Abstract 2214: Impact of comorbidities at diagnosis on prostate cancer treatment and survival

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Abstract Background: For Switzerland, it is currently unclear in which way comorbidities influence the choice of primary treatment in prostate cancer (PCa) patients and how comorbidities affect long-term survival of PCa patients. Thus, the aim of this study was to assess the associations of comorbidities with primary treatment of PCa patients and of comorbidities with PCa-specific mortality (PCSM) compared to other-cause mortality (OCM) in Switzerland. Patients and Methods: We included 1527 men diagnosed with PCa in 2000 and 2001 in the canton of Zurich. Comorbidities at time of diagnosis were based on the Charlson Comorbidity Index (CCI). For each patient, the scores of the respective comorbidities were summed up and classified into three groups: CCI 0 = no comorbidities, CCI 1 = sum of scores equals to 1, CCI 2+ = sum of scores equals to 2 or larger. Multiple imputation methods were applied to missing data for stage, grade and comorbidities. Multinomial logistic regression analyses were used to explore the associations of comorbidities with treatment. Cox regression models were used to estimate all-cause mortality, and Fine and Gray competing risk regression models to estimate sub-distribution hazard ratios for the outcomes PCSM and OCM. Results: Increasing age was associated with a decreasing probability of receiving curative treatment, whereas an increasing CCI did not influence the treatment decision as strongly as age. The probability of OCM was significantly higher for patients with comorbidities compared to those without comorbidities (CCI 1: 2.07 [95% CI 1.51 - 2.85], CCI 2+: 2.34 [1.59 - 3.44]); this was not observed for PCSM (CCI 1: 0.79 [0.50 - 1.23], CCI 2+: 0.97 [0.59 - 1.59]). In addition, comorbidities had a greater impact on the patients' mortality than age. Conclusions: The results of the current study suggest that the chronological age is a stronger predictor of treatment choices than comorbidities. This study supports the inclusion of comorbidities in treatment choices in order to offer more appropriate treatment for PCa patients to counteract over- or undertreatment. Citation Format: Katarina L. Matthes, Manuela Limam, Giulia Pestoni, Leonhard Held, Dimitri Korol, Sabine Rohrmann. Impact of comorbidities at diagnosis on prostate cancer treatment and survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2214.