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Myeloma: Patient accounts of their pathways to diagnosis
#MMPMID29617390
Howell DA
; Hart RI
; Smith AG
; Macleod U
; Patmore R
; Cook G
; Roman E
PLoS One
2018[]; 13
(4
): e0194788
PMID29617390
show ga
BACKGROUND: Pathways to myeloma diagnosis can be prolonged, and are often
preceded by multiple GP consultations and emergency presentation. This is the
first qualitative study to examine events leading to diagnosis by asking patients
about their experiences during this time. METHODS: Set within a UK
population-based cohort, semi-structured interviews were conducted with 20
myeloma patients with varying characteristics and pathways, 12 of whom invited
their relatives to take part. Interviews were audio-recorded and qualitative
analysis undertaken. RESULTS: Pre-diagnostic awareness of myeloma was minimal.
Disease onset was typically described as gradual, and health changes vague but
progressive, with increasing loss of function. A wide range of symptoms was
reported, with the similarity of these to self-limiting conditions failing to
raise suspicion of myeloma among patients and GPs. Patients tended to normalise
symptoms at first, although all eventually sought GP advice. GPs often initially
suggested benign diagnoses, which were sometimes only revised after multiple
consultations with persistent/worsening symptoms. Referrals were made to various
hospital specialities, and haematology if associated with abnormal blood tests
suggestive of myeloma. Once in secondary care, progress towards diagnosis was
generally rapid. CONCLUSIONS: Accounts confirmed that pathways to diagnosis could
be difficult, largely due to the way myeloma presents, and how symptoms are
interpreted and managed by patients and GPs. Recognition of 'normal' health and
consultation patterns for the individual could promote appropriate help-seeking
and timely referral when changes occur, and may be more effective than raising
awareness about the myriad of potential symptoms associated with this disease.
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