Medical Information from Internet for Tunisian Cancer Patients: A Double-Edged Weapon?

Background: Most cancer patients and/or their families consult the websites of scientific or patients' associations to find answers about diagnosis, treatment protocols and side effects, making internet nowadays the easiest way to get fast and updated information. Despite the fact that internet is since many years available in Tunisia, there is no data regarding its use for health information. Aims: To identify the procedures and motivations of Tunisian online health information seekers and report the impact of online findings on cancer patient's attitude toward their disease and their oncologist. Methods: We conducted a descriptive study using an individual, semi-structured, questionnaire-based interview was carried out from April to June 2017. Interviews were performed by staff members' oncology department at the Abderrahmane Mami Hospital in Tunisia. They were addressed to adult patients (aged ≥18 years) treated for localized or metastatic solid cancers. Statistical analysis included descriptive, bivariate and multivariate analyses. Results: We interviewed 100 patients, mostly (67%) females, with a mean age of 55 years (18-78), and high-school graduated for 35% of them. Eighty eight percent (88%) of them answered to be well informed about their health condition by their oncologist, but in 73% of cases, it didn't prevent them from searching information in internet. Online health information seekers were either patients alone (19%) or family members (21%) or both (33%). Most online health information seekers were interested to learn about new treatments (64%), nutrition (55%), management of treatment toxicity (54%), supportive care (35%), alternative medicine (27%) and access to online cancer forums (19%). Three quarters of patients have no doubt about the web informations reliability. Online health information had an impact on patients' decisions in 57.5% of cases. Web data pushed 14% of patients to take parallel medicines or dietary complements without any prescription (i.e. graviola). Conflicting information compared to that received from the treating physician is reported in 33% of cases, leading to a lack of confidence for only 4% of them. High-school graduates and easy internet access were significantly associated with web use in univariate and multivariate studies (HR: 0.167 CI 95% (0.02- 0.97), HR: 0.09 CI95% (0.018-0.446) respectively)