Introduction

Patients with cancer are required to understand and process complicated information about their diagnosis and treatments. They must navigate the healthcare system, ensure they get to their appointments, and seek help in a timely manner. Patients face difficult decisions about their treatment and care. Health literacy underpins all of this, yet it is unclear how commonly patients with cancer experience difficulties with health literacy. This review set out to identify the prevalence of lower/limited health literacy in the oncology setting.

Methods

Searches were carried out in MEDLINE, EMBASE, PsycINFO and CINAHL on 15/01/2021. Search terms included MeSH terms (neoplasms, health literacy) and keywords (cancer, malignancy, neoplasm, tumour, carcinoma, health literacy and health competence). Titles and abstracts were screened by two independent reviewers. Full texts were independently reviewed for eligibility by two reviewers according to the following inclusion criteria: patients with cancer aged ≥18 years, English language publication, general or cancer health literacy assessed with validated tool, prevalence of lower/limited health literacy stated. Quality was appraised using the Mixed Methods Appraisal Tool.

Results

4440 records were identified, of which 2495 were screened after removing duplicates. 405 full text articles were assessed for eligibility, and 51 articles relating to 45 studies were included. The reported prevalence of health literacy difficulties ranged from 3-86%. Thirteen health literacy assessment tools were used, most commonly variations of the REALM (N=13, prevalence 10-38%) and Chew screening questions (N=13, prevalence 3-65%). 69% of the studies were carried out in the USA (N=31) and 27% included only patients with breast cancer (N=12). 25 studies were of good quality (MMAT score 4-5/5, prevalence 3-86%)

Conclusion

There is a wide variation in reported prevalence of health literacy difficulties in the oncology setting. This is due to the different populations studied, health literacy assessment tools used and variations in how limited/lower health literacy is categorised. Nonetheless, many patients diagnosed with cancer will face additional difficulties as a result during the course of their disease. Further work is needed to understand how this affects patient experience and outcomes in practice.