Emergency diagnosis of multiple myeloma: a SEER-Medicare study

Non-specific presenting symptoms make multiple myeloma (MM) one of the most difficult hematologic cancers to diagnose, increasing the risk of late diagnosis and emergency presentation (EP). We examined the frequency of EP in MM, estimated associations between EP and patient-level factors, and MM symptom-related healthcare utilization in the year before diagnosis.

We studied Medicare beneficiaries age ≥ 66 years diagnosed with MM between 2008 and 2017. Emergency presentation (EP) was defined as diagnosis preceded by a recent ED visit, sub-classified as: inpatients (EP-IP) for subsequently admitted patients and outpatients (EP-OP) for those discharged for follow-up care.

Among 20,437 patients, 52% were male, 75% non-Hispanic White (NHW), and the median age was 76. Overall, 37% were diagnosed through involvement with the ED (EP-IP: 30%; EP-OP: 7%). In iteratively adjusted models, oldest age, female sex, non-Hispanic Black, Hispanic, Asian American, Native Hawaiian or Other Pacific Islander race and ethnicity, unmarried status, dual eligibility for Medicaid and Medicare, lowest county SES, rurality, frailty, and higher healthcare use in the year pre-diagnosis were associated with higher frequency of ED involvement in diagnosis. Symptom-related healthcare utilization was comparable among EP and non-EP groups in the year preceding MM diagnosis but markedly increased for the EP group in the month before diagnosis.

More than one-third of older US adults with MM are diagnosed through EP. Several socio-demographic, clinical and healthcare utilization factors are associated with EP. Similarities in healthcare utilization across EP status in the months preceding diagnosis suggest missed opportunities for earlier detection of MM.