WEB e Oncologia
Fabio Puglisi
Dipartimento di Oncologia Clinica, Centro di riferimento oncologico, Istituto Nazionale Tumori, Aviano
Dipartimento di Area Medica, Università degli Studi di Udine
The burden of cancer
• A new cancer is diagnosed every 30 seconds in the United States
• 1000 new cases are diagnosed every day in Italy
https://training.seer.cancer.gov/disease/war/
Worldwide Internet users
http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2017
The origins of Internet: 1960 (ARPANET in US) Exponential growth: from the late 1980s onward
Worldwide Internet users
http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2017
Cancer Information on the Internet
Different points of view
1. The Oncologist. “Keep up, stay sharp!”
2. The Patient. “Be informed to share decisions”
2. The Patient. Looking for alternative medicine.
3. Two powerful lobbies
The supplement pill
industry The media
...one of the most frustrating failings of human mind in its lilliputian
capacity for storing and retriving
important but
infrequenty used informations....
Haynes B. Ann Int Med 1996
Is medical education continuing?
“Medicine has a TL;DR problem (Too Long; Didn’t Read)”
“It would take 20 hours of reading each day for the average physician to comb through everything
published in their specialty.”
Quanto spesso leggi un articolo scientifico,
anche solo parzialmente?
Quanto spesso leggi un articolo scientifico
per intero?
Ritieni che i social media ti forniscano un
aiuto nel tuo aggiornamento professionale?
www http://http://www.oncotwitting.org/
Account Twitter™
https://twitter.com/ONcotwITting
Da marzo 2014
ONcotwITting (ON.IT.)
E-patients
• An e-patient is a health consumer who participates fully in his/her medical care.
• “E” can stand for electronic, equipped, enabled, empowered, engaged, and expert
• E-patients gather information using electronic communication tools in coping with medical conditions.
The patients know more about their diseases than me.
I must get faster modem, higher speed Internet access than
them.
No game
Media misinformation
They undermine the public’s
understanding of how we know if something is good for us, or bad for us
Goldacre B. Lancet Oncol 2009
Wi-Fi
The Daily Mail Oncological Ontology Project
A blog following the Daily Mail’s ongoing mission to divide all the inanimate objects in the world
into those that cause or cure cancer
Divorce
Coffee Toiletries
pepperRed
Liquorice
Coffee
Crusts
Resveratrol
Be careful with apparently
contradictory claims
Side effects of contradictory claims Results from a survey by WCRF
http://www.wcrf-uk.org
How can I be sure that what I read
on the web is true?
HONcode
the oldest and the most used ethical and trustworthy code for medical and health related information available on Internet.
Target audiences
• the general public
• the health
professionals
• the web publisher
http://www.airc.it/cancro/disinformazione/istruzioni-per-navigazione-sicura-internet/
http://www.airc.it/cancro/disinformazione/istruzioni-per-navigazione-sicura-internet/
Istruzioni per una navigazione sicura
• Fidarsi soprattutto dei siti istituzionali (OMS, Ministero della Salute, Istituto superiore di Sanità, ecc.)
• Accertarsi sempre che a rispondere sia un medico.
(verificare sul sito della FNOMCeO)
• Controllare la data a cui risale il documento.
• Verificare l'indipendenza del sito.
• Privilegiare chi fornisce riferimenti alla fonte originale della notizia.
• Presenza dell’HON-CODE
Mammograms bookings rose by 20% during
the 2-week peak
Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis
Chapman S, et al. Med J Aust 2005; 183 (5): 247-250
Media coverage on the issue of breast cancer increased by
a factor of 20 Increase
among previously unscreened women was
101%
Media Coverage of Medical Journals
• Top five newspapers by daily circulation
– The Wall Street Journal, – USA Today,
– The New York Times, – Los Angeles Times,
– San Jose Mercury Times
• Top five clinical journals by impact factor (JCR 2011)
– The New England Journal of Medicine – The Lancet
– JAMA,
– Annals of Internal Medicine, – PLoS Medicine.
Do the best articles make the news?
Selvaraj E, et al. PLoS One 2014;9(1):e85355. doi: 10.1371/journal.pone.0085355
Newspapers preferentially cover medical research with weaker methodology
• The media is more likely to cover observational studies and less likely to report RCTs than a reference of contemporary articles that appear in high impact journals.
– observational studies (75% vs. 47%, p<0.001) – RCTs (17% vs. 35%, p =0.016)
• When the media does cover observational studies, it selects those with lower sample sizes than observational studies appearing in high impact journals
– sample size (median: 1984 vs. 21136, p =0.029)
Selvaraj E, et al. PLoS One 2014;9(1):e85355. doi: 10.1371/journal.pone.0085355
Different news coverage on scientific paper may encourage readers to draw dubious causal conclusions from
observational data.
• ‘‘Statins cut mortality in cancer patients.’’
• ‘‘Statin-takers less likely to die from cancer.’’
• ‘‘Statins may lower risk of cancer death,’’
• ‘‘Regular statin use before and after a diagnosis of cancer could theoretically reduce cancer-related mortality.’’
The number of stories on T-DM1 were far fewer than the investigation of statins (77 and 311, respectively, per Google News Search on April 18, 2013).
The average reader may be eager to know
whether eating a diet heavy in red meat increases cancer risk, no
matter what methods were employed.
The literature digest
Making order of several messages
Anche vivere è
cancerogeno.
Back up
The oncologist
Some advantages
to be on facebook
http://www.airc.it/cancro/disinformazione/istruzioni-per-navigazione-sicura-internet/
http://www.airc.it/cancro/disinformazione/istruzioni-per-navigazione-sicura-internet/
Istruzioni per una navigazione sicura
• Fidarsi soprattutto dei siti istituzionali di enti autorevoli (OMS, Ministero della Salute, Istituto superiore di Sanità, ecc.)
• Accertarsi sempre che a rispondere sia un medico. In Italia c'è la possibilità di verificare sul sito della FNOMCeO
• Controllare la data a cui risale il documento.
• Verificare l'indipendenza del sito.
• Privilegiare chi fornisce almeno un riferimento alla fonte originale della notizia.
• Presenza del codice HON-CODE, elaborato dalla Health on the Net Foundation, che certifica l'adesione a una serie di linee guida di qualità dell'informazione medico scientifica online
