Integrated Palliative and Oncology Care Improved QOL, End-of-Life Care for Patients with AML

Integrated palliative and oncology care for patients with acute myeloid leukemia (AML) led to improved quality of life (QOL), psychological distress, and end of life care, according to data published in JAMA Oncology.

Because of this, the investigators concluded that integrated palliative care should be considered the new standard of care for treating patients with AML.

“Results of this multisite randomized clinical trial demonstrate that [integrated palliative and oncology care] improves QOL, depression and anxiety symptoms, and posttraumatic stress symptoms for patients with AML receiving intensive chemotherapy compared with usual care,” wrote the investigators.

Patient outcomes were assessed using the 44-item Functional Assessment of Cancer Therapy-Leukemia scale to assess QOL, which was graded on a range of 0 to 176, with subscales to assess anxiety and depression (range, 0-21). Additionally, posttraumatic stress disorder (PTSD) was scored on a range of 17 through 85 by the PTSD Checklist-Civilian version. For the assessment of outcomes longitudinally over time, the β estimated coefficient—where a positive outcome indicates a positive association between the intervention and the outcome of interest, and a negative outcome denotes the opposite—were reported for all time points at baseline, 2 weeks, 4 weeks, 12 weeks, and 24 weeks.

When compared with patients receiving usual care at 2 weeks of treatment, participants from the integrated palliative and oncology care group reported a better QOL (adjusted mean score, 107.59 vs 116.45; P = .04), lower depression levels (7.20 vs 5.68; P = .02), reduced anxiety (5.94 vs 4.53; P = .02), and lessened PTSD symptoms (31.69 vs 27.79; P = .01).

The intervention effects were also sustained through week 24 of the analysis for quality of life (β, 2.35; 95% CI, 0.02-4.68; P = .048), depression (β, −0.42; 95% CI, −0.82 to −0.02; P = .04), anxiety (β, −0.38; 95% CI, −0.75 to −0.01; P = .04), and PTSD symptoms (β, −1.43; 95% CI, −2.34 to −0.54; P = .002).

Moreover, when the investigators examined the group of patients who died, they found that those who received integrated palliative and oncology care were more likely to report discussing end-of-life care preferences than patients who only received usual care (21 of 28 [75.0%] vs 12 of 30 [40.0%]; P = .01).

This group of patients receiving integrated palliative and oncology care were also less likely to receive chemotherapy treatment near end of life than patients receiving usual care (15 of 43 [34.9%] vs 27 of 41 [65.9%]; P = .01).

There were 160 patients enrolled in the study out of 235 who were eligible, with a median age of 64.4 years (range, 19.7-80.1). Sixty-four of the patients were women, accounting for 40% of the total participant population.

“Although many oncologists question palliative care clinicians’ ability to meet the specialized needs of patients with AML, the present findings provide compelling evidence to the contrary,” wrote the investigators. “Although prior randomized trials of [integrated palliative and oncology] care models have traditionally excluded patients with hematologic cancers, this study establishes the role of palliative care for improving the QOL and care in patients with AML.”

The investigators randomized 2 cohorts of patients with AML to examine and collect data on integrated palliative and oncology care (n = 86) versus usual care (n = 74). For the palliative care group, patients were seen by palliative care clinicians twice a week during both initial and subsequent hospitalizations.

As for the limitations of the research, the investigators acknowledge that because the research was conducted at only tertiary care academic centers, the data is not generalizable across other care settings. Additionally, the sample of patients lacked strong ethnic and racial diversity, leaving unanswered questions regarding the effects of this research on that cohort of the population.

Reference:

El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia. JAMA Oncology. doi:10.1001/jamaoncol.2020.6343