LGBT patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers - and potentially all patients.

Purpose The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors. Methods Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years. Results Among all survivors, 33.2 % reported any financial concern, with 17.9 % reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0 % made any work modification and 15.3 % made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR=8.0; 95 % CI 2.2–28.4]; income <200 % of federal poverty level (FPL) [OR=15.7; 95 % CI 2.6–95.2] or between 200 and 400 % of FPL [OR=8.2; 95 % CI 1.3–51.4]; residence in a non-metropolitan service area [OR=6.4; 95 % CI 1.6–25.0]; and good/fair/poor self-rated health [OR=3.8; 95 % CI 1.0–14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR=4.1; 95 % CI 1.6–10.2], being married [OR=2.2; 95 % CI 1.0–4.7], uninsured [OR=3.5; 95 % CI 1.3–9.3], or publicly insured [OR=9.0; 95 % CI 3.3–24.4]. Conclusions A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance. Implications for cancer survivors Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.

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• Background Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment. • Objectives To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment. • Methods A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality &lt;269 mOsm/kg), and dehydration (serum osmolality ≥295 mOsm/kg). • Results Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample. • Conclusions Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.