Intensive or nonintensive chemotherapy for older AML patients?

Reducing the intensity of induction therapy in older patients acute myeloid leukemia (AML) does not routinely improve outcomes, a US study has shown

Researchers at the Fred Hutchinson Cancer Research Center, Seattle, used a risk score based on age, increased comorbidity burden and adverse cytogenetic risks to try predict prognosis when assigning patients to  intensive or non-intensive induction chemotherapy.

However they found that many older patients receiving intensive had superior outcomes to those assigned to the non-intensive group, although this was less likely for patients over 70 years of age. Their study also showed that the negative impact on quality of life from intensive chemo was not as large as expected, an also that patient expectations of cure from non-intensive therapy were overly optimistic.

In a commentary published in the journal Blood on the findings, Professor Andrew Wei of the Alfred Hospital, Melbourne, said the decision between intensive or non-intensive chemotherapy remained complex and multifactorial, but the study investigators had highlighted a useful range of  said there some factors to consider when evaluating older patients for non-intensive therapy.

Australia wins bronze in health services ranking

The COVID-19 ravaged UK’s National Health Service has slipped from first place to fourth in a ranking of global health services in 11 high-income countries allowing Australia to step onto the podium in third place overall.

US think tank the Commonwealth Fund’s assessment of healthcare system performance looked at 71 measures across five areas – access to care, care process, administrative efficiency, equity, and healthcare outcomes.

It found the top-performing countries overall to be Norway, the Netherlands, and Australia, followed by the UK.

Australia was first in the domains of equity and health care outcomes, second in administrative efficiency but performed less well in care process and access to care.

The UK’s drop in rankings has been attributed to the impact of the pandemic on the overall health service.

The United States ranked last overall and in all but one domain, despite spending far more of its gross domestic product on health care than other countries.

New Zealand topped the domain of care process which measures activities such as preventive care, safe care, coordinated care, and engagement and patient preferences.

Long COVID uncommon in children, research finds

Children who develop COVID-19 typically have mild illness and recover within a week, with just 4.4% experiencing symptoms beyond a month and almost all recovering fully by eight weeks, a large UK study has found.

Researchers from King’s College London said their findings suggest that long illness duration after infection with SARS-CoV-2 “appears less common in children than in adults”.

The study, published in Lancet Child and Adolescent Health, looked at data reported to the ZOE COVID app between 1 September 2020 and 22 February 2021, during which time 1,734 children developed symptoms of COVID-19 and received a positive PCR test.

The data showed that children were ill for an average of six days. Older children were generally ill for longer than primary school aged children (an average of 7 days in 12-17 year olds versus 5 days in 5-11 year olds), and were also more likely to experience symptoms after the four-week mark (5.1% vs 3.1%, respectively).

Also, children in the cohort experienced an average of three symptoms in the first week of illness, most commonly headache (62.2%), fatigue (55.0%), anosmia and dysosmia (39.6%), fever (37.7%) and persistent cough (25.5%).

Typically, only two symptoms remained in those experiencing symptoms after a month, the most common being fatigue. However, almost all children had symptom resolution by eight weeks, “providing reassurance about long-term outcomes”, the researchers said.