Automated health chats for symptom management of head and neck cancer patients undergoing radiation therapy

Conversational Agents to Support Pain Management: A Scoping Review

BACKGROUND

Pain-related conditions are the leading cause of years lived with disability globally. Managing pain presents significant challenges, including the need to address multiple biopsychosocial factors and the difficulty in delivering evidence-based treatments. Digital health technologies, such as conversational agents, offer the potential for personalised and accessible pain management. However, the characteristics and effectiveness of these interventions are not yet fully understood. This scoping review aims to comprehensively evaluate the applications and effectiveness of conversational agents in supporting pain management in adults (i.e., healthy individuals at risk of developing pain, individuals currently experiencing pain and healthcare providers or students involved in managing pain conditions).

METHODS

Searches were systematically conducted across six databases-MEDLINE PubMed, ACM Digital Library, CINAHL, Embase, PsycINFO, Cochrane CENTRAL-and five trial registries from inception.

RESULTS

Twenty-eight studies were included, focusing on capturing health information (n = 8), providing emotional support (n = 7), facilitating adherence to self-management exercises (n = 6), delivering psychological treatment (n = 5), offering organisational support (n = 1) and educating healthcare providers (n = 1). These studies addressed conditions with pain as a central or common symptom, including dementia (n = 7), cancer (n = 5) and musculoskeletal disorders (n = 4), among others. None of the conversational agents on the market covered all four stages recommended for translational research (development, feasibility, effectiveness and implementation).

CONCLUSION

The use of conversational agents in pain management is relatively new and involves diverse and promising appllications. However, evidence supporting their effectiveness in improving pain-related outcomes remains limited and heterogeneous. Future reseacrh should prioritise feasibility, reliability, and user experience studies to inform the design of robust randomised controlled trials.

SIGNIFICANCE

This scoping review comprehensively examines the use of conversational agents (CAs) in adult pain management. The study identified six applications of CAs to support pain management and highlights a lack of high-quality randomised controlled trials, particularly those preceded by development and feasibility studies. Clinicians and researchers can use these insights to guide future studies and improve applications of CAs in pain management.

Allies not enemies-creating a more empathetic and uplifting patient experience through technology and art

OBJECTIVE

To understand whether art and technology (mainly conversational agents) may help oncology patients to experience a more humanized journey.

METHODS

This narrative review encompasses a comprehensive examination of the existing literature in this field by a multicenter, multidisciplinary, and multiprofessional team aiming to analyze the current developments and potential future directions of using art and technology for patient engagement.

RESULTS

We identified three major themes of patient engagement with art and three major themes of patient engagement with technologies. Two real-case scenarios are reported from our experience to practically envision how findings from the literature can be implemented in different contexts.

CONCLUSION

Art therapy and technologies can be ancillary supports for healthcare professionals but are not substitutive of their expertise and responsibilities. Such tools may help to convey a more empathetic and uplifting patient journey if properly integrated within clinical practice, whereby the humanistic touch of medicine remains pivotal.

Expanding Global Radiotherapy Access via Telemedicine

AIMS

Cancer is a leading cause of death globally. Over 70% of the 10 million cancer deaths worldwide in 2020 occurred in low- and middle-income countries. Radiotherapy is an important cancer treatment, used in half of cancer patients. Significant global disparities in radiotherapy access exist, with low access in low- and middle-income countries. The benefits of tele-radiotherapy in low- and middle-income countries for expanding global radiotherapy access are yet to be fully realized. In this paper, we highlight potential applications of tele-radiotherapy in expanding access to high-quality radiotherapy in developing countries.

MATERIALS AND METHODS

We performed a literature search to retrieve studies involving telemedicine applications in radiotherapy to provide a comprehensive overview of the topic. PubMed database served as the main source for retrieving studies, using the following search terms: ("telemedicine", "radiotherapy", "telehealth", "remote monitoring", "oncology", and "remote training"). Additional selected papers were obtained from Web of Science, and Google Scholar using the same search terms.

RESULTS

Telemedicine in radiotherapy has many applications. Virtual training could upgrade radiotherapy skills in low- and middle-income countries, enabling safe adoption of new radiotherapy techniques and quality assurance. Tele-radiotherapy consultations and patient follow-up could improve the efficiency of clinics while tele-radiotherapy planning and peer-review could enable equitable global access to radiotherapy expertise. Telemedicine could also facilitate wider global access to radiotherapy trials. While telemedicine in radiotherapy holds significant promise in improving global radiotherapy access, several barriers to its adoption exist. These include a lack of infrastructure, data security concerns, regulatory challenges, resistance from providers and patients, financial constraints, miscommunication during remote consultations, and lack of training.

CONCLUSION

Tele-radiotherapy applications hold promise in providing solutions to overcome global radiotherapy access inequity but the benefits of tele-radiotherapy in low- and middle-income countries are yet to be fully realized.

Leveraging artificial intelligence-mediated communication for cancer prevention and control and drug addiction: A systematic review

OBJECTIVE

To conduct a systematic review on Artificial Intelligence-Mediated Communication (AIMC) behavioral interventions in cancer prevention/control and substance use.

METHODS

Eight databases were searched from 2017 to 2022 using the Population Intervention Control Outcome Study (PICOS) framework. We synthesized findings of AIMC-based interventions for adult populations in cancer prevention/control or substance use, applying SIGN Methodology Checklist 2 for quality assessments and reviewing retention and engagement.

RESULTS

Initial screening identified 187 studies; seven met inclusion criteria, involving 2768 participants. Females comprised 67.6% (n = 1870). Mean participant age was 42.73 years (SD = 7.00). Five studies demonstrated significant improvements in substance use recovery, physical activity, genetic testing, or dietary habits.

CONCLUSIONS

AIMC shows promise in enhancing health behaviors, but further exploration is needed on privacy risks, biases, safety concerns, chatbot features, and serving underserved populations.

IMPLICATIONS

There is a critical need to foster comprehensive fully powered studies and collaborations between technology developers, healthcare providers, and researchers. Policymakers can facilitate the responsible integration of AIMC technologies into healthcare systems, ensuring equitable access and maximizing their impact on public health outcomes.

Patients Facing Large Language Models in Oncology: A Narrative Review

The integration of large language models (LLMs) into oncology is transforming patients' journeys through education, diagnosis, treatment monitoring, and follow-up. This review examines the current landscape, potential benefits, and associated ethical and regulatory considerations of the application of LLMs for patients in the oncologic domain.

Cancer Patients' Perspectives and Requirements of Digital Health Technologies: A Scoping Literature Review

Digital health technologies have the potential to alleviate the increasing cancer burden. Incorporating patients' perspectives on digital health tools has been identified as a critical determinant for their successful uptake in cancer care. The main objective of this scoping review was to provide an overview of the existing evidence on cancer patients' perspectives and requirements for patient-facing digital health technologies. Three databases (CINAHL, MEDLINE, Science Direct) were searched and 128 studies were identified as eligible for inclusion. Web-based software/platforms, mobile or smartphone devices/applications, and remote sensing/wearable technologies employed for the delivery of interventions and patient monitoring were the most frequently employed technologies in cancer care. The abilities of digital tools to enable care management, user-friendliness, and facilitate patient-clinician interactions were the technological requirements predominantly considered as important by cancer patients. The findings from this review provide evidence that could inform future research on technology-associated parameters influencing cancer patients' decisions regarding the uptake and adoption of patient-facing digital health technologies.

Mobile Health System for Meeting Health Information Needs in Patients With Head and Neck Cancer Undergoing Radiotherapy: Development and Feasibility Study

Patients with head and neck cancer undergoing radiotherapy encounter physical and psychosocial challenges, indicating unmet needs. Mobile health technology can potentially support patients. This single-armed feasibility study included 30 patients with head and neck cancer undergoing radiotherapy. Patients were asked to use the Health Enjoy System, a mobile health support system that provides a disease-related resource for 1 week. We assessed the usability of the system and its limited efficacy in meeting patients' health information needs. The result showed that the system was well received by patients and effectively met their health information needs. They also reported free comments on the system's content, backend maintenance, and user engagement. This study supplies a foundation for further research to explore the potential benefits of the Health Enjoy System in supporting patients with head and neck cancer.

Interactive digital tools to support empowerment of people with cancer: a systematic literature review

PURPOSE

To identify and synthesise interactive digital tools used to support the empowerment of people with cancer and the outcomes of these tools.

METHODS

A systematic literature review was conducted using PubMed, CINAHL, Web of Science, Cochrane, Eric, Scopus, and PsycINFO databases in May 2023. Inclusion criteria were patient empowerment as an outcome supported by interactive digital tools expressed in study goal, methods or results, peer-reviewed studies published since 2010 in cancer care. Narrative synthesis was applied, and the quality of the studies was assessed following Joanna Briggs Institute checklists.

RESULTS

Out of 1571 records screened, 39 studies published in 2011-2022 with RCT (17), single-arm trial (15), quasi-experimental (1), and qualitative designs (6) were included. A total of 30 interactive digital tools were identified to support empowerment (4) and related aspects, such as self-management (2), coping (4), patient activation (9), and self-efficacy (19). Significant positive effects were found on empowerment (1), self-management (1), coping (1), patient activation (2), and self-efficacy (10). Patient experiences were positive. Interactivity occurred with the tool itself (22), peers (7), or nurses (7), physicians (2), psychologists, (2) or social workers (1).

CONCLUSION

Interactive digital tools have been developed extensively in recent years, varying in terms of content and methodology, favouring feasibility and pilot designs. In all of the tools, people with cancer are either active or recipients of information. The research evidence indicates positive outcomes for patient empowerment through interactive digital tools. Thus, even though promising, there still is need for further testing of the tools.

Multilingual Framework for Risk Assessment and Symptom Tracking (MRAST)

The importance and value of real-world data in healthcare cannot be overstated because it offers a valuable source of insights into patient experiences. Traditional patient-reported experience and outcomes measures (PREMs/PROMs) often fall short in addressing the complexities of these experiences due to subjectivity and their inability to precisely target the questions asked. In contrast, diary recordings offer a promising solution. They can provide a comprehensive picture of psychological well-being, encompassing both psychological and physiological symptoms. This study explores how using advanced digital technologies, i.e., automatic speech recognition and natural language processing, can efficiently capture patient insights in oncology settings. We introduce the MRAST framework, a simplified way to collect, structure, and understand patient data using questionnaires and diary recordings. The framework was validated in a prospective study with 81 colorectal and 85 breast cancer survivors, of whom 37 were male and 129 were female. Overall, the patients evaluated the solution as well made; they found it easy to use and integrate into their daily routine. The majority (75.3%) of the cancer survivors participating in the study were willing to engage in health monitoring activities using digital wearable devices daily for an extended period. Throughout the study, there was a noticeable increase in the number of participants who perceived the system as having excellent usability. Despite some negative feedback, 44.44% of patients still rated the app's usability as above satisfactory (i.e., 7.9 on 1-10 scale) and the experience with diary recording as above satisfactory (i.e., 7.0 on 1-10 scale). Overall, these findings also underscore the significance of user testing and continuous improvement in enhancing the usability and user acceptance of solutions like the MRAST framework. Overall, the automated extraction of information from diaries represents a pivotal step toward a more patient-centered approach, where healthcare decisions are based on real-world experiences and tailored to individual needs. The potential usefulness of such data is enormous, as it enables better measurement of everyday experiences and opens new avenues for patient-centered care.

Digital health in head and neck cancer: a systematic review

OBJECTIVE

Digital health tools are increasingly being recognised as effective interventions in monitoring chronic health conditions. This systematic review addressed how digital health is currently utilised in patients with head and neck cancer as an adjunct to care.

METHOD

Studies of the development or evaluation of an eHealth, telemedicine or telemonitoring tool were eligible. A narrative synthesis was performed as per Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines.

RESULTS

Twenty-nine studies of digital health tools in head and neck cancer were identified. Nine were randomised, controlled trials but most had concern of bias. Fourteen (48 per cent) of the interventions used multiple modes of delivery. The primary digital tool functions are symptom tracking and self-care, prehabilitation and rehabilitation, psychological support, and education, including decision aids. Most tools aimed to support patients during active cancer treatment.

CONCLUSION

There are a small number of digital health tools for head and neck cancer patients; however, there is a lack of well-designed randomised, controlled trials to demonstrate effectiveness.

Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review

BACKGROUND

Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC.

OBJECTIVE

This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments.

METHODS

The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords "mobile health technology" and "head and neck cancer" were combined to address the main concepts of the research questions.

RESULTS

Of the 1625 papers identified, 13 (0.8%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome-related indicators, (3) adherence, and (4) health-related quality of life.

CONCLUSIONS

A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients' health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology.

The Use of Chatbots in Oncological Care: A Narrative Review

Background

Few reports have investigated chatbots in patient care. We aimed to assess the current applications, limitations, and challenges in the literature on chatbots employed in oncological care.

Methods

We queried the PubMed database through April 2022 and included studies that investigated the use of chatbots in different phases of oncological care. The search used five different combinations of the specific terms "chatbot", "cancer", "oncology", and "conversational agent". Inclusion criteria were chatbot use in any aspect of oncological care-prevention, patient education, treatment, and surveillance.

Results

The initial search yielded 196 records, 21 of which met inclusion criteria. The identified chatbots mostly focused on breast and ovarian cancer (n=8), with the second most common being cervical cancer (n=3). Good patient satisfaction was reported among 14 of 21 chatbots. The most reported chatbot applications were cancer screening, prevention, risk stratification, treatment, monitoring, and management. Of 12 studies examining efficacy of care via chatbot, 9 demonstrated improvements compared to standard care.

Conclusion

Chatbots used for oncological care to date demonstrate high user satisfaction, and many have shown efficacy in improving patient-centered communication, accessibility to cancer-related information, and access to care. Currently, chatbots are primarily limited by the need for extensive user-testing and iterative improvement before widespread implementation.