Overall survival (OS) was poorer among patients with cancer who did not have an email address or accessed their patient portal. The study results were published in the journal JCO Clinical Cancer Informatics.1

Health literacy is the ability to access and understand health information and services to participate in decisions related to one’s own health. Low digital health literacy was defined in this study as the lack of an e-mail address in the patient’s electronic patient record (EPR). Digital health literacy involves being able to retrieve and understand health information electronically, and they noted that digital health helps to empower patients during care.

“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,” said the study investigators.

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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. Data obtained from patients were related to sex, age, certain cancer characteristics and outcomes, presence or absence of an e-mail address in the patient’s EPR, and whether or not the patient opened an account on the online patient portal. Overall survival was the primary endpoint, with Kaplan-Meier analyses adjusted with inverse probability of treatment weighting based on propensity scores. Multivariate analyses were also performed to identify predictors of OS.

The study evaluated a total of 15,244 patients with cancer, 55% of whom were women. Median patient age was 62 years (range, 19 to 103), and 35.5% of the patients had metastatic disease. EPRs showed e-mail addresses for 57.5% of patients, and a little more than one-quarter of patients (26.4%) had opened their patient portal account.

With a median follow-up of 3.6 years (range, 0 to 6.8), OS was significantly better among patients who had an email address in the EPR (P <.001). Multivariate analyses revealed various factors linked to poorer 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 e-mail address in the EPR (HR, 1.63; 95% CI, 1.33-2.00; P <.001).

“The absence of an e-mail 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 study 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