University of North Carolina School of Medicine, Chapel Hill.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
JAMA Oncol. 2024 Aug 1;10(8):1038-1046. doi: 10.1001/jamaoncol.2024.1823.
Patients with acute myeloid leukemia (AML) recognize days spent at home (home time) vs in a hospital or nursing facility as an important factor in treatment decision making. No study has adequately described home time among older adults with AML.
To describe home time among older adults with AML (aged ≥66 years) and compare home time between 2 common treatments: anthracycline-based chemotherapy and hypomethylating agents (HMAs).
DESIGN, SETTING, AND PARTICIPANTS: A cohort of adults aged 66 years or older with a new diagnosis of AML from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 2004 to 2016 was identified. Individuals were stratified into anthracycline-based therapy, HMAs, or chemotherapy, not otherwise specified (NOS) using claims.
The primary outcome was home time, quantified by subtracting the total number of person-days spent in hospitals and nursing facilities from the number of person-days survived and dividing by total person-days. A weighted multinomial regression model with stabilized inverse probability of treatment weighting to estimate adjusted home time was used.
The cohort included 7946 patients with AML: 2824 (35.5%) received anthracyclines, 2542 (32.0%) HMAs, and 2580 (32.5%) were classified as chemotherapy, NOS. Median (IQR) survival was 11.0 (5.0-27.0) months for those receiving anthracyclines and 8.0 (3.0-17.0) months for those receiving HMAs. Adjusted home time for all patients in the first year was 52.4%. Home time was highest among patients receiving HMAs (60.8%) followed by those receiving anthracyclines (51.9%). Despite having a shorter median survival, patients receiving HMAs had more total days at home and 33 more days at home in the first year on average than patients receiving anthracyclines (222 vs 189).
This retrospective study of older adults with AML using SEER-Medicare data and propensity score weighting suggests that the additional survival afforded by receiving anthracycline-based therapy was entirely offset by admission to the hospital or to nursing facilities.
急性髓系白血病 (AML) 患者将在家中度过的天数（居家时间）视为治疗决策的一个重要因素，而不是在医院或疗养院度过的天数。目前尚无研究充分描述老年 AML 患者的居家时间。
描述老年 AML 患者（年龄≥66 岁）的居家时间，并比较两种常见治疗方法（基于蒽环类药物的化疗和低甲基化剂 [HMAs]）之间的居家时间。
设计、地点和参与者：从 2004 年至 2016 年，使用医疗保险链接数据库，从监测、流行病学和最终结果 (SEER) 中确定了新诊断为 AML 的 66 岁或以上成年人的队列。使用索赔将个体分为基于蒽环类药物的治疗、HMAs 或未特指的其他化疗（NOS）。
主要结局是居家时间，通过从存活天数中减去在医院和疗养院度过的总天数，再除以总天数来量化。使用加权多项回归模型和稳定的逆概率治疗加权来估计调整后的居家时间。
该队列包括 7946 名 AML 患者：2824 名（35.5%）接受蒽环类药物治疗，2542 名（32.0%）接受 HMAs 治疗，2580 名（32.5%）被归类为化疗，NOS。接受蒽环类药物治疗的患者中位（IQR）生存时间为 11.0（5.0-27.0）个月，接受 HMAs 治疗的患者中位（IQR）生存时间为 8.0（3.0-17.0）个月。所有患者在第一年的调整后居家时间为 52.4%。接受 HMAs 治疗的患者居家时间最高（60.8%），其次是接受蒽环类药物治疗的患者（51.9%）。尽管中位生存时间较短，但接受 HMAs 治疗的患者在第一年的总居家天数和平均居家天数分别比接受蒽环类药物治疗的患者多 33 天（222 天比 189 天）。
本项使用 SEER-医疗保险数据和倾向评分加权的老年 AML 患者回顾性研究表明，接受基于蒽环类药物的治疗所带来的额外生存时间完全被住院或疗养院的住院时间所抵消。
