Time at home among older adults with acute myeloid leukemia based on treatment intensity: A SEER-Medicare analysis.

Abstract

6586 Background: Older adults with acute myeloid leukemia (AML) have identified time at home (TAH) as a critical outcome when deciding on treatment. No study to date has fully explored TAH for older adults with AML. Methods: We identified a cohort of adults age ≥66 years with a new diagnosis of AML from the SEER-Medicare linked database from 2004-2016. Individuals were stratified into high-intensity chemotherapy [HIC] v. hypomethylating agent [HMA] v. other using claims. The primary outcome was TAH, quantified by subtracting the total number of person-days spent in hospitals and skilled nursing facilities from the number of person-days survived. Demographics, comorbidities, frailty, and transfusion dependence were considered covariates. Results: 7,946 adults were included. 2,824 (36%) received HIC, 2,542 (32%) HMA, and 2,580 (33%) other. Mean age was 75 years (HIC: 73; HMA: 78; other: 76). The cohort was predominantly White (88%, Black 5%; Asian 3%; Hispanic 1%) and male (57%). Median survival was 7 months (HIC: 9; HMA: 8). Median total TAH was 151 days (Mean 426, Range 0-1825). Adults receiving HIC spent less time at home and more time hospitalized than those receiving HMAs each month in the first year (Table). Differences in TAH between HIC and HMA cohorts were most pronounced in the first 3 months (1st: 49.5% v. 86.5%; 2nd: 68.2% v. 84.1%; 3rd: 77.3% v. 86.8%). Total TAH over 12 months was lower for those receiving HIC v. HMA (51.7% [187 days] v. 56.9% [205 days]). Transfusion dependence (≥ 1/month) was associated with decreased TAH at 1 month (OR 0.81, p<0.001) and 12 months (OR 0.90, p=0.04). Other covariates were not associated with TAH. Conclusions: Although intensive chemotherapy resulted in slightly longer survival, older adults treated with HMAs had more time at home. Treatment decision-making should incorporate patient preferences for prolonging survival v. increasing time at home. The effect of new treatments (eg, venetoclax) on time at home should be evaluated in future studies. [Table: see text]