# CliCARE: Grounding Large Language Models in Clinical Guidelines for Decision Support over Longitudinal Cancer Electronic Health Records

arXiv: https://arxiv.org/abs/2507.22533 · HTML: https://mlsanity.com/paper/2507.22533/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Medical and biomedical RAG, one of 15 directions in Retrieval-augmented generation.
- Builds on 14 of its 41 references that are in the map.
- First posted on arXiv 30 Jul 2025.

## Placed in

- Retrieval-augmented generation / [Medical and biomedical RAG](https://mlsanity.com/rag/medical-and-biomedical-rag/)

## Builds on (most cited first, 14 of 14)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [Longformer: The Long-Document Transformer](https://mlsanity.com/paper/2004.05150/) (2020)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [LongBench: A Bilingual, Multitask Benchmark for Long Context Understanding](https://mlsanity.com/paper/2308.14508/) (2023)
- [Large Language Models are Inconsistent and Biased Evaluators](https://mlsanity.com/paper/2405.01724/) (2024)
- [MedRAG: Enhancing Retrieval-augmented Generation with Knowledge Graph-Elicited Reasoning for Healthcare Copilot](https://mlsanity.com/paper/2502.04413/) (2025)
- [LLM-based Medical Assistant Personalization with Short- and Long-Term Memory Coordination](https://mlsanity.com/paper/2309.11696/) (2023)
- [Efficient Knowledge Infusion via KG-LLM Alignment](https://mlsanity.com/paper/2406.03746/) (2024)
- [MedOdyssey: A Medical Domain Benchmark for Long Context Evaluation Up to 200K Tokens](https://mlsanity.com/paper/2406.15019/) (2024)
- [CancerLLM: A Large Language Model in Cancer Domain](https://mlsanity.com/paper/2406.10459/) (2024)
- [RAG-KG-IL: A Multi-Agent Hybrid Framework for Reducing Hallucinations and Enhancing LLM Reasoning through RAG and Incremental Knowledge Graph Learning Integration](https://mlsanity.com/paper/2503.13514/) (2025)
- [XAI4LLM. Let Machine Learning Models and LLMs Collaborate for Enhanced In-Context Learning in Healthcare](https://mlsanity.com/paper/2405.06270/) (2024)

## Built on by (most cited first, 4 of 4)

- [CliniCARE-Bench: Clinical Calibrated Audit of Medical Reasoning in EHR](https://mlsanity.com/paper/2608.07796/) (2026)
- [OmniFood-Bench: Evaluating VLMs for Nutrient Reasoning and Personalized Health Advice](https://mlsanity.com/paper/2607.08423/) (2026)
- [Grounded in Consensus, In Step With Emerging Science: A Consensus-Anchored Multi-Corpus Clinical Chatbot for Long COVID](https://mlsanity.com/paper/2607.25038/) (2026)
- [Large language models exhibit unreliable updating of clinical judgment as patient evidence evolves](https://mlsanity.com/paper/2610.02684/) (2026)

## Abstract (arXiv)

Large Language Models (LLMs) hold significant promise for improving clinical decision support and reducing physician burnout by synthesizing complex, longitudinal cancer Electronic Health Records (EHRs). However, their implementation in this critical field faces three primary challenges: the inability to effectively process the extensive length and fragmented nature of patient records for accurate temporal analysis; a heightened risk of clinical hallucination, as conventional grounding techniques such as Retrieval-Augmented Generation (RAG) do not adequately incorporate process-oriented clinical guidelines; and unreliable evaluation metrics that hinder the validation of AI systems in oncology. To address these issues, we propose CliCARE, a framework for Grounding Large Language Models in Clinical Guidelines for Decision Support over Longitudinal Cancer Electronic Health Records. The framework operates by transforming unstructured, longitudinal EHRs into patient-specific Temporal Knowledge Graphs (TKGs) to capture long-range dependencies, and then grounding the decision support process by aligning these real-world patient trajectories with a normative guideline knowledge graph. This approach provides oncologists with evidence-grounded decision support by generating a high-fidelity clinical summary and an actionable recommendation. We validated our framework using large-scale, longitudinal data from a private Chinese cancer dataset and the public English MIMIC-IV dataset. In these settings, CliCARE significantly outperforms baselines, including leading long-context LLMs and Knowledge Graph-enhanced RAG methods. The clinical validity of our results is supported by a robust evaluation protocol, which demonstrates a high correlation with assessments made by oncologists.