New results indicate that while many adults with acute myeloid leukemia (AML) experience some decline in physical health, patients can be grouped into four distinct trajectories of physical well-being (PWB). Marielle Jensen-Battaglia, PT, DPT, a licensed physical therapist and epidemiology PhD candidate at the University of Rochester Medical Center in New York, and colleagues published the results of the first study to explore risk factors associated with PWB trajectories among adults with AML in Blood Advances.
Hematologists recognize that health-related quality of life (HRQoL) is an important outcome in the treatment of AML, and previous research has demonstrated that while overall HRQoL among patients with AML often declines shortly after treatment initiation, most patients recover over time. The current study expands on this understanding by exploring distinct trajectories of change in Functional Assessment of Cancer Therapy Physical Well-Being (FACT-PWB) subscale, a valid and reliable measure of HRQoL. The authors noted, however, that a limitation of their study is that they pooled data from four supportive care trials.
The study had an initial sample size of 405 patients with a new diagnosis of AML. The investigators administered the FACT-PWB subscale at five time points over as many as 200 days of follow-up. They excluded patients with less than two measures of FACT-PWB from analysis, and the final analytic sample consisted of 343 patients with AML. The patients had a mean age of 69.5 years and were primarily male (61.8%) and white (90.3%) and had a college degree (52.7%). Nearly 52% (51.8%) of patients had intermediate-risk AML, 71.1% received intensive treatment, and 58% died during follow-up.
The researchers used group-based trajectory models (GBTM) to identify four groups of change in FACT-PWB:
- 0% of patients sorted into the stable group
- 8% sorted into a group with a slight decline
- 8% experienced early improvement, followed by later decline
- 4% experienced a steep decline and then recovered
The largest group (stable) had the lowest proportion of females (28.1%), the lowest on-study mortality (54.3%), and the second lowest baseline FACT-PWB (mean = 18.9).
The only patient-level factor that predicted the trajectory was baseline FACT-PWB. When the investigators performed a sensitivity analysis using GBTM to identify distinct trajectories of the outcome in a sample that excluded patients with missing FACT-PWB data due to death (28.9% of the original analytic sample), they found a very different picture of HRQoL over time. This analysis revealed three groups: 37.0% showed early decline followed by partial improvement, 55.5% demonstrated a steady trajectory of slight improvement, and 7.5% initially improved and then stabilized as follow-up continued.
Kah Poh (Melissa) Loh, MBBCh BAO, MS, a geriatric hematologist at Wilmot Cancer Institute in Rochester and senior author of the paper, said a better understanding of trajectories of self-reported and objective physical function can inform decision-making and interventions. She said she and her colleagues hoped their analysis would identify factors associated with physical outcomes in these patients.
“I was a little surprised that we couldn’t predict who fell into the four patterns,” Dr. Loh said. She explained that this may be because the investigators only analyzed data from available questionnaires and did not include other important variables that may be associated with PWB, such as social determinants of health or detailed data about patient health. She said clinicians inconsistently ask patients about their physical well-being or function, and she feels that the new data reinforce the importance of monitoring PWB longitudinally in these patients.
Any conflicts of interest declared by the authors can be found in the original article.
Reference
Jensen-Battaglia M, Sohn M, Consagra W, et al. Trajectories of physical well-being among adults with acute myeloid leukemia [published online ahead of print, 2024 March 1]. Blood Adv. doi: 10.1182/bloodadvances.2023011804.
