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      Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review

      review-article
      , MEng 1 , 2 , , PhD 3 , , PhD 4 , , PhD 5 , 6 ,
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Cancer
      JMIR Publications
      chatbot, artificial intelligence, machine learning, health, medicine, communication, diagnosis, cancer therapy, ethics, medical biophysics, mobile phone

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          Abstract

          Background

          Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility.

          Objective

          This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation.

          Methods

          A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion.

          Results

          Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored.

          Conclusions

          Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine.

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          Most cited references116

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          Cancer statistics, 2020

          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.
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            Machine Learning in Medicine

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              Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

              Application of deep learning algorithms to whole-slide pathology images can potentially improve diagnostic accuracy and efficiency.
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                Author and article information

                Contributors
                Journal
                JMIR Cancer
                JMIR Cancer
                JC
                JMIR Cancer
                JMIR Publications (Toronto, Canada )
                2369-1999
                Oct-Dec 2021
                29 November 2021
                : 7
                : 4
                : e27850
                Affiliations
                [1 ] Institute of Biomedical Engineering University of Toronto Toronto, ON Canada
                [2 ] Department of Medical Biophysics Western University London, ON Canada
                [3 ] Department of Humanities York University Toronto, ON Canada
                [4 ] Department of English York University Toronto, ON Canada
                [5 ] Department of Medical Physics, Radiation Medicine Program Princess Margaret Cancer Centre University Health Network Toronto, ON Canada
                [6 ] Department of Radiation Oncology University of Toronto Toronto, ON Canada
                Author notes
                Corresponding Author: James C L Chow james.chow@ 123456rmp.uhn.ca
                Author information
                https://orcid.org/0000-0002-8485-9968
                https://orcid.org/0000-0002-6990-7722
                https://orcid.org/0000-0002-5765-1635
                https://orcid.org/0000-0003-4202-4855
                Article
                v7i4e27850
                10.2196/27850
                8669585
                34847056
                ef17276e-a26b-4067-be6c-0bfeaca78aa0
                ©Lu Xu, Leslie Sanders, Kay Li, James C L Chow. Originally published in JMIR Cancer (https://cancer.jmir.org), 29.11.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cancer, is properly cited. The complete bibliographic information, a link to the original publication on https://cancer.jmir.org/, as well as this copyright and license information must be included.

                History
                : 9 February 2021
                : 10 June 2021
                : 2 July 2021
                : 18 September 2021
                Categories
                Review
                Review

                chatbot,artificial intelligence,machine learning,health,medicine,communication,diagnosis,cancer therapy,ethics,medical biophysics,mobile phone

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