Physical Function Views Differ Between Older AML Patients, Clinicians

Older adults with newly diagnosed acute myeloid leukemia (AML) frequently have different expectations from their treating oncologists about how their physical function will change, according to findings from a pilot randomized controlled trial published in Blood Advances.¹

“Although older adults with cancer often prioritize maintaining physical function when making treatment decisions, whether patients and oncologists have similar expectations of future functioning remains unknown,” wrote the researchers of the study. “We explored this among patients with acute myeloid leukemia (AML) and their oncologists in a pilot randomized controlled trial testing a decisional support tool (University of Rochester-Geriatric Oncology Assessment for Acute Myeloid Leukemia [UR-GOAL]).”

Wide Gap Between Patient and Oncologist Expectations

The study enrolled 100 adults 60 years and older with newly diagnosed AML. Of these, 77 patients treated by 8 oncologists completed questions about expected changes in physical function at 6 months and 1 year. Patients had a mean age of 73 years, and 61% were male patients.

The gap in expectations was substantial. Only 15% of patients anticipated that their physical function would decline at 6 months compared with 51% of oncologists; at 1 year, the corresponding figures were 20% and 54%. Overall, 68% of patients had expectations that differed from those of their oncologist, with weighted κ values of 0.10 at 6 months and 0.07 at 1 year, indicating very little agreement.

The investigators specifically examined “clinically meaningful discordance,” defined as patients expecting their physical function to remain stable or improve while their oncologist expected decline. This pattern occurred in approximately 40% of patients overall. More than 90% of patients also considered remaining in their own home as they age, or “aging in place,” somewhat or very important to them, highlighting the importance of functional outcomes in treatment decision-making.

Communication Tool Narrowed the Gap

Patients were randomized 1:1 to UR-GOAL or usual care. The UR-GOAL intervention included an AML-specific educational video and assessments addressing aging-related conditions, patient values and priorities, and prognostic awareness. A summary report was provided to the patient and oncologist before treatment-related discussions.¹

Clinically meaningful discordance was significantly less common among patients assigned to UR-GOAL than among those receiving usual care at 6 months (27% vs 56%; P = .010). However, the difference was not statistically significant at 1 year (36% vs 44%; P = .520).¹

The authors noted that their findings are consistent with prior research showing substantial patient-oncologist differences in other aspects of prognosis. In a secondary analysis of a cluster randomized trial involving 541 adults 70 years and older with advanced incurable cancers, approximately 60% of patient-oncologist dyads disagreed about cancer curability, and 72% disagreed about life-expectancy estimates. Discordance regarding life-expectancy estimates was associated with greater odds of hospitalization (adjusted OR, 1.64; 95% CI, 1.01-2.66).²

However, the investigators noted several limitations.¹ The study was a small pilot trial, with functional-prognosis responses available from 77 of 100 enrolled patients and 8 oncologists, limiting statistical power and generalizability. The findings also show that UR-GOAL reduced clinically meaningful discordance at 6 months but not at 1 year; the study was not designed to determine whether improved prognostic alignment translates into better functional outcomes, health care utilization, quality of life, or costs. A larger multicenter UR-GOAL trial (NCT06697600) is currently recruiting and will further evaluate the intervention in older adults with newly diagnosed AML and their caregivers.³

“Our prospective study of older adults with newly diagnosed AML provides an initial characterization of patient and oncologist expectations of functional prognosis for this population,” wrote the researchers. “We found oncologists were much more likely to expect patients to decline in the next 6 months or 1 year than patients themselves (> 50% of oncologist ratings vs 16%-20% of patient ratings).”

References

1. Jensen-Battaglia M, Mortaz-Hedjri S, Blumberg R, et al. Patient and oncologist expectations of functional prognosis among older adults with acute myeloid leukemia. Blood Adv. 2026;10(15):5389-5399. doi:10.1182/bloodadvances.2025019276
2. Loh KP, Seplaki CL, Sanapala C, et al. Association of prognostic understanding with health care use among older adults with advanced cancer: a secondary analysis of a cluster randomized clinical trial. JAMA Netw Open. 2022;5(2):e220018. doi:10.1001/jamanetworkopen.2022.0018
3. Loh KP, Ng QMR, Mohile SG, et al. Protocol of a decisional intervention for older adults with newly diagnosed acute myeloid leukemia and their caregivers: UR-GOAL 3. J Geriatr Oncol. 2025;16(2):102187. doi:10.1016/j.jgo.2025.102187