PURPOSE: symptoms of hyperthyroidism and hypothyroidism include weight changes, fatigue which can be confused with symptoms of cancer.very few data exit about the prevalence of thyroid disease in cancer patients. This was a prospective study testing thyroid functions in patients with various diagnosis of cancer in order to assess the prevalence of thyroid disease in those patients. METHODS: cross sectional study was conducted at the Comprahensive cancer center of Saint Vincents Hospital in NYC. Patients were recruited to have thyroid function done at the same time other blood work was done. Later data was collected from the patients chart regarding their type of cancer, the stage of their disease, and type of therapy they were receiving(chemotherapy, radiotherapy, hormonal therapy, etc)Thyroid function were performed by the hospital laboratory using standard kits.TSH normal range 0.49 ± 4.67Free T4 normal range 0.17 ± 1.85 RESULTS: Total of 158 cases analyzed to date.44 cases of breast cancer,25 cases of gastrointestinal cancer, 7 cases of lung cancer, 60 cases of hematological malignancies, and 22 cases of other types of cancer (ovarian, prostate, ks, etc).The mean age of patient was 57 y/ o(range 28 ± 86)There were 85 females and 73 males in the study.17 patients had abnormally low TSH suggesting subclinical hyperthyroidism and 1 patient had high T4 suggesting Thyrotoxicosis. 6 patients had elevated TSH and 3 had low T4 suggesting hypothyroidism. In total 26 cases (16%) of abnormal thyroid function in the population studied. CONCLUSION: The prevalence of thyroid disease in cancer patients is significant, and since the symptoms mimic those of cancer, both internists and oncologists caring for the patients should be aware of that. METHODS: We surveyed 2,500 adult patients seen in the ambulatory clinics of a university hospital. We asked patients about their desire for information regarding the side effects of prescription drugs. We asked 190 physicians practicing in the same clinics about their perceptions of patients' expectations for this information. We also collected information on age, gender and level of education for patients and age, gender and specialty for physicians. We found significant differences in responses of patients and physicians. RESULTS: Please see the Researchers have suggested that patients may understand treatment benefits better when they are presented as numbers needed to treat (NNT) rather than as absolute or relative risk reductions. We sought to determine if NNT helps patients interpret treatment benefits better than absolute risk reduction (ARR), relative risk reduction (RRR) or a combination of all three of these risk reduction presentations (COMBO). METHODS: We surveyed 357 men and women, ages 50 to 80, who presented for care at a university internal medicine clinic. After answering three questions assessing their ability to handle numbers (numeracy skill), subjects were asked to (1) state which of two drug treatments for a hypothetical disease Y provided more benefit, and (2) calculate the effect of drug treatment on a patient with a given baseline risk of disease. Risk information was presented to each subject in one of four randomly allocated risk formats±NNT (100 versus 250 people just like you would need to be treated for 5 years for a benefit against disease Y to be seen in one of you), ARR (treatment reduces the chance that you will develop disease Y by 10 versus 4 out of 1000 over the next 5 years), RRR (treatment reduces the chance that you will develop disease Y by 25% versus 10% over the next 5 years), or COMBO. RESULTS: Subject ability to interpret treatment benefits varied significantly with the risk presentation format they received. Patients correctly interpreted the treatment benefit most often when it was presented in the RRR format: when asked to state which of two treatments provided more benefit, subjects who received treatment benefit information in the RRR format responded correctly 60% of the time, whereas subjects receiving the COMBO, ARR, and NNT presentation formats responded correctly only 43%, 42%, and 30% of the time, respectively (p < 0.01). Most patients were unable to calculate the exact effect of drug treatment on a patient with a given baseline risk of disease, although subjects receiving the RRR and ARR formats responded correctly slightly more often (21% and 17%, respectively, compared to 7% for COMBO and 6% for NNT, p < 0.01). Higher numeracy skills were associated with increased ability to interpret treatment benefits: 88% of subjects who answered all three numeracy questions correctly stated which of two treatments provided more benefit versus only 63% of subjects who answered two questions correctly and 35% of subjects who answered one or no questions correctly (p < 0.01). This association persisted when subjects were asked to calculate the effect of drug treatment on a patient with a given baseline risk of disease. CONCLUSION: Patients are best able to interpret the benefits of treatment when they are presented in a RRR format. NNT is often misinterpreted by patients and should not be used alone to communicate risk to patients. PURPOSE: Depression is very common, particularly in primary care. While depression in otherwise healthy young patients is rather straightforward, it is less clear how to manage depressed patients with multiple medical problems. We assessed the level of physical and mental health impairment in primary care patients who had recently had depressive symptoms. METHODS: We identified two samples of veterans from the Primary Care Clinic at the VA Sepulveda Ambulatory Care Center who had depressive symptoms during a 7-month period: 290 patients whose primary care encounter form had a depression-related diagnosis (PC group) and 130 patients seen in primary care by Consultation L group). These patients all were sent a letter from their attending physician, inviting them to participate in a study of assisted referral back to primary care for patients who were still depressed. 19 PC group patients (7%) and 23 C&L group patients (18%) declined to participate and over half never responded (65% PC, 52% C&L). Respondents (82 PC, 39 C&L) were contacted 6 months after their initial diagnosis of depressive symptoms. The interviewer-administered initial survey included the Veterans Short Form-12 (SF-12V) and three questions on where they received health care. Respondents not currently seeing a mental health specialist were asked to complete a more detailed survey, which included measures of depression, anxiety, alcohol use and sociodemographics. RESULTS: Completed interviews were available for 86 patients (53 PC, 33 C&L). 14 patients who agreed to participate could not be reached and 20 interviews were still pending. The average Mental Component Score for respondents was 36.4. While 40% had no mental health impairment, 17% had impaired mental health (MCS 31 ± 40) and 43% had severely impaired mental health (MCS 30 or less). The average Physical Component Score for respondents was 37.3. The breakdown was similar to that for mental health: 38% had no physical health impairment, 24% had impaired physical health (PCS 31 ± 40), and 37% had severely impaired physical health (PCS 30 or less). 20% of respondents were both physically and mentally impaired and another 14% were severely impaired physically and mentally. Of those with current mental health impairment, the prevalence of physical health impairment was similar between the group seeing psychiatry and those not currently seeing psychiatry. CONCLUSION: Six months after having depressive symptoms identified, most veterans still have profoundly impaired mental health. Of note, the degree of physical health impairment is equally profound. This suggests that for many depressed patients in primary care, treatment models need to account for severe disability both physically and mentally. We assessed whether or not this same relationship holds among veterans, who themselves tend to be sicker and have more health care utilization than the general public. METHODS: As part of the baseline patient survey for a multi-site trial of evidence-based quality improvement for smoking cessation, we interviewed veterans at 18 sites in the Southwestern U.S. The survey, conducted by computer-assisted telephone interview among patients with at least 3 primary care visits in the prior 18 months, covered smoking history, health habits, health status and demographics. Questions were adapted from previously validated sources, including the California Tobacco Survey, Medical Outcomes Study, CES-D (depression), AUDIT (alcohol abuse), and others. Outpatient utilization data for FY 1999 were extracted from the VA Outpatient File at Austin and grouped by type of visit. Inpatient utilization data were obtained from the Patient Treatment File at Austin. Comparisons were done using chi-squared tests and ANOVA. For this preliminary analysis, we also analyzed the utilization data splitting subjects into those under 65 (n=3745) and those 65 or older (n = 3961). RESULTS: Of the 7,706 subjects interviewed, current smokers were more likely than former smokers or those who never smoked to be younger, less active, and divorced (all p < 0.001). Current smokers were more likely than the other two groups to have severe mental health impairment (21% vs. 12% vs. 14%, p < 0.001) and severe physical health impairment (55% vs. 48% vs. 46%, p=0.026). Current smokers were less likely than former smokers or those who never smoked to report being in excellent or very good health (16% vs. 22% vs. 26%, p < 0.001). Among current smokers, approximately half reported they never drink alcohol, but 18% met AUDIT criteria for alcohol abuse. Forty-three percent of current smokers met CES-D criteria for depression at the time of the interview. Current smokers, former smokers, and those who never smoked did not differ in the total number of outpatient visits or for emergency room or general medicine visits. Current smokers did average more mental health and social work visits and fewer medical subspecialty visits than former smokers or those who never smoked (p < 0.001). The rate and length of acute care hospitalizations did not differ among the three groups, but smokers had more nursing home admissions. When we analyzed the data separately for subjects over 65 and under 65, the utilization differences tended to occur predominantly in the half of the sample under age 65. CONCLUSION: While smokers had higher outpatient mental health use, they did not have higher utilization for most other categories. They tended to have worse functional and health status than former smokers and those who never smoked.