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

Background Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction (LVEF) ≤35%, miss ∼80% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization-repolarization relationship) have high 1-year all-cause mortality and could be further risk-stratified with clinical characteristics. Methods and Results We screened all 12-lead ECGs (∼50,000 patients) over 6 months at 2 large hospital systems and analyzed clinical characteristics and 1-year mortality. Patients with ECGs obtained in hospital areas with known high mortality rates were excluded. At one hospital, QRS score ≥5 and QRS-T angle ≥105° identified 8.0% of patients and was associated with an odds ratio (OR) of 2.79 [95% confidence interval 2.10-3.69] for 1-year mortality compared to patients below both ECG thresholds (13.9% vs. 5.5% death rate). LVEF was >35% in 82% of the former group of patients and addition of ECG measures to LVEF increased the discrimination of death risk (p<0.0001). At the second hospital, the OR was 2.42 [1.95-3.01] for 1-year mortality (8.8% vs. 3.8%). Adjustment for patient characteristics eliminated inter-hospital differences. Multivariable adjusted OR combining data from both hospitals was 1.53 [1.28-1.83]. Increasing heart rate and chronic renal impairment further predicted mortality. Conclusions Screening hospital ECG databases with QRS scoring and QRS-T angle analysis identifies patients with high 1-year all-cause mortality and predominantly preserved LVEF. This approach may represent a widely-available method to identify patients at increased risk of death.