Quality of Life in Elderly Patients with Acute Myeloid Leukemia.
Authors: Oliva Esther N. , Ronco Francesca , Impera Stefana , Vincelli Iolanda , Alati Caterina , Dimitrov Borislav D. , Giustolisi Rosario , Nobile Francesco 
Published: October 2019

Abstract
The therapeutic approach for acute myeloid leukemia (AML) in elderly patients is generally tailored on the basis of age, performance status, comorbidities and patient consent. Toxicity and low-response rates are major constraints and, in general, the therapeutic options are finally conditioned by the clinicians’ views about the patients’ health status and preferences. In this setting, the patients’ perception of their own health (health-related quality of life, or HRQOL) may be useful. With this purpose, we designed a prospective multicenter study to evaluate the predictive potentials of HRQOL measures on prognosis and outcome in elderly AML patients (aged over 60 years). We here present pilot baseline results on data obtained from 25 AML patients of median age 74 (range 60–91) yrs. HRQOL measures were obtained by applying the QOL-E©questionnaire at diagnosis. Reliability of the questionnaire was evaluated and associations with patient and disease-related factors were investigated. We found that the QOL-E© questionnaire as highly reliable in the AML patients (standardized Cronbach alpha coefficients> 0.70).
Table 1. Reliability of the QOL-E questionnaire.
QOL-E© domains Standardized Cronbach alpha coefficients QOL-E©scores were particularly low (reflecting poor HRQOL) in the fatigue and disease-specific domains. Physical 0.90 Functional 0.80 Social 0.80 Sexual 0.81 Fatigue 0.77 Disease-Specific 0.78 Total 0.70
Table 2. QOL-E scores in the AML patients.
QOL-E© domains QOL-E© scores* *Scores are standardized, expressed in percentage ±SEM Physical 60 ± 6 Functional 64 ± 4 Social 56 ± 6 Sexual 50 ± 8 Fatigue 34 ± 4 Disease-specific 26 ± 4 Total 38 ± 5
In this study, male AML patients (15 patients) perceived better well-being in the QOL-E© disease-specific domain than females (33±4 versus 15±7 %, p=0.04). The lack of domestic assistance (reflecting no previous need for help at home) was associated with better functional scores (p=0.037) and a lesser sense of fatigue (p=0.042) at diagnosis. Patients with concomitant diseases had a poorer sense of physical wellbeing (45± %) versus those without (28±8%, p=0.01). Increasing age significantly correlated with decreasing QOL-E© physical (r=−0.414, p=0.04), functional (r=−0.470, p=0.018) and fatigue (r=−0.487, p=0.015) scores. ECOG performance status (objective score of patient’s wellbeing) was not associated with subjective measures of HRQOL in the single domains, but only with the total score (r=−0.570, p=0.04). Noteworthy, the QOL-E© disease-specific scores correlated with the percentage of peripheral blasts (r=−0.302, p=0.078) and bone marrow blasts (r=−0.387, p=0.024). In conclusion, QOL-E© is a very simple and reliable instrument for the assessment of HRQOL in elderly patients with AML. At diagnosis HRQOL is poor, especially with increasing age and in patients with a high blast count. Future prospective results in an adequate number of patients may provide useful information on the implementation of patient-tailored therapy in this particular category of AML patients.