ACCORDING to findings from a recent cohort study of older adults with newly diagnosed acute myeloid leukaemia (AML), the survival benefit of patients receiving anthracycline-based therapy was entirely offset by admission to the hospital or nursing facilities. The number of days spent at home (“home time”) versus time spent in a medical facility is a significant factor in treatment decision-making for AML patients. Researchers attempted to describe “home time” in AML patients aged 66 and older while also comparing “home time” between patients receiving anthracycline-based chemotherapy and hypomethylating agents (HMAs).
The study, utilising data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 2004 to 2016, involved 7,946 older adults. The patients were stratified into three groups based on their treatment regimens: anthracycline-based chemotherapy, HMAs, and a general chemotherapy category not otherwise specified (NOS). The primary outcome measured was “home time,” calculated by subtracting the total number of days spent in hospitals and nursing facilities from the total number of days survived, then dividing by the total number of days in the year.
The study revealed that patients receiving HMAs experienced significantly more home time within the first year after chemotherapy compared to those treated with anthracyclines. Specifically, those on HMAs had an average of 222 days at home, while those on anthracyclines had 189 days. Despite the shorter median overall survival of 8 months for the HMA group compared to 11 months for the anthracycline group, the HMA patients benefited from more days at home, suggesting a better quality of life.
This discrepancy highlights a critical consideration for older AML patients: the additional survival time achieved through anthracycline-based therapy may be entirely offset by increased time spent in hospitals or nursing facilities. The study’s adjusted analysis, which accounted for various confounding factors, indicated that overall home time in the first year was 52.4% for all patients. Home time was highest among those receiving HMAs at 60.8%, compared to 51.9% for those receiving anthracyclines.
These findings suggest that hypomethylating agents may offer a preferable balance of survival and quality of life for older adults with AML. The results underscore the need for clinicians to adopt a more nuanced approach when discussing treatment options with elderly AML patients, ensuring that decisions align with patient preferences for home time and overall well-being—not just longevity.
Reference:
Richardson DR et al. Home time among older adults with acute myeloid leukemia following chemotherapy. 2024;DOI:10.1001/jamaoncol.2024.1823
