Amer M Zeidan1,2, Nikolai A Podoltsev1,2, Xiaoyi Wang2,3, Jan Philipp Bewersdorf1, Rory M Shallis1, Scott F Huntington1,2, Steven D Gore1,2, Amy J Davidoff2,4, Xiaomei Ma2,3, Rong Wang2,3. 1. Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut. 2. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut. 3. Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut. 4. Department of Health Policy and Management, School of Public Health, Yale University, New Haven, Connecticut.
Abstract
BACKGROUND: The majority of patients with acute myeloid leukemia (AML) are aged >65 years at the time of diagnosis and are not actively treated. The objective of the current study was to determine the prevalence, temporal trends, and factors associated with no active treatment (NAT) among older patients with AML in the United States. METHODS: A retrospective analysis was performed of Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 14,089 patients with AML residing in the United States who were diagnosed with AML at age ≥66 years during 2001 through 2013. NAT was defined as not receiving any chemotherapy, including hypomethylating agents. Multivariable logistic regression models were used to analyze sociodemographic, clinical, and provider characteristics associated with NAT. RESULTS: The percentage of patients with NAT decreased over time from 59.7% among patients diagnosed in 2001 to 42.8% among those diagnosed in 2013. The median overall survival for the entire cohort was 82 days from the time of diagnosis. Patients treated with NAT had worse survival compared with those receiving active treatment. Variables found to be associated with higher odds of NAT included older age, certain sociodemographic characteristics (household income within the lowest quartile, residence outside the Northeast region of the United States, and being unmarried), and clinical factors (≥3 comorbidities, the presence of mental disorders, recent hospitalization, and disability). CONCLUSIONS: Greater than one-half of older patients with AML residing in the United States do not receive any active leukemia-directed therapy despite the availability of lower intensity therapies such as hypomethylating agents. Lack of active therapy receipt is associated with inferior survival. Identifying predictors of NAT might improve the quality of care and survival in this patient population, especially as novel therapeutic options with lower toxicity are becoming available.
BACKGROUND: The majority of patients with acute myeloid leukemia (AML) are aged >65 years at the time of diagnosis and are not actively treated. The objective of the current study was to determine the prevalence, temporal trends, and factors associated with no active treatment (NAT) among older patients with AML in the United States. METHODS: A retrospective analysis was performed of Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 14,089 patients with AML residing in the United States who were diagnosed with AML at age ≥66 years during 2001 through 2013. NAT was defined as not receiving any chemotherapy, including hypomethylating agents. Multivariable logistic regression models were used to analyze sociodemographic, clinical, and provider characteristics associated with NAT. RESULTS: The percentage of patients with NAT decreased over time from 59.7% among patients diagnosed in 2001 to 42.8% among those diagnosed in 2013. The median overall survival for the entire cohort was 82 days from the time of diagnosis. Patients treated with NAT had worse survival compared with those receiving active treatment. Variables found to be associated with higher odds of NAT included older age, certain sociodemographic characteristics (household income within the lowest quartile, residence outside the Northeast region of the United States, and being unmarried), and clinical factors (≥3 comorbidities, the presence of mental disorders, recent hospitalization, and disability). CONCLUSIONS: Greater than one-half of older patients with AML residing in the United States do not receive any active leukemia-directed therapy despite the availability of lower intensity therapies such as hypomethylating agents. Lack of active therapy receipt is associated with inferior survival. Identifying predictors of NAT might improve the quality of care and survival in this patient population, especially as novel therapeutic options with lower toxicity are becoming available.
Authors: Amer M Zeidan; Rong Wang; Xiaoyi Wang; Rory M Shallis; Nikolai A Podoltsev; Jan P Bewersdorf; Scott F Huntington; Natalia Neparidze; Smith Giri; Steven D Gore; Amy J Davidoff; Xiaomei Ma Journal: Blood Adv Date: 2020-05-26
Authors: Rory M Shallis; Maximilian Stahl; Wei Wei; Pau Montesinos; Etienne Lengline; Judith Neukirchen; Vijaya R Bhatt; Mikkael A Sekeres; Amir T Fathi; Heiko Konig; Selina Luger; Irum Khan; Gail J Roboz; Thomas Cluzeau; David Martínez-Cuadron; Emmanuel Raffoux; Ulrich Germing; Jayadev Manikkam Umakanthan; Sudipto Mukhereje; Andrew M Brunner; Adam Miller; Christine M McMahon; Ellen K Ritchie; Rebeca Rodríguez-Veiga; Raphaël Itzykson; Blanca Boluda; Florence Rabian; Mar Tormo; Evelyn Acuña-Cruz; Emma Rabinovich; Brendan Yoo; Isabel Cano; Nikolai A Podoltsev; Jan Philipp Bewersdorf; Steven Gore; Amer M Zeidan Journal: Leuk Lymphoma Date: 2020-02-26
Authors: Chong Chyn Chua; Danielle Hammond; Andrew Kent; Ing Soo Tiong; Marina Y Konopleva; Daniel A Pollyea; Courtney D DiNardo; Andrew H Wei Journal: Blood Adv Date: 2022-07-12
Authors: Elizabeth Hubscher; Slaven Sikirica; Timothy Bell; Andrew Brown; Verna Welch; Alexander Russell-Smith; Paul D'Amico Journal: J Cancer Res Clin Oncol Date: 2021-08-30 Impact factor: 4.553
Authors: Alice S Mims; Jessica Kohlschmidt; Uma Borate; James S Blachly; Shelley Orwick; Ann-Kathrin Eisfeld; Dimitrios Papaioannou; Deedra Nicolet; Krzysztof Mrόzek; Eytan Stein; Bhavana Bhatnagar; Richard M Stone; Jonathan E Kolitz; Eunice S Wang; Bayard L Powell; Amy Burd; Ross L Levine; Brian J Druker; Clara D Bloomfield; John C Byrd Journal: J Hematol Oncol Date: 2021-06-23 Impact factor: 17.388