TY - JOUR
T1 - Patient-reported Health Status, Comorbidity Burden, and Prostate Cancer Treatment
AU - McMahon, Stephen
AU - Basak, Ram
AU - Zhou, Xi
AU - Smith, Angela B.
AU - Song, Lixin
AU - Pruthi, Raj S.
AU - Wallen, Eric M.
AU - Nielsen, Matthew E.
AU - Tan, Hung Jui
N1 - Funding Information:
Funding: Hung-Jui Tan, MD, MSHPM was supported by a Mentored Research Scholar Grant in Applied and Clinical Research, MRSG-18-193-01-CPPB , from the American Cancer Society as well as the NIH Loan Repayment Program . Stephen McMahon was supported by the Carolina Medical Student Research Program from the University of North Carolina, Chapel Hill School of Medicine . These funding sources had no role in the design, conduct, analysis, or decision to publish the manuscript.
Funding Information:
Funding: Hung-Jui Tan, MD, MSHPM was supported by a Mentored Research Scholar Grant in Applied and Clinical Research, MRSG-18-193-01-CPPB, from the American Cancer Society as well as the NIH Loan Repayment Program. Stephen McMahon was supported by the Carolina Medical Student Research Program from the University of North Carolina, Chapel Hill School of Medicine. These funding sources had no role in the design, conduct, analysis, or decision to publish the manuscript. Disclosures: The authors have no other financial disclosures or conflicts of interest to report.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Objective: To determine whether patient-reported health status, more so than comorbidity, influences treatment in men with localized prostate cancer. Methods: Using Surveillance, Epidemiology, and End Results data linked with Medicare claims and CAHPS surveys, we identified men aged 65-84 diagnosed with localized prostate cancer from 2004 to 2013 and ascertained their National Cancer Institute (NCI) comorbidity score and patient-reported health status. Adjusting for demographics and cancer risk, we examined the relationship between these measures and treatment for the overall cohort, low-risk men aged 65-74, intermediate/high-risk men aged 65-74, and men aged 75-84. Results: Among 2724 men, 43.0% rated their overall health as Excellent/Very Good, while 62.7% had a comorbidity score of 0. Beyond age and cancer risk, patient-reported health status was significantly associated with treatment. Compared to men reporting Excellent/Very Good health, men in Poor/Fair health less often received treatment (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.56-0.90). Younger men with intermediate/high-risk cancer in Good (OR 0.60, 95% CI 0.41-0.88) or Fair/Poor (OR 0.49, 95% CI 0.30-0.79) health less often underwent prostatectomy vs radiation compared to men in Excellent/Very Good health. In contrast, men with NCI comorbidity score of 1 more often received treatment (OR 1.37, 95% CI 1.11-1.70) compared to men with NCI comorbidity score of 0. Conclusion: Patient-reported health status drives treatment for prostate cancer in an appropriate direction whereas comorbidity has an inconsistent relationship. Greater understanding of this interplay between subjective and empiric assessments may facilitate more shared decision-making in prostate cancer care.
AB - Objective: To determine whether patient-reported health status, more so than comorbidity, influences treatment in men with localized prostate cancer. Methods: Using Surveillance, Epidemiology, and End Results data linked with Medicare claims and CAHPS surveys, we identified men aged 65-84 diagnosed with localized prostate cancer from 2004 to 2013 and ascertained their National Cancer Institute (NCI) comorbidity score and patient-reported health status. Adjusting for demographics and cancer risk, we examined the relationship between these measures and treatment for the overall cohort, low-risk men aged 65-74, intermediate/high-risk men aged 65-74, and men aged 75-84. Results: Among 2724 men, 43.0% rated their overall health as Excellent/Very Good, while 62.7% had a comorbidity score of 0. Beyond age and cancer risk, patient-reported health status was significantly associated with treatment. Compared to men reporting Excellent/Very Good health, men in Poor/Fair health less often received treatment (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.56-0.90). Younger men with intermediate/high-risk cancer in Good (OR 0.60, 95% CI 0.41-0.88) or Fair/Poor (OR 0.49, 95% CI 0.30-0.79) health less often underwent prostatectomy vs radiation compared to men in Excellent/Very Good health. In contrast, men with NCI comorbidity score of 1 more often received treatment (OR 1.37, 95% CI 1.11-1.70) compared to men with NCI comorbidity score of 0. Conclusion: Patient-reported health status drives treatment for prostate cancer in an appropriate direction whereas comorbidity has an inconsistent relationship. Greater understanding of this interplay between subjective and empiric assessments may facilitate more shared decision-making in prostate cancer care.
UR - http://www.scopus.com/inward/record.url?scp=85098048870&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85098048870&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2020.12.008
DO - 10.1016/j.urology.2020.12.008
M3 - Article
C2 - 33352164
AN - SCOPUS:85098048870
VL - 149
SP - 103
EP - 109
JO - Urology
JF - Urology
SN - 0090-4295
ER -