Grant Number:	5R01CA258193-02 Interpret this number
Primary Investigator:	Huang, I-Chan
Organization:	St. Jude Children'S Research Hospital
Project Title:	Patient-Generated Health Data to Predict Childhood Cancer Survivorship Outcomes
Fiscal Year:	2023

PROJECT SUMMARY/ABSTRACT There are approximately 500,000 childhood cancer survivors in the U.S. today. Childhood cancer survivors are vulnerable to late effects of therapy including chronic health conditions and premature death. Predicting survivor-specific risk of late effects, discussing how to manage these risks, and offering early preventions and interventions are critical components of survivorship care. Over 75% of childhood cancer survivors have prevalent symptoms, and constantly poor or worsening symptoms are associated with onset of medical late effects. However, regular symptom monitoring is uncommon in survivorship or primary care. The core concept of this R01 grant proposal is to enable regular monitoring of patient-generated health data (PGHD), including symptoms, physical activity, energy expenditure, sleep behavior and heart rate variability, and utilize these data in predicting survivor-specific risk of late effects to improve survivorship care and outcomes. The proposed application will enroll 620 adult survivors of childhood cancer from the St. Jude Lifetime Cohort Study who are ≥5 years post diagnosis and currently ≥18 years of age at enrollment to achieve the following 3 specific aims: Aim 1) use a mobile health platform to collect dynamic PGHD data over 3 months and use them to develop and validate risk prediction models for future quality-of-life (QOL); Aim 2) develop/validate risk prediction models and establish personalized risk prediction scores for other outcomes (unplanned care utilization, physical performance deficits, onset of chronic health conditions) using the same approach as Aim 1; and Aim 3) create a web-based tool to calculate and report personalized outcome-specific risks, and facilitate integration of risk scores into the survivor’s patient portal and hospital’s Electronic Health Record (EHR). We have a series of preliminary data to support this R01 grant proposal: a) in a pilot study assessing 20 common symptoms with a mobile health platform, childhood cancer survivors completed 90% of all required evaluations over 3 months; and b) in a prediction analysis from ongoing cohort of childhood cancer survivors, the inclusion of longitudinal symptom data generated a superior model performance in predicting future QOL (prediction measure, AUC=0.85) compared to the use of only age, sex, and childhood cancer type (AUC=0.63). Linking through a mobile health platform, we will use a smartphone to collect symptom data, a wrist-worn accelerometer to collect momentary activity/behavioral data, and a finger sensor to collect heart rate variability data. We will predict patient-reported outcomes (poor QOL, unplanned healthcare utilization) and clinically- assessed outcomes (physical performance deficits, onset of chronic health conditions) on the 12th and 24th months after collecting risk factors. We will apply state-of-the-art machine/statistical learning techniques to capture features of dynamic changes in PGHD to predict these outcomes. We will build a Central Cancer Survivorship Platform to integrate predicted risks presented with interpretable scores into a patient portal and EHR, and to inform clinicians and survivors about potential adverse-event risks for risk management/intervention.




Neighborhood Vulnerability and Associations with Poor Health-Related Quality-of-Life Among Adult Survivors of Childhood Cancer.
Authors: Choi J. , Horan M.R. , Brinkman T.M. , Srivastava D.K. , Ness K.K. , Armstrong G.T. , Hudson M.M. , Huang I.C. .
Source: Jnci Cancer Spectrum, 2024-09-17 00:00:00.0; , .
EPub date: 2024-09-17 00:00:00.0.
PMID: 39288319
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Joint Imbalance Adaptation for Radiology Report Generation.
Authors: Wu Y. , Huang I.C. , Huang X. .
Source: Research Square, 2024-08-30 00:00:00.0; , .
EPub date: 2024-08-30 00:00:00.0.
PMID: 39257991
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Using mHealth Technology to Evaluate Daily Symptom Burden among Adult Survivors of Childhood Cancer: A Feasibility Study.
Authors: Howell K.E. , Baedke J.L. , Bagherzadeh F. , McDonald A. , Nathan P.C. , Ness K.K. , Hudson M.M. , Armstrong G.T. , Yasui Y. , Huang I.C. .
Source: Cancers, 2024-08-27 00:00:00.0; 16(17), .
EPub date: 2024-08-27 00:00:00.0.
PMID: 39272842
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Using an mHealth approach to collect patient-generated health data for predicting adverse health outcomes among adult survivors of childhood cancer.
Authors: Howell K.E. , Shaw M. , Santucci A.K. , Rodgers K. , Ortiz Rodriguez I. , Taha D. , Laclair S. , Wolder C. , Cooper C. , Moon W. , et al. .
Source: Frontiers In Oncology, 2024; 14, p. 1374403.
EPub date: 2024-05-10 00:00:00.0.
PMID: 38800387
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Natural language processing with machine learning methods to analyze unstructured patient-reported outcomes derived from electronic health records: A systematic review.
Authors: Sim J.A. , Huang X. , Horan M.R. , Stewart C.M. , Robison L.L. , Hudson M.M. , Baker J.N. , Huang I.C. .
Source: Artificial Intelligence In Medicine, 2023 Dec; 146, p. 102701.
EPub date: 2023-11-01 00:00:00.0.
PMID: 38042599
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Response-shift effects in childhood cancer survivors: A prospective study.
Authors: Huang I.C. , Sim J.A. , Srivastava D. , Krull K.R. , Ness K.K. , Robison L.L. , Baker J.N. , Hudson M.M. , Schwartz C.E. .
Source: Psycho-oncology, 2023-05-15 00:00:00.0; , .
EPub date: 2023-05-15 00:00:00.0.
PMID: 37189277
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Determinants of health-related quality-of-life in adult survivors of childhood cancer: integrating personal and societal values through a health utility approach.
Authors: Horan M.R. , Srivastava D.K. , Bhakta N. , Ehrhardt M.J. , Brinkman T.M. , Baker J.N. , Yasui Y. , Krull K.R. , Ness K.K. , Robison L.L. , et al. .
Source: Eclinicalmedicine, 2023 Apr; 58, p. 101921.
EPub date: 2023-04-03 00:00:00.0.
PMID: 37090443
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Ten Considerations for Integrating Patient-Reported Outcomes into Clinical Care for Childhood Cancer Survivors.
Authors: Horan M.R. , Sim J.A. , Krull K.R. , Ness K.K. , Yasui Y. , Robison L.L. , Hudson M.M. , Baker J.N. , Huang I.C. .
Source: Cancers, 2023-02-06 00:00:00.0; 15(4), .
EPub date: 2023-02-06 00:00:00.0.
PMID: 36831370
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Associations of Symptom Clusters and Health Outcomes in Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study.
Authors: Shin H. , Dudley W.N. , Bhakta N. , Horan M.R. , Wang Z. , Bartlett T.R. , Srivastava D. , Yasui Y. , Baker J.N. , Robison L.L. , et al. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2022-09-27 00:00:00.0; , p. JCO2200361.
EPub date: 2022-09-27 00:00:00.0.
PMID: 36166720
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