Health Literacy in Surgical Oncology Patients: An Observational Study at a Comprehensive Cancer Center

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Luke D. Rothermel Department of Surgery, University Hospitals Seidman Cancer Center, Cleveland, Ohio;

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Claire C. Conley Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida;
Department of Oncology, Georgetown University, Washington, DC;

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Anuja L. Sarode University Hospitals Research in Surgical Outcomes and Effectiveness Center, University Hospitals, Cleveland, Ohio;

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Michael F. Young Morsani College of Medicine, University of South Florida, Tampa, Florida; and

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Zulema L. Uscanga Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida;

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McKenzie McIntyre Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida;

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Jason B. Fleming Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida.

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Susan T. Vadaparampil Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida;

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Background: Low health literacy is associated with increased resource use and poorer outcomes in medical and surgical patients with various diseases. This observational study was designed to determine (1) the prevalence of low health literacy among surgical patients with cancer at an NCI-designated Comprehensive Cancer Center (CCC), and (2) associations between health literacy and clinical outcomes. Methods: Patients receiving surgery (N=218) for gastrointestinal (60%) or genitourinary cancers (22%) or sarcomas (18%) were recruited during their postsurgical hospitalization. Patients self-reported health literacy using the Brief Health Literacy Screening Tool (BRIEF). Clinical data (length of stay [LoS], postacute care needs, and unplanned presentation for care within 30 days) were abstracted from the electronic medical records 90 days after surgery. Multivariate linear and logistic regressions were used to examine the relationship between health literacy and clinical outcomes, adjusting for potential confounding variables. Results: Of 218 participants, 31 (14%) showed low health literacy (BRIEF score ≤12). In regression analyses including 212 patients with complete data, low health literacy significantly predicted LoS (β = −1.82; 95% CI, −3.00 to −0.66; P=.002) and postacute care needs (odds ratio [OR], 0.25; 95% CI, 0.07–0.91). However, health literacy was not significantly associated with unplanned presentation for care in the 30 days after surgery (OR, 0.51; 95% CI, 0.20–1.29). Conclusions: This study demonstrates the prevalence of low health literacy in a surgical cancer population at a high-volume NCI-designated CCC and its association with important clinical outcomes, including hospital LoS and postacute care needs. Universal screening and patient navigation may be 2 approaches to mitigate the impact of low health literacy on postsurgical outcomes.

Submitted December 26, 2020; final revision received February 8, 2021; accepted for publication February 17, 2021.

Author contributions: Study design: Rothermel, Conley. Recruited and consented participants and administered surveys: Rothermel, Conley, Young, Uscanga, McIntyre. Patient chart review: Rothermel, Young. Data analysis: Conley, Sarode. Study oversight and guidance: Fleming, Vadaparampil. Writing – original draft: Rothermel, Conley, Sarode. Writing – review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the NCI of the NIH under award number T32CA090314 (S.T. Vadaparampil). This work was also supported by funding from Moffitt Cancer Center to Dr. Rothermel (Junior Scientist Partnership Fund; L.D. Rothermel and C.C. Conley, principal investigators).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Luke D. Rothermel, MD, MPH, Department of Surgery, University Hospitals Seidman Cancer Center, Lakeside 7010, 11100 Euclid Avenue, Cleveland, OH 44139. Email: luke.rothermel@uhhospitals.org
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