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Ramos F, Hermosín ML, Fuertes-Núñez M, Martínez P, Rodriguez-Medina C, Barrios M, Ibáñez F, Bernal T, Olave MT, Álvarez MÁ, Vahí M, Caballero-Velázquez T, González B, Altés A, García L, Fernández P, Durán MA, López R, Rafel M, Serrano J. Survival Outcomes and Health-Related Quality of Life in Older Adults Diagnosed with Acute Myeloid Leukemia Receiving Frontline Therapy in Daily Practice. J Pers Med 2023; 13:1667. [PMID: 38138894 PMCID: PMC10744855 DOI: 10.3390/jpm13121667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
Acute myeloid leukemia has a poor prognosis in older adults, and its management is often unclear due to its underrepresentation in clinical trials. Both overall survival (OS) and health-related quality-of-life (HRQoL) are key outcomes in this population, and patient-reported outcomes may contribute to patient stratification and treatment assignment. This prospective study included 138 consecutive patients treated in daily practice with the currently available non-targeted therapies (intensive chemotherapy [IC], attenuated chemotherapy [AC], hypomethylating agents [HMA], or palliative care [PC]). We evaluated patients' condition at diagnosis (Life expectancy [Lee Index for Older Adults], Geriatric Assessment in Hematology [GAH scale], HRQoL [EQ-5D-5L questionnaire], and fatigue [fatigue items of the QLQ-C30 scale]), OS, early death (ED), treatment tolerability (TT) and change in HRQoL over 12 months follow-up. The median OS was 7.1 months (IC not reached, AC 5.9, HMA 8.8, and PC 1.0). Poor risk AML category and receiving just palliative care, as well as a higher Lee index score in the patients receiving active therapy, independently predicted a shorter OS. The Lee Index and GAH scale were not useful for predicting TT. The white blood cell count was a valid predictor for ED. Patients' HRQoL remained stable during follow-up.
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Affiliation(s)
- Fernando Ramos
- Department of Hematology, Hospital Universitario de León, 24008 Leon, Spain
| | - María Lourdes Hermosín
- Department of Hematology, Hospital Universitario de Jerez de la Frontera, 11407 Jerez de la Frontera, Spain
| | | | - Pilar Martínez
- Department of Hematology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Carlos Rodriguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Manuel Barrios
- Department of Hematology, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Francisco Ibáñez
- Department of Hematology, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Teresa Bernal
- Department of Hematology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maria Teresa Olave
- Department of Hematology, Hospital Clinico Lozano Blesa, 50009 Zaragoza, Spain
| | | | - María Vahí
- Department of Hematology, Hospital Universitario Virgen de Valme, 41014 Sevilla, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Bernardo González
- Department of Hematology, Hospital Universitario de Canarias, 38320 La Laguna, Spain
| | - Albert Altés
- Department of Hematology, Hospital Sant Joan de Deu de Manresa—Fundació Althaia, 08243 Manresa, Spain
| | - Lorena García
- Department of Hematology, Complejo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
| | - Pascual Fernández
- Department of Hematology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - María Antonia Durán
- Department of Hematology, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Rocío López
- Medical Department, Hematology Area, Bristol Myers Squibb Company, Celgene, 28050 Madrid, Spain
| | - Montserrat Rafel
- Medical Department, Hematology Area, Bristol Myers Squibb Company, Celgene, 28050 Madrid, Spain
| | - Josefina Serrano
- Department of Hematology, Hospital Universitario Reina Sofía, IMIBIC UCO, 14004 Cordoba, Spain
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Ellis R, Blough A, Clark M. A systematic review of physical function tests as predictors of key clinical outcomes for adults with blood cancers. Support Care Cancer 2023; 31:555. [PMID: 37658864 DOI: 10.1007/s00520-023-08023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To determine which standardized physical performance tests are being used specifically in the assessment of adult patients before, during, or after undergoing treatment for hematologic malignancy and which of these functional tests have been demonstrated to have a correlation with key objective clinical outcome measures including mortality, progression-free survival, complete remission, hospital readmissions, emergency department visits, and hospital length of stay. METHODS PubMed/MEDLINE electronic databases were searched up to June 2021. Searches were restricted to English language. All resulting studies from the electronic database search were assessed by two reviewers for original research with physical performance data exclusive to patients with hematological malignancy. Studies with confounding intervention or the inclusion of pediatric patients were excluded. The quality of the remaining studies was assessed using PRISMA guidelines and Tooth Criteria by two reviewers, using a third reviewer to resolve any discrepancies. The main characteristics of each article, including sample size, population characteristics, physical performance testing methods, and significant and non-significant findings were extracted and compared. Additionally, one reviewer performed a literature review of the safety of physical performance testing. RESULTS One thousand two hundred fifty-six screened database results resulted in 14 studies included in the systematic review. All studies scored ≥ 0.59 on the Tooth Criteria, indicating moderate to high quality of reporting. Our review found six recurring measures of objective physical function assessed for correlation with clinical outcomes, primarily morbidity and mortality. The heterogeneity of each study precluded aggregate data analysis. CONCLUSIONS This review was a first step in evaluating which objective physical performance tests are best suited for identifying functional impairment before, during, and after oncologic treatment for adults with blood cancers. Additional studies are needed to determine the optimal objective functional measures to use as a guide in clinical decision-making in the hematologic patient population.
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Affiliation(s)
- Rosalie Ellis
- PGY2 at Moss Rehabilitation Hospital, Elkins Park, USA.
| | - Allison Blough
- PGY4 at University of Kansas Medical Center, Kansas City, USA
| | - Megan Clark
- Cancer Rehabilitation Fellowship Director at University of Kansas Medical Center, Kansas City, USA
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Ha H, Jeong Y, Lim JH, Suh YJ. Treatment Pattern, Financial Burden and Outcomes in Elderly Patients with Acute Myeloid Leukemia in Korea: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042317. [PMID: 35206499 PMCID: PMC8872510 DOI: 10.3390/ijerph19042317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 12/10/2022]
Abstract
Although approximately 50% of patients with acute myeloid leukemia (AML) are diagnosed over the age of 60 years, there is currently no established consensus on the treatment of elderly AML patients. Herein, we aimed to explore the incidence, medical expenditure, treatment, and outcomes of elderly AML patients in Korea by analyzing a nationwide cohort. We employed the Korean National Health Insurance Service-Senior cohort, which represents 10% of a random selection from a total of 5.5 million subjects aged 60 years or older. AML patients were identified according to the main diagnostic criteria of acute leukemia. Treatment for AML was divided into high- (high-dose cytarabine ± idarubicin) and low- (low-dose cytarabine or hypomethylating agents) intensity chemo-therapy and classified according to the chemotherapeutics protocol. We analyzed the survival outcomes and medical expenditures. Among 558,147 elderly patients, 471 were diagnosed with AML, and 195 (41.4%) were treated with chemotherapy. The median age was 65 years, and the median overall survival (OS) was 4.93 months (95% confidence interval, 4.47–5.43). Median OS was longer in patients undergoing chemotherapy than those in the best supportive care group (6.28 vs. 3.45 months, p < 0.001), and the difference was prominent in patients aged < 70 years. Twenty-eight (5.9%) patients received high-intensity chemotherapy, while 146 (31.0%) received low-intensity chemotherapy. The difference in median OS according to dose intensity was 4.6 months, which was longer in the high-intensity chemotherapy group (9.8 vs. 5.2 months in low-intensity group); however, the difference was not statistically significant. Patients who received high-intensity chemotherapy recorded longer hospital stays and incurred greater expenses on initial hospitalization. Elderly AML patients in Korea exhibited clinical benefits from chemotherapy. Although patients should be carefully selected for intensive treatment, chemotherapy, including low-intensity treatment, can be considered in elderly patients. Moreover, prospective studies on new agents or new treatment strategies are needed.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea;
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea;
| | - Joo Han Lim
- Department of Internal Medicine, Inha University Hospital, Incheon 22332, Korea;
- Correspondence: (J.H.L.); (Y.J.S.); Tel.: +82-32-890-2581 (J.H.L.); +82-32-890-2833 (Y.J.S.)
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon 22332, Korea
- Correspondence: (J.H.L.); (Y.J.S.); Tel.: +82-32-890-2581 (J.H.L.); +82-32-890-2833 (Y.J.S.)
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Nakano J, Fukushima T, Tanaka T, Fu JB, Morishita S. Physical function predicts mortality in patients with cancer: a systematic review and meta-analysis of observational studies. Support Care Cancer 2021; 29:5623-5634. [PMID: 33770257 DOI: 10.1007/s00520-021-06171-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/18/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to determine whether physical function can predict mortality in patients with cancer. METHODS Literature searches were conducted in Web of Science, CINAHL, the Cochrane Library, ProQuest, PEDro, and PubMed for articles published before September 2020. Four review authors retrieved studies using predetermined eligibility criteria and conducted quality assessment and data extraction. RESULTS A total of 1356 titles and abstracts were screened; ultimately, 26 studies were determined to be suitable for meta-analysis. Grip strength was significantly associated with mortality risk in patients with cancer (hazard ratio [HR] = 1.15, P = 0.005). Gait speed was also associated with mortality risk (HR = 1.58, P = 0.0004). In grip strength and gait speed, the subgroup comprised of patients with cancer aged ≥ 80 years had a higher effect size than that of patients aged < 80 years. The short physical performance battery measurement was markedly associated with mortality risk, showing the largest effect size (HR = 2.37, P < 0.00001). The 6-min walking test distance was significantly associated with mortality risk (HR = 1.55, P = 0.001). The timed up and go test was significantly associated with mortality risk with a high effect size (HR = 2.66, P < 0.00001). CONCLUSION This systematic review and meta-analysis demonstrated that physical function predicted mortality in patients with cancer. Furthermore, physical function outcomes in patients aged 80 years and above reflected a higher mortality.
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Affiliation(s)
- Jiro Nakano
- Department of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
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Cressman S, Hogge DE, Minden MD, Couban S, Karsan A, Broady R, McPherson E, Halani K, Weng JY, Peacock SJ. Quality of life and socioeconomic indicators associated with survival of myeloid leukemias in Canada. EJHAEM 2020; 1:69-78. [PMID: 35847696 PMCID: PMC9175748 DOI: 10.1002/jha2.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Abstract
Understanding how patient-reported quality of life (QoL) and socioeconomic status (SES) relate to survival of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) may improve prognostic information sharing. This study explores associations among QoL, SES, and survival through administration of the Euro-QoL 5-Dimension, 3-level and Functional Assessment of Cancer Therapy-Leukemia and financial impact questionnaires to 138 adult participants with newly diagnosed AML or MDS in a longitudinal, pan-Canadian study. Cox regression and lasso variable selection models were used to explore associations among QoL, SES, and established predictors of survival. Secondary outcomes were changes in QoL, performance of the QoL instruments, and lost income. We found that higher QoL and SES were positively associated with survival. The Lasso model selected the visual analog scale of the EQ-5D-3L as the most important predictor among all other variables (P = .03; 92% selection). Patients with AML report improved QoL after treatment, despite higher mean out-of-pocket expenditures compared with MDS (up to $599 CDN/month for AML vs $239 for MDS; P = .05), greater loss of productivity-related income (reaching $1786/month for AML vs $709 for MDS; P < .05), and greater caregiver effects (65% vs 35% caregiver productivity losses for AML vs MDS; P < .05). Our results suggest that including patient-reported QoL and socioeconomic indicators can improve the accuracy of survival models.
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Affiliation(s)
- Sonya Cressman
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
- Department of Cancer Control ReasearchBC Cancer Research CentreVancouverBritish ColumbiaCanada
- Canadian Centre for Applied Research in Cancer Control (ARCC)VancouverBritish ColumbiaCanada
| | - Donna E. Hogge
- Leukemia Bone Marrow Transplant Program of BCVancouver General HospitalVancouverBritish ColumbiaCanada
- Terry Fox LaboratoriesBritish Columbia Cancer Research CentreVancouverBritish ColumbiaCanada
| | - Mark D. Minden
- Department of Medical Oncology and HematologyPrincess Margaret HospitalTorontoOntarioCanada
| | - Stephen Couban
- Department of MedicineQueen Elizabeth II Health Sciences CentreHalifaxNova ScotiaCanada
| | - Aly Karsan
- Centre for Clinical GenomicsMichael Smith Genome Sciences CentreVancouverBritish ColumbiaCanada
- Cancer Genetics LaboratoryBritish Columbia Cancer AgencyVancouverBritish ColumbiaCanada
- Deptartment of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Raewyn Broady
- Leukemia Bone Marrow Transplant Program of BCVancouver General HospitalVancouverBritish ColumbiaCanada
| | | | | | - Jing Yi Weng
- Department of Cancer Control ReasearchBC Cancer Research CentreVancouverBritish ColumbiaCanada
| | - Stuart J. Peacock
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
- Department of Cancer Control ReasearchBC Cancer Research CentreVancouverBritish ColumbiaCanada
- Canadian Centre for Applied Research in Cancer Control (ARCC)VancouverBritish ColumbiaCanada
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Jiang Q. [Patient-reported outcome and its application in hematological neoplasm]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:614-619. [PMID: 32397032 PMCID: PMC7364910 DOI: 10.3760/cma.j.issn.0253-2727.2019.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
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Role of physical function in predicting short-term treatment outcome in Egyptian acute myeloid leukemia patients: a single center experience. Hematol Transfus Cell Ther 2019; 41:17-24. [PMID: 30793100 PMCID: PMC6371199 DOI: 10.1016/j.htct.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/08/2018] [Indexed: 01/06/2023] Open
Abstract
Background Acute myeloid leukemia (AML) is a potentially fatal hematological disease. Along with disease-related factors, patient-related factors, in particular age, are a strong predictor of outcome that influence treatment decisions. Many acute myeloid leukemia risk stratification models have been developed to predict the outcome of intensive chemotherapy. However, these models did not include physical function assessments. Methods This study investigated the impact of several factors, namely the performance status, physical function and age on the short-term outcomes of intensive chemotherapy in a cohort of 50 Egyptian patients with de novo acute myeloid leukemia. Results Complete remission after intensive chemotherapy in these myeloid leukemia patients at Day 28 was 56% and the mortality rate was 12% and 34% at Day 28 and Day 60, respectively. The pretreatment Eastern Cooperative Oncology Group score was significantly correlated with outcomes on Day 28 and Day 60 (p-value = 0.041 and p-value = 0.032, respectively). There were significant correlations between the two-minute walk test and outcomes of therapy on Day 28 and 60 (p-value = 0.032 and p-value = 0.047, respectively) and between grip strength test and outcomes of therapy on Day 28 and 60 (p-value = 0.046 and p-value = 0.047 respectively). Furthermore, there was a significant correlation between chair stand test and outcome of therapy on Day 28 (p-value = 0.023). Conclusion Performance status and physical function assessments were strong predictors of outcome of intensive chemotherapy in acute myeloid leukemia and we recommend the incorporation of these variables in risk stratification models for the personalization of therapy before treating acute myeloid leukemia patients with intensive chemotherapy.
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Patient-reported fatigue prior to treatment is prognostic of survival in patients with acute myeloid leukemia. Oncotarget 2018; 9:31244-31252. [PMID: 30131851 PMCID: PMC6101294 DOI: 10.18632/oncotarget.25787] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/08/2018] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) is associated with poor survival. While clinical prognostic factors of survival have been identified, the contribution of patient-reported symptoms has only received marginal attention. Fatigue is one of the most commonly reported symptoms of AML. There is some evidence that fatigue is associated with shorter survival in hematological malignancies. However, the prognostic effects of fatigue in a homogenous cohort of patients with untreated AML has not been tested. We here report results of a prospective study on the prognostic value of patient-reported fatigue prior to onset of treatment, for 2-year survival in 94 AML patients. Cox regression models controlling for demographic and clinical factors showed that those with severe fatigue (22%) had decreased survival rates (Hr = 2.255, 95% CI = 1.16-5.60, p = 0.019). Further exploration showed that fatigue was associated with increased plasma concentrations of IL-6 and TNF-α, but not with demographic or disease-related factors. In conclusion, we here show for the first time that the experience of severe fatigue prior to remission induction chemotherapy (IC) is prognostic for shorter survival in patients with AML of all ages. These findings point to the importance of interventions aimed at relieving fatigue especially before or in the early phases of treatment in order to improve survival.
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Greasley RU, Turner R, Collins K, Brown J, Bourke L, Rosario DJ. Treatment in the STAMPEDE era for castrate resistant prostate cancer in the UK: ongoing challenges and underappreciated clinical problems. BMC Cancer 2018; 18:667. [PMID: 29914436 PMCID: PMC6006691 DOI: 10.1186/s12885-018-4527-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/18/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to explore the opinions of healthcare professionals regarding the management of men with advanced prostate cancer with particular emphasis on treatment timing and sequencing; treatment adverse-effects and exercise a supportive therapy. METHODS Semi-structured interviews with a purposively selected group of healthcare professionals involved in prostate cancer care within the NHS, conducted over the phone or face to face. A total of 37 healthcare professionals participated in the interviews including urologists, clinical oncologists, medical oncologists, clinical nurse specialists, general practitioners, physiotherapists, exercise specialists, service managers, clinical commissioners and primary care physicians. RESULTS The availability of newer treatments for advanced prostate cancer as well as results from the STAMPEDE and CHAARTED trials has resulted in new challenges for patients and HCPs. This includes the impact of an increased workload on oncologists, a potential lack of clinical continuity between urology and oncology and uncertainties regarding optimal selection, timing and sequencing of chemotherapy and second-line treatment. Fitness for treatment in advanced prostate cancer populations remains a significant barrier to accessing therapies for patients with a poor performance status. Among this, muscle wastage can significantly affect performance status and consequentially compromise cancer therapy. Exercise was regarded as a potential therapy to mitigate the adverse-effects of treatment including the prevention or reduction in muscle wastage. CONCLUSIONS There is a lack of data guiding clinicians in this post STAMPEDE and CHAARTED era, work is needed to reassess and optimize the prostate cancer care pathway as it evolves. Exercise should be explored as a therapeutic option to mitigate the effects of long term ADT. Further study from a wider cohort of both prostate cancer care specialists and patients will aid in establishing a highly functioning pathway with optimal individualised care. TRIAL REGISTRATION Sustained exercise TrAining for Men wIth prostate caNcer on Androgen deprivation: the STAMINA programme (RP-DG-1213-10,010). REC Reference: 15/SW/0260 IRAS Project ID: 178340 Hospital ID: STH 18391 approved on 24/08/2015.
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Affiliation(s)
- Rosa U Greasley
- The Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Rebecca Turner
- The Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Janet Brown
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Liam Bourke
- The Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Derek J Rosario
- The Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Long-term recovery of quality of life and physical function over three years in adult survivors of acute myeloid leukemia after intensive chemotherapy. Leukemia 2018; 33:15-25. [PMID: 29884902 DOI: 10.1038/s41375-018-0162-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/07/2018] [Accepted: 04/13/2018] [Indexed: 02/04/2023]
Abstract
We previously described impairments in quality of life (QOL) and physical function among acute myeloid leukemia (AML) survivors between diagnosis and 1 year. The aim of the current study is to describe and compare to normative data QOL and physical function recovery over 3 years from diagnosis and treatment with intensive chemotherapy (IC). At assessments done at baseline (pre-IC) and at 11 time points over 3 years, QOL, fatigue, and 3 physical performance measures (PPMs; grip strength, 6-min walk test (6MWT), and timed chair stands) were collected. Long-term recovery was defined by reaching scores within the minimum clinically important difference of normative data. Global QOL recovery was seen in 79% at 1 year, 75% at 2 years, and 86% at 3 years. At 3 years, the QLQ-C30 subscales with the greatest recovery were physical and emotional functioning. For FACT-fatigue, recovery was seen in 68% at 1 year and 77% at 3 years. Recovery on PPMs was poorer on average, with only 17% on the 6MWT and 42% in grip strength returning to normal at 3 years. The vast majority of AML survivors after IC achieve recovery in QOL and fatigue by three years. However, recovery in physical performance remained blunted.
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Boucher NA, Johnson KS, LeBlanc TW. Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care. J Pain Symptom Manage 2018; 55:433-439. [PMID: 28935132 DOI: 10.1016/j.jpainsymman.2017.09.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 12/20/2022]
Abstract
CONTEXT Patients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed challenges and supports after intensive induction chemotherapy. OBJECTIVES We aimed to understand opportunities for palliative care interventions in this population. METHODS We conducted a qualitative study of AML patients with high-risk disease at Duke University Hospital, Durham, NC. Patients were interviewed about care experiences approximately 3 months after treatment initiation. Multiple coders used descriptive content analysis to identify common and recurrent themes. RESULTS We analyzed 22 patient transcripts. Sample demographics included 10 (45.5%) females, 12 (54.5%) males, mean age 62 (SD 10.9), 19 (86.4%) non-Hispanic white, and three (13.6%) nonwhite/non-Hispanic. All had high-risk disease, by age, relapse status, or molecular markers. We identified four themes in our analysis: physical symptoms, psychological issues, uncertainty regarding prognosis, and patients' sources of support. Specific challenges noted by patients included feelings of helplessness/hopelessness, activity restriction, fatigue, fevers, caregiver stress, and lack of clarity regarding treatment decision making. CONCLUSION AML patients face substantial challenges regarding physical symptoms, psychological distress, and uncertainty regarding prognosis. These challenges signal needs for which palliative care in high-risk AML patients may help. Our findings highlight opportunities to develop targeted palliative care interventions addressing unmet needs in AML patients.
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Affiliation(s)
- Nathan A Boucher
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Buckley SA, Kirtane K, Walter RB, Lee SJ, Lyman GH. Patient-reported outcomes in acute myeloid leukemia: Where are we now? Blood Rev 2017; 32:81-87. [PMID: 28888621 DOI: 10.1016/j.blre.2017.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/03/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022]
Abstract
Outcomes for acute myeloid leukemia remain poor, and treatment decisions must consider not just quantity, but also quality of life (QOL). We conducted a systematic review of studies in patients with acute myeloid leukemia or high-risk myelodysplastic syndrome that incorporated patient-reported outcome (PRO) measures. PubMed and PsycINFO were searched for articles published from January 2000 through June 2016. Forty-one were relevant for our review with more published in recent years. There was considerable inter-study heterogeneity in which instruments were used, and many studies employed multiple (often overlapping) instruments. Longitudinal studies in particular suffered from both high attrition rates due to disease-related mortality as well as waning compliance with questionnaire completion. There remain significant challenges to incorporation of PROs into leukemia trials. Despite these limitations, however, well-implemented PROs can provide important information beyond objective response outcomes and highlight areas of focus for clinicians caring for patients and for future research endeavors.
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Affiliation(s)
- Sarah A Buckley
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA.
| | - Kedar Kirtane
- Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephanie J Lee
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gary H Lyman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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LeBlanc TW, Fish LJ, Bloom CT, El-Jawahri A, Davis DM, Locke SC, Steinhauser KE, Pollak KI. Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making. Psychooncology 2016; 26:2063-2068. [DOI: 10.1002/pon.4309] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas W. LeBlanc
- Duke Cancer Institute; Durham NC USA
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine; Duke University School of Medicine; Durham NC USA
| | | | | | | | | | | | - Karen E. Steinhauser
- Division of General Internal Medicine, Department of Medicine; Duke University School of Medicine; Durham NC USA
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Rao AV. Fitness in the elderly: how to make decisions regarding acute myeloid leukemia induction. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:339-347. [PMID: 27913500 PMCID: PMC6142491 DOI: 10.1182/asheducation-2016.1.339] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Acute myeloid leukemia (AML) is a disease of the elderly, but less than half of these patients are offered therapy despite the evidence of better survival with treatment in this patient population. Assessing fit, vulnerable, and frail older adults with AML remains a challenge for the treating oncologist. A majority of AML patients are elderly and often have significant comorbidities, lack of social support, and older caregivers. Performance status (PS), a subjective measure of how a patient will tolerate cancer chemotherapy, has been strongly correlated with mortality in older AML patients. However, a large portion of older adults have poor PS as a result of their underlying AML, and these patients may end up being undertreated. Conversely, some patients with excellent PS unexpectedly end up with excessive toxicity and mortality. The treating physician thus needs a more objective and comprehensive method to differentiate patients along the fit-frail spectrum irrespective of their chronological age. For more than a decade, comprehensive geriatric assessment has been shown to improve routine oncology assessment by adding information about the functional, emotional, cognitive, and social status of older patients with cancer. In addition to the chronological and functional age, there is an attempt to quantify a patient's biological age to aid in better decision making. This chapter attempts to review the clinical challenges of AML treatment in the elderly population and to highlight the current literature and future research required to be able to assess fitness and maximize therapeutic options in this heterogeneous patient population.
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Affiliation(s)
- Arati V Rao
- Clinical Research, Hematology-Oncology, Gilead Sciences, Inc., Foster City, CA
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Velghe A, De Buyser S, Noens L, Demuynck R, Petrovic M. Hand grip strength as a screening tool for frailty in older patients with haematological malignancies. Acta Clin Belg 2016; 71:227-30. [PMID: 27118256 DOI: 10.1080/17843286.2016.1162381] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Frailty is a geriatric syndrome characterized by decreased physiological reserves and an age-related vulnerability to stressors with higher risk of adverse health outcomes. Comprehensive geriatric assessment (CGA) might detect frailty but is time-consuming, implying the need for initial frailty screening. Most frailty screening tools do not include functional measures. Hand grip strength (HGS) is a reliable surrogate for overall muscle strength and predicts functional decline, morbidity and mortality. No studies are available in cancer patients on HGS as screening tool for frailty. We aimed to assess whether HGS can be used as a screening tool to predict an abnormal CGA and therefore frailty. METHODS Single centre cohort study in 59 patients aged 70 years or more with a haematological malignancy. HGS was measured using a vigorimeter. A patient was considered frail if any of the CGA elements were impaired. RESULTS Mean HGS before start of therapy in women was 37.0 ± 14.3 kPa and in men 66.1 ± 13.1 kPa. An abnormal CGA was present in 52 subjects (88%). HGS was associated with concurrent abnormal CGA (p = 0.058 in women, p = 0.009 in men). AUC was 0.800 (SE = 0.130) in women and 0.847 (SE = 0.118) in men. Optimal HGS cut-off points for likelihood of abnormal CGA were ≤52 kPa in women and ≤80 kPa in men. DISCUSSION In older patients with haematological malignancies, impairment in muscle function is present at diagnosis. HGS seems a promising screening tool to identify patients with abnormal CGA.
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Timilshina N, Breunis H, Tomlinson G, Brandwein J, Alibhai SM. Do quality of life, physical function, or the Wheatley index at diagnosis predict 1-year mortality with intensive chemotherapy in older acute myeloid leukemia patients? Leuk Res 2016; 47:142-8. [DOI: 10.1016/j.leukres.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022]
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