Identifying Terminologies Used Prior to the Onset of Interstitial Lung Disease in Patients With Lung Cancer: Descriptive Analysis of Electronic Medical Record Data

Background: The growing importance of real-world data (RWD) as a source of evidence for drug effects has led to increased interest in clinical research utilizing secondary use data from electronic medical record systems. Although immune checkpoint inhibitors and targeted therapies have advanced lung cancer treatment, managing complications such as interstitial lung disease (ILD) remains challenging. Early detection and prevention of ILD are crucial for improving patient prognosis and quality of life; however, predictive biomarkers have yet to be established. Therefore, methods to identify ILD risk factors and enable early detection using RWD are needed. Objective: This exploratory study aimed to identify associated factors and prodromal symptoms of ILD onset using clinical data stored in a hospital information system. Methods: Clinical data of patients diagnosed with stage IV lung cancer between November 2011 and December 2018 were extracted from the hospital information system of the National Cancer Center Hospital in Japan. A total of 3 patient groups were defined: the ILD Set, based on laboratory test results and radiological records; the ILD-GC Set, which added glucocorticoid treatment to the ILD Set; and the No ILD Set, for patients without ILD. The primary endpoint was the frequency of Japanese words extracted from electronic medical records, specifically from notes in the Problem-Oriented System/Subjective, Objective, Assessment and Plan format. Noun frequencies were compared between the ILD or ILD-GC Sets and the No ILD Set. Free-text data were processed using morphological analysis, and terms were categorized using the Patient Disease Expression Dictionary or the World Health Organization Drug Dictionary. Key terms were extracted from physician and nurse records based on the descending order of ranking differences to identify associated factors and prodromal symptoms. Results: The analysis included 674 cases (105 in the ILD Set [including 12 in the ILD-GC Set] and 569 in the No ILD Set). Baseline characteristics showed no apparent differences across groups. In the 30 days prior to ILD onset, notable differences in word frequencies per 1000 notes between the ILD-GC Set and No ILD Set were observed in the following term categories: respiratory symptoms (eg, breathlessness, shortness of breath, oxygen), ranging from 170.59 to 46.51; pain or analgesics (eg, Lyrica [pregabalin], soreness, precordial pain, opioids), ranging from 462.88 to 45.16; and appetite-related terms (eg, inappetence, food intake, queasiness, Novamin [prochlorperazine]), ranging from 102.23 to 51.90. Conclusions: Terms related to respiratory symptoms, pain or analgesics, and appetite were identified as associated factors for ILD onset in patients with stage IV lung cancer using RWD from acute care institutions for malignant tumors. These findings may support the early detection of ILD and underscore the potential of RWD to generate real-world evidence that informs drug discovery and pharmaceutical development.

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