Internet-based Cancer Research Articles

Patient and caregiver experience with an online, open-access, standardized, evidence-based, cancer drug and supportive care educational platform.

e18811 Background: An open-access, web-based platform was developed to provide standardized, evidence-based information, that is cancer regimen-specific and supportive care focused. Online content was provided in the English language only for more than 200 anti-neoplastic regimens. A survey was conducted to determine reasons adult patients and their caregivers seek internet-based cancer drug information, and to evaluate if there is an unmet need for improved oncology therapy education. Methods: Between February 2020 and January 2021, patients and caregivers completed an online anonymous, English language survey deployed on the website www.chemoexperts.com. Results: A total of 1,021 website users responded. The majority of users were from North America (75%). Female respondents comprised 65% of the population and users self-identified as being a patient (67%), or family member/caregiver (33%). The mean age of respondents was 60.7 years (+ 16.2). Roughly two-thirds (66.4%) had a college degree. The majority of respondents reported they were either currently receiving (59.6%), or planning to receive (27.4%) treatment, however patients of all education levels, and in all phases of treatment (before, during, and after) sought online drug information. Clinical drug information education was reportedly provided by a doctor (68.9%), nurse (40.9%), physician assistant or nurse practitioner (23.8%), or pharmacist (15%), while 23% did not receive any education from clinical staff. Modes of education received by participants included printed material (73.9%), teaching in person (52.3%), and/or other internet sites (27.5%). Reasons for visiting the website were reported as follows: seeking additional information (92%), did not know what questions to ask (12%), looking at treatment alternatives (10%), forgot to ask questions (5%), not enough information given (11%), not enough time to ask questions (5%), and afraid to ask questions (2%). Respondents could mark all reasons. Among content sections, the percentage of users reported the side effect section as being the most useful. However, section usefulness varied based upon age, phase of treatment, and baseline education level. Overall, 86% reported finding the information they were looking for on the website. Conclusions: The majority of respondents received education from a health care provider, but not all. It is possible that the current pandemic prevented some patients from receiving education when in-person teaching was not available. However, many patients and caregivers still use the internet to seek additional drug information. These data highlight a continued unmet need for patients using online sources when searching for cancer drug and supportive care information. Further work is required to determine whether supplemental online, education can improve outcomes while reducing adverse effects.

To what extent do Internet-based cancer risk assessment tools adhere to best practices in risk communication: A content analysis (Preprint)

Background: Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. Objective: This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. Methods: We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. Results: Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user’s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. Conclusions: Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors.

A step towards equitable clinical trial recruitment: a protocol for the development and preliminary testing of an online prostate cancer health information and clinical trial matching tool

BackgroundRecruitment of a diverse participant pool to cancer clinical trials is an essential component of clinical research as it improves the generalizability of findings. Investigating and piloting novel recruitment strategies that take advantage of ubiquitous digital technologies has become an important component of facilitating broad recruitment and addressing inequities in clinical trial participation. Equitable and inclusive recruitment improves generalizability of clinical trial outcomes, benefiting patients, clinicians, and the research community. The increasing prevalence of online connectivity in the USA and use of the Internet as a resource for medical information provides an opportunity for digital recruitment strategies in cancer clinical trials. This study aims to measure the acceptability, preliminary estimates of efficacy, and feasibility of the Trial Library intervention, an Internet-based cancer clinical trial matching tool. This study will also examine the extent to which the Trial Library website, designed to address the linguistic and literacy needs of broader patient populations, influences patient-initiated conversations with physicians about clinical trial participation.MethodsThis is a study protocol for a non-randomized, single-arm pilot study. This is a mixed methods study design that utilizes the statistical analysis of quantitative survey data and the qualitative analysis of interview data to assess the participant experience with the Trial Library intervention. This study will examine (1) acceptability as a measure of participant satisfaction with this intervention, (2) preliminary measure of efficacy as a measure of proportion of participants with documented clinical trial discussion in the electronic medical record, and (3) feasibility of the intervention as a measure of duration of clinical visit.DiscussionThe principles that informed the design of the Trial Library intervention aim to be generalizable to clinical trials across many disease contexts. From the ground up, this intervention is built to be inclusive of the linguistic, literacy, and technological needs of underrepresented patient populations. This study will collect essential preliminary data prior to a multi-site randomized clinical trial of the Trial Library intervention.Trial registrationThis study has received institutional approval from the Committee of Human Subjects Research at the University of California, San Francisco.

Design and implementation of an Internet-based cancer risk assessment tool: Use over 10 years.

e13075 Background: Prevention and early intervention can improve survival and quality of life across all cancers. Patient understanding of risk factors, and associated actionable lifestyle changes and screening programs, is not well understood by clinicians. Methods: The Internet-based OncoLink “Reduce My Risk” tool was created in 2009 to provide information about cancer risk after individuals responded to a comprehensive survey regarding demographics and cancer risk factors. Research related to these data has been IRB-approved. Results: 28,001 surveys were submitted. Median age among respondents ≥18y was 26y (18-101). 60% were female, 87% lived in North America, and 76% were White/Non-Hispanic. 37% had at least a bachelor’s degree, and 22% had household income > $100,000/y; most lived in a city/suburb (81%). 13% were current smokers, 23% previous smokers, 10% used cigars or pipe tobacco (10%), 6% used oral snuff/chew/quid, and 29% reported secondhand smoke exposure. Other substance use included marijuana (22% former users, 10% current users), alcohol (52% current users, 8% of those ≥14 drinks/w), and areca nut, betel leaf, or exotic smoking (1%). BMI was ≥30 in 19%. 74% reported dietary risks and 36% infrequent exercise. Early intercourse and > 10 sexual partners were reported by 43% and 10%, respectively. Excess UV exposure was reported by 19%, and exposure to known carcinogens 14%; 1% were exposed to DES in utero, and < 1% took DES while pregnant. Nonmodifiable risk factors included family cancer history (64%) or genetic syndrome (3%), and cancer-predisposing health condition (26%). 31% of women began menstruating < 12y and 33% gave birth to a first child > 30y. Conclusions: This free, publicly accessible cancer risk assessment tool has a large user population with higher educational status, higher income, and smaller household than the general population. 97% of users report behaviors associated with cancer risk. Another 72% report non-modifiable risks. By understanding detailed characteristics of a large number of respondents, these data have the potential to answer many hypothesis-generating questions, with the ultimate goal of improving educational interventions to reduce cancer risk across the general public.

Using an Internet-Based Breast Cancer Risk Assessment Tool to Improve Social-Cognitive Precursors of Physical Activity.

Internet-based cancer risk assessment tools might serve as a strategy for translating epidemiological risk prediction research into public health practice. Understanding how such tools affect key social-cognitive precursors of behavior change is crucial for leveraging their potential into effective interventions. To test the effects of a publicly available, Internet-based, breast cancer risk assessment tool on social-cognitive precursors of physical activity. Women (N = 132) aged 40-78 with no personal cancer history indicated their perceived risk of breast cancer and were randomly assigned to receive personalized ( www.yourdiseaserisk.wustl.edu ) or nonpersonalized breast cancer risk information. Immediately thereafter, breast cancer risk perceptions and physical activity-related behavioral intentions, self-efficacy, and response efficacy were assessed. Personalized information elicited higher intentions, self-efficacy, and response efficacy than nonpersonalized information, P values < 0.05. Self-efficacy and response efficacy mediated the effect of personalizing information on intentions. Women who received personalized information corrected their inaccurate risk perceptions to some extent, P values < 0.05, but few fully accepted the information. Internet-based risk assessment tools can produce beneficial effects on important social-cognitive precursors of behavior change, but lingering skepticism, possibly due to defensive processing, needs to be addressed before the effects can be maximized.

The Utilization of Oncology Web-based Resources in Spanish-speaking Internet Users

There currently are few web-based resources written in Spanish providing oncology-specific information. This study examines utilization of Spanish-language oncology web-based resources and evaluates oncology-related Internet browsing practices of Spanish-speaking patients. OncoLink (http://www.oncolink.org) is the oldest and among the largest Internet-based cancer information resources. In September 2005, OncoLink pioneered OncoLink en español (OEE) (http://es.oncolink.org), a Spanish translation of OncoLink. Internet utilization data on these sites for 2006 to 2007 were compared. Visits to OncoLink rose from 4,440,843 in 2006 to 5,125,952 in 2007. OEE had 204,578 unique visitors and 240,442 visits in 2006, and 351,228 visitors and 412,153 visits in 2007. Although there was no time predilection for viewing OncoLink, less relative browsing on OEE was conducted during weekends and early morning hours. Although OncoLink readers searched for information on the most common cancers in the United States, OEE readers most often search for gastric, vaginal, osteosarcoma, leukemia, penile, cervical, and testicular malignancies. Average visit duration on OEE was shorter, and fewer readers surveyed OEE more than 15 minutes (4.5% vs. 14.9%, P < 0.001). Spanish-speaking users of web-based oncology resources are increasingly using the Internet to supplement their cancer knowledge. Limited available resources written in Spanish contribute to disparities in information access and disease outcomes. Spanish-speaking oncology readers differ from English-speaking readers in day and time of Internet browsing, visit duration, Internet search patterns, and types of cancers searched. By acknowledging these differences, content of web-based oncology resources can be developed to best target the needs of Spanish-speaking viewers.

Uncertain Terms: Message Features of Online Cancer News

About 113 million Americans have reported seeking health information online; however, little is known about the quality (or qualities) of the information being retrieved. Users have reported seeking information about health issues in an attempt to reduce negatively appraised uncertainties (Brashers, 2007), but less is known about the ability of the retrieved information to increase or produce unwanted uncertainty. A content analysis of online cancer news was conducted and suggests that 65% of Internet-based cancer news contains message features previously linked to the production of uncertainty (e.g., ambiguous or complex information). Though future research is required regarding uncertainty-related content and its effects, this project provides a foundation for such future endeavors.

Delivery of Internet-based cancer genetic counselling services to patients' homes: a feasibility study

We examined the feasibility of home videoconferencing for providing cancer genetic education and risk information to people at risk. Adults with possible hereditary colon or breast and ovarian cancer syndromes were offered Internet-based counselling. Participants were sent web cameras and software to install on their home PCs. They watched a prerecorded educational video and then took part in a live counselling session with a genetic counsellor. A total of 31 participants took part in Internet counselling sessions. Satisfaction with counselling was high in all domains studied, including technical (mean 4.3 on a 1-5 scale), education (mean 4.7), communication (mean 4.8), psychosocial (mean 4.1) and overall (mean 4.2). Qualitative data identified technical aspects that could be improved. All participants reported that they would recommend Internet-based counselling to others. Internet-based genetic counselling is feasible and associated with a high level of satisfaction among participants.

The role of Internet-based cancer survivorship care plans in care of the elderly

Abstract Objective Internet-based tools for communication about cancer survivorship may serve an unmet need; however, older age has been associated with decreased Internet use, and the role of Internet-based communication with the elderly remains unclear. Materials and Methods We created a publically available, Internet-based tool for creation of survivorship care plans, available at www.livestrongcareplan.org, and via OncoLink , a cancer information Web site based at the University of Pennsylvania. It allows users to enter information regarding demographics, diagnosis, and treatment and produces customized care plans. Results Between May 2007 and February 2010, 10,128 care plans were created; 828 (8%) for persons ≥70years (range 70–101, median 74). Diagnosis age for elderly users ranged from 32 to 100years (median 72). When compared to the younger users, elderly users were less likely to be Caucasian/college-educated ( p p p =0.001). A small proportion surveyed reported high levels of satisfaction with this tool. Conclusions Use of this Internet tool by elderly survivors is less frequent than by younger ones; however, a subset appears willing to use it and satisfied with the information provided. Elderly users are more likely to be followed by a PCP than younger ones, and care plans for the elderly are more frequently created by health care providers.

Adolescent and young adult use of Internet-based cancer survivorship care plans.

9117 Background: Adolescent and young adult (AYA) cancer survivors are a unique subset of the survivor population. Data suggest that most use the Internet for cancer information, seeking information on late effects, nutrition, exercise, and infertility, but 25-50% report an unmet need for information (Zebrack, 2007). Methods: In 5/07, we launched an Internet-based tool for creation of survivorship care plans (SCP). The care plan tool is available at www.livestrongcareplan.org, and via OncoLink, a cancer information website based at the University of Pennsylvania, serving over 3.9 million pages/ month to 385,000 unique IP addresses. The tool allows users to enter information regarding demographics, diagnosis, and treatment, and produces customized SCP that include guidelines for future care, as well as information on late effects, fertility, and age-appropriate screening. All information is provided by oncology nurses and physicians, and data collection is IRB approved. Results: Between 5/07 and 12/09, 9271 SCP were completed. Of these, 16% (1477) were for AYA survivors, of ages 18-39 (median 30). This group was 69% female and 81% Caucasian, with diagnoses most commonly of breast cancer (32%), lymphoma/leukemia (28%), and testicular cancer (8%); 84% reported treatment with chemotherapy, 75% surgery, and 54% radiation. 52% reported receiving current care from only an oncologist, 14% only a primary care provider, and 30% both. 14% reported receiving survivorship information previously. Of female users, 32% reported being unsure of whether menses would resume, and 17% had undergone treatment-induced menopause. The tool provided a “good” to “excellent” experience to 91% of AYA users, and 89% reported “good” to “excellent” satisfaction with information provided. Conclusions: AYA survivors represent a prominent group of users of this Internet SCP tool. Most have undergone multi-modality treatment, and may be at significant risk for late effects, including fertility issues as evidenced by many reporting treatment-related menopause. Most AYA are followed only by an oncologist, and have not received survivorship information previously. This population reports high-satisfaction with, and willingness to use, this type of tool. No significant financial relationships to disclose.

Comprehension of Internet-based numeric cancer information by older adults

Competency in health numeracy is essential in understanding risk about disease susceptibility and the consequences of disease treatment. Both health literacy and skill in using the Internet to obtain health information are lower among older compared with younger adults. Presentation format of health information has been shown to influence comprehension. The objective of this study was to determine the influence of information formatting (text and graphic) on older adults' comprehension of Internet-based numeric cancer risk information. This cross-sectional study involved a convenience sample of adults, aged 50 years and older from diverse ethnic and educational backgrounds. Cancer risk information, obtained from a Canadian Cancer Society web page, was presented as text, graphics or as a combination of text and graphics formats. Comprehension of the information was assessed by six questions focused on basic numeracy skill and ability to perform simple calculations and operations. A three-item general context numeracy and an eight-item health context numeracy instrument were used to describe health numeracy skills of participants. The six-item Newest Vital Sign (NVS) test was used to assess prose and numeric health literacy. There was no statistically significant effect of presentation format on participants' comprehension of the cancer information. Participants' comprehension of basic health numeracy information was positively correlated with education (p ≤ 0.05) and income (p ≤ 0.01) whereas comprehension of information that assessed calculation and operations numeracy skill was positively correlated only with income (p ≤ 0.05). Health literacy skill and income explained a significant proportion of the variance in overall comprehension of Internet-based cancer risk information (R2 = 0.414, p ≤ 0.01) in this sample of older adults. Format of numeric risk information was not a significant factor in the comprehension of cancer risk information in this group of ethnically diverse, older adults. However, comprehension of the information was related to health literacy skill and income.

What Is My Cancer Risk? How Internet-Based Cancer Risk Assessment Tools Communicate Individualized Risk Estimates to the Public: Content Analysis

Background Internet-based cancer risk assessment tools have the potential to inform the public about cancer risk and promote risk-reducing behaviors. However, poorly communicated information on these websites may result in unintended adverse health outcomes.Objective This study examined whether: (1) Internet-based cancer risk assessment tools use risk communication formats that facilitate comprehension and reduce bias (as identified by the empirical literature); (2) the use of these formats varies by website affiliation; and (3) the websites provided information necessary to evaluate the quality of the risk estimate.Methods A content analysis of Internet-based cancer risk assessment tools was conducted. The terms calculate cancer risk, cancer risk calculator, estimate cancer risk, assess cancer risk, and cancer risk assessment were searched using three search engines. We identified 47 risk assessment tools and coded each according to standardized criteria. We calculated simple frequencies on all coding categories and performed crosstabulations but did not conduct formal statistical analysis due to small cell sizes.Results Use of risk communication formats that facilitate comprehension and reduce bias varied widely (eg, 30% of websites [14/47] provided absolute and comparative risk information but 83% [39/47] provided safety messages). Use of formats that facilitate comprehension varied by website affiliation and communication strategy (eg, only 8.3% [1/12] websites affiliated with the health care industry provided absolute and comparative risk information, but 83% [5/6] of websites affiliated with a governmental organization did so). Only 53% (25/47) of websites provided information about the statistical model or the peer-reviewed literature that was used to calculate the risk estimate.Conclusion Internet-based cancer risk assessment tools varied in their use of risk communication formats that facilitate comprehension and reduce bias. Formats that are difficult to understand may cause people to misperceive their cancer risk and consequently take inappropriate action.

Social and psychological determinants of participation in internet-based cancer support groups

In this study, we identified the social and psychological characteristics of Danish cancer patients that determine use of the internet for support. We invited 230 cancer patients taking part in a public rehabilitation program to participate in an internet module comprising training in the retrieval of cancer-related information from the internet and self-support groups. Persons who were motivated to join the internet groups (N = 100; 47%) were compared with persons who chose not to participate (N = 111) on the basis of self-reported baseline questionnaire data. Nineteen persons either did not return the questionnaire or had missing values in confounding variables. Cancer patients who were motivated to participate in internet support groups belong to higher socioeconomic groups (based on household income and employment) compared to non-participants. We observed no difference between the two groups in quality of life or psychological well-being, while coping to some extent seemed related to participation in internet support groups. This study adds to the discussion on social inequality in internet use by cancer patients, showing that patients who are not inclined to use internet-based interventions are characterized by social position and employ more passive coping strategies.

Factors that influence seeking second opinions, patient satisfaction, and education in breast cancer care: an internet-based study.

Abstract Abstract #3107 Purpose: To examine factors associated with seeking second opinions, patient satisfaction, and education among a recently diagnosed internet-based breast cancer population. Methods: In 2007, 6970 of the 90,426 internet-registered female breast cancer patients completed an internet-based survey, developed jointly by members of the Department of Surgical Oncology at Emory University and the educational staff at the Healthcare business of Thomson Reuters, formerly Nexcura. After excluding caregivers (n=205), those not within 5 years of diagnosis (n=962) or for whom treatment information was missing (n=40), we analyzed 5763 patients. Chi-square tests were used to assess system characteristics and patient demographics by their second opinion, satisfaction, and informed status. Patient satisfaction was collapsed as low (1-3), moderate (4-6), or high (7-10). How informed patients considered themselves was combined into 3 categories: well-informed (well or very well informed), somewhat informed and uninformed (somewhat or very uninformed). Results: The majority of the 5763 patients were between ages 40 and 59 when diagnosed (75.43%), Caucasian (92.96%), currently married (76.33%), had a household income ≥ $50,000 (60.92%) and at least a 4-year college education (55.78%). Stage I and II cancers comprised 36.61 and 35.71% respectively. Over one-third (n=2039) sought a second opinion. Factors significantly associated with seeking a second opinion were higher socioeconomic or education status, feeling informed, receiving the initial diagnosis from a primary care physician or private community hospital, close proximity to the biopsy location, and less satisfaction with the initial biopsy experience. Patients highly satisfied with their second opinion (87.35%) were more likely to refer others (96.52%), use the second opinion facility for the next treatment (63.90%), and to not seek additional opinions (75.29%). Facility options and initially being treated with surgery or systemic therapy predicted high satisfaction with initial treatment. Medical oncologists were the most frequently cited primary source of breast cancer education (37.81%), followed by surgeons (30.57%), and the internet (12.77%). About 20% who cited these sources considered themselves somewhat or very uninformed. Conclusions: Women who seek information via the internet rely primarily on medical professionals for their breast cancer education. Factors related to the initial biopsy affect the likelihood of patients seeking a second opinion, satisfaction with second opinions can influence choices regarding the ensuing treatment steps, and factors associated with initial treatment influence patient satisfaction. Probing the issues underlying these findings could improve care for all. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3107.

Minimal invasive perineal radical prostatectomy

15566 Background: Radical perineal prostatectomy (RPP) has experienced a reappraisal as excellent surgical treatment option for patients with localized prostate cancer which is competing well with the retropubic (RRP), endoscopic and robotic approaches. Herein we report a new and improved minimal invasive technique of an intrafascial, nerve-sparing and seminal vesical sparing RPP. Methods: From July 2003 to July 2006, 507 radical prostatectomies (317 RPP, 190 RRP) have been performed by 3 surgeons. RPP selection criteria: PSA ≤ 10 ng/ml, Gleason sum ≤ 7, volume ≤ 50 ml. A minimal invasive technique (MI-RPP) was used in 146 of 317 RPP (46%) in order to potentially improve on the results of classical RPP. “Minimal invasive” was defined as an approach with reduced mobilisation of the rectum, intended bilateral nerve-sparing with intrafascial preparation and leaving the seminal vesicals in situ. This approach was compared to classical RPP and to RRP. Perioperative and follow-up data using validated questionnaires were centrally registered using an on-line internet-based prostate cancer data bank provided by the Tumorzentrum Berlin. Results: With a median follow-up of 12 months (0–24), the oncological outcome of patients with MI-RPP was not different to RPP or RRP (comparable T-stages). PSA relapse in MI-RPP, RPP, and RRP in pT2R0 was seen in 10.2%, 14.7%, and 9.7% respectively (n.s.). Continence rates (0–1 pad/d) at 4 weeks were 61.7%, 45.0%, and 43.8%, respectively. This improved at 12 months to 96.3%, 85.7%, and 85.6%, respectively (p &lt; 0,023; p &lt; 0,005). MI-RPP, RPP, and RRP showed pT2 in 70.5, 69.6, and 57.3% with R1pT2 in 1.9, 6.7, and 9.2%, resp. Nerve-sparing was performed in 90.4, 62.0, and 57.4% with median OR times of 90, 141, and 163 min. Catheter removal after more than 13 d was seen in 6.6, 13.6, and 33.3%, resp. Conclusions: MI-RPP represents an improved perineal technique regarding intraoperative and postoperative complications maintaining comparable oncological outcome to RPP and RRP. Leaving seminal vesicals in place did not increase PSA relapse rates. Since OR time is significantly less and early recovery is superior, MI-RPP should be the recommended first-line perineal approach to patients with low risk prostate cancer. At the time of the meeting, data of more than 600 patients will be presented. No significant financial relationships to disclose.

Clinical features of american versus non-american gynecologic cancer patients requesting information from a proprietary web-based decision-support program

As the Internet can potentially substantially reduce geographic barriers to the dissemination of health-related information, it would be interesting to know if non-American women with gynecologic malignancies accessing United States (US)-based cancer Web sites differ from American patients with the same illness. Aggregate data from individuals providing personal clinical information into one of four proprietary gynecologic cancer (cervix, endometrial, newly diagnosed and recurrent ovarian cancers) decision-support programs (NexProfiler Treatment Option Tools for Cancer; NexCura Inc., Seattle WA, USA) currently embedded within approximately 100 established cancer-related Web sites were examined for differences between American versus non-American patient populations. In this analysis, which included >15,000 patients, American and non-American gynecologic cancer patients were remarkably similar in most clinical characteristics, including age, stage of disease at presentation, overall health, and desire to receive information regarding clinical trials. Notable differences included features suggestive of a more aggressive surgical philosophy in the US (e.g., higher percentage of American recurrent ovarian cancer patients reported they had undergone a secondary surgical procedure; greater use of radiotherapy in non-American cervical cancer patients). Despite differences in geographic location and health care delivery systems, American and non-American patients with gynecologic malignancies and with access to Internet-based cancer information exhibit few, but notable, differences in self-reported clinical characteristics.

Spiritual Issues of Family Members in a Pancreatic Cancer Chat Room

To describe spiritual issues addressed by users of a pancreatic cancer informational Web site. Qualitative, descriptive. The patient and family chat room of Johns Hopkins Hospital's pancreatic cancer Web site. 600 postings on the pancreatic cancer Web site. Identification of categories and themes in Web postings using the constant comparison method of content analysis. Spirituality, relationship of the person posting a message (poster) to the person with cancer. Relationship of the poster to the person with pancreatic cancer was explicit in 68% (n = 410) of the 600 postings, and 83% of those 410 postings indicated that the poster was a family member. Issues of spirituality appeared in 19% (n = 114) of the 600 postings and addressed four themes: spiritual convergence, reframing suffering, hope, and acceptance of the power of God and eternal life. Six percent of postings were by family members reporting on the death of their loved ones, suggesting that the site also served a bereavement function. Family members of patients with pancreatic cancer sought and received spiritual comfort in a variety of forms in an Internet-based cancer chat room. Nurse developers of cancer information Web sites should periodically assess how the sites are being used and apply the information to the refinement of the sites to better meet user needs. Further study is needed to develop and evaluate cancer Web sites as an evolving medium for providing spiritual support to family members of patients with life-threatening forms of cancer.

An ecological framework for cancer communication: implications for research.

The field of cancer communication has undergone a major revolution as a result of the Internet. As recently as the early 1990s, face-to-face, print, and the telephone were the dominant methods of communication between health professionals and individuals in support of the prevention and treatment of cancer. Computer-supported interactive media existed, but this usually required sophisticated computer and video platforms that limited availability. The introduction of point-and-click interfaces for the Internet dramatically improved the ability of non-expert computer users to obtain and publish information electronically on the Web. Demand for Web access has driven computer sales for the home setting and improved the availability, capability, and affordability of desktop computers. New advances in information and computing technologies will lead to similarly dramatic changes in the affordability and accessibility of computers. Computers will move from the desktop into the environment and onto the body. Computers are becoming smaller, faster, more sophisticated, more responsive, less expensive, and—essentially—ubiquitous. Computers are evolving into much more than desktop communication devices. New computers include sensing, monitoring, geospatial tracking, just-in-time knowledge presentation, and a host of other information processes. The challenge for cancer communication researchers is to acknowledge the expanded capability of the Web and to move beyond the approaches to health promotion, behavior change, and communication that emerged during an era when language- and image-based interpersonal and mass communication strategies predominated. Ecological theory has been advanced since the early 1900s to explain the highly complex relationships among individuals, society, organizations, the built and natural environments, and personal and population health and well-being. This paper provides background on ecological theory, advances an Ecological Model of Internet-Based Cancer Communication intended to broaden the vision of potential uses of the Internet for cancer communication, and provides some examples of how such a model might inform future research and development in cancer communication.

Colon cancer risk counseling by health-care providers: perceived barriers and response to an internet-based cancer risk appraisal instrument.

Risk appraisal instruments may be helpful in reinforcing prevention messages, although little is known about physician acceptance of such instruments. We explored perceived barriers to colon cancer risk counseling and responses to the colon cancer component of an Internet-based risk appraisal instrument. We qualitatively assessed provider perceptions of barriers to colon cancer prevention and screening, and their responses to the Harvard Cancer Risk Index using focus groups of primary care providers. Many providers commented that the risk appraisal instrument may be most helpful to reinforce messages by a health-care provider. The tool may increase awareness about modifiable risk factors for cancer and help patients prioritize changes as well as improve screening acceptance. With regard to barriers to counseling patients about colon cancer prevention and screening, providers expressed concerns that behaviors are too difficult to change. In addition, they were frustrated by limited time for prevention counseling and poor reimbursement. The Internet-based risk index was well accepted, although providers thought it would be most effective when used to complement provider messages about prevention. Use of an Internet-based risk index along with physician counseling could help improve cancer prevention practices and cancer screening acceptance.

Patient and caregiver interest in internet-based cancer services.

The primary goal of this study was to identify the needs for, the interest in, and the feasibility of the implementation of an Internet-based cancer services web site. Additionally, group differences (racial, patient vs caregiver, or rural vs urban) were identified that might influence the implementation of such a project. Patients with cancer and caregivers (N = 319) in the waiting rooms of a cancer center located within a southeastern medical university completed questionnaires regarding their interest in Internet-based services. Topics included the likelihood of using Internet-based services, interest in home healthcare services delivered via a personal computer, and knowledge about and use of the Internet. Results indicated that most patient and caregiver respondents were interested in Internet-based cancer-related services such as information related to treatment (80%), conversations with physicians via the Internet (70%), and online support groups (65%). In addition, respondents reported that they would be likely to use such services (70%) and were interested in home healthcare services delivered via personal computers (60%). No group differences were found across ethnic groups, geographic settings, and patient status (patient vs caregivers) on these variables. Minorities, older individuals, and less educated individuals were less likely to have knowledge of and to have used the Internet. Patients with cancer and their caregivers are interested in supplementing in-person services with Internet-based services relating to their cancer treatment. Special efforts need to be made to reach ethnic minorities, the elderly, and those with less education with Internet-based programs.