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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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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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