Among patients with acute myeloid leukemia (AML), integrated palliative and oncology care (IPC) appears to improve quality of life (QOL) compared with usual care, according to research published in JAMA Oncology. The study investigators also noted that IPC should be seen as the new standard of care in AML.
Patients with AML who receive intensive chemotherapy have significant QOL-related issues, including psychological distress and increased symptom burden. In addition, there is evidence that while IPC can improve QOL-related outcomes in this patient population, it is rarely integrated into care, and an inadequate percentage of patients discuss end-of-life (EOL) care with their clinicians.
A team of researchers “conducted a multisite, nonblinded randomized clinical trial to assess the effect of [IPC] vs usual care on QOL, mood, symptom burden, posttraumatic stress symptoms, and EOL outcomes for hospitalized patients with AML receiving intensive chemotherapy.” The authors hypothesized that IPC would be linked with improved QOL-related outcomes and higher rates of discussing EOL preferences with clinicians.
Patients were asked to complete the 44-item Functional Assessment of Cancer Therapy-Leukemia scale to assess QOL, the 14-item Hospital Anxiety and Depression Scale, and the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian test. The tests were completed at baseline and at weeks 2, 4, 12, and 24.
Of 250 eligible patients, 160 patients were randomly assigned to either usual care (74 patients) or IPC (86 patients); the median patient age was 64.4 years (range, 19.7-80.1) and 138 patients (86.2%) were White.
At week 2, patients assigned to receive IPC scored higher on QOL assessment compared with patients assigned to usual care (adjusted mean score, 116.45 vs 107.59, respectively; P =.04). Patients receiving IPC also reported better depression scores compared with patients assigned to usual care (adjusted mean score, 5.68 vs 7.2, respectively; P =.02). Anxiety scores (P =.02) and symptoms of posttraumatic stress (P =.01) were also in favor of IPC compared with usual care, and these differences held through week 24.
Among patients who died during the study (n=58), those who received IPC were more likely to discuss EOL care preferences (75% in IPC vs 40% in usual care; P =.01). Patients in the IPC group did not receive chemotherapy as frequently as did those in the usual care group (34.9% vs 65.9%, respectively; P =.01).
“As these patients spend the majority of their time in the hospital and clinical settings, there are numerous opportunities to engage palliative care clinicians early and longitudinally in their care,” the authors noted. “Thus, early palliative care at the time of diagnosis for patients with AML should become standard of care to improve the QOL and care for this population.”
Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia: a randomized clinical trial. Published online December 17, 2020. JAMA Oncol. doi:10.1001/jamaoncol.2020.6343