The impact of remission status on patients’ experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data
Shared decision-making in acute myeloid leukemia (AML) requires understanding patients’ longitudinal experiences of illness, but little is known about the impact of remission status on patient-reported outcomes (PROs). We aimed to explore the association between remission status and PROs 6–12 months following induction chemotherapy.
Forty-two patients completed three validated instruments characterizing symptom burden (Patient Care Monitor v2.0), distress (NCCN Distress Thermometer), and QOL (FACT-Leu), as part of a longitudinal observational study. We used regression models to explore the relationship between remission status and PROs, and explore differences by initial disease type (de novo versus secondary/relapsed AML).
Those with secondary or relapsed AML at study onset had marked impairments in all measures compared to de novo AML patients. After 6 months, their mean distress score was 4.8 (> 4.0 warrants intervention), they reported a mean of 14.1 moderate/severe symptoms and had a mean QOL score of 113.6, compared to 1.0, 1.7, and 155.2, respectively, for those with de novo AML (p < .0001). Similarly, patients in relapse had a mean distress score of 5.3, a mean of 12.8 moderate/severe symptoms, and a mean QOL score of 113.4, compared to 1.8, 5.7, and 143.8, respectively, among those in remission (p < .005). These patterns persisted after adjusting for baseline differences (p < .0001).
Remission is associated with markedly better patient well-being in AML. Patients with secondary or relapsed AML face more severe symptom burden, distress, and QOL issues after induction. Interventions are needed to improve AML patients’ experiences of illness.
KeywordsAcute myeloid leukemia Quality of life Distress Symptom burden Remission Patient-reported outcomes
This research was supported by a Junior Career Development Award to Dr. LeBlanc from the National Palliative Care Research Center, and a Sojourns Scholars Award to Dr. LeBlanc from the Cambia Health Foundation. Dr. LeBlanc’s research is currently supported by the American Cancer Society (grant number 128776-MRSG-15-185-01-PCSM). Mr. Wolf is supported by the National Institutes of Health funding for the Duke Biostatistics Core (grant number UL1TR001117)
Compliance with ethical standards
The Institutional Review Board of the Duke University School of Medicine approved this protocol. Informed consent was obtained from all individual participants included in the study.
Conflicts of interest
The authors declare that they have no relevant conflicts of interest.
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