in their family and in their circle of friends all have a great impact on the QoL of patients.

The stigmata of chronic illness and malignancy also contribute to the development of depres‐ sion thus influencing quality of life. At the last stage of life it is a very hard task for the patient to face dying.

At the same time, family members are also in a troublesome situation. To accept the incurable illness of a beloved member of the family is a great psychical burden. Beside these, the increase of physical burden may cause insoluble task for the folks and this may generate sense of guilt.

Nowadays, the measuring of QoL is in a class by itself. QoL has become a prognostic factor. Several studies have demonstrated that better quality of life goes hand in hand with better prognosis. This is also the case with multiple myeloma.

© 2013 Gadó and Domján; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Results of examinations of QoL may help us to provide professional and effective support to the patient and their family through a holistic approach. Multidisciplinary co-operation is essential.

**4. Consequences of MM being a disease of the elderly**

performance status prevent the success of intensive treatment.

The choice of first-line treatment depends on a combination of factors.

these questions, QoL measurements can offer valuable meaning.

the treatment has become a major goal [7].

vation (watch and wait) is needed.

chemotherapy with ASCT.

The incidence of multiple myeloma (MM) increases with age and with the aging of the population, the number of adults with MM is expected to double in the next 20 years. Inten‐ sification of anti-myeloma therapy has resulted in a huge prolongation of survival data but this data mainly refers to younger patients who are eligible for these treatment modalities. Older patients are ineligible for high-dose therapy because it causes an unacceptably high mortality rate in that patient population. Several co-morbidities of this setting or poor

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On the other hand the significance of supportive measures for these patients has become a greater value. Besides the extended duration of survival, to improve the quality of survival by alleviating symptoms and achieving disease control while minimizing the adverse effects of

Factors affecting prognosis include burden of disease, type of cytogenetic abnormality present, patient related factors (such as age and performance status) and treatment response factors. Asymptomatic myeloma (smoldering myeloma) does not require any treatment, only obser‐

For patients under 70 and with good performance status, the treatment of choice is high-dose

The majority of patients are transplantation-ineligible because of poor performance status or co-morbidities. These patients are therefore offered a less intensive single-agent or combina‐ tion chemotherapy. Typically, combination therapies include chemotherapy with an alkylat‐ ing agent and corticosteroids. More recent treatment options may also include combination therapies that incorporate drugs such as thalidomide, bortezomib and lenalidomide [8].

Regardingthemaintenancetherapy,ifcompleteremission(CR)hasbeenreachedthereisnoneed for maintenance therapy with thalidomide or lenalidomide because there is no significant differenceinOS.Inthecaseoflenalidomide,asignificantlyincreasedriskofsecondarymalignan‐ cieswasreported[9].MaintenanceisadvisedforpatientswhohavenotreachedCR.Inthesecases, one of the new drugs (thalidomide, lenalidomide or bortezomib) is the drug of choice [10].

However, in line with all these improvements in the field of chemotherapy, some new questions have emerged. The patient has gained a longer life, but is this life good enough? Is it worth the sea of difficulties during the treatment period and even afterward? To answer

QoL can be defined in many ways. As a general term it is used to indicate the well-being of people and societies. A person's environment, physical and mental health, education, recrea‐ tion, social well-being, freedom, human rights and happiness are also significant factors.

**5. Definition of quality of life and importance of QoL measuring**
