Background and Purpose. The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions. Methods. A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists. Results. A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their

Appreciating the variability in information preferences across topics and patients may aid efforts to meet patients' information needs and improve outcomes.

This pilot qualitative study explored experiences and effects of spirituality and religion among lesbians diagnosed with cancer. A convenience sample of eight self-identified lesbians diagnosed with cancer responded to advertisements for the study. Each woman was interviewed, and interview transcripts were analyzed thematically. The results indicated that all participants found support in spirituality, though definitions of this term varied. Five women found religion supportive, but not one participant still worshipped in the tradition in which she was raised. The participants' identification as lesbian affected their relationships with all sources of support, including spirituality and religion. This finding suggests that clinicians working with cancer survivors should include spiritual and religious beliefs in their assessments and treatment planning, and further research on the experiences of lesbians with cancer is needed.

The Anne Arundel Medical Center (AAMC) DeCesaris Cancer Institute (DCI) began its participation in the ONS Foundation-supported Breast Cancer Care Quality Measures Set pilot study in 2010. The design and measures of the project were intriguing, paving a path for DCI to define quality measures and outcomes that were of value to the AAMC's oncology population and system. As the pilot program was getting underway, measurement instruments were selected for fatigue, distress, and sleep-wake disturbances. These were used as quality measures for care of patients receiving chemotherapy, to be reported to the Oncology Quality Council, AAMC DCI's Executive Quality Council, and the AAMC Board of Directors. Scores for these quality measures, as well as patient satisfaction scores for the Outpatient Infusion Center, have increased markedly since the 2010 pilot test. The increases in scores inspired nursing leadership, in conjunction with AAMC DCI's Medical Oncology Executive Committee, to develop an innovative nursing model, the advanced oncology nurse practitioner-led symptom management clinic, to systematically and efficiently treat the needs of patients with cancer.

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