General and Health-Related Internet Use Among Cancer Survivors in the United States: A 2013–2018 Cross-Sectional Analysis

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  • 1 Harvard Medical School, and
  • 2 Dana-Farber Cancer Institute, Boston, Massachusetts;
  • 3 Geisel School of Medicine, Hanover, New Hampshire;
  • 4 Department of Radiation Oncology, University of Miami Miller School of Medicine, and
  • 5 Office of Community Outreach and Engagement, Sylvester Comprehensive Cancer Center, Miami, Florida; and
  • 6 Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Background: A significant proportion of cancer survivors endorse ongoing health information needs and may use the internet to access information. We assessed patterns and predictors of general and health-specific internet use among cancer survivors. Methods: Using data from the National Health Interview Survey (NHIS), which was administered in 2013 through 2018, for adults reporting a cancer diagnosis, sample weight-adjusted estimates defined prevalence and multivariable logistic regressions defined adjusted odds ratios (aORs) of general and health-specific internet use, adjusting for relevant sociodemographic covariates, including healthcare satisfaction as the primary independent variable. The analysis for health-specific internet use was also repeated including a sex (female vs male)*healthcare satisfaction (very satisfied/somewhat satisfied vs somewhat dissatisfied/very dissatisfied) interaction term. Results: Among 12,970 survivors of cancer, general and health-specific internet use increased from 2013 to 2018 (from 63.2% to 70.8% and from 46.8% to 52.2%, respectively; P<.05 for both). Survivors who were very dissatisfied with healthcare were more likely to use the internet for health information compared with those who were very satisfied (59.5% vs 48.0%; aOR, 1.78; 95% CI, 1.20–2.64; P=.004). Younger age, female sex, higher educational attainment, and higher socioeconomic status were all associated with increased reported use of the internet for both general and health-specific purposes (P<.001 for all). There was a significant sex*healthcare satisfaction interaction (P=.009) such that for female survivors, healthcare dissatisfaction was associated with higher odds of health-specific internet use (61.4% vs 52.5%; P<.001; men, P=.97). No association was found between healthcare satisfaction and general internet use (P=.42). Conclusions: The increasing proportion of survivors of cancer using the internet for health-specific information may be associated with self-reported dissatisfaction with healthcare. Efforts are needed to improve both access to the internet and the quality of cancer-relevant online health information, and to enhance patients’ online health literacy.

Submitted January 1, 2020; accepted for publication May 12, 2020.

Author contributions: Study concept and design: All authors. Data analysis and interpretation: Dee, Muralidhar, Butler, Sha, Mahal, Nguyen, Sanford. Manuscript preparation: Dee, Sanford. Critical revision: Muralidhar, Butler, Yu, Sha, Mahal, Nguyen.

Disclosures: Dr. Nguyen has disclosed that he receives grant/research support from Bayer, Astellas, Ferring, Dendreon, Blue Earth, Genome Dx, Augmenix, Boston Scientific, Janssen, and Cota Healthcare. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Nina N. Sanford, MD, Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390-9303. Email: Nina.Sanford@UTSouthwestern.edu

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