Consulting "Dr. Google" for Prostate Cancer Treatment Options: A Contemporary Worldwide Trend Analysis

Abstract

Background: In the era of digital data, the Internet has become the primary source from which individuals draw healthcare information.

Objective: The aim of the present study is to determine worldwide public interest in prostate cancer (PCa) treatments, their penetrance and variation, and how they compare over time.

Design, setting, and participants: An analysis of worldwide search-engine trends included electronic Google queries from people who searched PCa treatment options from January 2004 to August 2018, worldwide. Join-point regression was performed. Comparisons of annual relative search volume (ARSV), average annual percentage change (AAPC), and temporal patterns were analysed to assess loss or gain of interest.

Outcome measurements and statistical analysis: Evaluations were made regarding (1) interest in PCa treatments, (2) comparison of people's interest, and (3) impact of the US Preventive Service Task Force (USPSTF) screening recommendation and National Comprehensive Cancer Network (NCCN) guideline endorsements on Internet searching for PCa treatments.

Results and limitations: The mean ARSV for "prostatectomy" was 73% in 2004 and decreased thereafter, reaching a nadir of 36% in 2014 (APC: -7.2%; 95% confidence interval [CI] -7.8, -6.7; p < 0.01). Similarly, decreased interest was recorded for radiation therapy (AAPC: -3.2%; p = 0.1), high-intensity focused ultrasound (AAPC: -2.3%; p = 0.1), hormonal therapy (AAPC: -11.6%; p < 0.01), ablation therapy (AAPC: -4.1%; p < 0.01), cryotherapy (AAPC: -9.9%; p < 0.01), and brachytherapy (AAPC: -8.3%; p < 0.01). A steep interest was found in active surveillance (AS) (AAPC: +14.2%; p < 0.01) and focal therapy (AAPC: +27.5%; p < 0.01). When trends were compared before and after NCCN and USPSTF recommendations, a consistent decrease of all the treatment options was found, while interest in focal therapy and AS showed an augmented mean ARSV (+19.6 and +31.6, respectively).

Conclusions: People are increasingly searching the Internet for PCa treatment options. A parallel decrease of interest was found for the nonmonitoring treatments, except for focal therapy, while an important growth of appeal has been recorded for AS. Understanding people inquisitiveness together with their degree of knowledge could be supportive to guiding counselling in the decision-making process and putting effort in certifying patient information.

Patient summary: In the era of digital data, patients are increasingly searching the Internet for prostate cancer (PCa) treatment options. To safeguard patients' knowledge, it is mandatory to understand how people seek healthcare information, guaranteeing certified and evidence-based information pertaining to PCa treatments options.

Keywords: Active surveillance; Brachytherapy; Cryoablation; Focal therapy; Google Trends; High-intensity focused ultrasound; Hormonal therapy; Living paper; Patient information; Prostate cancer; Prostatectomy; Radiotherapy.

Fig. 1 –

Google Trends relative search volume for PCa treatment options compared with radical prostatectomy by month, January 2004 to August 2018: (A) active surveillance, (B) radiation therapy, (C) hormonal therapy, and (D) focal therapy. PCa treatment searches were reported graphically with “radical prostatectomy” search since radical prostatectomy represents the gold standard treatment for PCa. AAPC = average annual percentage change; PCa = prostate cancer.

Fig. 2 –

Google Trends relative search volume for PCa treatment options compared with radical prostatectomy by month, January 2004 to August 2018: (A) HIFU, (B) cryoablation, (C) ablation therapy, (D) brachytherapy, and (E) photodynamic therapy. PCa treatment searches were reported graphically with “radical prostatectomy” search since radical prostatectomy represents the gold standard treatment for PCa. AAPC = average annual percentage change; HIFU = high-intensity focused ultrasound; PCa = prostate cancer.

Fig. 3 –

Mean ARSV PCa treatment comparison before and after NCCN guidelines and USPSTF screening recommendation. AS = active surveillance; ATh = ablation therapy; BTh = brachytherapy; CTh = cryotherapy; FTh = focal therapy; HIFU = high-intensity focused ultrasound; HTh = hormonal therapy; NCCN = National Comprehensive Cancer Network; PCa = prostate cancer; PDTh = photodynamic therapy; RP = radical prostatectomy; RTh = radiation therapy; USPSTF = US Preventive Service Task Force.