# Traj-CoA: Patient Trajectory Modeling via Chain-of-Agents for Lung Cancer Risk Prediction

arXiv: https://arxiv.org/abs/2510.10454 · HTML: https://mlsanity.com/paper/2510.10454/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 27 of its 59 references that are in the map.
- First posted on arXiv 12 Oct 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 27 of 27)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Overcoming catastrophic forgetting in neural networks](https://mlsanity.com/paper/1612.00796/) (2016)
- [Lost in the Middle: How Language Models Use Long Contexts](https://mlsanity.com/paper/2307.03172/) (2023)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [Mem0: Building Production-Ready AI Agents with Scalable Long-Term Memory](https://mlsanity.com/paper/2504.19413/) (2025)
- [A Survey on the Memory Mechanism of Large Language Model based Agents](https://mlsanity.com/paper/2404.13501/) (2024)
- [A Systematic Survey of Prompt Engineering in Large Language Models: Techniques and Applications](https://mlsanity.com/paper/2402.07927/) (2024)
- [Scaling Relationship on Learning Mathematical Reasoning with Large Language Models](https://mlsanity.com/paper/2308.01825/) (2023)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [RETAIN: An Interpretable Predictive Model for Healthcare using Reverse Time Attention Mechanism](https://mlsanity.com/paper/1608.05745/) (2016)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [Nomic Embed: Training a Reproducible Long Context Text Embedder](https://mlsanity.com/paper/2402.01613/) (2024)
- [BEHRT: Transformer for Electronic Health Records](https://mlsanity.com/paper/1907.09538/) (2019)
- [Chain of Agents: Large Language Models Collaborating on Long-Context Tasks](https://mlsanity.com/paper/2406.02818/) (2024)
- [MIMIC-Extract: A Data Extraction, Preprocessing, and Representation Pipeline for MIMIC-III](https://mlsanity.com/paper/1907.08322/) (2019)
- [A Survey of LLM-based Agents in Medicine: How far are we from Baymax?](https://mlsanity.com/paper/2502.11211/) (2025)
- [TxAgent: An AI Agent for Therapeutic Reasoning Across a Universe of Tools](https://mlsanity.com/paper/2503.10970/) (2025)
- [A Closer Look at AUROC and AUPRC under Class Imbalance](https://mlsanity.com/paper/2401.06091/) (2024)
- [Context Clues: Evaluating Long Context Models for Clinical Prediction Tasks on EHRs](https://mlsanity.com/paper/2412.16178/) (2024)
- [TIMER: Temporal Instruction Modeling and Evaluation for Longitudinal Clinical Records](https://mlsanity.com/paper/2503.04176/) (2025)
- [LongHealth: A Question Answering Benchmark with Long Clinical Documents](https://mlsanity.com/paper/2401.14490/) (2024)
- [Prompting Large Language Models for Zero-Shot Clinical Prediction with Structured Longitudinal Electronic Health Record Data](https://mlsanity.com/paper/2402.01713/) (2024)
- [ICE-NODE: Integration of Clinical Embeddings with Neural Ordinary Differential Equations](https://mlsanity.com/paper/2207.01873/) (2022)
- [Modelling Patient Trajectories Using Multimodal Information](https://mlsanity.com/paper/2209.04224/) (2022)
- [Multi-modal Graph Learning over UMLS Knowledge Graphs](https://mlsanity.com/paper/2307.04461/) (2023)

## Built on by (most cited first, 2 of 2)

- [AgentRx: A Benchmark Study of LLM Agents for Multimodal Clinical Prediction Tasks](https://mlsanity.com/paper/2605.10286/) (2026)
- [EHR-MPC: Inference-Time Control for Sepsis Treatment with Generative Patient Digital Twins](https://mlsanity.com/paper/2607.08793/) (2026)

## Abstract (arXiv)

Large language models (LLMs) offer a generalizable approach for modeling patient trajectories, but suffer from the long and noisy nature of electronic health records (EHR) data in temporal reasoning. To address these challenges, we introduce Traj-CoA, a multi-agent system involving chain-of-agents for patient trajectory modeling. Traj-CoA employs a chain of worker agents to process EHR data in manageable chunks sequentially, distilling critical events into a shared long-term memory module, EHRMem, to reduce noise and preserve a comprehensive timeline. A final manager agent synthesizes the worker agents' summary and the extracted timeline in EHRMem to make predictions. In a zero-shot one-year lung cancer risk prediction task based on five-year EHR data, Traj-CoA outperforms baselines of four categories. Analysis reveals that Traj-CoA exhibits clinically aligned temporal reasoning, establishing it as a promisingly robust and generalizable approach for modeling complex patient trajectories. Implementation of Traj-CoA is available on https://github.com/zengsihang/Traj-CoA.