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To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations.Cross-sectional assessment.National assessment.Otolaryngologists.Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers.In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P.05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different.Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.

Objective: Compare diffuse reflectance spectroscopy signature differences between malignant and nonmalignant mucosal tissue based on primary site of origin (ie, larynx, oropharynx, oral cavity).Method: Panendoscopy with biopsy patients were eligible. Diffuse reflectance spectroscopy (DRS) data were obtained from the tumor site and corresponding normal tissue. Biomarker specific optical absorption data were extracted for malignant and non-malignant tissues. Specific differences in malignant and non-malignant tissues were examined based on primary site.Results: Patients with mucosal squamous cell carcinoma of the head and neck were enrolled in the study. Overall, our data confirm prior findings that statistically significant differences in oxygen saturation (SO2%) (P < .01) and mean tissue scattering coefficient (MTSC) (P < .01) exist when comparing malignant and nonmalignant tissue. When stratified by anatomical site, SO2% is more indicative of malignancy than MTSC in the larynx. SO2% and MTSC are equally ...