Palliative care model improves quality of life during treatment for AML
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An integrative palliative and oncology care model improved quality of life, psychological distress and end-of-life care among patients with acute myeloid leukemia, according to a study presented during the ASCO20 Virtual Scientific Program.
Palliative care should be considered a new standard of care for patients with AML, researchers concluded.
“We know from our studies and the work of others that patients with AML face an incredibly challenging and potentially life-threatening illness,” Areej El-Jawahri, MD, instructor of medicine at Harvard Medical School, told Healio. “These patients often experience high toxicities from intensive chemotherapy, including a lot of side effects and symptoms, and they endure prolonged hospitalization for about 4 to 6 weeks immediately after diagnosis. We additionally know that there is a critical need to optimize end-of-life care for patients with AML, as they have a lot of unmet palliative care needs near the end of life and frequently receive intensive care at the end of life.”
El-Jawahri and colleagues assessed the effect of an integrated palliative and oncology care intervention compared with usual oncology care on quality of life, mood, post-traumatic stress symptoms and end-of-life care outcomes among patients with AML.
The study included 160 adults undergoing intensive treatment at multiple sites.
Researchers assigned 86 patients (median age, 63 years; range, 19-77; 57% men; 87.2% white) to the intervention, which included visits with palliative care clinicians at least twice per week during hospitalization for induction chemotherapy and all subsequent hospitalizations. The remaining 74 patients (median age, 65.2 years; range, 22-80; 63.5% men; 85.1% white) received usual oncology care.
Patients completed the Functional Assessment of Cancer Therapy-Leukemia, the Hospital Anxiety and Depression Scale and PTSD Checklist to assess quality of life, mood and PTSD symptoms at baseline and weeks 2, 4, 12 and 24.
Quality of life at week 2 served as the primary endpoint.
In addition, investigators used analysis of covariance and mixed linear effect models to evaluate the impact of the intervention on patient-reported outcomes.
Patients assigned the intervention reported better quality of life at week 2 than those who received usual care (107.59 vs. 116.45; P = .039). They also reported lower levels of depression (7.2 vs. 5.68; P = .021), less anxiety (5.94 vs. 4.53; P = .018) and fewer PTSD symptoms (31.69 vs. 27.79; P = .009).
The intervention effects from baseline appeared to be sustained up to week 24 for quality of life (2.35; P = .048), depression (0.42; P = .039), anxiety (0.38; P = .042) and PTSD symptoms (1.43; P = .002).
An analysis of patients who died showed those assigned the intervention had been more likely to report discussing end-of-life care options with their clinicians (75% vs. 40%; P = .009) but less likely to receive chemotherapy within the last 30 days of life (34.9% vs. 65.9%; P = .008).
“These data demonstrate the potential benefit of integrating palliative care in the care of patients with AML,” El-Jawahri said. “Based on the results of this trial, we believe that the evidence is compelling to recommend integrating palliative care for all patients diagnosed with AML receiving intensive chemotherapy. It should become the new standard of care for this population.
“We need to work now on ensuring that we have high-quality implementation and dissemination studies that allow for successful integration of palliative care across care settings and in different hospitals for patients with AML,” El-Jawahri added. “We also plan to study whether some of the elements of the palliative care intervention can be adapted and integrated into oncology practice by training oncology clinicians to provide maximal supportive care for their patients without requiring palliative care specialists.”
Perspective
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Martin Stockler, MD
The strengths of this study are that it showed benefits were sustained for 6 months, showed the intervention improved end-of-life discussions and care, and reduced aggressive care at the end of life. The main limitations were that it was performed at a leading academic tertiary care setting, and that the intervention and assessments were unblinded, so it is possible that intervention contamination occurred. However — if anything — this would mean the benefits likely would have been underestimated. The implication is that early palliative care was beneficial in high-risk AML. The biggest effects were on health-related quality of life, coping and planning, but not symptom burden. Future research should focus on how to implement and disseminate this intervention, and to look at the possibility of specialty palliative care vs. primary palliative care as a mechanism for delivering this intervention.
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