Oncology Expert Opines on Delayed Diagnosis of Bone Cancer

This case involves a middle aged female who began experiencing abdominal pain and presented to the emergency room in West Virginia. Labs were drawn and revealed moderately elevated erythrocyte sedimentation rate, low hemoglobin and hematocrit, and she was diagnosed with anemia. She was treated for the abdominal pain and released. The patient then followed up with her primary care physician. At her follow- up, she reported several weeks of hip pain with no trauma. Over the course of the next several months, the patient continued to see her primary care physician for hip pain. She is eventually prescribed physical therapy and steroid injections. Eventually, the woman reported that her pain was so unbearable that she required a wheelchair. She is seen by a rheumatologist who ordered a CT scan and lab work which revealed a bony lesion that was eventually diagnosed as metastatic cancer and was treated with tumor cryoablation.

Question(s) For Expert Witness

1.) How often do you treat patients with myeloma?

2.) In general, what kind of effect can a one year delay in diagnosis have on a patients prognosis?

Expert Witness Response E-098408

I am a myeloma specialist and see 2-5 new patients a week with multiple myeloma. I think a few things may have been missed in this case. The anemia should have been more thoroughly worked up by her PCP at the time he was seen. Additionally, his hip pain should've at least warranted a plain radiograph for evaluation. In practice, the most severe complications of myeloma are fractures from bone disease and acute renal failure. Failure to diagnose multiple myeloma may, in some instances, lead to irreversible kidney disease and/or disabling fractures. It is impossible to know, in this instance, whether early diagnosis could have mitigated the worsening pain.