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. 2024 Aug 1;10(8):1038-1046.
doi: 10.1001/jamaoncol.2024.1823.

Home Time Among Older Adults With Acute Myeloid Leukemia Following Chemotherapy

Daniel R Richardson  1   2 , Xi Zhou  2 , Katherine Reeder-Hayes  1   2 , Christopher E Jensen  1   3 , Jessica Islam  4 , Kah Poh Loh  5 , Arjun Gupta  6 , Ethan Basch  1   2 , Antonia V Bennett  2   7 , John F P Bridges  8 , Stephanie B Wheeler  2   7 , William A Wood  1   2 , Christopher D Baggett  2   9 , Jennifer L Lund  2   9
Affiliations

Home Time Among Older Adults With Acute Myeloid Leukemia Following Chemotherapy

Daniel R Richardson et al. JAMA Oncol. .

Abstract

Importance: Patients with acute myeloid leukemia (AML) recognize days spent at home (home time) vs in a hospital or nursing facility as an important factor in treatment decision making. No study has adequately described home time among older adults with AML.

Objective: To describe home time among older adults with AML (aged ≥66 years) and compare home time between 2 common treatments: anthracycline-based chemotherapy and hypomethylating agents (HMAs).

Design, setting, and participants: A cohort of adults aged 66 years or older with a new diagnosis of AML from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 2004 to 2016 was identified. Individuals were stratified into anthracycline-based therapy, HMAs, or chemotherapy, not otherwise specified (NOS) using claims.

Main outcomes and measures: The primary outcome was home time, quantified by subtracting the total number of person-days spent in hospitals and nursing facilities from the number of person-days survived and dividing by total person-days. A weighted multinomial regression model with stabilized inverse probability of treatment weighting to estimate adjusted home time was used.

Results: The cohort included 7946 patients with AML: 2824 (35.5%) received anthracyclines, 2542 (32.0%) HMAs, and 2580 (32.5%) were classified as chemotherapy, NOS. Median (IQR) survival was 11.0 (5.0-27.0) months for those receiving anthracyclines and 8.0 (3.0-17.0) months for those receiving HMAs. Adjusted home time for all patients in the first year was 52.4%. Home time was highest among patients receiving HMAs (60.8%) followed by those receiving anthracyclines (51.9%). Despite having a shorter median survival, patients receiving HMAs had more total days at home and 33 more days at home in the first year on average than patients receiving anthracyclines (222 vs 189).

Conclusions and relevance: This retrospective study of older adults with AML using SEER-Medicare data and propensity score weighting suggests that the additional survival afforded by receiving anthracycline-based therapy was entirely offset by admission to the hospital or to nursing facilities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Reeder-Hayes reported grants from Pfizer outside the submitted work. Dr Jensen reported research funding paid to institution from AbbVie outside the submitted work. Dr Loh reported honaroria from Pfizer outside the submitted work. Dr Basch reported personal fees from Navigating Cancer, Sivan, Verily, Astra Zeneca, and Resilience outside the submitted work. Dr Bridges reported personal fees from Boehringer Ingelheim outside the submitted work. Dr Wheeler reported grants from Pfizer and Astra Zeneca outside the submitted work. Dr Wood reported equity from Koneksa Health, personal fees from Quantum Health, and personal fees from Teladoc Health outside the submitted work. Dr Lund reported prior stock ownership from GSK outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram of the Included Cohort
AML indicates acute myeloid leukemia.
Figure 2.
Figure 2.. Percentage of Person-Days in Each Location For Older Patients With Acute Myeloid Leukemia (AML) Over The First 12 Months by Treatment
A, Percentage of person-days in each location for all patients with AML treated with some chemotherapy (n = 7946). B, Patients treated with anthracyclines (n = 2824). C, Patients treated with hypomethylating agents (n = 2542). Hospitalization includes long-term acute care facilities. Death includes lost to follow-up. Nursing home includes short- and long-term care facilities. HMA indicates hypomethylating agent.
Figure 3.
Figure 3.. Home Time Achieved by Patients Receiving Anthracyclines vs Hypomethylating Agents (HMAs) in the First 12 Months Following Chemotherapy
A, Adjusted person-days at home achieved by patients who received anthracyclines (n = 2824) compared with hypomethylating agents (n = 2542) in the first 12 months following chemotherapy administration. B, The adjusted cumulative person-days achieved by patients who received anthracyclines compared with hypomethylating agents in the first 12 months following chemotherapy.
See this image and copyright information in PMC

References

    1. Döhner H, Weisdorf DJ, Bloomfield CD. Acute Myeloid Leukemia. N Engl J Med. 2015;373(12):1136-1152. doi: 10.1056/NEJMra1406184 - DOI - PubMed
    1. Acute Myeloid Leukemia - Cancer Stat Facts. Acute Myeloid Leukemia Statistics. Published June 18, 2019. Accessed November 18, 2018. https://seer.cancer.gov/statfacts/html/amyl.html
    1. Klepin HD. Elderly acute myeloid leukemia: assessing risk. Curr Hematol Malig Rep. 2015;10(2):118-125. doi: 10.1007/s11899-015-0257-2 - DOI - PMC - PubMed
    1. Levit LA, Balogh E, Nass SJ, Ganz P; eds. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. National Academies Press Washington; 2013. doi: 10.17226/18359 - DOI - PubMed
    1. Schnipper LE, Davidson NE, Wollins DS, et al. Updating the American Society of Clinical Oncology Value Framework: revisions and reflections in response to comments received. J Clin Oncol. 2016;34(24):2925-2934. doi: 10.1200/JCO.2016.68.2518 - DOI - PubMed