Association Between Receipt of Definitive Treatment for Localized Prostate Cancer and Adverse Health Outcomes: A Claims-Based Approach |
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| Institution: | 1. McCourt School of Public Policy, Georgetown University, Washington, DC, USA;2. Department of Health Systems Administration, Georgetown University, Washington, DC, USA;1. Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands;2. Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands;3. Department of Health Sciences and the Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;1. Department of Medicine, University of Toronto, Toronto, ON, Canada;2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;3. ICES, Toronto and Ottawa, ON, Canada;4. Department of Medicine, Sinai Health System, Toronto, ON, Canada;5. Interdepartmental Division of Palliative Care, Sinai Health System, Toronto, ON, Canada;6. Temmy Latner Centre for Palliative Care, Toronto, ON, Canada;7. Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada;8. Arts and Science Program, McMaster University, Hamilton, ON, Canada;1. Precision HEOR, Boston, MA, USA;2. Novartis Gene Therapies, Inc, Bannockburn, IL, USA;3. Clarivate Analytics (Deutschland) GmbH, Frankfurt am Main, Germany;4. Novartis Gene Therapies Switzerland GmbH, Rotkreuz, Switzerland |
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| Abstract: | ObjectivesThis study aimed to examine adverse health outcomes associated with receipt of definitive treatments (prostatectomy, intensity-modulated radiation therapy IMRT] and brachytherapy).MethodsWe identified men aged 65 years and older who received a new diagnosis of localized prostate cancer from 4 state cancer registries (CA, FL, NJ, and TX) during the years 2006 to 2013. We merged the registry records for this cohort with Medicare enrollment and claims. We constructed indicators of treatment-related adverse outcomes using diagnosis codes reported on the claims. Stage 1 models the choice of definitive treatment versus active surveillance. Stage 2 examines the probability of experiencing a treatment-related adverse health outcome among men who chose definitive treatment.ResultsNotably, 81.4% of our cohort of 61 187 men received definitive treatment whereas 18.6% were monitored with active surveillance. The 5-year prostate cancer death rate was 0.28% to 1.75% irrespective of treatment received. Men monitored with active surveillance experienced minimal adverse health outcomes (0.16%-0.75%). The risks of urinary incontinence associated with prostatectomy were 31 and 39.5 percentage points higher than brachytherapy and IMRT, respectively. For erectile dysfunction, the risks were nearly 23 and 27.5 percentage points higher, respectively, than brachytherapy and IMRT. Prostatectomy was associated with lower risk of urinary dysfunction and bowel dysfunction than either brachytherapy or IMRT. Compared with brachytherapy, IMRT was associated with a lower risk of erectile dysfunction (32%), urinary incontinence (84%), and urinary dysfunction (30%).ConclusionsThis evidence should be of value to patient-physician decision making regarding the choice of definitive treatments versus active surveillance for men with localized disease. |
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| Keywords: | adverse treatment-related outcomes definitive treatment versus active surveillance low-risk prostate cancer |
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