# Lexical associations can characterize clinical documentation trends related to palliative care and metastatic cancer

## TL;DR

This study uses natural language processing to show that terms related to palliative care and metastatic cancer were documented together less frequently over time.

## Contribution

The study introduces a novel approach to analyzing clinical documentation trends using unsupervised language models.

## Key findings

- Terms for metastatic cancer and palliative care appeared in similar contexts in clinical notes each year.
- The relationship between these terms weakened over time, as shown by decreasing cosine similarities.
- Similar trends were observed when models were retrained on patients with a metastatic cancer diagnosis code.

## Abstract

Palliative care is known to improve quality of life in advanced cancer. Natural language processing offers insights to how documentation around palliative care in relation to metastatic cancer has changed. We analyzed inpatient clinical notes using unsupervised language models that learn how words related to metastatic cancer (e.g. “mets”, “metastases”) and palliative care (e.g. “palliative care”, “pal care”) appear relationally and change over time. We included any note from adults hospitalized at the University of California, San Francisco system. The primary outcome was how similarly terms related to metastatic cancer and palliative care appeared in notes using a mathematical approach (cosine similarity). We used word2vec to model language numerically as vectors. Relational data between vectors was captured using cosine similarity. We performed linear regression to identify changes in these relationships of terms over time. As a sensitivity analysis, we performed the same analysis per year restricted only to patients with an ICD-9/10 diagnosis code for metastatic cancer. Metastatic cancer and palliative care terms appeared in similar contexts in clinical notes each year, suggesting a close relationship in documentation. However, over time, this relationship weakened, with these terms becoming less commonly used together as measured by cosine similarities. We found similar trends when we retrained models just on patients with a diagnosis code for metastatic cancer. Text in clinical notes offers unique insights into how medical providers document palliative care in patients with advanced malignancies and how these documentation practices evolve over time.