The Association of Advanced Care Planning and Good Death in Palliative Elderly Acute Myeloid Leukemia Patients in Thailand

Abstract

Background: The goal of treatment for elderly AML patients is palliative care rather than curative chemotherapy. Advanced care planning (ACP) plays a crucial role in good death. However, the factors associated with ACP and good death have not been well described. Objective: This study aimed to characterize the association between advanced care planning and the outcome of good death in elderly AML patients. Method: AML patients aged ≥60, who received less intensive treatment from August 2020 to December 2021, were interviewed and prospectively followed. All clinical data and potential factors related to ACP and good death were collected. Results: Seventeen AML patients were included during the study period. The median age was 73 years (range 63-88). Twenty-five patients had passed away, with a median survival of 5.5 months. Thirteen patients had undergone ACP. Among them, twelve patients with ACP had passed away, and all had achieved good death, while six out of fifteen in the non-ACP group had achieved good death (p=0.003). Two-thirds of the ACP group initially expected to live for a year when undergoing ACP but later revised their expectations downward. In the non-ACP group, only two patients who achieved a good death were aware that AML would be the cause of death, whereas five out of six in the non-good death group were not aware of it. However, it was found that prognosis understanding alone did not correlate with successful end-of-life care. No other significant factors associated with patient outcomes were identified. Factors associated with the initiation of ACP discussions included decreased platelet count and increased blast count from baseline. Palliative performance status was not predictive when assessed too late. The median time from palliative consultation to death was 3.5 months, which appeared sufficient for patient preparation. Conclusion: The key factor associated with good death was the initiation of ACP discussions with the patient. Decreased platelet count and increased blast count from baseline could serve as warning signs.