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      Medical practitioners’ knowledge and awareness of multiple myeloma at public hospitals, Gauteng, South Africa

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          Abstract

          Background

          Multiple myeloma (MM) is a plasma cell malignancy associated with morbidity and mortality worldwide, and most patients are referred for specialist care very late with complications. The low index of suspicion among medical practitioners is among the reasons for the delay in MM diagnosis and management. This study aimed to determine the level of awareness and knowledge of MM among medical practitioners working in public hospitals of Tshwane Municipality, Gauteng Province, South Africa.

          Methods

          A cross-sectional descriptive study on 74 doctors working in three district, one regional and one central hospital using a convenience sampling.

          Results

          Seventy-four medical practitioners participated in this study. Their median age was 37 years with an interquartile range of 43–30 years. The majority (85%) of the respondents were aware of MM, while 74% were knowledgeable regarding MM presentations and diagnostic investigations.

          Conclusion

          The findings highlighted a high level of awareness and knowledge of MM among the study population, but almost all of the participants requested an educational information brochure on MM.

          Contribution

          Medical practitioners have a high level of awareness of multiple myeloma; however, there is a discrepancy between this level of awareness and the delayed presentation of patients at the public hospitals. As primary healthcare in South Africa is nurse-driven, the study indicates that not all primary healthcare providers may be aware of this disease. Future awareness campaigns should target other primary healthcare providers, including nurses and private general practitioners.

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          Most cited references43

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          International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.

          This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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            Multiple myeloma epidemiology and survival: A unique malignancy.

            Multiple myeloma (MM), although a rare disease, is the second most common hematologic malignancy. It is found in the spectrum of plasma cell dyscrasias, which begins with monoclonal gammopathy of unknown significance (MGUS) to overt plasma cell leukemia and extramedullary myeloma. MM is associated with significant morbidity due to its end-organ destruction. It is a disease of the older population and its incidence in the African American population is twice that of the European American population. Improvements in the treatment of MM in the past couple of decades, beginning with the use of autologous stem cell transplantation followed by availability of novel treatments such as immunomodulatory drugs (ImIDs) and proteasome inhibitors (PIs) has transformed the natural history of the disease leading to longer survival times. Advancements in the diagnosis, monitoring, and treatment of MM are of the utmost importance as the general population lives longer due to other improvements in health care. The recent introduction of novel therapies has been paralleled by advancements in the monitoring of MM, namely, by the availability exquisitely sensitive techniques in detecting minimal residual disease. As drug development and technology continues to improve, it will be important to design rationale clinical trials enrolling patient populations that represent the overall population, including racial minorities and the elderly, so that trial results can be appropriately extrapolated. Herein, the changing epidemiology, improvements in survival, and the health disparity observed in important subgroups of MM are reviewed.
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              Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets

              Background: Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis. Methods: Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006–2008, is categorised into one of eight ‘Routes to Diagnosis'. Results: Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival. Conclusion: Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis.
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                Author and article information

                Journal
                S Afr Fam Pract (2004)
                S Afr Fam Pract (2004)
                SAFP
                South African Family Practice
                AOSIS
                2078-6190
                2078-6204
                27 June 2023
                2023
                : 65
                : 1
                : 5644
                Affiliations
                [1 ]Department of Haematology, Faculty of Health Sciences, Sefako Makgatho University, Pretoria, South Africa
                [2 ]Department of Statistics, Faculty of Health Sciences, Sefako Makgatho University, Pretoria, South Africa
                Author notes
                Corresponding author: Andiswa Pooe, amtyobile@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-3886-4448
                https://orcid.org/0000-0003-2926-239X
                https://orcid.org/0000-0003-3101-5814
                Article
                SAFP-65-5644
                10.4102/safp.v65i1.5644
                10331045
                c8c45be1-ef9a-499d-ae51-c7a29e45bf4e
                © 2023. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 01 October 2022
                : 29 April 2023
                Categories
                Original Research

                multiple myeloma,awareness,knowledge,gauteng province,south africa

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