Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score

Comorbidities have been demonstrated to affect progression-free survival (PFS) and overall survival (OS), although their impact in multiple myeloma (MM) patients is as yet unsettled. We (1) assessed various comorbidities, (2) compared established comorbidity indices (CIs; Charlson comorbidity index (CCI), hematopoietic cell transplantation-specific comorbidity index (HCT-CI)), Kaplan Feinstein (KF) and Satariano index (SI) and (3) developed a MM-CI (Freiburger comorbidity index, FCI) in 127 MM patients. Univariate analysis determined moderate or severe pulmonary disease (hazard ratio (HR): 3.5, P<0.0001), renal impairment (via estimated glomerular filtration rate (eGFR); HR: 3.4, P=0.0018), decreased Karnofsky Performance Status (KPS, HR: 2.7, P=0.0004) and age (HR: 2, P=0.0114) as most important variables for diminished OS. Through multivariate analysis, the eGFR ⩽30 ml/min/1.73m2, impaired lung function and KPS ⩽70% were significant for decreased OS, with HRs of 2.9, 2.8 and 2.2, respectively. Combination of these risk factors within the FCI identified significantly different median OS rates of 118, 53 and 25 months with 0, 1 and 2 or 3 risk factors, respectively, (P<0.005). In light of our study, comorbidities are critical prognostic determinants for diminished PFS and OS. Moreover, comorbidity scores are important treatment decision tools and will be valuable to implement into future analyses and clinical trials in MM

The Meanings of Pain: A Qualitative Study of the Perspectives of Children Living with Pain in Northeastern Thailand.

This qualitative paper explores the perception of pain among north-eastern Thai children experiencing illness, aged from 4–18 years. Data was obtained from 17 children living in the community and 32 children admitted to two major hospitals in Isan, totaling 49 children. The qualitative data collection techniques used were observation, drawing, role-playing, story-telling, and “day conferences” (relaxed and informal group discussions). The study was conducted over 1 year and the data were analyzed using Fielding’s method of content analysis. The research found that children described their experience of pain as “disheartening”, “suffering”, and “torturing” and that the expression of pain in Isan families is characterized by avoidance and endurance. The findings suggest a role for a model of pain management in children specific to the sociocultural context of Isan, which focuses on family-centered care and acknowledges cultural diversity