Quality of Life and Psychological Distress in Patients with Acute Myeloid Leukemia (AML)
Authors: El-Jawahri Areej , Waldman Lauren , Greer Joseph , Abel Gregory A. , Steensma David P. , Brunner Andrew M. , Fathi Amir T. , DeAngelo Daniel J. , Wadleigh Martha , Hobbs Gabriela S. , Amrein Philip C. , Stone Richard M. , Temel Jennifer S 
Published: October 2019

Abstract
Background: Older patients with AML face difficult treatment decisions as they can be treated either with multi-drug 'intensive' chemotherapy requiring a prolonged hospitalization, or 'non-intensive' chemotherapy. Although intensive chemotherapy is often perceived by clinicians as more burdensome, studies comparing patients' quality of life (QOL) and psychological distress while receiving these treatments are lacking.
Methods: We conducted a longitudinal study of older patients (≥ 60 years) newly diagnosed with AML receiving intensive (i.e. 7+3: cytarabine/anthracycline combination) or non-intensive (i.e. hypomethylating agents) chemotherapy at two tertiary care hospitals. We assessed patient's QOL [Functional Assessment of Cancer Therapy-Leukemia], and psychological distress [Hospital Anxiety and Depression Scale [HADS]] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We compared the proportion of patients in each group reporting clinically significant depression or anxiety (HADS subscale cut off ≥ 7) and used mixed linear effects models to compare QOL and psychological distress longitudinally between groups.
Results: We enrolled consecutive patients within 72 hours of initiating intensive (n=50) or non-intensive (n=50) chemotherapy. There were no differences in baseline QOL, depression, or anxiety symptoms between the groups. At baseline, 33.33% (33/100) and 30% (30/100) of the overall cohort reported clinically significant depression and anxiety, respectively, with no differences between groups. At 4 weeks, 41.98% (34/81) of patients in the overall cohort reported clinically significant depression, with no differences between groups. In mixed linear effects models, there were no differences in QOL (β=-0.71, SE=1.12, P=0.527), depression (β=0.24, SE=0.20, P=0.226), or anxiety (β=-0.16, SE=0.19, P=0.386) symptoms between groups over time.
Conclusion: Older patients with AML receiving intensive and non-intensive chemotherapy experience similar QOL impairments and high rates of psychological distress. These findings underscore the need to develop supportive care interventions for older patients with AML, regardless of their initial treatment strategy.

Disclosures
Brunner: Takeda: Research Funding; Novartis: Research Funding; Celgene: Consultancy, Research Funding. Fathi:Celgene: Consultancy, Honoraria, Research Funding; Jazz: Honoraria; Boston Biomedical: Consultancy, Honoraria; Astellas: Honoraria; Agios: Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. DeAngelo:ARIAD: Consultancy, Research Funding; Takeda: Honoraria; Amgen: Consultancy; Shire: Honoraria; Blueprint Medicines: Honoraria, Research Funding; Pfizer Inc: Consultancy, Honoraria; Novartis Pharmaceuticals Corporation: Consultancy, Honoraria; BMS: Consultancy; Glycomimetics: Research Funding; Incyte: Consultancy, Honoraria. Amrein:Takeda: Research Funding.