A man aged 64 years was recently diagnosed with acute myeloid leukemia (AML). He also has chronic renal failure, atrial fibrillation (AF), and uncontrolled diabetes. Should the treatment goal be palliation and disease control or aim for curative?—JIA CONWAY, RN, MSN, CRNP, York, Pa.
AML has a 20%-40% survival rate. The first steps in this case are to determine the patient’s wishes and whether this is the first diagnosis or a second flare (which has a lower survival rate). Next, understand that survival rate is decreased with advancing age or hepatic/renal dysfunction. Then, decide if this patient’s uncontrolled diabetes is actually diabetes insipidus, which occurs in AML due to the infiltration of leukemic cells into the neurohypophysis. In addition, the hypermetabolic state of AML causes tachycardia and can lead to AF with rapid ventricular rate where 25% of cardiac output is lost because there is no atrial kick.
As for the question of whether to pursue palliative care or curative, the clinician’s true goal is quality of life, which means hydration (double the daily maintenance), beta blockers for AF, treatment of diabetes, electrolyte surveillance, and allopurinol to decrease hyperuricemia. Support the patient through education and provide guidance to enable an informed decision by the patient and his support system. —Maria Kidner, DNP, FNP-BC (143-10)