Objective: To report the results of treating autoimmune retinopathy (AIR) with immunosuppression therapy.Methods: Retrospective review of 30 consecutive patients with AIR followed for 3 to 89 months (median, 17 months) who were treated with immunosuppression (systemic or local). Subgroups were cancer-associated retinopathy (CAR), nonparaneoplastic AIR (npAIR), and npAIR with cystoid macular edema (npAIR/CME). Outcome measures were improvement of Snellen visual acuity by at least 2 lines, expansion of the visual field area by more than 25%, and resolution of CME.

OBJECTIVE Patients with inflammatory bowel disease (IBD) frequently receive immunosuppressive therapy. The immune response in these patients to vaccines has not been well studied. We conducted a prospective, open label study to evaluate the serologic response to influenza vaccine in children with IBD. METHODS Serum was obtained from 146 children and young adults with IBD (96 CD, 47 UC, 3 IC) for baseline influenza titer, immediately followed by immunization with trivalent [A/Solomon Islands/3/2006 (H1N1), A/Wisconsin/67/2005 (H3N2), and B/Malaysia/2506/2004 (B)] inactivated influenza vaccine. Subjects returned for repeat titers 3-9 weeks later. Seroprotection against each influenza strain was defined as hemagglutination inhibition (HAI) titer ≥40. Patients were categorized as non-immunosuppressed [(NIS), aminosalicylates only, antibiotics only, or no therapy] or immunosuppressed [(IS), any immunosuppressive agent]. IS patients were further subcategorized as: (1) tacrolimus; (2) TNF-alpha inhibitor; (3) immunomodulator; and (4) corticosteroids only. RESULTS More patients were seroprotected against strains A/H1N1 and A/H3N2 than B strain (p<0.02), regardless of immunosuppression status. The proportion seroprotected and geometric mean titers at post-vaccination were similar between NIS and IS groups for all three strains. Subanalysis of patients not seroprotected at baseline showed that those receiving anti-TNF therapy were less likely seroprotected against strain B (14%) compared to patients in the NIS group (39%, p=0.025). There were no serious vaccine-associated adverse events. CONCLUSION Influenza vaccination produces a high prevalence of seroprotection in IBD patients, particularly against A strains. The vaccine is well tolerated. Routine influenza vaccination in IBD patients is recommended, irrespective of whether patients receive immunosuppressive medications.

Background. Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction. Methods. This was an observational, cross-sectional, surveybased study assessing patient-reported financial burden (FB). Eligible patients were $21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for $1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale. Results. Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction

Purpose: The relationship between prescription medication adherence and financial burden is understudied, particularly in patients seeking financial assistance. Methods:We conducted a cross-sectional survey to examine the association between patient-reported prescription medication nonadherence and financial distress. Eligible patients were adults receiving treatment for solid malignancies enrolled between June 2010 and May 2011 from the HealthWell Foundation, a national copay assistance program. Nonadherence was defined as taking less medication than prescribed because of cost, not filling or partially filling a prescription because of cost, or taking medications prescribed for others. Logistic regression assessed associations between medication nonadherence and patient-reported, subjective financial distress.Results: Among 164 participants, 45% reported cost-related medication nonadherence. Four percent took medications prescribed for another person, 22% took less medication than prescribed, 25% filled a partial prescription, and 27% did not fill a prescription, all as a result of cost. Nonadherent participants were more likely than adherent participants to reduce spending on basics like food and clothing to pay for medication (P ϭ .01), and borrow and/or use credit to pay for medications (P Ͻ .01). In adjusted analyses, financial distress did not change odds of nonadherence (odds ratio [OR] ϭ 1.60; 95% CI, 0.71 to 3.60). Having a prescription drug plan (OR ϭ 0.27; 95% CI, 0.09 to 0.83) and older age (OR ϭ 0.48; 95% CI, 0.27 to 0.85) decreased odds of nonadherence. Being unemployed increased odds of nonadherence (OR ϭ 6.28; 95% CI, 1.60 to 24.64). Conclusions:Cost-related medication nonadherence was prevalent among cancer patients who sought financial assistance. Further investigation is needed to understand predictors of prescription medication adherence, a key component of quality care.