The Use of Chatbots in Oncological Care: A Narrative Review

Figures & data

Figure 1 PRISMA flowchart of literature review process.

Notes: PRISMA figure adapted based on guidelines from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. Creative Commons.

Table 1 Summary Table of Included Studies

PMID	Author	Study Design	Sample Size	Significant Finding/Result	Cancer Type	Chatbot Purpose
31774408	Jean-Emmanuel Bibault et al^Citation6	RCT	142	Chatbot usability scores of helping answer patient questions on cancer were found to be noninferior to the scores of physicians	Breast	Cancer treatment, monitoring, and management
3247762	Muhammad Amith et al^Citation30	Pilot study	24	Statistical difference reported of evidence of impact on health beliefs and perceptions of the HPV vaccine before and after chatbot counseling	Cervical	Cancer screening, prevention, and risk stratification
32704245	Muhammad Amith et al^Citation31	Pilot Study	16	An ontology-powered dialogue engine can be used to provide HPV counseling between patients and chatbots	Cervical	Cancer screening, prevention, and risk stratification
34391413	Izidor Mlakar et al^Citation32	Pilot study	160	Study expects that cancer survivors will significantly increase their self-efficacy, healthy habits, disease self-management and self-perceived quality of learning from intervention with embodied CA	Breast and Colorectal	Cancer survivorship
31045505	Benjamin Chaix et al^Citation33	Pilot Study	4737	88.00% of patients reported chatbot provided them with support and helped them follow their treatment effectively.	Breast	Cancer treatment, monitoring, and management
29978858	Ying Wu et al^Citation24	Pilot study	Unknown	Conversational agents can help increase cervical cancer screening rates among Hispanic women in a rural agricultural community	Cervical	Cancer screening, prevention, and risk stratification
29996666	Otis L Owens et al^Citation25	RCT	354	Participants experienced significant improvements in their prostate cancer knowledge, informed decision-making self-efficacy, and technology use self-efficacy with chatbot	Prostate	Cancer screening, prevention, and risk stratification
26728964	Timothy W Bickmore et al^Citation34	RCT	89	Conversational agents can be used to improve accessibility to Web-based searches and clinical trials including about cancer for low-health literacy patients	No type specified	Patient education and communication
32897737	Brandon M Welch et al^Citation35	RCT	14140	Chatbots can gather family health history information at the population level, with patients expressing high levels of engagement and interest	No type specified	Cancer screening, prevention, and risk stratification
33544084	Ann Sato et al^Citation36	Pilot Study	3	Chatbot systems can be applied to preliminary genetic medicine screening for HBOC	Breast and Ovarian	Cancer screening, prevention, and risk stratification
31160007	Antoine Piau et al^Citation37	Pilot study	52	Patients benefited from the chatbot regarding serious health and adherence issues requiring timely interventions	No type specified	Cancer treatment, monitoring, and management
34735417	Shivani Nazareth et al^Citation38	Retrospective Observational study	95,166	Chatbot digital health tools can help automatically flag high-risk patients to improve automatic transfer of data and give nurses more time for complex genetics services and patient interaction	Breast and Ovarian	Cancer screening, prevention, and risk stratification
34792472	Daniel Chavez-Yenter et al^Citation39	Pilot study	103	Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers.	No type specified	Cancer screening, prevention, and risk stratification
32357886	Sebastiaan M Stuij et al^Citation40	Interview Pilot Study	5	Chatbot users claim texts were “easier to read than a book” and users liked generation of reminders.	No type specified	Patient education and communication
33688839	Yuki Kataoka et al^Citation41	Mixed Methods Study	12 (11 patients, 1 caregiver)	Medical staff can use chatbots to educate patients about how to handle symptoms, but further studies are required to improve chatbots since satisfactory rates are not high	Lung	Cancer treatment, monitoring, and management
34700280	Daniel Ma et al^Citation42	Pilot study	95	61% of patients reported that chatbot helped with symptom self-management and reduced the need to call care team	Head and Neck	Cancer treatment, monitoring, and management
34192239	Benjamin Chaix et al^Citation43	Cross-sectional study	1771	Chatbot evaluated that prevalence of Peritraumatic distress in at-risk patients is high in France	Breast	Cancer treatment, monitoring, and management
31492408	Alison Chetlen et al^Citation44	Pilot study	55	74% of women stated that the chatbot improved the quality of care and quality of life; 87% of patients reported an improved understanding of their breast biopsy procedure	Breast	Cancer treatment, monitoring, and management
33168571	Brandie Heald et al^Citation45	Feasibility Study	4254	96.2% of patients completed the chat with the chatbot and genetic screening and testing for HCRC syndromes was carried out successfully	Colorectal	Cancer screening, prevention, and risk stratification
34649750	Elen Siglen et al^Citation46	Pilot study	2257	Final performance testing of chatbot indicated a fallback rate below 15%; users liked the layout and found the chatbot trustworthy and reader friendly	Breast and Ovarian	Cancer screening, prevention, and risk stratification
34078380	Kimberly A Kaphingst et al^Citation47	RCT	2780	The chatbot can advance the state of identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients	No type specified	Cancer screening, prevention, and risk stratification

Abbreviation: RCT, Randomized Controlled Trial.

Bibault JE, Chaix B, Nectoux P, Pienkowsky A, Guillemasse A, Brouard B. Healthcare ex machina: are conversational agents ready for prime time in oncology? Clin Transl Radiat Oncol. 2019;16:55–59. doi:10.1016/j.ctro.2019.04.002

 PubMed Web of Science ®Google Scholar

Amith M, Lin R, Cunningham R, et al. Examining potential usability and health beliefs among young adults using a conversational agent for HPV vaccine counseling - PubMed. AMIA Summits Transl Sci Proc. 2020;2020:7–16. doi:10.1145/3380991.3383937

 Google Scholar

Amith M, Lin R, Cui L, et al. An ontology-powered dialogue engine for patient communication of vaccines - PubMed. CEUR Workshop Proc. 2019;2539:55–60. PMID: 32704245.

 Google Scholar

Mlakar I, Lin S, Aleksandraviča I, et al. Patients-centered SurvivorShIp care plan after Cancer treatments based on big data and artificial intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors. BMC Med Inform Decis Mak. 2021;21(1):39. doi:10.1186/s12911-021-01603-w

 PubMed Web of Science ®Google Scholar

Chaix B, Bibault JE, Pienkowski A, et al. When chatbots meet patients: one-year prospective study of conversations between patients with breast cancer and a chatbot. JMIR Cancer. 2019;5(1):e12856. doi:10.2196/12856

 PubMed Web of Science ®Google Scholar

Wu Y, Samant D, Squibbs K, Chaet A, Morshedi B, Barnes LE. Design of interactive cancer education technology for latina farmworkers. Proc IEEE Syst Inf Eng Des Symp. 2014;2014:1–5. doi:10.1109/SIEDS.2014.6829908

 Google Scholar

Owens OL, Felder T, Tavakoli AS, et al. Evaluation of a computer-based decision aid for promoting informed prostate cancer screening decisions among African American men: iDecide. Am J Health Promot. 2019;33(2):267–278. doi:10.1177/0890117118786866

 PubMed Web of Science ®Google Scholar

Bickmore TW, Utami D, Matsuyama R, Paasche-Orlow MK. Improving access to online health information with conversational agents: a randomized controlled experiment. J Med Internet Res. 2016;18(1):e1. doi:10.2196/JMIR.5239

 PubMed Web of Science ®Google Scholar

Welch BM, Allen CG, Ritchie JB, Morrison H, Hughes-Halbert C, Schiffman JD. Using a chatbot to assess hereditary cancer risk. JCO Clin Cancer Inform. 2020;4(4):787–793. doi:10.1200/CCI.20.00014

 PubMedGoogle Scholar

Sato A, Haneda E, Suganuma N, Narimatsu H. Preliminary screening for hereditary breast and ovarian cancer using a chatbot augmented intelligence genetic counselor: development and feasibility study. JMIR Form Res. 2021;5(2):e25184. doi:10.2196/25184

 PubMedGoogle Scholar

Piau A, Crissey R, Brechemier D, Balardy L, Nourhashemi F. A smartphone chatbot application to optimize monitoring of older patients with cancer. Int J Med Inform. 2019;128:18–23. doi:10.1016/J.IJMEDINF.2019.05.013

 PubMed Web of Science ®Google Scholar

Nazareth S, Hayward L, Simmons E, et al. Hereditary cancer risk using a genetic chatbot before routine care visits. Obstet Gynecol. 2021;138(6):860–870. doi:10.1097/AOG.0000000000004596

 PubMed Web of Science ®Google Scholar

Chavez-Yenter D, Kimball KE, Kohlmann W, et al. Patient interactions with an automated conversational agent delivering pretest genetics education: descriptive study. J Med Internet Res. 2021;23(11):e29447. doi:10.2196/29447

 PubMed Web of Science ®Google Scholar

Stuij SM, Drossaert CHC, Labrie NHM, et al. Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach. BMC Med Educ. 2020;20(1):81. doi:10.1186/S12909-020-1985-0

 PubMed Web of Science ®Google Scholar

Kataoka Y, Takemura T, Sasajima M, Katoh N. Development and early feasibility of chatbots for educating patients with lung cancer and their caregivers in Japan: mixed methods study. JMIR Cancer. 2021;7(1):e26911. doi:10.2196/26911

 PubMed Web of Science ®Google Scholar

Ma D, Orner D, Ghaly MM, et al. Automated health chats for symptom management of head and neck cancer patients undergoing radiation therapy. Oral Oncol. 2021;122:105551. doi:10.1016/j.oraloncology.2021.105551

 PubMed Web of Science ®Google Scholar

Chaix B, Delamon G, Guillemassé A, Brouard B, Bibault JE. Psychological distress during the COVID-19 pandemic in France: a national assessment of at-risk populations. Gen Psychiatr. 2020;33(6):e100349. doi:10.1136/GPSYCH-2020-100349

 PubMed Web of Science ®Google Scholar

Chetlen A, Artrip R, Drury B, Arbaiza A, Moore M. Novel use of chatbot technology to educate patients before breast biopsy. J Am Coll Radiol. 2019;16(9Pt B):1305–1308. doi:10.1016/j.jacr.2019.05.050

 PubMedGoogle Scholar

Heald B, Keel E, Marquard J, et al. Using chatbots to screen for heritable cancer syndromes in patients undergoing routine colonoscopy. J Med Genet. 2021;58(12):807–814. doi:10.1136/jmedgenet-2020-107294

 PubMed Web of Science ®Google Scholar

Siglen E, Vetti HH, Lunde ABF, et al. Ask Rosa - the making of a digital genetic conversation tool, a chatbot, about hereditary breast and ovarian cancer. Patient Educ Couns. 2022;105(6):1488–1494. doi:10.1016/j.pec.2021.09.027

 PubMed Web of Science ®Google Scholar

Kaphingst KA, Kohlmann W, Chambers RL, et al. Comparing models of delivery for cancer genetics services among patients receiving primary care who meet criteria for genetic evaluation in two healthcare systems: BRIDGE randomized controlled trial. BMC Health Serv Res. 2021;21(1):494. doi:10.1186/S12913-021-06489-Y

 PubMed Web of Science ®Google Scholar