JMIR Cancer最新文献

Unlabelled: Despite growing evidence that narrative expertise may benefit cancer care professionals and the field, few hematology-oncology trainees pursue graduate degrees in the humanities. For those trainees with a particular interest in humanism in medicine, we advocate for integration of a Master of Fine Arts (MFA) degree concurrent with fellowship training. This pathway enables trainees to gain advanced skills in narrative competence, informing research and scholarly activities during fellowship and building a foundation for future careers that promote humanism in the field of hematology-oncology across clinical practice, education, research, and advocacy. Narrative competence describes the ability to create space for and elevate the voices of patients, families, and clinicians, which includes active listening, reflecting, sharing, and being moved by stories. In this paper, we review evidence suggesting that frequent exposure to suffering can threaten career longevity for cancer care clinicians, and we highlight narrative competence as an approach to mitigate moral distress, improve well-being, and bolster resilience for our workforce. The influence of narrative competence extends beyond patient care, with meaningful ramifications for advancing research, education, and advocacy efforts across the field. We encourage institutions with hematology-oncology fellowship programs that have capacity to support graduate studies to include the MFA as an option for trainees who aim to become thought leaders and experts in narrative competence. The MFA serves as a strategic mechanism to invest in growing the next generation of hematologist-oncologists with expertise in narrative competence to advance the field.

Background: Electronic health records contain inconsistently structured or free-text data, requiring efficient preprocessing to enable predictive health care models. Although artificial intelligence-driven natural language processing tools show promise for automating diagnosis classification, their comparative performance and clinical reliability require systematic evaluation.

Objective: The aim of this study is to evaluate the performance of 4 large language models (GPT-3.5, GPT-4o, Llama 3.2, and Gemini 1.5) and BioBERT in classifying cancer diagnoses from structured and unstructured electronic health records data.

Methods: We analyzed 762 unique diagnoses (326 International Classification of Diseases [ICD] code descriptions, 436 free-text entries) from 3456 records of patients with cancer. Models were tested on their ability to categorize diagnoses into 14 predefined categories. Two oncology experts validated classifications.

Results: BioBERT achieved the highest weighted macro F1-score for ICD codes (84.2) and matched GPT-4o in ICD code accuracy (90.8). For free-text diagnoses, GPT-4o outperformed BioBERT in weighted macro F1-score (71.8 vs 61.5) and achieved slightly higher accuracy (81.9 vs 81.6). GPT-3.5, Gemini, and Llama showed lower overall performance on both formats. Common misclassification patterns included confusion between metastasis and central nervous system tumors, as well as errors involving ambiguous or overlapping clinical terminology.

Conclusions: Although current performance levels appear sufficient for administrative and research use, reliable clinical applications will require standardized documentation practices alongside robust human oversight for high-stakes decision-making.

Background: Several guidelines recommend posttreatment surveillance for non-small cell lung cancer (NSCLC). However, studies evaluating surveillance patterns often cannot distinguish between imaging ordered for surveillance versus for symptoms suggestive of recurrence. Moreover, early recurrences and other competing events hamper efforts to determine true surveillance rates because of wide variability in reported guideline adherence in clinical practice. Leveraging comprehensive Veterans Health Administration data, we developed a novel competing risks framework to describe the patterns and predictors of NSCLC imaging surveillance.

Objective: This study aims to examine posttreatment surveillance to estimate the true surveillance rates and predictors of guideline-concordant care in patients with early-stage NSCLC.

Methods: The study cohort comprised veterans who were treated for stage 1 to 3 NSCLC between 2008 and 2016 and who survived for ≥6 months. Clinical documents and radiology reports were abstracted for image indication and clinical information. We estimated the cumulative probability of receiving guideline-concordant surveillance, defined as chest computed tomography imaging within 4 to 9 months after treatment, accounting for competing risks and censoring. Multivariable cause-specific Cox regression was used to estimate associations between patient factors and guideline-concordant surveillance, with adjustments made for multiple comparisons.

Results: The cohort consisted of 1888 patients. The mean age of the analysis cohort was 66.4 (SD 7.9) years; 95.9% (1811/1888) of the patients were male, 71.1% (1342/1888) of the patients were White, and 43.1% (814/1888) were married. Of the 1888 patients, 57% (n=1076) presented with stage 1 disease, and the most common treatment modality was surgery alone (n=1068, 56.6%). The most common type of imaging performed during the initial 120- to 270-day window was chest computed tomography (1460/3278, 44.5%). Chest X-rays accounted for 36.3% (1190/3278) of all imaging performed, while the remaining 11.8% (386/3278) and 7.4% (242/3278) were positron emission tomography scans or other imaging modalities, respectively. Compared to the years 2008 to 2010, patients treated for NSCLC from 2014 to 2016 had a significantly higher likelihood of receiving guideline-concordant surveillance (hazard ratio 1.42, P<.001).

Conclusions: In this unique application of a competing risks framework, the rate of guideline-concordant surveillance in this national cohort was lower than that reported in many previous studies. This finding highlights a potentially substantial gap in surveillance among eligible, asymptomatic lung cancer survivors. More strategies are needed to measure the true rate of guideline-concordant surveillance, along with education and advocacy to ensure guideline-concordant care.

Background: A growing number of people are living with comorbid dementia and cancer (CDC), and they are particularly likely to require support from family caregivers. Carers of people with CDC play a vital supportive role but have reported unmet support needs, including a lack of CDC-specific information resources and peer support. A targeted online peer support forum may provide an accessible way to help address unmet needs of carers of people with CDC.

Objective: This study aimed to explore the types and frequency of social support provided on an online peer support forum for caregivers of people with CDC, hosted by a dementia charity in the United Kingdom.

Methods: We conducted a mixed methods study using descriptive statistics and qualitative content analysis. All posts (N=893) on the forum since its launch in November 2018 to April 2024 were exported into Microsoft Excel for analysis. Descriptive statistics were used to examine forum use and user characteristics. Deductive content analysis was conducted to explore the types and frequency of social support provided on the forum. Posts were analyzed according to an adapted version of Cutrona and Suhr's Social Support Behavior Code, consisting of 5 main categories of support: informational, emotional, esteem, network, and tangible. Coding was completed independently by 2 coders, and any coding disagreements were resolved by reaching a consensus through discussion.

Results: A total of 258 usernames posted on the forum since its inception. There were 893 posts; 583 (65.3%) were coded as providing social support. All 5 Social Support Behavior Code categories were present in the forum posts. Informational support was the most common type of social support provided on the forum, which mostly involved providing suggestions for caregiving and coping strategies and sharing personal experiences that provide CDC-specific knowledge or insight. This was followed by emotional support, which consisted mostly of expressing shared understanding and empathy for caregivers in their unique situation of CDC and providing expressions of care for the recipient's well-being. Esteem, network, and tangible support were less common, though they included providing validation and relief of blame to other caregivers, typically in decision-making regarding cancer treatment; reminding caregivers that others were available on the forum for support; and expressing willingness to answer questions about their CDC caregiving experience.

Conclusions: This study demonstrates the use and value of a CDC-specific online forum as a source of social support for carers of people with CDC, facilitating users' access to CDC-specific information and peer support. The relatively new forum shows promise as a free and accessible resource that can contribute to addressing carers' informational and peer support needs.

Background: Online self-management interventions for cancer survivors are increasingly being used, but engagement is often difficult for patients. Given the importance of engagement for intervention effectiveness, identifying patient-reported barriers and facilitators is essential.

Objective: The aim of this study was to qualitatively examine barriers and facilitators influencing engagement with an online self-management intervention, offered with or without guidance, for cancer survivors experiencing chronic painful chemotherapy-induced peripheral neuropathy (CIPN).

Methods: Patients who took part in the Embrace Pain randomized controlled trial, conducted between December 2021 and July 2024, were invited to participate in this study. Eligible participants were adults with chronic painful CIPN, based on criteria including pain, completion of chemotherapy, and European Organisation for Research and Treatment of Cancer QLQ-CIPN20 Questionnaire (ie, cancer-specific measure of sensory, motor, and autonomic neuropathy). The Embrace Pain randomized controlled trial involved evaluating an online self-management acceptance and commitment therapy intervention for pain interference in daily life, with some participants receiving email guidance and others not. Thereafter, 12 patients experiencing chronic painful CIPN participated in semistructured interviews. Data were analyzed using thematic analysis. An inductive coding approach was applied, and Atlas.ti (Lumivero) was used for coding.

Results: In total, 2 themes and 17 codes emerged from the data, namely 7 codes for barriers and 10 codes for facilitators. Barriers included program schedule, burden, lack of guidance, irrelevance, mindfulness exercises, usability, and missing content. Facilitators included usability, recognition, positive self-management, program schedule, symptom management, relevance, guidance, experiential exercises, mindfulness exercises, and value-based living. Program schedule, guidance, mindfulness exercises, and usability proved to be barriers for some, while others indicated that they were facilitators for their use.

Conclusions: Participants' perceptions of the intervention varied, with engagement influenced by individual circumstances. These variations highlight the importance of personal context in shaping both uptake and effectiveness, indicating a need for tailored approaches to address diverse needs and challenges faced by participants.

As patients with cancer increasingly seek guidance from online sources, the patient-clinician relationship is at risk of being displaced by fragmented, often unreliable information. One of the primary drivers of this trend is the insufficient time available for in-depth, relational consultation with health care providers (HCPs). We argue that the current clinical routine, constrained by documentation and administrative demands, fails to allow adequate time for supporting the informational, emotional, and relational needs of patients navigating complex decisions. This shortfall undermines HCPs' ability to engage patients in shared decision-making and weakens the foundation of trust between patient and HCP. For some patients, this can result in selecting less-effective treatments or turning away from evidence-based care toward unproven online alternatives. While policy reforms to reduce administrative burdens and free up time for patient education and counseling are essential, they are slow to materialize, making immediate, actionable steps at the clinician level more urgent. We propose a set of practical, evidence-informed strategies that clinicians can adopt today to help meet patients' informational and emotional needs, strengthen patient-HCP relationships, and ensure that patients' health care decisions fit their preferences and are supported by scientific evidence.

Background: Insomnia affects the quality of life and health outcomes of cancer survivors. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia among cancer survivors, but it is not readily accessible due to the limited number of trained providers and the difficulties in providing care across wide geographical areas. Mobile health (mHealth) technologies represent a promising solution; however, these technologies are not tailored to the unique needs of cancer survivors.

Objective: This study aimed to understand the needs and preferences of cancer survivors and test the usability of an evidence-based CBT-I smartphone app called iCANSleep that will be tailored and accessible to cancer survivors.

Methods: A user-centered design (UCD) approach was applied, and cancer survivors were actively engaged in the app's design, usability testing, and prototype refinement. In phase 1, semistructured interviews were conducted with a purposive sample of cancer survivors (n=20) to inform the design of the app and its content. In phase 2, iterative low- (n=8) and high-fidelity (n=7) usability testing was conducted with participants until no further recommendations for change were suggested.

Results: Users suggested several defining characteristics, features, and desired functionalities, including a user-friendly and evidence-based design. They saw increased accessibility and simplicity as advantages of a mobile app but expressed some concerns about data security and losing the accountability that comes with in-person treatment. User testing highlighted the preference for images of real people and diverse stories over graphics and animated videos, and offered suggestions for enhanced navigation. The first iteration of the app was developed using the information gained during the needs assessment and usability testing. Feedback was integrated into the final prototype of the iCANSleep app, which will be tested for feasibility, acceptability, and efficacy.

Conclusions: Cancer survivors desire an insomnia treatment app that is simple, user-friendly, evidence-based, convenient, and secure. The iCANSleep app represents the merging of mHealth principles and best practices with evidence-based insomnia care, allowing for an intervention with minimal access barriers related to cost, geography, and provider availability. Feasibility, acceptability, and efficacy of the intervention will be maximized by following a UCD framework involving the engagement of end users at every design stage.