Tablet-Based Assessment of Fatigue, Depression, and Pain In Myeloma Patients: Cohort Study of Inflammatory Cytokines and QOL Measures In the Newly Diagnosed, Patients on Lenalidomide, and Survivors.

Multiple myeloma (MM) is an incurable clonal plasma cell cancer characterized by a microenvironment of inflammatory cytokines, specifically IL-6, VEGF, TNF-α, and marrow stromal cells that all support the growth of myeloma cells. Given the connection between depression with pro-inflammatory cytokines (Kiecolt-Glaser, et al. 2003) and a postulated connection with cancer relapse (Marx 2004), we hypothesized that these inflammatory cytokines not only promote disease progression, but also are associated with the patient's quality of life (Maes, et al. 1997) and that traditional definitions of high-risk disease will correlate with measures of depression and fatigue via circulating inflammatory cytokines. In fact, fatigue and depression might influence disease progression rather than being an obvious consequence.

For this pilot cohort study, we developed web-based versions of the Brief Fatigue Inventory (BFI), Brief Pain Inventory short form (BPI-SF), Functional Assessment of Cancer Therapy – General (FACT-G), and Center for Epidemiologic Studies Depression Scale-short form (CES-D) and administered the survey by tablet computer connected to our Wi-Fi in the myeloma clinic. This was a cohort study of five different patient groups – untreated patients, patients receiving lenalidomide-based therapy, patients 0–2 months post-treatment, patients 6–12 months after completion of treatment, and patients without treatment for more than 12 months. The first 10 patients were filled out feasibility questionnaires to provide data on patients' experience using a tablet computer. Plasma during the visit was cryopreserved and evaluated by RayBioTech's Quantibody Human Inflammation Array platform, a multiplexed sandwich ELISA-based technique of 40 different inflammatory cytokines.

We recruited 65 consecutive myeloma patients with complete quality of life data available in 42 patients. The majority of patients found the tablet-based method easy to use and understand, but more than a third did not find the experience enjoyable. On all scales, there was a non-significant worsening in fatigue, pain, and depression with decreased functional well-being in patients from diagnosis through initial treatment compared to patients >6 months from the most recent treatment. The FACT-G functional well-being yielded a mean summed score of 18.2+/−6 in this group compared to 21+/−6 in 652 lymphoma patients that were >2 years from diagnosis (Crespi CM et al, 2010). The brief fatigue inventory global fatigue score was 2.8+/−2.4. The brief pain inventory short-form mean severity score (the mean of the “worst,” “least,” “average,” and pain “now”) was 2.34. And the weighted sum from the CES-D was 7.19+/− 5.1, similar to breast cancer at least one year from diagnosis (van Wilgen et al, 2006). Quantitative data of the tested inflammatory cytokines will be presented.

There have been few efforts to explore the neuropsychoimmunologic axis in myeloma patients. Information generated from this work will allow us to further explore the connection between quality of life measures, myeloma cytogenetics, and circulating inflammatory cytokines, and ultimately devise interventions to improve quality of life of myeloma patients.

No relevant conflicts of interest to declare.