The use of health services among elderly patients with stage IV prostate cancer in the initial period following diagnosis.
OBJECTIVE
Information regarding variability in the type and extent of health services used by elderly patients with advanced prostate cancer (PCa) in the initial period following diagnosis is limited. We evaluated health services utilization among elderly men with stage IV PCa with (M1) and without (M0) distant metastasis during the year following diagnosis.


METHODS
We evaluated patients aged 66 and older with incident stage IV PCa during 2005-2007 using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Measures included skilled nursing facility (SNF) stay, hospice stay, and hospitalization. Multivariable logistic regression models were estimated to determine the association between M1 PCa and each health service. Poisson regression was used to assess hospital length of stay.


RESULTS
The final sample included 3379 patients (20% M0; 80% M1). In the year following diagnosis, M1 patients had greater use of SNF (M0: 8%; M1: 22%), hospice (M0: 5%; M1: 20%), and hospitalization (M0: 43%; M1: 61%). Compared to M0 patients, M1 patients had statistically significantly higher adjusted odds of SNF use (OR=1.89; 95% CI=1.38-2.59), hospice use (OR=3.22; 95% CI=2.19-4.72), and hospitalization (OR=1.45; 95% CI=1.20-1.75). Among those hospitalized, M1 patients had 24% longer length of stay (p<0.01).


CONCLUSIONS
There is 2- to 3-fold greater use of SNF and hospice, and higher hospitalization among M1 compared to M0 patients. Elderly patients with advanced PCa face significant clinical burden within the first year after their diagnosis. Greater understanding of the relationship between clinical disease burden and health services utilization can improve healthcare delivery in this population.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, United States. Electronic address: cyong001@umaryland.edu.
Candice
C
Yong
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, United States.
Eberechukwu
E
Onukwugha
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, United States.
C Daniel
CD
Mullins
Bayer Healthcare Pharmaceuticals, Inc., 6 West Belt, Wayne, NJ 07470, United States.
Brian
B
Seal
University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, United States; Veterans Affairs Medical Center, 10 N Greene Street, Baltimore, MD 21201, United States.
Arif
A
Hussain
D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States; D014853:Walkers / Q000706:statistics & numerical data; D014910:Wheelchairs / Q000706:statistics & numerical data
Health services; Hospice; Hospitalization; Prostatic neoplasms; Skilled nursing facility