Role of the ER in initial diagnostic pathway of multiple myeloma patients: A retrospective review of 80 presentations at a regional hospital

Delayed diagnosis is a common challenge in multiple myeloma and can significantly impact patient quality of life, outcomes, and potentially survival. Although multiple myeloma often first presents in primary care, research indicates that a substantial proportion of cases follow complex diagnostic pathways, with nearly one-third diagnosed in acute care or emergency room (ER) settings. Moreover, socially vulnerable and/or isolated populations may be disproportionately diagnosed in these acute care environments. Such diagnostic delays may exacerbate progressive bone disease, fractures, chronic disability, and pain, ultimately reducing patients’ quality of life and prognosis. Hence, our study aims to determine the proportion of multiple myeloma patients presenting to the ER at or before initial diagnosis and assess the nature of both acute and sub-acute presentations. We will conduct a retrospective chart review of multiple myeloma patients with a histopathological diagnosis within 5 years of study initiation who presented through the Windsor Regional Cancer Center, targeting a sample of 60–70 patients with single or multiple ER visits. Key factors to be analyzed include demographics, symptomatology, reasons for presentation, number of visits, ER disposition, disease progression, and changes in clinical status between the time of initial presentation and diagnosis. Through this study, we aim to identify the nature of emergent presentations in newly diagnosed multiple myeloma patients, while defining demographic and disease-related characteristics that may serve as associated risk factors. In doing so, we strive to facilitate strategies for more timely diagnosis to enhance patient outcomes and quality of life.