Hee-Mang Jung, who is a 42-year old early-stage breast cancer patient, takes tamoxifen pills. While she knows that this pill was recommended by her doctor, she is concerned that taking this pill will accelerate aging and have various side effects. She constantly asks herself if there is a better treatment option. After taking the pill for several days, she starts waking up every couple of hours in the middle of the night while sweating and flushing. As a result, Hee-Mang feels very miserable. She is unsure if she can continue with a treatment method that has so many side effects. Her next appointment with her doctor is five months away, and she feels anxious that she won’t have access to her doctor for such a long time.


In Hee-Mang’s next appointment with her doctor, the doctor recommends a new chatbot, “ToDoc ToDoc” that will help her stay connected to the doctor and monitor her symptoms.


Hee-Mang answers 1-2 daily questions related to her sleep, mood, eating, exercise and other aspects of her life that could be affected by her treatment. ToDoc ToDoc uses Artificial Intelligence and accumulated data to ask Hee-Mang questions every day.


As Hee-Mang enters a low sleep pattern score, the mobile and alters her with a message related to the sleep pattern change commonly observed with the patients who are taking the same medication.
“Don’t worry too much. Hot flushing is a very common symptom that 95% of patients experience in the first 2 weeks of taking this medication.”
This message comforts her while she still doesn’t feel completely normal.


A nurse at a leading hospital in Korea is checking the urgent patient list the first thing in the morning. The screen shows the 3 most urgent patients with their irregular symptoms so that she can follow up with them. She reviews the history of Hee-Mang’s survey results and becomes aware of Hee-Mang’s severe sleeping problem.
A nurse monitors the details of survey results on a big screen on her desk. She makes a note of the problem and consults with the doctor on an appropriate next step.


The nurse calls Hee-Mang and consults on her sleeping pattern and other wellness issues. They agree that it would be best to schedule an additional appointment with Hee-Mang’s doctor as soon as possible.
Hee-Mang is relieved that she can see the doctor soon and is hopeful that she can find a solution soon.


Hee-Mang comes in for the check-up. The doctor reviews her symptoms and consults with her. In addition to the medication, he recommends that she takes meditation classes and goes out for a regular exercise while reducing her working hours.
The doctor, showing Hee-Mang’s sleeping pattern history, explains what is causing her sleep irregularity and what other steps she can take when she encounters the same issues in the future.


Hee-Mang now takes Fridays off and rides her bike and takes a hike every week. Also, she tries to take time to meditate every evening before going to bed. She feels a lot better and her sleeping pattern has improved a lot during the past week.
Hee-Mang feels a lot more secured and relieved that her doctor and nurse are monitoring her progress every day and that they will notify her if they see any issues. Knowing she is in good hands, she can sleep much better.

The Busan CIC is leading a team consisting of Busan IT Promotion Agency (BIPA), a breast cancer center at a leading hospital in Korea and a medical start-up, “Weisure” to develop an interactive chatbot called “ToDoc ToDoc,” which will help breast cancer patients undergoing anti-hormone therapy successfully manage the therapy’s side-effects.

Breast cancer has emerged as a major health problem in Korea. The number of Korean breast cancer patients has doubled over the past decade, and the country’s breast cancer incidence rate has become one of the highest among Asian countries. Approximately 60 to 70% of breast cancer patients are recommended to receive anti-hormone therapy for about 5 to 10 years to reduce the risk of cancer recurrence. However, patients who receive anti-hormone therapy experience a number of side effects such as flushing, sweating, depression, insomnia and gynecological problems. Receiving sufficient counseling from their doctors for managing these side effects is difficult, as the majority of patients can only consult with their doctors for 3 to 5 minutes every 6 months. In response, patients try to search the Internet or ask other patients, but the unreliability of these information only increase their anxiety. These factors have combined to create a phenomenon in which breast cancer patients have discontinued their much-needed therapy.

The Busan CIC created a team that comprises BIPA, a breast cancer center at one of Korea’s largest hospitals, and Weisure to launch the Breast Cancer Challenge. The Busan CIC held a workshop using the ‘Amazon Working Backwards’ process and conducted a series of interviews to define the problem. In the near future, the Busan CIC will launch an additional workshop to develop the prototype. The prototype that the team is currently developing is a chatbot, through which breast cancer patients answer 1-2 questions every day about their symptoms. These questions are based on the 11-item Menopause Rating Scale (MRS) questionnaire, which is a formally validated scale according to the requirements for quality of life instruments. The chatbot will accumulate 5-8 cycles of data every month, with a cycle defined as the user’s response to all 11 questions, and consequently 30-48 cycles of data every 6 months, which is usually how frequently the user has an appointment with a doctor. Using Artificial Intelligence, the chatbot will use this data to create a progress report that allows users to both see changes in their symptoms and compare themselves to other breast cancer patients. As users’ doctors will have access to this data, medical appointments will be more efficient, as doctors would not have to spend the first few minutes of the appointment obtaining information about their patients’ symptoms. Instead, they could analyze the data before the appointment, and provide more consultation to their patients during the appointment. Additionally, patients would also not have to remember all the symptoms they encountered over the past six months, as their data will be readily available. In the future, the solution will expand to include a mobile app. While a chatbot could be simpler in terms of enabling the user to engage in a targeted interaction, the mobile app will offer significantly more ways for the user to interact with the app and their doctors. By including additional features, the mobile app will become even more interactive and useful for the user. In addition to accessing progress reports, users of the mobile app will be able to receive clinical communication and find a community that actively supports their road to recovery from breast cancer. They will be able to communicate with other patients who have encountered similar symptoms, and empower each other to foster a healthy and supportive community. Side-effect symptoms will also be classified by severity levels, and both the users and their doctors will be notified if the symptoms become too severe. Such notifications make urgent medical interventions possible. Survey questions will also become more varied to measure not only the user’s response to the 11-item MRS questionnaire, but also the user’s overall health. These features of the “ToDoc ToDoc” solution will hopefully increase users’ therapy adherence rate, thereby facilitating the recovery of breast cancer patients. Furthermore, the framework of the solution can be applied to other medical contexts. For instance, in areas like mental health, in which patients’ survey response data could be largely influential in enhancing treatment, an interactive digital solution could play a pivotal role.

A Leading Hospital’s Breast Cancer Center Releases Chatbot ‘ToDoc ToDoc’ to Improve Treatment Effect for Breast Cancer Patients by Monitoring Adverse Reactions to Anti-hormone Therapy
On November 19, 2021, a breast cancer center at a leading hospital in Korea released a chatbot named ‘ToDoc ToDoc,’ a new chatbot that helps patients undergoing anti-hormone therapy successfully complete planned treatment by closely managing side effects. Roughly 60-70% of all breast cancer patients are recommended to take anti-hormone therapy for 5 to 10 years to reduce the chances of breast cancer recurrence. However, patients who receive anti-hormone therapy may experience a variety of new symptoms such as flushing, sweating, depression, insomnia, and gynecological problems, making daily life difficult. In addition, even if they visit their treating doctors once every 6 months, they cannot get satisfactory counseling as each patient is only given 3 to 5 minutes per appointment, and it is often difficult for them to reschedule their earlier appointments to meet their needs. So, they try to search the web and get information from other patients, but unreliable information makes them more confused, anxious and curious about how to deal with such symptoms.

Under this situation, the chatbot ‘ToDoc ToDoc,’ which means to comfort someone who needs help in Korean, allows breast cancer patients who receive anti-hormone therapy to recognize, and properly respond to various adverse reactions of the therapy. As patients answer 1 or 2 side effect-related simple questions every day through the chatbot, the chatbot gradually generates personalized questions based on the data and AI. Then, it creates a ‘progress report’ by graphing and visualizing the condition of patients, making it easy to identify the degree of, and changes in the side effects that patients face. Patients can also check their condition by comparing themselves to other patients who are receiving the same therapy.

In the past, the medical staff had to collect data through regular checkups every six months. Now, they can collect data almost every day and ‘continuously’ monitor patients’ conditions. Also, the ‘progress report’ simplifies the treatment course from four steps of [hearing symptoms-analysis-diagnosis-treatment] to three steps of [referring to integrated data-diagnosis-treatment]. This helps doctors identify patients’ conditions quickly even within a short period of counseling time and provide customized care. In addition, the progress report can categorize symptoms into mild, moderate, and severe, and provide appropriate directions. For mild or moderate cases, it guides how to take care in daily life and for severe cases which require medical care, it alerts medical staff to recommend patients to visit nearby hospital/clinic or schedule early visits.

Hee-Mang Jung, 43-year-old breast cancer patient living in Suwon, said, “While receiving anti-hormone therapy, I sometimes can’t sleep due to fever and flushing. I feel nervous because I don’t know how serious the symptoms are. However, after using this chatbot, I found out that these reactions are common, so I felt relieved. Every time I visited doctor, it was difficult to explain what I have wondered about my symptoms for the past six months, like insomnia or fever, because I did not have enough time to explain or could not remember every symptoms. But now I feel comfortable because my doctor already knows what I have experienced, and consults using ‘ToDoc ToDoc’.” Haeng-Bok Choi, Professor of the breast and endocrine surgery department at the hospital, who is currently using ‘ToDoc ToDoc’ said, “It reduced the counseling time of listening and organizing patients’ anti-hormone therapy-related adverse reactions so now I can use time more efficiently and treat patients better. I can’t solve every adverse reaction occurring between regular medical treatments, but given that I can screen and manage patients with severe adverse effects, it is very helpful.”

Ki-Hoek Kim, professor of the breast cancer center at the hospital and sponsor of this chatbot said, “The ultimate goal of the ‘ToDoc ToDoc’ chatbot is to improve treatment compliance by more than 30% through the management of adverse reactions that patients have when receiving anti-hormone therapy. In the future, ‘ToDoc ToDoc’ aims to further improve treatment outcomes by adding more features such as speech input and precision medicine framework, which provides patients with more personalized care. Any breast cancer patient receiving anti-hormone therapy at the hospital can download ‘ToDoc ToDoc’ for free on the Kakao Talk platform, and use it by getting the chatbot permission and medical treatment data from the medical staff.

[Customer FAQs]
Q.Do I need a separate registration procedure or qualification to use the chatbot?
A.You need to be confirmed by the medical staff in charge if you are eligible for a subscription and then get information about the subscription process.

Q.Is it available on both Android and iOS?
A.Yes. It is available on both operating systems.

Q.Is it free of charge?
A.There is no cost for basic use. In case of services which imposes additional charges, it will be decided after additional guidance.

Q.I want to sign up and use on behalf of my spouse/daughter. Is it okay to do so as a guardian?
A.Generally, it can be used only by patients. For a patient who has difficulty using the chatbot, only a guardian who lives with the patient can check their eligibility with the medical staff.

Q.Are data stored safely without any chance of being exposed to third-party entities?
A.Data collected through the chatbot under the consent to use personal information is stored safely, and personal information is not disclosed to the outside.

Q.How many years will personal information be retained for?
A.Personal information is kept for 10 years, and after that it will be discarded.

Q.I have been cured. Then, will my personal information be deleted? Will my personal information be deleted after I have been cured?
A.Aside from the patient’s condition and usage of the chatbot, personal information will be kept for 10 years and will be deleted thereafter. If you want to stop using the chatbot, you can delete it from mobile device.

Q.I have a question about usage of the chatbot, where should I contact?
A.Go to the “Menu” in the chatbot and leave a question on ‘Q&A’.

[Doctors/Nurses/Medical Staff FAQs]
Q.Is there a separate chatbot for doctors and nurses?
A.There are web-based SW and mobile apps only for administrators.

Q.Is there a separate chatbot or app that allows medical staff to communicate with each other to answer patients' questions?
A.The questions written in ‘Q&A’ by patients can be checked and answered by medical staff through ‘ToDoc ToDoc’ chatbot or web page.

Q.If there are similar questions, is it possible to use previous answers and automatically reply?
A.Some of the answers to FAQs are automated.

Q.Should it be registered and managed as a medical device?
A.It is a non-medical device because it does not directly measure vital sign, images, or human-oriented specimen such as blood samples. (However, confirmation from KFDA is needed)

Q.Is the product required to be patented?
A.A patent is required for the overall service of symptom management for patients undergoing anti-hormone treatment.

Q.Is there any problem with the hospital’s security regulations?
A.We need to review the hospital's security regulations focusing on anonymization.

Q.Is there any example of using a similar solution in other hospitals?
A.We have not yet obtained cases of managing side effects by collecting direct and specific questionnaire on anti-hormone therapy. However, we know that a lot of software or services are under research, using questionnaires or other simple vital signs to identify and manage patients’ conditions. However, we do not know how much they are used in actual clinical sites.

Q.How much will it cost to operate? Does the cost increase as the number of users increases?
A.We need dedicated personnel to check patient’s clinical status, guide patients to use the chatbot, and answer questions. Also, data storage, maintenance, and security will generate additional cost. As the number of users increases, above mentioned costs will increase accordingly.