Prognostic, Treatment Perceptions Differ Between AML Patients, Oncologists
Prognosis and cure perceptions among older adults with acute myeloid leukemia (AML) often diverge from oncologist estimates, according to research presented at the 59th American Society of Hematology Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).
Many in this patient population did not report engaging in end-of-life discussions with their treatment providers, despite their poor prognoses.
Older patients with AML are usually treated with intensive multiagent chemotherapy, which may lead to a cure, or nonintensive palliative chemotherapy. Few studies have addressed whether these patients fully understand their prognosis and treatment risks, and how that potential lack of understanding influences treatment decisions.
Areej R El-Jawahri, MD, hematologist at Massachusetts General Hospital (Boston, MA), and colleagues conducted a longitudinal study of older patients (> 60 years) with newly diagnosed AML. Patient and oncologist perceptions of treatment-related mortality were assessed at baseline, with perception of prognosis reassessed after 1 month of treatment. Researchers further assessed whether end-of-life discussions occurred at 24 weeks.
The study included data from 100 patients receiving intensive (n = 50) or nonintensive (n = 50) chemotherapy. The majority of patients (95.06%) reported that it was “very important” for them to know their prognosis. However, researchers observed a significant discrepancy among patients who reported that death on treatment was at least “somewhat likely” (91.3%) and oncologists who reported that death was “very unlikely” (80%; P < .001).
Ninety percent of patients reported believing their leukemia was “very likely” to be cured, while 74% of oncologists reported that cure was “unlikely” or “very unlikely” (P < .001). These discrepancies persisted among patients receiving both intensive and nonintensive therapy.
Nearly all patients (97.6%) receiving intensive chemotherapy believed a cure was “somewhat likely” or “very likely”, while 58% of their oncologists described cure as “unlikely” (P < .001). Among patients receiving nonintensive chemotherapy, 82.1% of patients believed a cure was “somewhat or very likely”, while 90% of oncologists believed cure was unlikely (P < .001).
At 24 weeks, 77.8% of patients reported that they had not discussed end-of-life options with their oncologists.
These data underscore the critical gaps in communication and prognostic understanding in order patients with AML,” researchers concluded. “Interventions are needed to improve communication with oncologists and to ensure older patients with AML have an accurate understanding of their treatment risks and prognosis to make informed decisions about their treatment.”—Cameron Kelsall