The Online Cancer Nutrition Misinformation: A framework of behavior change based on exposure to cancer nutrition misinformation

Authors: WARNER, ECHO - University Of Arizona; BASEN-ENGQUIST, KAREN - Md Anderson Cancer Center; BADGER, TERRY - University Of Arizona; CRANE, TRACY - University Of Arizona; RABER-RAMSEY, MARGARET - Children'S Nutrition Research Center (CNRC)

Submitted to: CANCER
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/3/2022
Publication Date: 4/5/2022
Citation: Warner, E.L., Basen-Engquist, K.M., Badger, T.A., Crane, T.E., Raber-Ramsey, M. 2022. The online cancer nutrition misinformation: A framework of behavior change based on exposure to cancer nutrition misinformation. CANCER. https://doi.org/10.1002/cncr.34218.
DOI: https://doi.org/10.1002/cncr.34218

Interpretive Summary: A cancer diagnosis can be extremely disorienting, and food is one aspect of daily living that patients and their caregivers can still control. Unfortunately, nutritionists are not universally available in oncology care, and many patients turn to the internet for information about eating to prevent or treat cancer and related symptoms. Online recipes, diet, and nutrition information is largely unregulated and may contain misinformation. We need to understand what kind of content people see when they look for cancer-related nutrition information online, so we can address potentially harmful misinformation. In this study, we searched the social media site Pinterest using the terms "recipe" and "cancer" and randomly selected 103 of the resulting posts. We found health claims were extremely common on Pinterest (more than 6 claims per post on average). Given that Pinterest's community guidelines specifically limit medically unsupported health claims, we were alarmed to find that over a third of the posts in our sample claimed to treat or cure cancer. Additionally, we found that almost half of posts were for-profit with more than 1 in 3 directly selling a product on the webpage. We also examined post characteristics, types of claims, and the use of disclaimers, anecdotes, and scientific studies. We used this information to create a conceptual model, or map, of how exposure to this type of information may influence diet and treatment decisions among those with cancer. This work offers a critical first step in classifying nutrition misinformation online. While there is no clear solution to the issue of online nutrition misinformation, we can work to empower users (especially vulnerable populations such as cancer patients), with education resources and tools to help them navigate this content.

Technical Abstract: Patients with cancer and caregivers increasingly use the internet to find health and lifestyle information, yet online recipes, diet, and nutrition content are unregulated and may be confusing or even misleading. We describe cancer-related nutrition and meal planning information from Pinterest. In June 2020, we searched Pinterest using "cancer recipe" and "recipe for cancer" at 3 times daily for 2 weeks. Duplicates were removed for a final sample of n=103 pins. Each pin was coded for 58 variables including descriptives, cancer claims (eg, treatment, prevention, and cure), and nutrition claims (eg, "turmeric cures cancer"). We summarized each variable to describe the content of cancer nutrition claims on Pinterest and examined associations between claim types and contextual factors, including the use of academic citations, disclaimers, and personal anecdotes. Pinners had on average 116,767 followers (range, 0-1.5 million). Almost half of content sites were for profit (48.5%) and 34% were selling a product. Health claims were common, with content that purported to prevent (41.8%), treat (27.2%), or cure (10.7%) cancer. Vague phrases such as "anti-cancer," "cancer-fighting," or "cancer-busting" were also used. The inclusion of validity indicators including academic citations, disclaimers, and personal anecdotes varied significantly by the types of claims made. Together, these analyses informed the development of a conceptual framework of cancer-related nutrition misinformation. There are clear financial incentives for the promotion of cancer nutrition information online. More research is needed to understand how exposure to nutrition information can influence patient/caregiver behavior and downstream clinical and psychosocial outcomes.