Health literacy in patients with cancer: A multicenter national study.
Authors: Paillaud Elena , Galvin Angéline , Pulido Marina , Perrin Christophe , Grellety Thomas , Boudou-Rouquette Pascaline , Teyssonneau Diego , Ayati Siavoshe , Saint-Lezer Arnaud , Culine Stephane , Annonay Mylene , Soulem-Laviec Heidi , Boulahssass Rabia , Baldini Capucine , Tchalla Achille , Soubeyran Pierre-Louis , Lalet Caroline , Mebarki Soraya , Hue Lucas , Mathoulin-Pélissier Simone 
Published: June 2022

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Background: Health literacy (HL) is defined as the motivation and skills to access, understand, evaluate, and use information to make appropriate health decisions. The level of LS is low in Europe, including in France. For chronic patients, a low literacy is associated with limited skills in the self-management of the disease, the monitoring of treatments and is an obstacle in therapeutic education. In France, there is no study on patients with cancer. However, our pilot study with older adults with cancer showed that 72% had a low level of LS, a level defined by a questionnaire validated in French (Functional, Communicative and Critical Health Literacy-FCCHL, a score ≤ 4 = low level). The objective of this multicenter study is to evaluate HL in 2 cohorts of cancer patients: adults aged 65 and over (OLD) and adults aged 18 to 64 (Y). Methods: This multicenter cross-sectional study enrolled 1,518 patients aged 18 and over from 27/09/21 to 29/10/21 in 26 centers. Patients were either admitted in outpatient unit, or seen in oncology/geriatric oncology consultation, and with a treatment plan. They completed the FCCHL and 11 questions on the use of digital. Demographic and health data were also collected. The FCCHL consists of 3 subscales evaluating functional (access to information – 5 items), interactive (understanding of information – 5 items) and critical (use of information – 4 items) HL. The score for each subscale is calculated by taking the sum obtained for each item divided by the number of items and varies from 1 (low) to 5 (high). The overall score is calculated from the subscale scores. The primary endpoint was the rate of patients with an overall score of HL ≤ 4 (no. of subjects estimated at 420 per cohort, considering non-evaluable patients and an expected rate of HL ≤ 4 from 70% to 80%). Patients’ characteristics and their use of digital have been described. In addition, a multivariate exploratory analysis of the factors associated with an LS≤ 4 in the OLD cohort was performed. Results: Most patients (1,327(87%)) had completed all the FFCHL items (658 (84%) OLD cohort; 669 (91%) Y cohort). The proportion of men was higher in the OLD cohort (48% vs 34% Y cohort). Many of the patients lived at home in the 2 cohorts (98%) and half in urban area (56% cohort OLD vs 52% cohort Y). The patients had an advanced stage of cancer (70% OLD cohort vs 61% Y cohort). A low level of HL was reported in 70% of the Y cohort and in 78.7% of the OLD cohort. The use of digital tools was lower in the OLD cohort: 41% had never used the internet for their health vs. 14% in cohort Y; this use was very low for online consultations (respectively 83 and 64% never used them). For the OLD cohort, only advanced and/or metastatic cancer stage was associated with HL≤ 4 (after center adjustment). Conclusions: These results show a low level of HL in older as in the younger population. Actions need to be implemented for the detection of moderate or weak HL in the way to reduce barriers in the management of cancer treatments.