Early Palliative Care in Acute Myeloid Leukemia

Abstract

Background: Several novel targeted therapies seem to improve the outcome of acute myeloid leukemia (AML) patients. Nonetheless, the 5-year survival rate remains below 40%, and the trajectory of the disease remains physically and emotionally challenging, with little time to make relevant decisions. For patients with advanced solid tumors, the integration of early palliative care (EPC) with standard oncologic care a few weeks after diagnosis has demonstrated several benefits. However, this model is underutilized in patients with hematologic malignancies.

Methods: In this article, we analyze the palliative care (PC) needs of AML patients, examine the operational aspects of an integrated model, and review the evidence in favor of EPC integration in the AML course.

Results: AML patients have a high burden of physical and psychological symptoms and high use of avoidant coping strategies. Emerging studies, including a phase III randomized controlled trial, have reported that EPC is feasible for inpatients and outpatients, improves quality of life (QoL), promotes adaptive coping, reduces psychological symptoms, and enhances the quality of end-of-life care.

Conclusions: EPC should become the new standard of care for AML patients. However, this raises issues about the urgent development of adequate programs of education to increase timely access to PC.

Keywords: acute myeloid leukemia; disease trajectory; early palliative care; integration.

Figure 1

Effects of the early integration of palliative care on the disease trajectory of patients with acute myeloid leukemia. AML = acute myeloid leukemia; Pt = patients; PTSD = post-traumatic stress disorder symptoms; EASE = Emotion And Symptom-focused Engagement; psy = psychotherapeutic intervention; phy = screening of physical symptoms with targeted referral to palliative care; EPC = early palliative care; HSCT = hematopoietic stem cell transplant; GOC = goals of care discussions; ACP = advance care planning; EOL = end-of-life; ? = doubts about the possibility that EPC might be the best model for providing assistance and support to the population of AML patients cured of long-term therapy-related symptoms and mental health effects.