J Med Internet Res. 2025 Jul 30. doi: 10.2196/76968. Online ahead of print.
ABSTRACT
BACKGROUND: Cancer patients experience complex physical, psychosocial, and behavioral challenges that require continuous support. This need has intensified with the rising global cancer burden and limited scalability of traditional care models. In response, conversational agents (CAs) have emerged as promising digital interventions for enhancing cancer care, but evidence regarding their feasibility and effectiveness remains limited.
OBJECTIVE: To evaluate the feasibility and effectiveness of CAs in supporting cancer patient care and to summarize key characteristics of CA interventions to inform future design and implementation.
METHODS: We systematically searched PubMed, Cochrane Library, Web of Science, and Embase through February 3, 2025, and screened reference lists and trial registries for gray literature. Eligible studies included randomized controlled trials (RCTs) and nonrandomized intervention studies (NRIs) evaluating CA-delivered interventions targeting health outcomes in cancer patients. Two reviewers independently selected studies and extracted data. Study quality then appraised using the Cochrane Risk of Bias 2.0 tool for RCTs and the JBI Critical Appraisal Checklist for NRIs. Extracted data included study characteristics, CA features, and implementation outcomes including feasibility, acceptability and usability. Meta-analyses were conducted on physical activity, pain, anxiety, depression, psychological distress, and quality of life. Narrative synthesis was employed for outcomes with inconsistent reporting across studies, including health information acquisition and treatment-related side effects.
RESULTS: Seventeen studies involving 1817 cancer patients were included, with 10 studies being included in the meta-analysis. Meta-analysis showed significant improvements in physical activity (MD=1.44, 95% CI: 0.36 to 2.52, P<.01), pain (MD = -0.91, 95% CI: -1.44 to -0.38, P<.01), anxiety (SMD = -0.19, 95% CI: -0.35 to -0.02, P=.02), and quality of life (SMD = 0.35, 95% CI: 0.03 to 0.67, P=.03). No significant effects were observed for depression (SMD = -0.07, 95% CI: -0.42 to 0.27, P=.68) or psychological distress (SMD = -0.33, 95% CI: -0.66 to 0.01, P=.06). Narrative synthesis suggested that CAs have the potential to improve patients’ acquisition of health information and help manage treatment-related side effects. Notably, CAs were generally found to be safe, feasible, acceptable, and usable among cancer patients, particularly during the initial phase of use. However, user engagement tended to decline over time, underscoring the need for strategies to sustain long-term utilization.
CONCLUSIONS: This systematic review is the first comprehensive analysis to suggest that CAs are feasible, acceptable, usable, and effective interventions for cancer patients. Nevertheless, the limited psychological benefits and suboptimal long-term user engagement indicate the need for further refinement. Future research should adopt theory-based designs and leverage emerging technologies to enhance personalization, empathy, and sustained engagement in CA interventions. Robust evidence from large-scale randomized controlled trials is needed to strengthen the evidence base.
CLINICALTRIAL: Prospero CRD42025645982.
PMID:40736462 | DOI:10.2196/76968
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