Patient Preferences on Clinical Decision Making in Multiple Myeloma.

Purpose: To better understand the priorities that guide patients with multiple myeloma, we surveyed patients on four different treatment scenarios, each of treatment strategies shown to improve progression-free survival (PFS) but offering similar overall survival (OS) outcomes.

Methods: We conducted a survey using the HealthTree Cure Hub by the HealthTree Foundation, the largest online portal for people with plasma cell dyscrasias.

Results: The primary analysis cohort included 466 participants with myeloma, while an additional 297 responses from patients with smoldering myeloma or monoclonal gammopathy of uncertain significance were analyzed separately. When presented with either three-drug or four-drug frontline treatment for their myeloma, where four drugs offered better PFS, similar OS, and slightly increased toxicity, 56% of participants chose four drugs. For one-off consolidation treatment after induction, analogous to autologous transplant, which improved PFS but not OS, 50% of participants chose the consolidation. For maintenance therapy, where maintenance with two drugs offered better PFS, but similar OS and increased toxicity than one drug, 17% of participants chose two-drug maintenance. When evaluating a scenario for multiply relapsed disease, where a treatment improved PFS with increased toxicity, and no impact on OS, 7% of participants elected to receive this treatment.

Conclusion: Our findings show that many patients choose not to receive treatments that improve PFS if they do not positively affect OS and lead to substantial clinical, financial, and/or time toxicities.