National implementation of an AI-based virtual dietitian for patients with cancer.

Abstract

1500 Background: Nutritional status is an established key driver of cancer outcomes and patient experience. However, the workforce of oncology dietitians is unable to meet the needs of the population, and 80% of patients seek but do not receive nutrition support. Advances in artificial intelligence (AI) and machine learning (ML) capabilities afford the opportunity to expand reach and rapidly hone in on clinical and contextual needs to deliver evidence-based nutritional guidance. Methods: To address this unmet need, an AI-based nutrition expert-platform was developed. Interventions were curated by oncology-nutrition experts based on peer-reviewed literature and clinical guidelines to facilitate self-management of cancer side effects and optimize nutrition. A growing database of over 114,000 evidence-based interventions powers Ina, a text-message based virtual nutrition assistant. Interventions are continually enhanced and refined using AI and ML applied to an extensive learning dataset. The tool was implemented nationally in partnership with 25 cancer advocacy organizations. Data on demographics, patient-reported outcomes, and utilization were systematically collected. Results: Between July 2019 and August 2023, 3,310 users from all 50 states registered for the virtual nutrition platform. Based on self-report, users were 73% female; mean age 57 years (18-91); most common cancer types were GU (22%), Breast (21%), Gyn (19%), GI (14%), and Lung (12%), representing nearly 90% of users. Users were medically complex, with 50% reporting Stage 3-4 disease, 64% with metastases, and 50% with 2+ chronic conditions. Nutritional challenges were highly prevalent: 58% were overweight/obese by BMI, 83% reported barriers to good nutrition, and 42% had food allergies/intolerances. Levels of engagement were high: 68% of users texted queries to Ina, 79% completed surveys, and median user retention duration was 8.8 months. Overall, 94% of users reported being satisfied with the platform and 98% found the guidance to be helpful. In an evaluation of outcomes, 84% reported actively using the nutrition advice to guide their diets, 47% used the recommended recipes, and 82% felt the program improved their quality of life. In this cohort with high symptom burden, 88% reported Ina helped them manage their symptoms and 34% noted improved symptom control during participation. Conclusions: Implementation of an evidence-based AI virtual dietitian is feasible, and is reported by patients to be beneficial on diet, quality of life, and symptom control. Ongoing evaluations are assessing impact on other outcomes.