University of North Carolina School of Medicine, Chapel Hill, NC, USA; University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
Haematologica. 2023 Apr 1;108(4):1006-1014. doi: 10.3324/haematol.2022.280728.
Time at home is a critically important outcome to adults with acute myeloid leukemia (AML) when selecting treatment; however, no study to date has adequately described the amount of time older adults spend at home following initiation of chemotherapy. We queried records from a multi-institution health system to identify adults aged ≥60 years newly diagnosed with AML who were treated with azacitidine or venetoclax and evaluated the proportion of days at home (PDH) following diagnosis. Days were considered "at home" if patients were not admitted or seen in the emergency department or oncology/infusion clinic. Assessed covariates included demographics and disease risk. Associations between PDH and baseline characteristics were evaluated via linear regression, adjusted for log length of follow-up. From 2015-2020, 113 older adults were identified. Most received azacitidine plus venetoclax (51.3%) followed by azacitidine monotherapy (38.9%). The mean PDH for all patients was 0.58 (95% confidence interval: 0.54-0.63, median 0.63). PDH increased among survivors over time. PDH did not differ between therapy groups (adjusted mean, azacitidine plus venetoclax: 0.68; azacitidine monotherapy: 0.66; P=0.64) or between disease risk categories (P=0.34). Compared to patients receiving azacitidine monotherapy, patients receiving azacitidine plus venetoclax had longer clinic visits (median minutes: 127.9 vs. 112.9, P<0.001) and infusion visits (median minutes: 194.3 vs. 132.5, P<0.001). The burden of care for older adults with AML treated with "less intense" chemotherapy is high. The addition of venetoclax to azacitidine did not translate into increased time at home. Future prospective studies should evaluate patient-centered outcomes, including time at home, to inform shared decision-making and drug development.
当选择治疗方案时，急性髓系白血病（AML）成人的居家时间是一个非常重要的结果；然而，迄今为止尚无研究充分描述老年患者在开始化疗后居家的时间量。我们从一个多机构医疗系统的记录中查询了年龄≥60 岁新诊断为 AML 并接受阿扎胞苷或 venetoclax 治疗的成年人的资料，并评估了诊断后的居家天数（PDH）比例。如果患者未住院或在急诊室或肿瘤/输液诊所就诊，则认为该天为“在家”。评估的协变量包括人口统计学和疾病风险。通过线性回归评估 PDH 与基线特征之间的关系，并根据随访时间的对数进行调整。2015-2020 年，共确定了 113 名老年人。大多数患者接受了阿扎胞苷联合 venetoclax（51.3%）治疗，其次是阿扎胞苷单药治疗（38.9%）。所有患者的平均 PDH 为 0.58（95%置信区间：0.54-0.63，中位数 0.63）。随着时间的推移，幸存者的 PDH 逐渐增加。不同治疗组之间的 PDH 没有差异（调整后的平均阿扎胞苷联合 venetoclax：0.68；阿扎胞苷单药治疗：0.66；P=0.64）或疾病风险类别之间（P=0.34）。与接受阿扎胞苷单药治疗的患者相比，接受阿扎胞苷联合 venetoclax 治疗的患者的门诊就诊时间更长（中位数分钟数：127.9 比 112.9，P<0.001）和输液就诊时间更长（中位数分钟数：194.3 比 132.5，P<0.001）。接受“低强度”化疗治疗的老年 AML 患者的护理负担很高。阿扎胞苷联合 venetoclax 的应用并未增加居家时间。未来的前瞻性研究应评估以患者为中心的结局，包括居家时间，为共同决策和药物开发提供信息。
