Health-related quality of life (HRQOL) is an important outcome in cancer care. Few studies indicate that that health literacy (HL) influences cancer patients’ HRQOL, but additional investigation is needed. We examined the relation between HL and HRQOL among cancer patients. A cross-sectional survey was conducted with cancer patients in Wisconsin during 2006–2007. Data on sociodemographics, clinical characteristics, HRQOL, and HL were obtained from the state’s cancer registry and a mailed questionnaire. Regression analyses were used to characterize the association between HRQOL and HL. The study sample included 1,841 adults, newly diagnosed with lung, breast, colorectal, or prostate cancer in 2004 (response rate=68%). HRQOL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G). Adjusting for confounders, higher HL was associated with greater HRQOL (P <.0001). Controlling for covariates, we found significant differences between those in the highest and lowest health literacy categories (P <.0001) and in the physical (P <.0001), functional (P <.0001), emotional (P <.0001), and social (P =.0007) well-being subscales. These associations exceeded the minimally important difference threshold for overall HRQOL and functional well-being. HL is positively and independently associated with HRQOL among cancer patients. These findings support adoption of HL best practices by cancer care systems.

Rural residence is associated with disparities in cancer-related outcomes. Guided by the Chronic Care Model (CCM), the Rural Oncology Literacy Enhancement Study (ROLES) assessed health literacy and patient navigation needs among rural cancer patients. A mixed methods (qualitative and quantitative) approach was used, including: in-depth interviews, health literacy assessments, and phone surveys with cancer patients (N=53) from 5 oncology clinics in rural Wisconsin; focus groups and selfadministered surveys with staff (N=41) in these clinics. Within four dimensions of the CCM (community resources, self-management support, delivery system design, and decision support), this study uncovered multiple unmet navigation needs, health literacy limitations, and barriers to quality cancer care. System-level implementation of patient navigation and health literacy best practices could contribute to improved cancer care and patient outcomes among rural populations. Further research identifying effective interventions that reduce cancer disparities among rural cancer patients is necessary.

Purpose Low health literacy is associated with inadequate health care utilization and poor health outcomes, particularly among elderly persons. There is a dearth of research exploring the relationship between health literacy and place of residence (urbanicity). This study examined the association between urbanicity and health literacy, as well as factors related to low health literacy, among cancer patients. Methods A cross-sectional survey was conducted with a population-based sample of 1,841 cancer patients in Wisconsin. Data on sociodemographics, urbanicity, clinical characteristics, insurance status, and health literacy were obtained from the state’s cancer registry and participants’ answers to a mailed questionnaire. Partially and fully adjusted multivariate logistic regression models were fitted to examine: 1) the association between urbanicity and health literacy, and 2) the role of socioeconomic status as a possible mediator of this relationship. Findings Rural cancer patients had a 33% (95% CI: 1.06–1.67) higher odds of having lower levels of health literacy than their counterparts in more urbanized areas of Wisconsin. The association between urbanicity and health literacy attenuated after controlling for socioeconomic status. Conclusions Level of urbanicity was significantly related to health literacy. Socioeconomic status fully mediated the relationship between urbanicity and health literacy. These results call for policies and interventions to assess and address health literacy barriers among cancer patients in rural areas.