Other News // 16th September 2021
This Blood Cancer Awareness Month, we’re turning the spotlight on the dedicated band of consultants, GPs and laboratory scientists working away behind the scenes to break down the barriers to early detection, speed up referrals and ensure myeloma isn’t missed.
We caught up with Professor Guy Pratt, consultant haematologist at Queen Elizabeth Hospital, Birmingham and valued member of the Myeloma UK Early Diagnosis Steering Committee and MGUS Working Group about the challenges of educating GPs and healthcare professionals, and being on the frontline of myeloma care.
Who are you and what do you do?
I’m Professor Guy Pratt and I’m a consultant haematologist at Queen Elizabeth Hospital, Birmingham. I’ve been a consultant in haematology for about 20 years and myeloma is my main interest. We’re a large hospital and we do a large number of stem cell transplants and clinical trials.
What is your role in myeloma diagnosis?
As a haematologist and myeloma specialist, I see the patients who are referred to haematology with suspected myeloma. Usually, patients at that stage have had blood tests done by a GP, another speciality or a colleague, showing a myeloma protein. I then do all the work-up to determine whether the patient has myeloma or not. This includes bone marrow tests and cross-sectional scans.
In your experience what are the biggest challenges to a timely myeloma diagnosis?
The delay in diagnosis is a massive issue in myeloma. The problem is that patients have non-specific symptoms: they present with backache, tiredness or a chest infection. It’s a nightmare for GPs or even other specialities because myeloma is not at the top of the list of causes. Therefore, patients often return repeatedly to their GP and we commonly see an awful delay in diagnosis.
How have you been involved in the Myeloma UK early diagnosis work?
I’m on the Early Diagnosis Steering Committee, which looks at interactions with GPs, providing education, written materials and lectures. We also work with laboratories on best practices and issues surrounding reporting blood results – there’s a real lack of standardisation around the country. Personally, I’m also heavily involved in the development of national myeloma and MGUS guidelines.
Tell us more about your involvement with the MGUS working group?
MGUS is really common – at least 100 times more common than myeloma.
One area of research I am involved in is trying to characterize MGUS patients. Do they suffer from ill-health? In other words, is MGUS associated with bone disease or an increased risk of thrombosis or cancer? There’s quite a lot of suggestive published data, but there aren’t really any definitive answers.
Some MGUS patients will go on to develop myeloma, so there is also the question of screening for MGUS and whether we should be doing it. All myeloma patients will have had MGUS before developing myeloma and we know that MGUS patients who are picked up by chance and are monitored do better. That’s because they don’t face this delay in diagnosis that leads them to have catastrophic renal failure or bone disease. The problem with screening is that it’s hugely costly and it would require massive investment in terms of staff. And most MGUS patients don’t get myeloma, so you would be creating a lot of unnecessary anxiety.
Can you tell us more about the educational materials you’ve been helping to develop: who are they for and why?
Educating GPs and other specialities is really important. It’s very hard for healthcare professionals to be educated about absolutely everything. Nevertheless, we should educate and remind GPs that patients who have persistent backache or have a combination of symptoms that suggest myeloma – infections, backache, tiredness – should be tested.
The GP Myeloma Diagnostic Tool the Early Diagnosis Working Group put together is a great example of providing the right information in a simple way. It is two sides of A4: it’s very clear, well presented and illustrated. It’s providing GPs with recommendations as to when they should think about myeloma, what blood tests they should do and how to interpret the results. These are the three key areas for GPs.
What could haematologists do to improve or streamline myeloma diagnosis?
Laboratories are critical for swift diagnosis but not all haematologists work in partnership with labs. I personally have a very good relationship with the lab here and they’ll email me straight away if they get a paraprotein (myeloma protein) result or a light chain result. This should be done routinely in labs around the country, but unfortunately, there’s a lack of consistency.
I think artificial intelligence and computers are the way forward to make sure this happens and that patients who may have myeloma are identified and their blood results acted on as quickly as possible.
Also, if you have people presenting with back pain and they keep coming back to the GP, an alert should come up on their computer to trigger testing.
Haematologists are also key to making sure that local laboratories are reporting results well and highlighting clearly to GPs, or whichever speciality, what they ought to be doing with their results. Lab reports can be a nightmare for GPs: they get a funny result and they don’t know what it means.
What would you recommend lab scientists and healthcare professionals do to learn about myeloma?