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Values are presented as odds ratio (OR) and upper limit (UL) and lower limit (LL) of 95% confidence interval. SCC, Squamous cell cancer; BAC, bronchioloalveolar cancer. *Anatomic location of the tumor. The coding is derived from the ICD-O-3 topographical classification.10 
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The Journal of Thoracic and Cardiovascular Surgery c Volume 158, Number 2 578.e3 ARTICLE IN PRESS
Health Services Research
Change in Functional Status After Prostate Cancer Treatment Among Medicare Advantage Beneficiaries
Bruce L. Jacobs, Samia H. Lopa, Jonathan G. Yabes, Joel B. Nelson, Amber E. Barnato, and Howard B. Degenholtz
OBJECTIVE To examine the relationship between treatment and subsequent functional status among prostate
cancer patients. METHODS Using Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data, we
identified men 65 years or older diagnosed with prostate cancer between 1998 and 2009 (follow-
up through 2010) who were treated with conservative management, surgery, or radiation. Our pri-
mary outcome was functional status as measured by activities of daily living. Secondary outcomes
included physical component summary and mental component summary scores, which are both
calculated from the Short Form 36 (SF-36) and the Veterans RAND 12-item health survey (VR-
12) questionnaires. We included patients who completed 2 surveys and performed propensity
score analyses to match patients 1:5 with noncancer controls. We used generalized linear mixed
effects models, accounting for clustering due to insurance plan. RESULTS We identified 408 patients of whom 143 (35%) underwent conservative management, 59 (14%)
underwent surgery, and 206 (51%) underwent radiation. Among conservative management and radia-
tion patients, changes in functional status mirrored that Indoxyl Sulfate of their noncancer controls (all P > .05).
Among surgery patients, changes in activities of daily living scores were not significant, but physical
component summary (mean difference = 4.5, P < .001) and mental component summary (mean differ-
ence = 3.3, P = .01) scores declined slightly more than for their noncancer peers. CONCLUSION Surgery patients had a slight decline in their general functional status whereas conservative man-
agement and radiation patients had no differences in functional status compared with their non-
cancer peers. Although the functional status of surgery patients declined more than that of their
noncancer peers, this difference may not be clinically significant. UROLOGY 00: 1−8, 2019.
There are several effective treatments for localized prostate cancer, including conservative manage-ment, surgery, and radiation. All these treatments provide excellent cancer control,1,2 but can result in 
significant side effects, such as anxiety and multiple biop-sies with conservative management, urinary incontinence and erectile dysfunction with surgery, and irritative uri-nary and bowel symptoms with radiation.3,4
Financial Disclosure: These are financial disclosures, but not conflicts of interest:
there are no conflicts of interest for this manuscript.
Amber Barnato is a former board member of the Society of Medical Decision Making. Funding: Bruce Jacobs is supported in part by the National Institutes of Health GEMSSTAR award (R03AG048091) and the University of Pittsburgh Physicians Foundation.
Jonathan Yabes is supported in part by the University of Pittsburgh Clinical and Translational Science Institute − Research Education and Career Development Core (UL1 TR000005) Amber Barnato is supported in part by the Levy Cluster in Health Care Delivery at Dartmouth.
Howard Degenholtz is supported in part by a grant from the Health Resources Serv-ices Administration.
Author contributions
Bruce Jacobs: Conception and design, data acquisition, data analysis and interpre-tation, drafting of manuscript, critical revision of the manuscript, and statistical analyses.
Samia Lopa: Conception and design, data acquisition, data analysis and interpreta-tion, critical revision of the manuscript, and statistical analyses. 
Jonathan Yabes: Conception and design, data acquisition, data analysis and inter-pretation, critical revision of the manuscript, and statistical analyses.
Joel Nelson: Conception and design, data analysis and interpretation, critical revi-sion of the manuscript, supervision. Amber Barnato: Conception and design, data analysis and interpretation, drafting of manuscript, critical revision of the manuscript, supervision.
Howard Degenholtz: Conception and design, data analysis and interpretation, drafting of manuscript, critical revision of the manuscript, supervision.