Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer

Abstract

Introduction: Therapeutic options for men with metastatic prostate cancer have increased in the past decade. We studied recent treatment patterns for men with metastatic prostate cancer and how treatment patterns have changed over time.

Methods: Using the Surveillance, Epidemiology, and End Results‒Medicare database, we identified fee-for-service Medicare beneficiaries who either were diagnosed with metastatic prostate cancer or developed metastases following diagnosis, as indicated by the presence of claims with diagnoses codes for metastatic disease, between 2007 and 2017. We evaluated treatment patterns using claims.

Results: We identified 29,800 men with metastatic disease, of whom 4721 (18.8%) had metastatic disease at their initial diagnosis. The mean age was 77 years, and 77.9% of patients were non-Hispanic White. The proportion receiving antineoplastic agents within 3 years of the index date increased over time (from 9.7% in 2007 to 25.9% in 2017; P < .001). Opioid use within 3 years of prostate cancer diagnosis was stable during 2007 to 2013 (around 73%) but decreased through 2017 to 65.5% (P < .001). Patients diagnosed during 2015 to 2017 had longer median survival (32.6 months) compared to those diagnosed during 2007 to 2010 (26.6 months; P < .001).

Conclusions: Most metastatic prostate cancer patients do not receive life-prolonging antineoplastic therapies. Improved adoption of effective cancer therapies when appropriate may increase length and quality of survival among metastatic prostate cancer patients.

Keywords: SEER-Medicare; antineoplastic therapy; metastasis; physicians’ practice patterns; prostate cancer.

Figure 1.

Treatment and service combinations within 3 years of the index date for metastatic prostate cancer patients, initial cancer diagnosis 2007 to 2017, linked to Medicare claims through 2019. ADT/hospice indicates received ADT and transferred to hospice; ADT only, androgen deprivation therapy monotherapy; Drug/ADT, received ADT and antineoplastic agent; Drug/ADT/Hospice, transferred to hospice after receiving ADT and antineoplastic agent; Hospice only, transferred to hospice care without other therapy.

Figure 2.

Receipt of antineoplastic drugs following the index date for metastatic prostate cancer cases, initial cancer diagnosis 2007 to 2017, linked to Medicare claims through 2019. The index date is the date of diagnosis for patients with registry-diagnosed metastasis and the date of the first Medicare claim listing a diagnosis code for metastatic disease for patients initially diagnosed with nonmetastatic disease. “One year” and “three years” refer to the time period after index date.

Figure 3.

Receipt of opioid prescriptions following the index date for metastatic prostate cancer cases, initial cancer diagnosis 2007 to 2017, linked to Medicare claims through 2019. The index date is the date of diagnosis for patients with registry-diagnosed metastasis and the date of the first Medicare claim listing a diagnosis code for metastatic disease following a Surveillance, Epidemiology, and End Results registry diagnosis of prostate cancer stage M0. “One year” and “three years” refer to the time period after index date.

Figure 4.

Percent survival among metastatic prostate cancer patients by study period, initial cancer diagnosis 2007 to 2017, linked with Medicare claims through 2019. The graph shows Kaplan-Meier survival curves from the index date. The index date is the date of diagnosis for patients with registry-diagnosed metastasis (M1), and the date of the first Medicare claim listing a diagnosis code for metastatic disease following a Surveillance, Epidemiology, and End Results registry diagnosis of prostate cancer stage M0.

Figure.

Treatment and service combinations within 3 years of the index date for metastatic prostate cancer patients, initial cancer diagnosis 2007 to 2017, linked to Medicare claims through 2019. ADT/hospice indicates received ADT and transferred to hospice; ADT only, androgen deprivation therapy monotherapy; Drug/ADT, received ADT and antineoplastic agent; Drug/ADT/Hospice, transferred to hospice after receiving ADT and antineoplastic agent; Hospice only, transferred to hospice care without other therapy.