Twitter Polls: Tapping Into the Wisdom of Crowds

H. Jack West, MD


April 14, 2022

When news came on March 4 of the remarkably rapid approval of neoadjuvant nivolumab combined with chemotherapy for early-stage non–small cell lung cancer (NSCLC), it was clear that this option was potentially practice changing.

At the time, preliminary efficacy results from the CheckMate 816 trial, such as event-free survival, had not been yet formally presented, let alone peer-reviewed and published. That left me and others wondering how the results would be integrated into practice. This question is especially relevant, given that adjuvant chemotherapy has been the prevailing standard for most patients with resectable NSCLC for nearly two decades, and there are now multiple other competing standards of care.

To find out what the oncology community thinks of neoadjuvant chemoimmunotherapy as a practice option, Dipesh Uprety, MD, took to Twitter on March 5 to poll the broadest accessible swath of stakeholders on how they would manage such a case.

Uprety asked the Twitterverse: "If you have a young patient with a single station, non-bulky, resectable, N2 disease NSCLC, will you feel comfortable recommending neo-adjuvant Chemo-Nivo [chemotherapy plus nivolumab] followed by surgical resection?"

Less than 24 hours and 700 responses later, Uprety didn't have a clear consensus, but the responses offered a good quick take from the global community. A majority favored the neoadjuvant platform outlined by CheckMate 816, but more than 22% preferred another option, and almost 20% were undecided.

Uprety told me what struck him most "was the magnitude of response."

"In no time, providers from different corners of the world were sharing their opinions…partly because the topic is highly debatable," he said.

Over the past few years, Twitter has become the social media platform with the greatest reach for professional audiences, and clinicians have increasingly adopted it to keep up with the rapid pace of new clinical data and drug approvals, as news breaks on social media in real time.

Twitter polls have also become a useful tool. In a world of open questions and controversy surrounding competing options and the clinical significance of new results, there is also great value in tapping into insights from a global community of experts.

Although Twitter polls are limited to four potential responses, participants can offer comments to expound on their thoughts and offer alternative options beyond those listed.

Uperty's poll not only sparked huge interest from oncologists worldwide, with a final tally of 866 votes, but also generated multiple comments leading to discussions around the nuances of the options presented.

Gil Morgan, MD, an American oncologist practicing in Sweden who started the international online information service OncoAlert, notes that although Twitter polls do not provide an official, regulated source of research, they do "give us a special insight into the daily attitudes and practices of our colleagues worldwide." In addition, the anonymity of these responses allows participants "to pick with no fear of being judged," allowing "everyone to contribute their opinion and form part of our oncology community in social media."

Collecting a diverse array of viewpoints also enables us to avoid an echo chamber that might tempt us to believe our practice patterns and ways of thinking are the only way. Many institutions have a particular culture and practice that reflects the style of a dominant individual or group, but being able to glimpse the more varied approaches, independent of geography, can be eye-opening.

Furthermore, Twitter polls can offer a platform for oncologists without ready access to an expert in their region to tap into the collective expertise of subspecialists about management options for a complex case. General oncologists can post key aspects of a case without identifying information, often tagging the Twitter handles of well-known leaders in that subspecialty or using a disease hashtag, such as #LCSM to designate lung cancer social media.

Although there are always reasons to be critical of misinformation and other potential effects of social media, Rohit and Rahul Gosain, MD, community-based general oncologists who tweet from the handle @OncBrothers, note that "these Twitter polls are priceless and improve patient care. Not only the results but the discussions generated add value in understanding the nuances around the new data." The oncologists have received such favorable feedback from their own Twitter polls that they are planning to share cases using the platform on a regular basis to offer informal education.

I agree that Twitter polls can represent the best aspects of online education, especially in a world where new results are published frequently, helping us learn from each other while cultivating a stronger sense of a global community.

In the words of thoracic oncologist Balazs Halmos, MD, a prolific tweeter from Albert Einstein School of Medicine (@DrSteveMartin), "a Twitter poll can be like a plenary session discussion — on steroids."

I encourage you to join Twitter, and for those who have, follow colleagues to find these discussions, then join in!

H. Jack West, MD, associate clinical professor and executive director of employer services at City of Hope Comprehensive Cancer Center in Duarte, California, regularly comments on lung cancer for Medscape. Dr West serves as web editor for JAMA Oncology, edits and writes several sections on lung cancer for UpToDate, and leads a wide range of continuing education programs and other educational programs, including hosting the audio podcast West Wind.

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