Supportive Care in Cancer

, Volume 26, Issue 5, pp 1437–1445 | Cite as

The impact of remission status on patients’ experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data

  • Neha Kayastha
  • Steven P. Wolf
  • Susan C. Locke
  • Gregory P. Samsa
  • Areej El-Jawahri
  • Thomas W. LeBlanc
Original Article

Abstract

Purpose

Shared decision-making in acute myeloid leukemia (AML) requires understanding patients’ longitudinal experiences of illness, but little is known about the impact of remission status on patient-reported outcomes (PROs). We aimed to explore the association between remission status and PROs 6–12 months following induction chemotherapy.

Methods

Forty-two patients completed three validated instruments characterizing symptom burden (Patient Care Monitor v2.0), distress (NCCN Distress Thermometer), and QOL (FACT-Leu), as part of a longitudinal observational study. We used regression models to explore the relationship between remission status and PROs, and explore differences by initial disease type (de novo versus secondary/relapsed AML).

Results

Those with secondary or relapsed AML at study onset had marked impairments in all measures compared to de novo AML patients. After 6 months, their mean distress score was 4.8 (> 4.0 warrants intervention), they reported a mean of 14.1 moderate/severe symptoms and had a mean QOL score of 113.6, compared to 1.0, 1.7, and 155.2, respectively, for those with de novo AML (p < .0001). Similarly, patients in relapse had a mean distress score of 5.3, a mean of 12.8 moderate/severe symptoms, and a mean QOL score of 113.4, compared to 1.8, 5.7, and 143.8, respectively, among those in remission (p < .005). These patterns persisted after adjusting for baseline differences (p < .0001).

Conclusion

Remission is associated with markedly better patient well-being in AML. Patients with secondary or relapsed AML face more severe symptom burden, distress, and QOL issues after induction. Interventions are needed to improve AML patients’ experiences of illness.

Keywords

Acute myeloid leukemia Quality of life Distress Symptom burden Remission Patient-reported outcomes 

Notes

Compliance with ethical standards

The Institutional Review Board of the Duke University School of Medicine approved this protocol. Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

The authors declare that they have no relevant conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Neha Kayastha
    • 1
  • Steven P. Wolf
    • 2
    • 3
  • Susan C. Locke
    • 2
  • Gregory P. Samsa
    • 2
    • 3
  • Areej El-Jawahri
    • 4
  • Thomas W. LeBlanc
    • 1
    • 2
    • 5
  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Duke Cancer InstituteDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  4. 4.Department of Hematology and OncologyMassachusetts General HospitalBostonUSA
  5. 5.Duke University School of MedicineDurhamUSA

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