Landscape Assessment of the Perceptions of Distress and Symptom Burden in Patients with Monoclonal Gammopathy of Unknown Significance (MGUS) and Smoldering Multiple Myeloma (SMM)
Bibliographic record
Abstract
Background: Multiple myeloma (MM) is a fatal plasma cell malignancy that is proceeded by the asymptomatic precursor conditions of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). These conditions have been historically considered benign, and thus the standard clinical paradigm consists of watchful waiting until progression to clinically symptomatic MM - a paradigm that is anecdotally reported as a source of distress in this patient population. Despite well-documented evidence that patients with MM experience substantial emotional distress and symptom burden,(1) little is known about psychological distress and symptom burden in the setting of MGUS and SMM. Methods: We conducted a cross-sectional analysis of patients with MGUS and SMM participating in a longitudinal study of plasma cell precursor disease. Between February and May 2024, patients with MGUS and SMM were offered the opportunity to complete validated questionnaires to assess anxiety (Hospital Anxiety and Depression Scale (HADS)), depression (HADS), post-traumatic stress disorder (PTSD) (PTSD Checklist Civilian Version (PCL-C)), symptom burden (Edmonton Symptom Assessment System Revised (ESAS-r)) and fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)). We used histograms and Q-Q plots to check for normality and the Mann-Whitney U test to detect unadjusted associations between sociodemographic factors and each subscale. Quantile regression was used in adjusted models to estimate the median scores for each subscale conditional on age, sex, and income. Results: A total of 423 adults with MGUS (n=228) and SMM (n=195) completed the study questionnaires. The mean age was 64.9 years (range: 32 to 88 years), 40.7% were male, and nearly 90% were White, non-Hispanic. The prevalence of clinically significant anxiety, depression, PTSD symptoms, symptom burden, and fatigue was 27%, 13%, 24%, 29%, and 20% respectively. Mean subscale scores for aspects of psychological distress and symptom burden were not significantly different between MGUS and SMM patients. Overall, there were statistically significant differences between sociodemographic factors and the perceptions of psychological distress, symptom burden, and fatigue. In adjusted models, those with lower income had higher levels of depression (p<0.02), PTSD (p<0.05), symptom burden (p<0.02), and fatigue (p<0.02). Females had higher anxiety (p=0.01), and marginally higher symptom burden (p=0.05) compared to males. Older age was associated with lower anxiety (p<0.001), lower PTSD (p=0.03), lower symptom burden (p<0.001), and higher fatigue (p=0.02). Race, ethnicity, and education level were not associated with any subscale in adjusted models. Conclusions: Patients with MGUS and SMM experience substantial psychological distress prior to developing MM. Certain sociodemographic subgroups of patients had higher rates of psychological distress, symptom burden and fatigue for reasons that remain to be elucidated. It is essential that we develop a more comprehensive understanding of the supportive care needs of patients to improve their quality of life and care throughout their illness course. 1. O'Donnell EK, Shapiro YN, Yee AJ, Nadeem O, Hu BY, Laubach JP, et al. Quality of life, psychological distress, and prognostic perceptions in patients with multiple myeloma. Cancer. 2022;128(10):1996-2004.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".