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EDITORIAL COMMENT

      In this interesting study, an automatically calculated electronic comorbidity measure, the Care Assessment Needs (CAN) score, was studied as predictor of life expectancy in a huge Veterans Health Administration (VHA) patient sample.
      • N. N.
      • et al.
      Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration.
      The score was originally designed to estimate short-term risks of hospitalization and mortality. The authors demonstrated a strong association of the CAN score with medium-term mortality after prostate cancer diagnosis.
      • N. N.
      • et al.
      Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration.
      Although this instrument may be automatically available in VHA patients, its high complexity may hinder its routine use in different institutions. Instruments predicting life expectancy to support treatment selection in men with early prostate cancer should not only be accurate but also simple to use.
      • Daskivich TJ
      • Kwan L
      • Dash A
      • et al.
      Weighted versus unweighted Charlson score to predict long-term other-cause mortality in men with early-stage prostate cancer.
      In contrast to some contrary claims,
      • 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.
      at least in candidates for radical prostatectomy, clinicians are probably able raters of life expectancy. In our radical prostatectomy series, even patients with the highest risk of competing mortality (age-adjusted Charlson score of 6 or higher, comprising only 4% of the sample) had a 10-year non-prostate cancer mortality rate of only 40%
      • Froehner M.
      Patient reported vs claims based measures of health for modeling life expectancy in men with prostate cancer. Letter.
      and the 50% level was not reached before narrowly 14 years. Complex tools requiring comprehensive data collection will probably not change routine decision making in candidates for radical prostatectomy regardless of their accuracy. If the risk classifications were, however, automatically calculated and readily available, there may be a different situation. Because of the huge sample size and the detailed information collected, the impressive data source used in this study
      • N. N.
      • et al.
      Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration.
      should encourage further studies, for instance predicting 90-day mortality in vulnerable candidates for radical cystectomy.
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      References

        • N. N.
        • et al.
        Using an automated electronic health record score to estimate life expectancy in men diagnosed with prostate cancer in the Veterans Health Administration.
        Urology. 2021; ([in press])
        • Daskivich TJ
        • Kwan L
        • Dash A
        • et al.
        Weighted versus unweighted Charlson score to predict long-term other-cause mortality in men with early-stage prostate cancer.
        Eur Urol. 2014; 66: 1002-1009
        • 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 Int. 2007; 100: 1254-1258
        • Froehner M.
        Patient reported vs claims based measures of health for modeling life expectancy in men with prostate cancer. Letter.
        J Urol. 2021; 205: 1235-1236