Surveillance of Symptom Burden Using the Patient-Reported Outcome Version of the Common Terminology Criteria for Adverse Events in Patients With Various Types of Cancers During Chemoradiation Therapy: Real-World Study

Performance Improvement of a Natural Language Processing Tool for Extracting Patient Narratives Related to Medical States From Japanese Pharmaceutical Care Records by Increasing the Amount of Training Data: Natural Language Processing Analysis and Validation Study

BACKGROUND

Patients' oral expressions serve as valuable sources of clinical information to improve pharmacotherapy. Natural language processing (NLP) is a useful approach for analyzing unstructured text data, such as patient narratives. However, few studies have focused on using NLP for narratives in the Japanese language.

OBJECTIVE

We aimed to develop a high-performance NLP system for extracting clinical information from patient narratives by examining the performance progression with a gradual increase in the amount of training data.

METHODS

We used subjective texts from the pharmaceutical care records of Keio University Hospital from April 1, 2018, to March 31, 2019, comprising 12,004 records from 6559 cases. After preprocessing, we annotated diseases and symptoms within the texts. We then trained and evaluated a deep learning model (bidirectional encoder representations from transformers combined with a conditional random field [BERT-CRF]) through 10-fold cross-validation. The annotated data were divided into 10 subsets, and the amount of training data was progressively increased over 10 steps. We also analyzed the causes of errors. Finally, we applied the developed system to the analysis of case report texts to evaluate its usability for texts from other sources.

RESULTS

The F1-score of the system improved from 0.67 to 0.82 as the amount of training data increased from 1200 to 12,004 records. The F1-score reached 0.78 with 3600 records and was largely similar thereafter. As performance improved, errors from incorrect extractions decreased significantly, which resulted in an increase in precision. For case reports, the F1-score also increased from 0.34 to 0.41 as the training dataset expanded from 1200 to 12,004 records. Performance was lower for extracting symptoms from case report texts compared with pharmaceutical care records, suggesting that this system is more specialized for analyzing subjective data from pharmaceutical care records.

CONCLUSIONS

We successfully developed a high-performance system specialized in analyzing subjective data from pharmaceutical care records by training a large dataset, with near-complete saturation of system performance with about 3600 training records. This system will be useful for monitoring symptoms, offering benefits for both clinical practice and research.

Early taxane exposure and neurotoxicity in breast cancer patients

INTRODUCTION

Breast cancer is the most diagnosed tumor and a leading cause of cancer death in women worldwide. Taxanes are the most used chemotherapeutic agents and are strictly connected to neurotoxicity. Taxane-induced neuropathy (TIN) significantly impacts patients' quality of life (QOL). Early identification and management of TIN could improve preventive strategies to preserve patients' QOL during and after breast cancer treatment.

OBJECTIVE

This prospective, observational study aimed to evaluate the taxane-induced neuropathy (TIN) in early breast cancer patients treated with weekly paclitaxel at an earlier stage and identify any correlation between TIN and QOL.

METHODS

Data from stage I-III breast cancer patients treated with taxane-based therapy between 2018 and 2022 were collected at the Medical Oncology Unit of the University Hospital of Cagliari. Peripheral neuropathy was evaluated using the NCI-CTCAE scale (National Cancer Institute, Common Terminology Criteria for Adverse Events) at every drug administration. In contrast, QOL was assessed using EORTC QLC-CIPN20 and FACT-Taxane questionnaire at baseline (T0), after 4 weeks (T1) and 12 (T2) weeks of treatment. Statistical analysis was performed to evaluate the correlation between neurotoxicity and QOL.

RESULTS

Neurotoxicity incidence peaked at the third, fourth, and sixth week of treatment, with patients reporting grade 1 and 2 neurotoxicity. Simultaneously with increasing doses of paclitaxel, significant differences in QOL were observed in early treatment cycles relating to TIN presentation. Patients with higher neurotoxicity grades reported lower QOL scores.

CONCLUSIONS

Despite the absence of effective treatments to prevent paclitaxel-induced neurotoxicity, symptoms are managed through dosage reduction, delay, or treatment interruption. Future research should focus on identifying neuroprotective measures to avoid an irreversible decline in the quality of life for breast cancer survivors.

Predictors of Concordance between Patient-Reported and Provider-Documented Symptoms in the Context of Cancer and Multimorbidity

BACKGROUND

 The integration of patient-reported outcomes (PROs) into clinical care, particularly in the context of cancer and multimorbidity, is crucial. While PROs have the potential to enhance patient-centered care and improve health outcomes through improved symptom assessment, they are not always adequately documented by the health care team.

OBJECTIVES

 This study aimed to explore the concordance between patient-reported symptom occurrence and symptoms documented in electronic health records (EHRs) in people undergoing treatment for cancer in the context of multimorbidity.

METHODS

 We analyzed concordance between patient-reported symptom occurrence of 13 symptoms from the Memorial Symptom Assessment Scale and provider-documented symptoms extracted using NimbleMiner, a machine learning tool, from EHRs for 99 patients with various cancer diagnoses. Logistic regression guided with the Akaike Information Criterion was used to identify significant predictors of symptom concordance.

RESULTS

 Our findings revealed discrepancies in patient and provider reports, with itching showing the highest concordance (66%) and swelling showing the lowest concordance (40%). There was no statistically significant association between multimorbidity and high concordance, while lower concordance was observed for women, patients with advanced cancer stages, individuals with lower education levels, those who had partners, and patients undergoing highly emetogenic chemotherapy.

CONCLUSION

 These results highlight the challenges in achieving accurate and complete symptom documentation in EHRs and the necessity for targeted interventions to improve the precision of clinical documentation. By addressing these gaps, health care providers can better understand and manage patient symptoms, ultimately contributing to more personalized and effective cancer care.

Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis

OBJECTIVE

Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs).

METHODS

This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis.

RESULTS

Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6-18), suicide prevalence was 6% (95%CI:3-12), and self-harm prevalence was 15% (95%CI:8-26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10-28) as compared to CPCs below 50 (6%, 95%CI:3-12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13-23), as compared to children (5%, 95%CI:2-10) or mothers (3%, 95%CI:1-8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality.

CONCLUSION

We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors.

Long-term health outcomes by cancer diagnosed age among adolescent and young adult: multinational representative database

BACKGROUND

The cancer experienced in adolescent and young adult (AYA) could disturb developmental changes and long-term life. The current AYA guidelines and research for survivorship were developed and reported according to the general age range of 15-39 years; however, expected life events vary by diagnosed age. We aimed to examine the social, psychological, and physical well-being of AYA cancer survivors by age at diagnosis using a multinational representative dataset focusing on age at diagnosis.

METHODS

We conducted a cross-sectional study using the US and Korean National Health and Nutrition Examination Surveys from 2007 to 2018. Participants diagnosed with any cancer aged 15-39 years and were aged > 18 years at the survey year were defined as AYA cancer survivors. AYA were classified into three groups based on their diagnosed age: adolescent survivors (diagnosed between the ages of 15 and 19, n = 45), young adult survivors (diagnosed between the ages of 20 and 29, n = 238), and late young adult survivors (diagnosed between the ages of 30 and 39, n = 539). We also selected an age-, sex-, race-, and survey year-matched general population with 1:5 ratio among participants without cancer (N = 4110).

RESULTS

The average age of the survey was 29.1, 43.7, and 48.7 years for AYA survivors diagnosed during adolescence, young adulthood, and late young adulthood, respectively. Adolescent survivors had more non-couple marital status (adjusted odds ratio (aOR), 1.34; 95% CI, 1.10-1.64) and unemployed (aOR, 1.30; 95% CI, 1.05-1.61) compared to late young adult survivors. Comparing with the matched general, adolescent survivors were more in poor general health (aOR, 4.65; 95% CI, 2.09-10.38) and unemployed (aOR, 2.17; 95% CI, 1.12-4.24) and late young adult survivors were more non-couple (aOR, 1.40; 95% CI, 1.05-1.86).

CONCLUSION

This study provides evidence for future studies on long-term health, which may vary according to age at the time of diagnosis among AYA with cancer.

Developing quality indicators for cancer hospitals in China: a national modified Delphi process

OBJECTIVE

Although demand and supply of cancer care have been rapidly increasing in recent decades, there is a lack of systemic quality measurement for cancer hospitals in China. This study aimed to develop a set of core indicators for measuring quality of care for cancer hospitals in China.

DESIGN

The development of quality indicators was based on a literature review and a two-round modified Delphi survey. The theoretical framework and initial indicators were identified through the comprehensive literature review, and the selection of quality indicators relied on experts' consensus on the importance and feasibility of indicators by the modified Delphi process. In addition, indicator weight was identified using the analytical hierarchical process method and percentage weight method.

SETTING AND PARTICIPANTS

A panel of leading experts including oncologists, cancer care nurses, quality management experts from various regions of China were invited to participate in the two-round modified Delphi process from October to December 2020. A total of 25 experts completed the two-round modified Delphi process.

RESULTS

The experts reached consensus on a set of 47 indicators, comprising 17 structure indicators, 19 process indicators and 11 outcome indicators. Experts gave much higher weight to outcome indicators (accounting for 53.96% relative weight) than to structure (16.34%) and process (29.70%) indicators. In addition, experts also showed concerns and gave suggestions on data availability of specific outcome indicators.

CONCLUSIONS

Drawing on the comprehensive literature review and the modified Delphi process, this study developed a core set of quality indicators that can be used to evaluate quality performance of cancer hospitals. This is helpful in supporting quality cancer care in China and will provide new insights into the systemic measurement of cancer care internationally.

Network analysis used to investigate the interplay among somatic and psychological symptoms in patients with cancer and cancer survivors: a scoping review

PURPOSE

Patients with cancer often experience multiple somatic and psychological symptoms. Somatic and psychological symptoms are thought to be connected and may reinforce each other. Network analysis allows examination of the interconnectedness of individual symptoms. The aim of this scoping review was to examine the current state of knowledge about the associations between somatic and psychological symptoms in patients with cancer and cancer survivors, based on network analysis.

METHODS

This scoping review followed the five-stage framework of Arksey and O'Malley. The literature search was conducted in May, 2023 in PubMed, APA PsycINFO, Embase Cochrane central, and CINAHL databases.

RESULTS

Thirty-two studies were included, with eleven using longitudinal data. Seventeen studies reported on the strength of the associations: somatic and psychological symptoms were associated, although associations among somatic as well as among psychological symptoms were stronger. Other findings were the association between somatic and psychological symptoms was stronger in patients experiencing more severe symptoms; associations between symptoms over time remained rather stable; and different symptoms were central in the networks, with fatigue being among the most central in half of the studies.

IMPLICATIONS FOR CANCER SURVIVORS

Although the associations among somatic symptoms and among psychological symptoms were stronger, somatic and psychological symptoms were associated, especially in patients experiencing more severe symptoms. Fatigue was among the most central symptoms, bridging the somatic and psychological domain. These findings as well as future research based on network analysis may help to untangle the complex interplay of somatic and psychological symptoms in patients with cancer.

Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study

PURPOSE

Successful completion of chemotherapy is critical to improve breast cancer outcomes. Relative dose intensity (RDI), defined as the ratio of chemotherapy delivered to prescribed, is a measure of chemotherapy completion and is associated with cancer mortality. The effect of exercise and eating a healthy diet on RDI is unknown. We conducted a randomized trial of an exercise and nutrition intervention on RDI and pathologic complete response (pCR) in women diagnosed with breast cancer initiating chemotherapy.

METHODS

One hundred seventy-three women with stage I-III breast cancer were randomly assigned to usual care (UC; n = 86) or a home-based exercise and nutrition intervention with counseling sessions delivered by oncology-certified registered dietitians (n = 87). Chemotherapy dose adjustments and delays and pCR were abstracted from electronic medical records. T-tests and chi-square tests were used to examine the effect of the intervention versus UC on RDI and pCR.

RESULTS

Participants randomly assigned to intervention had greater improvements in exercise and diet quality compared with UC (P < .05). RDI was 92.9% ± 12.1% and 93.6% ± 11.1% for intervention and UC, respectively (P = .69); the proportion of patients in the intervention versus UC who achieved ≥85% RDI was 81% and 85%, respectively (P = .44). The proportion of patients who had at least one dose reduction and/or delay was 38% intervention and 36% UC (P = .80). Among 72 women who received neoadjuvant chemotherapy, women randomly assigned to intervention were more likely to have a pCR than those randomly assigned to UC (53% v 28%; P = .037).

CONCLUSION

Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pCR in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.

Efficacy of the PRO-CTCAE mobile application for improving patient participation in symptom management during cancer treatment: a randomized controlled trial

PURPOSE

Although mobile-based symptom monitoring is expected to improve patient participation in symptom management during anticancer therapy, previous trials have not evaluated its effectiveness. Therefore, this study aims to evaluate the impact of a symptom monitoring mobile application on improving patient participation in symptom management during anticancer therapy.

METHODS

We conducted a single-center, open-label, randomized controlled trial that enrolled patients with breast, lung, head and neck, esophageal, or gynecologic cancer who were scheduled to receive anticancer therapy (oral or intravenous) between October 2020 and March 2021. We excluded patients with physical or psychological problems. The intervention group received a symptom monitoring application for 8 weeks, and the control group received the usual clinical practice. At 8 weeks, the improvement in patient participation in symptom management was assessed, and additionally quality of life and unplanned clinical visits were assessed.

RESULTS

A total of 222 patients were included in the analysis, of whom 142 were randomly assigned to the intervention group and 71 to the control group. The intervention group reported better outcome in patient participation in symptom management than the control group at 8 weeks (mean scores of 8.5 vs. 8.0; P = 0.01). There were no significant differences between the groups in Quality of life (P = 0.88) and unplanned clinical visits (P = 0.39-0.76).

CONCLUSIONS

This study is meaningful in figuring out that the mobile-based symptom monitoring made them more engaged in their management. Future research should continue to evaluate the effects of patient participation as mediators of clinical outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04568278.