Impact of intensive chemotherapy versus supportive care on quality of life (QOL) of older adults with newly diagnosed acute myeloid leukemia (AML)

Abstract

8187 Background: Older patients with AML often have a poor prognosis and often do not tolerate intensive chemotherapy. When weighing alternate management strategies (e.g. best supportive care), impact upon QOL should be evaluated. However, there is limited published research in this area. Methods: Patients aged 60 or older presenting with newly diagnosed AML to an AML referral centre were enrolled regardless of treatment intent. Patients were excluded if life expectancy was under 1 month or they did not speak English. QOL was measured at baseline and at 1, 4, and 6 months. Questionnaires included the European Organization for the Research and Treatment of Cancer QLQ-C30 (global health, 5 QOL domains, 3 symptom domains) and the Functional Assessment of Cancer Therapy Fatigue subscale. Patients were stratified by intensive versus non-intensive treatment. Results: From June 2003 to July 2004, 28 patients (mean age 72) were enrolled. At baseline, global health, role function, and social function were the most affected domains. Fatigue was the predominant symptom. Among patients treated intensively, global health, role function, and social function improved over time. Other domains were unchanged. Non-intensively managed patients had smaller improvements in global health and improved role function and cognitive function. Social function declined and other domains remained stable. Fatigue scores improved minimally over time in both groups, and were unaffected by remission status. Pain scores were low at baseline but worsened slightly over time in both groups. Conclusion: QOL in older patients appears to be significantly affected by AML. Intensive chemotherapy is associated with greater improvement or less decline in several domains of QOL but little improvement in fatigue. These results can inform decision-making for older adults with AML and suggest the need for better symptom management. No significant financial relationships to disclose.