Treatment trade-offs in myeloma: A survey of consecutive patients about contemporary maintenance strategies

Brian L. Burnette, Angela Dispenzieri, Shaji K Kumar, Ann M. Harris, Jeff A Sloan, Jon C Tilburt, Robert A. Kyle, S Vincent Rajkumar

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.

Original languageEnglish (US)
Pages (from-to)4308-4315
Number of pages8
JournalCancer
Volume119
Issue number24
DOIs
StatePublished - Dec 15 2013

Fingerprint

Maintenance
Multiple Myeloma
Therapeutics
Health Care Costs
Disease-Free Survival
Survival
Costs and Cost Analysis
Surveys and Questionnaires
Autologous Transplantation
Peripheral Nervous System Diseases
Constipation
Standard of Care
Venous Thrombosis
Nausea
Fatigue
Diarrhea
Quality of Life

Keywords

  • autologous transplant
  • bortezomib
  • lenalidomide
  • maintenance
  • multiple myeloma
  • quality of life

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment trade-offs in myeloma : A survey of consecutive patients about contemporary maintenance strategies. / Burnette, Brian L.; Dispenzieri, Angela; Kumar, Shaji K; Harris, Ann M.; Sloan, Jeff A; Tilburt, Jon C; Kyle, Robert A.; Rajkumar, S Vincent.

In: Cancer, Vol. 119, No. 24, 15.12.2013, p. 4308-4315.

Research output: Contribution to journalArticle

@article{c3389d4e1afa49ca89d646b8dcb79826,
title = "Treatment trade-offs in myeloma: A survey of consecutive patients about contemporary maintenance strategies",
abstract = "BACKGROUND Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS Of 1159 surveys sent, 886 patients (83.2{\%}) responded, and 736 patients returned a completed survey (66{\%} raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27{\%} of patients, cytopenias by 24{\%}, deep vein thrombosis by 20{\%}, fatigue by 15{\%}, nausea by 8{\%}, and diarrhea/constipation by 7{\%}. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49{\%} of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42{\%}. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39{\%} of patients. CONCLUSIONS The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.",
keywords = "autologous transplant, bortezomib, lenalidomide, maintenance, multiple myeloma, quality of life",
author = "Burnette, {Brian L.} and Angela Dispenzieri and Kumar, {Shaji K} and Harris, {Ann M.} and Sloan, {Jeff A} and Tilburt, {Jon C} and Kyle, {Robert A.} and Rajkumar, {S Vincent}",
year = "2013",
month = "12",
day = "15",
doi = "10.1002/cncr.28340",
language = "English (US)",
volume = "119",
pages = "4308--4315",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "24",

}

TY - JOUR

T1 - Treatment trade-offs in myeloma

T2 - A survey of consecutive patients about contemporary maintenance strategies

AU - Burnette, Brian L.

AU - Dispenzieri, Angela

AU - Kumar, Shaji K

AU - Harris, Ann M.

AU - Sloan, Jeff A

AU - Tilburt, Jon C

AU - Kyle, Robert A.

AU - Rajkumar, S Vincent

PY - 2013/12/15

Y1 - 2013/12/15

N2 - BACKGROUND Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.

AB - BACKGROUND Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.

KW - autologous transplant

KW - bortezomib

KW - lenalidomide

KW - maintenance

KW - multiple myeloma

KW - quality of life

UR - http://www.scopus.com/inward/record.url?scp=84889883309&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889883309&partnerID=8YFLogxK

U2 - 10.1002/cncr.28340

DO - 10.1002/cncr.28340

M3 - Article

C2 - 24105720

AN - SCOPUS:84889883309

VL - 119

SP - 4308

EP - 4315

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 24

ER -