A Collaborative Palliative and Leukemia Care Model for Patients With AML Receiving Non-Intensive Therapy

Frequently people undergoing leukemia treatment experience physical and emotional symptoms
during the course of their illness. These can be very distressing to both patients and their
caregivers. Patients with acute leukemia receiving non-intensive therapy also often
experience a rapid decline in their health status and have a limited prognosis. Despite their
limited life-expectancy, they rarely engage in discussion with their clinicians regarding
their goals and preferences for care at the end of life. The study doctors want to know if
the early introduction of a team of clinicians that specialize in the lessening (palliation)
of many of these distressing symptoms and have expertise in enhancing communication about
prognosis and illness trajectory may improve the overall care of patients with acute
leukemia.

This team of clinicians is called the palliative care team and they focus on ways to improve
the participant's pain and other symptom management (nausea, fatigue, shortness of breath,
anxiety, etc.) and to assist the participant and the participant's caregivers in coping with
the emotional and social issues associated with their diagnosis. The team consists of
physicians and advance practice nurses who have been specially trained in the care of
patients facing serious illness.

The main purpose of this study is to compare two types of care - standard leukemia oncology
care and standard leukemia oncology care with collaborative involvement of palliative care
clinicians to see which is better for improving the experience of patients with acute myeloid
leukemia (AML) undergoing treatment.

The purpose of this research study is to find out whether introducing patients undergoing
treatment for acute myeloid leukemia to the palliative care team can improve their
end-of-life communication, understanding of their prognosis, and their physical and
psychological symptoms during the course of their illness.

Inclusion Criteria:

- Patients with AML receiving non-intensive therapy including hypomethylating agents,
single-agent chemotherapy, targeted therapy agents, or single or combination
non-intensive agents offered on a clinical trial, including the following populations:

- Newly diagnosed AML

- Relapsed AML

- Primary refractory AML

- The ability to provide informed consent

- The ability to comprehend English or complete questionnaires with minimal assistance
of an interpreter

Exclusion Criteria:

- Patients not receiving care at MGH

- Patients receiving intensive chemotherapy (requiring 4-6 week hospitalization)

- Patients receiving supportive care alone

- Major psychiatric illness or co-morbid conditions prohibiting compliance with study
procedures

- Patients already receiving palliative care