Monday, June 3, 2013

Cancer Patients Want to Talk About Costs

 Although financial distress is common, even in insured patients, discussion of costs of cancer care with doctors rarely happens, according to research to be presented at the annual meeting of the American Society of Clinical Oncology, held from May 31 to June 4 in Chicago. 
S. Yousuf Zafar, M.D., M.H.S., of Duke University in Durham, N.C., and colleagues performed a cross-sectional study of insured adults with solid tumors who had been receiving anticancer therapy for one month or longer. In-person interviews of consecutive patients were conducted at a referral center and three rural oncology clinics.
The researchers interviewed 302 participants (85 percent response rate) with a median age of 60 years and median income of $60,000 per year; most (78 percent) had incurable cancer. Even though the majority surveyed (58 percent) had private health insurance, the mean score for the group reflected moderate financial distress.
 The majority (52 percent) expressed any desire to talk about costs with their doctor, but only 19 percent said they had such discussions. Among 51 patients (17 percent) reporting high or overwhelming financial distress, only 13 (25 percent) had discussed financial concerns with the doctor. Overall, many (51 percent) claimed they wanted their doctors to consider costs in treatment decisions. Among those who discussed finances with their doctors, 57 percent thought that the discussion helped lower costs of care.
"With today‘s evolving health insurance landscape, cancer treatment-related costs to patients are more important than ever," Zafar said in a statement. "As providers, our team is convinced that cost discussions with our patients [are] important, and knowing that patients want to have these discussions should give us confidence in making this a routine practice."

Emotions in Alzheimer‘s Linked to Changes in Brain Size

 Emotional contagion, the tendency for two individuals to emotionally converge, increases as individuals progress from healthy to mild cognitive impairment to Alzheimer‘s disease, which correlates with smaller structures in the temporal lobe, according to a study published online May 28 in theProceedings of the National Academy of Sciences
Virginia E. Sturm, Ph.D., from the University of California San Francisco, and colleagues measured emotional contagion and depressive symptoms, and performed structural magnetic resonance imaging in 62 patients with mild cognitive impairment, 64 patients with Alzheimer‘s disease, and 111 healthy controls.
The researchers found that both emotional contagion and depressive symptoms significantly increased with increasing disease progression.
Only the higher emotional contagion significantly correlated with smaller volumes in the right inferior, middle, and superior temporal gyri, after correction for multiple comparisons. Higher emotional contagion also significantly correlated with smaller volumes in the right temporal pole, anterior hippocampus, parahippocampal gyrus, and left middle temporal gyrus, but the correlations did not survive correction.
"These findings suggest that in mild cognitive impairment and Alzheimer‘s disease, neurodegeneration of temporal lobe structures important for affective signal detection and emotion inhibition are associated with up-regulation of emotion-generating mechanisms," Sturm and colleagues conclude.