Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness.

Background: Pre-existing mental illness is known to adversely impact cancer care and outcomes, but this is yet to be assessed in the bladder cancer setting.

Objective: To characterize the patterns of care and survival of elderly patients with a pre-existing mental illness diagnosed with bladder cancer.

Design, Setting, And Participants: We conducted a retrospective analysis of patients enrolled in Surveillance, Epidemiology, and End Results (SEER)-Medicare.

Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery.

Introduction: Disparities in healthcare outcomes between races have been extensively described; however, studies fail to characterize the contribution of differences in distribution of covariates between groups and the impact of discrimination. This study aims to characterize the degree to which clinicodemographic factors and unmeasured confounders are contributing to any observed disparities between non-Hispanic white and black males on surgical outcomes after major urologic cancer surgery.

Methods: Non-Hispanic white and black males undergoing radical cystectomy, nephrectomy, or prostatectomy for cancer in the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this analysis.

Increased Surgical Complications in Smokers Undergoing Radical Cystectomy.

Background: Not only is smoking a risk factor for the development of bladder cancer, it has also been implicated in increasing surgical morbidity and mortality. In general, the demographic and clinical characteristics of smokers are different to non-smokers which can bias the results of the impact of smoking.

Objective: To evaluate the impact of smoking on radical cystectomy outcomes.

Finasteride does not prevent bladder cancer: A secondary analysis of the Medical Therapy for Prostatic Symptoms Study.

Background: Preclinical models have demonstrated that androgen receptor modulation can influence bladder carcinogenesis with an inverse association observed between serum androgen levels and bladder cancer (BC) incidence. It is still unclear whether 5α-reductase inhibitors, by preventing the conversion of testosterone to dihydrotestosterone, have a similar effect. This study aims to evaluate whether dihydrotestosterone-mediated androgen activity has an impact on BC incidence in a cohort of men included in a clinical trial of finasteride vs.

Place of Death of Individuals with Terminal Cancer: New Insights from Medicare Hospice Place-of-Service Codes.

Objectives: To use place-of-service (POS) codes in the Medicare hospice claims files to document where elderly hospice users with cancer die.

Design: Retrospective cohort study.

Setting: Surveillance, Epidemiology, and End Results (SEER) cancer registry areas.

Impact of initial local therapy on survival in men later receiving chemotherapy for prostate cancer: a population-based, propensity-weighted multivariable analysis.

Purpose: Prostate cancer remains a common disease that is frequently treated with multimodal therapy. The goal of this study was to assess the impact of treatment of the primary tumor on survival in men who go onto receive chemotherapy for prostate cancer.

Methods: Using surveillance, epidemiology and end results (SEER)-Medicare data from 1992 to 2009, we identified a cohort of 1614 men who received chemotherapy for prostate cancer.

Propensity-weighted long-term risk of urinary adverse events after prostate cancer surgery, radiation, or both.

Background: Prostate cancer is the second most common cancer in men and has high survivorship, yet little is known about the long-term risk of urinary adverse events (UAEs) after treatment.

Objective: To compare the long-term UAE incidence across treatment and control groups.

Design, Setting, And Participants: Using a matched-cohort design, we identified elderly men treated with external-beam radiotherapy (EBRT; n=44 318), brachytherapy (BT; n=14 259), EBRT+BT (n=11 835), radical prostatectomy (RP; n=26 970), RP+EBRT (n=1557), or cryotherapy (n=2115) for non-metastatic prostate cancer and 144 816 non-cancer control individuals from the population-based Surveillance, Epidemiology, and End Results-Medicare linked data from 1992-2007 with follow-up through 2009.

Factors associated with reduction in use of neoadjuvant androgen suppression therapy before radical prostatectomy.

Objective: To determine whether the prescribing patterns for nonindicated androgen suppression therapy (AST), using neoadjuvant AST as the model, changed according to the prevailing clinical evidence, changes in reimbursement, or evidence of increased harm from treatment.

Materials And Methods: We identified 34,976 men with prostate cancer who had undergone radical prostatectomy within 12 months of diagnosis from the Surveillance, Epidemiology, and End Results-Medicare data set (1992-2007), and their clinical and demographic parameters were assessed. We measured the Medicare claims for receipt of AST before radical prostatectomy and calculated the annual rates of neoadjuvant AST, which were adjusted for confounding variables using multivariate logistic regression analysis, and compared them with the prevailing published clinical data on the outcomes of neoadjuvant AST, changes in reimbursement, or published data on clinical harm from treatment.

Bias due to missing SEER data in D'Amico risk stratification of prostate cancer.

Purpose: We examined the degree of exclusion bias that may occur due to missing data when grouping prostate cancer cases from the SEER (Surveillance, Epidemiology and End Results) database into D'Amico clinical risk groups. Exclusion bias may occur since D'Amico staging requires all 3 variables to be known and data may not be missing at random.

Materials And Methods: From the SEER database we identified 132,606 men with incident prostate cancer from 2004 to 2006.

Intensity modulated radiation therapy replaces 3-dimensional conformal radiotherapy as prostate cancer treatment.

Purpose: We describe trends in the use of intensity modulated radiotherapy vs 3-dimensional conformal radiotherapy for prostate cancer and identified predictors of intensity modulated radiotherapy use.

Materials And Methods: From the SEER (Surveillance, Epidemiology and End Results)-Medicare database we identified 52,290 men with incident nonmetastatic prostate cancer from 2000 to 2007 who were treated with radiotherapy. We tracked trends in the use of intensity modulated radiotherapy, 3-dimensional conformal radiotherapy, brachytherapy and combinations.

Three-dimensional external beam radiotherapy for prostate cancer increases the risk of hip fracture.

Background: Hip fracture is associated with high morbidity and mortality. Pelvic external beam radiotherapy (EBRT) is known to increase the risk of hip fractures in women, but the effect in men is unknown.

Methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, 45,662 men who were aged ≥66 years and diagnosed with prostate cancer in 1992-2004 were identified.

Reduction in physician reimbursement and use of hormone therapy in prostate cancer.

Background: Use of androgen suppression therapy (AST) in prostate cancer increased more than threefold from 1991 to 1999. The 2003 Medicare Modernization Act reduced reimbursements for AST by 64% between 2004 and 2005, but the effect of this large reduction on use of AST is unknown.

Methods: A cohort of 72,818 men diagnosed with prostate cancer in 1992-2005 was identified from the Surveillance, Epidemiology, and End Results database.

Appendiceal carcinoid tumors: Predictors of lymph node metastasis and the impact of right hemicolectomy on survival.

Background And Objectives: Given the lack of population-based data in the literature, we sought to (1) identify predictors of appendiceal carcinoid tumor nodal metastasis to distinguish which patients would most likely benefit from hemicolectomy and (2) compare survival after hemicolectomy versus appendectomy alone.

Methods: Using the Surveillance Epidemiology and End Results Database (1988-2005), we identified patients with appendiceal carcinoid tumors who underwent resection. We identified risk factors for nodal metastasis using logistic regression models and used the Kaplan-Meier method to compare adjusted overall and cancer-specific survival after right hemicolectomy versus appendectomy alone.

Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer.

Introduction: Patients with unilateral breast cancer have an increased risk of developing contralateral breast cancer. A recent population-based study demonstrated that the proportion of patients with unilateral breast cancer in the United States who underwent contralateral prophylactic mastectomy (CPM) has increased by 150% in recent years. The current study evaluated patients who underwent breast cancer surgery in a metropolitan-based hospital system to determine factors associated with CPM.

Palliative radiotherapy in Medicare-certified freestanding hospices.

Hospice care is designed to provide a variety of services, including pain and symptom management, to terminally ill patients. Although palliative radiotherapy (PRT) has been shown to be effective in reducing pain and other symptoms related to tumor growth, only a few hospice patients receive this therapy. This analysis identifies Medicare-certified freestanding hospices that report use of radiotherapy using Medicare's Healthcare Cost Report Information System (HCRIS) dataset.

Medicare-certified home health care: urban-rural differences in utilization.

Context: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.

Purpose: To examine urban-rural differences in Medicare HHC utilization.

Trends in the incidence and treatment of parathyroid cancer in the United States.

Background: Parathyroid cancer is a rare cause of hyperparathyroidism. The objectives of this study were to determine the patterns of disease, treatment trends, and outcomes among patients with parathyroid cancer by using a population-based data source.

Methods: Surveillance, Epidemiology, and End Results (SEER) cancer registry data were used to identify patients who were diagnosed with parathyroid cancer from 1988 through 2003.