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El-Sherbini AH, Coroneos S, Zidan A, Othman M. Machine Learning as a Diagnostic and Prognostic Tool for Predicting Thrombosis in Cancer Patients: A Systematic Review. Semin Thromb Hemost 2024; 50:809-816. [PMID: 38604227 DOI: 10.1055/s-0044-1785482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Khorana score (KS) is an established risk assessment model for predicting cancer-associated thrombosis. However, it ignores several risk factors and has poor predictability in some cancer types. Machine learning (ML) is a novel technique used for the diagnosis and prognosis of several diseases, including cancer-associated thrombosis, when trained on specific diagnostic modalities. Consolidating the literature on the use of ML for the prediction of cancer-associated thrombosis is necessary to understand its diagnostic and prognostic abilities relative to KS. This systematic review aims to evaluate the current use and performance of ML algorithms to predict thrombosis in cancer patients. This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases Medline, EMBASE, Cochrane, and ClinicalTrials.gov, were searched from inception to September 15, 2023, for studies evaluating the use of ML models for the prediction of thrombosis in cancer patients. Search terms "machine learning," "artificial intelligence," "thrombosis," and "cancer" were used. Studies that examined adult cancer patients using any ML model were included. Two independent reviewers conducted study selection and data extraction. Three hundred citations were screened, of which 29 studies underwent a full-text review, and ultimately, 8 studies with 22,893 patients were included. Sample sizes ranged from 348 to 16,407 patients. Thrombosis was characterized as venous thromboembolism (n = 6) or peripherally inserted central catheter thrombosis (n = 2). The types of cancer included breast, gastric, colorectal, bladder, lung, esophageal, pancreatic, biliary, prostate, ovarian, genitourinary, head-neck, and sarcoma. All studies reported outcomes on the ML's predictive capacity. The extreme gradient boosting appears to be the best-performing model, and several models outperform KS in their respective datasets.
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Affiliation(s)
- Adham H El-Sherbini
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stefania Coroneos
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ali Zidan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Patell R, Zwicker JI, Singh R, Mantha S. Machine learning in cancer-associated thrombosis: hype or hope in untangling the clot. BLEEDING, THROMBOSIS AND VASCULAR BIOLOGY 2024; 3:21-29. [PMID: 39323613 PMCID: PMC11423546 DOI: 10.4081/btvb.2024.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 09/27/2024]
Abstract
The goal of machine learning (ML) is to create informative signals and useful tasks by leveraging large datasets to derive computational algorithms. ML has the potential to revolutionize the healthcare industry by boosting productivity, enhancing safe and effective patient care, and lightening the load on clinicians. In addition to gaining mechanistic insights into cancer-associated thrombosis (CAT), ML can be used to improve patient outcomes, streamline healthcare delivery, and spur innovation. Our review paper delves into the present and potential applications of this cutting-edge technology, encompassing three areas: i) computer vision-assisted diagnosis of thromboembolism from radiology data; ii) case detection from electronic health records using natural language processing; iii) algorithms for CAT prediction and risk stratification. The availability of large, well-annotated, high-quality datasets, overfitting, limited generalizability, the risk of propagating inherent bias, and a lack of transparency among patients and clinicians are among the challenges that must be overcome in order to effectively develop ML in the health sector. To guarantee that this powerful instrument can be utilized to maximize innovation in CAT, clinicians can collaborate with stakeholders such as computer scientists, regulatory bodies, and patient groups.
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Affiliation(s)
- Rushad Patell
- Division of Medical Oncology and Hematology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jeffrey I. Zwicker
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Rohan Singh
- Department of Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Simon Mantha
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
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O'Connor S, Vercell A, Wong D, Yorke J, Fallatah FA, Cave L, Anny Chen LY. The application and use of artificial intelligence in cancer nursing: A systematic review. Eur J Oncol Nurs 2024; 68:102510. [PMID: 38310664 DOI: 10.1016/j.ejon.2024.102510] [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: 10/05/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Artificial Intelligence is being applied in oncology to improve patient and service outcomes. Yet, there is a limited understanding of how these advanced computational techniques are employed in cancer nursing to inform clinical practice. This review aimed to identify and synthesise evidence on artificial intelligence in cancer nursing. METHODS CINAHL, MEDLINE, PsycINFO, and PubMed were searched using key terms between January 2010 and December 2022. Titles, abstracts, and then full texts were screened against eligibility criteria, resulting in twenty studies being included. Critical appraisal was undertaken, and relevant data extracted and analysed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Artificial intelligence was used in numerous areas including breast, colorectal, liver, and ovarian cancer care among others. Algorithms were trained and tested on primary and secondary datasets to build predictive models of health problems related to cancer. Studies reported this led to improvements in the accuracy of predicting health outcomes or identifying variables that improved outcome prediction. While nurses led most studies, few deployed an artificial intelligence based digital tool with cancer nurses in a real-world setting as studies largely focused on developing and validating predictive models. CONCLUSION Electronic cancer nursing datasets should be established to enable artificial intelligence techniques to be tested and if effective implemented in digital prediction and other AI-based tools. Cancer nurses need more education on machine learning and natural language processing, so they can lead and contribute to artificial intelligence developments in oncology.
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Affiliation(s)
- Siobhan O'Connor
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Amy Vercell
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom; The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, United Kingdom.
| | - David Wong
- Leeds Institute for Health Informatics, University of Leeds, Leeds, United Kingdom.
| | - Janelle Yorke
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom; The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, United Kingdom.
| | - Fatmah Abdulsamad Fallatah
- Department of Nursing Affairs, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Louise Cave
- NHS Transformation Directorate, NHS England, England, United Kingdom.
| | - Lu-Yen Anny Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Drăgan A, Drăgan AŞ. Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice. Cancers (Basel) 2024; 16:458. [PMID: 38275899 PMCID: PMC10813930 DOI: 10.3390/cancers16020458] [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: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Many cancer patients will experience venous thromboembolism (VTE) at some stage, with the highest rate in the initial period following diagnosis. Novel cancer therapies may further enhance the risk. VTE in a cancer setting is associated with poor prognostic, a decreased quality of life, and high healthcare costs. If thromboprophylaxis in hospitalized cancer patients and perioperative settings is widely accepted in clinical practice and supported by the guidelines, it is not the same situation in ambulatory cancer patient settings. The guidelines do not recommend primary thromboprophylaxis, except in high-risk cases. However, nowadays, risk stratification is still challenging, although many tools have been developed. The Khrorana score remains the most used method, but it has many limits. This narrative review aims to present the current relevant knowledge of VTE risk assessment in ambulatory cancer patients, starting from the guideline recommendations and continuing with the specific risk assessment methods and machine learning models approaches. Biomarkers, genetic, and clinical features were tested alone or in groups. Old and new models used in VTE risk assessment are exposed, underlining their clinical utility. Imaging and biomolecular approaches to VTE screening of outpatients with cancer are also presented, which could help clinical decisions.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Adrian Ştefan Drăgan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
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Franco-Moreno A, Madroñal-Cerezo E, Muñoz-Rivas N, Torres-Macho J, Ruiz-Giardín JM, Ancos-Aracil CL. Prediction of Venous Thromboembolism in Patients With Cancer Using Machine Learning Approaches: A Systematic Review and Meta-Analysis. JCO Clin Cancer Inform 2023; 7:e2300060. [PMID: 37616550 DOI: 10.1200/cci.23.00060] [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: 04/06/2023] [Revised: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Recent studies have suggested that machine learning (ML) could be used to predict venous thromboembolism (VTE) in cancer patients with high accuracy. METHODS We aimed to evaluate the performance of ML in predicting VTE events in patients with cancer. PubMed, Web of Science, and EMBASE to identify studies were searched. RESULTS Seven studies involving 12,249 patients with cancer were included. The combined results of the different ML models demonstrated good accuracy in the prediction of VTE. In the training set, the global pooled sensitivity was 0.87, the global pooled specificity was 0.87, and the AUC was 0.91, and in the test set 0.65, 0.84, and 0.80, respectively. CONCLUSION The prediction ML models showed good performance to predict VTE. External validation to determine the result's reproducibility is necessary.
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Affiliation(s)
- Anabel Franco-Moreno
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - Elena Madroñal-Cerezo
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
- Medicine Department, Complutense University, Madrid, Spain
| | - Juan Torres-Macho
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
- Medicine Department, Complutense University, Madrid, Spain
| | - José Manuel Ruiz-Giardín
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Cristina L Ancos-Aracil
- Thromboembolism Unit, Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
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Mantha S, Chatterjee S, Singh R, Cadley J, Poon C, Chatterjee A, Kelly D, Sterpi M, Soff G, Zwicker J, Soria J, Ruiz M, Muñoz A, Arcila M. Application of Machine Learning to the Prediction of Cancer-Associated Venous Thromboembolism. RESEARCH SQUARE 2023:rs.3.rs-2870367. [PMID: 37214902 PMCID: PMC10197737 DOI: 10.21203/rs.3.rs-2870367/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Venous thromboembolism (VTE) is a common and impactful complication of cancer. Several clinical prediction rules have been devised to estimate the risk of a thrombotic event in this patient population, however they are associated with limitations. We aimed to develop a predictive model of cancer-associated VTE using machine learning as a means to better integrate all available data, improve prediction accuracy and allow applicability regardless of timing for systemic therapy administration. A retrospective cohort was used to fit and validate the models, consisting of adult patients who had next generation sequencing performed on their solid tumor for the years 2014 to 2019. A deep learning survival model limited to demographic, cancer-specific, laboratory and pharmacological predictors was selected based on results from training data for 23,800 individuals and was evaluated on an internal validation set including 5,951 individuals, yielding a time-dependent concordance index of 0.72 (95% CI = 0.70-0.74) for the first 6 months of observation. Adapted models also performed well overall compared to the Khorana Score (KS) in two external cohorts of individuals starting systemic therapy; in an external validation set of 1,250 patients, the C-index was 0.71 (95% CI = 0.65-0.77) for the deep learning model vs 0.66 (95% CI = 0.59-0.72) for the KS and in a smaller external cohort of 358 patients the C-index was 0.59 (95% CI = 0.50-0.69) for the deep learning model vs 0.56 (95% CI = 0.48-0.64) for the KS. The proportions of patients accurately reclassified by the deep learning model were 25% and 26% respectively. In this large cohort of patients with a broad range of solid malignancies and at different phases of systemic therapy, the use of deep learning resulted in improved accuracy for VTE incidence predictions. Additional studies are needed to further assess the validity of this model.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gerald Soff
- University of Miami Health System/Sylvester Comprehensive Cancer Center
| | | | - José Soria
- Biomedical Research Institute Sant Pau (IIB-Sant Pau)
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