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Support Care Cancer. 2019 Jun 5. doi: 10.1007/s00520-019-04894-y. [Epub ahead of print]

The association between cancer care coordination and quality of life is stronger for breast cancer patients with lower health literacy: A Greater Plains Collaborative study.

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5240 MERF, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA.
Department of Medicine, University of Kansas Medical Center and University of Kansas Cancer Center, Kansas City, KS, USA.
Division of Hematology, Oncology and Transplantation, 420 Delaware St SE, MMC 480, Minneapolis, MN, 55455, USA.
Community and Health Systems, Nursing W433, Indiana University, Indianapolis, IN, 47405, USA.
Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St., WARF Room 307, Madison, WI, 53726, USA.
Division of Hematology, Oncology and Transplantation, Medical College of Wisconsin, Watertown Plank Road, 4th Fl Cancer Center, Milwaukee, WI, 53226, USA.
Science of Nursing Care, Nursing W401, Indiana University, Indianapolis, IN, 46220, USA.
N319 CPHB, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA.
S441A CPHB, Department of Epidemiology, University of Iowa, Iowa City, IA, 52242, USA.



Health literacy (HL) and cancer care coordination (CCC) were examined for their relationship to quality of life (QOL) among breast cancer survivors. CCC was hypothesized to have a stronger relationship to QOL for women with lower HL.


Women (N = 1138) who had completed treatment for Stage 0-III, ductal carcinoma breast cancer between January 2013 and May 2014 at one of eight large medical centers responded to a mailed questionnaire. Responses to questions about survivorship care planning and presence of professional care coordinator were combined to form an index of CCC. An index of HL was also derived. QOL was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) scales.


74.3% (N = 845) of patients reported having a health professional coordinate their care during treatment and 78.8% (N = 897) reported receiving survivorship care planning. CCC was classified as none, partial, or high for 7.1%, 32.7%, and 60.2% of the patients, respectively. Except for emotional well-being, the interaction between HL and CCC was significant for all QOL domains (p < .05); the effect of CCC on FACT-B scores was largest for people with lower HL. For the 39.8% of patients with less than high CCC, 111 (27.3%) had a level of HL associated with clinically meaningful lower QOL.


The association between CCC and later QOL is strongest for people who have lower HL. Prioritizing care coordination for patients with lower health literacy may be an effective strategy in a setting of limited resources.


Breast cancer; Care coordination; Health literacy; Quality of life; Survivorship


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