Impact of serious mental illness on the treatment and mortality of older patients with locoregional high-grade (nonmetastatic) prostate cancer

retrospective cohort analysis of 49 985 SEER-Medicare patients diagnosed between 2006 and 2013

Dennis A. Fried, Hossein Sadeghi-Nejad, Dian Gu, Shouhao Zhou, Weiguo He, Sharon H. Giordano, Sri Ram Pentakota, Kitaw Demissie, Drew Helmer, Chan Shen

Research output: Contribution to journalArticle

Abstract

Background: The influence of serious mental illness (SMI) on the treatment and survival of patients with high-grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer-specific mortality of SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods: We identified SEER-Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high-grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan-Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5-year cancer-specific survival. Results: Among 49 985 patients with locoregional high-grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49-0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67-0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5-year cancer-specific death (HR = 1.41, 95% CI: 1.06-1.89) after accounting for competing risks of non-cancer death. Conclusion: Among SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer-specific survival 5 years after diagnosis.

Original languageEnglish (US)
Pages (from-to)2612-2622
Number of pages11
JournalCancer medicine
Volume8
Issue number5
DOIs
StatePublished - May 1 2019

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Medicare
Prostatic Neoplasms
Cohort Studies
Mortality
Neoplasms
Therapeutics
Survival
Hormones
Radiation
Kaplan-Meier Estimate
Bipolar Disorder
Psychotic Disorders
Schizophrenia
Logistic Models

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Fried, Dennis A. ; Sadeghi-Nejad, Hossein ; Gu, Dian ; Zhou, Shouhao ; He, Weiguo ; Giordano, Sharon H. ; Pentakota, Sri Ram ; Demissie, Kitaw ; Helmer, Drew ; Shen, Chan. / Impact of serious mental illness on the treatment and mortality of older patients with locoregional high-grade (nonmetastatic) prostate cancer : retrospective cohort analysis of 49 985 SEER-Medicare patients diagnosed between 2006 and 2013. In: Cancer medicine. 2019 ; Vol. 8, No. 5. pp. 2612-2622.
@article{e8e6ff26c6f948e5a994895ba00dff26,
title = "Impact of serious mental illness on the treatment and mortality of older patients with locoregional high-grade (nonmetastatic) prostate cancer: retrospective cohort analysis of 49 985 SEER-Medicare patients diagnosed between 2006 and 2013",
abstract = "Background: The influence of serious mental illness (SMI) on the treatment and survival of patients with high-grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer-specific mortality of SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods: We identified SEER-Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high-grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan-Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5-year cancer-specific survival. Results: Among 49 985 patients with locoregional high-grade (nonmetastatic) prostate cancer, 523 (1.1{\%}) had SMI and 49 462 (98.9{\%}) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95{\%} CI: 0.49-0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95{\%} CI: 0.67-0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5-year cancer-specific death (HR = 1.41, 95{\%} CI: 1.06-1.89) after accounting for competing risks of non-cancer death. Conclusion: Among SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer-specific survival 5 years after diagnosis.",
author = "Fried, {Dennis A.} and Hossein Sadeghi-Nejad and Dian Gu and Shouhao Zhou and Weiguo He and Giordano, {Sharon H.} and Pentakota, {Sri Ram} and Kitaw Demissie and Drew Helmer and Chan Shen",
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Impact of serious mental illness on the treatment and mortality of older patients with locoregional high-grade (nonmetastatic) prostate cancer : retrospective cohort analysis of 49 985 SEER-Medicare patients diagnosed between 2006 and 2013. / Fried, Dennis A.; Sadeghi-Nejad, Hossein; Gu, Dian; Zhou, Shouhao; He, Weiguo; Giordano, Sharon H.; Pentakota, Sri Ram; Demissie, Kitaw; Helmer, Drew; Shen, Chan.

In: Cancer medicine, Vol. 8, No. 5, 01.05.2019, p. 2612-2622.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of serious mental illness on the treatment and mortality of older patients with locoregional high-grade (nonmetastatic) prostate cancer

T2 - retrospective cohort analysis of 49 985 SEER-Medicare patients diagnosed between 2006 and 2013

AU - Fried, Dennis A.

AU - Sadeghi-Nejad, Hossein

AU - Gu, Dian

AU - Zhou, Shouhao

AU - He, Weiguo

AU - Giordano, Sharon H.

AU - Pentakota, Sri Ram

AU - Demissie, Kitaw

AU - Helmer, Drew

AU - Shen, Chan

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: The influence of serious mental illness (SMI) on the treatment and survival of patients with high-grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer-specific mortality of SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods: We identified SEER-Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high-grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan-Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5-year cancer-specific survival. Results: Among 49 985 patients with locoregional high-grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49-0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67-0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5-year cancer-specific death (HR = 1.41, 95% CI: 1.06-1.89) after accounting for competing risks of non-cancer death. Conclusion: Among SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer-specific survival 5 years after diagnosis.

AB - Background: The influence of serious mental illness (SMI) on the treatment and survival of patients with high-grade prostate cancer is not well understood. We compared the initial cancer treatment and cancer-specific mortality of SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer with and without preexisting SMI. Methods: We identified SEER-Medicare patients who were 67 years of age or older diagnosed between 2006 and 2013 with locoregional high-grade (nonmetastatic) prostate cancer. Preexisting SMI was identified by claims indicative of bipolar disorder, schizophrenia, and other psychotic disorder, during the 2 years before cancer diagnosis. We used multivariable binary logistic regression to examine associations between SMI and receipt of surgery or radiation concurrent with hormone therapy (definitive initial treatment) within 1 year after cancer diagnosis. We used Kaplan-Meier survival curves, as well as Cox proportional hazards and competing risk models to evaluate unadjusted and adjusted associations between SMI and 5-year cancer-specific survival. Results: Among 49 985 patients with locoregional high-grade (nonmetastatic) prostate cancer, 523 (1.1%) had SMI and 49 462 (98.9%) had no SMI. Overall, SMI was associated with reduced odds of receiving surgery (OR = 0.66, 95% CI: 0.49-0.89) or radiation concurrent with hormone therapy (OR = 0.81, 95% CI: 0.67-0.98) as initial treatments in the year after cancer diagnosis. Additionally, SMI was associated with higher hazard of 5-year cancer-specific death (HR = 1.41, 95% CI: 1.06-1.89) after accounting for competing risks of non-cancer death. Conclusion: Among SEER-Medicare patients with locoregional high-grade (nonmetastatic) prostate cancer, those with preexisting SMI—relative to those without these conditions—were less likely to receive definitive initial treatment in the year after diagnosis and had poorer cancer-specific survival 5 years after diagnosis.

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DO - 10.1002/cam4.2109

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EP - 2622

JO - Cancer Medicine

JF - Cancer Medicine

SN - 2045-7634

IS - 5

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