Chun-Kit Ngan

Background: Patients with cancer and cancer survivors often experience multiple chronic health conditions, which can impact symptom burden and treatment outcomes. Despite the high prevalence of multimorbidity, research on cancer prognosis has predominantly focused on cancers in isolation. There is growing interest in machine learning techniques for cancer studies. However, these methods have not been applied in the context of supportive care for patients with cancer who have multimorbidity. Furthermore, few studies have investigated the associations between comorbidity clusters and mortality outcomes. Objective: This study investigated comorbidity clusters among patients with cancer using machine learning and examined their associations with mortality outcomes in two large representative samples from the United States and Hong Kong. Methods: This study used data from the National Health and Nutrition Examination Survey (NHANES) and the Hospital Authority Data Collaboration Laboratory (HADCL). Participants aged ≥20 years with a history of cancer were included. The study used a two-step framework to identify clusters of comorbidities in NHANES. In the first step, we used four machine learning techniques, including the Bernoulli mixture model and partition-based methods, to cluster the comorbidities. In the second step, domain experts reviewed and ranked the identified clusters to ensure clinical relevance. The clusters that had the highest average rank were selected for further analysis. The associations between comorbidity clusters and mortality outcomes were analyzed using Cox proportional hazards models. We conducted an external validation to evaluate the generalizability of the clusters identified in the NHANES cohort and their associations with mortality using HADCL. The same number of clusters was replicated based on the distinctive patterns and distribution of comorbidities observed within each cluster. Results: The study included 4390 participants in NHANES and 12,484 participants in HADCL. Four comorbidity clusters were identified: low comorbidity, metabolic, cardiovascular disease (CVD), and respiratory. In NHANES, participants in the respiratory cluster had the highest risk of all-cause mortality (adjusted hazard ratio [aHR] 1.62, 95% CI 1.26‐2.08; P<.001), followed by the CVD cluster (aHR 1.50, 95% CI 1.26‐1.80; P<.001) compared to the low comorbidity cluster. The 3 clusters were associated with higher risks of CVD-related mortality (aHR 1.48‐3.05, 95% CI 1.14-4.07; P<.003). The effects of comorbidity clusters on mortality were modified by income-to-poverty ratio (P for interaction=.04), diet quality (P for interaction=.02), and cancer prognosis (P for interaction=.005). In the HADCL (validation) cohort, participants in the respiratory and CVD clusters had a higher risk of all-cause mortality. Conclusions: High comorbidity burden clusters showed increased all-cause and CVD-related mortality in patients with cancer. These findings highlight the significance of considering comorbidity burden in cancer care. Machine learning approaches can provide valuable insights into complex multimorbidity profiles. Further research is needed to deepen understanding of the relationships between multimorbidity and cancer-specific outcomes.

Background: The number of survivors of cancer is growing, and they often experience negative long-term behavioral outcomes due to cancer treatments. There is a need for better computational methods to handle and predict these outcomes so that physicians and health care providers can implement preventive treatments. Objective: This study aimed to create a new feature selection algorithm to improve the performance of machine learning classifiers to predict negative long-term behavioral outcomes in survivors of cancer. Methods: We devised a hybrid deep learning–based feature selection approach to support early detection of negative long-term behavioral outcomes in survivors of cancer. Within a data-driven, clinical domain–guided framework to select the best set of features among cancer treatments, chronic health conditions, and socioenvironmental factors, we developed a 2-stage feature selection algorithm, that is, a multimetric, majority-voting filter and a deep dropout neural network, to dynamically and automatically select the best set of features for each behavioral outcome. We also conducted an experimental case study on existing study data with 102 survivors of acute lymphoblastic leukemia (aged 15-39 years at evaluation and >5 years postcancer diagnosis) who were treated in a public hospital in Hong Kong. Finally, we designed and implemented radial charts to illustrate the significance of the selected features on each behavioral outcome to support clinical professionals’ future treatment and diagnoses. Results: In this pilot study, we demonstrated that our approach outperforms the traditional statistical and computation methods, including linear and nonlinear feature selectors, for the addressed top-priority behavioral outcomes. Our approach holistically has higher F1, precision, and recall scores compared to existing feature selection methods. The models in this study select several significant clinical and socioenvironmental variables as risk factors associated with the development of behavioral problems in young survivors of acute lymphoblastic leukemia. Conclusions: Our novel feature selection algorithm has the potential to improve machine learning classifiers’ capability to predict adverse long-term behavioral outcomes in survivors of cancer.

Background: Immunotherapy has become a game changer in cancer treatment. The internet has been used by patients as a platform to share personal experiences and seek medical guidance. Despite the increased utilization of immunotherapy in clinical practice, few studies have investigated the perceptions about its use by analyzing social media data. Objective: This study aims to use BERTopic (a topic modeling technique that is an extension of the Bidirectional Encoder Representation from Transformers machine learning model) to explore the perceptions of online cancer communities regarding immunotherapy. Methods: A total of 4.9 million posts were extracted from Facebook, Twitter, Reddit, and 16 online cancer-related forums. The textual data were preprocessed by natural language processing. BERTopic modeling was performed to identify topics from the posts. The effectiveness of isolating topics from the posts was evaluated using 3 metrics: topic diversity, coherence, and quality. Sentiment analysis was performed to determine the polarity of each topic and categorize them as positive or negative. Based on the topics generated through topic modeling, thematic analysis was conducted to identify themes associated with immunotherapy. Results: After data cleaning, 3.6 million posts remained for modeling. The highest overall topic quality achieved by BERTopic was 70.47% (topic diversity: 87.86%; topic coherence: 80.21%). BERTopic generated 14 topics related to the perceptions of immunotherapy. The sentiment score of around 0.3 across the 14 topics suggested generally positive sentiments toward immunotherapy within the online communities. Six themes were identified, primarily covering (1) hopeful prospects offered by immunotherapy, (2) perceived effectiveness of immunotherapy, (3) complementary therapies or self-treatments, (4) financial and mental impact of undergoing immunotherapy, (5) impact on lifestyle and time schedules, and (6) side effects due to treatment. Conclusions: This study provides an overview of the multifaceted considerations essential for the application of immunotherapy as a therapeutic intervention. The topics and themes identified can serve as supporting information to facilitate physician-patient communication and the decision-making process. Furthermore, this study also demonstrates the effectiveness of BERTopic in analyzing large amounts of data to identify perceptions underlying social media and online communities.

BACKGROUND The number of survivors of cancer is growing, and they often experience negative long-term behavioral outcomes due to cancer treatments. There is a need for better computational methods to handle and predict these outcomes so that physicians and health care providers can implement preventive treatments. OBJECTIVE This study aimed to create a new feature selection algorithm to improve the performance of machine learning classifiers to predict negative long-term behavioral outcomes in survivors of cancer. METHODS We devised a hybrid deep learning–based feature selection approach to support early detection of negative long-term behavioral outcomes in survivors of cancer. Within a data-driven, clinical domain–guided framework to select the best set of features among cancer treatments, chronic health conditions, and socioenvironmental factors, we developed a 2-stage feature selection algorithm, that is, a multimetric, majority-voting filter and a deep dropout neural network, to dynamically and automatically select the best set of features for each behavioral outcome. We also conducted an experimental case study on existing study data with 102 survivors of acute lymphoblastic leukemia (aged 15-39 years at evaluation and >5 years postcancer diagnosis) who were treated in a public hospital in Hong Kong. Finally, we designed and implemented radial charts to illustrate the significance of the selected features on each behavioral outcome to support clinical professionals’ future treatment and diagnoses. RESULTS In this pilot study, we demonstrated that our approach outperforms the traditional statistical and computation methods, including linear and nonlinear feature selectors, for the addressed top-priority behavioral outcomes. Our approach holistically has higher F1, precision, and recall scores compared to existing feature selection methods. The models in this study select several significant clinical and socioenvironmental variables as risk factors associated with the development of behavioral problems in young survivors of acute lymphoblastic leukemia. CONCLUSIONS Our novel feature selection algorithm has the potential to improve machine learning classifiers’ capability to predict adverse long-term behavioral outcomes in survivors of cancer.

This research work aims to develop an analytical approach for optimizing team formation and predicting team performance in a competitive environment based on data on the competitors' skills prior to the team formation. There are several approaches in scientific literature to optimize and predict a team's performance. However, most studies employ fine-grained skill statistics of the individual members or constraints such as teams with a set group of members. Currently, no research tackles the highly constrained domain of the FIRST Robotics Competition. This research effort aims to fill this gap by providing an analytical method for optimizing and predicting team performance in a competitive environment while allowing these constraints and only using metrics on previous team performance, not on each individual member's performance. We apply our method to the drafting process of the FIRST Robotics competition, a domain in which the skills change year-over-year, team members change throughout the season, each match only has a superficial set of statistics, and alliance formation is key to competitive success. First, we develop a method that could extrapolate individual members' performance based on overall team performance. An alliance optimization algorithm is developed to optimize team formation and a deep neural network model is trained to predict the winning team, both using highly post-processed real-world data. Our method is able to successfully extract individual members' metrics from overall team statistics, form competitive teams, and predict the winning team with 84.08% accuracy.

Background: Patients with cancer are increasingly using forums and social media platforms to access health information and share their experiences, particularly in the use of traditional, complementary, and integrative medicine (TCIM). Despite the popularity of TCIM among patients with cancer, few related studies have used data from these web-based sources to explore the use of TCIM among patients with cancer. Objective: This study leveraged multiple forums and social media platforms to explore patients’ use, interest, and perception of TCIM for cancer care. Methods: Posts (in English) related to TCIM were collected from Facebook, Twitter, Reddit, and 16 health forums from inception until February 2022. Both manual assessments and natural language processing were performed. Descriptive analyses were performed to explore the most commonly discussed TCIM modalities for each symptom and cancer type. Sentiment analyses were performed to measure the polarity of each post or comment, and themes were identified from posts with positive and negative sentiments. TCIM modalities that are emerging or recommended in the guidelines were identified a priori. Exploratory topic-modeling analyses with latent Dirichlet allocation were conducted to investigate the patients’ perceptions of these modalities. Results: Among the 1,620,755 posts available, cancer-related symptoms, such as pain (10/10, 100% cancer types), anxiety and depression (9/10, 90%), and poor sleep (9/10, 90%), were commonly discussed. Cannabis was among the most frequently discussed TCIM modalities for pain in 7 (70%) out of 10 cancer types, as well as nausea and vomiting, loss of appetite, anxiety and depression, and poor sleep. A total of 7 positive and 7 negative themes were also identified. The positive themes included TCIM, making symptoms manageable, and reducing the need for medication and their side effects. The belief that TCIM and conventional treatments were not mutually exclusive and intolerance to conventional treatment may facilitate TCIM use. Conversely, TCIM was viewed as leading to patients’ refusal of conventional treatment or delays in diagnosis and treatment. Doctors’ ignorance regarding TCIM and the lack of information provided about TCIM may be barriers to its use. Exploratory analyses showed that TCIM recommendations were well discussed among patients; however, these modalities were also used for many other indications. Other notable topics included concerns about the legalization of cannabis, acupressure techniques, and positive experiences of meditation. Conclusions: Using machine learning techniques, social media and health forums provide a valuable resource for patient-generated data regarding the pattern of use and patients’ perceptions of TCIM. Such information will help clarify patients’ needs and concerns and provide directions for research on integrating TCIM into cancer care. Our results also suggest that effective communication about TCIM should be achieved and that doctors should be more open-minded to actively discuss TCIM use with their patients.

BACKGROUND Patients with cancer are increasingly using forums and social media platforms to access health information and share their experiences, particularly in the use of traditional, complementary, and integrative medicine (TCIM). Despite the popularity of TCIM among patients with cancer, few related studies have used data from these web-based sources to explore the use of TCIM among patients with cancer. OBJECTIVE This study leveraged multiple forums and social media platforms to explore patients’ use, interest, and perception of TCIM for cancer care. METHODS Posts (in English) related to TCIM were collected from Facebook, Twitter, Reddit, and 16 health forums from inception until February 2022. Both manual assessments and natural language processing were performed. Descriptive analyses were performed to explore the most commonly discussed TCIM modalities for each symptom and cancer type. Sentiment analyses were performed to measure the polarity of each post or comment, and themes were identified from posts with positive and negative sentiments. TCIM modalities that are emerging or recommended in the guidelines were identified a priori. Exploratory topic-modeling analyses with latent Dirichlet allocation were conducted to investigate the patients’ perceptions of these modalities. RESULTS Among the 1,620,755 posts available, cancer-related symptoms, such as pain (10/10, 100% cancer types), anxiety and depression (9/10, 90%), and poor sleep (9/10, 90%), were commonly discussed. Cannabis was among the most frequently discussed TCIM modalities for pain in 7 (70%) out of 10 cancer types, as well as nausea and vomiting, loss of appetite, anxiety and depression, and poor sleep. A total of 7 positive and 7 negative themes were also identified. The positive themes included TCIM, making symptoms manageable, and reducing the need for medication and their side effects. The belief that TCIM and conventional treatments were not mutually exclusive and intolerance to conventional treatment may facilitate TCIM use. Conversely, TCIM was viewed as leading to patients’ refusal of conventional treatment or delays in diagnosis and treatment. Doctors’ ignorance regarding TCIM and the lack of information provided about TCIM may be barriers to its use. Exploratory analyses showed that TCIM recommendations were well discussed among patients; however, these modalities were also used for many other indications. Other notable topics included concerns about the legalization of cannabis, acupressure techniques, and positive experiences of meditation. CONCLUSIONS Using machine learning techniques, social media and health forums provide a valuable resource for patient-generated data regarding the pattern of use and patients’ perceptions of TCIM. Such information will help clarify patients’ needs and concerns and provide directions for research on integrating TCIM into cancer care. Our results also suggest that effective communication about TCIM should be achieved and that doctors should be more open-minded to actively discuss TCIM use with their patients.