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Early dietitian referral in lung cancer: use of machine learning
  1. Michael Chung1,
  2. Iain Phillips2,
  3. Lindsey Allan3,
  4. Naomi Westran3,
  5. Adele Hug3 and
  6. Philip M Evans1,4
  1. 1CVSSP, University of Surrey, Guildford, UK
  2. 2Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
  3. 3Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  4. 4Chemical, Medical and Environmental Science, National Physical Laboratory, Teddington, UK
  1. Correspondence to Dr Iain Phillips, Edinburgh Cancer Centre, Western General Hospital, Edinburgh EH4 2XU, UK; iain.phillips{at}


Objectives The Dietetic Assessment and Intervention in Lung Cancer (DAIL) study was an observational cohort study. It triaged the need for dietetic input in patients with lung cancer, using questionnaires with 137 responses. This substudy tested if machine learning could predict need to see a dietitian (NTSD) using 5 or 10 measures.

Methods 76 cases from DAIL were included (Royal Surrey NHS Foundation Trust; RSH: 56, Frimley Park Hospital; FPH 20). Univariate analysis was used to find the strongest correlates with NTSD and ‘critical need to see a dietitian’ CNTSD. Those with a Spearman correlation above ±0.4 were selected to train a support vector machine (SVM) to predict NTSD and CNTSD. The 10 and 5 best correlates were evaluated.

Results 18 and 13 measures had a correlation above ±0.4 for NTSD and CNTSD, respectively, producing SVMs with 3% and 7% misclassification error. 10 measures yielded errors of 7% (NTSD) and 9% (CNTSD). 5 measures yielded between 7% and 11% errors. SVM trained on the RSH data and tested on the FPH data resulted in errors of 20%.

Conclusions Machine learning can predict NTSD producing misclassification errors <10%. With further work, this methodology allows integrated early referral to a dietitian independently of a healthcare professional.

  • cachexia
  • lung
  • symptoms and symptom management

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  • Contributors Study concept and planning: IP, LA and PME. Analysis of data: MC. Interpretation of data: all authors. Contribution and critical review of journal article: all authors.

  • Funding The DAIL study was funded by Chugai Pharma UK Ltd.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.