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Rapid learning in practice: A lung cancer survival decision support system in routine patient care data

BACKGROUND AND PURPOSE: A rapid learning approach has been proposed to extract and apply knowledge from routine care data rather than solely relying on clinical trial evidence. To validate this in practice we deployed a previously developed decision support system (DSS) in a typical, busy clinic for...

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Autores principales: Dekker, Andre, Vinod, Shalini, Holloway, Lois, Oberije, Cary, George, Armia, Goozee, Gary, Delaney, Geoff P., Lambin, Philippe, Thwaites, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5119278/
https://www.ncbi.nlm.nih.gov/pubmed/25241994
http://dx.doi.org/10.1016/j.radonc.2014.08.013
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author Dekker, Andre
Vinod, Shalini
Holloway, Lois
Oberije, Cary
George, Armia
Goozee, Gary
Delaney, Geoff P.
Lambin, Philippe
Thwaites, David
author_facet Dekker, Andre
Vinod, Shalini
Holloway, Lois
Oberije, Cary
George, Armia
Goozee, Gary
Delaney, Geoff P.
Lambin, Philippe
Thwaites, David
author_sort Dekker, Andre
collection PubMed
description BACKGROUND AND PURPOSE: A rapid learning approach has been proposed to extract and apply knowledge from routine care data rather than solely relying on clinical trial evidence. To validate this in practice we deployed a previously developed decision support system (DSS) in a typical, busy clinic for non-small cell lung cancer (NSCLC) patients. MATERIAL AND METHODS: Gender, age, performance status, lung function, lymph node status, tumor volume and survival were extracted without review from clinical data sources for lung cancer patients. With these data the DSS was tested to predict overall survival. RESULTS: 3919 lung cancer patients were identified with 159 eligible for inclusion, due to ineligible histology or stage, non-radical dose, missing tumor volume or survival. The DSS successfully identified a good prognosis group and a medium/poor prognosis group (2 year OS 69% vs. 27/30%, p < 0.001). Stage was less discriminatory (2 year OS 47% for stage I–II vs. 36% for stage IIIA–IIIB, p = 0.12) with most good prognosis patients having higher stage disease. The DSS predicted a large absolute overall survival benefit (~40%) for a radical dose compared to a non-radical dose in patients with a good prognosis, while no survival benefit of radical radiotherapy was predicted for patients with a poor prognosis. CONCLUSIONS: A rapid learning environment is possible with the quality of clinical data sufficient to validate a DSS. It uses patient and tumor features to identify prognostic groups in whom therapy can be individualized based on predicted outcomes. Especially the survival benefit of a radical versus non-radical dose predicted by the DSS for various prognostic groups has clinical relevance, but needs to be prospectively validated.
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spelling pubmed-51192782016-11-22 Rapid learning in practice: A lung cancer survival decision support system in routine patient care data Dekker, Andre Vinod, Shalini Holloway, Lois Oberije, Cary George, Armia Goozee, Gary Delaney, Geoff P. Lambin, Philippe Thwaites, David Radiother Oncol Article BACKGROUND AND PURPOSE: A rapid learning approach has been proposed to extract and apply knowledge from routine care data rather than solely relying on clinical trial evidence. To validate this in practice we deployed a previously developed decision support system (DSS) in a typical, busy clinic for non-small cell lung cancer (NSCLC) patients. MATERIAL AND METHODS: Gender, age, performance status, lung function, lymph node status, tumor volume and survival were extracted without review from clinical data sources for lung cancer patients. With these data the DSS was tested to predict overall survival. RESULTS: 3919 lung cancer patients were identified with 159 eligible for inclusion, due to ineligible histology or stage, non-radical dose, missing tumor volume or survival. The DSS successfully identified a good prognosis group and a medium/poor prognosis group (2 year OS 69% vs. 27/30%, p < 0.001). Stage was less discriminatory (2 year OS 47% for stage I–II vs. 36% for stage IIIA–IIIB, p = 0.12) with most good prognosis patients having higher stage disease. The DSS predicted a large absolute overall survival benefit (~40%) for a radical dose compared to a non-radical dose in patients with a good prognosis, while no survival benefit of radical radiotherapy was predicted for patients with a poor prognosis. CONCLUSIONS: A rapid learning environment is possible with the quality of clinical data sufficient to validate a DSS. It uses patient and tumor features to identify prognostic groups in whom therapy can be individualized based on predicted outcomes. Especially the survival benefit of a radical versus non-radical dose predicted by the DSS for various prognostic groups has clinical relevance, but needs to be prospectively validated. 2014-09-18 2014-10 /pmc/articles/PMC5119278/ /pubmed/25241994 http://dx.doi.org/10.1016/j.radonc.2014.08.013 Text en Radiotherapy and Oncology 113 (2014) 47–53 This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
spellingShingle Article
Dekker, Andre
Vinod, Shalini
Holloway, Lois
Oberije, Cary
George, Armia
Goozee, Gary
Delaney, Geoff P.
Lambin, Philippe
Thwaites, David
Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title_full Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title_fullStr Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title_full_unstemmed Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title_short Rapid learning in practice: A lung cancer survival decision support system in routine patient care data
title_sort rapid learning in practice: a lung cancer survival decision support system in routine patient care data
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5119278/
https://www.ncbi.nlm.nih.gov/pubmed/25241994
http://dx.doi.org/10.1016/j.radonc.2014.08.013
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