Economic and health literacy inequalities in patient-reported experiences of cancer care

BACKGROUND: Patients’ economic status and level of health literacy may influence their experiences with healthcare services. However, few studies have examined how these factors shape inequalities in patient-reported experiences measures (PREMs), particularly in cancer care. Thus, we investigated whether experiences of cancer care differed according to patients’ economic status and level of health literacy. METHODS: We used data from 3,220 adult patients diagnosed with cancer collected by the Swiss Cancer Patient Experiences (SCAPE) study in eight Swiss hospitals from September 2021 to February 2022. Logistic regressions were used to investigate the association between patients’ economic status and health literacy and 30 different outcomes, in separate models for each outcome. The outcomes covered eight different areas of cancer care experiences. Models were adjusted for patients’ age, gender, education level and self-rated health. Since hospitals were located in two different linguistic regions of Switzerland, we tested interaction effects between the regions and economic status and health literacy. RESULTS: In the sample, 30.6% of patients experienced economic hardship and 25.7% had a low health literacy. Patients with low economic status and low health literacy had worse experiences of cancer care for 21 outcomes and 24 outcomes, respectively, compared to patients reporting higher economic status and higher health literacy. No differences were found between linguistic regions in the effects of these two predictors. Discussion: Our study showed that economic and health literacy factors generated inequalities in patients’ experiences of cancer care: patients with lower economic status and health literacy were negatively affected in their cancer care experiences. Hence, disadvantaged patients may require specific attention in order to enhance their experiences with healthcare services, and promote a more equal treatment of patients in cancer care. KEY MESSAGES: • Few studies have investigated inequalities in patients’ experiences with cancer care, while factors such as economic status and health literacy may affect care experiences. • Patients who face economic hardship and with low health literacy showed a worse cancer care experience. These disadvantaged patients may require specific attention to improve their care experience.