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Non-compliance with a postmastectomy radiotherapy guideline: Decision tree and cause analysis
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
2008 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, Vol. 8, no 41Article in journal (Refereed) Published
Abstract [en]

Background: The guideline for postmastectomy radiotherapy (PMRT), which is prescribed to reduce recurrence of breast cancer in the chest wall and improve overall survival, is not always followed. Identifying and extracting important patterns of non-compliance are crucial in maintaining the quality of care in Oncology.

Methods: Analysis of 759 patients with malignant breast cancer using decision tree induction (DTI) found patterns of non-compliance with the guideline. The PMRT guideline was used to separate cases according to the recommendation to receive or not receive PMRT. The two groups of patients were analyzed separately. Resulting patterns were transformed into rules that were then compared with the reasons that were extracted by manual inspection of records for the non-compliant cases.

Results: Analyzing patients in the group who should receive PMRT according to the guideline did not result in a robust decision tree. However, classification of the other group, patients who should not receive PMRT treatment according to the guideline, resulted in a tree with nine leaves and three of them were representing non-compliance with the guideline. In a comparison between rules resulting from these three non-compliant patterns and manual inspection of patient records, the following was found:

In the decision tree, presence of perigland growth is the most important variable followed by number of malignantly invaded lymph nodes and level of Progesterone receptor. DNA index, age, size of the tumor and level of Estrogen receptor are also involved but with less importance. From manual inspection of the cases, the most frequent pattern for non-compliance is age above the threshold followed by near cut-off values for risk factors and unknown reasons.

Conclusion: Comparison of patterns of non-compliance acquired from data mining and manual inspection of patient records demonstrates that not all of the non-compliances are repetitive or important. There are some overlaps between important variables acquired from manual inspection of patient records and data mining but they are not identical. Data mining can highlight non-compliance patterns valuable for guideline authors and for medical audit. Improving guidelines by using feedback from data mining can improve the quality of care in oncology.

Place, publisher, year, edition, pages
2008. Vol. 8, no 41
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-15222OAI: oai:DiVA.org:liu-15222DiVA: diva2:113697
Note
Original publication: Amir R Razavi, Hans Gill, Hans Åhlfeldt and Nosrat Shahsavar, Non-compliance with a postmastectomy radiotherapy guideline: Decision tree and cause analysis, 2008, BMC Medical Informatics and Decision Making, (8), 41.http://dx.doi.org/10.1186/1472-6947-8-41. Copyright: The authorsAvailable from: 2008-10-24 Created: 2008-10-24 Last updated: 2012-02-22Bibliographically approved
In thesis
1. Applications of Knowledge Discovery in Quality Registries - Predicting Recurrence of Breast Cancer and Analyzing Non-compliance with a Clinical Guideline
Open this publication in new window or tab >>Applications of Knowledge Discovery in Quality Registries - Predicting Recurrence of Breast Cancer and Analyzing Non-compliance with a Clinical Guideline
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In medicine, data are produced from different sources and continuously stored in data depositories. Examples of these growing databases are quality registries. In Sweden, there are many cancer registries where data on cancer patients are gathered and recorded and are used mainly for reporting survival analyses to high level health authorities.

In this thesis, a breast cancer quality registry operating in South-East of Sweden is used as the data source for newer analytical techniques, i.e. data mining as a part of knowledge discovery in databases (KDD) methodology. Analyses are done to sift through these data in order to find interesting information and hidden knowledge. KDD consists of multiple steps, starting with gathering data from different sources and preparing them in data pre-processing stages prior to data mining.

Data were cleaned from outliers and noise and missing values were handled. Then a proper subset of the data was chosen by canonical correlation analysis (CCA) in a dimensionality reduction step. This technique was chosen because there were multiple outcomes, and variables had complex relationship to one another.

After data were prepared, they were analyzed with a data mining method. Decision tree induction as a simple and efficient method was used to mine the data. To show the benefits of proper data pre-processing, results from data mining with pre-processing of the data were compared with results from data mining without data pre-processing. The comparison showed that data pre-processing results in a more compact model with a better performance in predicting the recurrence of cancer.

An important part of knowledge discovery in medicine is to increase the involvement of medical experts in the process. This starts with enquiry about current problems in their field, which leads to finding areas where computer support can be helpful. The experts can suggest potentially important variables and should then approve and validate new patterns or knowledge as predictive or descriptive models. If it can be shown that the performance of a model is comparable to domain experts, it is more probable that the model will be used to support physicians in their daily decision-making. In this thesis, we validated the model by comparing predictions done by data mining and those made by domain experts without finding any significant difference between them.

Breast cancer patients who are treated with mastectomy are recommended to receive radiotherapy. This treatment is called postmastectomy radiotherapy (PMRT) and there is a guideline for prescribing it. A history of this treatment is stored in breast cancer registries. We analyzed these datasets using rules from a clinical guideline and identified cases that had not been treated according to the PMRT guideline. Data mining revealed some patterns of non-compliance with the PMRT guideline. Further analysis with data mining revealed some reasons for guideline non-compliance. These patterns were then compared with reasons acquired from manual inspection of patient records. The comparisons showed that patterns resulting from data mining were limited to the stored variables in the registry. A prerequisite for better results is availability of comprehensive datasets.

Medicine can take advantage of KDD methodology in different ways. The main advantage is being able to reuse information and explore hidden knowledge that can be obtained using advanced analysis techniques. The results depend on good collaboration between medical informaticians and domain experts and the availability of high quality data.

Place, publisher, year, edition, pages
Institutionen för medicinsk teknik, 2007. 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1018
Keyword
Breast cancer, Clinical guidelines, Canonical correlation analysis, Data Mining, Data pre-processing, Decision tree induction, Knowledge Discovery in Databases
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:liu:diva-10142 (URN)978-91-85895-81-6 (ISBN)
Public defence
2007-11-22, Elsa Brändström, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-10-30 Created: 2007-10-30 Last updated: 2009-05-12

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