Association of Health Literacy With Survival in Patients With Lung Cancer

Lung cancer is the leading cause of cancer-related deaths globally, with survival influenced by stage at diagnosis, comorbidities, and sociodemographic factors. Health literacy, which impacts patients' understanding of medical information and decision-making, has not been well studied in lung cancer survival outcomes.

In a retrospective cohort of patients diagnosed with lung cancer, how is health literacy associated with overall survival and cancer stage at diagnosis?

This retrospective cohort study included patients diagnosed with lung cancer between 2010 and 2022 at a single institution. Health literacy was measured using the Brief Health Literacy Screen (BHLS). Patients were divided into low health literacy (BHLS score ≤ 9) and intermediate-high health literacy (BHLS score > 9) groups. Data on demographics, clinical characteristics, and treatment were collected. Logistic regression examined associations between health literacy and patient characteristics. Cox proportional hazard models evaluated the impact of health literacy on survival, adjusting for covariates.

The study included 3,828 patients with lung cancer, and 19.1% (n = 730) had low health literacy. Logistic regression indicated that older age, male sex, non-White race/ethnicity, and lower education were associated with low health literacy. Stage IV disease was associated with increased odds of low health literacy by 65% compared with stage I disease (OR, 1.65; P < .001). Low health literacy was independently associated with a 26% higher hazard of death (hazard ratio, 1.26; P < .001), and adjusted survival curves demonstrated worse overall survival for patients with low health literacy across all lung cancer stages.

Our results show that low health literacy is associated with late-stage diagnosis and reduced overall survival in patients with lung cancer. Interventions addressing limited health literacy for patients with lung cancer could alleviate these disparities.