Functional Health Predictors of Other Cause Mortality Risk in Prostate Cancer

前列腺癌其他原因死亡风险的功能健康预测因素

• 批准号: 8783762
• 负责人: Daniel Mark Frendl
• 金额: $ 2.73万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-15 至 2017-06-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8783762
• 关键词: Accounting; Aftercare; Age; American; Cause of Death; Characteristics; Clinical; Comorbidity; Comorbidity Index; Data; Data Set; Databases; Development; Diagnosis; Elderly; Evaluation; Framingham Heart Study; Funding; Future; Generic Drugs; Goals; Guidelines; Health; Health Status; Health Surveys; Heterogeneity; Individual; Indolent; Left; Life; Life Expectancy; Link; Localized Malignant Neoplasm; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Medical Surveillance; Medicare; Methods; Modeling; Modification; Newly Diagnosed; Older Population; Outcome; Outcome Study; Patient Outcomes Assessments; Patients; Performance; Population; Process; Prostate; Prostatectomy; Quality of life; Radiation therapy; Reporting; Research; Research Personnel; Research Training; Risk; SF-36; Sampling; Staging; Techniques; Work; aggressive therapy; aging population; base; cancer diagnosis; cancer therapy; clinical decision-making; clinical risk; experience; functional status; improved; men; mortality; older men; older patient; pre-doctoral; predictive modeling; prototype; public health relevance; randomized trial; tool; tumor; urologic

DESCRIPTION (provided by applicant): This proposal has two primary aims: (1) to improve the understanding of the association between patient- reported functional health, comorbidity, and sociodemographic factors and other cause mortality in older men newly diagnosed with prostate cancer; (2) to develop a prototype tool for calculating individualized risk of other cause mortality in this population. Prostate cancer is the most common non-cutaneous cancer in American men and primarily afflicts those age 65 and older. However, most men are diagnosed at early stages with tumors that most often have an indolent course. Guidelines recommend that patients only pursue aggressive treatment if they have >10 year overall life expectancy. Within 5 years of diagnosis, only 11% of American men die due to their prostate cancer, while the majority of patients diagnosed with prostate cancer die of other causes. While validated calculation tools have been developed for clinical use in predicting prostate cancer related mortality, no validated tool has been developed from existing models that identify variables associated with the risk of dying of other causes (OCM). As men in the U.S. live longer and the population above age 65 is rapidly growing, individualized predictions of life expectancy are necessary given the substantial heterogeneity in individual health status. Nearly three quarters of this aging population may have multiple comorbid conditions. Previous work has shown that decrements in patient-reported functional health may be more strongly associated with OCM than the presence of most individual comorbidities. These findings have promise for improving the approach to accounting for the impact of multiple conditions. This predoctoral research training proposal seeks funding to explore the generalizability of prior work demonstrating the association of patient-reported functional health and OCM. The proposed work will help to identify the variables most strongly associated with OCM in older men with prostate cancer, utilizing data from 4,510 subjects in the linked Surveillance Epidemiology and End Results- Medicare Health Outcomes Study (SEER-MHOS) database. This database contains detailed information on cancer characteristics, treatment, cause of death, baseline comorbidities, sociodemographic information, and functional health measures. This proposal will evaluate and improve upon the performance of other cause mortality prediction models through modern statistical techniques to assess predictive model performance. After identifying key predictors of OCM, we propose to develop a prototype clinical risk-calculation tool that estimates personalized risk of 10-year OCM, adapting validated techniques for developing risk calculators. This study will help to establish the utility of patient- reported functional health measures in improving the accuracy of OCM risk estimation in older men newly diagnosed with prostate cancer and will make progress towards a clinically useful OCM risk estimation tool. Completion of this work will help to better identify older patients who would most likely benefit from aggressive treatment vs. those who may not, as they may be more likely to die of other causes.

描述（由申请人提供）：该提案有两个主要目的：（1）提高对新诊断患有前列腺癌的老年男性患者报告的功能健康、合并症、社会人口因素和其他原因死亡率之间关系的理解； (2) 开发计算其他原因个体化风险的原型工具 该人群的死亡率。前列腺癌是美国男性中最常见的非皮肤癌，主要影响 65 岁及以上的人群。然而，大多数男性在早期就被诊断出患有肿瘤，而且肿瘤通常呈惰性病程。指南建议患者只有在总体预期寿命 >10 年的情况下才寻求积极治疗。在诊断后 5 年内，只有 11% 的美国男性死于前列腺癌，而大多数诊断为前列腺癌的患者死于其他原因。虽然已经开发出经过验证的计算工具用于临床预测前列腺癌相关死亡率，但尚未从现有模型中开发出经过验证的工具来识别与其他原因死亡 (OCM) 风险相关的变量。随着美国男性寿命的延长以及 65 岁以上人口的迅速增长，考虑到个人健康状况的巨大异质性，对预期寿命进行个体化预测是必要的。近四分之三的老龄化人口可能患有多种合并症。先前的研究表明，患者报告的功能健康状况的下降可能与 OCM 的相关性比大多数个体合并症的存在更为密切。这些发现有望改进解释多种条件影响的方法。这项博士前研究培训计划寻求资金来探索先前工作的普遍性，证明患者报告的功能健康与 OCM 之间的关联。拟议的工作将利用关联的监测流行病学和最终结果 - 医疗保险健康结果研究 (SEER-MHOS) 数据库中 4,510 名受试者的数据，帮助确定与患有前列腺癌的老年男性 OCM 最密切相关的变量。该数据库包含有关癌症特征、治疗、死亡原因、基线合并症、社会人口统计信息和功能健康措施的详细信息。该提案将通过现代统计技术来评估和改进其他原因死亡率预测模型的性能，以评估预测模型的性能。在确定 OCM 的关键预测因素后，我们建议开发一个原型临床风险计算工具，用于估计 10 年 OCM 的个性化风险，并采用经过验证的技术来开发风险计算器。这项研究将有助于确定患者报告的功能健康测量在提高新诊断患有前列腺癌的老年男性 OCM 风险评估准确性方面的效用，并将在临床上有用的 OCM 风险评估工具方面取得进展。完成这项工作将有助于更好地识别哪些老年患者最有可能从积极治疗中受益，哪些老年患者可能不会受益，因为他们更有可能死于其他原因。