Impact of health literacy in cancer outpatients receiving oral anticancer drugs and followed by the ONCORAL multidisciplinary city-hospital educational follow-up: The LITTORAL study.

Abstract

12127 Background: Multidisciplinary follow-up is crucial to manage drug-related problems (DRP) associated with oral anticancer therapies (OAT). However, these approaches might fail to address social vulnerability determinants, such as a low level of health literacy (HL), which can be a barrier to patient education and contributes to inappropriate self-management of medications. This study aims to assess the impact of HL on relative dose intensity (RDI) of OAT and health-related quality of life (HRQoL) in cancer patients followed by Oncoral, a multidisciplinary program consisting in personalized face-to-face consultations with a pharmacist and nurse after each subsequent oncologist consultation, to prevent and correct DRPs. Methods: This prospective cohort study enrolled adult cancer patients who initiated OAT (baseline) from 11/03/2019 to 24/08/2022 and were followed by Oncoral for ≥6 months. HL was assessed at baseline using the HLS-EU16 questionnaire. The primary endpoint was RDI at 6 months, defined as the ratio between the prescribed dose of OAT and the optimal dose to be administered according to Summary of Product Characteristics. A RDI ≥80% was considered satisfactory, based on the literature. The secondary endpoint was the variation in HRQoL from baseline to 6 months of OAT, measured by the EORTC QLQ C30 questionnaire. Results: This study included 182 patients (58.2% male, median [range] age 69 [29-101] years), mostly with hematological malignancies (60.4%, including multiple myeloma 29.7% and chronic lymphocytic leukemia 11.0%) and breast cancer (12.1%). At baseline, the majority (71.8%) lived with a partner, 20.0% had children living at home. Most were retired (67.1%) but 18.2% worked full-time. Household incomes were inferior to French minimum wage for 20.6% of patients, and 20.6% only received elementary education. Mean HL score was 12.1 ± 3.12, 52.7% of patients having a HL score considered sufficient (13-16), 32.4% problematic (9-12) and 14.8% insufficient (0-8). RDI at 6 months was evaluable for 135 patients (74.2%), 68.9% of which maintained a RDI ≥ 80%. Mean RDI was 83.9 ± 20.4%. HL had no influence on 6-month RDI. Variation of HRQoL was evaluable for 114 patients (62.6%). Patients with inadequate HL showed lower emotional (p = 0.02) and cognitive scores (p = 0.03) at baseline. A significant improvement was shown at 6 months for global health status (+9.83 out of 100, p = 0.001), emotional functioning (+10.73, p < 0.001), insomnia (-14.03, p < 0.001), pain (-11.76, p = 0.02) and fatigue (-11.76, p = 0.005), with no difference in other scales. Conclusions: Cancer patients followed by Oncoral globally maintain a 6-month RDI ≥ 80% regardless of HL, with a HRQoL maintained or improving in all dimensions, suggesting that this personalized follow-up benefits to all patients and may limit the impact of social vulnerability.