title: Multiple myeloma: causes and consequences of delay in diagnosis.
abstract: BACKGROUND
  Myeloma is a serious and usually fatal haematological malignancy with reported mortality of 10-20% within the first 2 months of presentation. Symptoms are non-specific, and patients thus present to a range of medical practitioners.
  
  
  OBJECTIVE
  To analyse the causes and consequences of a delay in diagnosis of myeloma.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  The number and type of disease-related complications present at diagnosis of 92 patients with myeloma were categorized according to the medical practitioner to whom the patient initially presented, the time before diagnosis and the status of the patient at study end in 2006. Overall and disease-free survival were analysed.
  
  
  RESULTS
  Duration of symptoms >6 months prior to diagnosis was seen in 40% of the patients, of whom >50% had initially consulted a general practitioner. The most common presenting symptom (67%) was bone pain. The most common complications present at diagnosis were anaemia (54%), bone disease (45%) and renal failure (36%), with the highest frequency of complications in the group experiencing symptoms for >6 months. All patients in this group had two or more complications, while 40% in the group with symptoms for <3 months had no complications. A prolonged time to diagnosis had a significant effect on disease-free survival from both onset of first symptoms (p = 0.043) and from diagnosis (p = 0.003), but not on overall survival.
  
  
  CONCLUSIONS
  A prolonged delay before diagnosis is associated with a significant impact on the clinical course of multiple myeloma. There is a need to raise awareness of the presentation of this condition, especially among general practitioners.
authors.affiliation: Department of Academic Haematology, Royal Free Hospital and University College Medical School, London NW3 2QG, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Kariyawasan
authors.forename: D A
authors.initials: DA
authors.lastname: Hughes
authors.forename: M M
authors.initials: MM
authors.lastname: Jayatillake
authors.forename: A B
authors.initials: AB
authors.lastname: Mehta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors