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Outcomes and quality of care in acute myeloid leukemia over 40 years
Author(s) -
Alibhai Shabbir M. H.,
Leach Marc,
Minden Mark D.,
Brandwein Joseph
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24373
Subject(s) - medicine , myeloid leukemia , comorbidity , cancer registry , chemotherapy , multivariate analysis , referral , cancer , pediatrics , logistic regression , population , environmental health , family medicine
BACKGROUND: Acute myeloid leukemia (AML) is associated with a poor prognosis, particularly in older patients. To the authors' knowledge, few population‐based studies of AML treatment patterns and outcomes exist to date. METHODS: The authors used the Ontario Cancer Registry to identify all patients diagnosed with AML between 1965 and 2003. Referral to specialized cancer centers (SCCs) and receipt of chemotherapy were examined as quality of care indicators. Survival outcomes were examined using logistic regression at 30 days, 1 year, and 3 years. RESULTS: A total of 9365 patients (mean age, 58.1 years; range, 0 to 103 years) developed AML between 1965 and 2003. Overall, 75.1%, 32.9%, and 17.3% of patients survived to 30 days, 1 year, and 3 years, respectively. Although survival improved over time among patients aged 19 to 59 years, similar improvements were not seen among older patients. The proportion of patients receiving chemotherapy declined with age (59.0% vs 29.3% among patients ages 19‐59 vs ≥60 years). Fewer patients aged ≥60 years were referred to a SCC compared with younger patients (20.8% vs 29.9%). Younger age, less comorbidity, later year of diagnosis, receipt of chemotherapy, and being referred to a SCC were associated with better 30‐day and long‐term survival in multivariate models. CONCLUSIONS: Although the prognosis has improved over time among younger adults, it remains poor among those aged ≥60 years. Fewer older patients were referred to SCCs or treated with chemotherapy compared with younger patients, whereas both factors were associated with improved survival. Opportunities may exist to improve the quality of care and outcomes among older adults with AML. Cancer 2009. © 2009 American Cancer Society.