Prostate cancer treatment and survival: evidence for men with prevalent comorbid conditions.
BACKGROUND
The absence of evidence-based guidelines for prostate cancer treatment led the Institute of Medicine to include localized prostate cancer treatment among the 25 most important topics for comparative effectiveness research.


OBJECTIVE
This study compared prostate cancer treatment and survival in men with and without prevalent comorbid conditions.


METHODS
The sample comprised elderly men, aged 66 years and older, extracted from SEER-Medicare data, between 2004 and 2009 (N=73,563). Treatment and survival for men with at least 1 of 4 prevalent comorbid conditions were compared with men who did not have any of the 12 Charlson comorbid conditions. The sample was stratified by comorbid condition and low-risk, intermediate-risk, and high-risk disease.


RESULTS
Over half of men received some form of cancer-directed treatment, irrespective of comorbid condition. Men who have congestive heart failure (CHF) or multiple comorbid conditions were less likely to be treated, whereas men with diabetes were more likely to be treated. With the exception of men with CHF, men with comorbid conditions and low-risk disease received no survival benefit from any type of treatment.


CONCLUSIONS
Most men received treatment, particularly radiation therapy, regardless of comorbid condition. The evidence suggests more caution should be used when treating men with low-risk disease and comorbid conditions as they are at risk for adverse events and additional medical costs, without a survival benefit.
Departments of *Healthcare Policy and Research †Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
Cathy J
CJ
Bradley
Bassam
B
Dahman
Mitchell
M
Anscher
D000368:Aged; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D019317:Evidence-Based Medicine; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D018426:SEER Program; D015996:Survival Rate