Although the adverse effect of burnout on physicians has been widely documented, studies have shown an inconsistent relationship between burnout and the quality of patient care. We hypothesized that physician burnout will have an inverse relationship with the time spent at the bedside by physicians. In a cross-sectional study, we surveyed patients on their perception of the time spent by their physician on the day of the survey (4 categories: 0-5, 6-10, 11-15, >15 minutes). Oldenburg Burnout Inventory was used to assess physician burnout; burnout was defined as high levels of both exhaustion (≥2.25) and disengagement (≥2.10). Among the 1374 patients, the most commonly reported time spent at bedside category was 6-10 minutes (n=614, 45%). Among the 95 physicians who saw these patients, burnout was present in 44 (46%), with a higher prevalence in women (61% vs 39%; P=0.04). Using ordered logistic regression, we found no relationship between physician burnout and patient's perception of bedside time spent, without adjustment (odds ratio: 0.86, 95% CI: 0.65-1.16) or with adjustment (odds ratio: 0.85, 95% CI: 0.64-1.12) for potential confounders. Although physician burnout is not associated with patient perception of time spent at bedside, it may be associated with other patient outcomes that require further research.
Purpose
Weight gain after breast cancer poses health risks. We aimed to identify factors associated with weight gain during adjuvant endocrine therapy (AET).
Methods
Women initiating AET enrolled in a prospective cohort. Participants completed FACT-ES plus PROMIS pain interference, depression, anxiety, fatigue, sleep disturbance and physical function measures at baseline, 3, 6, 12, 24, 36, 48 and 60 months. Treatment-emergent symptoms were defined as changes in scores in the direction indicative of worsening symptoms that exceeded the minimal important difference at 3 and/or 6 months compared to baseline. We used logistic regression to evaluate associations of clinicodemographic features and treatment-emergent symptoms with clinically significant weight gain over 60 months (defined as ≥ 5% compared to baseline) in pre- and post-menopausal participants.
Results
Of 309 participants, 99 (32%) were pre-menopausal. The 60 months cumulative incidence of clinically significant weight gain was greater in pre- than post-menopausal participants (67% vs 43%, p < 0.001). Among pre-menopausal participants, treatment-emergent pain interference (OR 2.49), aromatase inhibitor receipt (OR 2.8), mastectomy, (OR 2.06) and White race (OR 7.13) were associated with weight gain. Among post-menopausal participants, treatment-emergent endocrine symptoms (OR 2.86), higher stage (OR 2.25) and White race (OR 2.29) were associated with weight gain while treatment-emergent physical function decline (OR 0.30) was associated with lower likelihood of weight gain.
Conclusions
Weight gain during AET is common, especially for pre-menopausal women. Clinicodemographic features and early treatment-emergent symptoms may identify at risk individuals.
Implications for cancer survivors
Patients at risk for weight gain can be identified early during AET.
Clinical trials.gov identifier
NCT01937052, registered September 3, 2013.
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