UICC World Cancer Congress 2006

Information and communication technologies (ICTs) provide significant opportunities to advance cancer control worldwide, especially in countries with limited resources. The Internet is the cornerstone of the revolution that is starting to transform some aspects of cancer care. Patients have been at the forefront of this revolution and many are now regularly using the Internet to obtain information about their disease and its treatment, seek support from on-line patient communities and support groups, share knowledge and experiences with other patients and to communicate with their professional carers and loved ones. The Internet has emerged as an important source of health-related information because patients appreciate its convenience, anonymity and the amount of information it contains. However, the Internet is not without its shortcomings. Despite the enormous amount of information available on the Internet, many consumers struggle to find quality information - the quality of many sites is unpredictable and most patients do not possess the knowledge or skills required to critically evaluate the information contained on different sites. In order to address these concerns, many governmental and non-governmental organizations have developed guidelines for quality health Websites and on how to evaluate health information on the Internet. Unfortunately, implementation of these guidelines to date has been patchy.

There are a number of resources available that can help patients hone their skills in evaluating the content of Websites, however, awareness about these resources amongst the cancer patient community is limited. Efforts are required to raise awareness about not only these resources but also the many quality criteria for health Websites that have been developed by reputable agencies. Moreover, cancer Website developers should be encouraged to be compliant with these guidelines and Governments need to be urged to take action if Website providers undermine cancer patients' rights. At a local level health professionals can help patients find reliable and useful information on the Internet by providing them with information about high quality Websites, particularly those that are culturally sensitive and appropriate to the local context.

Internet access is becoming a reality for cancer patients in many countries worldwide as basic infrastructure and services continue to improve, but there are major obstacles in ensuring access is available and affordable so that all can benefit. These obstacles include cultural and economic factors, infrastructure, literacy, and language. North America, with only 5% of the World's population, has an Internet penetration of 68%. This represents 22% of the global Internet use. In stark contrast, Africa has an Internet penetration of only around 2%. This represents 2% of the global Internet usage despite that fact that Africa has 14% of the World's population. Even Europe with 12.5% of the world's population can only boast 36% Internet penetration and 29% of global Internet use. In recent years enormous efforts have been made to address the digital divide and the growth in Internet usage in some regions of the world have been impressive. However, gaps remain in the use of ICTs and not all countries are benefiting (http://www.internetworldstats.com)

Language is a key obstacle to Internet use. Over 30% of all Internet users are English speakers a surprising figure given that relatively few people worldwide speak English as a native or second tongue. Yet most of the information available on the Internet is in English and therefore, there is little motivation for patients who do not speak English to use the Internet to find the information they need.

Gaps in Internet access and usage also exist within countries. Internet usage is much lower amongst senior citizens, people living in rural areas and those on low-income. It is estimated that approximately 20-25% of people in developed countries have a problem with health literacy – the capacity to read, understand and act on appropriate health information. It is not surprising that people who have health literacy problems also experience problems with computer literacy. Unfortunately, Website developers do not always apply the principles of good health communication when developing content for their sites. Digital inclusion can be promoted by tailoring on-line information to meet the needs of people with health literacy or other communication difficulties.

There is a need to foster discussion and debate amongst different stakeholder groups on ways the global cancer community can become more responsive to the needs of e-Cancer patients and promote e-inclusion. Global, national, and local measures are all required so that the benefits of the Internet can be extended to all cancer patients.