Chemotherapy in Elderly Patients with Acute Myeloid Leukemia (AML): Analysis of Socioeconomic Factors Using National Cancer Data Base (NCDB)
Authors: Upadhyay Smrity , Dahal Sumit , Khanal Nabin , Bhatt Vijaya R. , Silberstein Peter T. 
Published: October 2019

Abstract
Acute myeloid leukemia (AML) is one of the most common types of leukemia in adults, accounting for approximately 35% of leukemia in United States (CA Cancer J Clin 2014;64(1):9-29). The use of chemotherapy is associated with significant survival benefit in AML, particularly young and fit individuals. Although survival rates have improved remarkably in the younger age group, the prognosis in older patients continues to be poor. The receipt of chemotherapy has a potential to alter the prognosis in elderly AML patients, however, many older patients may not be able to receive chemotherapy. We analyzed the trend in chemotherapy use in AML patients ³60 years using NCDB to understand the socioeconomic determinants of chemotherapy use.
Methods: This is a retrospective study of AML patients (n= 99,664) diagnosed between 2000 and 2011 in the NCDB hospitals. NCDB contains approximately 70% of new cancer diagnosis in the United States and Puerto Rico. Chi-square test was used to determine any differences in characteristics of AML patients 60 years or above who did or did not receive systemic therapy.
Results: Nearly 61% of AML patients were 60 years or above (n= 60,477), however, chemotherapy use was significantly lower in these patients than those below 60 years (57% vs 70%, p < .0001). In patients 60 years or above, males were more likely to receive chemotherapy than females (59% vs 55%; p < .0001) (Table 1). While their use was higher at academic vs. non-academic hospitals (67% vs 51%; p < .0001), presence or absence of other comorbidities in these patients also determined its use (55% vs 60%, p < .0001). However, race, education or household income did not significantly affect chemotherapy use in the elderly population.
Conclusions: AML predominantly affects patients more than 60 years of age (Cancer. 2006;107(9):2099-107). The factors negatively influencing treatment outcomes, including poor performance status, the presence of comorbidities, adverse cytogenetics and antecedent hematologic disorders are more common in this subset of population (Blood research. 2014;49(2):95-9). The management of elderly AML patients is complex and requires good understanding of risks and benefits of chemotherapy in individual patient. Our study demonstrates that the chemotherapy use in elderly patients is lower than younger patients and differ by patients' gender, type of hospital and the presesnce of comorbidties. Understanding the health care disparities can help individualize and optimize cancer treatment leading to better quality of care in patients expected to have poorer outcomes.
Table 1. Pattern of chemotherapy use in patients 60 years or above with AML Parameter Percent of cases receiving chemotherapy p-value Gender <.0001 Male 59 Female 55 Race 0.3677 White 57 Black 57 Hispanics 59 Education (% with high school degree) 0.8611 ³ 88% 57 70-88% 57 < 69% 57 Income 0.0909 < $28,000 56 $28,000 to $48,999 57 ³ $49,000 58 Comorbidity <.0001 None 60 ³ 1 55 Treatment Facility <.0001 Academic Hospital 67 Other Hospitals 51

Disclosures
No relevant conflicts of interest to declare.