Advertisement

Supportive Care in Cancer

, Volume 26, Issue 3, pp 833–841 | Cite as

Symptom experience of multiple myeloma (syMMex) patients treated with autologous stem cell transplantation following high-dose melphalan: a descriptive longitudinal study

  • Matthias Naegele
  • Monika Kirsch
  • Gabriele Ihorst
  • Katharina Fierz
  • Monika Engelhardt
  • Sabina De GeestEmail author
Original Article

Abstract

Purpose

High-dose melphalan and autologous stem cell transplantation (ASCT) are associated with high symptom burden. This study aimed to explore multiple myeloma (MM) patients’ experience of symptom frequency, intensity, and distress during therapy.

Methods

This descriptive longitudinal study enrolled 29 MM patients who completed the 43-item PROVIVO questionnaire, measuring symptom experience across the dimensions of frequency, intensity, and distress at four assessment points: hospital admission (T0), leucocyte nadir (T1), discharge (T2), and 30 days post discharge (T3). Symptom assessment covered five categories: (1) physical, (2) emotional, (3) cognitive, (4) male/female urogenital symptoms, and (5) follow-up care planning (e.g., financial problems). Results were displayed as heat maps and bubble graphs for each patient, differences between T0 and T4 individually assessed, and intensity (IMS) and mean distress scores (DMS) calculated on a scale from 0 to 4.

Results

The most frequent, intense, and distressing physical symptoms were fatigue, diarrhea, and decreased appetite. As expected, peak symptom intensity (decreased appetite 2.79) and distress (diarrhea 2.11) were reported during high-dose melphalan and the leucocyte nadir (T1). Thereafter, most symptoms’ intensity and distress improved. Items on urogenital symptoms remained predominantly unanswered or patients were sexually inactive.

Conclusions

PROVIVO enabled exploration of various dimensions of MM patients’ symptom experiences, which differed substantially before and after ASCT. Our results suggest that high-dose melphalan, ASCT, and other intensive novel agent therapies warrant targeted symptom management programs that include focused patient support.

Keywords

Multiple myeloma High-dose melphalan Autologous stem cell transplantation Symptom experience Symptom management 

Notes

Acknowledgements

We wish to express our gratitude to Gila Sellam of the Institute of Nursing Science, Basel, for her review and useful discussions concerning this paper. We are also deeply indebted to Prof. Dr. Anca Grosu (Radiation Oncology, UKF), Prof. Dr. Georg Herget, Prof. Dr. Norbert Südkamp (Orthopedic and Traumatology, UKF), and the entire interdisciplinary MM tumor board for their intensive support and fruitful interaction for the sake of our MM patients. We are also grateful to Dr. Anne Rebafka, Freiburg, to Chris Shultis, Basel, for proofreading the manuscript, to Prof. Dr. Hermann Einsele and Prof. Dr. Stefan Knop (University of Würzburg), and to Prof. Dr. Hartmut Goldschmidt (University of Heidelberg) for deeply supportive and insightful recommendations at national and international meetings regarding our results.

Funding information

This work is supported by the Deutsche Krebshilfe (grants 1095969 and 111424 [to ME]).

Compliance with ethical standards

The analysis followed the guidelines of the Declaration of Helsinki principles and good clinical practice. All the patients gave written informed consent for institutionally initiated research studies and analyses of clinical outcome studies conforming to institutional review board guidelines. The study proposal was approved by the ethics committee of the University Hospital Freiburg, Germany (EV 339/12).

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

520_2017_3897_MOESM1_ESM.docx (191 kb)
Supplementary Fig. 1 (DOCX 191 kb).
520_2017_3897_MOESM2_ESM.docx (24 kb)
Supplementary Table 1 (DOCX 24 kb).

References

  1. 1.
    Moreau P et al (2013) Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi133–vi137CrossRefPubMedGoogle Scholar
  2. 2.
    Deutsches Register für Stammzelltransplantationen. Jahresbericht 2011. 2011 14.11.2011]; Available from: http://www.drst.de/download/jb2010.pdf
  3. 3.
    Cavo M et al (2011) International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood 117(23):6063–6073CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Engelhardt M et al (2010) Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches. Leuk Lymphoma 51(8):1424–1443CrossRefPubMedGoogle Scholar
  5. 5.
    Harousseau JL, Moreau P (2009) Autologous hematopoietic stem-cell transplantation for multiple myeloma. N Engl J Med 360(25):2645–2654CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson KO et al (2007) Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 39(12):759–766CrossRefPubMedGoogle Scholar
  7. 7.
    Campagnaro E et al (2008) Symptom burden after autologous stem cell transplantation for multiple myeloma. Cancer 112(7):1617–1624CrossRefPubMedGoogle Scholar
  8. 8.
    Larsen J et al (2003) Symptom distress, functional status and health-related quality of life before high-dose chemotherapy with stem-cell transplantation. Eur J Cancer Care 12(1):71–80CrossRefGoogle Scholar
  9. 9.
    Larsen J et al (2004) Symptom occurrence, symptom intensity, and symptom distress in patients undergoing high-dose chemotherapy with stem-cell transplantation. Cancer Nurs 27(1):55CrossRefPubMedGoogle Scholar
  10. 10.
    Larsen J et al (2007) Factors associated with poor general health after stem-cell transplantation. Support Care Cancer 15(7):849–857CrossRefPubMedGoogle Scholar
  11. 11.
    Andersson I et al (2008) Health related quality of life in stem cell transplantation: clinical and psychometric validation of the questionnaire module, high dose chemotherapy (HDC-19). Acta Oncol 47(2):275–285CrossRefPubMedGoogle Scholar
  12. 12.
    Gulbrandsen N et al (2001) Health-related quality of life in multiple myeloma patients receiving high-dose chemotherapy with autologous blood stem-cell support. Med Oncol 18(1):65–77CrossRefPubMedGoogle Scholar
  13. 13.
    Sherman AC et al (2003) Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation. Support Care Cancer 11(9):568–574CrossRefPubMedGoogle Scholar
  14. 14.
    Diez-Campelo M et al (2004) Quality of life assessment in patients undergoing reduced intensity conditioning allogeneic as compared to autologous transplantation: results of a prospective study. Bone Marrow Transplant 34(8):729–738CrossRefPubMedGoogle Scholar
  15. 15.
    Sherman AC et al (2004) Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation. Bone Marrow Transplant 33(9):955–962CrossRefPubMedGoogle Scholar
  16. 16.
    Uyl-de Groot CA et al (2005) Health related quality of life in patients with multiple myeloma undergoing a double transplantation. Eur J Haematol 74(2):136–143CrossRefPubMedGoogle Scholar
  17. 17.
    Sherman AC et al (2009) Changes in quality-of-life and psychosocial adjustment among multiple myeloma patients treated with high-dose melphalan and autologous stem cell transplantation. Biol Blood Marrow Transplant 15(1):12–20CrossRefPubMedGoogle Scholar
  18. 18.
    Armstrong TS (2003) Symptoms experience: a concept analysis. Oncol Nurs Forum 30(4):601–606CrossRefPubMedGoogle Scholar
  19. 19.
    Williams LA et al (2014) Symptom burden of busulfan + melphalan versus melphalan alone for multiple myeloma. Blood 124(21):1277–1277Google Scholar
  20. 20.
    Cohen MZ et al (2012) Symptoms and quality of life in diverse patients undergoing hematopoietic stem cell transplantation. J Pain Symptom Manag 44(2):168–180CrossRefGoogle Scholar
  21. 21.
    Jones D et al (2013) Validation of the M. D. Anderson Symptom Inventory multiple myeloma module. J Hematol Oncol 6:13CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Wang XS et al (2014) Inflammatory markers and development of symptom burden in patients with multiple myeloma during autologous stem cell transplantation. Clin Cancer Res 20(5):1366–1374CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Basch E et al (2006) Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol 7(11):903–909CrossRefPubMedGoogle Scholar
  24. 24.
    U.S. Department of Health and Human Services, National Institutes of Health, and N.C. Institute. Common Terminology Criteria for Adverse Events (CTCAE). 2010 04.12.2015]; Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf
  25. 25.
    Berger D et al (2009) Das Blaue Buch: Chemotherapie-Manual Hämatologie und Onkologie, 3rd edn. Springer, BerlinGoogle Scholar
  26. 26.
    Basch E et al (2007) Long-term toxicity monitoring via electronic patient-reported outcomes in patients receiving chemotherapy. J Clin Oncol 25(34):5374–5380CrossRefPubMedGoogle Scholar
  27. 27.
    Basch E et al (2009) Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst 101(23):1624–1632CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Knop S et al (2014) Response to lenalidomide, doxorubicin and dexamethasone (RAD) in newly diagnosed multiple myeloma is independent of cytogenetic risk and retained after double stem cell transplant. Blood 124(21):177–177Google Scholar
  29. 29.
    Rollig C, Knop S, Bornhauser M (2015) Multiple myeloma. Lancet 385(9983):2197–2208CrossRefPubMedGoogle Scholar
  30. 30.
    Engelhardt M et al (2016) Autotransplants in older multiple myeloma patients: hype or hope in the era of novel agents? HaematologicaGoogle Scholar
  31. 31.
    Straka C et al (2016) Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial. Haematologica 101(11):1398–1406CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Greipp PR et al (2005) International staging system for multiple myeloma. J Clin Oncol 23(15):3412–3420CrossRefPubMedGoogle Scholar
  33. 33.
    Mor V et al (1984) The Karnovsky Performance Status Scale. An examination of its reliability and validity in research setting. Cancer 53:2002–2007CrossRefPubMedGoogle Scholar
  34. 34.
    Svahn B et al (2000) Is it safe to treat allogeneic stem cell transplant recipients at home during the pancytopenic phase? A pilot trial. Bone Marrow Transplant 26(10):1057–1060CrossRefPubMedGoogle Scholar
  35. 35.
    Kirsch M et al (2015) Linguistic and content validation of a German-language PRO-CTCAE-based patient-reported outcomes instrument to evaluate the late effect symptom experience after allogeneic hematopoietic stem cell transplantation. Eur J Oncol Nurs 19(1):66–74CrossRefPubMedGoogle Scholar
  36. 36.
    Harousseau J, Dreyling M (2010) Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v155–v157CrossRefPubMedGoogle Scholar
  37. 37.
    Lanuza DM et al (2012) A longitudinal study of patients’ symptoms before and during the first year after lung transplantation. Clin Transpl 26(6):E576–E589CrossRefGoogle Scholar
  38. 38.
    Jim HS, Syrjala KL, Rizzo D (2012) Supportive care of hematopoietic cell transplant patients. Biol Blood Marrow Transplant 18(1 Suppl):S12–S16CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Snowden JA et al (2011) Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 154(1):76–103CrossRefPubMedGoogle Scholar
  40. 40.
    Gibson RJ et al (2013) Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Support Care Cancer 21(1):313–326CrossRefPubMedGoogle Scholar
  41. 41.
    Terpos, E., et al., European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica, 2015. 100(10): p. 1254–1266Google Scholar
  42. 42.
    Peterson DE et al (2013) Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy. Support Care Cancer 21(1):327–332CrossRefPubMedGoogle Scholar
  43. 43.
    Phillips D, Clancy K (1972) Some effects of “social desirability” in survey studies. Am J Sociol 77(5):921–940CrossRefGoogle Scholar
  44. 44.
    Stephens M (2005) The lived experience post-autologous haematopoietic stem cell transplant (HSCT): a phenomenological study. Eur J Oncol Nurs 9(3):204–215CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Matthias Naegele
    • 1
    • 2
  • Monika Kirsch
    • 2
    • 3
  • Gabriele Ihorst
    • 4
    • 5
  • Katharina Fierz
    • 2
  • Monika Engelhardt
    • 1
    • 5
  • Sabina De Geest
    • 2
    • 6
    Email author
  1. 1.Department of Hematology/OncologyUniversity of Freiburg Medical CenterFreiburgGermany
  2. 2.Nursing Science, Faculty of Medicine, Department Public HealthUniversity of BaselBaselSwitzerland
  3. 3.Department of HematologyUniversity Hospital BaselBaselSwitzerland
  4. 4.Clinical Trials UnitUniversity of FreiburgFreiburgGermany
  5. 5.Faculty of MedicineUniversity of FreiburgFreiburgGermany
  6. 6.Academic Center for Nursing and MidwiferyKU LeuvenLeuvenBelgium

Personalised recommendations