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. 2020 Sep;38(9):734.e1-734.e10.
doi: 10.1016/j.urolonc.2020.05.015. Epub 2020 Jul 13.

Life expectancy estimates for patients diagnosed with prostate cancer in the Veterans Health Administration

Ericka M Sohlberg  1 , I-Chun Thomas  2 , Jaden Yang  3 , Kristopher Kapphahn  3 , Timothy J Daskivich  4 , Ted A Skolarus  5 , Jeremy B Shelton  6 , Danil V Makarov  7 , Jonathan Bergman  6 , Christine Ko Bang  8 , Mary K Goldstein  9 , Todd H Wagner  10 , James D Brooks  1 , Manisha Desai  11 , John T Leppert  12
Affiliations

Life expectancy estimates for patients diagnosed with prostate cancer in the Veterans Health Administration

Ericka M Sohlberg et al. Urol Oncol. 2020 Sep.

Abstract

Purpose: Accurate life expectancy estimates are required to inform prostate cancer treatment decisions. However, few models are specific to the population served or easily implemented in a clinical setting. We sought to create life expectancy estimates specific to Veterans diagnosed with prostate cancer.

Materials and methods: Using national Veterans Health Administration electronic health records, we identified Veterans diagnosed with prostate cancer between 2000 and 2015. We abstracted demographics, comorbidities, oncologic staging, and treatment information. We fit Cox Proportional Hazards models to determine the impact of age, comorbidity, cancer risk, and race on survival. We stratified life expectancy estimates by age, comorbidity and cancer stage.

Results: Our analytic cohort included 145,678 patients. Survival modeling demonstrated the importance of age and comorbidity across all cancer risk categories. Life expectancy estimates generated from age and comorbidity data were predictive of overall survival (C-index 0.676, 95% CI 0.674-0.679) and visualized using Kaplan-Meier plots and heatmaps stratified by age and comorbidity. Separate life expectancy estimates were generated for patients with localized or advanced disease. These life expectancy estimates calibrate well across prostate cancer risk categories.

Conclusions: Life expectancy estimates are essential to providing patient-centered prostate cancer care. We developed accessible life expectancy estimation tools for Veterans diagnosed with prostate cancer that can be used in routine clinical practice to inform medical-decision making.

Keywords: Comorbidity; Life expectancy; Prostatic neoplasms; Veterans Health.

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Figures

Figure I:
Figure I:
The importance of age (A) and number of comorbid conditions (B) at the time of prostate cancer diagnosis on overall survival among 145,678 Veterans receiving care in the VHA.
Figure II:
Figure II:
Increasing age and number of comorbidities is associated with worsening overall survival in patients with prostate cancer across D’Amico risk groups, as well as for patients with locally advanced disease (clinical staging N>0 or T4) and metastatic disease.
Figure III:
Figure III:
Median overall survival for Veterans diagnosed with localized prostate cancer in the VHA. A) Median estimated overall survival is stratified by patient age and number of comorbidities. B) Median overall survival is represented in a heat map with green coloring illustrating estimated survival of greater than 10 years, while red coloring illustrates estimated median survival of less than 5 years.
Figure IV:
Figure IV:
Median overall survival is poor among Veterans with metastatic prostate cancer at the time of diagnosis. Even among patients with metastatic disease, median estimated life expectancy decreases with increasing age and increasing number of comorbid conditions. (A) The median overall survival is shown by age and number of comorbidities. (B) A heatmap illustrates median life expectancy with red coloring representing less than 2 years and green coloring representing four or more years.
Figure V:
Figure V:
The performance of the life expectancy estimate is compared with observed survival data demonstrating good calibration of these estimates across all prostate cancer risk categories.
See this image and copyright information in PMC

References

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