title: Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis.
abstract: Presenting symptoms of multiple myeloma (MM) are vague and nonspecific. Early detection poses a diagnostic challenge in primary care. We assessed whether clinical and laboratory data could provide early clues to MM diagnosis and whether time to detection affects survival.
  
  
  
  A retrospective population-based study, including 110 men and women diagnosed with MM between 2002 and 2011, and matched cancer-free controls presenting with back pain. Clinical and laboratory data were extracted from medical records for the 2-year period prior to diagnosis of MM/back pain complaint.
  
  
  
  During the two years prior to diagnosis 64 (58%) of MM patients complained of back pain, and 37 (34%) suffered from fatigue or weight loss. Case-control comparisons did not reveal any significant differences in the number of pain complaints or infections in the two-year prediagnostic period. However, fatigue or weight loss, anemia, elevated ESR and creatinine (p < 0.001 for all) occurred more frequently in MM patients than controls and were confirmed as independent predictors in multivariated analysis. TTD did not impact stage at diagnosis, survival, or mortality.
  
  
  
  Back pain accompanied by fatigue, weight loss or abnormal lab results should raise a "red flag" warning of MM. Nonetheless, we did not find evidence that TTD influences the initial stage or the prognosis of MM.
authors.affiliation: From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
authors.forename: Neta
authors.initials: N
authors.lastname: Goldschmidt
authors.affiliation: From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
authors.forename: Leora
authors.initials: L
authors.lastname: Zamir
authors.affiliation: From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
authors.forename: Alina
authors.initials: A
authors.lastname: Poperno
authors.affiliation: From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Kahan
authors.affiliation: From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D001416:Back Pain / Q000175:diagnosis* / Q000209:etiology; D001799:Blood Sedimentation; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D009367:Neoplasm Staging; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D015431:Weight Loss
chemical_list: D003404:Creatinine
keywords: Anemia; Back Pain; Creatinine; Early Detection of Cancer; Electronic Health Records; Health Maintenance Organizations; Multiple Myeloma; Primary Health Care; Prognosis; Retrospective Studies; Weight Loss