Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML).
Nicholson, S; Abel, GA; Fathi, AT; Steensma, DP; LeBlanc, TW; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Foster, J; Brunner, AM; Amrein, PC ...
Published in: Journal of Clinical Oncology
43 Background: Older patients ( > 60 years) with AML face difficult treatment decisions as they can be treated either with risky multi-drug intensive chemotherapy for a small chance of a cure, or non-intensive and non-curative palliative chemotherapy. However, studies have not described patients understanding of their prognosis and treatment risk. Methods: We conducted a longitudinal study of older patients newly diagnosed with AML at two tertiary care hospitals. At enrollment, we assessed patients and oncologists perception of treatment-related mortality. At one month, we assessed patients and oncologists perception of prognosis using the Prognosis and Treatment Perception Questionnaire. Results: We enrolled consecutive patients within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. The majority of patients reported that it is somewhat (58/92, 63.0%) or extremely (26/92, 28.3%) likely to die due to treatment while their oncologists reported that it is very unlikely (80.0%; 74/92) for the patient to die due to their treatment (P < 0.001). Most patients (90.0%, 73/81) reported that they were somewhat or very likely to be cured of their leukemia while most oncologists reported that it is unlikely or very unlikely for the patient to be cured (74% (60/81)) (P < 0.001). Patients receiving both intensive and non-intensive chemotherapy had significant misperceptions about their prognosis (Table 1). Conclusions: Older patients with AML have substantial misperceptions regarding the risks of their treatment and they overestimate the likelihood of cure, compared to their oncologists estimates. Prognostic misperceptions are especially striking in patients receiving non-intensive chemotherapy. Interventions to facilitate communication are needed to ensure patients with AML have an accurate understanding of their treatment risks and prognosis and are therefore enabled to make informed decisions about treatment. [Table: see text]
