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Acute myeloid leukemia

Quality of life and mood of older patients with acute myeloid leukemia (AML) receiving intensive and non-intensive chemotherapy

Abstract

Older patients with AML face difficult treatment decisions as they can be treated either with ‘intensive’ chemotherapy requiring prolonged hospitalization, or ‘non-intensive’ chemotherapy. Although clinicians often perceive intensive chemotherapy as more burdensome, research is lacking on patients’ quality of life (QOL) and psychological distress. We conducted a longitudinal study of older patients (≥60 years) newly diagnosed with AML receiving intensive (cytarabine/anthracycline combination) or non-intensive (hypomethylating agents) chemotherapy. We assessed patients’ QOL [Functional-Assessment-of-Cancer-Therapy-Leukemia] and psychological distress [Hospital-Anxiety-and-Depression-Scale] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We enrolled 75.2% (100/133) of eligible patients within 72-hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. Patient QOL improved over time (β = 0.32, P = 0.013). At baseline, 33.3% (33/100) and 30.0% (30/100) of patients reported clinically significant depression and anxiety symptoms, respectively, with no differences between groups. Patients’ depression symptoms did not change over time, while their anxiety symptoms decreased over time (β = −0.08, P < 0.001). Patient-reported QOL, depression and anxiety symptoms did not differ significantly at any time point between those who received intensive versus non-intensive chemotherapy. Older patients with AML experience improvements in their QOL and anxiety while undergoing treatment. Patients receiving intensive and non-intensive chemotherapy have similar QOL and mood trajectories.

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References

  1. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE, et al. Age and acute myeloid leukemia. Blood. 2006;107:3481–5. https://doi.org/10.1182/blood-2005-09-3724

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Estey E. Acute myeloid leukemia and myelodysplastic syndromes in older patients. J Clin Oncol. 2007;25:1908–15. https://doi.org/10.1200/JCO.2006.10.2731

    Article  PubMed  Google Scholar 

  3. Dombret H, Raffoux E, Gardin C. Acute myeloid leukemia in the elderly. Semin Oncol. 2008;35:430–8. https://doi.org/10.1053/j.seminoncol.2008.04.013

    Article  PubMed  Google Scholar 

  4. Dohner H, Estey EH, Amadori S, Appelbaum FR, Buchner T, Burnett AK, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115:453–74. https://doi.org/10.1182/blood-2009-07-235358

    Article  CAS  PubMed  Google Scholar 

  5. Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J, et al. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol. 2012;30:2670–7. https://doi.org/10.1200/JCO.2011.38.9429

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lubbert M, Suciu S, Baila L, Ruter BH, Platzbecker U, Giagounidis A, et al. Low-dose decitabine versus best supportive care in elderly patients with intermediate- or high-risk myelodysplastic syndrome (MDS) ineligible for intensive chemotherapy: final results of the randomized phase III study of the European Organisation for Research and Treatment of Cancer Leukemia Group and the German MDS Study Group. J Clin Oncol. 2011;29:1987–96. https://doi.org/10.1200/JCO.2010.30.9245

    Article  CAS  PubMed  Google Scholar 

  7. Sekeres MA, Stone RM, Zahrieh D, Neuberg D, Morrison V, De Angelo DJ, et al. Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia. 2004;18:809–16. https://doi.org/10.1038/sj.leu.2403289

    Article  CAS  PubMed  Google Scholar 

  8. El-Jawahri, AR et al. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015; https://doi.org/10.1002/cncr.29430

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rogers BB. Advances in the management of acute myeloid leukemia in older adult patients. Oncol Nurs Forum. 2010;37:E168–79. https://doi.org/10.1188/10.ONF.E168-E179

    Article  PubMed  Google Scholar 

  10. Storey S, Gray TF, Bryant AL. Comorbidity, physical function, and quality of life in older adults with acute myeloid. Leuk Curr Geriatr Rep. 2017;6:247–54. https://doi.org/10.1007/s13670-017-0227-8

    Article  Google Scholar 

  11. Buckley SA, Kirtane K, Walter RB, Lee SJ, Lyman GH. Patient-reported outcomes in acute myeloid leukemia: Where are we now? Blood Rev. 2018;32:81–87. https://doi.org/10.1016/j.blre.2017.08.010

    Article  PubMed  Google Scholar 

  12. Alibhai SM, Leach M, Kermalli H, Gupta V, Kowgier ME, Tomlinson GA, et al. The impact of acute myeloid leukemia and its treatment on quality of life and functional status in older adults. Crit Rev Oncol/Hematol. 2007;64:19–30. https://doi.org/10.1016/j.critrevonc.2007.07.003

    Article  Google Scholar 

  13. Hudson, P Positive aspects and challenges associated with caring for a dying relative at home. Int J Palliat Nurs. 2004;10:58–65. discussion 65. https://doi.org/10.12968/ijpn.2004.10.2.12454

    Article  PubMed  Google Scholar 

  14. Proot IM, Abu-Saad HH, ter Meulen RH, Goldsteen M, Spreeuwenberg C, Widdershoven GA. The needs of terminally ill patients at home: directing one’s life, health and things related to beloved others. Palliat Med. 2004;18:53–61.

    Article  PubMed  Google Scholar 

  15. El-Jawahri AR, Traeger LN, Kuzmuk K, Eusebio JR, Vandusen HB, Shin JA, et al. Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer. 2015;121:951–9. https://doi.org/10.1002/cncr.29149

    Article  PubMed  Google Scholar 

  16. Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D, et al. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum. 2004;31:1105–17. https://doi.org/10.1188/04.ONF.1105-1117

    Article  PubMed  PubMed Central  Google Scholar 

  17. Harding R, Higginson IJ. What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliat Med. 2003;17:63–74.

    Article  CAS  PubMed  Google Scholar 

  18. McCorkle R, Siefert ML, Dowd MF, Robinson JP, Pickett M. Effects of advanced practice nursing on patient and spouse depressive symptoms, sexual function, and marital interaction after radical prostatectomy. Urol Nurs. 2007;27:65–77. discussion 8–80.

    PubMed  Google Scholar 

  19. Northouse LL, Mood D, Templin T, Mellon S, George T. Couples’ patterns of adjustment to colon cancer. Social Sci & Med. 2000;50:271–84.

    Article  CAS  Google Scholar 

  20. Lau DT, Berman R, Halpern L, Pickard AS, Schrauf R, Witt W. Exploring factors that influence informal caregiving in medication management for home hospice patients. J Palliat Med. 2010;13:1085–90. https://doi.org/10.1089/jpm.2010.0082

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fife BL, Monahan PO, Abonour R, Wood LL, Stump TE. Adaptation of family caregivers during the acute phase of adult BMT. Bone Marrow Transplant. 2009;43:959–66. https://doi.org/10.1038/bmt.2008.405

    Article  CAS  PubMed  Google Scholar 

  22. Siston AK, List MA, Daugherty CK, Banik DM, Menke C, Cornetta K, et al. Psychosocial adjustment of patients and caregivers prior to allogeneic bone marrow transplantation. Bone Marrow Transplant. 2001;27:1181–8. https://doi.org/10.1038/sj.bmt.1703059

    Article  CAS  PubMed  Google Scholar 

  23. Foxall MJ, Gaston-Johansson F. Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. J Adv Nurs. 1996;24:915–23.

    Article  CAS  PubMed  Google Scholar 

  24. Cella D, Jensen SE, Webster K, Hongyan D, Lai JS, Rosen S, et al. Measuring health-related quality of life in leukemia: the Functional Assessment of Cancer Therapy--Leukemia (FACT-Leu) questionnaire. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes. Research. 2012;15:1051–8. https://doi.org/10.1016/j.jval.2012.08.2210

    Article  Google Scholar 

  25. Santana MJ, Au HJ, Dharma-Wardene M, Hewitt JD, Dupere D, Hanson J, et al. Health-related quality of life measures in routine clinical care: can FACT-fatigue help to assess the management of fatigue in cancer patients? Int J Technol Assess Health Care. 2009;25:90–96.

    Article  PubMed  Google Scholar 

  26. Mohamedali H, Breunis H, Timilshina N, Brandwein JM, Gupta V, Minden MD, et al. Older age is associated with similar quality of life and physical function compared to younger age during intensive chemotherapy for acute myeloid leukemia. Leuk Res. 2012;36:1241–8. https://doi.org/10.1016/j.leukres.2012.05.020

    Article  CAS  PubMed  Google Scholar 

  27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  CAS  Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J General Intern Med. 2001;16:606–13.

    Article  CAS  Google Scholar 

  29. Stone M. Acute Myeloid Leukemia in First Remission: To Choose Transplantation or Not? J Clin Oncol. 2012;21:1262–6.

    Google Scholar 

  30. Klepin HD. Elderly acute myeloid leukemia: assessing risk. Curr Hematol Malig Rep. 2015;10:118–25. https://doi.org/10.1007/s11899-015-0257-2

    Article  PubMed  PubMed Central  Google Scholar 

  31. Alibhai SM, Breunis H, Timilshina N, Brignardello-Petersen R, Tomlinson G, Mohamedali H, et al. Quality of life and physical function in adults treated with intensive chemotherapy for acute myeloid leukemia improve over time independent of age. J Geriatr Oncol. 2015;6:262–71. https://doi.org/10.1016/j.jgo.2015.04.002

    Article  PubMed  Google Scholar 

  32. Kayastha N, Wolf SP, Locke SC, Samsa GP, El-Jawahri A, LeBlanc TW. The impact of remission status on patients’ experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data. Support Care Cancer. 2018;26:1437–45. https://doi.org/10.1007/s00520-017-3973-4

    Article  PubMed  Google Scholar 

  33. Beattie S, Lebel S. The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review. Psycho-Oncol. 2011;20:1137–50. https://doi.org/10.1002/pon.1962

    Article  Google Scholar 

  34. Gemmill R, Cooke L, Williams AC, Grant M. Informal caregivers of hematopoietic cell transplant patients: a review and recommendations for interventions and research. Cancer Nurs. 2011;34:E13–21. https://doi.org/10.1097/NCC.0b013e31820a592d

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dionne-Odom JN, Azuero A, Lyons KD, Hull JG, Tosteson T, Li Z, et al. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial. J Clin Oncol: Off J Am Soc Clin Oncol. 2015;33:1446–52. https://doi.org/10.1200/JCO.2014.58.7824

    Article  Google Scholar 

  36. El-Jawahri, A Greer JA, Pirl WF, Park ER, Jackson VA, Back AL, et al. Effects of early integrated palliative care on caregivers of patients with lung and gastrointestinal cancer: a randomized clinical trial. The oncologist. 2017. https://doi.org/10.1634/theoncologist.2017-0227

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was supported by funds from the National Cancer Institute Federal Share Program (El-Jawahri), and K24 CA 181253 (Temel).

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Dr. El-Jawahri had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: El-Jawahri, Traeger, Abel, Steensma, Stone, Temel, and Greer. Acquisition of data: El-Jawahri, Waldman, VanDusen, Abel, Fathi, Steensma DeAngelo, Wadleigh, Hobbs, Foster, Brunner, Amrein, Stone, Temel, and Greer. Analysis and interpretation of data: El-Jawahri, Traeger, Waldman, VanDusen, Abel, Fathi, Steensma, LeBlanc, Horick, DeAngelo, Wadleigh, Hobbs, Foster, Brunner, Amrein, Stone, Temel, and Greer. Drafting of the manuscript: El-Jawahri, Abel, Steensma, Stone, Temel, and Greer. Critical revision of the manuscript for important intellectual content: El-Jawahri, Traeger, Waldman, VanDusen, Abel, Fathi, Steensma, LeBlanc, Horick, DeAngelo, Wadleigh, Hobbs, Foster, Brunner, Amrein, Stone, Temel, and Greer. Statistical analysis: El-Jawahri, Horick. Obtained funding: El-Jawahri. Administrative, technical, or material support: Waldman, VanDusen. Study supervision: El-Jawahri, Temel, and Greer.

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Correspondence to Areej El-Jawahri.

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El-Jawahri, A., Abel, G.A., Traeger, L. et al. Quality of life and mood of older patients with acute myeloid leukemia (AML) receiving intensive and non-intensive chemotherapy. Leukemia 33, 2393–2402 (2019). https://doi.org/10.1038/s41375-019-0449-1

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