Online cancer forums and complementary and alternative medicine in cancer care: effects of ehealth literacy and psychological distress on use and attitudes.
Online cancer forums are often assumed to promote misinformation and unsupported treatment claims, including some non-evidence-based complementary and alternative medicine (CAM) approaches. This study examined the relationship between online cancer forum use, attitudes toward complementary and alternative medicine (CAM), and the use of non-evidence-based therapies, with a specific focus on CAM approaches prevalent in German-speaking countries.
A cross-sectional anonymous online survey was conducted in June-July 2025 among adult users of the largest German cancer forum, assessing forum use, CAM-related attitudes (defined according to the German S3 guideline checklist, version 1.2), eHealth literacy, psychological distress, and sociodemographic and disease-related variables. Forum use was dichotomized by median split, and data were analyzed using non-parametric tests and multivariable regression models.
Among 458 participants, high versus low forum use differed by sociodemographic and disease-related factors but was not associated with eHealth literacy or psychological distress. Among CAM users (44.3%, n = 203), CAM use intensity was moderate (median = 2, IQR 1-3) and showed no association with forum use, eHealth literacy, psychological distress, or sociodemographic variables; no independent predictors were identified. CAM-related forum discussions were rated as significantly less trustworthy than discussions on conventional cancer treatments (t(383) = 16.88, p < 0.001), independent of eHealth literacy, psychological distress, or participant role.
The use of CAM approaches, including both evidence-based supportive interventions and non-evidence-based methods, was not associated with forum exposure, eHealth literacy, or psychological distress. Forum users demonstrated differentiated trust patterns, with consistently lower perceived credibility attributed to CAM-related discussions compared with discussions on conventional cancer treatments.
For cancer survivors, online cancer forums appear to function primarily as contextual support resources rather than drivers of non-evidence-based treatment decisions. Clinicians should therefore address forum use openly and early, focusing on guidance and shared decision-making instead of discouragement.
A cross-sectional anonymous online survey was conducted in June-July 2025 among adult users of the largest German cancer forum, assessing forum use, CAM-related attitudes (defined according to the German S3 guideline checklist, version 1.2), eHealth literacy, psychological distress, and sociodemographic and disease-related variables. Forum use was dichotomized by median split, and data were analyzed using non-parametric tests and multivariable regression models.
Among 458 participants, high versus low forum use differed by sociodemographic and disease-related factors but was not associated with eHealth literacy or psychological distress. Among CAM users (44.3%, n = 203), CAM use intensity was moderate (median = 2, IQR 1-3) and showed no association with forum use, eHealth literacy, psychological distress, or sociodemographic variables; no independent predictors were identified. CAM-related forum discussions were rated as significantly less trustworthy than discussions on conventional cancer treatments (t(383) = 16.88, p < 0.001), independent of eHealth literacy, psychological distress, or participant role.
The use of CAM approaches, including both evidence-based supportive interventions and non-evidence-based methods, was not associated with forum exposure, eHealth literacy, or psychological distress. Forum users demonstrated differentiated trust patterns, with consistently lower perceived credibility attributed to CAM-related discussions compared with discussions on conventional cancer treatments.
For cancer survivors, online cancer forums appear to function primarily as contextual support resources rather than drivers of non-evidence-based treatment decisions. Clinicians should therefore address forum use openly and early, focusing on guidance and shared decision-making instead of discouragement.