Artificial intelligence methods applied to longitudinal data from electronic health records for prediction of cancer:...

Early detection and diagnosis of cancer are vital to improving outcomes for patients. Artificial intelligence (AI) models have shown promise in the early detection and diagnosis of cancer, but there is limited evidence on methods that fully exploit the longitudinal data stored within electronic health records (EHRs). This review aims to summarise methods currently utilised for prediction of cancer from longitudinal data and provides recommendations on how such models should be developed.

The review was conducted following PRISMA-ScR guidance. Six databases (MEDLINE, EMBASE, Web of Science, IEEE Xplore, PubMed and SCOPUS) were searched for relevant records published before 2/2/2024. Search terms related to the concepts "artificial intelligence", "prediction", "health records", "longitudinal", and "cancer". Data were extracted relating to several areas of the articles: (1) publication details, (2) study characteristics, (3) input data, (4) model characteristics, (4) reproducibility, and (5) quality assessment using the PROBAST tool. Models were evaluated against a framework for terminology relating to reporting of cancer detection and risk prediction models.

Of 653 records screened, 33 were included in the review; 10 predicted risk of cancer, 18 performed either cancer detection or early detection, 4 predicted recurrence, and 1 predicted metastasis. The most common cancers predicted in the studies were colorectal (n = 9) and pancreatic cancer (n = 9). 16 studies used feature engineering to represent temporal data, with the most common features representing trends. 18 used deep learning models which take a direct sequential input, most commonly recurrent neural networks, but also including convolutional neural networks and transformers. Prediction windows and lead times varied greatly between studies, even for models predicting the same cancer. High risk of bias was found in 90% of the studies. This risk was often introduced due to inappropriate study design (n = 26) and sample size (n = 26).

This review highlights the breadth of approaches to cancer prediction from longitudinal data. We identify areas where reporting of methods could be improved, particularly regarding where in a patients' trajectory the model is applied. The review shows opportunities for further work, including comparison of these approaches and their applications in other cancers.