Colon cancer patient information seeking and the adoption of targeted therapy for on-label and off-label indications.

In the last 40 years patients have become more involved in their health care as the doctor-patient relationship has shifted from a largely paternalistic model to an emphasis on patient autonomy.1-5 At the same time, there has been unprecedented growth in the amount of health information that is available to patients. Widespread access to communication technologies such as the internet has made health information almost ubiquitous.6, 7 This increased access is reflected in widespread health information seeking by lay individuals. For example, approximately 45% of people report looking for cancer information and approximately 39% of cancer patients seek cancer information on the internet. 6, 8 If patients' use of health information is increasing, it remains unclear how these phenomena will influence medical outcomes. Patient access to information may erode components of the doctor-patient relationship, however increased access may lead to more informed patients and improved shared decision making.9-12 Additionally, patient information seeking may produce adverse effects such as an increased demand for cancer related therapies and technologies. Increased patient access to medical information may also directly influence population health by influencing health behaviors and reducing disparities in information access.6, 7, 13 Theories suggest that access to health information may impact the diffusion and adoption of new medical technologies. Diffusion of innovation is a complex process that is influenced by factors as diverse as pricing, government regulation, patient, physician and technology characteristics, and physician interpersonal networks.14-21 Patterns of adoption of new technologies are also strongly influenced by exposure to information.15, 22 Physicians commonly encounter information in a professional context but there is evidence that media coverage influences physician attitudes about scientific discoveries and amplifies the impact of publications in the research community.23, 24 Patients may learn about novel therapies from sources such as the media and the internet. This phenomenon may be particularly important for cancer treatment when new therapies are rapidly developed and receive considerable media attention. Although several studies have demonstrated that people who look for health information have improved knowledge, engage in more cancer-prevention behaviors and take more active roles in decision making, little published work exists that examines the relationship between cancer information seeking and cancer treatment.25-27 In one study, 47% of patients referred for participation in a prominent phase I drug trial first learned about the trial from media sources and 51% of those patients subsequently contacted their doctor for more information.28 Here we report the results of a study examining the relationship between cancer patient information seeking and awareness about and use of novel targeted therapy for colon cancer. We focused on treatments with targeted therapy, bevacizumab (Avastintm) and cetuximab (Erbituxtm), because of their clinical importance, significant media coverage and recent FDA approval. We investigated awareness and use of targeted therapy in both on-label and off-label indications because we thought that there might be both positive and negative associations of information seeking on drug use. We hypothesized that there would be a relationship between information seeking and awareness of targeted therapies for all colon cancer patients because information on bevacizumab and cetuximab is widely available and would likely be encountered during treatment information seeking, regardless of whether targeted therapy would be indicated. Additionally, because treatment information seeking may lead patients to inquire about specific medications and subsequently receive those medications, we hypothesized that information seeking would be associated with the use of targeted therapy with a greater effect in patients for whom targeted therapy is approved by the FDA.