Human-in-the-Loop Automation for CTCAE Grading

Introduction: Why Autonomy Is the Wrong Goal

In oncology safety, autonomy is not the objective. Accuracy, transparency, and accountability are. Any system that removes clinicians from the grading loop introduces unacceptable risk.

Human-in-the-loop automation offers a safer alternative.

What Human-in-the-Loop Really Means

In a proper design, systems suggest rather than decide. They surface candidate adverse events, map them to CTCAE terms, and present evidence. Clinicians accept, modify, or reject these suggestions.

Every action is visible and attributable.

Transparency as a Safety Requirement

Clinicians must be able to see why a suggestion was made. Source text, lab values, and applicable definitions should be immediately accessible. Black-box outputs erode trust and create audit risk.

Governance and Oversight

Safe automation requires governance: defined user roles, escalation pathways, performance review, and change control. Updates to logic or models must be managed like any other safety-critical system.

Augmentation, Not Replacement

When done well, automation reduces cognitive load and documentation burden while preserving clinical authority. The clinician remains responsible, but no longer works alone against an overwhelming volume of data.