title: Skeletal-related events and mortality among older men with advanced prostate cancer.
abstract: OBJECTIVE
  Skeletal-related events (SREs) are defined as a cluster of events including clinical diagnoses and treatment. Using claims data, the burden of SREs as a group has been reported among patients with cancer. We investigate the mortality impact of subcomponents of SREs, a topic that has received limited attention among older men.
  
  
  METHODS
  We analyzed prostate cancer (PCa) and all-cause mortality among men diagnosed with metastatic PCa from 2000 to 2007 using Surveillance, Epidemiology, and End Results data linked with 1999-2009 Medicare data. We created three measures of pathological fracture (PF), spinal cord compression (SCC), and bone surgery (BS) that differed in the use of claims-based bone metastasis information. We reported covariate-adjusted hazard ratios (HRs) using the full sample and a propensity score-matched sample (PSMS).
  
  
  RESULTS
  Application of inclusion/exclusion criteria resulted in 7062 men in the full sample (1776 in the PSMS). PCa-specific (all-cause mortality) was 54% (80%) at a median follow-up of 609days. SRE prevalence ranged from 9.7% to 17.1% across the measures. In a PCa mortality model, the HR associated with an SRE ranged from 1.07 (0.98-1.16) to 1.31 (1.18-1.45). The HRs for SCC and PF were statistically significant and positively associated with PCa-specific mortality. The results for BS depended on the measure. Results for SCC and BS, but not for PF, were preserved using a PSMS.
  
  
  CONCLUSIONS
  The relationship between SREs and mortality among older men with metastatic PCa was driven by SCC and depended on the definition used to measure SREs.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA. Electronic address: eonukwug@rx.umaryland.edu.
authors.forename: Eberechukwu
authors.initials: E
authors.lastname: Onukwugha
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Yong
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA.
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
authors.affiliation: Bayer HealthCare Pharmaceuticals, Inc., USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Seal
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: McNally
authors.affiliation: University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Veterans Affairs Medical Center, Baltimore, MD 21201, USA.
authors.forename: Arif
authors.initials: A
authors.lastname: Hussain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary*; D017281:Cost of Illness; D004812:Epidemiologic Methods; D005598:Fractures, Spontaneous / Q000401:mortality; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000401:mortality*; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary; D014481:United States / Q000453:epidemiology
keywords: Bone surgery; Fractures; Health services research; Prostatic neoplasms; Spinal cord compression; Survival