Treatment decision-making in acute myeloid leukemia: a qualitative study of older adults and community oncologists

Abstract

Little is known about the characteristics of patients, physicians, and organizations that influence treatment decisions in older patients with AML. We conducted qualitative interviews with community oncologists and older patients with AML to elicit factors that influence their treatment decision-making. Recruitment was done via purposive sampling and continued until theoretical saturation was reached, resulting in the inclusion of 15 patients and 15 oncologists. Participants’ responses were analyzed using directed content analysis. Oncologists and patients considered comorbidities, functional status, emotional health, cognition, and social factors when deciding treatment; most oncologists evaluated these using clinical gestalt. Sixty-seven percent of patients perceived that treatment was their only option and that they had not been offered a choice. In conclusion, treatment decision-making is complex and influenced by patient-related factors. These factors can be assessed as part of a geriatric assessment which can help oncologists better determine fitness and guide treatment decision-making.

Keywords:

• Treatment decision-making
• acute myeloid leukemia
• older adults
• geriatric hematology

Acknowledgements

We wish to acknowledge Dr. Susan Rosenthal, MD for her editorial assistance and Ms. Shuhan Yang for her assistance with creation of figures.

Disclosure statement

Dr. Loh serves as a consultant to Pfizer and Seattle Genetics. Dr. Mohile served as a consultant to Seattle Genetics and received research funding from Carevive for other projects.

Additional information

Funding

The work was supported by the National Cancer Institute at the National Institute of Health [UG1 CA189961]; [K99CA237744 to KPL], the National Institute of Aging at the National Institute of Health [K24 AG056589 to SGM], and the Wilmot Research Fellowship Award (to KPL).