The relationship between health literacy, patient activation, and health outcomes in breast cancer patients

The aim of this study was to evaluate the level of health literacy and patient activation in a sample of breast cancer patients as well as examine the relationships of these constructs to health outcomes. A cross-sectional study design was employed. HER-2 positive breast cancer patients receiving care at 12 oncology clinics in Texas who had scheduled office appointments between August and October 2018 were approached to participate in the study via convenience sampling. Patients who expressed willingness to participate in the study were given a 67-item survey to complete during their office visit. The survey consisted of the 6-item cancer health literacy measure (CHLT-6), the 6-item newest vital sign (NVS), the 13-item patient activation measure (PAM 13), the 27-item functional assessment of cancer therapy (FACT-G v. 4), two items measuring the quality of patient-provider communication, and single item measures for the number of ED visits/hospitalizations as well as clinical and demographic patient characteristics. All variables were analyzed descriptively (means, frequencies). Bivariate and multivariate analyses were also conducted to assess the relationships between variables and predict health outcomes. Almost 90 percent (N=146) of the 164 patients approached participated in the study. Results from the 146 study participants showed that the average age was 57.1±10.8 years. The majority were female (99%), Caucasian (72%), married or in a relationship (70%), at least had a college degree (53%), and had an annual household income over $50,000 (66%). Clinically, there was an almost equal distribution of patients from cancer stage 1 to stage 4 and most patients had been diagnosed for the first time within the last 5 years (78%). Ninety-two percent (N=134) of participants had adequate cancer health literacy while 79 percent (N= 114) had adequate general health literacy based on their CHLT-6 and NVS scores, respectively. The mean patient activation score was 65.9±15.7 (of a possible 100) with most patients (68%, N= 99) in the higher levels (level 3 or 4) of activation. The average quality of life based on an overall FACT-G score of 108 was high (82.6±16.1). Bivariate analysis showed significant positive relationships between cancer health literacy and educational level, and household income. Ethnic minorities were also found to have significantly lower patient activation scores compared to Whites. Multivariate analysis revealed that cancer health literacy, patient activation, educational level, and number of treatment types received explained 23 percent of the variation in quality of life, and all except cancer health literacy were positive and significant predictors. It is important to pay attention to modifiable factors such as patient activation that impact breast cancer patients’ quality of life in interventions aimed to improve quality of life, especially in ethnic minorities who tend to have lower patient activation levels. The high levels and homogeneity of cancer health literacy among study participants could have influenced its non-significant relationship with quality of life. Further assessments of health literacy and patient activation with quality of life as well as other health outcomes in larger and more diverse populations of breast cancer patients are warranted.Pharmaceutical Science

The effect of a tailored patient activation intervention in inflammatory bowel disease (IBD) patients – a pilot study

Patient activation may improve medication adherence by equipping patients with skills and knowledge about their disease. There is evidence of a positive relationship between activation and quality of life in IBD patients. However, the impact of a tailored patient activation intervention (PAI) among this group of patients has not been investigated. Activated patients are motivated to be partners in managing their health and would most likely remain in remission for longer periods (in the case of IBD patients). The purpose of this study was to evaluate the effectiveness of a Patient Activation Intervention (PAI) tailored to the needs of individual IBD patients in improving patient activation levels (primary outcome) as well as medication adherence, and satisfaction with medical care. A pre-test, post-test, control group design was employed. IBD patients, who met the inclusion criteria, were selected from medical records via convenience sampling, were consented and completed a baseline survey. They were then categorized into one of four patient activation stages based on responses to the 13-item patient activation measure (PAM-13) at baseline. During their office visit, intervention group patients (N=23) were given a tailored PAI based on their stage which consisted of an information booklet and focused discussion with the gastroenterologist, while the control group (N=27) received usual care. For those who completed both surveys (N=20 intervention group and N=21 control group), baseline scores were compared to 1-month post-intervention scores for changes in patient activation score/stage, medication adherence, and satisfaction with medical care using Chi square and T tests. The majority of participants were Caucasian (88%), female (64%), college graduates (56%), and had Crohn’s disease (59.2%). Averaging across both groups, females had a significantly higher (p=0.04) mean activation score (Mean=70.9, SD=15.4) than males (Mean=60.9, SD=10.7) at baseline and this trend was the same post-intervention (75.6 females vs 64.4 males; p=0.03). The mean activation score difference pre- vs post-intervention for the intervention group (Mean=6.8, SD=12.0) was higher than that of the control group (Mean=1.9, SD=12.5; p=0.21). There was no significant difference in medication adherence or satisfaction scores pre- vs post-intervention for either group. Tailored PAIs have the potential to provide customized medical care to patients (especially those with chronic conditions) and to involve them in their disease management, leading to improved health outcomes.Pharmaceutical Science

Representative sequencing: Unbiased sampling of solid tumor tissue

International audienceAlthough thousands of solid tumors have been sequenced to date, a fundamental under-sampling bias isinherent in current methodologies. This is caused by a tissue sample input of fixed dimensions (e.g., 6 mmbiopsy), which becomes grossly under-powered as tumor volume scales. Here, we demonstrate representative sequencing (Rep-Seq) as a new method to achieve unbiased tumor tissue sampling. Rep-Seq uses fixed residual tumor material, which is homogenized and subjected to next-generation sequencing. Analysis of intratumor tumor mutation burden (TMB) variability shows a high level of misclassification using current single-biopsy methods, with 20% of lung and 52% of bladder tumors having at least one biopsy with high TMB butlow clonal TMB overall. Misclassification rates by contrast are reduced to 2% (lung) and 4% (bladder) when a more representative sampling methodology is used. Rep-Seq offers an improved sampling protocol for tumor profiling, with significant potential for improved clinical utility and more accurate deconvolution of clonal structure