Lu SC, Xu C, Nguyen CH, Geng Y, Pfob A, Sidey-Gibbons C. Machine Learning-Based Short-Term Mortality Prediction Models for Patients With Cancer Using Electronic Health Record Data: Systematic Review and Critical Appraisal.
JMIR Med Inform 2022;
10:e33182. [PMID:
35285816 PMCID:
PMC8961346 DOI:
10.2196/33182]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND
In the United States, national guidelines suggest that aggressive cancer care should be avoided in the final months of life. However, guideline compliance currently requires clinicians to make judgments based on their experience as to when a patient is nearing the end of their life. Machine learning (ML) algorithms may facilitate improved end-of-life care provision for patients with cancer by identifying patients at risk of short-term mortality.
OBJECTIVE
This study aims to summarize the evidence for applying ML in ≤1-year cancer mortality prediction to assist with the transition to end-of-life care for patients with cancer.
METHODS
We searched MEDLINE, Embase, Scopus, Web of Science, and IEEE to identify relevant articles. We included studies describing ML algorithms predicting ≤1-year mortality in patients of oncology. We used the prediction model risk of bias assessment tool to assess the quality of the included studies.
RESULTS
We included 15 articles involving 110,058 patients in the final synthesis. Of the 15 studies, 12 (80%) had a high or unclear risk of bias. The model performance was good: the area under the receiver operating characteristic curve ranged from 0.72 to 0.92. We identified common issues leading to biased models, including using a single performance metric, incomplete reporting of or inappropriate modeling practice, and small sample size.
CONCLUSIONS
We found encouraging signs of ML performance in predicting short-term cancer mortality. Nevertheless, no included ML algorithms are suitable for clinical practice at the current stage because of the high risk of bias and uncertainty regarding real-world performance. Further research is needed to develop ML models using the modern standards of algorithm development and reporting.
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