title: Quality of life and physical function in adults treated with intensive chemotherapy for acute myeloid leukemia improve over time independent of age.
abstract: OBJECTIVE
  Intensive chemotherapy (IC) is the primary treatment of acute myeloid leukemia (AML) but is associated with significant toxicity, particularly in older adults. We characterized the impact of AML and its treatment on quality of life (QOL) and physical function in younger (age 18-59) and older (age 60+) patients with AML over 1year from diagnosis.
  
  
  METHODS
  AML patients undergoing IC without stem-cell transplant at two tertiary care centers were enrolled in a prospective, longitudinal study. Assessments were done pre-IC and at 7 time points over the next year. QOL, fatigue, and physical performance (grip strength, 2-minute walk test (2MWT), timed chair stands) were measured in all patients whereas daily function was measured only in older patients. Data were analyzed using mixed effects regression models.
  
  
  RESULTS
  237 patients were recruited (140 younger and 97 older, 56% male). One-year survival was 79% and 60% among younger and older patients, respectively. For patients in remission, global QOL and fatigue improved significantly over time (p<0.001 for both); trends were similar between older and younger patients. Grip strength did not change over time (p=0.58) whereas both the 2MWT (p<0.001) and timed chair stands (p<0.001) improved significantly. Daily function improved significantly over time (p=0.003).
  
  
  CONCLUSIONS
  Survivors of AML in remission after IC achieve significant improvements in QOL, fatigue, and physical function over time with similar trajectories for older and younger patients. These data suggest that appropriately selected older patients do well following IC.
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada. Electronic address: shabbir.alibhai@uhn.on.ca.
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
authors.forename: Henriette
authors.initials: H
authors.lastname: Breunis
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
authors.forename: Narhari
authors.initials: N
authors.lastname: Timilshina
authors.affiliation: Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Av. Libertador Bernardo O'Higgins, 1058 Santiago, Chile.
authors.forename: Romina
authors.initials: R
authors.lastname: Brignardello-Petersen
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Department of Public Health Sciences, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
authors.forename: Hassanabbas
authors.initials: H
authors.lastname: Mohamedali
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Minden
authors.affiliation: Department of Psychiatry, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
authors.forename: Madeline
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
authors.affiliation: Department of Medicine, University of Alberta, 11350-83 Avenue, Edmonton, Alberta T6G 2G3, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Brandwein
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005080:Exercise Test / Q000706:statistics & numerical data; D005221:Fatigue / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Acute myeloid leukemia; Aging; Chemotherapy; Depression; Physical function; Prospective study; Quality of life; Survivorship