Transition in Quality Of Life Among Older Patients With Bladder Cancer and Its Association With Treatment: A Clustering Approach

Purpose: To classify older patients with bladder cancer (BC) based on quality-of-life (QoL) measures and explore the clusters transitions over a 2-year period and patient characteristics, BC stages, and treatment. Patients with BC report a significant decline in functional status and QoL. The association of this transition and patient characteristics and treatment over time is not known. We aim to explore this association. Methods: Data were obtained from patients with BC in the SEER-MHOS database (1998-2021). Unsupervised cluster analysis was employed to identify homogeneous clusters of patients with similar functionality based on age, physical and mental component score, and ability to perform activities of daily living. Univariate and multivariable analyses were performed to assess the association of patient characteristics and treatment on cluster transitions over a 2-year interval. Results: The final cohort consisted of 2934 (age 65 or older) older patients with BC. We identified 3 distinct clusters: 67.9% in Cluster 1; 25.4% in Cluster 2; and 6.7% in Cluster 3. After 2 years, 11.7% patients showed improvement and 14% experienced a decline. Cancer/treatment characteristics were not associated with cluster transition. Younger age and being married were identified as factors associated with improvement. Older age, non–homeownership, and last-year fall were associated with transition to less healthy cluster. Conclusions: Over a 2-year interval after BC diagnosis, a quarter of patients will have substantial changes in QoL. No significant association was observed between cluster transition and BC characteristics. Age as well as marital, fall, and homeowner status do impact this transition.