Determining treatment pathways for older patients with acute myeloid leukemia: patient and clinician perspectives

Introduction: Achieving remission and prolonging duration of response are the primary treatment objectives for patients with acute myeloid leukemia (AML). However, identifying the best approach for older patients poses a significant challenge. This review explores the treatment pathways for older patients, especially those not eligible for stem cell transplantation and emphasizes the importance of optimizing outcomes by actively involving patients in their care plans. Areas covered: There is currently no clinical consensus on when to use intensive or less-intensive induction chemotherapy for older patients, and more empirical evidence is needed. Meanwhile, this decision must still account for patients’ preferences and circumstances in addition to the benefits and risks of therapy. Survey data have shown that patients want to be involved in their treatment decisions and that higher patient engagement improves patient-reported quality of care and satisfaction. While the importance of patient engagement is widely recognized, clinicians can work toward bridging the gap between patients’ preferred and perceived levels of involvement in their treatment decisions. Expert opinion: Patient engagement in treatment decisions is particularly important for older patients with AML. Understanding patients’ perspectives and expectations for clinical and quality-of-life outcomes is essential to tailoring the most appropriate and effective treatment plan.