Do quality of life or physical function at diagnosis predict short-term outcomes during intensive chemotherapy in AML?
BACKGROUND
Intensive chemotherapy (IC) used to treat acute myeloid leukemia (AML) is associated with toxicity, particularly in older adults. Emerging data suggest that baseline quality of life (QOL) and physical function may predict outcomes in oncology, although data in AML are limited. We investigated the association between baseline QOL and physical function with short-term treatment outcomes in adults and elderly AML patients.


MATERIALS AND METHODS
We conducted a prospective, longitudinal study of adults (age 18+) AML patients undergoing IC. Before starting IC, patients completed the European Organisation for the Research and Treatment of Cancer (EORTC) 30-item questionnaire (QLQ-C30) and Functional Assessment of Cancer Therapy Fatigue subscale (FACT-Fatigue) in addition to physical function tests (grip strength, timed chair stands, 2-min walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission and achievement of complete remission (CR). Logistic regression was carried out to evaluate each outcome.


RESULTS
Of the 239 patients (median age 57.5 years), 56.7% were male and median Charlson comorbidity score was 0. Sixty-day mortality, ICU admission and CR occurred in 9 (3.7%), 15 (6.3%) and 167 (69.9%) patients, respectively. Using univariate regression, neither QOL nor physical function at presentation was predictive of 60-day mortality (all P > 0.05), whereas ICU admission (P < 0.001) and remission status at 30 days (P = 0.007) were. Fatigue (P = 0.004) and role functioning (P = 0.003) were predictors of ICU admission; QOL and physical function were not. A higher Charlson score predicted ICU admission (P = 0.01) and remission status (P = 0.002). The cytogenetic risk group was associated with achievement of CR (P = 0.02); QOL and physical function were not (all P > 0.05). Findings were similar when patients age 60+ were examined. Relationships between fatigue and role functioning with ICU admission deserve further exploration.


CONCLUSIONS
Baseline QOL and physical function tests in this prospective study were not associated with short-term mortality, ICU admission or achievement of CR after the first cycle of chemotherapy.
['Timilshina|N|N|', 'Breunis|H|H|', 'Brandwein|J M|JM|', 'Minden|M D|MD|', 'Gupta|V|V|', "O'Neill|S|S|", 'Tomlinson|G A|GA|', 'Buckstein|R|R|', 'Li|M|M|', 'Alibhai|S M H|SMH|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D004358:Drug Therapy D005260:Female D006801:Humans D007362:Intensive Care Units D015470:Leukemia, Myeloid, Acute D016015:Logistic Models D008297:Male D008875:Middle Aged D011379:Prognosis D011788:Quality of Life D011795:Surveys and Questionnaires D016896:Treatment Outcome
quality of life physical function acute myeloid leukemia elderly fatigue short-term mortality