**10. HRQoL studies in MM**

Though HRQoL examinations are widely used especially in cancer patients and they are an integral component of clinical trials with new drugs, MM patients are relatively poorly studied in this respect. A PubMed search with terms of "multiple myeloma and quality of life or healthrelated quality of life" has resulted in only 51 items.

These studies targeted the comparison of HRQoL of MM patients in different countries [23], treated with different therapeutic schedules, receiving new drugs [24], underwent ASCT or tandem ASCT [25], special issues of the elderly [26], the effect of anemia and fatigue and also the effect of personality on disease outcome [27]. Methodological aspects are also emphasized [20].

who were less than 60 years of age. HRQoL was integrated into the trial, using the EORTC QLQ-C30 questionnaire. Of the 274 patients receiving intensive therapy, 221 (81%) were compared to 113 (94%) of 120 patients receiving conventional melphalan-prednisone treat‐ ment. Prior to treatment, there were no statistically significant differences in any HRQoL score between the two groups. One month after the start of induction chemotherapy, the patients on intensive treatment had lower scores that gradually improved and at 12 and 24 months, the HRQoL was similar to that of the control patients. At 36 months, there was a trend toward less fatigue, pain, nausea, and appetite loss in the intensive-treatment group. Despite the moderate HRQoL reduction associated with the early intensive chemotherapy phase, the 18 months of

Quality of Life Issues of Patients with Multiple Myeloma

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

283

QOL results of an Australian study on MM patients who underwent dose-reduced tandem ASCT were published in 2011. Patients younger than 60 years old received conditioning with melphalan 140 mg/m2 and patients who were Older than or equal to 60 years old received 100

In a University of Arkansas study, the decreases in functioning after transplantation were less pronounced than anticipated. At stem cell collection, physical deficits were common, with most patients scoring 1 standard deviation below population norms for physical well-being (70.2%) and functional well-being (57.5%), and many reporting at least moderate fatigue (94.7%) and pain (39.4%). Clinically meaningful levels of anxiety (39.4%), depression (40.4%) and cancer-related distress (37.0%) were evident in a notable proportion of patients. After transplantation, there was a worsening of transplant-related concerns, depression and lifesatisfaction. However, pain improved and social functioning was well preserved. Older patients were not more compromised than younger ones. In multivariate analyses, they

Thalidomide with melphalan and prednisone (MPT) was defined as standard treatment in elderly patients with MM. In a randomized trial (HOVON49), a prospective HRQoL study was initiated in order to assess the impact of thalidomide on QoL. Patients aged 65 years and older with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. 284 patients were included (MP, n=149; MPT n=135). HRQoL was assessed with the QLQ-

reported better overall QoL and less depression than before transplantation [32].

. EORTC QLQ-C30 and the QLQ-MY24 questionnaires were conducted after each ASCT and thereafter every 3 months for 24 months. Mean global health measure improved from 3.44 before transplant to 4.50 (1being very poor and 7 being excellent) at the second and subsequent follow-up visits and the mean global QoL score improved from 3.61 to 4.71. Pain symptoms were reduced and physical functioning improved throughout the period of post-transplant follow-up. The study showed that dose-reduced tandem ASCT was well tolerated with low toxicity although there was a transient reduction in QoL during both transplants. Posttransplant follow-up showed significant improvement in overall HRQoL that reflects posi‐

prolonged survival seem to be associated with a good HRQoL [30].

tively on the overall disease-outcome [31].

**14. QoL assessment of elderly MM patients**

mg/m2

## **11. Disease-specific complaints and HRQoL of MM patients**

Patients with MM experience a very high symptom burden and low HRQOL. In a study published in 2012, the Eindhoven Cancer Registry was used to select all patients diag‐ nosed with MM from 1999 to 2010. Patients were asked at baseline and 1 year later. Patients with MM reported statistically significant and clinically relevant worse scores on all EORTC QLQ-C30 scales compared to the norm. Also, patients with MM reported a mean de‐ crease (e.g., worsening) between baseline and 1-year follow-up scores for: QoL (74% of patients had a deteriorated score), fatigue (50%), nausea and vomiting (71%), pain (59%) and dyspnoea (66%). The most bothering symptoms during the past week were tingling hands/feet (32%), back pain (28%), bone aches/pain (26%), pain in arm/shoulder (19%) and feeling drowsy (18%). Also, 37% worried about their future health, 34% thought about their disease and 21% worried about dying [28].
