Selection of MDS treatment: impact on quality of life

Yazan Madanat, doctor of medicine: Based on your experience, do you see or talk to patients weigh the quality of life factors against the toxicity of the treatment and put them all together? How do you see patients weighing all of these things in making a treatment decision? How does quality of life impact this conversation and decision making?

Mikkael A. Sekeres, MD: It has a pretty big impact. I try to think of it from the perspective of my patients as they make different decisions about how to approach this serious illness than I do. At my age, I still have young children at home who are of school age, and I view my role as a parent as successfully leading my children to adulthood. I will accept any type of therapy for a diagnosis that will get me to this point. Someone who is 80 years old and has children who has seen their children – and probably their grandchildren – reach adulthood may have different goals and needs. My patients have reduced their focus on their goals, just like in the book Being mortal by Atul Gawande, when he writes about how people, as they age, focus on closer groups of friends and family and more immediate goals.

Even if we say that treatment with hypomethylating agents is very tolerable, some of my patients will say, “No, thank you. I don’t want to be in the clinic that many days a month. Or if they lean towards something even easier, like oral decitabine, they say, “No, I don’t want to deal with these side effects. This impacts him much more than patients in their 60s who have higher risk MDS. [myelodysplastic syndromes], for example. My older patients are certainly much more reluctant to have a transplant. We talk about it with every new diagnosis, but only a small percentage of my patients say, “Please make an appointment with a transplant doctor.” It’s not because I’m negative about the transplant. I always encourage my patients to have a conversation and trust their instinct for that conversation. Many of them don’t even want to initiate a conversation

Transcription edited for clarity

Martin E. Berry