Receipt of guideline-concordant treatment in elderly prostate cancer patients

Ronald C Chen; William R Carpenter; Laura H Hendrix; John Bainbridge; Andrew Z Wang; Matthew E Nielsen; Paul A Godley

doi:10.1016/j.ijrobp.2013.11.004

Receipt of guideline-concordant treatment in elderly prostate cancer patients

Int J Radiat Oncol Biol Phys. 2014 Feb 1;88(2):332-8. doi: 10.1016/j.ijrobp.2013.11.004.

Authors

Ronald C Chen¹, William R Carpenter², Laura H Hendrix³, John Bainbridge⁴, Andrew Z Wang⁵, Matthew E Nielsen⁶, Paul A Godley⁷

Affiliations

¹ Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: Ronald_chen@med.unc.edu.
² Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³ Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁴ Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁵ Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁶ Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁷ Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

PMID: 24411605
DOI: 10.1016/j.ijrobp.2013.11.004

Abstract

Purpose: To examine the proportion of elderly prostate cancer patients receiving guideline-concordant treatment, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.

Methods and materials: A total of 29,001 men diagnosed in 2004-2007 with localized prostate cancer, aged 66 to 79 years, were included. We characterized the proportion of men who received treatment concordant with the National Comprehensive Cancer Network guidelines, stratified by risk group and age. Logistic regression was used to examine covariates associated with receipt of guideline-concordant management.

Results: Guideline concordance was 79%-89% for patients with low- or intermediate-risk disease. Among high-risk patients, 66.6% of those aged 66-69 years received guideline-concordant management, compared with 51.9% of those aged 75-79 years. Discordance was mainly due to conservative management-no treatment or hormone therapy alone. Among the subgroup of patients aged ≤76 years with no measured comorbidity, findings were similar. On multivariable analysis, older age (75-79 vs 66-69 years, odds ratio 0.51, 95% confidence interval 0.50-0.57) was associated with a lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not.

Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease.

MeSH terms

Age Factors
Aged
Guideline Adherence*
Humans
Life Expectancy
Logistic Models
Male
Prostatic Neoplasms / therapy*
SEER Program