Sex, Age, and Income Level Are Associated with Undertreatment for AML

A study published online in the Journal of Cancer Research and Clinical Oncology found that patient characteristics such as sex, age, and income level were associated with undertreatment of acute myeloid leukemia (AML).

The researchers aimed to evaluate the incidence of patients eligible for non-intensive chemotherapy (NIC) who were receiving no active antileukemic treatment (NAAT), but rather receiving only best supportive care (BSC).

The team conducted a literature review and identified 25 studies with real-world data on AML treatment, comprising 220,569 patients. Most studies were retrospective analyses of databases. Eleven studies used single-center data or were prospective. Studies represented regions including the U.S., Europe, Asia, and South America. Twenty-four studies reported patient age, and the pooled average age was 70.6 years.

In the US, the weighted average rate of patients receiving NAAT was 30.0%, ranging from 10.0% to 61.4%. In Europe, the rate of NAAT ranged from 24.1% to 35.0%. In a study from India, 65.5% of patients received NAAT. Overall, according to the authors, the rate of NAAT among patients with AML decreased over the last two decades.

Twelve studies reported an association between older age and decreased likelihood of receiving antileukemia treatment. A higher comorbidity index score or presence of a chronic, uncontrolled comorbid condition were the second most common factors associated with NAAT. The most common comorbidities were cardiovascular disease and diabetes. A history of previous hematologic malignancy was also associated with decreased likelihood of chemotherapy.

In seven studies from the US, female sex was significantly associated with NAAT. Three studies in the US identified an association between Black race and lower odds of receiving antileukemia treatment (odds ratio [OR] range, 0.67–0.85); however, this trend was not seen in other studies using Medicare data or the National Cancer Database (NCDB). In fact, a study of NCDB data from 2003 to 2013 found higher odds of systemic treatment for Black versus White patients (OR 1.20). Lower household status was associated with NAAT in five studies and unmarried status was associated with NAAT in two studies.

Receiving NAAT was associated with poor outcomes. Overall, patients receiving NAAT had worse overall survival (OS) compared to patients receiving active treatment. The median reported OS for NAAT versus active care ranged from 1.2–4.8 months vs. 5.0–14.4 months, respectively.

In conclusion, the authors wrote, “In our review, the most common factor associated with receipt of NAAT was increasing age. Current AML treatment guidelines recommend that age should not be the sole determinant of a patient’s eligibility for treatment, however, the pervasiveness of this finding suggests physicians may continue to strongly consider age in treatment decisions.”

Reference

Hubscher E, Sikirica S, Bell T, et al. Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC). J Cancer Res Clin Oncol. 2021 Nov;147(11):3359-3368.