Trade-off preferences in older adults with newly diagnosed acute myeloid leukemia.

Abstract

1537 Background: Treatment decisions for older adults with acute myeloid leukemia (AML) are highly preference-sensitive, requiring a balance between survival and other important outcomes such as toxicities and quality of life (QoL). Understanding patients' trade-off preferences is critical for guiding personalized treatment planning. We examined the trade-off preferences of older adults newly diagnosed with AML and factors influencing these preferences. Methods: We collected data from two clinical trials evaluating an AML communication tool. Older adults completed questionnaires at diagnosis assessing trade-offs between survival and two key outcomes: a) maintaining QoL and b) treatment-related toxicities (nausea/vomiting, bedbound status, assistance with daily activities, worsening memory, and confusion). The survival-QoL trade-off was categorized as agree vs. disagree. Trade-offs for treatment-related toxicities were scored from 0 to 5, with higher scores indicating a greater willingness to endure toxicities for survival. We used binary logistic regression to identify factors associated with survival-QoL trade-off, while ordinal logistic regression was used for survival-toxicity trade-off. Results: We included 95 older patients with newly diagnosed AML; mean age was 73.7 (SD 7.6), 38% female, and 94% White. Approximately 37% received intensive and 54% received lower-intensity treatment. Only 15% prioritized survival over maintaining QoL, 39% neutral, and 46% prioritize maintaining QoL over survival (Table). Over 60% would decline treatments leading to confusion, and 45% would avoid treatments causing bedbound status. On multivariable analyses, patients enrolled with a caregiver had a significantly higher odds of prioritizing survival over QoL [Odds Ratio (OR): 5.92, p=0.04]. Employed patients were more likely to endure treatment-related toxicities for survival compared to those who were unemployed, retired or homemaker (OR: 7.76, p<0.01). Conclusions: Trade-off preferences among older adults with AML vary widely and are influenced by caregiving support and employment status. Actively eliciting these preferences is essential to align treatment decisions with individual patient values. Preferences of older adults with AML. I would like to try treatments for my cancer if they could help me live longer, even if it is very likely they would Agree/Strongly agree Neutral Disagree/Strongly disagree Have high level of side effects (e.g., nausea/vomiting) 60% 24% 16% Make me require more assistance from family and friends with completing daily activities (e.g., shopping, managing money) 53% 22% 25% Make me bedbound and unable to use the bathroom without assistance 35% 20% 45% Make my memory worse 29% 29% 40% Cause me to become confused often so that I am not aware of my surroundings 15% 23% 61% Living longer is more important to me than maintaining my quality of life 15% 39% 46%