Quality of life and mood of older patients with acute myeloid leukemia (AML) receiving intensive and non-intensive chemotherapy

• Published in: Leukemia Vol. 33; no. 10; pp. 2393 - 2402
• Main Authors: El-Jawahri, Areej, Abel, Gregory A., Traeger, Lara, Waldman, Lauren, Markovitz, Netana, VanDusen, Harry, Fathi, Amir, Steensma, David P., LeBlanc, Thomas W., Horick, Nora K., DeAngelo, Daniel J., Wadleigh, Martha, Hobbs, Gabriela, Foster, Julia, Brunner, Andrew M., Amrein, Philip, Stone, Richard M., Temel, Jennifer S., Greer, Joseph A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2019; Nature Publishing Group
• Subjects: 692/700/228/415; 692/700/784; Acute myeloid leukemia; Affect - physiology; Aged; Aged, 80 and over; Anthracycline; Anthracyclines - therapeutic use; Antineoplastic Agents - therapeutic use; Anxiety; Anxiety - physiopathology; Cancer Research; Chemotherapy; Correlation analysis; Critical Care Medicine; Cytarabine; Cytarabine - therapeutic use; Demographic aspects; Depression - psychology; Female; Health aspects; Hematology; Humans; Intensive; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - psychology; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Mood; Mood (Psychology); Myeloid leukemia; Oncology; Patients; Quality of Life; United States
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/s41375-019-0449-1

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.