Functional Health Predictors of Other Cause Mortality Risk in Prostate Cancer

描述(由申请人提供)：这项建议有两个主要目的：(1)提高对患者报告的功能性健康、合并症和社会人口学因素与新诊断为前列腺癌的老年男性的其他原因死亡率之间的关系的理解；(2)开发一个计算其他原因的个体化风险的原型工具 这一人群的死亡率。前列腺癌是美国男性最常见的非皮肤癌，主要困扰65岁及以上的人。然而，大多数男性在早期就被诊断出患有肿瘤，这些肿瘤通常都有一个缓慢的病程。指南建议，只有在总体预期寿命为10年的情况下，患者才应寻求积极治疗。在确诊的5年内，只有11%的美国男性死于前列腺癌，而大多数被诊断为前列腺癌的患者死于其他原因。虽然已经开发了用于临床预测前列腺癌相关死亡率的验证计算工具，但还没有从现有模型中开发出验证工具来识别与其他原因死亡风险(OCM)相关的变量。随着美国男性寿命的延长和65岁以上人口的快速增长，考虑到个人健康状况的巨大异质性，个性化的预期寿命预测是必要的。近四分之三的老龄化人口可能患有多种并存疾病。先前的工作表明，患者报告的功能健康水平的下降可能与OCM的相关性比大多数个体合并疾病的存在更强。这些发现有望改进计算多种疾病影响的方法。这项博士前研究培训建议寻求资金，以探索先前工作的概括性，证明患者报告的功能健康与OCM之间的联系。这项拟议的工作将利用关联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4510名受试者的数据，帮助确定与前列腺癌老年男性OCM最相关的变量。该数据库包含有关癌症特征、治疗、死因、基线合并症、社会人口学信息和功能性健康措施的详细信息。这项建议将通过现代统计技术评估预测模型的性能，并对其他原因死亡率预测模型的性能进行评估和改进。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，该工具估计10年OCM的个性化风险，采用经过验证的技术来开发风险计算器。这项研究将有助于建立患者报告的功能性健康措施在提高新诊断为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。这项工作的完成将有助于更好地识别最有可能从积极治疗中受益的老年患者与那些可能不受益的老年患者，因为他们可能更有可能死于其他原因。

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.