|The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
The inclusion of integrated palliative care (IPC) as part of induction chemotherapy in patients with acute myeloid leukemia (AML) facilitates active coping strategies while reducing avoidant coping. Improvement in coping skills accounted for a substantial positive effect of a palliative care intervention on quality of life (QOL) and symptoms of depression and anxiety. These findings were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.
AML is a rare hematologic malignancy, and its treatment includes high-dose, intensive induction chemotherapy that may involve prolonged hospitalization. Patients often experience significantly associated symptoms of anxiety and depression, as well as a decreased QOL.
IPC generally has been shown to improve QOL, anxiety, and depression in patients with solid tumors. “However, most of these studies have excluded patients with hematologic malignancies. So little has been known about whether integrated palliative care could similarly improve the patient experience for those with blood cancers like AML,” explained Thomas LeBlanc, MD, of the Duke University School of Medicine in Durham, North Carolina.
Therefore, a nonblinded, multisite, randomized trial (ClinicalTrials.gov Identifier: NCT02975869) of patients with AML hospitalized during induction therapy was conducted to determine the impact of IPC on coping and outcomes in this patient population.
Of 250 eligible patients, 160 were enrolled and randomly assigned to integrated palliative and oncology care (n=86) or usual care (n=74) groups. Participants in the IPC group were seen by palliative care clinicians at least twice weekly while hospitalized for induction therapy and during any subsequent hospitalizations. The intervention focused on symptom assessment/management, psychological support and coping, and rapport- building. QOL, mood, and coping were measured via patient completion of the Functional Assessment of Cancer Therapy-Leukemia scale, the Hospital Anxiety and Depression Scale, and the Brief COPE questionnaire (to assess QOL). These measures were assessed at baseline and at weeks 2, 4, 12, and 24.
Coping strategies were categorized as approach-oriented (active coping, positive reframing, and acceptance) or avoidant-oriented (denial or self-blame). Linear regression models, adjusting for baseline score, were used to measure the effect of the intervention on coping. Causal mediation regression models were used to measure whether changes in coping during the initial hospitalization had an impact on QOL and symptoms of depression and anxiety. In this presentation, Dr LeBlanc discussed the findings at the primary endpoint of 2 weeks.
Participants in the IPC arm reported more approach-oriented coping (B=1.85; 95% CI, 0.62-0.38; P =.004) and less avoidant-oriented coping (B = -0.70; 95% CI, -1.28 to -0.11; P =.020). Intervention effects on approach-oriented coping were sustained up to week 24 (B=0.36; 95% CI, 0.68-0.09; P =.010) but not on avoidant-oriented coping (B = -0.01; 95% CI, -0.28 to 0.05; P =.163).
Changes in approach-oriented coping and avoidant-oriented coping during hospitalization partially mediated the intervention effects on QOL (indirect effect, 6.58; 95% CI, 2.14-13.63), depression (indirect effect, -1.08; 95% CI -2.05 to -0.27), and anxiety symptoms (indirect effect, -0.52; 95% CI, -1.25 to -0.04).
These changes accounted for 78% of the intervention effect on improvement in QOL and 66% of the intervention effect on improvement in depression. Although the intervention did result in improvement in anxiety, the overall impact was less (35%).
“Integrated palliative care as part of high-dose chemotherapy hospitalization for AML clearly facilitates more positive active coping strategies for these patients and reduces the more negative, avoidant coping for these patients,” concluded Dr LeBlanc.
“These findings offer some really important insights into the mechanism by which palliative care may improve the patient experience of serious illness care, specifically in high-dose chemotherapy and AML,” he added.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Read more of Oncology Nurse Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.
LeBlanc TW, Kavanaugh A, Webb J, et al. Palliative care and coping in patients with acute myeloid leukemia receiving intensive induction therapy: a mediation analysis of data from a randomized trial. J Clin Oncol. 2021;39(suppl15; abstr 12007). doi:10.1200/JCO.2021.39.15_suppl12007