Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy.

Abstract

83 Background: Distress screening is a recommended component of comprehensive cancer care, and is now required as a condition of cancer center accreditation by the American College of Surgeons Commission on Cancer. However, the etiology and severity of distress in patients with AML has not been described. Methods: We enrolled hospitalized patients with AML initiating induction chemotherapy, and assessed their distress levels weekly during their month-long hospitalization using the NCCN distress thermometer (DT). The DT is a validated (0-10), 11-point ordinal scale with an accompanying 39-item problem list. We analyzed data using descriptive statistics and Kruskal-Wallis tests. Results: Twenty-six patients provided complete data for analysis.Mean age of study participants was 58.7 (SD 12.2). Patients had high-risk disease characteristics including 13 (50%) being > 60 years old, 13 (50%) with high-risk cytogenetics, and 9 (31%) with relapsed disease. Distress levels were high during the first week of induction (median 5.5; IQR 2-8). The most frequent concerns were largely from the “emotional problems” section of the DT problem list, including: worry (77%), nervousness (62%), fears (54%), and sadness (54%). Physical problems like fatigue (69%) and sleep difficulties (58%) were also prominent. Median distress scores remained above the NCCN DT threshold for referral to support services (score ≥ 4) in weeks 2 and 3 (median scores: 4 (1-8) and 5.5 (2-7), respectively), but improved to 2 (1-6) in week 4. Nervousness and worry were significantly improved at week 4 (p < 0.01), but sadness persisted in 32% and fatigue in 60% of patients at the 4th assessment. Problems with eating and with diarrhea were also still prominent in week 4, at 48% and 36% respectively. Conclusions: Distress is prominent among inpatients with AML receiving induction chemotherapy, with frequent psychological concerns upfront, and persistent symptom distress in later weeks of therapy. These findings underscore the burden of unmet palliative care needs among hospitalized patients with AML. Interventions are needed to address psychological and physical distress in this population.