Anmol Singh1, Susan C Locke2, Steven P Wolf2, Tara A Albrecht3, Jesse D Troy2,4, Heather Derry5, Areej El-Jawahri6, Thomas W LeBlanc7,8. 1. Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA. 2. Duke Cancer Institute, Durham, NC, 27710, USA. 3. Duke University School of Nursing, Duke University, Durham, NC, 27710, USA. 4. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA. 5. Weill Cornell Medical College, New York, NY, 10065, USA. 6. Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA. 7. Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA. thomas.leblanc@duke.edu. 8. Duke Cancer Institute, Durham, NC, 27710, USA. thomas.leblanc@duke.edu.
Abstract
PURPOSE: Adults with acute myeloid leukemia (AML) face considerable distress and often have a poor prognosis. However, little is known about these patients' perceptions of prognosis and how this relates to emotional well-being (EWB). METHODS: We conducted a prospective, observational study of 50 adult patients with AML initiating chemotherapy, and surveyed them longitudinally for 6 months about their prognosis, treatment goals, quality of life, and EWB (by FACT-G). We derived a prognostic estimate for each patient based on data from published trials summarized in National Comprehensive Care Network Guidelines. We used descriptive statistics and longitudinal modeling to test the hypothesis that more accurate prognostic awareness is associated with worse EWB. RESULTS: Most patients (n = 43; 86%) had an objectively poor prognosis attributable to relapsed disease, complex karyotype, or FLT3 mutation. Yet, 74% of patients reported expecting a 50% or greater chance of cure. Patients with a poor prognosis more often had discordant prognostic estimates, compared to those with favorable risk AML (OR = 7.25, 95% CI 1.21, 43.37). Patient-reported prognostic estimates did not vary significantly over time. At baseline, patients who better understood their prognosis had worse EWB and overall quality-of-life scores (EWB 12 vs. 19.5; p = 0.01; FACT-G 65 vs. 75.5; p = 0.01). CONCLUSION: Patients with AML overestimate their prognosis, and awareness of a poor prognosis is associated with worse emotional well-being. Efforts are needed to improve patients' understanding of their prognosis, and to provide more psychosocial support and attention to well-being as part of high-quality leukemia care.
PURPOSE: Adults with acute myeloid leukemia (AML) face considerable distress and often have a poor prognosis. However, little is known about these patients' perceptions of prognosis and how this relates to emotional well-being (EWB). METHODS: We conducted a prospective, observational study of 50 adult patients with AML initiating chemotherapy, and surveyed them longitudinally for 6 months about their prognosis, treatment goals, quality of life, and EWB (by FACT-G). We derived a prognostic estimate for each patient based on data from published trials summarized in National Comprehensive Care Network Guidelines. We used descriptive statistics and longitudinal modeling to test the hypothesis that more accurate prognostic awareness is associated with worse EWB. RESULTS: Most patients (n = 43; 86%) had an objectively poor prognosis attributable to relapsed disease, complex karyotype, or FLT3 mutation. Yet, 74% of patients reported expecting a 50% or greater chance of cure. Patients with a poor prognosis more often had discordant prognostic estimates, compared to those with favorable risk AML (OR = 7.25, 95% CI 1.21, 43.37). Patient-reported prognostic estimates did not vary significantly over time. At baseline, patients who better understood their prognosis had worse EWB and overall quality-of-life scores (EWB 12 vs. 19.5; p = 0.01; FACT-G 65 vs. 75.5; p = 0.01). CONCLUSION: Patients with AML overestimate their prognosis, and awareness of a poor prognosis is associated with worse emotional well-being. Efforts are needed to improve patients' understanding of their prognosis, and to provide more psychosocial support and attention to well-being as part of high-quality leukemia care.
Authors: Thomas W LeBlanc; Laura J Fish; Catherine T Bloom; Areej El-Jawahri; Debra M Davis; Susan C Locke; Karen E Steinhauser; Kathryn I Pollak Journal: Psychooncology Date: 2016-12-19 Impact factor: 3.894
Authors: J C Weeks; E F Cook; S J O'Day; L M Peterson; N Wenger; D Reding; F E Harrell; P Kussin; N V Dawson; A F Connors; J Lynn; R S Phillips Journal: JAMA Date: 1998-06-03 Impact factor: 56.272
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Authors: M A Sekeres; R M Stone; D Zahrieh; D Neuberg; V Morrison; D J De Angelo; I Galinsky; S J Lee Journal: Leukemia Date: 2004-04 Impact factor: 11.528