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Background Pancreatic cancer patients have poor quality of life. Testosterone deficiency is associated with constitutional symptoms and sexual dysfunction which may contribute to poor quality of life. We investigated the prevalence of screening for and presence of testosterone deficiency in male pancreatic cancer patients. Methods To determine the frequency of screening for testosterone deficiency in pancreatic cancer patients, our institution’s electronic medical record system was queried for male patients diagnosed with a pancreatic mass between 2006 and 2020 and an available testosterone level. In a separate analysis, total testosterone was measured in serum samples from a cohort of 89 male pancreatic ductal adenocarcinoma (PDAC) patients. Low serum testosterone was defined as <300 ng/dL. Results One thousand five hundred and sixty-six male patients were identified with a pancreatic mass, and 35 (2.2%) also had a testosterone level. In our analysis cohort, 44 of 89 patients (49.4%) were found to have low serum testosterone. Symptoms consistent with testosterone deficiency were documented for 70% of these patients, with fatigue being the most common. Testosterone level had no significant association with progression-free survival (PFS) (P=0.66) or overall survival (OS) (P=0.95). Conclusions Testosterone deficiency is common but rarely assessed in male patients with pancreatic cancer. Further studies are warranted to explore the possibility of testosterone supplementation to improve quality of life in this patient population.

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Introduction: Parents often access online resources to educate themselves when a child is diagnosed with developmental dysplasia of the hip (DDH). In order to be fully understood by the average adult American, online health information must be written at an elementary school reading level. It was hypothesized that current available online resources regarding DDH would score poorly on objective measures of readability (syntax reading grade-level), understandability (ability to process key messages), and actionability (providing actions the reader may take). It was additionally hypothesized that the readability, understandability, and actionability would not correlate with search rank. Methods: Patient education materials were identified utilizing two independent online searches of the term “DDH” utilizing a commonly used search ending. From the top 50 search results, websites were included if directed at educating patients/parents regarding DDH. News articles, non-text material (video), research and journal articles, industry websites, and articles not related to DDH were excluded. The readability of included resources was quantified using the Flesch-Kincaid Grade Level Index. The Patient Education Materials Assessment Tool (PEMAT) was used to assess understandability and actionability using a 0-100% scale for both measures of interest. Spearman’s rho was used to examine the association between a website’s average search rank (from first to last) and its readability, understandability, and actionability. Statistical significance was defined as p<0.05. Results: From 60 unique websites, 37 websites met inclusion criteria. The mean reading grade level (Flesch-Kincaid) was 12.54±2.72, with no websites having a reading level ≤ 6. No readability statistics were statistically associated with search rank (lowest three p-values: 0.80, 0.83, 0.85). Mean understandability and actionability scores were 55.19± 13.96 and 16.58±21.69, respectively. Among understandability criteria, only 27.03% (10/37) resources made their purpose evident and only 10.81% (4/37) included summaries. Among actionability categories, 40.54% (15/37) of websites identified ≥1 action for readers, but only 5.41% (2/37) studies broke down actions into explicit, easy to understand steps. The order of search results was not associated with understandability (rho: -0.21, p=0.22) or actionability (rho: 0.0878, p=0.61). Conclusion: Overall, the online DDH patient/parent educational materials that were assessed scored poorly with respect to readability, understandability, and actionability. Currently, search rank for DDH materials is not associated with the readability, understandability, or actionability of these resources. In the era of shared decision-making and readily available information, patients often turn to the internet for additional insight into the diagnosis, management, and outcomes of DDH. Therefore, future efforts should be made by medical professionals to improve the readability, understandability, and actionability of online resources in order to optimize parental understanding and facilitate informed decision-making.

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