Quality of life and physical function in adults treated with intensive chemotherapy for acute myeloid leukemia improve over time independent of age

Abstract

Objectives: Intensive chemotherapy (IC) is the primary treatment of acute myeloid leukemia (AML) but is associated with significant toxicity, particularly in older adults. We characterized the impact of AML and its treatment on quality of life (QOL) and physical function in younger (age 18-59) and older (age 60+) patients with AML over 1 year from diagnosis.

Materials and Methods: AML patients undergoing IC without stem-cell transplant at two tertiary care centers were enrolled in a prospective, longitudinal study. Assessments were done pre-IC and at 7 time points over the next year. QOL, fatigue, and physical performance (grip strength, 2-minute walk test (2MWT), timed chair stands) were measured in all patients whereas daily function was measured only in older patients. Data were analyzed using mixed effects regression models.

Results: 237 patients were recruited (140 younger and 97 older, 56% male). One-year survival was 79% and 60% among younger and older patients, respectively. For patients in remission, global QOL and fatigue improved significantly over time (p < 0.001 for both); trends were similar between older and younger patients. Grip strength did not change over time (p = 0.58) whereas both the 2MWT (p < 0.001) and timed chair stands (p < 0.001) improved significantly. Daily function improved significantly over time (p = 0.003).

Conclusions: Survivors of AML in remission after IC achieve significant improvements in QOL, fatigue, and physical function over time with similar trajectories for older and younger patients. These data suggest that appropriately selected older patients do well following IC.