Multiple Myeloma

Multiple Myeloma

Burden of Multiple Myeloma Patient Care on Health Care in Curaçao

 

Background

Multiple myeloma (MM) is a hematological malignancy characterized by clonal proliferation of plasma cells in the bone marrow resulting in end-organ damage with morbidity and early mortality if left untreated. Even though patients with myeloma may experience long disease free periods after first line treatment, all eventually relapse and die of their disease.

Clinical features of MM include hypercalcemia, renal failure, anemia and osteolytic bone lesions. MM accounts for approximately 1% of all malignancies and 13% of hematological malignancies. In the United States the annual incidence is 4 to 5 per 100,000. Myeloma incidence varies with ethnicity, with the incidence in African Americans and blacks from Africa being two to three times higher than in the caucasian population. The median age at diagnosis is approximately 70 years, where the average age of diagnosis has been shown to be significantly lower in blacks as compared to caucasians.

With the advent of improved supportive care (antibiotics, transfusions, radiotherapy) and especially since the development of new effective therapies, survival of myeloma patients has improved dramatically over the course of the last decades. Where the median survival was less than one year before the introduction of alkylating agents, the median survival of myeloma patients is now approximately eight years.

All patients diagnosed with MM in Curaçao are treated at the Department of Hematology/Medical Oncology and Radiotherapy at the Sint Elisabeth Hospital. Clinical observation suggests an increased incidence of MM as compared to literature. Also, high dose melphalan (HDM) followed by autologous stem cell transplant (ASCT) has not been used frequently as many patients were either not transplant eligible due to medical condition or due to choice (balancing the impact of several months away from their kin for a palliative treatment). However, contrary to expectation of several experts in the field, the advent of new treatment modalities has not obliviated the need for HDM and ASCT but seems to add to its effectiveness. These observations, together with the explosion of new but often expensive treatment modalities necessitates critical analysis of MM in Curaçao.

 

Study questions and methods

A retrospective analysis of all patients diagnosed with MM (and smoldering myeloma) of the period 2009-2016 will be performed at the Department of Hematology/Medical Oncology and Radiotherapy. The following questions will be addressed:

  1. What is the incidence of MM in Curaçao?
  2. What is the time to start second-line treatment of MM patients in Curaçao.
  3. How did patients undergoing HDM-ASCT fare as compared to non-transplant treated patients.
  4. What is the burden of MM care as expressed by treatment costs, number of days spent in hospital, number of radiotherapy treatments etc.
  5. Given the incidence of MM in Curaçao, what would be the financial impact of employing different new treatment modalities?

 

Study period

August – November 2016

 

Investigators

Meulenberg, medical student

Schnog, internist-hematologist/medical oncologist

Samson, radiation oncologist

Andrea, radiation oncologist

Coronel, pathologist

 

For more information contact:

Dr. John – John Schnog
Head of the department of Oncology
Address: Pater Eeuwensweg 36
Willemstad, Curaçao
Tel: +5999 522 6613
Email: j.schnog@cbhri.com

Combined Modality Treatment

Combined Modality Treatment

Outcome of Combined Modality Treatment Employing Modern Chemotherapy with Cobalt Based Radiotherapy in Curaçao

 

Background

Many cancers are currently treated with the combination of radiotherapy and chemotherapy as a radiosensitizer (combined modality treatment, CMT). In Curaçao, radiotherapy is delivered employing a cobalt radiation machine (Theratronics (1981) and Plato treatment planning system (2002)). For most indications randomized controlled trials are lacking between linear accelerator based radiotherapy and cobalt based radiation. With the exception of specific cases, structurally referring patients to centers employing linear accelerator based radiotherapy, is not economically feasible. All patients in Curaçao eligible for CMT are treated at the Department of Hematology/Medical Oncology and Radiotherapy in the Saint Elisabeth Hospital. As a measure of quality of the care delivered, we want to assess outcome of CMT in Curaçao and compare this to published trial data as well as published ‘real world data’ in both low, middle and high income countries.

 

Study questions and methods

A retrospective analysis of all patients treated with CMT for the cancers stated below during the period 2010-2014 will be performed in order to answer the following questions:

  1. What are the characteristics of the patients treated with CMT on Curaçao for rectal cancer, head and neck cancer, cervical cancer, lung cancer, esophageal cancer and anal cancer.
  2. What is the progression free survival (PFS) of patients treated with CMT in Curaçao for rectal cancer, head and neck cancer, cervical cancer, lung cancer, esophageal cancer and anal cancer?
  3. What are patterns of treatment failure in patients treated with CMT in Curaçao for rectal cancer, head and neck cancer, cervical cancer, lung cancer, esophageal cancer and anal cancer?
  4. What are the determinants of PFS in these patients?
  5. What are the rates of grade 3 and 4 toxicity during and after treatment?
  6. How does our outcome compare to the literature, specifically to:
  • Clinical trial data?
  • Real world data in high income countries?
  • Real world data in low- and middle income countries?

Study period

June – December 2016

 

Investigators

R van der Horst, medical student

Schnog, internist-hematologist/medical oncologist

Samson, radiation oncologist

Andrea, radiation oncologist

Coronel, pathologist

 

For more information contact:

Dr. John – John Schnog
Head of the department of Oncology
Address: Pater Eeuwensweg 36
Willemstad, Curaçao
Tel: +5999 522 6613
Email: j.schnog@cbhri.com

X