Cancer patients who scored lower on health literacy screening experienced higher all-cause mortality, according to a study published in the journal Cancer.

The study followed Vanderbilt-Ingram Cancer Center patients for a median of 3.1 years who had taken the Brief Health Literacy Screen. Patients who had high health literacy on the screening lived 9.4 months longer compared to those with low health literacy (score of nine or lower). The 9,603 patients in the retrospective cohort study were diagnosed with either prostate, lung, breast, renal, colorectal, brain, head and neck, bladder, pancreatic, liver, sarcoma or gastric cancer.

“Cancer care is extremely complex, and we highlight that health literacy is an important risk factor in terms of survival in one of the largest studies conducted evaluating the impact of health literacy and cancer survival,” said the study’s senior author, Kamran Idrees, MD, MSCI, MMHC, Ingram Professor of Cancer Research, professor of Surgery and chief of the Division of Surgical Oncology and Endocrine Surgery.

He further stated, “Since health literacy is a modifiable risk factor, it provides us an opportunity for real-time identification of patients with low health literacy to personalize care, provide health literacy sensitive resources, tailored instruction and education to improve their cancer care.”

The screening consists of three multiple-choice questions about patients’ comfort levels with understanding medical information and filling out hospital forms. A point system, ranging from one to five, is assessed according to answers to the questions.

Although the study did not seek to discover causal findings, such as direct links between patient mortality and patients’ ability to make informed decisions about treatment scenarios, the investigators surmised the difference in outcomes was likely multifactorial.

The investigators stated they endorsed the routine collection of health literacy information for patients diagnosed with cancer and that they encouraged the adoption of strategies to improve organizational health literacy in facilities that provide cancer care. They noted that not all cancer patients with low health literacy experienced worse outcomes. Observational studies for specific cancer types that assess health literacy are needed to evaluate interventions aimed at improving outcomes, they said.

Other Vanderbilt authors on the study included Kelvin Moses, MD, PhD, Julia Whitman, MS, and Sunil Kripalani, MD, MSc.

The investigators state that to their knowledge the study is the first to assess the association between health literacy and all-cause mortality among different cancer types.

The research received support from a Society of Surgical Oncology Foundation Investigator Award for a grant titled “Health Literacy and Cancer Outcomes.”