Patient-Clinician Discordance in Perceptions of Treatment Risks and Benefits in Older Patients with Acute Myeloid Leukemia

Abstract

Older patients with acute myeloid leukemia (AML) are confronted with challenging decisions regarding treatment with "intensive" chemotherapy that carries significant toxicity for a small chance of a cure versus "nonintensive" chemotherapy to control the disease, but with fewer side effects. A clear understanding of the likely outcome and risks of the various treatment strategies is essential for these patients to make informed decisions about their care. This article reports that older patients with AML overestimate both the risks and benefits of treatment and have substantial misperceptions about their prognosis. Interventions to enhance patients' understanding of their prognosis and treatment risk are needed.

Patient‐hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study

“…2 In another study of 100 older patients with acute myeloid leukemia, patients who reported a lower likelihood of cure compared with their hematologists were more likely to report greater depressive symptoms. 3 The difference in findings among these studies compared with those of the current study may reflect the heterogeneity of study populations and varying follow-up periods. Therefore, the relationships between psychological health and prognostic understanding need to be evaluated further in future studies.…”

“…Prior studies have demonstrated that up to 82% of patients with hematologic malignancies have a different understanding of their prognosis compared with their hematologist. [2][3][4][5] The majority of this discordance is skewed toward optimism, whereby patients tend to have higher expectations for cure. Discordance may exist due to patient-related (eg, beliefs, emotional distress, social support), physician-related (eg, communication, reluctance Cancer March 15, 2020 in discussing prognosis), and societal factors.…”

“…[6][7][8][9][10][11][12] This discordance appears to have significant implications for care received, because patients who are more optimistic also are more likely to opt for aggressive care 13 and are less likely to accept palliative and comfort-oriented care. [14][15][16] To the best of our knowledge, prognostic discordance has been relatively underexplored in patients with hematologic malignancies, with the sparse existing studies having small sample sizes, [2][3][4] being conducted at a single site, and being focused primarily on patients with acute myeloid leukemia and myelodysplastic syndromes, or those undergoing allogeneic HCT.…”

Temporal patterns and predictors of receiving no active treatment among older patients with acute myeloid leukemia in the United States: A population‐level analysis

“…Patients who believe their prognosis is more favorable are more likely to pursue aggressive treatment . The majority of patients tend to overestimate their chance of cure, both for AML and other types of cancer …”

“…Although the acuity of an AML diagnosis can be overwhelming for patients, a majority want to be involved in the decision-making process regarding treatment options. [35][36][37][38] Patients who believe their prognosis is more favorable are more likely to pursue aggressive treatment. 37 The majority of patients tend to overestimate their chance of cure, both for AML and other types of cancer.…”