Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms

Background: Patient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information. Objective: To evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram. Design, setting, and participants: Adults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient's 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram. Outcome measurements and statistical analysis: Participants’ answers were compared to a “reference” estimate and a “ballpark” estimate of ±10 percentage points of the “reference” value. Results and limitations: A total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8–19.2%) were within the “ballpark” estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8–31.3%) correctly used the nomogram and 51% (95% CI 42.6–59.6%) estimated within the “ballpark” when using the nomogram. Conclusions: Use of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information. Patient summary: The general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports. Unrestricted Internet searching by the general public usually yields an inaccurate estimation of life expectancy. Nomograms, while often improperly used by the general public, improve estimation accuracy. Nomograms provide powerful, validated information that patients can use, in discussion with their physician, to make treatment decisions.