Clinical Scorecard: Impact of Delayed Diagnosis on Disease Severity in Multiple Myeloma: Insights from the COVID-19 Pandemic
At a Glance
Category
Detail
Condition
Multiple Myeloma
Key Mechanisms
Delayed diagnosis due to vague, non-specific symptoms leading to emergency presentations with higher disease burden; COVID-19 pandemic exacerbated delays via reduced referrals and altered care pathways
Target Population
Patients with newly diagnosed multiple myeloma
Care Setting
Primary care, emergency services, and hospital oncology settings
Key Highlights
32% of myeloma diagnoses in 2013 were made via emergency care, associated with shorter survival and higher disease burden (CRAB features, ISS scores).
COVID-19 pandemic caused a 70% fall in urgent cancer referrals and 24% fewer primary care contacts for possible cancer symptoms, potentially delaying myeloma diagnosis.
Audit of 323 newly diagnosed MM patients (pre- and post-COVID cohorts) showed no significant difference in age, sex ratio, or proportion of smoldering MM, but pandemic impacted diagnostic and treatment pathways.
Guideline-Based Recommendations
Diagnosis
Recognize the diagnostic challenge posed by vague and non-specific symptoms of myeloma.
Avoid reliance solely on emergency presentations; encourage timely primary care referrals for suspected myeloma.
Use revised IMWG criteria for classification of symptomatic and smoldering myeloma.
Management
Adapt treatment pathways to minimize SARS-CoV-2 exposure while ensuring timely therapy initiation.
Continue genetic risk assessment where possible to guide prognosis and treatment.
Consider frailty scoring (IMWG Frailty Score) and risk profiling (UKMRA MRP) in management decisions.
Monitoring & Follow-up
Monitor disease stage at presentation using CRAB features and ISS scores.
Track route to diagnosis and timing from symptom onset to diagnosis to identify delays.
Assess initial response to therapy and adjust management accordingly.
Risks
Delayed diagnosis is associated with higher disease burden and poorer outcomes.
Emergency route diagnosis correlates with shorter survival.
COVID-19 pandemic-related disruptions may increase risk of delayed diagnosis and treatment.
Patient & Prescribing Data
Newly diagnosed multiple myeloma patients from January 2019 to July 2021 across 5 UK institutions
No significant differences in baseline characteristics pre- and post-COVID; genetic testing continued during pandemic; altered pathways aimed to reduce infection risk but may have delayed diagnosis and treatment.
Clinical Best Practices
Maintain vigilance for myeloma in patients with vague symptoms to reduce emergency presentations.
Ensure continuity of diagnostic services including genetic risk assessment during healthcare disruptions.
Incorporate frailty and risk profiling tools to individualize treatment plans.
Leverage telemedicine cautiously, recognizing limitations in assessing non-specific symptoms.
Monitor impact of pandemic-related changes on cancer referral and diagnosis rates to mitigate delays.
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
