title: Association of functional status and treatment choice among older men with prostate cancer in the Medicare Advantage population.
abstract: BACKGROUND
  There are several effective treatments for prostate cancer. To what extent a patient's functional status influences the treatment decision is unknown. This study examined the association between functional status and treatment among older men with prostate cancer.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data were used to identify men who were 65 years old or older and were diagnosed with prostate cancer between 1998 and 2009. The primary outcome was treatment choice: conservative management, surgery, or radiation within 1 year of the diagnosis. The exposure was the functional status assessed as 4 measures within 3 domains: 1) physical function (activities of daily living [ADLs] and physical component summary score), 2) cognitive function (survey completer: self vs proxy), and 3) emotional well-being (mental component summary score). A multivariate, multinomial logistic regression was fitted with adjustments for several patient, tumor, and regional characteristics.
  
  
  RESULTS
  This study identified 508 conservative management patients, 195 surgery patients, and 603 radiation patients. Compared with men with no ADL dependency, those with any ADL dependency had lower odds of receiving surgery (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.38-0.99) or radiation (OR, 0.58; 95% CI, 0.43-0.78) versus conservative management. ADL dependency did not differ when surgery and radiation were compared. Patients with a proxy survey response were less likely to receive surgery or radiation versus conservative management.
  
  
  CONCLUSIONS
  Functional status is associated with treatment choice for men with prostate cancer. Future research should examine whether this is due to physician recommendations, patient preferences, or a combination. Cancer 2016;122:3199-206. © 2016 American Cancer Society.
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania. jacobsbl2@upmc.edu.|Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. jacobsbl2@upmc.edu.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Samia H
authors.initials: SH
authors.lastname: Lopa
authors.affiliation: Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Yabes
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Nelson
authors.affiliation: Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Health Policy Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato
authors.affiliation: Department of Health Policy Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Degenholtz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002755:Choice Behavior; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000706:statistics & numerical data*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D057240:Patient Preference; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D057832:Watchful Waiting
keywords: activities of daily living; conservative management; functional status; prostate cancer; radiation; surgery