1. May, Brandon

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Social media, including Facebook, YouTube, Twitter, and Snapchat, has created an unparalleled medium in which individuals from around the world can connect, share information, and learn within a matter of seconds. Companies and organizations have begun leveraging the direct, specialized communication these platforms have in effort to broaden their reach. Health organizations and medical practices are also exploring the power of social media for implementing cancer prevention programs as well as to conduct surveillance research of health-related behaviors in an effort to curb the rising incidence of the most preventable forms of cancer.

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Cancer remains a leading cause of death globally, and there is a large consensus supporting the theory that cancer can be preventable in several cases. In fact, the risk of 50-60 percent of all carcinomas may be minimized with vaccinations, weight control, smoking cessation, and increasing physical activity (Nat Rev Cancer 2006;6(1):75-83; Annu Rev Public Health 2012;33:137-156). Social media may be an important strategy in which small-, medium-, and large-sized health organizations can target cancer prevention initiatives to a broad and specific audience.


According to a Pew Research Center survey, younger Americans between the ages of 18 and 24 use a variety of social media platforms, particularly Snapchat and YouTube, and the majority of these users access these platforms several times a day. Additionally, a large majority of survey respondents between the ages of 30 and 49 and ages 50 and 64 report using any social media platform (75% and 64%, respectively), whereas only 37 percent of individuals ages >=65 years report using these platforms. Considering preventative habits are generally set at younger ages, the use of social media applications, which are largely used by young people, may be a novel and effective strategy for mitigating the rising tide of cancer in the current and future population.


Researching Social Media

Research into the use of social media for cancer prevention primarily focuses on the surveillance of publicly available data on health and behaviors. Passively collected online data can, in theory, facilitate greater identification of disease outbreaks, specifically at their earliest stages. Since many adults using social media often share health information with their networks, data garnered from these networks may help researchers understand public health behaviors better than they would using traditional health surveillance methods. In addition, public health professionals can evaluate these data to gain greater understanding of community perceptions regarding cancer prevention behaviors, including routine cancer screening.


"The strengths of social media are to provide peer group sharing and support among patients and caregivers with similar interests," noted Claire Jungyoun Han, PhD, MSN, RN, CCRN, a Postdoctoral Fellow with the BCPT Cancer Fellowship (Biobehavioral Cancer Prevention and Control Training Program), Department of Health Services, University of Washington, Seattle. She is an active proponent of social media use for cancer prevention and suggests that these platforms can be particularly helpful in cancer patients with more severe emotional and psychological distress due to the disease itself, side effects of treatment, uncertainty regarding their future, and after care outcomes.


Her published research on the topic has demonstrated high acceptability and feasibility of using social media education initiatives for cancer care and prevention (Cancer Nurs 2017; doi:10.1097/NCC.0000000000000534). "Peer group support via social media showed benefits to mental health and emotional distress, which linked to better quality of life and confidence in managing their cancer," Han explained when asked about her findings. "Also, they can share important messages and information [to patients] to reduce the risk of cancer. This information includes education on the importance of a healthy lifestyle."


In addition to Han's research, another study examined online Twitter discussions among young women as they related to cervical cancer prevention (JMIR Public Health Surveill 2016;2(1):e21). The investigation found that among women who shared their cervical cancer screening experiences, these discussions were often saturated in language that encouraged other women to undergo screening.


Ideally, health communication professionals can borrow and modify this language to include in organizational-driven social media campaigns designed to support cancer prevention behaviors.


Analyses of social media data may be important for understanding medication-related behaviors as well, whether in regard to cancer or other forms of disease. In one study analyzing data from the personal and professional image-sharing Instagram platform, investigators found that the misuse of codeine, an opioid analgesic, was associated with cannabis, benzodiazepine, and alcohol use (JMIR Public Health Surveill 2018;4(1):e22). This information may offer a better "real-world" perspective for medication use and abuse in patients prescribed this therapy, since many traditional research studies rely on self-reported data, all of which may be prone to social desirability bias.


In addition to surveillance, social media offers potential for performing intervention research designed to promote health and wellness. Benefits of Web-based interventions include the ability to scale up, lower cost, and provide ease of participation. "These interventions can also harness the interaction dynamics of web-based social networks and create positive peer-to-peer momentum for behavior change," researchers Urmimala Sarkar, MD, MPH, and colleagues wrote in their viewpoint JMIR literature review article on social media use for cancer prevention (J Med Internet Res 2018;20(6):e203).


One study leveraged Google AdWords to advertise messages on skin cancer prevention, targeting mostly women who searched for tanning beds (J Am Med Assoc Dermatol 2016;152(1):101-102). Over a 2-month period, these messages were displayed >200,000 times and featured a click-through ratio of 1 percent. Another trial, aimed at studying the feasibility of a social media intervention campaign, was able to achieve an 18 percent range of reported 7-day abstinence from smoking tobacco at 12-month follow-up (J Med Internet Res 2015;17(12):e291). The program implemented in the study involved enrolling smokers to a Facebook smoking cessation group, which encouraged engagement among participants.


Some Drawbacks

"Although social media interventions have the significant advantage of reaching people where they are, more complex health behaviors such as quitting smoking may require more intensive interventions beyond online social interactions," Sarkar and colleagues wrote. "For instance, replacing in-person tobacco cessation counseling with online counseling allows participants to receive content without consuming transportation time, and at their convenience; however, there is a concern that delivering interventions online may dilute their effectiveness, especially because of the lack of personal connection."


Sarkar told Oncology Times that, while social media can be a vehicle for people who are trying to foster positive health, the "sheer volume of social media content makes it challenging to cut through the 'noise' and capture people's attention." In addition, key patient populations where research is needed, especially older adults and the elderly, are not active on social media. This represents a primary limitation of using social media for cancer prevention and treatment research, she explained.


While social media platforms tend to be intuitive in structure and generally offer easy-to-digest content for patients and caregivers, there are several limitations of online social networking programs for caring for the cancer patient. "The information shared among peer groups and users are often complex and incorrect with the lack of evidences," Han commented. "Users can be tired to sort out important messages in what they really need to prevent cancer, or users can follow incorrect opinions and information. Thus, we always recommend that social media regarding health should involve health care professionals such as professional consultation channels or communication/discussion functions."


In the near future, researchers expect to see an overall increase in the number of health care professionals who are involved in social media for managing and preventing cancer. "Also, we can use social media as an education or intervention tool to provide educational information for the cancer prevention, such as in a cancer care campaign, and management, as well as communication channels," Han noted.


Brandon May is a contributing writer.