acute myeloid leukemia; health-related quality of life; hematologic neoplasms; long-term cancer survivors; patient-reported outcome; quality of life; Humans; Male; Female; Middle Aged; Aged; Cross-Sectional Studies; Surveys and Questionnaires; Adult; Exercise; Comorbidity; Quality of Life; Leukemia, Myeloid, Acute/psychology; Leukemia, Myeloid, Acute/epidemiology; Leukemia, Myeloid, Acute/therapy; Life Style; Cancer Survivors/psychology
Abstract :
[en] [en] BACKGROUND: Despite improvements in survival outcomes for acute myeloid leukemia (AML), limited evidence is available on health-related quality of life (HRQoL) and health problems experienced by long-term survivors.
PATIENTS AND METHODS: This international, cross-sectional study evaluated HRQoL, comorbidities, and lifestyle behaviors among long-term AML survivors enrolled from 24 centers across 6 countries. Health-related quality of life was assessed using the SF-36 and the EORTC QLQ-C30 questionnaires, while comorbidities were measured with an adapted version of the validated self-administered comorbidity questionnaire. Lifestyle factors, including physical activity, diet, smoking, alcohol consumption, and body mass index, were also assessed.
RESULTS: Overall, 225 AML survivors were enrolled, with a median time since diagnosis of 8.8 years (IQR 6.4-11.9) and a median age of 58.9 years (IQR 49.0-67.0). Compared with the general population, AML survivors exhibited clinically relevant impairments in SF-36 physical functioning (Δ = -8.09, P < .001) and role physical scales (Δ = -11.09, P < .001), as well as clinically relevant lower physical component summary scores (Δ = -3.94, P < .001). Survivors treated with alloSCT reported worse HRQoL profiles compared with those treated with autoSCT or chemotherapy only. Comorbidities were highly prevalent (88.5%), with impaired vision, back pain, and arthrosis/arthritis being the most frequent. Analysis of lifestyle behaviors showed that 66.2% of AML survivors were physically inactive, 80.2% did not meet dietary recommendations, and 55.3% were overweight/obese. Multivariate analysis identified physical inactivity as the only independent factor associated with worse HRQoL (β = -6.3, P < .001).
CONCLUSION: Our study shows that AML survivors experience physical limitations and a high comorbidity burden even many years after diagnosis, and it provides insights to better inform survivorship care programs. Further research examining the relationship between physical activity and HRQoL in long-term AML survivors is warranted.
Disciplines :
Hematology
Author, co-author :
Efficace, Fabio ; Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome 00182, Italy
Cannella, Laura; Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome 00182, Italy
Thomas, Xavier; Hospices Civils de Lyon, Department of Clinical Hematology, Centre Hospitalier Lyon-Sud, Pierre Bénite 69495, France
Yuksel, Meltem Kurt; Department of Hematology, Ankara University Faculty of Medicine, Ankara 06620, Turkey
Trisolini, Silvia Maria; Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome 00161,Italy
Capria, Saveria; Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome 00161,Italy
Sparano, Francesco; Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome 00182, Italy
Baldi, Thomas; Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome 00182, Italy
Audisio, Ernesta; SC Ematologia 2, AOU Città della Salute e della Scienza, Torino 10126, Italy
Maurillo, Luca; Hematology, Fondazione Policlinico Tor Vergata, Rome 00133, Italy
Lemoli, Roberto Massimo; IRCCS-San Martino Hospital, Genoa 16132, Italy ; Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genova 16132, Italy
Imovilli, Annalisa; Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42123, Italy
Panovska-Stavridis, Irina; University "Cyril and Methodius"-Skopje, Medical Faculty-Skopje, University Clinic of Hematology- Skopje, Skopje 1000, North Macedonia
Fracchiolla, Nicola; UOC Oncoematologia, Fondazione IRCCS "Ca' Granda" Ospedale Maggiore Policlinico, Milano 20122, Italy
Vallisa, Daniele; Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza 29121, Italy
Crugnola, Monica; Hematology Unit and BMT, University Hospital of Parma, Parma 43126, Italy
Melillo, Lorella Maria Antonia; UO Ematologia, Ospedale "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo 71013, Italy ; U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Policlinico Foggia Ospedaliero-Universitario, Foggia 71122, Italy
Skerget, Matevz; Department of Hematology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia ; Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
Vignetti, Marco; Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome 00182, Italy
Baron, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques
Zhang N, Wu J, Wang Q, et al. Global burden of hematologic malignancies and evolution patterns over the past 30 years. Blood Cancer J. 2023; 13: 82.
Sharma R, Jani C. Mapping incidence and mortality of leukemia and its subtypes in 21 world regions in last three decades and projections to 2030. Ann Hematol. 2022; 101: 1523-1534.
Du M, Chen W, Liu K, et al. The global burden of leukemia and its attributable factors in 204 countries and territories: findings from the global burden of disease 2019 study and projections to 2030. J Oncol. 2022; 2022: 1612702.
Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F. Epidemiological patterns of leukaemia in 184 countries: a population-based study. Lancet Haematol. 2018; 5: e14-e24.
Jani CT, Ahmed A, Singh H, et al. Burden of AML, 1990-2019: estimates from the global burden of disease study. JCO Glob Oncol. 2023; 9: e2300229.
Hemminki K, Hemminki J, Försti A, Sud A. Survival in hematological malignancies in the nordic countries through a half century with correlation to treatment. Leukemia. 2023; 37: 854-863.
Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: recent progress and enduring challenges. Blood Rev. 2019; 36: 70-87.
Sasaki K, Ravandi F, Kadia TM, et al. De novo acute myeloid leukemia: a population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980 to 2017. Cancer. 2021; 127: 2049-2061.
Pulte D, Jansen L, Castro FA, et al. Survival in patients with acute myeloblastic leukemia in Germany and the United States: major differences in survival in young adults. Int J Cancer. 2016; 139: 1289-1296.
Heuser M, Ofran Y, Boissel N, et al. Acute myeloid leukaemia in adult patients: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020; 31: 697-712.
Bhansali RS, Pratz KW, Lai C. Recent advances in targeted therapies in acute myeloid leukemia. J Hematol Oncol. 2023; 16: 29.
Lübbert M, Wijermans PW, Kicinski M, et al. 10-day decitabine versus 3 + 7 chemotherapy followed by allografting in older patients with acute myeloid leukaemia: an open-label, randomised, controlled, phase 3 trial. Lancet Haematol. 2023; 10: e879-e889.
Cucchi DGJ, Polak TB, Ossenkoppele GJ, et al. Two decades of targeted therapies in acute myeloid leukemia. Leukemia. 2021; 35: 651-660.
DiNardo CD, Wei AH. How I treat acute myeloid leukemia in the era of new drugs. Blood. 2020; 135: 85-96.
Dhakal P, Loeffler BT, Ravindra A, Acharya L, Pyakuryal A, Bhatt VR. Improved overall survival in acute myeloid leukemia over the last 15 years. JCO. 2024; 42: 6543-6543.
Ramsey I, de Rooij BH, Mols F, et al. Cancer survivors who fully participate in the PROFILES registry have better health-related quality of life than those who drop out. J Cancer Surviv. 2019; 13: 829-839.
Ekels A, van de Poll-Franse LV, Posthuma EFM, et al. Persistent symptoms of fatigue, neuropathy and role-functioning impairment among indolent non-Hodgkin lymphoma survivors: a longitudinal PROFILES registry study. Br J Haematol. 2022; 197: 590-601.
Chang KH, Hwang WL, Muo CH, Hsu CY, Teng CJ. Outcome and late effects among acute myeloid leukemia survivors: a nationwide population-based study. Support Care Cancer. 2016; 24: 4993-5000.
Major CK, Kantarjian H, Sasaki K, et al. Survivorship in AML - a landmark analysis on the outcomes of acute myelogenous leukemia patients after maintaining complete remission for at least 3 years. Leuk Lymphoma. 2020; 61: 3120-3127.
Ahmad TA, Gopal DP, Chelala C, Dayem Ullah AZ, Taylor SJ. Multimorbidity in people living with and beyond cancer: a scoping review. Am J Cancer Res. 2023; 13: 4346-4365.
Siembida EJ, Smith AW, Potosky AL, Graves KD, Jensen RE. Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors. Qual Life Res. 2021; 30: 1119-1129.
Götze H, Taubenheim S, Dietz A, Lordick F, Mehnert A. Comorbid conditions and health-related quality of life in long-term cancer survivors-associations with demographic and medical characteristics. J Cancer Surviv. 2018; 12: 712-720.
Efficace F, Breccia M, Avvisati G, et al. Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia. Leukemia. 2019; 33: 1598-1607.
van de Poll-Franse LV, Horevoorts N, van Eenbergen M, et al. The patient reported outcomes following initial treatment and long term evaluation of survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer. 2011; 47: 2188-2194.
Ware JE Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30: 473-483.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993; 85: 365-376.
Ware JE Jr., Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care. 1995; 33: As264-79.
Mols F, Aaronson NK, Vingerhoets AJ, et al. Quality of life among long-term non-Hodgkin lymphoma survivors: a population-based study. Cancer. 2007; 109: 1659-1667.
Thong MS, Mols F, Coebergh JW, Roukema JA, van de Poll-Franse LV. The impact of disease progression on perceived health status and quality of life of long-term cancer survivors. J Cancer Surviv. 2009; 3: 164-173.
Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual. 3rd ed. European Organisation for Research and Treatment of Cancer, Brussels; 2001.
Messerer D, Engel J, Hasford J, et al. Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia. Haematologica. 2008; 93: 826-833.
Zittoun R, Suciu S, Watson M, et al. Quality of life in patients with acute myelogenous leukemia in prolonged first complete remission after bone marrow transplantation (allogeneic or autologous) or chemotherapy: a cross-sectional study of the EORTC-GIMEMA AML 8A trial. Bone Marrow Transplant. 1997; 20: 307-315.
Efficace F, Cottone F, Sommer K, et al. Validation of the European organisation for research and treatment of cancer quality of life questionnaire core 30 summary score in patients with hematologic malignancies. Value Health. 2019; 22: 1303-1310.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003; 49: 156-163.
Ligibel JA, Alfano CM, Courneya KS, et al. American society of clinical oncology position statement on obesity and cancer. J Clin Oncol. 2014; 32: 3568-3574.
Ligibel JA, Alfano CM, Hershman D, et al. Recommendations for obesity clinical trials in cancer survivors: American society of clinical oncology statement. J Clin Oncol. 2015; 33: 3961-3967.
Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985; 10: 141-146.
Amireault S, Godin G, Lacombe J, Sabiston CM. The use of the Godin-Shephard Leisure-Time physical activity questionnaire in oncology research: a systematic review. BMC Med Res Methodol. 2015; 15: 60.
WHO Guidelines Approved by the Guidelines Review Committee. Global Recommendations on Physical Activity for Health. World Health Organization; 2010.
Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. Geneva, Switzerland: World Health Organization; 2003.
Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American cancer society's SCS-II. J Clin Oncol. 2008; 26: 2198-2204.
Mood C. Life-style and self-rated global health in Sweden: a prospective analysis spanning three decades. Prev Med. 2013; 57: 802-806.
Apolone G, Mosconi P. The italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol. 1998; 51: 1025-1036.
Sloan J, Symonds T, Vargas-Chanes D, Fridley B. Practical guidelines for assessing the clinical significance of health-related quality of life changes within clinical trials. Drug Information J. 2003; 37: 23-31.
Colangelo KJ, Pope JE, Peschken C. The minimally important difference for patient reported outcomes in systemic lupus erythematosus including the HAQ-DI, pain, fatigue, and SF-36. J Rheumatol. 2009; 36: 2231-2237.
Sekhon S, Pope J, Baron M. The minimally important difference in clinical practice for patient-centered outcomes including health assessment questionnaire, fatigue, pain, sleep, global visual analog scale, and SF-36 in scleroderma. J Rheumatol. 2010; 37: 591-598.
Cocks K, King MT, Velikova G, Martyn St-James M, Fayers PM, Brown JM. Evidence-based guidelines for determination of sample size and interpretation of the european organisation for the research and treatment of cancer quality of life questionnaire core 30. J Clin Oncol. 2011; 29: 89-96.
Kurosawa S, Yamaguchi T, Mori T, et al. Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia. Bone Marrow Transplant. 2015; 50: 1241-1249.
Leunis A, Redekop WK, Uyl-de Groot CA, Lowenberg B. Impaired health-related quality of life in acute myeloid leukemia survivors: a single-center study. Eur J Haematol. 2014; 93: 198-206.
Kiserud CE, Lockmer S, Baerug I, Dahl AA, Kimby E, Østenstad B. Health-related quality of life and chronic fatigue in long-term survivors of indolent lymphoma - a comparison with normative data. Leuk Lymphoma. 2023; 64: 349-355.
Arden-Close E, Pacey A, Eiser C. Health-related quality of life in survivors of lymphoma: a systematic review and methodological critique. Leuk Lymphoma. 2010; 51: 628-640.
Telzerow E, Gorlich D, Sauerland C, et al. Quality of life and life satisfaction in long-term survivors of acute myeloid leukemia. Leukemia. 2025; 39: 2663-2672.
Watson M, Buck G, Wheatley K, et al. Adverse impact of bone marrow transplantation on quality of life in acute myeloid leukaemia patients; analysis of the UK medical research council AML 10 trial. Eur J Cancer. 2004; 40: 971-978.
Suh KJ, Shin DY, Kim I, et al. Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population. Ann Hematol. 2019; 98: 2357-2366.
Graf S, Cecchini M. "Diet, physical activity and sedentary behaviours: analysis of trends, inequalities and clustering in selected oecd countries", OECD Health Working Papers, No. 100, OECD Publishing; 2017. 10.1787/54464f80-en
OECD/WHO. Step up! Tackling the Burden of Insufficient Physical Activity in Europe. OECD Publishing; 2023. 10.1787/500a9601-en
Strain T, Flaxman S, Guthold R, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants. Lancet Glob Health. 2024; 12: e1232-e1243.
Chang PH, Lai YH, Shun SC, et al. Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manage. 2008; 35: 524-534.
Alibhai SM, Durbano S, Breunis H, et al. A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Res. 2015; S0145-2126:30365-9.
Alibhai SM, O'Neill S, Fisher-Schlombs K, et al. A pilot phase II RCT of a home-based exercise intervention for survivors of AML. Support Care Cancer. 2014; 22: 881-889.
Alibhai SM, O'Neill S, Fisher-Schlombs K, et al. A clinical trial of supervised exercise for adult inpatients with acute myeloid leukemia (AML) undergoing induction chemotherapy. Leuk Res. 2012; 36: 1255-1261.
Klepin HD, Danhauer SC, Tooze JA, et al. Exercise for older adult inpatients with acute myelogenous leukemia: a pilot study. J Geriatr Oncol. 2011; 2: 11-17.
Stauder R, Lambert J, Desruol-Allardin S, et al. Patient-reported outcome measures in studies of myelodysplastic syndromes and acute myeloid leukemia: literature review and landscape analysis. Eur J Haematol. 2020; 104: 476-487.
