Background: Prognosis discussion is an essential component of informed decision-making. However, many terminally ill patients have a limited awareness of their prognosis and the causes are unclear. Objective: To explore the impact of physicians' propensity to discuss prognosis on advanced cancer patients' prognosis awareness. Design: Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, a prospective cohort study with patient and physician surveys. Setting/Subjects: We investigated 686 patients with metastatic lung or colorectal cancer at diagnosis who participated in the CanCORS study and reported about their life expectancy. Data were linked to the physician survey from 486 physicians who were identified by these patients as filling important roles in their cancer care. Results: Few patients with metastatic cancers (16.5%) reported an accurate awareness of their prognosis, defined as reporting a life expectancy of less than 2 years for lung cancer or less than 5 years for colorectal cancer. Patients whose most-important-doctor (in helping patient make decisions) reported discussing prognosis with terminally ill patients earlier were more likely than those whose doctors deferred these discussions to have an accurate prognosis awareness (adjusted proportion, 18.5% versus 7.6%; odds ratio, 3.23; 95% confidence interval, 1.39-7.52; p = 0.006). Conclusions: Few patients with advanced cancer could articulate an accurate prognosis estimate, despite most having received chemotherapy and many physicians reported they would discuss prognosis early. Physicians' propensity to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis.

Background Androgen deprivation therapy (ADT) for prostate cancer is associated with decreased insulin sensitivity and incident diabetes. Few data are available about the effects of ADT on diabetes control among men with diabetes. We examined care for over 7500 men with prostate cancer who had diabetes at the time of diagnosis to assess the effect of ADT on diabetes control, as measured by HbA1c levels and the intensification of diabetes drug therapy. Methods We compared hemoglobin A1c (HbA1c) levels and intensification of diabetes pharmacotherapy among 2237 pairs of propensity matched men with prostate cancer and diabetes who were or were not treated with ADT. We calculated the difference-in-difference of HbA1c levels at baseline and 1 and 2 years in the 2 groups, compared using a paired t test. We used a Cox proportional hazards model to estimate time to intensification of diabetes therapy. Results The mean (SE) HbA1c at baseline was 7.24 (0.05) for the ADT group and 7.24 (0.04) for the no-ADT group. HbA1c increased at 1 year for men treated with ADT to 7.38 (0.04) and decreased among men not treated with ADT to 7.14 (0.04), for a difference in differences of +0.24 (P=0.008). Results were similar at 2 years (P=.03). Receipt of ADT was also associated with an increased hazard of addition of diabetes medication (adjusted hazard ratio=1.20, 95% CI=1.09-1.32). Conclusions ADT is associated with worsening of diabetes control, with both increases in HbA1c levels and the need for additional diabetes medications.

Background: Knowledge of existing prescription patterns in the treatment of newly-diagnosed hypertension can provide useful information for improving clinical practice in this field. The aims of this study are to determine the prescription patterns and time trends for antihypertensive medication in newly-diagnosed cases of uncomplicated hypertension in Taiwan and to compare these with current clinical guidelines.

No abstract