Paging Dr. Google: Characterizing Direct to Consumer Internet Advertisements from Oncology Treatment Centers

Abstract

Patients increasingly use internet searches to compare treatment options and decide on oncology treatment centers. The objective of this study is to examine the type of oncology treatment centers that were advertised on web-based searches. A series of keyword searches were conducted using the Google search engine. Based on search trends, 3 of the top relevant search phrases were used ("best cancer doctor", "best cancer treatment", and "cancer treatment near me"). Modifiers were added to each search term to reflect the cancer categories with the highest prevalence: "breast", "prostate", and "lung". This yielded 12 search phrases that were used on a search hub that simulates Google searches from different geographic locations. The 30 most populous city locations were used. Of the four paid advertisements at the top of each search, the cancer treatment centers were categorized into centers that are National Cancer Institute-Designated (NCIs), Commission on Cancer (CoC) accredited, non-CoC accredited, and non-traditional treatment centers. Advertisements that weren't for cancer treatment centers were excluded. Of the 360 searches and 817 subsequent cancer treatment center advertisements, 51.2% were for NCI, 12.2% were CoC accredited, 26.9% were non-CoC accredited, and 9.7% were non-traditional treatment centers. The search phrase that yielded the highest ratio of NCI results was "best cancer doctor" at 74.4% and the phrase that yielded the lowest was "prostate cancer treatment near me" at 37.1%. Of the known 71 NCI centers in the country, 42 (59.2%) did not have any advertisements. Of the 35 NCI centers located in one of the target cities, 12 (34.3%) did not have any advertisements. Notably, two specific NCI centers accounted for 49.5% of the NCI advertisements. Similarly, one specific non-traditional treatment center accounted for 48.1% of the non-traditional center advertisements. Regarding non-traditional treatment centers, there was geographic variation with Boston having 38.1% of searches yielding non-traditional treatment center advertisements as opposed to six cities having 0%. The ratio of non-traditional treatment center advertisements by region were as follows: Northeast with 13.6%, West with 12.6%, South with 7.7%, and Midwest with 5.0%. These results indicate that most direct-to-consumer cancer advertisements come from CoC or NCI centers. Among advertisements coming from NCI centers, relatively few centers account for the majority of advertisements with most NCI centers having no advertising presence. Future research is needed to evaluate claims, costs, and the ethical considerations of direct-to-consumer marketing, where the potential for mischaracterizing the strength of the scientific evidence to vulnerable cancer populations requires more scrutiny.