Survey Study Of Patients Research Articles

Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients

The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.

Why Some Mastectomy Patients Opt to Undergo Delayed Breast Reconstruction: Results of a Long-Term Prospective Study.

Delayed breast reconstruction is an option for women who have undergone mastectomy; however, uptake is low. The purpose of this study was to identify premastectomy and postmastectomy demographic, clinical, and psychosocial predictors of uptake of delayed breast reconstruction in the long-term survivorship period. This was a prospective longitudinal survey study of mastectomy patients in which a repeated measures design was used to evaluate uptake of delayed breast reconstruction. Demographic, clinical, and psychosocial variables were collected before mastectomy and 1 year after mastectomy. Information regarding uptake of delayed breast reconstruction was collected at approximately 6 years after mastectomy. A predictive model was designed using a multivariate logistic regression model and Akiake information criterion stepwise algorithm. Ninety-six mastectomy patients were followed from before mastectomy to 75.2 months after mastectomy, and 35 women (36.5 percent) underwent delayed breast reconstruction. Women who elected for delayed breast reconstruction experienced worsening of body concerns from before mastectomy to 1 year after mastectomy, compared with women who did not elect to undergo delayed breast reconstruction (p = 0.03). Mean scores for psychological distress were significantly worse both before mastectomy and 1 year after mastectomy in women who went on to undergo delayed breast reconstruction compared with those who did not undergo delayed breast reconstruction (p = 0.034 and p = 0.022, respectively). A predictive model for the uptake of delayed breast reconstruction was developed using demographic, clinical, and psychosocial characteristics. The area under the receiver operating characteristic curve was 85 percent, indicating good precision. Women who are experiencing higher levels of distress, anxiety, and body concerns both before and after mastectomy appear to be significantly likely to select delayed breast reconstruction. This may have implications for postreconstruction satisfaction and psychosocial functioning. Risk, III.

E10-B Palliative Care Needs at Different Phases in the Illness Trajectory: A Survey Study in Patients with Cancer

E10-B Palliative Care Needs at Different Phases in the Illness Trajectory: A Survey Study in Patients with Cancer

Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

Importance: Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM. Objectives: The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations. Design, Setting, and Participants: We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n = 167), a nail specialty clinic (n = 44), and a primary care clinic (n = 152). Main Outcomes and Measures: Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination. Results: Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as “very unsatisfied” with the evaluation of their nails by their dermatologist. Conclusions and Relevance: Our data shows that there is a lack of patient knowledge of LM and warning signs for SM. Further testing is needed to determine whether educating patients about LM, warning signs for SM, and nail self-examinations would improve patient outcomes.

Scan-associated distress in lung cancer: Quantifying the impact of “scanxiety”

ObjectivesDiagnostic imaging may be a major source of cancer-related distress, a condition known as “scanxiety”. Scant scholarly work has been performed to evaluate scan-associated distress in cancer. We sought to characterize risk factors for scan-associated distress among patients with Non-Small Cell Lung Cancer (NSCLC), and to evaluate the impact of scan-associated distress on quality of life. Materials and methodsWe conducted a cross-sectional survey study of patients with recurrent/metastatic NSCLC treated at an academic medical center. Clinical and demographic variables were obtained through chart abstraction and patient self-report. We used a modified version of the Impact of Event Scale 6 (IES-6) to specifically assess distress associated with scans, and quality of life was measured using the Functional Assessment of Cancer Therapy − Lung (FACT-L). ResultsAmong 103 participants (survey response rate 76.3%), median age was 67, 61.2% were women, and 82.5% were white. At the study visit, 72.8% of subjects discussed a recent scan, and 83% reported some scan-associated distress. Scan-associated distress was not associated with whether the patient had a recent scan, progressive disease or time from diagnosis. Scan-associated distress was associated with impaired quality of life (p=0.004); each unit increase in IES-6 corresponded to an approximately one-unit decrease in FACT-L score. ConclusionScan-associated distress is a common problem among patients with NSCLC, and is associated with impaired quality of life. Scan-associated distress severity was not associated with time since diagnosis or whether a recent scan was discussed at the study visit, which implies scan-associated distress may be a persistent problem.

Celiac disease diagnosis still significantly delayed – Doctor's but not patients’ delay responsive for the increased total delay in women

BackgroundThere is insufficient data on diagnostic delay and associated factors in celiac disease (CeD) as well as on its potential impact on the course of disease. MethodsSpecifically taking its two components – patients’ and doctors’ delay – into account, we performed a large systematic patient survey study among unselected CeD patients in Switzerland. ResultsWe found a mean/median total diagnostic delay of 87/24 months (IQR 5–96), with a range from 0 up to 780 months and roughly equal fractions of patients’ and doctors’ delay. Both mean/median total (93.1/24 vs. 60.2/12, p<0.001) and doctors’ (41.8/3 vs. 23.9/2, p<0.001) diagnostic delay were significantly higher in female vs. male patients, whereas patients’ delay was similar, regardless of preceding irritable bowel syndrome diagnosis. Patients with a diagnostic delay shorter than 2 years were significantly less often in need of steroids and/or immunosuppressants, substitution for any nutritional deficiency but more often free of symptoms 6 and 12 months after diagnosis. ConclusionsThere is a substantial diagnostic delay in CeD, which is associated with a worse clinical outcome and significantly longer in female patients. This increased diagnostic delay in women is due to doctors’ but not patients’ delay and cannot be explained by antecedent IBS prior to establishing the CeD diagnosis.

Palliative care needs at different phases in the illness trajectory: a survey study in patients with cancer.

Despite the growing consensus on the benefits of initiating palliative care early in the disease trajectory, it remains unclear at what point palliative care needs emerge. This study investigates quality of life and unmet palliative care needs at three phases in the cancer trajectory, curative, life-prolonging and most advanced (prognosis <6months/no further disease-modifying treatment). We collected self-reported data from 620 patients with cancer in the University Hospital of Ghent, Belgium. They completed a questionnaire on quality of life (using the EORTC QLQ-C30) and unmet care needs within the domains of palliative care. We used European reference values of the EORTC QLQ-C30 to compare the mean scores with a norm group. The groups further on in the cancer trajectory reported statistically and clinically poorer functioning compared with earlier phases, also when controlled for the effects of sex, age or type of cancer. Higher symptom burdens for fatigue, pain, dyspnoea and appetite loss were found in groups further into the trajectory, p<.001. Patients in the curative phase experienced physical symptoms and had clinically worse functioning than a European reference group. This paper demonstrates the ongoing need for oncologists to address the broader palliative care needs of patients from diagnosis onwards.

Early palliative care for children with cancer: A multi-institutional survey study of pediatric oncology patients and parents.

10582Background: Based on strong recent evidence, clinical consensus is growing that early Palliative care (PC) integration for cancer patients is the optimal care model; however, PC remains underu...

Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis

BackgroundUndergoing diagnostic evaluation for cancer has been associated with a high prevalence of anxiety and depression and affected health-related quality of life (HRQoL). The aims of this study were to assess HRQoL, anxiety, and depression pre- and post-diagnosis in patients undergoing diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors.MethodsA prospective, multicenter survey study of patients suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus patients with non-cancer diagnoses were calculated. The impact of baseline psychological, socio-demographic, and medical factors on HRQoL, anxiety and depression at follow-up was explored by bootstrapped multivariate linear regression analyses and logistic regression analyses.ResultsA total of 838 patients participated in this study; 679 (81 %) completed the follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of the follow-up. Patients presented initially with a high burden of symptoms and affected role and emotional functioning and global health/QL, irrespective of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis. There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self-rated health.ConclusionsPatients undergoing diagnostic evaluations for cancer based on non-specific symptoms experience a high prevalence of anxiety and affected quality of life prior to knowledge of the diagnosis. The predictive value of the baseline scores is important when assessing the psychological impact of undergoing diagnostic evaluations for cancer.

Focal vitiligo: long-term follow-up of 52 cases.

Focal vitiligo is characterized by depigmented patches located in a small area without a typical segmental distribution. Focal vitiligo is classified as an undetermined type of vitiligo, and a more definitive diagnosis can be made when the lesions have not evolved into non-segmental or segmental vitiligo after a period of 1-2 years. However, the chance of progression is not known and may lead to treatment-indecision. The objective was to study the characteristics of patients with focal vitiligo and possible predictors of progression. We conducted a survey study in patients with initial diagnosis of focal vitiligo between January 2005 and June 2010. Focal vitiligo was defined as either a small acquired isolated depigmented lesion without typical segmental distribution, or two to three small acquired lesions localized in a non-segmental area with a maximum of 5 cm. The survey comprised of 21 questions concerning the patient's characteristics, the onset of focal vitiligo, progression of depigmentation and treatment history. We identified 128 eligible patients and the response rate was 40.6% (n = 52 completed questionnaires). Progression to non-segmental vitiligo occurred in 23%. The median follow-up duration was 7 years. In 11.5% of the patients, progression to non-segmental vitiligo occurred within 2 years after onset. Nevertheless, even after a first stable period of more than 2 years, another 11.5% of the patients advanced to non-segmental vitiligo. No associated prognostic factors at baseline of progression to non-segmental or long-lasting focal vitiligo were found. Focal vitiligo is a rare subtype of vitiligo and most patients have long-lasting focal lesions after onset of the disease. In this study, focal vitiligo progressed to typical non-segmental vitiligo, but not towards typical segmental vitiligo. Progression 2 years after onset of focal vitiligo, occurs in 50% of the patients with eventual progression to non-segmental vitiligo. There seem to be no clinical signs that predict progression in focal vitiligo.

The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension.

Restless legs syndrome (RLS), a burdensome sleep disorder, has been associated with cardiovascular disease (CVD), hypertension, diabetes, and related disorders. However, the relationship of RLS to history of pregnancy-induced hypertension (PIH), a predictor of subsequent CVD, diabetes, and associated conditions, remains little explored. In this study, we investigated the relationship of RLS to history of PIH in a sample of primary care patients. Participants were women aged ≥40 years drawn from an anonymous survey study of West Virginia primary care patients. Data collected included detailed information on demographics, lifestyle factors, sleep patterns, and reproductive/medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or unsure about their pregnancy status were excluded from the analyses. Of the 498 participants in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms ≥once/week, 11.9% with symptoms ≥3 times/week); 73 (16.5% of parous women) reported a history of PIH, defined as physician-diagnosed preeclampsia or gestational hypertension. After adjustment for demographics, lifestyle characteristics, obesity, reproductive history, health conditions, and other factors, those reporting a history of PIH were approximately twice as likely to meet criteria for RLS (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.1, 3.6). These associations increased in magnitude with increasing symptom frequency (adjusted OR for RLS with symptoms ≥3 times/week = 3.8; CI 1.9, 7.6; p for trend = 0.003). History of PIH was strongly and positively related to current RLS in this study of primary care patients; these findings further support a possible role for metabolic dysregulation in RLS etiology.

Abstract P6-10-11: State based dense breast legislation and its effect on patient awareness

Abstract Recent efforts by advocacy groups to enact state government mandated legislation requiring that patients with dense breast tissue be informed of their breast density has been met with mixed responses by the medical community and cancer advocacy groups. Breast density has been well characterized as a risk factor for breast cancer, and is known to make mammogram interpretation more difficult. There are no formal recommendations for additional screening and management of patients who have dense breasts. There is no standard measurement in place for what defines dense breasts on mammography. Many women's health practitioners seeing radiology reports that comment on breast density are not adequately prepared to counsel patients in terms of best practice, as guidelines do not exist. Despite uncertainty of how knowledge of breast density impacts ongoing imaging or whether it impacts cancer early detection, 21 states have now enacted laws mandating breast density reporting It is unclear whether in states with mandatory reporting more patients are actually being informed about their breast density. "Are You Dense", the advocacy group driving this legislation, states that 40% of women have dense breast tissue and that 95% of these women are unaware of their breast density. The aim of this patient survey study was to determine whether state legislation for mandatory breast density reporting has altered the number of women informed about their breast density compared to states without mandatory reporting. A 19 question survey was introduced using the social media site Facebook targeting women who are health conscious. Patients were asked to answer questions about their age, personal and family history of cancer, personal and family history of genetic testing, health behaviors including tobacco and alcohol intake and exercise habits and BMI, and personal history of breast screening results and whether they had been told they had dense breasts by a health care provider. Results were recorded and data analyzed using chi square and student t test. 17,936 women visited the survey site, and 15,392 women completed the survey. Of these, 3,536 women reported to be over 40 and eligible for mammography screening. 1,997 (56%) reported that they had been informed by a health provider that they had "dense breast tissue". Among patients residing in the 21 states with mandatory reporting, 59% (1231 out of 2098 responding) reported being told they had dense breasts vs 53% (766 out of 1438) of patients residing in states without mandatory reporting. While groups advocating for mandatory reporting of breast density want to ensure that women with dense breast tissue are informed of their risk, and have access to an early breast cancer diagnosis, it is yet unclear whether this legislation impacts early cancer diagnosis or whether patients are actually being informed with increased frequency based on the legislation. Our study did not show a significant difference in the number of patients being informed of increased breast density in states with mandatory reporting. Additional studies are required to determine whether this legislation has any impact on patient awareness, uptake of additional screening, and earlier detection of breast cancer. Citation Format: Lindner D, Vasic J. State based dense breast legislation and its effect on patient awareness. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-11.

Temozolomide therapy in patients with aggressive pituitary adenomas or carcinomas.

Temozolomide is effective in some patients with progressive pituitary adenoma or carcinoma. We report a survey study of Italian patients treated with Temozolomide because of aggressive pituitary adenoma or carcinoma resistant to standard therapies. Italian endocrinologists were surveyed and asked to participate into the study. A questionnaire was sent to all those who agreed and had used Temozolomide in at least one patient with pituitary tumor. Database was closed in December 2013. A literature review was also performed. Thirty-one patients were included into the analysis. Mean age at start of Temozolomide treatment was 58.3 ± 1.9 years (± standard error). Six of the 31 (19.4%) Italian patients had a pituitary carcinoma. Twenty-five patients (80.6%) had disease control during Temozolomide treatment, while 6 patients (19.4%) had disease progression. Median follow-up after beginning Temozolomide was 43 months. Thirteen patients had tumor growth after stopping Temozolomide. The 2-year progression-free survival was 47.7% (95% CI 29.5-65.9%), while the 2-year disease control duration was 59.1% (95% CI 39.1-79.1%). Eleven patients died of progressive disease and other two patients of unrelated causes. The 2-year and 4-year overall survival rates were 83.9% (95% CI 70.7-97.1%) and 59.6% (95% CI 40.0-79.2%), respectively. Temozolomide is an additional effective therapeutic option for the treatment of aggressive pituitary tumors. The drug is well tolerated and causes few severe adverse effects. Recurrence of the tumor can occur after an initial positive response and usually portends a grim outcome.

Differences Between Emergency Nurse Perception and Patient Reported Experience With an ED HIV and Hepatitis C Virus Screening Program

Nontargeted human immunodeficiency virus (HIV) screening and targeted hepatitis C virus (HCV) screening for selected high-risk patients (those born between 1945 and 1965 and those who report injection drug use) was integrated into our ED triage process and carried out by nurses. Determining whether emergency nurses accurately perceive what patients experience is important to know because staff misperceptions may pose a barrier to program adherence and sustainability. We performed a cross-sectional survey study of emergency nurses and patients to assess the accuracy of emergency nurses' perception of patient experience with the HIV/HCV screening program. Respondents evaluated their level of agreement using a 5-item Likert scale for 9 statements across 4 domains related to the patient experience with the screening process (satisfaction, sense of autonomy, sense of privacy, and comfort level). Surveys were completed by 65 of the 153 eligible emergency nurses (42%). Of the 1040 patients approached, 610 (59%) were eligible, and 491 of the 610 eligible patients (80%) completed surveys. Across all domains, statistically significant differences were found between emergency nurse perception and patient report, P < .001. Emergency nurses perceived patients to be less satisfied with the screening program, more uncomfortable with being asked screening questions, more concerned about privacy issues, and less likely to feel that the decision to decline screening was autonomous than were patients. Emergency nurses not only frequently misperceive how patients experience ED-based HIV/HCV screening, but these misperceptions are skewed toward the negative, representing a type of staff bias. Further research is recommended to determine if such misperceptions adversely affect implementation of screening.

Pregnancy Outcomes and Symptom Relief Following Robot-Assisted Laparoscopic Myomectomy (RALM): A Patient Survey Study With Clinical Correlation

Pregnancy Outcomes and Symptom Relief Following Robot-Assisted Laparoscopic Myomectomy (RALM): A Patient Survey Study With Clinical Correlation

The Association of Restless Legs Syndrome to History of Gestational Diabetes in an Appalachian Primary Care Population.

Restless legs syndrome (RLS) is a burdensome sensorimotor disorder that has been linked to diabetes and obesity. However, the relationship of RLS to gestational diabetes mellitus (GDM), a common pregnancy complication strongly associated with obesity and a harbinger of diabetes, remains unknown. In this study, we examined the association of RLS to history of GDM in a sample of older female primary care patients. Participants were community-dwelling women aged ≥ 40 years drawn from an anonymous survey study of West Virginia adult primary care patients. Data gathered included detailed information on demographics, lifestyle factors, reproductive history, sleep patterns, and medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or had missing data on key variables were excluded from the analyses. Of the 498 participants included in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms at least once/week). After adjustment for demographics, lifestyle characteristics, body mass index, diabetes and other comorbid conditions, parity, and other factors, those reporting history of GDM were almost three times as likely to meet criteria for RLS (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.3, 5.3). This association increased in magnitude with increasing symptom frequency (adjusted OR for RLS symptoms ≥ 3×/week = 4.8, CI 2.1, 11.2, p for trend = 0.004). History of GDM was strongly and positively related to RLS in this study of older female primary care patients, offering further support for a possible role of metabolic dysregulation in RLS development.

Emergency Department Bouncebacks: Is Lack of Primary Care Access the Primary Cause?

BackgroundNational emergency department (ED) bounceback rates within 30 days of previous ED discharge have been found to be as high as 26%. We hypothesize that having a primary care physician (PCP) would prevent bouncebacks to the ED because a patient would have a medical resource for follow-up and continued care. MethodsWe performed a prospective, consecutive, anonymous survey study of adult ED patients at a suburban teaching hospital with 88,000 visits annually, from July 5, 2011 through August 8, 2011. Using chi-squared and Fisher's exact tests, we compared patients with an initial visit to those returning within 30 days of a previous visit to our ED. ResultsWe collected 1084 surveys. Those in the bounceback group were more likely to have no insurance (10.2% vs. 4.4%) or Medicaid (17.7% vs. 10.8%) and less likely to have a PCP (79% vs. 86%). Of those with a PCP, 9% in both groups had seen their PCP that day, 58% (initial visit) and 49% (bouncebacks) could have been seen that day, and 35% & 36%, respectively, within 1 week. Of those with a PCP, 38% of initial visits and 32% of bouncebacks stated they had already seen their physician at least once. ConclusionOur results suggest that patients who bounce back to the ED might have already contacted their PCP. Although insurance status and the lack thereof predict a higher likelihood to bounce back to the ED, many bouncebacks are insured patients with PCPs able to be seen the same day.

Sa1275 The Diagnostic Delay in Celiac Disease Is Significantly Increased in Women Due to Doctor's but Not Patient's Delay

Background: The majority of celiac disease (CD) cases remain undiagnosed (tip of the iceberg phenomenon) due to a variety of reasons, such as silent disease or unspecific symptoms with overlap to other diseases and insufficient awareness in both patients as well as physicians. The total diagnostic delay can be subdivided into patient's (gap between beginning of symptoms and first medical consultation) and doctor's (gap between first medical consultation and definitive diagnosis of CD) delay. There is insufficient data on diagnostic delay and associated factors in CD. In addition, it remains to be clarified, whether its extent has an impact on the course of the disease. Methods: We performed a large systematic patient survey study among unselected CD patients in Switzerland. Results were analyzed in total as well as in among selected subgroup of patients by means of descriptive statistics with a special focus on diagnostic delay. Results: A total of 1673 patients (76.1% female; mean age 41.1 y, range 0-92y, mean age at diagnosis 31y, range 0-83y) were analyzed. We found a mean total diagnostic delay of 72.1 months (median 18, IQR 4-72), with an enormous range from 0 up to 780 months and roughly equal fractions of patient's and doctor's delay with 39.5 (median 3, IQR 0-24) and 39.6 (median 4, IQR 0-28) months, respectively. While the mean age of diagnosis was not different in female vs. male patients (30.8 vs. 31.1 y), both, total (76.1 vs. 56.4, p=0.026) and doctor's (43.5 vs. 25.1, p 2 years, with no difference per se in freedom from symptoms between men vs. women. Treatment of nutritional deficiencies states was significantly more frequent in the long vs. short delay patients (74 vs. 58.5%, p<0.001). Conclusions: There is a substantial diagnostic delay in CD, due to both patient's and doctor's delay. Diagnostic delay is significantly longer in patients with older age at diagnosis and in female patients. This increased diagnostic delay in women is due to doctor's but not patient's delay, indicative of an insufficient awareness in physicians for CD especially in women. In addition, an increased diagnostic delay above two years is associated with a lower chance of clinical remission 6 and 12 months after diagnosis.

Evaluating Supportive Care for Children with Cancer: A Multi-Institutional Survey Study of Pediatric Oncology Patients and Parents (TH346-C)

•Discuss effective strategies and challenges for the delivery of early palliative care in pediatric oncology.•Discuss parent/patient attitudes toward symptom burden and management and early palliative care integration from the time of diagnosis in pediatric oncology. Based on strong recent evidence, clinical consensus touts early palliative care (PC) integration in oncology as the optimal care model; however, PC remains underutilized in pediatric oncology (ped-onc), and little is known regarding patient and family attitudes toward early PC. We conducted a multi-institutional study of ped-onc patients and parents to determine perception of symptom burden and management early in treatment and assess views on early integration of PC. Novel survey tools were developed using validated formats, when available. After IRB approval and pretesting, surveys were administered to 130 patient/parent dyads at three sites (NIH, JH, SJCRH). Eligibility criteria included patient age 10-17 at diagnosis, diagnosis date >1 month and <1 year, and English speaking. Preliminary analysis at 75% accrual was assessed for trends in response content frequencies, percentages, and degree of concordance between parent and child. Most children/parents (55%/49%) stated they would want to meet with PC around the time of diagnosis with only 2% of children and 6% of parents opposed. Seventy-nine percent of children/parents rated current quality of life (QoL) as good to excellent; 82%/84% considered QoL “somewhat important” or “very important” in decision making, yet 68%/83% prioritized cure over QoL when making treatment choices. Both anticipated improved health (96%) and elevated chance of cure (78%/86%) despite 13% of participants not evaluating expectations with their providers. Of parents whose perception of their child’s suffering from pain lacked concordance with that of their child (72.2%), 43.6% underestimated suffering and 58.7% overestimated their pain control; of those discordant with regard to nausea/vomiting (74.7%), 59.3% underestimated severity and 60.87% overestimated symptom control. Interim analysis reveals tentative trends that suggest that early integration of PC would be welcomed by the majority of ped-onc patients and families and would likely improve overall care.

Prevalence of Body Dysmorphic Disorder and Impact on Subjective Outcome amongst Singaporean Rhinoplasty Patients

Importance: To improve understanding of body dysmorphic disorder in Asian rhinoplasty patients Objective: To determine the prevalence of body dysmorphic disorder (BDD) in Asian patients who received cosmetic rhinoplasty and determine its impact on subjective outcomes after surgery. Design: A survey study of patients who received cosmetic rhinoplasty between January 2009 and December 2012 was undertaken. Telephone interview using validated instruments (Body Dysmorphic Disorder Questionnaire and Rhinoplasty Outcome Evaluation) were performed to determine the prevalence of BDD and the subjects? pre-/ post-operative subjective scoring of their noses. Setting: Tertiary care hospital Participants: All adult patients who received rhinoplasty for mainly cosmetic indications were included into our study population. Main Outcome Measures: Those who screened positive on the Body Dysmorphic Disorder Questionnaire were considered to have BDD. The Rhinoplasty Outcome Evaluation quantified the individual?s perception of his/her nose before and after the operation. Results: Fifty-two patients who received cosmetic rhinoplasty were approached and forty-seven (90%) agreed to and completed the interview. The mean age of participants was 31.1 years. Twenty-seven (57%) of the participants were male and 20 were female. Of the 47 patients who participated in the study, seven (15%) were identified to have possible BDD. Six out of 7 of them were male. The BDD-group (mean age=26.0) was significantly younger (p=0.003) than the non-BDD group (mean age=32.0). Although the revision rate was clinically higher for the BDD group (29%) than the non-BDD group (12.5%), this was not statistically significant (p=0.276). Both groups reported overall improvement in ROE scores but patients with BDD had significantly lower pre- and post-operative ROE scores compared to non-BDD patients (p<0.05). Conclusion and Relevance: Our results show that BDD is quite prevalent amongst patients who have received cosmetic rhinoplasty. BDD patients are likely to have poorer subjective outcomes after surgery although they may experience some improvement in satisfaction when compared to before surgery. Level of Evidence: 3