AI based sentiment analysis of online discussions related to cervical brachytherapy

Graphical abstract

Highlights

• •AI-driven analysis of online forums reveals unique patient experiences with cervical brachytherapy.
• •Negative sentiments were highest in discussions about bowel, urinary, pain, and fatigue concerns.
• •Unstructured patient narratives highlight gaps in traditional quality-of-life assessments.
• •Findings can improve patient education, informed consent, and clinician-patient communication.

Abstract

Purpose/Objective(s)

Few studies have documented the experiences of patients receiving cervical brachytherapy. While evidence regarding quality of life issues in this population has emerged, traditional structured questionnaires often fail to capture the full range of patient perspectives. We hypothesized that analyzing unfiltered patient discussions from online forums would reveal unique insights into patient experiences, including previously unidentified emotional responses, concerns, and coping strategies. This study applied an artificial intelligence (AI) workflow to analyze cervical cancer and brachytherapy discussions from an online forum.

Materials/Methods

We extracted posts and comments from the subreddit r/cervicalcancer, focusing on discussions about brachytherapy between November 2020 and January 2024. We applied a processing pipeline to prepare the data for analysis. The content was analyzed using RoBERTa, a pre-trained deep learning model, to categorize sentiments as positive, negative, or neutral. We further evaluated posts using pre-defined keyword tagging to identify dominant topics within conversations based on recent literature.

Results

The analysis encompassed 898 unique posts and comments from an initial dataset of 1075 entries. Overall sentiments were categorized as 40.4% positive, 29.9% negative, and 29.7% neutral. Discussions related to “Bowel Domain” showed the highest proportion of negative sentiments (51.2%) among all topics. “Urinary Domain” (46.8%), “Pain” (43.4%), “Fatigue” (42.4%), and “Anesthesia” (41.4%) discussions also reflected predominantly negative sentiments. In contrast, “Recovery” and “Survivorship” discussions were predominantly positive. The sentiments on “Sex” and “Mental Health” related topics displayed a more balanced distribution between positive and negative perspectives.

Conclusion

Our study demonstrates the value of analyzing unstructured patient narratives from online forums related to cervical brachytherapy. We identified patterns of concerns that can inform clinical practice, particularly regarding patient education about bowel and urinary side effects. These findings can improve informed consent discussions and help clinicians better address patients’ significant concerns. Further work will focus on developing automated systems to bridge the gap between clinicians’ understanding and patients’ lived experiences.

Introduction

Cervical cancer is the fourth most common cancer in women globally, with an estimated 660,000 new cases and 350,000 deaths in 2022.[1,2] Alongside concurrent chemoradiotherapy, imageguided brachytherapy is fundamental to the curative treatment of locally advanced cervical cancer.[3] Brachytherapy is a highly localized treatment that achieves conformal, high-dose radiation by inserting intracavitary applicators or interstitial needles directly within or adjacent to the cervical tumor. A remote after-loader then advances a sealed radioactive source through these channels to predetermined dwell positions and times, calculated by computerized treatment planning, before safely retracting it into its shielded housing. This tightly localized dose distribution is central to the technique’s therapeutic effectiveness.[3,4] However, despite its demonstrated efficacy, there are limited data on the lived experiences of patients undergoing this procedure. Existing research has begun to address aspects of quality of life and patient experiences; however, traditional tools, such as structured questionnaires, often fail to capture the full range of patient perspectives.[5].

In contrast, online forums offer a platform where patients can share their thoughts, emotions, and experiences more openly than they might in formal clinical surveys or structured interviews.[6] Recent advances in artificial intelligence (AI) and natural language processing (NLP) tools have created new opportunities to analyze these patient-generated narratives at scale. AI workflows can efficiently process large volumes of unstructured discussions in these forums and identify patterns that might be missed by structured clinical surveys.[[6], [7], [8]] Sentiment analysis, a subset of NLP, enables systematic classification of emotions expressed in text as positive, negative, or neutral. This approach allows for consistent analysis across thousands of patient narratives, offering advantages in throughput and standardization compared to manual review.

In this study, we applied an NLP workflow to analyze online forum discussions about cervical cancer and brachytherapy, allowing us to capture unfiltered patient perspectives. Our objective was to examine the experiences shared by patients undergoing brachytherapy and to uncover patterns, concerns, and information needs that may not be evident in traditional clinical settings. We hypothesized that an AI-driven analysis of these forums would reveal unique insights into patient experiences, including previously unidentified emotional responses, concerns, and coping strategies. These findings could play a critical role in informing more effective patient education, enhancing support systems, and fostering clearer and more empathetic communication between healthcare providers and patients, ultimately improving the overall care experience for individuals undergoing brachytherapy.

Methods

This study did not require institutional review based on the criteria of the Common Rule (45 CFR §46 − US Department of Health and Human Services Regulations for the Protection of Human Subjects in Research) because it used publicly accessible, de-identified data. We elected to use Reddit which is a social news aggregation, content rating, and discussion website. Users submit content to the site such as links, text posts, images, and videos, which are then voted up or down by other members. Subreddits are user-created communities within Reddit that are dedicated to specific topics, allowing for focused discussions among individuals with shared interests or experiences. In this case r/cervicalcancer, dedicated to discussions around cervical cancer. We utilized the Reddit Application Programming Interface (API) to extract posts and comments from the subreddit r/cervicalcancer, focusing on discussions about brachytherapy between November 2020 and January 2024.[9] This approach allowed us to capture a broad range of patient experiences and discussions related to this treatment.

Data preprocessing involved several steps to ensure analytical readiness. We began by cleaning the data by removing irrelevant or illegible text such as URLs, special characters, and excessive white space. Next, we converted all text to lowercase for uniformity and generated the corpus for analysis.

To analyze sentiment within the posts and comments, we employed the Robustly Optimized Bidirectional Encoder Representations from Transformers Pretraining Approach model (RoBERTa), a transformer-based NLP model. RoBERTa, a refined version of Bidirectional Encoder Representations from Transformers (BERT), is pre-trained on large corpora, including datasets from social media and other text sources.[10].

We utilized the model to classify each individual post or comment. The RoBERTa model outputs probabilities for each sentiment class (positive, negative, neutral). The sentiment label was assigned based on the class with the highest probability. For instance, if the probability for ‘negative’ was 0.7, ‘neutral’ 0.2, and ‘positive’ 0.1, the comment was classified as negative. No manual oversight was involved in the final sentiment classification by the RoBERTa model, as it is an automated process. However, the initial training data for such models typically involves human-annotated examples. By analyzing these probability distributions for posts associated with specific themes, we aimed to understand how patients collectively expressed their attitudes toward aspects of cervical cancer care. The limitations of applying a general-purpose sentiment model to specialized medical discussions are addressed in our limitations section.

In addition to sentiment analysis, we applied keyword tagging to categorize and identify dominant topics within the posts using the spaCy natural language processing library.[11] spaCy is an open-source library for advanced Natural Language Processing (NLP) in Python. In this study, spaCy was primarily used for keyword extraction and tokenization, which facilitated the identification and categorization of dominant topics within the posts. It helped in efficiently processing the raw text data to prepare it for thematic analysis based on our predefined keyword list. While the RoBERTa model performed sentiment classification, thematic categorization and subgrouping were guided by a human curated keyword list and subsequent manual review for refinement and grouping. This method allowed us to map patient discussions to key themes and concerns related to their brachytherapy experience. The overall workflow of our study, including data extraction, preprocessing, sentiment analysis, and topic modelling, is illustrated in Fig. 1.

Fig. 1.

Workflow Pipeline for Sentiment Analysis and Keyword Tagging of Online Patient Discussions on Brachytherapy.

By combining sentiment analysis with keyword-based topic identification, we aimed to provide meaningful insights into the concerns and experiences of patients undergoing cervical brachytherapy, as expressed in an unfiltered, online environment. All data extraction, preprocessing, and sentiment analysis using the RoBERTa model, as well as keyword tagging with spaCy, were performed in Python 3.8. This included data cleaning, tokenization, and the application of the sentiment model. Statistical analyses, including descriptive statistics (e.g., frequencies, percentages) and the generation of visualizations, were conducted in R Studio. Our study primarily utilized descriptive statistical tests to summarize and present the characteristics of the data, such as the distribution of sentiments across different topics.

In our analysis, each post/comment (or “snippet”) is preserved as one record and then assigned all topic categories that apply. Sentiment, however, was determined once per snippet by the pre-trained models, yielding a single overall label. Thus, while a quotation can address multiple topical categories simultaneously, it cannot be double coded as both “Positive” and “Negative” sentiment; the mixed feelings are retained in the text itself, but we assign only the dominant sentiment per text snippet.

It is important to note that data were drawn from a self-selected subset of Reddit posts and comments, so the sample may not represent the broader cervical-brachytherapy population. Because authorship on Reddit is anonymous, we could not verify the authenticity of clinical details, determine geographic context, or recover treatment-modality specifics (e.g., intracavitary vs interstitial). In addition, the sentiment-analysis model, validated on general social-media corpora, was not fine-tuned on oncology-specific language, which may affect nuance detection. These design constraints should be kept in mind when interpreting the ensuing results.

Results

From the initial dataset of 1075 entries, after excluding 89 duplicates, 45 entries in languages other than English, and 43 posts unrelated to brachytherapy, we analyzed 898 unique posts and comments from 191 users (44 users both posted and commented, 6 posted only, and 141 commented only). Sentiment analysis revealed that 40.4 % (363) of posts expressed positive sentiments, while 29.9 % (268) were negative and 29.7 % (267) were neutral.

Following sentiment categorization, we examined specific keywords within the posts to identify underlying themes. The scope and frequency of keywords in this cohort are shown in Fig. 2. Through manual review, these keywords were grouped into five main categories: treatment experience and logistics, physical side effects and symptoms, psychological and emotional well-being, sexual and reproductive health, and recovery and survivorship. The detailed breakdown of specific keywords and their associated sentiments is shown in Fig. 3.

Fig. 2.

Bubble Chart Depicting the Distribution of Keywords in Online Discussions Related to Brachytherapy.

Fig. 3.

Sentiment Distribution Across Keywords in Online Discussions Related to Brachytherapy.

Treatment experience and logistics

Manual review of posts related to treatment experience and logistics identified two predominant subcategories: waiting and anesthesia. Overall sentiment analysis of posts in this theme showed that 42.1 % expressed positive sentiments, 31.4 % negative, and 26.5 % neutral.

Waiting Period

Within the waiting subcategory, common themes in these discussions included waiting times between treatments, treatment delays, and scheduling challenges. Sentiment analysis of waiting-specific posts revealed that 39.4 % expressed positive sentiments, 30.5 % negative, and 30.1 % neutral. While posts about scheduling and between-treatment waiting were generally mixed, discussions about waiting during treatment sessions were predominantly negative. An example included “the worst part about that experience was having to lay flat on my back for hours.”.

Anesthesia

Anesthesia was a more challenging topic, with most posts expressing negative experiences (41.4 %). Many posters described undergoing brachytherapy with minimal or no anesthesia, resulting in traumatic experiences. One individual shared, “my hospital didn’t use anesthesia for brachy when I had it (only 4 years ago). It was insanely barbaric and traumatizing. And then I found out everywhere else people were put out for the procedure, and all I got was some Ativan and a shot of morphine! I complained to my radiation oncologist how horrific it was, and he promised he was going to update their protocol.” Another user echoed a similar sentiment: “I had three without any sedation or painkillers and it was just bloody awful. I won’t sugarcoat it. But if you have the option for sedation and/or anesthesia, it won't be any worse than what you have already experienced in treatments.”.

However, not all experiences were negative. Approximately 30 % of posts reflected a more positive experience with anesthesia, with one individual noting, “brachytherapy sounded a lot scarier than it actually is. General anesthesia is very common for treatment. It’s definitely better to not be awake when they’re putting the rods in! You'll probably be awake for treatment.”.

Physical side effects and symptoms

Pain

Pain was a frequent theme within the physical side effects and symptoms subgroup, with negative sentiments being most prevalent (43.5 %). Many patients reported considerable pain during or immediately after brachytherapy. One individual shared, “I just finished the procedure on Wednesday. They put 20 piercing rods in me instead of 5, so the pain was worse than for most others! They gave me Dilaudid when I woke, but made me wait a while in pain, and if it weren’t for my friend being there with me to ask them because I didn’t even have a nurse call button.” Another poster highlighted the discomfort associated with the removal process: “The worst part is taking out the gauze packing and rods at the end. But it's done quickly and definitely not as much pain as you're already going through with your bladder. You can do this!” A lack of sedation or pain management was also a recurrent theme in these discussions. One individual remarked, “I had three without any sedation or painkillers, and it was just bloody awful. I won’t sugarcoat it. But if you have the option for sedation and/or anesthesia, it won't be any worse than what you have already experienced in treatments. I recovered quickly, and once everything was inserted, it felt like nothing more than strong menstrual cramps.” The persistence of pain even after the procedure was also mentioned: “The pain does not go away even with pain meds. It lowers the pain a bit, but it’s always there. I am going on 2 weeks of pain now.”.

Gastrointestinal symptoms

Gastrointestinal (GI) symptoms, including diarrhea, constipation, and other GI issues, were frequently discussed by patients, with sentiment analysis showing a predominantly negative tone of 51.2 %. These symptoms are likely attributed to a combination of external beam radiation therapy (EBRT) and brachytherapy; however, they represent a significant concern for many patients. The shared experiences ranged from acute to chronic symptoms, indicating the varying impact of treatment on gastrointestinal health. Some individuals expressed frustration and surprise regarding the severity of these symptoms. One poster stated, “Honestly, why didn't they warn us? And if they did warn us, why didn't they warn us louder?? It burns when I pee, it burns when I poop, it burns when I think about either; the whole crotch region is just a source of anguish right now!” Other patients have detailed ongoing and long-term consequences such as inflammation, GI bleeding, and intestinal blockages. One individual shared their experience, “I've had 2 years of inflammation, GI bleeding that I get iron infusions for, diarrhea, and scar tissue that causes intestinal blockages. But a lot of people have no issues after, so you never know how your body will respond.” There were also instances in which patients discussed severe complications, including fistulas and anal stenosis, which significantly impacted their quality of life. One user described their thoughts on the potential for radiation-induced damage: “I just can't even imagine radiation damaging me like that and me still being happy to be alive. Fistulas and anal stenosis, a shriveled vagina and no estrogen, broken hips…” Another individual, despite experiencing fistulas and severe bowel issues, reflected on their ordeal with a somewhat positive outlook: “I have fistulas, which I do believe to be caused by radiation damage. I had so many problems with my bowels and bladder because of the tumor, then radiation damage. And yes, I would go through it again.”.

Urinary symptoms

Urinary issues were another common concern among patients, with 46.8 % negative sentiments. Patients reported a range of experiences, from acute to chronic urinary complications. One poster described severe acute issues following treatment: “I'm so done… This week my bladder is so fried I'm peeing blood and wearing a pad for leakage. I'm feeling like I can't win, and my radiology team just shrugs off all my concerns as 'normal' side effects. Meanwhile, I'm terrified of having long-term issues from treatment, and they just don't care.” Other posts highlighted the simultaneous occurrence of multiple symptoms, including gastrointestinal and urinary issues. One individual stated, “I had horrible diarrhea and also extreme pain urinating.” Chronic issues, such as radiation-induced cystitis, were also a significant concern, with some patients expressing uncertainty about the duration of these symptoms. One user asked, “Does the cystitis go away eventually? The radiation has aggravated my urethra, so it does burn when I urinate.”.

Fatigue

Fatigue was another frequently reported symptom, with 42.4 % of entries expressing negative sentiments. Patients reported significant exhaustion which affected their daily activities and quality of life. One individual shared, “Fatigue is probably the biggest [symptom], but even that is getting a lot better.” Another patient detailed the extent of their exhaustion following brachytherapy: “I was wiped out for a week after brachytherapy — as in, I was sleeping 16 h a day for the first week after. I started to get out and about again after the first week and was able to visit family around 10 days after, but needed lots of rests.”.

Sleeping issues were less commonly mentioned among the posts, with 47.6 % of entries being neutral. However, some patients did describe insomnia as a particularly challenging side effect of treatment. One individual stated,” One week on [from brachytherapy], I can say that the side effects have been far worse than I anticipated or was warned. The two worst aspects have been insomnia and joint/musculoskeletal pain.”.

Swelling and lymphedema were mentioned less frequently in the discussions, with 38.5 % of these entries were positive. Many posts provided supportive advice and shared personal strategies for managing these symptoms. One individual suggested, “I went to Pilates classes to help with my pelvic floor and to just get moving. The pain issue is tough — I think the poster's idea about a lymphedema clinic is a good one. There is a lot you can do about lymphedema, including supportive hose and massage.” Another user offered a different approach, stating, “Another thing that helps with my swelling is dry brush lymphatic massage; there is a very good video on YouTube that explains it. Movement always helps keep the swelling down for me too.”.

Psychological and emotional well-being

Mental health concerns, including stress, anxiety, depression, and post-traumatic stress disorder (PTSD), were commonly mentioned in the discussions, with sentiments being fairly balanced between negative (35.2 %) and positive (34.8 %). One individual shared their worry about their symptoms being dismissed: “I'm just worried that any symptoms I have now are going to be downplayed, which is what happened when I first went to see someone and was told, 'Well, your periods can change.' Does anyone know if this paranoia ever goes away?”.

Another poster reflected on their trauma from the procedure: “I did 6 [brachytherapy treatments] … Did it feel embarrassing and horrible for you? Did they give you pain meds or just tell you what to take? It's affected me mentally and sexually… but I can't explain it to anyone close to me.”.

In addition to these accounts of distress, some posters offered advice on seeking professional help to cope with the emotional challenges associated with brachytherapy. One individual encouraged others: “Please seek a therapist. It’s so important that you work through this trauma. There will be a lot of important gyno visits you will need to attend over the next several years.” Another poster shared their own journey: “I also sought counseling about 6 months later because the reality of never being able to get pregnant really put me in a dark place.”.

Sexual and reproductive health

Concerns regarding sexual activity, intimacy, and relationships were commonly discussed, with 38.3 % of the sentiments being negative. Many patients expressed distress regarding the loss of their sex life, or the physical pain associated with intimacy after brachytherapy. One user remarked, “I haven't used my dilators, not a single time since given to me in the summer. If I ignore it, it isn't real… I was wrong. Is it too late? Has my vagina narrowed forever?” Another patient shared their frustration with treatment: “I'm so scared of my vagina drying up, being scarred, and losing my sex drive or ability to enjoy intimacy. I just want to have pain-free sex.” For many, the prospect of returning to a normal sex life seemed daunting: “I cry thinking about how sex can never lead to a pregnancy for us, and my heart breaks in the moment. I can't distinguish pleasure from trauma.” Another poster highlighted the emotional impact of treatment on intimacy: “Also go ahead and ask your doc about dilating — that was something that totally blindsided me. I was 29 at diagnosis, so losing my sex life was the worst part, honestly. (It isn’t like that for everyone, it's just been painful for me so far.)”.

Some posts related to sexual experience were neutral, and simply described their experiences, seeking advice or sharing their methods for managing post-treatment sexual health. One patient said, “I have not used dilators yet, but am having lots of sex, which my sexual health specialist says is equivalent. If I stop having sex, I will start using dilators—I understand the 'use it or lose it' clause applies from here on out.” Another user mentioned, “My radiation oncologist is a bit of an alarmist already, and he said today I'll have to wait 4 to 6 weeks to have sex or start using dilators *after* I'm done with brachy.”.

Positive experiences were also shared, with many users offering support and practical tips for maintaining sexual function aftertreatment. One poster noted, “As for sexual function, I think it's really person by person. I did notice some tightening, so I recommend staying on top of using the dilator. Things can sometimes be a little uncomfortable & less stretchy than before, but it adapts with use.” Others highlighted the importance of getting professional help early: “My oncologist set me up with a sexual health specialist while I was doing the brachytherapy… I strongly recommend you try to get the same! It really calmed me down.”.

Discussions about iatrogenic menopause, particularly its impact on young patients undergoing brachytherapy, were slightly more negative, with 39.8 % of the posts reflecting distress over early onset menopause and its associated challenges. Many patients shared their struggles with physical changes and the emotional toll of premature menopause. One patient remarked on her experience with menopause and side effects, “I had cancer. But it feels like I still have cancer, and I always will have; some side effects will never go away.” Another poster described how treatment forced them into early menopause: “I've been taking calcium because the radiotherapy put me into menopause (I'm in my late 30 s).” The emotional weight of early menopause was evident in many accounts, as younger patients expressed their grief over the loss of fertility and the physical symptoms of aging. One patient shared, “I can't have children anymore. I'm in menopause. I'm 26 years old, feeling stuck in the body of a 70-year-old woman.”.

Recovery and survivorship

Sentiments regarding recovery were more evenly distributed, with 36.6 % of posts reflecting a sense of progress in the healing process, rehabilitation, and returning to normalcy after brachytherapy. Patients shared their experiences of physical improvement and overcoming challenges during recovery.

Survivorship, which focused on life post-treatment and managing long-term side effects, had a more neutral tone, with 45.5 % of posts being neutral. Many patients discussed their ongoing adjustments to living as survivors. One notable comment highlights the struggle. “I have been having a hard time mentally since my initial treatment. I was so focused on survival, just going through the waves and doing what I was told to do, I didn’t really battle with any depression during treatment. But afterwards, I feel like you are so involved with doctors for weeks, and then they just send you on your way, which was a shock.”.

Discussion

In this study, our analysis of online forum discussions revealed significant variability in patient experiences with cervical brachytherapy, with particular concerns regarding gastrointestinal toxicity, urinary dysfunction, and sexual function. By applying advanced artificial intelligence techniques, particularly NLP tools such as sentiment analysis, we were able to efficiently aggregate and analyze large volumes of patient-reported experiences from online forums. The polarity and frequency of sensitive information presented in anonymous online forums often highlights issues that are not openly discussed with treating physicians.[12] This approach allowed us to efficiently review content that would be time-consuming to manually analyze, enabling unique insights into patient experiences, providing a valuable resource for understanding patient concerns in a way that traditional methods might miss.

Our findings highlight that brachytherapy side effects remain a significant patient concern. Capturing patients’ stories highlights their daily struggles, especially with treatment side effects, recovery, and mental health, as reflected in sentiment and text entries.. The variability of experiences among cervical cancer patients undergoing brachytherapy is striking, with some reporting manageable symptoms whereas others experience severe challenges. This is especially alarming regarding pain and anesthesia, both of which, along with sexual function, have historically been neglected aspects of cancer care and survivorship, as noted by an increasing body of literature.[13,14] While EMBRACE II outlines gold standard protocols for image guided brachytherapy, including treatment planning and delivery, our findings suggest these guidelines are not uniformly translated into supportive care practices.[15].

These patient-reported experiences are consistent with observations in clinical research literature, validating the utility of our approach. The variability in patient experiences observed in our study aligns with previous research findings. Humphrey et al. validated this variability in the U.K., consistent with earlier studies by Velgi and Fitch.[16,17] Our findings highlight the complex interrelations between distress, pain, and anxiety in brachytherapy and broader cancer diagnoses. Kwekkeboom et al. found that most women undergoing high-dose-rate brachytherapy reported mild to moderate pain, especially during instrument removal, supporting our observations.[18] Matsuda et al. noted that while median pain scores were low, about 30 % of patients desired more effective anesthesia, emphasizing the need for individualized pain management. [19].

Similar to our study, significant issues with pain control and psychological support in patients undergoing cervical brachytherapy were reported elsewhere: moderate pain affected 18.2 % of patients and 43.3 % required rescue analgesia in a Spanish HDR series, while 26 % experienced severe pain despite conscious sedation in an earlier U.S. cohort.[18,22] Mental-health morbidity was likewise high. Clinically significant anxiety ranged from 38.7 % (Morocco) to 60 % (Tunisia), depression from 16.1 % to 57.5 %, and post-treatment PTSD reached 41 %.[23,24] These external figures closely parallel the sentiments quantified in our analysis. Humphrey et al. emphasized improved patient care and pain management strategies.[16] Rivera et al.’s survey revealed variability in pain management during gynecologic brachytherapy, with potential PTSD symptoms due to inadequate pain control.[20] These findings underscore the importance of addressing pain and distress comprehensively to improve patient experiences during cervical cancer brachytherapy.

Our study has several limitations. First, it was limited to a subset of entries from an online forum, which may have introduced bias. It is worth noting that online forums may inherently contain selection bias, as patients with negative experiences are generally more motivated to seek support and share their stories online compared to those with neutral or positive experiences. This phenomenon has been documented in other healthcare domains, suggesting that our dataset may overrepresent negative experiences despite the balanced sentiment distribution we observed.[21] However, we observed a balance between neutral and positive sentiments, indicating that the discussions were not predominantly negative. Additionally, while the sentiment analysis tool we utilized has been validated for social media, it has not been specifically validated for this population, potentially missing some nuances in medical jargon or clinical experiences. Another limitation is the inability to corroborate patient reports, an issue common to patient-reported outcomes (PROs) and other qualitative methods. Despite these limitations, a key strength of our study is the use of NLP methods to capture patient sentiments and discussions in an anonymous online setting, demonstrating, facilitating more comprehensive understanding than would be possible through manual review alone.

This study represents an initial step toward using AI workflows to better understand patient experiences with cervical brachytherapy through online discussion. By systematically processing large amounts of unstructured patient narratives, we were able to identify patterns of concerns and experiences that can directly inform clinical practice. The next step is to develop an automatic pipeline that can further bridge the gap between clinicians’ insights and patients’ experiences, enhancing the feedback loop. This can improve clinical decisions, consent discussions, and patient education regarding treatment expectations, side effects, and survivorship. Further research on these technologies is necessary to fully leverage their capabilities in understanding and addressing the broader aspects of cervical cancer care.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.