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  • br ADL score br PCS score

    2021-03-02


    ADL score
    PCS score
    MCS score
    Abbreviations: ADL, activities of daily living; IQR, interquartile range; MCS, mental component summary; PCS, physical component sum-mary; SD, standard deviation.
    * P values for continuous and categorical variables are from the Wilcoxon rank sum test and chi-square test, respectively; they represent comparisons between the noncancer patients and each treatment group separately (ie, noncancer controls vs conservative management, noncancer controls vs surgery, noncancer controls vs radiation).
    ** Exact numbers not shown in compliance with SEER-MHOS guidelines. *** Missing data includes marital status (280 noncancer, 44 conservative management, <11 surgery, 15 radiation), education (437 non-cancer, <11 conservative management, <11 radiation), and household income (5785 noncancer, 27 conservative management, <11 sur-gery, 29 radiation). Missing values were imputed in subsequent analyses.
    who underwent surgery, radiation, or active surveillance.4 Yet, there are also studies that demonstrate that even 1-point lower PCS and MCS scores are associated with signifi-cant increased risks of hospitalization and mortality.25
    Regardless, the findings in this study have important implications. While studies have examined disease-specific functional outcomes among prostate cancer patients,26 few have assessed general functional status.7 This study is unique in that it examines general functional status among a cohort of Medicare Advantage beneficiaries during a time in which 
    several new surgical and 2NBDG technologies emerged. The observation that surgery patients showed no difference in ADL scores but a decline in PCS scores raises the ques-tion of whether more granular measurements of physical function may improve the evaluation of general functional status in this population. For example, the Nagi scale con-tains 12 questions about physical function, including inqui-ries about difficulty lifting objects as heavy as ten pounds and difficulty standing for long periods, which are not assessed as part of the PCS score.27
    ARTICLE IN PRESS
    Figure 1. Changes* in ADL (A), PCS (B) and MCS (C) scores among patients undergoing conservative management and their matched noncancer peers*Changes are based on 2 surveys: one prior to conservative management and one after conserva-tive management. In the matched noncancer group, the time interval between the 2 surveys is matched with that of the treated patients. Compared with matched noncancer patients, conservative management patients experienced no differen-ces in ADL, PCS, or MCS scores over time (all P > 0.05). The P value is testing if the change in the outcome (ADL, PCS, or MCS) from before to after differs by treatment. A positive slope represents a decline in 2NBDG functional status for ADL’s and an improvement in functional status for PCS and MCS scores. Some confidence intervals are too small to be seen in figure. Abbreviations: ADL, activities of daily living; MCS, mental component summary; PCS, physical component summary.
    Our findings should be interpreted in the context of sev-eral limitations. First, we used a dataset that only contained information about Medicare Advantage beneficiaries. These beneficiaries may represent healthier individuals,28 
    and thus, our findings may not be generalizable to the Medicare fee-for-service population. However, the superior health of Medicare Advantage beneficiaries may be overes-timated.29 Regardless, the number of Medicare Advantage
    ARTICLE IN PRESS
    Figure 2. Changes* in ADL (A), PCS (B) and MCS (C) scores among patients undergoing surgery and their matched non-cancer peers.*Changes are based on 2 surveys. For the surgery patients, one survey is prior to surgery and one survey is after surgery. In the matched noncancer group, the time interval between the 2 surveys is matched with that of the surgery patients. Compared with matched noncancer patients, surgery patients experienced no differences in ADL scores over time (P = 0.96). Surgery patients did show a decline in PCS (adjusted mean difference = 4.5, P < 0.001) and MCS (adjusted mean difference = 3.3, P = 0.01) scores. The P value is testing if the change in the outcome (ADL, PCS, or MCS) from before to after differs by treatment. A positive slope represents a decline in functional status for ADL’s and an improvement in func-tional status for PCS and MCS scores. Some confidence intervals are too small to be seen in figure. Abbreviations: ADL, activities of daily living; MCS, mental component summary; PCS, physical component summary
    beneficiaries in the United States is increasing (as high as 25% of the Medicare population during the study period)30 and few opportunities exist to examine the health of this population on a national level.
    Second, since we required patients to have a survey before and after treatment, the number of patients receiving