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Vickers A. Do not treat Bill Gates for prostate cancer! Algorithmic bias and causality in medical prediction. BJU Int 2023; 131:263-264. [PMID: 36716733 DOI: 10.1111/bju.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Simhal RK, Sholklapper TN, Simhal AK, Zwart AL, Danner MT, Kumar D, Aghdam N, Suy S, Hankins RA, Kowalczyk KJ, Collins SP. Association of baseline self-reported fatigue with overall survival after stereotactic body radiation therapy for localized prostate cancer. Front Oncol 2022; 12:1015264. [PMID: 36620537 PMCID: PMC9816795 DOI: 10.3389/fonc.2022.1015264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Stereotactic Body Radiation Therapy (SBRT) has emerged as a definitive therapy for localized prostate cancer (PCa). However, more data is needed to predict patient prognosis to help guide which patients will benefit most from treatment. The FACIT-Fatigue (FACIT-F) is a well validated, widely used survey for assessing fatigue. However, the role of fatigue in predicting PCa survival has yet to be studied. Herein, we investigate the role of FACIT-F as a baseline predictor for overall survival (OS) in patients undergoing SBRT for localized PCa. Methods A retrospective review was conducted of 1358 patients who received SBRT monotherapy between January 2008 to April 2021 at an academic, tertiary referral center. FACIT-F scores (range 0 to 52) were summed for patients who answered all 13-items on the survey. FACIT-F total scores of ≥35 represented severe fatigue. Patients receiving androgen deprivation therapy were excluded. Differences in fatigue groups were evaluated using chi-squared tests. OS rates were determined using the Kaplan-Meier method and predictors of OS were evaluated using Cox proportional hazard method. Results Baseline full FACIT-F scores and survival data was available for 891 patients. 5-year OS was 87.6% and 95.2%, respectively, for the severely fatigued and non-fatigued groups. Chi-squared analysis of fatigue groups showed no significant difference in the following categories: D'Amico risk group, age, ethnicity, grade group, T-stage, or PSA density. Severe fatigue was associated with a significant decrease in OS (hazard ratio 2.76; 95%CI 1.55 - 4.89). The Cox proportional hazard model revealed that age and FACIT-F were both statistically significant (p <0.05). Conclusion Baseline FACIT-F scores are significantly associated with OS. Higher FACIT-F scores, representing less fatigued patients, are associated with an overall survival benefit. These results indicate that the FACIT-F survey could serve as an additional metric for clinicians in determining prognostic factors for patients undergoing SBRT.
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Affiliation(s)
- Rishabh K. Simhal
- School of Medicine, Georgetown University, Washington, DC, United States,*Correspondence: Rishabh K. Simhal,
| | | | - Anish K. Simhal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alan L. Zwart
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Malika T. Danner
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Deepak Kumar
- Julius L. Chambers Research Institute, North Carolina Central University, Durham, NC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Simeng Suy
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ryan A. Hankins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Keith J. Kowalczyk
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sean P. Collins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
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