Using machine learning to predict health-related quality of life outcomes in patients with low grade glioma, meningioma, and acoustic neuroma

Abstract

Background: Predicting reduced health-related quality of life (HRQoL) after resection of a benign or low-grade brain tumour provides the opportunity for early intervention, and targeted expenditure of scarce supportive care resources. We aimed to develop, and evaluate the performance of, machine learning (ML) algorithms to predict HRQoL outcomes in this patient group.

Methods: Using a large prospective dataset of HRQoL outcomes in patients surgically treated for low grade glioma, acoustic neuroma and meningioma, we investigated the capability of ML to predict a) HRQoL-impacting symptoms persisting between 12 and 60 months from tumour resection and b) a decline in global HRQoL by more than the minimum clinically important difference below a normative population mean within 12 and 60 months after resection. Ten-fold cross-validation was used to measure the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (PR-AUC), sensitivity, and specificity of models. Six ML algorithms were explored per outcome: Random Forest Classifier, Decision Tree Classifier, Logistic Regression, K Neighbours Classifier, Support Vector Machine, and Gradient Boosting Machine.

Results: The final cohort included 262 patients. Outcome measures for which AUC>0.9 were Appetite loss, Constipation, Nausea and vomiting, Diarrhoea, Dyspnoea and Fatigue. AUC was between 0.8 and 0.9 for global HRQoL and Financial difficulty. Pain and Insomnia achieved AUCs below 0.8. PR-AUCs were similar overall to the AUC of each respective classifier.

Conclusions: ML algorithms based on routine demographic and perioperative data show promise in their ability to predict HRQoL outcomes in patients with low grade and benign brain tumours between 12 and 60 months after surgery.

Fig 1. Optimal model performance metrics across the different outcome measures.

Fig 2. Receiver operating characteristic of the best performing algorithm for the five most prevalent outcome measures in the dataset.

Fig 3. Precision-recall curve of the best performing algorithm for the five most prevalent outcome measures in the dataset.

Fig 4. Worked example of ML model for global HRQoL.

Twelve demographic and perioperative data inputs are used by the Support Vector Machine to predict whether global HRQoL will decline below the normative population mean (4) within 12–60 months of tumour resection.