Skeletal-related events and mortality among men diagnosed with advanced prostate cancer: The impact of alternative measures of radiation to the bone

Skeletal-related events (SREs), which include radiation to the bone (RtB), can occur among patients with bone metastasis (BM). There is a recognized potential for misclassification of RtB when using claims data. We compared alternative measures of RtB to better understand their impact on SRE prevale...

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Veröffentlicht in:PloS one Jg. 12; H. 4; S. e0175956
Hauptverfasser: Onukwugha, Eberechukwu, Kwok, Young, Ciezki, Jay P., Yong, Candice, Plaisant, Catherine, Reddy, Chandana A., Mullins, C. Daniel, Seal, Brian, Valderrama, Adriana, Hussain, Arif
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 18.04.2017
Public Library of Science (PLoS)
Schlagworte:
Aged
Aged, 80 and over
Analysis
Biology and Life Sciences
Bone and Bones - pathology
Bone and Bones - radiation effects
Bone cancer
Bone Neoplasms - mortality
Bone Neoplasms - radiotherapy
Bone Neoplasms - secondary
Bone surgery
Breast cancer
Cadmium
Cancer therapies
Castration
Clinical medicine
Clinical trials
Complications
Complications and side effects
Compression
Computer graphics
Data processing
Demographic aspects
Epidemiology
Fractures
Government programs
Guidelines
Health aspects
Health care
Humans
Impact analysis
Lungs
Male
Medical diagnosis
Medical research
Medicare
Medicine and Health Sciences
Mens health
Metastases
Metastasis
Morbidity
Mortality
Multiple myeloma
Musculoskeletal system
Oncology
Palliation
Pancreatic cancer
People and Places
Pharmacy
Physics
Population studies
Prognosis
Proportional Hazards Models
Prostate
Prostate - pathology
Prostate cancer
Prostate carcinoma
Prostatic Neoplasms - mortality
Prostatic Neoplasms - pathology
Quality of life
Radiation
Radiation exposure
Radiation therapy
Retrospective Studies
Risk factors
Spinal cord
Studies
Surgery
Survival
United States
United States - epidemiology
Zoledronic acid
United States
Cleveland Ohio
United States > US
ISSN:1932-6203, 1932-6203
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Zusammenfassung:Skeletal-related events (SREs), which include radiation to the bone (RtB), can occur among patients with bone metastasis (BM). There is a recognized potential for misclassification of RtB when using claims data. We compared alternative measures of RtB to better understand their impact on SRE prevalence and SRE-related mortality. We analyzed data for stage IV prostate cancer (PCa) cases identified between 2005 and 2009 in the Surveillance, Epidemiology, and End Results registry linked with Medicare claims. We created two measures of RtB: 1) a literature-based measure requiring the presence of a prior claim with a BM code; 2) a new measure requiring either that the BM code coincided with the radiation episode or that the duration of the radiation episode was less than or equal to 4 weeks. We estimated adjusted hazard ratios of an SRE using both measures among stratified samples: no metastasis (M0), metastasis to bone (M1b) and other sites (M1c). The study sample included 5,074 men with stage IV PCa (median age 77 years), of whom 22% had M0, 54% had M1b, and 24% had M1c disease at time of PCa diagnosis. Based on Approaches 1 and 2, the proportion with probable RtB was 5% and 8% among M0, 30% and 30% among M1b, and 25% and 27% among M1c patients. Among M0 patients, the adjusted hazard ratio (AHR) associated with an SRE was 1.27 when using Approach 1 (95% confidence interval, CI: 0.95-1.7) and 1.49 when using Approach 2 (95% CI: 1.14-1.96). However, the impact of SREs on mortality did not differ between both approaches among M1b and M1c patients. We found that alternative measures used to define RtB as SRE in claims data impact conclusions regarding the effect of SREs on mortality among M0 but not M1 patients.
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These authors also contributed equally to this work.
Conceptualization: EO CDM AH BS.Data curation: EO CY.Formal analysis: EO CY CP.Funding acquisition: EO CDM BS AV.Investigation: EO CY.Methodology: EO YK JPC CY CAR AH.Project administration: EO.Resources: EO BS AV.Software: EO CY CP.Supervision: EO CDM AH.Visualization: EO YK JPC CY CP CAR.Writing – original draft: EO YK JPC CY.Writing – review & editing: EO YK JPC CY CP CAR CDM BS AV AH.
Competing Interests: The competing interests listed are those that were accurate at the time of the study. We have the following interests: Brian Seal and Adriana Valderrama are employed by Bayer HealthCare. EO: Consulting or Advisory Role - Janssen; AstraZeneca; Grant – Bayer Healthcare Pharmaceuticals. CDM: Consulting or Advisory Role - Amgen; Bayer; Bristol-Myers Squibb; GlaxoSmithKline; Novartis; Pfizer. Grants – Bayer Healthcare Pharmaceuticals, Pfizer. AV: Employment – Bayer; Stock and Other Ownership Interests – Bayer. BS: Employment – Bayer; Stock and Other Ownership Interests – Bayer. There are no patents, products in development or marketed products to declare. These competing interests do not alter our adherence to all of the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0175956