Have you ever searched for information about cancer? Chances are, if you have, it was a Google search that led to a website like WebMD, the Mayo Clinic, or a charity such as the American Cancer Society or Cancer Research UK. Research on cancer information seeking behaviour of the public tells us that most people first turn to the Internet, with more in-depth searching possibly extending to talks with friends, family, and health professionals. But who searches for cancer information? We already know that people in America who actively seek out information about cancer are most often well educated, have a high income, are under age 65, are white, and have a usual source of health care (1).

Currently, the global rise in cancer incidence has coincided with the technological revolution that sees internet and mobile usage increasing across the globe (2). As a result, searches for cancer information have increased among the public, but these increases are occurring disproportionately among people with higher levels of education and income (3). This trend indicates that social inequalities in health communications are widening, and will continue to do so. The outcome would be that people who are the best educated and most economically advantaged would have the best opportunities for access to, and use of, information about cancer to help them make informed decisions about prevention and early diagnosis.

To learn more about this issue, we conducted a study investigating the relationships between literacy, cancer fatalism, and active seeking of cancer information (4). Cancer fatalism can be described as deterministic thoughts about the external causes of the disease, the inability to prevent it, and the inevitability of death at diagnosis (5). We wondered whether low literacy and cancer fatalism pose barriers to seeking cancer information, and in particular whether low literacy might lead to fatalistic beliefs about cancer, which might then in turn stop people from seeking out cancer information.

Our logic model of the relationships between low health literacy, cancer fatalism, and cancer information seeking

We used data from the publicly available U.S. Health Information National Trends Survey (HINTS). The HINTS is a great resource for anyone who interested in trends in the use of cancer-related information among the general American public. The survey is nationally representative of American adults aged 18 years and over. We used data from the third cycle of the fourth round of HINTS, which was conducted in 2013. We used data from 2,657 American adults who had no cancer history. The measures of interest were:

Health literacy

• Reading comprehension of a nutrition label, scored out of 4 points

Cancer fatalism

• Agreement/disagreement with each of three statements:
• “It seems like everything causes cancer”
• “There’s not much you can do to lower your chances of getting cancer”
• “When I think about cancer, I automatically think about death”

Cancer information seeking

• Asked respondents whether they had ever searched for cancer information

The results shown below are representative of the American public aged 18 years and over.

What did we find?

One-third (34%) of American adults had low literacy, according to our measure. This is a substantial proportion of the population, given that the measure assessed basic reading comprehension of a nutrition label, which is important for health.

Most American adults (66%) agreed that, “it seems like everything causes cancer”. However, most disagreed (71%) with “there’s not much you can do to lower your chances of getting cancer”. Responses were more evenly balanced to, “when I think about cancer, I automatically think of death”, with 58% agreeing.

Just over half (53%) of the American public had ever searched for information about cancer. Independently of sociodemographic factors, adults with low literacy were less likely to search for information than those with high literacy. People who agreed that, “there’s not much you can do to lower your chances of getting cancer” were also less likely to search for cancer information. The other two fatalistic beliefs were not associated with cancer information seeking, but people with low income and low education were less likely to actively seek out cancer information.

Finally, we found that while literacy had a strong direct effect on cancer information seeking, the fatalistic belief, “there’s not much you can do to lower your chances of getting cancer” explained about 14% of the effect of literacy on cancer information seeking. This means that people with low literacy are slightly more likely to hold this fatalistic belief, which in turns acts as a barrier to seeking out information.

What does it mean?

This study indicates that addressing health literacy and fatalism about cancer prevention should be a priority for future cancer communication strategies. Population groups with less access to health care, who are the most vulnerable to low literacy and fatalistic beliefs about cancer, are also the least likely to benefit from cancer information. We feel that strategies to improve public beliefs and knowledge about cancer might be best placed outside of the clinical environment. For example, advertising strategies and public events in opportunistic settings such as road shows might help to increase incidental exposure to cancer information among those people who are least likely to actively seek it (6-8). Communication strategies such as patient narratives, such as those found on the Prevent Cancer Foundation website, also show promise. Overall, fatalism and health literacy may represent useful targets for cancer control strategies aiming to increase all people’s abilities to manage their risk of cancer, and to reduce social inequalities across the continuum of cancer control.

The full paper is available at Health Education and Behavior.

References

1. Finney Rutten LJ, Squiers L, Hesse B. Cancer-Related Information Seeking: Hints from the 2003 Health Information National Trends Survey (HINTS). J Health Commun 2006;11:147-156. doi: 10.1080/10810730600637574
2. Viswanath K. The communications revolution and cancer control. Nat Rev Cancer 2015;5:828-835. doi:10.1038/nrc1718
3. Finney Rutten LJ, Agunwamba AA, Wilson P, Chawla N, Vieux S, Blanch-Hartigan D, et al. Cancer-related information seeking among cancer survivors: Trends over a decade (2003-2013). J Cancer Educ 2015 [Epub ahead of print]. doi:10.1007/s13187-015-0802-7
4. Kobayashi LC, Smith SG. Cancer fatalism, literacy, and cancer information seeking in the American public. Health Educ Behav 2015 [Epub ahead of print]. doi: 10.1177/1090198115604616
5. Niederdeppe J, Levy AG. Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomarkers Prev 2007;16:998-1003.
6. Ironmonger L, Ohuma E, Ormiston-Smith N, Gildea C, Thomson CS, Peake MD. An evaluation of the impact of large-scale interventions to raise public awareness of a lung cancer symptom. Br J Cancer 2015;112:207- 216. doi:10.1038/bjc.2014.596
7. Power E, Wardle J. Change in public awareness of symptoms and perceived barriers to seeing a doctor following Be Clear on Cancer campaigns in England. Br J Cancer 2015;112:S22-S26. doi:10.1038/bjc.2015.32
8. Smith SG, Rendell H, George H, Power E. Improving cancer control through a community-based cancer awareness initiative. Prev Med 2014;60:121-123. doi:10.1016/j.ypmed.2013.11.002

Cancer is a widely feared disease but outcomes are constantly improving, and last year Cancer Research UK reported that half of patients now survive over ten years. Much of this is due to improvements in treatment and catching cancer early, but is public opinion about cancer becoming more positive?

We carried out a study using data from the International Cancer Benchmarking Partnership, which looked at the UK public’s attitudes towards cancer and how likely they are to believe negative and positive statements about it.

Almost everyone was aware that early detection is important for survival and agreed that cancer can often be cured. However, at the same time some people also believed cancer is a death sentence and that they would rather not know if they have it. Their opinions about cancer were therefore very mixed, which has also been shown recently by an interview study. This could have to do with the different experiences people have of cancer and the range of cancer outcomes for different people and different cancers. Although we took into account whether people had personal experience of cancer (i.e. whether they had been diagnosed with cancer, or someone close within their family or friends had) in our analyses, we had not asked about the kind of experience they had (i.e. whether they had seen others survive, suffer or carry on with life as usual).

The group most likely to hold these mixed opinions were those from socially deprived backgrounds, which we measured using highest level of education as a marker. Unfortunately deprivation still increases the chance of having worse cancer outcomes and perhaps this group struggle to reconcile their more negative experience of the disease with widely promoted early detection principles.

This is important because research shows that negative beliefs about cancer may put people off going to their doctor with worrying symptoms or taking part in screening. If these negative beliefs about the chance of surviving cancer win over positive attitudes to early detection, they could become a self-fulfilling prophecy and help to maintain inequalities in cancer outcomes.
So it seems that while positive messages about early detection have successfully been communicated, negative and fearful attitudes remain deep-seated. Health campaigns need more innovative and meaningful messages to target negative beliefs about cancer survival. Simply reiterating that beating cancer is possible may not be enough.

Article Reference: Quaife SL, Winstanley K, Robb KA, Simon AE, Ramirez AJ, Forbes LJL, Brain KE, Gavin A, Wardle J. (2015). Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study.  European Journal of Cancer Prevention. doi: 10.1097/CEJ.0000000000000140

http://journals.lww.com/eurjcancerprev/Abstract/publishahea/Socioeconomic_inequalities_in_attitudes_towards.99519.aspx