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Misdiagnosis in Myeloma
Misdiagnosis in myeloma is common. I’ve read dozens of stories from newly diagnosed MM patients recounting months of doctor’s appointments that led to misdiagnosis after misdiagnosis.
The challenge, according to the study below, is “nonspecific symptoms” or NSS. While the study discussed is about cancer in general, it might as well be about MM- fatigue, night sweats, and unintentional weight loss are three of the most common NSS of people who may have pre-MM and go to their primary care physician for help.
On top of NSS is the fact that many newly diagnosed MM patients have co-morbidities. The average age of a NDMM patient is 70 years of age.
What are the signs and symptoms of multiple #myeloma?
The solution? According to the research below, a “ CT-guided early diagnosis pathway for NSS is effective in detecting important pathology in a high proportion of patients.”
Which is how my own non-specific symptoms (bone pain) led to a diagnosis of a single bone plasmacytoma in my neck. Okay, it was an X-ray, not a CT scan, but you get the idea.
The single most important MM statistic that I learned years ago is that 96% of all newly diagnosed MM patients are relatively advanced at stage 2 or 3, depending on the staging system used. I think NSS has a lot to do with this statistic.
Are you a newly diagnosed MM patient? Do you have a “misdiagnosis in myeloma” story? Scroll down the page and let me know.
Thanks,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
How to Identify Cancer in Patients With Nonspecific Symptoms
Primary care physicians (PCPs) are the first point of contact for patients and continue to play a key role in assessing signs and symptoms and directing patients to further tests when a serious illness, such as cancer, is suspected. Today, PCPs manage an increasingly broad range of complex and severe conditions across one or more relatively brief encounters. It is not surprising, then, that the primary care setting is vulnerable to diagnostic errors — missed, delayed, or incorrect diagnoses. Despite significant advances in diagnosis and treatment, cancer remains among the most frequently missed diagnoses.
The importance of timely, early cancer diagnosis is well established in medical science, but it is often complicated by the wide range of symptoms cancer can present. These range from specific manifestations, such as postmenopausal vaginal bleeding or new-onset seizures in people without a history of epilepsy, to nonspecific symptoms (NSS), such as fatigue, unintentional weight loss, and loss of appetite.
Role of NSS in Diagnosis
Identifying cancer in patients who report NSS is particularly difficult for PCPs, even though these symptoms are present in 22% of cancer cases. NSS are frequently associated with a variety of noncancer conditions, especially in patients with comorbidities such as heart failure, chronic obstructive pulmonary disease, or depression, which share symptoms such as loss of appetite and fatigue.
In primary care, some NSS are very common; for example, fatigue is reported in 1 in 4 patients. The overlap of NSS can delay cancer diagnosis, resulting in a more advanced stage at diagnosis, worse clinical outcomes, and reduced quality of life.
Attributing NSS to Cancer
A scoping review explored what is known about how PCPs attribute NSS to a potential malignancy and sought to identify gaps in the literature. In the absence of a consensus classification of NSS in cancer, the researchers used the list of cancer‑associated NSS provided by the National Institute for Health and Care Excellence (NICE), the UK’s health guidance body. The “NICE list” includes fatigue, unexplained weight loss, loss of appetite, early satiety, deep vein thrombosis, pallor, new‑onset diabetes, night sweats, unexplained fever, persistent or recurrent unexplained infections, and itching…
NSS and Associated Factors
Some NSS on the UK’s NICE list are uncommon features of cancer— for example, night sweats have a maximum reported prevalence of 6% in patients with Hodgkin lymphoma, and new-onset diabetes is found in only 1% of pancreatic cancer cases. Because of their low prevalence, these symptoms may be underrecognized by PCPs as potential signs of cancer.
Weight loss was the most frequently cited NSS, followed by fatigue. Recurrent infections and pallor were mentioned in only two studies, and no studies were identified that discussed factors influencing the attribution of new-onset diabetes, itching, night sweats, loss of appetite, early satiety, or unexplained fever to a potential cancer.
Deep vein thrombosis, especially when of unclear origin, quickly raised concern about a potential cancer, even when it occurred in isolation…
Outcomes of Screening Patients With NSS
Literature published over the past 20 years confirms that diagnosing cancer in patients with NSS is challenging and often involves multiple referrals, a lengthy diagnostic pathway, and worse outcomes. NSS are common in numerous benign and serious conditions, and patients may undergo multiple tests and specialty visits before diagnosis. In addition, intervals between the first PCP visit and the specialist assessment for suspected cancer tend to be longer than for patients with alarm symptoms, and patients with NSS are more likely to be diagnosed in the emergency department or at an advanced stage…
These results indicate that a CT-guided early diagnosis pathway for NSS is effective in detecting important pathology in a high proportion of patients, but most tumors were treated at an advanced stage, with no evidence over time of a reduction in late-stage cancer diagnoses.
This story was translated from Univadis Italy, part of the Medscape Professional Network.
Misdiagnosis in myeloma Misdiagnosis in myeloma