Early Palliative Care in Acute Myeloid Leukemia

SIMPLE SUMMARY: Several new targeted drugs for the treatment of acute myeloid leukemia (AML) have been developed in recent years. However, their potential efficacy should be balanced with the possibility of a poor outcome. For patients with solid tumors, the integration of palliative care (PC) with standard oncologic care, eight weeks after the diagnosis of advanced cancer, has demonstrated many benefits. In patients with hematologic malignancies, this model is underutilized. Here, we review the PC needs and the evidence in the literature supporting the early integration of PC in the disease trajectory of patients with AML. Early PC should be the standard of care for patients with AML. Efforts should also be made to extend the integrated PC model to patients with other hematologic malignancies. ABSTRACT: Background: Several novel targeted therapies seem to improve the outcome of acute myeloid leukemia (AML) patients. Nonetheless, the 5-year survival rate remains below 40%, and the trajectory of the disease remains physically and emotionally challenging, with little time to make relevant decisions. For patients with advanced solid tumors, the integration of early palliative care (EPC) with standard oncologic care a few weeks after diagnosis has demonstrated several benefits. However, this model is underutilized in patients with hematologic malignancies. Methods: In this article, we analyze the palliative care (PC) needs of AML patients, examine the operational aspects of an integrated model, and review the evidence in favor of EPC integration in the AML course. Results: AML patients have a high burden of physical and psychological symptoms and high use of avoidant coping strategies. Emerging studies, including a phase III randomized controlled trial, have reported that EPC is feasible for inpatients and outpatients, improves quality of life (QoL), promotes adaptive coping, reduces psychological symptoms, and enhances the quality of end-of-life care. Conclusions: EPC should become the new standard of care for AML patients. However, this raises issues about the urgent development of adequate programs of education to increase timely access to PC.