Andrea Schumacher

Fatigue as an important aspect of quality of life in patients with acute myeloid leukemia

Quality of life (QL) was evaluated in 101 patients with AML undergoing intensive and prolonged treatment at 12 sequential time points by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C 30 questionnaire and the profile of mood states scale (POMS). For those patients having completed the course of inpatient treatment (n=37), QL improved from the beginning of chemotherapy to the end of inpatient treatment. Patients who subsequently went off protocol did not differ significantly in their self-assessed QL when compared with patients who completed therapy. Fatigue was more closely related to QL than nausea/emesis or appetite loss, but did not correlate with hemoglobin levels.

Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia

Background The impact on quality of life of allogeneic stem cell transplantation or conventional chemotherapy in patients with acute myeloid leukemia remains unclear, mainly because of a lack of studies with long-term follow-up. The German AML-Intergroup, therefore, initiated a survey on quality of life of patients with a relapse-free survival of at least 5 years after first-line treatment. Design and Methods The EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics was used. The questionnaire was returned by 419 of 818 patients (51.2%) identified by six study groups. The patients’ median age at diagnosis was 42 years, and the median follow-up period was 8 years. One hundred and seventy patients were treated with stem cell transplantation (121 allogenic, 49 autologous) in first complete remission; the other 249 patients were treated with conventional chemotherapy. Results The ECOG activity index revealed normal activity in 45% vs. 60% of the patients in the allogeneic stem cell transplantation vs. conventional chemotherapy groups, respectively and disabled person status in 60% vs. 35%. All QLQ-C30 functions, except physical functioning and pain, were poorer in allogeneic stem cell transplantation patients. Problems in leisure-time activities, social life, and financial management, sexual limitations and adverse effects were significantly more frequent in patients after allogeneic stem cell transplantation than after conventional chemotherapy. Multivariate logistic regression models on global health status revealed concomitant disease, age >45 years, and allogeneic stem cell transplantation as significant risk factors. Conclusions These results indicate that, compared to conventional chemotherapy, allogeneic stem cell transplantation has a significantly worse long-term impact on quality of life. This needs to be considered when treatment options are discussed.

Psycho-Oncology in a united Europe—changes and challenges

The paper provides an overview on the 11th scientific conference of the European Society for Psycho-Oncology (ESPO), which took place in June 2001, at Heidelberg, Germany. The main topics discussed during the conference were: (1) the state of the art of research on the effects of psychological interventions in cancer patients; (2) psychosocial aspects in the new field of cancer genetics; (3) recent developments in Quality of Life research; (4) Psycho-Oncology from an European perspective; and (5) children and cancer. The conference gave an impressive picture of the many achievements Psycho-Oncology in Europe has accomplished during the last years, in the clinical and scientific domain. With recent biomedical innovations Psycho-Oncology is facing new challenges. Despite these achievements limitations have become apparent. Identifying these limitations, future aims can be outlined. Among these, there is the need for methodological refinement, as well as for proof of clinical relevance of research results, in order to narrow the gap between research and practice.

Quality of Life and Coping in Patients with Acute Myeloid Leukemia (AML)

Intensification of treatment for AML resulted in a substantial improvement in longterm prognosis. As intensive therapy might be associated with high morbidity and most patients with AML eventually relapse, quality of life (QL) of patients has become an important parameter to be assessed. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group (Munster). QL has been analyzed throughout therapy at 12 different time points by using the EORTC-QLQ C 30 questionnaire. Patients’ coping strategies were assessed by the Freiburg Questionnaire on Coping with Illness, patients’ individual perception of their disease and therapy by a semi-structured interview. 101 patients were enrolled in the protocol. For those patients having completed the courses of inpatient treatment (n=37), Physical functioning (p<.001), Emotional functioning (p<.001) and Subjective QL (p<.001) improved significantly from beginning of therapy to the end of inpatient treatment. As shown by a one-way analysis of variance, patients who subsequently went off protocol did not differ in their QL when compared with patients who completed therapy. During treatment, Active problem-solving decreased over time (p=.023). As clarified by the qualitative data, the duration of therapy and the uncertainty of a longterm remission were a major challenge for patients’ coping skills. Including QL as an outcome parameter shows that intensive therapy is not associated with poor QL. Patients’ subjective benefit outweighs the adverse effects of antileukemic therapy.

Including Quality of Life as an Important End Point in Evaluating Intensive and Prolonged Treatment for Acute Myeloid Leukemia (AML)

Intensification of treatment for AML resulted in a substantial improvement in longterm prognosis (Buchner 1997). As intensive therapy might be associated with high morbidity and most patients with AML eventually relapse, quality of life (QL) of patients has become an important parameter to be assessed. This study was designed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group.