Exploring Symptom Burden, Treatment Bother, Physical Function, and Quality of Life By Frailty Status in Patients with Acute Myeloid Leukemia

Abstract

Introduction: Evidence-based guidelines for patients with Acute Myeloid Leukemia (AML) acknowledge the importance of frailty status when deciding on treatment. Frailty status may also influence patient outcomes throughout cancer treatment. Electronic Patient Reported Outcomes (ePROs) effectively capture the real-world patient experience as it relates to frailty status and health outcomes. Using ePROs, this study explored symptom burden, treatment bother, physical function, and quality of life across fit, intermediate, and frail patients with AML . Methods: All consenting adult patients with an AML diagnosis and current evidence of treatment were enrolled in the Carevive PROmPT® remote symptom monitoring platform between September 1, 2020 and March 10, 2023. Demographic and clinical characteristics were captured at baseline, including age, sex, race, frailty status, comorbidities, and social determinants of health. Classification of a patient's frailty status (fit, intermediate, or frail) involved triangulating data from three separate sources: Carevive's electronic Geriatric Assessment (eGA), the Cancer and Aging Resilience Evaluation (CARE) geriatric survey, and self-reported activity level. Validated psychometric tools were also used weekly to capture each outcome of interest, including symptoms (PRO-CTCAE), treatment bother (FACT-GP5), physical function (PROMIS-4a) and quality of life (EORTC QLQ #29-30). All results were stratified by frailty status. Results: A total of 124 patients were included in the analysis. The median age of patients was 66 (range 21-88), half were male (50%), a majority were white (76%), and most had at least one comorbidity (69%). The median follow up time was 12 weeks (range 1-89). Frailty status was successfully classified for 117 (94%) patients and 98% of patients with 12+ weeks of follow up; among those classified, 38 (32%) were fit, 63 (54%) were intermediate, and 16 (14%) were frail. Across all patients, the most frequently reported symptoms were fatigue (23% across all patient-weeks), decreased appetite (18% across all patient-weeks), and general pain (18% across all patient-weeks) (See Figure). Symptom burden was considerably lower for fit patients at the start of their treatment (12%) compared to intermediate (18%) and frail (20%) patients. Fit patients also had a consistent reduction in symptom burden over time (Week 1: 11%; Week 12: 4%), as did intermediate patients (Week 1: 20%; Week 12: 11%). However, frail patients had intermittent spikes of symptom burden across the same time period (Week 5: 17%, Week 11: 17%). Treatment bother, physical function, and quality of life were comparable between fit and intermediate patients but consistently worse for frail patients. Conclusions: This study illustrates the feasibility of using remote symptom monitoring for gathering data on frailty status, symptom burden, treatment bother, physical function, and quality of life for patients with AML. Findings suggest there may be functional differences in the overall patient experience at different levels of frailty. This further supports the importance of using frailty status in oncology care, especially to identify actionable risk factors for poor health outcomes during cancer treatment.