No Benefit in Outcomes With Higher Resource Use in Metastatic Prostate Cancer

Increases in monitoring of prostate-specific antigen (PSA) levels and bone health were not associated with improved survival or quality of care at end of life (EOL) for patients with metastatic prostate cancer, according to a new study. The higher resource use was associated with significantly increased healthcare costs.

“Although it is widely recognized that cancer and EOL care is responsible for a substantial proportion of healthcare expenditures, the appropriateness of that care is challenging to quantify objectively,” wrote study authors led by Jim C. Hu, MD, MPH, of Weill Cornell Medical College in New York. “Evaluating the cost-effectiveness of screening and treatment protocols and their impact on care remains important as more men with metastatic disease are diagnosed and live longer.”

The new study used data from the Surveillance, Epidemiology, and End Results (SEER) database to examine treatment patterns and healthcare costs in metastatic prostate cancer patients. It included a total of 3,026 men. The results were published in Cancer.

The patients were categorized based on use of healthcare resources. “Extreme” users were those who either received PSA testing more than once per month, or who underwent cross-sectional imaging or bone scanning more than every 2 months over a 6-month period. A total of 791 men fit that classification (26%).

The extreme users were younger (median age of 73 years) than the non-extreme users (77 years; P < .001). They were also more likely to be white (78.4% vs 71.8%; P < .001), and had a higher education level and higher median income; there were some regional differences as well.

There were no differences, however, with regard to the quality of care at EOL. Among the extreme users, 20.1% had more than one hospital admission, compared with 16.7% of non-extreme users (P = .07); 18.2% and 15.7%, respectively, had more than one emergency department visit (P = .16). There was also no difference in the number of patients who entered the intensive care unit within 1 month of death (26.2% vs 22.7%; P = .09), or in the proportion of patients who had a length of stay of 14 days or longer (13.8% vs 12.3%; P = .36).

The same was true for proportions of patients who entered hospice care within 7 days of death (4.5% of extreme users vs 3.3% of non-extreme users; P = .20), within 30 days of death (15.0% vs 12.8%; P = .19), and within 6 months of death (21.5% vs 20.3%; P = .53). The adjusted rate of deaths per 100 person-years was 29.22 among extreme users, and 27.05 among non-extreme users (P = .19). The same was seen for prostate cancer–specific mortality.

Not surprisingly, costs were higher among the extreme users. In the first year after diagnosis, their healthcare costs were 22.9% higher than non-extreme users on an adjusted analysis (P < .001), at $35,454 compared with $27,983. In the last year of life, costs were 35.1% higher among the extreme users (P < .001).

“In men diagnosed with metastatic prostate cancer, more frequent PSA testing and imaging were associated with substantially higher costs without an observed benefit in survival nor in quality of care at EOL,” the authors concluded. “Physicians are encouraged to discuss treatment goals with patients and to devise appropriate monitoring plans based on these goals.”