TY - JOUR
T1 - Home Time among Older Adults with Acute Myeloid Leukemia Following Chemotherapy
AU - Richardson, Daniel R.
AU - Zhou, Xi
AU - Reeder-Hayes, Katherine
AU - Jensen, Christopher E.
AU - Islam, Jessica
AU - Loh, Kah Poh
AU - Gupta, Arjun
AU - Basch, Ethan
AU - Bennett, Antonia V.
AU - Bridges, John F.P.
AU - Wheeler, Stephanie B.
AU - Wood, William A.
AU - Baggett, Christopher D.
AU - Lund, Jennifer L.
N1 - Publisher Copyright:
© 2024 American Medical Association. All rights reserved.
PY - 2024/8/15
Y1 - 2024/8/15
N2 - IMPORTANCE Patients with acutemyeloid 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. OBJECTIVE 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. MAIN OUTCOMES AND MEASURES The primary outcomewas 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. RESULTS 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). CONCLUSIONS AND RELEVANCE 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.
AB - IMPORTANCE Patients with acutemyeloid 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. OBJECTIVE 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. MAIN OUTCOMES AND MEASURES The primary outcomewas 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. RESULTS 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). CONCLUSIONS AND RELEVANCE 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.
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U2 - 10.1001/jamaoncol.2024.1823
DO - 10.1001/jamaoncol.2024.1823
M3 - Article
C2 - 38869885
AN - SCOPUS:85196398250
SN - 2374-2437
VL - 10
SP - 1038
EP - 1046
JO - JAMA Oncology
JF - JAMA Oncology
IS - 8
ER -