• Nahid Zeinali, Alaa Albashayreh, Weiguo Fan, and Stephanie Gilbertson White.
• Department of Computer Science and Informatics (N.Z.), University of Iowa, Iowa, USA. Electronic address: Nahid-Zeinali@uiowa.edu.
• J Pain Symptom Manage. 2024 Aug 1; 68 (2): 190198.e1190-198.e1.

ContextExtracting cancer symptom documentation allows clinicians to develop highly individualized symptom prediction algorithms to deliver symptom management care. Leveraging advanced language models to detect symptom data in clinical narratives can significantly enhance this process.ObjectiveThis study uses a pretrained large language model to detect and extract cancer symptoms in clinical notes.MethodsWe developed a pretrained language model to identify cancer symptoms in clinical notes based on a clinical corpus from the Enterprise Data Warehouse for Research at a healthcare system in the Midwestern United States. This study was conducted in 4 phases:1 pretraining a Bio-Clinical BERT model on one million unlabeled clinical documents,2 fine-tuning Symptom-BERT for detecting 13 cancer symptom groups within 1112 annotated clinical notes,3 generating 180 synthetic clinical notes using ChatGPT-4 for external validation, and4 comparing the internal and external performance of Symptom-BERT against a non-pretrained version and six other BERT implementations.ResultsThe Symptom-BERT model effectively detected cancer symptoms in clinical notes. It achieved results with a micro-averaged F1-score of 0.933, an AUC of 0.929 internally, and 0.831 and 0.834 externally. Our analysis shows that physical symptoms, like Pruritus, are typically identified with higher performance than psychological symptoms, such as anxiety.ConclusionThis study underscores the transformative potential of specialized pretraining on domain-specific data in boosting the performance of language models for medical applications. The Symptom-BERT model's exceptional efficacy in detecting cancer symptoms heralds a groundbreaking stride in patient-centered AI technologies, offering a promising path to elevate symptom management and cultivate superior patient self-care outcomes.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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