The missing link: Health literacy and cognitive function in treatment adherence in head and neck cancer
Williams A, Miller MK, and Olex M. The missing link: Health literacy and cognitive function in treatment adherence in head and neck cancer. Psycho-Oncology 2020; 29:69.
Background/Purpose: Health literacy is the degree to which a person has the capacity to obtain, process, and understand basic information and services needed to make decisions about their health care. Poor health literacy has been associated with difficulties managing medications, assessing and evaluating health information, completing medical and financial forms, and comparing nutritional information of foods. As such, health literacy is closely related to adherence to medical treatment. Cognitive function contributes to one's health literacy, though also independently contributes to adherence. Patients with head and neck cancers require complex, often multimodal care, and both health literacy and cognitive function have been found to be lower than the general population. However, no study has examined the interaction between cognitive function and health literacy in the vulnerable patient population. Methods: 200 consecutive patients presenting for pretreatment evaluation with an embedded health psychologist received standardized assessment protocol of cognitive assessment (Montreal Cognitive Assessment), health literacy (REALM-SF), understanding of medical recommendations, and education history. Treatment adherence was obtained via chart review and was defined as having completed the treatment recommended by the Multi-Disciplinary Tumor Board. Results: Patients were predominantly male (83%), white (80%) with an average age of 67 years (SD = 9.87 years.). The average years of education was 13 years (equivalent to "some college"). The mean health literacy score was 5 (SD = 1, range 0-7), indicating an average level of reading equivalent to seventh-eighth grade. The mean cognitive function score was 21 (SD = 5, range 10-30). Health literacy and cognitive function were correlated (P < .05). Treatment adherence data was available for the 200 patients included, with 95% adhering to Tumor Board recommendations. Lower health literacy and lower cognitive function were associated with non-adherence to treatment recommendations (P < .05). Conclusions and Implications: Health literacy and cognitive function are rarely studied in head and neck cancer. These important contributors to treatment understanding and adherence are even less frequently clinically evaluated in this vulnerable population. The current study demonstrates the need for assessment of both health literacy and cognitive function in patients with head and neck cancer to aid in identification and intervention to improve treatment adherence, survival outcomes, and quality of life.