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Importance: The stratification of indeterminate lung nodules is a growing problem, but the burden of lung nodules on healthcare services is not well-described. Manual service evaluation and research cohort curation can be time-consuming and potentially improved by automation.Objective: To automate lung nodule identification in a tertiary cancer centre.Methods: This retrospective cohort study used Electronic Healthcare Records to identify CT reports generated between 31st October 2011 and 24th July 2020. A structured query language/natural language processing tool was developed to classify reports according to lung nodule status. Performance was externally validated. Sentences were used to train machine-learning classifiers to predict concerning nodule features in 2,000 patients.Results: 14,586 patients with lung nodules were identified. The cancer types most commonly associated with lung nodules were lung (39%), neuro-endocrine (38%), skin (35%), colorectal (33%) and sarcoma (33%). Lung nodule patients had a greater proportion of metastatic diagnoses (45 vs. 23%, p < 0.001), a higher mean post-baseline scan number (6.56 vs. 1.93, p < 0.001), and a shorter mean scan interval (4.1 vs. 5.9 months, p < 0.001) than those without nodules. Inter-observer agreement for sentence classification was 0.94 internally and 0.98 externally. Sensitivity and specificity for nodule identification were 93 and 99% internally, and 100 and 100% at external validation, respectively. A linear-support vector machine model predicted concerning sentence features with 94% accuracy.Conclusion: We have developed and validated an accurate tool for automated lung nodule identification that is valuable for service evaluation and research data acquisition.

Pneumonitis is a well-described, potentially life-threatening adverse effect of immune checkpoint inhibitors (ICI) and thoracic radiotherapy. It can require additional investigations, treatment, and interruption of cancer therapy. It is important for clinicians to have an awareness of its incidence and severity, however real-world data are lacking and do not always correlate with findings from clinical trials. Similarly, there is a dearth of information on cost impact of symptomatic pneumonitis. Informatics approaches are increasingly being applied to healthcare data for their ability to identify specific patient cohorts efficiently, at scale. We developed a Structured Query Language (SQL)-based informatics algorithm which we applied to CT report text to identify cases of ICI and radiotherapy pneumonitis between 1/1/2015 and 31/12/2020. Further data on severity, investigations, medical management were also acquired from the electronic health record. We identified 248 cases of pneumonitis attributable to ICI and/or radiotherapy, of which 139 were symptomatic with CTCAE severity grade 2 or more. The grade ≥2 ICI pneumonitis incidence in our cohort is 5.43%, greater than the all-grade 1.3–2.7% incidence reported in the literature. Time to onset of ICI pneumonitis was also longer in our cohort (mean 4.5 months, range 4 days-21 months), compared to the median 2.7 months (range 9 days−19.2 months) described in the literature. The estimated average healthcare cost of symptomatic pneumonitis is £3932.33 per patient. In this study we use an informatics approach to present new real-world data on the incidence, severity, management, and resource burden of ICI and radiotherapy pneumonitis. To our knowledge, this is the first study to look at real-world incidence and healthcare resource utilisation at the per-patient level in a UK cancer hospital. Improved management of pneumonitis may facilitate prompt continuation of cancer therapy, and improved outcomes for this not insubstantial cohort of patients.

Introduction Management of malignant pleural disease has advanced over the past decade with the role of a pleural specialist service becoming increasingly essential in efforts to optimise patient care. The use of indwelling pleural catheters (IPC) has changed the arena in which malignant pleural effusions (MPE) can be managed, allowing more patient autonomy and less use of hospital resources. The LENT scoring system, validated in 2014, is often used to guide decision making in patients with MPE. Current ATS recommendations suggest IPCs are not suitable in individuals with a ‘very short survival’ prognosis however this determination is variable and is an example of where the LENT scoring system may be involved. Methods Retrospective analysis was carried out on patients who underwent IPC insertion at our institution between 2016 and 2019. All patients were seen in the specialist pleural service and underwent subsequent intervention. Data collected included primary cancer diagnosis, date of first pleural aspiration, LENT score, observed complications, IPC removal date if applicable and date of death to calculate survival time. Results 58 patients underwent successful IPC insertion of which 5 were for non-malignant disease (2/5 refractory heart failure, 3/5 advanced liver cirrhosis). The remaining 53 patients all had a confirmed pathological diagnosis of malignant pleural effusion. At the time of submission, 8 patients remained alive and were excluded from analysis leaving a remaining 45 cases. Using LENT assessment 13/45 classed as high risk, 31/45 as moderate and 1/45 as low. The observed average survival time in high risk patients was 122 days and median 93 days. This was notably higher than the anticipated 44 days predicted median survival time noted in the literature. Conclusion Our data suggests that high risk patients according to LENT assessment were more likely to live longer following IPC intervention and aftercare. This suggests that use of prognostic assessment tools may be ineffective in this sub-group and should be employed with caution. The improved patient outcomes reinforce the benefit of a dynamic responsive pleural service. They may also reflect upon the increased recognition of tumour heterogeneity alongside the recent advent of novel molecular based therapies.

A cross-sectional study is reported in which loneliness and emotional problems are explored in adolescent victims of direct or relational bullying, together with the potentially moderating influence of friendship quality. Adolescents (N=401, mean age 13.5) completed the School Relationships Questionnaire, to identify bullying and victimisation roles, the Friendship Activity Questionnaire (FAQ), the Strengths and Difficulties Questionnaire (SDQ) to assess emotional problems, and the Loneliness and Social Dissatisfaction Questionnaire (LSDQ). Relational victims, but not direct victims reported significantly elevated feelings of loneliness and emotional problems compared to non-victims. Direct victims reported a significantly higher quality of friendship, compared to non-victims. Poor quality of friendship was also associated with high levels of loneliness, and vice versa for direct victims, but not for relational victims. This indicates that the higher quality of friendship found in direct victims is associated with the reduced levels of loneliness found in this group. Given the cross-sectional nature of this study, it is not possible to ascertain whether this association truly reflects the role of friendship quality as a moderator, and hence protective factor against adverse influences of victimisation. The different mechanisms underlying direct and relational victimisation are important for future research and intervention programmes.

Introduction: London has a high incidence of TB, and the boroughs served by Barking, Havering, and Redbridge University Hospitals Trust (BHRUT) reflects a high risk population. A recent review of BHRUT TB lymphadenitis cases between 2009 and 2013 revealed more lymph node (LN) samples were sent for histology than microbiology, potentially impacting management of these patients. Aim: To identify whether age affected the diagnostic sampling of lymph nodes in TB lymphadenitis. Method: A retrospective analysis of the investigations performed against the age of the patient, using the London TB Register (LTBR) to identify cases of TB lymphadenitis in BHRUT between 2009 and 2013. Results: 324 patients were identified. Of these, 231 (71.3%) had LN samples sent for histology, and 179 (55.2%) had LN samples sent for microbiology. This was analysed further for each age group (Table 1). In addition, 50-80% of histological samples in each age group were consistent with a diagnosis of TB. Conclusion: In the older population (>60 years), almost all LN samples were sent for histology, indicating that in this cohort of patients, the primary differential is of a histological nature, i.e. cancer, due to their age. This analysis suggests we should change our current multidisciplinary practice by sending all LN samples for microbiological investigation, as in high risk populations, TB should always be a differential for lymphadenitis.