Which better predicts mortality among older men, a prostate cancer (PCa) diagnosis or vulnerability on the Vulnerable Elders Survey (VES-13)? A retrospective cohort study

Abstract Objectives Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elde...

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Bibliographic Details
Published in:Journal of geriatric oncology 2016-11, Vol.7 (6), p.437-443
Main Authors: Lowenstein, Lisa M, Mohile, Supriya G, Gil, Heather Hopkins, Pandya, Chintan, Hemmerich, Joshua, Rodin, Miriam, Dale, William
Format: Article
Language:English
Subjects:
Aged
Analysis of Variance
Case-Control Studies
Frail Elderly - statistics & numerical data
Geriatric Assessment - methods
Health Status
Hematology, Oncology and Palliative Medicine
Humans
Internal Medicine
Kaplan-Meier Estimate
Male
Mortality
Prostate cancer
Prostatic Neoplasms - mortality
Retrospective Studies
Surveys and Questionnaires
Vulnerability
Vulnerable Populations - statistics & numerical data
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Summary:Abstract Objectives Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls. Materials and Methods Men aged ≥ 65 years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality. Results and Conclusions The mean age for men with a PCa diagnosis and controls was 77.9 years and 76.1 years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13 ≥ 3: HR = 4.46, p < 0.01; VES13 ≥ 6: HR = 3.77, p < 0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13 ≥ 3: HR = 1.14, p = 0.59; VES13 ≥ 6: HR = 1.06, p = 0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.
ISSN:1879-4068
1879-4076
DOI:10.1016/j.jgo.2016.07.011