Misperceptions About Prognosis in Acute Myeloid Leukemia Highlight the Need for Better Patient-Physician Communication

Older patients with acute myeloid leukemia (AML) tend to overestimate both the risks of treatment and their likelihood of cure, according to results of a new study. These findings underscore the importance of better communication between patients and their oncologists about AML and end-of-life care.

Thomas W. LeBlanc, MD, MA, MHS, of the Duke Cancer Institute, presented results from the study at the American Society of Hematology's 59th Annual Meeting & Exposition, December 9 to 12, 2017, in Atlanta, GA.

"Older patients with AML face difficult treatment decisions, as they can be treated with either risky multi-drug intensive chemotherapy for a small chance of a cure or nonintensive and noncurative palliative chemotherapy," LeBlanc said. Informed decision making is critical, but little is known about how well older patients understand their prognosis and the risks of treatment.

In the current study, LeBlanc and his team examined perceptions about AML among 100 patients older than 60 years with newly diagnosed AML. Patients were enrolled from 2 tertiary care hospitals within 72 hours of starting intensive chemotherapy (n = 50) or nonintensive chemotherapy (n = 50). Most patients were classified as having intermediate-risk (48%) or high-risk (46%) disease. The median patient age was 71 years.

Patients and their oncologists answered a series of survey questions about the patient's disease and treatment over the course of several months. At the beginning of treatment, patients and oncologists reported their perceptions about treatment-related mortality. One month later, patients and oncologists described their perceptions about disease prognosis, using the Perception of Treatment and Prognosis Questionnaire. Lastly, 6 months after starting treatment, patients were asked whether they discussed their wishes regarding end-of-life care with their oncologist. The research team then compared responses between patients and oncologists to assess the quality of communication around treatment decision making.

Patients overestimate treatment risk
Results showed that patients have a poor understanding of the risks associated with chemotherapy. The majority of patients (91%) reported that it is at least "somewhat" likely for the patient to die as a result of treatment, suggesting that patients overestimate the risk of treatment-related mortality. The majority of oncologists (80%), however, reported that it is "very unlikely" for the patient to die as a direct result of treatment (P < .001).

Patients overestimate the possibility of cure
Most patients (95%) agreed that it is "very important" to know their prognosis. Despite this desire to understand the course of their disease, results indicate major gaps in patient knowledge about the likelihood of a cure. Overall, 90% of patients reported that they were "somewhat likely" or "very likely" to be cured of their AML. By comparison, 74% of oncologists reported that a cure for their patients' AML was "unlikely" or "very unlikely" (P < .001).

Patients' misperceptions about their disease prognosis were consistent across the study, regardless of the type of chemotherapy received (Table). Nearly all patients treated with intensive chemotherapy (97.6%) reported that they were "somewhat likely" or "very likely" to be cured, whereas 58% of oncologists indicated that a cure was "unlikely" (P < .001). Similarly, the majority of patients who were treated with nonintensive chemotherapy (82.1%) believed that a cure was "somewhat likely" or "very likely," whereas 90% of oncologists believed that a cure was "unlikely" with this regimen (P < .001).

TABLE. Differences in Patient Versus Physician Perceptions of Likelihood of a Cure

Somewhat likely
Very likely
P value
Likelihood of Cure With Intensive Chemotherapy
< .001
Likelihood of Cure With Nonintensive Chemotherapy
< .001

Misperceptions about the likelihood of a cure may lead to poor planning for end-of-life care. Despite their poor prognosis, most patients (77.8%) had not yet discussed their preferences for end-of-life care with their oncologists 6 months after starting treatment for AML.

"Overall, the survey results revealed substantial and pervasive gaps in communication and prognostic understanding among older patients with AML," LeBlanc said. "Interventions are needed to improve communication between patients and oncologists and ensure that older patients with AML have an accurate understanding of their treatment risks and prognosis to make informed decisions about their treatment."

Source: El-Jawahri A, Abel GA, Greer J, et al. Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia. Presented at: American Society of Hematology 59th Annual Meeting; December 9-12, 2017; Atlanta, GA. Abstract 349.