Early Signals Before Myeloma: Real-World Data Reveal Missed Opportunities for Earlier Diagnosis

In a real-world claims analysis of nearly 5000 patients later diagnosed with multiple myeloma, distinct patterns of health care utilization emerged as early as a year before diagnosis—well before the disease was formally recognized.

In this interview with Pharmacy Times, Faith Davies, MD, a hematologist-oncologist at NYU Langone Health, discussed how subtle but accumulating red flags such as cytopenias, musculoskeletal pain, and unexpected specialty visits may signal an opportunity for earlier intervention. She also explores how pharmacists, by synthesizing laboratory trends, claims data, and persistent symptoms, can play a critical role in recognizing with nonspecific findings warrant a closer look for underlying malignancy.

Q: What were the most notable findings from this real-world analysis of health care utilization in the 2 years before multiple myeloma (MM) diagnosis?

Faith Davies, MD: Yeah, so my study looked at health care utilization for myeloma patients prior to their diagnosis, and we were able to do this by using a health claims database. We had nearly 5000 patients who were diagnosed with myeloma and 5000 patients that were their controls, and they were very, very closely matched, not only for age, race, but also comorbidities. And our main findings were that even a year before diagnosis, we could see that myeloma patients accessed their care differently to how non-myeloma patients did. So even though at that time we didn't know the patient had myeloma, you could see that they had a collection of different diagnoses and procedural codes that the patients that were closely matched to them didn't have, suggesting that we're potentially missing an opportunity for early diagnosis in these patients.

Q: Given the significantly higher rates of anemia, pancytopenia, and neutropenia codes in the pre-MM cohort beginning 12 months before diagnosis, how should pharmacists think about these hematologic red flags when reviewing laboratory data or claims patterns?

Davies: So, I think that's the step that we need to take forward, because we know that myeloma patients do present with blood conditions, so anemia, cytopenias. We also know that they potentially present with renal failure, aches and pains, muscle pains, etc. And I think that one of our findings was that it wasn't one particular thing that pointed towards their patients going on to develop myeloma. It was a kind of collection of, I guess, what we might call nonspecific things that, as a whole, went on to develop this. And so you're right, I think we all need to be more observant when we're looking through our patients records, both at their claims side of things, but also those bloods and so on. And try and think myeloma in these cases,

Interestingly, there were a couple of things that maybe you wouldn't have expected to pop up. So, there were patients who were tending to see more of their cardiologists or more of their gastroenterologists. There was a higher kind of incidence of patients having GERD and having an endoscopy, so whether that was all related to the underlying anemia and the patient maybe went to the gastroenterologist or the cardiologist before they made it to the hematologist, it's really difficult to tell from claims data. But I think having that from it on a day to day basis, having that kind of knowledge and thought process of, “Oh, I wonder,” is going to be really important.

Q: Musculoskeletal pain was more frequently coded in patients later diagnosed with MM, even up to a year prior. How might pharmacists help differentiate routine musculoskeletal complaints from those that may warrant further evaluation for underlying malignancy?

Davies: This is a real important one, because I think that depending on people's locations, it may be that they only ever see one myeloma patient in a lifetime, but they're going to see many, many patients with back pain and so on. So again, I think it's either the patient that has persistent issues and problems and their symptoms that don't resolve with the regular kind of therapy. So maybe the outliers, or indeed, those patients that are maybe younger than you would be expecting or are presenting with more severe symptoms than you might expect. So, anybody that's going to set off a little kind of alarm bell. And then putting the whole story together, as well. So essentially, if they were also to have pancytopenia or anything like that, then that's when we would really think about it. And then, as you kind of alluded to, for us, particularly patients not going on to get issues related to nonsteroidal use and so on, because of their renal function, is very important.