Elderly men are at significantly elevated risk of hospitalizations for non-cancer conditions after being diagnosed with non-metastatic prostate cancer (PCa), data suggest.
In a study of 57,489 Medicare beneficiaries aged 67 years or older with incident PCa, the rate of non-cancer hospitalizations (NCHs) was significantly higher during the year after a PCa diagnosis compared with the year before (5.1% vs. 3.2%), Amit D. Raval, PhD, of West Virginia University in Morgantown, and colleagues reported in the Journal of the National Comprehensive Cancer Network (2016;14:186-194).
“These findings highlight the need for targeted research, program, policy, and intervention efforts to reduce the excess NCHs in this group,” Dr. Raval’s group concluded.
Using 2000 through 2010 data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, the researchers conducted a population-based retrospective cohort study of 57,489 male Medicare beneficiaries aged 67 years or older with incident PCa. Dr. Raval’s team identified NCHs in 3 periods before and 3 period after the incidence of PCa. Each period consisted of 120 days. For the study, the investigators considered NCHs to be any admission to an inpatient facility with a principal diagnosis for conditions other than PCa or hospitalizations for causes other than cancer-related complications.
Results showed that men were 38% more likely to have NCHs in the post-cancer period than the pre-cancer period, after adjusting for pre-cancer and post-cancer periods as well as types of chronic conditions and predisposing, enabling, need, and external environment factors.
Predisposing factors were unique characteristics of patients who tend to engage more or less use of health services. These include age, race/ethnicity, and marital status. Enabling factors were those that enable patients to use health services, and include income, education, access to care, and initial cancer treatment. Need factors are conditions affecting the need to use health services at the individual level. External environmental factors are those that facilitate the use of health services as reflected in the structure of services in an individual’s geographic area.
In addition, results showed that patients with cardiometabolic conditions alone or combined with respiratory or mental health conditions had a greater increase in the risk of NCHs during the post-cancer period compared with the pre-cancer period.
The researchers pointed out that the highest rates of NCHs occurred during the first 4 months after the cancer diagnosis. “There are several plausible explanations for this increased risk,” the authors stated. “It has been documented that the diagnosis of prostate cancer can trigger psychological distress, anxiety, and suicidal ideations. This increase in psychological stress may increase blood levels of epinephrine and norepinephrine, resulting in increased heart rate, blood pressure, and blood sugar levels.”
Dr. Raval’s group pointed out that previous research suggests that acute emotional or psychological stress experienced by elderly men with preexisting cardiometabolic conditions may trigger the incidence of another heart failure episode, leading to hospitalization. “The study findings reinforce the need for intervention to reduce NCHs among elderly men with incident prostate cancer” the authors wrote.