ELHT Evidence Hub
  • Home
  • Meet the Team
  • Library Facilities
  • Library News
  • FAQS
  • Evidence Search Request
Picture

An in Depth Analysis of Factors Contributing to Diagnostic Delay in Myeloma: A Retrospective UK Study of Patients Journey from Primary Care to Specialist Secondary Care

5/11/2021

0 Comments

 
Author(s) Hossain M.I.; Sen R.; Adiyodi J.; Hampson P.; Nowell C.; Khan S.; Sundararaman S.; Basu S.
Institution(s) (Hossain, Sen, Adiyodi) East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
(Hampson, Nowell) The Binding Site, Birmingham, United Kingdom
(Khan) Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
(Sundararaman) West Midlands University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
(Basu) The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
Source Blood; Nov 2021; vol. 138 ; p. 3007
Language English
Database EMBASE
AbstractIntroduction Patients with Multiple Myeloma (MM) often have a significant delay between onset of symptoms and diagnosis of disease. As a result, a significant number of patients present via emergency routes with severe co-morbidities which affect survival rates. Timely diagnosis relies on the early recognition of symptoms and blood test results which may indicate disease. Methods We examined the medical records of 142 newly diagnosed MM patients (121 intact immunoglobulin and 21 light chains) across 2 UK Hospitals. Patients included had not previously been diagnosed with a plasma cell dyscrasia, including Monoclonal Gammopathy of Undetermined Significance (MGUS). Clinical symptoms and blood test results were examined from the time of initial presentation to the healthcare system with symptoms indicative of MM, to the point of diagnosis in order to highlight patterns of symptoms and blood tests results which may give an early indication of disease. Blood tests results recorded included globulin, calcium, creatinine, erythroid sedimentation rate and haemoglobin. Time to diagnosis from presentation with symptoms indicative of MM was also measured as well as the patient pathway from the point of presentation to the point of diagnosis. Results The median time to diagnosis from initial presentation was 77 days (range 0 - 12,986). Initial presentation was most commonly via primary care (58.1%). Urgent secondary care presentation was documented in 28.5% which included acute medical unit (15.6%), the emergency department (7.1%), and other secondary care specialities (5.7%) respectively. Multiple GP visits were common prior to haematology referral with a median of 3 visits (range 1 - 40). Initial presenting symptoms varied, but of those with data recorded (n=107) back/bone pain was the most common (58.2%) followed by anaemia (18.7%), fracture (7.5%), recurrent infection (7.5%) and renal impairment (3.7%) respectively. Interestingly, analysis of evaluable blood test results revealed a raised globulin was most often evident prior to diagnosis with 58% of patients recording an abnormal globulin a median of 140 days (range 3 - 4297) prior to diagnosis of disease. Conclusions Multiple GP visits prior to establishing a diagnosis of myeloma is very common. Inclusion of abnormal globulin to reflex electrophoresis request and serum free light chain assay may serve as a useful trigger for investigation when interpreted alongside presenting symptoms and other blood test results. Increased awareness of myeloma warning signs in primary care may reduce diagnostic delay and avoid presentation with severe co-morbidities in emergency settings. Disclosures: No relevant conflicts of interest to declare.Copyright © 2021 American Society of Hematology


  • Request full text article from the library
0 Comments



Leave a Reply.

    The following databases were searched:
    EMBASE,  MEDLINE, PsycINFO, BNI, CINAHL, 
    to find  ELHT staff publications

    Specialties

    All
    ANAESTHETICS
    CAMHS
    CARDIOLOGY
    COVID 19
    DEMENTIA
    DERMATOLOGY
    DIABETES
    DIETETICS
    EMERGENCY CARE
    ENDOCRINOLOGY
    EVIDENCE BASED MEDICINE
    GASTROENTEROLOGY
    GYNAECOLOGY
    HAEMATOLOGY
    MATERNITY
    MAXILLOFACIAL
    NEONATOLOGY
    NEUROLOGY
    NURSING
    OBSTETRICS
    ONCOLOGY
    ORTHOPAEDICS
    PAEDIATRICS
    PHARMACY
    PHYSIOTHERAPY
    RADIOLOGY
    RESPIRATORY
    RHEUMATOLOGY
    STROKE
    SURGERY
    UROLOGY
    VASCULAR SURGERY

    RSS Feed

    Archives

    August 2022
    July 2022
    May 2022
    April 2022
    March 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    December 2020
    November 2020
    October 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019

Learning Centre Library
Royal Blackburn Teaching Hospital
01254 734312 or Ext 84312
library.blackburn@elht.nhs.uk
​Find us
​​Mackenzie Library
Burnley General Teaching Hospital
01282 803114 or Ext. 13114
library.burnley@elht.nhs.uk

Find us
​Staffed Opening Hours
Mon     08:30-16:30
Tue      08:30-16:30
Wed     08:30-16:30
Thu      08:30-16:30
Fri        08:30-16:00
24/7 access to both libraries is available - please see library staff
View our Quality Standards and Performance
Picture
Picture
  • Home
  • Meet the Team
  • Library Facilities
  • Library News
  • FAQS
  • Evidence Search Request