The odds of hospital readmission for complications do not differ significantly between radical surgery and radiation therapy for relatively healthy, older men with localized prostate cancer (PCa), researchers reported in BJU International.
Investigators led by Stephen B. Williams, MD, of the University of Texas Medical Branch in Galveston, compared the risks of hospitalization within 12 months of primary, definitive therapies—radical prostatectomy (RP) or radiation therapy (RT)—administered within 6 months of PCa diagnosis. RP was open, minimally invasive, or perineal, and RT involved external beam, brachytherapy, or both with or without androgen deprivation therapy (luteinizing hormone-releasing hormone agonist or orchiectomy). To minimize the influence of advanced age and high comorbidity burden, the researchers limited their investigation to 29,571 patients (T1 or T2 PCa) aged 66 to 75 years with few or no comorbidities by Charlson Comorbidity score from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. They also compared treatment-related admissions with hospitalizations for any cause.
Multivariate analysis showed that men who underwent RP had 20% lower odds for hospital admissions for any condition. Yet, they had 15% higher odds of being hospitalized for treatment-related complications.
“Our findings are consistent with prior reports suggesting complications related to therapy following surgery occur sooner than that of radiotherapy patients,” Dr Williams and colleagues explained.
Overall, the most common reasons for complications in descending order were genitourinary, respiratory, gastrointestinal, and cardiac issues, heterologous blood transfusions, and vascular and wound problems. Tumor characteristics generally were associated with hospitalizations.
By comparison, patients who had external beam radiotherapy/intensity modulated radiotherapy had 16% lower risk of hospitalization from complications than surgery patients. “These findings support prior studies confirming decreased side effect profile associated with three-dimensional conformal radiotherapy and IMRT,” according to Dr Williams and colleagues.
When the team used propensity score weighted analyses to further compare RP and RT, they found no significant differences in the risks for treatment-related hospitalizations.
With respect to cost, it was more expensive on average to treat men hospitalized for complications after RT: $18,381 vs $13,203.
“These findings are important in the current healthcare climate with an ever increasing demand for comparative effectiveness research discerning high quality cost-effective care over the entire care cycle,” Dr Williams and colleagues remarked. Hospitals now face penalties for readmissions for certain conditions and bundled payments are becoming a norm.
PSA values and long-term risk of hospitalization were not assessed in this study, the investigators acknowledged.
1. Williams SB, Chamie K, Duan Z, et al. Risk of Hospitalization Following Primary Treatment for Prostate Cancer. BJU Int. 2016 Aug 25. doi: 10.1111/bju.13647. [Epub ahead of print]