Introduction
fatigue, cancer, pain, insomnia, Cancer
CANCER, ADVANCED CANCER, CANCER
Older adults with advanced cancer usually present with a wide range of physical and psychological symptoms, such as insomnia, fatigue, and pain, prior to cancer treatments.In recent years, patient-reported outcomes (PROs) have been increasingly used as a measure to capture symptom burden in patients with cancer.To standardize the analysis of PRO-CTCAE data, the NCI formed a Cancer Treatment Tolerability Consortium with 4 research teams in 2018, as part of the Cancer Moonshot initiative.To mitigate knowledge gaps, this study aimed to (1) identify patient clusters based on pretreatment PRO-CTCAE severity items using an unsupervised machine learning approach; (2) examine differences in patient characteristics and individual and total symptom severity by clusters; and (3) evaluate the longitudinal associations of patient clusters with unplanned hospitalization, overall mortality, and clinician-rated toxic effects. We hypothesized that the patterns of unplanned hospitalizations, mortality, and toxic effects will differ by symptom clusters.