Quality of Life in Patients with Multiple Myeloma

Kwan-Suk Jo; Ja-Young Ban; Jee-Yeon Yoon; Seung-Hye Kook; Hyun-Sun Yoon; Yang-Sook Yoo

doi:10.7469/kjan.2016.28.3.314

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Jo, Ban, Yoon, Kook, Yoon, and Yoo: Quality of Life in Patients with Multiple Myeloma

Original Article

Korean J Adult Nurs 2016;28(3):314-322.

Published online: June 2016

DOI: https://doi.org/10.7469/kjan.2016.28.3.314

Quality of Life in Patients with Multiple Myeloma

Kwan-Suk Jo¹, Ja-Young Ban¹, Jee-Yeon Yoon¹, Seung-Hye Kook¹, Hyun-Sun Yoon¹, Yang-Sook Yoo²

^¹Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul

^²College of Nursing, The Catholic University of Korea, Seoul, Korea

Corresponding author: Yoo, Yang-Sook College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul 06591, Korea. Tel: +82-2-2258-7411, Fax: +82-2-2258-7772, E-mail: ysyoo@catholic.ac.kr

Received 6 April 201611 May 2016 Accepted 21 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the quality of life reported by patients with multiple myeloma and secondly to identify the factors that impact the quality of life (QoL). Methods: 189 patients with multiple myeloma completed survey questionnaires. Quality of life was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core (EORTC QLQ-C) 30 and Multiple Myeloma (MY) 20. The data were analyzed using the t-test, ANOVA, Kruskal-Wallis test, Duncan test and the Mann-Whitney test.

Results

The mean score for each subscale of EORTC QLQ-C30 was 53.35 for global health status, 73.37 for functional scale, and 31.29 for symptom scale. The mean score for each subscale of EORTC QLQ-MY20 was 60.49 for future perspective, 59.78 for body image, 20.25 for disease symptom and 24.99 for side effect of treatment. Quality of life was reported to be significantly lower among females, unemployed, dependence on a sibling for financial support for treatment, a diagnosis of anemia, having treatment, high score on Eastern Coorperative Oncology Group and high grade peripheral neuropathy.

Conclusion

The results of the survey can identify characteristics impacting the QoL of patients with multiple myeloma. Developing appropriate educational strategies and nursing interventions would enhance their QoL.

Keywords: Multiple myeloma, Quality of life, Symptom

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Table 1.

Health-related Quality of Life (QLQ-C30) according to General Characteristics of Participants (N=189

Characteristics	Categories	n (%)	Global health status		Functional		Symptom
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	≤49	16 (8.5)	54.16±23.57	0.10	68.75±15.42	1.22	31.17±14.16	1.84
	50~59	67 (35.5)	54.35±22.20	(.957)	71.22±19.83	(.302)	22.62±16.23	(.140)
	60~69	77 (40.7)	52.71±20.51		74.75±17.54		23.93±15.68
	≥70	29 (15.3)	52.01±23.21		77.19±17.48		20.28±12.76
Gender	Male	101 (53.4)	55.44±21.74	1.42	76.29±17.05	2.38	21.72±15.02	1.72
Gender	Female	88 (46.6)	50.94±21.60	(.156)	70.01±19.10	(.018)	25.59±15.78	(.086)
Education completed	Elementary school	28 (14.8)	52.08±18.92	0.97	71.39±18.75	1.41	21.00±13.59	0.45
	Middle school	32 (16.9)	50.78±20.45	(.405)	75.62±16.75	(.241)	25.67±16.26	(.711)
	High school	58 (30.7)	51.14±20.85		69.96±20.17		23.79±16.55
	≥College	71 (37.6)	56.80±23.91		75.37±18.26		23.32±15.02
Marital status	Married	176 (93.1)	54.16±21.73	1.91	73.62±18.32	0.69	23.12±15.54	1.30
Marital status	Single	13 (6.9)	42.30±19.38	(.057)	69.94±17.76	(.485)	28.91±13.68	(.193)
Religion	Yes	119 (63.0)	53.92±22.14	0.46	74.02±18.08	0.64	23.87±15.06	0.40
Religion	No	70 (37.0)	52.38±21.14	(.639)	72.25±18.64	(.520)	22.92±15.32	(.685)
Monthly household income (10,000 won)	≤100	56 (29.6)	51.93±20.03	1.55	73.96±17.39	0.35	22.74±13.94	0.26
	101~200	38 (20.1)	51.09±18.39	(.817)^†	71.23±17.34	(.839)	25.55±16.57	(.902)
	201~300	38 (20.1)	55.04±22.63		75.04±16.35		22.95±13.63
	301~400	23 (12.2)	57.60±19.77		75.24±19.69		24.44±17.81
	≥401	34 (18.0)	53.43±27.98		71.63±22.03		22.56±17.40
Payer of treatment fee	Patient	103 (54.5)	56.22±22.61	2.10	76.22±18.15	1.97	21.53±15.46	1.70
	Spouse	53 (28.0)	52.51±21.90	(.101)	69.52±18.70	(.119)	26.69±15.47	(.167)
	Offspring	27 (14.3)	46.60±17.33		71.40±17.53		23.41±12.93
	Sibling	6 (3.2)	41.66±13.94		67.22±13.93		30.24±22.56
Job	Yes	58 (30.7)	56.17±56.17	1.19	77.70±17.32	2.19	20.12±14.12	2.02
Job	No	131 (69.3)	52.09±20.76	(.235)	71.45±18.40	(.029)	25.03±15.84	(.044)
Renal failure	Yes	12 (6.3)	58.33±25.12	0.82	71.16±20.33	0.43	24.02±13.06	0.11
Renal failure	No	177 (93.7)	53.01±21.53	(.413)	73.51±18.16	(.667)	23.49±15.64	(.909)
Anemia	Yes	27 (14.3)	43.20±23.34	2.66	68.46±19.67	1.51	32.32±19.40	3.27
Anemia	No	162 (85.7)	55.04±21.06	(.008)	74.18±18.95	(.132)	22.05±14.25	(.001)
Bone destruction	Yes	62 (32.8)	50.67±21.88	1.18	73.07±17.99	0.15	21.66±14.52	1.15
Bone destruction	No	127 (67.2)	54.65±21.63	(.238)	73.51±18.46	(.877)	24.43±15.88	(.204)
HSCT	Yes	113 (59.8)	53.83±22.41	0.37	71.65±19.18	1.58	24.22±16.77	0.76
HSCT	No	76 (40.2)	52.63±20.82	(.710)	75.92±16.60	(.116)	22.48±13.32	(.448)
Ongoing treatment	Yes	90 (47.6)	46.20±19.75	4.52	68.77±17.20	3.38	28.65±13.86	4.57
Ongoing treatment	No	99 (52.4)	59.84±21.50	(.001)	77.54±18.27	(.001)	18.86±15.42	(.001)
Months since diagnosis made	≤12	55 (29.1)	49.09±20.51	1.35	70.87±19.43	2.40	26.61±15.50	2.41
	13~24	48 (25.4)	57.11±19.44	(.258)	76.93±16.92	(.069)	19.89±13.97	(.068)
	25~36	25 (13.2)	56.33±21.14		79.24±14.17		19.67±12.75
	≥37	61 (32.3)	53.00±24.39		70.40±19.01		25.17±16.93
ECOG PS	0	21 (11.1)	71.82±18.7^a	14.22	83.07±12.07^a	8.50	17.96±13.60^a	5.02
	1	134 (70.9)	53.91±20.53^b	(.001)	74.81±17.55^ab	(.001)	22.70±15.08^a	(.002)
	2	29 (15.3)	43.67±17.48^b	c＜b＜a	63.52±18.44^bc	c＜a	27.82±13.23^a	a＜b
	3	5 (2.7)	16.66±11.78^c		50.86±20.43^c		44.07±26.09^b
Peripheral neuropathy	Grade I	52 (27.5)	60.57±23.51^a	6.33	78.76±16.38^a	3.77	20.50±16.08^a	4.22
	Grade II	75 (39.7)	55.22±19.65^ab	(.001)	73.29±17.87^a	(.012)	22.08±13.87^a	(.006)
	Grade III	50 (26.5)	47.00±1835^bc	c＜a	70.79±18.05^a	b＜a	25.72±14.73^a	a＜b
	Grade IV	12 (6.3)	36.80±25.24^c		61.22±22.93^b		36.47±19.09^b

HSCT=hematopoietic stem cell transplantation, ECOG PS=eastern cooperative oncology group performance score, QLQ-C=quality of life questionnaire-core;

^† Kruskal-Wallis test.

Table 2.

Health-related and Multiple Myeloma related Quality of Life (N=189)

Variables		M±SD
Health-related quality of life (QLQ-C30)	General health status	53.35±21.73
	Functional	73.37±18.26
	Role	69.22±27.24
	Physical	70.86±20.25
	Emotional	74.95±21.44
	Social	74.95±25.93
	Cognitive	76.85±21.16
	Symptom	23.52±15.46
	Fatigue	38.97±22.79
	Insomnia	30.15±29.40
	Pain	29.18±29.35
	Financial difficulties	25.22±27.15
	Dyspnea	22.39±25.68
	Constipation	22.39±29.74
	Appetite loss	22.22±28.96
	Diarrhea	11.46±21.28
	Nausea and vomiting	9.70±18.59
Multiple myeloma related quality of life (QLQ-MY20)	Functional
	Body image	59.78±31.22
	Future perspective	60.49±25.32
	Symptom
	Side effect of treatment	24.99±16.70
	Disease associated symptoms	20.25±19.58

QLQ-C=quality of life questionnaire-core; QLQ-MY=quality of life questionnaire-multiple myeloma.

Table 3.

Multiple Myeloma related Quality of Life (QLQ-MY20) according to General Characteristics of Participants (N=189)

Characteristics	Categories	Future perspective		Body image		Disease symptom		Side effect of treatment
Characteristics	Categories	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (year)	≤49	52.08±28.89	0.85	58.33±33.33^ab ^a	2.87	24.30±20.67	0.39	31.04±14.59	5.22 ^†
	50~59	59.36±26.83	(.496)	52.23±33.44^a ^ab	(.037)	21.14±21.41	(.754)	26.97±19.93	(.156)^†
	60~69	62.77±24.03		62.33±27.75^ab	a＜b	19.11±18.37		23.89±15.15
	≥70	61.68±23.11		71.26±60.50^b		18.96±18.27		20.00±11.81
Gender	Male	66.00±24.58	3.28	66.99±28.08	3.46	14.13±14.56	4.73	19.81±13.72	4.75
Gender	Female	54.16±24.80	(.001)	51.51±32.71	(.001)	27.27±22.18	(.001)	30.94±17.89	(.001)
Education completed	Elementary school	55.15±24.65	0.85	57.14±29.89	0.81	25.39±17.98	7.43 ^†	27.14±14.53	1.00
	Middle school	62.84±25.49	(.466)	54.16±33.60	(.486)	19.44±22.04	(.059)^†	25.31±18.01	(.393)
	High school	58.62±22.96		59.19±29.97		23.27±22.03		26.96±16.37
	≥College	63.06±27.33		63.84±31.74		16.11±16.10		22.39±17.13
Marital status	Married	60.60±25.55	0.22	59.84±31.53	0.09	20.35±19.83	0.27	24.64±16.87	1.06
Marital status	Single	58.97±22.85	(.823)	58.97±27.73	(.923)	18.80±16.43	(.783)	29.74±13.90	(.289)
Religion	Yes	59.85±24.84	0.45	58.30±30.60	1.88	20.35±19.66	0.09	26.33±17.34	1.43
Religion	No	61.58±26.25	(.650)	60.71±31.58	(.052)	20.07±19.59	(.926)	22.72±15.40	(.153)
Monthly household income (10,000 won)	≤100	60.51±23.39	0.28	56.54±28.36	1.74	22.51±19.11	5.93	24.28±16.27	0.87
	101~200	59.64±26.77	(.887)	54.38±30.43	(.142)	22.66±21.15	(.204)^†	28.07±17.06	(.479)
	201~300	63.15±22.53		67.54±30.49		13.74±14.19		24.49±15.22
	301~400	62.31±24.55		69.56±34.68		23.18±24.42		20.28±17.60
	≥401	57.18±30.72		55.88±33.55		19.11±20.66		26.47±18.03
Payer of Treatment fee	Patient	67.31±25.79^a	6.05	63.43±31.48^a	2.89	16.72±19.12	2.74	20.97±15.59^a	5.78
	Spouse	52.41±21.72^ab ^ab	(.001)	53.45±27.95^ab ^a	(.037)	23.79±19.00	(.045)	30.52±16.54^ab ^a	(.001)
	Offspring	53.49±23.27^ab	b＜a	64.19±31.92^a	b＜a	24.48±19.68		26.41±14.64^a	a＜b
	Sibling	46.29±25.74^b		33.33±36.51^b		30.55±24.02		38.88±25.87^b
Job	Yes	63.98±28.93	1.16	63.79±30.12	1.17	13.02±14.47	3.97	21.20±14.55	2.09
Job	No	58.94±23.50	(.247)	58.01±31.64	(.242)	23.45±20.72	(.001)	26.67±17.35	(.038)
Renal failure	Yes	52.77±29.63	1.09	55.55±41.03	0.48	19.90±21.38	0.06	25.55±15.52	0.12
Renal failure	No	61.01±25.01	(.277)	60.07±30.57	(.629)	20.27±19.52	(.950)	24.95±16.82	(.905)
Anemia	Yes	57.20±23.05	0.72	61.72±35.45	0.34	21.39±22.89	0.32	30.86±17.50	1.98
Anemia	No	61.04±25.71	(.467)	59.46±30.57	(.728)	20.06±19.05	(.744)	24.01±16.41	(.048)
Bone destruction	Yes	62.18±25.08	0.64	60.21±31.26	0.13	22.84±19.37	1.27	24.26±15.70	0.42
Bone destruction	No	59.66±25.49	(.522)	59.58±31.32	(.896)	18.98±19.64	(.204)	25.35±17.21	(.674)
HSCT	Yes	60.57±26.72	0.05	58.11±32.96	0.90	20.94±20.86	0.61	26.13±16.75	1.14
HSCT	No	60.38±23.25	(.960)	62.28±28.46	(.370)	19.22±17.60	(.542)	23.30±16.59	(.254)
Ongoing treatment	Yes	56.54±24.28	2.06	57.03±30.08	1.15	22.28±19.32	1.36	29.89±15.74	3.99
Ongoing treatment	No	64.08±25.83	(.041)	62.28±32.17	(.249)	18.40±19.74	(.175)	20.53±16.36	(.001)
Months since diagnosis made	≤12	55.55±23.61	2.67	58.18±31.56	0.39	21.31±17.46	0.92	27.34±19.00	4.75
	13~24	68.75±22.65	(.050)	63.88±29.84	(.758)	17.59±16.85	(.428)	20.41±13.00	(.191)^†
	25~36	61.77±27.04		60.02±36.00		16.88±19.14		22.80±14.22
	≥37	57.92±26.99		57.92±30.36		22.76±23.25		27.37±17.49
ECOG PS	0	65.07±28.39^a	4.22	71.42±26.42^a	2.85	10.58±14.58^a	^a 9.59	17.46±19.23^a	3.48
	1	63.10±24.81^a	(.006)	60.94±30.73^ab	(.039)	18.86±17.81^a	^ab (.001)	24.80±15.91^a	(.017)
	2	49.04±19.58^ab	b＜a	49.42±31.64^ab	b＜a	27.77±20.99^b	^bc a＜c	28.62±15.34^ab	a＜b
	3	37.77±32.01^b		40.00±43.46^b		54.44±30.02^c	^c	40.66±22.28^b
Peripheral neuropathy	Grade I	64.31±24.82^a	2.76	64.74±33.27	8.34	13.78±15.26^a	^a 13.40	19.61±16.88^a	5.35
	Grade II	61.62±22.01^a ^a	(.043)	63.55±25.80	(.039)^†	19.70±18.52^b ^c	^b ^c (.004)^† ^‡	24.33±15.94^ab ^b	(.001)
	Grade III	59.33±28.80^a	b＜a	54.66±32.82		23.44±19.31^c	^c a＜c, d^‡	28.46±15.78^b	a＜c
	Grade IV	41.66±26.00^b		36.11±36.22		38.42±30.00^d	^d	38.05±15.66^c

HSCT=hematopoietic stem cell transplantation, ECOG PS=Eastern Cooperative Oncology Group performance score, QLQ-MY=Quality of Life Questionnaire-Multiple Myeloma;

^† Kruskal-Wallis test,

^‡ Mann-Whitney test.

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