Conference Coverage

Video Recap—Multiple Myeloma Across the Care Continuum

Brittany Watson, MD, MPH,
Joseph Mikhael, MD, MEd, FRCPC

Key Highlights

  • Primary care clinicians are often at the forefront of recognizing multiple myeloma because patients frequently present first with vague symptoms such as fatigue, pain, anemia, renal insufficiency, or back pain.
  • When multiple myeloma is suspected, clinicians should order the appropriate diagnostic tests, including serum protein electrophoresis, and should not forget to include free light chains.
  • Strong collaboration between primary care clinicians and specialists is essential for earlier diagnosis, long-term management, and improved outcomes for patients with multiple myeloma.

Multiple myeloma can be challenging to diagnose in the primary care setting because patients often present with nonspecific symptoms such as fatigue, pain, anemia, renal insufficiency, or back pain. Brittany Watson, MD, MPH, FAAFP, DABOM, and Joseph Mikhael, MD, MEd, FRCPC, FACP emphasize that primary care clinicians are often the first point of contact for these patients and play a critical role in identifying possible multiple myeloma early. They also discuss the importance of ordering serum protein electrophoresis and free light chains, recognizing health disparities in delayed diagnosis, and collaborating with specialists as patients live longer with multiple myeloma as a chronic disease.

Additional Resources: https://www.hmpglobalevents.com/pupc

Transcript

Consultant360: What are some of the key themes of your presentation?

Brittany Watson, MD, MPH, FAAFP, DABOM: So during our presentation, we really wanted to emphasize the importance of early recognition and detection of multiple myeloma. Primary care is really on the forefront of the diagnosis, so it's really important that we catch this early so that we can order the correct test and refer to our specialist colleagues. And you'll see throughout the presentation we say over and over again the importance of ordering the SPEP and not forgetting the free light chains when you order that SPEP. We also talked about the disease mimics such as diabetes because the symptoms of multiple myeloma are often vague and they can sometimes mix with the other diagnoses that we see commonly. So really being mindful whenever we interact and encounter patients who are presenting with those symptoms. Also, it's important to remember that with the advancement of technology and treatment for multiple myeloma, our patients are living longer.

So it's more of a chronic disease, which we're really good at managing. So we need to partner closely with our specialist colleagues in order to take really excellent care of our patients with multiple myeloma.

Consultant360: Why is this topic particularly relevant right now?

Joseph Mikhael, MD, MEd, FRCPC, FACP: This is a particularly relevant topic. As Dr. Watson noted, this partnership between the generalist and the specialist is so important for the care of the patient and a lot of it in myeloma has to do with the delayed diagnosis. We know now that the average patient with multiple myeloma actually sees their primary care provider three times with signs and systems consistent with myeloma before the diagnosis is suspected and then confirmed. And it's because as Dr. Watson has noted, the signs and symptoms of myeloma tend to be quite vague, fatigue, pain, maybe anemia if a blood test was done. So this is particularly relevant because we know when we can catch the diagnosis earlier, patients will do better. Furthermore, it's particularly relevant now as we've come to appreciate the nature of the health disparity in multiple myeloma, that that delayed diagnosis is even longer in African-American and Latino-American patients often because they have less access to primary care.

There may be mimicking conditions like diabetes and others that prevents that clarity of the diagnosis of multiple myeloma. And that's why we thought it was so important to have this kind of session where primary care sees its incredible value in catching the diagnosis earlier and partnering with our specialty colleagues.

Consultant360: What are the most important takeaways from your session?

Dr Watson: So the most important takeaways, I'll say again, primary care is really at the forefront of making this diagnosis. Primary care is where many of these patients present first. So making sure that we're getting this diagnosis early is going to really be life-changing for the patients that we served. Second is going to be again, when we realize that, hey, maybe we should be thinking about multiple myeloma ordering the right tests, not forgetting the free light chains when we are ordering that SPEP. And lastly, again, the partnership with our specialist colleagues is very important as we care for our patients long-term.

Consultant360: Finally, what gaps in our knowledge still remain on this topic?

Dr Mikhael: There are still gaps in our knowledge of multiple myeloma, and primarily it has to do with whether or not we should be screening for multiple myeloma. We now screen for breast cancer. We screened for colon cancer, and we've learned that that has actually not only hastened a diagnosis, it's actually had an impact on overall survival. We're now doing the large trials, one huge trial in Iceland with over 85,000 patients enrolled to determine will it save lives if we screen patients and not just wait for signs and symptoms consistent with myeloma? So that's a major gap that could very heavily influence how primary care approaches the diagnosis of multiple myeloma. But until we are there, we want to fill part of that gap by recognizing those individuals who are at the highest risk of developing myeloma. It's twice as common in African-American individuals diagnosed younger and Latino Americans, more likely in individuals as we age and indeed more likely if there happens to be a family member that has a myeloma or another hematologic condition.

So we hope to fill those gaps with time to better understand how we could catch myeloma even earlier, but in the interim, being sensitive and aware of the diagnosis, even in common back pain and renal insufficiency and anemia and fatigue, the things that primary care sees every day will help us hasten the diagnosis and of course produce better outcomes in our patients with multiple myeloma.

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