Association of Comorbidity, Age, and Radical Surgical Therapy for Prostate Cancer, Bladder Cancer, and Renal Cell Carcinoma

Impact of comorbidities on prostate cancer-specific mortality: A population-based cohort study

AIM

To assess the impact of comorbidities on prostate cancer mortality.

METHODS

We studied 15,695 South Australian men diagnosed with prostate cancer between 2003 and 2019 from state-wide administrative linked data sets. Comorbidity was measured 1-year before prostate cancer diagnosis using Rx-Risk, a medication-based comorbidity index. Flexible parametric competing risk regression was used to estimate the independent association between comorbidities and prostate cancer-specific mortality. Specific common comorbidities within Rx-Risk (cardiac disorders, diabetes, chronic airway diseases, depression and anxiety, thrombosis, and pain) were also assessed to determine their association with mortality. All models were adjusted for sociodemographic variables, tumor characteristics, and treatment type.

RESULTS

Prostate cancer-specific mortality was higher for patients with a Rx-Risk score ≥3 versus 0 (adjusted sub-hazard ratio (sHR) 1.34, 95% CI: 1.15-1.56). Lower comorbidity scores (Rx-Risk score 2 vs. 0 and Rx-Risk score 1 vs. 0) were not significantly associated with prostate cancer-specific mortality. Men who were using medications for cardiac disorders (sHR 1.31, 95% CI: 1.13-1.52), chronic airway disease (sHR 1.20, 95% CI: 1.01-1.44), depression and anxiety (sHR 1.17, 95% CI: 1.02-1.35), and thrombosis (sHR 1.21, 95% CI: 1.04-1.42) were at increased risk of dying from prostate cancer compared with men not on those medications. Use of medications for diabetes and chronic pain were not associated with prostate cancer-specific mortality. All Rx-Risk score categories and the specific comorbidities were also associated with increased risk of all-cause mortality.

CONCLUSION

The findings showed that ≥3 comorbid conditions and specific comorbidities including cardiac disease, chronic airway disease, depression and anxiety, and thrombosis were associated with poor prostate cancer-specific survival. Appropriate management of these comorbidities may help to improve survival in prostate cancer patients.

Medication-based Comorbidity Measures and Prostate Cancer Treatment Selection

INTRODUCTION

We aimed to assess the association between comorbidities and prostate cancer management.

PATIENTS AND METHODS

We studied 12,603 South Australian men diagnosed with prostate cancer between 2003 and 2019. Comorbidity was measured one year prior to prostate cancer diagnosis using a medication-based comorbidity index (Rx-Risk). Binomial logistic regression analyses were used to assess the association between comorbidities and primary treatment selection (active surveillance, radical prostatectomy (RP), external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT), brachytherapy, ADT alone, and watchful waiting (WW)). Certain common comorbidities within Rx-Risk (cardiac disorders, diabetes, chronic airway diseases, depression and anxiety, thrombosis, and chronic pain) were also assessed. All models were adjusted for sociodemographic and tumor characteristics.

RESULTS

Likelihood of receiving RP was lower among men with Rx-Risk score ≥3 (odds ratio (OR) 0.62, 95%CI:0.56-0.69) and Rx-Risk 2 (OR 0.80, 95%CI:0.70-0.92) compared with no comorbidity (Rx-Risk ≤0). Men with high comorbidity (Rx-Risk ≥3) were more likely to have received ADT alone (OR 1.76, 95%CI:1.40-2.21), EBRT (OR 1.30, 95%CI:1.17-1.45) or WW (OR 1.49, 95%CI:1.19-1.88) compared with Rx-Risk ≤0. Pre-existing cardiac and respiratory disorders, thrombosis, diabetes, depression and anxiety, and chronic pain were associated with lower likelihood of selecting RP and higher likelihood of EBRT (except chronic airway disease) or WW (except diabetes and depression and anxiety). Cardiac disorders and thrombosis were associated with higher likelihood of selecting ADT alone. Furthermore, age had greater effect on treatment choice than the level of comorbidity.

CONCLUSION

High comorbidity burden was associated with primary treatment choice, with significantly less RP and more EBRT, WW and ADT alone among men with higher levels of comorbidity. Each of the individual comorbid conditions also influenced treatment selection.

Burden and prognostic impact of cardiovascular disease in patients with cancer

The number of patients at the intersection of cancer and cardiovascular disease (CVD) is increasing, reflecting ageing global populations, rising burden of shared cardiometabolic risk factors, and improved cancer survival. Many cancer treatments carry a risk of cardiotoxicity. Baseline cardiovascular risk assessment is recommended in all patients with cancer and requires consideration of individual patient risk and the cardiotoxicity profile of proposed anticancer therapies. Patients with pre-existing CVD are potentially at high or very high risk of cancer-therapy related cardiovascular toxicity. The detection of pre-existing CVD should prompt cardiac optimisation and planning of surveillance during cancer treatment. In patients with severe CVD, the risk of certain cancer therapies may be prohibitively high. Such decisions require multidisciplinary discussion with consideration of alternative anti-cancer therapies, risk-benefit assessment, and patient preference. Current practice is primarily guided by expert opinion and data from select clinical cohorts. There is need for development of a stronger evidence base to guide clinical practice in cardio-oncology. The establishment of multicentre international registries and national-level healthcare data linkage projects are important steps towards facilitating enrichment of cardio-oncology research programmes. In this narrative review, we consider epidemiological trends of cancer and CVD comorbidities and the impact of their co-occurrence on clinical outcomes, current approach to supporting cancer patients with pre-existing CVD and gaps in existing knowledge.

Racial disparities in nephrectomy and mortality among patients with renal cell carcinoma: Findings from SEER

PURPOSE

To assess racial differences in the receipt of nephrectomy in patients diagnosed RCC in the US.

MATERIALS AND METHODS

2005 to 2015 data from the SEER database was analyzed and 70,059 patients with RCC were identified. We compared demographic and tumor characteristics between black patients and white patients. We applied logistic regression to assess the association between race and the odds of the receipt of nephrectomy. We also applied Cox proportional hazards model to assess the impact of race on cancer-specific mortality (CSM) and all-cause mortality (ACM) in patients diagnosed with RCC in the US.

RESULTS

Black patients had 18% lower odds of receiving nephrectomy compared to white patients (p < 0.0001). The odds of the receipt of nephrectomy also reduced with age at diagnosis. In addition, patients with T3 stage had the greatest odds of receiving nephrectomy when compared to T1 (p < 0.0001). There was no difference in the risk of cancer-specific mortality between black patients and white patients; black patients had 27% greater odds of all-cause mortality than white patients (p < 0.0001). Patients who did not receive nephrectomy had a 42% and 35% higher risk of CSM and ACM respectively, when compared to patients who received nephrectomy.

CONCLUSIONS

Black patients diagnosed with RCC in the US have a greater ACM risk and are less likely than white patients to receive nephrectomy. Systemic changes are needed to eliminate racial disparity in the treatment and outcomes of RCC in the US.

[Specificity of the management of metastatic renal cancer in the older patient]

AIM

To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients.

METHOD

Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment.

RESULTS

The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways.

CONCLUSION

The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.

Racial Disparities in the Presentation, Early Definitive Surgical Treatment, and Mortality Among Men Diagnosed with Poorly Differentiated/Undifferentiated Non-metastatic Prostate Cancer in the USA

OBJECTIVE

To assess the influence of race on presentation of poorly differentiated/undifferentiated prostate cancer, use of radical prostatectomy (RP) as primary treatment and survival outcomes.

METHODS

Using the 2004-2014 files of the Surveillance, Epidemiology, and End Results (SEER) data, we identified 244,167 black and white men diagnosed with poorly differentiated/undifferentiated prostate cancer. Demographic and tumor characteristics of study patients were compared by race. Logistic regression was used to evaluate the influence of race on receipt of RP. Cox proportional hazard models were fitted to determine the impact of RP and race on cancer-specific mortality (CSM) and all-cause mortality (ACM).

RESULTS

Compared to white men, black men were diagnosed of prostate cancer at a younger age (64.2 years versus (vs) 67.5 years, p < 0.0001) and presented with higher median prostate-specific antigen, PSA (24.4 ng/ml vs 22.1 ng/ml, p < 0.0001) but lower disease stage. Lower proportion of black men received RP compared to white men (33.9% vs 42.6%; p < 0.0001). The odds of receipt of RP were 2 times higher in white men relative to black men. The risks of CSM and ACM were over 2 times and 3 times respectively higher in patients who did not receive RP vs patients who received RP in the study population and in each race.

CONCLUSION

Despite the younger age at diagnosis of poorly differentiated/undifferentiated prostate cancer and higher PSA at diagnosis in black men, white men had significantly higher odds of receipt of RP relative to black men.

Assessment of CEP55, PLK1 and FOXM1 expression in patients with bladder cancer in comparison with healthy individuals

This case/control study is aimed at investigating the expression of CEP55, PLK1 and FOXM1 in bladder cancer tissues and comparing it with healthy tissue and their relationship with clinicopathological features of BC. Total RNA was extracted; then, gene expression was performed using real-time PCR relative to 18 s rRNA. 2-ΔΔCT method was used to calculate the relative expression of genes. A significant over expression of FOXM1, PLK1 and CEP55 was observed in tumor samples compared to adjacent and normal bladder tissues (all p = 0.001). Therefore, they may be supposed as potential candidate's biomarkers for early diagnosis and targets for cancer therapy.

Are the Pathological Characteristics of Prostate Cancer More Aggressive or More Indolent Depending upon the Patient Age?

Purpose. To identify pathological characteristics of prostate cancer according to patient age at diagnosis. Methods. A retrospective review of 2,929 men diagnosed with prostate cancer was performed. Pathological characteristics were compared across age groups: ≤55, 56–75, and >75 years. Results. The study cohort included 133 patients (4.5%), 2,033 patients (69.5%), and 763 patients (26.0%) in the three age groups, respectively. The median pathological Gleason sums in the three age groups were 8, 7, and 8, respectively. The Gleason sum, primary Gleason score, and second primary Gleason score were significantly different among the three age groups (Z = 12.975, p = 0.002; Z = 9.264, p = 0.010; Z = 6.692, p = 0.035, resp.). The percentages of Gleason pattern 5 tumors for the three age groups were 44.4%, 32.3%, and 36.8%, respectively; they were significantly different (χ² = 11.641, p = 0.003). The percentages of tumors with Gleason score grade groups 3–5 for the three age groups were 66.9%, 60.5%, and 66.3%, respectively; they were significantly different (χ² = 9.401, p = 0.009). Conclusions. The present study indicated that men aged ≤55 years or >75 years show higher levels of clinically significant prostate cancer compared to patients between the ages of 55 and 75 years. Younger and more elderly male patients are more likely to have a more aggressive disease.

The Impact of Comorbidity on Surgical Outcomes in Older Adults with Cancer

OBJECTIVES

To provide an overview of the impact of comorbidity on surgical outcomes and postoperative geriatric events in older adults with cancer, and review key components of quality perioperative nursing care of older adults with cancer.

DATA SOURCES

Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations.

CONCLUSION

The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults after cancer surgery have a substantial impact on surgical outcomes, quality of life, and health care costs. Practical and efficient models of comprehensive assessment, prevention, and management of postoperative geriatric events and comorbid conditions are needed to improve surgical outcomes for this vulnerable cancer population.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses practicing in clinical and research settings have a responsibility to arm themselves with evidence-based knowledge and resources to improve the perioperative care of older adults with cancer.