Cognition in Multiple Myeloma Patients

Abstract

Background A major area of concern expressed by multiple myeloma patients is cognitive change after treatment. Cognition is a seldom-reported outcome of treatment for cancer survivors. As disease-free survival continues to improve in the multiple myeloma population, patients are faced with returning to their pre-diagnosis activities coupled with cognitive changes that alter their interactions with the world around them. Studies to date have been inconclusive of cognitive change over time in myeloma patients, largely due to study design that does not establish baseline cognition. Objectives We want to understand the trajectory of cognitive function over time in multiple myeloma patients compared to a control group, by acquiring true baseline cognitive data at diagnosis and following subjects over time. Secondarily, we want to determine if there is a correlative impact on quality of life. Methods We have enrolled 20 myeloma participants and 20 control participants, made up largely of caregivers. After informed consent, we perform cognitive testing using selected tests from the NIH Toolbox cognitive domain, administered on an iPad. These tests assess processing speed, working memory, attention, and executive function at four time points: at diagnosis, after initial treatment, four months later or 100 days post-autologous stem cell transplant, and nine months after that or one year post-autologous transplant. A quality of life questionnaire (FACT-MM) is also completed at the time of each testing. Current Status We have collected baseline and secondary time-point data thus far with limited tertiary time-point data. We will continue to study this population longitudinally through early 2020 to complete testing. Preliminary data shows that myeloma patients and controls have similar baseline cognition with mean cognitive scores of 47.8 and 47.9, respectively. Controls appear to improve cognitively at the second testing, with a mean score of 52.7, likely due to practice effect. Myeloma patients stay about the same to slightly worse following induction treatment with a mean cognitive score of 45.6. Interestingly, our quality-of-life data suggests that myeloma patients improve functionally and emotionally following initial treatment, but controls (i.e. caregivers) worsen slightly, both functionally and emotionally, which endorses the growing priority of caregiver support.