Predicting Fear of Breast Cancer Recurrence in women five years after diagnosis using Machine Learning and healthcare reimbursement data from the French nationwide VICAN survey ☆

Objective: A major concern for cancer survivors after treatment is the Fear of Cancer Recurrence (FCR), which is the fear that cancer will reappear or progress. This fear can be exacerbated by medical uncertainty about the future, leading to harmful obsession and having a negative impact on quality of life. This study aims to develop a predictive Machine Learning (ML) model using healthcare reimbursement data to better predict FCR and understand the factors influencing FCR in women with breast cancer five years after their diagnosis. Materials and Methods: We used data from the VICAN (VIe apr & egrave;s le CANcer) survey to propose an interpretable model to identify patients at risk of developing clinical FCR. The reimbursement data for each patient were analyzed beyond the first two years of treatment, excluding the initial phase influenced by the cancer curative therapeutic process. Data experiments were conducted, including the use of algorithms such as Random Forest, Support Vector Machines, Gradient Boosting, eXtreme Gradient Boosting, and Multilayer Perceptron. The AUC was used to choose the optimal model. Results: The dataset is composed of 918 patients classified regarding FCR. The experimental design incorporated classification levels of medications, biological and medical procedures. Subsequently, data was generated for two experiments, facilitating examination at the ultimate healthcare classification level in Experiment 1, while Experiment 2 targeted the penultimate classification level. Overall, the best-performing model achieved an AUC of 66%. This demonstrates some effectiveness of the algorithms in detecting patients at risk of developing clinical FCR and encourages further investigations to enhance the model's performance and assess its generalizability. Conclusion: ML applied to reimbursement data has shown promise in predicting FCR, aiding in the identification of patients at risk of developing it. The results pave the way for personalized prevention and intervention strategies, representing a significant advancement in postcancer care focusing on the needs of survivors.