Abstract
ObjectiveTo develop a tool for estimating the 10-year risk of death from other causes in men with localized prostate cancer.Subjects and methodsWe identified 2,425 patients from the Surveillance Epidemiology and End Results—Medicare Health Outcomes Survey database, age <80, newly diagnosed with clinical stage T1-T3a prostate cancer from 1/1/1998-12/31/2009, with follow-up through 2/28/2013. We developed a Fine and Gray competing-risks model for 10-year other cause mortality considering age, patient-reported comorbid medical conditions, component scores and items of the SF-36 Health Survey, activities of daily living, and sociodemographic characteristics. Model discrimination and calibration were compared to predictions from Social Security life table mortality risk estimates.ResultsOver a median follow-up of 7.7 years, 76 men died of prostate-specific causes and 465 died of other causes. The strongest predictors of 10-year other cause mortality risk included increasing age at diagnosis, higher approximated Charlson Comorbidity Index score, worse patient-reported general health (fair or poor vs. excellent-good), smoking at diagnosis, and marital status (all other vs. married) (all p<0.05). Model discrimination improved over Social Security life tables (c-index of 0.70 vs. 0.59, respectively). Predictions were more accurate than predictions from the Social Security life tables, which overestimated risk in our population.ConclusionsWe provide a tool for estimating the 10-year risk of dying from other causes when making decisions about treating prostate cancer using pre-treatment patient-reported characteristics.
Highlights
We provide a tool for estimating the 10-year risk of dying from other causes when making decisions about treating prostate cancer using pre-treatment patient-reported characteristics
Accurate assessment of life expectancy is critical to enabling evidence-based treatment decisionmaking for over 230,000 men diagnosed with prostate cancer in the U.S annually [1]
Accurate mortality risk prediction is especially important for patients age 65–80, the age group most frequently receiving a new diagnosis of prostate cancer, who are more likely than younger men to die of other causes but still are often considered for definitive treatment
Summary
Accurate assessment of life expectancy is critical to enabling evidence-based treatment decisionmaking for over 230,000 men diagnosed with prostate cancer in the U.S annually [1]. There remains limited evidence supporting that these tools are meaningfully better than the Social Security life tables in assessing 10-year mortality risk [15]. Existing tools have yet to evaluate whether integration of age and comorbidity information with patient-reported factors, such as physical functioning and general health, which are increasingly seen as valuable for comprehensively assessing health and other cause mortality risk, improve predictions [14,15,17,18]. Accurate mortality risk prediction is especially important for patients age 65–80, the age group most frequently receiving a new diagnosis of prostate cancer, who are more likely than younger men to die of other causes but still are often considered for definitive treatment. We sought to provide individualized risk predictions through a supplemental online risk estimation tool
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
