PARIS – Elderly patients with multiple myeloma and severe comorbid disease are more than twice as likely to die as were those with no comorbidities, data from a single-center, retrospective study show.
Mild or moderate comorbidities did not appear to influence overall survival significantly in the 179-patient study. The hazard ratio (HR) for death in patients with severe comorbidity vs. none was 2.36 (P = .01), which was associated with a median overall survival of 15.1 months.
Median overall survival was 43.1 months for those with no comorbidities and 31.5 and 35 months, respectively, in those with mild (HR, 1.38; P = .26) or moderate (HR, 1.5; P = .19) comorbidities.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma," said lead author Dr. Tanya M. Wildes of Washington University in St. Louis.
Nevertheless, comorbidities are not currently incorporated into any staging systems for the disease, Dr. Wildes observed in an interview at the annual meeting of the International Society of Geriatric Oncology.
The research is part of a wider project that is looking at the value of performing a geriatric assessment to help predict which elderly patients with hematological malignancies may be able to undergo standard cancer treatment, or require additional monitoring for adverse events, or more supportive care.
"The severity of comorbidities is associated with poorer survival in older adults with multiple myeloma."
In the current study, Dr. Wildes and her colleagues identified all patients who were diagnosed and treated for multiple myeloma at Barnes-Jewish Hospital, St. Louis, between January 2000 and March 2010. Demographic, clinical, and survival data were obtained, with concomitant conditions graded using the Adult Comorbidity Evaluation (ACE) 27 index as none, mild, moderate, or severe.
The primary end point of the study was overall survival, the duration of which was calculated from the date of diagnosis until the time of last follow-up.
The median age of patients at baseline was 69 years (range, 65-91 years). There was a similar percentage of men (48.4%) and women (51.4%), and 75% of the population was white. Most of the remainder were black (23.5%).
According to the ACE-27 index, 41.3% of patients had mild, 24.6% had moderate, and 15.6% had severe comorbidities. The remaining 18.5% had no comorbidities.
"The challenge with multiple myeloma is that some of the comorbidities may be disease related as opposed to patient’s underlying comorbidities," Dr. Wildes noted. That would require reviewing the patients’ medical records, which was not done in the current evaluation of this data set but is something that the researchers plan on looking at next.
"These are hypothesis-generating data at the moment," Dr. Wildes said. Further study, to evaluate the impact of comorbidities on survival in multiple myeloma and their influence on patients’ tolerance of therapy and treatment decisions, is needed.
"On average, three comorbidities can be expected in a patient [aged] 65 years and older," said Dr. Lazzaro Repetto of the Istituto Nazionale di Riposo e Cura per Anziani at the Istituto di Ricovero e Cura a Carattere Scientifico in Rome.
Speaking at separate session during the meeting, Dr. Repetto said common comorbidities in elderly cancer patients included cardiovascular disease, renal insufficiency, diabetes, dementia, depression, anemia, osteoporosis, arthritis and arthrosis, and chronic obstructive pulmonary disease. All of these may have an impact on survival.
Indeed, other research presented by a Danish team showed that colorectal and lung cancers in particular were associated with a high number of comorbidities when compared with the general elderly population. A high comorbidity burden was also linked to reduced overall survival, but only in those with lung cancer, reported Dr. Trine Lembrecht Jørgensen of Odense (Denmark) University Hospital and associates.
The presence of comorbidities can alter treatment decisions, influencing the type of treatment offered, said Dr. Repetto. However, although assessing comorbid disease is important, it should always be part of a wider geriatric assessment, he advised. This should include measures of cognition, emotional and physical functioning, medication use, socioeconomic and social support factors, and the patient’s wishes.
"Using the geriatric assessment we can personalize treatment, and optimize the balance between benefit and risk of our decisions," Dr. Repetto suggested.
Dr. Wildes’ research was supported by a grant from the U.S. National Cancer Institute. Dr. Wildes and Dr. Repetto had no conflicts of interest.