Palliative care interventions and their early integration in the management of older adults with acute myeloid leukemia: a narrative review.

Abstract

Background and objective: Palliative care (PC) interventions have become essential in treating patients with acute myeloid leukemia (AML). Studies indicate that the early PC (EPC) integration during the entire disease course, from the diagnosis and the start of treatment until the end-of-life (EOL), especially regarding the decision-making process and the relief of symptom burden, can significantly impact the patient's quality of life (QoL) of AML patients and comprehensively address their physical and psychosocial needs. This narrative review synthesizes quantitative and qualitative research, including observational and randomized clinical studies, as well as review articles, to place issues of EPC within the context of AML.

Methods: This overview details our Medline English literature search from January 2010 to June 2025. A systematic search on PubMed was conducted in two phases: March-April 2025 and June 2025. We used several keywords, including AML, EOL care, EPC, PC, QoL, and symptom relief. Furthermore, we reviewed https://clinicaltrials.gov/ (last accessed June 30, 2025) and conducted manual searches of references to ensure the completeness of our findings. Additionally, we obtained expert insights through discussions with specialists in AML and PC.

Key content and findings: The key agendas of PC are symptom control, emotional support, and quality communication along the painful process of AML diagnosis and treatment. In this instance, patients who receive EPC experience a reduction in pain, anxiety, and depression compared to when patients are under standard care (SC), not supplemented with EPC. Additionally, integrating EPC is capable of enhancing patient-practitioner communication because it allows them to select the most appropriate treatment, ideally suited to the specific needs and experience of the patient.

Conclusions: The results of our review highlighted the evolving AML landscape, where novel therapies are now in practice, and numerous others are in development. Therefore, newer, reduced-intensity regimens can provide a duration of disease control but not remission. Thus, decision-making with treating physicians and initial treatment to control symptoms, together with psychological counseling, are integral parts of AML treatment, aiming to achieve greater satisfaction and better emotional well-being in patients and caregivers.