Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology Obu, Japan.
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Cancer Med. 2024 Oct;13(20):e70311. doi: 10.1002/cam4.70311.
The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population.
We conducted a postal follow-up survey, associated with the National Center for Geriatrics and Gerontology-Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed.
Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65-74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03-3.04), colorectal (AOR, 1.70, 95% CI 1.08-2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40-6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11-2.99).
Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient-centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health-related information.
痴呆症、轻度认知障碍和癌症的发病率随年龄增长而上升，给患者及其家庭带来了挑战。然而，目前针对认知障碍患者，尚无明确的癌症筛查指南。本研究分析了照顾者健康素养对该人群筛查行为的影响。
我们进行了一项邮政随访调查，该调查与日本国立老年医学和老年学研究中心的“痴呆症患者生活故事”项目相关，以评估主要照顾者在过去 2 年内报告患者参加日本厚生劳动省推荐的常规癌症筛查的情况。比较了记忆诊所队列与全国平均水平的筛查率，并分析了照顾者健康素养水平对筛查的影响。
在分析的 826 名个体中，记忆诊所队列的女性患者（65-74 岁）乳腺癌筛查率较低，为 11%，而全国平均水平为 32%。照顾者健康素养水平较高与筛查率增加显著相关。对于女性患者，具有较高沟通健康素养的照顾者更有可能确保患者参加胃（调整后的优势比 [AOR]，1.77；95%置信区间 [CI]，1.03-3.04）、结直肠癌（AOR，1.70，95% CI 1.08-2.70）和乳腺癌（AOR，3.08；95% CI，1.40-6.76）筛查。对于男性患者，较高的沟通健康素养与肺癌筛查参与度增加相关（AOR，1.82；95% CI，1.11-2.99）。
我们的研究强调了认知障碍患者与普通人群之间在癌症筛查参与度方面存在显著差距，这可能源于筛查程序的复杂性和照顾者的巨大负担。通过以患者为中心的沟通策略，可以实现更明智的决策和增加筛查率，这些策略可以适应患者的认知能力，确保健康相关信息的可理解性和可及性。
