Lisa M Lowenstein1, Supriya G Mohile2, Heather Hopkins Gil3, Chintan Pandya4, Joshua Hemmerich5, Miriam Rodin6, William Dale5. 1. James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. Electronic address: lmlowenstein@mdanderson.org. 2. James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. 3. Division of Geriatrics and Aging, University of Rochester, 435 East Henrietta Road, Rochester, NY 14620, USA. 4. Department of Public Health Sciences, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, USA. 5. Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, 5841 South Maryland Ave., MC, 6098, Chicago, IL, USA. 6. Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd., St. Louis, MO. 63104, USA.
Abstract
OBJECTIVES: Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls. MATERIALS AND METHODS: Men aged ≥65years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality. RESULTS AND CONCLUSIONS: The mean age for men with a PCa diagnosis and controls was 77.9years and 76.1years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13≥3: HR=4.46, p<0.01; VES13≥6: HR=3.77, p<0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13≥3: HR=1.14, p=0.59; VES13≥6: HR=1.06, p=0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.
OBJECTIVES: Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls. MATERIALS AND METHODS:Men aged ≥65years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality. RESULTS AND CONCLUSIONS: The mean age for men with a PCa diagnosis and controls was 77.9years and 76.1years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13≥3: HR=4.46, p<0.01; VES13≥6: HR=3.77, p<0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13≥3: HR=1.14, p=0.59; VES13≥6: HR=1.06, p=0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.
Authors: Trevor A Jolly; Allison M Deal; Kirsten A Nyrop; Grant R Williams; Mackenzi Pergolotti; William A Wood; Shani M Alston; Brittaney-Belle E Gordon; Samara A Dixon; Susan G Moore; W Chris Taylor; Michael Messino; Hyman B Muss Journal: Oncologist Date: 2015-03-12
Authors: Lillian Min; William Yoon; Jeff Mariano; Neil S Wenger; Marc N Elliott; Caren Kamberg; Debra Saliba Journal: J Am Geriatr Soc Date: 2009-09-28 Impact factor: 5.562