Although hematologic cancers such as lymphoma and leukemia are much less prevalent than other cancer types such as colorectal cancer or breast cancer [1], in developed countries such as Australia they are a major cause of cancer death, due to poor survival rates compared with other cancers [1]. Diagnosis and treatment can have a devastating impact on life expectancy, fertility and sexuality [2,3], and overall health [4]. Accordingly, these patients report a need for information [5] and support [6]. Canadian data indicate that rates of clinical distress among those with hematologic cancers can range from 32% to 48% given the debilitating nature of the disease and its treatment [7]. Australian data indicate that hematologic cancer patients are also often isolated from support systems due to the need to travel to major hospitals for treatment, with treatment potentially lasting several months [5,8].

The prevalence and nature of the disease and its treatment raise some particular issues for the provision of psychosocial support. The opportunities for peer support, for example, are limited by the relative rarity of an age- or gender-matched survivor being available for either face-to-face or telephone-based peer-support programs. The concentration of hematologic professionals in major centers also can result in low access to face-to-face information and support once a patient has completed a round of treatment, particularly for those who live in nonmetropolitan locations. Further, opportunities for social and peer support may be limited due to lengthy inpatient stays and restriction of activities due to risk of neutropenic infection. Therefore, it is likely that a suite of options needs to be made available in order that hematologic cancer patients receive sufficient information and support throughout the months and years that may follow diagnosis.

Alongside the vital role of specialist medical staff, the Internet offers unique advantages for the delivery of information and psychosocial support to hematologic cancer patients, primarily due to its high level of accessibility. Up to 77% of Australian cancer patients access information about cancer via the Internet [9]. Internet access in Australia has quadrupled between 1998 and 2008 [10]. The most recent Australian data suggest that 72% of the population have home Internet access [10], while in the United States up to 69% of people may have home Internet access [11]. For those in regional and remote areas [12] the Internet may overcome some geographic barriers. It provides a way of connecting with information, services, and others in a similar situation no matter their location or level of wellness. It also offers the opportunity to provide peer online forums to obtain support from others in similar positions, who may not be accessible face-to-face.

A small group of studies have explored the effectiveness of Web-based psychosocial support for cancer survivors using robust randomized controlled designs [13-17], with mixed findings for psychosocial outcomes. The single study that included hematologic cancer survivors [15] also involved participants with other types of cancer diagnoses and suggested that those who were single, older, and less educated were less likely to use the Web-based intervention. Issues of reach and access in relation to Web-based interventions have also rarely been addressed.

While Internet accessibility is apparently high and increasing, there are no current data about the accessibility of this resource for hematologic cancer patients. Internet access can differ according to income, education, age, and geographic location [12,18]. These differences may in turn create or exacerbate inequality. Given that the sociodemographic profile of adult hematologic cancer patients includes a substantial proportion of older age groups [1], it is important to establish whether older or disadvantaged patients have ready access to the Internet in a manner that is conducive to its use for obtaining support and information.

The study aimed to do the following in a cross-sectional sample of people with a diagnosis of a hematologic cancer: (1) investigate the proportion of metropolitan versus regional survivors who reported a high level of access to the Internet, (2) measure the proportion who reported being likely to use various sources (Internet, print, telephone, face-to-face) for information and support and the perceived benefits of Internet options, and (3) explore the sociodemographic characteristics of survivors who reported both a high level of Internet access and being likely to use the Internet for information or support.

As approximately three-quarters (73%) of the sample reported a high level of Internet access, such an approach appears to be relatively accessible to most patients. It must, however, be acknowledged that a substantial minority of the sample (20%) reported either having no Internet access at all (18%) or no access for personal use (2%). As higher reported Internet access was associated with higher educational level, younger age, being married, and being employed, those with less access appear to be a potentially isolated and disadvantaged group. Therefore, in order to avoid creating inequity, care should be taken to develop and provide appropriate alternative forms of information and support for such patients. An unexpected finding was that of no reported differences between regional and metropolitan participants regarding access to the Internet, other than greater difficulties with connectivity in regional areas. Therefore, Web-based approaches may indeed assist with improving access to information and support for cancer survivors, across a range of geographic locations. It is likely that adult patients with cancers other than hematologic cancers would similarly benefit from access to Web-based options for information and support.

The reported likelihood of using the Internet for obtaining information or seeking support was relatively low at 62% and 27%, respectively. Studies of Web-based interventions for depression and anxiety found that 78% to 95% of participants took up the offer [21-24]. It may be that the concrete offer of a Web-based program at a time of need is more engaging than the hypothetical possibility proposed in the present study. The samples of patients with a mental illness were younger than the hematologic cancer patient sample and, therefore, likely to be more familiar with Web-based technology.

The data suggest that, while the vast majority of patients reported being likely to use multiple modes for gathering information or seeking support (88% and 68%, respectively), face-to-face and print were the generally preferred forms. Notably, almost 1 in 4 participants reported they would access only one form of support, suggesting that retaining a range of support options is required in order to cater for the support needs of all hematologic cancer patients.

Interestingly, patients’ preference for receiving information via face-to-face or print mode has not changed over time, despite increased accessibility to Internet resources. Previous work by Hinds et al suggested that cancer patients receiving radiotherapy preferred to receive verbal information from their physician in the pretreatment phase and printed information in the posttreatment phase [25]. A more recent systematic review that examined information needs and sources of information across a wider range of cancer patients found that the most frequently cited sources of information were health care professionals and printed materials [26].

In accordance with our findings, one other study has found that cancer patients who were single, older, male, and less educated [15] were less likely than their counterparts to engage with Web-based forms of information or support. Therefore, while Web-based provision of information may be attractive to the majority of patients, those who are less interested in such formats should not be forgotten. The perceived disadvantages of the Internet, particularly complexity and impersonality, also suggest the development of customized Web-based information sources may be useful for patients, rather than relying on generic engine-based searches such as Google. Promotion, careful training, and assistance may reduce some reticence toward newer forms of technology, although print or face-to-face options may need to be retained for those who continue to need or prefer such forms of communication.

An additional new finding is the association between being classified as anxious and a reported likelihood of using the Internet for information and support. This may reflect a greater need or desire for information and support among this group, potentially driving a desire to access available options. Alternatively, anxious cancer survivors may prefer options that require less interpersonal interaction. Other studies support the view that level of anxiety mediates the relationship between seeking information online and using health care services [27].