Contributions
Abstract: PB1728
Type: Publication Only
Background
AML is diagnosed at a median age of 67; once over 60 years of age, the 5-years survival rates for patients with AML fall substantially because they are often not eligible for intensive chemotherapy (NIC). Less intensive chemotherapeutic agents and best supportive care are potential treatment options in this population. There is scant published literature on the impact of disease and treatment on the health-related quality of life (HRQoL) in NIC AML patients.
Aims
We aimed to determine the reported quality of life among NIC AML patients.
Methods
We conducted a systematic literature review (SLR) of evidence on HRQoL reported in patients with NIC AML. MEDLINE, Cochrane database, and conference abstracts (EHA, ASCO, ESMO, and ASH) were searched using matches on pre-specified population, interventions, comparators, outcomes and study designs (PICOS approach) from January 2000 through November 2017 for relevant studies that reported HRQoL and patient preference utilities in NIC AML. Based on the WHO AML criteria, studies on patients with RAEB-t myelodysplastic syndrome (MDS) (≥ 20% bone marrow blast) were also included. Randomized clinical trials (RCTs), prospective observational studies and patient surveys were included. Systematic reviews and meta-analyses were used for bibliographic search. Two researchers independently selected trials, assessed trial quality, and extracted and analysed data.
Results
A total of 13 records from 12 original studies were identified. These included 5 records from 4 original RCTs, 3 prospective studies, 4 patient survey studies, and 1 cost-effectiveness analysis reporting utility values. Ten studies utilized the EORTC QLQ-C30 questionnaire, 5 reported EQ-5D values. Other scales used included QOL-E, QOL Cancer Survivor, FACT-Leukemia, FACT-Fatigue, Global Fatigue Scale, FACIT Fatigue, Activities of Daily Living index and Hospital Anxiety and Depression Scale. Four QLQ-C30 domains were considered most relevant: fatigue, physical function (PF), Global Health Status (GHS) and dyspnea. A 10-point minimally important difference (MID) threshold on a 100-point scale was assumed by a majority of studies to represent meaningful change. At baseline, NIC AML patients had poor HRQoL scores especially in fatigue (33) and GHS (50) on a 0-100 scale, with higher scores indicating better health. Low baseline HRQoL scores, especially PF and fatigue (<50) were shown to be significant independent predictors of poor survival. Clinical responders demonstrated meaningful improvements in QLQ-C30 physical, role, cognitive and social functioning, GHS, fatigue and EQ-5D scores from baseline after being treated with chemotherapy. Clinically meaningful and significant improvements in fatigue and PF were observed with non-intensive chemotherapeutic agents across several studies.
Conclusion
Although HRQoL is highly subjective, it plays a crucial role in the treatment of AML patients. Fatigue and physical function at baseline have been identified as independent prognostic factors for overall survival with several studies showing improvement in both domains with treatment. Randomized controlled studies should incorporate evaluation of treatment impact on patient’s physical function and fatigue as important measures of effectiveness.
Session topic: 4. Acute myeloid leukemia - Clinical
Keyword(s): Acute Myeloid Leukemia, Clinical data, Quality of Life, Systematic review
Abstract: PB1728
Type: Publication Only
Background
AML is diagnosed at a median age of 67; once over 60 years of age, the 5-years survival rates for patients with AML fall substantially because they are often not eligible for intensive chemotherapy (NIC). Less intensive chemotherapeutic agents and best supportive care are potential treatment options in this population. There is scant published literature on the impact of disease and treatment on the health-related quality of life (HRQoL) in NIC AML patients.
Aims
We aimed to determine the reported quality of life among NIC AML patients.
Methods
We conducted a systematic literature review (SLR) of evidence on HRQoL reported in patients with NIC AML. MEDLINE, Cochrane database, and conference abstracts (EHA, ASCO, ESMO, and ASH) were searched using matches on pre-specified population, interventions, comparators, outcomes and study designs (PICOS approach) from January 2000 through November 2017 for relevant studies that reported HRQoL and patient preference utilities in NIC AML. Based on the WHO AML criteria, studies on patients with RAEB-t myelodysplastic syndrome (MDS) (≥ 20% bone marrow blast) were also included. Randomized clinical trials (RCTs), prospective observational studies and patient surveys were included. Systematic reviews and meta-analyses were used for bibliographic search. Two researchers independently selected trials, assessed trial quality, and extracted and analysed data.
Results
A total of 13 records from 12 original studies were identified. These included 5 records from 4 original RCTs, 3 prospective studies, 4 patient survey studies, and 1 cost-effectiveness analysis reporting utility values. Ten studies utilized the EORTC QLQ-C30 questionnaire, 5 reported EQ-5D values. Other scales used included QOL-E, QOL Cancer Survivor, FACT-Leukemia, FACT-Fatigue, Global Fatigue Scale, FACIT Fatigue, Activities of Daily Living index and Hospital Anxiety and Depression Scale. Four QLQ-C30 domains were considered most relevant: fatigue, physical function (PF), Global Health Status (GHS) and dyspnea. A 10-point minimally important difference (MID) threshold on a 100-point scale was assumed by a majority of studies to represent meaningful change. At baseline, NIC AML patients had poor HRQoL scores especially in fatigue (33) and GHS (50) on a 0-100 scale, with higher scores indicating better health. Low baseline HRQoL scores, especially PF and fatigue (<50) were shown to be significant independent predictors of poor survival. Clinical responders demonstrated meaningful improvements in QLQ-C30 physical, role, cognitive and social functioning, GHS, fatigue and EQ-5D scores from baseline after being treated with chemotherapy. Clinically meaningful and significant improvements in fatigue and PF were observed with non-intensive chemotherapeutic agents across several studies.
Conclusion
Although HRQoL is highly subjective, it plays a crucial role in the treatment of AML patients. Fatigue and physical function at baseline have been identified as independent prognostic factors for overall survival with several studies showing improvement in both domains with treatment. Randomized controlled studies should incorporate evaluation of treatment impact on patient’s physical function and fatigue as important measures of effectiveness.
Session topic: 4. Acute myeloid leukemia - Clinical
Keyword(s): Acute Myeloid Leukemia, Clinical data, Quality of Life, Systematic review