If you have multiple myeloma, you're certainly familiar with spending time in the clinic. Some patients may dread the wait time while others may look forward to the social interaction. Regardless of how patients feel about their experience, there may be costs of spending time in the clinic that have gone unnoticed or perhaps just accepted, because patients have had fewer options in the past. Takeda Oncology has a new oral proteasome inhibitor on the market called Ninlaro. Takeda conducted a patient survey trying to understand the burden of myeloma therapy for relapsed/refractory multiple myeloma patients and their caregivers comparing oral medications vs. injectable medications. They asked 124 patients about the effectiveness, satisfaction and convenience with multiple myeloma treatment over the past 2-3 weeks. Higher scores on this portion of the survey indicated higher global satisfaction, better perceived effectiveness and better convenience. Patients were also asked about their performance status (how fit they are), their level of frailty, demographics, treatment-related questions and the burden of illness related to their myeloma. When oral vs. injectable myeloma drugs were compared. The study found:

• Doctor visits per month: .7 (oral) vs. 3.4 (injectable)
• Average monthly minutes of travel time to treatment center: 75 (oral) vs. 264 (injectable)
• Average minimum monthly minutes spent at the doctor's office: 51 (oral) vs. 414 (injectable)
• Monthly minutes of clinic visit time for patient: 126 (oral) vs. 678 (injectable)
• Monthly minutes of clinic visit time for caregivers: 96 (oral) vs. 371 (injectable)

The most interesting portion of the study identified the monthly costs of treatment comparing oral vs. injectable therapies. For oral therapies that myeloma patients are already familiar with (like Revlimid or Thalomid), oral medication minutes should also include time spent calling the specialty pharmacy to complete the monthly patient survey every month and the time hanging out to meet the delivery FEDEX or UPS truck. Another consideration for patients could also include the difference in coverage of oral medications vs. injectable medications, especially for Medicare patients. This could include both copay differences and overall coverage differences. For patients who are evaluating their current medications, talking to your doctor about your personal situation is key. As myeloma medications advance, it's critical to have these conversations on a regular basis to ensure you are taking advantage that all progress has to offer.