Abstract
Background The occurrence of adverse drug reactions with chemotherapy among cancer patients is a well-documented phenomenon. However, the understanding of contributoring factors and their influence on the severity of adverse drug reactions is incomplete without the psychosocial factors affecting them. Objective The present study was done to understand if factors like Health literacy and cognition levels have an association with the severity of adverse drug reactions of cancer chemotherapy. Setting This study was done in the Department of Medical Oncology in a tertiary care hospital in India. Method Two hundred and twenty-four patients meeting the study inclusion and exclusion criteria took part in the study. Details of adverse drug reactions were collected as per the central drugs standard control organization format and severity of adverse drug reactions assessed with National Cancer Institute common terminology criteria of adverse events, version 5.0. Health Literacy and Cognition Levels of patients were assessed using standardized questionnaires, i.e., Short test of functional health literacy in adults and short portable mental status questionnaire, respectively. Data were anonymized and analyzed using Statistical Package for Social Sciences version 16.0 software. Pearson’s Chi square test (p value ≤ 0.05 was considered statistically significant) was used to study the associations. Main outcome measure The associations of Health Literacy and Cognition Levels with the severity of adverse drug reactions. Result We found that both Health Literacy and Cognition Levels had a statistically significant association with Grade 3 and above adverse drug reactions in cancer patients receiving chemotherapy. Conclusion An initial assessment of Health Literacy and Cognition Levels in cancer patients by cancer care providers can help identify patients at high risk of developing severe adverse drug reactions. Interventional measures for improving Health Literacy by healthcare providers can help reduce the overall burden of disease on the patient due to adverse drug reactions.
Highlights
Functional Health Literacy (HL) and formal education are two separate entities
Less severe Adverse Drug Reactions may reduce the global healthcare costs which may act as an incentive to cancer care providers at improving Health Literacy
The present study has suggested that patients with lower HL and Cognition Level (CL) are more vulnerable to experience more serious Adverse Drug Reactions (ADRs) due to cancer chemotherapy; a mandatory pre-assessment of HL and CL as a part of comprehensive cancer care can help identify patients at risk of serious ADRs
Summary
Functional Health Literacy (HL) and formal education are two separate entities. Clinicians often consider an uneducated patient to be illiterate in health behavior whereas an educated patient may not necessarily be health literate too. In the National Adult Literacy Survey by Kirsch et al [2], 44% of adult men were found to be literate but had inadequate functional HL. It implies that reading labels on medicine bottles, understanding doctor’s advice and prescription, and following medical instructions are not carried out in the expected form. The understanding of contributoring factors and their influence on the severity of adverse drug reactions is incomplete without the psychosocial factors affecting them
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