UPJ INSIGHT Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer (x19210)

By: Christopher P. Filson, MD, MS, Kaiser Permanente Los Angeles Medical Center, California; Thomas B. Richards, MD, Centers for Disease Control and Prevention, Atlanta, Georgia; Donatus U. Ekwueme, PhD, MS, Centers for Disease Control and Prevention, Atlanta, Georgia; David H. Howard, PhD, Winship Cancer Institute, Emory University, Atlanta, Georgia | Posted on: 20 May 2024

Filson CP, Richards TB, Ekwueme DU, Howard DH. Patterns of care for Medicare beneficiaries with metastatic prostate cancer. Urol Pract. 2024;11(3):489-497. doi:10.1097/UPJ.0000000000000557

Study Need and Importance

Treatment options for men with metastatic prostate cancer have expanded with the introduction of new treatments, including radium-223, sipuleucel-T, abiraterone, and enzalutamide. Although these drugs are effective, they are more expensive than androgen deprivation therapy or docetaxel. Understanding the real-world treatment of patients with metastatic prostate cancer can inform opportunities to optimize care delivery and survivorship. We sought to describe the treatment of Medicare beneficiaries with metastatic prostate cancer using data from the Surveillance, Epidemiology, and End Results–Medicare database for 2007 to 2017. The database links tumor registry records to Medicare claims for fee-for-service Medicare beneficiaries. We identified men with metastatic disease based on registry records and, separately, diagnosis codes for metastatic disease.

What We Found

In our sample of 29,800 patients, we found that the share receiving androgen deprivation therapy only within 3 years of developing metastatic disease decreased (46.1% in 2007-2010 vs 36.2% in 2015-2018; Figure). The proportion receiving antineoplastic agents and ADT increased from 6.8% in 2007-2010 to 19.7% in 2015-2018 and was 33.4% among beneficiaries who developed metastatic prostate cancer in 2017. The proportion of patients who received hospice care only did not change significantly (7.7% during 2007-2010, 8.1% during 2015-2018). Opioid use within 3 years of prostate cancer diagnosis was stable during 2007 to 2013 (around 73%) but decreased through 2017 to 65.5% (not shown). Survival time increased: median survival was 26.5 months for patients with an index date from 2007 to 2010, 27.5 months for patients with an index date from 2011 to 2014, and 32.6 months for patients with an index date from 2015 to 2017.

Figure. Treatment and service combinations within 3 years of the index date for metastatic prostate cancer patients, initial cancer diagnosis 2007 to 2017, linked to Medicare claims through 2019. ADT/hospice indicates received ADT and transferred to hospice; ADT only, androgen deprivation therapy monotherapy; Drug/ADT, received ADT and antineoplastic agent; Drug/ADT/Hospice, transferred to hospice after receiving ADT and antineoplastic agent; Hospice only, transferred to hospice care without other therapy.

Limitations

Our sample may not reflect patterns of care among Medicare beneficiaries in managed care plans or those younger than age 65. Our claims-based definition for metastases may misclassify patients.

Interpretation for Patient Care

While use of approved antineoplastic medications has increased, there is room to improve care delivery for patients with metastatic prostate cancer. Examples include improving uptake of medications like abiraterone and enzalutamide for those eligible, ensuring opioid therapy is offered and used for those in severe pain where appropriate, and minimizing disparities in receiving hospice care at the end of life.