Patients with acute myeloid leukemia (AML) receive intensive chemotherapy. Their life quality and mood decline during hospitalization. During the end of life (EOL), they also receive aggressive care. However, integrated palliative and oncology care (IPC) can be helpful. This study evaluates the effects of IPC on patient-reported and EOL outcomes.
A randomized clinical trial was designed at multiple sites. A total of 160 adult AML patients undergoing intensive chemotherapy were selected. They were grouped into IPC with 86 and usual care (UC) with 74 patients. The data was collected from 4 tertiary care US hospitals from Jan 2017 to the end of July 2019. QoL was scored using the Cancer Therapy-Leukemia scale, Hospital Anxiety and Depression Scale (HADS), and PTSD checklist. Fisher exact test, covariance adjustments, and linear effect models were used to evaluate patient-reported discussions, preference, and outcomes.
Out of 160 patients, 64 or 40% were women, and the median age was 64.4. The QOL, low depression, anxiety, and PTSD scores at week 2 for the IPC group were 116.45, 5.68, 4.53, and 27.79, respectively. Simultaneously, the same scores for the UC group were 107.59, 7.20, 5.94, and 31.69. The results showed sustained palliative interventions for up to 24 weeks. 21 of 28 IPC patients discussed EOL preferences, with 15 of 43 rejecting chemotherapy. The UC group was less responsive, with 12 of 30 and 27 of 41 discussing needs and refusing treatment.
The two IPC physician visits per week improved QOL substantially. Palliative care should be the new standard for AML patients as it lowers psychological distress, anxiety, and depression.