ImportancePatients with acute myeloid leukemia (AML) recognize days spent at home (home time) vs in a hospital or nursing facility as an important factor in treatment decision making. No study has adequately described home time among older adults with AML.ObjectiveTo describe home time among older adults with AML (aged ≥66 years) and compare home time between 2 common treatments: anthracycline-based chemotherapy and hypomethylating agents (HMAs).Design, Setting, and ParticipantsA cohort of adults aged 66 years or older with a new diagnosis of AML from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 2004 to 2016 was identified. Individuals were stratified into anthracycline-based therapy, HMAs, or chemotherapy, not otherwise specified (NOS) using claims.Main Outcomes and MeasuresThe primary outcome was home time, quantified by subtracting the total number of person-days spent in hospitals and nursing facilities from the number of person-days survived and dividing by total person-days. A weighted multinomial regression model with stabilized inverse probability of treatment weighting to estimate adjusted home time was used.ResultsThe cohort included 7946 patients with AML: 2824 (35.5%) received anthracyclines, 2542 (32.0%) HMAs, and 2580 (32.5%) were classified as chemotherapy, NOS. Median (IQR) survival was 11.0 (5.0-27.0) months for those receiving anthracyclines and 8.0 (3.0-17.0) months for those receiving HMAs. Adjusted home time for all patients in the first year was 52.4%. Home time was highest among patients receiving HMAs (60.8%) followed by those receiving anthracyclines (51.9%). Despite having a shorter median survival, patients receiving HMAs had more total days at home and 33 more days at home in the first year on average than patients receiving anthracyclines (222 vs 189).Conclusions and RelevanceThis retrospective study of older adults with AML using SEER-Medicare data and propensity score weighting suggests that the additional survival afforded by receiving anthracycline-based therapy was entirely offset by admission to the hospital or to nursing facilities.

中文翻译：

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患有急性髓性白血病的老年人化疗后的居家时间


重要性急性髓系白血病 (AML) 患者认为在家（在家时间）与在医院或护理机构度过的时间是治疗决策的重要因素。尚无研究充分描述 AML 老年人的家庭时间。目的描述 AML 老年人（年龄≥66 岁）的家庭时间，并比较两种常见治疗方法：基于蒽环类药物的化疗和低甲基化药物 (HMA) 之间的家庭时间。环境和参与者根据 2004 年至 2016 年监测、流行病学和最终结果 (SEER)-医疗保险链接数据库，确定了一组 66 岁或以上的新诊断为 AML 的成年人。使用声明将个体分层为基于蒽环类药物的治疗、HMA 或化疗，未另行指定 (NOS)。 主要结果和措施 主要结果是家庭时间，通过从医院和护理机构中花费的总人天数中减去来进行量化。存活的人日数除以总人日数。使用具有稳定的治疗权重逆概率的加权多项回归模型来估计调整后的家庭时间。结果该队列包括 7946 名 AML 患者：2824 名 (35.5%) 接受了蒽环类药物治疗，2542 名 (32.0%) 名 HMA 接受治疗，2580 名 (32.5%) 名接受了 HMA 治疗。分类为化疗，NOS。接受蒽环类药物治疗的中位生存期 (IQR) 为 11.0 (5.0-27.0) 个月，接受 HMA 治疗的中位生存期为 8.0 (3.0-17.0) 个月。第一年所有患者调整后的在家时间为 52.4%。接受 HMA 的患者在家时间最长 (60.8%)，其次是接受蒽环类药物的患者 (51.9%)。 尽管中位生存期较短，但接受 HMA 的患者在家总天数更长，第一年平均在家天数比接受蒽环类药物的患者多 33 天（222 比 189）。 结论和相关性这项使用 SEER 对患有 AML 的老年人进行的回顾性研究-医疗保险数据和倾向评分权重表明，接受基于蒽环类药物的治疗所带来的额外生存率完全被住院或护理机构所抵消。