{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T04:09:49Z","timestamp":1728878989059},"posted":{"date-parts":[[2024,4,16]]},"group-title":"In Review","reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,4,10]]},"abstract":"<title>Abstract<\/title>\n        <p>Multimorbidity is a common condition among cancer patients, resulting in increased complexity of care and risk of negative outcomes. This study aims to use clustering analysis to identify and characterize multimorbidity patterns among hospitalized prostate cancer patients in Portugal. This is a retrospective observational study using inpatient data from the Portuguese National Hospital Morbidity Database. Data on hospital admissions with a diagnosis of prostate cancer occurring in all public hospitals in mainland Portugal during 2011\u20132017 were considered. Partitioning clustering algorithms, namely K-modes, PAM (Partitioning Around Medoids), and hierarchical clustering, were used to identify multimorbidity clusters. Results obtained from the different clustering approaches were compared and assessed in terms of clinical relevance. A total of 10394 inpatient episodes were analyzed, with 6091 (58%) reporting multimorbidity. Similar clusters were obtained through the different partitioning approaches, with PAM presenting a higher stability and the best quality results in terms of average silhouette. The analysis of the 6 clusters obtained with PAM reveals groups with a pattern of hypertension co-occurring with diabetes, obesity, and arrhythmia, in addition to cancer itself. In this study, the validity of cluster analysis as an exploratory method for identifying clusters of multimorbid conditions among prostate cancer patients in Portugal was demonstrated, identifying relevant patterns of disease co-occurrence, with potential impact on treatment decisions and outcomes. The identified clusters revealed conditions that typically co-occur with prostate of cancer and that can be controlled throughout all phases of cancer survivorship by means of healthier behaviors aligned with integrated and coordinated care.<\/p>","DOI":"10.21203\/rs.3.rs-4247648\/v1","type":"posted-content","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T15:59:53Z","timestamp":1713283193000},"source":"Crossref","is-referenced-by-count":0,"title":["Multimorbidity patterns among patients hospitalized with prostate cancer in Portugal: a cluster analysis approach"],"prefix":"10.21203","author":[{"given":"Patr\u00edcia","family":"Carvalho","sequence":"first","affiliation":[{"name":"Institute of Engineering \u2013 Polytechnic of Porto"}]},{"given":"Julio","family":"Souza","sequence":"additional","affiliation":[{"name":"Institute of Engineering \u2013 Polytechnic of Porto"}]},{"given":"Francisco","family":"Botelho","sequence":"additional","affiliation":[{"name":"Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Mariana","family":"Lobo","sequence":"additional","affiliation":[{"name":"University of Porto"}]},{"given":"Goreti","family":"Marreiros","sequence":"additional","affiliation":[{"name":"Institute of Engineering \u2013 Polytechnic of Porto"}]},{"given":"Alberto","family":"Freitas","sequence":"additional","affiliation":[{"name":"University of Porto"}]}],"member":"297","reference":[{"issue":"6","key":"ref1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.acuroe.2022.01.002","article-title":"Palma Dos Reis, J. Active surveillance protocol in prostate cancer in Portugal","volume":"46","author":"Silva Gaspar SR","year":"2022","unstructured":"Silva Gaspar SR, Fernandes M, Castro A, Oliveira T, Dias S. Palma Dos Reis, J. Active surveillance protocol in prostate cancer in Portugal. Actas Urol\u00f3gicas Espa\u00f1olas (English Edition). 2022;46(6):329\u201339. https:\/\/doi.org\/10.1016\/j.acuroe.2022.01.002.","journal-title":"Actas Urol\u00f3gicas Espa\u00f1olas (English Edition)"},{"key":"ref2","unstructured":"Global burden of disease study 2019. (GBD 2019) data resources. Healthdata.org., https:\/\/ghdx.healthdata.org\/gbd-2019, last accessed 2023\/04\/14."},{"issue":"Suppl 1","key":"ref3","doi-asserted-by":"publisher","first-page":"185","DOI":"10.18865\/ed.30.S1.185","article-title":"Co-morbidities in a Retrospective Cohort of Prostate Cancer Patients","volume":"30","author":"Jefferson M","year":"2020","unstructured":"Jefferson M, Drake RR, Lilly M, Savage SJ, Price T, S., Hughes Halbert C. 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BMC Public Health. 2015;15(1):415. https:\/\/doi.org\/10.1186\/s12889-015-1733-2.","journal-title":"BMC Public Health"},{"issue":"1","key":"ref5","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1186\/s12885-021-08102-1","article-title":"Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study","volume":"21","author":"Kon\u00e9 AP","year":"2021","unstructured":"Kon\u00e9 AP, Scharf D. Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study. BMC Cancer. 2021;21(1):406. https:\/\/doi.org\/10.1186\/s12885-021-08102-1.","journal-title":"BMC Cancer"},{"key":"ref6","unstructured":"The Academy of Medical Sciences. Multimorbidity: A Priority for Global Health Research, https:\/\/acmedsci.ac.uk\/policy\/policy-projects\/multimorbidity, last accessed 2023\/04\/03."},{"key":"ref7","unstructured":"The Academy of Medical Sciences. Multimorbidity: A Priority for Global Health Research. https:\/\/acmedsci.ac.uk\/policy\/policy-projects\/multimorbidity, last accessed 2023\/08\/25."},{"key":"ref8","unstructured":"Medical Research Council. Multimorbidity in the UK Population: Understanding Disease Clustering. 2018; https:\/\/mrc.ukri.org\/funding\/browse\/multimorbidity\/multimorbidity-in-the-uk-population-understanding-disease-clustering\/, last accessed 2023\/08\/25."},{"issue":"2","key":"ref9","doi-asserted-by":"publisher","DOI":"10.5580\/2cc3","article-title":"Perspectives, constructs and methods in the measurement of multimorbidity and comorbidity: A critical review","volume":"10","author":"Haregu T","year":"2012","unstructured":"Haregu T, Oldenburg B, Setswe G, Elliott J. Perspectives, constructs and methods in the measurement of multimorbidity and comorbidity: A critical review. Internet J Epidemiol. 2012;10(2). https:\/\/doi.org\/10.5580\/2cc3.","journal-title":"Internet J Epidemiol"},{"issue":"3","key":"ref10","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1002\/cncr.32201","article-title":"Impact of multimorbidity subgroups on the health care use of early pediatric cancer survivors","volume":"126","author":"Harrington RL","year":"2020","unstructured":"Harrington RL, Qato DM, Antoon JW, Caskey RN, Schumock GT, Lee TA. Impact of multimorbidity subgroups on the health care use of early pediatric cancer survivors. Cancer. 2020;126(3):649\u201358. https:\/\/doi.org\/10.1002\/cncr.32201.","journal-title":"Cancer"},{"issue":"8","key":"ref11","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1093\/jnci\/djab007","article-title":"Defining multimorbidity and its impact in older United States veterans newly treated for multiple myeloma","volume":"113","author":"Fillmore NR","year":"2021","unstructured":"Fillmore NR, DuMontier C, Yildirim C, La J, Epstein MM, Cheng D, Cirstea D, Yellapragada S, Abel GA, Gaziano JM, Do N, Brophy M, Kim DH, Munshi NC, Driver JA. Defining multimorbidity and its impact in older United States veterans newly treated for multiple myeloma. J Natl Cancer Inst. 2021;113(8):1084\u201393. https:\/\/doi.org\/10.1093\/jnci\/djab007.","journal-title":"J Natl Cancer Inst"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"263355652211486","DOI":"10.1177\/26335565221148616","article-title":"I. 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Front Med. 2021;8:651925. https:\/\/doi.org\/10.3389\/fmed.2021.651925.","journal-title":"Front Med"},{"issue":"1","key":"ref15","doi-asserted-by":"publisher","first-page":"16485","DOI":"10.1038\/s41598-022-20546-4","article-title":"Understanding multimorbidity trajectories in Scotland using sequence analysis","volume":"12","author":"Cezard G","year":"2022","unstructured":"Cezard G, Sullivan F, Keenan K. Understanding multimorbidity trajectories in Scotland using sequence analysis. Sci Rep. 2022;12(1):16485. https:\/\/doi.org\/10.1038\/s41598-022-20546-4.","journal-title":"Sci Rep"},{"issue":"10","key":"ref16","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1002\/ijc.33736","article-title":"SURBCAN Group. Multimorbidity clusters among long-term breast cancer survivors in Spain: Results of the SURBCAN study","volume":"149","author":"Jansana A","year":"2021","unstructured":"Jansana A, Poblador-Plou B, Gimeno-Miguel A, Lanzuela M, Prados-Torres A, Domingo L, Comas M, Sanz-Cuesta T, Cura-Gonzalez D, Iba\u00f1ez I, Abizanda B, Duarte-Salles M, Padilla-Ruiz T, Redondo M, Castells M, Sala X. SURBCAN Group. Multimorbidity clusters among long-term breast cancer survivors in Spain: Results of the SURBCAN study. Int J Cancer. 2021;149(10):1755\u201367. https:\/\/doi.org\/10.1002\/ijc.33736.","journal-title":"Int J Cancer"},{"issue":"1","key":"ref17","doi-asserted-by":"publisher","first-page":"5134","DOI":"10.1038\/s41598-022-08690-3","article-title":"Identifying multimorbidity clusters in an unselected population of hospitalised patients","volume":"12","author":"Robertson L","year":"2022","unstructured":"Robertson L, Vieira R, Butler J, Johnston M, Sawhney S, Black C. 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Eur Urol. 2021;79(2):243\u201362. https:\/\/doi.org\/10.1016\/j.eururo.2020.09.042. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on.","journal-title":"Eur Urol"},{"issue":"1","key":"ref19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser A","year":"1998","unstructured":"Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8\u201327. https:\/\/doi.org\/10.1097\/00005650-199801000-00004.","journal-title":"Med Care"},{"issue":"104242","key":"ref20","doi-asserted-by":"publisher","first-page":"104242","DOI":"10.1016\/j.jbi.2022.104242","article-title":"Multisource and temporal variability in Portuguese hospital administrative datasets: Data quality implications","volume":"136","author":"Souza J","year":"2022","unstructured":"Souza J, Caballero I, Vasco Santos J, Lobo M, Pinto A, Viana J, S\u00e1ez C, Lopes F, Freitas A. Multisource and temporal variability in Portuguese hospital administrative datasets: Data quality implications. J Biomed Inform. 2022;136(104242):104242. https:\/\/doi.org\/10.1016\/j.jbi.2022.104242.","journal-title":"J Biomed Inform"},{"issue":"11","key":"ref21","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan H","year":"2005","unstructured":"Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130\u20139. https:\/\/doi.org\/10.1097\/01.mlr.0000182534.19832.83.","journal-title":"Med Care"},{"issue":"2","key":"ref22","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3390\/smartcities2020015","article-title":"Public preferences and willingness to pay for shared autonomous vehicles services in Nagoya","volume":"2","author":"Hao M","year":"2019","unstructured":"Hao M, Li Y, Yamamoto T. Public preferences and willingness to pay for shared autonomous vehicles services in Nagoya. Japan Smart Cities. 2019;2(2):230\u201344. https:\/\/doi.org\/10.3390\/smartcities2020015.","journal-title":"Japan Smart Cities"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/3691316","author":"Zhou H","year":"2017","unstructured":"Zhou H, Zhang Y, Liu YA, Global-Relationship. Dissimilarity Measure for the k-Modes Clustering Algorithm. Computational intelligence and neuroscience, 2017, 3691316 (2017). https:\/\/doi.org\/10.1155\/2017\/3691316."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.neucom.2013.11.024","article-title":"The k-modes type clustering plus between-cluster information for categorical data","volume":"133","author":"Bai L","year":"2014","unstructured":"Bai L, Liang J. The k-modes type clustering plus between-cluster information for categorical data. Neurocomputing. 2014;133:111\u201321. https:\/\/doi.org\/10.1016\/j.neucom.2013.11.024.","journal-title":"Neurocomputing"},{"issue":"3","key":"ref25","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/bf02289588","article-title":"Hierarchical clustering schemes","volume":"32","author":"Johnson SC","year":"1967","unstructured":"Johnson SC. Hierarchical clustering schemes. Psychometrika. 1967;32(3):241\u201354. https:\/\/doi.org\/10.1007\/bf02289588.","journal-title":"Psychometrika"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/0377-0427(87)90125-7","article-title":"A graphical aid to the interpretation and validation of cluster analysis","volume":"20","author":"Rousseeuw PJ","year":"1987","unstructured":"Rousseeuw PJ, Silhouettes. A graphical aid to the interpretation and validation of cluster analysis. J Comput Appl Math. 1987;20:53\u201365. https:\/\/doi.org\/10.1016\/0377-0427(87)90125-7.","journal-title":"J Comput Appl Math"},{"issue":"5","key":"ref27","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1111\/jgs.14868","article-title":"Effect of chronic diseases and multimorbidity on survival and functioning in elderly adults","volume":"65","author":"Rizzuto D","year":"2017","unstructured":"Rizzuto D, Melis RJF, Angleman S, Qiu C, Marengoni A. Effect of chronic diseases and multimorbidity on survival and functioning in elderly adults. J Am Geriatr Soc. 2017;65(5):1056\u201360. https:\/\/doi.org\/10.1111\/jgs.14868.","journal-title":"J Am Geriatr Soc"},{"issue":"8","key":"ref28","doi-asserted-by":"publisher","first-page":"e0272265","DOI":"10.1371\/journal.pone.0272265","article-title":"Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland","volume":"17","author":"Bayer-Oglesby L","year":"2022","unstructured":"Bayer-Oglesby L, Zumbrunn A, Bachmann N, on behalf of the SIHOS Team. Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland. PLoS ONE. 2022;17(8):e0272265. https:\/\/doi.org\/10.1371\/journal.pone.0272265.","journal-title":"PLoS ONE"},{"issue":"1","key":"ref29","doi-asserted-by":"publisher","first-page":"4","DOI":"10.15256\/joc.2016.6.72","article-title":"What do we know? What should we do?","volume":"6","author":"Navickas R","year":"2016","unstructured":"Navickas R, Petric VK, Feigl AB, Seychell M, Multimorbidity. What do we know? What should we do? J comorbidity. 2016;6(1):4\u201311. https:\/\/doi.org\/10.15256\/joc.2016.6.72.","journal-title":"J comorbidity"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-2572781\/v1","article-title":"Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Research square, rs.3.rs-2572781","author":"Benzo R","year":"2023","unstructured":"Benzo R, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Research square, rs.3.rs-2572781 (2023). https:\/\/doi.org\/10.21203\/rs.3.rs-2572781\/v1."},{"issue":"1","key":"ref31","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ando.2014.09.001","article-title":"Prostate cancer: The main risk and protective factors-Epigenetic modifications","volume":"76","author":"Adjakly M","year":"2015","unstructured":"Adjakly M, Ngollo M, Dagdemir A, Judes G, Pajon A, Karsli-Ceppioglu S, Penault-Llorca F, Boiteux JP, Bignon YJ, Guy L, Bernard-Gallon D. Prostate cancer: The main risk and protective factors-Epigenetic modifications. Ann Endocrinol. 2015;76(1):25\u201341. https:\/\/doi.org\/10.1016\/j.ando.2014.09.001.","journal-title":"Ann Endocrinol"},{"issue":"5","key":"ref32","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.euf.2018.02.007","article-title":"Latest Evidence on the Impact of Smoking, Sports, and Sexual Activity as Modifiable Lifestyle Risk Factors for Prostate Cancer Incidence, Recurrence, and Progression: A Systematic Review of the Literature by the European Association of Urology Section of Oncological Urology (ESOU)","volume":"5","author":"Brookman-May SD","year":"2019","unstructured":"Brookman-May SD, Campi R, Henr\u00edquez JDS, Klatte T, Langenhuijsen JF, Brausi M, Linares-Espin\u00f3s E, Volpe A, Marszalek M, Akdogan B, Roll C, Stief CG, Rodriguez-Faba O, Minervini A. Latest Evidence on the Impact of Smoking, Sports, and Sexual Activity as Modifiable Lifestyle Risk Factors for Prostate Cancer Incidence, Recurrence, and Progression: A Systematic Review of the Literature by the European Association of Urology Section of Oncological Urology (ESOU). Eur Urol focus. 2019;5(5):756\u201387. https:\/\/doi.org\/10.1016\/j.euf.2018.02.007.","journal-title":"Eur Urol focus"},{"issue":"6","key":"ref33","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.euo.2021.09.006","article-title":"Epidemiology and Prevention of Prostate Cancer","volume":"4","author":"Gandaglia G","year":"2021","unstructured":"Gandaglia G, Leni R, Bray F, Fleshner N, Freedland SJ, Kibel A, Stattin P, Van Poppel H, La Vecchia C. Epidemiology and Prevention of Prostate Cancer. Eur Urol Oncol. 2021;4(6):877\u201392. https:\/\/doi.org\/10.1016\/j.euo.2021.09.006.","journal-title":"Eur Urol Oncol"},{"key":"ref34","unstructured":"Ministry of Health. (2018). Registo oncol\u00f3gico nacional de todos os tumores na popula\u00e7\u00e3o residente de Portugal. Retrieved from: https:\/\/ron.min-saude.pt\/media\/2196\/2021-0518_publica%C3%A7%C3%A3o-ron_2018.pdf, last accessed 23\/08\/18."},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1177\/1833358319840575","author":"Souza J","year":"2020","unstructured":"Souza J, Santos JV, Canedo VB, Betanzos A, Alves D, Freitas A. (2020). Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases. Health information management: journal of the Health Information Management Association of Australia, 49(1), 47\u201357 (2020). https:\/\/doi.org\/10.1177\/1833358319840575."}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/www.researchsquare.com\/article\/rs-4247648\/v1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.researchsquare.com\/article\/rs-4247648\/v1.html","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T23:08:39Z","timestamp":1728860919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchsquare.com\/article\/rs-4247648\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,16]]},"references-count":35,"URL":"https:\/\/doi.org\/10.21203\/rs.3.rs-4247648\/v1","relation":{},"subject":[],"published":{"date-parts":[[2024,4,16]]},"subtype":"preprint"}}