Advertisement

Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sanda MG
        • Cadeddu JA
        • Kirkby E
        • et al.
        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
        • Mohler JL
        • Antonarakis ES
        • Armstrong AJ
        • et al.
        Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology.
        Journal of the National Comprehensive Cancer Network. 2019; 17: 479-505
        • Lowrance WT
        • Breau RH
        • Chou R
        • et al.
        Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART I. [Miscellaneous Article].
        Journal of Urology. 2021; 205: 14-21https://doi.org/10.1097/JU.0000000000001375
        • Walz J
        • Gallina A
        • Perrotte P
        • et al.
        Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer.
        BJU international. 2007; 100: 1254-1258
        • Leung KMYB
        • Hopman WM
        • Kawakami J
        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
        • Kent M
        • Penson DF
        • Albertsen PC
        • et al.
        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
        • Sohlberg EM
        • Thomas I-C
        • Yang J
        • et al.
        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
        • Daskivich TJ
        • Kwan L
        • Dash A
        • Saigal C
        • Litwin MS
        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
        • Daskivich TJ
        • Thomas I-C
        • Luu M
        • et al.
        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
        • Hawken SR
        • Auffenberg GB
        • Miller DC
        • et al.
        Calculating life expectancy to inform prostate cancer screening and treatment decisions.
        BJU Int. 2017; 120: 9-11https://doi.org/10.1111/bju.13812
        • Wang L
        • Porter B
        • Maynard C
        • et al.
        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
        • Ruiz JG
        • Priyadarshni S
        • Rahaman Z
        • et al.
        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
        • Nelson KM
        • Chang ET
        • Zulman DM
        • Rubenstein LV
        • Kirkland FD
        • Fihn SD
        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
        • Sohn M-W
        • Arnold N
        • Maynard C
        • Hynes DM
        Accuracy and completeness of mortality data in the Department of Veterans Affairs.
        Population health metrics. 2006; 4: 2
        • Deyo RA
        • Cherkin DC
        • Ciol MA
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        Journal of clinical epidemiology. 1992; 45: 613-619
        • Charlson M
        • Szatrowski TP
        • Peterson J
        • Gold J
        Validation of a combined comorbidity index.
        Journal of clinical epidemiology. 1994; 47: 1245-1251
        • Daskivich TJ
        • Chamie K
        • Kwan L
        • et al.
        Overtreatment of men with low-risk prostate cancer and significant comorbidity.
        Cancer. 2011; 117: 2058-2066
        • Abdollah F
        • Ye Z
        • Miller DC
        • et al.
        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
        • Wilt TJ
        • Brawer MK
        • Jones KM
        • et al.
        Radical prostatectomy versus observation for localized prostate cancer.
        N Engl J Med. 2012; 367: 203-213https://doi.org/10.1056/NEJMoa1113162
        • Wilt TJ
        • Jones KM
        • Barry MJ
        • et al.
        Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.
        N Engl J Med. 2017; 377: 132-142https://doi.org/10.1056/NEJMoa1615869
        • Wilt TJ
        • Vo TN
        • Langsetmo L
        • et al.
        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
        • Barbosa PV
        • Thomas I-C
        • Srinivas S
        • et al.
        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
        • Leppert JT
        • Asch SM
        • Bergman J
        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
        • Kazis LE
        • Ren XS
        • Lee A
        • et al.
        Health status in VA patients: results from the Veterans Health Study.
        American Journal of Medical Quality. 1999; 14: 28-38
        • Rogers WH
        • Kazis LE
        • Miller DR
        • et al.
        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
        • Agha Z
        • Lofgren RP
        • VanRuiswyk JV
        • Layde PM
        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
        • Selim AJ
        • Berlowitz DR
        • Fincke G
        • et al.
        The health status of elderly veteran enrollees in the Veterans Health Administration.
        Journal of the American Geriatrics Society. 2004; 52: 1271-1276
        • Keating NL
        • Landrum MB
        • Lamont EB
        • et al.
        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
        • Blay E
        • DeLancey JO
        • Hewitt DB
        • Chung JW
        • Bilimoria KY
        Initial public reporting of quality at Veterans Affairs vs non–Veterans Affairs hospitals.
        JAMA internal medicine. 2017; 177: 882-885
        • Landrum MB
        • Keating NL
        • Lamont EB
        • et al.
        Survival of older patients with cancer in the Veterans Health Administration versus fee-for-service Medicare.
        Journal of clinical oncology. 2012; 30: 1072