Remission induction therapy for patients with acute myeloid leukemia (AML) is intensive, necessitating a four-to-six-week hospitalization. In a study examining whether the treatment also translated into more intensive symptom burden, investigators discovered that patients with AML face significant symptom burden and a decline in quality of life throughout treatment induction, which suggests a need to initiate palliative care services.
“Patients receiving induction chemotherapy for AML have a more significant symptom burden than we often realize despite our best efforts at aggressively managing their symptoms,” said the study’s lead author, Thomas W. LeBlanc, MD, MA, from Duke Cancer Institute and the Division of Hematologic Malignancies and Cellular Therapy at Duke University School of Medicine. The research was presented at the 2015 ASH Annual Meeting.
The study enrolled 43 inpatients with AML undergoing intensive induction chemotherapy. Patients had a mean age of 59.4 years, and 49 percent (n=21) were female. The researchers evaluated patients on a weekly basis to assess their symptoms, quality of life, and distress during a month-long hospitalization for induction. Patients were then evaluated monthly in follow-up using the following three tools:
- Patient Care Monitor v2.0 (PCM)
- Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu)
- National Comprehensive Cancer Network (NCCN) distress thermometer (DT)
Throughout the four-week induction, the study’s participants reported moderate to severe levels of fatigue (56%), dysgeusia (44%), difficulty sleeping (38%), dry mouth (37%), and reduced appetite (35%).
Although patients were receiving standard supportive care, moderate to severe symptoms were still present – most prominently in the second and third weeks of treatment. These included diarrhea (35%), daytime sleepiness (30%), and nausea (27.5%).
“Some of the most prevalent symptoms are ones that we might expect to improve with targeted attention, such as diarrhea, difficulty sleeping, and dry mouth,” Dr. LeBlanc told ASH Clinical News. “These findings suggest that we should develop and test new models for improving supportive care for AML patients during induction to improve the patient experience.”
Quality-of-life scores also decreased for patients following chemotherapy induction. According to the data, the mean quality-of-life scores dropped from 121.8 in the first week of treatment to 108.2 in the second week (p<0.01). After the second week of treatment, the scores began to slowly rise, reaching levels higher than baseline by the third month.
Along with declines in quality-of-life scores, the researchers found that patients experienced significant amounts of distress — particularly during the first three weeks of therapy. Using the NCCN DT, the mean distress score across the four weeks of follow-up was four — the threshold score for recommending a patient for additional support services, the authors noted.
The researchers also found that patients who were not in remission when their recovery bone marrow biopsy was done between 30 and 45 days post-induction had significantly worse quality of life and greater distress than those patients who were in remission. Dr. LeBlanc said that while this finding may be intuitive, it still represents an unaddressed need in clinical practice and suggests the need for a palliative care specialist for those patients with relapsed/refractory AML.
“A palliative care specialist adds a symptom management expert to the picture and also a clinician with further expertise in assessing and addressing the psychosocial distress issues,” said Dr. LeBlanc.
LeBlanc T, Wolf S, El-Jawahri A, et al. Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: Results of a prospective electronic patient-reported outcomes study. Abstract #4496. Presented at the American Society of Hematology Annual Meeting, December 7, 2015; Orlando, FL.