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Session: ePoster: Quality and Cost 7 (Mon115)

EP813 - Health Literacy and Time to Initiation of Treatment in Colorectal Cancer Patients

Monday, May 12, 2025
1:20 PM – 1:25 PM PT

    ePoster Presenter(s)

  • Emma Bradley, MD

    Resident Physician
    Vanderbilt University Medical Center
    Nashville, TN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • SS

    Sobia Siddiqui, MBBS

    Research Fellow Trainee
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    Disclosure information not submitted.

  • Alexander T. Hawkins, MD, MPH

    Associate Professor
    Vanderbilt University Medical Center
    VIMC
    Nashville, Tennessee, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Aimal Khan, MD

    Assistant Professor of Surgery
    Vanderbilt University Medical Center

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • KI

    Kamran Idrees, MD MSCI MMHC.

    Associate Professor of Surgery
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Emma Bradley, MD: This individual has no financial relationships with ineligible companies.
Alexander T. Hawkins, MD, MPH: This individual has no financial relationships with ineligible companies.
Aimal Khan, MD: This individual has no financial relationships with ineligible companies.
Kamran Idrees, MD MSCI MMHC.: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Delays in care directly impact oncologic outcomes for patients with colorectal cancer. Health literacy (HL) influences the ways in which patients obtain, process and access health information and services. While HL has emerged as a key determinant of health in many chronic diseases, its association with timeliness of colorectal cancer care has not been described. We hypothesize that patients with lower health literacy will have longer time from colorectal cancer diagnosis to initiation of treatment.

Methods/Interventions: A cohort of patients with newly diagnosed colorectal cancer from a tertiary care referral center from 2010 to 2022 was retrospectively reviewed. Health literacy was assessed via the validated Brief Health Literacy Screen (BHLS). Demographic and oncologic data was derived from the institutional cancer registry. Primary outcome was time from cancer diagnosis to initiation of treatment (curative surgery or neoadjuvant therapy). Multivariable regression was used to examine the associations between HL and time to treatment, controlling for patient demographic, oncologic characteristics and cancer type.

Results/Outcomes: Among 2043 patients with Stage I-IV colorectal cancer, there were 228 (12.6%) patients with low HL (BHLS≤9) and 1586 (87.4%) patients with high HL (BHLS>9). Patients with low HL were more likely to be older (66 vs 59 years old, p< 0.0001), male (62.7% vs 54.22%, p=0.016), federally insured (68% vs 40.2%), and have higher mean Elixhauser comorbidity scores (1.5 vs 1.13, p< 0.0001). Average number of days to initiation of therapy was 51.7±41 (7.4 weeks) in patients with low HL, compared to 43.8±33 (6.3 weeks) in those with higher HL (p=0.0012). Figure 1 demonstrates the cumulative proportion of patients in each health literacy group that initiated treatment over time. In a multivariable linear regression adjusted for age, sex, race, insurance, cancer type and stage, Elixhauser comorbidity score, travel distance and initial treatment received (surgery vs chemotherapy), time to treatment initiation was 5.42 days longer in patients with low HL compared to patients with high HL (95% CI 0.64-10.2, p=0.026). Federal insurance (vs private), lower Elixhauser comorbidity score, lower stage, rectal cancer (vs colon) and neoadjuvant chemotherapy (vs surgery first) were also associated with increased time to initiation of therapy.

Conclusion/Discussion: This study demonstrates that lower patient health literacy is associated with increased time to treatment initiation among patients with newly diagnosed colorectal cancer, even when adjusted for other patient characteristics. Promoting timely colorectal cancer care in a health-literacy sensitive manner may have the potential to improve patient experience and oncologic outcomes.