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Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

Leukemia volume 18, pages 809–816 (2004)Cite this article

Abstract

Older patients with acute myeloid leukemia (AML) and advanced myelodysplastic syndrome (aMDS) must decide between receiving intensive induction chemotherapy (IC) or nonintensive chemotherapy/best supportive care (NIC). Little information exists about what factors influence treatment decisions and what quality of life (QOL) is associated with treatment choices. We prospectively examined 43 patients 60 years or older who were interviewed at diagnosis and periodically over 1 year. IC choice was associated with younger age (66 vs 76 years, P=0.01) and AML diagnosis, but not with performance status, comorbidities, or QOL. In total, 63% of all patients reported not being offered other treatment options despite physician documentation of alternatives. Patient and physician estimates of cure differed significantly: 74% of patients estimated their chance of cure to be 50% or greater, yet for 89% of patients physician estimates of cure were 10% or less. IC patients experienced decreased QOL at 2 weeks, but rebounded to baseline and to NIC levels by 6 weeks. Initial QOL is not associated with treatment choice in older AML and aMDS patients. Regardless of treatment choice, patients report not being offered treatment options and overestimate their chances of cure. In IC patients, QOL decreases during hospitalization but rebounds after discharge.

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Authors and Affiliations

  1. Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH, USA

    M A Sekeres

  2. Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    R M Stone, D J De Angelo, I Galinsky & S J Lee

  3. Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA

    D Zahrieh & D Neuberg

  4. Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA

    V Morrison

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  1. M A Sekeres
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Correspondence to M A Sekeres.

Additional information

Presented in part at the American Society of Hematology 43rd and 44th annual meetings (2001: Orlando, FL; 2002: Philadelphia, PA) and at Leukemia 2002: Towards the Cure (2002: Miami, FL).This study was completed at the Dana-Farber Cancer Institute and Minneapolis Veterans Administration Medical Center

Supplementary Information

Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu).

Supplementary information

Supplementary Figure 1

Number of patients completing surveys and outcome at each time point. *In the IC group, Week 6 questionnaires and clinical data were collected 1-2 weeks from hospital discharge for induction chemotherapy. (JPG 517 kb)

Supplementary Table 2 (XLS 14 kb)

Supplementary Table 3 (XLS 15 kb)

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Sekeres, M., Stone, R., Zahrieh, D. et al. Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia 18, 809–816 (2004). https://doi.org/10.1038/sj.leu.2403289

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