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Clinical Review Abstract

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Skeletal-related events (SREs), baseline comorbidity, and survival among elderly patients (pts) with metastatic (M1) prostate cancer (PCa) in SEER-Medicare.

Prostate Cancer

Genitourinary (Prostate) Cancer

2013 ASCO Annual Meeting

Abstract No:

J Clin Oncol 31, 2013 (suppl; abstr e16027)

Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual Meeting but not presented at the Meeting, can be found online only.

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

Abstract Disclosures


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)


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