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

Bradley D. McDowell, Jennifer Klemp, Anne Blaes, Andrea A. Cohee, Amy Trentham-Dietz, Sailaja Kamaraju, Julie L. Otte, Sarah L. Mott, Elizabeth A. Chrischilles

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)887-895
Number of pages9
JournalSupportive Care in Cancer
Issue number2
StatePublished - Feb 1 2020

Bibliographical note

Funding Information:
The authors would like to thank Julie McGregor, Amy Godecker, Kathy Peck, and Sarah Esmond for their assistance with data collection and study conduct; the Share Thoughts on Breast Cancer patient advocates who helped develop the study questionnaire including Cheryl Jernigan and Jody Rock; the study site coordinators and project managers who conducted the study mailings including Teresa Bosler, Michele Coady, Mack Dressler, Sarah Esmond, Bret Gardner, Amy Godecker, Brian Gryzlak, Julie McGregor, Deb Multerer, Char Napurski, Kathy Peck, Nick Rudzianski, Sabrina Uppal, Xiao Zhang, and Brittany Zschoche; investigators overseeing data collection including Drs. Anne Berger, Anne Blaes, Elizabeth Chrischilles, Lindsay Cowell, Barbara Haley, Jennifer Klemp, Ingrid Lizarraga, Joan Neuner, Adedayo Onitilo, Amalie Ramirez, and Priyanka Sharma; and the Greater Plains Collaborative informatics team who integrated tumor registry data and selected the study samples including Bhargav Adagarla, Daniel Connolly, Tamara McMahon, Glenn Bushee, Supreet Kathpalia, Jim McClay, Eneida Mendonca, Tom Mish, Susan Morrison, Phillip Reeder, Nicholas Smith, and Laurel Verhagen.

Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Breast cancer
  • Care coordination
  • Health literacy
  • Quality of life
  • Survivorship
  • Health Literacy/standards
  • Cancer Survivors
  • Humans
  • Middle Aged
  • Quality of Life/psychology
  • Breast Neoplasms/psychology
  • Female
  • Surveys and Questionnaires

PubMed: MeSH publication types

  • Journal Article


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