Overall survival (OS) was poorer among patients with cancer who had limited digital health literacy, according to study results published in JCO Clinical Cancer Informatics.

Health literacy is the ability to access and understand health information and services to participate in decisions related to one’s own health. Digital health literacy involves being able to retrieve and understand health information electronically. Limited digital health literacy was defined in this study as the lack of an email address in the patient’s electronic patient record (EPR).

“The negative impact of limited health literacy on the survival of patients with diabetes or chronic heart failure has already been demonstrated, but to our knowledge, it has never been discussed in patients with cancer,” the investigators wrote.

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The study was a noninterventional analysis of adults treated at Centre Léon Bérard in Lyon, France, who had received a cancer diagnosis between 2015 and 2017. The investigators obtained data on patients’ sex and age, certain cancer characteristics and outcomes, the presence or absence of an email address in the patient’s EPR, and whether or not the patient opened an account on the online patient portal. OS was the primary endpoint.

The analysis included 15,244 patients, 55% of whom were women. The median patient age was 62 (range, 19 to 103) years, and 35.5% of patients had metastatic disease. EPRs showed email addresses for 57.5% of patients, and 26.4% had opened their patient portal account.

With a median follow-up of 3.6 (range, 0 to 6.8) years, OS was significantly better among patients who had an email address in the EPR (P <.001). Multivariate analyses revealed various factors linked to worse OS, including de novo metastatic disease (hazard ratio [HR], 2.63; 95% CI, 2.47-2.79; P <.001), male sex (HR, 1.27; 95% CI, 1.15-1.41; P <.001), older age (HR, 1.02; 95% CI, 1.02-1.03; P <.001), and lack of an email address in the EPR (HR, 1.63; 95% CI, 1.33-2.00; P <.001).

“The absence of an email address for patients with cancer can be considered as a modern factor of fragility taking into account the prognostic impact on the OS of this population,” the investigators concluded.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original study for a full list of authors’ disclosures.


Heudel PE, Delrieu L, Dumas E, et al. Impact of limited e-health literacy on the overall survival of patients with cancer. JCO Clin Cancer Inform. 2022;6:e2100174. doi:10.1200/CCI.21.00174

This article originally appeared on Oncology Nurse Advisor