Types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer.

OBJECTIVE: To examine the association between types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer. METHODS: A population-based retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. The study cohort consisted of elderly men (≥ 66 years) with localised prostate cancer diagnosed between 2002 and 2009 (N = 98,264). The initial cancer treatment received during the 6 months after cancer diagnosis consisted of (i) radical prostatectomy (RP); (ii) radiation therapy (RT); (iii) hormone therapy; and (iv) no treatment. Pre-existing chronic conditions were classified into the following eight groups: (i) only cardiometabolic conditions (CM); (ii) only mental health conditions (MH); (iii) only respiratory conditions (RESP); (iv) CM and MH; (v) CM and RESP; (vi) MH and RESP; (vii) all three conditions, CM, MH and RESP; and (viii) none of the three types of conditions. RESULTS: Only 20% did not receive any cancer treatment; 47.4%, 22.1% and 10.5% received RT, RP, and hormone therapy, respectively. In multinomial logistic regression, elderly men with only RESP were more likely to receive RP as compared with those with all the three types of chronic conditions; those with only CM, only RESP, CM and MH or CM and RESP were more likely to receive RT. No significant associations were observed between the receipt of hormone therapy and types of chronic conditions. CONCLUSIONS: A significant proportion of elderly men with chronic conditions have received aggressive initial cancer treatment. Our study findings suggest a conservative approach for the initial prostate cancer treatment among elderly men with significant chronic conditions and localised prostate cancer.

Association between statins and clinical outcomes among men with prostate cancer: a systematic review and meta-analysis.

BACKGROUND: Mixed evidence exists regarding the effects of statins among men with prostate cancer. We aimed to determine the association between statin use and clinical outcomes in prostate cancer using systematic review and meta-analysis. METHODS: Original articles published until second week of August 2015 were searched in electronic databases (Medline-Ovid, Pubmed, Scopus, The Cochrane Library, Web of Science, ProQuest) for studies on statin use in prostate cancer. The main clinical outcomes for the review were: biochemical recurrence (BCR), metastases, and all-cause and prostate cancer-specific mortality. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I(2) statistics. Meta-regression was performed, wherever significant heterogeneity was found in the meta-analyses, to find factors associated with poor outcomes, and sensitivity analyses were conducted to assess the robustness of findings. The analyses were conducted using RevMan v5.3, STATA v14, and R v3.1.1. RESULTS: Out of the 1002 retrieved citations, 34 observational cohort studies met the inclusion criteria. Statin use was associated with a 21% reduction in the risk of BCR among those treated with radiation therapy (pHR: 0.79, 95% CI: 0.65, 0.95, P-value=0.01, 10 studies, I(2)=54%), whereas it was not associated with the BCR among those treated with radical prostatectomy (pHR: 0.94, 95% CI: 0.81, 1.09, P-value=0.43, 15 studies, I(2)=65%). Statin use was associated with a 22% reduction in the risk of metastases (pHR: 0.78, 95% CI: 0.68, 0.87, P-value<0.001, 6 studies, I(2)=0%), and a 24% reduction in risk of both all-cause mortality (pHR: 0.76, 95% CI: 0.63, 0.91, P-value=0.004, 6 studies, I(2)=71%), and prostate cancer-specific mortality (pHR: 0.76, 95% CI: 0.64, 0.89, P-value=0.0007, 5 studies, I(2)=40%). CONCLUSIONS: Our systematic review found that statin significantly reduced the all-cause and prostate cancer-specific mortality and improved the BCR in certain subgroup of men with prostate cancer. In future, randomized controlled trials should be conducted to establish efficacy of statins among men with prostate cancer.

Impact of metformin on clinical outcomes among men with prostate cancer: a systematic review and meta-analysis.

BACKGROUND: Conflicting evidence exists regarding the beneficial effects of metformin in prostate cancer. To determine the association between metformin and clinical outcomes in prostate cancer using systematic review and meta-analysis. METHODS: Original articles published in English until third week of July, 2014 were searched in electronic databases (Medline-Ovid, Scopus, The Cochrane Library, Web of Science, ProQuest) for studies on metformin use in prostate cancer. The clinical outcomes assessed were: development of biochemical recurrence, metastases or castration-resistant metastatic cancer, all-cause and prostate cancer-specific mortality. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I2 statistics. Sensitivity analysis was conducted to assess the robustness of findings and publication bias was assessed by the Egger's regression asymmetry test and contour plot. RESULTS: Out of 230 retrieved citations, eight retrospective cohort studies and one nested-case-control study met the inclusion criteria. Metformin use was marginally associated with reduction in the risk of biochemical recurrence (pHR: 0.82, 95% CI: 0.67, 1.01, P-value=0.06, I2=25%, five studies). Metformin use was not significantly associated with metastases (pHR: 0.59, 95% 0.30-1.18, P-value=0.14, I2=74%, three studies), all-cause mortality (pHR: 0.86; 95% CI, 0.67, 1.10, P-value=0.23, I2: 73%, six studies) and prostate cancer-specific mortality (pHR: 0.76, 95% CI: 0.43, 1.33, P-value = 0.33, I2=60%, four studies). Pooled estimates for all outcomes varied in sensitivity analysis by diabetes status and primary treatment of prostate cancer. Systematic review revealed mixed findings on metformin use and the risk of CRPC. CONCLUSIONS: Metformin may reduce the risk of biochemical recurrence in prostate cancer. Given the potential of selection bias in the observational studies, randomized trials should be designed to assess the efficacy of metformin use in prostate cancer.

Health-related quality of life in patients with chronic obstructive pulmonary disease in North India.

BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a major health problem in India and constitutes an important cause of mortality and morbidity. A cross-sectional study was undertaken to assess health-related quality of life (HRQL) and its determinants in patients with COPD from India. MATERIALS AND METHODS: A total of 126 patients (73.81% male) were enrolled using convenient sampling prospectively in this cross-sectional study. Eligible patients were assessed for socioeconomic status, anthropometric measures, COPD severity, dyspnea and health status using the Hindi version of St George's Respiratory Questionnaire (SGRQ). Linear regression model was used to examine the association between risk factors and HRQL score (a higher score indicating poorer HRQL), adjusting for age and sex. RESULTS: The mean total score for SGRQ in the patients was 52.66 ± 12.89, indicating a marked impairment of HRQL. Impairment was associated with the severity of airway obstruction, but within each Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, the variation (SD) was wide [stage I: 47.8 ± 12.3 (n = 14); stage II: 49.28 ± 11.69 (n = 47); stage III: 53.47 ± 11.69 (n = 44); stage IV: 61.75 ± 14.14 (n = 21)]. A regression analysis showed that body mass index, forced expiratory volume in 1 s (FEV 1 ), dyspnea grade, and depression were associated with poor HRQL. CONCLUSION: HRQL of COPD patients was significantly impaired across stages. Marked impairment of HRQL was found even in patients with mild disease.