Internet and Prognosis in Advanced Cancer

Copyright © 2015 by American Society of Clinical Oncology

Obtaining Helpful Information From the Internet About Prognosis in Advanced Cancer

Ivan Chik, MPH and Thomas J. Smith, MD, FACP, FASCO, FAAHPM⇑


University of Hawai'i John A. Burns School of Medicine, Honolulu, HI; and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD

Corresponding author: Thomas J. Smith, MD, FACP, FASCO, FAAHPM, the Harry J. Duffey Family Professor of Palliative Medicine, Johns Hopkins Medical Institutions, Professor of Oncology, Sidney Kimmel Comprehensive Cancer Center, 600 N Wolfe St, Blalock 369, Baltimore, MD 21287-0005; e-mail: tsmit136@jhmi.edu.

Abstract

Purpose: Prognostic awareness, or knowing that one has a life-ending disease, is associated with a better end-of-life experience, including less depression and anxiety. We sought to determine whether reliable sources on the Internet contained helpful prognostic information about advanced cancer.

Methods: We played the role of a 62-year-old person with stage IV incurable cancer and accessed four commonly used Web sites for the 10 most common causes of cancer death (American Cancer Society, ASCO, National Cancer Institute, Up To Date), as well as disease-specific Web sites.

Results: Approximately half the Web sites (26 of 50; 52%) had some notation of 5-year survival. Only four of 50 (8%) gave any average or median survival. Only 13 of 50 (26%) noted that stage IV cancer was a serious and usually life-ending illness. Nearly all had some information about hospice and palliative care.

Conclusion: Information that can help with patient prognostic awareness is not currently found on cancer-related Web sites. Oncologists should be aware that their patients will not find estimates of survival or treatment effect on the Internet. This may contribute to overoptimistic estimates of survival and subsequent aggressive end-of-life care.