Impact of Health Literacy in Hematology Outpatients Receiving Oral Anticancer Drugs and Followed By the Oncoral Multidisciplinary City-Hospital Educational Follow-up

Background

Oral anticancer therapies (OAT) are often associated with drug-related problems (DRP) in patients with hematological malignancies, justifying the implementation of multidisciplinary prevention follow-ups. However, these approaches might fail to address social vulnerability factors. Among them, a low level of health literacy (HL) can be a barrier to patient education and contributes to inappropriate self-management of medications. This study aims to assess the influence of HL on relative dose intensity (RDI) of OAT and health-related quality of life (HRQoL) in patients with hematological malignancies followed by the personalized multidisciplinary program Oncoral.

Methods

This prospective cohort study enrolled adult patients with hematological malignancies who initiated OAT (baseline) from 11/03/2019 to 24/08/2022 and were followed by Oncoral for ≥6 months. Oncoral consists of personalized face-to-face consultations with a pharmacist and nurse after each subsequent oncologist consultation, to prevent and correct DRPs. Interviews were tailored to each patient in terms of social determinants. HL was assessed at baseline using the HLS-EU16 questionnaire. The primary endpoint was RDI at 6 months, calculated 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, according to the literature. The secondary endpoint was the variation in HRQoL from baseline to 6 months of OAT, as measured by the EORTC QLQ C30 questionnaire. Associations with HL were assessed using Kruskal-Wallis tests for quantitative variables and χ² tests of independence with Cramér V test for qualitative variables.

Results

This study included 110 patients (sex ratio M/F 2.3, median [range] age 71 [31-93] years), mostly with multiple myeloma (50.0%), chronic lymphocytic leukemia (17.9%) and non-Hodgkin lymphoma (12.5%). Among them, 105 patients completed baseline questionnaires. The majority (75.2%) were married or lived with a partner, 18.1% had children living at home, 22.8% lived alone. Most were retired (69.5%) but 16.2% worked full-time. Household incomes were inferior to French minimum wage for 55.2%. Most patients had obtained a high school diploma or further degree (63.8%), while 23.8% only received elementary education. Mean HL score was 11.8 ± 3.2, with 48.2% of patients having a HL score considered sufficient (13-16), 35.5% problematic (9-12) and 16.4% insufficient (0-8). RDI at 6 months was evaluable for 82 patient (73.2%). Mean RDI was 84.8 ± 21.5% and 76.2% of patients maintaining a RDI ≥ 80%. HL had no influence on 6-month RDI, however age was associated with a lower RDI (p=0,017). Variation of HRQoL was evaluable for 59 patients (56.2%). For global health status and functional scales (physical, role, social emotional and cognitive functioning), mean scores ranged from 50.3 ± 26.7 to 59.3 ± 14.6 (out of 100) at baseline and from 55.7 ± 16.6 to 62.9 ± 19.4 at 6 months, with a significant improvement of global health status (+9.2, p=0.007) and no significant difference on the other components. For symptoms scales, mean scores ranged from 36.1 ± 9.4 to 48.5 ± 28.9 at baseline and from 36.8 ± 13.5 to 44.3 ± 23.9 at 6 months, with no significant variation of each score. Patients with sufficient HL showed a lower mean emotional score at baseline (suggesting higher stress/anxiety) (p=0.03) but there was no more difference at 6-month.

Conclusion

Hematology 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. These are the first results that begin to show that personalized monitoring may limit the impact of social vulnerabilities.