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Currently submitted to: JMIR Cancer

Date Submitted: Oct 28, 2020
Open Peer Review Period: Oct 28, 2020 - Dec 23, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Is the internet a valuable source of information on transarterial chemoembolization for patients? A systematic review.

  • Georgios Antonios Sideris; 
  • Aikaterini Themis Vyllioti; 
  • Danai Dima; 
  • Michael Chill; 
  • Njogu Njuguna



Transarterial chemoembolization (TACE) is the reason for thousands of web searches given its palliative role in liver cancer treatment.


The purpose of our study is to assess the reliability, quality, completeness, readability, understandability and actionability of websites providing information on TACE for patients.


The 5 most popular keywords pertaining to TACE were searched in Google, Yahoo and Bing. General website characteristics as well as presence of Health on the Net (HON) code certification were documented. Website assessment was performed using the following scores: DISCERN, Journal of the American Medical Association (JAMA), Flesch-Kincaid Grade Level (FRES), Flesch Reading- Ease Score (FKGL) and Patient Education Materials Assessment Tool (PEMAT). A novel TACE-specific content score was designed to evaluate website completeness.


The search yielded 3750 websites. Eighty-one website entities met inclusion criteria. HON code certification was present in 11.5% of website domains. Authorship was absent in 88% of websites, whereas sources were absent in 83% of websites. Medical disclaimer was not provided in 31% of websites. Date of publication or of last update was not listed in 58% of websites. Median DISCERN score was 47 (IQR 40.5 – 54.0). Median TACE-content score was 35 (IQR 27 – 43). Median readability grade level was in the 11th grade. Sixty percent and 16% of websites were deemed understandable and actionable, respectively. Not-for-profit websites fared significantly better on JAMA, DISCERN, and TACE- content scores (p <0.05).


The content referring to TACE that is currently available online is unreliable, incomplete, difficult to read, understandable but not actionable, and characterized by low overall quality. Websites need to revise their content in order to optimally educate consumers and support shared decision-making.


Please cite as:

Sideris GA, Vyllioti AT, Dima D, Chill M, Njuguna N

Is the internet a valuable source of information on transarterial chemoembolization for patients? A systematic review.

JMIR Preprints. 28/10/2020:25357

DOI: 10.2196/preprints.25357


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