Substance use disorder and its effects on outcomes in men with advanced‐stage prostate cancer

BACKGROUND Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. METHODS This was an observational cohort s...

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Bibliographic Details
Published in:Cancer 2014-11, Vol.120 (21), p.3338-3345
Main Authors: Chhatre, Sumedha, Metzger, David S., Malkowicz, S. Bruce, Woody, George, Jayadevappa, Ravishankar
Format: Article
Language:English
Subjects:
advanced prostate cancer
Aged
Aged, 80 and over
Biological and medical sciences
health services
Humans
Insurance Claim Review
Male
Medical sciences
Medicare elderly
mortality
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Neoplasm Staging
Nephrology. Urinary tract diseases
Prostatic Neoplasms - complications
Prostatic Neoplasms - drug therapy
Prostatic Neoplasms - mortality
Prostatic Neoplasms - pathology
substance use disorder
Substance-Related Disorders - classification
Substance-Related Disorders - complications
Substance-Related Disorders - pathology
Treatment Outcome
Tumors
Tumors of the urinary system
United States
Urinary tract. Prostate gland
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Summary:BACKGROUND Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. METHODS This was an observational cohort study using Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked data from 2000 to 2009. Among men who were diagnosed with advanced prostate cancer between 2001 and 2004, we identified those who had a claim for substance use disorder in the year before cancer diagnosis, 1 year after cancer diagnosis, and an additional 4 years after diagnosis. The outcomes investigated were use of health services, costs, and mortality. RESULTS The prevalence of substance use disorder was 10.6%. The category drug psychoses and related had greater odds of inpatient hospitalizations (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9‐2.8), outpatient hospital visits (OR, 2.6; 95% CI, 1.9‐3.6), and emergency room visits (OR, 1.7; 95% CI, 1.2‐2.4). Substance use disorder in the follow‐up phase was associated with greater odds of inpatient hospitalizations (OR, 2.0; 95% CI, 1.8‐2.2), outpatient hospital visits (OR, 2.0; 95% CI, 1.7‐2.4), and emergency room visits (OR, 1.7; 95% CI, 1.5‐2.1). Compared with men who did not have substance use disorder, those in the category drug psychoses and related had 70% higher costs, and those who had substance use disorder during the follow‐up phase had 60% higher costs. The hazard of all‐cause mortality was highest for patients in the drug psychoses and related category (hazard ratio, 1.3; 95% CI, 1.1‐1.7) and the substance use disorder in treatment phase category (hazard ratio, 1.5; 95% CI, 1.3‐1.7). CONCLUSIONS The intersection of advanced prostate cancer and substance use disorder may adversely affect outcomes. Incorporating substance use screening and treatments into prostate cancer care guidelines and coordination of care is desirable. Cancer 2014;120:3338–3345. © 2014 American Cancer Society. The intersection of advanced prostate cancer and substance use disorder appears to adversely affect outcomes. Thus, incorporating substance use screening and treatments into prostate cancer care guidelines and care coordination is desirable.
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.28861