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Why Do Some Patients With Newly Diagnosed AML Decline Treatment?

By: Kayci Reyer
Posted: Wednesday, February 3, 2021

According to research published in the American Journal of Hematology, some patients with acute myeloid leukemia (AML) decline antileukemic treatment despite being eligible to receive it. Lalit Saini, MD, of the London Health Sciences Centre in Canada, and colleagues sought to determine what factors may influence a patient’s decision to receive best supportive care alone.

The study collected data on 316 patients who had been diagnosed with AML between January 2013 and December 2016, as listed in the Alberta Cancer Registry. Patients were stratified by treatment type: intensive therapy, nonintensive therapy, and no therapy. For those in the no-therapy group, a review of available clinical data was performed to discern the reasons for patients having received best supportive care alone. In this group, three primary categories were identified: (1) patients who had died prior to the initiation of any treatment (38%); (2) patients with severe comorbidities (19%); and (3) patients who declined to receive antileukemic therapy and/or for whom treatment options were limited (43%).

Patients in the third category were slightly older than those in the nonintensive therapy group and more likely to live in a rural area (56% vs. 26%). In both the nonintensive and no-therapy groups, the proportion of patients rose with age, with the no-therapy group including 36% of all patients between the ages of 70 and 79 and 59% of those older than 80. These factors may indicate that lack of accessibility to treatment facilities, due to age-related frailty or significant required travel, may influence a patient’s decision to decline treatment.

“For such patients, the availability of an effective oral regimen would potentially make treatment more accessible for many patients,” concluded the authors. “It will be interesting to see whether the frequency of patients opting for no treatment declines in the coming years, as more effective and oral‐based nonintensive treatments become widely available.”

Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.



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