부산대학교 도서관

Health literacy (HL) is defined as the ability of an individual to obtain and translate knowledge and information to maintain his/her own healthcare. 1In the recent years, this topic has garnered more interest due to its benefits for the patients and health care system. Despite its importance, a study by Kutner et al found that nearly one third of patients had "basic" or "below basic" HL. 2Our study aimed to identify how HL is associated with all-cause mortality in patients with genitourinary (GU) malignancies. This retrospective cohort study included 3,146 bladder, prostate and renal cancer patients who initially received care at our institution between 2008 and 2015. Data on patient demographics, co-morbidities, treatments, and health literacy were obtained by linking cancer records to electronic medical charts. Health literacy was assessed using the validated Basic Health Literacy Screen (BHLS) with scores ranging from 3 to 15; higher scores indicate better health literacy. Data on vitality was obtained via institutional cancer registry. The association between health literacy and all-cause mortality was estimated using the multivariable Cox proportional hazards models for each of the 3 cancer types adjusting for age, gender, race/ethnicity, AJCC cancer stage, Elixhauser co-morbidity score, treatment type, and insurance status. Among the cohort, 1,629 (52%) patients had prostate cancer, renal 939 (30%) had renal cancer, and 578 (18%) had bladder cancer. Patients with stage I cancer had higher median BHLS scores compared to those with stage IV cancer for all GU malignancies—prostate cancer (median score 15 vs. 12.5), renal (median score 14 vs. 13), and bladder cancer (median score 14 vs. 12.5). In adjusted analyses that compared the relative effect of a low HLS to high HLS (BHLS score of 9 vs. 15) on all-cause mortality by cancer type and stage, a low BHLS score was associated with a higher likelihood of death in stage II (adjusted hazard ratio [aHR] 2.6, 95% CI 1.5 to 5.1) and III (aHR 1.4, 95% CI 1.4 to 6.0) prostate cancer; stage I renal cancer (aHR 1.8, 95% CI 1.1 to 3.4); stage II bladder cancer (aHR 1.6, 95% CI 1.0 to 2.8). HL is independently associated with overall survival in patients with urologic malignancies. Individual GU cancers show variable associations with HL and survival, with some stages of cancer being more strongly associated than others. Future studies are necessary to identify how the effects of low HL can be mitigated in this patient population. [ABSTRACT FROM AUTHOR]