Background: Investigators have used administrative claims to better understand cancer outcomes when a research question cannot feasibly be examined within a study. The Prostate Cancer Prevention Trial (PCPT) showed that seven years of finasteridereduced prostate cancer (PC) risk by 25% in men age 55 years or older. However, it was unclear whether the observed reduction in PC for finasteride participants would be maintained after finasteride discontinuation. Methods: We examined PC diagnoses identified by PCPT study records and Medicare claims (finasteride = 9423, placebo = 9457). A Medicare-defined PC diagnosis algorithm was defined using diagnosis and procedure codes. Multivariable Cox regression was used to examine time to PC within prespecified follow-up windows (<6.5, 6.5-7.5, and >7.5 years) using time-dependent covariates interacting with intervention assignment to account for the PCPT protocol-specified end-of-study biopsy at seven years. All statistical tests were two-sided. Results: Median follow-up using the linked database was 16 years. Overall, finasteride arm participants had a 21.1% decrease in the hazard ratio of PC (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.74 to 0.84, P < .001). The beneficial effect of finasteride in reducing the hazard ratio of PC was most pronounced in the first 7.5 years (HR = 0.71, 95% CI = 0.66 to 0.77, P < .001), consistent with the original study findings; after 7.5 years, there was no increased risk of PC for finasteride arm participants (HR = 1.10, 95% CI = 0.96 to 1.26, P = .18). Conclusions: Finasteride provides a substantial reduction in PC through 16 years of follow-up. There was no strong evidence that the benefit of finasteride diminished after the end-of-study follow-up. Utilizing Medicare claims to augment PCPT follow-up illustrates how the novel use of secondary data sources can enhance the ability to detect long-term outcomes from prospective studies.
RCT Entities:
Background: Investigators have used administrative claims to better understand cancer outcomes when a research question cannot feasibly be examined within a study. The Prostate Cancer Prevention Trial (PCPT) showed that seven years of finasteride reduced prostate cancer (PC) risk by 25% in men age 55 years or older. However, it was unclear whether the observed reduction in PC for finasterideparticipants would be maintained after finasteride discontinuation. Methods: We examined PC diagnoses identified by PCPT study records and Medicare claims (finasteride = 9423, placebo = 9457). A Medicare-defined PC diagnosis algorithm was defined using diagnosis and procedure codes. Multivariable Cox regression was used to examine time to PC within prespecified follow-up windows (<6.5, 6.5-7.5, and >7.5 years) using time-dependent covariates interacting with intervention assignment to account for the PCPT protocol-specified end-of-study biopsy at seven years. All statistical tests were two-sided. Results: Median follow-up using the linked database was 16 years. Overall, finasteride arm participants had a 21.1% decrease in the hazard ratio of PC (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.74 to 0.84, P < .001). The beneficial effect of finasteride in reducing the hazard ratio of PC was most pronounced in the first 7.5 years (HR = 0.71, 95% CI = 0.66 to 0.77, P < .001), consistent with the original study findings; after 7.5 years, there was no increased risk of PC for finasteride arm participants (HR = 1.10, 95% CI = 0.96 to 1.26, P = .18). Conclusions: Finasteride provides a substantial reduction in PC through 16 years of follow-up. There was no strong evidence that the benefit of finasteride diminished after the end-of-study follow-up. Utilizing Medicare claims to augment PCPT follow-up illustrates how the novel use of secondary data sources can enhance the ability to detect long-term outcomes from prospective studies.
Authors: D K McClish; L Penberthy; M Whittemore; C Newschaffer; D Woolard; C E Desch; S Retchin Journal: Am J Epidemiol Date: 1997-02-01 Impact factor: 4.897
Authors: Dawn L Hershman; Joseph M Unger; Jason D Wright; Scott Ramsey; Cathee Till; Catherine M Tangen; William E Barlow; Charles Blanke; Ian M Thompson; Maha Hussain Journal: JAMA Oncol Date: 2016-04 Impact factor: 31.777
Authors: Jessica Chubak; Onchee Yu; Gaia Pocobelli; Lois Lamerato; Joe Webster; Marianne N Prout; Marianne Ulcickas Yood; William E Barlow; Diana S M Buist Journal: J Natl Cancer Inst Date: 2012-04-30 Impact factor: 13.506
Authors: Jennifer L Malin; Katherine L Kahn; John Adams; Lorna Kwan; Marianne Laouri; Patricia A Ganz Journal: J Natl Cancer Inst Date: 2002-06-05 Impact factor: 13.506
Authors: Michael J Hassett; Debra P Ritzwoller; Nathan Taback; Nikki Carroll; Angel M Cronin; Gladys V Ting; Deb Schrag; Joan L Warren; Mark C Hornbrook; Jane C Weeks Journal: Med Care Date: 2014-10 Impact factor: 2.983
Authors: Ian M Thompson; Phyllis J Goodman; Catherine M Tangen; Howard L Parnes; Lori M Minasian; Paul A Godley; M Scott Lucia; Leslie G Ford Journal: N Engl J Med Date: 2013-08-15 Impact factor: 91.245