Older patients with acute myeloid leukemia (AML) had substantial misperceptions regarding the risks of their treatment—whether intensive or palliative chemotherapy—and the likelihood of cure compared with their oncologists, according to the results of a study (abstract 43) presented at the 2017 Palliative and Supportive Care in Oncology Symposium, held October 27–28 in San Diego.
AML patients older than 60 years significantly overestimated the likelihood of cure and the risks of dying from treatment.
“Older patients, particularly those about the age of 60, with AML face difficult treatment decisions,” said Areej El-Jawahri, MD, assistant professor of medicine at Massachusetts General Hospital in Boston. “Often they are choosing between risky intensive chemotherapy—that is usually given in the hospital—requiring a long, 4- to 6-week hospitalization for a small chance of a cure, or they have non-intensive, non-curative palliative chemotherapy with the goal of prolonging life, and maybe relieving some of their symptoms and enhancing quality of life.”
According to El-Jawahri, to date there is no standard of care for these patients. Therefore, in order for these patients to make informed decisions about their treatment, they must have a good understanding of their prognosis as well as the risk from treatment, she said.
The study assessed patient and oncologist perception of treatment-related mortality at study enrollment. One-hundred patients from two tertiary care hospitals were enrolled within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. The median age of patients was 71, and more than one-half had a college education.
Within 3 days of starting treatment, both the patients and their physicians were given a questionnaire to assess how they perceived the likelihood of dying from the treatment. One month later, they completed a follow-up questionnaire to assess perceptions of prognosis. Within that timeframe, most patients received laboratory results that more definitively established the type and stage of cancer.
The majority of patients reported that it was ‘somewhat’ (63%) or ‘extremely’ (28.3%) likely that they would die due to treatment compared with 80% of their oncologists who reported that it was ‘very unlikely’ for the patients to die from their treatment (P < .001).
Similarly, at 1 month, 90% of patients reported that they were ‘somewhat’ or ‘very likely’ to be cured of their leukemia, compared with 74% of oncologists who reported that it was ‘unlikely’ or ‘very unlikely’ for the patient to be cured (P < .001).
“Perceptions of prognosis in both patients receiving intensive and non-intensive chemotherapy had misperceptions of prognosis; however, patients receiving non-intensive chemotherapy had the highest rate of prognostic discordance,” El-Jawahri said.
Among patients receiving intensive chemotherapy, almost all patients believed a cure was either ‘somewhat likely’ (36.6%) or ‘very likely’ (61%). Patients receiving non-intensive, palliative chemotherapy had only slightly better results, with 38.5% believing a cure ‘somewhat likely’ and 43.6% believing it was ‘very likely.’ In contrast, none of their oncologists thought that a cure was likely.
“A shared understanding of prognosis and treatment risk between clinicians and patients is crucial in informed consent, and this study adds to the literature on the deficiencies that exist in accurate knowledge on both sides of this interface,” said American Society of Clinical Oncology (ASCO) expert Andrew S. Epstein, MD, commenting on the results of the study. “Interventions to facilitate communication around this are needed.”