{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:50:19Z","timestamp":1760057419340,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Juravinski Hospital and Cancer Centre Foundation"},{"name":"Leukemia and Lymphoma Society of Canada"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Patients with transplant-ineligible (TIE) multiple myeloma (MM) have high rates of symptom burden. The aim of this study was to develop and validate a prognostic model to predict symptoms in patients with TIE MM. Methods: In this population-based, retrospective cohort study, using multiple administrative health care databases linked using a unique encrypted patient identifier in Ontario, Canada, symptoms were identified using the patient self-reported Edmonton Symptom Assessment System (ESAS) at each clinic visit. The primary outcome was the presence of moderate-to-severe (ESAS score 4\u201310) symptoms (specifically symptoms of pain, tiredness, depression, and impaired well-being) within one year from the index date. Using the entire cohort, a multivariable logistic regression model with baseline covariates was developed to predict the risk of experiencing each of the above symptoms, categorized as moderate to severe within 1 year post-index date. Internal validation of the model was assessed via bootstrap validation methods. Results: A total of 1535 TIE adults with MM met the inclusion criteria. The median age was 75, with 25.2% of patients aged 80 years or older. In the multivariate analysis, baseline symptoms continued to be most associated with future symptom burden. Baseline severe pain (OR 9.84, 95% CI 6.29\u201315.7) was most associated with patients experiencing moderate\u2013severe pain one year post-index date. Similarly, baseline severe tiredness (OR 17.34, 95% CI 9.00\u201333.42), baseline severe depression (OR 28.07, 95% CI 15.96\u201349.38), and baseline severely impaired well-being (OR 4.12, 95% CI 2.30\u20137.37) were the biggest predictors of patients experiencing moderate\u2013severe tiredness, depression, and impaired well-being, respectively, at one year after the index date. Conclusions: Patients with MM experience persisting symptoms of pain, tiredness, depression, and impaired well-being, with baseline symptoms being the biggest predictor of future symptom burden.<\/jats:p>","DOI":"10.3390\/cancers17030489","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T09:35:07Z","timestamp":1738575307000},"page":"489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Prognostic Symptom Model Incorporating Patient-Reported Symptoms for Transplant-Ineligible Patients with Multiple Myeloma"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2831-9107","authenticated-orcid":false,"given":"Amaris K.","family":"Balitsky","sequence":"first","affiliation":[{"name":"Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"},{"name":"Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada"},{"name":"Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rinku","family":"Sutradhar","sequence":"additional","affiliation":[{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada"},{"name":"Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-1714","authenticated-orcid":false,"given":"Hsien","family":"Seow","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"},{"name":"Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada"},{"name":"Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada"},{"name":"ICES McMaster, Hamilton, ON L8S 4K1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia","family":"Gayowsky","sequence":"additional","affiliation":[{"name":"ICES McMaster, Hamilton, ON L8S 4K1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alissa","family":"Visram","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"},{"name":"Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Caalgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9407-6265","authenticated-orcid":false,"given":"Irwindeep","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Alberta, Edmonton, AB T6G 2G3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-1067","authenticated-orcid":false,"given":"Hira","family":"Mian","sequence":"additional","affiliation":[{"name":"Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"},{"name":"Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada"},{"name":"Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada"},{"name":"ICES McMaster, Hamilton, ON L8S 4K1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,1]]},"reference":[{"key":"ref_1","unstructured":"National Cancer Institute (2023, September 11). National Cancer Institute Surveillance, Epidemiology, and End Results Program, Available online: https:\/\/seer.cancer.gov\/statfacts\/html\/mulmy.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1182\/blood.V124.21.1320.1320","article-title":"Early Mortality in Multiple Myeloma: Risk Factors and Impact on Population Outcomes","volume":"124","author":"Costa","year":"2014","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.3324\/haematol.2020.267757","article-title":"Symptom burden in transplant ineligible patients with newly diagnosed multiple myeloma: A population-based cohort study","volume":"106","author":"Mian","year":"2021","journal-title":"Haematologica"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3406","DOI":"10.1200\/JCO.21.02614","article-title":"Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma: A European Myeloma Network (EMN) Report Within the HARMONY Project","volume":"40","author":"Cairns","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2863","DOI":"10.1200\/JCO.2015.61.2267","article-title":"Revised International Staging System for Multiple Myeloma: A Report from International Myeloma Working Group","volume":"33","author":"Palumbo","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3412","DOI":"10.1200\/JCO.2005.04.242","article-title":"International staging system for multiple myeloma","volume":"23","author":"Greipp","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jmoldx.2020.10.010","article-title":"Analytical Validation of SKY92 for the Identification of High-Risk Multiple Myeloma","volume":"23","author":"Huigh","year":"2021","journal-title":"J. Mol. Diagn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1200\/JCO.2013.53.5948","article-title":"What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials","volume":"32","author":"Kotronoulas","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2424793","DOI":"10.1001\/jamanetworkopen.2024.24793","article-title":"Patient-Reported Outcome Measures in Cancer Care: An Updated Systematic Review and Meta-Analysis","volume":"7","author":"Balitsky","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1200\/JCO.2015.63.0830","article-title":"Symptom Monitoring with Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial","volume":"34","author":"Basch","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101781","DOI":"10.1016\/j.jgo.2024.101781","article-title":"Understanding health outcome preferences of older adults diagnosed with multiple myeloma","volume":"15","author":"Maheshwari","year":"2024","journal-title":"J. Geriatr. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments","volume":"53","author":"Hui","year":"2017","journal-title":"J. Pain Symptom Manag."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jpainsymman.2009.06.010","article-title":"A single set of numerical cutpoints to define moderate and severe symptoms for the Edmonton Symptom Assessment System","volume":"39","author":"Selby","year":"2010","journal-title":"J. Pain Symptom Manag."},{"key":"ref_15","unstructured":"(2023, September 11). Canada\u2019s Drug and Health Technology Agency\u2014Multiple Myeloma. Available online: https:\/\/www.cadth.ca\/multiple-myeloma."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/082585979601200102","article-title":"Palliative performance scale (PPS): A new tool","volume":"12","author":"Anderson","year":"1996","journal-title":"J. Palliat. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4376","DOI":"10.1200\/JCO.2009.27.1916","article-title":"Prognostic factors in patients with advanced cancer: Use of the patient-generated subjective global assessment in survival prediction","volume":"28","author":"Martin","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.jpainsymman.2018.02.015","article-title":"Patient-Reported Functional Status in Outpatients with Advanced Cancer: Correlation with Physician-Reported Scores and Survival","volume":"55","author":"Popovic","year":"2018","journal-title":"J. Pain Symptom Manag."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/oncolo\/oyae041","article-title":"A Prognostic Survival Model Incorporating Patient-Reported Outcomes for Transplant-Ineligible Patients with Multiple Myeloma","volume":"29","author":"Mian","year":"2024","journal-title":"Oncologist"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e201768","DOI":"10.1001\/jamanetworkopen.2020.1768","article-title":"Development and Validation of a Prognostic Survival Model with Patient-Reported Outcomes for Patients with Cancer","volume":"3","author":"Seow","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/0269216319833588","article-title":"Symptoms and anxiety predict declining health-related quality of life in multiple myeloma: A prospective, multi-centre longitudinal study","volume":"33","author":"Ramsenthaler","year":"2019","journal-title":"Palliat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1177\/0269216310391692","article-title":"Haematological malignancy: Are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data","volume":"25","author":"Howell","year":"2011","journal-title":"Palliat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Howell, D.A., Wang, H.-I., Smith, A.G., Howard, M.R., Patmore, R.D., and Roman, E. (2013). Place of death in haematological malignancy: Variations by disease sub-type and time from diagnosis to death. BMC Palliat. Care, 12.","DOI":"10.1186\/1472-684X-12-42"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1136\/bmjspcare-2013-000578","article-title":"Variations in specialist palliative care referrals: Findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma","volume":"5","author":"Howell","year":"2015","journal-title":"BMJ Support Palliat. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1038\/leu.2008.336","article-title":"Pathogenesis of myeloma bone disease","volume":"23","author":"Roodman","year":"2009","journal-title":"Leukemia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1038\/leu.2017.138","article-title":"Natural history of relapsed myeloma, refractory to immunomodulatory drugs and proteasome inhibitors: A multicenter IMWG study","volume":"31","author":"Kumar","year":"2017","journal-title":"Leukemia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4716","DOI":"10.1182\/blood.V112.11.4716.4716","article-title":"Management of Anemia in Multiple Myeloma Patients Treated with Erythropoiesis Stimulating Agents (ESAs): Findings from the European Anemia Cancer Treatment (A.C.T.) Study","volume":"112","author":"Ludwig","year":"2008","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s00277-020-04356-0","article-title":"Health-related quality of life in patients with multiple myeloma participating in a multidisciplinary rehabilitation program","volume":"100","author":"Nielsen","year":"2021","journal-title":"Ann. Hematol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/489\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:25:33Z","timestamp":1760027133000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,1]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["cancers17030489"],"URL":"https:\/\/doi.org\/10.3390\/cancers17030489","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2025,2,1]]}}}