Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates

Abstract

BACKGROUND: Treatment choice in prostate cancer is influenced by pre-existing comorbid illnesses, but information about their individual prognostic impact is sparse, and only 1 comorbidity index has been developed for this setting. The authors assessed the impact of individual comorbid illnesses on the risk of early, other-cause death in prostate cancer treatment candidates and propose a modification of an existing comorbidity scale. METHODS: A populationbased case-cohort study included patients diagnosed from 1990 through 1998 in Ontario, Canada who had planned curative radiotherapy or prostatectomy. The subcohort numbered 1643, and the case sample (those dying of other causes within 10 years) numbered 630. Ontario Cancer Registry data were linked to data from medical charts, including: age, comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), stage, prostate-specific antigen, Gleason score, and treatment. Cox proportional hazards regression assessed the age-adjusted association between CIRS-G and other-cause death. RESULTS: Respiratory and cardiac diseases were the most common comorbidities and most strongly associated with an increased risk of death. Other important comorbidities included vascular disease, renal disease, and diabetes. The modified CIRS-G pros score yielded a relative risk (RR) of 1.64 (95% confidence interval [CI], 1.52-1.76) for those scoring 1 compared with 0 and RR 1.18 (95% CI, 1.15-1.21) for each increment above 1. Except for those aged >80 years, results were consistent across treatment type and age group. CON-CLUSIONS: This study provides estimates of the role of individual comorbid illnesses in prostate cancer. The modified CIRS-G pros could be useful in the clinic and in future research on this patient population.

Obesity, Diabetes Mellitus and Vascular Disease: A Complex Relationship with Prostate Cancer

“…More than 30% of men with PCa die of cardiovascular disease, which constitutes one of the most common causes of death in this patient population [11]- [13]. Nevertheless, only a few studies have explored the relationship between vascular disease and PCa risk, with inconclusive results [14]- [18].…”

Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radical prostatectomy

“…Data for the study were collected as part of a larger populationbased case-cohort study designed to evaluate variations in case selection and outcomes across and within treatment modalities in prostate cancer. 5 A linked population-based database containing the Ontario Cancer Registry (OCR), hospital discharge data, and cancer clinic data housed at the Queen's University Cancer Research Institute Division of Cancer Care and Epidemiology (CCE) 6 was used to identify all curatively treated patients with adenocarcinoma of the prostate diagnosed in Ontario between January 1, 1990, and December 31, 1998. We selected a region-stratified random sample of approximately 10% of the 17 934 patients meeting these criteria (n = 1703).…”

“…We examined how these indicator-outcome associations were influenced by the following potential confounders: age at diagnosis; comorbidity, as measured by the Cumulative Illness Rating Scale for Geriatrics (Prostate) (CIRS-G (pros) ) 5 ; disease severity based on pre-treatment PSA, clinical tumour stage, and Gleason score; 10 and treatment era.…”

Connecting with prostate cancer survivors

“…2 These results are perhaps not surprising in the face of previous reports suggesting that almost 10% of men treated in Ontario die of other causes within 10 years of definitive treatment of their disease. 3 The "layers of uncertainty" 4 that have resulted from this knowledge gap have complicated our ability to communicate and support our patients, especially those who are considering PSA testing or contemplating their preferred management for localized disease. This underscores the need to re-double our efforts to create, study and implement effective health communication for the benefit of men and their families, and not lose site of some of the gains realized over the years.…”