Revealing the impact of social circumstances on the selection of cancer therapy through natural language processing of social work notes.

Objective: We aimed to investigate the impact of social circumstances on cancer therapy selection using natural language processing to derive insights from social worker documentation. Materials and Methods: We developed and employed a Bidirectional Encoder Representations from Transformers (BERT) based approach, using a hierarchical multi-step BERT model (BERT-MS), to predict the prescription of targeted cancer therapy to patients based solely on documentation by clinical social workers. Our corpus included free-text clinical social work notes, combined with medication prescription information, for all patients treated for breast cancer at UCSF between 2012 and 2021. We conducted a feature importance analysis to identify the specific social circumstances that impact cancer therapy regimen. Results: Using only social work notes, we consistently predicted the administration of targeted therapies, suggesting systematic differences in treatment selection exist due to non-clinical factors. The findings were confirmed by several language models, with GatorTron achieving the best performance with an area under the receiver operating characteristic curve (AUROC) of 0.721 and a Macro F1 score of 0.616. The UCSF BERT-MS model, capable of leveraging multiple pieces of notes, surpassed the UCSF-BERT model in both AUROC and Macro-F1. Our feature importance analysis identified several clinically intuitive social determinants of health that potentially contribute to disparities in treatment. Discussion: Leveraging social work notes can be instrumental in identifying disparities in clinical decision-making. Hypotheses generated in an automated way could be used to guide patient-specific quality improvement interventions. Further validation with diverse clinical outcomes and prospective studies is essential. Conclusions: Our findings indicate that significant disparities exist among breast cancer patients receiving different types of therapies based on social determinants of health. Social work reports play a crucial role in understanding these disparities in clinical decision-making.