The role of Internet resources in clinical oncology: promises and challenges

Connected and supported: a scoping review of how online communities provide social support for breast cancer survivors

PURPOSE

To (i) assess how and to what extent online communities are used among breast cancer survivors (BCS) as a source of social support, (ii) describe the kind of support BCS access through online communities, and (iii) explore how these communities foster social support for BCS that promotes well-being and reduces the challenges of survivorship.

METHODS

We conducted a scoping review. A professional librarian performed a comprehensive search in multiple databases from January 2010 to May 2023. The review process adhered to the Johana Briggs Institute's method guidelines and the PRISMA-ScR reporting system.

RESULTS

Fifteen studies were included. Participants used social media, cancer support communities, message boards, or websites for information and emotional support. Qualitative findings resulted in four themes: to reassure; to empower; to promote equity, diversity, and inclusion; and to demonstrate for BCS the drawbacks of online support.

CONCLUSIONS

We underscore that a variety of internet websites and social media platforms are valuable for and appreciated by BCS, especially as a source of social support and human connectedness. Our study raises the existing gap in cultural/ethnic representation in this field and shows that institutional and organizational efforts are needed to address gaps in information regarding access to social support for multiethnic BCS women.

IMPLICATIONS FOR CANCER SURVIVORS

This data synthesis will empower the BCS community by sharing how they can strengthen and support their peers and community via their participation in online communities that connect and support cancer survivors in healthcare spaces.

Designing a virtual breast cancer prevention program for Iranian women: A study protocol

BACKGROUND

The growing number of breast cancer patients in Iran, following the lower referrals of women to screening centers after the outbreak of the COVID-19, suggests the need for designing virtual educational interventions to teach self-care methods to women. The aim of this study is to design a virtual training program for the prevention of breast cancer in women based on the steps of the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) educational design model.

MATERIALS AND METHODS

This developmental study will be conducted based on the steps of the ADDIE model. In the first step (analysis), a qualitative study, literature review, and a panel of experts will be conducted to analyze the situation (learners, content, platforms, and media for the electronic presentation of the program). In the design step, the learning objectives, educational strategies, and the way of program's implementation and evaluation will be specified. In the third step, not only are the content, storyboard, and educational program developed, but the pilot study is also conducted and formative assessment is performed. In the fourth step, the program will be provided to the audience and will be implemented as a preliminary program. In the final step, the final virtual education program for the prevention of breast cancer in women will be presented based on the results of the evaluation.

CONCLUSIONS

Using a comprehensive and systematic educational design model can be a step toward making changes and encouraging innovations in breast cancer prevention education programs in women based on virtual education. Given the existing needs and conditions, this program can promote cancer preventive behaviors as much as possible, reduce the costs imposed on the family and healthcare systems, and lower the complications and mortality rate caused by the delayed diagnosis of the disease.

Investigation of the Readability and Reliability of Online Health Information for Cancer Patients During the Coronavirus Pandemic

For cancer patients undergoing treatment who may be at higher risk of COVID-19, access to high-quality online health information (OHI) may be of particular importance amidst a plethora of harmful medical misinformation online. Therefore, we assessed the readability and quality of OHI available for various cancer types and treatment modalities. Search phrases included "cancer radiation COVID," "cancer surgery COVID," "cancer chemotherapy COVID," and "cancer type COVID," for the fourteen most common cancer types (e.g., "prostate cancer COVID" and "breast cancer COVID"), yielding a total of 17 search phrases. The first 20 sources were recorded and analyzed for each keyword, yielding a total of 340 unique sources. For each of these sources, the approximate grade level required to comprehend the text was calculated as a mean of five validated readability scores; subsequently, for the first ten results of each search, the DISCERN tool was manually used to assess quality. Search terms were translated into Spanish and French, and a quality assessment using the Health on the Net Code (HONcode) accreditation was conducted. The median grade level readability for all sources was 13 (IQR 11-14). Median DISCERN scores for the 170 sources assessed were 55 out of 75, suggesting good quality. OHI with quality scores below the median DISCERN score had a median readability of 12.5 (IQR 11-14) grade reading level vs 14 (IQR 12-17) for those above the median DISCERN score (T-test P < 0.0001). Percentages of HONcode-accredited websites were 34.9%, 39.9%, and 38.6% for English, Spanish, and French OHI, respectively. We conclude that efforts are needed to make high-quality OHI available at the appropriate reading level for patients with cancer; such efforts may contribute to the alleviation of disparities in access to healthcare information.

Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China

BACKGROUND

Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up).

OBJECTIVE

This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults.

METHODS

Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors.

RESULTS

Overall, 13% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas.

CONCLUSIONS

Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority.

Lessons for Oncology From the COVID-19 Pandemic: Operationalizing and Scaling Virtual Cancer Care in Health Systems

ABSTRACT

After several decades of slow expansion, the use of virtual care in oncology rapidly expanded during the COVID-19 pandemic. Data from cancer centers across the country show that most patients and providers were satisfied with components of virtual care, and virtual care may be able to improve access to care. However, the rapid implementation of programs during the pandemic worsened disparities in access to virtual care. Health systems must develop strategies to monitor quality, support patients and providers, promote health equity, and overcome regulatory challenges to successfully deliver care in hybrid systems that combine in-person and virtual care.

Adapting systematic scoping study methods to identify cancer-specific physical activity opportunities in Ontario, Canada

BACKGROUND

Identifying cancer-specific physical activity programs and post-secondary courses targeting students in academic settings (i.e., "real world" opportunities) may promote physical activity behaviors among cancer survivors. Using knowledge synthesis methods such as systematic scoping study methods may facilitate knowledge tool development and guide evidence-based practice to improve knowledge transfer. However, identifying these opportunities poses a challenge as systematic scoping study methods have yet to be applied and adapted to this context. Thus, to extend systematic scoping study methods, the purpose of the current investigation is to describe the adaptation of systematic scoping study methods in the context of cancer-specific "real world" opportunities in Ontario, Canada.

METHODS

Systematic scoping study methods were adapted to develop a knowledge tool, which was a credible resource website for researchers, clinicians, and survivors. Three search strategies including Advanced Google Search, targeted website search, and consultations with experts were used to identify eligible (e.g., appropriate for cancer survivors, offered in the community) cancer-specific physical activity programs. Only the targeted website search was used to search post-secondary institutions because they are centralized onto one government website.

RESULTS

Fifty-eight programs and 10 post-secondary courses met the eligibility criteria. Relevant data from these opportunities were extracted, charted, synthesized, and uploaded onto the resource website. The most successful search strategy for cancer-specific physical activity programs was the targeted website search followed by Google Advanced Search and consultations with content experts.

CONCLUSIONS

Challenges were experienced due to lack of standard reporting among opportunities, bias of potentially relevant records, and changing nature of resulting records. The current investigation demonstrated that systematic scoping study methods can be applied to cancer-specific physical activity programs and post-secondary courses in the context of cancer survivorship in Ontario yielding robust results. The method can be further adapted and updated in future knowledge syntheses in health-related contexts.

SYSTEMATIC REVIEW REGISTRATION

The systematic scoping review method protocol has not been registered.

Bladder Cancer and Google Trends: Associations Between US Search Patterns and Disease Outcomes May Show Need for Improved Awareness Strategies

Interest in and awareness of bladder cancer may translate to better health-seeking behaviors and earlier detection, given modifiable risk factors such as smoking. We assessed bladder cancer interest in the USA over the past 15 years as reflected by Internet search trends, and correlated these trends with epidemiologic patterns in bladder cancer. Google Trends was used to estimate US bladder cancer interest in the unit search volume index (SVI), which estimates the volume of online search activity for a specified period relative to the highest volume of searches within a specified location. Between January 2004 and June 2019, SVIs were collected for the search term "bladder cancer" and other related search terms. To evaluate the effect of public awareness campaigns, the SVIs for the month of May (US bladder cancer awareness month) were compared with the SVIs of all other months. Correlations between "bladder cancer" SVI and incidence, mortality, and mortality-to-incidence ratio (proxy for survival) by state were evaluated. There was no increase in the relative search volumes for "bladder cancer" during the national bladder cancer awareness month compared with all other months (p = 0.27). By state, there were positive correlations between SVIs of "bladder cancer" and incidence (R = 0.72, p < 0.001) and mortality (R = 0.47, p < 0.001). However, there was no correlation between SVIs and mortality-to-incidence ratio (R = - 0.24, p = 0.08). Interest in bladder cancer is positively associated with disease incidence and mortality but not survival, suggesting interest is driven by new diagnoses or deaths, and not early detection that can improve survival. Our findings may show the need for better public education endeavors.

Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review

Purpose

To examine the evidence of the feasibility, acceptability, and potential efficacy of online supportive care interventions for people living with and beyond lung cancer (LWBLC).

Methods

Studies were identified through searches of Medline, EMBASE, PsychINFO, and CINAHL databases using a structured search strategy. The inclusion criteria (1) examined the feasibility, acceptability, and/or efficacy of an online intervention aiming to provide supportive care for people living with and beyond lung cancer; (2) delivered an intervention in a single arm or RCT study pre/post design; (3) if a mixed sample, presented independent lung cancer data.

Results

Eight studies were included; two randomised controlled trials (RCTs). Included studies reported on the following outcomes: feasibility and acceptability of an online, supportive care intervention, and/or changes in quality of life, emotional functioning, physical functioning, and/or symptom distress.

Conclusion

Preliminary evidence suggests that online supportive care among individuals LWBLC is feasible and acceptable, although there is little high-level evidence. Most were small pilot and feasibility studies, suggesting that online supportive care in this group is in its infancy. The integration of online supportive care into the cancer pathway may improve quality of life, physical and emotional functioning, and reduce symptom distress. Online modalities of supportive care can increase reach and accessibility of supportive care platforms, which could provide tailored support. People LWBLC display high symptom burden and unmet supportive care needs. More research is needed to address the dearth of literature in online supportive care for people LWBLC.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06274-x.

General and Health-Related Internet Use Among Cancer Survivors in the United States: A 2013-2018 Cross-Sectional Analysis

BACKGROUND

A significant proportion of cancer survivors endorse ongoing health information needs and may use the internet to access information. We assessed patterns and predictors of general and health-specific internet use among cancer survivors.

METHODS

Using data from the National Health Interview Survey (NHIS), which was administered in 2013 through 2018, for adults reporting a cancer diagnosis, sample weight-adjusted estimates defined prevalence and multivariable logistic regressions defined adjusted odds ratios (aORs) of general and health-specific internet use, adjusting for relevant sociodemographic covariates, including healthcare satisfaction as the primary independent variable. The analysis for health-specific internet use was also repeated including a sex (female vs male)*healthcare satisfaction (very satisfied/somewhat satisfied vs somewhat dissatisfied/very dissatisfied) interaction term.

RESULTS

Among 12,970 survivors of cancer, general and health-specific internet use increased from 2013 to 2018 (from 63.2% to 70.8% and from 46.8% to 52.2%, respectively; P<.05 for both). Survivors who were very dissatisfied with healthcare were more likely to use the internet for health information compared with those who were very satisfied (59.5% vs 48.0%; aOR, 1.78; 95% CI, 1.20-2.64; P=.004). Younger age, female sex, higher educational attainment, and higher socioeconomic status were all associated with increased reported use of the internet for both general and health-specific purposes (P<.001 for all). There was a significant sex*healthcare satisfaction interaction (P=.009) such that for female survivors, healthcare dissatisfaction was associated with higher odds of health-specific internet use (61.4% vs 52.5%; P<.001; men, P=.97). No association was found between healthcare satisfaction and general internet use (P=.42).

CONCLUSIONS

The increasing proportion of survivors of cancer using the internet for health-specific information may be associated with self-reported dissatisfaction with healthcare. Efforts are needed to improve both access to the internet and the quality of cancer-relevant online health information, and to enhance patients' online health literacy.

Assessment of Online Resources for Returning to School During and After Treatment of Childhood Cancer

To evaluate current online parent education resources for children returning to school after a cancer diagnosis. Online search was conducted using 3 search engines and terms recommended by affected families. Sites were evaluated by 3 reviewers for understandability and actionability (scored 0-100%) using the Patient Education Materials Assessment Tool (PEMAT). Readability was assessed using Flesch-Kincaid (grade K-12) and content comprehensiveness by a clinical expert review for 5 late effect domains (scored 0-100%). A total of 56 unique online resources were evaluated. Mean understandability and actionability scores were 54% (range 17-83) and 36% (range 0-83) respectively. The mean Flesch-Kincaid grade level was 10th grade (mode 12th). Comprehensiveness of domain coverage was 34% (mode 20%). Some high-quality materials for this topic are available, but generally low scores on the PEMAT scales and high reading level estimates on Flesch-Kincaid indicate parents may have difficulty understanding and using the information. The low scores for comprehensiveness of information indicate parents will likely need to access multiple sources for complete information. A table provides the names, website (URL), and scoring for the 24 top-rated sites and can be used to make recommendations to parents with improved confidence in quality.

The role of Connected Health technologies in supporting families affected by paediatric cancer: A systematic review

OBJECTIVES

Families impacted by paediatric cancer are met with logistical, financial and psychological impacts, with severe acute respiratory syndrome coronavirus two creating additional barriers and stressors for these families. Connected Health (CH) may facilitate cancer care. The objective of the present study was to systematically review CH for families/informal caregivers affected by paediatric cancer.

METHODS

Using search terms relating to: (1) paediatric cancer, (2) family/caregivers and (3) CH, the databases of PsycINFO, Pubmed, EMBASE and Web of Science were searched. Inclusion criteria included an evaluation of CH technologies for supportive care for families/caregivers affected by paediatric cancer at any stage of treatment or survivorship.

RESULTS

Sixteen studies met inclusion criteria. CH was primarily web-based (n = 6), however smartphone applications (n = 5), telehealth (n = 2) and online groups (n = 3) were utilised. Intervention areas included psycho-social (n = 6), health and information provision (n = 8) and palliative care (n = 2).

CONCLUSIONS

While limited studies have evaluated the impact of CH on families living with paediatric cancer, emerging evidence suggests potential benefits. More evidenced-based interventions are required.

Availability and Readability of Online Patient Information on Osteosarcoma: Assessment of Pediatric Hospital and National Cancer Institute-Designated Cancer Center (NCIDCC) Osteosarcoma Web Pages

Online patient information (OPI) plays an important role in pediatric orthopaedic patient/caregiver education and decision-making. We assessed the availability and readability of OPI about osteosarcoma found at pediatric hospital and U.S. National Cancer Institute-designated cancer center (NCIDCC) websites.

Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China

BACKGROUND

As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China.

OBJECTIVE

This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology.

METHODS

We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals.

RESULTS

Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%).

CONCLUSIONS

We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

Arthroplasty information on the internet: quality or quantity?

AIMS

Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients' quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online.

METHODS

We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers.

RESULTS

'Total joint replacement' had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites.

CONCLUSION

Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly.

Age differences in patterns and confidence of using internet and social media for cancer-care among cancer survivors

OBJECTIVES

The internet and social media provide information and support to cancer survivors, and adolescent and young adults (AYA, age < 40 years), adults, and older (age 65+ years) cancer survivors may have different needs. We evaluated the impact of age on cancer-related internet and social media use and confidence in evaluating online information for cancer-care decision making.

MATERIALS AND METHODS

Cancer survivors completed a convenience cross-sectional survey evaluating their cancer-related internet and social media use and their confidence in using these resources for decision making. Multivariable regression models evaluated the impact of age on usage patterns and confidence.

RESULTS

Among 371 cancer survivors, 58 were older adults and 138 were AYA; 74% used the internet and 39% social media for cancer care; 48% felt confident in using online information for cancer-care decisions. Compared to adult survivors, there was a non-significant trend for older survivors to be less likely to use the internet for cancer-care information(aOR = 0.49, 95% CI[0.23-1.03], P = .06), while AYA were more likely to use social media for cancer-care (aOR = 1.79[1.08-2.99], P = .03). Although confidence at using online information for cancer-care decision making did not differ between age groups, increasing age had a non-significant trend towards reduced confidence (aOR = 0.99 per year [0.97-1.00], P = .09). Most commonly researched and desired online information were causes/risk factors/symptoms, treatment options, and prognosis/outcomes.

CONCLUSIONS

Age may influence the use of internet and social media for cancer-care, and older cancer survivors may be less confident at evaluating online information for cancer-care decision making. Future research should explore other strategies at meeting the informational needs of older cancer survivors.

Trends, Quality, and Readability of Online Health Resources on Proton Radiation Therapy

PURPOSE

Many patients weighing cancer treatment options may consider relatively novel options including proton radiation therapy (PRT) and turn to the Internet for online health resources (OHR). However, quality and readability of OHR for radiation oncology therapies has been shown to need improvement. Because the OHR that patients access can influence their treatment decisions, our study sought to understand the patterns of use, quality, and readability of OHR on PRT.

METHODS AND MATERIALS

To validate the need to assess OHR on PRT, we assessed search patterns in the United States for the search phrase "proton therapy" using Google Trends. The Google search engine was then queried for websites with PRT information using 10 search phrases. The subsequent websites were analyzed for readability by the Flesch-Kincaid Grade Level and a Composite Grade Level (CGL) metric comprised of 5 readability metrics. Quality was analyzed using the DISCERN instrument.

RESULTS

Search volume index for "proton therapy" increased by an average of 2.0% each year for the last 15 years (January 1, 2005 to June 1, 2019, P < .001). States that had a greater number of proton centers tended to have a greater relative search volume in Google (P < .001). Of the 45 unique websites identified, the mean Flesch-Kincaid Grade Level was 12.0 (range, 7.3-18.6) and the mean CGL was 12.4 (range, 7-18). In addition, 80% of PRT pages required greater than 11th grade CGL. The mean DISCERN score of all websites was 39.8 out of 75, which corresponds to "fair" quality OHR.

CONCLUSIONS

Despite increasing interest in PRT OHR, in general, PRT websites require reading levels much higher than currently recommended, making PRT OHR less accessible to the average patient. Provision of high-quality PRT OHR at the appropriate reading level may increase comprehension of PRT, improve patient autonomy, and facilitate informed decision-making among radiation oncology patients.

Nutrition guidance for cancer patients and survivors-A review of the websites of Irish healthcare and charitable organisations and cancer centres

OBJECTIVE

To determine availability of nutrition information for cancer patients and survivors from Irish healthcare organisations, cancer charity and support groups and assess its quality and readability.

DESIGN

Cross-sectional.

SETTING

The National Health Service Executive websites were searched, as were the sites of the ten largest cancer charities/support groups identified through the Benefacts website. An additional internet search was conducted to ensure no large organisations/support groups were missed (February 2019). Quality of nutrition content was assessed using an evidence-based checklist and readability assessed using two validated formulas.

RESULTS

Thirty-two websites were identified, five contained nutrition information for cancer patients (15.6%), and three for cancer survivors (9.3%). The quality of the nutrition content ranged from 19.5 to 29/40 (mean ± SD, 23.2 ± 3.2; median = 21, interquartile range (IQR) = 7). There was a lack of practical strategies for implementation. Only 40% of material had an acceptable readability level (sixth-seventh grade level). Readability scores (mean ± SD) were 68.5 ± 6.0 for Flesch Reading Ease Score and 7.8 ± 1.1 for Flesch-Kincaid Grade Level Score.

CONCLUSION

There is limited nutrition information on Irish health and cancer websites and in particular very few tailored to cancer survivors. Irish health and cancer organisations should consider providing nutrition information that is easily accessible to all.

Cancer-Related Internet Use and Online Social Networking Among Patients in an Early-Phase Clinical Trials Clinic at a Comprehensive Cancer Center

PURPOSE

We examined patterns, correlates, and the impact of cancer-related Internet use among patients with advanced cancer in a phase I clinical trials clinic for molecularly targeted oncologic agents.

METHODS

An anonymous questionnaire on Internet use for cancer-related purposes that incorporated input from phase I clinical trial oncologists and patients was self-administered by patients age ≥ 18 years in a phase I clinic. Multivariable modeling was used. Data were analyzed for the overall sample and by generation, which was defined by year of birth.

RESULTS

Of 291 patients (52% women, 82% non-Hispanic white, 50% age ≤ 60 years), 62% were cancer-related Internet users (CIUs). Cancer-related Internet use was associated with an income of ≥ $60,000 (odds ratio, 2.42; P = .004). CIUs used the Internet to learn about their cancer (85%), treatment adverse effects (65%), clinical trials (52%), new alternative treatments (42%), and symptom management (41%). CIUs most frequently used the hospital Web site (70%) to learn about clinical trials, followed by ClinicalTrials.gov (42%) and search engines (41%). The emotional impact of Internet-derived cancer information on CIUs varied-56% felt empowered, 34% anxious, 29% relieved, and 17% confused. Cancer-related Internet information made 51% of patients from the Millennial (born after 1990) and Generation X/Y (born 1965 to 1990) CIU populations anxious compared with < 29% of CIUs from older generations (born 1964 and before). Most CIUs desired more online information about new experimental drugs (91%) and US Food and Drug Administration-approved drugs for cancer (72%).

CONCLUSION

As most phase I patients use the Internet for cancer-related purposes, the Internet overall and hospital Web sites should provide more extensive, pertinent, and helpful information on clinical trials and cancer treatment to phase I patients.

A usability study to test the effectiveness, efficiency and simplicity of a newly developed Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE): Protocol paper

The Internet-based Exercise-focused Health App for Lung cancer survivors (iEXHALE) is a mobile web app being developed to provide lung cancer survivors with an algorithm-based, tailor-made, self-management programme to inform their exercise choices and improve symptom severity. The aim of this protocol paper is to detail the plan for conducting the usability study to test the effectiveness, efficiency and simplicity of an exercise-focused self-management mobile web app for lung cancer survivors. The mixed methods study will consist of three consecutive phases, each interspersed with elements of data analysis and app prototype redevelopment. The study will take place in Oxford, United Kingdom. Ethical approvals have been obtained. The study will contribute to lung cancer survivorship research and is important in the app developmental process. This study contributes to the international forum for the exchange of practice, innovation and research, increases transparency in mobile health developmental processes and contributes to the methodological evidence base.

Mobile applications in oncology: A systematic review of health science databases

INTRODUCTION

In recent years there has been an exponential growth in the number of mobile applications (apps) relating to the early diagnosis of cancer and prevention of side effects during cancer treatment. For health care professionals and users, it can thus be difficult to determine the most appropriate app for given needs and assess the level of scientific evidence supporting their use. Therefore, this review aims to examine the research studies that deal with this issue and determine the characteristics of the apps involved.

METHODOLOGY

This study involved a systematic review of the scientific literature on randomized clinical trials that use apps to improve cancer management among patients, using the Pubmed (Medline), Latin America and the Caribbean in Health Sciences (LILACS), and Cochrane databases. The search was limited to articles written in English and Spanish published in the last 10 years. A search of the App Store for iOS devices and Google Play for Android devices was performed to find the apps identified in the included research articles.

RESULTS

In total, 54 articles were found to analyze the development of an application in the field of oncology. These articles were most frequently related to the use of apps for the early detection of cancer (n = 28), particularly melanoma (n = 9). In total, 21 studies reflected the application used. The apps featured in nine articles were located using the App Store and Google Play (n = 9), of which five were created to manage cancer-related issues. The rest of the apps were designed for use in the general population (n = 4).

CONCLUSIONS

There is an increasing number of research articles that study the use of apps in the field of oncology; however, these mobile applications tend to disappear from app stores after the studies are completed.

The day after: correlates of patient-reported outcomes with actigraphy-assessed sleep in cancer patients at home (inCASA project)

Subjective sleep assessment in cancer patients poorly correlates with actigraphy parameters that usually encompass multiple nights. We aimed to determine the objective actigraphy measures that best correlated with subjective sleep ratings on a night-by-night basis in cancer patients. Thirty-one cancer patients daily self-rated sleep disturbances using the single dedicated item of the MD Anderson Symptom Inventory (0-10 scale) with 18 other items, and continuously wore a wrist actigraph for 30 days. Objective sleep parameters were computed from the actigraphy nighttime series, and correlated with subjective sleep disturbances reported on the following day, using repeated measures correlations. Multilevel Poisson regression analysis was performed to identify the objective and subjective parameters that affected subjective sleep rating. Poor subjective sleep score was correlated with poor sleep efficiency (rrm = -0.13, p = 0.002) and large number of wake episodes (rrm = 0.12, p = 0.005) on the rated night. Multilevel analysis demonstrated that the expected sleep disturbance score was affected by the joint contribution of the wake episodes (exp(β) = 1.01, 95% confidence interval = 1.00 to 1.02, p = 0.016), fatigue (exp(β) = 1.35, 95% confidence interval = 1.15 to 1.55, p < 0.001) and drowsiness (exp(β) = 1.70, 95% confidence interval = 1.19 to 2.62, p = 0.018), self-rated the following evening, and sleep disturbance experienced one night before (exp(β) = 1.77, 95% confidence interval = 1.41 to 2.22, p < 0.001). The night-by-night approach within a multidimensional home tele-monitoring framework mainly identified the objective number of wake episodes computed from actigraphy records as the main determinant of the severity of sleep complaint in cancer patients on chemotherapy. This quantitative information remotely obtained in real time from cancer patients provides a novel framework for streamlining and evaluating interventions toward sleep improvement in cancer patients.

Nutrition Education Services Described on National Cancer Institute (NCI)-Designated Cancer Center Websites

For women diagnosed with breast cancer, healthy weight and enhanced nutrition may improve outcomes. The goal of this study is to examine the nutrition education services available on National Cancer Institute (NCI)-Designated Cancer Centers' websites. In 2017, websites of all 61 NCI-Designated Cancer Centers that provide adult clinical care were reviewed at least twice. Websites were analyzed for the existence and type of expert-directed nutrition education services for breast cancer survivors. Of the 61 websites analyzed, 49 (80%) provided information about nutrition education. Twenty (33%) included only nutrition counseling, three (5%) only nutrition classes, and 26 (42%) both counseling and classes. Forty-six websites included information about nutrition counseling; of these, 39 had an easily identifiable description. Thirty-seven class options were offered, 22% were specific to breast cancer, 16% to subgroups such as young women, 41% were nutrition-only classes, and 24% included skills education. Nutrition services are an important part of breast cancer treatment. This study demonstrated that most NCI-designated cancer centers offered counseling. However, the type of information that was offered varied and services were not always specific to patients with breast cancer. Further research is needed to confirm the presence of services, assess patient access, and demonstrate their efficacy in promoting optimal survivor outcomes.

Google Search Trends in Oncology and the Impact of Celebrity Cancer Awareness

Introduction

There is widespread public interest when celebrities are diagnosed with cancer. We sought to assess how this interest impacts awareness of prevalent cancers.

Methods

We reviewed common cancer-related search terms using Google Trends (Google LLC, Mountain View, CA) between the years 2004 and 2017 and retrospectively correlated these findings with media or celebrity-related events. The Google Trends application was used to obtain the “search volume index” (SVI), defined as the number of searches for a specific term standardized to the total number of searches over that time period. Data were presented in a graphical format. Isolated peaks of greater than 25% from the baseline SVI were identified. Using the date of the peaks, a further search was performed to determine if any event in the media triggered the peak.

Results

“Lung Cancer,” “Pancreas Cancer,” “Endometrial Cancer,” “Cervical Cancer,” “Brain Cancer,” and “Glioblastoma” each had the highest peak correspond with a celebrity-related event covered in the media. These search terms displayed several additional isolated peaks, the majority of which could all be correlated with a significant media event (%). The search term “Breast Cancer” consistently had a peaked interest during October (breast cancer awareness month). Breast cancer events relating to public figures had little to no relative impact on search volume during this period. None of the other cancer search terms displayed the same cyclical pattern during their respective awareness months. Colon, rectal, and prostate cancer demonstrated stable search volumes over time, without an isolated peak.

Conclusion

Internet search activity among English speakers of most general cancer terms exhibit peaks coinciding with events that occur to celebrity figures or advances in medicines that are substantially covered in the media. In all cases but “breast cancer,” these events lend to higher search activity as compared to campaigns and awareness months. Our study suggests that media coverage of public figures with cancer may trigger substantial Internet interest in non-breast cancers, more so than traditional efforts to raise awareness.

Data Work: Meaning-Making in the Era of Data-Rich Medicine

In the era of data-rich medicine, an increasing number of domains of people’s lives are datafied and rendered usable for health care purposes. Yet, deriving insights for clinical practice and individual life choices and deciding what data or information should be used for this purpose pose difficult challenges that require tremendous time, resources, and skill. Thus, big data not only promises new clinical insights but also generates new—and heretofore largely unarticulated—forms of work for patients, families, and health care providers alike. Building on science studies, medical informatics, Anselm Strauss and colleagues’ concept of patient work, and subsequent elaborations of articulation work, in this article, we analyze the forms of work engendered by the need to make data and information actionable for the treatment decisions and lives of individual patients. We outline three areas of data work, which we characterize as the work of supporting digital data practices, the work of interpretation and contextualization, and the work of inclusion and interaction. This is a first step toward naming and making visible these forms of work in order that they can be adequately seen, rewarded, and assessed in the future. We argue that making data work visible is also necessary to ensure that the insights of big and diverse datasets can be applied in meaningful and equitable ways for better health care.

Cancer-Related Internet Use and Its Association With Patient Decision Making and Trust in Physicians Among Patients in an Early Drug Development Clinic: A Questionnaire-Based Cross-Sectional Observational Study

Background

The role of cancer-related internet use on the patient-physician relationship has not been adequately explored among patients who are cancer-related internet users (CIUs) in early-phase clinical trial clinics.

Objective

We examined the association between cancer-related internet use and the patient-physician relationship and decision making among CIUs in an early drug development clinic.

Methods

Of 291 Phase I clinic patients who completed a questionnaire on internet use, 179 were CIUs. Generations were defined by the year of patient’s birth: “millennials” (after 1990) and “Generation X/Y” (1965-1990) grouped as “Millennials or Generation X/Y”; “Baby Boomers” (1946-1964); and “Greatest or Silent Generation” (1945 and earlier). Statistical analyses included the Wilcoxon matched-pairs signed-rank test and the Mann-Whitney U test.

Results

CIUs were 52% (94/179) female, 44% (78/179) were older than 60 years, and 60% (108/179) had household incomes exceeding US $60,000. The sources of information on cancer and clinical trials included physicians (171/179, 96%), the internet (159/179, 89%), and other clinical trial personnel (121/179, 68%). For the overall sample and each generation, the median values for trust in referring and Phase I clinical trial physicians among early drug development clinic CIUs were 5 on a 0-5 scale, with 5 indicating “complete trust.” CIUs’ trust in their referring (5) and phase 1 (5) physicians was higher than CIUs’ trust in Web-based cancer-related information (3; P<.001 for both). CIUs who reported visiting the National Cancer Institute (NCI) website, NCI.org, to learn about cancer reported higher levels of trust in Web-based cancer-related information than CIUs who did not use the NCI website (P=.02). Approximately half of CIUs discussed internet information with their doctor. Only 14% (23/165) of CIUs had asked their physician to recommend cancer-related websites, and 24% (35/144) of CIUs reported at least occasional conflict between their physician’s advice and Web-based information.

Conclusions

Despite the plethora of websites related to cancer and cancer clinical trials, patients in early-phase clinical trial settings trust their physicians more than Web-based information. Cancer-related organizations should provide regularly updated links to trustworthy websites with cancer and clinical trial information for patients and providers and educate providers on reliable cancer websites so that they can better direct their patients to appropriate internet content.

Valuing Mobile Health: An Open-Ended Contingent Valuation Survey of a National Digital Health Program

BACKGROUND

Changing population demographics and technology developments have resulted in growing interest in the potential of consumer-facing digital health. In the United Kingdom, a £37 million (US $49 million) national digital health program delivering assisted living lifestyles at scale (dallas) aimed to deploy such technologies at scale. However, little is known about how consumers value such digital health opportunities.

OBJECTIVE

This study explored consumers' perspectives on the potential value of digital health technologies, particularly mobile health (mHealth), to promote well-being by examining their willingness-to-pay (WTP) for such health solutions.

METHODS

A contingent valuation study involving a UK-wide survey that asked participants to report open-ended absolute and marginal WTP or willingness-to-accept for the gain or loss of a hypothetical mHealth app, Healthy Connections.

RESULTS

A UK-representative cohort (n=1697) and a dallas-like (representative of dallas intervention communities) cohort (n=305) were surveyed. Positive absolute and marginal WTP valuations of the app were identified across both cohorts (absolute WTP: UK-representative cohort £196 or US $258 and dallas-like cohort £162 or US $214; marginal WTP: UK-representative cohort £160 or US $211 and dallas-like cohort £151 or US $199). Among both cohorts, there was a high prevalence of zeros for both the absolute WTP (UK-representative cohort: 467/1697, 27.52% and dallas-like cohort: 95/305, 31.15%) and marginal WTP (UK-representative cohort: 487/1697, 28.70% and dallas-like cohort: 99/305, 32.5%). In both cohorts, better general health, previous amount spent on health apps (UK-representative cohort 0.64, 95% CI 0.27 to 1.01; dallas-like cohort: 1.27, 95% CI 0.32 to 2.23), and age had a significant (P>.00) association with WTP (UK-representative cohort: -0.1, 95% CI -0.02 to -0.01; dallas-like cohort: -0.02, 95% CI -0.03 to -0.01), with younger participants willing to pay more for the app. In the UK-representative cohort, as expected, higher WTP was positively associated with income up to £30,000 or US $39,642 (0.21, 95% CI 0.14 to 0.4) and increased spending on existing phone and internet services (0.52, 95% CI 0.30 to 0.74). The amount spent on existing health apps was shown to be a positive indicator of WTP across cohorts, although the effect was marginal (UK-representative cohort 0.01, 95% CI 0.01 to 0.01; dallas-like cohort 0.01, 95% CI 0.01 to 0.02).

CONCLUSIONS

This study demonstrates that consumers value mHealth solutions that promote well-being, social connectivity, and health care control, but it is not universally embraced. For mHealth to achieve its potential, apps need to be tailored to user accessibility and health needs, and more understanding of what hinders frequent users of digital technologies and those with long-term conditions is required. This novel application of WTP in a digital health context demonstrates an economic argument for investing in upskilling the population to promote access and expedite uptake and utilization of such digital health and well-being apps.

Promotion and marketing of bioidentical hormone therapy on the internet: a content analysis of websites

OBJECTIVE

To evaluate the quality of information presented and claims made on websites offering bioidentical hormone therapy (BHT) products or services.

METHODS

A quantitative content analysis was completed on 100 websites promoting or offering BHT products or services. Websites were identified through Google search engine from September to October 2013. Search terms included "bioidentical hormone therapy" or "bioidentical progesterone," accompanied by "purchase or buy," "service," or "doctors." The Brief DISCERN instrument was used to determine the quality of the health information.

RESULTS

Websites were from Canada (59%), United States (38%), and other countries (3%). Almost half of the websites originated from medical clinics (47%), and healthcare professionals offering BHT services included physicians (50%), pharmacists (19%), and naturopaths (16%). Majority of websites promoted BHT as custom-compounded formulations (62%), with only 27% indicating that BHT is also commercially available. Websites overall claimed that BHT had less risk compared with conventional hormone therapy (62%). BHT was described as having less breast cancer risk (40%), whereas over a quarter of websites described BHT as "protective" for breast cancer. Websites mainly targeted women (99%), with males mentioned in 62% of websites. Product descriptors used to promote BHT included individualization (77%), natural (70%), hormone imbalance (56%), and antiaging (50%). The mean Brief DISCERN score was 15, indicating lower quality of information.

CONCLUSIONS

Claims made about BHT on the internet are misleading and not consistent with current professional organizations' recommendations. Understanding how BHT may be promoted on the internet can help healthcare professionals when educating patients.

E-health tools in oncology nursing: Perceptions of nurses and contributions to patient care and advanced practice

As oncology nurses confront a rapidly evolving field with increased workplace pressure, the integration of evidence-based connected health platforms within practice presents promise. This study explores nurses' perceptions regarding the utility of e-health tools, with a focus on the Oncology Interactive Navigator (OIN^TM), as a potential contributor to their practice and interactions with patients. Focus groups with oncology nurses were conducted at two time points: prior to exposure to the OIN^TM (T1, n=8) and four weeks post unrestricted tool access (T2, n=7). Using qualitative constant comparison analysis, three themes emerged: (1) Key factors driving e-health use are multidimensional and evolving; (2) Dual role of e-health in meeting patient needs and supporting practice; (3) E-health as a catalyst for professional development and networking. E-health is appealing to oncology nurses, as it serves to advance practice and support patient care. Future research should explore best practices for optimal clinical implementation among all stakeholders involved.

Electronic Health Information Exchange Opportunities for Self-management of Care: Responses from Older Adults With and Without Cancer History in the United States

PURPOSE OF STUDY

Of 15.5 million US cancer survivors, 80% are ≥ 55 years. Supporting older patients in care self-management through electronic health information (EHI) exchange may enhance recovery. We assessed: (1) perceived importance of EHI access to adults ≥ 55 years (incl survivors) and (2) age-related preferences for EHI exchange.

RECENT FINDINGS

Older adults are one of the fastest-growing user groups for internet/technologies. Most older adults 55-64 years are active internet users, and use among adults ≥ 65 years is growing quickly as baby boomers mature. Understanding EHI patient-provider exchange preferences may provide opportunities for older patients but also begin to address the future needs of other patient populations, including cancer survivors. We observed a "digital divide" for perceived importance of EHI access and EHI exchange interests. Engaging older adults (i.e., ≥ 75 years) to improve comfort/experience with technologies may support EHI use in self-management. Survivors may have distinct EHI needs/preferences than older adults without cancer history.

When Personal Feels Invasive: Foreseeing Challenges in Precision Medicine Communication

Precision medicine (PM) draws upon individual biological and psychosocial factors to create a personalized approach to healthcare. To date, little is known about how healthcare consumers will respond to such highly personalized guidance and treatment. The assumption is that responses will generally be favorable; yet in the media and in online public discussions about PM, concerns have been raised about invasions of privacy and autonomy. Findings from the tailoring literature-relevant because PM is, in a sense, "hypertailoring"-similarly suggest a potential for provoking unintended consequences such as personalization reactance, wherein perceived threat to one's privacy or freedom can lead to rejection of the personalized message or its source. Here, we review extant tailoring and other relevant research to identify challenges that could arise in PM communication. We then draw upon a patient-centered communication perspective to highlight elements of the communication process wherein resistance could be mitigated. This review aims to provide preliminary guidance for practitioners when communicating with patients and healthcare consumers about PM, as well as point scholars toward fruitful topics for research in this emerging health communication area.

Is Connected Health Contributing to a Healthier Population?

Connected health tools, including mobile phones, incorporate various functions that capture events, direct actions, and make informed decisions based on complex sources of data. Connected health, a term recently proposed by some academics and industry, refers to the development, testing, and integration of smart technology tools into health care. Through these means, connected health creates interconnectivity across various environments, profoundly changing the way we learn, self-regulate, and communicate with one another. In health care, mobile phones enable more precise diagnostics, personalized health recommendations that enhance patient experiences and outcomes while containing health care costs. However, for connected health to achieve its full potential, issues must be addressed pertaining to active engagement in use, privacy, security, and quality, as well as the development of evidence-based guidelines. This commentary discusses these key challenges and explores the promise of connected health, specifically eHealth and mHealth. Anchored within the context of cancer, the authors’ area of expertise, the ideas put forward can readily be applied to other health-related disciplines.

Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States

PURPOSE

The increase in use of health information technologies (HIT) presents new opportunities for patient engagement and self-management. Patients in rural areas stand to benefit especially from increased access to health care tools and electronic communication with providers. We assessed the adoption of 4 HIT tools over time by rural or urban residency.

METHODS

Analyses were conducted using data from 7 iterations of the National Cancer Institute's Health Information National Trends Survey (HINTS; 2003-2014). Rural/urban residency was based on the USDA's 2003 Rural-Urban Continuum Codes. Outcomes of interest included managing personal health information online; whether providers maintain electronic health records (EHRs); e-mailing health care providers; and purchasing medicine online. Bivariate analyses and logistic regression were used to assess relationships between geography and outcomes, controlling for sociodemographic characteristics.

FINDINGS

In total, 6,043 (17.6%, weighted) of the 33,749 respondents across the 7 administrations of HINTS lived in rural areas. Rural participants were less likely to report regular access to Internet (OR = 0.70, 95% CI = 0.61-0.80). Rural respondents were neither more nor less likely to report that their health care providers maintained EHRs than were urban respondents; however, they had decreased odds of managing personal health information online (OR = 0.59, 95% CI = 0.40-0.78) and e-mailing health care providers (OR = 0.62, 95% CI = 0.49-0.77).

CONCLUSIONS

The digital divide between rural and urban residents extends to HIT. Additional investigation is needed to determine whether the decreased use of HIT may be due to lack of Internet connectivity or awareness of these tools.

Rationale, Procedures, and Response Rates for the 2015 Administration of NCI's Health Information National Trends Survey: HINTS-FDA 2015

The National Cancer Institute (NCI) developed the Health Information National Trends Survey (HINTS) to monitor population trends in cancer communication practices, information preferences, health risk behaviors, attitudes, and cancer knowledge. The U.S. Food and Drug Administration (FDA) recognized HINTS as a unique data resource for informing its health communication endeavors and partnered with NCI to field HINTS-FDA 2015. HINTS-FDA 2015 was a self-administered paper instrument sent by mail May 29 to September 8, 2015, using a random probability-based sample of U.S. postal addresses stratified by county-level smoking rates, with an oversampling of high and medium-high smoking strata to increase the yield of current smokers responding to the survey. The response rate for HINTS-FDA 2015 was 33% (N = 3,738). The yield of current smokers (n = 495) was lower than expected, but the sampling strategy achieved the goal of obtaining more former smokers (n = 1,132). Public-use HINTS-FDA 2015 data and supporting documentation have been available for download and secondary data analyses since June 2016 at http://hints.cancer.gov . NCI and FDA encourage the use of HINTS-FDA for health communication research and practice related to tobacco-related communications, public knowledge, and behaviors as well as beliefs and actions related to medical products and dietary supplements.