Table 1.

Studies evaluating the early integration of palliative care in patients with acute myeloid leukemia.

First Author	Study Design	Population	Intervention	Endpoints	Scales and Measures	Results
El-Jawahri A [65] 2020 and Nelson AM [68] 2021	Multisite, nonblinded, phase III randomized clinical trial	160 pts: 86 EPC 74 SC	EPC: inpatient PC physician, an AP nurse, or physician assistant. First visit within 72 of randomization. At least 2 visits a week during hospitalization up to 1 year after randomization. No outpatient visits SC: supportive care measures as per their oncology team. PC allowed at patients’ request or at the request of their oncologist.	Primary: QOL at week 2 Secondary: symptom burden, anxiety, depression, PTSD, patient reported EOL discussions, hospitalizations in the last week of life, chemotherapy in the last 30 days of life, and hospice use	FACT-Leuk ESAS PHQ-9 HADS PTSD Checklist–Civilia Brief COPE [68]	Better QOL (EPC:116.45 vs. SC:107.59; p = 0.04). Lower depression (EPC: 5.68 vs. SC: 7.20; p = 0.02; and EPC: 6.34 vs. SC: 8.00; p = 0.04). Lower anxiety (EPC: 4.53 vs. SC: 5.94; p = 0.02). Lower PTSD symptoms (EPC:27.79 vs. SC: 31.69; p = 0.01). Greater use of approach-oriented coping at 2 and 24 weeks (B = 1.85; SE = 0.62; p = 0.004 and B = –0.39; SE = 0.15; p = 0.01) [68]. Lower use of avoidant coping at week 2 (B = –0.70; SE = 0.29; p = 0.02) [68]. Better QOL and lower anxiety, depression, and PTSD symptoms were maintained longitudinally. Higher frequency of discussion about EOL care preferences (EPC: 21 of 28 [75.0%] vs. SC: 12 of 30 [40.0%]; p = 0.01) and lower frequency of chemotherapy in the last 30 days of life (EPC: 15 of 43 [34.9%] vs. SC: 27 of 41 [65.9%]; p = 0.01). No differences in symptom burden, PHQ-9 scores, or changes in the use of avoidant coping strategies [68], longitudinally. No differences in hospice use, hospice length of stay, or hospitalization in the last week of life.
Rodin G [66] 2020	Single-center phase II trial evaluating feasibility and tolerability, calculation of sample size, and timing of the primary endpoint	31 pts: 17 EPC 14 SC	EPC: mainly inpatient 8–12 psychotherapeutic sessions, over 8 weeks by a trained mental health clinician (EASE-psy), and systematic screening of physical symptoms (EASE-phys) with triggered referral to PC. PC team: a physician and nurse. First visit within 1 month of inpatient admission. Rare outpatient evaluation SC: PC allowed at request	Primary: severity of traumatic stress symptoms Secondary: physical symptom burden, pain, QOL, depressive symptoms and patients’ satisfaction with care	ESAS-AL SASRQ MSAS BPI FACIT- Sp BDI-II FAMCARE-P16	Feasibility outcome met Reduced traumatic stress symptoms at 4 and 12 weeks: EASE group: M (SE) = 24.26 (5.63), vs. SC group, M (SE) = 40.13 (5.50), p = 0.048; M (SE) = 21.03 (5.71), vs. SC group, M (SE) = 38.27 (5.46), p = 0.033 Lower pain intensity and pain interference with daily activities at 12 weeks, EASE group: M (SE) = 2.23 (2.66) vs. SC: M (SE) = 9.66 (2.09), p = 0.032. EASE group: M (SE) = 4.68 (6.27) vs. SC: M (SE) = 27.73 (4.88), p = 0.006. Lower rates of pts with ASD or threshold ASD at 12 weeks: EASE group: 7.7% (1/13) vs. SC: 42.1% (8/19), p = 0.05. No differences in physical symptom severity, symptom-related distress, depressive symptoms, satisfaction with care, and overall quality of life.
Potenza L [67] 2021	Single-center observational retrospective	215 pts: 131 EPC 84 late referrals to PC	EPC: exclusively outpatient One trained physician and one fellow First visit at a median of 5 weeks after the diagnosis. Monthly visits or frequency driven by disease trajectory. At least three visits Late PC: patients with only 1 or 2 visits of PC	Primary: presence of quality indicators of PC and EOL care	5 indicators of quality for PC [30]: psychological support, assessing and managing pain, GOC and prognosis, ACP, accessing home-care service 14 indicators of quality of EOL care [27]	Higher rates of Assessment and management of pain (EPC 100% vs. LatePC 46%; p = 0.00001) GOC (EPC 71.8% vs. LatePC 43%; p = 0.00001) ACP (EPC 57.3% vs. LatePC 2.3%; p = 0.00001) Home care service (EPC 43.5% vs. LatePC 14.2%; p = 0.00001) Lower rate of Chemotherapy in the last 14 days of life (EPC 2.7% vs. LatePC 13.9%; p = 0.0228) ICU admission and intubation in the last month of life (EPC 0% and 0% vs. LatePC 14.7% and 6.1%; p = 0.0007 and 0.0314) Access to ED ≥2 within 30 days of death (EPC 4% vs. LatePC 23.5%; p = 0.001) Death in acute facilities (EPC 5.3% vs. LatePC 31.4%; p = 0.002) RC transfusion in the last week of life (EPC 49.3% vs. LatePC 28.12%; p = 0.0315). No differences in Hospitalization ≥2 within 30 days of death, hospice length of stay > 7 days, platelet transfusion in the last week of life

EPC = early palliative care; SC = standard care; AP = advance practitioner; QOL = quality of life; PTSD = post-traumatic stress disorder; Brief COPE = Brief Coping Orientation to Problems Experienced Inventory; EOL = end-of-life; FACT-Leuk = Functional Assessment of Cancer Therapy–Leukemia; ESAS = Edmonton Symptom Assessment Scale; PHQ-9 = Patient Health Questionnaire; HADS = Hospital Anxiety and Depression Scale; EASE = Emotion And Symptom-focused Engagement; SASRQ = Stanford Acute Stress Reaction Questionnaire; MSAS = Memorial Symptom Assessment Scale; BPI = Brief Pain Inventory; FACIT-Sp = Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; BDI-II = Beck Depression Inventory-II; FAMCARE-P16 = Family Satisfaction with Care-Patient Version; GOC = goals of care conversations; ACP = advance care planning.