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Integrated Palliative, Oncology Care for AML Improves PROs

May 15, 2020

A study to be presented at the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program (May 29-31, 2020) highlights the results of an integrated palliative and oncology care model for patients with acute myeloid leukemia (AML).

Patients with AML who receive intensive chemotherapy often experience a significant decline in their quality of life (QoL) and mood during their hospitalization for induction chemotherapy. Additionally, these patients often receive aggressive end-of-life care.

Areej El-Jawahri, MD, Massachusetts General Hospital, and colleagues designed a study to examine the effects of integrated palliative and oncology care on QoL, mood, post-traumatic stress symptoms, and end-of-life outcomes in patients with AML. The multisite trial randomized 160 patients with AML undergoing intensive chemotherapy between January 2017 and July 2019, 86 of whom received integrated palliative and oncology care and the remaining 74 of whom received usual oncology care.

Patients in the intervention group were seen by palliative care clinicians at least twice per week during hospitalization for induction therapy as well as any subsequent hospitalization. All patients completed the Functional Assessment of Cancer Therapy-Leukemia; the Hospital Anxiety and Depression Scale; and the Post-Traumatic Stress Checklist to assess their QoL, mood, and post-traumatic stress symptoms at baseline as well as weeks 2, 4, 12, and 24.

The primary endpoint of the analysis was QoL at week 2, researchers noted.

Dr El-Jawahri and colleagues found that patients in the intervention group reported better QoL than those receiving usual care (116.45 vs 107.59, respectively; P = .039), as well as lower depression (5.68 vs 7.20, respectively; P = .021), anxiety (4.53 vs 5.94, respectively; P = .018), and post-traumatic stress symptoms (27.79 vs 31.69, respectively; P = .009) at week 2. Intervention effects were sustained up to week 24 for QoL, depression, anxiety, and post-traumatic stress symptoms.

Furthermore, researchers found that among deceased patients, those receiving the intervention were more likely to report discussing their end-of-life care preferences with their clinicians (75.0% vs 40.0%, respectively; P = .009) and less likely to receive chemotherapy in the last 30 days of life (34.9% vs 65.9%, respectively; P = .008) than those receiving usual care.

Researchers acknowledged that there was no difference in hospice utilization or hospitalization between the patient groups at end of life.

These results support the consideration of palliative care as a new standard of care for patients with AML, authors of the study concluded.—Zachary Bessette

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