School of Medicine, University of North Carolina, Chapel Hill, NC.
Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC.
Urology. 2021 Mar;149:103-109. doi: 10.1016/j.urology.2020.12.008. Epub 2020 Dec 19.
To determine whether patient-reported health status, more so than comorbidity, influences treatment in men with localized prostate cancer.
Using Surveillance, Epidemiology, and End Results data linked with Medicare claims and CAHPS surveys, we identified men aged 65-84 diagnosed with localized prostate cancer from 2004 to 2013 and ascertained their National Cancer Institute (NCI) comorbidity score and patient-reported health status. Adjusting for demographics and cancer risk, we examined the relationship between these measures and treatment for the overall cohort, low-risk men aged 65-74, intermediate/high-risk men aged 65-74, and men aged 75-84.
Among 2724 men, 43.0% rated their overall health as Excellent/Very Good, while 62.7% had a comorbidity score of 0. Beyond age and cancer risk, patient-reported health status was significantly associated with treatment. Compared to men reporting Excellent/Very Good health, men in Poor/Fair health less often received treatment (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.56-0.90). Younger men with intermediate/high-risk cancer in Good (OR 0.60, 95% CI 0.41-0.88) or Fair/Poor (OR 0.49, 95% CI 0.30-0.79) health less often underwent prostatectomy vs radiation compared to men in Excellent/Very Good health. In contrast, men with NCI comorbidity score of 1 more often received treatment (OR 1.37, 95% CI 1.11-1.70) compared to men with NCI comorbidity score of 0.
Patient-reported health status drives treatment for prostate cancer in an appropriate direction whereas comorbidity has an inconsistent relationship. Greater understanding of this interplay between subjective and empiric assessments may facilitate more shared decision-making in prostate cancer care.
确定患者报告的健康状况是否比合并症更能影响局限性前列腺癌患者的治疗。
利用监测、流行病学和最终结果数据与医疗保险索赔和 CAHPS 调查相联系，我们确定了 2004 年至 2013 年间被诊断为局限性前列腺癌的年龄在 65-84 岁的男性，并确定了他们的国家癌症研究所（NCI）合并症评分和患者报告的健康状况。在调整人口统计学和癌症风险后，我们检查了这些措施与整个队列、年龄在 65-74 岁的低危男性、年龄在 65-74 岁的中/高危男性以及年龄在 75-84 岁的男性之间的治疗关系。
在 2724 名男性中，43.0%的人总体健康状况评为优秀/非常好，而 62.7%的人合并症评分为 0。除了年龄和癌症风险外，患者报告的健康状况与治疗显著相关。与报告健康状况优秀/非常好的男性相比，健康状况差/差的男性接受治疗的可能性较低（比值比[OR]0.71，95%置信区间[CI]0.56-0.90）。年龄较小、患有中/高危癌症、健康状况良好（OR0.60，95%CI0.41-0.88）或差/差（OR0.49，95%CI0.30-0.79）的男性接受前列腺切除术与放射治疗的可能性低于健康状况优秀/非常好的男性。相比之下，合并症评分为 1 的男性比合并症评分为 0 的男性更常接受治疗（OR1.37，95%CI1.11-1.70）。
患者报告的健康状况朝着适当的方向推动前列腺癌的治疗，而合并症与治疗的关系不一致。对这种主观和经验评估之间相互作用的进一步理解可能有助于在前列腺癌治疗中促进更多的共同决策。
