The internet for medical information about cancer: help or hindrance?

Disinformation: A Bibliometric Review

OBJECTIVES

This paper aimed to provide a systematic review of relevant articles from the perspectives of literature distribution, research hotspots, and existing results to obtain the frontier directions in the field of disinformation.

METHODS

We analyzed disinformation publications published between 2002 and 2021 using bibliometric methods based on the Web of Science. There were 5666 papers analyzed using Derwent Data Analyzer (DDA).

RESULTS

The result shows that the USA was the most influential country in this area, while Ecker and Lewandowsky from the University of Western Australia published the largest volumes of papers. Keywords such as "social media", "COVID-19", and "vaccination" have gained immense popularity recently.

CONCLUSIONS

We summarized four themes that are of the biggest concern to scholars: group heterogeneity of misinformation in memory, disinformation mechanism in social media, public health related to COVID-19, and application of big data technology in the infodemic. The future agenda of disinformation is summarized from three aspects: the mechanism of disinformation, social media users, and the application of algorithms. This work can be a meaningful resource for researchers' study in the area of disinformation.

Does Internet Use Affect Medical Decisions among Older Adults in China? Evidence from CHARLS

Background: The rapid growth of the elderly population poses a huge challenge for people to access medical services. The key to get rid of the dilemma is for patients to go firstly to primary medical institutions. Existing studies have identified numerous factors that can affect patients’ health institution choice. However, we currently know little about the role of Internet use in the patients’ medical decisions. The objective of this study is to explore health-seeking behavior and institution choice under the background of the Internet era from the perspective of older adults, and to analyze whether the Internet could guide patients to the appropriate medical institution so as to accomplish hierarchical treatment. Methods: The dataset comprises 9416 people aged 45 or above from the China Health and Retirement Longitudinal Survey (CHARLS), which, through multistage cluster sampling, was conducted in 2011, 2013, and 2015. Logistic regression, PSM, and FE model are used to estimate the influence of Internet use on the health care decision-making behavior. Results: Internet use has a significant positive impact on the self-treatment of common diseases (β = 0.05, p < 0.05). In terms of medical institution choices, those who use Internet are more inclined to choose top-level hospitals than community health service institutions to treat common diseases (β = 0.06, p < 0.01). Conclusions: The Internet has lowered the obstacles to learning about common ailments, resulting in a substitution impact of self-treatment for hospital care. However, Internet use may aggravate older adults’ perception of the risk of disease, which exacerbates the tendency of going to higher-level medical institutions for medical treatment. The finding of the study is useful for further rational planning and utilization of the Internet in order to guide patients to appropriate medical institution, which helps to improve the efficiency of the overall medical and health services.

Assessing the quality of online information on glaucoma procedures

OBJECTIVE

To investigate the quality of information related to glaucoma procedures found online using 2 different assessment tools.

DESIGN

Cross-sectional survey of 100 web sites found via Google search engine.

METHODS

The terms "peripheral iridotomy" and "trabeculectomy" along with synonymous keywords were inputted into Google's search engine. The first 50 functional websites for each term were assessed by 2 independent raters using the DISCERN instrument as well as a quality assessment tool by the Journal of the American Medical Association (JAMA). Statistical analysis included an evaluation of intra-rater reproducibility and interclass correlation between the 2 scales.

MAIN OUTCOME MEASURES

(i) Quality of web site content based on DISCERN and JAMA scores, (ii) quality of web site based on categorization of web site (iii), intra-rater reproducibility of each scale, and (iv) interclass correlation between the 2 rating scales.

RESULTS

Only 22% of the web sites for peripheral iridotomy and 34% of the web sites for trabeculectomy met all the criteria for JAMA's quality assessment. The mean DISCERN scores for peripheral iridotomy and trabeculectomy were 44 and 43.7, respectively, indicating poor quality. For the DISCERN scale, level of agreement between raters for each question ranged from κ = 0.550 (95% confidence interval [CI] 0.700-1.026) to κ = 0.884 (95% CI 0.751-1.017). For the JAMA 4 scale, level of agreement for each question ranged from κ = 0.874 (95% CI 0.734-1.01) to κ = 1.00.

CONCLUSION

Our study indicates that information found online for two common ophthalmic procedures is of variable and poor quality. Thus, patients may be receiving misinformation online and better measures need to be implemented to avoid the dissemination of low-quality health information.

Assessing how health information needs of individuals with colorectal cancer are met across the care continuum: an international cross-sectional survey

BACKGROUND

Studies evaluating health information needs in colorectal cancer (CRC) lack specificity in terms of study samples involving patients. We assessed how health information needs of individuals with CRC are met across the care continuum.

METHODS

We administered an international, online based survey. Participants were eligible for the study if they: 1) were 18 years of age or older; 2) received a diagnosis of CRC; and 3) were able to complete the online health survey in English, French, Spanish, or Mandarin. We grouped participants according to treatment status. The survey comprised sections: 1) demographic and cancer characteristics; 2) health information needs; and 3) health status and quality of life. We used multivariable regression models to identify factors associated with having health information needs met and evaluated impacts on health-related outcomes.

RESULTS

We analyzed survey responses from 1041 participants including 258 who were currently undergoing treatment and 783 who had completed treatment. Findings suggest that information needs regarding CRC treatments were largely met. However, we found unmet information needs regarding psychosocial impacts of CRC. This includes work/employment, mental health, sexual activity, and nutrition and diet. We did not identify significant predictors of having met health information needs, however, among participants undergoing treatment, those with colon cancer were more likely to have met health information needs regarding their treatments as compared to those with rectal cancer (0.125, 95% CI, 0.00 to 0.25, p-value = 0.051).

CONCLUSIONS

Our study provides a comprehensive assessment of health information needs among individuals with CRC across the care continuum.

Identifying Complementary and Alternative Medicine Usage Information from Internet Resources. A Systematic Review

OBJECTIVES

Identify and highlight research issues and methods used in studying Complementary and Alternative Medicine (CAM) information needs, access, and exchange over the Internet.

METHODS

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from PubMed to identify articles that have studied Internet use in the CAM context. Additional searches were conducted at Nature.com and Google Scholar.

RESULTS

The Internet provides a major medium for attaining CAM information and can also serve as an avenue for conducting CAM related surveys. Based on the literature analyzed in this review, there seems to be significant interest in developing methodologies for identifying CAM treatments, including the analysis of search query data and social media platform discussions. Several studies have also underscored the challenges in developing approaches for identifying the reliability of CAM-related information on the Internet, which may not be supported with reliable sources. The overall findings of this review suggest that there are opportunities for developing approaches for making available accurate information and developing ways to restrict the spread and sale of potentially harmful CAM products and information.

CONCLUSIONS

Advances in Internet research are yet to be used in context of understanding CAM prevalence and perspectives. Such approaches may provide valuable insights into the current trends and needs in context of CAM use and spread.

Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians

OBJECTIVE

Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.

DESIGN

Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.

RESULTS

Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind-body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07-2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.

CONCLUSIONS

CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

Use of complementary and alternative medicine before and after organ removal due to urologic cancer

OBJECTIVE

Many patients use complementary and alternative medicine (CAM) as primary treatment or symptom relief for a variety of illnesses. This study was designed to investigate the influence of surgical removal of a tumor-bearing urogenital organ on CAM use.

METHODS

From 2007 to 2011, 350 patients underwent major urological surgery for kidney, prostate, or bladder cancer at the Goethe-University Hospital, Frankfurt, Germany. Data from 172 patients (49%), who returned a questionnaire, were retrospectively evaluated using the hospital information system along with the questionnaire to objectify CAM use 2 years before and after surgery.

RESULTS

From the 172 patients returning questionnaires, 56 (33%) used CAM before and/or after surgery and 116 (67%) never used CAM. Of the 56 CAM users, 30 (54%) used CAM presurgery and 53 (95%) used CAM postsurgery, indicating a significant change of mind about CAM use. Patients of German nationality used CAM significantly more than patients of other nationalities. Higher educational status (high-school diploma or higher) was a significant factor in favor of CAM use. The most common type of CAM used before/after surgery was an alternative medical system (63/49%), a manipulative and body-based method (50/19%), and a biological-based therapy (37/32%). Information about CAM, either provided by medical professionals or by other sources, was the main reason determining whether patients used CAM or not.

CONCLUSION

The number of patients using CAM almost doubled after surgical removal of a cancer-bearing organ. Better awareness and understanding of CAM use by medical professionals could improve patient counseling.

Online survey of cancer patients on complementary and alternative medicine

INTRODUCTION

Complementary and alternative medicine (CAM) is often used by cancer patients, yet, communication with the oncologist is poor. The objective of our study was to gather information on patients' usage of CAM, source of information, and aims, in order to derive strategies to improve the communication between physicians and patients on this topic.

MATERIALS AND METHODS

An online survey was conducted by linking a standardized questionnaire to the largest internet portal for cancer patients in Germany. The questionnaire addresses CAM usage, disclosure to physicians, source of information, objectives for using CAM, and perceived reasons for cancer.

RESULTS

Of 170 participants, 77% were currently using CAM. Disclosure to a physician was rather high with 63% having informed their oncologist. Asked whether the oncologist took time to discuss CAM, 74% answered 'no'. Most frequently used are biologically based therapies, relaxation techniques, prayer, and meditation. Most patients want to reduce side effects, boost their immune system, and get active. Almost half the participants had positive experiences with some type of CAM before they fell ill.

CONCLUSION

Understanding patients' concepts of the etiology of cancer and accepting their goals for using CAM may help oncologists communicate with their patients and guide them to a safe use of CAM.

Online survey of patients with breast cancer on complementary and alternative medicine

About 50% of cancer patients use complementary and alternative medicine (CAM). Women with breast cancer use CAM more frequently than others. We linked a questionnaire to the largest internet portal for cancer patients in Germany. The questionnaire addresses attitude towards CAM, disclosure to the oncologist, source of information, and objectives for use of CAM. 80 patients with breast cancer took part in our study, 61 currently using CAM. Most frequently used CAM methods were selenium, relaxation techniques, prayer, vitamin C, and meditation. Satisfaction was highest with relaxation techniques, vitamin C, homeopathy, yoga and Chinese herbs, lowest with mistletoe and acupuncture. 70% of participants did not think their oncologist took time to discuss CAM. Only 16% believed that their oncologist was well-informed about CAM. 46% relied on naturopaths and non-medical practitioners concerning CAM. Objectives for the use of CAM were to reduce side effects, boost the immune system, and become active.

Why do some cancer patients receiving chemotherapy choose to take complementary and alternative medicines and what are the risks?

Complementary and alternative medicine (CAM) cover a broad and diverse group of treatments and products that do not tend to be widely used by conventional healthcare professions. CAM that is systemically absorbed is the most likely to interfere with concurrent chemotherapy and potentially cause harm to cancer patients. Patients receiving chemotherapy may be consuming CAM to treat cancer, to lessen chemotherapy side effects, for symptom management, or to treat conditions unrelated to their cancer. A small proportion of cancer patients decide to use CAM alone to treat cancer and delay conventional treatment. Cancer patients may be influenced in their CAM decision-making by others: practitioners, family, friends, spouse and even casual acquaintances met in waiting rooms and support groups. This influence may range from encouraging and supporting the patient's decision through to making the decisions for the patient. When tested in rigorous clinical trials, no CAM cancer treatments alone have shown benefit beyond placebo. With the exception of ginger to treat chemotherapy-induced nausea, there is no compelling evidence overriding risk to take complementary medicines for supportive care during chemotherapy treatment. There is, however, established evidence to use mind-body complementary therapies for supportive care during chemotherapy treatment.

Patients with advanced cancer and their usage of complementary and alternative medicine

PURPOSE

A total of 40 % of cancer patients use complementary and alternative medicine (CAM), and patients with advanced cancer use CAM more often than others. The aim of our study was to gather data on CAM use and reasons to use CAM of patients with advanced cancer being admitted for residential palliative care and their relatives.

METHODS

Structured interviews were carried out with 25 patients and 25 relatives of those patients, respectively, of a German comprehensive cancer center based on a standardized questionnaire of the working group Prevention and Integrative Oncology of the German Cancer Society.

RESULTS

Median age of patients was 64.5 years (relatives: 53.5); 15 patients were male and 10 were female (relatives: 7 and 18). In total, 40 % of all patients used some CAM method at the time of the study, supplements and prayer being the most frequent method. Main reasons for using CAM were to sustain one's own strength (52 % for patients and 72 % for relatives) and to be able to do something by oneself (36 and 40 %). Sources of information were television/radio (48 and 28 %) and family/friends (40 and 48 %). Relatives also use the Internet (40 %).

CONCLUSIONS

Also for patients in palliative care and their relatives, CAM is important. Reasons for using CAM are similar for patients with less advanced cancer. As most patients do not discuss using CAM with their physician, side effects and interactions of biologically based treatments may be dangerous. The desire of patients to act autonomously should be encouraged. Yet, physicians should ensure safe administration of complementary methods by including CAM in their communication with the patient and the family.

Online information on complementary and alternative medicine for cancer patients: evidence-based recommendations

BACKGROUND

Many cancer patients use complementary and alternative medicine (CAM). Most websites offering online information on CAM are not helpful for them.

METHODS

We extracted decisive elements for online information on CAM by analyzing the literature on the information needs of cancer patients and on counseling cancer patients on CAM.

RESULTS

Key issues for online information on CAM are the qualification of the authors, transparency and accountability of the information, description of the aims, a scientific approach, description of treatment alternatives, support for the patient-physician relationship, individualized information, a summary of the information, disclosure of funding, and the privacy policy.

CONCLUSIONS

The communicative challenge will be to convey information without destroying hope and motivation. We suggest that CAM topics should be integrated into broader information provided on cancer (etiology, conventional treatment). By also providing information for physicians, such a website could promote shared decision-making. Online information will gain the status of independent expert knowledge if provided by a well-known scientific organization as, e.g., a national cancer society.

Survey on the worldwide Chronic Myeloid Leukemia Advocates Network regarding complementary and alternative medicine

PURPOSE

Many cancer patients use complementary and alternative medicine (CAM). However, data in hematological cancers are lacking on which types of CAM are being used, what information sources on CAM patients use and to what extent CAM is being addressed in the consultation with the hematologist.

METHODS

We developed a standardized questionnaire on CAM which was provided online to the representatives of the worldwide Chronic Myeloid Leukemia Advocates Network.

RESULTS

A total of 53 leaders of patients' advocacy groups for chronic myeloid leukemia (CML) patients from 35 countries responded to the survey. In almost all countries, CAM is important for CML patients and is widely used in addition to conventional leukemia treatment. Mostly, patients have to pay by themselves. General practitioners, herbalists, healers and naturopaths are the main sources for CAM treatments. Information on CAM is derived most frequently from the Internet, and family and friends, but rarely provided by the oncologist. Disclosure of CAM use to the oncologist is low, but increases if oncologists offer CAM.

CONCLUSIONS

In spite of very different health care systems, the features of CAM usage are similar in the different countries. We suggest extending the cooperation of self-help and scientists in order to provide training of oncologists on CAM and quality-controlled, evidence-based information on CAM on the Internet both for patients as well as health professionals as a promising strategy to increase safe use of CAM in patients with CML.

The International Collaboration on Complementary Therapy Resources (ICCR): working together to improve online CAM information

BACKGROUND

Use of the Internet to find health information is increasing dramatically but the quality of information, particularly on complementary and alternative medicine (CAM) is variable. The International Collaboration on Complementary Therapy Resources (ICCR) involves collaboration between the national CAM information centers in Australia, Denmark, Norway, the United Kingdom, and the United States, and a CAM information service in Germany.

OBJECTIVES

The study objectives were to compare the services and areas of expertise offered by each of the national CAM information services, to explore common challenges encountered in practice, and to establish specific objectives for the collaboration.

DESIGN

The workshop incorporated set templates for presentations, brainstorming, and analysis of notes to identify common themes.

RESULTS

Differences and similarities between the various services were revealed. Common challenges were identified under the main themes of overall context, users and needs, content and processes. Based on these themes, it was possible to agree on a number of specific objectives.

CONCLUSIONS

The member organizations of the ICCR serve a range of different audiences and have varied remits to fulfill. For the international collaboration to be effective, it was necessary to identify common challenges and to agree on specific objectives and potential ways of working together. Progress to date is also discussed together with plans for the future.

Complementary and alternative medicine use among cancer survivors: a population-based study

INTRODUCTION

The use of complementary and alternative medicine (CAM) among cancer survivors is high, yet less is known about reasons behind such use or the communication of CAM with conventional medical providers.

METHODS

Cross-sectional, multivariate logistic regression models were developed to evaluate the similarities and differences between cancer survivors and non-cancer controls in the 2007 National Health Interview Survey with 23,393 participants, including 1,471 cancer survivors.

RESULTS

Among cancer survivors, 66.5% reported ever using CAM and 43.3% having used CAM in the past year. When compared with the general population, cancer survivors used CAM more often for general disease prevention, immune enhancement, and for pain (Adjusted Odds Ratio [AOR] 1.27, 95% Confidence Interval [CI] 1.10-1.48; AOR 1.32, 95% CI 1.05-1.62; AOR 1.42, 95% CI 1.05-1.92, respectively). Cancer survivors were more likely to use CAM because of recommendations from their provider (AOR 1.54, 95% CI 1.26-1.88) and were more likely to disclose their CAM use to their provider (AOR 1.45, 95% CI 1.22-1.72).

DISCUSSIONS/CONCLUSIONS

When compared to the general population, cancer survivors were more likely to use CAM and communicate this use with providers, indicating a growing integration of CAM in conventional medical care.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are more likely than the general population to communicate CAM use with providers, suggesting greater integration of CAM use in conventional care. However, the majority of CAM use is still not being communicated to providers, indicating an important area for improvement in patient-centered care.

Patient information in radiation oncology: a cross-sectional pilot study using the EORTC QLQ-INFO26 module

Background

The availability of alternative sources of information, e. g. the internet, may influence the quantity and quality of information cancer patients receive regarding their disease and treatment. The purpose of the present study was to assess perception of information in cancer patients during radiotherapy as well as media preferences and specifically the utilization of the internet.

Methods

In a cross-sectional, single-centre study 94 patients currently undergoing radiotherapy were asked to complete two questionnaires. The EORTC QLQ-INFO26 module was used to assess the quality and quantity of information received by patients in the areas disease, medical tests, treatment, other services, different places of care and how to help themselves, as well as qualitative aspects as helpfulness of and satisfaction with this information. The importance of different media, in particular the internet, was investigated by a nine-item questionnaire.

Results

The response rate was n = 72 patients (77%). Patients felt best informed concerning medical tests (mean ± SD score 79 ± 22, scale 0-100) followed by disease (68 ± 21). Treatment (52 ± 24) and different places of care and other services (30 ± 36 and 30 ± 30, respectively) ranked last. 37% of patients were very satisfied and 37% moderately satisfied with the amount of information received, 61% wished more information. Among eight media, brochures, television and internet were ranked as most important. 41% used the internet themselves or via friends or family, mostly for research of classic and alternative treatment options. Unavailability and the necessity of computer skills were most mentioned obstacles.

Conclusion

In a single-center pilot study, radiotherapy patients indicated having received most information about medical tests and their disease. Patients very satisfied with their information had received the largest amount of information. Brochures, television and internet were the most important media. Individual patient needs should be considered in the development of novel information strategies.

Systematic Internet-Based Review of Complementary and Alternative Medicine for Glaucoma

OBJECTIVE

To identify the most popular forms of complementary and alternative medicine (CAM) for glaucoma on the Internet and to assess the quality of the most popular Web sites addressing CAM for glaucoma.

DESIGN

Systematic Internet-based search.

METHODS

Using a predefined search algorithm, Web sites most likely to receive hits from people searching the Internet for information on CAM therapies for glaucoma were identified.

MAIN OUTCOME MEASURES

Web sites were evaluated for quality based on the Sandvik score. Each Web site was also assessed for external validation based on listing on the Health on the Net (HON) Foundation Web site in accordance with their code of approval. Finally, the risk each Web site potentially posed to patients was assessed using a previously described scoring method.

RESULTS

Twenty-one Web sites were included in our study. Forty-four different CAM therapies were encountered; vitamin C supplements, forskolin, and diet and lifestyle modulation were the most common CAMs discussed. The mean Sandvik score for all Web sites was 9.4 (standard deviation, 2.6). Only one Web site was listed in the HON Foundation code of approval. Two of the 21 Web sites received the highest risk scores of 3 of a potential 4 points. None of the Web sites discouraged adhering to a clinician's advice. Fourteen of the 21 Web sites assessed provided commercial details promoting CAM, with the possibility of purchasing remedies or arranging consultations. Thirteen Web sites provided opinions and experiences without factual details.

CONCLUSIONS

Medical information conveyed over the Internet is of variable quality and is not subject to regulation. Many sources of information contain advice on therapies that have no evidence base and may put patients at risk. It is important that researchers and health care providers be aware of the content and quality of this information so as to offer advice to patients about the evidence and potential risks of CAM therapies. This can only be achieved by increasing awareness among ophthalmologists of the range of products and quality of information available for CAM therapies for glaucoma.

Internet methods for delivering behavioral and health-related interventions (eHealth)

Emerging communications technologies allow us to potentially reach more individuals with effective health-related advice and information at a very low cost. As we begin a new era of "personalized medicine," advances in consumer health informatics will parallel and eventually merge with those being made in bioinformatics (e.g., genomic information), medical informatics (e.g., electronic medical records), and public health informatics (e.g., disease surveillance). This article discusses access, use, quality, and types of eHealth programming with a focus on the Internet as the initial instantiation of this programming. Also discussed are criteria relevant to the dissemination of eHealth programming in real-world settings. Finally, possible directions for future eHealth research are presented.

A systematic review of information in decision aids

OBJECTIVE

We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate.

SEARCH STRATEGY

DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: 'decision aid'; shared decision making' and 'patients'; 'multimedia or leaflets or pamphlets or videos and patients and decision making'. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006.

DATA EXTRACTION

Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences.

MAIN RESULTS

68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patients' guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide false-positive than false-negative rates.

CONCLUSIONS

The review led us to be concerned about completeness, balance and accuracy of information included in DAs.

Complementary and Alternative Medicine During Cancer Treatment: Beyond Innocence

Nowadays, complementary and alternative medicine (CAM) is popular all over the world. Billions of dollars are spent in this booming business. For several reasons, young, female, educated, and higher socioeconomic class cancer patients, in particular, have shown interest in these agents. Unfortunately, besides direct (and sometimes serious) side effects, several CAM ingredients are capable of interfering with the metabolism of concurrently used drugs, which may render the therapeutic outcome of the subscribed drug unpredictable. In the case of anticancer drugs, with their usually narrow therapeutic window, this may have dramatic consequences and can lead to unacceptable toxicities in some cases or decreased therapeutic activity in others. Therefore, cancer patients should be warned for these possible interactions and be advised to discuss CAM use openly with their treating physician. The general concept that natural products are harmless should thus be changed into a more realistic and responsible attitude. A tightened legislation and regulation (including Internet advertising and sales) could play a crucial role in this awareness process. This should finally enable safe exploration of the potential advantageous aspects of CAM, while living with cancer.

Patterns of Internet use and impact on patients with melanoma

BACKGROUND

Patients with cancer and their families frequently, and increasingly, turn to outside sources for information, particularly the World Wide Web. Our objective was to examine the use of the Internet and its impact among patients with melanoma.

METHODS

A prospective survey was obtained from 1613 consecutive patients with cutaneous melanoma seen at our institution between August 2001 and February 2003. Main outcome measures included the ability to access the Internet, Internet use to search for melanoma information, and responses to such Internet searches. Further analysis of whether there were differences based on age, sex, or disease severity was performed.

RESULTS

Of patients with melanoma, 39% indicated that they had used the Internet to research their disease, 30% themselves and 9% had someone else do it for them. Nearly half (47%) of patients younger than 40 years researched melanoma on the Internet compared with only 12% of patients 60 years or older. Neither sex nor disease severity impacted Internet use. The vast majority of patients (94%) thought the Internet was useful, 67% believed it helped them better understand their condition, and 45% said they would recommend using the Internet to others to find information about medical conditions. Roughly a third thought it decreased their anxiety, whereas a similar proportion believed the Internet made them more anxious. Increased anxiety correlated with decreasing age and increasing disease severity.

CONCLUSIONS

The use of the Internet is common among patients with melanoma. Anxiety attributed to online information about their disease suggests that clinicians caring for patients with melanoma should familiarize themselves with online melanoma information, and be proactive in assisting their patients in using this resource.

Essiac and Flor-Essence herbal tonics stimulate the in vitro growth of human breast cancer cells

BACKGROUND

People diagnosed with cancer often self-administer complementary and alternative medicines (CAMs) to supplement their conventional treatments, improve health, or prevent recurrence. Flor-Essence and Essiac Herbal Tonics are commercially available complex mixtures of herbal extracts sold as dietary supplements and used by cancer patients based on anecdotal evidence that they can treat or prevent disease. In this study, we evaluated Flor-Essence and Essiac for their effects on the growth of human tumor cells in culture.

METHODS

The effect of Flor-Essence and Essiac((R)) herbal tonics on cell proliferation was tested in MCF-7, MDA-MB-436, MDA-MB-231, and T47D cancer cells isolated from human breast tumors. Estrogen receptor (ER) dependent activation of a luciferase reporter construct was tested in MCF-7 cells. Specific binding to the ER was tested using an ICI 182,780 competition assay.

RESULTS

Flor-Essence and Essiac herbal tonics at 1%, 2%, 4% and 8% stimulated cell proliferation relative to untreated controls in both estrogen receptor positive (MCF-7 and T47D) and estrogen receptor negative (MDA-MB-231 and MDA-MB-436) cell lines. Exposure to the tonics also produced a dose-dependent increase in ER dependent luciferase activity in MCF-7 cells. A 10(-7) M concentration of ICI 182,780 inhibited the induction of ER dependent luciferase activity by Flor-Essence and Essiac, but did not affect cell proliferation.

CONCLUSION

Flor-Essence and Essiac Herbal Tonics can stimulate the growth of human breast cancer cells through ER mediated as well as ER independent mechanisms of action.

Assessment of osteoporosis-website quality

INTRODUCTION

The Internet provides great opportunities for patient healthcare education, but poses risks that inaccurate, outdated, or harmful information will be disseminated. Osteoporosis is a topic of great interest to patients, many of whom use the Internet to obtain medical information. The aim of this study was to develop and evaluate measurement tools to determine the quality of osteoporosis websites for patients.

METHODS

Quality indicators in the categories of content, credibility, navigability, currency, and readability were incorporated into separate evaluation tools for healthcare professionals and for patients. Websites were selected from an Internet search. Interobserver reliability and validity were assessed, and a sample of osteoporosis websites was evaluated by an osteoporosis nurse educator and compared to patient evaluations.

RESULTS

For the quality indicators, there was 79% agreement between the osteoporosis nurse educators, 88% agreement between the physician osteoporosis experts, and 71% agreement comparing the osteoporosis nurse educators to the physician osteoporosis experts. Quality scores for evaluated websites ranged from 18-96 (maximum possible=100), with a mean of 66. Websites with Uniform Resource Locator (URL) suffix .com scored significantly lower compared to those with .gov (P<0.05), .edu (P<0.01), and .org (P<0.01). Healthcare professionals and patients were in agreement on the quality of the highest-rated websites, with less agreement for lower-rated websites.

CONCLUSIONS

In summary, a tool for measuring the quality of medical websites was developed and evaluated. Significant variability in osteoporosis-website quality was observed. Higher-quality scores were associated with a higher level of search engine match and specific URL suffixes. A validated tool for evaluating medical websites may have value in assisting patients to select high-quality osteoporosis educational information on the Internet, and may encourage website developers to improve the quality of information that is provided.

Online cancer services: types of services offered and associated health outcomes

There are advantages and disadvantages associated with utilization of online health services among individuals living with cancer. Accessing accurate, reliable health-related information online gives patients the power to enhance their understanding of information they obtain from their health care providers. However, online health information can often be confusing for patients to interpret, and it can sometimes be conflicting or incorrect. Based on a framework by Eysenbach, the following paper discusses various types of cancer services that are available online, and it addresses both positive and negative health outcomes that have been linked to utilizing such services.

Creating a framework for online cancer services research to facilitate timely and interdisciplinary applications

Researchers from a wide array of disciplines have conducted engaging and informative studies in recent years concerning the use of the Internet for cancer-related services. Typically, these publications provide key data related to utilization statistics, how online information can be used, what users want or expect from the Internet, outcomes or impacts, and quality and credibility of websites. These are important themes for understanding online cancer issues. However, this special issue of the Journal of Medical Internet Research seeks to recast these themes in a way that will facilitate pragmatic and applied means of employing data in prescriptive and interdisciplinary ways. This issue includes 14 papers that exemplify applications for the research framework recommended in this paper. This framework includes an expanded focus on the development and design of online cancer services, online consumer behavior/communication, behavior change, and living with cancer.

Assessing websites on complementary and alternative medicine for cancer

BACKGROUND

Many cancer patients search the World Wide Web for information on complementary and alternative medicine. The aim of this study was to evaluate the quality of such information and identify the treatments most frequently discussed. Materials and methods We used a pre-tested search strategy to identify the websites that are most likely to be used by cancer patients and assessed them according to pre-defined criteria.

RESULTS

Thirty-two websites were included in this analysis. The quality of these sites was scored on a point system and varied between 8 and 14 points with a maximum of 14. Most sites issued recommendations for a plethora of treatments, which are typically not supported by sound scientific evidence. Three sites had the potential for harming patients through the advice issued. The most frequently discussed therapies were herbal medicines, diets and mind-body therapies.

CONCLUSION

The most popular websites on complementary and alternative medicine for cancer offer information of extremely variable quality. Many endorse unproven therapies and some are outright dangerous.

Internet Breast Health Information Use and Coping among Women with Breast Cancer

The objective of this work was to study, among breast cancer patients, if Internet health information use is associated with coping. Questionnaires were completed (n = 178) regarding Internet use and also coping as measured by the Brief Cope. MANOVA analyses were conducted for the 14 coping subscales. Following a significant MANOVA omnibus test, univariate ANOVA and multivariate ANCOVA analyses adjusting for covariates were performed. Univariate ANOVA showed acceptance, active coping, self-blame, and denial coping associated with Internet use but these results were not maintained in the multivariate ANCOVA models. Internet health information use is not associated with psychological coping in breast cancer patients.

The current position of complementary/alternative medicine in cancer

Complementary/alternative medicine is a tempting option for many cancer patients. Unfortunately, reliable information is not always easy to obtain and some cancer patients may be misled by interested parties. Research in this area is scarce and with numerous therapies we cannot be sure about efficacy or safety. It follows that our current knowledge gaps urgently needs to be filled.