"A lot to manage and still have some kind of a life": How multiple myeloma impacts the function and quality-of-life of Black-White patient-caregiver dyads

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 71; no. 10; pp. 3208 - 3220
• Main Authors: Bates-Fraser, Lauren C, Mills, Jiona, Mihas, Paul, Wildes, Tanya M, Kent, Erin E, Erisnor, Gabriell, Adams, Leah, Grant, Shakira J
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.10.2023
• Subjects: Adaptability; Black or African American; Caregivers; Caregivers - psychology; Comorbidity; Diagnosis; Elder care; Humans; Multiple myeloma; Multiple Myeloma - therapy; Older people; Patients; Quality of Life; Social factors; Social interactions; White; multiple myeloma; health-related quality of life; physical function; social-emotional health; caregiver
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.18482

Multiple myeloma (MM) is an incurable debilitating blood cancer associated with the lowest health related quality of life (HRQoL) of all cancers. With nearly 88% of adults aged ≥55 years at diagnosis, age-associated physical losses, comorbidities, and social factors contribute to worsening HRQoL. This qualitative study assessed dyadic (patient-informal caregiver) perspectives on the factors contributing to HRQoL in MM survivors. We recruited 21 dyads from the UNC-Chapel Hill Lineberger Comprehensive Cancer between 11/2021 and 04/2022. Participants completed a single dyadic semistructured interview capturing broad perspectives on MM. We used ATLAS. ti v 9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk, Inc.). This iterative approach allowed the exploration and identification of themes within and across transcripts. The mean age at enrollment was 71 years (median: 71, range: 57-90) for patients and 68 years (median 67, range: 37-88) for caregivers. All dyads were racially concordant (11 Black/AA and 10 White). However, we aggregated the findings due to no consistent racial differences. Six themes related to (1) physical burden, (2) treatment challenges, (3) losses of independence, (4) caregiver burden, (5) patient and caregiver perseverance, and (6) adjustment to a new normal were identified. Dyads also experienced MM together, resulting in patients and caregivers experiencing changes in their ability to engage in physical and social activities, which further contributed to poor HRQoL. Patients' increased need for social support led to shifts in the caregiver roles, resulting in caregivers feeling burdened by their responsibilities. All dyads acknowledged the need for perseverance and adaptability to a new normal with MM. The functional, psychosocial, and HRQoL of older patients with MM and their caregivers remain impacted ≥6 months after a new diagnosis highlighting clinical and research opportunities to focus on preserving or improving the health of dyads living with MM.