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.

Large language models (LLMs) are transforming the capabilities of medical chatbots by enabling more context-aware, human-like interactions. This review presents a comprehensive analysis of their applications, technical foundations, benefits, challenges, and future directions in healthcare. LLMs are increasingly used in patient-facing roles, such as symptom checking, health information delivery, and mental health support, as well as in clinician-facing applications, including documentation, decision support, and education. However, as a study from 2024 warns, there is a need to manage “extreme AI risks amid rapid progress”. We examine transformer-based architectures, fine-tuning strategies, and evaluation benchmarks specific to medical domains to identify their potential to transfer and mitigate AI risks when using LLMs in medical chatbots. While LLMs offer advantages in scalability, personalization, and 24/7 accessibility, their deployment in healthcare also raises critical concerns. These include hallucinations (the generation of factually incorrect or misleading content by an AI model), algorithmic biases, privacy risks, and a lack of regulatory clarity. Ethical and legal challenges, such as accountability, explainability, and liability, remain unresolved. Importantly, this review integrates broader insights on AI safety, drawing attention to the systemic risks associated with rapid LLM deployment. As highlighted in recent policy research, including work on managing extreme AI risks, there is an urgent need for governance frameworks that extend beyond technical reliability to include societal oversight and long-term alignment. We advocate for responsible innovation and sustained collaboration among clinicians, developers, ethicists, and regulators to ensure that LLM-powered medical chatbots are deployed safely, equitably, and transparently within healthcare systems.

This review explores the transformative integration of artificial intelligence (AI) and healthcare through conversational AI leveraging Natural Language Processing (NLP). Focusing on Large Language Models (LLMs), this paper navigates through various sections, commencing with an overview of AI’s significance in healthcare and the role of conversational AI. It delves into fundamental NLP techniques, emphasizing their facilitation of seamless healthcare conversations. Examining the evolution of LLMs within NLP frameworks, the paper discusses key models used in healthcare, exploring their advantages and implementation challenges. Practical applications in healthcare conversations, from patient-centric utilities like diagnosis and treatment suggestions to healthcare provider support systems, are detailed. Ethical and legal considerations, including patient privacy, ethical implications, and regulatory compliance, are addressed. The review concludes by spotlighting current challenges, envisaging future trends, and highlighting the transformative potential of LLMs and NLP in reshaping healthcare interactions.

The integration of chatbots in oncology underscores the pressing need for human-centered artificial intelligence (AI) that addresses patient and family concerns with empathy and precision. Human-centered AI emphasizes ethical principles, empathy, and user-centric approaches, ensuring technology aligns with human values and needs. This review critically examines the ethical implications of using large language models (LLMs) like GPT-3 and GPT-4 (OpenAI) in oncology chatbots. It examines how these models replicate human-like language patterns, impacting the design of ethical AI systems. The paper identifies key strategies for ethically developing oncology chatbots, focusing on potential biases arising from extensive datasets and neural networks. Specific datasets, such as those sourced from predominantly Western medical literature and patient interactions, may introduce biases by overrepresenting certain demographic groups. Moreover, the training methodologies of LLMs, including fine-tuning processes, can exacerbate these biases, leading to outputs that may disproportionately favor affluent or Western populations while neglecting marginalized communities. By providing examples of biased outputs in oncology chatbots, the review highlights the ethical challenges LLMs present and the need for mitigation strategies. The study emphasizes integrating human-centric values into AI to mitigate these biases, ultimately advocating for the development of oncology chatbots that are aligned with ethical principles and capable of serving diverse patient populations equitably.

Objectives: This study aims to make radiotherapy knowledge regarding healthcare accessible to the general public by developing an AI-powered chatbot. The interactive nature of the chatbot is expected to facilitate better understanding of information on radiotherapy through communication with users. Methods: Using the IBM Watson Assistant platform on IBM Cloud, the chatbot was constructed following a pre-designed flowchart that outlines the conversation flow. This approach ensured the development of the chatbot with a clear mindset and allowed for effective tracking of the conversation. The chatbot is equipped to furnish users with information and quizzes on radiotherapy to assess their understanding of the subject. Results: By adopting a question-and-answer approach, the chatbot can engage in human-like communication with users seeking information about radiotherapy. As some users may feel anxious and struggle to articulate their queries, the chatbot is designed to be user-friendly and reassuring, providing a list of questions for the user to choose from. Feedback on the chatbot’s content was mostly positive, despite a few limitations. The chatbot performed well and successfully conveyed knowledge as intended. Conclusions: There is a need to enhance the chatbot’s conversation approach to improve user interaction. Including translation capabilities to cater to individuals with different first languages would also be advantageous. Lastly, the newly launched ChatGPT could potentially be developed into a medical chatbot to facilitate knowledge transfer.

Context: In cancer centres and hospitals particularly during the pandemic, there was a great demand for information, which could hardly be handled by the limited manpower available. This necessitated the development of an educational chatbot to disseminate topics in radiotherapy customized for various user groups, such as patients and their families, the general public and radiation staff. Objective: In response to the clinical demands, the objective of this work is to explore how to design a chatbot for educational purposes in radiotherapy using artificial intelligence. Methods: The chatbot is designed using the dialogue tree and layered structure, incorporated with artificial intelligence features such as natural language processing (NLP). This chatbot can be created in most platforms such as the IBM Watson Assistant and deposited in a website or various social media. Results: Based on the question-and-answer approach, the chatbot can provide humanlike communication to users requesting information on radiotherapy. At times, the user, often worried, may not be able to pinpoint the question exactly. Thus, the chatbot will be user friendly and reassuring, offering a list of questions for the user to select. The NLP system helps the chatbot to predict the intent of the user so as to provide the most accurate and precise response to him or her. It is found that the preferred educational features in a chatbot are functional features such as mathematical operations, which should be updated and modified routinely to provide new contents and features. Conclusions: It is concluded that an educational chatbot can be created using artificial intelligence to provide information transfer to users with different backgrounds in radiotherapy. In addition, testing and evaluating the performance of the chatbot is important, in response to user’s feedback to further upgrade and fine-tune the chatbot.