From the Guidelines
Most patients with multiple myeloma experience a delay in diagnosis, typically requiring multiple visits to their primary care provider before the diagnosis is considered.
Typical Time to Diagnosis
- The average time to diagnosis is not explicitly stated, but it is mentioned that most patients will visit their primary care provider three times with signs and symptoms consistent with myeloma before the diagnosis of multiple myeloma is considered 1.
- This delay can be attributed to various factors, including reduced access to primary care, mistrust in the healthcare system, financial barriers, poor physician-patient communication, and physician’s bias 1.
- Additionally, misinterpretation of symptoms, such as pain being attributed to arthritis or osteoporosis, can also contribute to the delay in diagnosis 1.
- It is essential to note that these delays can have significant implications for the timely initiation of treatment, with African American patients experiencing an average delay of 5.2 months from diagnosis to start of treatment with novel therapy, compared to 2.7 months for White patients 1.
From the Research
Time to Diagnosis for Multiple Myeloma
The time to diagnosis for multiple myeloma can vary, but several studies have reported the following findings:
- The median time from first symptoms to diagnosis was 4 months in a retrospective analysis and 6 months in a prospective analysis 2
- The median time to diagnosis was 7 months in a prospective interdisciplinary study 3
- The median time from first-recorded bone pain to multiple myeloma diagnosis was 220 days (approximately 7 months) in a population-based cohort study 4
- The median time from first-recorded hypercalcaemia, renal impairment, or anaemia to multiple myeloma diagnosis was 23,58, and 73 days, respectively 4
Factors Affecting Time to Diagnosis
Several factors can affect the time to diagnosis, including:
- Non-specific symptoms, such as back pain, fatigue, and weight loss 3, 4, 5
- Lack of awareness of multiple myeloma among primary care physicians 3, 4
- Underuse of investigations to evaluate CRAB criteria, including targeted imaging 4
- Presence of comorbidities, such as skeletal disease 3
Impact of Diagnostic Delay
The impact of diagnostic delay on patient outcomes is unclear, with some studies suggesting that it does not affect overall survival or prognosis 2, 5, while others suggest that it may lead to increased morbidity and decreased patient satisfaction 2