search

OHDSI / OncologyWG

Oncology Working Group Repository
https://ohdsi.github.io/OncologyWG
Apache License 2.0
56 stars 24 forks source link

Disambiguate the Hemonc.org “OR” regimens into multiple regimens. #70

Open mgurley opened 5 years ago

jeremywarner commented 5 years ago

The following ambiguous regimens have been resolved: Those containing prednisone and prednisolone Those containing trastuzumab and Trastuzumab and hyaluronidase Those containing rituximab and Rituximab and hyaluronidase Those containing L-asparaginase and Erwinaze *Those containing folinic acid and levoleucovorin

Still to-do but probably can wait until after the symposium Those containing more than one interferon, including peg-interferon Others that I haven't found yet

cgreich commented 5 years ago

Actually, there are a whole lot of ambiguous cases, where the containing drugs are identical, but the regimen is different. 444 of them. The cases are due to:

1. Different dosages 35806136 | IL-2 monotherapy | Aldesleukin 35806131 | High-dose Interleukin-2 | Aldesleukin 35806132 | Low-dose Interleukin-2 | Aldesleukin

2. Non-chemo components 35803617 | BFR | bendamustine,fludarabine,rituximab 35806101 | BFR, then allo HSCT | bendamustine,fludarabine,rituximab

3. Missing components 35803688 | Bevacizumab monotherapy | bevacizumab 35804263 | Doxorubicin non-pegylated liposomal and Bevacizumab | bevacizumab

4. Assigning components, when a classification of components would be more appropriate 35806840 | Bicalutamide monotherapy | bicalutamide 35806821 | ADT | bicalutamide

5. Truly same cocktail with different dosages for slightly different populations 35805112 | VACOP-B | Bleomycin,Cyclophosphamide,Doxorubicin,Etoposide,Prednisone,Vincristine 35805817 | ABVE-PC | Bleomycin,Cyclophosphamide,Doxorubicin,Etoposide,Prednisone,Vincristine

6. Same chemo, but different formulation of the components 35804247 | Capecitabine and Paclitaxel | capecitabine,Paclitaxel 35804248 | Capecitabine and Paclitaxel, nanoparticle albumin-bound | capecitabine,Paclitaxel

7. Alternating schedules vs constant schedules 35805447 | VACA | Cyclophosphamide,Dactinomycin,Doxorubicin,Vincristine 35805457 | VAdCA | Cyclophosphamide,Dactinomycin,Doxorubicin,Vincristine

8. Different route of administration 35806901 | Axitinib monotherapy | axitinib 35805789 | Axitinib and TACE | axitinib

Some differences are legit, and our detection algorithms need to be able to figure it out. Others might need some debugging or additional info. But I am not sure.

jeremywarner commented 5 years ago

Gee, is that all? 😊 – at least it isn’t every single regimen!

This is a different type of ambiguity and gets to the meat of it – taking care of the “OR” regimens was a necessary first step but doesn’t resolve this ambiguity. How to distinguish AC from ddAC? One can’t from just the drug names, but one can at least narrow down the possibilities. Specific responses, below.

Best, Jeremy

Jeremy L. Warner MD, MS, FAMIA Associate Professor of Medicine and Biomedical Informatics at Vanderbilt University Medical Director, Vanderbilt Cancer Registry Chair, AMIA Visual Analytics Work Group Deputy Editor, HemOnc.org

Rhonda N. Fox Administrative Assistant II rhonda.fox@vumc.org 615.322.4967

From: Christian Reich notifications@github.com Reply-To: OHDSI/OncologyWG reply@reply.github.com Date: Monday, September 2, 2019 at 1:45 PM To: OHDSI/OncologyWG OncologyWG@noreply.github.com Cc: "Warner, Jeremy" jeremy.warner@vumc.org, Comment comment@noreply.github.com Subject: Re: [OHDSI/OncologyWG] Disambiguate the Hemonc.org “OR” regimens into multiple regimens. (#70)

Actually, there are a whole lot of ambiguous cases, where the containing drugs are identical, but the regimen is different. 444 of them. The cases are due to:

  1. Different dosages 35806136 | IL-2 monotherapy | Aldesleukin 35806131 | High-dose Interleukin-2 | Aldesleukin 35806132 | Low-dose Interleukin-2 | Aldesleukin

IL-2 monotherapy shouldn’t exist, but the others need to be kept separate; the doses and schedules and supportive meds and efficacy are very different. There are others that we’re in the process of combining, such as 7+3d (low-dose), 7+3d (standard-dose), 7+3d (intermediate-dose), and 7+3d (high-dose). There is no one easy rule to distinguish a “variant” from a truly separate regimen.

  1. Non-chemo components 35803617 | BFR | bendamustine,fludarabine,rituximab 35806101 | BFR, then allo HSCT | bendamustine,fludarabine,rituximab

Allo HSCT should be a thing, not just a placeholder – we’re in processing of adding it as an immunotherapy. That will disambiguate these.

  1. Missing components 35803688 | Bevacizumab monotherapy | bevacizumab 35804263 | Doxorubicin non-pegylated liposomal and Bevacizumab | bevacizumab

This is an example of a drug that doesn’t have an RxNorm code (NPLD/Myocet). In the HemOnc relationship “Has antineoplastic” these regimens are not ambiguous; it is only in the “Has antineopl Rx” that they are. Solution I guess is to assign an RxNorm extension to NPLD and similar?

  1. Assigning components, when a classification of components would be more appropriate 35806840 | Bicalutamide monotherapy | bicalutamide 35806821 | ADT | bicalutamide

Agree – this is an artifact of how things are represented on the website, e.g. https://hemonc.org/wiki/Prostate_cancer#ADT_2. The problem is that there are three types of ADT: LHRH agonist/analogue, LHRH antagonist, and Bilateral orchiectomy. The first two are classes in themselves. Some regimens specify a choice of 1 of the 3, some 2 of the 3, some all 3. In all cases it is “ADT”. Ideas on how to solve this?

  1. Truly same cocktail with different dosages for slightly different populations 35805112 | VACOP-B | Bleomycin,Cyclophosphamide,Doxorubicin,Etoposide,Prednisone,Vincristine 35805817 | ABVE-PC | Bleomycin,Cyclophosphamide,Doxorubicin,Etoposide,Prednisone,Vincristine

These are examples where we have to embrace the ambiguity and look for another way to arrive at the answer, perhaps through NLP of the clinician notes!

  1. Same chemo, but different formulation of the components 35804247 | Capecitabine and Paclitaxel | capecitabine,Paclitaxel 35804248 | Capecitabine and Paclitaxel, nanoparticle albumin-bound | capecitabine,Paclitaxel

Ah yes, so here is a case where the decision not to use precise ingredient causes problems. These are distinctly different regimens with different efficacy, toxicity, dosing, etc. They have been compared head-to-head. There is no logical reason to combine them into one regimen…

  1. Alternating schedules vs constant schedules 35805447 | VACA | Cyclophosphamide,Dactinomycin,Doxorubicin,Vincristine 35805457 | VAdCA | Cyclophosphamide,Dactinomycin,Doxorubicin,Vincristine

An interesting and important edge case that isn’t really that edge, especially for institutions that are fans of HyperCVAD/MA, like we are. Probably what we have to do is add some kind of indicator variable for an alternating regimen.

  1. Different route of administration 35806901 | Axitinib monotherapy | axitinib 35805789 | Axitinib and TACE | axitinib

Actually this is a special case of a drug combined with a procedure (trans-arterial chemoembolization [TACE]) to create a regimen. Again it doesn’t work if relying only on the “Has antineopl Rx” pointers, but using “Has antineoplastic” should disambiguate.

Some differences are legit, and our detection algorithms need to be able to figure it out. Others might need some debugging or additional info. But I am not sure.

— You are receiving this because you commented. Reply to this email directly, view it on GitHubhttps://nam05.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgithub.com%2FOHDSI%2FOncologyWG%2Fissues%2F70%3Femail_source%3Dnotifications%26email_token%3DAC52KJ2TBEZVPSRC3524ASLQHVNKTA5CNFSM4ISMAPB2YY3PNVWWK3TUL52HS4DFVREXG43VMVBW63LNMVXHJKTDN5WW2ZLOORPWSZGOD5WMK7Y%23issuecomment-527222143&data=02%7C01%7Cjeremy.warner%40vumc.org%7C7b1f9444d36d4299889b08d72fd5a775%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637030466998770954&sdata=PuC5mo0Sj1Pn8ECJ%2Bh2gREXmHDhAGojrRd9x7h%2Buz1o%3D&reserved=0, or mute the threadhttps://nam05.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgithub.com%2Fnotifications%2Funsubscribe-auth%2FAC52KJ2UZNOW63XDZNSN2HTQHVNKTANCNFSM4ISMAPBQ&data=02%7C01%7Cjeremy.warner%40vumc.org%7C7b1f9444d36d4299889b08d72fd5a775%7Cef57503014244ed8b83c12c533d879ab%7C0%7C0%7C637030466998780949&sdata=4FiMZbxGXMnHiQXCxP1Y%2BXnqxP13a3TfWlTszREWGWQ%3D&reserved=0.