Patient and oncologist expectations of functional prognosis among older adults with acute myeloid leukemia

While 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. We explored this among patients with acute myeloid leukemia (AML) and their oncologists in a pilot RCT testing a decisional support tool (UR-GOAL). We included adults ≥ 60 years old with newly diagnosed AML randomized 1:1 to UR-GOAL (AML educational video, assessment of aging-related conditions, values, and prognostic awareness) or usual care (UC). After initiating treatment, patients and oncologists reported whether they expected the patient's physical function to decline, improve, or stay the same over the next 6 months and 1 year (functional prognosis). We estimated patient oncologist agreement using weighted kappas (κ) and evaluated differences by study arm. Out of 100 enrolled patients, 77, who received care from 8 oncologists, responded to questions about the patient's functional prognosis. Patients were 73 (SD 6.8) years old on average, and 39% were female. Fewer patients (15% at 6 months, 20% at 1 year) anticipated their function would decline, vs. their oncologists (51% at 6 months, 54% at 1 year). Most patients (68%) had discordant expectations from their oncologist, with κ=0.10 (6 months), κ=0.07 (1 year). However, clinically meaningful discordance (patient: maintain or improve, oncologist: decline) was less common among UR-GOAL patients vs. UC (27% vs. 56%, p=0.010). Older adults with AML have expectations about their future physical function which differ from their oncologists. UR-GOAL may reduce this discordance. NCT05335369