1
|
Miyake M, Nishimura N, Nishioka Y, Fujii T, Oda Y, Miyamoto T, Tomizawa M, Shimizu T, Owari T, Ohnishi K, Hori S, Morizawa Y, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Imamura T, Fujimoto K. Clinical impact of the intensity of follow-up cystoscopy in patients with high-risk non-muscle-invasive bladder cancer. Int Urol Nephrol 2024; 56:827-837. [PMID: 37910382 DOI: 10.1007/s11255-023-03851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE There is significant lack on evidence regarding the effect of non-adherence to a recommended protocol in follow-up of high-risk non-muscle-invasive bladder cancer (NMIBC), or the impact of delaying detection of recurrent lesion. Here, we aimed to investigate the optimal frequency of follow-up cystoscopy of high-risk NMIBC with respect to oncological safety in the Japanese real-world clinical practice. METHODS This retrospective single-center study included 206 patients with primary high-risk NMIBC. The intensity (%) of follow-up cystoscopy was calculated based on actual visits for cystoscopy and guideline-recommended frequency in the first 24-month follow-up period. Inverse probability of treatment weighting analyses was used to reduce the risk of bias between groups. We performed a restricted cubic spline analysis with knots at intensity of follow-up cystoscopy ≤ 100% group to examine the possible association of progression risk with the intensity of follow-up as a continuous exposure. RESULTS The median intensity was 87.5% (interquartile range, 75-100). Adjusted multivariate analysis for MIBC-free and progression-free survival demonstrated no significant difference between adjusted ≤ 75% and > 75% intensity groups. A restricted cubic spline analysis suggested no significant effect of the intensity of follow-up on progression risk, and hazard ratios of patients of < 100% intensity were equivalent to those of patients of 100% intensity. CONCLUSION Our finding suggested decreased intensity of follow-up cystoscopy did not affect oncological outcomes in patients with high-risk NMIBC. Further prospective trials directly aimed at investigating optimized follow-up schedules for NMIBC are mandatory before substantial changes to existing clinical guidelines.
Collapse
Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Oda
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tatsuki Miyamoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kenta Ohnishi
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
2
|
Lyall V, Ould Ismail AA, Haggstrom DA, Issa MM, Siddiqui MM, Tosoian J, Schroeck FR. Accurate Documentation Contributes to Guideline-concordant Surveillance of Nonmuscle Invasive Bladder Cancer: A Multisite Department of Veterans Affairs Study. Urology 2023; 181:92-97. [PMID: 37660946 PMCID: PMC10901298 DOI: 10.1016/j.urology.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To determine if accurate documentation of bladder cancer risk was associated with a clinician surveillance recommendation that is concordant with AUA guidelines among patients with nonmuscle invasive bladder cancer (NMIBC). METHODS We prospectively collected data from cystoscopy encounter notes from four Department of Veterans Affairs (VA) sites to ascertain whether they included accurate documentation of bladder cancer risk and a recommendation for a guideline-concordant surveillance interval. Accurate documentation was a clinician-recorded risk classification matching a gold standard assigned by the research team. Clinician recommendations were guideline-concordant if the clinician recorded a surveillance interval that was in line with the AUA guideline. RESULTS Among 296 encounters, 75 were for low-, 98 for intermediate-, and 123 for high-risk NMIBC. 52% of encounters had accurate documentation of NMIBC risk. Accurate documentation of risk was less common among encounters for low-risk bladder cancer (36% vs 52% for intermediate- and 62% for high-risk, P < .05). Guideline-concordant surveillance recommendations were also less common in patients with low-risk bladder cancer (67% vs 89% for intermediate- and 94% for high-risk, P < .05). Accurate documentation was associated with a 29% and 15% increase in guideline-concordant surveillance recommendations for low- and intermediate-risk disease, respectively (P < .05). CONCLUSION Accurate risk documentation was associated with more guideline-concordant surveillance recommendations among low- and intermediate-risk patients. Implementation strategies facilitating assessment and documentation of risk may be useful to reduce overuse of surveillance in this group and to prevent unnecessary cost, anxiety, and procedural harms.
Collapse
Affiliation(s)
- Vikram Lyall
- White River Junction VA Healthcare System, White River Junction, VT; Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - David A Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Regenstrief Institute, & Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Muta M Issa
- Atlanta VA Medical Center & Emory University School of Medicine, Atlanta, GA
| | | | | | - Florian R Schroeck
- White River Junction VA Healthcare System, White River Junction, VT; Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH.
| |
Collapse
|
3
|
Schroeck FR, Ould Ismail AA, Haggstrom DA, Sanchez SL, Walker DR, Zubkoff L. Data-driven approach to implementation mapping for the selection of implementation strategies: a case example for risk-aligned bladder cancer surveillance. Implement Sci 2022; 17:58. [PMID: 36050742 PMCID: PMC9438061 DOI: 10.1186/s13012-022-01231-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation Mapping is an organized method to select implementation strategies. However, there are 73 Expert Recommendations for Implementing Change (ERIC) strategies. Thus, it is difficult for implementation scientists to map all potential strategies to the determinants of their chosen implementation science framework. Prior work using Implementation Mapping employed advisory panels to select implementation strategies. This article presents a data-driven approach to implementation mapping, in which we systematically evaluated all 73 ERIC strategies using the Tailored Implementation for Chronic Diseases (TICD) framework. We illustrate our approach using implementation of risk-aligned bladder cancer surveillance as a case example. METHODS We developed objectives based on previously collected qualitative data organized by TICD determinants, i.e., what needs to be changed to achieve more risk-aligned surveillance. Next, we evaluated all 73 ERIC strategies, excluding those that were not applicable to our clinical setting. The remaining strategies were mapped to the objectives using data visualization techniques to make sense of the large matrices. Finally, we selected strategies with high impact, based on (1) broad scope, defined as a strategy addressing more than the median number of objectives, (2) requiring low or moderate time commitment from clinical teams, and (3) evidence of effectiveness from the literature. RESULTS We identified 63 unique objectives. Of the 73 ERIC strategies, 45 were excluded because they were not applicable to our clinical setting (e.g., not feasible within the confines of the setting, not appropriate for the context). Thus, 28 ERIC strategies were mapped to the 63 objectives. Strategies addressed 0 to 26 objectives (median 10.5). Of the 28 ERIC strategies, 10 required low and 8 moderate time commitments from clinical teams. We selected 9 strategies based on high impact, each with a clearly documented rationale for selection. CONCLUSIONS We enhanced Implementation Mapping via a data-driven approach to the selection of implementation strategies. Our approach provides a practical method for other implementation scientists to use when selecting implementation strategies and has the advantage of favoring data-driven strategy selection over expert opinion.
Collapse
Affiliation(s)
- Florian R Schroeck
- White River Junction VA Medical Center, White River Junction, VT, USA. .,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. .,Dartmouth Cancer Center, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, USA.
| | | | - David A Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.,Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Steven L Sanchez
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - DeRon R Walker
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL, USA.,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
Okorie CL, Gatsby E, Schroeck FR, Ould Ismail AA, Lynch KE. Using electronic health records to streamline provider recruitment for implementation science studies. PLoS One 2022; 17:e0267915. [PMID: 35560153 PMCID: PMC9106149 DOI: 10.1371/journal.pone.0267915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common provider screening strategies but require substantial time, effort, and resources. The automated use of electronic health record (EHR) data may streamline provider identification for implementation science research. Here, we describe an approach to provider screening for a Veterans Health Administration (VHA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Methods Our goal was to identify providers at 6 pre-specified facilities who performed ≥10 surveillance cystoscopy procedures among bladder cancer patients in the 12 months prior to recruitment start on January 16, 2020, and who were currently practicing at 1 of 6 pre-specified facilities. Using VHA EHR data (using CPT, ICD10 procedure, and ICD10 diagnosis codes), we identified cystoscopy procedures performed after an initial bladder cancer diagnosis (i.e., surveillance procedures). Procedures were linked to VHA staff data to determine the provider of record, the number of cystoscopies they performed, and their current location of practice. To validate this approach, we performed a chart review of 105 procedures performed by a random sample of identified providers. The proportion of correctly identified procedures was calculated (Positive Predictive Value (PPV)), along with binomial 95% confidence intervals (CI). Findings We identified 1,917,856 cystoscopies performed on 703,324 patients from October 1, 1999—January 16, 2020, across the nationwide VHA. Of those procedures, 40% were done on patients who had a prior record of bladder cancer and were completed by 15,065 distinct providers. Of those, 61 performed ≥ 10 procedures and were currently practicing at 1 of the 6 facilities of interest in the 1 year prior to study recruitment. The random chart review of 7 providers found 101 of 105 procedures (PPV: 96%; 95% CI: 91% to 99%) were surveillance procedures and were performed by the selected provider on the recorded date. Implications These results show that EHR data can be used for accurate identification of healthcare providers as research participants when inclusion criteria consist of both patient- (temporal relationship between diagnosis and procedure) and provider-level (frequency of procedure and location of current practice) factors. As administrative codes and provider identifiers are collected in most, if not all, EHRs for billing purposes this approach can be translated from provider recruitment in VHA to other healthcare systems. Implementation studies should consider this method of screening providers.
Collapse
Affiliation(s)
- Chiamaka L. Okorie
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Elise Gatsby
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
| | - Florian R. Schroeck
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
| | - A. Aziz Ould Ismail
- White River Junction VA Medical Center, White River Junction, VT, United States of America
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
- * E-mail:
| |
Collapse
|
5
|
Santos T, Tariq A, Gichoya JW, Trivedi H, Banerjee I. Automatic Classification of Cancer Pathology Reports: A Systematic Review. J Pathol Inform 2022; 13:100003. [PMID: 35242443 PMCID: PMC8860734 DOI: 10.1016/j.jpi.2022.100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Pathology reports primarily consist of unstructured free text and thus the clinical information contained in the reports is not trivial to access or query. Multiple natural language processing (NLP) techniques have been proposed to automate the coding of pathology reports via text classification. In this systematic review, we follow the guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Page et al., 2020: BMJ.) to identify the NLP systems for classifying pathology reports published between the years of 2010 and 2021. Based on our search criteria, a total of 3445 records were retrieved, and 25 articles met the final review criteria. We benchmarked the systems based on methodology, complexity of the prediction task and core types of NLP models: i) Rule-based and Intelligent systems, ii) statistical machine learning, and iii) deep learning. While certain tasks are well addressed by these models, many others have limitations and remain as open challenges, such as, extraction of many cancer characteristics (size, shape, type of cancer, others) from pathology reports. We investigated the final set of papers (25) and addressed their potential as well as their limitations. We hope that this systematic review helps researchers prioritize the development of innovated approaches to tackle the current limitations and help the advancement of cancer research.
Collapse
Affiliation(s)
- Thiago Santos
- Department of Computer Science, Emory University, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory School of Medicine, Atlanta, GA, USA
- Corresponding author.
| | - Amara Tariq
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Judy Wawira Gichoya
- Department of Biomedical Informatics, Emory School of Medicine, Atlanta, GA, USA
- Department of Radiology, Emory School of Medicine, Atlanta, GA, USA
| | - Hari Trivedi
- Department of Biomedical Informatics, Emory School of Medicine, Atlanta, GA, USA
- Department of Radiology, Emory School of Medicine, Atlanta, GA, USA
| | - Imon Banerjee
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Computer Engineering, Arizona State University, AZ, USA
| |
Collapse
|
6
|
Schroeck FR, Ould Ismail AA, Perry GN, Haggstrom DA, Sanchez SL, Walker DR, Young J, Zickmund S, Zubkoff L. Determinants of Risk-Aligned Bladder Cancer Surveillance-Mixed-Methods Evaluation Using the Tailored Implementation for Chronic Diseases Framework. JCO Oncol Pract 2022; 18:e152-e162. [PMID: 34464159 PMCID: PMC8835627 DOI: 10.1200/op.21.00226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE For many patients with cancer, the frequency of surveillance after primary treatment depends on the risk for cancer recurrence or progression. Lack of risk-aligned surveillance means too many unnecessary surveillance procedures for low-risk patients and not enough for high-risk patients. Using bladder cancer as an example, we examined whether practice determinants differ between Department of Veterans Affairs sites where risk-aligned surveillance was more (risk-aligned sites) or less common (need improvement sites). METHODS We used our prior quantitative data to identify two risk-aligned sites and four need improvement sites. We performed semistructured interviews with 40 Veterans Affairs staff guided by the Tailored Implementation for Chronic Diseases framework that were deductively coded. We integrated quantitative data (risk-aligned site v need improvement site) and qualitative data from interviews, cross-tabulating salient determinants by site type. RESULTS There were 14 participants from risk-aligned sites and 26 participants from need improvement sites. Irrespective of site type, we found a lack of knowledge on guideline recommendations. Additional salient determinants at need improvement sites were a lack of resources ("the next available without overbooking is probably seven to eight weeks out") and an absence of routines to incorporate risk-aligned surveillance ("I have my own guidelines that I've been using for 35 years"). CONCLUSION Knowledge, resources, and lack of routines were salient barriers to risk-aligned bladder cancer surveillance. Implementation strategies addressing knowledge and resources can likely contribute to more risk-aligned surveillance. In addition, reminders for providers to incorporate risk into their surveillance plans may improve their routines.
Collapse
Affiliation(s)
- Florian R. Schroeck
- From the White River Junction VA Medical Center, White River Junction, VT,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH,Florian R. Schroeck, MD, MS, VA Outcomes Group, WRJ VA Medical Center, 215 N Main St, White River Junction, VT 05009; e-mail:
| | | | - Grace N. Perry
- Department of Medicine, University of Utah, Salt Lake City, UT
| | - David A. Haggstrom
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN,Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Steven L. Sanchez
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN
| | - DeRon R. Walker
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN
| | - Jeanette Young
- VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Susan Zickmund
- Department of Medicine, University of Utah, Salt Lake City, UT,VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Lisa Zubkoff
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL,Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
7
|
Culpan M, Keser F, Acar HC, Otunctemur A, Kucuk EV, Erdem S, Ozer M, Sen UT, Degirmenci E, Ergul R, Atis RG, Yildirim A. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14490. [PMID: 34117682 PMCID: PMC8420249 DOI: 10.1111/ijcp.14490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
Collapse
Affiliation(s)
- Meftun Culpan
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Ferhat Keser
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Hazal Cansu Acar
- Department of Public HealthCerrahpasa Faculty of MedicineIstanbul University‐CerrahpasaIstanbulTurkey
| | - Alper Otunctemur
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Eyup Veli Kucuk
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Selcuk Erdem
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Ozer
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Ugur Tolga Sen
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Enes Degirmenci
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Rifat Ergul
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ramazan Gokhan Atis
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Asif Yildirim
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| |
Collapse
|
8
|
Hu D, Zhang H, Li S, Wang Y, Wu N, Lu X. Automatic Extraction of Lung Cancer Staging Information From Computed Tomography Reports: Deep Learning Approach. JMIR Med Inform 2021; 9:e27955. [PMID: 34287213 PMCID: PMC8339987 DOI: 10.2196/27955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide. Clinical staging of lung cancer plays a crucial role in making treatment decisions and evaluating prognosis. However, in clinical practice, approximately one-half of the clinical stages of lung cancer patients are inconsistent with their pathological stages. As one of the most important diagnostic modalities for staging, chest computed tomography (CT) provides a wealth of information about cancer staging, but the free-text nature of the CT reports obstructs their computerization. OBJECTIVE We aimed to automatically extract the staging-related information from CT reports to support accurate clinical staging of lung cancer. METHODS In this study, we developed an information extraction (IE) system to extract the staging-related information from CT reports. The system consisted of the following three parts: named entity recognition (NER), relation classification (RC), and postprocessing (PP). We first summarized 22 questions about lung cancer staging based on the TNM staging guideline. Next, three state-of-the-art NER algorithms were implemented to recognize the entities of interest. Next, we designed a novel RC method using the relation sign constraint (RSC) to classify the relations between entities. Finally, a rule-based PP module was established to obtain the formatted answers using the results of NER and RC. RESULTS We evaluated the developed IE system on a clinical data set containing 392 chest CT reports collected from the Department of Thoracic Surgery II in the Peking University Cancer Hospital. The experimental results showed that the bidirectional encoder representation from transformers (BERT) model outperformed the iterated dilated convolutional neural networks-conditional random field (ID-CNN-CRF) and bidirectional long short-term memory networks-conditional random field (Bi-LSTM-CRF) for NER tasks with macro-F1 scores of 80.97% and 90.06% under the exact and inexact matching schemes, respectively. For the RC task, the proposed RSC showed better performance than the baseline methods. Further, the BERT-RSC model achieved the best performance with a macro-F1 score of 97.13% and a micro-F1 score of 98.37%. Moreover, the rule-based PP module could correctly obtain the formatted results using the extractions of NER and RC, achieving a macro-F1 score of 94.57% and a micro-F1 score of 96.74% for all the 22 questions. CONCLUSIONS We conclude that the developed IE system can effectively and accurately extract information about lung cancer staging from CT reports. Experimental results show that the extracted results have significant potential for further use in stage verification and prediction to facilitate accurate clinical staging.
Collapse
Affiliation(s)
- Danqing Hu
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
- Key Laboratory for Biomedical Engineering, Ministry of Education, Hangzhou, China
| | - Huanyao Zhang
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
- Key Laboratory for Biomedical Engineering, Ministry of Education, Hangzhou, China
| | - Shaolei Li
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuhong Wang
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
- Key Laboratory for Biomedical Engineering, Ministry of Education, Hangzhou, China
| | - Nan Wu
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xudong Lu
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
- Key Laboratory for Biomedical Engineering, Ministry of Education, Hangzhou, China
| |
Collapse
|
9
|
Russell B, Kotecha P, Thurairaja R, Nair R, Malde S, Kumar P, Khan MS. Endoscopic surveillance for bladder cancer: a systematic review of contemporary worldwide practices. Transl Androl Urol 2021; 10:2750-2761. [PMID: 34295760 PMCID: PMC8261410 DOI: 10.21037/tau-20-1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/25/2021] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this systematic review was to identify the current endoscopic surveillance strategies in use across the world and to determine whether these were sufficient or if any recommendations for changes in the guidelines could be made. This review focused on the cystoscopic follow-up of non-muscle invasive bladder cancer (NMIBC) patients and muscle invasive bladder cancer (MIBC) patients who had undergone bladder sparing treatments. Methods A literature search was carried out on Medline and Embase using OVID gateway according to a pre-defined protocol. Systematic screening of the identified studies was carried out by two authors. Quality assessment was performed using the Joanna Briggs critical appraisal tools. Data was extracted on various aspects including the follow-up regime utilised, patients included, outcomes investigated and a summary of the results. The studies were compared in a narrative nature. Results A total of 2,604 studies were identified from the search strategy, of which 14 were deemed suitable for inclusion following the screening process. The studies identified were from nine countries and were mainly observational or qualitative. There was a huge variation in the follow-up regimes utilised within the studies with no clear consensus as to which regime was the most suitable. However, all studies utilised an initial cystoscopy at three months post-TURBT. No studies were identified which investigated the endoscopic follow-up strategies for MIBC patients who opted for bladder conservation with chemoradiation. Conclusions There is no universally accepted protocol for endoscopic follow-up of patients with NMIBC bladder cancer. Guidance on cystoscopic monitoring of bladder in patients who have undergone chemoradiation for MIBC is also lacking.
Collapse
Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Pinky Kotecha
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Ramesh Thurairaja
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Rajesh Nair
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Pardeep Kumar
- Department of Urology, Royal Marsden NHS Foundation Trust, London, UK
| | | |
Collapse
|
10
|
Rezaee ME, Ismail AAO, Okorie CL, Seigne JD, Lynch KE, Schroeck FR. Partial Versus Complete Bacillus Calmette-Guérin Intravesical Therapy and Bladder Cancer Outcomes in High-risk Non-muscle-invasive Bladder Cancer: Is NIMBUS the Full Story? EUR UROL SUPPL 2021; 26:35-43. [PMID: 34337506 PMCID: PMC8317819 DOI: 10.1016/j.euros.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 01/09/2023] Open
Abstract
Background It is important to understand the implications of reduced bacillus Calmette-Guérin (BCG) treatment intensity, given global shortages and early termination of the NIMBUS trial. Objective To assess the association of partial versus complete BCG induction with outcomes. Design, setting, and participants This is a retrospective cohort study of veterans diagnosed with high-risk non–muscle-invasive bladder cancer (NMIBC; high grade [HG] Ta, T1, or carcinoma in situ) between 2005 and 2011 with follow-up through 2014. Intervention Patients were categorized into partial versus complete BCG induction (one to five vs five or more instillations). Partial BCG induction subgroups were defined for comparison with the NIMBUS trial. Outcome measurements and statistical analysis Propensity score–adjusted regression models were used to assess the association of partial BCG induction with risk of recurrence and bladder cancer death. Results and limitations Among 540 patients, 114 (21.1%) underwent partial BCG induction. Partial versus complete BCG induction was not significantly associated with the risk of recurrence in HG Ta (cumulative incidence [CIn] 46.6% vs 53.9% at 5 yr, p = 0.38) or T1 (CIn 47.1% vs 56.7 at 5 yr, p = 0.19) disease. Similarly, we found no increased risk of bladder cancer death (HG Ta: CIn 4.7%7vs 5.4% at 5 yr, p = 0.87; T1: CIn 10.0% vs 11.4% at 5 yr, p = 0.77). NIMBUS-like induction was associated with an increased risk of recurrence in patients with HG Ta disease, although not statistically significant. Unmeasured confounding is a limitation. Conclusions Cancer outcomes were similar among high-risk NMIBC patients who underwent partial versus complete BCG induction, suggesting that future research is needed to determine how to optimize BCG delivery for the greatest number of patients, especially during global shortages. Patient summary Outcomes were similar between patients receiving partial and complete courses of bacillus Calmette-Guérin (BCG) therapy. Future research is needed to determine how to best deliver BCG to the greatest number of patients, particularly during medication shortages.
Collapse
Affiliation(s)
- Michael E Rezaee
- White River Junction VA Medical Center, White River Junction, VT, USA.,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - John D Seigne
- White River Junction VA Medical Center, White River Junction, VT, USA.,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Kristine E Lynch
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA
| | - Florian R Schroeck
- White River Junction VA Medical Center, White River Junction, VT, USA.,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| |
Collapse
|
11
|
Garg T, McMullen CK, Leo MC, O'Keeffe-Rosetti MC, Weinmann S, Nielsen ME. Predicting risk of multiple levels of recurrence and progression after initial diagnosis of nonmuscle-invasive bladder cancer in a multisite, community-based cohort. Cancer 2020; 127:520-527. [PMID: 33146913 DOI: 10.1002/cncr.33300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/08/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nonmuscle-invasive bladder cancer (NMIBC) has heterogeneous recurrence and progression outcomes. Available risk calculators estimate recurrence and progression but do not predict the recurrence stage or grade, which may influence downstream treatment. The objective of this study was to predict risk-stratified NMIBC recurrence and progression based on recurrence tumor classification and grade. METHODS In total, 2956 patients with NMIBC (<T2) who were diagnosed at Kaiser Permanente Northwest and Geisinger from 1994 to 2015 were identified. Recurrences were annotated for tumor classification and grade. Four risk-stratified outcomes were created based on the tumor classification and grade of the recurrence: 1) any recurrence, 2) intermediate-risk recurrence (Ta high grade, carcinoma in situ, T1 low grade) or higher, 3) high-risk recurrence (T1 high grade) or progression (clinical T2), and 4) progression. Multivariable Cox proportional hazards regression was used to compute 1-year and 5-year risk estimates for each outcome based on initial tumor classification and grade. RESULTS Over a median follow-up of 29.4 months, there were 1062 recurrences (35.9%), including 111 progressions (3.8%). The adjusted hazard of high-risk recurrence or progression increased, depending on initial tumor classification and grade: The adjusted hazard ratio was 2.60 (95% CI, 1.62-4.15) for Ta high-grade tumors, 4.74 (95% CI, 3.01-7.47) for tumor in situ or Ta with carcinoma in situ, and 7.14 (95% CI, 4.97-10.26) T1 high-grade tumors. Using Ta high-grade tumors as an example, the 1-year and 5-year predicted rates of adjusted risk of a high-risk recurrence or progression were 4.4% and 7.9%, respectively. CONCLUSIONS The 1-year and 5-year predicted risk of high-risk recurrences and progression increased with higher tumor classification and grade at diagnosis. These granular risk estimates may further inform risk-stratified treatment and surveillance for patients with NMIBC.
Collapse
Affiliation(s)
- Tullika Garg
- Department of Urology, Geisinger, Danville, Pennsylvania.,Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Matthew E Nielsen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.,Department of Urology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.,Departments of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina.,Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| |
Collapse
|
12
|
Schroeck FR, St Ivany A, Lowrance W, Makarov DV, Goodney PP, Zubkoff L. Patient Perspectives on the Implementation of Risk-Aligned Bladder Cancer Surveillance: Systematic Evaluation Using the Tailored Implementation for Chronic Diseases Framework. JCO Oncol Pract 2020; 16:e668-e677. [PMID: 32119595 PMCID: PMC10841578 DOI: 10.1200/jop.19.00576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many patients living with bladder cancer do not undergo surveillance that is aligned with their risk for recurrence or progression, which exposes them to unnecessary risk and burden of procedures. To implement risk-aligned surveillance as recommended by multiple guidelines, we need to understand patient-, provider-, and system-level factors contributing to the delivery of risk-aligned surveillance. In this study, we sought to systematically assess patient-level factors. PARTICIPANTS AND METHODS Guided by the Tailored Implementation for Chronic Diseases framework, we conducted semistructured interviews with 22 patients with bladder cancer undergoing surveillance cystoscopy procedures at three facilities within the Department of Veterans Affairs. Patients were sampled using quantitative data on bladder cancer risk category (low v high) and on surveillance category (aligned v not aligned with cancer risk). Interview transcripts were analyzed using a priori codes from the Tailored Implementation for Chronic Diseases framework. Quantitative and qualitative data were integrated by cross-tabulating determinants across risk and surveillance categories. RESULTS Participants included seven low-risk and 15 high-risk patients; 10 underwent risk-aligned surveillance and 12 did not. In mixed-methods analyses, perception of risk appropriately differed by risk but not by surveillance category. Participants understood the recommended surveillance schedule according to their risk category. Participants emphatically expressed that adhering to providers' recommendations is prudent; intentions to adhere did not vary across risk and surveillance categories. CONCLUSION Participants intended to adhere to providers' recommendations and strongly endorsed the importance of adherence. These findings suggest implementation strategies to improve risk-aligned surveillance may be most effective when targeting provider- and system-level factors rather than patient-level factors.
Collapse
Affiliation(s)
- Florian R. Schroeck
- White River Junction VA Medical Center, White River Junction, VT
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Amanda St Ivany
- Department of Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - William Lowrance
- Salt Lake City VA Healthcare System, Salt Lake City, UT
- Department of Urology, University of Utah, Salt Lake City, UT
| | - Danil V. Makarov
- New York Harbor VA Healthcare System, New York, NY
- Departments of Urology and Population Health, New York University, New York, NY
| | - Philip P. Goodney
- White River Junction VA Medical Center, White River Junction, VT
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Lisa Zubkoff
- White River Junction VA Medical Center, White River Junction, VT
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| |
Collapse
|
13
|
Rezaee ME, Lynch KE, Li Z, MacKenzie TA, Seigne JD, Robertson DJ, Sirovich B, Goodney PP, Schroeck FR. The impact of low- versus high-intensity surveillance cystoscopy on surgical care and cancer outcomes in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). PLoS One 2020; 15:e0230417. [PMID: 32203532 PMCID: PMC7089561 DOI: 10.1371/journal.pone.0230417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the association of low- vs. guideline-recommended high-intensity cystoscopic surveillance with outcomes among patients with high-risk non-muscle invasive bladder cancer (NMIBC). Materials & methods A retrospective cohort study of Veterans Affairs patients diagnosed with high-risk NMIBC between 2005 and 2011 with follow-up through 2014. Patients were categorized by number of surveillance cystoscopies over two years following diagnosis: low- (1–5) vs. high-intensity (6 or more) surveillance. Propensity score adjusted regression models were used to assess the association of low-intensity cystoscopic surveillance with frequency of transurethral resections, and risk of progression to invasive disease and bladder cancer death. Results Among 1,542 patients, 520 (33.7%) underwent low-intensity cystoscopic surveillance. Patients undergoing low-intensity surveillance had fewer transurethral resections (37 vs. 99 per 100 person-years; p<0.001). Risk of death from bladder cancer did not differ significantly by low (cumulative incidence [CIn] 8.4% [95% CI 6.5–10.9) at 5 years) vs. high-intensity surveillance (CIn 9.1% [95% CI 7.4–11.2) at 5 years, p = 0.61). Low vs. high-intensity surveillance was not associated with increased risk of bladder cancer death among patients with Ta (CIn 5.7% vs. 8.2% at 5 years p = 0.24) or T1 disease at diagnosis (CIn 10.2% vs. 9.1% at 5 years, p = 0.58). Among patients with Ta disease, low-intensity surveillance was associated with decreased risk of progression to invasive disease (T1 or T2) or bladder cancer death (CIn 19.3% vs. 31.3% at 5 years, p = 0.002). Conclusions Patients with high-risk NMIBC undergoing low- vs. high-intensity cystoscopic surveillance underwent fewer transurethral resections, but did not experience an increased risk of progression or bladder cancer death. These findings provide a strong rationale for a clinical trial to determine whether low-intensity surveillance is comparable to high-intensity surveillance for cancer control in high-risk NMIBC.
Collapse
Affiliation(s)
- Michael E. Rezaee
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
| | - Zhongze Li
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Todd A. MacKenzie
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - John D. Seigne
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Douglas J. Robertson
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Brenda Sirovich
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Philip P. Goodney
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Florian R. Schroeck
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
- * E-mail:
| |
Collapse
|
14
|
A frame semantic overview of NLP-based information extraction for cancer-related EHR notes. J Biomed Inform 2019; 100:103301. [PMID: 31589927 DOI: 10.1016/j.jbi.2019.103301] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/04/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is a lot of information about cancer in Electronic Health Record (EHR) notes that can be useful for biomedical research provided natural language processing (NLP) methods are available to extract and structure this information. In this paper, we present a scoping review of existing clinical NLP literature for cancer. METHODS We identified studies describing an NLP method to extract specific cancer-related information from EHR sources from PubMed, Google Scholar, ACL Anthology, and existing reviews. Two exclusion criteria were used in this study. We excluded articles where the extraction techniques used were too broad to be represented as frames (e.g., document classification) and also where very low-level extraction methods were used (e.g. simply identifying clinical concepts). 78 articles were included in the final review. We organized this information according to frame semantic principles to help identify common areas of overlap and potential gaps. RESULTS Frames were created from the reviewed articles pertaining to cancer information such as cancer diagnosis, tumor description, cancer procedure, breast cancer diagnosis, prostate cancer diagnosis and pain in prostate cancer patients. These frames included both a definition as well as specific frame elements (i.e. extractable attributes). We found that cancer diagnosis was the most common frame among the reviewed papers (36 out of 78), with recent work focusing on extracting information related to treatment and breast cancer diagnosis. CONCLUSION The list of common frames described in this paper identifies important cancer-related information extracted by existing NLP techniques and serves as a useful resource for future researchers requiring cancer information extracted from EHR notes. We also argue, due to the heavy duplication of cancer NLP systems, that a general purpose resource of annotated cancer frames and corresponding NLP tools would be valuable.
Collapse
|
15
|
Han DS, Lynch KE, Chang JW, Sirovich B, Robertson DJ, Swanton AR, Seigne JD, Goodney PP, Schroeck FR. Overuse of Cystoscopic Surveillance Among Patients With Low-risk Non-Muscle-invasive Bladder Cancer - A National Study of Patient, Provider, and Facility Factors. Urology 2019; 131:112-119. [PMID: 31145947 DOI: 10.1016/j.urology.2019.04.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/05/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To understand cystoscopic surveillance practices among patients with low-risk non-muscle-invasive bladder cancer (NMIBC) within the Department of Veterans Affairs (VA). METHODS Using a validated natural language processing algorithm, we included patients newly diagnosed with low-risk (ie low-grade Ta) NMIBC from 2005 to 2011 in the VA. Patients were followed until cancer recurrence, death, last contact, or 2 years after diagnosis. Based on guidelines, surveillance overuse was defined as >1 cystoscopy if followed <1 year, >2 cystoscopies if followed 1 to <2 years, or >3 cystoscopies if followed for 2 years. We identified patient, provider, and facility factors associated with overuse using multilevel logistic regression. RESULTS Overuse occurred in 75% of patients (852/1135) - with an excess of 1846 more cystoscopies performed than recommended. Adjusting for 14 factors, overuse was associated with patient race (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.28, 0.85 unlisted race vs White), having 2 comorbidities (OR 1.60, 95% CI: 1.00, 2.55 vs no comorbidities), and earlier year of diagnosis (OR 2.50, 95% CI: 1.29, 4.83 for 2005 vs 2011, and OR 2.03, 95% CI: 1.11, 3.69 for 2006 vs 2011). On sensitivity analyses assuming all patients were diagnosed with multifocal or large low-grade tumors (ie, intermediate-risk), overuse would have still occurred in 45% of patients. CONCLUSION Overuse of cystoscopy among patients with low-risk NMIBC was common, raising concerns about bladder cancer surveillance cost and quality. However, few factors were associated with overuse. Further qualitative research is needed to identify other determinants of overuse not readily captured in administrative data.
Collapse
Affiliation(s)
- David S Han
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH
| | - Kristine E Lynch
- VA Salt Lake City Health Care System and the Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Ji Won Chang
- VA Salt Lake City Health Care System and the Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Brenda Sirovich
- The White River Junction VA Medical Center, White River Junction, VT
| | | | - Amanda R Swanton
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John D Seigne
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- The White River Junction VA Medical Center, White River Junction, VT
| | - Florian R Schroeck
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH; The White River Junction VA Medical Center, White River Junction, VT; Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| |
Collapse
|
16
|
Schroeck FR, Lynch KE, Li Z, MacKenzie TA, Han DS, Seigne JD, Robertson DJ, Sirovich B, Goodney PP. The impact of frequent cystoscopy on surgical care and cancer outcomes among patients with low-risk, non-muscle-invasive bladder cancer. Cancer 2019; 125:3147-3154. [PMID: 31120559 DOI: 10.1002/cncr.32185] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/21/2019] [Accepted: 04/29/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surveillance recommendations for patients with low-risk, non-muscle-invasive bladder cancer (NMIBC) are based on limited evidence. The objective of this study was to add to the evidence by assessing outcomes after frequent versus recommended cystoscopic surveillance. METHODS This was a retrospective cohort study of patients diagnosed with low-risk (low-grade Ta (AJCC)) NMIBC from 2005 to 2011 with follow-up through 2014 from the Department of Veterans Affairs. Patients were classified as having undergone frequent versus recommended cystoscopic surveillance (>3 vs 1-3 cystoscopies in the first 2 years after diagnosis). By using propensity score-adjusted models, the authors estimated the impact of frequent cystoscopy on the number of transurethral resections, the number of resections without cancer in the specimen, and the risk of progression to muscle-invasive cancer or bladder cancer death. RESULTS Among 1042 patients, 798 (77%) had more frequent cystoscopy than recommended. In adjusted analyses, the frequent cystoscopy group had twice as many transurethral resections (55 vs 26 per 100 person-years; P < .001) and more than 3 times as many resections without cancer in the specimen (5.7 vs 1.6 per 100 person-years; P < .001). Frequent cystoscopy was not associated with time to progression or bladder cancer death (3% at 5 years in both groups; P = .990). CONCLUSIONS Frequent cystoscopy among patients with low-risk NMIBC was associated with twice as many transurethral resections and did not decrease the risk for bladder cancer progression or death, supporting current guidelines.
Collapse
Affiliation(s)
- Florian R Schroeck
- Department of Veterans Affairs (VA) Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.,Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Kristine E Lynch
- VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Zhongze Li
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - David S Han
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - John D Seigne
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Douglas J Robertson
- Department of Veterans Affairs (VA) Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Brenda Sirovich
- Department of Veterans Affairs (VA) Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Philip P Goodney
- Department of Veterans Affairs (VA) Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| |
Collapse
|