Association of Patient Health Literacy With NCCN-Concordant Colorectal Cancer Treatment and Survival

Low health literacy (HL) is associated with poor health outcomes. As cancer care becomes increasingly complex, HL plays a critical role in empowering patients to successfully navigate care. Although HL has been shown to play a role in colorectal cancer (CRC) screening, its impact on oncologic treatment is less well defined. This study evaluated the association between HL and receipt of guideline-concordant CRC treatment and subsequent survival outcomes.

We conducted a retrospective analysis of patients with CRC from 2010 to 2022 at a tertiary referral center. HL level was assessed using the Brief Health Literacy Screen (BHLS). Receipt of CRC treatment was evaluated based on the NCCN Guidelines according to cancer stage and type. Multivariable logistic regression and Cox proportional hazard models were used to assess associations with treatment and survival.

Among 2,111 patients with CRC, mean BHLS score was 12.9. Higher HL was associated with an increased likelihood of receiving guideline-directed treatment in unadjusted (88.2% vs 72.0%; P<.0001) and adjusted analyses (odds ratio [OR], 1.13; 95% CI, 1.09-1.19). The relationship between HL and receipt of NCCN-concordant treatment was most prominent in patients with higher-stage disease, with an adjusted OR [aOR] of 1.12 (95% CI, 1.04-1.22) for stage II; 1.08 (95% CI, 1.002-1.17) for stage III; and 1.29 (95% CI, 1.17-1.43) for stage IV. Higher HL was also associated with lower all-cause mortality (aHR, 0.95; 95% CI, 0.92-0.97), particularly in stage 0-I (aOR, 0.87; 95% CI, 0.81-0.93) and stage III CRC (aOR, 0.94; 95% CI, 0.89-0.99).

In patients with CRC, lower HL was independently associated with decreased odds of receiving guideline recommended treatment and poorer survival. As a modifiable risk factor, addressing HL may enhance CRC treatment and outcomes.