It’s always an acute scenario when a patient presents with acute myeloid leukemia (AML), and it’s important for payers to keep that in mind, says Bruno Medeiros, MD, associate professor of medicine (hematology) at the Stanford University Medical Center and director of Cancer Center Infusion Area Treatment Services at the Stanford Cancer Center.
“These patients are arriving at the hospital with a life-threatening illness, and their survival could be measured in weeks. That means they need a complete workup so their care team can gain a complete understanding of their disease process in a rapid manner.”
That means physicians need to be able to move quickly to care for patients with AML, and they need to have payers on board with the ability to make real-time decisions about treatment plans, adds Medeiros.
Here are four more things payers need to be aware of about the treatment of AML:
1. There are many comorbidities in older adults
Philip Kuriakose, MD, senior staff physician at Henry Ford Cancer Institute and assistant professor at Wayne State University Medical School, says that since AML presents at an older age, patients with the condition may be struggling with other chronic conditions such as diabetes, hypertension, heart failure, or kidney disease.
Because AML patients must also manage those conditions, Kuriakose, who is also a member of the American Society of Hematology’s committee on practice, says it’s difficult to prototype this disease. Thus, treatment is very different from patient to patient, he adds.
2. Treatment differs significantly from other cancer types
Treating AML is also different from treating other types of cancer. With AML, chemotherapy is often delivered to patients in an inpatient setting—and, often, hospitalizations are prolonged or patients have to return to the hospital if there are complications.
Medeiros says that inpatient hospitalizations for AML patients can be as long as four to six weeks, and physicians may have to decide to refer a patient for a bone marrow transplant, which can add additional complexity and require additional resources.
Payers should look to bone marrow transplant pathways for guidance on covering appropriate treatment paths for AML.
As is the case with the treatment of bone marrow transplants, payers could rely on working closely with Centers of Excellence, such as with Boston’s Dana-Farber Cancer Institute and Arizona’s Mayo Clinic for bone marrow transplants, says Medeiros.
In his ideal treatment approach for AML, only Centers of Excellence would be able to treat such patients, which would allow specific healthcare facilities to work collaboratively with payers to optimize and standardize care, he says. On a practical level, the Centers of Excellence for AML would be regional, meaning, for example, that a location in Omaha, Nebraska, would treat patients in Nebraska and a Boston location would treat New England patients.
3. Clinical trials hold promise for AML patients, but costly
Clinical trials can be a good option for patients with AML, says Medeiros. Sponsored by the government or the pharmaceutical industry, patients involved in clinical trials are treated with experimental drugs in centers based on clinical trial protocols. And often, these clinical trials are done in conjunction with other clinical therapies for AML.
However, since clinical trial drugs may not be “fruitful” and indeed “toxic,” he adds that these patients may need to be admitted to the hospital more frequently, which also adds cost.
4. Many tests may be needed
Kuriakose notes that many patients with AML are potentially curable. That means many patients will have to endure a variety of tests, and payers should be aware of this as decisions are made about appropriate treatment paths.