Robotic cystectomy outcomes overstated by web data


Internet-based information on robotic cystectomy, much of it provided by surgeons, often overstates claims and outcomes compared to what can be supported by evidence.

Fewer than 15% of the Web sites evaluated provided factual information. Another small percentage of the sites provided factual information but also included erroneous information.

"Journal articles go through a peer-review process to determine the accuracy and appropriateness of information," said senior author Raj Pruthi, MD, director of urologic oncology at the University of North Carolina. "Unfortunately, when information is put on the Internet, the material doesn't go through such a review process. In fact, it's a bit like the Wild West in terms of what information is out there."

Using the Google and Yahoo search engines, investigators entered the search term "robotic cystectomy" to identify the top 50 Web sites on the procedure for each search engine. The sites were analyzed with respect to the type of Web site, presence and accuracy of information about bladder cancer and robotic cystectomy outcomes, use of information from a manufacturer's Web site, and references.

Of the 100 sites identified, 61 were surgeon or provider sites, two-thirds of which were sponsored by academic medical centers.

Factual information rare

Analysis of the information on the 61 Web sites showed that only 13% provided factual information. Another 7% provided factual but also erroneous information. Dr. Pruthi said 80% of the sites had no information about bladder cancer. One-third of the sites used information taken directly from the manufacturer's Web site, and 16% had links to the manufacturer's site.

With regard to outcomes of robotic cystectomy, 41% of the Web sites had no information about surgical/oncologic outcomes, 39% contained unsubstantiated information or claims, 5% provided evidence-backed information, and 15% provided a mix of unsubstantiated and evidence-based information.

Information about functional outcomes was absent on 74% of the sites, and the remaining Web sites had only unsubstantiated information. Information about recovery was absent from 40% of the Web sites, 26% provided unsubstantiated information, 13% had evidence-based information about recovery, and 21% had a mix of unsupported and evidence-based information. Only 7% of the Web sites provided references in support of information.

Unsubstantiated information often came in the form of exaggerated results or outcomes, Dr. Pruthi said. For example, one provider Web site claimed that robotic cystectomy resulted in removal of 14% more tumor compared with conventional surgery.

"In most cases, the unsubstantiated information tended to be overly optimistic," said Dr. Pruthi. "They overstated the outcomes of the robotic approach, such as faster recovery and improved functional outcomes."

The findings should represent "a bit of a wake-up call to all of us who provide information," he added. "We need to provide evidence-based information for our patients and not overstate claims and outcomes with robotic surgery, or with any novel technique or approach."

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