Abstract B044: Preliminary findings on cancer health literacy and frailty in older adults with cancer: Insights from the ongoing GAIN-S GOTO trial

Abstract Background: Limited health literacy is associated with frailty and poor outcomes among older adults, but data linking cancer health literacy to frailty in older adults with cancer are limited, especially in low-resource settings. We conducted a preliminary analysis using interim data from the ongoing geriatric assessment-guided intervention and supportive care trial via the multi-institutional Geriatric Oncology Therapy Optimization program (GAIN-S GOTO) to examine this association. Methods: GAIN-S is a single institution randomized controlled trial (RCT) within the Cancer and Aging Research Group (CARG)- GOTO initiative, delivering geriatric assessment (GA)–guided intervention via telehealth to support oncology decision-making in low-resource community practices. Eligible participants were ≥65 years with a new cancer diagnosis initiating therapy. Before treatment, patients completed a GA and the 6-item Cancer Health Literacy Test (CHLT-6). Participants with fewer than 5 correct answers were classified as limited. Frailty was measured using the Deficit Accumulation Index (DAI; range 0-1) based on the GA and categorized as robust (<0.2), prefrail (0.2–0.34), or frail (≥0.35). We used multinomial and ordinal logistic regression to examine the association between cancer health literacy and frailty. Analyses were performed in SAS 9.4, with two-sided p-values <0.05 considered significant. Results: Among 91 participants (median age 71, range 65–88), 65% were female. The most common cancers were lung (n=17), breast (n=13), endometrial (n=11), and colorectal (n=10). Forty-three (47%) had stage I–III disease and 48 (53%) had stage IV. Thirty-nine (43%) had a high school education or less, 62 (68%) were White, and 50 (55%) were married. Overall, 21 (23%) were classified as having limited cancer health literacy. Limited cancer health literacy was more common among those with lower education (39% vs. 12%, p=0.003). Based on DAI, 33 (36%) were robust, 40 (44%) prefrail, and 18 (20%) frail. In multivariable multinomial logistic regression, limited cancer health literacy was associated with significantly higher odds of frailty (OR=4.7, 95% CI: 1.06–21.2, p=0.04) and non-significantly higher odds of prefrailty (OR=2.16, 95% CI: 0.58–8.10, p=0.17) after adjusting for age and education. Ordinal logistic regression showed a significant trend toward greater frailty severity associated with limited cancer health literacy (p=0.04). Conclusions: Limited cancer health literacy was associated with higher frailty among older adults with cancer in low-resource settings participating in a clinical trial. Incorporating cancer health literacy evaluation into geriatric assessment may help identify vulnerable patients with cancer and guide supportive interventions. These findings have implications for patient centered equitable cancer care and clinical trial engagement among older adults. Future directions include identifying whether adding cancer health literacy assessment enhances the effectiveness of geriatric assessment to improve cancer treatment outcomes. Citation Format: Tanyanika Phillips, Can-Lan Sun, Heeyoung Kim, Leana Cabrera Chien, Africa Robison, Su Su Soe San, Ty Lee, Vani Katheria, William Dale. Preliminary findings on cancer health literacy and frailty in older adults with cancer: Insights from the ongoing GAIN-S GOTO trial [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B044.