Practice patterns and outcomes for adults with acute myeloid leukemia receiving care in community vs academic settings

Abstract

Consistent with observations in other disease settings, retrospective studies have indicated that treatment outcomes for adults with acute myeloid leukemia (AML) are better in higher- vs lower-volume hospitals and academic vs nonacademic centers, with greatest benefits noted in acute promyelocytic leukemia. Younger age, more frequent receipt of chemotherapy and hematopoietic cell transplantation, and differences in comorbidities and socioeconomic factors may partially account for these differences. With new therapeutic options including oral small molecule inhibitors and parenteral drugs suitable for outpatient administration, there is increasing interest from patients and physicians in treating AML in the community setting and avoiding referral to academic centers. This may be particularly true for older adults, for whom treatment rates in the community have historically been low, and for those with comorbidities, because treatment benefits are estimated to be low, and thus travel to academic centers is perceived as especially burdensome. How the volume-outcome relationship is affected by the shift of the treatment landscape in AML over the last few years is unknown. Additionally, improvements in supportive care (transfusion support, broad-spectrum oral antimicrobials), resulting in gradually decreasing early death rates over time, and the growing focus on the impact of AML therapy on quality of life and treatment cost concerns further fuel the larger trend toward an increasing proportion of care delivered in the outpatient setting. Here, we examine whether the current shift of administering chemotherapy and supportive care to the outpatient setting can be translated to the community setting without compromising patient outcomes.

Financial Implications of Early Hospital Discharge After AML-Like Induction Chemotherapy: A 4-Year Retrospective Analysis

“…There was no difference between laboratory/ pathology charges ($692 vs $780/day; P5. 19) or imaging charges ($181 vs $167/day; P5.057). However, patients with EHD had higher miscellaneous charges than medically matched control patients ($84 vs $70/day; P,.001).…”

What Does the Economic Burden of Acute Myeloid Leukemia Treatment Look Like for the Next Decade? An Analysis of Key Findings, Challenges and Recommendations

“…Conventional therapies for AML incur considerable costs and healthcare resource utilization (HCRU), with hospital-based chemotherapy infusions, the need for frequent monitoring, and the inevitable need to treat serious adverse effects of treatment. 7 HSCT, while potentially curative, is a costly inpatient procedure. Newer treatments, with more manageable safety profiles, may help to limit medical and hospitalization costs, but in general these novel drugs cost more than conventional chemotherapy.…”

“…Most recently, the COVID-19 pandemic has accelerated the push towards using telehealth and outpatient care when appropriate, and it is likely that these new approaches to care will influence treatment practices in the long term. 7 …”

“…These include the advent of oral AML therapies and chemotherapy regimens that can be administered in the outpatient setting, as well as improved supportive care that may reduce the need for emergency care and prolonged hospitalizations. 7 …”

Moving the Treatment of Acute Myeloid Leukemia to the Outpatient Setting: Current Expert Perspectives and Consensus Findings

“…Interest in moving toward outpatient management has increased as healthcare providers have become more comfortable with the prevention and treatment of complications associated with the intensive treatment of AML [5]. The trend toward outpatient management is driven not only by the potential to reduce the substantial financial costs of inpatient treatment, but also the desire to improve quality of life and family/caregiver support for patients, some of whom may find prolonged inpatient stay inconvenient or extremely challenging [5,6].…”