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Learning Objectives After completing this course, the reader will be able to: Outline the five steps that comprise shared decision making.Identify specific tactics that can be used to engage a patient in a shared decision making process. This article is available for continuing medical education credit at CME.TheOncologist.com Background. There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference-sensitive decisions by incorporating patient preferences into decision discussions. Methods. This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient-centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference-sensitive decisions in which SDM can enhance the clinical encounter. Results. Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision-making process. Conclusion. Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.

Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors’ implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors’ knowledge of the Public Health Service’ s clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors’ knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.

Objective To systematically review the literature regarding factors related to women's menopausal symptom management decision making. Methods The PubMed.gov online search engine was queried using pre-selected inclusion and exclusion criteria. Reference lists of articles were also reviewed to identify potentially missed articles. Full-text, English-language, peer-reviewed articles on factors related to menopausal symptom management decisions were reviewed. Results A total of 16 articles (15 data-based, 1 review of literature) from 6 different countries were reviewed. Most articles were related to decisions about one class of therapies and did not take into account all available therapeutic options. In the 15 data-based articles, diverse methods were used: qualitative (47%), quantitative (47%), and mixed (6%), with most being cross-sectional (93%). Very few of the data-based articles were based on a conceptual model (20%) and none used findings to derive an explanatory or predictive model. Most samples were not representative of special populations, such as women with breast cancer. Factors fell into four broad categories: (1) individual characteristics (demographics, menopause experience, symptomatology); (2) values, attitudes, beliefs, and preferences (attitudes and beliefs about menopause and treatments, preferred modalities, tolerance for risks/side effects); (3) facts and information about menopause and symptom management (amount, type, source, credibility, availability); and (4) health care context (health care provider communication, trust, availability/time, knowledge, relationship). Conclusions Additional descriptive studies are needed understand women's menopausal symptom management decisions in the context of all available therapies so that a comprehensive model of menopausal symptom management decision making can be specified. Additional understanding is needed regarding decisions in special populations of menopausal women such as breast cancer survivors, a group for whom menopausal symptom management can be particularly complex.

Dental hygienists have opportunities to take a substantive role in tobacco control efforts. Previous research has suggested that implementation of tobacco cessation strategies has been sub-optimal, but few studies have examined factors associated with dental hygienists' delivery of evidence-based tobacco cessation treatment. Among dental hygienists, the current study investigated tobacco-related knowledge and attitudes, as well as clinical practices consistent with evidence-based guidelines for tobacco cessation.Practicing dental hygienists in the state of Kentucky (n=308) responded to a paper and pencil questionnaire that collected information regarding their demographic, clinical characteristics and knowledge, attitudes and clinical practices regarding tobacco cessation treatment.Participants were somewhat familiar with evidence-based clinical practice guidelines regarding tobacco cessation treatment, but reported infrequent implementation of the 5 A's (Ask, Advise, Assess, Assist, Arrange). While participants were well aware of health risks associated with tobacco use and the value of cessation, few reported comfort or confidence in their ability to employ evidence-based interventions. However, several key variables were associated with implementation of recommended clinical practices (guideline awareness, comfort with specific tobacco cessation activities and self-efficacy).Results identified potential deficiencies in areas of tobacco control knowledge and confidence among dental hygienists. Correlations with evidence-based tobacco control practices suggest that knowledge and attitudes could serve as targets for education and training programs to promote greater implementation. While dental hygienists have unique opportunities to reduce tobacco-related morbidity and mortality, more education and training is necessary to increase adoption, implementation and sustainability of these important interventions.

Objective To systematically review the literature regarding the effects of menopausal symptom management decision aids. Methods Using pre-designated inclusion and exclusion criteria, relevant articles were located using the PubMed.gov online search engine and reviewing reference lists of relevant articles. Full-text, English-language, peer-reviewed articles relevant to testing decision aids in uncontrolled trials (UCT) and randomized controlled trials (RCT) were reviewed. Results The 18 articles represented 15 trials focused on natural health products decision aids (1 UCT, 1 RCT) or hormone therapy decision aids (1 UCT, 12 RCT). Whereas the natural health products aid was intended for women deciding about menopausal symptom management strategies, decision aids for hormone therapy were intended for a broader group of menopausal women and included indications for symptom management, prevention of heart disease, and prevention of osteoporosis. Many trials occurred prior to two pivotal events: the 2002 announcement of the Women's Health Initiative findings and the 2006 publication of the International Patient Decision Aids Standards. Study limitations may help explain contradictory findings for outcomes such as decisional conflict, decisional confidence, decisional satisfaction, knowledge and values, and decisions. Conclusions There is a relatively scant contemporary literature related to menopausal symptom management decision aids. Additional methodologically sound studies are needed to develop and subsequently test decision aids that are based on (a) contemporary knowledge regarding the wide array of available therapies and (b) international standards for decision aids that include consideration of women's values and preferences.

Voluntary nurse turnover, which is costly and disrupts patient care, has not been studied as an organizational phenomenon within substance abuse treatment organizations. In this exploratory study, we examined the frequency and correlates of nurse turnover within treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN). During face-to-face interviews conducted in 2005–2006, 215 program administrators reported the number of nurses currently employed. Leaders of programs with nursing staff then described the number of nurses who had voluntarily quit in the past year, the degree to which filling vacant nursing positions was difficult, and the average number of days to fill a vacant position. About two-thirds of these programs had at least one nurse on staff. In programs with nurses, the average rate of voluntary turnover was 15.0%. Turnover was significantly lower in hospital-based programs and programs offering adolescent treatment, but higher in facilities offering residential treatment. The majority of administrators indicated that filling vacant nurse positions was difficult and took more than two months to complete. These findings suggest that nurse turnover is a significant issue facing many substance abuse treatment facilities. Efforts to improve retention of the addiction treatment workforce should be expanded to include nursing professionals.

Lung cancer patients generally experience high levels of physical and psychological distress and decreased quality of life (QOL). Sense of coherence (SOC) has been conceptualized as a personality orientation reflecting the degree to which an individual perceives their world as comprehensible, manageable and meaningful. The present study investigated the associations of SOC with QOL in lung cancer. It also examined potential psychological mediators by which SOC may exert its influences on QOL. Fifty-six participants with non-small cell lung cancer were administered self-report assessments of SOC, QOL and psychological distress. Results revealed that SOC was positively associated with QOL and this relationship may be mediated by depressive symptoms. The current study supports the notion that SOC may be a protective factor with regard to psychological adjustment and QOL in cancer survivors.

To develop and test a biopsychosocial model using structural equation modeling for predicting orofacial pain symptoms in a sample of patients with masticatory muscle pain (MMP).Data were collected from clinic records of 251 adult patients who presented for initial evaluation to the Orofacial Pain Center at the University of Kentucky College of Dentistry and were subsequently diagnosed with MMP. Data were used to fit a model relating stressors, psychological distress, arousal, sleep problems, oral parafunction, and pain symptoms. Items from the Multidimensional Pain Inventory (MPI) and the IMPATH:TMJ, a comprehensive biopsychosocial assessment of patients with temporomandibular disorders (TMD), were used to construct a measurement model of five latent variables.Estimation of the model indicated a good fit to the data and significant associations between stressors, psychological distress, arousal, sleep problems, and pain symptoms. Sleep problems partially mediated the relation between arousal and pain symptoms. Contrary to hypotheses, no association occurred between oral parafunction and pain symptoms, possibly indicating that any relationship between oral parafunction and pain symptoms may not exist.Results from the model tested in the present study are an additional step toward developing a more comprehensive biopsychosocial model explaining the nature and etiology of MMP in orofacial pain and TMD. With additional development and testing, it may also serve as an aid to planning interventions, especially psychosocial interventions targeting stress management, psychophysiological regulation, psychological distress, and sleep problems.

Clinician communication is critical to positive outcomes for patients and families in most health contexts. Researchers have investigated areas such as defining and teaching effective communication and identifying specific outcomes that can be improved through more effective communication. In the area of cancer care, advances in detection and treatment require that clinicians develop new skills to adapt to the evolving needs of patients, families, and other members of the health care team. Some areas that require the attention of researchers are defining, assessing, and teaching effective communication in the context of the specific desires and preferences of individual patients and special populations; and meeting the needs of patients across the cancer continuum from screening, diagnosis, treatment to palliative care and survivorship. This report highlights three areas of research in cancer clinician communication including key areas of current and emerging research and theories and approaches for future research.

Treatment for head and neck cancer precipitates a myriad of distressing symptoms. Patients may be isolated both physically and socially and may lack the self-efficacy to report problems and participate as partners in their care. The goal of this project was to design a telehealth intervention to address such isolation, develop patient self-efficacy, and improve symptom management during the treatment experience. Participatory action research and a review of the literature were used to develop electronically administered symptom management algorithms addressing all major symptoms experienced by patients undergoing treatment for head and neck cancers. Daily questions and related messages were then programmed into an easy-to-use telehealth messaging device, the Health Buddy(R). Clinician and patient acceptance, feasibility, and technology issues were measured. Using participatory action research is an effective means for developing electronic algorithms acceptable to both clinicians and patients. The use of a simple tele-messaging device as an adjunct to symptom management is feasible, affordable, and acceptable to patients. This telehealth intervention provides support and education to patients undergoing treatment for head and neck cancers.

Aim: Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy. Goal: To validate a new symptom-predominant classification for gastroparesis using symptom severity and quality-of-life measures. Study: Subjects with gastroparesis for > 2 months were prospectively enrolled. A physician classified each subject into one of the following: vomiting-predominant, dyspepsia-predominant, or regurgitation-predominant gastroparesis. Subjects also classified themselves independently from the physician. Each subject completed a Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and SF-12v2 Health-Related Quality-Of-Life survey. Receiver operating characteristic curves were constructed with sensitivity and specificity of each PAGI-SYM subscale to differentiate subjects into symptom-predominant subgroups. Area under the curve (AUC) was used to compare the receiver operating characteristic curves. Analysis of variance, Cohen's kappa (K) statistic, student t test, and Pearson correlation (r) were used. Results: One hundred subjects (87 females, mean 48 y) were enrolled. There was a 78% concordance between physician and subject's classification of gastroparesis with substantial correlation (K = 0.64). PAGI-SYM nausea/vomiting subscale (AUC = 0.79) and PAGI-SYM heartburn/regurgitation subscale (AUC = 0.73) were the best in differentiating subjects into vomiting-predominant and regurgitation-predominant gastroparesis, respectively. No subscale was adequate to differentiate dyspepsia-predominant gastroparesis. SF-12v2 total scores significantly correlated with worsening of the total PAGI-SYM scores (r = -0.339 to -0.600, all P < 0.001). Conclusions: There was a substantial agreement between physician and patient using a symptom-predominant gastroparesis classification. Results suggest that a predominant-symptom classification is a valid means to categorize subjects with vomiting-predominant and regurgitation-predominant gastroparesis. Patients with dyspepsia and delayed gastric emptying need further research.

Lung cancer remains a devastating disease associated with substantial morbidity and mortality. Recent research has suggested that lung cancer screening with spiral computed tomography scans might reduce lung cancer mortality. Studies of lung cancer screening have also suggested that significant numbers of participants quit smoking after screening. However, most have relied solely on self-reported smoking behavior, which may be less accurate among participants in lung cancer screening. To assess the validity of self-reported smoking status among participants in a lung cancer screening trial, this study compared self-reported smoking status against urinary cotinine levels. The sample included 55 consecutive participants enrolled in a randomized clinical trial comparing annual spiral computed tomography and chest X-ray for lung cancer screening. Participants were a mean of 59 years of age and predominantly Caucasian (96%) and male (55%). Self-reported smoking status was assessed before and after participants learned of the purpose of the biochemical verification study. Using urinary cotinine as the “gold standard,” the sensitivity and specificity of self-reported smoking status were 91% and 95%, respectively (κ = 0.85, P < 0.001, 95% confidence interval = 0.71-0.99). Total misclassification rate was 7%. However, three of the four misclassified participants reported concurrent use of nicotine replacement strategies. Eliminating these cases from the analysis revealed sensitivity of 100% and specificity of 95% (κ = 0.96, P < 0.001, 95% confidence interval = 0.88-1.00). In conclusion, self-reported smoking status among participants in a lung cancer screening trial was highly consistent with urinary cotinine test results. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1825–8)

Many patients play an active role in determining their cancer treatments, and the communication of medical information influences patient decision-making. This study examined participants' preferences between various methods of communicating quantitative risks and benefits of adjuvant chemotherapy. Using clinical vignettes, participants were first asked to decide whether or not to endorse chemotherapy and were subsequently asked about their preferences for the methods used to communicate the risks and benefits. Participants preferred the absolute survival benefit method over negatively framed methods, such as relative or absolute risk reduction. We also present analysis of qualitative data which supports the conclusions drawn from quantitative analyses. In summary, the absolute survival benefit was shown to be the superior method of communicating quantitative risks and benefits of chemotherapy. Failure to use clear and concise methods of communicating quantitative risk and benefit information may compromise efforts to obtain informed consent for treatment. Copyright © 2004 John Wiley & Sons, Ltd.

OBJECTIVE This article provides an overview of how psychosomatic research on pain has evolved over the past 60 years as exemplified by studies published in Psychosomatic Medicine. METHODS Each issue of Psychosomatic Medicine from 1939 to 1999 was reviewed to identify papers that dealt with pain, painful medical conditions, or pain management. A total of 150 papers were identified and grouped into seven categories: 1) case studies; 2) studies of personality traits and other individual differences; 3) psychophysiological studies of pain; 4) studies using pain induction techniques; 5) studies examining the relation of relation of race, ethnicity, and culture to pain; 6) studies of pain unique to women; and 7) studies examining treatments for pain. RESULTS A substantial number of studies on pain and painful conditions were published in the Journal in the 1940s and 1950s, and that number has almost doubled in the most recent full decade of the Journal. Within the pain area, however, the topics of interest to psychosomatic researchers have been, and continue to be, quite diverse. Although publications on certain methods or topics (eg, psychodynamic case studies, physiological correlates of pain) have decreased over time, publications on other topics (eg, personality traits and individual differences) have remained relatively constant, and publications on still other topics (eg, studies using pain induction techniques; studies of race, ethnicity, and culture; women's pain; and treatment studies) have flourished recently. CONCLUSIONS Considered overall, the results of our review suggest that the face of pain research published in PM has changed considerably in the past 60 years. Given the ongoing commitment of psychosomatic researchers to this area, we expect this evolution to continue in the years to come.

The impact of benign breast biopsy (BBB) on distress and perceptions of risk for breast cancer (BC) was examined. Interviews were conducted with 100 women shortly after notification of biopsy results and 4 and 8 months post-BBB. Compared with matched healthy comparison (HC) women without BBB, the BBB group evidenced greater BC-specific distress at baseline. BC-specific distress declined after BBB, remaining elevated relative to the HC group at the 8-month follow-up. Dispositional (optimism, informational coping style), demographic (education), clinical (family history of BC), and cognitive (BC risk perception) variables were associated with baseline levels of BC-specific distress or persistence of distress. Results support the monitoring process model (S. M. Miller, 1995) and the cognitive social health information processing model (S. M. Miller, Y. Shoda,K. Hurley, 1996).

Identification of posttraumatic stress disorder (PTSD) symptoms and diagnoses in survivors of cancer is a growing area of research, but no published data exist regarding the symptom structure of PTSD in survivors of malignant disease. Findings from investigations of the PTSD symptom structure in other trauma populations have been inconsistent and have not been concordant with the re-experiencing, avoidance/numbing, and arousal symptom clusters specified in DSM-IV. The present study employed confirmatory factor analysis to evaluate the extent to which the implied second-order factor structure of PTSD was replicated in a sample of 142 breast cancer survivors. PTSD symptoms were measured using the PTSD Checklist--Civilian Version (PCL-C). Fit indices reflected a moderate fit of the symptom structure implied by the DSM-IV. These findings provide some tentative support for the DSM-IV clustering of PTSD symptoms and for the validity of cancer-related PTSD.

BACKGROUND Although interviews are commonly used to gather research data, the integrity of interview data can be threatened by discrepancies between interviewers and respondents on such characteristics as race, gender, or age. OBJECTIVES To determine if participants' reports of the prevalence and severity of 30 symptoms varied as a function of interviewer gender. Symptoms that were assessed included general physical symptoms (diarrhea, headaches), psychological symptoms (feel blue and depressed, worry about nervous breakdown), and menopausal symptoms (hot flashes, vaginal dryness). METHOD Structured telephone interviews were completed by 137 women who were a mean of 56.5 years old (SD = 11.1, range 36-83) and a mean of 38.8 months (SD = 23.6) postdiagnosis of breast cancer. Interviewers included two women and two men. RESULTS Symptom prevalence and severity did not vary as a function of interviewer gender. CONCLUSIONS Findings suggest that both male and female interviewers can be used successfully to assess participants' reports of physical, psychological, or menopausal symptoms.

PURPOSE Great interest in predictive testing for hereditary cancer syndromes has been reported. Prior research has focused on testing for specific hereditary syndromes and/or among individuals at high risk for positive carrier status. Given anticipated expansion of both the range of hereditary syndromes for which testing will be available, as well as the clinical settings in which testing will occur, assessment of interest in hereditary cancer risk testing and notification in the general public is warranted. METHODS As part of an annual statewide telephone survey, adults' (N = 654) interest in hereditary cancer risk testing and notification was assessed. RESULTS Interest in both risk testing (82%) and risk notification (87%) was high. Logistic regression analyses indicated that disinterest in risk notification was associated with female sex, performance of fewer health protective behaviors, and better perceptions of personal health. Disinterest in risk testing was associated with these same variables as well as older age, less concern over developing cancer, and a more extensive history of cancer in first degree relatives. CONCLUSION In the absence of risk-reducing behaviors with demonstrable efficacy, hereditary risk testing programs may have difficulty attracting the interest of those at greatest risk for carrier status. In contrast, many individuals at low risk for positive carrier status might seek testing, perhaps as a means of seeking reassurance regarding their low hereditary risk.

Background/Objective: Head and neck squamous cell carcinoma (HNSCC) is a debilitating and deadly disease, particularly among African Americans. Cure rates increase from 30% to 80% if the disease is detected early. This study evaluated the acceptability of a non-invasive, easy to administer, very affordable, and innovative rinse technique that assays the soluble form of CD44 and total protein as HNSCC early detection markers in a sample of African American men and women. The aim of the study was to determine whether the rinse was acceptable and whether the outcome of the rinse was likely to promote screening behavior. Methods: Participants (N=127) were from underserved, low-income (83% of sample reported annual income of less than $15,000), African American backgrounds (mean age = 51.24). Men (n=73) and women (n=53) were administered a questionnaire to capture satisfaction, intention to repeat the test, and whether the results of the test would affect screening behavior after using the rinse. Nearly 100% of the sample was currently smoking or using nicotine products. Descriptive statistics, t-tests and Analysis of Variance (ANOVA) were employed using SPSS 19 (IBM). Results: Findings showed that using the rinse was highly acceptable to African American men and women (i.e., philosophy behind use, ease of rinse, willingness to repeat, perceived willingness of others in their social group to use rinse, all mean scores = strongly agree). With regard to the rinse's potential effects of behavior, mean scores indicate that participants strongly agreed that: (a) they would act on a positive cancer finding based on the rinse by scheduling an appointment for treatment, (b) they would perform the rinse as prescribed, (c) they would engage in preventative behaviors if the rinse indicated a high probability of getting HNC, (d) they would stop smoking if the rinse indicated a high probability of getting HNC, and (e) people who are at high risk of HNC should stop smoking. Acceptability of the rinse and the rinse's potential effects on behavior did not differ between males and females (all p-values of t-tests > .05) or based on educational attainment categories (all p-values of ANOVAs > .05). Compared to currently unemployed participants, those who were employed reported that: the rinse was harder to do (t(1,124)=-2.37, p=.019); were more likely to schedule a treatment appointment based on the rinse's outcome (t(1,124)=3.54, p=.001); they were more likely to rinse as prescribed (t(1,124)=2.84, p=.003); and they were more likely to take action to prevent HNSCC based on the determination of the rinse (t(1,124)=3.04, p=.003). Interestingly, individuals with health care coverage reported that the test was harder to do (F(2, 123)=4.92, p=.009), but did not differ from uninsured participants on any other variables (all p-values of ANOVAs > .05). Discussion: Findings indicate that a simple, easy to use rinse technique is acceptable to patients and is highly likely to promote screening behavior among African Americans at risk for HNSCC. Differences were noted between insured versus uninsured participants, employed versus unemployed participants but no differences were observed between men and women and between groups based on educational attainment. Citation Format: Suzanne C. Lechner, Lutecia H. Mateus Pereira, Erika Reategui, Claudia Gordon, Jamie Studts, Margaret Byrne, Monica Webb Hooper, David J. Lee, Elizabeth J. Franzmann. Acceptability of a rinse technique for diagnosing head and neck squamous cell carcinoma among African Americans. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B83.

Background: As the voice of the National Cancer Institute, the Cancer Information Service (CIS) maintains the mission of communicating evidence-based cancer information to the public, including cancer patients, family members, friends, and health care professionals. While the CIS is predominantly a telephone-based service, the new LiveHelp format offers online information seekers the opportunity to use an instant messaging platform to ask questions and seek assistance from highly trained cancer information specialists (IS). Although LiveHelp has been in operation since 2003, no data exists regarding this novel and expanding method of conveying cancer information and communicating with cancer information consumers. The study aims were: (1) to characterize the purpose of the contact, discussion topics, and resources utilized in LiveHelp sessions focused on lung cancer and (2) to provide descriptive demographic information regarding lung cancer information seekers. Methods: Information captured in the Electronic Contact Record Form (ECRF) associated with each LiveHelp session was used to address study aims. The ECRF contains data coded by ISs during or following each contact. A pre-existing coding scheme is used by ISs to report the purpose of the session and subsequent actions taken. Additionally, approximately 25% of respondents are asked to complete a demographic survey following the LiveHelp session. Data from all lung cancer-related LiveHelp sessions conducted in 2008 were analyzed. Results: Of the 20,939 LiveHelp sessions in 2008, lung cancer was the second most common malignancy addressed (n=1,179, 5.6%). Most users were relatives or friends of cancer patients (66%) and relatively few were cancer patients (13%). The contact purpose was generally motivated by a concern about a family member or friend with cancer (47%), but contacts also sought to understand medical information (25%) or address questions about personal health concerns (10%). The primary subject of the contact was most commonly lung cancer-specific information (e.g., staging, prognosis [42%]), but also frequently addressed treatment or side effect management issues (16%). ISs primarily referred contacts to the NCI's cancer.gov portal (79%). Secondary referrals included recommending review of CIS fact sheets (40%) and consulting with a health care provider (28%). With regard to available demographic information (n=159), users were predominantly female (81%), Caucasian (87%), had a bachelor's degree or higher (55%), had private health insurance (60%), and were an average age of 43 years (±14). Surprisingly, 30% reported having no access to healthcare. The vast majority of users initially located LiveHelp via the Internet (80%) and were first-time CIS users (89%). Conclusions: Given its prevalence and impact, it is not surprising that lung cancer is the most common non-sex-specific malignancy for which individuals contact LiveHelp. Interestingly, the vast majority of these contacts are generated by family or friends of individuals diagnosed with lung cancer. Although descriptive data regarding the users and content of LiveHelp provides basic information about its educational and support functions, analyzing the information exchange embedded in the content of the session transcripts would provide an even greater understanding of how to optimize cancer communication efforts via LiveHelp. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B1.

Lung cancer is the most common cause of cancer-related death in the United States. These patients report higher levels of emotional distress than any other population of cancer patients. It is not clear whether lung cancer patients receive adequate treatment for their psychological symptoms. We conducted exploratory analysis to examine the adequacy of treatment for emotional distress. We recruited 29 patients with lung cancer (59% females, 41% males, mean age=66) and assessed their current use of mood altering medications, symptom distress, cancer-specific anxiety, and generalized anxiety. Independent samples t tests were used to compare measures of adjustment for cancer patients currently taking mood-altering medications to those not on such medications. The analysis showed that subjects on mood altering medications reported higher symptom distress, higher cancerspecific anxiety, and higher general anxiety than the comparison group. When subjects on antidepressants and anxiolytics were examined separately, we found elevated levels of symptom distress and cancerspecific anxiety in subjects on antidepressants. These data suggest that mood disturbance may not be adequately addressed even when treated with mood-altering medications. Psychotherapeutic intervention may be beneficial for lung cancer patients.