Acute Myeloid Leukaemia (AML) Model of Care

Aim

To optimise the quality of care for patients with AML and enable a consistent approach to the provision of care. It provides a set of principles and outlines the key requirements at each stage of the patient’s journey based on evidence of best practice. It incorporates guidelines related to various components of the model.

Benefits

Key points included in this model are:

  • Mechanisms to ensure early identification and referral to an AML treatment centre
  • A multidisciplinary team (MDT) approach to treatment planning and the provision of care in an appropriate setting
  • The use of ambulatory care services to enable early discharge programs in a safe and efficient way
  • Effective follow-up and supportive care for all patients with AML 

Summary

The AML model of care describes a comprehensive, multidisciplinary approach to providing patient and family-centred care throughout the patient’s journey.

The major steps in the patient’s journey are:

  • Presentation and referral
  • Diagnosis and work-up for treatment
  • Safe treatment models
  • Referral for transplant
  • Follow-up care
  • Identification and management of relapse
  • Long-term survivorship or end-of-life care.

Not all patients will experience every stage of this journey; however, the key requirement is to provide safe and effective care. 

Background

Acute myeloid leukaemia (AML) is a rapidly progressive disease of the bone marrow in which too many immature cells from the myeloid lineage are produced. The onset of AML is usually rapid with presentation and diagnosis occurring within weeks of the onset of symptoms(1). Diagnosis and management of haematological malignancies require a specialised multidisciplinary approach with systemic treatment in metropolitan centres that have developed clinical expertise within the specialty.

Treatment requires intensive systemic chemotherapy to induce remission and control the disease, and is associated with significant morbidity and mortality(2). Each treatment cycle lasts approximately 28 days with an extended period of neutropenia expected to last for approximately 17 – 22 days from the commencement of treatment. Traditional treatment models have required inpatient stays for the duration of neutropenia. In 2010 / 2011, among all cancers across Australia, acute myeloid leukaemia was responsible for the longest average length of hospital stay at 17.5 days(3) Recent models increasingly utilise ambulatory care settings for monitoring and supportive care, admitting patients only for febrile neutropenia and management of other serious complications that cannot be reasonably supported in the ambulatory setting.

1. Estey E, Döhner H. Acute myeloid leukaemia. The Lancet. 2006;368(9550):1894-907.

2. Zuckerman T, Ganzel C, Tallman MS, Rowe JM. How I treat hematologic emergencies in adults with acute leukemia. Blood. 2012;120(10):1993-2002.

3. Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia. An Overview 2012. Canberra: AIHW; 2012.

Partnerships

Project working group members

Key Dates

9 September 2013Model of care consultation closing date
13 September 2013Submission to the ACI for economic appraisal
19 June 2015

Completion of model of care evaluation plan

Pilot Sites

Implementation Sites

Evaluation

This model of care recognises the importance of uniform data collection across the BMT Network to support monitoring and evaluation, and improved patient outcomes.

The collection of an AML minimum data set (in development) is essential to provide information about patient outcome variances. Complete and timely data submission to various cancer registries, including the ABMTRR, will also enhance the monitoring and evaluation of this model of care.

It is acknowledged that not all Local Health Districts (LHDs) will have the ability to implement this model of care. 

ACI will provide a self-assessment tool for LHDs to measure their preparedness for implementation. ACI will work with LHDs to advocate strategies that address identified gaps.

Related Initiatives

Further Details

For more information go to the Blood and Marrow Transplant: Malignant Haematology page on the ACI website.

Contact

Jody Gough
BMT Network - Clinical Nurse Consultant
jody.gough@health.nsw.gov.au
02 9464 4606

Daniel Comerford
Director, Acute Care
daniel.comerford@health.nsw.gov.au
02 9464 4602

Page Top | Added: 5 November 2013 | Last modified: 10 July 2015