Clinical Review Abstract
Trials in Progress Abstract
Abstracts selected for publication but not presentation at the Annual Meeting
Abstracts granted an exception in accordance with ASCO's Conflict of Interest Policy
Skeletal-related events (SREs), baseline comorbidity, and survival among elderly patients (pts) with metastatic (M1) prostate cancer (PCa) in SEER-Medicare.
Genitourinary (Prostate) Cancer
2013 ASCO Annual Meeting
J Clin Oncol 31, 2013 (suppl; abstr e16027)
Author(s): Ebere Onukwugha, Candice Yong, C. Daniel Mullins, Brian S. Seal, Arif Hussain; University of Maryland School of Pharmacy, Baltimore, MD; Bayer HealthCare Pharmaceuticals, Wayne, NJ; University of Maryland School of Medicine, Baltimore, MD
Background: The prevalence of comorbidities increases with age in older men diagnosed with M1 PCa. However, the relationship between comorbidities, PCa, SREs, and mortality is not well understood. Methods: We analyzed pts aged 66+ diagnosed with M1 PCa between 2000 and 2007 from the linked Surveillance, Epidemiology, and End Results (SEER) and Medicare dataset. Pts surviving at least 30 days post-diagnosis were identified and followed until death or censoring in December 2009. Pathologic fracture, spinal cord compression, and bone surgery were identified from Medicare claims based on three measures: 1) SRE claim occurred after claims with a bone metastasis (BM) ICD 9 code; 2) BM ICD 9 code directly coincided with SRE claim; 3) SRE was not anchored to BM. Cox proportional hazards regression models controlled for demographic and clinical factors, including interaction terms involving indicators for comorbidities. Regression models were estimated using all-cause and PCa-specific mortality as outcomes. Results: Application of inclusion/exclusion criteria resulted in 7,062 pts. PCa-specific and all-cause mortality were 54% and 80% at a median (mean; min; max) follow up of 609 days (837; 30; 3,653). The proportion with any SRE was 17% (Measure 1), 9.7% (Measure 2), and 17.1% (Measure 3). Joint tests indicated statistically significant interaction terms using Measure 1 for PCa-specific mortality and Measure 3 for all-cause mortality. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) on the SRE indicators are shown in the Table. Conclusions: The association between SREs and death among elderly M1 PCa patients is affected by comorbidities.
|Baseline comorbidity (SRE measure)||Outcome
|All-cause mortality||PCa-specific mortality|
|AHR of SRE (95% CI)||AHR of SRE (95% CI)|
|Alcohol disorder (M1)||NA||3.04 (1.24 – 7.44)|
|Cardiac arrhythmias (M2)||1.4 (1.04 – 1.88)||1.55 (1.08 – 2.22)|
|Coagulopathy (M1)||0.58 (0.34 – 0.99)||0.46 (0.23 – 0.9)|
|Hypothyroidism (M2 and M3)||NA||1.8 (1.07 – 3.06)|
|Other neurological diseases (M3)||0.59 (0.4 – 0.87)||NA|
|Osteoporosis (M1)||2.35 (1.06 – 5.21)||NA|
|Paralysis (M2)||0.51 (0.27 – 0.95)||NA|
|Peripheral vascular disease (M2)||1.7 (1.1 – 2.63)||1.86 (1.1 – 3.12)|
Other Abstracts in this Sub-Category:
1. Clinical outcomes in patients with castrate-refractory prostate cancer (CRPC) metastatic to bone randomized in the factorial TRAPEZE trial to docetaxel (D) with strontium-89 (Sr89), zoledronic acid (ZA), neither, or both (ISRCTN 12808747).