Use of total illness burden index for prostate cancer (TIBI-CaP) to predict nonprostate cancer morbidity.

Abstract

215 Background: Comorbidities significantly influence how physicians approach the treatment of prostate cancer and should be evaluated prior to the prostate biopsy. The Total Illness Burden Index for Prostate Cancer (TIBI-CaP) patient questionnaire and Charlson Comorbidity Index (CCI) usually calculated by the physician, may provide information on competing risks but have not been compared prospectively. Methods: A prospective observational cohort study was performed of 133 participants prior to obtaining a transrectal ultrasound guided prostate biopsy. Eleven patients had incomplete data or missing follow-up; therefore, a total of 122 (92%) patients were retained for a mean of 21 months (range 4 – 31 months). The TIBI-CaP and CCI scores were compared between subgroups defined by non-elective hospital admission, elective surgery, non-prostate malignancy and survival status using t-tests. Results: Patients averaged 64.5 years at enrollment. One patient died in the study from a metastatic sarcoma. The overall hospital admission rate was 17% (21/122), most commonly from cardiovascular or pulmonary complications. Forty-six men (38%) were diagnosed with cancer on the prostate biopsy. The most common treatments were prostatectomy (39%), active surveillance (26%), or external beam radiation therapy (20%). Twenty-three percent (28/122) had elective surgery and 5% (6/122) were diagnosed with a non-prostate malignancy. Mean TIBI-CaP scores were higher in men who were admitted to the hospital (5.1 vs. 3.5, p=0.03), had elective surgery (4.8 vs. 3.4, p=0.05) or non-prostate cancer (5.5 vs 3.7, p=0.17). No significant differences were observed in CCI scores In stepwise logistic regression, a TIBI-CaP score > 5.0 was associated with 3.5 times higher risk for hospital admission (95% CI: 1.3–10.0, p=0.02). Conclusions: The patient-reported measure of comorbidity (TIBI-CaP) identified patients at high risk for non-elective hospital admission over at 20 month average follow up period and may aid medical decision making specifically in the prostate biopsy population better than that of the Charlson Comorbidity Index.