Table 3.

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

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.