Internet's Impact on
Cancer Needs More Study

Nearly four out of 10 people with cancer in the developed world use the Internet, but the impact of the World Wide Web on cancer outcome is still uncertain, according to a report from Canada.

Although much discussion of online cancer information has focused on the negative aspects of the Internet, such as inaccurate information, "the glass is filled almost to the top with unprecedented opportunities," according to Dr. Gunther Eysenbach of the University of Toronto.

"It would be a mistake to leave them untapped by focusing our attention on the small area that is empty," Eysenbach notes in a report in the November/December issue of CA: A Cancer Journal for Clinicians.

Getting a good grasp of how many people use the Internet to learn about cancer is tricky, but Eysenbach estimates that more than 2 million people with cancer are online worldwide.

In his report, the Toronto researcher breaks down Internet use into four categories: communication, community, content and e-commerce.

E-mail between people with cancer and their physicians may offer some benefits, but it is not cost-effective enough to become a routine part of clinical practice, according to Eysenbach.

Online communities that put people with cancer in touch with one another, however, have already become routine for many people with cancer.

"Virtual communities are probably the one Internet application area with the greatest effect on persons with cancer," according to Eysenbach. He points out that virtual communities allow people to discuss sensitive topics with other people in an anonymous, stigma-free way.

As for the content of Web sites, Eysenbach and his colleagues have developed the "CREDIBLE" tool that sets standards for Internet information: - Current and frequently updated - References cited - Explicit purpose and intention of the site - Disclosure of sponsors - Interests declared and no conflicts of interest - Balanced content that lists advantages and disadvantages - Level of Evidence indicated.

The Web may be a seemingly endless source of information, but it is also "a gigantic marketplace," Eysenbach points out. Exact figures are hard to come by, but two studies suggest that more than 10 percent of people with cancer who use the Internet have purchased complementary or alternative treatments online.

Although there is a reported case of a person with cancer who was severely harmed by an alternative therapy that was purchased online, Eysenbach states that "to blame the Internet for this would be like blaming telephone books or libraries for similar events that have occurred before."

Future research, according to Eysenbach, should focus less on whether the Internet has a good or bad impact, but instead on maximizing its positive effect for people with cancer who would like to use it.

SOURCE: CA: A Cancer Journal for Clinicians, November/December 2003.

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