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Why do people die from Multiple Myeloma?  Lack Of Awareness??  It Is Complicated!!

10/6/2014

39 Comments

 
PictureThe Creativity of the Myeloma Specialist SAVES LIFE!
I first wrote on this subject in 2012, and I thought it time for an update.  I still feel that many people die sooner than they need to, and still do not understand why there is such a difference between what is and what could be.  The what could be is that many centers have patients who live for an average of 10 years or more, and the average life expectancy  for all multiple myeloma patients is just  4 years based on the most recent National Cancer Institute survival data.  So why the big gap between the two?  Some of the reasons are the following:

1) The miserable Lack of Awareness of Mulitple Myeloma, the symptoms,and the complexity is just sad, and contributes to delayed and incorrect diagnosis.


The NHS or National Heath Service in the United Kingdom has some of the best historic data that exists for Multiple Myeloma.  They did some research and found that only 3% of the general population has ever heard of Multiple Myeloma, and if you talk to most myeloma patients they will tell you the first time they heard of it was at diagnosis.  You have heard of leukemia and lymphoma, which are blood cancers, but not Multiple Myeloma?  This lack of awareness translates into what I call the Multiple Myeloma Catch 22 (A can't win situation).   With multiple myeloma the time from first symptoms to diagnosis for 25% of patients takes over 306 days to diagnose. The average life expectancy for myeloma patients if not treated  is 279 days.  Because of this lack of awareness by the general public and the general practitioners, this group of 25 percent of patients are "Dead at Diagnosis".  


If you find yourself in this group of patients, do not delay, and get to a skilled multiple myeloma professional immediately.  You have no time to leave your care in the hands of a local oncologist. You need expert care immediately.


Awareness is so important, we now have a number of initiatives in place to try to get awareness up from the miserable 3% of the population to 90% or more.  This is a huge mountain to climb, but we have Mambo For Myeloma and Songs For Life awareness programs started by myeloma patient advocates.  Please participate in these programs so that we might raise awareness, save life, and raise funds for a cure. 


2) Quality of Care is of Utmost Importance, including Supportive Care

Some early death is understandable. I have seen patients who have been given Decadron as their only care, and I know this is such a substandard treatment.  Then there is the patient who chooses to only do holistic treatment,  or the patient who chooses no treatment, because his faith will heal him.   This was their choice, and I can understand it, but I certainly do not agree with these choices, and unfortunately the outcomes were inevitable.   And one reader commented that it is caused by the lack of health insurance, and I agree that this has an impact.  However, many myeloma patients have access to Medicare, and only 16.3% of the US population does not have health insurance. The differences in the death rate are not 15 or 20%, but 200 to 1000%.   So these cases I believe are not the norm, and account for only a small amount of the difference.  I can only therefore submit to you that this difference must be in the quality of care.

There are a number of people who somehow seem to beat the odds.  Mike Katz, from the IMF(International Myeloma Foundation) is a 20-plus year survivor.  Does the fact that he is aware of all the latest and greatest myeloma discoveries weigh at all in his longevity?  Pretty darn good move Mike!  Or Barb Hammack (who is no longer with us) but survived for 20-plus years and was a member of a myeloma patient to patient forum. Her doctor happens to have gone to school with Dr. Berenson, and Dr. Berenson, a myeloma specialist from LA, has some of the best survival statistics in the world.  Are you starting to get the connection?    

The point here is that there is a big difference between the skills of a myeloma specialist, and that of your local oncologist.  Andrew Shorr of Patient Power had an interview with a Dr. Bensinger( a multiple myeloma specialist) and asked the question about whether patients should seek a second opinion.  His reply "I do think it's very important that patients with newly diagnosed myeloma consider a second opinion. And the reason is that this is not that common a disease. Despite the increased awareness of the disease in the community and among physicians, this is still a relatively rare disease. There's only about 17,000 new cases in the US. It's only one percent of all cancers and only ten percent of all blood cancers. And so it's a relatively uncommon disease, and I think there's so much new information out there that even practicing oncologists can't always keep up with the new information.  In addition, they should be made aware or least the patient should be made aware of possible trials that are available to them. That's how we've made all the progress in the treatment of this disease, is through clinical trials."  So if this belief exists in the Multiple Myeloma specialist community, then why is there still such a disparity in outcomes?  Sorry folks, I can only speculate. Much of this difference must be because of the leading edge knowledge of the myeloma specialists at these exceptional facilitates, and their focus on supportive care.  They have a great offense(specialists) and defense(supportive care).    

Part of it may be that the disease is just so rare that the dissemination of this information would never reach the light of day if not for organizations like the IMF(International Myeloma Foundation).  How many people know that March is Multiple Myeloma awareness month?  The IMF has been at the forefront of this education process, but unfortunately the National Cancer Institute life expectancy numbers continue to lag those at the best institutions.  So if this life saving information is not reaching the myeloma patient community, how can we improve the awareness? 

In this day of the internet, Facebook and Twitter,  I therefore recommend that each of you send this post to  your Facebook friends and Twitter followers, just to let them know about Multiple Myeloma  and ask them to participate in the Myeloma Awareness Programs (Mambo for Myeloma and Songs For Life).  I will almost guarantee that one of the people you send this to will know someone with a myeloma patient in their circle of contacts who could benefit from this information. Because I have found that "Knowledge is power" and "Ignorance can kill!"  

You will find more information on multiple myeloma if you go to the web site www.myelomasurvival.com or follow me on twitter @grpetersen1.  God bless all who have to be on this journey/ [email protected]
39 Comments
lisa kelly
10/9/2014 06:07:46 am

Very interesting

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Dianna Chiles
10/9/2014 09:16:02 am

Well done article Gary. Question, where does the money raised with "mambo" go? You might add that to the FB post.

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Gary Petersen link
10/9/2014 11:00:49 pm

Thank You Dianna, If you click on the words Mambo for Myeloma in this post it will link to a post that explains that you can choose your between the IMF, MMRF, CrowdCare Foundation, or MMORE Foundaton.

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Vicki K
10/10/2014 01:02:57 am

Excellent article - thank you for the well-written and concise explanation.

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Larry P
10/10/2014 01:12:13 am

And then one has to take into consideration the different (types) of MM.
For example, the IgA Kappa type is said to be the most aggressive, and the treatment selected and expected survival might vary greatly due to the type you are diagnosed with.

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Gary Petersen link
10/10/2014 01:52:02 am

Thank you Vicki, I am glad you found it of value. Larry you are so right about high and low risk, old vs. young patients, renal failure, IgA Kappa, etc. I assume the average National Cancer Institute data has a similar % of high and low risk, etc, as the listing of myeloma specialists would have. It is my hope that "the law of averages" and "the law of large numbers" will make the comparison truly comparable.

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Keith
10/10/2014 08:42:59 pm

You're right. The 1st time I had heard of multiple myeloma was when I was diagnosed..... I was multiple who? Had an autonomous stem cell transplant at UNC
in 2010. Was in full remission until early this year. Been on revlimed, dext and a clinical trial drug at UNC and have just received a full remission status in 8 months. Take advantage of clinical trials as well if you can. .great article

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Gary Petersen link
10/12/2014 12:59:05 am

Keith, congratulations on your second CR. Going to a clinic with myeloma clinical trials is so important. Once you run out of the standard treatments, it is the clinical trial that will keep you one step ahead of the reaper. We just need to get this awareness message out so more patients have a better chance at more life.

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Jenny Hack
10/11/2014 10:14:50 am

Gary,
Very informative.Patients must take an active roll to fight this disease. In certain cases, some have know idea of their numbers, light chain etc.They do not even confer with a MM specialist. The way I can fight this disease is expanding my knowledge of the latest advances etc. This is why your articles are so important. They are easily understood and hopefully will help educate .

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Gary Petersen link
10/12/2014 01:05:42 am

Thank you Jenny for your kind comments, and I hope I am able to help educate the myeloma patient community. Like you say, being your own best advocate is so so important, and a support group is one way to help obtain this type of information. But nothing is more important than patient self advocacy.

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Wendy Thomas
10/11/2014 10:48:54 pm

I'm an onc nurse and years ago I worked as a second opinion nurse. I received a call from a small town family doc. One of his patients had ended up in the ED with chest pain while out of town. The doc was contacted by the ED doc because a chest X-Ray showed lytic lesions. The doc was certain his patient had some sort of cancer and by the time the patient got home and saw him, wanted to be able to have a thoughtful plan. This doctor remains my all time favorite doctor, and I never even met him. I said I suspected MM told him what labs to draw. We ended transplanting the patient for his MM. One of my best days as a nurse. Daily I see poor quality care by well meaning general oncologists who struggle to keep up with an overwhelming amount of onc infor. Getting education to the world is the answer. Look for what it has done for diseases like AIDS and breast ca.

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Gary Petersen link
10/12/2014 01:14:59 am

Wendy, my general practitioner Dr. Fong is also my hero. He was relentless in finding out why my kidneys had failed, and found it as MM in just 1 week. The GP can be our salvation, and I wrote an article on this that all GP's should read.

http://www.myelomasurvival.com/1/post/2014/04/multiple-myeloma-who-may-just-save-your-life-it-is-your-family-doctor.html

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PPI Claim Companies link
10/12/2014 08:35:09 pm

The bad thing is that 20% or more of patients died in the first year from a delayed diagnosis.

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Gary Petersern link
10/13/2014 02:53:54 am

Yes I agree, however the UK has published that 20% die within the first two months of diagnosis. Seems like your company should be making a lot of claims for those 20% of patients. Maybe you can raise awareness because we have had little impact.

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Lance Bachmann link
11/11/2014 03:42:42 pm

I was very pleased to find this site.I wanted to thank you for this great read!

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Jill Platt link
11/16/2014 06:15:48 pm

Diagnosed Nov 2013. Still on velcade and dex. Have been suffering bad diarrhoea for some months. Any ideas

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Gary Petersen link
11/17/2014 01:53:42 am

You may want to sign up to Smart Patients and ask this question. You will find a number of myeloma patients who have taken Rd and had the same problem. You can sign up at the link: https://www.smartpatients.com/

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Jill platt
3/17/2015 09:53:26 pm

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Tim
5/30/2015 04:03:01 pm

I have been diagnosed with t(4;14) MM. I am 41 yrs old and no doc I have seen has looked beyond 5 yrs. stating transplants, trials ect will buy me a year to two years each at best. I have been on my first clinical trial for three months and have achieved remission in blood and marrow, yet they still expect it to come back and kill me with in 5 years (statistics show).

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Gary Petersen link
6/2/2015 03:05:56 am

Tim, some locationns no longer think of the 4:14 translocation as high risk. Mayo Clinic considers it intermediate risk, see the link: http://nebula.wsimg.com/630f693ce6ec40594a3ed0e983a0ca7d?AccessKeyId=A0994494BBBCBE4A0363&disposition=0&alloworigin=1, and UAMS now considers it standard risk. A standard risk patient at UAMS has a 60% chance of cure, and an average life expectancy of over 15 years. The data from the UK shows paients under 49 years of age live twice as long as those at the average age of 69 years of age. You need the help of a myeloma specialist and a list can be found at the link: http://www.myelomasurvival.com/myeloma-specialists-listing.html With the right choices you just might be around to bounce your grandkids on your knee. Best Regards Gary

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Tim
6/2/2015 03:41:19 pm

Gary,
Thank you for the information, it meant a lot to both my wife and I. We have currently set appointments in AR and are calling MAYO this week. Its good to read something with hope as we have not had much these past few months. Today we did get the rest of my bone marrow results and after 3 months clinical trial I am in full remission including the FISH analysis. Now its on to staying there as long as I can.

Thanks again Gary
Tim

Lee
8/2/2015 11:56:43 am

Diagnosed last week. Lots to learn!

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frank beugelink
8/10/2015 03:48:35 am

I have read your article, were you recommend to use only experience doctors, who have at least 100 MM patient, the Dr. I have is fairly young and I doubt that she has had 100 MM patient.
She is a partner in the Palo Verde Cancer Specialist, organisation and was recommended by my Pain and PCP, I will ask the question, as how many MM patient she has or had in the present and past. If we don,t give the new Dr.s an change to specialize in becoming experienced in MM, what is going to happened to us in the future ??
I know I might taking certain risk, but I did and do visit for a check-up with a Specialist at the Mayo Clinic in Scottsdale, AZ. Do you recommend to visit this specialist every 6 or 12 months ??
Regards, Frank Beugelink

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Patricia
8/31/2015 12:38:56 pm

My mother was diagnosed 12 years ago. The doctors caught it in the very early stages, which is of utmost importance. A simple blood test is all it takes. She also has great doctors and she has a positive outlook. Also very important!

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gary arvary
1/22/2016 12:49:42 am

I was diagnosed 2010 and am beginning to see a resurgence of my IgA three years following my second transplant. have been on low dose Rev for 1.5 years then move to full dose rev/dex for 1.5 years. Still no M-spike. but am concerned about the next step. Am thinking adding Velcade to the regime but am concerned about my ability to work on VRD. Any one with similar experience?

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Ronald Hood
9/30/2016 12:18:45 am

Gary:

I've been on VRD since being diagnosed 5 months ago. Occasional constipation has been my only side effect.
Getting the Velcade shots in my stomach have helped prevent neuropothy, I'm told.
The VRD have caused my numbers to go in a positive direction. I take 25 mg of Revimid each day (21 days, then off 7 days) and 40 mg once per week of Dex.
I'm 74 and retired, but think I could work if I were younger or wanted to. My Oncologist says transplants should not be needed due to advancement in drug research.
Hope this helps. Best of luck.

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Michelle
7/15/2016 12:55:36 pm

I don't agree with most of the premise of this article. My partner was diagnosed with aggressive MM, immediately sought treatment at a top cancer hospital with a top MM specialist, and they still could not do anything to halt its progression. He died 9 short months later. It was not because of a lack of awareness or quality of care.

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Gary Petersen link
7/16/2016 06:47:32 am

Michelle, I am so sorry for your loss. You did all the right things, but for the 15% of patients who are high risk little is available to beat the the two year average life expectancy of high risk myeloma other than the allo transplant or clinical trials. However, when high risk myeloma has a breakthrough it will be the myeloma specialist who will be the first to use it. For the 85% of patients who are low risk, early diagnosls and a myeloma specialist is what will provide a life expectancy of 2 to 3 time the current average for all patients of 5 years. Myeloma Sucks! Gary Petersen

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Lenard cohen
8/8/2016 11:24:33 am

Why isnt there a worlwide data base for patients with mm. Giving age, other disease and treatment s.
Including trials and hospitals.
Len cohen

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Gary Petersen link
8/11/2016 04:02:35 pm

Lenard, HIPA rules have prevented this from happening unless the patient agrees to sharing data. As yet this has not occurred, that I know of unti the MMRF has started a program to do that. Now Celgenes and Taketa have added another 8000 patients to the data base. Would'nt it have been great if all 25,000 newly diagnosed each year would have been part of the study. The CURE is in the history, but like you no one has taped it as yet. OUTSTANDING question!

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Pam Phipps
9/23/2016 08:06:58 am

My husband was diagnosed with MM March 2016 he has 3 lesions, one in right sacrum one in the left sacrum and one in his sternum. His doctor has yet to tell us what stage it is in. When we asked he said it doesn't matter either you have it or you don't. He has had 22 radiation treatments and Wednesday he starts on Velcade and Remimid. I really wish I know what stage he is in. He is always very fatigued and always in pain.

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Gary Petersen link
9/25/2016 01:52:02 pm

Pam, I can see you were not satisfied with your husband's doctors response. I would not be either. Staging is important in that patients in stage 1 have a life expectancy twice a patient in stage 3. A more important measure is genetic testing to determine how aggressive the disease might be. FISH test and GEP test will provide that information. A great example of how this impacts care is outlined by Mayo Clinics mSmart treatment recommendations. You can see them at the link: https://www.msmart.org/
I have a lot of information at www.myelomasurvival.com and at the bottom of the home page is a number of excellent links. The statement "you either have it or you don't" would show me a true level of ignorance of the complexity of myeloma. You may want to find a myeloma specialist from the list at: http://www.myelomasurvival.com/myeloma-specialists-listing.html

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Debbie Cummings link
12/3/2016 06:26:41 am

Pam - Your husband was diagnosed in March of this year; I was diagnosied on April 29, 2016. I just got home yesterday from my 2nd stem cell transplant of my own cells. My doctotor is a Multitilple Myeloma specialist and has been for may years. My local oncologist said you have basically two years; we have some good chemo for thos two years to make like good. I looked at him and said that won't work for me. I came back the next week for my chemo and asked to have my primary chare changed over to Dr.
Guido Tricot at the Multiple Mylemoma Program at Holden Comprehensive Cancer Center - Iowa's Largest NCI Designated Comprehensive Cancer Center; Is known for it's tandem autoglous transplant treatemnet.

IN 7 months I am in remission. 89% of my blood cells were cancerous on 4/29/2016; today they are zero. I will be on chemo as a maintenance for the next two years. They have treated over 5,000 Multiple Myeloma patitients. The reason I chose them (besides being in my home state) is they believe in a vey aggressive fast approach to treatment; for a life in the future.

The last 7 months has not been a picknkik. I sometimes wondered if I would make it with a 2 week, 3 week and 5 week hospitail stay in Iowa City; this was a lot of time away from home and my loved ones. But, I think well work it. I am 58 years old and a grandmother of 5. I want to be around to play with them and the ones that aren't here yet. All the daily tials and tributes I posted to the posthope website below; hope this all helps you.

http://posthope.org/debcummings

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Gary Petersen link
12/3/2016 06:57:49 am

Debbie, your story is one that I have seen played out over and over again. A local oncologist is just not equipped to tackle this disease. You have chosen one of the very best myeloma doctors in the world in Dr. Tricot. He has had a average life expectancy 2 to 3 times longer than the national average. You are a prime example of someone becoming their own best advocate.

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Tracy
7/20/2020 09:39:22 am

My sister, 47 yo, was diagnosed with MM a few days ago and the news devastated my entire family. We are shattered but try to be strong to help her through this difficult time. We live in So Cal and believe we have great access to MM specialists. Appointments are being made to seek second and third opinion, with City of Hope and Dr. Berenson, do you think these institution/experts are good or should we try to go to Mayo Clinic?
She's young and has no symptoms. Her bone marrow biopsy is fine so I think she has a high chance to get treated. Waiting to get PET scan and staging.
Thank you so much and we need a lot of prayers.

CAREY kennard
8/29/2019 02:14:40 am

we are from South Africa, my hubby dx with non secretory Myeloma. He had a rod inserted in his left femur after a tumor removed. we do see a haemologist and hubby is on Velcade, Thailomide and dex with monthly infusions of Zometa. we still trying to understand what he actually has. his dr tells us there are no stages but says he is low risk. how can he be low risk if he is has to put all these drugs in him which make him feel terrible than before he was dx. We are from South African and see a Haemotologist, I would love for South Africa to be put on the puts for MM as there are so many patients here that have MM. USA seem to have the best specialists and long life expectancy for the patients. I just want the best for my hubby to try and give him a long life but i feel i hit a wall. can you advise me on this, also can you give advice on what types of foods are best

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Andie
10/13/2019 06:56:04 am

Research mainly benefits MM patients who are diagnosed in their younger years. Patients over 65 are most often not candidates for stem cell transplants. Of the people I have had encountered, those over 65 at diagnosis, they rarely survived over 2-3. It could be the delay in diagnosis or co-morbidities? I am not sure but we certainly do not seem to focus research on older patients.

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Dan
11/22/2019 04:35:12 am

I am 69 years old and was diagnosed in Dec 2018. I had 80% of bone marrow involvement, IGg kappa and plasma blastic. In Jan 2019 I did 3 months of RVD but could not tolerate the Revlimid and had serious side effects from Velcade. In June 2019 I did a stem cell transplant but it did not work as all numbers higher than before transplant . I am back on Velcade. I am not eligible for any of the trials according to my Doctors at Mayo's. I am concerned about my life expectancy as I have not been given much information. Any thoughts?

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Kristy
11/23/2019 11:58:48 am

My husband was disagnosed this past month (Oct 2019). He had two lesions. One in his left femur and one in his right pelvic/femur. They did a screw and glue in his right pelvic and inserted a rod in his left femur because they were worried they weren't strong enough to carry any of his weight and could fracture. My husband is 49 years old. Now that his surgeries are done, they are planning to do radiation in these areas, along with Chemo and after checmo, a stem cell transplant. Before they start radiation they want to remove healthy stem cells to freeze for his stem cell transplant. We are working with a Myeloma specialist at Froedtert Hospital in Milwaukue, WI. Besides these treatments, what can we expect once he has finished his treatments?

As his spouse, do they have support groups for family members. We have come to terms that this will be apart of our lives moving forward. I want to know what type of quality of life with my husband have or should expect to have?

From what we are understanding my husband is between a stage 0 and 1.

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    Gary R. Petersen
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