1
|
Levine MN, Kemppainen J, Rosenberg M, Pettengell C, Bogach J, Whelan T, Saha A, Ranisau J, Petch J. Breast cancer learning health system: Patient information from a data and analytics platform characterizes care provided. Learn Health Syst 2024; 8:e10409. [PMID: 39036532 PMCID: PMC11257056 DOI: 10.1002/lrh2.10409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose In a learning health system (LHS), data gathered from clinical practice informs care and scientific investigation. To demonstrate how a novel data and analytics platform can enable an LHS at a regional cancer center by characterizing the care provided to breast cancer patients. Methods Socioeconomic information, tumor characteristics, treatments and outcomes were extracted from the platform and combined to characterize the patient population and their clinical course. Oncologists were asked to identify examples where clinical practice guidelines (CPGs) or policy changes had varying impacts on practice. These constructs were evaluated by extracting the corresponding data. Results Breast cancer patients (5768) seen at the Juravinski Cancer Centre between January 2014 and June 2022 were included. The average age was 62.5 years. The commonest histology was invasive ductal carcinoma (74.6%); 77% were estrogen receptor-positive and 15.5% were HER2 Neu positive. Breast-conserving surgery (BCS) occurred in 56%. For the 4294 patients who received systemic therapy, the initial indications were adjuvant (3096), neoadjuvant (828) and palliative (370). Metastases occurred in 531 patients and 495 patients died. Lowest-income patients had a higher mortality rate. For the adoption of CPGs, the uptake for adjuvant bisphosphonate was very low, 8% as predicted, compared to 64% for pertuzumab, a HER2 targeted agent and 40.2% for CD4/6 inhibitors in metastases. During COVID-19, the provincial cancer agency issued a policy to shorten the duration of radiation after BCS. There was a significant reduction in the average number of fractions to the breast by five fractions. Conclusion Our platform characterized care and the clinical course of breast cancer patients. Practice changes in response to regulatory developments and policy changes were measured. Establishing a data platform is important for an LHS. The next step is for the data to feedback and change practice, that is, close the loop.
Collapse
Affiliation(s)
- Mark N. Levine
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Joel Kemppainen
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | - Morgan Rosenberg
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | | | - Jessica Bogach
- Department of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Tim Whelan
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Ashirbani Saha
- Department of OncologyMcMaster UniversityHamiltonOntarioCanada
- Escarpment Cancer Research InstituteHamiltonOntarioCanada
| | - Jonathan Ranisau
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
| | - Jeremy Petch
- Centre for Data Science and Digital HealthHamilton Health SciencesHamiltonOntarioCanada
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Population Health Research Institute, Hamilton Health SciencesHamiltonOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoHamiltonOntarioCanada
| |
Collapse
|
2
|
Petch J, Kempainnen J, Pettengell C, Aviv S, Butler B, Pond G, Saha A, Bogach J, Allard-Coutu A, Sztur P, Ranisau J, Levine M. Developing a Data and Analytics Platform to Enable a Breast Cancer Learning Health System at a Regional Cancer Center. JCO Clin Cancer Inform 2023; 7:e2200182. [PMID: 37001040 PMCID: PMC10281330 DOI: 10.1200/cci.22.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/10/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE This study documents the creation of automated, longitudinal, and prospective data and analytics platform for breast cancer at a regional cancer center. This platform combines principles of data warehousing with natural language processing (NLP) to provide the integrated, timely, meaningful, high-quality, and actionable data required to establish a learning health system. METHODS Data from six hospital information systems and one external data source were integrated on a nightly basis by automated extract/transform/load jobs. Free-text clinical documentation was processed using a commercial NLP engine. RESULTS The platform contains 141 data elements of 7,019 patients with newly diagnosed breast cancer who received care at our regional cancer center from January 1, 2014, to June 3, 2022. Daily updating of the database takes an average of 56 minutes. Evaluation of the tuning of NLP jobs found overall high performance, with an F1 of 1.0 for 19 variables, with a further 16 variables with an F1 of > 0.95. CONCLUSION This study describes how data warehousing combined with NLP can be used to create a prospective data and analytics platform to enable a learning health system. Although upfront time investment required to create the platform was considerable, now that it has been developed, daily data processing is completed automatically in less than an hour.
Collapse
Affiliation(s)
- Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Joel Kempainnen
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
| | | | | | | | - Greg Pond
- Escarpment Cancer Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Ashirbani Saha
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
- Escarpment Cancer Research Institute, Hamilton Health Sciences, Hamilton, Canada
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jessica Bogach
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Peter Sztur
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
| | - Jonathan Ranisau
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Canada
| | - Mark Levine
- Hamilton Health Sciences, Hamilton, Canada
- Escarpment Cancer Research Institute, Hamilton Health Sciences, Hamilton, Canada
| |
Collapse
|
3
|
Chen H. From the editor - In - Chief: Featured papers in the July issue. Am J Surg 2021; 222:1. [PMID: 34144773 DOI: 10.1016/j.amjsurg.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Hagen ME, Douissard J, Ris F, Toso C. Liquid biopsy & surgery: What's ahead? Am J Surg 2021; 222:1191-1192. [PMID: 34210398 DOI: 10.1016/j.amjsurg.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Jonathan Douissard
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Frederic Ris
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| |
Collapse
|