title: Do quality of life or physical function at diagnosis predict short-term outcomes during intensive chemotherapy in AML?
abstract: BACKGROUND
  Intensive chemotherapy (IC) used to treat acute myeloid leukemia (AML) is associated with toxicity, particularly in older adults. Emerging data suggest that baseline quality of life (QOL) and physical function may predict outcomes in oncology, although data in AML are limited. We investigated the association between baseline QOL and physical function with short-term treatment outcomes in adults and elderly AML patients.
  
  
  METHODS
  We conducted a prospective, longitudinal study of adults (age 18+) AML patients undergoing IC. Before starting IC, patients completed the European Organisation for the Research and Treatment of Cancer (EORTC) 30-item questionnaire (QLQ-C30) and Functional Assessment of Cancer Therapy Fatigue subscale (FACT-Fatigue) in addition to physical function tests (grip strength, timed chair stands, 2-min walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission and achievement of complete remission (CR). Logistic regression was carried out to evaluate each outcome.
  
  
  RESULTS
  Of the 239 patients (median age 57.5 years), 56.7% were male and median Charlson comorbidity score was 0. Sixty-day mortality, ICU admission and CR occurred in 9 (3.7%), 15 (6.3%) and 167 (69.9%) patients, respectively. Using univariate regression, neither QOL nor physical function at presentation was predictive of 60-day mortality (all P > 0.05), whereas ICU admission (P < 0.001) and remission status at 30 days (P = 0.007) were. Fatigue (P = 0.004) and role functioning (P = 0.003) were predictors of ICU admission; QOL and physical function were not. A higher Charlson score predicted ICU admission (P = 0.01) and remission status (P = 0.002). The cytogenetic risk group was associated with achievement of CR (P = 0.02); QOL and physical function were not (all P > 0.05). Findings were similar when patients age 60+ were examined. Relationships between fatigue and role functioning with ICU admission deserve further exploration.
  
  
  CONCLUSIONS
  Baseline QOL and physical function tests in this prospective study were not associated with short-term mortality, ICU admission or achievement of CR after the first cycle of chemotherapy.
authors.affiliation: Department of Medicine, University Health Network, Toronto.
authors.forename: N
authors.initials: N
authors.lastname: Timilshina
authors.affiliation: Department of Medicine, University Health Network, Toronto.
authors.forename: H
authors.initials: H
authors.lastname: Breunis
authors.affiliation: Division of Hematology, Department of Medicine, University of Alberta, Edmonton.
authors.forename: J M
authors.initials: JM
authors.lastname: Brandwein
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto.
authors.forename: M D
authors.initials: MD
authors.lastname: Minden
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto.
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Medicine, University Health Network, Toronto.
authors.forename: S
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Institute of Health Policy, Management, and Evaluation; Department of Public Health Sciences.
authors.forename: G A
authors.initials: GA
authors.lastname: Tomlinson
authors.affiliation: Hematology/Oncology, Sunnybrook Odette Cancer Center.
authors.forename: R
authors.initials: R
authors.lastname: Buckstein
authors.affiliation: Department of Psychiatry.
authors.forename: M
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Medicine, University Health Network, Toronto; Institute of Health Policy, Management, and Evaluation; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: shabbir.alibhai@uhn.ca.
authors.forename: S M H
authors.initials: SMH
authors.lastname: Alibhai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: acute myeloid leukemia; elderly; fatigue; physical function; quality of life; short-term mortality