Oncologic Conditions Research Articles

Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach

Background Primary ovarian insufficiency (POI) can be seen in adolescents secondary to genetic or autoimmune conditions, or gonadotoxic therapies. Often times, its underlying cause is not identified. It is a rare condition in pediatrics, but a thorough evaluation is required for a timely diagnosis and optimizing outcomes. Objectives We aim to describe the clinical phenotype of idiopathic POI in an adolescent population seen in a referral center, and evaluate its diagnostic approach. Methods All patients evaluated between 2012 and 2018 were identified using the diagnostic codes for POI. Medical records were manually reviewed and clinical information was extracted. Cases were excluded from the final sample if they were found to have incomplete diagnostic information, Turner syndrome, eating disorders, gonadal surgeries and/or a history of oncological conditions or treatments. Results Forty-eight patients with POI were identified, and only seven met the established criteria. Anti-ovarian and anti-thyroid antibodies were evaluated in 100% and 86%, respectively, while only 29% were tested for anti-adrenal autoimmunity. The karyotype was obtained consistently, while the fragile X mental retardation 1 (FMR1) gene expansion was only assessed in approximately a third of the patients. Finally, only 29% of patients received reproductive counseling or referral to a fertility specialist. Conclusions Diagnostic evaluation for POI appears to be challenging to pediatric providers. Anti-ovarian antibodies are frequently obtained despite the lack of their clinical significance in POI, while anti-adrenal antibodies, which are the preferred diagnostic test, are not commonly obtained. Reproductive orientation or referral is seldom provided to the adolescent population.

Outcomes of Bladder Preservation Following Treatment for Rhabdomyosarcoma

Genitourinary rhabdomyosarcoma (RMS) is a relatively uncommon pediatric urologic oncologic condition with significant implications for both short- and long-term bladder functions. It is important for both pediatric and adult urologists to be aware of the pathophysiology, treatment, and long-term prognosis of this tumor and its potential impact on bladder function in both pediatric and adult survivors. Abnormalities in bladder function may arise secondary to surgical or medical management. Typical presenting complaints include lower urinary tract symptoms, which may be more common in pediatric RMS survivors than in survivors of other childhood cancers. Post-treatment evaluation of urinary function should include a baseline urodynamics study and an assessment of symptom severity and bother using validated, age-appropriate questionnaires. Upper tract monitoring should include renal/bladder ultrasound and serum creatinine. Hemorrhagic cystitis, which often develops acutely in patients receiving alkylating agents, may also present as a late effect. Lastly, urinary diversion may be required in patients with bladder/prostate (BP)-RMS either due to initial or delayed cystectomy or due to radiation-related loss of bladder function. Recent data suggest that diversion can maintain excellent quality of life in these patients. Both BP-RMS and its treatments have the potential for profound impacts on long-term bladder function. Most BP-RMS patients will survive beyond their initial diagnosis and treatment, and it is therefore important for both pediatric and adult urologists to be aware of the pathophysiology, treatment, and long-term prognosis of this tumor and its potential impact on bladder function in both pediatric and adult survivors.

The role of social workers in pediatric oncology

Introduction. In the past years, the role of social workers in the oncological disease treatment processes has significantly increased. The role implies supporting patient’s psychosocial conditions. The objective of the study was to study the psycho-social challenges of oncological children and their families and to define a role of social work in this area. Methods. As part of a qualitative study, five interviews were conducted with pediatric oncologists, also 15 in-depth interviews with family members of oncological patients and a focus group with 8 members. For the quantitative study, 62 beneficiaries and 12 medical specialists were interviewed. Results. The children with oncology conditions and their families faced psycho-social challenges and were in need of social workers’ support in overcoming those challenges. The study demonstrated a low level of public awareness. There is a lack of information among both doctors and beneficiaries. Both psychologists and social workers are involved in re-socialization of oncological children and they care for the improvement of children’s quality of life and support their families. However, there are only a few of such organizations. Therefore, many people who need their support have no chance to take such services. Conclusion. Implementing the social work in the pediatric oncology will be a major step toward the medical quality standards.

Validity, reliability, and feasibility of the Brief School Needs Inventory: Evaluating educational risk for students with chronic health conditions.

Researchers have increasingly emphasized the need to include routine educational and cognitive screening in the care plan for youth with chronic health conditions. Prior to now, a screener did not exist to asses risk/need in education in the pediatric setting; thus, this research aimed to examine the validity, reliability, and feasibility of the newly developed Brief School Needs Inventory (BSNI), which stratifies a patients level of educational risk/need in the context of a health condition. The authors developed and pilot-tested two versions of an education risk screener utilizing a mixed-methods design, which included an expert panel review process and assessments for validity, reliability, and feasibility. Ninety-eight school-age survivors of an oncologic disease were assessed for educational risk. Participants were assigned to two groups and administered either the initial (n=48) or revised (n=50) version of the screener. The final version of the screener, the BSNI, predicted educational risk in congruence with school liaisons perceived risk assessment with 94% accuracy. Liaisons also reported confidence in the results of 98% of cases for the BSNI. Similarly, expert panel results for the BSNI indicated a high degree of interrater agreement and content validity. The BSNI was found to be a valid and reliable screener for predicting educational risk for youth with oncologic conditions; future studies will examine use of the screener within other pediatric chronic populations.

Long-term results of the Global Modular Replacement System tumor prosthesis for reconstruction after limb-sparing bone resections in orthopedic oncologic conditions: Results from a national cohort.

We investigated implant revision, implant failure, and amputation risk after limb-sparing bone tumor surgery using the Global Modular Replacement System (GMRS) tumor prosthesis in patients suffering from bone sarcomas (BS), giant cell tumors (GCT), or metastatic bone disease (MBD). A retrospective study of a nationwide consecutive cohort (n = 119, 47 [12-81] years, M/F = 65/54) having limb-sparing surgery and reconstruction using the GMRS tumor prosthesis due to bone tumors (BS/GCT/MBD = 70/8/41) from 2005 to 2013. Anatomical locations were as followed: distal femur (n = 49), proximal femur (n = 41), proximal tibia (n = 26), or total femur (n = 3). Kaplan-Meier survival analysis and competing risk analysis with death as a competing risk were used for statistical analysis. For BS and GCT patients, 5-year patient survival was 72% (95% confidence interval [CI]: 59-85%) and for MBD 33% (95% CI: 19-48%). Thirty-two patients underwent revision surgery (5-year revision incidence 14%; 95% CI: 8-21%). Twelve patients had revision of bone-anchored parts (implant failure) with a 5-year revision incidence 6% (95% CI: 2-10%). Ten amputations were performed due to local relapse (n = 9) or recurrent infections (n = 1) with a 5-year incidence of amputation: 8% (95% CI: 3-13%). We identified a low risk of revision and amputation when using the GMRS tumor prosthesis for limb-sparing bone tumor.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two-Year Retrospective Analysis

Acupuncture and the administration of herbal supplements are increasingly used in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively) and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7 ± 3.7 vs. 9.5 ± 4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections in acupuncture points (pharmacopuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

SUN-243 Evaluation of Primary Ovarian Insufficiency in Adolescents Is a Challenge for Pediatric Providers

Background Primary ovarian insufficiency (POI) is characterized by ovarian dysfunction resulting in premature cessation of menses. Excluding patients with gonadal dysgenesis, it is estimated that only 0.01% of adolescents will experience POI. After thorough evaluation, the underlying cause remains elusive in 85-90% of cases. Ovarian function in POI is variable, intermittent, and unpredictable. The lack of well-established criteria and low prevalence in adolescents make the diagnosis and management challenging. Methods Using diagnostic codes we identified all cases of ovarian insufficiency between 2012 and 2018 seen at a children’s hospital in South Florida. We reviewed all cases diagnosed with ovarian insufficiency and chose those meeting current adult diagnostic criteria for POI for further analysis. Patients with missing information, gonadal dysgenesis, eating disorders, gonadal surgeries and/or a history of oncological conditions, or exposure to gonado-toxic treatments, were excluded. We conducted chart reviews, and relevant clinical and diagnostic information was extracted. Results A total of 48 patients diagnosed with ovarian insufficiency were identified; only seven met inclusion criteria. Mean age of diagnosis was 15.5 and 15.2 years respectively for primary and secondary amenorrhea. Patients with POI were evaluated and treated by the pediatrician, endocrinologist, and/or adolescent medicine specialist. Anti-ovarian antibodies were evaluated in all cases, anti-thyroid antibodies in six of the patients, but only two patients were tested for the presence of anti-adrenal antibodies. Karyotype was obtained in all of them, while genetic evaluation of FMR1 gene was performed in two. Finally, only two patients received reproductive counseling or were referred to a fertility specialist. One of them was referred after she had a spontaneous pregnancy and voluntary interruption. Conclusions Anti-ovarian antibodies were always obtained despite their lack of clinical significance in POI. Anti-adrenal antibodies, which are a better diagnostic test, were not evaluated as often as expected. Genetic evaluation was mostly limited to karyotype. Evaluation for FMR-1 premutation may be helpful for the diagnosis and management of the patient, as well as other female relatives. Only two of the seven patients received reproductive counseling or were referred to reproductive medicine. This is a key part of the evaluation and management of POI, since an early and appropriate intervention may improve the chances of fertility preservation as well as promote reproductive health in the adolescent population. Better training in the evaluation and management of patients with POI is needed across pediatric providers that care for these patients.

Cardiovascular Mortality and Morbidity Burden in Successive and Age Pre-Stratified Case-Control Cohorts of Breast Cancer Women. A Population-Based Study

Background: The existence, the components and the clinical relevance of treatment related cardiotoxicity in breast cancer patients are still the subject of controversial findings and recommendations. Two of the possible main determinants of uncertainty were taken as the focus of the present analysis of cardiovascular (CV) mortality and morbidity: the overtime changing risk profile of breast cancer protocols; the age-dependence of the role of background CV risk. Methods: Prospective comparative assessment of two cohorts of breast cancer women, cases, and their closely matched controls followed for three (36 330) and five years (23 906), covering the period Jan 1, 2007 to Dec 31, 2013. The pertinent NHS administrative databases were analyzed with Cox proportional hazards regression models to assess the differences in the incidence of fatal and not fatal CV events between pre-stratified cohorts of cases and controls representing three successive generations of breast cancer care and three age groups: <50, 50-69, ≥70 years. Findings: The hypothesis of important improvements in the benefit /risk profile in successive cohorts of exposed women is documented by the decreases in directly breast cancer related deaths (7*7, 7*0, 6*5%), in the presence of stable rates of cardiac causes of death. What matters more is the very low and decreasing incidence (from 1*3 to 0*5%) of the expectedly most significant indicator of cardiac toxicity, heart failure (HF), whose hazard ratio (HR) reaches a reasonable level of significance only in the first period studied (HR:1*71 95%CI: 1*19-2*46). Morbidity and longer follow-up confirm the above data on HF incidence and risk (HR:1*52 95%CI: 1*13-2*04). Incidence and HR for hospitalization for thromboembolic events, recognized CV events associated with the systemic toxicity of oncological conditions, more than to its treatments, are an indirect but strong indicator of the informative validity of the database analyzed. Interpretation: In agreement with most recent experimental and epidemiological data, our report documents a low, decreasing incidence and clinical relevance of treatment-related cardiotoxicity. Awareness of its potential occurrence must be accompanied by the expected directly related CV risk of a cancer and age-dependent condition. Besides the routine assessments, personalized monitoring, on the basis of concomitant CV risks or morbidity, could be needed especially in older patients. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interest: No competing interests. Ethical Approval: Data anonymization prior to any analysis and data protection procedures followed the strict criteria adopted by the Puglia Region Health Care Agency, in full compliance with national regulations, and the ethical requirements foreseen for the epidemiological utilization of administrative databases). No informed consent is required when using anonymous aggregated data.

External radiation exposure rate after18F-FDG PET/CT examination

18F fluorodeoxyglucose (FDG) is widely used for PET CT examinations; however, positron-emitting florin generates relatively high gamma radiation (511 keV) raising occupational as well as public safety concerns. This study aimed to measure the rate of radiation emitted from patients that underwent18FDG PET/CT examination for oncological conditions, approximately 2 hours after the procedure, before and after urination. A total of 100 patients who underwent18F-FDG PET/CT examination were included in this study. Following imaging, external radiation exposure rate was measured using proportional counter probe at 1-m distance, approximately 2 hours after the completion of imaging procedure, before and after urination. Factors effecting resulting exposure from patients were examined. The mean post-urination activity ranged between 0.2 and 6.3 μSv/h (median, 1.8 μSv/h). Presence of metastasis, tumor type and gender did not have any effect on mean post-urination activity (P&gt;0.05 for all comparisons). Older age, greater BMI and higher administered dose were associated with higher post-urination activity (P &lt; 0.05 for all comparisons). Findings of this study showed that 2 hours after radionuclide injection, activity rate from patients is far below the recommended limits for general population and further decreases after urination. Discharging patients at 2 hours after urination would not seem to pose radiation health risk for relatives, public or other hospital staff.

Overview on vitamin D and sunbed use.

Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV-emitting tanning devices, as well as the whole UV spectrum, as group-1 carcinogens, as they significantly increase the risk of melanoma and non-melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk-benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.

Temporal phenotyping of medically complex children via PARAFAC2 tensor factorization.

Our aim is to extract clinically-meaningful phenotypes from longitudinal electronic health records (EHRs) of medically-complex children. This is a fragile set of patients consuming a disproportionate amount of pediatric care resources but who often end up with sub-optimal clinical outcome. The rise in available electronic health records (EHRs) provide a rich data source that can be used to disentangle their complex clinical conditions into concise, clinically-meaningful groups of characteristics. We aim at identifying those phenotypes and their temporal evolution in a scalable, computational manner, which avoids the time-consuming manual chart review. We analyze longitudinal EHRs from Children's Healthcare of Atlanta including 1045 medically complex patients with a total of 59,948 encounters over 2 years. We apply a tensor factorization method called PARAFAC2 to extract: (a) clinically-meaningful groups of features (b) concise patient representations indicating the presence of a phenotype for each patient, and (c) temporal signatures indicating the evolution of those phenotypes over time for each patient. We identified four medically complex phenotypes, namely gastrointestinal disorders, oncological conditions, blood-related disorders, and neurological system disorders, which have distinct clinical characterizations among patients. We demonstrate the utility of patient representations produced by PARAFAC2, towards identifying groups of patients with significant survival variations. Finally, we showcase representative examples of the temporal phenotypic trends extracted for different patients. Unsupervised temporal phenotyping is an important task since it minimizes the burden on behalf of clinical experts, by relegating their involvement in the output phenotypes' validation. PARAFAC2 enjoys several compelling properties towards temporal computational phenotyping: (a) it is able to handle high-dimensional data and variable numbers of encounters across patients, (b) it has an intuitive interpretation and (c) it is free from ad-hoc parameter choices. Computational phenotypes, such as the ones computed by our approach, have multiple applications; we highlight three of them which are particularly useful for medically complex children: (1) integration into clinical decision support systems, (2) interpretable mortality prediction and 3) clinical trial recruitment. PARAFAC2 can be applied to unsupervised temporal phenotyping tasks where precise definitions of different phenotypes are absent, and lengths of patient records are varying.

Tumor localization and surgical margins identification in breast cancer using ICG-fluorescence imaging

Introduction: The accuracy of tumor localisation and perioperative margin assessment in breast cancer (BC) is of critical importance in surgical treatment planning. Currently, gross pathological evaluation, frozen section, imprint cytology, intraoperative ultrasound, and two-view specimen mammography are used for intraoperative margins evaluation. The most commonly used methods in pre-operative marking of non-palpable breast tumor are wire-guided localization, radioguided occult lesion localization, carbonmarking and intraoperative ultrasound. These procedures have several disadvantages, are labor intensive, not fully reliable, time consuming, may lead to poor cosmesis, and therefore novel strategies are necessary. Fluorescence imaging (FI) has emerged as a new technique for improving tumor detection and to guide surgical resection in different oncological conditions. The pourpose of this study are to evaluate the role of FI using an intraoperative intravenous injection of free indocyanine green (ICG) for the localization of breast tumors cancer and evaluate if it can be utilized to assess the residual disease of the surgical specimen.

Benign Bone Tumors When They Coexist with Common Orthopaedic Conditions.

Benign and malignant bone tumors around the knee can be encountered with concomitant orthopaedic disease. As such, it is important to recognize these oncologic processes that may impact or alter the routine treatment of more common orthopaedic processes. Frequently, these rare oncologic conditions are discovered only through the evaluation of acute injuries as in the setting of fractures or sports injuries. Other times, they are encountered when evaluating chronic entities, such as arthroplasty. This article aims to provide general guidelines and management strategies for benign bone tumors when they coincide with common orthopaedic conditions around the knee.

Choroid plexus papilloma: case report

ABSTRACT Choroid plexus papillomas (CPP) are a rare oncological condition. They affect mostly the pediatric population, and the diagnosis is associated with clinical findings, imaging and anatomopathological methods. We report the case of a 49-year-old woman who underwent neurosurgical evaluation for chronic headache and emotional stress. CPP is a rare central nervous system tumor in the adult population. We present, therefore, a case in an adult female, whose diagnosis was confirmed by histopathology methods. Surgical treatment is the gold standard, showing full resolution in almost all cases.

Iron deficiency and cancer – clinical implications

Anemia is a frequent complication in oncologic patients, being encountered both at the moment of cancer diagnosis and during different oncologic therapies. The presence of anemia, regardless of the cause or mechanism, in oncologic patients adversely affects the quality of life, the outcome of the neoplastic disease and the adherence to treatment. The mechanisms involved in the appearance of anemia in oncologic patients are intricated. Iron deficiency is a frequent cause of anemia in oncologic patients. This de­fi­cien­cy is noticed in approximately 50% of patients with solid and hematological tumors. In oncologic patients, the pre­va­lent mechanism for iron deficiency is the functional mechanism. In this case, the iron stores are reduced due to the underlying oncologic condition or due to inflammatory processes associated to cancer treatments. Iron deficiency in cancer patients is often underestimated, mainly due to the difficulty of defining iron deficiency on the basis of usual laboratory markers. The current therapeutic options of cancer anemia include blood transfusions, iron substitution and erythropoietin-stimulating agents.

Meeting the psychosocial needs of adolescents and their families during a diagnosis of acute lymphoblastic leukaemia.

Acute lymphoblastic leukaemia (ALL), an oncological condition affecting blood-producing cells, is the most common type of childhood cancer. It is more common in younger children but the number of young people diagnosed is significant, with about 125 new cases diagnosed each year. While survival rates are high, diagnostic tests, symptoms and treatment regimens can have negative psychological and sociological implications for patients and their families. This article examines the role of the registered children's nurse in meeting the psychosocial needs of adolescents and their families during a diagnosis of ALL. The psychosocial needs considered in this article include those for information, emotional support, collaborative decision-making, education and socialisation. The article also considers physical health needs and financial concerns. The importance of focusing on patients' and families' concerns when arranging psychosocial support is highlighted, together with the requirement to reassess their needs continually throughout the trajectory of the illness.

The Iceberg Map of germline mutations in childhood cancer: focus on primary immunodeficiencies.

The risk of cancer is higher, and its outcome is worse in patients with primary immunodeficiency (PID) than in members of the general population. Thus, the inter-relationship of malignant diseases with PIDs requires more study. Large genetic screens identified a vast number of germline mutations in childhood cancer patient samples. Although TP53 was the most frequent single gene identified as mutated, many PID disorders like DNA repair defects are among the inborn causes of childhood cancer. We provide a comprehensive analysis of compiled data from seven recent studies that focused on germline genetic landscapes and preexisting conditions in pediatric oncology. As potentially causal germline variants were identified in ≈8% of malignancies in children and adolescents, we visualized this proportion as the 'tips of the icebergs'. The results of additional network analyses showed the shared patterns of germline mutations in various malignancies and yielded a spatial distribution of the 'icebergs'. The 'iceberg map of germline mutations in childhood cancers' was created to increase the awareness of the inborn genetic underpinnings of childhood malignancies and their relationships with immunodeficiencies. Needs and perspectives of clinical immunologists and pediatric oncologists to both improve patient care and guide research at this critical interface are discussed. VIDEO ABSTRACT.

Soft tissue sarcomas: limb salvage using reconstructive plastic surgery techniques

The treatment of choice for soft tissue sarcomas with local involvement is still the complete surgical removal into healthy tissue. The aim of surgery is to achieve tumor-free resection margins in the sense of a R0 resection. No other treatment option can equally replace this important oncological condition. The enormous development in the field of reconstructive plastic surgery and in particular the advances in flap techniques and microsurgery enable limb salvage and the functional reconstruction even in the case of extensive tumors.

Sirtuin 5 Deficiency Does Not Compromise Innate Immune Responses to Bacterial Infections

Sirtuin 5 (SIRT5) is a member of the family of NAD+-dependent lysine/histone deacetylases. SIRT5 resides mainly in the mitochondria where it catalyzes deacetylation, demalonylation, desuccinylation, and deglutarylation of lysine to regulate metabolic and oxidative stress response pathways. Pharmacologic inhibitors of SIRT5 are under development for oncologic conditions, but nothing is known about the impact of SIRT5 on antimicrobial innate immune defenses. Using SIRT5 knockout mice, we show that SIRT5 deficiency does not affect immune cell development, cytokine production and proliferation by macrophages and splenocytes exposed to microbial and immunological stimuli. Moreover, preclinical models suggest that SIRT5 deficiency does not worsen endotoxemia, Klebsiella pneumoniae and Streptococcus pneumoniae pneumonia, Escherichia coli peritonitis, listeriosis, and staphylococcal infection. Altogether, these data support the safety profile in terms of susceptibility to infections of SIRT5 inhibitors under development.

A systematic review of the clinical application of data-driven population segmentation analysis

BackgroundData-driven population segmentation analysis utilizes data analytics to divide a heterogeneous population into parsimonious and relatively homogenous groups with similar healthcare characteristics. It is a promising patient-centric analysis that enables effective integrated healthcare interventions specific for each segment. Although widely applied, there is no systematic review on the clinical application of data-driven population segmentation analysis.MethodsWe carried out a systematic literature search using PubMed, Embase and Web of Science following PRISMA criteria. We included English peer-reviewed articles that applied data-driven population segmentation analysis on empirical health data. We summarized the clinical settings in which segmentation analysis was applied, compared and contrasted strengths, limitations, and practical considerations of different segmentation methods, and assessed the segmentation outcome of all included studies. The studies were assessed by two independent reviewers.ResultsWe retrieved 14,514 articles and included 216 articles. Data-driven population segmentation analysis was widely used in different clinical contexts. 163 studies examined the general population while 53 focused on specific population with certain diseases or conditions, including psychological, oncological, respiratory, cardiovascular, and gastrointestinal conditions. Variables used for segmentation in the studies are heterogeneous. Most studies (n = 170) utilized secondary data in community settings (n = 185). The most common segmentation method was latent class/profile/transition/growth analysis (n = 96) followed by K-means cluster analysis (n = 60) and hierarchical analysis (n = 50), each having its advantages, disadvantages, and practical considerations. We also identified key criteria to evaluate a segmentation framework: internal validity, external validity, identifiability/interpretability, substantiality, stability, actionability/accessibility, and parsimony.ConclusionsData-driven population segmentation has been widely applied and holds great potential in managing population health. The evaluations of segmentation outcome require the interplay of data analytics and subject matter expertise. The optimal framework for segmentation requires further research.