To determine whether patient-reported health status, more so than comorbidity, influences treatment in men with localized prostate cancer.
Using SEER data linked with Medicare claims and CAHPS surveys, we identified men aged 65-84 diagnosed with localized prostate cancer from 2004-2013 and ascertained their NCI Comorbidity score and patient-reported health status. Adjusting for demographics and cancer risk, we examined the relationship between these measures and treatment for the overall cohort, low risk men aged 65-74, intermediate/high risk men aged 65-74, and men aged 75-84.
Among 2,724 men, 43.0% rated their overall health as Excellent/Very Good while 62.7% had a comorbidity score of 0. Beyond age and cancer risk, patient-reported health status was significantly associated with treatment. Compared to men reporting Excellent/Very Good health, men in Poor/Fair health less often received treatment (OR 0.71, 95% CI 0.56-0.90). Younger men with intermediate/high risk cancer in Good (OR 0.60, 95% CI 0.41-0.88) or Fair/Poor (OR 0.49 95% CI 0.30-0.79) health less often underwent prostatectomy versus radiation compared to men in Excellent/Very Good health. In contrast, men with NCI comorbidity score of 1 more often received treatment (OR 1.37, 95% CI 1.11-1.70) compared to men with NCI comorbidity score of 0.
Patient-reported health status drives treatment for prostate cancer in an appropriate direction whereas comorbidity has an inconsistent relationship. Greater understanding of this interplay between subjective and empiric assessments may facilitate more shared decision-making in prostate cancer care.

Copyright © 2020. Published by Elsevier Inc.