Abstract
Background:Accurate cause of death assignment is crucial for prostate cancer epidemiology and trials reporting prostate cancer-specific mortality outcomes.Methods:We compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002–2015).Results:Of 1236 deaths assessed, expert committee evaluation attributed 523 (42%) to prostate cancer, agreeing with death certificate cause of death in 1134 cases (92%, 95% CI: 90%, 93%). The sensitivity of death certificates in identifying prostate cancer deaths as classified by the committee was 91% (95% CI: 89%, 94%); specificity was 92% (95% CI: 90%, 94%). Sensitivity and specificity were lower where death occurred within 1 year of diagnosis, and where there was another primary cancer diagnosis.Conclusions:UK death certificates accurately identify cause of death in men with prostate cancer, supporting their use in routine statistics. Possible differential misattribution by trial arm supports independent evaluation in randomised trials.
Highlights
MethodsWe compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002–2015)
Accurate cause of death assignment is crucial for prostate cancer epidemiology and trials reporting prostate cancerspecific mortality outcomes
The sensitivity of death certificates in identifying prostate cancer deaths as classified by the committee was 91%; specificity was 92%
Summary
We compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002–2015). Blinded to death certificate and underlying cause of death, detailed information was obtained from the medical records of all men with a potential prostate cancer death (see Supplementary Table 1 for the triggers used to review a potential prostate cancer death), and used to generate a short structured clinical vignette (Williams et al, 2015); (see Supplementary Material 1). Members of an international CoDE committee reviewed the vignettes They completed a questionnaire that when followed in sequence, and using detailed definitions adapted from the European Randomised Study of Screening for Prostate Cancer trial (de Koning et al, 2003) acted as an algorithm for assigning cause of death into the following categories: definite, probable, possible, unlikely or definitely not prostate cancer, and definite or probable intervention-related mortality (Supplementary Material 2). The death certificate underlying cause of death was accepted where a review was not triggered (i.e., in the absence of a potential prostate cancer death, these were recorded as due to other causes)
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