Defining Effective Practices in Quality Care for Patients with Acute Myeloid Leukemia

Acute myeloid leukemia is a rare, rapidly progressing disease that is commonly treated through stem cell transplants. While allogeneic stem cell transplants are an important treatment option, not all patients are eligible due to factors such as age, performance status, disease characteristics, or other comorbidities. Thus, for transplant-ineligible patients, it is important for providers to choose treatment strategies that will keep the patient’s disease in remission and improve their long-term survival.

To help patients around the United States achieve better health outcomes, the Association of Cancer Care Centers (ACCC) in partnership with the HealthTree Foundation for Acute Myeloid Leukemia, and with support of Bristol Myers-Squibb, developed and implemented an education program, Achieving and Maintaining Better Outcomes for Patients with Acute Myeloid Leukemia. This program examines barriers in care coordination and therapy options for transplant-ineligible patients and identifies best practices to improve outcomes across the acute myeloid leukemia treatment landscape.

As part of the education program, ACCC designed a cohort-based quality improvement initiative to facilitate peer-to-peer learning and cross-collaboration across 4 selected cancer programs and practices. With the guidance of the ACCC Acute Myeloid Leukemia Advisory Committee and expert faculty—led by Thomas LeBlanc, MD, hematologic oncologist, associate professor of medicine and associate professor in population health sciences at Duke University—the cohort informed the development of an effective practice guide and a quality improvement toolkit.

The Effective Practice Guide titled, “Effective Practices for Achieving and Maintaining Better Outcomes for Patients with Acute Myeloid Leukemia,” highlights recommendations for cancer care providers to improve care quality and outcomes for patients with acute myeloid leukemia who do not receive a transplant. The Guide provides 9 key recommendations that cancer care team members should consider when treating patients with acute myeloid leukemia:

1: Address Social Drivers of Health

Eligibility for a transplant is dependent on many factors including, age, functional status, comorbidities, as well as psychosocial and economic factors. Screening patients for social needs is recommended for providers to better understand how social drivers of health impact the communities they serve and to aid them in developing strategies to mitigate barriers to care.

2: Apply Guideline-concordant Evaluation and Treatment

Allogeneic transplant is considered the best treatment option for long-term remission for people with acute myeloid leukemia. However, there are many factors that affect eligibility. For transplant-ineligible patients, it is critical for cancer care teams to consider strategies that help keep the patient in remission for as long as possible. Further, treatment considerations should include up-to-date guidance on disease-specific and patient-specific characteristics and risk factors.

3: Engage Patients in Shared Decision-Making

Establishing goals of care with patient input is a key step in shared decision-making and should occur throughout the care journey. The conversation should help the provider understand patient values and priorities to better define treatment options.

4: Increase Participation in Clinical Trials

For those who are transplant ineligible, participation in a clinical trial may be the best option for treatment. While there are increasing numbers of clinical trials available for patients with acute myeloid leukemia, providers need to support clinical trial awareness and access. This is particularly important for this patient population, as ineligibility often causes poor health outcomes.

5: Establish an External Care Coordination Plan

There are many considerations when deciding where a patient should receive treatment, including provider level of expertise in treating acute myeloid leukemia, treatment options available, and a patients’ ability to travel. Care coordination between larger cancer programs and community oncologists will help ensure the patient has access to standardized treatment options and clinical trials close to home.

6: Incorporate Supportive Care and Symptom Management

Acute myeloid leukemia is an aggressive disease and treating it often causes equally aggressive side effects. Consequently, it is important that supportive care services are provided to address symptoms patients experience while undergoing treatment. Additionally, it is critical for care teams to implement effective symptom management of the disease and treatments.

7: Support Oral Oncolytic Adherence

The use of oral drugs for cancer treatment continues to grow exponentially. Oral medication offers benefits such as reduced clinic visits but have similar effects to intravenous chemotherapies and may have increased costs.

8: Apply Evidence-Based Health Literacy Practices

Due to the difficulty of treating acute myeloid leukemia, providers must convey complex information to patients and caregivers. Providers need to ensure they are using multimodal communication strategies that are culturally and linguistically appropriate and easily understandable.

9: Provide Caregiver Support

Family members or friends often step in as caregivers to help patients with activities outside of clinical touchpoints such as: arranging transportation, making meals, helping with medication management, navigating insurance, among many others. To prevent burnout and negative impacts on caregivers’ quality of life, it is important to screen for caregiver burden and provide resources as available.

Looking Forward

The Effective Practice Guide also includes checklists that should be used during diagnosis and relapse. The checklists were developed to support treatment selection and delivery for patients with acute myeloid leukemia based on clinical guidelines, disease characteristics, and patient preferences and goals to ensure optimal care and outcomes.

Look for the release of the Effective Practice Guide next month and for more information and resources on the program, visit the ACCC website.