Rapidly changing myeloma epidemiology in the general population: Increased incidence, older patients, and longer survival.

The incidence of multiple myeloma is characterized by a steep increase with advancing age. Dramatic improvements in survival have been reported in clinical trials; however, elderly patients are generally underrepresented in these. The aims of this study are to review patterns of incidence and survival in multiple myeloma in the general population. We searched PubMed for population-based studies on trends in incidence and survival published between January 1, 2000 and June 30, 2017 and based on regional or national cancer registries and report the following results of the review. The age-adjusted incidence of multiple myeloma has increased during the second half of the twentieth century in some countries but remained stable in areas with high case ascertainment and access to universal medical care. The crude incidence is increasing globally due to an aging population. Survival rates have improved, and 5-year relative survival rates are now around 50% and over 60% in patients 65-70 years or younger. Preliminary data suggest a 3-fold increase in the prevalence of multiple myeloma. We conclude that the number of multiple myeloma patients is increasing in the general population due to (i) aging populations and (ii) more patients living longer due to modern drugs.

Incidence of multiple myeloma in Great Britain, Sweden, and Malmö, Sweden: the impact of differences in case ascertainment on observed incidence trends.

OBJECTIVES: The increased incidence of multiple myeloma (MM) across China and East Asia stimulated us to examine the current rates in Great Britain, where rates increased dramatically in the second half of the 20th century. However, rates have been stable and high during this period in Malmö, Sweden, where there is a keen interest in MM. We thus assessed recent changes in MM incidence in Great Britain, Sweden overall, and Malmö, Sweden, and examined how these changes might explain recent reports of increased MM incidence across Asia. DESIGN: Estimation of MM incidence for Great Britain, Sweden overall, and Malmö, Sweden. POPULATIONS: MM incidence data for Great Britain (1975-2009) were obtained from Cancer Research UK and for Sweden (1970-2009) from the Swedish Cancer Registry. MM incidence data from Malmö, Sweden, were available from 1950 to 2012. MAIN OUTCOME MEASURES: Age-specific incidence of MM in Great Britain, Sweden overall, and Malmö, Sweden. RESULTS: MM incidence in Great Britain, Sweden overall, and Malmö increased progressively with age, even among the oldest group. The MM age-adjusted incidence (European standard population) increased by 69% from 1975-1979 to 2005-2009 in Great Britain, from 3.2/100,000 to 5.4/100,000. The largest increases occurred among those 70-79 years of age, for whom rates increased from 17.9/100,000 to 33.6/100,000; reflecting an increase of 69%. During this same period, the age-adjusted incidence (European stand population) in Sweden overall remained stable, at approximately 4.7/100,000. CONCLUSIONS: MM age-specific incidence is now similar in Great Britain, Sweden overall, and Malmö. We believe this is a result of improvements in case ascertainment in Great Britain, particularly among the elderly. Similar changes can be predicted to occur across Asia as improved access to healthcare contributes to better diagnosis of MM.

Project I See in NC: Initial results of a program to increase access to retinal examinations among diabetic individuals in North Carolina.

BACKGROUND: Diabetic retinopathy is the leading cause of preventable blindness in adults. Project I See in NC was begun to determine whether access to eye screening for Medicaid recipients and uninsured patients with diabetes in North Carolina could be improved. METHODS: We targeted Medicaid recipients and uninsured adults with diabetes for screening in 2 Community Care of North Carolina Networks. Screenings were performed in primary care settings throughout 6 counties in the Northwest Community Care Network and 6 counties in Access III of Community Care of the Lower Cape Fear. Patients were screened using a high-resolution digital retinal camera with images read at a centralized reading center at Wake Forest School of Medicine. RESULTS: A total of 1,688 patients were screened from October 2005 through September 2007. Nearly 15% (282) were found to have mild, nonproliferative-to-proliferative retinopathy, while the majority of patients had no evidence of diabetic retinopathy. Nearly 12% (196) required referral to an ophthalmologist, with 5% (86) requiring urgent referral for potentially sight-threatening retinopathy. LIMITATIONS: We were not able to confirm which patients kept their ophthalmologic appointments; however, we are currently analyzing data from the Medicaid patients in our study who required ophthalmologic referral. CONCLUSIONS: Remote digital retinal screening for diabetic retinopathy is feasible in primary care settings in both urban and rural areas of North Carolina, and it may prove to be an effective means of reaching more patients who require annual screening examinations.

Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic.

OBJECTIVE: To define age-adjusted incidence trends in multiple myeloma (MM) in a well-characterized population during a long period, given that some, but not all, studies have reported increasing MM incidence over time and that clinical experience from some centers suggests an increased incidence mainly in younger age groups. PATIENTS AND METHODS: We identified all patients (N=773) with MM diagnosed in Malmö, Sweden, from January 1, 1950, through December 31, 2005. Using census data for the population of Malmö, we calculated age- and sex-specific incidence rates. Incidence rates were also calculated for 10-year birth cohorts. Analyses for trends were performed using the Poisson regression. RESULTS: From 1950 through 2005, the average annual age-adjusted (European standard population) incidence rate remained stable (Poisson regression, P=.07 for men and P=.67 for women). Also, comparisons between 10-year birth cohorts (from 1870-1879 to 1970-1979) failed to detect any increase. Between 1950-1959 and 2000-2005, the median age at diagnosis of MM increased from 70 to 74 years, and the proportion of newly diagnosed patients aged 80 years or older increased from 16% to 31%. CONCLUSION: Our finding of stable MM incidence rates for all age groups during the past 5 decades suggests that recent clinical observations of an increase of MM in the young may reflect an increased referral stream of younger patients with MM, which in turn might be a consequence of improved access to better MM therapies. Importantly, because of the aging population, the proportion of patients with MM aged 80 years or older doubled between 1950-1959 and 2000-2005.

Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study.

PURPOSE Randomized multiple myeloma (MM) studies show improved response rates and better progression-free survival for newer therapies. However, a less pronounced effect has been found for overall survival (OS). Using population-based data including detailed treatment information for individual patients, we assessed survival patterns for all patients diagnosed with MM in Malmö, Sweden from 1950 to 2005. PATIENTS AND METHODS We identified 773 patients with MM (48% males). On the basis of the age limit used for treatment with high-dose melphalan with autologous stem-cell support (HDM-ASCT; < or = 65 years old) in Sweden, we constructed Kaplan-Meier curves and used the Breslow generalized Wilcoxon test to evaluate OS patterns (diagnosed in six calendar periods) for patients 65 years old or younger and patients older than 65 years. Results Including all age groups, patients diagnosed from 1960 to 1969 had a better survival than patients diagnosed from 1950 to 1959. In subsequent 10-year calendar periods, median OS increased from 24.3 to 56.3 months (P = .036) in patients < or = 65 years old. In contrast, OS did not improve among patients older than age 65 years (21.2 to 26.7 months, P = .7). CONCLUSION With the establishment of HDM-ASCT as the standard therapy for younger patients with MM, OS has improved significantly for this age group in the general MM population. With novel therapies being commonly used at disease progression, presumably it becomes increasingly difficult to confirm survival differences between defined induction, consolidation, and maintenance therapies in the future. Consequently, in the era of novel MM therapies, population-based studies will serve as a necessary complement to randomized trials.

It's in the cards: a practice-friendly, real-time data collection strategy for quality improvement.

The heart of the Card Response Project, a six-step data collection strategy, is the clinician, armed with a pocket-sized card for rapid completion during clinic visits.