Recent Articles
Progression-free survival (PFS) is a crucial endpoint in cancer drug research. The clinician-confirmed cancer progression, namely real-world PFS (rwPFS) in unstructured text (i.e. clinical notes) has been shown to serve as a reasonable surrogate for real-world indicators in ascertaining progression endpoints. Response Evaluation Criteria in Solid Tumors(RECIST) is traditionally used in clinical trials using serial imaging evaluations, which is not practical when working with real-world data. Manual abstraction of clinical progression from unstructured notes continues to be the gold standard. However, this process is a resource-intensive and time-consuming process. Natural Language processing(NLP), a subdomain of machine learning, has shown promise in accelerating the extraction of tumor progression from real world data in recent years.
Relapse is a major event in lymphoma patients. Therefore, early detection may have an impact on quality of life and overall survival. Patient-related outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for lymphoma patients at high risk of relapse.
Multidisciplinary team (MDT) meetings play a critical role in cancer care by fostering collaboration between different healthcare professionals to develop optimal treatment recommendations. However, meeting scheduling and coordination rely heavily on manual work, making information-sharing and integration challenging. This results in incomplete information, affecting decision-making efficiency and impacting the progress of MDT. This project aimed to optimize and digitize the MDT workflow by interviewing the members of an MDT and implementing an integrated information platform utilizing the Fast Healthcare Interoperability Resources (FHIR) standard. MDT process re-engineering was conducted at a central Taiwan medical center. To digitize the workflow, our hospital adopted the NAVIFY® Tumor Board (NTB), a cloud-based platform integrating medical data using international standards, including logical object identifiers, names, and codes (LOINC), systemized nomenclature of medicine – clinical terms (SNOMED-CT), M-code, and FHIR. We improved our hospital’s information system using application programming interfaces (APIs) to consolidate data from various systems, excluding sensitive cases. Using FHIR, we aggregated, analyzed, and converted the data for seamless integration. Utilizing a user experience design, we gained insights into the lung cancer MDT's processes and needs. We conducted two phases: pre- and post-NTB integration. Ethnographic observations and stakeholder interviews revealed pain points. The affinity diagram method categorized the pain points during the discussion process, leading to efficient solutions. We divided the observation period into two phases: before and after integrating the NTB with the hospital information system (HIS). In Phase 1, there were 83 steps across the six MDT activities, leading to inefficiencies and potential delays in patient care. In Phase 2, we streamlined the tumor board process into 33 steps by introducing new functions and optimizing the data entry for pathologists. We converted the related medical data to the FHIR format using six FHIR resources and improved our HIS by developing functions and APIs to interoperate among various systems; consolidating data from different sources, excluding sensitive cases; and enhancing overall system efficiency. The MDT workflow reduced steps by 67.65%, lowering the coordinated activity time from 30 to 5 minutes. Improved efficiency boosted productivity and coordination in each case of manager feedback. This study optimized and digitized the workflow of MDT meetings, significantly enhancing the efficiency and accuracy of the tumor board process to benefit both medical professionals and patients. Based on FHIR, we integrated the data scattered across different information systems in our hospital and established a system interoperability interface that conformed to the standard. While digitizing the work of MDT meetings, we also promoted the optimization and transformation of related information systems and improved their service quality. We recommend additional research to assess the usability of a tumor board platform.
Cancer is a life-threatening disease and a leading cause of death worldwide, with an estimated 611,000 deaths and over 2 million new cases in the United States in 2024. The rising incidence of major cancers, including among younger individuals, highlights the need for early screening and monitoring of risk factors to manage and decrease cancer risk.
The introduction of oral anti-cancer therapies has, at least in part, shifted treatment from clinician-supervised hospital care to patient-managed home regimens. However, breast cancer patients receiving oral cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy still require regular hospital visits to monitor side effects. Telemonitoring has the potential to reduce hospital visits, while maintaining quality care.
Survivors of childhood cancer are at risk of medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. However, <50% of survivors attend their aftercare, and only 35% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care.
Background: Patients frequently resort to the internet to access information about cancer. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence-powered chatbot, has signified a potential paradigm shift in how cancer patients can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public's limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delay in receiving appropriate treatment.
Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anti-cancer therapy (SACTs), the crucial life-saving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions.
Oncology patients often face complex choices between treatment regimens with different risk-benefit ratios. The 4D PICTURE (Producing Improved Cancer Outcomes Through User-Centered Research) project aims to support patients, their families, and clinicians with these complex decisions by developing data-driven decision support tools (DSTs) for patients with breast cancer, prostate cancer, and melanoma as part of care path redesign using a methodology called MetroMapping. There are myriad ethical issues to consider as the project will create data-driven prognostic models and develop conversation tools using artificial intelligence while including patient perspectives by setting up boards of experiential experts in 8 different countries. This paper aims to review the key ethical challenges related to the design and development of DSTs in oncology. To explore the ethics of DSTs in cancer care, the project adopted the Embedded Ethics approach—embedding ethicists into research teams to sensitize team members to ethical aspects and assist in reflecting on those aspects throughout the project. We conducted what we call an embedded review of the project drawing from key literature on topics related to the different work packages of the 4D PICTURE project, whereas the analysis was an iterative process involving discussions with researchers in the project. Our review identified 13 key ethical challenges related to the development of DSTs and the redesigning of care paths for more personalized cancer care. Several ethical aspects were related to general potential issues of data bias and privacy but prompted specific research questions, for instance, about the inclusion of certain demographic variables in models. Design methodology in the 4D PICTURE project can provide insights related to design justice, a novel consideration in health care DSTs. Ethical points of attention related to health care policy, such as cost-effectiveness, financial sustainability, and environmental impact, were also identified, along with challenges in the research process itself, emphasizing the importance of epistemic justice, the role of embedded ethicists, and psychological safety. This viewpoint highlights ethical aspects previously neglected in the digital health ethics literature and zooms in on real-world challenges in an ongoing project. It underscores the need for researchers and leaders in data-driven medical research projects to address ethical challenges beyond the scientific core of the project. More generally, our tailored review approach provides a model for embedding ethics into large data-driven oncology research projects from the start, which helps ensure that technological innovations are designed and developed in an appropriate and patient-centered manner.
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for gastrointestinal (GI) cancer patients with peritoneal disease (PD). This patient population is at high risk of malnutrition and CRS-HIPEC can further negatively impact patients’ nutritional status. However, there has been limited testing of nutritional interventions for this patient population.
