Care Patterns and Barriers to Outpatient Care for Adults With AML Following Intensive Chemotherapy at NCCN Member Institutions
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
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Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA
Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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Background: Prolonged hospitalization following intensive (re)induction chemotherapy for acute myeloid leukemia (AML), while standard, is costly and resource intense, limits inpatient bed capacity, and negatively impacts quality of life. Early hospital discharge (EHD) following completion of chemotherapy has proven safe as an alternative at select institutions, but is not widely implemented. Patients and Methods: From February 2023 through May 2023, the NCCN Best Practices Committee conducted a survey evaluating AML hospitalization patterns, care models, and barriers to EHD at its 33 member institutions. Results: A total of 30 (91%) institutions completed the survey; two-thirds treat >100 patients with AML annually and 45% treat more than half of these with intensive chemotherapy. In the (re)induction setting, 80% of institutions keep patients hospitalized until blood count recovery, whereas 20% aim to discharge patients after completion of chemotherapy if medically stable and logistically feasible. The predominant reasons for the perceived need for ongoing hospitalization were high risk of infection, treatment toxicities, and lack of nearby/accessible housing. There was no significant association between ability to practice EHD and annual AML volume or treatment intensity patterns (P=.60 and P=.11, respectively). In contrast, in the postremission setting, 87% of centers support patients following chemotherapy in the outpatient setting unless toxicities arise requiring readmission. Survey responses showed that 80% of centers were interested in exploring EHD after (re)induction but noted significant barriers, including accessible housing (71%), transportation (50%), high toxicity/infection rate (50%), high transfusion burden (50%), and limited bed availability for rehospitalization (50%). Conclusions: Hospitalization and care patterns following intensive AML therapy vary widely across major US cancer institutions. Although only 20% of surveyed centers practice EHD following intensive (re)induction chemotherapy, 87% do so following postremission therapy. Given the interest in exploring the EHD approach given potential advantages of EHD for both patients and health care systems, strategies to address identified medical and logistical barriers should be explored.
Submitted October 2, 2023; final revision received January 29, 2024; accepted for publication March 4, 2024. Published online July 30, 2024.
Author contributions: Methodology: Halpern, Sugalski, Bandini, Stewart, Walter. Formal analysis: Halpern, Othus, Walter. Investigation: Sugalski, Bandini, Stewart. Writing—original draft: Halpern, Walter. Writing—review & editing: Sugalski, Bandini, Othus, Stewart.
Disclosures: A.B. Halpern has disclosed receiving grant/research support from Imago Biosciences, Merck, Bayer, Gilead, Jazz Pharmaceuticals, Incyte, Karyopharm, and Disc Medicine; and serving as a consultant for Abbvie and Notable laboratories. R.B. Walter has disclosed receiving grant/research support from Amgen, Aptevo, Celgene, ImmunoGen, Janssen, Jazz, Kura, MacroGenics, and Pfizer; having ownership interests in Amphivena; and serving as a consultant for Abbvie, Adicet, Amphivena, BerGenBio, Bristol Myers Squibb, GlaxoSmithKline, ImmunoGen, Kura, and Orum. F.M. Stewart has disclosed having a spouse who receives research support from Glycomimetics, Pfizer, GPCR, and Notable laboratories; and serving as a scientific advisor for Accordant Health Services. J.M. Sugalski and L. Bandini have disclosed being employed by the National Comprehensive Cancer Network. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7026. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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