Abstract
Objectives
To determine if clustering methods can use a holistic assessment of health-related
quality-of-life after BC diagnosis to predict survival outcomes independent of clinical
characteristics. In the United States, an estimated 81,180 cases of bladder cancer
(BC) will be diagnosed in 2022. We aim to help address the knowledge gap concerning
the impact of patient functional status on outcomes.
Materials and Methods
This is a cross-sectional, retrospective cohort study of patients in the SEER-MHOS
registry. Age and SF-36 responses were used as K-means inputs to identify homogenous
clusters of older patients with bladder cancer. We analyzed the association between
the identified clusters, patient and disease characteristics, and outcomes. We used
Cox proportional hazard regression to compare overall survival.
Results
We identified five homogenous clusters that exhibited differences in patient characteristics
and survival. There was no significant difference in cancer stage or surgery type
among the clusters. The Cox proportional hazard regression demonstrated significant
associations of cluster with gender, age, education, marital status, smoking status,
type of surgery, and cancer stage on overall survival. Cluster independently predicted
overall survival.
Conclusions
Using unsupervised machine learning, we identified clusters of patients with bladder
cancer who had similar mental and physical function scores. Cluster grouping suggests
that patients’ mental and physical function may not be based on disease or treatment.
There are significant survival differences between all clusters, demonstrating that
a holistic assessment of patient-reported health-related quality-of-life has the potential
to predict survival and possible modifiable risk factors in older patients with bladder
cancer.
Key words
Abbreviations:
ADL (activities of daily living), BC (bladder cancer), HR-QoL (health-related quality-of-life), SEER-MHOS (surveillance, epidemiology, and end results-Medicare health outcomes survey), PH (proportional Hazard), MIBC (muscle invasive bladder cancer), NMIBC (non-muscle invasive bladder cancer)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 5,
2022
Received:
October 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declarations of interest: none
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
