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A cancer survival calculator is being developed using artificial intelligence

Key Takeaways  Credit: American College of Surgeons Key Takeaways  A cancer survival calculator prototype developed with machine learning showed that…

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Key Takeaways 

Credit: American College of Surgeons

Key Takeaways 

  • A cancer survival calculator prototype developed with machine learning showed that for each of three cancer types tested, more factors than cancer stage significantly influenced patients’ survival. 
  • Preliminary research on the calculator found high accuracy of this individualized survival estimator. 

BOSTON (October 20, 2023): Researchers have developed an artificial intelligence (AI)–based tool for estimating a newly diagnosed cancer patient’s chances for surviving long term, according to a study presented at the American College of Surgeons (ACS) Clinical Congress 2023. 

Currently, estimating survival rates for patients with cancer primarily depends on their cancer stage, said lead study author Lauren Janczewski, MD, a clinical scholar with ACS Cancer Programs and a general surgical resident at Northwestern University McGaw Medical Center, Chicago.  

“There is a multitude of other factors that may influence a patient’s survival beyond just their staging criteria,” Dr. Janczewski said. “We sought to develop this Cancer Survival Calculator to provide a more personalized estimate of what patients can expect regarding their cancer prognosis.” 

Using a type of AI known as machine learning, the multicenter research team created a prototype tool called the Cancer Survival Calculator and tested it on a nationwide cancer dataset. Initial tests estimated five-year survival for patients with cancers of the breast, thyroid, and pancreas. 

Study details 

According to Dr. Janczewski, this study aimed to identify the patient, tumor, and treatment characteristics that most greatly influence patient survival for each cancer type. 

After cancer experts recommended characteristics to study, the researchers collected relevant information from patients diagnosed in 2015 and 2017 with breast, thyroid, and pancreatic cancers. The patients’ records were part of the National Cancer Database (NCDB), which contains records of 72 percent of newly diagnosed cancer cases in the United States.* 

Three-fourths of the collected data were used to train the machine learning algorithms to recognize patterns between characteristics at diagnosis and patients’ survival at five years, and then to rank the factors with the greatest influence on survival. With the remaining data, the researchers used statistical methods to test the prototype’s accuracy in estimating survival. 

Key findings 

The team included data from 259,485 breast cancer patients, 76,624 thyroid cancer patients, and 84,514 pancreatic cancer patients. The researchers found multiple characteristics specific to patients, tumors, and treatments for all three cancer sites significantly influenced survival.  

The top four factors influencing whether patients were alive five years after diagnosis were as follows, by cancer site: 

  • Breast cancer: (1) whether the patient had cancer surgery, (2) the patient’s age at diagnosis, (3) tumor size, and (4) time from diagnosis to treatment. 
  • Thyroid cancer: (1) age at diagnosis, (2) tumor size, (3) time to treatment, and (4) lymph node involvement. 
  • Pancreatic cancer: (1) cancer surgery; (2) histology, or microscopic analysis of the cancer, (3) tumor size, and (4) age at diagnosis. 

Also found to be important for survival from breast cancer were hormone receptor status, which is part of breast cancer staging, and the presence of Ki-67, a biomarker in breast cancer. 

Although some of the predictive factors, such as tumor size, are part of cancer staging, Dr. Janczewski said their results showed that many more factors influence survival for cancer patients beyond their disease stage. 

Furthermore, their validation testing showed that the calculator was “highly accurate” for all three cancer sites at estimating cancer survival rates – within nine to 10 months of actual survival, Dr. Janczewski reported. 

Advantages of the new calculator 

The Cancer Survival Calculator differs in several ways from cancer survival estimators already in use, according to Dr. Janczewski: 

  1. The novel calculator includes specific tumor biomarkers and treatment variables that are known to affect a patient’s estimated prognosis, which Dr. Janczewski said many prior survival calculators lack.  
  2. The dataset used to develop the new calculator, the NCDB, is more comprehensive than other calculators’ datasets, according to Dr. Janczewski.
  3. The Cancer Survival Calculator uses new data modeling, such as machine learning, which speeds up processing. The models’ risk predictions also demonstrated improved accuracy compared with predictions generated by older calculators, she said.  

Future steps 

The next steps that Dr. Janczewski identified are to finalize a user interface that will allow the use of the Cancer Survival Calculator in clinical practice, followed by pilot testing the calculator at selected cancer centers.  

Eventually, the researchers hope to broaden the calculator by adding all other cancer sites included in the NCDB. Initially, the calculator included breast, thyroid, and pancreatic cancers because these cancers have diverse patient populations and differing frequencies and average survival rates, she said. 

The research team plans to make the finalized informational tool available to healthcare practitioners. 

Study coauthors are Joseph Cotler, PhD; Bryan Palis, MA; Tanya Hoskin, MA; Courtney Day, MS; Ryan Merkow, MD, MS, FACS; Heidi Nelson, MD, FACS; Tracy Wang, MD, FACS; and Judy Boughey, MBBCh, FACS. Mayo Clinic and the Medical College of Wisconsin were study centers with Northwestern University. 

The study authors have no disclosures. 

Citation: Janczewski L, et al. Development of a National Cancer Survival Calculator Prototype Using Machine Learning, Scientific Forum, American College of Surgeons (ACS) Clinical Congress 2023. 

___________________ 

*The NCDB is a joint program of the ACS Commission on Cancer and the American Cancer Society. The database collects more than 1.5 million new cancer cases each year. 

# # # 

About the American College of Surgeons 

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.


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Delivering aid during war is tricky − here’s what to know about what Gaza relief operations may face

The politics of delivering aid in war zones are messy, the ethics fraught and the logistics daunting. But getting everything right is essential − and…

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Palestinians on the outskirts of Gaza City walk by buildings destroyed by Israeli bombardment on Oct. 20, 2023. AP Photo/Ali Mahmoud

The 2.2 million people who live in Gaza are facing economic isolation and experiencing incessant bombardment. Their supplies of essential resources, including food and water, are quickly dwindling.

In response, U.S. President Joe Biden has pledged US$100 million in humanitarian assistance for the citizens of Gaza.

As a scholar of peace and conflict economics who served as a World Bank consultant during the 2014 war between Hamas and Israel, I believe that Biden’s promise raises fundamental questions regarding the delivery of humanitarian aid in a war zone. Political constraints, ethical quandaries and the need to protect the security of aid workers and local communities always make it a logistical nightmare.

In this specific predicament, U.S. officials have to choose a strategy to deliver the aid without the perception of benefiting Hamas, a group the U.S. and Israel both classify as a terrorist organization.

Logistics

When aiding people in war zones, you can’t just send money, a development strategy called “cash transfers” that has become increasingly popular due to its efficiency. Sending money can boost the supply of locally produced goods and services and help people on the ground pay for what they need most. But injecting cash into an economy so completely cut off from the world would only stoke inflation.

So the aid must consist of goods that have to be brought into Gaza, and services provided by people working as part of an aid mission. Humanitarian aid can include food and water; health, sanitation and hygiene supplies and services; and tents and other materials for shelter and settlement.

Due to the closure of the border with Israel, aid can arrive in Gaza only via the Rafah crossing on the Egyptian border.

The U.S. Agency for International Development, or USAID, will likely turn to its longtime partner on the ground, the United Nations Relief and Works Agency, or UNRWA, to serve as supply depots and distribute goods. That agency, originally founded in 1949 as a temporary measure until a two-state solution could be found, serves in effect as a parallel yet unelected government for Palestinian refugees.

USAID will likely want to tap into UNRWA’s network of 284 schools – many of which are now transformed into humanitarian shelters housing two-thirds of the estimated 1 million people displaced by Israeli airstrikes – and 22 hospitals to expedite distribution.

Map of Gaza and its neighbors
Gaza is a self-governing Palestinian territory. The narrow piece of land is located on the coast of the Mediterranean Sea, bordered by Israel and Egypt. PeterHermesFurian/iStock via Getty Images Plus

Politics

Prior to the Trump administration, the U.S. was typically the largest single provider of aid to the West Bank and Gaza. USAID administers the lion’s share of it.

Since Biden took office, total yearly U.S. assistance for the Palestinian territories has totaled around $150 million, restored from just $8 million in 2020 under the Trump administration. During the Obama administration, however, the U.S. was providing more aid to the territories than it is now, with $1 billion disbursed in the 2013 fiscal year.

But the White House needs Congress to approve this assistance – a process that requires the House of Representatives to elect a new speaker and then for lawmakers to approve aid to Gaza once that happens.

Ethics

The United Nations Relief and Works Agency is a U.N. organization. It’s not run by Hamas, unlike, for instance, the Gaza Ministry of Health. However, Hamas has frequently undermined UNRWA’s efforts and diverted international aid for military purposes.

Hamas has repeatedly used UNRWA schools as rocket depots. They have repeatedly tunneled beneath UNRWA schools. They have dismantled European Union-funded water pipes to use as rocket fuselages. And even since the most recent violence broke out, the UNRWA has accused Hamas of stealing fuel and food from its Gaza premises.

Humanitarian aid professionals regularly have to contend with these trade-offs when deciding to what extent they can work with governments and local authorities that commit violent acts. They need to do so in exchange for the access required to help civilians under their control.

Similarly, Biden has had to make concessions to Israel while brokering for the freedom to send humanitarian aid to Gaza. For example, he has assured Israel that if any of the aid is diverted by Hamas, the operation will cease.

This promise may have been politically necessary. But if Biden already believes Hamas to be uncaring about civilian welfare, he may not expect the group to refrain from taking what they can.

Security best practices

What can be done to protect the security of humanitarian aid operations that take place in the midst of dangerous conflicts?

Under International Humanitarian Law, local authorities have the primary responsibility for ensuring the delivery of aid – even when they aren’t carrying out that task. To increase the chances that the local authorities will not attack them, aid groups can give “humanitarian notification” and voluntarily alert the local government as to where they will be operating.

Hamas has repeatedly flouted international norms and laws. So the question of if and how the aid convoy will be protected looms large.

Under the current agreement between the U.S., Israel and Egypt, the convoy will raise the U.N. flag. International inspectors will make sure no weapons are on board the vehicles before crossing over from Arish, Egypt, to Rafah, a city located on the Gaza Strip’s border with Egypt.

The aid convoy will likely cross without militarized security. This puts it at some danger of diversion once inside Gaza. But whether the aid convoy is attacked, seized or left alone, the Biden administration will have demonstrated its willingness to attempt a humanitarian relief operation. In this sense, a relatively small first convoy bearing water, medical supplies and food, among other items, serves as a test balloon for a sustained operation to follow soon after.

If the U.S. were to provide the humanitarian convoy a military escort, by contrast, Hamas could see its presence as a provocation. Washington’s support for Israel is so strong that the U.S. could potentially be judged as a party in the conflict between Israel and Hamas.

In that case, the presence of U.S. armed forces might provoke attacks on Gaza-bound aid convoys by Hamas and Islamic jihad fighters that otherwise would not have occurred. Combined with the mobilization of two U.S. Navy carrier groups in the eastern Mediterranean Sea, I’d be concerned that such a move might also stoke regional anger. It would undermine the Biden administration’s attempts to cool the situation.

On U.N.-approved missions, aid delivery may be secured by third-party peacekeepers – meaning, in this case, personnel who are neither Israeli nor Palestinian – with the U.N. Security Council’s blessing. In this case, tragically, it’s unlikely that such a resolution could conceivably pass such a vote, much less quickly enough to make a difference.

Topher L. McDougal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Diagnosis and management of postoperative wound infections in the head and neck region

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]” Credit: 2023 Barbarewicz…

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“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

Credit: 2023 Barbarewicz et al.

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

BUFFALO, NY- October 20, 2023 – A new research perspective was published in Oncoscience (Volume 10) on October 4, 2023, entitled, “Diagnosis and management of postoperative wound infections in the head and neck region.”

In everyday clinical practice at a department for oral and maxillofacial surgery, a large number of surgical procedures in the head and neck region take place under both outpatient and inpatient conditions. The basis of every surgical intervention is the patient’s consent to the respective procedure. Particular attention is drawn to the general and operation-specific risks. 

Particularly in the case of soft tissue procedures in the facial region, bleeding, secondary bleeding, scarring and infection of the surgical area are among the most common complications/risks, depending on the respective procedure. In their new perspective, researchers Filip Barbarewicz, Kai-Olaf Henkel and Florian Dudde from Army Hospital Hamburg in Germany discuss the diagnosis and management of postoperative infections in the head and neck region.

“In order to minimize the wound infections/surgical site infections, aseptic operating conditions with maximum sterility are required.”

Furthermore, depending on the extent of the surgical procedure and the patient‘s previous illnesses, peri- and/or postoperative antibiotics should be considered in order to avoid postoperative surgical site infection. Abscesses, cellulitis, phlegmone and (depending on the location of the procedure) empyema are among the most common postoperative infections in the respective surgical area. The main pathogens of these infections are staphylococci, although mixed (germ) patterns are also possible. 

“Risk factors for the development of a postoperative surgical site infection include, in particular, increased age, smoking, multiple comorbidities and/or systemic diseases (e.g., diabetes mellitus type II) as well as congenital and/ or acquired immune deficiency [10, 11].”

 

Continue reading the paper: DOI: https://doi.org/10.18632/oncoscience.589 

Correspondence to: Florian Dudde

Email: floriandudde@gmx.de 

Keywords: surgical site infection, head and neck surgery

 

About Oncoscience

Oncoscience is a peer-reviewed, open-access, traditional journal covering the rapidly growing field of cancer research, especially emergent topics not currently covered by other journals. This journal has a special mission: Freeing oncology from publication cost. It is free for the readers and the authors.

To learn more about Oncoscience, visit Oncoscience.us and connect with us on social media:

For media inquiries, please contact media@impactjournals.com.

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Biden’s Student Loan Forgiveness Plan Makes the Poor Pay for the Rich

A year after the Supreme Court struck down President Biden’s student loan forgiveness plan, he presented a new scheme to the Department of Education…

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A year after the Supreme Court struck down President Biden’s student loan forgiveness plan, he presented a new scheme to the Department of Education on Tuesday. While it is less aggressive than the prior plan, this proposal would cost hundreds of billions of taxpayer dollars, doing more harm than good. 

As the legendary economist Milton Friedman noted, “One of the great mistakes is to judge policies and programs by their intentions rather than their results.” 

Higher education in America is costly, and this “forgiveness” would make it worse. 

Signing up for potentially life-long student loans at a young age is too normalized. At the same time, not enough borrowers can secure jobs that offer adequate financial support to pay off these massive loans upon graduation or leaving college. These issues demand serious attention. But “erasing” student loans, as well-intentioned as it may be, is not the panacea Americans have been led to believe.

Upon closer examination, the President’s forgiveness plan creates winners and losers, ultimately benefiting higher-income earners the most. In reality, this plan amounts to wealth redistribution. To quote another top economist, Thomas Sowell described this clearly: “There are no solutions, only trade-offs.” 

Forgiving student loans is not the end of the road but the beginning of a trade-off for a rising federal fiscal crisis and soaring college tuition. 

When the federal government uses taxpayer funds to give student loans, it charges an interest rate to account for the cost of the loan. To say that all borrowers no longer have to pay would mean taxpayers lose along with those who pay for it and those who have been paying or have paid off their student loans.

According to the Committee for a Responsible Federal Budget, student debt forgiveness could cost at least $360 billion. 

Let’s consider that there will be 168 million tax returns filed this year. A simple calculation suggests that student loan forgiveness could add around $2,000 yearly in taxes per taxpayer, based on the CRFB’s central estimate. 

Clearly, nothing is free, and the burden of student loan forgiveness will be shifted to taxpayers.

One notable feature of this plan is that forgiveness is unavailable to individuals earning over $125,000 annually. In practice, this means that six-figure earners could have their debts partially paid off by lower-income tax filers who might not have even pursued higher education. This skewed allocation of resources is a sharp departure from progressive policy.

Data show that half of Americans are already frustrated with “Bidenomics.” 

Inflation remains high, affordable housing is a distant dream, and wages fail to keep up with soaring inflation. Introducing the potential of an additional $2,000 annual tax burden at least for those already struggling, mainly to subsidize high-income earners, adds insult to injury.

Furthermore, it’s vital to recognize that the burden of unpaid student loans should not fall on low-income earners or Americans who did not attend college. Incentives play a crucial role in influencing markets. 

By removing the incentive for student loan borrowers to repay their debts, we may encourage more individuals to pursue higher education and accumulate debt without the intention of paying it back. After all, why would they when it can be written off through higher taxes for everyone?

The ripple effect of this plan could be far-reaching. 

It may make college more accessible for some, opening the floodgates for students and the need for universities to expand and hire more staff, leading to even higher college tuition. This perverse incentive will set a precedent that will create a cycle of soaring tuition, which would counteract the original goal of making higher education more affordable.

While the intention behind President Biden’s student loan forgiveness may appear noble (in likelihood, it is a rent-seeking move), the results may prove detrimental to our nation’s economic stability and fairness. And if the debt is monetized, more inflation will result.

Forgiving student loans will exacerbate existing problems, with the brunt of the burden falling on lower-income Americans. Instead of improving the situation, it will likely create an intricate web of financial consequences, indirectly affecting the very people it aims to help. But that is the result of most government programs with good intentions.

 


 

Vance Ginn, Ph.D., is president of Ginn Economic Consulting, chief economist or senior fellow at multiple state thinks across the country, host of the Let People Prosper Show, and previously the associate director for economic policy of the White House’s Office of Management and Budget, 2019-20. Follow him on X.com @VanceGinn.

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