Key factors associated with a lower utilization of initial chemotherapy for acute myeloid leukemia
| Study . | Patients not receiving chemotherapy . | Older age . | Comorbidities . | Race . | Lower education . | Lower income . | Insurance status . |
|---|---|---|---|---|---|---|---|
| Present (US) (2003-2012) | 25% | Yes | Yes | Lower in African American | No | Yes | Yes |
| SEER-Medicare (2000-2007)*,8 | 61% among patients ≥ 65 y | Yes | Yes | No | Yes | Yes | Medicare patients only |
| SEER-Medicare (1997-2007)9 | 57% among patients ≥ 65 y | Yes | Yes | Lower in African American | Medicare patients only | ||
| California Cancer Registry (1998-2008)10 | 25%-39% depending on race | Yes | Yes | Lower in African American | |||
| Denmark (2000-2014)13 | † | Yes† | Yes† | Yes† | Universal healthcare system | ||
| Netherlands (2007-2012)11 | 5-66%‡ | Yes |
| Study . | Patients not receiving chemotherapy . | Older age . | Comorbidities . | Race . | Lower education . | Lower income . | Insurance status . |
|---|---|---|---|---|---|---|---|
| Present (US) (2003-2012) | 25% | Yes | Yes | Lower in African American | No | Yes | Yes |
| SEER-Medicare (2000-2007)*,8 | 61% among patients ≥ 65 y | Yes | Yes | No | Yes | Yes | Medicare patients only |
| SEER-Medicare (1997-2007)9 | 57% among patients ≥ 65 y | Yes | Yes | Lower in African American | Medicare patients only | ||
| California Cancer Registry (1998-2008)10 | 25%-39% depending on race | Yes | Yes | Lower in African American | |||
| Denmark (2000-2014)13 | † | Yes† | Yes† | Yes† | Universal healthcare system | ||
| Netherlands (2007-2012)11 | 5-66%‡ | Yes |
Our study also demonstrated a lower use of chemotherapy in patients treated at non-academic centers, hospital with low volume of AML patients, and patients with therapy-related, intermediate or high-risk acute myeloid leukemia, and a higher use in patients who traveled greater distance to receive care.
This study also demonstrated lower rates of receipt of chemotherapy in patients from rural areas and those with prior diagnosis of myelodysplastic syndrome.
47% of patients received palliative intent therapy; however, whether chemotherapy or only supportive care therapy is not specified. The receipt of intensive chemotherapy was lower among older patients and those with lower education and lower income levels (mainly among older patients).
Depending on the age: 5% in patients aged 18-40 years and 66% in patients aged >70 years. The rates of chemotherapy use were higher for patients with acute promyelocytic leukemia and those treated in 2007-2012 compared with prior years.