Purpose. Cancer patients carry rising burdens of health carerelated out-of-pocket expenses, and a growing number of patients are considered "underinsured." Our objective was to describe experiences of insured cancer patients requesting copayment assistance and to describe the impact of health care expenses on well-being and treatment. Methods. We conducted baseline and follow-up surveys regarding the impact of health care costs on well-being and treatment among cancer patients who contacted a national copayment assistance foundation along with a comparison sample of patients treated at an academic medical center. Results. Among 254 participants, 75% applied for drug copayment assistance. Forty-two percent of participants reported a significant or catastrophic subjective financial burden; 68% cut back on leisure activities, 46% reduced spending on food and clothing, and 46% used savings to defray out-of-pocket expenses. To save money, 20% took less than the prescribed amount of medication, 19% partially filled prescriptions, and 24% avoided filling prescriptions altogether. Copayment assistance applicants were more likely than nonapplicants to employ at least one of these strategies to defray costs (98% vs. 78%). In an adjusted analysis, younger age, larger household size, applying for copayment assistance, and communicating with physicians about costs were associated with greater subjective financial burden. Conclusion. Insured patients undergoing cancer treatment and seeking copayment assistance experience considerable subjective financial burden, and they may alter their care to defray out-of-pocket expenses. Health insurance does not eliminate financial distress or health disparities among cancer patients. Future research should investigate coverage thresholds that minimize adverse financial outcomes and identify cancer patients at greatest risk for financial toxicity. TheOncologist 2013;18:381-390Implications for Practice: The number of insured patients is increasing, but insured patients are paying more out of pocket for cancer care due to increased cost sharing. As a result, the number of underinsured cancer patients is increasing. Patients are faced with greater out-of-pocket health care costs, but treatment decision making is often made without consideration of these expenses. In our study, insured patients undergoing cancer treatment and seeking copayment assistance experienced considerable subjective financial burden, and they altered care to defray out-of-pocket expenses. Health insurance does not eliminate financial distress or health disparities among cancer patients. Financial distress or "financial toxicity" as a result of disease or treatment decisions might be considered analogous to physical toxicity and might be considered a relevant variable in guiding cancer management. Understanding how and among whom to best measure financial distress is critical to the design of future interventional studies.

Background To investigate the prognostic importance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer (NSCLC). Patients and methods Using a prospective design, 118 consecutive participants with histologically confirmed metastatic (inoperable) NSCLC and Eastern Cooperative Oncology group (ECOG) 0–3 completed a six-minute walk test to assess functional capacity and questionnaire that assessed self-reported exercise behavior. Cox proportional models were used to estimate the risk of all-cause mortality according to six-minute walk distance (6MWD) (<358.5 m, 358.5–450 m, ≥450 m) and exercise behavior (MET-hrs wk−1) categories with adjustment for important covariates. Results Median follow-up was 26.6 months; 77 deaths were reported during this period. Functional capacity was an independent predictor of survival (Ptrend = 0.003) and added incremental prognostic value beyond that provided by PS plus other traditional markers of prognosis (Ptrend = 0.025). Compared with patients achieving a 6MWD <358.5 m, the adjusted hazard ratio (HR) for all-cause mortality was 0.61 (95% CI, 0.34–1.07) for a 6MWD of 358.5–450 m, and 0.48 (95% CI, 0.24–0.93) for a 6MWD >450 m. In unadjusted analysis, there was a borderline significant effect of exercise behavior on survival (p = 0.052). Median survival was 12.89 months (95% CI, 9.11–21.05 months) for those reporting <9 MET-hrs wk−1 compared with 25.63 months (95% CI, 11.28 to ∞ months) for those reporting ≥9 MET-hrs wk−1. Conclusions Functional capacity is a strong independent predictor of survival in advanced NSCLC that adds to the prediction of survival beyond traditional risk factors. This parameter may improve risk stratification and prognostication in NSCLC.

Caregivers for patients undergoing solid organ transplantation play an essential role in the process of transplantation. However, little is known about stress and coping among these caregivers. Six hundred and twenty-one primary caregivers of potential candidates for lung (n = 317), liver (n = 147), heart (n = 115), and/or kidney (n = 42) transplantation completed a psychometric test battery at the time of the candidate’s initial pre-transplant psychosocial evaluation. Caregivers were generally well adjusted, with only 17% exhibiting clinical symptoms of depression (Beck Depression Inventory-II score > 13) and 13% reporting clinical levels of anxiety (State Trait Anxiety Inventory score >48). Greater caregiver burden and negative coping styles were associated with higher levels of depression. Greater objective burden and avoidant coping were associated with higher levels of anxiety. Caregivers evidenced a high degree of socially desirable (i.e., defensive) responding, which may reflect a deliberate effort to minimize fears or worries so as to not jeopardize patients’ listing status.

We were able to define predictors of admission for patients having LH/RAH managed with an ERAS pathway. Increased ASA physical status, being African American, and increased length of procedure were significantly associated with admission after LH/RAH performed under an ERAS pathway. In addition, the incidences of urgent clinic and ER visits, readmissions, and reoperations within 90 days of surgery were similar for patients who were discharged on the day of surgery compared to those admitted.

Hypothetical vignettes were used to examine the effects of classroom context variables (pedagogical quality and classroom goal structure) on undergraduate (study 1) and graduate (study 2) students' judgments about cheating. Consistent with attribution theory and previous findings, poor (versus good) pedagogy and performance (versus mastery) goals structures resulted in more teacher blame and less student blame for cheating, and cheating was rated as more acceptable and more likely in these situations. Participants' own prior cheating history but not their experience as a classroom teacher also affected these judgments. Relations between classroom context variables and assigned blame for cheating were mediated by students' assessments of the fairness of the classroom situation.