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A Blinded Comparison of Patient Treatments to Therapeutic Options Presented by an Artificial Intelligence-based Clinical Decision-support system

Date

30 Sep 2019

Session

Poster Display session 3

Presenters

Suthida Suwanvecho

Citation

Annals of Oncology (2019) 30 (suppl_5): v574-v584. 10.1093/annonc/mdz257

Authors

S. Suwanvecho1, H. Suwanrusme1, T. Jirakulaporn1, N. Taechakraichana1, P. Lungchukiet1, N. Thanakarn1, W. Decha1, W. Boonpakdee1, A. Preininger2, I. Dankwa-Mullan3, M. Solomon2, S. Wang2, G. Jackson2, V. Patel4, E.H. Shortliffe4, N. Kiatikajornthada1

Author affiliations

  • 1 Department Of Oncology, Bunrungrad International Hospital, 10110 - Bangkok/TH
  • 2 Watson Health, IBM Corporation, 02142 - Cambridge/US
  • 3 Ibm Watson Health, IBM Corporation, 20814 - Bethesda/US
  • 4 Dept. Of Biomedical Informatics, Columbia University, 10025 - New York/US
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Resources

Background

Comparison of options from clinical decision-support (CDS) systems and decisions made in practice may be biased towards the treating institution. In this retrospective study, bias was minimized by blinding evaluators to the source of treatment recommendations, either Watson for Oncology® (WFO®) or treatments patients received at Bumrungrad International Hospital (BIH), a user of WFO®.

Methods

Treatments given were compared to therapeutic options provided by WFO®. Treatments that were identical to WFO® “recommended” (green, acceptable) were not evaluated further. Paired treatments were evaluated independently in a blinded fashion by each oncologist before consensus ranking of each pair as either acceptable, acceptable alternatives, or unacceptable treatment. The consensus for each treatment was compared to WFO®, with WFO® “for consideration” (yellow, acceptable alternative), and “not recommended” (red, unacceptable). Chi-squared tests analyzed the association between risk factors and discordant recommendations.

Results

Of 228 treatments given to patients with lung, colon, breast and rectal cancers, 174 were identical to WFO® acceptable (green) and not evaluated further; 54 non-identical pairs were evaluated (Table). Overall, 88.6% of decisions were either the same or viewed as equally acceptable by oncologists; oncologists preferred 3.9% of BIH treatments and 4.4% of WFO treatments. In cases where reasons for discordance were provided, 70% were due to BIH oncologist preference, 20% to patient preference and 10% to WFO treatment availability. We found no association between discordant recommendations and patient age or stage of cancer.Table: 1435P

TreatmentsN (%) 228 Total
Treatments are identical174 (76.3%)
Oncologists’ Evaluations
Acceptable alternatives28 (12.3%)
BIH Preferred9 (3.9%)
WFO Preferred10 (4.4%)
Both WFO and BIH-Rx unacceptable7 (3.1%)

Conclusions

This blinded study suggests WFO®’s therapeutic options are at as least as good as (or are an acceptable alternative to) treatments in practice. Blinding evaluators to source of treatment may minimize bias in comparisons of CDS systems and decisions made in practice.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Bumrungrad International Hospital.

Funding

Bumrungrad International Hospital.

Disclosure

All authors have declared no conflicts of interest.

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