Machine Learning Approaches to Predict 6-Month Mortality Among Patients With Cancer

Question Can machine learning algorithms identify oncology patients at risk of short-term mortality to inform timely conversations between patients and physicians regrading serious illness? Findings In this cohort study of 26 525 patients seen in oncology practices within a large academic health system, machine learning algorithms accurately identified patients at high risk of 6-month mortality with good discrimination and positive predictive value. When the gradient boosting algorithm was applied in real time, most patients who were classified as having high risk were deemed appropriate by oncology clinicians for a conversation regarding serious illness. Meaning In this study, machine learning algorithms accurately identified patients with cancer who were at risk of 6-month mortality, suggesting that these models could facilitate more timely conversations between patients and physicians regarding goals and values. Importance Machine learning algorithms could identify patients with cancer who are at risk of short-term mortality. However, it is unclear how different machine learning algorithms compare and whether they could prompt clinicians to have timely conversations about treatment and end-of-life preferences. Objectives To develop, validate, and compare machine learning algorithms that use structured electronic health record data before a clinic visit to predict mortality among patients with cancer. Design, Setting, and Participants Cohort study of 26 525 adult patients who had outpatient oncology or hematology/oncology encounters at a large academic cancer center and 10 affiliated community practices between February 1, 2016, and July 1, 2016.