APCCC 2024: Dealing with Inequality – the Promise and Pitfalls for Social Media and AI for Prostate Cancer in Disadvantaged Populations

(UroToday.com) The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) meeting featured a session on global access to advanced prostate cancer in low- and lower-middle income countries, and a presentation by Dr. Stacy Loeb discussing the promise and pitfalls of social media and artificial intelligence for prostate cancer in disadvantaged populations. Dr. Loeb started by highlighting the recent Lancet publication reporting the Lancet Commission on Prostate Cancer,¹ which provides recommendations for addressing the surge in cases for low- and middle-income countries. Two important aspects are (i) artificial intelligence can complement or supplement deficits in the health profession and important skillsets, and (ii) social media can provide potentially powerful means of improving awareness and assisting with navigation within healthcare systems. However, there are also potential risks.

Dr. Loeb notes that in 2022, 78% of Latin America/Caribbean inhabitants and 36% of sub-Saharan African inhabitants were using the internet. Further, 109 per 100 people in Latin America and 89 per 100 people in sub-Saharan Africa have mobile cellular subscriptions. In some low-income countries, mobile connections are more reliably accessible than electricity and clean water, which is particularly useful for reminders for medication adherence and behavior change. Artificial intelligence apps can scale at minimal marginal cost (compared to increasing the number of healthcare professionals). Dr. Loeb states that there is higher use of social networks among black and Hispanic US adults, as is seen in the following table:

Other examples of potential roles for social media and artificial intelligence for prostate cancer in low- and middle-income countries include:

Awareness and education: awareness messaging on social media leads to cancer screening
Screening and diagnosis: Artificial intelligence-assisted radiology and pathology interpretation
Treatment selection: Artificial intelligence for tailored advice based on cloud-based medical records, and virtual tumor boards for healthcare
Treatment: follow-up visits with telemedicine (ie. via WhatsApp)
Survivorship: advice and support from the online community

Social media is useful for raising awareness and disseminating evidence-based information. This includes the Prostate Cancer Genetics Podcast, which is a prospective study of a podcast series to provide public education on prostate cancer genetics, as well as a prospective study of a sponsored ad campaign on Facebook to raise awareness about prostate cancer risk. In Mexico during the COVID-19 pandemic, geriatric oncology care was provided via telemedicine for older patients, with 75% of the consultations taking place via WhatsApp, including 32% of chemotherapy being prescribed remotely, and 81% of geriatric assessments being successfully performed. Another example is using WeChat to provide pelvic floor training, resulting in improved continence after radical prostatectomy.

Dr. Loeb cautions that there is a dark side to social media, which was evident during the most recent Ebola outbreak. Tweets about Ebola in Guinea, Liberia, and Nigeria in 2014 led to disinformation that Ebola may be cured by the plant ewedu, or by blood transfusions, as well as by drinking and washing in salty water. Prostate cancer misinformation is also widespread across all social media platforms, including:

YouTube: 42% of the top 150 videos had some misinformation
Instagram: 41% of posts with objective information was misinformation
TikTock: 41% of posts with objective information was misinformation
Pinterest: 15% of pins in search for prostate cancer had misinformation
Podcasts: 13% contained moderate to high misinformation

In work from Dr. Loeb’s group, aimed to characterize the quality of information and presence of misinformation about skin, lung, breast, colorectal, and prostate cancers generated by four artificial intelligence chatbots.² Google Trends' top 5 search queries related to skin, lung, breast, colorectal, and prostate cancer from January 1, 2021, to January 1, 2023, were input. The quality of text responses generated by the four artificial intelligence chatbots was good (median DISCERN score of 5, range: 2-5) and no misinformation was identified. Understandability was moderate (median PEMAT Understandability score of 66.7%, range: 33.3%-90.1%), and actionability was poor (median PEMAT Actionability score of 20.0%, range: 0%-40.0%).

Additional work from Dr. Loeb assessed representation in online prostate cancer content among racial and ethnic minorities.³ This study retrieved 150 websites and 150 videos about "prostate cancer" using the most widely used search engine (Google) and social network (YouTube). Among 81 websites and 127 videos featuring people, 37% and 24% had perceived Black representation, and racial/ethnic disparities were discussed in 27% and 17%, respectively. Among 1,526 people featured, 9% and 1% were perceived as Black and Latinx, respectively.

In a recently published study, Dr. Loeb and colleagues conducted 7 virtual focus groups with Black patients with prostate cancer.⁴ A quote from this study sums up the findings of this important qualitative initiative “To the majority of African Americans, you think you’re less like to get it [prostate cancer] because you see less African Americans on the internet and on the websites, when it’s absolutely the other way around.” Thus, these focus groups with Black patients with prostate cancer identify negative consequences from underrepresentation.

Dr. Loeb concluded her presentation by discussing the promise and pitfalls of social media and artificial intelligence for prostate cancer in disadvantaged populations with the following take-home messages:

Social media and artificial intelligence hold great promise to help with the surge in prostate cancer, particularly in low- and middle-income countries
The benefits include raising awareness, enhancing clinical care, and providing support
Drawbacks include challenges with readability, spread of disinformation, and limited representation of diversity
Efforts are needed to ensure accuracy, comprehensibility, and equity in the provision of digital information and services

Presented by: Stacy Loeb, MD, New York University, New York, NY

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Advanced Prostate Cancer Consensus Conference (APCCC) Meeting, Lugano, Switzerland, Thurs, Apr 25 - Sat, Apr 27, 2024.

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