The Use of Natural Language Processing to Assess Social Support in Patients With Advanced Cancer

Data examining associations among social support, survival, and healthcare utilization are lacking in patients with advanced cancer. We conducted a cross-sectional secondary analysis using data from a prospective longitudinal cohort study of 966 hospitalized patients with advanced cancer at Massachu...

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Bibliographic Details
Published in:	The oncologist (Dayton, Ohio) Ohio), 2023-02, Vol.28 (2), p.165-171
Main Authors:	Bhatt, Sunil, Johnson, P Connor, Markovitz, Netana H, Gray, Tamryn, Nipp, Ryan D, Ufere, Nneka, Rice, Julia, Reynolds, Matthew J, Lavoie, Mitchell W, Clay, Madison A, Lindvall, Charlotta, El-Jawahri, Areej
Format:	Article
Language:	eng
Subjects:	Aged Cancer Cancer patients Care and treatment Computational linguistics Cross-Sectional Studies Electronic records Evaluation Health aspects Health Outcomes and Economics of Cancer Care Hospital patients Humans Language processing Longitudinal Studies Lung cancer Medical care Medical records Medical research Medicine, Experimental Natural language interfaces Natural Language Processing Neoplasms - therapy Prospective Studies Social aspects Social networks Utilization
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Summary:	Data examining associations among social support, survival, and healthcare utilization are lacking in patients with advanced cancer. We conducted a cross-sectional secondary analysis using data from a prospective longitudinal cohort study of 966 hospitalized patients with advanced cancer at Massachusetts General Hospital from 2014 through 2017. We used NLP to identify extent of patients' social support (limited versus adequate as defined by NLP-aided review of the Electronic Health Record (EHR)). Two independent coders achieved a Kappa of 0.90 (95% CI: 0.84-1.00) using NLP. Using multivariable regression models, we examined associations of social support with: 1) OS; 2) death or readmission within 90 days of hospital discharge; 3) time to readmission within 90 days; and 4) hospital length of stay (LOS). Patients' median age was 65 (range: 21-92) years, and a plurality had gastrointestinal (GI) cancer (34.3%) followed by lung cancer (19.5%). 6.2% (60/966) of patients had limited social support. In multivariable analyses, limited social support was not significantly associated with OS (HR = 1.13, P = 0.390), death or readmission (OR = 1.18, P = 0.578), time to readmission (HR = 0.92, P = 0.698), or LOS (β = -0.22, P = 0.726). We identified a potential interaction suggesting cancer type (GI cancer versus other) may be an effect modifier of the relationship between social support and OS (interaction term P = 0.053). In separate unadjusted analyses, limited social support was associated with lower OS (HR = 2.10, P = 0.008) in patients with GI cancer but not other cancer types (HR = 1.00, P = 0.991). We used NLP to assess the extent of social support in patients with advanced cancer. We did not identify significant associations of social support with OS or healthcare utilization but found cancer type may be an effect modifier of the relationship between social support and OS. These findings underscore the potential utility of NLP for evaluating social support in patients with advanced cancer.
ISSN:	1083-7159 1549-490X