Clinical Report: Impact of COVID-19 on Diagnosis and Severity in Multiple Myeloma
Overview
This clinical audit of 323 newly diagnosed multiple myeloma (MM) patients across five UK centers compared pre- and post-COVID-19 cohorts, revealing that the pandemic significantly altered routes to diagnosis and disease severity at presentation. Despite similar patient demographics, post-COVID patients exhibited more emergency presentations and higher disease burden, highlighting the detrimental impact of diagnostic delays during the pandemic.
Background
Multiple myeloma often presents with vague symptoms, leading to diagnostic challenges and frequent emergency diagnoses associated with poorer outcomes. The COVID-19 pandemic caused substantial disruptions in healthcare delivery, including a 70% reduction in urgent cancer referrals and increased reliance on telemedicine, potentially delaying MM diagnosis. Early evidence suggested cancer patients, particularly those with hematologic malignancies, faced higher risks from SARS-CoV-2 infection, prompting altered diagnostic and treatment pathways. This study investigates how these pandemic-related changes affected MM diagnosis routes, disease stage at presentation, and patient outcomes.
Data Highlights
Characteristic
Pre-COVID (n=110)
Post-COVID (n=213)
p-value
Median Age (years)
71
71
NS
Male:Female Ratio
1.56
1.45
NS
Smoldering MM (%)
15.5%
19.2%
0.25
Emergency Route Diagnosis (%)
Data not fully provided
Increased (exact % not provided)
Significant increase noted
High-Risk Cytogenetics (%)
Similar prevalence
Similar prevalence
NS
Key Findings
323 consecutive MM patients were audited from January 2019 to July 2021 across 5 UK centers.
The cohort was divided into pre-COVID (Jan 2019–Jan 2020) and post-COVID (Feb 2020–July 2021) groups.
No significant differences in age or sex distribution were observed between cohorts.
Proportion of smoldering MM cases was similar pre- and post-pandemic.
Post-COVID cohort showed increased emergency presentations and higher disease burden at diagnosis, consistent with delayed diagnosis.
Genetic risk assessment availability improved post-COVID, but prevalence of high-risk cytogenetics remained similar.
Clinical Implications
Clinicians should be aware that pandemic-related disruptions have led to delayed MM diagnoses, resulting in more advanced disease at presentation and increased emergency admissions. Maintaining timely diagnostic pathways and careful assessment of vague symptoms, even via telemedicine, is critical to avoid worsening patient outcomes. Enhanced vigilance and streamlined referral processes are necessary to mitigate the impact of healthcare disruptions on MM prognosis.
Conclusion
The COVID-19 pandemic has adversely affected the route to diagnosis and disease severity in multiple myeloma patients, emphasizing the need for resilient cancer diagnostic services. Ongoing monitoring and adaptation of care pathways are essential to improve outcomes in this vulnerable population.
References
NCIN Routes to Diagnosis Report 2013 -- Emergency presentations and survival in myeloma
IMWG Revised Criteria 2014 -- Classification of symptomatic and smoldering myeloma
UK Myeloma Research Alliance -- Myeloma risk profile and frailty scoring
by Jonathan Carmichael, Frances Seymour, Graham McIlroy, Sarrah Tayabali, Rosie Amerikanou, Sylvia Feyler, Rakesh Popat, Guy Pratt, Christopher Parrish, A. John Ashcroft, Graham H. Jackson, Gordon Cook
