Presentation Authors: Ericka Sohlberg*, I-Chun Thomas, Stanford, CA, Timothy Daskivich, Los Angeles, CA, Ted Skolarus, Ann Arbor, MI, Jeremy Shelton, Los Angeles, CA, Danil Makarov, New York City, NY, Jonathan Bergman, Los Angeles, CA, Christine Bang, Baltimore, MD, Kristopher Kapphahn, Jaden Yang, James D Brooks, Manisha Desai, John T Leppert, Stanford, CA
Introduction: Accurate estimates of baseline life expectancy are required to better inform prostate cancer treatment decisions and avoid over- and under-treatment. The Veterans Health Administration (VHA) cares for patients with prostate cancer with a higher burden of comorbidity than seen in the community. It can be challenging to select appropriate management for patients with increasing comorbidity burden without relevant survival data. Although many models exist to predict life expectancy in men with prostate cancer, few are specific to the VHA population or easily implemented in the clinic setting.
Methods: Using the national VHA electronic health records, we identified all patients 18 years or older diagnosed with prostate cancer between 2000 and 2013. Patient demographics, comorbidities, and tumor staging information were abstracted. Overall survival information was calculated using the VA National Death Index with follow-up through 2015. We stratified patients by treatment type, number of comorbidities and D'Amico Risk Classification. We plotted visual estimates of overall survival using Kaplan-Meier methods and represented 10-year life expectancy cut-offs in table and heat map formats.
Results: We identified 181,009 total patients, of whom 126,461 had complete oncologic data. The majority of patients were 60-74 years of age with a median of one comorbidity, and 38% were diagnosed with low risk prostate cancer. Kaplan-Meier analysis illustrated the negative impact of increasing comorbidities and cancer risk on survival, summarized further in table format.
Conclusions: Life expectancy estimates are essential to providing high-quality patient-centered prostate cancer care. We have developed an accessible tool to enhance medical decision-making for VHA patients with prostate cancer that can be easily adopted into routine clinical use.
Source of Funding: VHA Merit Review (I01 HX0021261 to JL)