Fibromyalgia (FM) patients present with heterogeneous symptoms including pain, fatigue, depression, and sleep disturbance. Symptom severity often drives treatment prioritization. This study sought to characterize FM severity based on clinical assessment and standardized patient self-report of FM impact on pain, sleep, and mood. 203 FM patients were recruited from 20 US physician offices during routine visits. Patients completed questions about their average pain over the past 24 hours, the Medical Outcomes Study (MOS)Sleep Scale, and the Hospital Anxiety and Depression Scale (HADS). FM severity was defined using patients' Fibromyalgia Impact Questionnaire (FIQ)total scores:0-<39, 39-<59, and 59-100 representing mild, moderate, and severe, respectively. Patients and physicians ranked FM severity in stand-alone questions. Site staff completed case report forms using patients' medical records. The mean (SD) age was 47.9 (10.9) and 95% of the patients were female. Most patients were classified as having moderate (24%) or severe (66%) FM. FIQ-based FM severity was significantly correlated with both patient self-assessed and physician-reported FM severity (p<0.0001). Severe FM was associated with more tender points compared to moderate and mild FM (15.1 vs. 13.8 vs. 13.7 respectively, p<0.05). As FM severity worsened, more patients were diagnosed with depressive symptoms (p<0.0001), major depressive disorder (p=0.02), anxiety (p=0.002), and chronic fatigue syndrome (p=0.003). The mean (SD) average pain score increased significantly (p<0.0001) as FM severity worsened. Patients also reported significantly worse HADS Depression, HADS Anxiety, and MOS Sleep scores (p<0.0001) as FM severity worsened. There were no significant differences in age, gender, time since first experiencing FM, or time since diagnosis across FM severity levels. FM presents a substantial burden to patients. Severe FM was more likely to be accompanied by comorbid depression, anxiety, or chronic fatigue syndrome than mild or moderate FM. (Funded by Pfizer.)

P>Introduction:Few studies have comprehensively assessed the burden associated with fibromyalgia (FM). This cross-sectional, observational study evaluates the impact of FM on patients in France and Germany.Methods:A total of 299 FM patients were recruited from 33 physician offices in France and Germany during routine visits. Patients completed a survey that included the Brief Pain Inventory-Short Form (BPI-sf), Fibromyalgia Impact Questionnaire (FIQ), EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS) to describe their pain, FM and health-related quality of life (HRQOL). FM severity was defined using patients' FIQ total scores with 0 to < 39, 39 to < 59 and 59-100, representing mild, moderate and severe FM, respectively. Site staff completed case report forms using patients' medical records.Results:Mean (standard deviation, SD) age was 54.2 (12.6); 81% of patients were women. The mean (SD) FIQ total score was 53.3 (19.6); 33% and 44% of patients reported moderate and severe FM, respectively. Most patients (91%) were receiving prescription medications for FM during the study. Patients reported a mean (SD) EQ-5D health state valuation of 0.44 (0.33) and a mean (SD) BPI-sf Pain Severity Index score of 4.9 (1.8). Forty-one percent of patients reported some level of disruption in their employment because of FM; employed patients missed a mean (SD) of 2.2 (4.6) workdays during the past 4 weeks. An increase in FM severity was significantly associated with increased pain severity, productivity loss, sleep disturbance and higher anxiety and depression (p < 0.0001).Conclusions:There is a substantial burden of illness including treatment limitations for FM patients in France and Germany.

Purpose/Objective(s)To evaluate the time-related burden of mucositis management on radiation oncology staff treating head and neck cancer (HNC) patients (pts).Materials/MethodsA web-based survey was designed to estimate the time associated with managing mucositis related to HNC treatment. Licensed radiation oncologists (MDs) treating at least 3 HNC pts per month and registered nurses (RNs) actively practicing in a radiation oncology facility completed a standardized web-based survey. The survey was designed after detailed interviews with 4 MDs and RNs to identify key activities and the estimated time associated with mucositis management in RT patients. Time associated with each task was analyzed using descriptive statistics. Total activity time was calculated for each treatment week for MDs and RNs. Total mucositis management-related activity time was calculated by summing the total reported time for pre-, during-, and post-treatment periods. Facility characteristics and MDs' and RNs' time for managing mucositis between facility types were compared between academically affiliated and private/community based facilities using t test.ResultsOn average, MDs (n = 50) and RNs (n = 51) reported practicing 15 and10 years in radiation oncology, respectively, treating 40 and 73 pts per month (15% HNC pts), and treating an average of 10 and 16 HNC pts who received radiotherapy (RT) in the prior 2 months, respectively. Respondents reported that their pts received a mean target RT dose of 72 Gy, with 81% of pts usually receiving 6 or 7 week regimens and 92% pts on average developing mucositis (71% WHO Grade 2 or 3 as the worst grade). MDs and RNs reported a total of 7.2 hours and 12.1 hours per pt, respectively, for managing mucositis-related activities from planning to post-treatment. During the treatment phase, responders reported that the average time spent per pt increased each week from 0.5 hours for Week 1 to 1.4 hours for Week 7 for MDs and from 1.3-2.0 hours for RNs. Based on the reported MD average of treating 60 HNC pts per year, MDs and RNs would spend 21% and 35% of a standard 2,080 hour work year, respectively, with activities related to mucositis prevention and management. From treatment planning through the post-treatment period, there were no statistically significant differences in MD- or RN-reported time for mucositis management between those working in academic affiliated setting and those working in private/community-based setting.ConclusionsOver 90% of HNC pts receiving RT were reported to develop mucositis. The amount of time spent managing mucositis-related activities for HNC pts receiving RT is estimated to be substantial and should be anticipated in treatment planning, with considerations of prevention strategies being a priority. Purpose/Objective(s)To evaluate the time-related burden of mucositis management on radiation oncology staff treating head and neck cancer (HNC) patients (pts). To evaluate the time-related burden of mucositis management on radiation oncology staff treating head and neck cancer (HNC) patients (pts). Materials/MethodsA web-based survey was designed to estimate the time associated with managing mucositis related to HNC treatment. Licensed radiation oncologists (MDs) treating at least 3 HNC pts per month and registered nurses (RNs) actively practicing in a radiation oncology facility completed a standardized web-based survey. The survey was designed after detailed interviews with 4 MDs and RNs to identify key activities and the estimated time associated with mucositis management in RT patients. Time associated with each task was analyzed using descriptive statistics. Total activity time was calculated for each treatment week for MDs and RNs. Total mucositis management-related activity time was calculated by summing the total reported time for pre-, during-, and post-treatment periods. Facility characteristics and MDs' and RNs' time for managing mucositis between facility types were compared between academically affiliated and private/community based facilities using t test. A web-based survey was designed to estimate the time associated with managing mucositis related to HNC treatment. Licensed radiation oncologists (MDs) treating at least 3 HNC pts per month and registered nurses (RNs) actively practicing in a radiation oncology facility completed a standardized web-based survey. The survey was designed after detailed interviews with 4 MDs and RNs to identify key activities and the estimated time associated with mucositis management in RT patients. Time associated with each task was analyzed using descriptive statistics. Total activity time was calculated for each treatment week for MDs and RNs. Total mucositis management-related activity time was calculated by summing the total reported time for pre-, during-, and post-treatment periods. Facility characteristics and MDs' and RNs' time for managing mucositis between facility types were compared between academically affiliated and private/community based facilities using t test. ResultsOn average, MDs (n = 50) and RNs (n = 51) reported practicing 15 and10 years in radiation oncology, respectively, treating 40 and 73 pts per month (15% HNC pts), and treating an average of 10 and 16 HNC pts who received radiotherapy (RT) in the prior 2 months, respectively. Respondents reported that their pts received a mean target RT dose of 72 Gy, with 81% of pts usually receiving 6 or 7 week regimens and 92% pts on average developing mucositis (71% WHO Grade 2 or 3 as the worst grade). MDs and RNs reported a total of 7.2 hours and 12.1 hours per pt, respectively, for managing mucositis-related activities from planning to post-treatment. During the treatment phase, responders reported that the average time spent per pt increased each week from 0.5 hours for Week 1 to 1.4 hours for Week 7 for MDs and from 1.3-2.0 hours for RNs. Based on the reported MD average of treating 60 HNC pts per year, MDs and RNs would spend 21% and 35% of a standard 2,080 hour work year, respectively, with activities related to mucositis prevention and management. From treatment planning through the post-treatment period, there were no statistically significant differences in MD- or RN-reported time for mucositis management between those working in academic affiliated setting and those working in private/community-based setting. On average, MDs (n = 50) and RNs (n = 51) reported practicing 15 and10 years in radiation oncology, respectively, treating 40 and 73 pts per month (15% HNC pts), and treating an average of 10 and 16 HNC pts who received radiotherapy (RT) in the prior 2 months, respectively. Respondents reported that their pts received a mean target RT dose of 72 Gy, with 81% of pts usually receiving 6 or 7 week regimens and 92% pts on average developing mucositis (71% WHO Grade 2 or 3 as the worst grade). MDs and RNs reported a total of 7.2 hours and 12.1 hours per pt, respectively, for managing mucositis-related activities from planning to post-treatment. During the treatment phase, responders reported that the average time spent per pt increased each week from 0.5 hours for Week 1 to 1.4 hours for Week 7 for MDs and from 1.3-2.0 hours for RNs. Based on the reported MD average of treating 60 HNC pts per year, MDs and RNs would spend 21% and 35% of a standard 2,080 hour work year, respectively, with activities related to mucositis prevention and management. From treatment planning through the post-treatment period, there were no statistically significant differences in MD- or RN-reported time for mucositis management between those working in academic affiliated setting and those working in private/community-based setting. ConclusionsOver 90% of HNC pts receiving RT were reported to develop mucositis. The amount of time spent managing mucositis-related activities for HNC pts receiving RT is estimated to be substantial and should be anticipated in treatment planning, with considerations of prevention strategies being a priority. Over 90% of HNC pts receiving RT were reported to develop mucositis. The amount of time spent managing mucositis-related activities for HNC pts receiving RT is estimated to be substantial and should be anticipated in treatment planning, with considerations of prevention strategies being a priority.

1.8 230,984 38,034 269,018 Other OR procedures on vessels other than head and neck 3.5 202,967 71,949 274,916 Treatment; fracture or dislocation of hip and femur 3.7 597,104 76,479 673,583 Respiratory intubation and mechanical ventilation 4.8 382,971 98,854 481,825 Arthroplasty knee 5.1 257,022 106,589 363,611 Hip replacement; total and partial 7.7 568,390 159,243 727,632 Upper gastrointestinal endoscopy; biopsy Percent of All Hospital Discharges with Transfusion (%)* NonTransfused Transfused N Primary CCS Procedure Category