Patient compliance is critical for equivalent clinical outcomes for breast cancer treated by breast-conservation therapy

Literacy and health outcomes: a systematic review of the literature

OBJECTIVE

To review the relationship between literacy and health outcomes.

DATA SOURCES

We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003.

STUDY SELECTION

We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes. Two abstractors reviewed each study for inclusion and resolved disagreements by discussion.

DATA EXTRACTION

One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry. The whole study team reconciled disagreements about information in evidence tables. Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality.

DATA SYNTHESIS

We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report. Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources. Patients with low literacy were generally 1.5 to 3 times more likely to experience a given poor outcome. The average quality of the articles was fair to good. Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons.

CONCLUSIONS

Low literacy is associated with several adverse health outcomes. Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions.

FACT-G: reliability and validity of the Malayalam translation

BACKGROUND

Emphasis is currently being placed on the need for quality of life in cancer survivors. There is a great need to identify an appropriate tool for quality of life estimation in these linguistically and culturally different settings.

PATIENTS AND METHOD

The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was translated into the Malayalam language complying with the standard cross-cultural translation methodology. The tool was validated and used for estimating quality of life (QOL) of 214 cancer patients undergoing treatment with curative intent.

RESULTS

Cronbach's alpha for the Malayalam version of the FACT-G was 0.8, and for the subscales it ranged from 0.64 to 0.83, compared to source tool alpha of 0.89, with the subscale's ranging from 0.63 to 0.89. The mean overall FACT-G score was 79.8 (standard deviation [SD] = 18.7). Socio-economic factors such as education, education of the spouse, occupation of the spouse, and family income were found to influence FACT-G scores.

CONCLUSION

Despite cultural variations, the local Malayalam language version of the FACT-G scale was found to be reliable like the source scale and sensitive cross-culturally. The instrument makes it possible to identify domains influencing QOL and thereby may help direct interventions to them.

Patient care in multidisciplinary cancer clinics: does attention to psychosocial needs predict patient satisfaction?

Satisfaction with treatment is an important early indicator of medical outcome for cancer patients. This study examined patient satisfaction with treatment-planning and follow-up appointments among 58 recently diagnosed ENT and GI cancer patients seen at a multidisciplinary cancer clinic. Patients reported which medical specialties they saw, whether adjuvant treatment was planned, and whether they had a chance to discuss their feelings about the diagnosis. Patients also rated the attention paid by staff to several psychosocial issues considered relevant to cancer. These included how the patient was coping, support services available, and the issue of common emotional reactions to cancer. Patients then rated their overall satisfaction with their clinic visits. Overall satisfaction was predicted by younger age, female gender, and greater attention to how patients were coping with their illness. Having a chance to discuss one's feelings about the diagnosis, and staff attention to other psychosocial issues, also predicted patient satisfaction. The relationship of these psychosocial issues to patient satisfaction did not vary by gender. Results suggest that patient satisfaction may be enhanced when hospital staff attend to and provide for the psychosocial needs engendered by a diagnosis of cancer.

Race, socioeconomic status, and breast carcinoma in the U.S: what have we learned from clinical studies

BACKGROUND

Whether African-American women have biologically more aggressive breast carcinoma compared with white women and whether race acts as a significant independent prognostic factor for survival have not been determined. Alternatively, race merely may be a surrogate for socioeconomic status (SES).

METHODS

A literature review was performed of clinical trials and retrospective studies in the U.S. that compared survival between white women and black women with breast carcinoma after adjustment for known prognostic factors (patient age, disease stage, lymph node status, and estrogen receptor status) to assess the impact of race and SES.

RESULTS

Single institutional and clinical studies suggest that, when black patients are treated appropriately and other prognostic variables are controlled, their survival is similar to the survival of white patients. Twelve retrospective studies and 1 analysis of a clinical trial included SES and race as variables for survival. Only three of those studies revealed race as a significant prognostic factor for survival after adjusting for SES.

CONCLUSIONS

SES replaces race as a predictor of worse outcome after women are diagnosed with breast carcinoma in many studies. However, black women present with more advanced disease that appear more aggressive biologically, and they present at a younger age compared with white women. Further research should be conducted concerning the precise elements of SES that account for the incidence of breast carcinoma, age at diagnosis, hormone receptor status, and survival to devise better strategies to improve outcome.

Racial differences in treatment and survival from early-stage breast carcinoma

BACKGROUND

African-American women have a significantly worse prognosis from breast carcinoma compared with white women, even when the stage at diagnosis is equivalent. The purpose of this study was to analyze racial differences in the treatment (use of breast-conserving surgery and radiation therapy) of women with early-stage breast carcinoma and the resulting effects on survival rates.

METHODS

Subjects included 10,073 African-American and 123,127 white women diagnosed with Stage I, IIA, or IIB breast carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results program between 1988 and 1998. Comparisons were made by race with treatment, age, hormone receptor status, and stage at the time of diagnosis. Survival analyses were conducted to compare risk of death for African-American and white women while controlling for age, stage, and hormone receptor status.

RESULTS

Among women diagnosed with early-stage breast carcinoma who receive breast-conserving surgery, African-American women were significantly less likely to receive follow-up radiation therapy in every 10-year age group except in the older than 85 age group. Whether treatment was equivalent or suboptimal, survival for African-American women with early-stage breast carcinoma was significantly worse. However, when treatment was equivalent, the effects of racial differences on survival were significantly less compared with survival associated with suboptimal treatment.

CONCLUSIONS

Significant racial differences exist in the treatment of women with early-stage breast carcinoma. Public health efforts to eliminate suboptimal treatment would reduce, but not eliminate, racial disparity in survival.