Warning Signs And Delays In The Timely Diagnosis Of Multiple Myeloma: A Scoping Review

This project consists of a scoping review of the available scientific literature on the clinical manifestations and care processes leading up to the diagnosis of multiple myeloma, with a particular focus on its recognition in primary care. Its objective is to gather, organize, and analyze the available evidence regarding the symptoms, warning signs, laboratory abnormalities, and clinical circumstances that may raise suspicion of this disease, as well as the factors that hinder its identification and timely referral, in order to contribute to early diagnosis and a better initial management of this condition in primary care. In addition, the study will analyze the tools and strategies that have been proposed or evaluated to improve the identification of patients with suspected multiple myeloma and expedite their access to specialized care. The information will be organized into three categories: population characteristics and presenting symptoms; initial management, care pathways, and diagnostic timeframes; and causes of delays, missed opportunities, and interventions for improvement. As expected outcomes, we aim to obtain a structured characterization of prediagnostic manifestations and the combinations of findings that studies associate with the need for further investigation into possible multiple myeloma. We also aim to identify the main points of difficulty in the care pathway, describe the reported time intervals between the onset of symptoms, the first consultation, referral, and diagnosis, and distinguish between strategies supported by empirical evidence and those that remain merely proposed. The contribution of this scoping review is to provide a useful evidence base for the training of primary care professionals and to inform future improvements in initial assessment, test ordering, and coordination with specialized services. The project does not aim to validate a diagnostic algorithm on its own or to demonstrate a reduction in delays in care; its contribution lies in identifying which practices are supported by the available evidence, which require further evaluation, and how they could guide a more timely approach to patients with suspected multiple myeloma.