JMIR Cancer最新文献

Background: Patients with breast cancer frequently experience significant uncertainty, prompting them to seek detailed, personalized, and reliable medical information to enhance adherence to prescribed treatments, medications, and recommended lifestyle adjustments. Although high-quality information exists within oncology guidelines and patient-oriented resources, the provision of tailored responses to individual patient queries remains challenging, especially for non-English-speaking populations.

Objective: This study aims to evaluate the potential of an artificial intelligence-driven chatbot, specifically leveraging ChatGPT (GPT-4; OpenAI) combined with retrieval-augmented generation, to deliver personalized answers to complex breast cancer-related patient questions in German.

Methods: We collaborated with one of Germany's largest breast cancer Patient Representation Groups to collect authentic patient inquiries, receiving a total of 118 questions. After initial screening, we selected 104 medical questions, organized into 7 distinct categories: aftercare, bone health, ductal carcinoma in situ, diagnostics, nutrition and supplements, complementary medicine, and therapy. A customized version of GPT-4 was configured with specific system prompts emphasizing empathetic, evidence-based responses and integrated with a comprehensive database comprising guidelines, recommendations, and patient information materials published by recognized German medical societies. To assess chatbot responses, we used 4 evaluation criteria: comprehensibility (clarity from a patient perspective), correctness (accuracy per current medical guidelines), completeness (inclusion of all relevant aspects), and potential harm (risk of undue patient harm or misinformation). Ratings were conducted using a 5-point Likert scale by a breast cancer expert (correctness, completeness, and potential harm) and patient representatives (comprehensibility).

Results: The chatbot provided high-quality responses across multiple dimensions. Of the 499 responses evaluated for comprehensibility, 427 (85.6%) were rated as comprehensible. Among the 104 responses assessed for the remaining dimensions, 91 (87.5%) were rated as correct, 72 (69.2%) as complete, and 93 (89.4%) as nonharmful. Reasons for incomplete answers included omission of reimbursement details, updates from recent therapeutic guidelines, or nuanced recommendations regarding endocrine therapy and aftercare schedules. In addition, 6 (5.8%) of the answers were rated as potentially harmful due to outdated or contextually inappropriate recommendations. The chatbot also performed well in the nutrition and bone health categories despite occasionally incomplete document retrieval.

Conclusions: Our findings demonstrate that an artificial intelligence-powered chatbot with GPT-4 and retrieval augmentation can effectively provide persona

Background: Eastern Asia has historically had the highest global incidence and mortality rates of gastric cancer (GC) while substantial disparities exist between countries. The overall burden of GC remains insufficiently explored.

Objective: Using the Global Burden of Disease Study 2021, this research aims to estimate the burden and risk factors of GC in Eastern Asia from 1990 to 2021.

Methods: Incidence, age-standardized incidence rate (ASIR), deaths, age-standardized mortality rate (ASMR), disability-adjusted life years, age-standardized disability-adjusted life year rate (ASDR), and risk factor burdens for GC were analyzed in Eastern Asia from 1990 to 2021. Joinpoint analysis determined average annual percent change (AAPC) and annual percent change, while age-period-cohort analysis assessed temporal trends. The Bayesian age-period-cohort model projected GC burden from 2021 to 2035. All analyses used R software (version 4.4.1; R Foundation for Statistical Computing).

Results: In 2021, Eastern Asia reported 748,235 new GC cases and 527,054 deaths, accounting for 60.8% (748,235/1,230,232) of new cases and 55.2% (527,054/954,373) of deaths reported globally. From 1990 to 2021, South Korea showed the largest declines in ASIR, ASMR, and ASDR, with ASMR decreasing from 55.4 per 100,000 to 13.3 per 100,000 (AAPC -4.5, 95% CI -4.8 to -4.3). ASIR, ASMR, and ASDR also showed a downward trend in Japan and China, with an AAPC of -3.0 (95% CI -3.2 to -2.8) for ASMR in Japan and -2.4 (95% CI -2.6 to -2.3) in China. The GC burden of North Korea was basically stable, with an AAPC of ASMR of -0.8 (95% CI -0.8 to -0.8). Mongolia showed a slight decline, with an AAPC of ASMR of -1.4 (95% CI -1.7 to -1.0), and the burden of GC was the highest. High-sodium diets and smoking were the main risk factors for disability-adjusted life years of GC in 2021. Smoking contributed to a decline in ASDR as the sociodemographic index increased. Projections suggest continued ASDR reductions across Eastern Asia from 2022 to 2035, though Mongolia will maintain the highest burden.

Conclusions: Despite a decrease from 1990 to 2021, GC remains a significant public health issue in Eastern Asia. Addressing it necessitates prioritizing primary and secondary prevention, including reducing risk factors and enhancing early screening.

Background: Adolescent and young adult survivors of cancer (aged 15-39 years) frequently engage in hazardous alcohol use, which can have multiple mental and physical health effects.

Objective: The aim of this study was 2-fold, to identify the necessary adaptations to an existing motivational interviewing-based mHealth (mobile health) alcohol reduction intervention, called Tracking and Reducing Alcohol Consumption (TRAC), for posttreatment adolescents and young adults, and to develop a tailored intervention for this vulnerable and underserved population.

Methods: This was a qualitative study consisting of key informant interviews with posttreatment adolescents and young adults aged 18-39 years, oncology and psych-oncology providers, and community advocates (n=15) to inform the adaptation of TRAC. Thematic qualitative analysis of interview findings was conducted to determine necessary changes to the intervention protocol and content, which would ultimately lead to the development of the new TRAC adolescent and young adult intervention.

Results: Key informant interviews revealed a need for the intervention to address cancer-specific alcohol use triggers such as scan-related anxiety, financial toxicity, and reproductive health concerns. They also indicated the need to provide education on the link between alcohol and cancer and to reduce the time burden of the intervention, given the many competing life demands of adolescents and young adults. Significant changes were made to the TRAC intervention to create the TRAC adolescent and young adult. We reduced the number of required sessions from 8 to 4, introduced a session devoted to managing cancer-specific triggers, and provided survivors with more information about alcohol and its relationship to cancer.

Conclusions: There is potential to increase alcohol intervention relevance and fit for adolescents and young adults by including tailored content relevant to their life experiences while also maintaining core components of such interventions, such as self-monitoring and goal-setting. Remote, brief interventions are important for ensuring acceptability. The new TRAC adolescent and young adult intervention represents a potentially valuable tool in addressing high rates of hazardous alcohol use among this population and warrants further evaluation in randomized trials.

Background: In contemporary health care, patient-centered care has emerged as a pivotal paradigm shift that redefines the traditional physician-centric model. Particularly in the context of cancer care, marked by its intricate nature and emotional impact, there is a pressing requirement to rethink how health care is delivered. In this context, comprehensive cancer care networks (CCCNs) provide a new means of structuring and delivering quality cancer care, recognizing each patient's unique preferences and needs.

Objective: This study aimed to establish a consistent definition and framework for patient centeredness in CCCNs, facilitating the integration of a patient-centered approach to enhance care quality.

Methods: We conducted an umbrella review focusing on generic and oncology-specific dimensions of patient centeredness to establish the definition and framework. The data were analyzed and synthesized using an inductive category development approach, which guided the derivation of dimensions for the framework. The review was complemented by a survey of 23 key stakeholders within CCCNs and a focus group with patient representatives. This process involved iterative group discussions to achieve consensus on the framework and definition.

Results: The study presents a robust definition and framework of patient centeredness tailored to CCCNs, validated by an initial agreement rate of 96% among survey respondents. Patient centeredness in a CCCN is defined as a philosophy of care prioritizing the physical, emotional, and social needs and personal values of patients with cancer at every step of the patient pathway. In patient-centered CCCNs, patients are empowered and engaged in becoming active partners in health care in relation to their individual preferences and capabilities, with the goal of providing personalized, high-quality, holistic care with the best possible outcomes. The framework comprises 8 primary dimensions: empowering patients, engaging and involving patients, treating the patient as a unique person, enhancing the therapeutic relationship, enhancing a patient-centered culture, providing holistic care, recognizing and supporting the health care professional as a person, and coordinating care. Each dimension is supported by specific subdimensions and actionable patient-centered activities that facilitate practical implementation.

Conclusions: The results provide a comprehensive perspective on the complex elements that compose patient-centered care within CCCNs in Europe. This contributes to a better understanding and application of patient centeredness in cancer care and possibly other contexts. The results presented in this paper promise to support cancer care networks and other health care contexts in creating a patient-centered environment where patients feel genuinely heard, valued, and actively engaged in their care decision

Unlabelled: Understanding the impact of online cancer misinformation exposure on health outcomes is an area of growing concern, but few methods exist to objectively measure this exposure. The primary aim of this paper is to describe the lessons learned in using web-monitoring software to measure exposure to online cancer misinformation among patients with cancer. These lessons learned emerged from our experience conducting a prospective pilot study from October 2022 to August 2023 wherein we adopted commercially available web-monitoring software to capture cancer-related web content. A total of 56 patients with cancer completed a baseline survey, and 17 of these participants installed web-monitoring software on their personal computer for 30 days and completed a follow-up survey. We use implementation outcomes to describe the feasibility of this methodological approach using lessons learned in 3 topic areas, namely data quality, software implementation, and participant acceptability. We found the web-monitoring data to be appropriate for our research aim to objectively measure cancer misinformation exposure, although compatibility issues with social media websites and mobile devices negatively impacted data quality. A complex installation process negatively impacted implementation and caused an unknown number of participants to drop out after the baseline survey. Among participants who completed the study, reported acceptability of web-monitoring software for research purposes was high, though potentially biased by selective retention. This pilot study testing web-monitoring software for research purposes among patients with cancer demonstrates high acceptability but low feasibility due to implementation barriers. We propose practical solutions to address these barriers and believe the lessons learned here offer a promising foundation for improving methods to objectively measure patient exposure to online cancer information. Future studies should focus on exploring perceptions of web-monitoring among nonparticipants, considering alternative approaches, and expanding web-monitoring to include mobile devices.

Background: Chemotherapy causes physiological, psychological, and social impairments in patients with cancer. Frailty reduces the effectiveness of chemotherapy and increases the toxicity associated with radiotherapy and chemotherapy, the possibility of chemotherapy failure, and adverse outcomes. However, factors affecting chemotherapy-related frailty in patients with cancer remain unclarified.

Objective: This systematic review aimed to identify risk factors driving frailty progression during chemotherapy in patients with cancer.

Methods: A comprehensive systematic search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), and SinoMed for observational studies (cohort, cross-sectional, or case-control) on factors affecting the debility-of-chemotherapy stage in patients with cancers between the inception of the database and February 2025, with an updated search executed in May 2025. Literature screening, quality evaluation using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist, and data extraction were conducted independently by 2 authors. Meta-analysis, effect size combination, sensitivity analysis, and publication bias analysis were performed using RevMan (version 5.4; The Cochrane Collaboration) and R (version 4.4.3; R Foundation).

Results: The analysis comprised 14 studies (8 cross-sectional, 2 repeated cross-sectional, 3 cohort, and 1 mixed-design), including 3879 patients with cancer and 23 influencing factors. Methodological quality assessment using Agency for Healthcare Research and Quality (mean 8.8, SD 1.3, 95% CI 7.9-9.7; SE 0.4) and Newcastle-Ottawa Scale (mean 8.0, SD 1.0, 95% CI 6.7-9.3; SE 0.6) revealed 73% (8/11) of cross-sectional studies as high-quality. The meta-analysis showed a 35% (95% CI 22%-50%) prevalence of frailty during chemotherapy in these patients. Cancer stage (odds ratio 1.99, 95% CI 1.64-2.42), chemotherapy frequency (odds ratio 2.60, 95% CI 1.83-3.70), transfer (odds ratio 2.18, 95% CI 1.50-3.17), hemoglobin (odds ratio 0.29, 95% CI 0.18-0.47), white blood cell (odds ratio 0.37, 95% CI 0.21-0.65), comorbidity (odds ratio 1.93, 95% CI 1.30-2.86), and hypoproteinemia (odds ratio 1.74, 95% CI 1.31-2.30) were risk factors for frailty in patients at the chemotherapy stage.

Conclusions: Frailty during chemotherapy was strongly associated with advanced cancer stage, frequent treatment cycles, metastasis, anemia, leukopenia, comorbidities, and hypoproteinemia. Clinically actionable findings emphasized hemoglobin and albumin monitoring as preventive targets, while heterogeneity in assessment tools and population bias limited generalizability. The integration of frailty screening into chemotherapy workflows is urgent to mitigate treatment-related functional decline.

Background: Cervical cancer (CC) screening participation remains suboptimal among vulnerable populations in France. This study aimed to develop and evaluate AppDate-You, a chatbot-based decision aid, to support women from socioeconomically disadvantaged areas in the French Occitanie region to make informed decisions about CC screening, particularly human papillomavirus self-sampling (HPVss).

Objective: This study aimed to explore the needs, preferences, and barriers related to CC screening and to design and validate a user-centered, empathetic, and effective chatbot-based decision aid to empower women experiencing socioeconomic challenges in France to make informed choices about HPVss.

Methods: The chatbot was developed following a validated framework for developing decision aids. The process included qualitative research involving online and in-person interviews and focus groups with women and health care professionals, followed by alpha testing with both groups and beta testing with women only. Participants included women (both French and non-French speaking) aged between 30 and 65 years from socioeconomically disadvantaged areas of the Occitanie region and health care professionals (general practitioners, gynecologists, and midwives) working with these populations. AppDate-You was made accessible through WhatsApp and Facebook Messenger, offering text-based and voice-based interactions and multimedia content.

Results: The exploratory phase identified key barriers to screening and digital tool preferences. Prototype testing revealed great satisfaction with the chatbot's performance, educational value, and content quality. Contrary to the expectations of health care professionals, women from diverse backgrounds, including women who were older and socioeconomically disadvantaged, were willing and able to use the tool. Users-even those with limited digital literacy-found AppDate-You innovative, user-friendly, and informative. In the beta testing phase, 80% (12/15) of the participants expressed interest in HPVss. Some limitations were identified, such as the chatbot's occasional repetitive responses and the need for clearer medical terminology.

Conclusions: This study demonstrates the potential for artificial intelligence chatbots to improve access to health education and increase cervical screening intention among underserved populations. The user-centered approach resulted in a tool that effectively meets the needs of the target population.

International registered report identifier (irrid): RR2-10.2196/39288.