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Cancer Websites You Can Recommend to Your Patients Source: Sybil Biermann, MD, Assistant Professor, Department of Orthopedic Surgery, University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan With the continued changes and proliferation of health information websites, it remains a challenge to stay on top of the best Web information. Which websites have the best content? Which are user-friendly? Where should we direct our patients? Where can we find information for those whose first 1anguage is not English? Focusing on what's good, what's new, and what's popular, this column will appear periodically in the pages of ONCOLOGY. In this series, we will review oncology sites that may be useful to you and your patients. Four key criteria will form the basis of these reviews: currency, authorship, advertising, and referencing. "Net appeal," referring to the esthetics of the site, will also be discussed because of its importance to many patients, but de-emphasized due to its relative unimportance vis-à-vis content.
This Month's Site Review: National Institutes of health Arguably the gold standard of patient oncology information, the US National Institutes of Health (NHI) site - more specifically the National Cancer Institute (NCI) site (Figure 1) - contains a broad range of oncology information for both physicians and patients. Organized by diagnosis and clearly divided into patient and physician information (Figure 2), what the site lacks in colorful graphics it more than makes up for in high-quality peer-reviewed content. In fact, many other sites actually duplicate statements from their site. The information found here is arrived at by expert consensus and posted on the NCI sites. Often revised to maintain currency, the national site includes information on diagnosis, staging, treatments, prognosis, and a current database of federally funded clinical trials. Two notable divisions of this information are the Cancer.gov (Figure 3) and MedlinePlus sites (Figure 4), which are posted by the NIH and contain no advertising of any type.
Cancer.gov and PDQ A valuable tool for the practitioner, NCI's Comprehensive Cancer Database, or PDQ (Physician Data Query), contains a vast amount of information (Figure 3). Subsets of data include cancer information summaries for physicians and patients, a clinical trials database, and directories of health professionals and organizations involved in cancer care. Material is overseen by editorial boards comprised o experts in their fields, and is regularly checked and updated. Both common and uncommon cancers are addressed. PDQ cancer information is neatly divided into "patient" and "health professional" categories. To facilitate subject - treatment, prevention, screening/detection, alternative/complementary care, supportive care, and genetics, divides the retrieval of specific information, statement. Statements are reviewed and updated monthly by specialists on the site's editorial boards. Health professional statements have detailed information on prognosis, staging, and treatment, are referenced, and cover a broad number of cancers, some quite uncommon. Complementary and alternative medicine summaries, available in the health professional format only, are treatment-specific (rather than disease-specific) write-ups about commonly used contemporary alternative therapies, including any available information regarding preclinical and clinical studies. Screening/detection and prevention summaries summarize current approaches, with annotations regarding levels of evidence for specific statements. The cancer clinical trials database - the world's most comprehensive - may be one of the most powerful tools available to the practicing oncologist. This feature presents abstracts of nearly 2,000 open, active clinical trials in a database that is searchable by cancer, state, treatment modality, phase, location, drug, and other variables.
Medline Plus MedlinePlus (Figure 4) is the main patient-entry portal to the system, with the entire gamut of health information, including a helpful medical encyclopedia, medical dictionary, physician directories, and other resources. Initially developed to five consumers an alternative to the physician-oriented Medline, the system has grown to gargantuan proportions yet remains well organized and current with information on a specific malady only a few clicks away. Two short clicks form the main page (Health Topics, figure 4, to Cancers, Figure 5 & Figure 6) puts the viewer onto the Cancer Information section, with links neatly laid out by diagnosis on an alphabetical table of contents (Figure 6). Each cancer type has an independent page (Figure 7) with scores of links, including NCI-generated basic fact sheets, recent updates (eg, Reuter’s health articles), and references to other material, such as information from the American Cancer Society. With the reorganization of MedlinePlus last year, a Spanish-language version was introduced. This version captures, in Spanish, the best features of MedlinePlus.
The Question of "Net Appeal" Consumers often judge the credibility of medical information sites by relatively superficial benchmarks, including the appeal of site design, whereas medical experts tend to evaluate content. In an innovative study sponsored by Consumer Web Watch (a project of Consumer's Union, the nonprofit publisher of Consumer Reports magazine), investigators evaluated how experts and consumers of health information judge the credibility of information. The study compared the ranking of health-care websites by health information experts with that of consumers. Additionally, both experts and consumers were queried regarding the importance of various website elements that may contribute to credibility. Not surprisingly, experts rated sites on expertise-based elements such as reputation and affiliation of both the posting on the site and information sources. Consumers, on the other hand, were most influenced by the design, or look of the site. What does this mean for healthcare providers? Left to their own inclinations, consumers are likely to choose information from sites with more "net appeal." As clinicians, we can help offset this inclination by recommending sites such as MedlinePlus or cancer.gov to our patients, thereby tipping the credibility balance.
Figure 1 - National Cancer Institute Figure 2 - NCI Treatment Summaries Figure 3 - NCI Non-small Cell Lung Cancer info for patients Figure 4 - Medline Plus Homepage Figure 5 - Medline Plus Health Topics Figure 6 - Medline Plus Cancer Topics Figure 7 - Medline Plus
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