ABSTRACT
Objectives
To determine if an automatically calculated electronic health record score can estimate
intermediate-term life expectancy in men with prostate cancer to provide guideline
concordant care.
Methods
We identified all men (n = 36,591) diagnosed with prostate cancer in 2013–2015 in the VHA. Of the 36,591,
35,364 (96.6%) had an available Care Assessment Needs (CAN) score (range: 0-99) automatically
calculated in the 30 days prior to the date of diagnosis. It was designed to estimate
short-term risks of hospitalization and mortality. We fit unadjusted and multivariable
Cox proportional hazards regression models to determine the association between the
CAN score and overall survival among men with prostate cancer. We compared CAN score
performance to two established comorbidity measures: The Charlson Comorbidity Index
and Prostate Cancer Comorbidity Index (PCCI).
Results
Among 35,364 men, the CAN score correlated with overall stage, with mean scores of
46.5 ( ± 22.4), 58.0 ( ± 24.4), and 68.1 ( ± 24.3) in localized, locally advanced,
and metastatic disease, respectively. In both unadjusted and adjusted models for prostate
cancer risk, the CAN score was independently associated with survival (HR = 1.23 95%CI
1.22-1.24 & adjusted HR = 1.17 95%CI 1.16-1.18 per 5-unit change, respectively). The
CAN score (overall C-Index 0.74) yielded better discrimination (AUC = 0.76) than PCCI
(AUC = 0.65) or Charlson Comorbidity Index (AUC = 0.66) for 5-year survival.
Conclusion
The CAN score is strongly associated with intermediate-term survival following a prostate
cancer diagnosis. The CAN score is an example of how learning health care systems
can implement multi-dimensional tools to provide fully automated life expectancy estimates
to facilitate patient-centered cancer care.
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References
- Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.The Journal of urology. 2018; 199: 683-690
- Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology.Journal of the National Comprehensive Cancer Network. 2019; 17: 479-505
- Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART I. [Miscellaneous Article].Journal of Urology. 2021; 205: 14-21https://doi.org/10.1097/JU.0000000000001375
- Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer.BJU international. 2007; 100: 1254-1258
- Challenging the 10-year rule: The accuracy of patient life expectancy predictions by physicians in relation to prostate cancer management.Can Urol Assoc J. 2012; 6: 367-373https://doi.org/10.5489/cuaj.11161
- Successful external validation of a model to predict other cause mortality in localized prostate cancer.BMC Med. 2016; 14: 25https://doi.org/10.1186/s12916-016-0572-z
- Life expectancy estimates for patients diagnosed with prostate cancer in the Veterans Health Administration.Urologic Oncology: Seminars and Original Investigations. 2020; 38: 734.e1-734.e10https://doi.org/10.1016/j.urolonc.2020.05.015
- An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer.Journal of Urology. 2015; 194: 73-78https://doi.org/10.1016/j.juro.2015.01.081
- External Validation of the Prostate Cancer Specific Comorbidity Index: A Claims Based Tool for the Prediction of Life Expectancy in Men with Prostate Cancer.Journal of Urology. 2019; 202: 518-524https://doi.org/10.1097/JU.0000000000000287
- Calculating life expectancy to inform prostate cancer screening and treatment decisions.BJU Int. 2017; 120: 9-11https://doi.org/10.1111/bju.13812
- Predicting Risk of Hospitalization or Death Among Patients Receiving Primary Care in the Veterans Health Administration.Medical Care. 2013; 51: 368-373https://doi.org/10.1097/MLR.0b013e31827da95a
- Validation of an automatically generated screening score for frailty: the care assessment need (CAN) score.BMC Geriatr. 2018; 18: 106https://doi.org/10.1186/s12877-018-0802-7
- Using Predictive Analytics to Guide Patient Care and Research in a National Health System.J GEN INTERN MED. 2019; 34: 1379-1380https://doi.org/10.1007/s11606-019-04961-4
- Accuracy and completeness of mortality data in the Department of Veterans Affairs.Population health metrics. 2006; 4: 2
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.Journal of clinical epidemiology. 1992; 45: 613-619
- Validation of a combined comorbidity index.Journal of clinical epidemiology. 1994; 47: 1245-1251
- Overtreatment of men with low-risk prostate cancer and significant comorbidity.Cancer. 2011; 117: 2058-2066
- Understanding the Use of Prostate Biopsy Among Men with Limited Life Expectancy in a Statewide Quality Improvement Collaborative.Eur Urol. 2016; 70: 854-861https://doi.org/10.1016/j.eururo.2016.03.054
- Radical prostatectomy versus observation for localized prostate cancer.N Engl J Med. 2012; 367: 203-213https://doi.org/10.1056/NEJMoa1113162
- Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.N Engl J Med. 2017; 377: 132-142https://doi.org/10.1056/NEJMoa1615869
- Radical Prostatectomy or Observation for Clinically Localized Prostate Cancer: Extended Follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT).European Urology. 2020; 77: 713-724https://doi.org/10.1016/j.eururo.2020.02.009
- Overall Survival in Patients with Localized Prostate Cancer in the US Veterans Health Administration: Is PIVOT Generalizable?.Eur Urol. 2016; 70: 227-230https://doi.org/10.1016/j.eururo.2016.02.037
- Ethical Pitfalls When Estimating Life Expectancy for Patients with Prostate Cancer.Journal of Urology. 2018; 200: 709-711https://doi.org/10.1016/j.juro.2018.06.008
- Health status in VA patients: results from the Veterans Health Study.American Journal of Medical Quality. 1999; 14: 28-38
- Comparing the health status of VA and non-VA ambulatory patients: the veterans’ health and medical outcomes studies.The Journal of ambulatory care management. 2004; 27: 249-262
- Are patients at Veterans Affairs medical centers sicker?: A comparative analysis of health status and medical resource use.Archives of internal medicine. 2000; 160: 3252-3257
- The health status of elderly veteran enrollees in the Veterans Health Administration.Journal of the American Geriatrics Society. 2004; 52: 1271-1276
- Quality of Care for Older Patients With Cancer in the Veterans Health Administration Versus the Private Sector.Ann Intern Med. 2011; 154: 727-736https://doi.org/10.7326/0003-4819-154-11-201106070-00004
- Initial public reporting of quality at Veterans Affairs vs non–Veterans Affairs hospitals.JAMA internal medicine. 2017; 177: 882-885
- Survival of older patients with cancer in the Veterans Health Administration versus fee-for-service Medicare.Journal of clinical oncology. 2012; 30: 1072
Article info
Publication history
Published online: June 14, 2021
Accepted:
May 9,
2021
Received:
March 9,
2021
Footnotes
Funding: This work was supported in part by VA Merit Review (I01 HX0021261 to JL) from the United States (U.S.). Dr. Chertow was supported by an award from the NIH / NIDDK (K24 DK085446). Department of Veterans Affairs Health Services Research and Development Service work was supported using resources and facilities at the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. Dr. Skolarus is supported by National Cancer Institute (R01 CA242559, R37 CA222885). The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government.
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Published by Elsevier Inc.
