1
|
Choo JM, Ryu HS, Kim JS, Cheong JY, Baek SJ, Kwak JM, Kim J. Conversational artificial intelligence (chatGPT™) in the management of complex colorectal cancer patients: early experience. ANZ J Surg 2024; 94:356-361. [PMID: 37905713 DOI: 10.1111/ans.18749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION In 2022 chatGPT™ (OpenAI, San Francisco) was introduced to the public. The complex reasoning and the natural language processing (NLP) ability of the AI platform has generated much excitement about the potential applications. This study conducted a preliminary analysis of the chatGPT™'s ability to formulate a management plan in accordance with oncological principles for patients with colorectal cancer. METHODOLOGY Colorectal cancer cases discussed in the multidisciplinary tumor (MDT) board at a single tertiary institution between September 2022 and January 2023 were prospectively collected. The treatment recommendations made by the chatGPT™ for Stage IV, recurrent, synchronous colorectal cancer were analysed for adherence to oncological principles. The recommendations by chatGPT™ were compared with the decision plans made by the MDT. RESULTS In all cases, the chatGPT™ was able to adhere to oncological principles. The recommendations in all 30 cases factored in the patient's overall health and functional status. The oncological management recommendation concordance rate between chatGPT™ and the MDT was 86.7%. CONCLUSIONS This study shows a high concordance rate of the chatGPT™'s recommendations with that given by the MDT in the management of complex colorectal patients. This will need to be verified in a larger prospective study.
Collapse
Affiliation(s)
- Jeong Min Choo
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Hyo Seon Ryu
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ji Seon Kim
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ju Yong Cheong
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Se-Jin Baek
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jung Myun Kwak
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jin Kim
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
2
|
Nervo A, Retta F, Ragni A, Piovesan A, Gallo M, Arvat E. Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective. Cancer Manag Res 2022; 14:3047-3062. [PMID: 36275786 PMCID: PMC9584766 DOI: 10.2147/cmar.s340967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with thyroid cancer (TC) usually have an excellent prognosis; however, 5-10% of them develop an advanced disease. The prognosis of this subgroup is still favourable if the lesions respond to radioactive iodine (RAI) treatment. Nearly two-thirds of advanced TC patients become RAI-refractory (RAI-R), and their management is challenging. A multidisciplinary approach in the context of a tumour board is essential to define a personalized strategy. Systemic therapy is not always the best option. In case of slow neoplastic growth and low tumour burden, active surveillance may represent a valuable choice. Local approaches might be considered if the disease progression is limited to a single or few lesions, also in combination and during systemic therapy. Antiresorptive treatment may be started in presence of bone metastases. In case of rapid and/or symptomatic progression involving multiple lesions and/or organs, systemic therapy has to be considered, in absence of contraindications. The multi-kinase inhibitors (MKIs) lenvatinib and sorafenib are currently available as first-line treatment for advanced progressive RAI-R TC. Among second-line options, cabozantinib has been recently approved in RAI-R TC who progressed during MKIs targeting the vascular endothelial growth factor receptor (VEGFR). In the last few years, next-generation sequencing (NGS) assays have been increasingly employed, permitting identification of the genetic alterations harboured by TC, with a significant impact on patients' management. Novel selective targeted therapies have been introduced for the treatment of RAI-R TC in selected cases: REarranged during Transfection (RET) inhibitors (selpercatinib and pralsetinib) and Tropomyosin Receptor Kinase (TRK) inhibitors (larotrectinib and entrectinib) have recently expanded the panorama of the therapeutic options. Moreover, immune checkpoint inhibitors (ICIs) have shown promising results, and they are still under investigation.
Collapse
Affiliation(s)
- Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy,Correspondence: Alice Nervo, Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Via Genova 3, Turin, 10126, Italy, Tel +390116336611, Fax +390116334703, Email
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| |
Collapse
|
3
|
Ankolekar A, van der Heijden B, Dekker A, Roumen C, De Ruysscher D, Reymen B, Berlanga A, Oberije C, Fijten R. Clinician perspectives on clinical decision support systems in lung cancer: Implications for shared decision-making. Health Expect 2022; 25:1342-1351. [PMID: 35535474 PMCID: PMC9327823 DOI: 10.1111/hex.13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Lung cancer treatment decisions are typically made among clinical experts in a multidisciplinary tumour board (MTB) based on clinical data and guidelines. The rise of artificial intelligence and cultural shifts towards patient autonomy are changing the nature of clinical decision‐making towards personalized treatments. This can be supported by clinical decision support systems (CDSSs) that generate personalized treatment information as a basis for shared decision‐making (SDM). Little is known about lung cancer patients' treatment decisions and the potential for SDM supported by CDSSs. The aim of this study is to understand to what extent SDM is done in current practice and what clinicians need to improve it. Objective To explore (1) the extent to which patient preferences are taken into consideration in non‐small‐cell lung cancer (NSCLC) treatment decisions; (2) clinician perspectives on using CDSSs to support SDM. Design Mixed methods study consisting of a retrospective cohort study on patient deviation from MTB advice and reasons for deviation, qualitative interviews with lung cancer specialists and observations of MTB discussions and patient consultations. Setting and Participants NSCLC patients (N = 257) treated at a single radiotherapy clinic and nine lung cancer specialists from six Dutch clinics. Results We found a 10.9% (n = 28) deviation rate from MTB advice; 50% (n = 14) were due to patient preference, of which 85.7% (n = 12) chose a less intensive treatment than MTB advice. Current MTB recommendations are based on clinician experience, guidelines and patients' performance status. Most specialists (n = 7) were receptive towards CDSSs but cited barriers, such as lack of trust, lack of validation studies and time. CDSSs were considered valuable during MTB discussions rather than in consultations. Conclusion Lung cancer decisions are heavily influenced by clinical guidelines and experience, yet many patients prefer less intensive treatments. CDSSs can support SDM by presenting the harms and benefits of different treatment options rather than giving single treatment advice. External validation of CDSSs should be prioritized. Patient or Public Contribution This study did not involve patients or the public explicitly; however, the study design was informed by prior interviews with volunteers of a cancer patient advocacy group. The study objectives and data collection were supported by Dutch health care insurer CZ for a project titled ‘My Best Treatment’ that improves patient‐centeredness and the lung cancer patient pathway in the Netherlands.
Collapse
Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Britt van der Heijden
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cary Oberije
- The D-Lab, GROW School for Oncology, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
4
|
Ferraioli D, Bally O, Meeus P, Benayoun D, Bakrin N, De Saint Hilaire P, Beal Ardisson D, Provençal J, Barletta H, Mousseau M, Chauleur C, Verbaere S, Knibiehly A, Fuso L, Charreton A, Devouassoux-Shisheboran M, Chopin N, Glehen O, Labrosse-Canat H, Farsi F, Ray-Coquard I. Impact of multidisciplinary tumour board in the management of ovarian carcinoma in the first-line setting. Exhaustive analysis from the Rhone-Alpes region. Eur J Cancer Care (Engl) 2020; 29:e13313. [PMID: 32894629 DOI: 10.1111/ecc.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Epithelial ovarian cancer (EOC) is a poor prognosis disease partly linked to diagnosis at an advanced stage. The quality of care management is a factor that needs to be explored, more specifically optimal organisation of first-line treatment. METHODS A retrospective study, dealing with all patients diagnosed within the Rhone-Alpes region with initial diagnosis EOC in 2012, was performed. The aim was to describe the impact of multidisciplinary tumour boards (MTB) in the organisation of care and the consequence on the patient's outcomes. RESULTS 271 EOC were analysed. 206 patients had an advanced EOC. Median progression-free survival (PFS) is 17.8 months (CI95%, 14.6-21.2) for AOC. 157 patients (57.9%) had a front-line surgery versus 114 patients (42.1%) interval debulking surgery. PFS for AOC patients with no residual disease is 24.3 months compared with 15.3 months for patients with residual disease (p = .01). No macroscopic residual disease is more frequent in the patients discussed before surgery in MTB compared with patients not submitted before surgery (73% vs. 56.2%, p < .001). CONCLUSION These results highlight the heterogeneity of medical practices in terms of front-line surgery versus interval surgery, in the administration of neoadjuvant chemotherapy and in the setting of MTB discussion.
Collapse
Affiliation(s)
- Domenico Ferraioli
- Gynecology Department, Leon Berard Cancer Center, Lyon, France.,Department of Internal Medicine, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Olivia Bally
- Oncology Department, Private Hospital Jean Mermoz, Lyon, France
| | - Pierre Meeus
- Surgical Department, Leon Berard Cancer Center, Lyon, France
| | - David Benayoun
- Oncology Department, University Hospital of Lyon, Lyon, France
| | - Naoual Bakrin
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | | | | | - Hugues Barletta
- Surgical Department, Private Hospital Drome Ardeche, Valence, France
| | - Mireille Mousseau
- Surgical Department, University Hospital of Grenoble, Grenoble, France
| | - Céline Chauleur
- Oncology Department, Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Sylvain Verbaere
- Surgical Department, Private Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alain Knibiehly
- Surgical Department, Hospital of Montelimar, Montelimar, France
| | - Luca Fuso
- Gynecology Oncology Department, Ordine Mauriziano Hospital, Turin, Italy
| | | | | | - Nicolas Chopin
- Gynecology Department, Leon Berard Cancer Center, Lyon, France
| | - Olivier Glehen
- Surgical Department, University Hospital of Lyon, Lyon, France
| | | | - Fadila Farsi
- Regional Network of Cancer (ONCO AuRA), Lyon, France
| | | |
Collapse
|
5
|
Gillis A, Morris M, Bhatt N, Ridgway P. Pilot evaluation of a novel observational tool for collaboration and communication within multidisciplinary team meetings (MDTs). Commun Med 2016; 13:135-147. [PMID: 29958345 DOI: 10.1558/cam.26716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite widespread use of multidisciplinary team meetings (MDTs) to facilitate patient care, little evidence exists that MDTs improve patient survival or impact care. Research into MDT function and outcome is limited. This pilot study looks to validate a novel tool developed to assess MDT functioning. METHODS A tool was developed with predefined Likert behaviour stems in the areas of structure, communication and collaboration. The tool was evaluated in nine MDTs by three independent observers and included participant evaluation. Inter-rater reliability was calculated with intraclass-correlation coefficients (ICC); Student's t-test was used to calculate significance in participant evaluation and matched observations. RESULTS The tool was used to evaluate 9 MDTs, discussing 133 cases. The overall ICC for the three coders was 0.935; for each MDT: 0.776-0.917. The inter-rater reliability for each MDT observation ranged from 0.245-0.923; the majority with an ICC >0.8. No significant difference was noted between participant evaluation and observer response. DISCUSSION MDTs provide a means of coordinating complex care for patients. This tool provides a means of evaluating group interaction within MDTs and is designed for use by different medical personnel. The pilot study has shown promising ICC; further evaluation is needed using a broader group of MDTs and including case complexity and outcome.
Collapse
|