Trends, Quality, and Readability of Online Health Resources on Proton Radiation Therapy

Sybil T. Sha, Subha Perni, Vinayak Muralidhar, Brandon A. Mahal, Nina N. Sanford, Paul L. Nguyen, Edward Christopher Dee

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: Many patients weighing cancer treatment options may consider relatively novel options including proton radiation therapy (PRT) and turn to the Internet for online health resources (OHR). However, quality and readability of OHR for radiation oncology therapies has been shown to need improvement. Because the OHR that patients access can influence their treatment decisions, our study sought to understand the patterns of use, quality, and readability of OHR on PRT. Methods and Materials: To validate the need to assess OHR on PRT, we assessed search patterns in the United States for the search phrase “proton therapy” using Google Trends. The Google search engine was then queried for websites with PRT information using 10 search phrases. The subsequent websites were analyzed for readability by the Flesch-Kincaid Grade Level and a Composite Grade Level (CGL) metric comprised of 5 readability metrics. Quality was analyzed using the DISCERN instrument. Results: Search volume index for “proton therapy” increased by an average of 2.0% each year for the last 15 years (January 1, 2005 to June 1, 2019, P < .001). States that had a greater number of proton centers tended to have a greater relative search volume in Google (P < .001). Of the 45 unique websites identified, the mean Flesch-Kincaid Grade Level was 12.0 (range, 7.3-18.6) and the mean CGL was 12.4 (range, 7-18). In addition, 80% of PRT pages required greater than 11th grade CGL. The mean DISCERN score of all websites was 39.8 out of 75, which corresponds to “fair” quality OHR. Conclusions: Despite increasing interest in PRT OHR, in general, PRT websites require reading levels much higher than currently recommended, making PRT OHR less accessible to the average patient. Provision of high-quality PRT OHR at the appropriate reading level may increase comprehension of PRT, improve patient autonomy, and facilitate informed decision-making among radiation oncology patients.

Original languageEnglish (US)
Pages (from-to)33-38
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number1
StatePublished - May 1 2020

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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