Supportive Care in Cancer

, Volume 21, Issue 2, pp 599–607 | Cite as

Impact of the treatment-free interval on health-related quality of life in patients with multiple myeloma: a UK cross-sectional survey

  • S. Acaster
  • S. Gaugris
  • G. Velikova
  • K. Yong
  • A. J. Lloyd
Original Article



While the impact of various treatments on myeloma patients’ health-related quality of life (HRQL) has been reported, the impact of a treatment-free interval (TFI) is currently unclear. The aims of this study were to assess if (1) a TFI is associated with a better HRQL vs. other treatment phases and (2) the length of the TFI influences HRQL.


A cross-sectional postal survey was conducted in the UK. The survey was sent to 605 multiple myeloma patients via the charity Myeloma UK and asked patients to rate their HRQL using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), EORTC QLQ-MY20 and the EQ-5D. The results were analysed using ordinary least squares regression.


Surveys of 402 (67 %) were returned; 370 (61 %) were considered eligible for analysis. Results demonstrated that being in a first TFI relative to other treatment phases and experiencing a longer TFI were significantly associated with better HRQL as assessed by various domains of the QLQ-C30, MY20 and EQ-5D.


Patients enjoy better HRQL when in their first TFI, and the length of the TFI also positively impacts on HRQL This information may be important for patients and their physicians making treatment decisions and has implications for treatment protocols incorporating extended therapy.


Multiple myeloma Quality of life Treatment-free interval Treatment phase HRQL 



The authors would like to thank Myeloma UK for their assistance in this study and all patients that participated.

Conflict of interest

This study and manuscript were sponsored by Janssen-Cilag Ltd., where the author Sabine Gaugris is an employee. All primary data is available for review if requested.


  1. 1.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F (1993) The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
  2. 2.
    Adam Z, Pour L, Svobodník A, Scudla V, Salajka F, Vytrasová M, Bacovský J, Schützová M, Koza V, Sumná E, Franková H, Lehanka F, Gumulec J, Stavarová Y, Cahová S, Vránová M, Dostálová V, Kessler P, Walterová L, Meluzínová I, Seifertová N, Sláma O, Büchler T, Krejcí M, Bencíková V, Nykodýmová V, Dusek L, Hájek R, Czech Myeloma Group (2002) Quality of life and tolerance of maintenance treatment in patients with multiple myeloma. [Czech]. Vnitr Lek 48:216–229PubMedGoogle Scholar
  3. 3.
    Bird JM, Owen RG, D'Sa S, Snowden JA, Pratt G, Ashcroft J, Yong K, Cook G, Feyler S, Davies F, Morgan G, Cavenagh J, Low E, Behrens J, Haemato-oncology Task Force of the British Committee for Standards in Haematology (BCSH) and UK Myeloma Forum (2011) Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol 154:32–75PubMedCrossRefGoogle Scholar
  4. 4.
    Bladé J, Cibeira MT, Fernández de Larrea C, Rosiñol L (2010) Multiple myeloma. Ann Oncol: Official Journal of the European Society for Medical Oncology/ESMO 21(Suppl 7):vii313–vii319CrossRefGoogle Scholar
  5. 5.
    Cancer Research UK (2007) Accessed 20 Dec 2010
  6. 6.
    Cocks K, Cohen D, Wisløff F, Sezer O, Lee S, Hippe E, Gimsing P, Turesson I, Hajek R, Smith A, Graham L, Phillips A, Stead M, Velikova G, Brown J, EORTC Quality of Life Group (2007) An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-MY20) in assessing the quality of life of patients with multiple myeloma. Eur J Cancer 43:1670–1678PubMedCrossRefGoogle Scholar
  7. 7.
    Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A, San Miguel J, Hellman A, Facon T, Foà R, Corso A, Masliak Z, Olesnyckj M, Yu Z, Patin J, Zeldis JB, Knight RD, Multiple Myeloma (010) Study Investigators (2007) Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 357:2123–2132PubMedCrossRefGoogle Scholar
  8. 8.
    Dolan P (1997) Modelling valuations for EuroQol Health States. Med Care 35:1095–1108PubMedCrossRefGoogle Scholar
  9. 9.
    Dubois D, Dhawan R, van de Velde H, Esseltine D, Gupta S, Viala M, de la Loge C (2006) Descriptive and prognostic value of patient-reported outcomes: the bortezomib experience in relapsed and refractory multiple myeloma. J Clin Oncol 24:976–982PubMedCrossRefGoogle Scholar
  10. 10.
    EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  11. 11.
    Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B, Renaud M, Harousseau JL, Guillerm G, Chaleteix C, Dib M, Voillat L, Maisonneuve H, Troncy J, Dorvaux V, Monconduit M, Martin C, Casassus P, Jaubert J, Jardel H, Doyen C, Kolb B, Anglaret B, Grosbois B, Yakoub-Agha I, Mathiot C, Avet-Loiseau H (2007) Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99–06): a randomised trial. Lancet 370:1209–1218PubMedCrossRefGoogle Scholar
  12. 12.
    Fayers P, Aaronson NK, Bjordal K, Curran D, Groenvold M, EORTC Quality of Life Study Group (2001) EORTC QLQ-C30 scoring manual, 3rd edn. EORTC Quality of Life Group, BrusselsGoogle Scholar
  13. 13.
    Gulbrandsen N, Wisløff F, Brinch L, Carlson K, Dahl IM, Gimsing P, Hippe E, Hjorth M, Knudsen LM, Lamvik J, Lenhoff S, Lofvenberg E, Nesthus I, Nielsen JL, Turesson I, Westin J, Nordic Myeloma Study Group (2001) Health-related quality of life in multiple myeloma patients receiving high-dose chemotherapy with autologous blood stem-cell support. Med Oncol 18:65–77PubMedCrossRefGoogle Scholar
  14. 14.
    Hulin C, Facon T, Rodon P, Pegourie B, Benboubker L, Doyen C, Dib M, Guillerm G, Salles B, Eschard JP, Lenain P, Casassus P, Azais I, Decaux O, Garderet L, Mathiot C, Fontan J, Lafon I, Virion JM, Moreau P (2009) Efficacy of melphalan and prednisone plus thalidomide in patients older than 75 years with newly diagnosed multiple myeloma: IFM 01/01 trial. J Clin Oncol 27:3664–3670PubMedCrossRefGoogle Scholar
  15. 15.
    Kind P (1996) The EuroQoL instrument: An index of health-related quality of life. In: Spilker (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  16. 16.
    Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Dingli D, Russell SJ, Lust JA, Greipp PR, Kyle RA, Gertz MA (2008) Improved survival in multiple myeloma and the impact of novel therapies. Blood 111:2516–2520PubMedCrossRefGoogle Scholar
  17. 17.
    Kvam AK, Fayers P, Hjermstad M, Gulbrandsen N, Wisloff F (2009) Health-related quality of life assessment in randomised controlled trials in multiple myeloma: a critical review of methodology and impact on treatment recommendations. Eur J Haematol 83:279–289PubMedCrossRefGoogle Scholar
  18. 18.
    Lee SJ, Richardson PG, Sonneveld P, Schuster MW, Irwin D, San Miguel JF, Crawford B, Massaro J, Dhawan R, Gupta S, Anderson KC (2008) Bortezomib is associated with better health-related quality of life than high-dose dexamethasone in patients with relapsed multiple myeloma: results from the APEX study. Br J Haematol 143:511–519PubMedGoogle Scholar
  19. 19.
    Palumbo A, Bringhen S, Caravita T, Merla E, Capparella V, Callea V, Cangialosi C, Grasso M, Rossini F, Galli M, Catalano L, Zamagni E, Petrucci MT, De Stefano V, Ceccarelli M, Ambrosini MT, Avonto I, Falco P, Ciccone G, Liberati AM, Musto P, Boccadoro M, Italian Multiple Myeloma Network GIMEMA (2006) Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomized controlled trial. Lancet 367:825–831PubMedCrossRefGoogle Scholar
  20. 20.
    Palumbo A, Sezer O, Kyle R, Miguel JS, Orlowski RZ, Moreau P, Niesvizky R, Morgan G, Comenzo R, Sonneveld P, Kumar S, Hajek R, Giralt S, Bringhen S, Anderson KS, Richardson PG, Cavo M, Davies F, Bladé J, Einsele H, Dimopoulos MA, Spencer A, Dispenzieri A, Reiman T, Shimizu K, Lee JH, Attal M, Boccadoro M, Mateos M, Chen W, Ludwig H, Joshua D, Chim J, Hungria V, Turesson I, Durie BG, Lonial S, IMWG (2009) International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 23:1716–1730PubMedCrossRefGoogle Scholar
  21. 21.
    Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T, Harousseau JL, Ben-Yehuda D, Lonial S, Goldschmidt H, Reece D, San-Miguel JF, Bladé J, Boccadoro M, Cavenagh J, Dalton WS, Boral AL, Esseltine DL, Porter JB, Schenkein D, Anderson KC, Assessment of Proteasome Inhibition for Extending Remissions (APEX) Investigators (2005) Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 352:2487–2498PubMedCrossRefGoogle Scholar
  22. 22.
    Shah N, Lonial S (2010) Evidence-based mini-review: treatment options for patients with relapsed/refractory myeloma previously treated with novel agents and high-dose chemotherapy and autologous stem-cell transplantation. Hematology/the Education Program of the American Society of Hematology. American Society of Hematology. Education Program 2010: 310–313Google Scholar
  23. 23.
    Singer CR (1997) ABC of clinical haematology. Multiple myeloma and related conditions. BMJ 314:960–963PubMedCrossRefGoogle Scholar
  24. 24.
    Sirohi B, Powles R (2004) Multiple myeloma. Lancet 363:875–887PubMedCrossRefGoogle Scholar
  25. 25.
    Stead ML, Brown JM, Velikova G, Kaasa S, Wisløff F, Child JA, Hippe E, Hjorth M, Sezer O, Selby P (1999) Development of an EORTC questionnaire module to be used in health-related quality-of-life assessment for patients with multiple myeloma. European organization for research and treatment of cancer study group on quality of life. Br J Haematol 104:605–611PubMedCrossRefGoogle Scholar
  26. 26.
    van Agthoven M, Segeren CM, Buijt I, Uyl-De Groot CA, van der Holt B, Lokhorst HM, Sonneveld P (2004) A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem-cell rescue in newly diagnosed patients with stage II/III multiple myeloma; a prospective randomised phase III study. Eur J Cancer 40:1159–1169PubMedGoogle Scholar
  27. 27.
    Waage A, Gimsing P, Fayers P, Abildgaard N, Ahlberg L, Björkstrand B, Carlson K, Dahl IM, Forsberg K, Gulbrandsen N, Haukås E, Hjertner O, Hjorth M, Karlsson T, Knudsen LM, Nielsen JL, Linder O, Mellqvist UH, Nesthus I, Rolke J, Strandberg M, Sørbø JH, Wisløff F, Juliusson G, Turesson I, Nordic Myeloma Study Group (2010) Melphalan and prednisone plus thalidomide or placebo in elderly patients with multiple myeloma. Blood 116:1405–1412. doi: 10.1182/blood-2009-08-237974 PubMedCrossRefGoogle Scholar
  28. 28.
    Wijermans P, Schaafsma M, Termorshuizen F, Ammerlaan R, Wittebol S, Sinnige H, Zweegman S, van Marwijk Kooy M, van der Griend R, Lokhorst H, Sonneveld P, Dutch-Belgium Cooperative Group HOVON (2010) Phase III study of the value of thalidomide added to melphalan plus prednisolone in elderly patients with newly diagnosed multiple myeloma: the HOVON 49 study. J Clin Oncol 28:3160–3166. doi: 10.1200/JCO.2009.26.1610 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • S. Acaster
    • 1
  • S. Gaugris
    • 2
  • G. Velikova
    • 3
  • K. Yong
    • 4
  • A. J. Lloyd
    • 5
  1. 1.Oxford Outcomes Ltd.San FranciscoUSA
  2. 2.Janssen-Cilag Ltd.BucksUK
  3. 3.St. James’s Institute of OncologyUniversity of LeedsLeedsUK
  4. 4.University College HospitalLondonUK
  5. 5.Oxford Outcomes Ltd.OxfordUK

Personalised recommendations