Distress Management: Comprehensive and Humane Practices after Changes in Routine of Cancer Care

Psycho-OncologyPsycho-Oncology 19(Suppl. 2):S1–S313(2010)Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1776

Abstracts of the IPOS 12th World Congress of Psycho-Oncology, 25–29 May 2010, Quebec City, QC, Canada

SYMPOSIUM ABSTRACTS

S1808

Psychopharmacologic Management of Depression,

Delirium, and Anxiety in Psycho-oncology for Non-

Psychiatrists

SYMPOSIUM DESCRIPTION: Delirium, De-pression, and Anxiety Disorders comprise over90% of the psychiatric disorders diagnosed andtreated in various cancer treatment settings. Mostpsycho-oncology care is provided by clinicians whoare not psychiatrists, but rather psychologists,social workers, psychotherapists, counselors, aswell as nurses and oncologists, with limitedexpertise in psychopharmacologic management ofthese common psychiatric syndromes. While Anxi-ety and Depression are common in bot theambulatory and inpatient cancer settings, deliriumis particularly prevalent in inpatient and palliativecare settings. This symposium will provide non-psychiatrist psycho-oncologists, nurses and oncol-ogists, with critical knowledge of assessment andmanagement of these major psychiatric complica-tions of cancer, with a special emphasis onpsychopharmacologic issues. The Symposium pre-senters are recognized international experts in thetopics of Delirium, Depression and Anxiety inCancer. The Discussant will give the perspective ofa Psychologist who integrates psychopharmacolo-gic management issues into the multidisciplinarycare of cancer patients.

S1808-1

Psychopharmacologic Management of Delirium in

the Cancer Patient

William BreitbartMemorial Sloan-Kettering Cancer Center,New York City, New York, United States

OBJECTIVES: Delirium is the most commonneuropsychiatric complication in the patient withcancer, occurring in up to 85% of cancer patientsin the last weeks of life. This lecture will teach

participants how to diagnose delirium accurately,undertake appropriate assessment of etiologies,and understand the benefits and the risks ofpsychopharmacologic interventions currentlyavailable for managing delirium in the cancersetting. METHOD: Delirium is characterized byan abrupt onset of disturbances of consciousness,attention, cognition, and perception. Delirium isassociated with increased morbidity and mortalityin cancer patients, causing distress in patients,family members, and staff. Delirium interferes withpain and symptom control. Delirium is a sign ofphysiologic disturbance, usually involving multiplemedical etiologies. The management of deliriuminvolves the concurrent search to identify and treatits medical causes while utilizing pharmacologicand non-pharmacologic interventions to controlthe symptoms of delirium. RESULTS: This lecturewill review the literature on the use of neurolepticand sedative agents in the management of thesymptoms of delirium in cancer. Clinical trials oftypical and atypical antipsychotics and sedativeagents will be reviewed. Side Effects of typical andatypical antipsychotics will be reviewed includingextrapyradimal syndromes, neuroleptic malignantsyndrome, metabolic syndrome, and cardiovascu-lar syndromes. CONCLUSIONS: Psycho-oncolo-gists and clinicians who care for cancer patientsmust be able to diagnose delirium accurately,undertake appropriate assessment of etiologies,and understand the benefits and the risks ofpsychopharmacologic interventions currentlyavailable for managing delirium in the cancersetting. Typical and Atypical anti-psychotic med-ications play an important role in the effectivemanagement of the symptoms of delirium in thecancer patient.

S1808-2

A Review of Depression for the Non-Psychiatrist

Harvey ChochinovUniversity of Manitoba, Winnipeg, Manitoba,Canada

r 2010 The Authors. Journal compilation r 2010 John Wiley & Sons, Ltd.

OBJECTIVES: Depression is a common source ofdistress and suffering for patients facing lifethreatening and life limiting conditions. Thepurpose of this presentation is to provide non-psychiatrists, working within a cancer or palliativecare setting, an overview of the area of depression.METHOD: This presentation will review some ofthe pertinent literature addressing depression,particularly focusing on empirical studies whosefindings have helped inform the field. These studiesinclude epidemiological data, screening data anddata examining the interface between depressionand various common sources of distress facingpatients with poor prognoses. Finally, an overviewof various treatment approaches, including psycho-pharmaceutical interventions, will be provided.RESULTS: Various studies affirm that clinicaldepression is an important source of distressamongst patients nearing end of life. Diagnosticacumen improves with an awareness of the clinicalfeatures of depression, as well as an ability to applyempirically validated screening approaches. Know-ing how to treat depression can also improveclinical outcomes and enhance the quality of life forpatients whose illness has been complicated bydepression. CONCLUSIONS: Appreciating theintricacies of depression can provide non-psychiatric clinicians a better understandingof their cancer and palliative care patients.Knowing how to screen for, diagnose and treatdepression is an important component ofcomprehensive psychosocial care. Such care canhelp improve the quality of life, and lessen theburden of suffering, for patients who are nearingend-of-life.

S1808-3

Psychopharmacologic Management of Anxiety in

Cancer Patients

Luigi GrassiPsychiatry Section, University of Ferrara, Ferrara,Emiglia Romana, Italy

OBJECTIVES: Anxiety represents a commonproblem among cancer patients. In managinganxiety it is important to differentiate betweenanxiety due to abnormal physiological states fromanxiety disorders meeting the DSM or the WHO-ICD criteria. Clinical anxiety can be a manifesta-tion of variety of disorders including: AnxietyDisorders (e.g. Panic Attack disorder, Phobia andSocial Phobia, Post-Traumatic Stress Disorder),Adjustment Disorders, Depressive Disorders, aswell as mood, cognitive and other disorders whereanxiety can be an important dimension (e.g.Somatoform Disorders). METHOD: In this pre-sentation the most important literature regardingthe treatment of anxiety in cancer patients will be

reviewed both in terms of RCTs and observationalstudies and clinical experience. RESULTS: Benzo-diazepines (BDZ) by acting on the GABA system,have a sedative, anxiolytic, and anticonvulsanteffect. BDZ should be used for short periods oftime and can help patients in reducing anxietybefore medical or surgical procedures, chemother-apy or other anxiety provoking situations. SelectiveSerotonin Re-uptake Inhibitors (SSRIs) and drugsacting on both noradrenaline and serotonin(NSRI’s) have been used successfully. Other drugs(e.g. atypical antipsychotics) can also have a role inpsychopharmacological treatment of anxiety.CONCLUSIONS: Several classes of drugs can beusefully employed in oncology setting to treatanxiety, according to the diagnosis and thephenomenology of the symptom spectrum(categorical and dimensional assessment). Psycho-pharmacological treatment, associated withpsychological or rehabilitation intervention,should be considered as a part of integratedapproaches to cancer in order to improve thepatients’ quality of life.

S1808-4

Psychopharmacology for non-Prescribing Providers

E. Alessandra StradaBeth Israel Medical Center and Albert EinsteinCollege of Medicine, New York, New York,United States

OBJECTIVES: The goal of this presentation is toillustrate how knowledge of psychopharmacologycan be integrated into interdisciplinary care inpsycho-oncology by nonmedical mental healthprofessionals. Adequate care of patients withcancer includes assessment and treatment ofpsychiatric disorders that may pre-exist the cancerdiagnosis, or may develop following the diagnosis.Depression, Anxiety Disorders and delirium arethe most common disorders in these patients.Clinical psychologists are often directly involvedin the diagnosis and management of these dis-orders. METHOD: In the United States, themajority of mental health services for patients withcancer are provided by clinical psychologists, socialworkers, and other nonmedical therapists, whomay assume a major role in diagnosing disorderssuch as depression and anxiety in cancer patientsand monitoring patients’ response to psychotropicmedications. These practitioners are frequent con-tact with patients and may be in the best positionto observe symptomatic improvement, side effectsproblems, and issues involving medicationcompliance. RESULTS: It is increasingly impor-tant that all mental health professional workingin psycho-oncology develop familiarity withpsychiatric medication treatment. The ability of

r 2010 The Authors. Journal compilation r 2010 John Wiley & Sons, Ltd. Psycho-Oncology 19(Suppl. 2):S1–S313(2010)

DOI: 10.1002/pon

S2 Symposium Abstracts

nonmedical professionals to accurately communi-cate with medical providers to discuss diagnosis,target symptoms, presumed etiology, and treat-ment modalities is an important aspect of inter-disciplinary care in psycho-oncology. Clinicalpsychologists and other mental health profes-sionals can use knowledge of psychopharmacologyto develop a successful collaboration withmedical professionals involved in patient care.CONCLUSIONS: Nonmedical clinicians who in-tegrate psychopharmacology management issueswith their expertise in the diagnosis and treatmentof psychiatric disorders can provide a higher levelof care to patients with cancer.

S1810

Flourishing Or Flailing? The Impact Of Cancer On

Survivors And Their Caregivers Across The Cancer

Trajectory

SYMPOSIUM DESCRIPTION: This symposiumbrings together three cutting-edge studies andprovides a comprehensive description of thepsychosocial issues encountered by cancer survi-vors and their caregivers by presenting data frompatient cohorts at different time points along theillness trajectory and different sub-groups, includ-ing cancer caregivers and cancer survivors fromculturally diverse backgrounds. The three presen-tations in this symposium will focus on: 1) thepositive and negative impacts of cancer onsurvivors over the first 2 years post-diagnosis; 2)the financial and psychosocial impacts of cancer onthe caregivers of cancer survivors 6 months post-diagnosis; and 3) the cancer-related challenges andconcerns faced by cancer survivors from differentcultural backgrounds (Arabic, Greek and Chinese).The first two studies reported in this symposiumare from the two largest longitudinal populationbased studies of cancer survivors and theircaregivers in Australia. These studies address animportant gap in the literature by including adescription and discussion of the patient andcaregiver sub-groups who do well and sub-groupswho do poorly, and examine the predictors of theseoutcomes. Particularly, this is one of the firstanalyses identifying the predictors of borderline/clinical anxiety or depression among cancer care-giver. The third presentation of the symposiumreports on the most substantial study of psychoso-cial outcomes of migrants with cancer living inAustralia. This study provides insight into thecancer experience of this sub-group of patients,which remains under-reported in the cancerliterature, and identifies areas where additionalpsychosocial support is needed. Particular atten-tion is given to discuss these research findingsin the context of developing relevant and

innovative psychosocial interventions to optimise(or maintain) illness adjustment of patientsand their caregivers throughout the cancerjourney.

S1810-1

Predicting Borderline/Clinical Anxiety and

Depression Among a Large, Population-Based

Sample of Cancer Caregivers Six Months Post-

Diagnosis

Afaf Girgis, Sylvie Lambert, Fiona Stacey, Chris-tophe LecathelinaisCentre for Health Research & Psycho-oncology(CHeRP), Cancer Council New South Wales,University of Newcastle & Hunter MedicalResearch Institute, Newcastle, New South Wales,Australia

OBJECTIVES: A range of challenges faced bycancer caregivers is now documented, as well as thepersonal and contextual variables mediating theirlevels of anxiety and depression. However, moststudies predict sub-clinical levels of anxiety ordepression and little is known about what con-tributes to caregivers reaching borderline/clinicallevels of anxiety or depression. This study ad-dresses this knowledge gap and identifies thepredictors of borderline/clinical anxiety or depres-sion among caregivers of cancer survivors. METH-OD: 547 cancer caregivers, participating inAustralia’s first longitudinal study of caregivers,were surveyed at 6-8 months post-diagnosis.Prevalence of anxiety and depression was assessedusing the Hospital Anxiety and Depression Scale.Predictors measured included demographics, caregiving roles and strains, psychosocial unmet needs,and caregivers’ personal and contextual resources.Data were analysed using chi-square and forwardstepwise logistic regression. RESULTS: Avoidantcoping was the strongest predictor of anxiety anddepression, followed by interference in regularactivities due to care giving role and experiencingat least moderate/high unmet emotional/psycholo-gical need. Additional predictors of anxiety in-cluded interference in regular activities due to ownhealth problems and seeking assistance from ahealth care professional. Depression was alsopredicted by not living with the cancer survivor,having out-of-pocket expenses, managing patientmedication, and low physical quality of life.CONCLUSIONS: This analysis identified wherepartners/caregivers require additional assistance toovercome the challenges of their new responsibil-ities and maintain their well-being. An increasedawareness of predictors of borderline/clinicalanxiety and depression can contribute tooptimising referral to support care services forthose caregivers most at risk and tailoring


DOI: 10.1002/pon

Symposium Abstracts S3

of interventions to enhance psychosocialadjustment.

S1810-2

‘It’s Been A Journey, I Am A Survivor’: Patterns ofAdjustment Across the Cancer TrajectoryAllison Boyes1, Afaf Girgis1, Alison Zucca1,Catherine D’Este2

Centre for Health Research & Psycho-oncology(CHeRP), Cancer Council New South Wales,University of Newcastle & Hunter Medical ResearchInstitute, Newcastle, New South Wales, Australia1,University of Newcastle, Newcastle, New SouthWales, Australia2

OBJECTIVES: Understanding the onset, dura-tion, frequency and severity of the positive andnegative effects of cancer is essential to knowinghow to best support the growing population ofcancer survivors to ‘thrive’. This presentationwill describe survivors’ patterns of psychosocialwellbeing and service utilisation over the first 2years since diagnosis, and the characteristics ofthose who sustain or develop high levels ofpsychosocial morbidity. METHOD: A cohort of1,453 survivors diagnosed with one of the eightmost incident cancers was recruited from twostate-based cancer registries. Participants com-pleted a self-report survey that assessed a rangeof outcomes including anxiety, depression, dis-tress, perceived needs, quality of life, appraisal,post-traumatic growth, lifestyle behaviours aswell as patient, disease and treatment character-istics. Survey data gathered at approximatelysix, 12 and 24 months post-diagnosis wereexamined and triangulated with informationfrom in-depth interviews. RESULTS: About20% of survivors either developed or continuedto experience elevated levels of psychologicalmorbidity over time. About one-third reporteda clinically important decrease in QoL frombaseline to 1-year post-diagnosis. Even at 6-months post-diagnosis, positive effects werereported such as enhanced appreciation for life(79%). A range of risk factors associated withsustained or emergent psychological morbiditywere identified. CONCLUSIONS: Althoughmost survivors have adjusted well to theircancer diagnosis and treatment by 12 monthspost-diagnosis, issues develop and/or persistfor others. These findings emphasise the im-portance of periodic screening for distress andtailored intervention across the cancer trajec-tory, including the survivorship phase. Survi-vors’ reports of positive effects of cancer asearly as 6 months post-diagnosis suggest con-siderable resilience and adaptability in the faceof adversity.

S1810-3

Unmet Needs in Chinese (Mandarin and Cantonese),

Greek, and Arabic-Speaking Cancer Survivors in

Australia

L. Aldridge1, J. McGrane1, P. Butow1, A. Girgis2,M. Jefford3, P. Schofield3, M. King1, M. Eisenbruch4,P. Yates5, S. Connell5, P. Duggal-Beri1, M. Sze1,E. Lobb1, D. Goldstein6

Psycho-oncology Co-operative Research Group(PoCoG), The University of Sydney, Camperdown,New South Wales, Australia1, Centre for HealthResearch and Psycho-oncology (CHeRP), TheCancer Council New South Wales, University ofNewcastle & Hunter Medical Research Institute,Newcastle, New South Wales, Australia2, Suppor-tive Care Research Group, Peter MacCallumCancer Centre, Melbourne, VIC, Australia3, Schoolof Psychology, Psychiatry, and PsychologicalMedicine, Monash University, Melbourne, VIC,Australia4, School of Nursing and Midwifery,Queensland University of Technology, Brisbane,Queensland, Australia5, Department of MedicalOncology, Prince of Wales Hospital, Randwick,New South Wales, Australia6

OBJECTIVES: Although Australia is one of themost culturally diverse countries in the world, verylittle is known about the experiences of culturallyand linguistically diverse (CALD) cancer patients.Our group is conducting a population-based studyof Chinese (Mandarin and Cantonese), Greek andArabic-speaking migrant cancer survivors and amatched control group of Australian-born English-speaking cancer survivors to assess levels ofpsychological distress, unmet need, and quality oflife of these groups. METHOD: Participants wereborn in a country where Chinese, Greek or Arabicis spoken (or Australia) and diagnosed with cancerin 2004–2007. Questionnaires were completed intheir preferred language and assessed anxiety anddepression (HADS), quality of life (FACT-G), andunmet needs (items from the SCNS, CaSUN, andour own work addressing culturally specific issues).Preliminary data is available for CALD survivors(n5 150 to date) recruited through cancer registriesin New South Wales and Queensland. RESULTS:Over 35% of survivors experienced elevatedanxiety and over 20% elevated depression, com-pared to 21% and 11% respectively in a popula-tion-based sample of Australian cancer survivors 5years post-diagnosis. Quality of life scores werebelow Australian population norms on all do-mains. Highest unmet needs were for help with‘managing concerns about the cancer comingback’, ‘information about cancer and its treat-ment’, ‘written information in my language’,and a ‘specialist who speaks my language’.CONCLUSIONS: Results highlight that CALDcancer patients are potentially more at risk for


DOI: 10.1002/pon


psychological morbidity than native Australians.In addition, results identified areas of unmet needwhich might be better addressed by the healthsystem, particularly with regards to the provisionof information and support. These results can beused to inform the design of relevant and targetedpsychosocial interventions. Possible strategies forintervention will be discussed.

S1813

Adaptations of Meaning-Centered Psychotherapy

for other populations and purposes in psycho-

oncology and palliative care

SYMPOSIUMDESCRIPTION:Meaning-CenteredPsychotherapy (MCP) for ambulatory advancedcancer patients has been developed and tested inclinical trials in both Group and Individual formatsby Breitbart and colleagues at Memorial Sloan-Kettering Cancer Center. This Symposium describesfour novel interventions that represent adaptationsof MCP for other populations and purposes in thecancer and palliative care settings. Presenter 1 willpresent Meaning-Centered Psychotherapy forNurses in Palliative Care. Presenter 2 will presentMeaning-Centered Bereavement Intervention forParents who have lost a child to cancer. Presenter3 will present Meaning-Centered ApproachesAdapted to Inpatient and Home Hospice Patients.Finally, Presenter 4 will present a CognitiveExistential Intervention with meaning components.The Discussant will comment on the expansion ofMCP in psycho-oncology and palliative care.

S1813-1

Meaning-Centered Grief Intervention for Parents

Who Have Lost a Child to Cancer

Wendy LichtenthalMemorial Sloan-Kettering cancer Center, New York,New York, United States

OBJECTIVES: In addition to profound grief,parents who lose a child to cancer face uniquechallenges in making meaning of their loss. Theymay struggle with their sense of identity andpurpose, the meaning of their child’s life, andfinding sense and significance in the loss. Thepurpose of this ongoing study is to aid in theadaptation of Meaning-Centered Psychotherapy,an intervention designed to enhance meaning andreduce distress, for parents bereaved by cancer.METHOD: Parents bereaved 6 months to 3 yearsago are being recruited from 75 families. Partici-pants will first complete quantitative assessments of1) meaning and purpose, 2) prolonged griefdisorder (PGD), 3) insecure attachment, 4) adjust-ment, and 5) intervention preferences and per-ceived barriers to psychosocial service use. We will

then conduct in-depth qualitative interviews with asubset of parents (n5 24) about themes of mean-ing-making, comparing parents with high vs. lowlevels of PGD. RESULTS: This study will informdevelopment of a meaning-centered grief interven-tion by a) characterizing the challenges in findingmeaning that parents face in order to shape thecontent of a treatment manual, b) examiningthemes in parents with and without clinicallysignificant levels of PGD, and c) identifyingparents’ intervention preferences, needs, and bar-riers to psychosocial service use to determine thebest target population and intervention format.Preliminary findings will be presented. CONCLU-SIONS: Parents bereaved by cancer may grapplewith finding meaning in their loss and with shiftingtheir identity from dedicated caregivers to bereavedparents. Information about the unique themes ofmeaning and intervention preferences among par-ents who lose a child to cancer are crucial to thedevelopment of a theory-driven, tailored interven-tion that is acceptable, effective at enhancingmeaning and reducing suffering, and has thepotential to be readily disseminated within pedia-tric cancer care facilities.

S1813-2

A Meaning-centered Intervention for Oncology and

Palliative Care Nurses: Exploring Processes and

Outcomes

Lise Fillion, Melanie Vachon, Doris Leung, SandyLavoieLaval University, Quebec City, Quebec,United Kingdom

OBJECTIVES: Nurses working in oncology andpalliative care frequently encounter existential andspiritual challenges. To address this problem, weadapted a Meaning-centered Intervention (MCI),and tested its efficacy to enhance nurses’ jobsatisfaction and quality of life using an RCTdesign. While nurses in the experimental groupreported more perceived personal benefits, emo-tional and spiritual quality of life remainedunaffected by the intervention. Two pilot studieswere designed to explore factors contributing tothese null findings. METHOD: The first goal wasto pre-test the 5-week format. The second goal wasto explore nurses’ existential, and spiritual experi-ences of the MCI and to describe the qualitativeeffects of the MCI from the nurses’ point of view.Two qualitative studies were conducted, withFrench (n5 11), and English (n5 16) samples.The first study focused on spirituality experiences,while the second emphasised the meaning ofexperiences. Interpretative phenomenological ana-lysis was used. Quantitative outcomes were ex-plored. RESULTS: Nurses’ participation andattendance was excellent. Two themes emerged


DOI: 10.1002/pon


from the first study. The MCI expanded nurses’spiritual and existential awareness. A group’scontaining function for nurses was revealed. Forthe second study, post-MCI findings revealedgreater awareness for meaning of suffering, andimportance of self-care. Self-care was defined asexperiences of personal growth and emphasis onboundaries between their private and professionalselves. How the MCI provided a safe space wasalso revealed. CONCLUSIONS: Both studiessupported the relevance of the experiential contentand the group format. Both studies associate MCIeffects with personal growth and support. Explora-tion of outcomes is provided. Next steps arediscussed.

S1813-3

A Cognitive-Existential Intervention to Improve

Existential and Global Quality of Life in Non-

Metastatic Cancer Patients

Pierre GagnonCHUQ- Hotel-Dieu de Quebec and Maison Michel-Sarrazin, Laval University, Quebec City, Quebec,Canada

OBJECTIVES: While existential issues are oftenconsidered in advanced cancer, non-metastaticcancer patients are also concerned with existentialdistress. In addition, they are in a better physicaland mental condition to get involved in moreintensive interventions that are often necessary toproperly address these issues. We developed anintervention, partially adapted from Meaning-Centered Psychotherapy to address the needs ofthis population. METHOD: A 12-session cogni-tive-existential intervention was designed to ad-dress existential and global Quality of Life (QoL)of French-Canadian non-metastatic cancer patientsin group and individual formats. A pilot studyevaluated the intervention, now in an efficacy trial,comparing group and individual formats to stan-dard care. Existential QoL is measured by theFACIT-SP and the existential subscale of theMcGill Quality of Life (MQoL) questionnaire;global Quality of Life is measured by the MQoL.RESULTS: The pilot phase confirmed the feasi-bility of the study with recruitment of 33 non-metastatic cancer patients. The attendance rate was94% and the rate of completion of questionnaireswas 96.7%. Quality control confirmed the standar-dization of the interventions. Several pilot datashowed full or near statistical significance. We havenow recruited 87 patients that were randomized inthe efficacy trial. Preliminary data show highsatisfaction rates and interest in the intervention.CONCLUSIONS: The feasibility of the study wasconfirmed by the pilot study. Preliminary datasuggest high satisfaction rates and interest in non

metastatic cancer patients. The potential efficacy ofthe intervention on existential and global quality oflife will have to be confirmed by the completion ofthe larger study.

S1813-4

Meaning-Centered Psychotherapy with Hospice

Patients

E. Alessandra StradaBeth Israel Medical Center and Albert EinsteinCollege of Medicine, New York, New York,United States

OBJECTIVES: Loss of meaning, fear of dying, anddemoralization are commonly experienced byhospice patients as they approach death. Thedelivery of psychotherapy to these patients iscomplicated by the limitations imposed by thesetting, as well as by the sudden physical andcognitive changes. As a result, patients’ emotionalneeds may be unmet. This presentation will discusshow meaning-centered psychotherapy can be effec-tively adapted to address emotional suffering inhospice patients and their caregivers. METHOD:Meaning-centered psychotherapy has the potentialto effectively address loss of meaning, relieveemotional suffering, and ease the dying processhospice patients. However, both the therapy modeland session structure need to be adapted to thehospice setting, the patient’ condition, and care-givers’ emotional functioning. Assessment skills,flexibility and sound clinical judgment are required.This case-based presentation will describe howclinicians can effectively use meaning-centeredpsychotherapy with hospice patients and theircaregivers. RESULTS: Meaning-centered interven-tions can be successfully adapted to the inpatientand home hospice setting. However, frequency,length of session, and recipient may need tochange from session to session. When patientsare approaching death the quality of theirdistress, therapeutic goals, and ability to engagein the session may change rapidly. Awareness ofthese clinical issues will allow clinicians towork effectively with hospice patients until themoment of death. CONCLUSIONS: Hospicepatients represents a vulnerable and potentiallyundeserved population due to the lack of psy-chotherapy models that specifically addresstheir unique needs and challenge. Meaning-basedand transpersonal interventions, appropriatelyadapted to the needs and circumstance ofhospice patients and their caregivers, representan important resource in psycho-social oncology.It is important that clinicians learn to applythese models to patients who are experiencingloss of meaning and emotional suffering at the endof life.


DOI: 10.1002/pon


S1816

Support for the Supporters: Does It Matter More

For Caregivers?

SYMPOSIUM DESCRIPTION: The role of sup-port in maintaining and improving well-being ofcancer patients has been well acknowledged andstudied. Much less attention has been given to thesupport needs and the effects of social andprofessional support for the family caregivers. Thislack is surprising, in light of the well documentedempirical evidence on the negative effects ofcaregiving burden on physical and psychologicalhealth of the caregivers. Many unanswered ques-tions include what are the effects of different typesof support or different sources of support, does theneeds for support change over time, and howprofessional support should be extended. Thissymposium addresses some of these concerns fromfive different angles in examining the effects ofsocial support and across different phases incaregivership trajectory. Yves Libert addressescommunication issues, barriers and challenges offamily caregivers. The presentation describes stu-dies conducted in Belgium focusing on caregivers’experience, desire for formal psychological sup-port, and on training programs aiming at improv-ing physicians’ communication skills in three-person interviews where caregivers accompany thepatient. Youngmee Kim presents a national studyin the United States (US) that examined the overalleffect of social support perceived to be available forcaregivers and the relative contribution of varioussources of social support on caregivers’ quality oflife during long-term survivorship phase. DavidWellisch focuses on a specific group of caregivers --women who are at high risk for breast cancer dueto breast cancer in family relatives and are obese/overweight in the US. In addition to the cargivingexperience, these women experience an additionalsource of stress – being in a high risk group forbreast cancer. Wellisch presents results of aprofessional support program targeted for thispopulation to improve their lifestyle behaviors.Miri Cohen illustrates the efficacy of an interven-tion program in Israel for caregivers that was useda cognitive-behavioral approach and included abio-feedback to enhance well- being, and outcomesof the intervention comparing its efficacy for oldand young caregivers. Talia Zaider focuses on theend-of-life (EOL) experiences reported by familycaregivers in the US. Her presentation highlightsthe significance of relational characteristics, such aspreparedness and sense of life completion, on thecaregivers’ EOL experience. Lea Baider, in herdiscussion, highlights directions for future researchas well as support programs for caregivers ofcancer patients, during the early and long-termphases of survivorship.

S1816-1

Whose Support Matters More to Caregivers’

Quality of Life During Long-term Survivorship

Youngmee Kim1, Charles Carver1, Rachel Spillers2

University of Miami, Coral Gables, Florida, UnitedStates1, American Cancer Society, Atlanta, Georgia,United States2

OBJECTIVES: Although beneficial effects of socialsupport (SS) provided by caregivers on survivors’quality of life (QOL) have been well documented,effects for caregivers’ QOL remain unclear, parti-cularly during long-term survivorship. This studyexamined the overall effect of SS perceived to beavailable for caregivers and the relative contribu-tion of various SS sources on caregivers’ QOL fiveyears after the cancer diagnosis. Moderating effectsof gender on the relations between SS and QOLwere also explored. METHOD: A total of 261spousal caregivers participating in the NationalQuality of Life Survey for Caregivers at both 2 (T1)and 5 (T2) years after the initial cancer diagnosisprovided complete data for the study variables.Overall support and sources of SS were measuredusing MSPSS, and QOL (mental and physicalhealth) was measured using MOS SF-36 at both T1and T2. Age, SS at T1, and QOL at T1 wereincluded as covariates. RESULTS: General linearmodeling revealed that less overall SS available forcaregivers at T2 were related to poorer mentalQOL (po0.001), after controlling for the effects ofcovariates. SS from spouse (survivor) at T2 thatwas relatively less than SS from other sources, wasmarginally related to caregivers’ poorer mentalQOL (pso0.08). Among female caregivers,relatively less SS from family at T2 was related topoorer mental QOL(pso0.03). No effects onphysical QOL were significant. CONCLUSIONS:Results suggest that overall SS is beneficial forcaregivers’ mental health. Lack of SS fromspouse (survivor) for all caregivers and lackof SS from family for female caregivers appear tobe detrimental at the long-term survivorshipphase. Educational programs for caregivers,particularly targeting female caregivers, designedto assist them improve ways to seek outsupport from various sources may help them findhope and meaning years after the initial cancerexperience.

S1816-2

Cognitive-Behavior Group Intervention as a Model

of Support for Older and Younger Caregivers

Miri Cohen1, Abraham Kuten2, Georgeta Fried2,Roni Gagin2

University of Haifa, Haifa, Israel1, RambamMedical Center, Haifa, Israel2


DOI: 10.1002/pon


OBJECTIVES: One of the most important aims ofsupporting caregivers is to assist them improvingtheir adjustment and coping and reducing distress.The study examined the efficacy of CBT groupintervention designed to achieve this aim. Also, weaimed to compare its efficacy between younger andolder caregivers in outcomes of CBT groupintervention, including psychological aspects (dis-tress and adjustment) and physical symptoms(sleep disturbance and fatigue). METHOD:Forty-nine older (65–80) and 41 younger (33–64)spouses of cancer patients receiving chemotherapyparticipated in CBT groups. All participantscompleted pre- and post-intervention, and a 4-month follow-up questionnaire consisting of theBrief Symptom Inventory (BSI), PsychologicalAdjustment to Illness scale (PAIS), Mini sleepquestionnaire (MSQ), Fatigue Symptoms Inven-tory (FSI) and Multidimensional Scale of PerceivedSocial Support (MSPSS). Participants also re-ported adherence to home practice. RESULTS:Significant decreases in BSI and PAIS were foundfor both age groups at post-intervention andfollow-up assessments. Improvement in PAIS wasmore prominent among the older participants,whereas decreases in sleep problems and fatiguewere more prominent among the younger group.Improvement in psychological distress indexed byRCI was also significant for both groups. Further-more, perceived social support and home practiceat post-intervention and follow up predictedimprovement in distress measures. CONCLU-SIONS: The findings provide evidence that care-givers in all ages benefit from the supportive CBTin improving their psychological distress andreducing physical symptoms. This is especiallyimportant in light of the common professionalview of older adults being less receptive to, andhaving lower benefits from, group and/or CBT.The results highlight that professional supportshould focus on reducing physical as well aspsychological symptoms of distress.

S1816-3

A Pilot Study of a Lifestyle Group Intervention for

Overweight Women at High Risk for Breast Cancer

David Wellisch1, Adam Arechiga2, Roger Gould1,David Heber1

UCLA, Los Angeles, California, United States1,Loma Linda University, Loma Linda, California,United States2

OBJECTIVES: This was a pilot study to evaluatethe feasibility of a lifestyle intervention for womenwho were obese/overweight and at high risk forbreast cancer. Research questions include (a)Could an educational/supportive group be asso-ciated with improved psychological functioning,QOL factors, and health related behaviors?, (b)

Could high risk women be in such a group andcomplete the intervention?, (c) Could includinginternet (homework) component be successfully?,and (d) Would this lead to improvements in bodycomposition? METHOD: This pilot group inter-vention was a pre/post design with a 12-weekfollow-up. The intervention was standardized andtotaled twelve 2-hour interventions. Each sessionwas partially based on an internet program(masterinfood.com) which addressed emotionaleating. The three components of health education,focused psychological support, and homework(mastering food modules) were interwoven. Threestandardized questionnaires (Brief Symptom In-ventory, SF-36, and Health Promoting LifestyleProfile- 2) were administered three times (pre/post/follow-up). RESULTS: Thirteen subjects com-pleted baseline, twelve week questionnaires, andbody composition testing. There was a 2.4 lbaverage weight loss during the intervention (ns).From baseline to week 12, all of the SF-36variables were significantly different(pp0.001).For health promoting variables, five of six sub-scales and the total score were significantlydifferent (total score5 po0.001). For the BSI,two of the clinical subscales (Depression andInterpersonal Sensitivity) were significantly differ-ent. CONCLUSIONS: This group interventionwas feasible within limits. Several psychologicalindices were improved by this group experience.The combination of internet based modules andhealth education materials worked well in thisgroup format. However, subjects with histories ofaddiction, mental illness, and significant psycho-pathology did not fit well with this model. Thegroup experience was too brief to significantlyaffect weight loss and body composition.

S1816-4

Social Support for Caregivers of Cancer Patients:

Communication Issues, Barriers and Challenges

Yves Libert, Isabelle Merckaert, Daris RazaviUniversite Libre de Bruxelles, Brussels, Belgium

OBJECTIVES: Due to the evolution of medicineand the organization of care, partners, parents,children and other family members have becomeincreasingly involved in cancer care. This talk willaddress communication issues, barriers and chal-lenges arising from this involvement. METHOD:Studies were conducted in Belgium focusing oncaregivers’ distress, desire for formal psychologicalsupport, detection of difficulties experienced bytheir relatives and on training programs aiming atimproving physicians’ communication skills inthree-person interviews where caregivers accom-pany the patient. RESULTS: Results from theStudy 1 showed that one caregiver out of twoexperienced psychological distress and that one out


DOI: 10.1002/pon


of five spontaneously desired formal psychologicalsupport. The second study showed that caregiversdetected most of the physical and psychologicaldifficulties experienced by cancer patients. How tobetter involve caregivers in patient care has alsobeen examined. Two randomised controlled studiesshowed that, after a communication skills training,physicians were more patient- and caregiver-centred. CONCLUSIONS: Findings emphasizethe need to improve caregivers’ involvement incancer care. They need to be helped, they desire tobe helped and they are potential resources forphysicians. Communication skills trainingprograms focusing on communication skills inthree-person interview could be a way to achievethis goal.

S1816-5

The Association Between Family Relationships and

Caregivers’ End of Life Experiences

Talia Zaider, David KissaneMemorial Sloan-Kettering Cancer Center, New York,NY, United States

OBJECTIVES: This study examined the end-of-life(EOL) experiences reported by family members ofadvanced cancer patients. Prior research haselicited patient and caregiver perspectives on whatconstitutes a ‘good death’ experience (Steinhauseret al., 2000). In addition to symptom management,relational experiences were considered important.Our goal was to determine whether the quality ofthese EOL experiences is associated with relationalcharacteristics of the caregiving family. METHOD:Family members (n5 64) of advanced cancerpatients were randomized to a controlled trial ofFamily Focused Grief Therapy. Two dimensions ofEOL experiences were measured: (1) Preparation(e.g. ‘I worry that my family is not prepared tocope with the future’) and (2) Sense of LifeCompletion (e.g. I have been able to say importantthings to my relative’). Participants also completedmeasures of family functioning, coping and dis-tress. RESULTS: Results indicated significantassociations between aspects of family functioningand family members’ EOL experiences and con-cerns. Specifically, caregivers who perceived poorcommunication and high levels of conflict in theirfamily as a whole were more likely to be distressed,and to score low on preparation and sense of lifecompletion. Interestingly, family cohesivenesswas not related to caregivers’ EOL experiences.CONCLUSIONS: Our results suggest that thequality of caregivers’ EOL experiences, i.e. thedegree to which they experience preparedness andclosure, is associated with the quality of therelationships that surround them. Whereas muchresearch has focused on caregivers’ individualstrengths and vulnerabilities, our findings underscore

the importance of attending to their relational life asa key component of their adaptation prior to thedeath of a loved one.

S1820

Realizing Excellence in a Psychosocial Oncology

Program: Implementing a Strategic Framework

Focused on Demonstrating Quality of Service

through Performance Indicators

SYMPOSIUM DESCRIPTION: Limited re-sources and a growing demand for services havecontributed to the expectation of accountability inhealthcare. Psychosocial oncology programs areincreasingly challenged to demonstrate the effi-ciency and efficacy of their services. This sympo-sium discusses the development framework,implementation, and evaluation of a recentlyfunded Psychosocial Oncology Program at anAcademic Health Sciences Centre. Dr. CarolineGerin-Lajoie will present the strategic frameworkadopted by the program to provide the foundationfor setting the organizational goals, direction forservice provision, operational excellence, and theframework for the program evaluation process.Ms. Diane Manii will describe key elements thatenabled the program to move from the theory ofprogram excellence to the daily management ofclinical service delivery. Dr. Cheryl Harris willpresent an overview of key program evaluationprinciples and their application in the ongoingevaluation of this new program. The presentersconclude that further work is needed to continuedeveloping and implementing program evaluationmodels across PSOP’s. This could eventually leadto a national consensus document outlining anagreed upon framework for psychosocial oncologyprograms.

S1820-1

A Strategic Framework for Quality of Service and

Performance Indicators

Caroline Gerin-Lajoie

The Ottawa Hospital Cancer Centre & OttawaHospital Research Institute, Ottawa, Ontario,Canada

OBJECTIVES: Hospitals and health care centersmust build the culture, tools and processes tosustain high quality and safe patient care in ahealthcare environment challenged by shortages ofhealthcare professionals, funding constraints,changing care practices and increasing expectationsfrom patients, governments and community.METHOD: In order to achieve performanceexcellence in quality and patient safety, an Aca-demic Health Sciences Centre decided to align its 3


DOI: 10.1002/pon


year Quality Plan with a strategic framework basedon ‘Hardwiring Excellence’ (Quint Studer). In thismodel, 6 Pillars including Service, Quality, People,Finance, Growth, and Community, provide thefoundation for setting the organizational goals anddirection for service and operational excellence,and provide the framework for an evaluationprocess. RESULTS: The Psychosocial OncologyProgram within this Academic Health SciencesCentre applied the above framework to developkey indicators that measure Service, Quality,People, Finance, Growth, and Community. CON-CLUSIONS: According to the Studer Group, toachieve excellence organizations must be able toobjectively assess their current status and thentrack their progress to the goals they have set. Thefuture challenge will be to reach a nationalconsensus on a framework for psychosocial oncol-ogy programs nationwide with specific benchmarktools, performance indicators and other programevaluation guidelines.

S1820-2

Program Infrastructure for Quality Patient Care,

Accountability and Sustainability

Diane ManiiThe Ottawa Hospital Cancer Centre & OttawaHospital Reserach Institute, Ottawa, Ontario,Canada

OBJECTIVES: The delivery of psychosocial ser-vices appears to be reliant on local resources andadvocacy, with limited guidelines on programstructure, accountability and sustainability. Thispresentation will describe key elements that enablea program to move from the theory of programdevelopment to the daily management of clinicalwork load based on referral indicators, intakeprocess, work load management, an interprofes-sional model of care and data collection method.METHOD: The program was founded on aliterature review, hospital and provincial consulta-tion and a financial sustainability analysis. Thisresulted in the development of an interprofessionalprogram that combines both psychosocial andrehabilitation disciplines. Referral to the programfollows a referral process that includes screening,an intake referral form and multidisciplinaryrounds. A work load management strategy wasdeveloped to manage wait lists, provide guidanceon program priorities and formalize work loadexpectations. RESULTS: The program receives250–300 new referrals per month. Patients nowreceive services previously unavailable or with longwait lists from an interprofessional team. Over andabove professional standards of care, accountabil-ity is monitored through a health human resourcedata management collection. The indicators ofaccessibility and safety are captured by this system.

To ensure sustainability, the following issues havebeen targeted for ongoing evaluation: reducedoncology visits to Emergency, admissions, andlength of stay. CONCLUSIONS: If PsychosocialOncology Programs are to remain an essentialaspect of quality patient care, they must not onlydemonstrate a reduction in human suffering butalso capture the level of work necessary to providethese services that is measured and accountable.These data can then be evaluated in terms of costavoidance to the institution.

S1820-3

Psychosocial Oncology Program Evaluation:

Key Principles and Application

Cheryl HarrisThe Ottawa Hospital Cancer Centre & OttawaHospital Research Institute, Ottawa, Ontario,Canada

OBJECTIVES: Given limited resources in health-care and a growing need for services, psychosocialoncology programs are increasingly challenged todemonstrate the efficiency and efficacy of theirservices. An overview of key program evaluationprinciples and their application in establishing theongoing evaluation process of a recently fundedPsychosocial Oncology Program will be presented.METHOD: The purpose of program evaluation,major types of evaluation, and common concernsabout implementing evaluations will be discussed.The steps in planning and implementing a success-ful Psychosocial Oncology Program Evaluationthat is consistent with the Studer Model 6 Pillarstrategic framework will be presented including thedevelopment of a logic model with particular focuson outcome evaluation (e.g. selection of measures,research design and methodological challenges,methods of data analysis). RESULTS: Preliminarydata consistent with the Studer Model 6 Pillarevaluation framework including indicators ofService, Quality, People, Finance, Growth, andCommunity will be presented. Particular emphasiswill be on descriptive data (e.g. trends in referrals,patient demographics, frequency and type ofprofessional contact) and patient self-report data(e.g. distress, interpersonal functioning, quality oflife, satisfaction with services). CONCLUSIONS:With the growing expectation of accountability inhealthcare, psychosocial oncology programs mustevaluate, enhance, and document the high-qualityservices they provide. The development and im-plementation of a program evaluation model istherefore crucial. By informing ongoing programdevelopment, the measurement of key indicatorspropels the evolution of the program. A consensusdocument outlining an agreed upon framework forpsychosocial oncology program evaluation couldfacilitate this essential process.


DOI: 10.1002/pon


S1822

Cancer Navigation in Canada: Models, Framework,

Competencies and Tools

SYMPOSIUM DESCRIPTION: Canada has em-barked on implementing the Canadian Strategy onCancer Control under the auspices of the CanadianPartnership Against Cancer. One of the eightaction groups, the Cancer Journey Action Group,has the mandate of providing leadership to achievea person-centered cancer system - changing thesystem so that patient, survivor and familymembers are better served. Navigation, one of thedriving forces for this change, will be describedduring this symposium, with illustrations from theprovinces of Nova Scotia and Quebec regardingtheir experiences in the implementation and eva-luation of their programs.

S1822-1

Navigation Models in Canada

Margaret I FitchOdette Cancer Centre, Toronto, Ontario, Canada

OBJECTIVES: Individuals diagnosed with cancerexperience more than a physical impact - social,emotional, psychological, spiritual and practicalconsequences emerge also. Some individuals mo-bilize their own networks finding resources theyrequire. However, many patients experience unmetneeds and frustration about not knowing where toturn for information and assistance. In Canada,patient navigation has emerged as a systemintervention to assist patients and families meettheir supportive care needs during and after cancertreatment. METHOD: Across Canada, variousmodels of patient navigation have emerged -professional, peer, virtual - in an effort to findways to support patients and better serve theirneeds throughout the cancer journey. Building oninput from cross country stakeholder workshops,and input from patients and survivors, program-matic approaches have been developed and are inthe process of being implemented in variousjurisdictions. RESULTS: The experience in im-plementing patient navigation has resulted in agrowing clarity regarding the conceptualization ofpatient navigation and description of how theprograms can be organized. Roles for navigatorsand navigation tools (aids) are gaining in specificityand definition. Descriptions of program ap-proaches, roles and responsibilities, and expectedoutcomes are now available to share based on theimplementation experiences. CONCLUSIONS:Clearly it is important to implement a patientnavigation program model that is appropriate forthe identified gaps in service delivery. The out-comes that can be achieved by implementing a

patient navigation program will vary with eachprogram model. Each jurisdiction needs to assessgaps in service carefully and select the approachesthat best fulfill the specific gaps.

S1822-2

Canadian Professional Navigation Framework

Lise Fillion1, Sandra Cook2, Anne-Marie Viellette3,Marie de Serres4, Richard Doll5, ArmineeKazanjian6

Laval University, Quebec City, Quebec, Canada1,Cancer Care Nova Scotia, Halifax, Nova Scotia,Canada2, Hotel-Dieu de Quebec, Quebec City,Quebec, Canada3, Maison Michel-Sarrazin, QuebecCity, Quebec, Canada4, BC Cancer Agency,Vancouver, British Columbia, Canada5, Universityof British Columbia, Vancouver, British Columbia,Canada6

OBJECTIVES: For many cancer control programsthe implementation of cancer navigation is acrucial component of improving continuity of care.However, literature has failed to describe cancernavigation consistently. A theoretical frameworkwas defined from literature. This study aimed atcontributing to a better understanding of profes-sional navigation in validating and refining theframework content in testing its comprehensive-ness. METHOD: Two well-implemented Canadianmodels of professional navigation, the OncologyPivot Nurse (OPN) in Quebec Province and, theCancer Patient Navigator (CPN) in Nova Scotiawere selected. A two-case qualitative evaluativedesign, involving three units was used (2 in Quebec:supraregional and local oncology team; 1 in NovaScotia: local team). Qualitative interviews wereconducted with professional navigators, patientsand family members, front line staff, familyphysicians, health administrators (interviews:n5 49; focus groups: n5 10). RESULTS: Datacollection and analyses were conducted followingour initial definition of navigation, which includedtwo dimensions. Results contribute to validate the2-dimension model. The first dimension, health-system-oriented, refers to continuity of care,including informational, management, and rela-tional continuity. The second dimension, patient-centered, corresponds to empowerment, includingactive coping, cancer self-management and sup-portive care. Data validation included systematicliterature review, and meetings with OPNs, CPNs,clinical experts, managers, decision makers andresearchers from Canada. CONCLUSIONS: Thetheoretical definition was challenged and refined byintegrating our qualitative findings and iterativevalidation process. This framework brings clarityabout the role and functions of professionalnavigators and suggests relevant outcomes forprogram evaluations.


DOI: 10.1002/pon


S1822-3

Scope of Practice and Associated Competency Re-

quirements for Professional Cancer Patient Navigators

Sandra Cook1, Lise Fillion2, Anne-Marie Veillette3,Marie de Serres4, Richard Doll5, ArmineeKazanjian6

Cancer Care Nova Scotia, Halifax, NS, Canada1,Laval University, Quebec City, Quebec, Canada2,Hotel Dieu de Quebec, Quebec City, Quebec,Canada3, Maison Michel-Sarrazin Research Team,Quebec City, Quebec, Canada4, BC Cancer Agency,Vancouver, British Columbia, Canada5, Universityof British Columbia, Vancouver, British Columbia,Canada6

OBJECTIVES: The Canadian professional naviga-tion framework identified a number of key func-tions that could improve continuity of care andcontribute to the patient’s experience of a coordi-nated patient focused system of care. This studyaims to further define the scope of practice andcompetency standards required for professionalcancer navigators to successfully fulfill their roleeffectively, to understand their relationship withother members of the cancer team and to minimizerole confusion. METHOD: A literature review ofrelevant professional standards including those forspecialized oncology nurses was completed. Func-tions identified in the professional navigationframework were mapped to the 7 practice domainsidentified in the CANO Practice Standards andCompetencies for the Specialized Oncology Nurses2006 document. The CANO self assessment toolwas completed by a number of Oncology PivotNurse (OPN) in Quebec and, the Cancer PatientNavigator (CPN) in Nova Scotia to validate thecompetencies. RESULTS: Synthesis of multiplesources of evidence identified a set of competencystandards for validation by professional cancerpatient navigators. These standards are based onthe current practice standards for specializedoncology nurses and reflect consensus of theindividuals practicing as professional navigatorsin Quebec and Nova Scotia. Five practice domains,reflecting the knowledge and skills of professionalnavigators, have been identified (supportive care,collaborative care, coordinated care, informationprovision, teaching, coaching, and clinical exper-tise). CONCLUSIONS: Data validation includedsystematic literature review, and consultation withprofessional cancer patient navigators, clinicalexperts and managers. The standards developedare intended for those who work within a model ofcare that reflects ongoing support either directly orindirectly across the entire cancer journey. A corefeature of navigation practice is continuity of careand collaborative practice and is highly dependenton effective relationships with other health profes-sionals.

S1822-4

Professional Navigators’ Role in Screening for

Distress

Anne-Marie Veillette1, Lise Fillion2, SandraCook3, Marie de Serres4, Richard Doll5, ArmineeKazanjian6

Hotel Dieu de Quebec, Quebec City, Quebec,Canada1, Laval University, Quebec City, Quebec,Canada2, Cancer Care Nova Scotia, Halifax, NovaScotia, Canada3, Maison Michel-Sarrazin ResearchTeam, Quebec City, Quebec, Canada4, BC CancerAgency, Vancouver, British Columbia, Canada5,University of British Columbia, Vancouver, BritishColumbia, Canada6

OBJECTIVES: Cancer patients experience differentlevels of distress. Outside medical treatment, betteraccess to supportive and coordinated care isexpected. For professional navigators, facilitatingmedical and biopsychosocial care coordinationappears as a crucial function. As a process tofacilitate coordination, screening for distress issuggested as a first stage, prior to assessing physical,practical and, psychosocial needs. This study aimedat describing the professional navigator’s role inimplementating processes of a screening for distresstool. METHOD: This qualitative evaluative designincluded 2 cases: Pivot Nurses in Oncology (PNOs)and Cancer Patient Navigators (CPNs). Qualitativeinterviews were conducted with PNOs, CPNs,psychosocial/spiritual oncology staff and key healthadministrators (interviews: n5 4; focus groups:n5 7). The implementation process assessmentstudy employs an operational framework based ona theory of emergent action including seven dimen-sions: inputs, activities, participation, reactions,effects on patient/family empowerment, effects oncontinuity of care, overall impact. RESULTS:Professional navigators described the tools as usefulfor continuity of care and patient and familyempowerment. The tool completion contributes toa comprehensive assessment of patients’ unmetneeds, facilitates intervention planning, referrals,and interprofessional collaboration. Results indi-cate, however, that professional navigators havesimilar challenges regarding the integration of thetool in their practice (need to address distressingcomponents revealed by the tool, subsequentevaluation and interpretation of distress scores,workload and time management issues). CONCLU-SIONS: This study contributes to describe therelevance of the implementation of screening fordistress tools by professional navigators. It empha-sizes how systematic screening could facilitatesprofessional navigators’ role of improving accessto supportive care for cancer patients when needed(targeted intervention, efficient referrals). Impact ofthis change of practice on oncology team function-ing is discussed (organizational and clinical issues).


DOI: 10.1002/pon


Preparation of the field prior to implementation andsupport throughout the implementation process isdiscussed.

S1824

Difficult Cases and Taboo Topics in Pediatric

Psycho-Oncology

SYMPOSIUM DESCRIPTION: Pediatric psycho-oncology has grown and prospered as a field for thepast 20 years, providing supportive care andpsychological services to children with cancer, theirparents and siblings and to survivors of pediatriccancer. Physicians and nurses have become increas-ingly aware of the broad psychosocial impact ofcancer and cancer treatment and of the importanceof attending to emotional distress throughout thecontinuum of cancer treatment. While most childrenand families go through cancer treatment withoutsuffering from clinically significant psychologicaldistress or treatment refusal, there are cases wherethe patient or parent does present with psychiatricillness during the child’s treatment or wherepsychological issues threaten the potential successof treatment. Such cases present a challenge for themental health provider who must treat the psycho-logical problem in the context of the constraints andchanging exigencies of the child’s disease. Thetrajectory of the cancer may exacerbate psychologi-cal problems, as when the child’s terminal illnessintensifies the suicidal ideation of a parent. Thissymposium will focus on these rare, but difficultcases where the experienced mental health clinicianmust work closely with the pediatric oncology teamin treating severe psychiatric distress in a parent orchild or refusal of treatment by the child with cancer.The speakers will elucidate discrete elements con-tributing to such exteme conditions and will focusattention on preventive strategies. Dr. DanielOppenheim will discuss a case of an adolescent’srefusal of treatment where the issues concernedidentity, immigration, and low self-esteem andthreatened the well-being of an entire family. Dr.Lori Wiener will discuss a case of selective mutism ina 10- year-old, newly-diagnosed child with a braintumor and the differential diagnoses and complica-tions with consent and treatment which this challen-ging symptom engendered. Dr. Joanna Breyer willreport on the response of the mental health andmedical treatment teams to suicidal ideation in twoparents of terminally ill children and will discuss theteams’ response when one of the parents did latercommit suicide immediately following the death ofhis child. She will suggest factors a team shouldconsider and actions they can take to lessen thelikelihood of such a devastating outcome. Dr.Andrea Farkas Patenaude will discuss these clinicallydemanding cases of extreme symtomatology in thecontext of pediatric psycho-oncology treatment and

training as they reflect our understanding of the roleof the mental health practitioner in this setting.

S1824-1

An Adolescent’s Refusal of Treatment: How to Deal

with Its Multiple Causes

Daniel Oppenheim, D Valteau-Couanet, S DauchyDepartments of Paediatrics and Supportive Care andPsycho-oncology unit, Institut Gustave Roussy,Villejuif, France

OBJECTIVES: To show how complex is anadolescent’s refusal of treatment and how to dealwith its various causes, we present a case oftreatment refusal. In France, there is an increasingnumber of complex family histories and individualswith a complex sense of identity. These individualsare especially vulnerable when confronted with anordeal such as cancer. METHOD: Interviews withB (15 year-old) with osteosarcoma and his parentsare described. He accepted conventional che-motherapy but refused high dose chemotherapy.His doctor’s explanations and warnings provedineffective. He accused his mother of being respon-sible for his illness. His father conceded that he hadno authority over him and was worried about hisaging parents in his country. If B. dies, he will buryhim in his country and remain there with B.’syounger brother. RESULTS: B. accepted somepsychotherapeutic interviews, and expressed a mainpoint: he said he had no identity (B. was born inFrance, his parents in two different countries), noreligion either (his father is a Muslim and hismother a Catholic) and no value. At last, heaccepted a weaker treatment. B’s mother was afraidshe could lose her two sons and her husband, andcommit suicide. She regained confidence in herparental role. CONCLUSIONS: Several psycho-oncological objectives were linked: that B. acceptshis treatment - and if not, that his refusal did notcause him distress-, accepts his family historyand acquires a sufficient sense of identity and value;that his father takes parental and marital respon-sibility seriously; that his mother understands B’saggressiveness, and imagines her future if he were todie; that his brother positions himself in thissituation; that the medical staff acts appropriately.

S1824-2

Selective Mutism and Treatment Refusal in a 10

Year-Old Girl with a Newly Diagnosed High Risk

Brain Tumor

Lori WienerNational Cancer Institute, Bethesda, Maryland,United States

OBJECTIVES: The diagnosis of cancer is a highlystressful event for a child and family. Selective


DOI: 10.1002/pon


mutism is a rare response to the anxiety associatedwith the diagnosis or invasive medical procedures.While behavior therapy is commonly used toreduce anxiety, this may not be possible when lifesaving treatment must be given immediately. Thistalk will address the challenges inherent in workingwith children who present with selective mutism ina medical setting. METHOD: The case of a 10year-old girl with a newly diagnosed brain tumor,selective mutism and treatment refusal will bepresented. Reflections one year later, from thepatient, family, and staff point of view will bediscussed. The author will review how selectivemutism can be confused with oppositional andmanipulating behavior and the potential relation-ship between selective mutism and post-traumaticstress disorder. RESULTS: Significant psychologi-cal distress was characterized by unwillingness toleave the family car for radiation therapy, refusalto look at or talk to medical personnel, andaggressive verbal and physical behavior within themedical center. Interventions tried as well as short-term and long-term consequences will be reviewed.Discussion will cover enrolling children who arenot consenting to treatment in research, workingwith resistance, and supporting the staff andfamilies of highly resistant children. CONCLU-SIONS: New insights can be gained through thediscussion of difficult cases. Selective mutism is anextreme response to significant anxiety. Pitfalls thatcan occur without excellent interdisciplinary andfamily communication will be addressed. Confer-ence participants will gain insight into the perspec-tive of a child and family one-year post treatmentand how hope, meaning, resiliency, and positivepsychological growth experiences can be obtainedeven when significant distress is present.

S1824-3

Making Meaning of Expressed Suicidal Ideation in

Parents of Terminally Ill Children with Cancer -

Therapeutic Considerations and Recommendations

Joanna BreyerDana Farber Cancer Institute and ChildrensHospital, Boston, Massachusetts, United States

OBJECTIVES: The death of a child is the hardestloss for a parent to bear. Over two thousandchildren in the United States and many thousandsof children worldwide die of cancer each year.Many parents make statements containing suicidalideation as they learn of their child’s terminalprognosis. Caregivers must assess the seriousnessof a parent’s potential suicidality while providingsupport for the child, siblings and parents as thechild nears death. METHOD: Examples of varioussuicidal statements will be given. Two cases wherefathers made suicidal statements to family mem-

bers or caregivers during their child’s treatmentcourse will be presented. The role of the psycho-social clinicians and the medical caregivers in eachcase will be described. RESULTS: Most parentalstatements expressing suicidal ideation are notassociated with suicidal gestures after the child’sdeath. Key questions for clinicians to ask will bedescribed. However, in one of the two cases above,the father did commit suicide the day his child died.Contributing factors to the different outcome in thetwo cases will be outlined. Actions taken in the twocases by caregivers will be compared. Staff reac-tions will be described. CONCLUSIONS: Themeaning behind a parent’s expression of suicidalideation is crucial - often these statements reflectdeep sadness and helplessness rather than suicidalintent. However, such statements need furtherassessment by the psychosocial clinician and some-times require therapeutic actions and safety plans.Specific suggestions for caregivers are given. Theseinclude the role of an individual therapist, theimportance of ongoing suicide evaluation, a sharedsafety plan and planning the appropriate setting forchild’s death.

S1829

Psychooncologial perspectives on pain

SYMPOSIUM DESCRIPTION: The proposed 90minute symposium aims to cover the experience ofpain in cancer patients, psychiatric Aspects ofcancer pain, psychological and psychopharmaco-logical aspects of pain management and burnout inpain patients will be discussed. Chair: Prof. Dr.Sedat Ozkan. The speakers are: Prof. Dr. SedatOzkan-Psychiatric Aspects of cancer pain, Prof.Dr. Luigi Grassi: Depression and pain, Prof. Dr.Mine Ozkan-Psychological and psychopharmaco-logical aspects of pain management, ZeynepArmay-Cancer in the Terminal Phase: Effects onthe treatment team and family.

S1829-1

Cancer in the Terminal Phase: Effects on the

Treatment Team and Family

Zeynep ArmayIstanbul University, NA, Turkey

OBJECTIVES: With a demanding workload andemotional burden the psycho-oncology team andfamily members is under the treat of variousemotional problems. Pain is the most frequentlyencountered problem in terminal stage cancerpatients and can be very difficult to manage. Thispresentation aims to summarize the effects ofworking with endstage cancer patients on thetreatment team and the burden experienced by


DOI: 10.1002/pon


family members. METHOD: This presentation willinvolve discussion of the results of two ongoingstudies carried out with treatment team membersworking with endstage cancer patients and familymembers. RESULTS: This presentation will in-volve discussion of the results of two ongoingstudies carried out with treatment team membersworking with endstage cancer patients and familymembers. CONCLUSIONS: Results will be dis-cussed with specific cultural differences. Conclu-sions will be made by highlighting specificrecommendations on program development incancer hospitals. Psychooncological approacheswill be discussed.

S1829-2

Psychological and Psychopharmacological Aspects

of Pain Management

Mine OzkanIstanbul University, Istanbul, Turkey

OBJECTIVES: Psychiatric treatment of pain incancer patients requires a multidisciplinary ap-proach. Psychiatric medications are importantcontributors of various problems in cancer patientswho experience pain. METHOD: Depression isamong the most frequently encountered psychiatricproblems in this group of patients. Depression andpain are comorbid conditions in cancer patientswith pain and they have a triggering effect on eachother. RESULTS: Especially antidepressants areindicated in cancer patients with pain in controllingboth pain and depression. Sleep disorders are alsofrequent in cancer patients who experience painand are effectively treated with antidepressants.CONCLUSIONS: In addition, antipsychotic med-ications and antiepileptics are also important in themanagement of cancer pain. In this speech thedetails of psychothropic and psychiatric treatmentof pain patients will be presented.

S1829-3

Depression and Pain: A Multifaceted Relationship

Luigi Grassi, Maria Giulia Nanni, Rosangela

Caruso Section of Psychiatry, University of Ferrara,

Italy

Luigi GrassiUniversity of Ferrara, Ferrera, Italy

OBJECTIVES: Pain has been defined by theInternational Association for the Study of Pain as‘An unpleasant sensory and emotional experiencearising from actual or potential tissue damage ordescribed in terms of such damage’. In cancerpatients pain is a debilitating symptom due toseveral factors, including neurophysiological, cog-nitive, environmental and personological factors.METHOD: The relationship between pain and

depression, as a specific neurobiological, cognitive,environmental and personological event, has beenstudied both in non-cancer and in cancer settingsfor a long time. We present a review of the mostimportant studies examining this association andsome data of our own research in non-cancer andcancer settings. RESULTS: The prevalence ofchronic painful physical symptoms is increased inpatients with depression in the Factors InfluencingDepression Endpoints Research Study involving513 Italian patients with a clinically diagnosedepisode of depression. A significant relationshipbetween pain and depression was also found in astudy of 1,108 Italian cancer patients, but theresults indicate differences between these twosituations. CONCLUSIONS: In cancer patients,more than non-cancer patients with non malignantpain, the association with depression is confirmedin some circumstances but not in others. Anadvanced stage of illness, age, and sex seem to beassociated to pain irrespective of the presence/absence of depression. Further longitudinal studiesare necessary to understand the possible interde-pendence of pain and depression in cancer.

S1832

Fear of Cancer Recurrence

SYMPOSIUM DESCRIPTION: Improved meth-ods of cancer detection and treatment have led torising numbers of patients surviving and living withthe disease for prolonged periods of time. As thenumbers of cancer survivors continue to grow,increasing attention is being given to factors thatimpact quality-of-life. Fear of cancer recurrence(FCR) is among the most commonly reportedproblems and yet one of the most prevalent areasof unmet needs amongst cancer survivors. Somedegree of FCR is almost universal in cancersurvivors. Partly because of the complexity andthe heterogeneity of the phenomenon, few studieshave addressed this issue. Indeed, there is noconsensus definition or conceptualization of FCR,nor is there currently a standardized assessmentmethod to adequately distinguish between normaland clinical (i.e. ‘pathological’) levels of FCR.Finally, current knowledge regarding the predic-tors and impact of FCR in cancer survivors islimited. The goal of this symposium is to highlightsome avenues and strategies in the pursuit of abetter understanding of FCR, including its assess-ment, prevalence, correlates, and impact on func-tioning. The first presentation will provide a brief,critical overview of existing measures of FCR anddescribe initial steps in the development of anEnglish version of the Fear of Cancer RecurrenceInventory (FCRI). The second presentation willfocus on a multidimensional conceptualization ofFCR and will present the results of a confirmatory


DOI: 10.1002/pon


factor analysis of the FCRI-French version. Thethird presentation will demonstrate the researchapplication of the FCRI by documenting theprevalence of FCR in early-stage breast cancersurvivors and describing the clinical, demographicand behavioural factors associated with FCR inthis patient population. The fourth presentationwill address the prevalence, persistence, andcorrelates of FCR in a large-scale, nationalpopulation-based study of 1, 3, 6, or 11-yearsurvivors of six different cancer types. The finalpresentation will include a discussion of recom-mendations for both future research and clinicalmanagement of FCR in cancer patients andsurvivors. Attendees at this symposium cananticipate gaining a greater understanding ofthe complexity of FCR, learning about emergingtools and sophistication in the assessment ofFCR, and about the predictors and impact ofthis common problem amongst those affected bycancer.

S1832-1

A Confirmatory Factor Analysis of the Fear of

Cancer Recurrence Inventory (FCRI) - French

Version

Sebastien Simard1, Josee Savard2

Institut universitaire de cardiologie et de pneumolo-gie de Quebec, Ecole de psychologie, UniversiteLaval, Quebec City, Quebec, Canada1, Centre derecherche en cancerologie de l’Universite Laval,Ecole de psychologie, Universite Laval, QuebecCity, Quebec, Canada2

OBJECTIVES: Recently, we developed the Fear ofCancer Recurrence Inventory (FCRI), a question-naire evaluating seven multidimensional aspects ofFCR. Although our previous work supported thereliability and validity of the questionnaire, thefactor structure was only evaluated using explora-tory factor analysis. The purpose of this study wasto confirm the original structure factors of theFCRI-French version and to support the multi-dimensional conceptualization of FCR. METH-OD: A provincial medical databank (RAMQ) wasused to randomly select a large pool of 5,000French-Canadian patients who had been treatedfor breast, prostate, lung and colon cancer withinthe past ten years. Of these, 1,986 patientscompleted by mail a battery of self-report ques-tionnaires including the FCRI. Confirmatoryfactor analysis (CFA) was used to test the originalfactor structure. RESULTS: The final CFA modelfor the total sample indicated a reasonably goodfitting with the original seven factor structure(X2(812)5 3126, p5 0.001; RMSEA5 0.56;CFI5 0.91; PNFI5 0.84). Five additional pathswere added between items correlated in the samefactor in order to obtain the best model fit. In

addition, CFA were performed separately forbreast (n5 977, RMSEA5 0.56; CFI5 0.90;PNFI5 0.82) and prostate (n5 727; RMSEA5

0.56; CFI5 0.91; PNFI5 0.83) cancer groups andsupported the stability of the original model.CONCLUSIONS: The findings confirmed theoriginal seven multidimensional factor structureof the FCRI in cancer patients and its validity. Inaccording to Lee-Jones’s initial formulation (1997),this study supported the importance of viewingFCR multidimensionally. Further research isneeded to empirically validate the FCRI-Englishversion and to assess the predictive and evaluativevalidity of this scale. The presentation will beconclude with a discussion of future develop-mentthe multidimensional conceptualization ofthe FCR.

S1832-2

Fear of Cancer Recurrence in Younger Breast

Cancer Survivors

Belinda Thewes1, Phyllis Butow1, Eugenie Batterby1,Jane Beith2, Susan Pendlebury3, Michael Cavanagh4,Maree Abbott4, Felicity Brazel5

Centre for Medical Psychology and Evidence-BasedDecision-Making, School of Psychology, Universityof Sydney, Sydney, Australia1, Dept. MedicalOncology, Sydney Cancer Centre, Royal PrinceAlfred Hospital, Sydney, Australia2, Dept RadiationOncology, St.Vincent’s Hospital, Sydney, Australia3,School of Psychology, University of Sydney, Sydney,Australia4, Breast Cancer Action Group of NewSouth Wales, Sydney, Australia5

OBJECTIVES: Fear of cancer recurrence (FCR) isone of the greatest areas of unmet need for helpamongst cancer survivors. Younger patients areparticularly vulnerable to experiencing FCR. Thisstudy aimed to report the prevalence of FCR inearly-stage breast cancer survivors, aged 45 yearsor less at diagnosis, and describes the clinical,demographic and behavioural factors associatedwith FCR in this sub-group of breast cancersurvivors. METHOD: Data were collected in across-sectional web-based survey of 200 womendiagnosed with Stage 0–2 breast cancer at least oneyear ago. All participants were aged 45 years or lessat diagnosis and were recruited through oncologyclinics and breast cancer consumer groups. FCRwas assessed using the Fear of Cancer RecurrenceInventory (FCRI). RESULTS: Based on a pre-liminary analysis of the first 81 patients, 69% ofyounger breast cancer survivors reported clinicallevels of FCR. High levels of FCR in participantswas associated with younger age at diagnosis(r5�0.48, po0.001), having locally advanceddisease (t5�2.5, p5 0.01), over estimating one’srisk of recurrence (F5 6.65, po0.01), frequencyof breast self examination (F5 7.81; p5 0.001),


DOI: 10.1002/pon


frequency of unplanned medical appointments(t5�2.07, po0.05; t5�2.8, po0.01), and levelof depression and anxiety (r5 0.56, po0.001).Data from the final sample will be reported in thispresentation. CONCLUSIONS: FCR is commonin younger breast cancer survivors and is asso-ciated with psychological morbidity. The results ofthe present study will be used to guide thedevelopment of psychological and educationalinterventions for cancer patients who experiencehigh levels of FCR.

S1832-3

Prevalence and Correlates of Fear of Cancer

Recurrence among Cancer Survivors: Results of the

American Cancer Society’s Studies of Cancer

Survivors (SCS)

Kevin Stein, Chiewkwei Kaw, Rachel SpillersAmerican Cancer Society, Atlanta, Georgia,United States

OBJECTIVES: Fear of cancer recurrence (FCR) isa common, and often distressing, problem forcancer survivors. Little is known, however, abouthow FCR varies across survivors of differentcancers or different time points along the survivor-ship continuum. Thus, the present study sought toevaluate the prevalence, persistence, and correlatesof FCR in a national, large-scale, population-basedstudy of cancer survivors. METHOD: Participantswere 9,653 survivors from a national study of 1, 3,6, and 11-year survivors of 6 cancers (breast,prostate, colon, bladder, uterine, and skin melano-ma). FCR was measured via a 4-item empirically-derived factor from the Cancer Problems in LivingScale, a 28-item checklist of problems cancersurvivors may experience. Mean FCR factor scoreswere analyzed using univariate correlations and ageneral linear model (GLM). RESULTS: Nearlyhalf (46.5%) of the survivors reported moderate-to-severe FCR, with 1-yr survivors reporting high-er FCR than the other time-since-diagnosis cohorts(po0.001). Univariate analyses indicated higherFCR was associated with being female, younger,Hispanic, and a breast cancer survivor as well aslater stage and more co-morbidities (po0.001). AGLM controlling for medical and demographiccharacteristics indicated those with higher FCRhad poorer mental and physical health, lowerspirituality, and more depression and anxiety(po0.001). CONCLUSIONS: These findings in-dicate that a large percentage of cancer survivorsexperience fear that their cancer will return. WhileFCR is most prevalent in short-term survivors, itappears to remain problematic for some long-termsurvivors, even up to 11-years after the initialdiagnosis. Variability across disease site ispresent, but may be explained by gender differencesand psychosocial issues. Results can inform

interventions and future research on FCR withcancer survivors.

S1832-4

Empirical Validation of the English Version of the

Fear of Cancer Recurrence Inventory

Sophie Lebel1, Sebastien Simard2, Cheryl Harris3,Monique Lefebvre4, Shailendra Verma4, LisePaquet5, Josee Savard6, Gerald Devins7

Universite d’Ottawa, Ottawa, Ontario, Canada1,Institut universitaire de cardiologie et de pneumolo-gie de Quebec, Universite Laval, Quebec, Quebec,Canada2, Ottawa Hospital Cancer Center, Ottawa,Ontario, Canada3, Ottawa Hospital, Ottawa, Ontario,Canada4, Carleton University, Ottawa, Ontario,Canada5, Centre de recherche en cancerologie etEcole de psychologie, Universite Laval, Quebec,Quebec, Canada6, Ontario Cancer Institute, Univer-sity of Toronto, Toronto, Ontario, Canada7

OBJECTIVES: Cancer survivors report that helpin managing fear of cancer recurrence is theirgreatest unmet need. This paper will provide a briefoverview of existing measures of FCR, most ofwhich have unknown psychometric adequacy. Oneinstrument with strong evidence to support itsvalidity is a 42-item French instrument entitled TheFear of Cancer Recurrence Inventory (FCRI;Simard & Savard, 2009). The present paperdescribes initial efforts to validate an Englishversion of the FCRI. METHOD: The FCRI wastranslated into English using a forward-backwardtranslation procedure. The translated FCRI waspilot-tested with 18 English-speaking cancer pa-tients. We established cross-cultural equivalency ofthe French and English versions by administeringboth forms to 40 bilingual cancer patients. In afinal stage yet to be completed, 420 English-speaking breast, colon, prostate, and lung cancersurvivors will complete the FCRI. Participants willbe randomly selected from the Cancer CareOntario provincial survivor registry. RESULTS:Initial pilot-testing (n5 8) of the FCRI led to a fewsome semantic changes. Additional testing (n5 10)indicated that all items were clear and easy toanswer. Administration of the French and Englishversions to bilingual respondents indicated fewdifferences in the way respondents answered bothversions. Both versions had Cronbach’s al-phas40.90. CONCLUSIONS: We have completed3 of the 4 steps needed to validate the Englishversion of the FCRI. Initial results are encoura-ging: The English translation appears adequate andacceptable to patients. Results support the culturalequivalence of the English FCRI to its originalFrench version. Research in progress will evaluatethe psychometric properties of the English versionof FCRI. The presentation will conclude with adiscussion of clinical and research relevance.


DOI: 10.1002/pon


S1836

The Science of the Personal: Exploring Hope,

Meaning, Prayer, and Spiritual Wellbeing

SYMPOSIUM DESCRIPTION: This 90-minutesymposium covers the science of the personal in anexploration of hope, meaning, prayer, and spiritualwellbeing in the cancer-affected. The first paperexplores what dying cancer patients and theirfamilies can do with hope following a qualitativeinvestigation of 40 palliative patients and 21 familymembers, specifically utilising discourse-analytictechniques. The second paper explores the uniquecontribution of peace, meaning, and faith to theestimation of 999 newly-diagnosed cancer patients’quality of life, and further assesses how theseexistential concepts are related to other wellbeingand cancer coping styles. The third paper investi-gates the impact of Christian intercessory prayeron cancer patients’ spiritual wellbeing and otherquality of life factors, in a double-blindedrandomised controlled trial, and asks whether thiskind of intervention is meaningful and whatfuture endpoints should and could be targeted.Finally, the fourth paper explores 40 narrativereflections written on the experience of being aspouse of an advanced cancer patient in anexploration of hope, meaning, and spiritual well-ness. This final paper brings together all fourpapers in a discussion of how practice and researchinform each other with specific emphasis on thepersonal.

S1836-1

Hope, Life, and Death: What Can Dying Cancer

Patients and Their Families do with Hope?

Jaklin Eliott, Ian OlverCancer Council Australia, Sydney, New SouthWales, Australia

OBJECTIVES: Cancer patients and their familiesare expected to have hope but this can beproblematic for people facing death, who aresometimes labelled without hope. However, pa-tients (and their families) often continue to expresshope, sometimes of cure, which can cause dis-comfort to healthcare professionals concernedabout denial, or unrealistic hope. We presentempirical data to argue that such concern ismisplaced, as this hope can be understood, not asdeath-denying, but as life-affirming. METHOD:Semi-structured interviews with patients withcancer and family members were conducted,audio-recorded, transcribed, and examined for thepresence of hope. Statements containing or refer-encing hope from 40 patients and 21 familymembers (28 patients within weeks of death) were

analysed using discourse-analytic techniques. Ana-lysis was augmented by thematic analysis of mediatexts referencing cancer and hope, and constructsof hope found within the medical and psychologi-cal literature. RESULTS: Patients’ and families’hopes of cure are sustained by normative beliefsabout the power of medical technology promul-gated within media. Cancer patients and theirfamilies resist and negatively evaluate implicationsthat hope is gone, even when facing imminentdeath, as the absence of hope (‘no hope’) char-acterised the patient as merely a biologicalentity. Many saw hope as changing, positioningthem in relation to intimate others, with hopesreflecting and constituting different stages in life.CONCLUSIONS: Requiring that patients andfamilies relinquish hopes of cure challenges theaccumulative weight and legitimacy of dominantbeliefs about hope and medical science. Thesignificance of their hopes for more life rests onhow this values parties and relationships involved,not on the attainability of the hope. Whenconfronted with death, the challenge is toidentify those hopes that maintain engagement inlife, but are appropriate and relevant for this finalstage of life.

S1836-2

Peace, Meaning, and Faith: Isolating Which Dimen-

sions of Spiritual Wellbeing are Most Integral to

Improving Quality of Life and Coping in Patients

with New Cancer Diagnoses

Hayley Whitford, Ian OlverCancer Council Australia, Sydney, New SouthWales, Australia

OBJECTIVES: This study explored the uniqueassociations between the newly proposed three-factor structure of the 12-item FACIT-Sp SpiritualWellbeing scale (Peace, Meaning, and Faith) andquality of life (QoL) in an Australian oncologypopulation. Correlations between the three-factors,QoL (Total QoL and the subscales of Physical,Social, Emotional, and Functional Wellbeing), andcancer coping styles were also investigated. METH-OD: A total of 999 consecutive cancer patients(53.2% male; age range 21–93, M5 60.8 years,SD5 12.9) with new, mixed diagnoses contempor-aneously completed the Functional Assessment ofChronic Illness Therapy - Spiritual Well-Being(FACIT-Sp; a measure of QoL) and the MentalAdjustment to Cancer (MAC) scale (a measure ofcancer coping styles) as part of a larger study onQoL and spiritual wellbeing. RESULTS: Hierarch-ical multiple regressions revealed Peace predicted15.8% (R2 Change) of the variance on QoLcontrolling for Meaning and Faith, and Meaningpredicted 5.8% of the variance on QoL controlling


DOI: 10.1002/pon


for Peace and Faith (po0.001). Peace showedlarge-to-moderate associations with improvedFunctional and Emotional Wellbeing, and FightingSpirit, and decreased Helplessness/Hopelessness,and Anxious Preoccupation. Meaning showedlarge-to-moderate correlations with improvedFunctional Wellbeing, Fighting Spirit, and de-creased Helplessness/Hopelessness, but also im-proved Social Wellbeing. CONCLUSIONS:The three-factor structure of FACIT-Sp SpiritualWellbeing scale appears psychometrically superiorto the previous two-factor solution as it furtherdiscriminates between which dimensions of spiri-tuality are most highly associated with improvedQoL facets and coping styles. These findingssuggest this new distinction will aid in fine tuningour understanding of how to calculate the trueburden of cancer. This study further provides morenormative data on patients with new cancerdiagnoses.

S1836-3

Investigating Spiritual Wellbeing as a Meaningful

Endpoint in a Study of Prayer in Cancer Patients

Ian OlverCancer Council Australia, Sydney, New SouthWales, Australia

OBJECTIVES: Anecdotes and a few randomisedclinical trials suggest a positive impact of inter-cessory prayer on health outcomes but the evidenceis equivocal. Many endpoints have been used; wechose a change in spiritual wellbeing as measuredby The Functional Assessment of Chronic IllnessTherapy - Spiritual Well-being (FACIT-Sp) as themost likely endpoint to demonstrate change in arandomised trial of intercessory prayer. METH-OD: A total of 999 new patients at an Australiancancer centre were randomised to receive remoteintercessory prayer (n5 509) or no prayer(n5 490). With ethics committee approval, patientsremained blind to the intervention but consented tomeasuring quality of life and completing theFACIT-Sp and repeating it 6 months later. Anestablished Christian prayer chain was providedwith sufficient but unidentifiable information abouteach intervention patient to pray for them.RESULTS: Randomisation yielded comparablegroups. The prayer group showed a small, statis-tically significant improvement over time in Spiri-tual Wellbeing compared to the control group(p5 0.02, partial 25 0.01) but only due to thePeace and Faith domains while the Meaningdomain of FACIT-Sp worsened. Only Emotionalwellbeing improved (p5 0.04, partial Z2 5 0.01) onthe quality of life scales. There were no significantdifferences between groups on other wellbeingsubscales. CONCLUSIONS: The study demon-

strated a measurable impact of prayer on 2 of the 3domains of spiritual wellbeing and emotionalwellbeing. The study was not designed to definemechanisms of action, and it is unclear whyonly certain aspects of spiritual wellbeing im-proved. Questions remain: How can we judgewhether prayer has had a meaningful impact?What should further studies use as endpoints?What degree of difference should they be poweredto detect?

S1836-4

Hope, Meaning, and Spiritual Wellbeing: Heuristic

Reflections from the Other Side

Ronna JevneUniversity of Alberta, Edmonton, Alberta, Canada

OBJECTIVES: Being a researcher or a practitioneraddressing quality of life issues such as hope,meaning, and spiritual wellness is a differentjourney than living the uncertainty faced by cancerpatients and family members. The challenge asscientists and practitioners is to honor both thetenants of our disciplines’ understandings ofresearch and the human experience we more fully,and with good intention, strive to understand. Anyimbalance has substantive consequences to allinvolved. METHOD: Using a heuristic framework,more than forty narrative reflections written on theexperience of being a spouse of an advanced cancerpatient are explored to address the question, ‘Whatis the experience of hope, meaning, and spiritualwellbeing as lived by the spouse of an advancedcancer patient during a five-month period of life-threatening illness?’ A secondary question, ‘Whatare the enhancers and inhibitors of hope andmeaning?’ will be addressed. RESULTS: Thedevelopment of a ‘creative synthesis’ forms theoutcome of a heuristic study. As such, theresearcher as scientist-artist develops an aestheticrendition of the themes and essential meanings ofthe phenomena. In the case of this study the theme‘Obedience to the moment’ is central to theexperience. Sub-themes of suffering, imperma-nence, and peace that relate to enhancers andinhibitors of hope, meaning, and spiritual wellnesswill be described. CONCLUSIONS: Results of thisstudy and the three others will be used togenerate questions for dialogue. How do practiceand research inform each other? On what candiverse disciplines agree about what constitutesresearch? Can there be, as Denzin and Lincolnsuggest, ‘a sacred science’ that would link all itspractitioners and participants in bonds that arerespectful of humanity? How can we further letthose who experience suffering teach us about itsrealities?


DOI: 10.1002/pon


S1837

The Cultural Context of Screening for Early

Detection of Breast Cancer

SYMPOSIUM DESCRIPTION: While earlybreast cancer detection is critical to survival, effortsto educate and convince women to attend breastcancer screening programs are only partiallysuccessful. The many studies examining barriersto and promoters of screening have been mainlybased on models of health behaviors, assessingcognitive, behavioral or emotional factors that areassumed to be universal. However, evidence isaccumulating that cultural perceptions and beliefs,social norms and historical/contextual processesamong specific ethnic groups play a major role inshaping screening behaviors. Of major concern isthat women from ethnic minority groups are oftenunder-screened, with breast cancer detected inmore advanced stages. Accordingly, this sympo-sium will concentrate on the understudied area ofthe cultural factors affecting screening behaviors inspecific ethnic groups, to better understand howculture affects screening and hence the survival ofwomen. The presentations will focus on Jewish andother high risk ethnic minority women in Europe,Arab women in Israel, Palestinian women in thePalestinian Authority, and Hispanic women invarious settings. In their systematic review KarenBelkic’ group found that European surveillanceprograms for woman with high breast cancer riskdid not adequately cover high-risk ethnic minoritygroups. Mariam Awad and colleagues assessedscreening behaviors and barriers to screening in397 randomly sampled Palestinian women in theWest Bank. They found a unique combination ofpersonal, cultural and environmental barriers,related to very low rate of screenings. LourdesBaezconde-Garbanati will present a study on U.S.women born in Latin America, a study now beingextended to immigrants in Sweden. High familismand low fatalism were significant, independentpredictors of on-time mammography. A majorbarrier for Latinas not receiving recent mammo-grams was lack of attention to their own health dueto placing family as top priority. Faisal Azaiza andMiri Cohen will present cultural, religious andsocial barriers to and promoters of screening inthree distinct groups of Arab women in Israel:Muslims, Christians and Druze. They will alsopresent a theoretical model and a tool for assess-ment of cultural barriers to and promoters ofscreening and its possible application with differentcultural groups. In the last part of the symposium,Prof. Lea Baider, in her discussion, will highlightdirections for future research as well as translatingthe studies into cultural-sensitive interventions toincrease attendance to screening programs amongwomen from minority groups worldwide.

S1837-1

Screening of High-Risk Groups for Breast and

Ovarian Cancer in Europe: A Focus on the Jewish

Population

Karen Belkic1, Karen Belkic2, Miri Cohen3,Marcela Marquez1, Marcela Marquez4, MiriamMints1, Brigitte Wilczek5, Anne H. Berman1,Enrique Castellanos1, Martha Castellanos6

Institutes of Oncology-Pathology and of ClinicalNeurosciences, Department of Obstetrics and Gyne-cology, Karolinska Institute and Hospital, Stock-holm, Sweden1, Institute for Prevention Research,the Keck School of Medicine of the University ofSouthern California, Los Angeles, California,United States2, Deaprtment of Gerontology, Uni-versity of Haifa, Haifa, Israel3, School of Medicine,Autonomous University of Nuevo Leon, Monterrey,N.L., Mexico4, Sankt Gorans Hospital, Stockholm,Sweden5, Stockholm Ambulatory Care Center,Saltsjo Bana, Stockholm, Sweden6

OBJECTIVES: Lower breast cancer screening ratesare often found among ethnic minority groups andthose born outside the host country. This is ofparticular concern for high-risk groups. We aim to:1) systematically review the literature concerningbreast cancer early detection practices (BCEDP):among Jewish women, a prototypic high-riskgroup; 2) examine European surveillance studiesof high-risk for breast and/or ovarian cancer inorder to assess the likelihood of adequatelydetecting women from minority ethnic groups.METHOD: We identified empirical studies onJewish women concerning: a) adherence to breastcancer screening guidelines and its relation tosocio-demographic characteristics, b) barriers andpromoters for breast cancer screening or c) social-psychological aspects of genetic testing/risk assess-ment for breast and ovarian cancer. We thensearched for European-based studies that targetedwomen at high risk for breast and/or ovariancancer and that had imaging as part of thesurveillance protocol. RESULTS: We found nostudies about BCEDP among Jewish women inEurope. Some Jewish women in the U.S. andIsrael, including recent immigrants, are under-screened. The European surveillance studiesshowed a clear benefit of magnetic resonanceimaging and/or more intensive screening forwomen with increased breast cancer risk. SomeEuropean-based surveillance studies consideredhigh-risk ethnic minority groups, including Jewishwomen, but none provided adequate outreach toensure that these groups were included in theirprograms. CONCLUSIONS: The special screeningneeds of the Jewish population in Europe have notbeen met regarding breast and ovarian cancer. Thismay also be the case for other ethnic minoritygroups. Since these groups are often dispersed


DOI: 10.1002/pon


among many European countries, a European-wide, population-based approach is suggested toaddress their specific screening needs. For theJewish population of Europe as well as otherethnic minority groups, cultural sensitivity is vitalfor these efforts.

S1837-2

Breast Cancer Screening among Latinas: Our

Research in the U.S. and Initial Findings for

Scandinavia

Lourdes Baezconde-Garbanati1, Lorena Teran2,Marcela Marquez3, Marcela Marquez4, MarthaCastellanos5, Enrique Castellanos3, Brigitte Wilc-zek6, Miri Cohen7, Karen Belkic1, Karen Belkic3

Institute for Prevention Research, the Keck Schoolof Medicine of the University of SouthernCalifornia, Los Angeles, California, United States1,Department of Pediatrics, University of California,Irvine, California, United States2, Institutes ofOncology-Pathology and of Clinical Neurosciences,Department of Obstetrics and Gynecology,Karolinska Institute and Hospital, Stockholm,Sweden3, School of Medicine, Autonomous Univer-sity of Nuevo Leon, Monterrey, N.L., Mexico4,Stockholm Ambulatory Care Center, SaltsjoBana,Stockholm, Sweden5, Department of Mammogra-phy, Sankt Gorans Hospital, Stockholm, Sweden6,Department of Gerontology, Faculty of SocialWelfare and Health Sciences, University of Haifa,Haifa, Israel7

OBJECTIVES: Sweden has a well-developed popu-lation-based mammography screening program withhigh overall participation rates. Related in substan-tial measure to early-stage detection, Swedish breastcancer survival rates are among the world’s highest.However, not all segments of the Swedish popula-tion benefit equally from that screening program.Latin-American-born women born are significantlyless likely than Swedish-born women to attendinvitational mammography. We seek to know whythis is so, informed by our research among Latinasin the U.S. METHOD: We tested an expandedmodel incorporating the Theory of Planned Beha-vior (TPB), cultural factors, potential facilitatorsand barriers among seventy-two Latinas with low-incomes in Southern California who had contactedan Early-Detection Program and received a mam-mogram 3–4 years earlier. We also performed asystematic review concerning the reasons for non-attendance in mammography programs in Swedenor elsewhere in Scandinavia among women born inLatin America. RESULTS: Cultural factors: highfamilism and low fatalism were significant, indepen-dent predictors of on-time mammography in South-ern California Latinas. However, a major barrier fornot receiving recent mammograms was lack ofattention to own health due to placing family as top

priority. We found no published studies examiningthe reasons for Latina non-attendance in mammo-graphy programs in Sweden or elsewhere inScandinavia. We are now pilot-testing a question-naire among Latinas in Sweden regarding mammo-graphy and health. CONCLUSIONS: Interventionsgeared at increasing breast cancer screening amongLatinas should emphasize the benefits to them andsimultaneously to their families.Incorporation of‘personalismo’ and our knowledge about socialnorms by approaching women on a neighborhoodor other community-based group represent promis-ing strategies. Outreach on breast cancer screeningshould be integrated into on-going European andU.S. surveillance programs among women at highrisk for breast cancer.

S1837-3

A Theoretical Model for the Conceptualization of

Cultural Barriers to and Promoters of Breast Cancer

Screening: Implications for Research and Intervention

Faisal Azaiza1, Miri Cohen1, Miri Cohen2

School of Social Work, Univrsity of Haifa, Haifa,Israel1, Deaprtment of Gerontology, University ofHaifa, Haifa, Israel2

OBJECTIVES: To propose a theoretical model ofculture-related barriers to and promoters of screen-ing for the early detection of breast cancer, and itsimplementation for research and intervention. Themodel was developed based on studies with IsraeliArab women. The model’s development, based ona series of studies including validation of a culture-related beliefs questionnaire and testing an inter-vention to increase screening attendance, is de-tailed. METHOD: Starting with five focus groups(N5 51) with Arab Israeli women, to learn aboutcognitions, beliefs and attitudes to breast cancerand early detection screening, a theoretical modeland a questionnaire were developed and tested in arandom sample of 300 Arab women. Based on theresults, a tailored intervention aimed to lowerbarriers and increase screening attendance wasdeveloped and tested with 42 women and 24matched controls. RESULTS: A model with fivefactors emerged that explained 54.6% of thecumulative variance: social barriers, exposurebarriers, environmental barriers, uneasiness withown body, and traditional beliefs about cancer.Post-intervention, a significant decrease in barriersto screening was found in the intervention groupbut not in the control group. While at pre-intervention similar rates of attending screeningwere found, at post-intervention 48% of the studygroup but only 12.5% of the controls attended orscheduled mammography. CONCLUSIONS:Culture-sensitive interventions are a prerequisiteto create change in screening attendance bywomen from different ethnic backgrounds. The


DOI: 10.1002/pon


interventions should be constructed based on adeep understanding of the specific culture-relatedbarriers of particular ethnic groups. The proposedmodel can serve as a basis for understandingculture-based barriers and promoters, but shouldbe adapted to different ethnic groups.

S1837-4

Factors Associated with Low Screening for Breast

Cancer in the Palestinian Authority: Relations of

Environmental Barriers and Cancer-Related Fatal-

ism

Mriam Awad1, Francoise Daoud1, Faisal Azaiza2,Miri Cohen3

Faculty of Nursing & Health Sciences, BethlehemUniversity, Bethlehem, Palestinian Territory, Occu-pied1, School of Social Work, University of Haifa,Haifa, Israel2, Department of Gerontology, Uni-versity of Haifa, Haifa, Israel3

OBJECTIVES: Screening for breast cancer is ofteninhibited by cultural perceptions and social norms,factors which often interact with living in low-income countries. Palestinian women residing in theWest Bank belong to a traditional and religioussociety in a low-income country. We examined theirscreening behaviors and knowledge in relation tothese inhibitory cultural and environmental factors.METHOD: Participants were 397 Palestinian wo-men, aged 30–65, residing in the West Bank part ofthe Palestinian Authority. The sample was stratifiedto proportionally represent Muslim and Christianwomen from cities, villages and refugee camps ofeach West Bank district. Participation rate was98.3%. The participants completed questionnaireson breast examination (mammography, clinicalbreast examination (CBE) and self breast examina-tion (SBE), knowledge and behaviors, perceivedcancer fatalism, health beliefs, and environmentalbarriers. RESULTS: Most of the women did notknow the recommended frequencies for any of thebreast examinations. Over 70% had never under-gone mammography or CBE, while 62% hadperformed SBE; a tendency to over-perform SBEwas found. Women were more likely to undergobreast examinations if they were less religious andmore educated, expressed lower personal barriersand lower fatalism, and perceived higher effective-ness of the examinations. CONCLUSIONS: Pales-tinian women tend to perform more SBE, probablydue to low access to mammography and CBE andunawareness of the recently proven inefficiency ofSBE. This and the very low rate of mammographyand CBE attendance and knowledge are majorhealth concerns. The women reported personal,cultural and environmental barriers, which shouldbe addressed by educational programs. Resourcesfor early detection and treatment of breast cancershould then be allocated.

S1841

Developmental Differences, Changes after Death of

a Brother or Sister in Bereaved Siblings and Advice

to Health Professionals

SYMPOSIUM DESCRIPTION: The death of achild with cancer has a life changing impact on familymembers, including siblings. Little is known regardingthe bereavement experiences of siblings after the deathof a brother or sister. Research also suggests manybereaved parents are dissatisfied with their child’send-of-life (EOL) care. In this symposium we willpresent developmental differences and changes insiblings’ bereavement experiences after the death, aswell as advice to healthcare professionals frombereaved siblings and parents.The first report is partof a large longitudinal study of family bereavement inone institution; the other two reports are part of alarge, multisite study from three children’s hospitals inthe United States and Canada. These studies enrolledlarge samples (31 parents, 24 siblings; 65 parents, 39siblings, respectively), and used qualitative interviewswith grounded theory analysis in one study andcontent analysis of specific questions in the other twostudies. The first report will present developmentaldifferences in expression of grief, siblings coping,sibling-parent relationship, bonds with disease siblingand post-traumatic growth. The second report willpresent changes experienced by bereaved siblings intheir relationships, life perspective, personal life andschool. Finally, the third report will present advice forprofessionals in three major areas, improving medicalcommunication, providing families with support andresources, and providing continuity of care through-out the illness, EOL and bereavement. These studiescontribute to the state of science on sibling bereave-ment and bereavement care in general. Understandingbereaved siblings’ developmental differences and thechanges that siblings undergo following the death of abrother or sister will guide the development of servicesfor bereaved siblings and their families. Integratingthe advice provided by bereaved family members intoactive and EOL pediatric care will improve bereave-ment outcome for families. Clinical and researchimplications will be discussed.

S1841-1

Parental Report of Developmental Differences in

Siblings’ Grieving and Coping Experiences after

Childhood Cancer Death

Maru E. Barrera1, Rifat Alam1, Norma D’Agostino1,David Nicholas1, Gerald Schneiderman1

The Hospital for Sick Children, Toronto, Ontario,Canada1, The Hospital for Sick Children, Toronto,Ontario, Canada2, Princess Margaret Hospital,Toronto, Ontario, Canada3, Univesity of Calgary,Calgary, Alberta, Canada4, University of Toronto,Toronto, Ontario, Canada5


DOI: 10.1002/pon


OBJECTIVES: The death of a child with cancerhas a life changing impact on family members,including siblings. Little is known regarding thebereavement experiences of siblings. The purposeof this study was to investigate longitudinally thebereavement experiences of parents and siblingsafter a childhood cancer death. Developmentaldifferences in sibling bereavement are the focus ofthis report. METHOD: Thirty-one parents (19mothers and 12 fathers) of 24 surviving siblingswere interviewed separately about their and theirsurviving children’s bereavement and coping ex-periences 6 months post-death (T1); eighteen (13mothers and 5 fathers) parents were interviewed 12months (T2) later. Interviews were analyzedfollowing grounded theory methodology, aided byNVivo software. To describe emerging themesabout siblings overtime, their age was dichoto-mized as younger o9 years) and older aged 49years). RESULTS: Several themes emerged: 1)expression of grief (older siblings: intense grief;younger siblings: delayed grief); 2) siblings coping(resuming daily routine for both groups, talkingwith friends and counselling for older siblings); 3)siblings-parents relationship (older siblings: con-flictual but improved overtime; younger siblingsattention seeking); 5) bond with deceased sibling(younger siblings: pretend-play, using their belong-ings; older siblings: building legacy); 6) post-traumatic growth (older siblings: caring for others;younger siblings: comprehending death overtime).CONCLUSIONS: The results illustrate uniqueparental perceptions of grieving and coping bypre-school and school-aged siblings, given thedevelopmental needs of bereaved siblings. Futureresearch should include in-depth interviews withsiblings, which will enrich and complement par-ental perspectives of these developmental differ-ences. Combined, these findings will guide thedesign of bereavement support services for be-reaved siblings and their families.

S1841-2

Changes In Siblings After The Death Of A Brother

Or Sister To Cancer

Terrah Foster1, Mary Jo Gilmer1, KathrynVannatta1, Betty Davies1, Maru Barrera1, DianeFairclough1, Cynthia Gerhardt1

Vanderbilt University, Vanderbilt Tenn, UnitedStates1, Vanderbilt University, Vanderbilt, Tenn,United States2, Nationwide Children Hospital,Columbus Ohio, United States3, University ofCalifornia San Francisco, San Francisco, California,United States4, Hospital for Sick Children, Toronto,Ontario, Canada5, University of Colorado HealthSciences Center, Seattle, Wa, United States6,The Research Institute at Nationwide Children’sHospital, Columbus Ohio, United States7

OBJECTIVES: Based on perceptions of bereavedparents and siblings, this study examined changesexperienced by siblings after the death of a brotheror sister to cancer. METHOD: Mothers (n5 36),fathers (n5 24), and siblings (n5 39) were recruitedfrom 39 families 3–12 months post-loss (M5 10.7,SD5 3.5). Researchers conducted semi-structuredhome interviews, asking open-ended questions witheach parent and sibling separately. Content analy-sis is currently in progress and has identifiedemerging themes. RESULTS: Parents and siblingsidentified four major categories of change experi-enced by bereaved brothers and sisters. Siblingsexperienced changes in their relationships (e.g.peers, family), life perspective (e.g. priorities),personal life (e.g. behaviors, emotions), and school(e.g. grades). Some sibling changes were positivewhile others were seen as negative. Differences andsimilarities between parent and sibling reports willbe discussed. CONCLUSIONS: This study con-tributes to the state of science on bereavement care.Practice implications will be developed afteranalysis is complete and will offer guidance toimprove aftercare for bereaved siblings and theirfamilies. Additional research is needed to furtherdescribe needs of bereaved siblings and to developstrategies to promote helpful aspects of changeexperienced by bereaved siblings.

S1841-3

A Qualitative Study of Advice to Healthcare

Professionals from Bereaved Parents and Siblings

Amii Corbisiero1, K. Julia Kaal1, AmandaThompson1, Maru Barrera1, Diane Fairclough1,Betty Davies1, Terrah Foster1, Mary Jo Gilmer1,Nancy Hogan1, Kathryn Vannatta1, CynthiaGerhardt1

The Research Institute at Nationwide Children’sHospital-, Columbus, OH, United States1, TheResearch Institute at Nationwide Children’s Hospi-tal-, Columbus, OH, United States2, Children’sNational Medical Center, Washington, DC, UnitedStates3, The Hospital for Sick Children, Toronto,Ontario, Canada4, University of Colorado, Denver,CO, United States5, University of Victoria, Victoria,British Columbia, Canada6, Vanderbilt University,Nashville, TN, United States7, VanderbiltUniversity, Nashville, TN, United States8, LoyolaUniversity, Chicago, IL, United States9,Nationwide Children’s Hospital, Columbus, OH,United States10, Nationwide Children’s Hospital,Columbus, OH, United States11

OBJECTIVES: Research suggests that many be-reaved parents are dissatisfied with their child’scare at end-oflife, particularly symptom manage-ment, communication, and continuity of care.Physicians’ perspectives may rely more on medicalaspects of care, while parents may emphasize


DOI: 10.1002/pon


interpersonal factors, such as relationship qualityand support. Our aim was to better understand theperspectives of bereaved mothers, fathers, andsiblings by soliciting their advice to healthcareprofessionals who work with families of seriouslyill children. METHOD: Families were recruitedfrom three children’s hospitals in the United Statesand Canada 3–12 months (M5 10.7, SD5 3.5)after their child died of cancer. Participants from40 families (65 parents, 39 siblings) were inter-viewed separately at home. Data were derived fromthe question, ‘What advice, if any, do you have forus as healthcare providers and researchers, whowork with children and families?’ Emerging themeswere identified through content analysis of tran-scripts. RESULTS: Three major themes emergedregarding the need for improved medical commu-nication, family support, and continuity of care.Parents emphasized the need for empathic andhonest communication about the child’s health, aswell as information about supportive servicesthroughout the experience. Lesser themes involvedcontinuing research and education for the publicgood, providing financial help, and accommodat-ing the needs of siblings. Siblings had fewersuggestions overall, and many participants offeredpraise and expressed satisfaction with care. CON-CLUSIONS: Results from this study are unique.Unlike previous work, they are based on separateinterviews with parents and siblings, conducted lessthan a year after the child’s death. Contrary toresearch relying on physician report, symptommanagement was not a primary complaint offamilies. Many were pleased with their care, butmedical communication, support, and continuitywere major areas in need of improvement. Addres-sing these domains of clinical care is important forfuture research.

S1842

Common, Avoidable Errors in Psychosocial

Oncology Research: Strategies To Strengthen the

Knowledge Base

SYMPOSIUM DESCRIPTION: Recurring theo-retical, methodological and analytical oversightsand errors compromise the information value ofresearch and, thus, undermine contributions tonew knowledge. Experience indicates that this isjust as true in psychosocial oncology as in otherfields. In this symposium, we identify four types oferrors that frequently arise in psychosocial onco-logy research and suggest concrete ways they canbe avoided. Three presenters will, in turn, addressthe following topics: (1) overreliance on ad-hocresearch questions as opposed to theoretically-derived hypotheses; (2) measurement redundancy;

(3) reliance on distal/global as opposed to moreproximal/specific outcomes; and (4) too few studiesthat directly assess the role of gender influences.Each presenter illustrates one of these issues withexamples from the psychosocial oncology literatureand suggests how it can best be addressed toenhance the quality of our knowledge base andsupport scientifically-sound decisions. This sympo-sium is timely as researchers are now exposed to avariety of research orientations and strategies thatbode well for a rich and informative knowledgebase in psychosocial oncology. An explicit discus-sion of potential pitfalls will help ensure that theevidence being produced is of the highest qualityand relevance.

S1842-1

Advances in Psychosocial Oncology Research: Is

Theory Really Guiding the Way?

Carmen G. LoiselleMcGill University, Montreal, Canada

OBJECTIVES: Recently, there has been a call forgreater reliance on theoretically-driven proposi-tions by psychosocial oncology researchers toprovide more rigorous and structured explanationsof relevant phenomena. This call has resulted inresearch agendas that more explicitly incorporatetheory into clinical research. However, new chal-lenges emerge from this trend and they arediscussed herein. METHOD: Required readingsfor the Psychosocial Oncology Research Training(PORT) program graduate seminar were reviewedto identify issues regarding the integration oftheory into empirical work. Recurring issues werenoted. RESULTS: The most common issue per-tains to reliance on ad-hoc research questions asopposed to theoretically-derived propositionswhich undermines cumulative knowledge genera-tion. In addition, along the cancer continuum,strong theory-driven work is mostly prominent incancer prevention and survivorship/end-of-life re-search and less so in research considering earlydisease and clinical treatment phases. Of note,operationalization of concepts is not always con-gruent with theoretical underpinnings therebythreatening both internal and external validity.Concrete examples of issues are presented. CON-CLUSIONS: Greater reliance on theory-drivenresearch across the various phases of the cancercontrol continuum is important. We are cognizant,however, that the relative importance of theory inquantitative as opposed to qualitative researchremains a topic of debate. The explicit discussion ofpitfalls and potential contributions of theoryprovides a foundation to continue to addressoptimal knowledge generation in the field.


DOI: 10.1002/pon


S1842-2

Effective Measurement in Psychosocial Oncology

Research

Gerald DevinsOntario Cancer Institute, Toronto, Ontario, CanadaOBJECTIVES: Effective measurement is crucial inresearch. Two measurement pitfalls often under-mine psychosocial oncology research: (a) ‘Measure-ment redundancy’ occurs when instrumentsintended to tap independent concepts that arehypothesized to be causally related include commonitem content; and (b) an emphasis on outcomevariables that are distal to the process underinvestigation makes it difficult to detect hypo-thesized relations. METHOD: Examples from thepsychosocial oncology research literature wereidentified to illustrate the two measurement pitfallshighlighted. Examples of effective, alternative meth-ods were also identified to help audience membersenhance measurement in their own research.RESULTS: The paper demonstrates how bothmeasurement redundancy and selecting ‘distal’rather than ‘proximal’ outcome measures threatenthe validity of psychosocial oncology researchfindings. This is particularly likely when instrumentstap global (i.e. general) concepts. Examples of moreeffective methods (e.g. selecting instruments prox-imal and directly related to the phenomenon ofinterest) illustrate how to achieve more effective,scientifically sound measurements, yielding moreinformative findings. CONCLUSIONS: Ensuringthat instruments selected to tap distinct concepts donot overlap at the measurement level will reduceambiguity in interpreting findings. Selection ofspecific outcomes proximal to the processes underinvestigation will enable more compelling tests ofhypotheses. Addressing both issues will enhanceconfidence in the validity of study findings and theoverall quality of psychosocial oncology research.

S1842-3

Gender Matters in Psychosocial Oncology Research

Joan BottorffUBC Okanagan, British Columbia, Canada

OBJECTIVES: Gender, defined as socially pre-scribed and experienced dimensions of ‘femaleness’and ‘maleness’ in society, is evident in the diverseways individuals engage in behaviours. Despitegrowing evidence about the importance of genderin understanding health behaviour and healthoutcomes, the influence of gender, as well as theinterplay within and between genders in people’slives, is not systematically examined in psychoso-cial oncology research. METHOD: Conceptualiza-tions of gender and implications for psychosocialoncology research will be discussed. Challenges inmoving beyond the binaries of sex and gender will

be explored. RESULTS: Selected examples ofpsychosocial oncology research will be presentedto demonstrate the importance of disaggregatingdata to examine gender differences (without pre-suming that any such differences exist), and the useof frameworks of masculinities and femininities inplanning and conducting research. Implications forstudy design and recommendations for futureresearch will be presented. CONCLUSIONS:Accounting for gender and sex in psychosocialoncology research has the potential to make healthresearch more just, more rigorous and more useful.

S1843

What makes cancer stressful? Treatment, illness

intrusiveness, and culturally based determinants

SYMPOSIUM DESCRIPTION: Cancer imposessignificant psychosocial stress, attributable to a widerange of factors. This symposium includes threepapers that address complementary determinants ofcancer-related stressors. The first paper presents aprospective, longitudinal examination of the stressimposed by treatment (bone marrow transplanta-tion) and investigates hypothesized determinants(common cancer symptoms and treatment sideeffects, and illness intrusiveness). The second paperexamines how illness intrusiveness (i.e. cancer-induced lifestyle disruptions that compromisequality of life) is shaped jointly by exposure tocancer-related stressors and symptom distress. Thethird paper examines the ways in which culturalsyndromes (i.e. complex vectors of culturally basedvalues, attitudes, and beliefs) influence the appraisalof common cancer-related stressors.

S1843-1

Course of Psychosocial Adjustment in Allogeneic

Bone Marrow Transplantation: From Pre-treatment

to Long-term Survivorship

Kenneth Mah1, Jeffrey H. Lipton2, Hans A.Messner2, Anargyros Xenocostas3, Ada Y.M.Wong4, Gerald M. Devins5

Toronto General Hospital, Toronto, Ontario,Canada1, Princess Margaret Hospital, Toronto,Ontario, Canada2, London Health Sciences Centre,London, Ontario, Canada3, University of Toronto,Toronto, Ontario, Canada4, Ontario Cancer Insti-tute, Toronto, Ontario, Canada5

OBJECTIVES: Allogeneic bone marrow transplan-tation (alloBMT) imposes adaptive challenges.Most studies focus on post-treatment psychosocialoutcomes; few address adjustment across treatmentstages. We (a) present initial results from anongoing, prospective, longitudinal investigation ofpsychosocial adjustment at pretreatment (PreTx),treatment (Tx), and 3-month posttreatment periods


DOI: 10.1002/pon


(3mo-PostTx); and (b) compare the results toparallel measurements gathered from long-termalloBMT survivors 1-101 years posttreatment(Lt-PostTx) from our earlier alloBMT studies.METHOD: Hematologic cancer patients under-going alloBMT completed self-report measures ofdepressive symptoms (Centre for EpidemiologicStudies-Depression Scale [CESD)) and psychologi-cal well-being (Affect Balance Scale [ABS]) atPreTx (n5 31), Tx (n5 31), 3mo-PostTx (n5 31),and Lt-PostTx stages (n5 168). Repeated-mea-sures ANCOVAs examined treatment-stage effectsand between-subjects ANCOVAs compared 3mo-PostTx and Lt-PostTx survivors (three subgroups:1-yr, 2–5 yr, 45-yr). Covariates included cancersymptoms and illness intrusiveness (Illness Intru-siveness Ratings Scale). RESULTS: Depressivesymptoms were significantly higher during Tx(CESD M5 21.8) than at PreTx (M5 11.0) or3mo-PostTx (M5 11.3), but not after controllingfor covariates. Psychological well-being did notdiffer significantly (ABS M5 3.1–4.0). Depressivesymptoms did not differ significantly acrossshort- and long-term survivors, but psychologicalwell-being did: 3mo-PostTx (ABS M5 3.1) vs.Lt-PostTx (Ms5 6.2–7.1), even after controllingfor covariates. CONCLUSIONS: Distress andwell-being show different trajectories during al-loBMT and survivorship. Symptoms and lifestyledisruptions (illness intrusiveness) may cause acutedistress during the alloBMT procedure, but formany it appears to subside after they return home.Well-being, on the other hand, appears to be lowduring alloBMT and in the first months thereafter,but it appears to increase by 1-year posttreatmentand remains stable thereafter, likely because peoplefeel more confident about long-term survivorship.

S1843-2

Cancer-related Stressors Moderate Effects of

Symptom Burden on Illness Intrusiveness in Head

and Neck Cancer

Gerald M. Devins1, Kenneth Mah2, Ada Y.M.Wong3, Ruth N.F. Lee4, Sophie Lebel5, JonathanC. Irish6, Gary Rodin1

Ontario Cancer Institute, Toronto, Ontario,Canada1, Toronto General Hospital, Toronto,Ontario, Canada2, University of Toronto, Toronto,Ontario, Canada3, Hamilton Health Sciences,Hamilton, Ontario, Canada4, University of Ottawa,Ottawa, Ontario, Canada5, Princess MargaretHospital, Toronto, Ontario, Canada6

OBJECTIVES: Cancer symptoms and treatmentside effects introduce lifestyle disruptions (i.e. illnessintrusiveness) that compromise quality of life. Theillness intrusiveness theoretical framework positsthat these effects are moderated by the context in

which disease and treatment occur. This study teststhe hypothesis that the magnitude of illness intru-siveness due to symptoms and side effects ismoderated by exposure to other cancer-relatedstressors. We test this in people affected by headand neck cancer (HNCa). METHOD: 418 HNCaoutpatients participated in structured interviews tocomplete self-report measures of cancer-relatedstressors (Cancer-Related Stressor Checklist, tap-ping seven distinct domains), Symptom Burden(Modified Symptom Assessment Scale), IllnessIntrusiveness Ratings Scale (total and three sub-scales), and a checklist of independent stressful lifeevents (SLEs) as part of a much larger batteryconcerning illness intrusiveness and quality of life inHNCa. Statistical methods involved hierarchicalmultiple regression analysis, controlling for SLEs.RESULTS: Symptom burden correlated signifi-cantly and uniquely with illness intrusiveness(partial r5 0.34), but cancer-related stressors didnot. As hypothesized, statistically significant Symp-tom Burden x Cancer-Related Stressors interactionswere evident for total illness intrusiveness (and itssubscales) for five of seven cancer-related stressordomains. Illness intrusiveness increased more dra-matically in association with increasing symptomburden when respondents were exposed to manycancer-related stressors (M11 SD) than when theywere exposed to few (M-1 SD). CONCLUSIONS:These results are consistent with the illness intru-siveness theoretical framework premises that HNCasymptoms and side effects (a) contribute to illnessintrusiveness and (b) their effects are moderated bythe context in which disease and treatment occur.Results were consistent across many, but not all,stressor domains. In addition to the direct effects ofdisease and treatment, the context of relatedstressors to which one is exposed also shapes thepsychosocial impact of life-threatening disease.

S1843-3

Congruence Between Cultural Syndromes and

Appraisals of Common Cancer-Related Stressors

Ada Y.M. Wong1, Kenneth Mah2, Ruth N.F.Lee3, Jonathan C. Irish4, Gary Rodin5, Gerald M.Devins5

University of Toronto, Toronto, Ontario, Canada1,Toronto General Hospital, Toronto, Ontario,Canada2, Hamilton Health Sciences, Hamilton,Ontario, Canada3, Princess Margaret Hospital,Toronto, Ontario, Canada4, Ontario Cancer Insti-tute, Toronto, Ontario, Canada5

OBJECTIVES: Culturally rooted social values,attitudes, and beliefs (i.e. cultural syndromes) arebelieved to influence the appraisal of subjectiveexperience. People with strong individualistvalues (emphasizing independence and autonomy)


DOI: 10.1002/pon


may attribute cancer-related distress to stressorsthat threaten individualist values, whereas thosewith strong collectivist values (emphasizingindependence and social harmony) may be moresensitive to stressors that threaten collectivist values.This paper tests whether the appraisal of cancer-related stressors are congruent with cultural values.METHOD: In structured qualitative interviews,head and neck cancer outpatients (N5 240) de-scribed the factors (‘stressor facets’) causing distresswhen directly exposed to eight cancer-relatedstressors. Those who had not experienced a givenstressor were asked to speculate on their response ifthey were to experience it (‘hypothetical exposure’).The Individualism-Collectivism Scale tapped cultur-al syndromes. Transcript content analysis deter-mined the frequency with which respondentsidentified stressor facets reflecting individualism,collectivism, both cultural syndromes, or neither.RESULTS: Higher individualism scores were asso-ciated with more individualism-related stressorfacets (r5 0.209), but fewer non-individualism-related facets (r5�0.141), p5 0.048, for thosewho experienced illness intrusiveness. Higher col-lectivism scores were associated with fewer collecti-vism-related stressor facets (r5�0.138) but morenon-collectivism-related facets (r5 0.143),p5 0.036, in overall responses to existential stres-sors. This difference became nonsignificant whenanalyses were limited to those who actually experi-enced existential stressors. Low numbers of reportedfacets may have limited power to detect otherfindings. CONCLUSIONS: Adherence to individu-alist values was associated with individualism-related appraisals of cancer-related stressors, butonly when respondents were exposed to ‘illnessintrusiveness’ stressors. Attention to culture helpsexplain why people report different stress appraisalsand levels of perceived stress in response to commoncancer-related circumstances. It may be advisable tolimit assessments of stress-related psychologicalresponses to circumstances with which people havehad direct experience, rather than including circum-stances to which they have not been exposed.

S1844

Existential-Spiritual Suffering at the End of Life:

A Multidisciplinary Approach to Identifying and

Treating End of Life Suffering in Cancer Care

SYMPOSIUM DESCRIPTION: The AmericanMedical Association (2008) defines existential suffer-ing ‘as the experience of agony and distress thatresults from living in an unbearable state ofexistence.’ The medical and palliative care literatureoffers various, yet often vague, descriptions ofexistential pain and suffering at the end of life, buthas yet to come to a shared consensus on this

powerful concept. There are myriad, ostensiblyinterchangeable, terms that connote existential-spiritual suffering in palliative care literature:‘psycho-existential suffering’ (Murata & Morita,2006), ‘existential distress’ (Schuman-Olivier,2008), ‘existential pain’ (Strang et al, 2004), and‘spiritual pain’ (Mako et al, 2006). To date, there isno widely held operational definition for thisparticular kind of suffering that triggers deepsadness, anxiety and despair at the end of life.When symptoms are medically managed andphysiological pain is effectively controlled—howdo we then contend with this seemingly ominousentity called ‘existential suffering’ at the end of lifewith no commonly shared language or direction?This symposium will offer a multidisciplinaryapproach to how existential-spiritual suffering inend of life cancer care is understood from medical,spiritual and psychological perspectives. Does per-sonal suffering lie in the hands of palliative caredoctors, spiritual care providers or the psycho-socialcare team? To answer these questions—a Pain &Palliative Care doctor, a Clinical Psychologist, and aDirector of Chaplaincy, from nationally recognizedNCI designated comprehensive cancer centers, willeach present how they identify existential-spiritualpain in their work with the terminally ill, and howthey specifically treat this suffering in the frameworkof their given disciplines. The medical doctor, withexpertise in pain management and palliative care,will present how existential suffering (e.g. EoLdespair, desire for hastened death, demoralization)is medically managed on a palliative care unit, andoffer potential ways it may feasibly be addressed in amedical milieu. The clinical psychologist, withexpertise in Existential Psychology and EoL care,will offer an overview of existential suffering as anumbrella concept encompassing ways human beingsare afflicted (via: angst, dread, despair) by facingtheir mortality. Meaning-Centered and Dignity-Conserving therapy case vignettes will be utilizedto identify EoL existential suffering and ways totreat it via psycho-social therapeutic support.Finally a chaplain, with expertise in spiritual andreligious practices, will present ways of interpretingspiritual pain from religious, as well as secular,perspectives, and offer ways to assuage this sufferingand effectively minister to the dying.

S1844-1

Existential-Spiritual Suffering at the End of Life:

A Chaplaincy Perspective

Jane MatherMemorial Sloan-Kettering Cancer Center, New York,New York, United States

OBJECTIVES: Dying is as much a spiritual as abiological process. Separation from the world and


DOI: 10.1002/pon


all that has defined meaning/purpose to a humanlife can be as devastating as the loss of mobility orincontinence, even for those who do or do notespouse religious beliefs. Identifying themes ofspiritual pain, existential suffering and religiousdistress is predominantly the role of the profes-sional chaplain, but is most effectively treated by ateam of collaborative caregivers. METHOD: AsDirector of Chaplaincy at a national cancer center,the presenter will offer an overview of howexistential-spiritual suffering is identified and as-suaged by spiritual care providers. Specifically, thechaplain’s role is to: 1) assess/support transitionsfrom cure through dying to death, 2) ease sufferingbased on patients’ spiritual beliefs and values, 3)help the multidisciplinary care team to developcare plans that respect patient/family beliefs andvalues as resources for EoL comfort and healing.RESULTS: Embedded screens, assessments andprotocols, early identification and consistent teamcollaboration are essential means to improvequality EOL care. A team approach to care acrossIn-patient and Out-patient units has improvedreferrals to palliative and hospice care, anddecreased the number of bounce-backs. Earlierintervention has made the aforementioned transi-tions less abrupt and gentler. The team takesregular time to acknowledge the losses, identify thenames and grieve for the patients who have died.CONCLUSIONS: Exploring spiritual suffering,developing patient/family resources and identifyingbarriers to their effectiveness are the standard ofcare in responding to EoL concerns. As this teamapproach improves quality of care for patients andfamilies, it also helps build resilience and preventcompassion fatigue among staff. Spiritual careproviders are essential in this EoL team approach,as they help inform palliative practitioners of waysto effectively identify and assuage spiritual/reli-gious pain while ministering to the dying.

S1844-2

Existential-Spiritual Suffering at the End of Life: A

Pain and Palliative Medicine Approach to Identify-

ing and Palliating Existential-Spiritual Pain in

Patients with Terminal Illness

Dana TarcatuCity of Hope National Medical Center, Duarte, CA,United States

OBJECTIVES: Many palliative care physicians areoften faced with the challenge of treating physicalsymptoms that are unexplainable and do notrespond to standard effective interventions. Symp-toms like refractory pain, intractable nausea,extreme fatigue or anorexia cannot be controlledeven when multiple mechanism-based interventionsare rigorously applied. This is often a signal that

patients’ suffering is not related to the primarysymptoms being treated by the physician, but maybe a direct consequence of existential-spiritualdistress. METHOD: A Pain & Palliative Carephysician will present a medical approach toidentifying ‘existential pain’ and barriers to alle-viating the non-physical dimensions of suffering inpatients with life-limiting illnesses. A series of casevignettes will be presented to exemplify the mostcommon ‘faces’ of existential suffering at the end oflife. The audience will be taught practical strategiesto identify and treat end of life existential sufferingfrom a medical perspective. RESULTS: Mostpalliative care specialists do not receive formaltraining in identifying existential pain and sufferingin terminally ill patients. Therefore, they havelimited knowledge and skills for appropriatelyrecognizing and palliating existential-spiritual painwhen it occurs. Practical methods of assessmentand specific strategies used to help physiciansrelieve existential pain and suffering will bepresented by way of didactic an interactiveexercises. CONCLUSIONS: Physical pain may bea major component of suffering, but in the contextof an advanced illness suffering encompasses muchmore than physical distress and often occurs in theabsence of physical pain. Distinguishing betweenphysical and psychological symptoms is clinicallyimportant, as effective management often requiresfundamentally different interventions. The skillsand resources of an interdisciplinary palliative careteam are required to assess the various componentsof total pain and intervene to alleviate thesesymptoms.

S1844-3

The Shadow Side of Meaning and Hope: A Psycho-

Social Approach to Existential-Spiritual Suffering at

the End of Life

Shannon PoppitoCity of Hope National Medical Center, Duarte, CA,United States

OBJECTIVES: End of Life existential distresscannot be easily pigeonholed into clean-cut diag-nosable DSM-IV categories as depression andanxiety. Renown existentialists as Kierkegaard,Heidegger and Sartre have characterized existentialdistress (i.e. angst, despair, annihilation) as apowerfully embodied ‘dread’ of mortality, seededwithin each human being, which calls one’s veryBeing into question. Existential suffering at the endof life is authentically lived as a more fundamen-tally urgent and foreboding state-of-Being for theindividual facing death. METHOD: A clinicalpsychologist, with expertise in Existential Psychol-ogy and End of Life Care, will first delineatethe philosophical underpinnings of ‘existential


DOI: 10.1002/pon


suffering’ as an umbrella concept encompassing themyriad ways individuals experience existentialabsence (i.e. separation from Life) via existentialangst, despair, isolation, and guilt. Therapeuticcase vignettes from the psychologist’s Meaning-Centered and Dignity-Conserving interventionswith terminally ill cancer patients will identifythese different forms of existential distress as theyarise in EoL psychosocial care. RESULTS: Casevignettes from terminally ill patients experiencingexistential distress, such as unremitting angst orprofound guilt and despair, will be presented toshow how EoL practitioners may utilize a mean-ing-oriented dialogue to explore ‘existential ab-sence’ and help buffer existential suffering.Therapeutic meaning-navigated life-review allowspatients to revisit positive and negative moments inlife, and reflect upon feelings and memories; givingpatients the opportunity to rescript and restorecertain moments that bring meaningful closure tolife. CONCLUSIONS: End of Life literatureexamining terminal patients’ will to live and desirefor hastened death all point to existential ruptures,insults or losses in Life-meaning/purpose, autono-my/control, and overall sense of dignity/integrity inone’s state-of-Being at the end of life. By trackingthe shadows of meaning and hope before death,palliative care practitioners have a rich opportunityto unearth purposeful ways of bringing meaningfulpresence to this existential absence through mean-ing-directed life-review within the life-completionprocess.

S1845

Meaning & Legacy Across the Life Span:

Existential-Developmental Dimensions of End-of-

Life Cancer Care

SYMPOSIUM DESCRIPTION: ‘What matters,therefore, is not the meaning of life in general, butrather the specific meaning of a person’s life at agiven moment.’ (Viktor Frankl, 1969). The diag-nosis of cancer at any age of life and stage ofdisease inaugurates both existential and develop-mental crises—of Being (existence) and becoming(development). Cancer becomes a veritable wakeup call for patients and loved ones to seek meaningin their existence, in order to buffer the ominousthreat of mortality. Therapeutic exploration ofmeaning and legacy across the life-span allows forthe emergence of uniquely individual, as well asuniversally shared, ways of understanding howterminally-ill patients of all ages find meaning anda reason to live in the face of advanced cancer anddeath. This symposium will offer a multi-disciplin-ary approach to exploring meaning and legacyacross the life span of terminally cancer patients—from Pediatrics to Geriatrics. A Clinical Psycho-

Oncologist, with expertise in Existential Psychol-ogy and Palliative Care, will first lay the groundwork for interpreting existential issues from adevelopmental perspective across the life span incancer care. Existential-developmental dimensionsof terminally-ill cancer patients are delineatedacross domains of: 1. Chronological Age, 2.Developmental Milestones, 3. Life Events/CrisisPoints (past & present), 4. Cancer Events/CrisisPoints (past & present), and 5. Voice & Choice(patient & parent/loved one). Patient case vignetteswill be presented from the psychologist’s Meaning-Centered Therapy (Breitbart et al) and Dignity-Conserving Therapy (Chochinov et al) with term-inally ill cancer patients, in order to highlightExistential-Developmental themes across the adultlife span. A Pediatric Psycho-Oncologist, withprimary expertise in Child Psychology and Psy-cho-Oncology, will define ways children of differingdevelopmental ages and stages take up meaningand engage in ‘legacy play’ at the end of life.Patient/Parent case vignettes will be offered tohighlight the terminally ill child’s voice and choicein taking up meaning and legacy at the end of life,and the impact of parents’ respective voice andchoice in the process. Finally, a Psychiatrist, withexpertise in Psycho-Oncology & Palliative Care,will offer a medical perspective on how meaningand legacy are utilized to prepare terminally-illgeriatric patients for the death and dyingprocess. Case vignettes from Dignity ConservingTherapy (Chochinov et al) will show how theexploration of meaning and legacy help assuageexistential suffering and contribute to essentialpreparatory grief work for patients and familiesat the end of life.

S1845-1

Meaning and Legacy in the Terminally-Ill Elderly:

Dignity Therapy and Its Impact on Patients and

Health Professionals

G.R. Tait, A. McDougall, C. Schryer, L. LingardUniversity of Toronto, Toronto, Canada

OBJECTIVES: More work must be done toaddress the existential needs of elderly dyingpatients, and how best to educate physicians tomeet these needs. Dignity Therapy (Chochinovet al.) helps terminally-ill patients narrate their life-story; thereby making meaning of their existenceand legacy. This presentation will explore thenature of stories told by elderly terminally illpatients via the dignity interview, to track howmeaning-making and legacy work engage elderly inthe life completion process. METHOD: Medicalresidents were taught to utilize Dignity Therapy asa way to open dialogue with terminally ill elderlypatients about life-meaning and living-legacy in the


DOI: 10.1002/pon


face of death. Dignity interviews were administeredto twelve elderly patients by residents. Qualitativeinterviews of physicians were analyzed to under-stand their experience of administering the inter-view. The patient dignity transcripts were analyzedusing a linguistic discourse analysis, to examine thenature of narratives elicited by the dignity inter-view. RESULTS: This presentation will offerqualitative data to illustrate a) the transformativeimpact of Dignity Therapy on elderly patients andtheir physicians, and b) the resources and con-straints afforded by the dignity protocol and thenarrative turns elicited. From a developmentalperspective, a dying elderly patient’s meaning andlegacy making, often in the form of impartingwisdom, may solidify navigation through Erikson’sfinal and socially contextualized stage of Ego-Integrity vs. Despair in a preparatory life-comple-tion process. CONCLUSIONS: Dignity therapy isan example of a single one-hour session interven-tion that provides patients an opportunity to makemeaning out of life and impending death, and tosolidify a sense of integrity by using one’sindividual agency to create a legacy that bearsone’s addressees in mind, both family andhealth professionals. Future research must con-tinue to examine the specific needs of dying elderlypatients, with their unique developmental positionin mind.

S1845-2

Giving Voice and Choice to Children at the End of

Life: An Exploration of Meaning and Legacy in

Pediatric Palliative Care

Regina Melchor-BeauprePrivate Practice, Gainesville, Florida, United States

OBJECTIVES: Findings from the American Psy-chological Association’s task force on end-of-lifeissues indicate that meaning-making and legacy-play may be important coping strategies for dyingchildren and adolescents. The purpose of thispresentation is to explore, via Pediatric Oncologycase studies/vignettes, the kaleidoscope of a-staticdevelopmental transitions within which childrenand adolescents journey. As with adults, thesefindings reflect that the need for meaning andlegacy evolves both in uniquely and universally-shared ways across the lifespan. METHOD: Thispresentation will examine the continuum of mean-ing and legacy across child development at the endof life, utilizing an existential-developmental con-ceptual model. This framework will show howchildren struggling with cancer actually experienceever-changing perceptions of the same illnessthroughout their development and disease trajec-tory. It also reflects children’s and adolescents’ever-transitioning voice and choice throughout the

end of life process, in light of cognitive-develop-mental processes as object permanence, magicalthinking and omnipotent fantasy. RESULTS:Salient existential-developmental issues emerge inthe lives of terminally ill children via: 1) illnessprogression, 2) family life events and dynamics,3) the impact of the parental voice and choice, and4) the unheard voices of children and adolescentsconfronting their last stage of life. This thenprovides clinical relevance for the exploration ofmeaning-making and legacy-play for terminally illchildren-not only as creative coping strategies, butalso for preparatory grief and life-completionwork. CONCLUSIONS: By exploring existential-developmental issues across Pediatric Psycho-On-cology, we hope to promote standardized practicesthat will ultimately give voice to terminally-illchildren and adolescents across their life-span anddisease trajectory. Such expression will shed lighton such essential existential-developmental needsas: 1) meaning-making, 2) authentic EoL voice andchoice, 3) EoL continuity of self, autonomy andagency, and finally 4) the ability to create and leavebehind a legacy that will ultimately live on beyondthem.

S1845-3

The Middle-Way: Traversing the Existential-

Developmental Terrain of Adult Terminal Cancer

via the Cultivation of Meaning & Legacy at the End

of Life

Shannon PoppitoCity of Hope National Medical Center, Duarte, CA,United States

OBJECTIVES: The middle way between childhoodand old-age traverses the vast terrain of adult life;carrying rich developmental potential and promise.For Erik Erikson, Early Adulthood holds therelational possibility for ‘Intimacy’ with its definingvirtue of ‘Love.’ Middle Adulthood holds thecreative potential for ‘Generativity’ with its authen-tic virtue of ‘Care.’ When adult cancer patients facethe ominous threat of terminal illness and death,these developmental possibilities are called intoquestion by ever-looming existential boundaries.METHOD: A clinical psychologist, with expertisein Existential Psychology and End of Life care, willlay the groundwork for interpreting existentialissues from an adult developmental perspective incancer care. Therapeutic case vignettes arepresented from the psychologist’s Meaning-Centered (Breitbart et al.) and Dignity-Conserving(Chochinov et al.) interventions with adult termin-ally ill cancer patients, highlighting specificExistential-Developmental themes across the adultlifespan. Exploration of meaning and legacy vialife-review is shown to promote the life-completion


DOI: 10.1002/pon


process. RESULTS: Existential-developmental di-mensions of terminally-ill cancer patients aredelineated across five domains: 1. ChronologicalAge, 2. Adult Developmental Milestones, 3. LifeEvents/Crisis Points (past & present), 4. CancerEvents/Crisis Points (past & present), and 5. Voice& Choice (patient & loved ones). Meaning-Centered and Dignity-Conserving therapy casevignettes highlight dimensions of existential ab-sence (e.g. angst, isolation, guilt) and existentialpresence (e.g. existential care, joy, equanimity) bytracking meaning and legacy themes across thesedevelopmental domains. CONCLUSIONS: Asadult terminally ill patients face the end of life,therapeutic care should purposefully reflect theappropriate age and developmental stage of thedying patient. Early adult developmental mile-stones differ in breadth and scope from middle tolate adulthood. Meaning and legacy work mustreflect the existential and developmental dimen-sions of each respective stage; allowing unmetdreams and possibilities (e.g. marriage, children,travel, career, grand-parenting) to be processedand mourned in a therapeutically preparatorylife-completion fashion.

S1846

Psychodynamic Approach of Different Stages of

Cancer: From Diagnostic Disclosure to End of Life

Acceptation

SYMPOSIUMDESCRIPTION: France has now alonger experience in cancer breaking bad news.Special cancer disclosure protocol have beenexperimented and we’ll present some principalresults. What are the psychological factors thatallow active decision making in patients ? On 50patients interviews, we’ll present why 18% refusedthe adjuvant chemotherapy after breast cancersurgery. As a counter-intuitive result, the patientswith highest anxiety level accepted the chemother-apy when the refusal was coming from securedpeople. More the doctors were confident intreatment and more patients accepted it. We’llconfront these results to international literature.The psychodynamic approach of death is basedupon understanding unconscious caregivers desiresfor the patients. Nevertheless death is still a socialtaboo and even if it’s seldom talked, patients acceptto speak from death. But death can be talked onlyif subjectivity of patients is recognized. It is only inthat case of fantasies acceptation that patientsdynamic mental functionning may start again. Weare studying now new types of blogs that arewritten after their illness by women with cancer.Although blogs written during illness were essen-tially centered on recovering from narcissismwounds, those blogs are aimed to the group, the

� clan�. As a new socialization way to cope withthe paradoxical abandonnic feelings of recovery,women seem invested with a mission. They writethat they need to share their experiences as a vitaltreatment of their misfortune community. Ourapproach is based on psychodynamic ethic, i.e.respect of subjectivity, acceptation of unconsciousfeelings behind obvious aspects of language, use oftransferance as a tool of psychotherapy. Ourmethods are essentially qualitative but are basedon longitudinal studies. With this frame, we cangenerate new type of results especially those basedupon unconscious representations and consequencesof fantasmatic relations. This epistemology isspecially adapted in archaıc phenomenons asregression, death anxiety, fusionnal relations as theyare typical in hospital wards with cancer threats.

S1846-1

Adjuvant Chemotherapy in Breast Cancer. Do You

Agree or Not? Patients Decision Making Factors

Livia Edery1, Marie-Frederique Bacque1

Centre Oscar Lambret, Lille, France1, University ofStrasbourg, Strasbourg, France2

OBJECTIVES: To define the psychological factorsinvolved in the active participation of the patient toits therapeutic protocol. To bring to light thevariables allowing to know the level of patientsparticipation about their therapeutic protocol. Toadjust the patients medical information. To orga-nize by communicational marks for physicians thepsychological impact of the medical information.METHOD: A descriptive, longitudinal study. 50breast cancer patients. After a curative surgicalintervention adjuvant chemotherapy has beenproposed to all patients. Two research timesdefined by stages of therapeutic protocol: thetherapeutic protocol’s announcement by oncologistand before the 1st cure of chemotherapy. Each ofboth groups is assessed in co-factors of decision-making: Patient’s psychopathology (SCL-90R andHADS) and psychological strategies adopted bypatients (DSQ-88). Non-verbal modalities of com-munication are studied in three physicians. RE-SULTS: 82% patients accepted the adjuvantchemotherapy 18% refused it. Assent to therapeu-tic protocol is determined by hostility, sensitivity,anxiety and depression psychopathological levels.More the anxiety level of announcement is highmore patients have accepted treatment. Physician’sconfidence and treatment’s obligation feeling car-ried weight on the patient agreement. Non-directive physician and chemotherapy’s bad effectsinfluenced on patient’s refusal.No influence ofnon-verbal communication adopted by physicianon patients decision-making. CONCLUSIONS:About 1/5 patients have refused adjuvant


DOI: 10.1002/pon


chemotherapy. Personality, expectations and psy-chological strategies of the patient take part in theprogress of the consultation and even her decision-making. Oncologist’s communication is necessaryto explain purpose of adjuvant treatment. Thisrelation defined by real exchange can destabilizedecision-making of patient. Stressful aspect ofconsultation has an impact on the physician-patient relationship and not the opposite. Thismay strengthen or inhibit implication of patientdecision-making.

S1846-2

Death: Psychodynamic Approach. Hope, Meaning

and Revelation

David Marie1, Marie-Frederique Bacque1

Hopital de la Timone,Marseille, France1, Universityof Strasbourg, Strasbourg, France2

OBJECTIVES: In psycho-oncology, death has aplace at the first meetings. Nevertheless, the speechof caregivers states diagnosis, prognosis andsupport. They project their desires on the patient.Medicine, undefined third party, tries to interactfor the patient and prevents him from autonomy.This quest to be human before being a patientrequests an appropriation of the disease. The lackunderlined by cancer requires a self-empowerment.METHOD: Psycho-oncologist in a medical oncol-ogy and palliative care wards, we postulate thehypothesis that the presence of death in the speechis not the main factor of distress and mentalsuffering. For this, we followed 90 patients for 5sessions minimum. These interviews were firstpractice support and guidance. Our presentationis the process of action-research whose data werethe subject of a discourse analysis on the basisof Freudian psycho-dynamic nosography.RESULTS: Death is little or seldom discussedduring interviews. However without being expli-citly named, we find a persistent infection in thespeech of patients in both curative and palliativesituation. The fear of death, so imaginative with itsdefence mechanisms, highlights its potential forpsychological development and changes in internalposition. The results show that death is notconsidered as dangerous in patient’s-psycho-oncol-ogist psychological interspace. CONCLUSIONS:Death remains a taboo as a social fact. Cancerremains a psychological fact inside illness trajec-tory. Talking about death is hard, but patientswant to be able to say something about it.Representations of death are involved in perpetu-ating a subjectivity that avoids the inherentrational fears of death. Death takes place as afunction to a psychological dynamism attendingfor life. A life that combines meaning, hope andoften revelation.

S1846-3

Announcement Plan in Oncology. Thoughts, Paral-

lels and Questions about Diagnosis Consultations

and Oncogenetic Consultations

Eliane MarxCentre Paul Strauss, Strasbourg, France

OBJECTIVES: The measure 40 of the Cancer Planin France has, among others things, taken intoaccount psychological consequences of severalannouncements for patient and family: first diag-nosis, recurrence, change in treatment, transitionfrom curative to palliative care. The setting up andthe organization took in consideration differentaspects. The experience of the oncogenetic con-sultation gave us opportunity to coordinate thisrecent project. METHOD: These considerationsare proceeding on one hand from the analysis ofthe medical organization arising from healthministery law texts, and on the other hand fromclinical approach based on psychodynamic inter-views with patients and their family. RESULTS: Inspite of institutional and organization difficulties,the assessment shows that patients and familyappreciate time given by professionals engaged inthe announcement of cancer and treatment, andduring oncogenetic consultation about geneticpredisposition risk. Patients estimate first explana-tions of the medical situation then answers to alltheir questions. CONCLUSIONS: We have to takeinto account the gap existing sometimes betweenthe needs of patients and the requests of both thepolicies and the medical institution. These factorsare determinant for the good resolution of thisproject.

S1846-4

Blog Writing By Breast Cancer Patients. Group

Psychotherapeutic Effects in Blog Writing/Reading

Gilbert Gsell-Herold, Marie-Frederique BacqueUniversite de Strasbourg, Strasbourg, France

OBJECTIVES: Previous communications showedthat specific way of women communication can befound in blogs. The temporality of these womendescribed-within the illness- allows us to considerthis way of writing as a barometer of theirpsychological state. Recently we discovered thatsome blogs were created in the ‘after illness’ (10%),spreading a testimony of hope and faith in healing.We confirm the hypothsesis that it reinforces thenarcissism and generates a ‘group’ effect. METH-OD: We explored over Internet thirty blogs held bywomen suffering of breast cancer. We’ve made athematic analysis with these blog contents. Therecurring themes are those of femininity, seduction,issues of sexuality, fertility, problems affecting the


DOI: 10.1002/pon


body, self-representation, trauma. It shows asearch for meaning, faith, group effect (the clan)and hope. RESULTS: The essential new data ofthese blogs is temporality. They are writtenafter the illness and not during it. There is a shiftfrom individual to group, more space left to others.It is no more a matter of ‘I’ but of ‘US’, the clan.There is room for testimony of other patients,doctors, or summaries of books. There isobviously a switch-over from pure introspectivenarration to a sharing socializing experience.CONCLUSIONS: ‘Doucediva’ said at time ofillness announcement that ‘she was nothinganymore, neither male nor female’. After thedisease and the removal of a breast she said shefelt ‘more feminine’ through reconstruction sur-gery. For such women, sharing an experience isvital. They let their blog read on forums. Unlikethe women who testified during the disease, theyseek to make themselves known. The narcissisticenhancement goes through recognition by otherreaders.

S1847

Improving the Quality of Psychosocial Care: Trans-

lating Knowledge into Practice to Transform Patient

Experience of Cancer

SYMPOSIUM DESCRIPTION: The focus of thissymposium is to describe an integrated pan-Canadian approach to improving the quality ofpsychosocial care through translating knowledgeinto practice using a systematic and rigorousmethodology and step wise approach. Specifically,we will demonstrate the application of adaptationmethodology in the development of recommenda-tions for psychosocial assessment and in thesynthesis of knowledge embedded across nationaland international guidelines into user friendlyevidence-based algorithms to facilitate effectiveaction and consistency in point-of-care practice.We will challenge current assumptions thatscreening alone will improve patient outcomesand discuss the need for a theory-based approachin designing interventions/health system innova-tions to improve care processes and the need tospecify causal links to patient outcomes. Anemphasis on standardized assessment and a tieredapproach to interventions at point-of-carewill be discussed. A pan-Canadian partnershipfacilitated our approach and fostered initialuptake of this work. The symposium will presentthe findings of the synthesis work, guidelinedevelopment processes including recommen-dations and the critical next steps needed totranslate our guideline products into changedpractice that could transform patient experienceof cancer.

S1847-1

Screening Is Not Enough: Theory-Based Practice

Change Is Needed to Improve Patient Outcomes

Doris Howell1, Shelley Currie2, Samantha Mayo3,Glenn Jones4, Michael Boyle5, Thomas Hack6,Esther Green7, Lawrence Hoffman8, JudySimpson9, Vivian Collacutt10, Deborah McLeod11,Carol Digout12, Margaret Harrison13

Princess Margaret Hospital, Toronto, Ontario,Canada1, Alberta International Medical GraduatesProgram, Calgary, Alberta, Canada2, University ofToronto, Toronto, Ontario, Canada3, Credit ValleyHospital, Mississauga, Ontario, Canada4, InterlockEmployee Assistance/PPC Worldwide, Victoria,British Columbia, Canada5, University of Manitoba,Winnipeg, MN, Canada6, Cancer Care Ontario,Toronto, Ontario, Canada7, Royal Victoria Hospi-tal/McGill University, Montreal, Quebec, Canada8,Capital Health/Cancer Care Nova Scotia, Halifax,Nova Scotia, Canada9, Alberta Health Services –Cancer Care, Edmonton, Alberta, Canada10, CapitalHealth/Dalhousie University, Halifax, Nova Scotia,Canada11, Canadian Partnership Against Cancer,Toronto, Ontario, Canada12, Queens University,Kingston, Ontario, Canada13

OBJECTIVES: Screening for distress and the useof standardized patient-reported outcomes (PRO)as part of routine clinical practice are proposed as ameans to identify unmet needs, facilitate patient-centered communication, and monitor response totreatment. This assumption was examined in arecent systematic review as part of a psychosocialassessment guideline development initiative. Weconducted a systematic review to examine theeffectiveness of routine psychosocial assessmenton psychosocial and supportive care outcomes.METHOD: A search of databases: CINAHL,EMBASE, HealthSTAR, MEDLINE, PsycINFO,Cochrane Database of Systematic Reviews,DARE, HTA (Health Technology Assessments),and CCTR (Cochrane Central Register of Con-trolled Trials) was conducted. Search terms:cancer, neoplasm, psychosocial aspects of illness,psychosocial factors, psychosocial support, psy-chological stress, symptom distress, psychosocialcare, distress syndrome, psychosocial readjustment,assessment and screening. Eligible studies reviewedindependently were: adult, cancer, English, sys-tematic reviews, randomized trials, and cohortcomparison studies. RESULTS: The search yielded421 references: eight studies met inclusion criteria.A descriptive synthesis was completed since studyheterogeneity precluded meta-analysis. Our find-ings were consistent with the IOM that there islittle high quality evidence of the impact of routinePRO screening on patient outcomes. However,computerized screening is highly acceptable topatients. CONCLUSIONS: Screening alone does


DOI: 10.1002/pon


not automatically lead to improved outcomesunless followed by assessment and targeted inter-ventions to address multi-causal determinants ofdistress. A theory-driven approach to practicechange interventions is needed with explicit causalrelationships specified between assessment, careprocesses and outcomes.

S1847-2

Moving Beyond Screening to Evidence-Based

Psychosocial Clinical Practice

Doris Howell1, Susan Keller-Olaman2, KarenBiggs3, Larry Broadfield4, Joanna Chung5, ShelleyCurrie6, Mary Jane Esplen7, Debbie Gravelle8,Esther Green9, Tom Hack10, Marc Hamel11, PamJohnston12, Tom Oliver13, Anne-Marie Stacey14,Nelda Swinton15, Ann Syme16, Margaret Fitch17

Princess Margaret Hospital, Toronto, Ontario,Canada1, Canadian Partnership Against Cancer,Toronto, Ontario, Canada2, Juravinski CancerCentre, Hamilton, Ontario, Canada3, Cancer CareNova Scotia, Halifax, Nova Scotia, Canada4, BCChildren’s Hospital, Vancouver, British Columbia,Canada5, NA, Canmore, Alberta, Canada6, TorontoGeneral Research Institute, Toronto, Ontario,Canada7, Bruyere Continuing Care ElisabethBruyere Hospital, Ottawa, Ontario, Canada8,Cancer Care Ontario, Toronto, Ontario, Canada9,University of Manitoba/CancerCare Manitoba,Winnipeg,MN, Canada10,McGill University HealthCenter/Montreal General Hospital, Montreal,Quebec, Canada11, CancerCare Manitoba,Winnipeg, MN, Canada12,Canadian PartnershipAgainst Cancer, Hamilton, Ontario, Canada13,Cross Cancer Institute, Edmonton, Alberta,Canada14, Jewish General Hospital, Montreal,Quebec, Canada15, BC Cancer Agency, Victoria,British Columbia, Canada16, Odette Cancer Centre,Toronto, Ontario, Canada17

OBJECTIVES: Studies report that the cancersystem is falling short in addressing distress andsupportive care needs. This failure contributes tophysical and psychological morbidity, poor qualityof life, and disability. Screening for distress isproposed as a solution but in itself will unlikelytranslate directly into improved quality of psycho-social care or patient outcomes without equalattention to the use of evidence-based psychosocialassessment and interventions in routine clinicalpractice. METHOD: The selection of appropriateinterventions can be leveraged through uptake ofevidence-based guidelines. Unfortunately, guide-lines are viewed as complex to implement andrarely used to guide clinical practice and requireadaptation to be relevant to the local health careenvironment. We used an Adaptation methodology(ADAPTE Collaboration, 2007) to synthesizeguidelines into assessment and intervention algo-

rithms and care pathways to ensure that multi-causal determinants of distress are addressed inroutine clinical practice. RESULTS: As part ofcancer control, we are working across provincialand territorial boundaries in a national pan-Canadian partnership to foster uptake of evi-dence-based psychosocial care by translatingknowledge embedded in guidelines into actionablepan-Canadian guides to practice for local uptake.These knowledge products have the potential toimprove the quality of psychosocial care as part ofnational implementation of distress screening asthe 6th vital sign. CONCLUSIONS: A compre-hensive understanding of patient-specific psycho-social health care needs is an essential precursor toappropriate interventions and for facilitating accessto relevant psychosocial services.

S1847-3

Clinical Practice Guidelines for Psychosocial

Oncology: How Did We Do It?

Tom Hack1, Shelley Currie2, Joanne Stephan3,Michael Boyle4, Doris Howell5, Samantha Mayo6,Glen Jones7, Esther Green8, Lawrence Hoffman9,Judy Simpson10, Vivienne Collacutt11, DeborahMcLeod12, Carol Digout13, Margaret Harrison14

University of Manitoba, Winnipeg, MN, Canada1,NA, Canmore, Alberta, Canada2, Fraser ValleyCancer Centre, Surrey, British Columbia, Canada3,Interlock Employee Assistance/PPC Worldwide,Toronto, Ontario, Canada4, Princess MargaretHospital, Toronto, Ontario, Canada5, University ofToronto, Toronto, Ontario, Canada6, Credit ValleyHospital, Mississauga, Ontario, Canada7, CancerCare Ontario, Toronto, Ontario, Canada8, RoyalVictoria Hospital/McGill University, Montreal,Quebec, Canada9, Capital Health/Cancer CareNova Scotia, Halifax, Nova Scotia, Canada10,Alberta Health Services – Cancer Care, Edmonton,Alberta, Canada11, Capital Health/Dalhousie Uni-versity, Halifax, Nova Scotia, Canada12, CanadianPartnership Against Cancer, Toronto, Ontario,Canada13, Queens University, Kingston, Ontario,Canada14

OBJECTIVES: This presentation will provide abrief history of key developmental elements leadingto the successful formation of the CanadianPartnership Against Cancer (the Partnership)-Canadian Association of Psychosocial Oncology(CAPO) clinical practice guideline expert panel.METHOD: Based on primary documents from thetime period, the presentation provides a briefhistory of key developmental elements leading tothe formation of the Partnership-CAPO expertpanel, focusing on the collaborative process in-itiated by CAPO and BC Cancer Agency in 2002.Major partnering organizations contributions willbe highlighted and the 12 recommendations for


DOI: 10.1002/pon


psychosocial health care needs assessment foradults, will be introduced. The emerging role ofthe CAPO as the guideline ‘custodian’ is described.RESULTS: The partnering organizations were ableto join together in a common purpose andcollaborative effort to produce the first pan-Canadian clinical practice guideline for psychoso-cial care of adults. The role of CAPO as the‘custodian’ of the guideline is beginning to emerge,along with opportunities for knowledge translationresearch and clinician involvement in disseminationand implementation. CONCLUSIONS: The devel-opment of clinical practice guidelines is a complexand resource-intensive endeavour. The develop-ment of clinical practice guidelines for psychosocialcare poses some unique challenges. Despite thesechallenges, a national, interdisciplinary, multi-stakeholder expert panel was successfully formed,and completed its mandate to produce the firstpan-Canadian clinical practice guideline for psy-chosocial care of adults. This work has generatednational and international interest in both theprocess and end result of the endeavor.

S1847-4

Use of Adaptation Methodology to Develop a

Psychosocial Assessment Guideline

Shelley Currie1, Doris Howell2, Samantha Mayo3,Glen Jones4, Michael Boyle5, Thomas Hack6,Esther Green7, Lawrence Hoffman8, Judy Simp-son9, Vivian Collacutt10, Deborah McLeod11,Carol Digout12, Margaret Harrison13

N/A, Canmore, Alberta, Canada1, Princess Margar-et Hospital, Toronto, Ontario, Canada2, Universityof Toronto, Toronto, Ontario, Canada3, CreditValley Hospital, Mississauga, Ontario, Canada4,Interlock Employee Assistance, Victoria, BritishColumbia, Canada5, University of Manitoba, Win-nipeg, Manitoba, Canada6, Cancer Care Ontario,Toronto, Ontario, Canada7, Royal Victoria Hospi-tal/McGill University, Montreal, Quebec, Canada8,Capital Health/Cancer Care Nova Scotia, Halifax,Nova Scotia, Canada9, Alberta Health Services –Cancer Care, Edmonton, Alberta, Canada10, CapitalHealth/Dalhousie University, Halifax, Nova Scotia,Canada11, Canadian Partnership Against Cancer,Toronto, Ontario, Canada12, Queens University,Kingston, Ontario, Canada13

OBJECTIVES: The purpose of this abstract is toprovide an overview of the use of Adaptationmethodology in the development of a clinicalpractice guideline for psychosocial assessment inadult cancer patients. As noted in the Institute ofMedicine (2008) report on improving the care ofthe ‘whole person’ experiencing cancer, carefulassessment and ongoing re-assessment of needs isconsidered central to the whole process of careprovision and appropriate service allocation.

METHOD: We combined Adaptation methodol-ogy used to develop clinical practice guidelinescontextualized to the local environment combinedwith traditional de novo guideline developmentprocesses and expert panel consensus to developsubstantive recommendations for ‘whole person’psychosocial needs assessment. Thus, we alsosearched traditional databases to identify empiricalevidence to support development of the recom-mendations and tools that could support theassessment. RESULTS: Following an extensivesearch for evidence-based guidelines and empiricalevidence in traditional data bases, twelve substan-tive recommendations were endorsed by the inter-professional expert panel for psychosocial healthcare needs assessment. These recommendationsbuilt on an a priori endorsed supportive careconceptual framework and assessment categoriesincluding screening, comprehensive and focusedapproaches. CONCLUSIONS: The implementa-tion and uptake of evidence-based practice can befacilitated through the use of clinical practiceguidelines that have been contextualized to thelocal health care setting. Use of this developedguideline has the potential to improve clinicaldecision making in the selection of effectiveinterventions, appropriate referral to psychosocialresources and overall quality of life.

S1861

Addressing Nurses’ Knowledge And Skill Needs In

Providing Emotional Care To Patients: Experiences

Through An Innovative Provincial-Based Program

SYMPOSIUM DESCRIPTION: Cancer and itstreatment has significant impacts on the quality oflife of patients and their families. A significantportion of patients experience distress and mostpatients will benefit through the integration ofemotional care throughout their care experience.Nurses play an important role in providing this careand in facilitating appropriate referrals where furtherexpertise or assessment is needed. However, evidencesuggests despite a strong desire to integrate thisaspect of care into their practice, nurses lackconfidence and skill in assessing and managing thecomplex communication and adjustment issuesexperiences by patients and their families. Further-more, although there is some awareness of assess-ment tools or methods, most nurses do not utilizethem or feel uncertain as to how to make referralswith the exception of cases of extreme distress.Purpose: This symposium will provide an overviewof a publically funded provincial approach to providecontinuing educational courses and as well as atgraduate level to nurses at any point along the cancercontinuum to assist them to feel more confident andskilled in assessment and provision of emotional careto patients and their families. Learning models


DOI: 10.1002/pon


include train the trainer programs, elearning modesas well as clinical mentorship. Qualitative andquantitative findings from train the trainer programsand elearning approaches will be presented with adiscussion on the implications of the program.

S1861-1

Addressing Psychosocial Needs In Cancer Care - A

Train The Trainer Workshop For Oncology Nurses

Mary Jane Esplen1, Esther Green2, JonathanHunter3, Deborah Mcleod4, Mary Campbell5,Susan Clarke1, Jiahui Wong1

de Souza Institute, Toronto, Ontario, Canada1,Cancer Care Ontario, Toronto, Ontario, Canada2,Mount Sinai Hospital, Toronto, Ontario, Canada3,QEII Health Sciences Centre,Halifax, Nova Scotia,Canada4, Capital District Mental Health Program,Halifax, Nova Scotia, Canada5

OBJECTIVES: Being diagnosed with cancer canhave significant emotional impacts for the individualand his/her family. As direct health care providers,many oncology nurses reported that they lack thetraining and tools to manage psychosocial issues. Toaddress this service gap, Our Institute offered anannual province wide psychosocial train the trainerworkshop for nurses. Participants learn fundamentalpsychosocial assessment and management skills andbring back the knowledge to staff in their ownorganization. METHOD: A one-day workshop wasoffered in 2009 and a second one was scheduled forMarch 2010 for front-line nurses across one provincein Canada. The workshop covers impact of canceron psychosocial, spiritual and quality of life;assessment tools to determine how to intervene andwhen a referral is required; methods to addresspsychosocial issues in oncology and palliative careand the nurse’s role in managing the emotionalaspects of cancer care. RESULTS: Seventy nursesparticipated in the 2009 training and another 70 areexpected in 2010. Demographics from both cohortswill be presented and changes in their perceivedknowledge and competencies in psychosocial aspectsof cancer care will be reported. A six month followup was carried out with the first cohort on theirknowledge translation activities. Some participantsbenefited tremendously from such training anddelivered a variety of local tailored teaching whileothers reported implementation barriers. CONCLU-SIONS: This evaluation will explore train the trainerworkshop as an effective teaching method to buildcapacity over a short period across a large geo-graphic area. Workshop recipients received ongoingcoaching from experts at our Institute and hadaccess to all tools and materials in psychosocial carebest practices. Factors impacting success or failure inknowledge translation activities, the role of nursechampions and creative local tailored programs willbe shared at the conference.

S1861-2

Interprofessional Psychosocial Oncology Education

for Nurses: Outcomes from the IPODE Project

Deborah McLeod1, Janet Curran2, MaureenWhite2, Serge Dumont3

QEII Health Sciences Centre, Halifax, Nova Scotia,Canada1, Dalhousie University, Halifax, NovaScotia, Canada2, L’Hotel-Dieu de Quebec CancerResearch Center, Quebec, Quebec, Canada3

OBJECTIVES: Satisfaction surveys of people affectedby cancer have consistently shown low levels ofsatisfaction with how psychosocial distress is ad-dressed by health professionals. One factor thatappears to contribute to this finding is a lack ofreadily accessible psychosocial oncology education fornurses and other health professionals. In response tothis need, the Canadian Association of PsychosocialOncology launched the Interprofessional PsychosocialOncology Distance Education (IPODE) project toaddress this gap. METHOD: The IPODE project isin its third year of course offerings with close to 250learners to date. Uptake has been excellent, with highlevels of satisfaction with the course reported. About60% of the participants are nurses. Evaluation of thecourse includes a T1 (pre-course) & T2 (post-course)survey designed to assess knowledge and attitudesabout interprofessional psychosocial oncology prac-tice, and a T3 questionnaire designed to assesschanges in practice. RESULTS: Findings from nurseparticipants suggest that they find the coursesparticularly helpful in enhancing knowledge ofpsychosocial concerns and interprofessional skill. Avariety of specific changes in practice are reported as aresult of the course, including shifts in communicationwith other disciplines, increased skill in assessing suchconcerns as depression and anxiety and enhancedreflective practice. CONCLUSIONS: Provision ofdistance education using a web-based format is aneffective approach for the delivery of interprofessionalpsychosocial oncology education. Nurses identifysignificant benefits from the inclusion of otherdisciplines such as social workers, spiritual careproviders and psychologists in the learner groups.

S1861-3

Providing Psychosocial Training for Inpatient Head

and Neck Cancer Surgery Nurses - A Knowledge

Translation Initiative

Ashleigh Pugh, Susan Clarke, Jiahui Wong, MaryJane Esplende Souza Institute, Toronto, Ontario, Canada

OBJECTIVES: Following a provincial PsychosocialTrain the Trainer Workshop, a two-day trainingsession was offered for nurses in a surgical oncologyunit. Patients in this unit often go through disfiguringhead and neck surgical procedures which significantly


DOI: 10.1002/pon


alter their body image and often affect and theirability to communicate with others. Surgical oncol-ogy nurses identified urgent needs for psychosocialtraining, to provide them knowledge and tools tobetter support their patients in hospital and postdischarge. METHOD: Day 1 of the two-day trainingsession covered psychosocial distress in cancer,commonly used psychosocial assessment tools andthe application of the tools tailored to the head andneck cancer patient population. In day 2, standar-dized patient was used to provide nurses with ascenario of how psychosocial distress can manifest in‘real life situation’. Nurses were encouraged to applytheir learned knowledge and skills and consolidatetheir learning through hands on experiences. RE-SULTS: Twenty two nurses participated in theJanuary training session and another twenty nurseswill receive training in February. Demographicsincluded educational background, years of nursing,oncology experience, and the perceived confidence inidentifying and addressing psychosocial distress.Initial response from the first 22 nurses indicated alow perceived confidence in psychosocial aspects ofcancer care. They had an average of 9 years ofnursing experience. Changes in confidence postintervention will be reported. CONCLUSIONS: Thisevaluation will demonstrate the needs and clinicalutility of the psychosocial training to build essentialclinical skills in assessment and intervention forinpatient surgical oncology nurses. By identifyingpsychosocial distress early on, nurses can supportpatients physically and emotionally through thedifficult cancer journeys. It also helps to empowernurses as they strive to provide high quality andpatient centered care in one of the most challengingfields of medical care - Oncology.

S1910

International Models of Collaboration: Research,

Training and Practice in Professionally-led Online

support groups

SYMPOSIUM DESCRIPTION: note: co-chair is DrMitch Golant, Cancer Support Community, LosAngeles, California, United States. The U.S. basedCancer Support Community (CSC) began conductingand researching professionally-facilitated, real-time (ie.chat) online support groups for cancer patients andfamily caregivers in 1998. Early evaluation indicatedthat the modality was efficacious and yielded similarbenefits as face-to-face support groups. A trainingmodel was developed, and CSC clinical staff describeddeveloping ‘work arounds’ that enabled them tofacilitate high quality emotional support in text-onlygroups. Online support groups were identified inCanada as a promising approach to increase access ofpsychosocial care to hard-to-reach populations. In2006, following workshops and discussion with CSC,a pan-Canadian group of Psychosocial Oncology

program leaders and clinician-researchers decided topilot the CSC approach in Canada, and to assess thefeasibility and potential of the model within theCanadian context. Over the next few years, 14Canadian clinicians associated with a Cancer JourneyAction Group/ Canadian Partnership Against Cancerinitiative were trained with the Cancer SupportCommunity. Technology, ethical, jurisdictional andorganizational challenges to hosting professionally-ledonline groups were resolved. Two randomized pilotstudies with young and rural breast cancer survivorswere successfully initiated. A host of pilot groups withdiverse cancer populations (including prostate, ad-vanced and metastatic, and head and neck cancers,and family caregivers) and models of support(supportive expressive and psychoeducation) wereconducted in Provinces across Canada. This sympo-sium brings together members of this internationalcollaboration, who share their knowledge in theeducation, clinical practice and research of OSG’s.The collaboration has to date served hundreds ofcancer patients and their family members in the U.Sand Canada. It has yielded a robust InternationalTraining model and community of practice andquantitative and qualitative research findings addres-sing questions of feasibility, and therapeutic processand outcomes. A Facilitators Training Manual thatdetails the essential skills for facilitating synchronousonline support groups has been developed, and isdescribed in the symposium. The experience ofbecoming competent and leading online supportgroups is detailed by Canadian facilitators trained inthe CSC model. Key research findings extracted fromover 24 OSG’s are presented, which illuminateprocesses and benefits experienced by participants,and challenges that remain. The conclusion of thiscollaborative effort is that professionally-led OSG’sare an unexpectedly dynamic, emotionally rich andpowerful modality. This symposium is essential forprogram leaders, clinicians and researchers who areinterested in expanding the reach of psychosocialoncology by harnessing the internet for group support.

S1910-1

Professionally-led Online Support Groups for

Cancer Patients and Caregivers: Emerging Results

from A Pan-Canadian Research Initiative

Joanne Stephen1, Michael Speca2, Jill Turner6, JillTaylor-Brown3, Kate Collie6, Karen Fergus4,Deborah McLeod5, Kate Macgregor1, Tobi Patkau2

BC Cancer Agency, Vancouver, Canada1, AlbertaHealth Services, Calgary, Canada2, Cancer CareManitoba, Winnipeg, Canada3, Odette Cancer Center,Toronto, Canada4, Capital Health, Halifax, Canada5,Alberta Health Services, Edmonton, Canada6

OBJECTIVES: Online support groups (OSG’s) wereidentified as a promising option for national programdelivery by a Pan-Canadian initiative (Rebalance


DOI: 10.1002/pon


Focus/Cancer Journey Action Group). A subgroupof program leaders and clinician-researchers locatedat large cancer centers across Canada identified 3 keyquestions to direct a program of research: Arenational, professionally-led OSG’s feasible? AreOSG’s acceptable and satisfying to participants? Dotherapeutically-meaningful processes and outcomesoccur in, and result from, OSG’s? METHOD: Amixed methods approach was identified. Tworandomized pilot studies (for young and rural breastcancer survivors), and individual demonstrationgroups (for diverse cancer sites and caregivers) wereheld across Canada in 2008–2010. Psychometricassessments were conducted at pre, post and 3 monthfollow up with web-based tools in the 2 trials. Semi-structured telephone interviews were conductedamong a convenience sample across all OSG’s tounderstand participant experience. Descriptive quan-titative and qualitative analyses were performed.RESULTS: 179 patients enrolled in 24 onlinesupport groups. Attendance and drop out rates arecomparable to conventional groups. Fifty interviewswere held. Qualitative analyses suggest that 1)technology-enhanced emotional expression; 2) pro-fessional facilitation, and 3) group cohesion wereassociated with high satisfaction and positive out-comes including distress reduction, reduced sense ofaloneness, and improved self-care. Preliminary quan-titative analyses suggested that emotional processingand expression mediated reduced illness intrusivenessamong young breast cancer survivors. CONCLU-SIONS: OSG’s are not uniformly helpful, and thereare remaining questions related to feasibility andsuitability that remain to be answered. Overallhowever, professionally-led online support groupsare acceptable and satisfying for large numbers ofcancer patients, survivors and family caregivers.Anonymity and privacy related to technology aremore helpful than hindering. Therapeutically mean-ingful processes can be engaged in professionally-ledOSG’s, and yield outcomes that are comparable tothose found in high quality f2f support groups.

S1910-2

Facilitating Online Support Groups: A Training

Manual

Joanne Buzaglo1, Mitch Golant1, Mort Leiberman5,Jason Owen2, Joanne Stephen3, Anne Gessert1,Stephen Lepore4, Erica Weiss1

Cancer Support Community, Philadelphia, Pennsyl-vania, United States1, Loma Linda University,Loma Linda, California, United States2, BC CancerAgency, Vancouver, British Columbia, Canada3,Temple University, Philadelphia, Pennsylvania,United States4, California State University,San Francisco, California, United States5

OBJECTIVES: While online support groups(OSGs) for cancer patients and families have been

in existence for over 10 years, the lack of publishedguidelines has inhibited the growth and quality offacilitated OSGs. OSG facilitators, typicallytrained in face-to-face models, report role uncer-tainty and confusion when leading groups online.Based on pioneering research and on going work inOSGs, the Cancer Support Community developedan evidence-based manual to train professionalsand enhance quality of OSG facilitation. METH-OD: In March 2009, the Cancer Support Commu-nity (CSC) hosted a 2-day retreat with OSGfacilitators from CSC and a Canadian PartnershipAgainst Cancer (CPAC) initiative to identifychallenges and highlight best practices based on11 years of OSG facilitation and 27 years in theCSC Patient-Active model. Researchers presentedtheory and evidence on the mechanisms ofsuccessful professionally led OSGs. CSC generateda training manual with input and feedback fromthe Retreat participants. RESULTS: The OSGFacilitation Training Manual is a comprehensivedocument designed to complement professionaltraining in OSG facilitation. It is divided into 7sections including CSC’s Patient Active frame-work, Background and Benefits of OSGs, theFacilitator’s Role, Practical Guidance and Super-vision, Helpful Phrases and Transitions. Featuredin the Appendices is the example of the Canadianapplication of CSC OSG facilitation training. Tipson best practices are embedded with examples fromtranscripts to illustrate key points. CONCLU-SIONS: The creation of this evidence-based OSGFacilitation Manual represents a significant con-tribution to psycho-oncology by providing guide-lines for the practice of OSGs that otherwise do notexist. The manual reflects the international colla-boration between CSC and CPAC, and speaks tothe opportunity for wide spread dissemination. Theultimate goal is to provide accessible, high qualityprofessional psychosocial support for cancer pa-tients and families through state-of-the-art trainingin OSG facilitation.

S1910-3

Making the Virtual a Reality: The Clinician’s

Experience in Facilitating Online Support Groups

Karen Flood1, Heather Rennie1, Lesley Howells1,Anne Gessert1

BC Cancer Agency, Vancouver, British Columbia,Canada1, BC Cancer Agency, Surrey and Abbots-ford, British Columbia, Canada2, Maggie’s CancerCaring Centres, Dundee, Scotland, United Kingdom3,Cancer Support Community, California, UnitedStates4

OBJECTIVES: As use of internet technologiesbecome more common, so may the demand forprofessionally-facilitated online support groups(OSGs). To offer effective online support


DOI: 10.1002/pon


psychosocial-oncology professionals need to be-come skilled in, and comfortable with, using thismedium to communicate therapeutically and facil-itate healthy group dynamics. Knowledge oftraining in this medium and ongoing supervisionrecommended, types of online services for varyingclient needs, and understanding of therapeuticgroup processes possible, are required. METHOD:This presentation is based on the lived experienceof clinicians facilitating OSGs (Canada, UK) andproviding supervision (US, Canada). Groups con-sist of patients or caregivers, and are ongoing,focusing on support; or psycho-educational andtime-limited. During real time text-based sessions,facilitators use counselling skills to enhance groupexperience. Facilitators receive training by clin-icians who work extensively online, remainingengaged in ongoing consultation and supervisionto nurture and reinforce facilitation skill develop-ment and discuss online issues. RESULTS: Ob-servations on ‘goodness of fit’ between thismedium, types of OSGs, and population areexplored. Clinical and group facilitation skills,supervision experience, and therapeutic factorspossible online are highlighted. Special emphasiswill be placed on how facilitators can use the onlinemedium to address sensitive issues with bothcaregiver and patient populations, and demon-strate how meaningful, deeply supportive ex-changes can happen online. Group participantfeedback will also be highlighted. CONCLU-SIONS: Perceptions from learning the technologyand gaining competence through training, supervision and consultation, and experienceare reviewed. Information is shared with cliniciansand researchers interested in the use of internettechnologies for providing psychosocial supportto a range of cancer patient and caregiverpopulations.

S1916

A Presidential Symposium on Psycho-oncology and

Palliative Care as a Human Rights Issue

SYMPOSIUM DESCRIPTION: In 2008, theInternational Psycho-oncology Society (IPOS)joined major international palliative care andcancer care organizations to support a JointDeclaration and Statement of Commitment callingfor the recognition of Palliative Care and PainTreatment as Human Rights. IPOS has been at theforefront of expanding this declaration to specifi-cally include psycho-oncology (i.e. psychosocial,existential and spiritual care of cancer patients) as aHuman Right. IPOS has created a ‘Human RightsTask Force’, and the First Presidential Symposiumon Palliative Care and Psycho-oncology waspresented at the 11th World Congress in Viennain 2009. As President of IPOS, I am now proposing

the second such Presidential Symposium on Psy-cho-oncology and Palliative Care as a HumanRights Issue. This symposium is supported in partby the Soros Foundation’s Open Society Institutewhich has been a major advocate in promotingpain and palliative care as a Human Rights issue.This symposium brings together a group ofinternational experts in the Human Rights aspectsof Psycho-oncology and Palliative Care. Thespeakers and the topics they will cover include: 1)Luigi Grassi MD, President of the IPOS Federa-tion of Psycho-Oncology Societies and Chair,Department of Psychiatry, University of Ferrara,Italy, will give a presentation entitled: Psycho-Oncology and Palliative Care as a Human Right:an International Perspective.; 2) Luzia TravadoPhD, IPOS Board of Directors, Advisor to theNational Coordinator of Oncological Diseases forthe President of the European Union Parliamentfor the areas of psycho-oncology, palliative careand international relations, and contributor to theEU Parliament report on Palliative Care, Lisbon,Portugal, will give a presentation entitled: Pallia-tive Care in the European Union: Psycho-oncologyand Palliative Care as Human Rights.; 3) LeaBaider, PhD, Former President of IPOS andDirector, Psycho-Oncology Unit, Hadassah Uni-versity Hospital, Jerusalem, Israel, will give apresentation entitled: Psycho-oncology and Pallia-tive care in the Middle East: a Human Rights Issue;4) David Morrison, PhD, FRSA, Prince EdwardIsland Cancer Treatment Center, Member ofCAPO and IPOS, Former Senior Advisor to theCanadian Government External Affairs Depart-ment, Human Rights Division, will give a pre-sentation entitled: Protection and Promotion ofHuman Rights and Dignity: an IPOS Responsi-bility; 5) Diederik Lohman MA, Senior Research-er, Human Rights Watch, Health and HumanRights Program, New York, USA. Will give apresentation entitled What IPOS and Psycho-oncology can do next: Lessons learned from thePain and Palliative Care Experience.

S1916-1

What IPOS and Psycho-oncology Can Do Next:

Lessons Learned from the Pain and Palliative Care

Experience

Diederik LohmanHuman Rights Watch, New York, New York,United States

OBJECTIVES: The campaign by pain, palliativecare and human rights advocates to frame access topain treatment and palliative care as an issue ofpatient rights and government obligations holdsimportant lessons for IPOS and Psycho-oncology.The campaign has helped articulate more clearlythe responsibilities of governments in ensuring that


DOI: 10.1002/pon


patients have access to appropriate health services,which has enabled patients, providers and others toadvocate more effectively for much-needed govern-ment action. METHOD: In recent years, pain,palliative care and human rights advocates havejoined forces to develop a human rights approachto pain treatment and palliative care. Afteridentifying specific obligations of governments inimproving availability of these health services andmapping common barriers, they have begunadvocacy campaigns in international forums, likethe Commission on Narcotic Drugs, with the UNhuman rights agencies, as well as in individualcountries, pressing for steps to overcome barriers.RESULTS: This advocacy has resulted in, amongothers, the Commission on Narcotic Drugs recog-nizing that ensuring adequate availability ofmedical opioids is a key challenge, and the UNSpecial Rapporteur on Torture recognizing thatdenial of pain treatment when pain is severe canconstitute cruel, inhuman and degrading treatment.In country settings, advocates are using the humanrights framework to encourage their governmentsto address specific barriers, like unnecessarily strictdrug regulations. CONCLUSIONS: The humanrights framework provides opportunities to IPOSand advocates for psycho-oncology to encouragethe international community and individual gov-ernments to take steps to overcome variousbarriers that exist to better availability of psycho-oncology, including failings in government policyand inadequate training for healthcare workers. Inparticular, joint advocacy at the World HealthAssembly with pain, palliative care and humanrights advocates promoting a full range of pallia-tive care services, including psycho-oncology, holdspromise.

S1916-2

Psycho-oncology and Palliative Care in the Middle

East: A Human Rights Issue

Lea BaiderHadassah University Hospital, Jerusalem, Israel

OBJECTIVES: To appraise the attitude towardshealth and illness within the basic cultural andreligious norms of the Muslim society, and high-light this as a Human Rights issue. In particular,spiritual care will be examined as an integralcomponent of comprehensive cancer care forprevention, education and treatment of Muslimwomen in the Middle East. METHOD: It isestimated that there are 1.5 to 1.7 billion Muslimsworldwide, with 15 million (3% of the population)Muslims living in Europe and 0.08% living in theUnited States. Muslim men and women are thrustinto different social positions and family rolesreconciled with their religious and cultural norms.RESULTS: Muslim women, in particular, are at a

disadvantage socially, economically and education-ally due to restrictions placed on them by thepractices and laws of Islam. The highest value forwomen is the role they play as wife and mother,with clear expectations to put family responsibilitybefore any other external demand or personaldesire/goal. Muslim women suffer from poorerhealth than the general population in Europe, andthis disparity is an important Human Rights issue.CONCLUSIONS: It should be understood that,within Muslim social and familial contexts, womenare considered inferior family members. Thismindset contributes to their low self-image andnegative emotional perception of healthcare andillness. It should also be understood that the degreeto which Muslim beliefs and norms restrict women,affects their decisions regarding compliance withWestern healthcare practices, recommendations forcancer screening and cancer prevention. Thisconstitutes a Human Rights crisis.

S1916-3

The Protection and Promotion of Human Rights and

Dignity for Cancer Patients: An IPOS Responsi-

bility

David MorrisonPrince Edward Island Cancer Treatment Center,Prince Edward Island, Canada

OBJECTIVES: Healthcare is a fundamental issue ofhuman rights. Psychosocial oncology’s stated aim isthat cancer patients and families receive optimalpsychosocial care at all stages of disease andsurvivorship. Cancer care is now moving towardgreater protection and promotion of human rightsand dignity. Following the initiative of IPOS, weconsider how to protect and promote the rights anddignity of patients and families in all aspects ofcancer support, treatment and planning. METH-OD: In this new initiative, international palliativecare leads the way; psychosocial associations andcancer societies become partners; the World CancerDeclaration can be framed in human rights terms;collaboration ensures the recognition of our ownevidenced based practice. RESULTS: In this newinitiative, international palliative care leads the way;psychosocial associations and cancer societies be-come partners; the World Cancer Declaration canbe framed in human rights terms; collaborationensures the recognition of our own evidenced basedpractice. CONCLUSIONS: Psychosocial treatmentshould no longer be left to the whim of cancerprogram managers. We can never forget thatsupportive care, palliative care and appropriate paincontrol are not offered as extras in treatment, butare a patient’s right. Reframing what we do, interms of dignity and rights, deepens our scope ofpractice, and presents psychosocial oncology prac-tice as more than an ‘option,’ but as a necessity.


DOI: 10.1002/pon


S1916-4

Psycho-Oncology and Palliative Care as a Human

Right: An International Perspective

Luigi GrassiUniversity of Ferrara, Ferrara, Italy

OBJECTIVES: The history of human rights datesback to centuries. Seneca said that We are the partsof one great body. Nature bids us extend our handsto all in need of help. The United Nations UniversalDeclaration of Human Rights (Article 1, 1948)states that All human beings are born free andequal in dignity and rights. They are endowed withreason and conscience and should act towards oneanother in a spirit of brotherhood. METHOD: TheUICC promoted a declaration centered on healthpolicy, prevention, early detection, and the right toproper cancer treatment, however the psychosocialburden of cancer is not stressed. Data haverepeatedly demonstrated negative psychosocialconsequences of cancer, leading organizations, suchas IPOS, to stress that all cancer patients and theirfamilies worldwide should receive psychosocial careat all stages of disease and survivorship. RE-SULTS: Thus, emotional pain, spiritual pain,hopelessness, distress and demoralization, just tocite only some, should be the target of a general andglobal approach to cancer patients. On thesepremises, it is necessary to change the partial viewof cancer and to affirm the right to mental healthwhich extends not only to timely and appropriatehealth care but to the underlying determinants ofhealth, including availability, accessibility, accept-ability and quality. CONCLUSIONS: Therefore, 1)psychosocial care and psychosocial treatment arecomponents that contribute to the full exercise ofthe right to health; 2) access to psychosocial careincludes access to appropriate treatment andservices needed for the relief of suffering; 3) nationalcancer plans should require a focus on educationfor physicians, nurses and other related disciplinesabout the basic principles of psychosocial care.

S1916-5

Palliative Care in the European Union: Psycho-

oncology and Palliative Care as Human Rights

Luzia TravadoCentral Lisbon Hospital Centre - Hospital S. Jose,Lisbon, Portugal

OBJECTIVES: In February 2000, more than 100international leaders of government, patient advo-cacy leaders, cancer research organizations andcorporations met in Paris at the first WorldSummit Against Cancer. Participants reaffirmedtheir commitment to global eradication of cancerby signing The Charter of Paris. In 2005 the

European Cancer Patients Coalition lobbying withMembers of European Parliament Against Cancersigned the Warsaw Declaration to call on policymakers to promote cancer as an EU priority.METHOD: In 2007 the Portuguese EU Presidencyfollowed by efforts in 2008 brought cancer into theEU health agenda. A set of recommendations toimprove cancer control and care in the EU weresigned by 27 Member-States (MS). This documentrecognizes the important role of psychosocial andpalliative care: ‘cancer treatment and care ismultidisciplinary, involving the cooperation ofoncological surgery,(y)as well as psychosocialsupport and rehabilitation and when cancer is nottreatable, palliative care’. RESULTS: These re-commendations will improve these areas in EU. In2009 the European Commission launched theEuropean Partnership for Action Against Cancerto support MS and stakeholders in their efforts totackle cancer more efficiently by providing aframework for identifying and sharing informa-tion, capacity and expertise in cancer preventionand control. A Joint Action (JA) was submitted toEC targeting four areas. Psychosocial and pallia-tive care are included in promotion of goodpractice in cancer care. CONCLUSIONS: JA willstart late 2010. IPOS is leading the action:Integrated and holistic models of care (psychoso-cial dimension, rehabilitation and long term sup-port for people living with cancer). The objective isto assess and provide training in communicationsskills and psychosocial care in under-served coun-tries or regions. We expect this action willcontribute to improve better cancer care andreduce inequalities in accessing psychosocial carefor European citizens, therefore recognizing psy-cho-oncology as a human right.

S1918

Screening for Distress, the 6th Vital Sign: Results of

2 Longitudinal Studies

SYMPOSIUM DESCRIPTION: It is well estab-lished that 35–45% of cancer patients experiencehigh levels of distress throughout the diseasetrajectory. In response to this, Screening forDistress has emerged as a way to identify andaddress patients’ needs at the earliest point in time.As a clinical practice Screening for Distress isbecoming more common; however, much of thedata that exists is cross-sectional. This symposiumwill discuss the results of two large longitudinalstudies on screening for distress. The first studyassessed usual care and screened patients at 4 timepoints over the course of a year without anyintervention offered specific to identified distress.The second study also followed patients over a yearbut examined 2 triage models: personalized triage


DOI: 10.1002/pon


with an individual phone call and computerizedtriage which provided referral information basedon identified needs. Patterns of distress andconcerns over time, the impact of triage onlongitudinal distress, and the role of ethnicity indistress will be discussed in each of the three talks.ACKNOWLEDGEMENT OF FUNDING: TheAlberta Cancer Board Research Initiative Program& The Alberta Heritage Foundation for MedicalResearch.

S1918-1

Evaluation of Distress and Common Problems in a

General Population of Cancer Patients at Diagnosis,

3, 6, and 12 Months: Does Distress Change Over

Time Without Triage?

Dr. Janine Giese-Davis1, Linda Carlson1, ShannonGroff2, Barry Bultz1

Tom Baker Cancer Centre and the University ofCalgary, Calgary, Alberta, Canada1, Tom BakerCancer Centre, Calgary, Alberta, Canada2

OBJECTIVES: This Screening for Distress studyexamined the typical trajectory of distress over timein a general sample of cancer patients. Patientswere approached at the time of first-time cancervisits and asked to fill out paper screeninginstruments. Compared with other randomizedscreening studies in our group, this study wasmeant to examine what happens without activetriage or provision of information on availableresources. METHOD: A general group of patientswere screened with the DT, Fatigue and PainThermometers, Common Problems Checklist andPSSCAN Part-C for anxiety and depression atbaseline, 3, 6 and 12 months follow-up using paper-and-pencil surveys with telephone follow-up. Outof 1839 patients approached, 1328 consented toscreening. The most common type of cancer wasGI (23.3%) followed by prostate (17.8%) andgynecologic (10.1%). 53.9% of patients screenedwere male and average age was 59.65 years.RESULTS: The most common problems identifiedat baseline were worry about friends and family(41.5%), sleep difficulties (33.2%) and burden toothers (29.0%). Mean DT levels were 3.90, fatiguewas 3.49 and pain 2.11 (of 10). 48.0% of allpatients were positive for DT caseness (X4) but15.1% were above the cut point for depression.Slopes analyses found that depression, anxiety,and total psychosocial and practical problems(but not fatigue or pain) decreased significantlyover time. CONCLUSIONS: In this generalcancer group where males outnumbered females,similar levels of distress, fatigue, and pain werereported as other samples where femalesoutnumbered males. Similar percentages of com-

mon problems were also reported. Distress, but notfatigue or pain, decreased significantly over time.This suggests that time alone will not resolve thesetwo common symptoms in a general cancerpopulation.

S1918-2

Effect of Online Screening for Distress in Newly

Diagnosed Cancer Patients Followed by Computer-

ized versus Personalized Triage at 3, 6 and 12 Month

Follow-up: A Randomized Controlled Trial

Dr. Linda Carlson1, Shannon Groff2, Janine Giese-Davis1, Barry Bultz1


OBJECTIVES: Screening for distress has beenrecommended for all newly diagnosed cancerpatients; however this rarely happens and when itdoes evaluation of the long-term efficacy of screen-ing has not been conducted. This study used arandomized controlled design to compare routineonline screening for distress and common problemson subsequent distress and resource utilization intwo conditions: screening followed by personalizedphone triage and screening followed by persona-lized computerized triage. METHOD: Patientswere screened with the DT, Fatigue and PainThermometers, Common Problems Checklist andPSSCAN Part-C for anxiety and depression atbaseline, 3, 6 and 12 months follow-up usingcomputerized touch screens. 1150 patients wereassigned to computerized triage and 1244 topersonalized triage. The most common type ofcancer was breast (32.6%) followed by GI (13.2%)and lung (11.8%). Sixty-one percent of patientsscreened were female and average age was 58 years.RESULTS: The most common problems identifiedat baseline were worry about friends andfamily (44.9%), sleep difficulties (43.9%) andburden to others (31.9%). Mean DT levels were4.23, fatigue was 3.75 and pain 2.34 (of 10).64.3% of all patients were positive for DT caseness(X4). Slopes analyses found that compared tocomputerized triage, those who received persona-lized triage improved more over 12 months onmeasures of pain, fatigue and total psychologicalproblems. CONCLUSIONS: Although distressdecreased over time for both groups, personalizedtriage seemed to have more benefit than computer-ized triage for decreasing pain, fatigue andtotal psychological problems such as coping andworry about friends and family. However, bothgroups saw similar decreases over time in overalldistress, anxiety and depression. Further analyseswill investigate the role of referral to and uptake ofresources between groups.


DOI: 10.1002/pon


S1918-3

Asking the Right Questions: Identifying Diversity and

Disparity of Outcomes by Patient Ethnicity within a

Randomized Controlled Trial of Screening for Distress

Dr. Bejoy Thomas1, Linda Carlson1, ShannonGroff2, Barry Bultz1


OBJECTIVES: In the 2006 Canadian census, four in10 (42.9%) residents reported their origin as ‘Cana-dian’ in combination with other origins. Yet unlikethe United States, Canadian cancer registries do notrecord patient ethnicity; therefore, ethnic disparitiesin cancer care cannot currently be determined.Classifying patient ethnicity in Canada’s mosaic isalso complex and hence categorization for mean-ingful comparison is difficult. However, not askingthe question does not imply an absence of theproblem. METHOD: A stratified random sample ofpatients in the Screening for Distress computerizedvs. personalized triage RCT was collated for thisstudy. Cancer patients were classified into 4 groupsbased on physical appearance (looks White/looksNon-White) cross tabulated by Language (EnglishOnly/English Not First Language). The sample wasfurther interviewed on their ethno-cultural heritage.This data was analyzed with the Screening forDistress RCT data - baseline, 3, 6 and 12 monthsfollow-up. RESULTS: 683 patients from the Screen-ing study were assigned by stratified-random selectionto the study - 1. White English-only speakers o40%;2. Non-White English-only speakerso16%; 3. Whitenon-native English speakers o27%; 4. non-Whitenon-native English speakerso18%. On the symptomburden scores, patients from Group 1 fared bettercompared to the three other groups. Patients fromGroups 2 and 3 improved with time. However, visibleminorities irrespective of English skills (Group 4),fared poorly over time. CONCLUSIONS: Althoughlongitudinally distress decreased in 3 of 4 groups, theclassic minority patients in group 4 (irrespective ofEnglish proficiency) indicated growing distress. Thisimplies that the pathways multicultural patients takein their cancer journey are dissimilar, and theservices/resources offered to them may need to besensitive, targeted, adapted and adjusted to thesegroups. Further analyses will investigate the role ofpatient ethnicity on cancer-related concerns, adher-ence to referrals and uptake of existing resources.

S1919

Screening for Distress, the 6th Vital Sign: The

Implementation Experience of 4 Canadian Jurisdictions

SYMPOSIUM DESCRIPTION: Canada hasembarked on implementing a national strategy

for cancer control and funding has been madeavailable for 5 years to implement the CanadianStrategy on Cancer Control (CSCC) through theauspices of the Canadian Partnership AgainstCancer (CPAC). One of the eight action groupscharged with specific mandates is the CancerJourney Action Group (CJAG). Its mandate is toprovide leadership to change the focus of thecancer system so that patient, survivor and familymember needs are better served. CPAC/CJAG hasendorsed Screening for Distress, the 6th Vital Sign,as a priority direction and one of its drivers tomove ‘person centered care’ forward. This sympo-sium will focus on the implementation experienceof 4 jurisdictions who are currently implementingScreening for Distress: British Columbia, North-eastern Ontario, Nova Scotia, and Quebec City,.This work presents an excellent opportunity todiscuss the implementation of Screening forDistress and the associated strategies and lessonslearned. ACKNOWLEDGEMENT OF FUND-ING: Canadian Partnership Against Cancer.

S1919-1

Screening for Distress and Symptom Management:

The British Columbia Experience

Ann Syme, Jeff Barnett, Kathleen Yue, JudyOliver, Elena Serrano, Natalie Ferguson, KarenLevyBritish Columbia Cancer Agency, Victoria, BritishColumbia, Canada

OBJECTIVES: The purpose of this project is toimplement provincial Screening for Distress forcancer patients in order to promote person-centered care. Planning is well underway in fiveBritish Columbia Regional Cancer Centers. Asecond project - Symptom Management Guidelines(SMG) for nursing was recently completed. In-tegration of these two projects referred to asScreening Assessment and Management of Symp-toms (SAMS) provides a standardized approach toaddress the results from patients self assessment.METHOD: This is an 18 month implementationproject involving BCCA and the Regional HealthAuthority partners. Methods inherent within theproject include: 1) SAMS Project charter 2) Teamdevelopment within each centre consists of asteering committee, a clinical design team, frontline staff, volunteers and IT support 3) Commu-nication plan 4) SAMS education plan to supportnurses during implementation phase 5) Evaluationplan designed to target patients, staff and systemmetrics 6) Sustainability plan RESULTS: Theimplementation of SAMS at two of five regionalcenters will be ‘live’ by May 2010 with all fivesites ‘live’ by March 2011. Processes related tothe planning, implementation and evaluationphases will be described. Lessons learned including


DOI: 10.1002/pon


successes and barriers discovered in the implemen-tation of SAMS will also be discussed. Progressregarding the initial planning with Regional HealthAuthorities will be described. CONCLUSIONS:This innovative approach to the implementation ofScreening for Distress in tandem with nursingfocused evidence based symptom managementguidelines (SMG) will identify patient distress andprovoke a focused nursing assessment with evi-dence based interventions at point of care. This isan ambitious change to established practice andorganizational processes and therefore requires riskmanagement. Learning’s taken from each siteimplementation will be invaluable to the continuedsuccess of the project.

S1919-2

Expanding Screening for Distress in Rural Health:

A Focus on Patient-Centered Cancer Care

Ms. Carole Mayer, Sheila Damore-Petingola, MikeConlon, Katherine MackenzieRegional Cancer Program of the Hopital regional deSudbury Regional Hospital, Sudbury, Ontario,Canada

OBJECTIVES: Cancer patients living in ruralcommunities often travel several hours to a tertiarycancer centre for treatment. Community OncologyClinic Network (COCN) sites were established,permitting patients to receive chemotherapy closerto home. Despite the success of this strategy,patients report not always having their psychoso-cial needs met. This presentation focuses on a twoyear quality improvement project to implementscreening for distress at 14 COCN sites, improvingpatient-centered cancer care closer to home.METHOD: The project plan includes: (1) Strategicplanning to engage support of stakeholders; (2)Develop and implement processes to screen fordistress while respecting cultural diversity; (3)Implement Screening for Distress tools-EdmontonSymptom Assessment Scale (ESAS) and theCanadian Problem Checklist (CPC); (4) Applyconcepts of Participatory Action Research as partof knowledge translation; (5) Anticipate and planthe delivery of psychosocial oncology services inrural communities and; (6) Develop and implementan evaluation plan. RESULTS: Patients attendinga COCN site are now screened for three criticaldomains: (1) physical (nutrition [nausea, vomiting,appetite, weight change], pain, fatigue, dyspneaand sleep); (2) practical (transportation, finances,drug coverage and accommodation); and (3)psychosocial (anxiety, depression, worry, socialsupport, communication). Successes and challengesto implement this model of care will be shared andpreliminary results presented, based on dataaccrued during the first year of the project.

CONCLUSIONS: Screening for Distress as the6th vital sign has meant a shift in practice for healthcare professionals working at a COCN site. Thefeedback received thus far from health careprofessionals and patients participating in thescreening process, is critical to improving ourprocesses. We are confident this approach willresult in patients having improved access topsychosocial care, reflecting a true practice ofpatient-centered care.

S1919-3

Screening for Distress: The Nova Scotia Experience

Dr. Janice Howes1, Marianne Arab2, Kelly Fenn2,Sandra Cook2, Deborah McLeod2

QE II Health Sciences Centre, Capital Health, andCancer Care Nova Scotia, Halifax, Nova Scotia,Canada1, Cancer Care Nova Scotia, Halifax, NovaScotia, Canada2

OBJECTIVES: The purpose of the Nova ScotiaScreening for Distress Implementation project is toimprove person-centred care for cancer patients.By providing front-line staff with a systematicmethod of identifying the supportive care needsand concerns of cancer patients, we enable them torespond effectively to the physical, psychosocial,and practical concerns of patients. In Nova Scotia,the implementation of Screening for Distressinvolves three key components: direct clinicalservice, education, and evaluation. METHOD:This 18-month action-focused implementationproject began in June, 2009. Screening for Distressis being implemented in four phases, beginningwith four first adopter Cancer Patient Navigatorsthroughout the province. Preliminary data fromthe Navigators, as well as two cancer site teams ofCapital Health will be presented. This will besupplemented by the Nova Scotia project team’sexperience of the implementation process. RE-SULTS: The key strengths and challenges of theimplementation of Screening for Distress in NovaScotia will be discussed. Key strengths include:patients screened and concerns managed, stake-holder support, and positive feedback from front-line staff. Challenges include: charting andcommunication issues, time and resource concerns,as well as education and training of front-line staffto handle distress issues identified through screen-ing. CONCLUSIONS: Preliminary data will bediscussed in regards to person-centred care forcancer patients. Recommendations for continuedimplementation of Screening for Distress through-out Nova Scotia as well as in other jurisdictionswill be discussed. Work is needed to developeducation and training opportunities for front-linecancer care staff, taking into account variations inlocal contexts.


DOI: 10.1002/pon


S1919-4

Implementation of Distress Screening in Quebec City:

Process, Challenges, and Preliminary Outcomes

Dr. Marie-Claude Blais1, Josiane Mathieu2, LiseFillion2, Marie de Serres2, Annie Tremblay2,France Robert2

Universite du Quebec e Trois-Rivieres & CentreHospitalier Universitaire de Quebec, Quebec City,Quebec, Canada1, Hotel-Dieu de Quebec, QuebecCity, Quebec, Canada2

OBJECTIVES: Since March 2009, our team is activelyworking at the implementation of systematic Screeningfor Distress at the Hotel-Dieu de Quebec, a hospitaltreating cancer patients from the East of the QuebecProvince. The purpose of this presentation is to describeour approach, the challenges encountered and lessonslearned throughout this endeavour involving thedevelopment of close bridges between clinical, organisa-tional and research components. METHOD: Follow-ing the development of a screening toolkit and trainingmaterial in collaboration with CPAC/CJAG, steps wereundertaken for field preparation and frontline staff buy-in. We opted for a step-by-step approach to trainingstaff and implementing screening: pivot oncology nurseswere firstly involved, followed by front line staff fromthe radiation, haematology, and palliative care clinics.Screening for Distress is under way for patients from allcancer sites at several times points over the cancerjourney. RESULTS: We firstly present qualitative dataon the implementation process enlightening the chal-lenges encountered and practical strategies introducedto facilitating this important practice change. Typicalmyths about Screening for Distress regularly expressedby front line staff are also discussed. Quantitative datacollected among four cancer sites will provide apreliminary portrait of distress over the cancer journey,allowing for a discussion of the former myths validity aswell as the quality of the implementation process.CONCLUSIONS: Screening for Distress offers aformidable occasion of dialogue with patients essentialto a patient-centered care vision. Throughout thispractice change, front line staff was dedicated to qualityimprovement while being in need for support andfeedback. This process shed light on organisationalchallenges, particularly at the moment of survivorshiptransition. Pragmatic and careful steps need to beundertaken in order to successfully implement Screen-ing for Distress and ensure its sustainability within busyoncology clinics.

S1921

Dyadic Coping and Meaning Making in Couples

with Unique Needs: Challenges and Opportunities

for Psychosocial Oncology Practice

SYMPOSIUM DESCRIPTION: Research evi-dence highlights the significant psychological im-

pact of cancer not only on the individual, but alsoon the couple relationship. Much of this researchfocuses on effects such as distress, includinganxiety, depression & post-traumatic stress. Lessis known about opportunities for shared growth,such as post-traumatic growth (PTG) and mean-ing-making in couples coping with cancer. There isevidence to suggest that partners’ who share aunified coping philosophy and effectively supporteach other demonstrate better psychosocial adjust-ment including PTG, and relationship satisfaction.While dyadic coping has been identified as aprotective variable for couples, interventions de-signed specifically to help couples to enhancecoping are limited. This is particularly true forcouples in underserved populations and those withspecialized needs. In this symposium, we examinecouples and cancer in two underserved popula-tions: couples dealing with hematological cancersand hematopoietic stem cell transplants (HSCT),and couples where a woman was diagnosed withbreast cancer at a relatively young age, at or beforethe age of 40. The symposium papers discuss theunique needs of these populations and the asso-ciated adaptational challenges in the context ofintimate relationships. In the first two papers, wepresent both the descriptive, quantitative data froma feasibility study of 11 couples dealing with HSCTand the qualitative data from in-depth interviewsover the 18 months of the study. Next we presentfindings from a pilot study of a novel onlineintervention designed to support and instill dyadiccoping in young couples dealing with breast cancer.The final paper discusses the challenges andopportunities associated with providing onlinefacilitation to couples in general and young couplesin particular.

S1921-1

Traumatic Stress, Depression and Caregiver Quality

of Life among Spouses of Hematopoietic Stem Cell

Transplant Recipients: A Feasibility Study

Brenda Sabo1, Deborah McLeod2, StephenCouban1, Jean Hughes1

Dalhousie Universities, Halifax, Nova Scotia,Canada1, QEII Health Sciences Centre, Halifax,Nova Scotia, Canada2

OBJECTIVES: Few studies have explored thepsychosocial health of spouses caring for patientsundergoing hematopoietic stem cell transplanta-tion (HSCT). This study was undertaken to: i)identify adverse effects such as depression, trau-matic stress and decreased quality of life associatedwith the caregiver role; and ii) identify at whatpoints along the treatment continuum spouses aremost vulnerable (pre-HSCT; 6 weeks post HSCT;6 months post-HSCT and 1-year post HSCT).METHOD: A multi-method feasibility study


DOI: 10.1002/pon


explored the experience of spousal care-giving at 4time points across the HSCT treatment continuum.Three questionnaires were used to screen fordepression, caregiver burden and traumatic stressrespectively. The questionnaires included: CES-D(Radloff, 1977), CQOLC (Weitner et al, 1997) andProQOL-R-IV (Stamm, 2009). Descriptive analysiswere conducted including frequencies, means andcorrelations. RESULTS: Findings from the quan-titative component of the study suggest that thetime immediately prior to, and 6 weeks followingHSCT are periods of high distress for the spouse,with 50% of spouses at increased risk forexperiencing traumatic stress and 38% experien-cing depression. While the 6-month mark saw anoverall improvement in psychological well being,the level of distress and care giver burden began torise again at 1-year. CONCLUSIONS: The levelsof depression and traumatic stress were very highacross all 4 time points and, as might be expected,correlated with quality of life. Given the potentialrisk for depression, traumatic stress and poorquality of life, spousal care givers should beregularly assessed for psychological distress acrossthe treatment continuum as part of routine caredelivery. More understanding is needed about theexperience of care giving in order to design relevantinterventions for this population.

S1921-2

Dyadic Coping and Breast Cancer: From Theory to

Application

Karen Fergus1, Deborah McLeod2, Wendy Carter1

York University, Toronto, Ontario, Canada1,QEII Health Sciences Centre,Halifax, Nova Scotia,Canada2, Sunnybrook Odette Cancer Centre,Toronto, Ontario, Canada3

OBJECTIVES: The purpose of this presentation istwofold: (1) to provide an overview of the shift inthe psychosocial oncology and health psychologyliteratures from individualistic to interactionalmodels of coping with illness - with an emphasison dyadic and communal coping processes, and (2)to demonstrate the application of these principlesto the creation of an innovative online interventionfor young couples facing breast cancer. METHOD:Couplelinks.ca is a custom-designed website offer-ing a professionally facilitated, couple-centredintervention entailing informational and experien-tial components. The program consists of sixlearning modules undertaken weekly by the couple.Approximately 15 couples were enrolled in theprogram in order to test its feasibility and benefit.Participant feedback on one of the learningmodules, a creative exercise designed to enhancethe couple’s capacity to adopt a ‘we’ orientation inrelation to cancer, was analyzed. RESULTS:Couples indicated a range of reactions to the

exercise. Preliminary analysis of benefit revealedthe following themes: Fun and laughter; enjoymentof shared participation in creative form of expres-sion; enhanced communication around difficulttopic; recognition of similarity of experience;reinforcement of feelings of togetherness; andreinforcement that cancer is a shared experience.Feedback from the minority of couples who didnot find the exercise enjoyable or useful will also bepresented. CONCLUSIONS: Preliminary analysisof responses to the ‘Facing Cancer as a UnifiedFront’ exercise suggests that the creative co-construction of a shared metaphor is conduciveto dyadic coping and to the couple’s experience ofassuming a ‘we’ orientation in relation to breastcancer. Despite encouraging preliminary findings,study of longer-term benefits (e.g. whether and howthe metaphor or image evolves or changes overtime for couples, and/or becomes incorporated intotheir ongoing discourse) is warranted.

S1921-3

Spousal Care-giving in Hematopoietic Stem Cell

Transplantation: Hope and Meaning Across Time

Deborah McLeod1, Brenda Sabo2, StephenCouban1, Jean Hughes2

QEII Health Sciences Centre, Halifax, NovaScotia, Canada1, Dalhousie University, Halifax,Nova Scotia, Canada2

OBJECTIVES: Hematopoietic stem cell transplan-tation (HSCT) is a difficult procedure associatedwith high levels of distress for recipients and familymembers. Care-giving demands for family mem-bers, particularly the spouse, are also high. There isvery little evidence in the literature, however,regarding care-giving in this population. Anexploratory study was undertaken in order tobetter understand the experience and meaning ofspousal care-giving and in this paper we report thequalitative findings. METHOD: A multi-methodstudy design was used to understand the experienceof spousal care-giving. Semi-structured interviewswere conducted across four points in time: pre-HSCT, 6 weeks post-HSCT, 6 months post-HSCT,and 1-year post-HSCT. The qualitative componentwas informed by interpretative phenomenology.Thematic analysis was used to identify the corethemes regarding the experience and meaning ofHSCT spousal care-giving. RESULTS: Findingssuggest professionals and families place unrealisticexpectations on the spouse. To meet expectations,some spouse’s suppress their emotions and needs,while others struggled to separate their role ascaregiver from that of spouse. Maintaining hopewas important for many as they navigated theuncertain path through treatment. Some foundhope challenged by the incongruent messages givenwithin the acute care setting. Overall burden was


DOI: 10.1002/pon


extreme and sources of support for the spouseswere sparse. CONCLUSIONS: These exploratoryfindings highlight the need for psychosocial oncol-ogy care to address spousal distress across theHSCT trajectory, though what interventions wouldbe most effective and when are unknown. Thespousal relationship and hope were variables thatthe spouses identified as influencing their well-being. More understanding of dyadic variablessuch as coping and adjustment, as well as how hopeis negotiated in relationships between spouses andwith health professionals is needed.

S1921-4

Online Facilitation of a Couple-focused Intervention

Wendy Carter1, Karen Fergus2

Sunnybrook Odette Cancer Centre, Toronto,Ontario, Canada1, York University, Toronto,Ontario, Canada2

OBJECTIVES: An online-intervention was de-signed to extend the application of online supportprograms to include couples, and specifically youngcouples affected by breast cancer. The objectives ofthis presentation are to: 1) describe the role of thefacilitator for a novel online couple interventionand, 2) outline the benefits, challenges, and specialconsiderations for this population as they haveunique psychosocial needs including extensive loss,and struggle to make meaning of their experiences.METHOD: Couplelinks.ca is a unique 6-weekonline intervention designed for young coupleswith breast cancer. The program consists of sixexperiential learning modules based on relationshipprinciples demonstrated to underlie optimal couplecoping. Approximately fifteen couples have beenguided through the online program. Although theprogram is self-guiding to a large extent, ongoingcommunication and interaction with the facilitatorplay an integral role in supporting the couple’slearning process. RESULTS: The online facilitatorreceived high ratings on helpfulness suggesting thatthe majority of couples found value in thefacilitator’s involvement and support. Ongoingfacilitator tasks included: maintaining a balancebetween flexibility and structure; tailoring facil-itator involvement to suit each dyad’s unique issuesand strengths; and fostering compliance. Insightswith respect to the benefits and challenges of onlinefacilitation, and strategies to facilitate greatermeaningfulness will be shared and highlightedthrough the use of examples. CONCLUSIONS:Online-interventions with younger couples withbreast cancer demonstrate distinct advantages aswell as challenges. Recommendations for thedevelopment and implementation of strategies toincrease compliance, reduce differential involve-ment in dyads, and facilitate meaningful conversa-tions among couples are provided.

S1922

Why Psychosocial Care is Difficult to Integrate into

Routine Cancer Care: Stigma is the Elephant in the

Room

SYMPOSIUM DESCRIPTION: PURPOSE: Thissymposium aims to review the concept of stigmarelating to cancer and psychological distress,specific tumor sites, the personal, cultural andhealth system factors that may contribute, andinterventions to combat stigma and its conse-quences. METHODS: The symposium will com-prise 3 papers: 1) a historical context and overviewof the international progress and barriers tointegration of psychosocial care in routine oncol-ogy practice; 2) a review of stigma relating tocancer and mental health problems includingspecific cancer sites; contributing factors and theadverse impact on patients and their carers 3)review of models for potential interventions toaddress such stigma of psychological distress in thecare of patients with cancer drawing upon evidencefrom population and clinical studies, includingissues in diverse geographic and cultural settings.RESULTS: Important gains have been madeinternationally in recognition of psychologicaldistress in cancer care. There is a widespread callfor greater integration of psychosocial care inroutine cancer care, yet major attitudinal barrierspersist to this being translated to clinical services.The stigma of psychological distress and psycho-social interventions as have been under-addressedas a major barrier to integration of psychosocialcare barriers at the patient, family, and healthsystem level. CONCLUSIONS: Stigma regardingpsychosocial distress and mental health needscontinue to present a major barrier to achievingthe important goal of integration of psychooncol-ogy services in routine care. Such stigma caninfluence patient, family, clinician and healthservice responses to psychosocial needs in thesetting of cancer. Strategies to address theseattitudinal and organisational barriers can beidentified and represent a critical area for futurepsychooncology research and service development.

S1922-1

Stigma: A Hidden Barrier to Psychosocial Care

Jimmie HollandDepartment of Psychiatry and BehavioralSciences, Memorial Sloan-Kettering Cancer Center,New York, New York, United States

OBJECTIVES: This paper will review majorbarriers and impediments to the integration of theimportant achievements of psychooncology intoroutine cancer care with a specific focus on theongoing adverse impact of stigma attached to


DOI: 10.1002/pon


psychosocial needs. METHOD: An historicaloverview of international developments in thepromotion of integrated psychosocial care withinroutine cancer care was conducted, including thekey policy directions such as the 2007 Institute ofMedicine report on cancer care, clinical guidelines,effective methods and tools for detection andmanagement of psychological distress in routinecancer care. These are reviewed alongside availableevidence regarding translation into clinical prac-tice. RESULTS: Major gains have been made inrecent years in recognition of the essential role ofpsychosocial care in cancer services, yet theprogress towards integration of such care inoncology services has been limited. Despite someimprovement in cancer-related stigma, substantialunaddressed attitudinal barriers exist to patientsreceiving effective care, to cancer clinicians ensur-ing provision of quality psychosocial care, and tohealth services ensuring its inclusion in routinepractice. CONCLUSIONS: The calls fromprofessional bodies, policy makers and advocacygroups for greater integration of psychosocialcare in cancer services have not been matched byintegration of psychosocial care in routinepractice in many settings. Stigma is a majorhidden barrier to be confronted and addressed inorder to achieve the necessary improvements inquality and access to psychosocial care in cancerservices.

S1922-2

Overcoming Stigma in Psychooncology: Removing

the Elephant from the Room

Brian KellySchool of Medicine and Public Health, University ofNewcastle, Newcastle, New South Wales, Australia

OBJECTIVES: This paper will briefly discussstigma specifically relating to mental illness; reviewmajor international strategies aimed to combatsuch stigma and application of lessons from theseprograms to the task of promoting integratedpsychosocial services in cancer care. METHOD:Findings were reviewed from international studiesinvestigating contemporary attitudes and beliefsregarding mental disorders and psychologicaldistress, with a focus on interventions to addressstigma and the implications of these findings forimproving wider availability of psychosocial care incancer services. RESULTS: Despite large-scaleinternational programs addressing the stigma ofmental illness, beliefs and attitudes that discouragerecognition and seeking effective help for psycho-logical distress are common. These have directrelevance to attitudes to distress in the setting ofcancer. Multifaceted strategies are recommendedto build patient’s confidence in psychosocial care,address attitudinal barriers within clinicians as well

as the broader community, and promote servicemodels appropriate to the diverse clinical andgeographic settings of cancer care. CONCLU-SIONS: Strategies to address stigma are a majorinternational priority. Psycho oncology researchhas potential to contribute to understandingmethods to combat stigma in this setting andimprove translation of the unanimous call forintegration of care into routine practice. This alsorequires attention to the cultural socioeconomicand geographic diversity of settings of routinecancer care (including primary care, and specialistservices).

S1922-3

The Stigma of Cancer: Current Themes

Mark WeinbergerDepartment of Psychiatry, Weill Cornell MedicalCollege, New York, New York, United States

OBJECTIVES: There is heightened social stigmaassociated with specific cancer sites based on theorigin of the disease, the perceived role of healthbehaviours or lifestyle and prevailing views aboutits preventability (i.e. lung cancer and smoking,cervical cancer and sexual activity) and the effectsof the disease (i.e. prostate and breast cancer andsexuality). This paper will discuss stigma related todifferent cancer sites. METHOD: Findings werereviewed from studies investigating contemporaryattitudes and beliefs related to specific cancer sitesincluding lung, cervical, breast, gynaecologic andprostate, as well as HIV-related cancers. RE-SULTS: Compounding the stigma associated withcancer in general, there appears to be recalcitrantand pervasive attitudes towards people withcancers that are related to their lifestyle andbehaviours. Where tumour risk is associated withtobacco use or linked to stigmatized behaviours(such as sexuality), there is heightened stigmaaimed at these subgroups. In addition to a reviewof the literature, clinical observations from thespeakers will also be shared. CONCLUSIONS:Specific strategies to address stigma of specifictumor sites is imperative. Interventions are neces-sary to attenuate heightened stigma toward specificsubgroups of cancer patients. As psycho oncologyresearch continues to examine stigma and canceroverall, an eye toward specific subgroups isnecessary.

S1924

A Tale of Two Cities: The Quality of Dying and

Death for Metastatic Cancer Patients in Toronto

and Jerusalem

SYMPOSIUM DESCRIPTION: Interest in ‘thegood death’ has grown in recent years a result of


DOI: 10.1002/pon


increased openness to the discussion of death inmany societies, the lengthening trajectory fromonset of illness to death and the demographic shiftin Western countries. Nevertheless, systematicresearch on the quality of death and dying haslagged behind that of other clinical outcomes, andhas been hampered by methodological, ethical andpractical difficulties. Much of the research whichhas been published thus far has been limited in itsgeographic location and was conducted prior to therapid growth in palliative and end of life careservices. It is unclear to what extent there havebeen improvements in the quality of death anddying over the past decade and also whether theseoutcomes have been affected by changing expecta-tions and values regarding death and dying. It isalso not established how the quality of death anddying is affected by regional differences in thedelivery of palliative care and other health careresources and by cultural attitudes regarding theend of life. This symposium will include anoverview of the concept of the quality of deathand dying and its measurement and findings from aresearch project on the quality of death and dyingand on bereavement morbidity which is beingconducted in Canada and Israel. These countrieshave many similarities in standards of medical care,but also some differences in the availability ofpalliative care and in cultural and religiousexpectations regarding the end of life. We inter-viewed bereaved caregivers of patients with solidtumours 8-10 months after the death of the patient.The quality of death and dying was evaluated usingthe multidimensional Quality of Dying and Deathquestionnaire and bereavement morbidity in thecaregivers was evaluated using the Beck DepressionInventory-II, the Texas Revised Inventory of Griefand the Impact of Event Scale-Revised 8 to 10months after patient death. Data will be presentedregarded the quality of death and dying and itsrelationship to bereavement morbidity. The im-plications of these findings will be discussed interms of understanding the determinants of thequality of death and dying and the methodologicalissues which affect the measurement and interpre-tation this construct.

S1924-1

The Quality of Dying and Death Construct and Its

Measurement

Sarah Hales, Gary Rodin, Camilla ZimmermannPrincess Margaret Hospital, Toronto, Ontario,Canada

OBJECTIVES: Ensuring a ‘good death’ for theterminally ill has not only become an importantgoal of medicine but has also now captured thepopular imagination. However, there has been littleagreement regarding its definition, measurement,

and how its evaluation is affected by cultural,socioeconomic or individual factors. We havereviewed the literature on the quality of dyingand death construct and have evaluated currentlyavailable tools to measure the quality of dying anddeath. METHOD: The health care literature(databases MEDLINE, Healthstar, and CINAHL)was searched using keyword terms ‘quality ofdying/death’ and ‘good/bad death’. Letters, editor-ials, historical reports, case reports and reviewswere excluded. We selected papers for furtherreview in which the quality of dying and deathwas defined or conceptualized or in which a qualityof dying and death measure was described.RESULTS: The quality of dying and deathconstruct consistently includes physical, psycholo-gical, social, spiritual/existential domains. Freedomfrom pain and suffering is most commonlyidentified as important in the quality of deathand dying. However, individual and family differ-ences are found regarding preferences for deathpreparation and for the circumstances of death,with ‘flexible realism’ emerging as death ap-proaches. National differences are evident, basedon such factors as resource availability and culturalvalues such as autonomy and control. CONCLU-SIONS: There is remarkable consistency in thedimensions of the quality of dying and deathidentified across cultures, although research hasbeen limited by methodological, practical, andethical considerations. A wide range of interven-tions are now being applied to improve the qualityof dying and death, however, further research isneeded to clarify the factors which shape thisoutcome and the interventions which will ensure, atthe very least, the ‘good-enough’ death.

S1924-2

The Quality of Dying and Death for Metastatic

Cancer Patients in Toronto, Canada

Sarah Hales1, Christopher Lo1, Lucia Gagliese2,Camilla Zimmermann1, Amna Husain3, MichalBraun4, Gary Rodin1

Princess Margaret Hospital, Toronto, Ontario,Canada1, University Health Network, Toronto,Ontario, Canada2, Mount Sinai Hospital, Toronto,Ontario, Canada3, Interdisciplinary Center atHerzliya, Herzliya, Israel4

OBJECTIVES: The Quality of Dying and Deathquestionnaire (QODD) is one of the best availablestandardized measures of quality of dying anddeath, but to date it has not been appliedspecifically to cancer populations or those outsideof the United States. This study aimed to assess thequality of dying and death in metastatic cancerpatients and its relationship to bereaved caregiverdistress and other demographic and care variables.METHOD: Participants were bereaved caregivers


DOI: 10.1002/pon


of metastatic solid tumour cancer patients treatedat a Canadian comprehensive cancer care treat-ment centre and home palliative care program.They completed the QODD and measures ofdepression (Beck Depression Inventory-II), grief(Texas Revised Inventory of Grief) and stress-response symptoms (Impact of Event Scale-Re-vised) 8 to 10 months after patient death.RESULTS: In 239 deaths evaluated, the meanQODD score was 65.8 (range 32.5 to 93.3, SD 12.0)on a scale of 0 to 100, with higher scores indicatingbetter quality of death. Scores 460 were found in68.9% of the sample. After multiple regressionanalysis, patient female gender, greater caregiverage, location of death at home, and less caregiverstress response symptoms predicted better qualityof death, accounting for 20% of the variance(po0.05). CONCLUSIONS: The relatively highQODD ratings in this sample, compared toprevious research and the Israeli arm of this study,could be due to greater death acceptance andpreparation, almost universal access to palliativecare, and /or caregiver recruitment and responsebiases. Caregiver and patient characteristics mayaffect QODD ratings due to their influence on theprocess of dying and location of death and/or dueto the impact of the bereavement on the retro-spective evaluation.

S1924-3

The Quality of Dying and Death for Metastatic

Cancer Patients in Jerusalem, Israel

Michal Braun1, Ilanit Hasson-Ohayon2, DaliahGalinsky3, Wilner Omer3, Sarah Hales4, ChristopherLo4, Lucia Gagliese5, Camilla Zimmermann4, GaryRodin4

Interdisciplinary Center at Herzliya, Herzliya,Israel1, Bar Ilan University, Ramat-Gan, Israel2,Hadassah Medical Center, Jerusalem, Israel3,Princess Margaret Hospital, Toronto, Canada4,University Health Network, Toronto, Canada5

OBJECTIVES: The majority of research evaluat-ing the quality of dying and death has beenconducted in the United States and the UnitedKingdom. More research is required to assess howjudgments regarding the dying experience areinfluenced by differences in culture, religion andhealth care provision. This study examines thequality of dying and death of metastatic cancerpatients in Jerusalem, Israel, and its relationship tobereaved caregiver distress, demographic and carevariables. METHOD: Bereaved caregivers of me-tastatic solid tumor cancer patients were recruited.They were administered the Quality of Dying andDeath questionnaire (QODD) and measures ofdepression (Beck Depression Inventory-II), grief(Texas Revised Inventory of Grief) and stress-response symptoms (Impact of Event Scale-Re-

vised) 8 to 10 months after patient death.RESULTS: 95 deaths were evaluated. MeanQODD score was 57.2 (SD 15.0), on a scale of 0to 100 with higher scores indicating better qualityof death. Scores 460 were found in 47.4% of thesample. QODD correlated with older caregiver age(po0.05), greater depression (po0.05), stressresponse symptoms (po0.05) and with location ofdeath at home (po0.05). The QODD scores werelower than in the North American arm of thestudy. CONCLUSIONS: The quality of dying anddeath evaluations in this sample of metastaticcancer patients were lower than those found in asimilar study conducted in Toronto, Canada.Possible explanations may include cultural differ-ences (e.g. regarding death acceptance) and/or inthe availability of palliative care programs. Thesedifferences will be discussed.

S1928

The Family Journey Through Illness: The Story Of

Margaret

SYMPOSIUM DESCRIPTION: Theoretical con-cepts: In the lifetime of every person, high stresssituations and periods of intense and anticipatedcrisis occur. Of these life events and situations,those which make the greatest demands on aperson’s coping ability are the unexpected eventsthat have no direct or causal link with the lifestyleor particular behaviour - such as life threateningdisease which intrudes into and engulf everydimension of life. Cancer is one of such life-threatening events. Methods: The presentation of aclinical narrative of a young patient with cancerand her family will set the stage for the discussionconcerning different techniques and approaches tothe family management. The focus will be on thepatients coping skills, the health team communica-tion with patient and family, the sense of meaningand the family dynamics within the illness context.Discussion: Cancer affects three out of fourfamilies and cancer diagnosis and treatment shouldbe viewed as both intra- and interpersonal process.When a patient has cancer, the family also hascancer as a component of its daily life. Thediscussion will encourage a complementary ofdimensions: E. Andritsch will present the complex-ities of the patient and family symbiosis, and themedical aspects of the patient, Dr. D. Razavi willdiscuss his expertise on the health team commu-nication; Prof. Dr. William Breitbart will concen-trate on the aspects of sense of meaning and Prof.Dr Lea Baider will talk about the family dynamics.Conclusion: By understanding the trajectory of theillness within each patient’s particular narrativeand family social context, we may provide themand their health care team with more appropriate


DOI: 10.1002/pon


tools and meaningful answers during the longtrajectory of illness.

S1928-1

A Never-Ending Challenge For Psycho-Oncology:

Dealing And Responding Appropriately To The

Numerous Dimensions Of Patients’ And Relatives’

Distress

Darius RazaviJules Bordet Institute, Cancer Center of theUniversite Libre de Bruxelles, Bruxelles, Belgium

OBJECTIVES: Elisabeth Andritsch presentationof the situation of a 21 years old woman with anadvanced osteosarcoma and of the reactions of herparents will give an opportunity to propose, besidetheoretical hypothesis, suggestions for an appro-priate multidisciplinary intervention. METHOD:After having recalled the numerous theoreticalframeworks needed to understand the dynamic ofthe clinical problems encountered (i.e. trauma,distress, anxiety, regression, protective shield,defensive idealization, splitting), suggestions aboutneeded interventions will be presented: adjustedand personalized - dyadic or triadic -communica-tion with the patient and her parent (form andcontent), communication with the staff (form andcontent). RESULTS: This presentation will allow adiscussion about the transfer to clinical settings ofresults of empirical studies on communication andcare organization in highly emotional and uncer-tain contexts. CONCLUSIONS: Case presentationduring symposium at an international level isneeded to consider the difficulties to implement ina clinical setting information and recommenda-tions derived from pertinent research. Parent andchild relationships in oncology, as one of the mostcomplex clinical situation, offer a unique opportu-nity to discuss this issue.

S1928-2

Beyond Words: Family Interaction Of A Young

Cancer Patient

Lea BaiderHadassah University Hospital. Jerusalem, Jerusalem,Israel

OBJECTIVES: Cancer is a life threatening diseasethat every family matters. Families provide thecontext of adjustment in which the person withcancer responds and behaves to the disease. Andevery member of the family is profoundly affectedduring the entire trajectory of cancer. METHOD:The methods will be based on the analysis andpsychological understanding of a classical clinicalhistory of a young cancer patient and her family.The family adaptation to cancer diagnosis andtreatment is a continuing process with many critical

cycles. It can be seen as a threat and anopportunity, and as a chance for resilience,recovery and a new modes of adaptation. RE-SULTS: Furthermore, illness within the familynecessitates sharing and communication. Thefamily ‘s collective perception shape the meaningof the illness of each family member. And thefamily appraisal of the illness is an integral part ofliving together, with their conflict, their brokenroutine, their silences and the unspoken words.Family members can be supportive of one anotherthrough their own mode of silent or open verbalcommunication. CONCLUSIONS: To understandand conclude the best mode of family interactionthrough the clinical case to be presented. And toobserve how some families cultures value quietacceptance of events over which they have nopossible control, and others value the opendiscussion of feelings as a way to enhance theirsense of togetherness and well being.

S1928-3

Applying Concepts of Meaning Centered

Psychotherapy in the Clinical Setting

William BreitbartDepartment of Psychiatry and Behavioral Sciences,New York, United States

OBJECTIVES: A case vignette will be presented ofa 21 year old woman with a diagnosis ofosteosarcoma and lung metastatses. The purposeof my presentation is to discuss the application ofconcepts of Meaning-Centered Psychotherapy to aspecific clinical case, as part of a multi-perspective(i.e. family approach, communications approach,and meaning centered approach) discussion of thecase. METHOD: Meaning-Centered Psychother-apy (MCP) is an existentially oriented approach topsychotherapy in patients with advanced cancer,based on the work of Viktor Frankl, and developedby Breitbart and colleagues and Memorial Sloan-Kettering Cancer Center. To date this approachhas been studied in research clinical trials, in bothgroup and individual formats with demonstratedefficacy. RESULTS: The case will be discussedfrom the perspective of the importance of meaningin human existence, particularly as one faces lifelimiting illness. The concept of meaning and thesources of meaning; experiencial sources, creativesources, historical/legacy sources, and the attitudethat one takes towards suffering will be presentedas specific to working with this patient. Existentialconcepts of Freedom, Responsibility, ExistentialIsolation, Fear of Meaninglessness, and DeathAnxiety will also be highlighted. CONCLUSIONS:A meaning-centered approach to the care ofadvanced cancer patients is another perspectiveon psychotherapeutic intervention that may be


DOI: 10.1002/pon


useful to clinicians treating such patient in Psycho-oncology practices.

S2000

Integrating Oncology Nursing and Psychosocial

Oncology

SYMPOSIUM DESCRIPTION: Cancer and itstreatment have more than a physical impact. Thereare social, psychological, emotional and practicalconsequences as well. Some individuals, givenrelevant information and support, mobilize theirown networks and manage to cope with thesituation. Others, however, benefit from additionaldeeper intervention and/or referral. Nonetheless,all individuals with cancer need to be screened toassess the level of distress given that screening fordistress is the sixth vital sign. Oncology nurses arethe pivotal point of contact for cancer patientsregarding psychosocial concerns. The nurse’s initialinteraction and assessment has a significant impacton whether cancer patients feel supported and areconnected with the appropriate resources. Thissymposium will explore the role of oncology nursesin meeting psychosocial health needs of cancerpatients. Best practices and professional standardsdescribe the role of oncology nurses in screeningfor distress, assessment for identified patientconcerns, and the provision of evidence-basedpsychosocial interventions. We intend to highlightcurrent developments to support and engageoncology nurses to provide psychosocial care forcancer patients, with a particular focus on screen-ing for distress. The following speakers will providethe session:

Deborah McLeod – CAPO representative – focuson educational preparation of oncology nurses toprepare them in psychosocial care.Ruth McCorkle – IPOS representative who willfocus on screening and assessmentDoris Howell – CANO representative – focus onpsychosocial health assessment guideline and theresources to support practice, such as algorithms.Sanchia Aranda - ISNCC representative - focus ondistress screening and assessment in other countries

S2000-1

Development of a Web-based Education Resource to

Support a National Screening for Distress Program

D. McLeod1, Angela Morck2

Dalhousie University & QEII Health SciencesCentre, Halifax/Nova Scotia, Canada1, Universityof Calgary

OBJECTIVES: The completion of a screening toolis an important first step in addressing thepsychosocial health needs of people affected by

cancer. In addition, screening must be followed bytimely, evidence-based interventions if screening isto have an impact on relevant outcomes. Thisproject was designed to address the learning needsassociated with a screening for distress program fornurses and other health professionals. METHOD:To address these needs, the Canadian Associationof Psychosocial Oncology (CAPO), with supportfrom the Canadian Partnership Against Cancer,created a web-based education program to supportthe national screening for distress agenda. Theeducation program was designed for health profes-sionals, particularly nurses, to address screeningresults, and to plan appropriate interventions. Thefinal education program was designed to take 5–6hours to complete. RESULTS: The programsupports clinically grounded and interactive learn-ing through the use of PowerPoint presentations,video clips of clinical interactions with patients andfamily members, and test questions. Presentationtopics include, for example, strategies for dealingwith screening results, managing referrals, andsupportive counseling. The supportive counselingmodules were developed based on the CanadianAssociation of Nurses in Oncology (CANO)Standards of Practice. This learning resource iscurrently being piloted. Preliminary evaluationresults will be presented. CONCLUSIONS: Basedon our experience with the IPODE project, weknow that health professionals value web-basedlearning for its accessibility and convenience. Weexpect the uptake to be high and that the programwill be useful to nurses and other health profes-sionals as they transition to using screening toolsfor distress.

S2000-2

Overview and Implications of the Institute of

Medicine Report, Cancer Care for the Whole

Patient: Meeting Psychosocial Health Needs

Ruth McCorkleYale University, New Haven, CT, University ofArizona, Tucson, AZ, Memorial Sloan KetteringCancer Center, New York, NY, USA

OBJECTIVES: To present a summary of theInstitute of Medicine(IOM) report and its recom-mendations; to discuss the role of the AmericanPsychosocial Oncology Society (APOS) in formingthe Alliance for Quality Psychosocial Cancer Care.METHOD: In October 2007 the Institute ofMedicine (IOM) released a report titled CancerCare for the Whole Patient: Meeting PsychosocialHealth Needs mandating changes in the delivery ofquality cancer care to include psychosocial services.Ten recommendations were made including that allcancer care should include appropriate psychoso-cial services. RESULTS: Psychological distress,particularly depression and anxiety, in adults


DOI: 10.1002/pon


diagnosed with cancer has been well documentedand significantly influences cancer recovery andquality of life. Symptoms of depression, forexample, are associated with decreased compliancewith adjuvant therapy and a number of cognitiveand functional impairments. Psychological distressin older cancer survivors can increase treatment-related side effects and decrease abilities to managetheir symptoms, adding to the burden of the illness.With the publication of the report, there is agrowing national recognition that many patientsand their families report unmet psychosocial needs,and that psychosocial assessment and treatment isa standard of quality cancer care. The NationalComprehensive Cancer Network (NCCN) haspublished clinical practice guidelines for distressmanagement, including screening. CONCLU-SIONS: APOS has firmly established itself as thesingle national organization devoted solely topsychosocial care in cancer in the United States.APOS recognizes that psychosocial assessment is astandard component of cancer care and that eachpatient’s psychosocial needs must be documentedwith a plan for needed services. APOS took thelead in forming the Alliance for Quality Psychoso-cial Cancer Care which currently includes morethan 30 member organizations committed tointegrating psychosocial screening and relatedservices into the standard of quality care for cancerpatients.

S2000-3

Facilitating Better Psychosocial and Supportive

Care Practices to Reduce Distress

Doris HowellOncology Nursing Research, Princess MargaretHospital, Toronto, Canada.

OBJECTIVES: Distress is a normative response tocancer with some patients experiencing moreserious distress related to multi-determinant causessuch as unrelieved symptoms and difficulty adjust-ing. Reducing distress is dependent on ensuring theprovision of best practices in symptom care,supportive-education, and social connections.METHOD: We used adaptation (ADAPTE) meth-odology to develop evidence-based algorithms tosupport better practices in psychosocial andsupportive care. Local contextual adaptation of

guidelines is an initial step in fostering translationinto practice. This should be followed by use of aknowledge translation framework to facilitate asystematic and planned implementation processwith use of multifaceted approaches to addressmulti-level barriers to practice change. RESULTS:The focus of this presentation is on facilitatingpractice change through systematic planningand tailored implementation approaches. Theevidence supporting a multifaceted approachwill be reviewed and application in knowledgetranslation demonstrated. CONCLUSIONS:Improving practice requires systematic planning,high quality facilitation, and multifacetedapproaches to address known barriers topractice change at multi-levels of the adoptersand organization

S2000-4

Supportive Needs Screening - An Australian

Experience

Sanchia ArandaPeter MacCullum Cancer Centre and MelbourneUniversity, Melbourne, Australia

OBJECTIVES: With the increasing emphasis onthe importance of supportive care, a goal of havinginformed and supported patients was included inthe 2001 strategic plan of the Peter MacCullumCancer Centre in Melbourne, Australia. METH-OD: In 2002, a project to implement supportiveneeds screening was initiated. Cancer site-specificservices with an appointed service lead clinicianshifted the focus away from medical, radiation andsurgical oncology to an integrated treatmentapproach and formal multidisciplinary structures.Infrastructure funding allowed a parallel develop-ment of supportive care, nursing research, andpractice development efforts that gave momentumto the strategic directions. RESULTS: Eight yearslater, this project has developed into a wellestablished program of initial needs screening andresponse across all clinical tumor streams. Thework is now influencing State policy with targetsset for all health services to implement supportiveneeds screening in cancer populations. CONCLU-SIONS: This presentation will reflect upon thisjourney, exploring the barriers and facilitators thathave influenced progress along the way.


DOI: 10.1002/pon


ORAL ABSTRACTS

A-2

Working Towards an Understanding of the

Psychosocial Needs of Young Adults: Examining

Distress, Social Support and Interest in Online

Support

Liane S. Kandler1, Scott M. Sellick2

Lakehead University, Thunder Bay, Ontario,Canada1, Thunder Bay Regional Health SciencesCentre, Thunder Bay, Ontario, Canada2

OBJECTIVES: Cancer in young adulthood hasunique psychosocial implications, making it im-perative that these needs be evaluated. We aim toassess distress levels of young adults, socialsupport, and interest in online support for youngadults. Our goal is to compare distress screeningmeasures commonly used, to examine the relation-ship between support and distress, and to evaluateinterest in online support. This is the first stage, tobe followed by a 10-week semi-structured onlinesupport group. METHOD: Young adults (18 to44) diagnosed at the Cancer Centre after Septem-ber 2004 will be invited to complete a questionnairepackage. Participants will be asked to complete ademographic questionnaire which also assessescomputer and internet use, and interest in receivingsupport online. Distress measures include theHospital Anxiety and Depression Scale, the Perso-nal Well-Being Checklist, and the EdmontonSymptom Assessment System. The Berlin SocialSupport Scale will measure actual and perceivedsupport. RESULTS: Questionnaire mailing tookplace January 6, 2010; results are pending. We aimto analyze 1) whether social support and distresspredict interest in participating in an onlinesupport group using a multiple regression analysis,with particular emphasis on separating actualversus perceived social support and the individualdistress measures, and 2) the relationships betweendistress measures. CONCLUSIONS: Online sup-port groups are an explosive new communicationmedium within healthcare, but little research existsdescribing factors motivating online use. We aim toadd to this growing body of literature by evaluating

interest in online support, and how this relates tosocial support and the level of distress experiencedby the individual. This preliminary research will beused to guide the development of an online supportgroup.

A-3

Medical, Psychological and Social Aspects of

Cancer Diagnosis Disclosure and Non-Disclosure in

Romania

Degi Laszlo CsabaBabes-Bolyai University, Cluj Napoca, CJ,Romania

OBJECTIVES: Only few studies are concernedwith consequences of cancer diagnosis non-disclo-sure. We aim to compare cancer patients based oncancer diagnosis disclosure and also we evaluatethe odds of non-disclosure. METHOD: 420 cancerpatients were included in our study, 342 withmalign and 78 with benign tumors. 238 women and185 men completed our questionnaire whichincluded standard measures of depression, hope-lessness, ways of coping and life events. Oncologyclinicians answered short questionnaire in whichthey indicated type, stage and location of tumor,treatments received and whether patients haveknowledge of their cancer diagnosis or not.RESULTS: Cancer patients who were not in-formed about their cancer diagnosis are older,more isolated, undereducated and also they havesignificantly higher levels of depression, hopeless-ness and consequently lower problem-focusedcoping potential. Odds of cancer diagnosesnon-disclosure are mainly influenced by tumortype (malign) and depression. CONCLUSIONS:Our results underline the importance of patient-focused cancer diagnosis disclosure. Relevancy ofour clinical research should be addressed startingfrom the fact that in Romania there are noprevious reference data about cancer diagnosisnon-disclosure, based on multivariate statisticalanalyses.


S54 Oral Abstracts

A-4

Coping with Breast Cancer, A Phenomenological

Study

Myrna A. A. Doumit1, Huda Abu Saad Huijer1,Jane Kelley3, Nagi El Saghir1, Nada Nassar2

American University of Beirut, faculty of Medicine,School of Nursing, Beirut, Lebanon1, AmericanUniversity of Beirut Medical Center, Beirut, Lebanon2,Mississipi University, Mississipi, United States3

OBJECTIVES: The purpose of this study was togain a more in depth understanding of the copingstrategies espoused by breast cancer Lebanesewomen. METHOD: The study followed purposefulsampling and saturation principles in which 10female participants diagnosed with breast cancer,stages I–III were interviewed based on their genuineknowledge of the phenomena, and their willingnessto communicate that information. Interviews wereconducted between December 2007 and May 2008.All interviews were audio taped and transcribedverbatim. Data were analyzed following a herme-neutical process as described by Diekelmann andIronside (1998). RESULTS: Seven main themes andone constitutive pattern emerged from the studydescribing the Lebanese women’s coping strategieswith breast cancer. Emerging positive coping andhindering factors are similar to experiences andcoping strategies of other breast cancer women;however, the negative stigma of cancer in theLebanese culture, and the imbedded role of religionin Lebanese society are bases of the differences inthe coping strategies of Lebanese women with breastcancer. CONCLUSIONS: The results of the presentstudy add to the knowledge base, as they portraysubjective experiences of coping with breast cancer.These findings cannot be directly generalized butthey could act as a basis for further research onwhich to base a development of a framework for anapproach to care that promotes coping processes inLebanese women living with a breast cancer.

A-6

Interdisciplinary Treatment Planning for Patients

with Cancer Pain: Incorporating Psychosocial Issues

Diane NovyThe University of Texas M. D. Anderson CancerCenter, Houston, TX, United States

OBJECTIVES: Identify the unique contributions ofdifferent disciplines in cancer pain treatment.Identify the patient’s involvement as the treatmentplan is developed. Consider ways to integrate eachteam member’s perspective into a comprehensivetreatment plan. METHOD: This is a casepresentation with a video of a patient with phantomlimb pain following surgery for sarcoma. Perspec-tive of team members (physician, chaplain, psychol-

ogist, social worker, rehab specialist) are presented.RESULTS: This video demonstrates the work at M.D. Anderson Cancer Center’s Center of ExcellencePain Center in providing a comprehensive treatmentapproach to pain. Numerous psychosocial issues arediscussed by patient and the video offers ways thatthose issues are handled. CONCLUSIONS: Thereare a number of cancer care professionals who areintegral to the management of each patient. For thepatient example used in the video, the roles of thephysician, rehab expert, psychologist, chaplain, andsocial worker are made clear. The psychologicalprocesses that affect physical symptoms and painare also discussed.

A-10

Cancer and Spiritual Experiences: Redefining the

Self Through Initiatory Ordeal

Vonarx NicolasUniversite Laval, Quebec, Canada

OBJECTIVES: Present the results of a study thatfocused on the presence of religious practices andknowledge in the journeys of cancer patientssearching for meaning and a cure. Show how thediscussion of spiritual experiences led us toexamine how people’s identities were testedthrough their cancer ordeal. METHOD: The datacollection for this study was conducted in Quebecwith 10 cancer patients. We interviewed eachperson individually, discussing their experience ofthe disease and the resources to which they turned.RESULTS: By following the identity-buildingprocess that was at work in illness, we came to agreater understanding of how religious practicesand knowledge can be useful. We observed thatthese resources were particularly helpful when theywere used to turn inwards, pay attention to oneself,strive for wholeness, connect with somethinggreater than oneself, and transform values so thatthey supported a psychosocial version of oneself.CONCLUSIONS: Examining the role played byreligious and spiritual practices and knowledge incancer patients required that we attempt to under-stand their spiritual experiences by focusing on theself-discovery that occurred through the initiatoryordeal of their illness.

A-12

Exploring the Therapeutic Value of Hope in

Palliative Nursing

Karimah Alidina, Ildico TetteroJoseph Brant Memorial Hospital, Burlington,Ontario, Canada

OBJECTIVES: Hope is a multi-dimensional con-cept that is integral to a dying person’s needs. It isan essential resource that assists individuals with a


DOI: 10.1002/pon

Oral Abstracts S55

life threatening illness to cope during times ofintense physical and psychological distress. Theobjective of this article is to explore and analyze thetherapeutic value of hope in Palliative nursing.METHOD: The phenomenon of hope will beexplored through the analysis and application ofDufault and Martocchio’s Multidimensional Modelof Hope to a clinical scenario that was experiencedwas the authors. RESULTS: Factors determininghope in cancer patients will be identified as well asinterventions that can foster hope in dying patients.Discussion includes examination of literature gaps,relevance to nursing practice, and practical strate-gies to engender hope and thereby enhance qualityof life in advanced cancer patients. CONCLU-SIONS: Most terminally-ill patients require hope tomaintain their dignity, to cope with their stressorsand to enhance their quality of life. The Multi-dimensional Model of Hope explains the concept ofhope in the form of two spheres and six dimensions.The MMH has contributed significantly to thedepth and breadth of our current knowledge base ofhope in palliative settings.

A-13

Coping Strategies and Self Efficacy as the Mediator

of the QOL in Cancer Patients

Amani Khalil1, Mohamed Khalil1

MMU, Manchester, United Kingdom1, KFU,Dammam, Saudi Arabia2

OBJECTIVES: General: To study the role ofdifferent types of coping strategies and self efficacy,on The Quality of life of cancer patients inSudanese community. Specific: 1. To evaluate theeffect of different type of coping strategies on theQuality of life of cancer patients.; 2. To understandcoping strategies specific to different phases ofdisease.; 3. To investigate the role of self-efficacy inpredicting Quality of life for cancer patientsMETHOD: Two hundred of newly diagnosedcancer patients with various types of cancer. Age17–60 and both gender will be recruited fromSudan. Tools: Questionnaires using the Ways ofCoping Inventory-Cancer Version, Self-EfficacyScale-cancer version (Schwarzer, 1992) and Qualityof life scale- (Cohen et al., 1995) Cancer versionwill be used. Data will be analyzed using SPSScomputer software. Statistical significance will beconsidered at (po0.05). RESULTS: Expectedresults: Applying these coping strategies is expectedto significantly reduce the psychological distress inmost of the cancer patients pairing in minddifferent type of personality and culture effects.As well as self efficacy can be mediator on theQuality of life. Our study will shed light on thesignificance of applying different type of copingstrategies in patients with cancer and theinfluence of self efficacy on human functioning.

CONCLUSIONS: Expected conclusions: Psychologi-cal coping strategies will have an important influenceon QOL in patients with cancer. As well as selfefficacy can be mediator on the QOL. Our study willshed light on the significance of applying DIFFER-ENT TYPE coping strategies in patients with cancer.

A-18

Survivorship: A Key Component for Breast Center

Accreditation

Diane Thompson, Darlena ChadwickThe Queen’s Medical Center, Honolulu, HI, UnitedStates

OBJECTIVES: Survivorship is a crucial issue thatmerits additional attention. The purpose of thisabstract is to review accreditation programs thatconsider a survivorship program a standardrequirement. Breast accreditation programs in-clude the National Quality Measure for BreastCenters (NQMBC), administered by the NationalConsortium of Breast Centers, and the NationalAccreditation Program for Breast Center(NAPBC), administered by the American Collegeof Surgeons with board representation from 15organizations. METHOD: Standards forNQMBC, NAPBC and The Commission onCancer were reviewed. Additionally, we reviewedthe quality measure requirements for other cancerprograms and professional memberships. Theseincluded Centers for Medicare and MedicaidServices: Physician Reporting Quality Initiative(PQRI), American Society of Clinical Oncology:Quality Oncology Practice Initiative (QOPI), andthe American Society for Therapeutic Radiologyand Oncology: Performance Assessment for theAdvancement of Radiation Oncology Treatment(PAAROT). Of note, the PQRI may be linked topay-for-performance criteria. RESULTS: Cur-rently only the NAPBC requires centers to providea surveillance plan for survivors. While there are nospecific requirements as to the nature of theprogram, a description of an accredited programmay be helpful: The program emphasizes overallquality of life. It includes a mammography/ultra-sounds recall information system, mental healthand nutrition counseling, a survivorship navigator,education and support programs. A complimen-tary web-based platform, facilitated by the navi-gator provides ongoing communication betweenthe treatment team and the survivor. CONCLU-SIONS: National standards as mandated by theNABPC will encourage breast programs to developa survivorship plan. Over 1,100 breast centers haveexpressed interest in NAPBC accreditation and 105breast centers are now accredited since the programbegan one year ago. Additional survivorshipqualifications should be added to the NQMBC,PQRI, QOPI and the PARROT programs. With


DOI: 10.1002/pon

S56 Oral Abstracts

survival rates as high as 95% for early stage breastcancers, survivorship management should be anintegral part of the treatment plan.

A-21

Impact of Spirituality on Palliative Care Physicians:

Personally and Professionally

Dori SeccarecciaPrincess Margaret Hospital and Toronto GeneralHospital, Toronto Ontario, Canada

OBJECTIVES: The overall purpose of this studywas to explore palliative care physicians’ personaland professional experiences regarding spiritualityincluding any differences they perceived betweenreligion and spirituality. METHOD: This studyemployed the qualitative method of phenomenol-ogy. A purposeful sample of participants wasrecruited. Physicians were identified by the re-searchers based on prior knowledge of physicianswho were articulate, good communicators andprepared to share their personal and professionalfeelings, attitudes and experiences concerning spiri-tuality in palliative care. Maximum variation withrespect to gender and years in practice wasconsidered. RESULTS: A number of interpretivecategories and themes emerged in relation topalliative care physicians’ perspectives and experi-ences about the spiritual domain of care includingthe concept of spirituality and the differencebetween spirituality and religion. The quintessentialtheme permeating all the themes was the concept ofhow the participant’s own spirituality impactedtheir practice of palliative care and how thepractice of palliative care impacted their ownspirituality. These were inextricably woven together.CONCLUSIONS: This study revealed the relationalnature of how spirituality interacts with physicians’personal and professional beliefs and practices andthat addressing spirituality is essential to providingcompassionate and holistic care. Despite a broadview of spirituality there seemed no doubt that thespiritual domain was fundamental to physiciansfulfilling the mandate of alleviating suffering andpromoting healing which in turn nourished personalspirituality allowing some defence against theemotional stress of the work.

A-24

Pilot Study of Performance of the Arabic Functional

Assessment of Cancer Therapy (FACT-G) in

Egyptian Cancer Patients

Noha M.N. Awad1, Mohamed Farouk2, HusseinEl-Shafei1, Abbas M. Omar�2, Amr AbdelazizElsaid�2 (�Joint senior authors)High Institute of Public Health, Alexandria Uni-versity, Alexandria, Egypt1, Faculty of Medicine,Alexandria University, Alexandria, Egypt2

OBJECTIVES: To test FACT-G (Arabic) onEgyptian cancer patients. METHOD: FACT-Gwas administered to 23 Egyptian patients followedby a semi-structured interview requesting patientsto identify any difficulties. Audio-recordings of thepatient-researcher interview were made and con-tent analysis performed. Twenty-three patientswere enrolled over 8 weeks. RESULTS: Responsepattern showed U shaped distribution in 12/23patients(52%). Fourteen patients(60.8%) re-sponded with (not at all) or (very much) to morethan half the items. Analysis of responses per itemshowed U/J-shaped curve except pain which wasnormally distributed. Cronbach’s Alpha was 0.824for physical functioning subscale but markedlylower for social and family well being. Questionsinvolving satisfaction/acceptance were perceived inunique cultural context eliciting responses ofpre-destined acceptance regardless emotionalfunctioning. Nineteen patients (82.6%) reportedquestionnaire was difficult to understand.CONCLUSIONS: These results raise concernsregarding the comparability of QOL data collectedfrom Arabic speaking communities in multinationalclinical trials to the data collected from westerncountries and the methodological appropriateness oflicensing drugs based on QOL advantage from suchdata. Cultural adaptation of Arabic translation ofFACT-G is recommended before results can bepooled with other populations.

A-26

Complementary and Alternative Medicine Use and

Distress Among Australian Women with Cancer: A

Prospective Longitudinal Investigation

Lisa Beatty1, Jon Adams3, David Sibbritt2, TraceyWade1

Flinders University, Adelaide, SA, Australia1, Uni-versity of Newcastle, Newcastle, NSW, Australia2,University of Queensland, Brisbane, QLD, Australia3

OBJECTIVES: While several cross-sectional stu-dies have examined the medical, demographic andpsychological correlates of complementary andalternative medicine (CAM) use among womenwith cancer, few prospective longitudinal investiga-tions have been reported. The purpose of thepresent study is to prospectively examine (i)whether pre-cancer distress is predictive of CAMuse at cancer diagnosis, (ii) whether CAM usepredicts distress after cancer, and (iii) whetherCAM mediates the relationship between pre- andpost cancer-related distress. METHOD: Fourwaves of data from the Australian LongitudinalStudy of Women’s Health were analysed. Partici-pants were women who did not have cancer atSurvey 1, but who reported developing cancer atsubsequent surveys. Measures included CAMusage (number of CAM consultations over the


DOI: 10.1002/pon

Oral Abstracts S57

past 12 months); and distress (SF-36; CES-D; theGoldberg Anxiety and Depression Scale). Long-itudinal analyses were conducted according to atime-lag model using Linear Mixed Modelling,which can model repeated measures. RESULTS:The changes in prevalence over time for CAMusage and distress within each age cohort and bycancer type will be discussed. Findings from theprospective predictive and meditational analyses ofthe (i) combined samples and (ii) separate agecohorts will then be presented. CONCLUSIONS:It is anticipated that the findings of this study willprovide longitudinal confirmation of the correla-tions previously observed between distress, CAMand cancer. That is, this study will provide insightas to whether utilising CAM is an effectiveintervention for managing the distress arising fromcancer diagnosis, and whether particular agegroups obtain greater benefit.

A-29

An Investigation of Psychological Distress (Depres-

sion and Anxiety) in People with Head and Neck

Cancer

Kate Neilson1, Annabel Pollard1, Ann Boonzaier1,June Corry1, David Castle3, Marcelle Grey2, KarenMead2, David Smith2, Tom Trauer3, JeremyCouper1

Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia1, RMIT University, Melbourne,Victoria, Australia2, St Vincent’s Hospital,Mlebourne, Victoria, Australia3

OBJECTIVES: Studies demonstrate that patientswith head and neck cancer experience elevatedpsychological distress, and that distress and qualityof life change during treatment. However, little isknown about the psychological distress, particu-larly symptoms of depression and anxiety, amongstAustralian patients. The purpose of the currentstudy was to assess symptoms of depression andanxiety in patients with head and neck cancer(HNC) before and after radiotherapy. METHOD:Prospective longitudinal observational study ofconsecutive HNC outpatients at a tertiary cancercentre in Australia. Eligibility included a diagnosisfor the first time of cancer in the head and neckregion, where the patient agreed to undertakecancer treatment involving radiotherapy withcurative intent. Data were collected before com-mencement of radiotherapy and again threeweeks after completing treatment. Symptoms ofdepression and anxiety were assessed by theHospital Anxiety and Depression Scale (HADS).RESULTS: Seventy-five participants completedpre- and post-treatment questionnaires. Depressionmean scores significantly increased from pre- topost-treatment, while anxiety scores significantlydecreased over the same period. The prevalence of

mild to severe depression was 15% pre-treatmentand doubled to 30% post-treatment. The preva-lence of mild to severe symptoms of anxiety was30% pre-treatment, reducing to 17% post-treatment. Pre-treatment depression and receivingchemotherapy predicted post-treatment depression.Pre-treatment anxiety scores and gender predictedpost-treatment anxiety. CONCLUSIONS: Theseresults suggest that rates of depression in HNCpatients increase following cancer treatment, withone third of patients experiencing clinically sig-nificant symptoms of depression following radio-therapy. Therefore, ongoing monitoring to identifypatients at risk is important. Psychosocial inter-ventions need to be developed and evaluated tomeet the changing needs of this patient group asthey undergo treatment for HNC.

A-37

Cognitive Behavioral Therapy and Physical Exercise

for Climacteric Symptoms in Breast Cancer Patients

Experiencing Treatment Induced Menopause: First

Results of a Multicenter Trial

Saskia Duijts, Hester Oldenburg, Marc vanBeurden, Neil AaronsonThe Netherlands Cancer Institute - Antoni vanLeeuwenhoek hospital, Amsterdam, Netherlands

OBJECTIVES: Premature menopause is a majorconcern for younger women undergoing adjuvanttherapy for breast cancer. Hormone replacementtherapy is contraindicated; non-hormonal medica-tions show bothersome side-effects. Cognitivebehavioral therapy (CBT) and physical exercise(PE) have been shown to have a positive impact onsymptoms in naturally occurring menopause. Theobjective of this study is to assess the effectivenessof these interventions on climacteric symptoms andquality of life (QoL) in breast cancer patientsexperiencing treatment-induced menopause.METHOD: In this randomized controlled multi-center trial, patients are being allocated to (1) CBT,(2) PE, (3) combined intervention (CBT/PE) or (4)a waiting list control group. Questionnaires arecompleted at baseline (T0), twelve weeks (T1) andsix months (T2) follow-up. Outcome measuresinclude menopausal symptoms (FACT-ES;HFRS), sexuality (SAQ), body- and self image(QLQ-BR23), urinary symptoms (BFLUTS), psy-chological distress (HADS) and health-related QoL(SF36). Preliminary intention-to-treat (ITT) andper-protocol (PP) analyses have been conducted.RESULTS: To date, 334 patients have completedthe first follow-up questionnaire (T1). Non-com-pliance rate with the interventions was 46%.Nevertheless, significant group differences favoringthe interventions were observed for menopausalsymptoms (FACT-ES: ITT p5 0.022; PPp5 0.039) (HFRS: both ITT and PP po0.001),


DOI: 10.1002/pon

S58 Oral Abstracts

urinary symptoms (ITT p5 0.022; PP p5 0.006),psychological distress (PP only p5 0.015), self-reported physical functioning (ITT p5 0.007, PPp5 0.002), fatigue (ITT p5 0.023, PP p5 0.031),and general health perceptions (PP only p5 0.013).CONCLUSIONS: Both cognitive behavioral ther-apy and physical exercise appear to reduceclimacteric symptoms and have additional benefitsfor health-related quality of life. If proven effectiveover the longer follow-up period, implementationof this intervention program, perhaps with mod-ifications to increase compliance, will be a welcomeaddition to the regular medical care of breastcancer patients experiencing treatment-inducedmenopause.

A-38

Coping Together: Development and Pilot Testing of

a Self-Directed Coping Skills Intervention for

Patient-Primary Support Person Dyads

Sylvie Lambert1, Afaf Girgis1, Suzanne Chambers2,Kendra Sundquist3

Centre for Health Research and Psycho-oncology(CHeRP), The Cancer Council NSW, University ofNewcastle & Hunter Medical Research Institute,Newcastle, New South Wales, Australia1, GriffithInstitute for Health and Medical Research, GriffithUniversity, Brisbane, Queensland, Australia2,Cancer Council New South Wales, Sydney,New South Wales, Australia3

OBJECTIVES: Patient’s (Pt) and their primarysupport person’s (PSP) distress is partiallymediated by the counterpart’s illness adjustmentand ability to cope with challenges, which in turnsubstantiate the need for holistic psychosocialinterventions targeting the Pt-PSP dyads. To date,effective Pt-PSP dyad-based coping interventionsare delivered by highly trained health professionals,limiting their long-term sustainability and patientreach. To overcome these limitations, the researchteam developed a self-directed coping skills train-ing intervention for Pt-PSP dyads. METHOD: Acoping skills training workbook was developed toprovide Pt-PSP dyads with effective strategies tomanage common physical or psychosocial chal-lenges faced in the early post-diagnosis period.Topics included in the workbook were based on theoutlines of professionally-led, Pt-PSP-based copinginterventions and empirical evidence in this area.Early on in the development process, the work-book was presented to 25 Pt-PSP dyads participat-ing in an interview to evaluate its suitability andstrengths/weaknesses. RESULTS: The workbookaddresses five topics: symptom management, in-formation-seeking, feelings and emotions, commu-nication, and decision-making/problem-solving.This resource goes beyond mere provision ofinformation by suggesting strategies that Pt-PSP

dyads can use to address independently, as much aspossible, their concerns. This is achieved byengaging them in exercises that encourage theapplication of knowledge to their situation. Pt-PSPdyads (n5 25) are currently reviewing this resourceand findings will be available at the time of thispresentation. CONCLUSIONS: A novel, evidence-based, self-directed coping skill straining interven-tion, which is acceptable to Pt-PSP dyads, wasdeveloped. This workbook is anticipated to providedyads with the resources needed to appraise morepositively the challenges they face and their abilityto cope with these. This workbook translatescutting-edge psychosocial research and makes itavailable to Pt-PSP dyads. In 2010, the workbook’seffectiveness in decreasing Pt-PSP dyad’s anxietywill be evaluated.

A-42

Identifying Empirical Targets for Intervention in

Men with Prostate Cancer

Suzanne Chambers1, Megan Ferguson1,R.A. Gardiner2, Joanne Aitken1

Cancer Council Queensland, Brisbane, Queensland,Australia1, University of Queensland, Brisbane,Queensland, Australia2

OBJECTIVES: Prostate cancer is the most com-mon cancer in men, excluding non-melanoma skincancer. With increasing incidence and survivalfrom prostate cancer, the number of men in thecommunity living with the consequences of diag-nosis and treatment is increasing. Men diagnosedwith prostate cancer face a number of health andpsychosocial challenges throughout diagnosis andtreatment. Identifying intervention targets to im-prove men’s quality of life is important in assistingmen through their cancer journey. METHOD:Participants were 1074 men newly diagnosed withprostate cancer who were referred to the study bytheir diagnosing urologist. Participants were partof a broader longitudinal epidemiological andpsychosocial study examining the patterns of careand long term outcomes for men diagnosed andtreated for prostate cancer. Participants completedbaseline assessments (average 25.5 days post-diagnosis) examining health concerns, psychosocialoutcomes and quality of life. A subset of 131 menalso completed questionnaires on lifestyle beha-viours. RESULTS: More than one-third of menreported having high cholesterol; 15% heartdisease; 40% high blood pressure; 41% arthritis;and 11% diabetes. Using body mass index as anindicator, 70% of men were obese or overweightrepresenting a higher percentage than currentnorms. In addition, a higher percentage of menwere sedentary or not meeting guidelines forsufficient time in physical activity than availablenorm data. CONCLUSIONS: Prostate cancer is a


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disease associated with aging such that most mendiagnosed are over 55 years of age. These men willoften experience co-morbid chronic illnesses andare likely to be overweight and sedentary. Anyintervention that seeks to make a significant impacton quality of life for men with prostate cancershould consider the broader health issues these menface and the impact this has on their health-relatedquality of life.

A-44

Translating Peer Support into a Research Setting:

Working with Different Priorities

Suzanne Chambers, Samantha Clutton, MeganFerguson, Sylvia Milner, Brigid Hanley, Jeff DunnCancer Council Queensland, Brisbane, Queensland,Australia

OBJECTIVES: A source of support that has highuptake amongst cancer patients is peer support.However, the efficacy of peer support as a methodof psychosocial intervention has not been empiri-cally tested. We developed a randomised controlledtrial of a tele-based support intervention forcouples following prostate cancer designed to bedelivered by peers: men who have previouslyundergone treatment for prostate cancer. Thispresentation describes the challenges of translatingpeer support into the research setting. METHOD:Nine peer support volunteers underwent extensivetraining to support their role. Training included:working within a research protocol, role descrip-tion and boundaries, current treatment ap-proaches, helping couples and sexuality afterprostate cancer. Therapy manuals were developedto assist the peer support volunteers throughoutthe delivery of the intervention. The interventionaimed to support couples through diagnosis andtreatment, with a focus on coping with thesexuality side-effects of treatment. RESULTS:Challenges experienced in undertaking this re-search included: identification of appropriate peers;ensuring peers worked within the boundaries of thestudy and their role and adhered to researchprotocols; monitoring intervention calls to ensureadherence to protocols; minimising inappropriatedisclosures from peers; encouraging peers toengage female partners of the men with prostatecancer; and ongoing supervision. CONCLU-SIONS: Working with peer support volunteers isan intensive process that requires in-depth trainingand monitoring. Peers often report frustration withthe boundaries and protocols that define their rolewithin a research context as these may not reflecttheir own priorities and agenda in providingsupport to men and their partners after prostatecancer diagnosis. Providing regular opportunitiesfor peers to meet and discuss these challengesassists with the transition of peers into research.

A-45

Supporting Couples Following Prostate Cancer

Diagnosis: Peer Support as a Model for Intervention

Suzanne Chambers1, Leslie Schover2, KimHalford3, Samantha Clutton1, Megan Ferguson1,R.A. Gardiner3, Stefano Occhipinti4, Jeff Dunn1

Cancer Council Queensland, Brisbane, Queensland,Australia1, University of Texas M.D. AndersonCancer Center, Houston, Texas, United States2,University of Queensland, Brisbane, Queensland,Australia3, Griffith University, Brisbane,Queensland, Australia4

OBJECTIVES: Men diagnosed with prostatecancer face a number of psychological and physicalchallenges. In particular, erectile dysfunction (ED)following surgery for prostate cancer is quitecommon. ED may not only impact on the patientbut also intimate relationships with partners.A common source of support for men following aprostate cancer diagnosis is peer support. Thispresentation describes a pilot of a couples-basedsexuality support intervention designed to bedelivered by peers. METHOD: 13 couples under-going surgery for prostate cancer were recruitedthrough their diagnosing urologist. The peersupport intervention focused on the challenges ofdiagnosis and treatment, in particular relationshipenhancement and coping with ED. Therapymanuals guided the delivery of the support inter-vention, with 2 calls delivered pre-treatment and 6calls delivered in the first 6 months followingtreatment. Couples completed psychosocial assess-ments at baseline, 3 and 6 months post-treatment;and intervention outcomes were recorded.RESULTS: Most common intervention compo-nents delivered pre-treatment were: treatment side-effects, managing side-effects, psycho-educationand couple communication. Common post-treat-ment intervention components were: relationshipsand intimacy, managing side-effects, couple com-munication and doctor communication. At 3months post-treatment, all participants showedsignificant decreases in cancer specific distress(p5 0.000), although partners showed greaterdecreases than the men (p5 0.017). Compared topre-treatment, men showed significant increases insexuality supportive care needs (p5 0.035) andpost-traumatic growth (p5 0.023) after treatment.CONCLUSIONS: Peer support as a model ofintervention following a diagnosis of prostatecancer may be appropriate and effective. Peersare able to identify and articulate with the commonchallenges and concerns of men and theirpartners following prostate cancer treatment.Our early results show that peers are able toengage not only the man but also his partner in thedelivery of a couples-based sexuality supportintervention.


DOI: 10.1002/pon

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A-46

The Nature and Meaning of Hematological Cancer

Nursing: Moving Beyond Adverse Psychosocial

Consequences Towards Compassionate Presence

Brenda Sabo1,2

Dalhousie University, Halifax, Canada1, NovaScotia Cancer Center, Halifax, Canada2

OBJECTIVES: The purpose of this doctoral re-search was to explore occupational health among alittle studied sub-specialty of oncology nursing, theblood and marrow transplant (BMT) nurse. Whileinitially postulated that working with BMT patientsand families could be expected to result in adversepsychosocial consequences such as compassionfatigue, burnout, moral distress and vicarioustrauma, the research was expanded to include thebenefits BMT nurses derived from providing care forthis patient-family population. METHOD: A quali-tative design grounded in interpretative phenomen-ology (Heidegger and van Manan) was used toexplore the nature and meaning of BMT nursing at 3Canadian tertiary healthcare facilities. Twelve nurseswere recruited and participated in two telephoneinterviews each. Open-ended questions were used toelicit the stories of BMT nursing work Two focusgroups were conducted to provide the nurses with anopportunity to discuss the findings and offer their ‘sowhat next’ suggestions. RESULTS: Using thematicanalysis, four core themes emerged: bearing witnessto suffering, navigating uncertainty, comfortable inone’s skin and the need for support which provided arich description of the nature of BMT nurses’ work.Compassionate Presence was a de nova findingthreaded throughout the four core themes and cameto reflect the meaning of BMT nursing work. Thefindings will be presented along with their relevancefor practice, education and future research.CONCLUSIONS: While providing care for acutelyill patients in pain and suffering or at end-of-life maybe considered emotionally overwhelming and stress-ful, it does not inevitably lead to adverse psychoso-cial consequences (compassion fatigue, burnout,moral distress and vicarious trauma) as has beensuggested by researchers in occupational health andtrauma. Compassionate Presence appeared to serveas a counterpoint suggesting that when nursesexhibit this quality it may potentially serve to protectthem from adverse psychological effects.

A-47

The Impact of Expectations on Experience: Further

Exploring the Influence of Anxiety and Cancer

Coping Styles on Chemotherapy-Naive Patients’

Expected Side Effects

Hayley Whitford, Ian OlverCancer Council Australia, Sydney, New SouthWales, Australia

OBJECTIVES: The experience of side effects differsbetween patients receiving similar chemotherapyregimens. With a lack of pharmacological explana-tions for such variations, previous research hashighlighted how expectations of certain toxicitiescan impact on a patient’s experience of treatment.However, not much is known about how psycho-logical variables impact upon the creation of suchexpectations. This preliminary investigation aimedto improve on previous studies while furtherexploring the impact of anxiety and cancer copingstyles. METHOD: Fifty-eight chemotherapy-naivepatients rated their expectations of having 20chemotherapy side effects on 100-point linearanalog self-assessment (LASA) scales. Patients alsocompleted the State Anxiety Inventory (SAI) andthe Mental Adjustment to Cancer (MAC) scale.After their first chemotherapy session, 45 patientscompleted the same 100-point LASA scales indicat-ing their perceived experience of the same 20 sideeffects. Primary nurses also rated their expectationsof the patients’ toxicities, to control for theirinfluence. RESULTS: After controlling nurses’expectations and patients’ performance status,hierarchical regressions showed patient expecta-tions accounted for significant variance on per-ceived experiences of sleeping disturbance (26%),skin itchiness/scaling (25%), bleeding (17%), feel-ing tired (15%), mood changes (12%), and hair loss(8%).Correlations with toxicity expectationsshowed the coping style ‘Anxious Preoccupation’to have the highest associations while ‘FightingSpirit’ showed no significant relationships. Stateanxiety was only significantly related to expecta-tions of nervousness and mood changes.CONCLUSIONS: The current study builds onour previous findings of how expectations ofchemotherapy side effects can negatively impactpatients’ treatment experiences. These results, whileonly preliminary, can now guide future explorationsinto how coping styles can seriously impact on theperceived experience of chemotherapy, especiallyfor patients with high levels of anxious preoccupa-tion with their diagnosis.

A-48

Mindfulness Based Stress Reduction - Too Stressed

to Participate? Psychosocial Characteristics of

Participants and Non-Participants: Initial Results

From a Randomized Controlled Trial (MICA)

Hanne Wurtzen1, Peter Elsass2, Henrik FlygerFlyger3, Christoffer Johansen1

Department of Psychosocial Cancer Research,Copenhagen, Denmark1, University of Copenhagen,Copenhagen, Denmark2, Department of BreastSurgery, Herlev Hospital, Copenhagen, Denmark3

OBJECTIVES: Mindfulness based stress reduction(MBSR) is a well-described eight-week course,


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including 24 contact hours145min. home practicesix days a week, thus quite demanding for patients.A randomized controlled trial is being conductedto evaluate the effect of MBSR on variouspsychosocial, lifestyle and existential outcomeamong Danish women with non-metastatic breastcancer (BC). Data on psychosocial characteristicsof participants and non-participants will be com-pared in order to determine possible significantpsychosocial differences. METHOD: A total of 338women diagnosed with BC stage I-III, receivingstandard medical care were randomized to either 8-week MBSR intervention or assessment only, while120 eligible non-participating women only filledout the baseline questionnaire. The questionnairecontains standardized scales measuring levels ofdepression and anxiety, elements of mindfulness,personality, psychological symptoms, wellbeing,sleep, late effects, diet and existential well-being.Study-specific questions on socio-demographicfactors, smoking, alcohol consumption, and ex-ercise habits are included. RESULTS: The resultsof statistical analysis of similarities and differencesbetween participants and non-participants withregard to personality, psychosocial symptom bur-den, existential well-being and lifestyle choices, allpotentially related to stress, will be presented.CONCLUSIONS: Firm knowledge of bothdifferences and similarities between participantsand non-participants will inform cliniciansabout the acceptability of the MBSR interventionamong non-metastatic BC patients in standardmedical care.

A-50

Knowledge and Self-Care Skills of Childhood

Cancer Survivors Transitioning From Paediatric to

Adult Care

Norma D’Agostino1, Sharon Guger2

Princess Margaret Hospital, Toronto, Ontario,Canada1, The Hospital for Sick Children, Toronto,Ontario, Canada2

OBJECTIVES: Survivors of childhood cancertreated in the paediatric cancer centre oftentransition to the adult cancer centre, yet clinicaldata indicates that as many as 30% are lost tofollow-up. To successfully manage this transition,knowledge of their cancer history and associatedrisks and independent self-care skills are necessary.The presentation will describe the knowledge andself-care skills of survivors of childhood cancer atthe time of transition from paediatric to adulttertiary cancer centres. METHOD: The knowledgeand self-care skills of 44 survivors were evaluatedat their last paediatric clinic visit and at their firstadult clinic visit approximately one year later.These skills were assessed using self-report ques-tionnaires. Participants were all a minimum of four

years post-diagnosis and at least two years post-treatment completion. Survivors who were signifi-cantly neurocognitively impaired and/or deemedunable to comprehend the study questionnaireswere excluded. Only data from the first assessmentare reported here. RESULTS: Participants en-dorsed knowing how to manage activities relatedto academic and vocational planning, but were lesslikely to report having the skills required tomanage the logistics of their healthcare. One thirdof participants were unable to provide their specificdiagnosis and over 40% could not identify theirrisks for specific late effects. CONCLUSIONS:Survivors are not exiting the paediatric system withthe knowledge and self-care skills required tosuccessfully navigate the adult health care system.This suggests that more attention needs to beplaced on preparing survivors for this transition.

A-51

Incidence and Correlates of Positive and Negative

Effects of BRCA1/2 Genetic Testing on Familial

Relationships: A Three-Year Follow-up Study

Julie Lapointe1, Karine Bouchard2, JacquesSimard3, Michel Dorval1

Faculte de pharmacie, Universite Laval, Quebec,Canada1, URESP, Centre de recherche FRSQ duCentre hospitalier affilie universitaire de Quebec,Quebec, Canada2, Laboratoire de genomique ducancer, Centre de recherche du CHUQ-CHUL,Quebec, Canada3

OBJECTIVES: Previous studies have shown thatmost individuals undergoing BRCA1/2 genetictesting share their test result with their first degreerelatives quickly after it is disclosed. However, littleis known about how the communication ofBRCA1/2 test results affects the relationshipsbetween family members in the long term. Weassessed the incidence of positive and negativefamily relationship effects of BRCA1/2 testing inthe three years following result disclosure, andidentified factors associated with such effects.METHOD: This study includes 552 French-Canadians (485 women, 67 men) who underwentBRCA1/2 testing between 1998 and 2004. Threeyears following result disclosure participants wereasked whether having undergone genetic testinghad any positive and/or negative effects onrelationships with their relatives and, if so, toidentify those with whom the relationship im-proved or deteriorated. Demographic, psychoso-cial and medical characteristics potentiallyassociated with these outcomes were assessed atpre-test, and 1, 12 and 36 months post-disclosure.RESULTS: Globally, 13% of participants reportedthat BRCA1/2 testing had positive effects on theirrelationships, and 4% reported negative effects.The corresponding figures were 12% and 4%, and


DOI: 10.1002/pon

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15% and 1.5%, for women and men, respectively.Among women, both positive and negative effectswere most often reported by mutation carriers andinvolved relationships with sisters. Having hadcancer, lower education, and psychological distresswere also associated with the perception thatgenetic testing negatively affected familial relation-ships. CONCLUSIONS: Genetic testing for breastcancer susceptibility is associated with morepositive than negative effects on familial relation-ships. However, some individuals are at higher riskof family adverse effects following genetic testing.They and their providers may need to be alert tothese unexpected effects of testing. A better under-standing of how BRCA1/2 testing can positivelyaffect family dynamics may suggest strategies forgenetic services providers to help individuals derivethe most from their testing experience.

A-52

Below the Belt: Talking About Life After Prostate

Cancer. Results of a Randomised Controlled Trial

Addie Wootten, Heather Siddons, Anthony CostelloDepartment of Urology, Royal Melbourne Hospital,Parkville, Victoria, Australia

OBJECTIVES: ‘Below the Belt: Talking about lifeafter prostate cancer’ is a psychological grouptherapy intervention for men living with sexualdysfunction post radical prostatectomy that wasdeveloped and evaluated at the Royal MelbourneHospital, Australia. This group therapy program isan 8-week structured psychological therapy groupprogram conducted by two experienced psycholo-gists with men more than 6 months post radicalprostatectomy. METHOD: A total of 65 men tookpart in the 8-week group intervention. Participantswere randomly assigned to either a wait-list group(n5 34) or intervention group (n5 31). All partici-pants received the intervention. The interventiongroup completed three sets of questionnaires; - 8weeks, baseline and completion of the intervention.The waitlist group completed two wait-list ques-tionnaire sets at - 16 weeks and - 8-weeks as well asbaseline and at completion of the intervention.RESULTS: A paired-sample t-test was conductedwhich indicated a number of significant changesacross the intervention time as compared to the 8week wait time. Sexual arousal significantly im-proved (t(56)5�2.49, p5 0.016); Sexual drive andrelationship quality significantly improved(t(52)5�2.86, p5 0.006); Sexual Confidence sig-nificantly improved (t(57)5�9.12, po0.0001);Masculine self-esteem significantly improved(t(57)5 2.07, po0.05); The perception of CancerControl significantly improved (t(57)5 2.54,p5 0.014) and the perception of making aninformed decision worsened (t(55)5 2.05,po0.05). Further results will be discussed.

CONCLUSIONS: The results obtained as well asqualitative information gathered throughout thegroup program indicated that men benefit fromparticipating in a structured group therapy pro-gram across a number of QoL domains. Menreported feeling more confident in their sexual lives,more self-confident in terms of their masculinity aswell as well feeling supported by group members.This study lends strong support to the need forappropriate and timely psychological interventionsfor men coping with sexual dysfunction.

A-61

Breast Cancer in a Cultural Context: Spousal

Relationship, Body Image, and Emotional Distress

in Arab Breast Cancer Survivors

Miri Cohen1, Ahlam Abdallah – Mabjish1, JamalZidan2

School of Social Work, Faculty of Social Welfareand Health Sciences, University of Haifa, Haifa,Israel1, Ziv Medical Center, Sefad and Faculty ofMedicine, Technion, Haifa, Israel2

OBJECTIVES: The cultural context of personaland spousal coping with breast cancer, especially itseffects on women in traditional societies, is an arealittle studied. We set out to examine three majorareas which are culturally constructed and also verygreatly affected by breast cancer: spousal relation-ships, sharing household tasks, and body image,and their effects on emotional distress in Arabbreast cancer patients. METHOD: Participantswere 56 Arab breast cancer survivors and 71 age-and education-matched healthy Arab women (con-trol group). They filled out questionnaires givingpersonal and medical details, spouse’s support,division of household tasks, body image, andemotional distress. RESULTS: Breast cancer survi-vors reported receiving more support from theirspouses, more cooperation in household tasks andhigher emotional distress than the controls, whileno difference was found in body image. Emotionaldistress was predicted by education, income, lowerperceived support, and an interaction of group� -body image, indicating that body image wasassociated with emotional distress in the studygroup only. Perceived spousal support mediated therelations between education and income and emo-tional distress. CONCLUSIONS: The findingssupport the view of spousal support being uni-versally associated with personal well-being. How-ever, sharing household tasks is less expected fromhusbands in Arab society, so its absence does notaffect women’s well-being. In contrast to data fromWestern societies, associations between body imageand distress were prominent it the survivors grouponly. The findings illuminate the mutual effect ofillness and cultural context and the importance ofcultural competence in psycho-social interventions.


DOI: 10.1002/pon

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A-65

Enhancing Psychosocial Oncology/Palliative Care:

A Community-Based Supportive Care Continuing

Education Program for Health Care Professionals

William M. Haynes, Valerie Barrington, ChristinePowerDr. H. Bliss Murphy Cancer Centre, St. John’s, NL,Canada

OBJECTIVES: A project was funded to assess theeducation and training needs of health care practi-tioners in relation to their provision of psychosocialoncology and palliative care for oncology patientsand families. This presentation will describe thisproject development and delivery experience, high-lighting important themes for continuing educationof health care professionals. Of particular relevanceto this conference theme will be the attention given totraining in issues of distress management and hopefocused communication skills. METHOD: Theproject was structured in three phases:Networkingand Needs Assessment (12 months): Focus groupswith health care professionals, patients and familiesto identify knowledge and skill areas for develop-ment. Development, Test Piloting and Delivery ofEducation Services (18 months): Content analysis offocus group information to identify themes forcontinuing education and development of relatedtraining modules. Project Evaluation and Dissemina-tion (6 months): Summative and formative evalua-tion strategies and final project report. RESULTS:217 health care professionals and 75 patients/familieshave been interviewed across 20 rural communitiesand small urban centers. This represents the con-sumer base of the current health care system designedto administer both generalist and specialist healthcare programs and services over a large geographi-cally disperse region. Content analysis yielded a seriesof 9 continuing education modules. On-site deliveryof many of these modules has taken place. It isanticipated that many more will be scheduled in2010. CONCLUSIONS: While health care profes-sionals more readily identified specific skills setrequirements for training, patients and familiesreported needing more human relationship attributesfrom their care providers, such as compassion andempathy. Nine training modules have been devel-oped to address these findings as follows:

Introduction to Psychosocial Oncology and Pallia-tive Care

Distress and Hope

Counseling the Cancer Patient and their Family

Nutrition

Pain and Symptom Assessment and Management

Communication

Dying and Death

Grief and Bereavement

A-74

The Right To Know vs. The Duty To Be Aware

Shlomit Perry, Simon WeinDavidoff Center, Beilinson Hospital, Petach-Tikva,Israel

OBJECTIVES: Should adult terminally ill patientsbe told about their impending deaths? How muchand when should they be told? Who should makethe decision? METHOD: Theoretical conceptuali-zation of the ‘right to know’ in medical setting wasused. ‘Israel’s Dying Patient Law’ which empha-sizes autonomy and the right to know, establishesthe physician’s duty to inform dying patients oftheir prognosis. We will contrast the interpretationof the right to know with three different types ofrights: the right to education, the right forparenthood, and the right for freedom of speech.RESULTS: Discussion:The right to know is amoral value, and knowledge about an impendingdeath has practical advantages. Rights and dutiescan be viewed as diametrically positioned - withrights beginning where duties end. Rights arecreated when human needs are not met, and aresubsequently recognized socially and legally. Alegally recognized right assumes someone else has aduty to fulfill it. CONCLUSIONS: The lawdemands that the doctor tell the patient the ‘wholetruth’. But is there a duty to know ‘all’ that there isto know? What happens when disease impairscognitive ability and emotional distress precludesfull disclosures? What is the level of awareness beconsidered suitable for a ‘good death’? How do wedefine ‘awareness’? We must be cautious that theright to know does not become a burdensomeobligation to be told.

A-75

Neurocognitive Assessment in Pediatric Cancer

Patients - Our Experience in Tertiary Care Cancer

Center in India

Savita Goswami, Lekhika Sonkusare, RohiniHavaldar, Jayita DeodharTata Memorial Hospital, Mumbai, Maharashtra,India

OBJECTIVES: Neurocognitive problems are afrequent long-term outcome following treatmentof cranial irradiation and/or antimetabolite che-motherapy. Cranial radiation is known to ad-versely affect the developing central nervous system(CNS), which subsequently leads to neurocognitivedeficits. Existing researches have shown thatimpairments within the domains of memory,processing speed, and attention occur very com-monly in pediatric cancer patients and this canadversely affect academic, social, and vocationalsuccess, thereby impacting quality of life from


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childhood to adulthood. METHOD: A retrospec-tive analysis, of all new referrals for Neurocognitivetesting to our unit of an oncology tertiary carehospital, over a 3 year period was carried out. Aproforma was designed to note demographicvariables & referral patterns. Neurocognitive test-ing details were also evaluated. Descriptive statisticsare used. RESULTS: A total of 87 cancer patientswere assessed on neuro cognitive tests between 3–19years of age. All patients were assessed onstandardizes tests. Majority of were referred bymedical oncology mainly for scholastic difficultiesand adjustment issues. Overall, approximately22(25%) patients had average intelligence and21(24%) had mild to moderate retardation.15(17%) patients were of borderline intelligenceand 18(20%) with above average intelligence.Details of domain impairments are discussed.CONCLUSIONS: Majority of patients had adjust-ment and behavioral problems and scholasticdifficulties despite average and borderline intelli-gence. Research Implication: Identification of do-mains in neuropsychological testing in differentgroups of children with cancer, based on variousfactors like disease, psychological, socio-cultural,modalities of treatment used should be studiedfurther. Clinical Implications: Neurocognitive testingprior to and post chemotherapy as well as radiationcan be more helpful in assessment of functionalstatus and therapeutic intervention planning.

A-77

Understanding and Improving Breast Cancer Self-

Management Through Social Networks and Infra-

structures within Portuguese-Speaking Communities

in Toronto: A Pilot Study

Christine Maheu1, Margareth Zanchetta2, SepaliGuruge2, Scott Secord3, Maritt Kirst4, PamelaCatton3

York University, School of Nursing, Toronto,Ontario, Canada1, Daphne Cockwell School ofNursing, Faculty of Community Services-RyersonUniversity, Toronto, Ontario, Canada2, UniversityHealth Network, Princess Margaret Hospital, BreastCancer Survivorship Program, Toronto, Ontario,Canada3, St. Michael’s Hospital, Centre for Researchon Inner City Health, Toronto, Ontario, Canada4

OBJECTIVES: The purpose of this study is todescribe Portuguese speaking women’s social andcultural capital, behavior patterns and networksand their challenges, barriers, readiness and inten-tions to use breast cancer self-management ser-vices. Moreover, within the aim of the presentstudy is to explore the potential of creating andconsolidating new supportive networks as per-ceived by health care professionals, social servicesproviders, breast cancer survivors and other com-munity members. METHOD: This study embraces

a critical ethnography approach. The researchersare interested in both service providers andwomen’s perspectives on using or refusing servicesthat can improve breast cancer self-management.Interviews and focus groups are conducted withcommunity members including at least 25 Portu-guese speaking women living with breast cancerand community providers of social and health careservices until reaching data saturation. The analy-sis will be done through thematic and contentanalysis. RESULTS: The study is ongoing. Cur-rently, five health care organizations servingPortuguese population have been contacted. Weare in the process of planning a focus group withmen from the Portuguese community. The indivi-dual interviews with Portuguese women affected bybreast cancer have been completed. CONCLU-SIONS: The findings from this study will con-tribute to the body of knowledge related to theuptake of breast cancer services by Portuguesespeaking women in the greater Toronto area and tobuilding socio-ecological strategies for chronicdisease prevention and management. The findingswill also be used to guide and inform futureprogram development of clinical services to beoffered to this population by the Breast CancerSurvivorship Program at Princess Margaret Hos-pital, Toronto, Ontario, Canada.

A-83

‘Meaning and Purpose’, A Pilot Study of ‘MaP

Therapy’ in an Advanced Cancer Cohort

Carrie LethborgSt Vincent’s Hospital, Fitzroy, Victoria, Australia

OBJECTIVES: This paper describes the develop-ment and piloting of a brief meaning and purpose(MaP) focused psychotherapy. METHOD: Twoprevious studies considering the role of meaning inadjustment to cancer, conducted by the authors,offered a model to develop this intervention. Acohort of patients with advanced cancer partici-pated in the therapy and was interviewed about thisexperience using qualitative methods. RESULTS:Participants’ descriptions of their MaP therapyexperience illustrated that each of our goals(promoting coherence, encouraging meaning andpurpose while recognising suffering and strength-ening meaning in relation to others) were allrelevant to this therapy. Specific themes describedin their experiences offered useful informationabout the process of MaP therapy and meaningbased therapy in general. CONCLUSIONS: Thethemes arising from this study suggest that MaPtherapy encourages reflection, offers insights, canbe confronting but can also allow the participant to‘shift’ their perspective and focus on meaningfulgoals. This therapy can be counterintuitive to bothpatient and counsellor and yet has the potential to


DOI: 10.1002/pon

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positively impact on adjustment in the setting ofadvanced cancer.

A-84

Don’t Hold Back: Exploring Work Strain and Stress

Out Of The Oncologists’ Perspective

Martine Hoffmann1, Gilles Michaux1, NikolaiVodolazsky2

Univeristy of Luxembourg, Walferdange, Luxem-bourg1, Omsk State Medical Academy, Omsk,Russian Federation2

OBJECTIVES: The purpose of the present pilot-study, conducted within the framework of a Trans-European Mobility Programme for University Stu-dies (TEMPUS), was to explore major difficulties andstrain experienced by medical professionals in thecontext of their daily oncological practice. Theproject consortium comprised partners from France,Luxembourg and Russia; data collection for thepresent study was realized in Russia. METHOD:Data were collected in 2008 in medical schools andaffiliated hospitals. The study sample consisted ofN5158 participants; thereof 29% were oncologists,24% general practitioners and 57% were medicalstudents. As for the methodology, anonymous paper-pencil questionnaires were conjointly developed byresearches and practitioners, and translated by therespective project partners. The completed question-naires were assembled locally and transferred toLuxembourg for data coding and statistical analyses.RESULTS: On a descriptive level, results elucidatedincreased levels of subjective stress in oncologists andgeneral practitioners compared to the medicalstudents. On a multivariate level, hierarchical clusteranalyses, assembling subjects with respect to theirexperienced stress intensity and problem frequency,resulted in a three-cluster solution: The largest clusterregroups physicians with ‘moderate’ self-reportedstrain, whereat the two latter clusters assemblephysicians categorized at ‘high risk’ for burnout.CONCLUSIONS: All in all, the findings stressed theoverall need and the explicit request for a problem-tailored psycho oncological training programme inmedical personnel. A first draft of a modular trainingprogramme in development will be presented anddiscussed.

A-85

Palliative Care in Canada: The Economic Perspec-

tive for Families and Health Care System

Serge Dumont1, Philip Jacobs2, KonradFassbender2, Veronique Trucotte1, DonnaAnderson1, Franc-ois Harel1

Laval University Cancer Research Centre, PalliativeCare Research Team, Maison Michel-Sarrazin,Quebec City, QC, Canada1, University of Alberta,Edmonton, AB, Canada2

OBJECTIVES: Demographic changes and anincrease in life expectancy have resulted in anaging of the population. This situation hasincreased the demand for health and social servicesfor people with diminishing abilities or a terminaldisease. The purpose of this study was to providepolicy makers, policy analysts and other groupswith information regarding the economic burden ofpersonally borne costs attributable to the palliationphase of care and the context in which they occur.METHOD: Prospective survey of 248 familycaregivers looking after terminally ill patients infive regions across Canada. This study wascomprised of four specific objectives: Identify andmeasure resource utilisation (goods/services) dur-ing the palliative phase of care; estimate resourcecosts; identify who delivers these goods andservices (public health care system, families, privatefor profit and non profit, voluntary sector) anddetermine who (patient, informal caregiver, gov-ernment, volunteer organisations, etc.) pays forwhat. RESULTS: The study provides: descriptivedata for the physical resources average personalcosts; estimation of health care service utilisationand related costs. In regard to cost sharing, thegovernment and families sustained respectively71.3% and 26.6% of the mean total cost perpatient. CONCLUSIONS: The study results allowus to draw a clear picture that highlights the extentto which, and the areas that, families need to beassisted in their efforts to care for their loved ones.

A-87

The Production of a Resource Manual to Assist in

the Education of Those at Risk of Developing

Lymphedema

Jenna Gregan, Renee Leahy, Kitty MartinhoThe Ottawa Hospital, Ottawa, Canada

OBJECTIVES: The development of lymphedemacan be a physical complication accompanying thediagnosis and treatment of cancer. This process canlead to limitations in physical function andnegative feelings about self image. With timelyeducation and possible intervention lymphedemacan sometimes be avoided or if it develops itsprogress can be mitigated. Our aim was to developan educational tool which would assist in theeducation of those at risk of developing lymphe-dema. METHOD: An amalgamation of lymphe-dema education and treatment resources wascompleted. The language and descriptions utilizedwere altered to facilitate patient acquisition ofknowledge. Areas attended to include lymphedemaof the upper extremity, lower extremity, trunk,head and neck. The focus was to highlight signsand symptoms to be monitored, risk reductionpractices and self management techniques.RESULTS: A partnership of Physiotherapists in


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the Pyschosocial Oncology Program at the OttawaHospital Cancer Centre was able to produce aresource manual to support the population theyserve. The guide defines Lymphedema, outlines itsrisk factors, highlights signs and symptoms to beaware of, offers treatment options and predomi-nantly focuses on self management strategies.CONCLUSIONS: This guide has now becomethe framework for a monthly education sessionbeing offered to all patients of The OttawaRegional Cancer Centre. It was felt that a onehour presentation would be the most effective andefficient method of reaching and educating a widepopulation of at risk cancer survivors.

A-88

A Metasynthesis Study of the Hope Experience of

Family Caregivers of Persons with Chronic Illness

Wendy Duggleby1, Lorraine Holtslander2, JariKylma3, Vicky Duncan4, Chad Hammond5,Allison Williams6

University of Alberta, Edmonton, AB, Canada1,University of Saskatchewan, Saskatoon, Sk,Canada2, Universtiy of Kuopio, Kuopio, Finland3,University of Saskatchewan, Saskatoon, Sk, Canada4,University of Saskatchewan, Saskatoon, Sk, Canada5,McMaster University, Hamilton, ON, Canada6

OBJECTIVES: Health care of persons withchronic illness is increasingly being provided byfamily caregivers. A key psychosocial resourceamong family caregivers to deal with their caregiv-ing experience is hope. Given the importance ofhope to family caregivers, the development ofknowledge in this area is critical. The purpose ofthis metasynthesis study was to describe the hopeexperience of family caregivers of persons withchronic illness. METHOD: The metasynthesis ofqualitative research studies followed the proce-dures outlined by Sandelowski and Barroso (2007).The procedural steps were: (a) comprehensivesearch, (b) appraising reports of qualitative studies,(c) classification of studies, and (d) synthesis of thefindings. Eight databases were searched for quali-tative and mixed method studies of the hopeexperience of primary caregivers caring for personsof all ages with chronic illnesses between 1988 and2008. Study findings were analyzed. RESULTS:Fourteen studies were included. Several types ofcoexisting hope (possibilities for positive futureoutcomes) were found that varied with internal,external, and situational factors. The degree ofuncertainty with respect to achieving the hopes offamily caregivers of persons with chronic illnessdetermined which processes or pathways of hopethey engaged in to strengthen their hope.Hope outcomes were identified. A new conceptualmodel of hope emerged entitled: TransitionalDynamic Possibilities Within Uncertainty.

CONCLUSIONS: The new model proposes aunique understanding of hope that has not beenpreviously found in the literature. It clarifies therelationships between uncertainty and hope, fac-tors influencing hope, and hope outcomes. Factorsinfluencing hope and the outcomes of hope mayplay a role in assessing hope, and differing path-ways of hope provide a foundation for future hopeinterventions. Hope was essential to the health andwell-being of family caregivers of persons withchronic illness.

A-89

Improving Access to Psychosocial Oncology Care

Using ESAS Scores

John MedeirosHamilton Health Sciences, Hamilton, Canada

OBJECTIVES: Research has shown that a sig-nificant gap exists between the expressed psycho-social needs of cancer patients and their access topsychosocial oncology care (JCC Patient Satisfac-tion Survey, 2008). The aim of this study was toassess whether using the Edmonton SymptomAssessment Scale (ESAS) scores of anxiety anddepression as a screening tool for Oncologypatients would improve access to psychosocialservices. METHOD: ESAS scores of all patientscoming to a regional cancer centre for a 2 weekperiod in January 2009 were reviewed. Patientswith a score of X7 on anxiety or depression arereported here. These patients were contacted by apsychosocial oncology professional to discuss theirself-assessed scores. The patients were invited toschedule a psychosocial appointment. The numberof patients eligible for contact, those contacted,demographics and patient reported concerns, werecollated. RESULTS: Ten percent of patients whocompleted the ESAS (34/344) had a score X7 onanxiety5 9.0% (31/344) and depression5 5.2% (8/344). Of these, 24 (70%) were contacted. Fifty fourpercent reported concerns around financial, re-source, or relationship issues. Of patients contacted11(45.8%) were interested in scheduling a psycho-social appointment. Females were more likely torequest an appointment than males (8:3), and 6patients (54.5%) had been previously referred bytheir oncology team. CONCLUSIONS: This studyfurther demonstrates that a clinically significantnumber of cancer patients report a high degree ofanxiety and depression at their regular clinic visitsas documented in the literature. Some ESAS scoresmay reflect situational or instrumental issues whichcan be effectively addressed by a social worker.A score of X7 for anxiety or depressionmay represent a reasonable clinical threshold foran automatic referral to psychosocial oncologyservices.


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A-91

Fear, Fate and Fatality: Portrayal of Cancer in

Indian Film Media

Sanghamitra PatiSCB Medical College, Orissa, India

OBJECTIVES: Cancer is an emerging health careproblem in India and is associated with tremendousfear and stigma in the country. Studies suggest thatIndian public holds inaccurate beliefs and miscon-strued opinions about Cancer. Bollywood (Hindifilms) is inextricably linked to Indian socio-culturalfabric and plays a crucial role in influencing thebeliefs and attitude of its population. Are myths andfear about cancer being promoted through movies?This paper explores the cinematic representations ofcancer in popular Bollywood films. METHOD: Thereview was limited to Hindi movies released between1950 and 2008. Movies depicting or having cancer ascentral theme were selected for study. In each ofthese films the depiction of cancer was a key factoror the turning point of the story and one of theprotagonists suffers from cancer. The content andcharacters of the movies were analyzed in the contextof cancer and were related to contemporaryoncology knowledge and practice. RESULTS: Thisanalysis of 20th-century Hindi films with cancerthemes revealed (1) Fear, fatalism and inevitabilityare the common themes associated with cancer in thefilms (2) Bollywood films rarely depict commoncancers. Cancers like leukemia and brain tumorspredominate because they are considered ‘visuallyacceptable’ (3) Contemporary health policy issuesand Important clinical oncology issues, includingtreatment, symptom management, amelioration ofside effects, and facilitation of the process of dying,have not been reflected in movies. CONCLUSIONS:Cinematic portrayals are not representative of thetypes of cancer that are prevalent among Indians,nor are filmmakers concerned with realistic aspectsof Cancer. Altogether, Bollywood films have re-mained deficient in their attempt to representadequate and appropriate cancer knowledge andpractice. The depictions lacked informed attitudesabout cancer and the role of medical intervention toovercome it. In short, learning about cancer from theglamour world could be termed a ‘gloomy affair’ forthe Indian audience.

A-92

A Support Group Programme for Family Members

in Palliative Care

Anette Henriksson1, Birgitta Andershed2, EvaBenzein3, Britt-Marie Ternestedt4

Orebro University, Orebro, Sweden1, OreboUniversity, Orebro, Sweden2, Linne University,Vaxjo, Sweden3, Ersta Skondal Hogskola, Stock-holm, Sweden4

OBJECTIVES: Relatives were invited to take partin a support group programme during the latepalliative phase of their family member. The groupmet once a week, for six weeks, and each meetinghad a theme with a professional guest from thespecialized palliative team.The purpose of thestudy was to describe relatives experiences of thesupport group programme and the subsequentimpact on their lives as relatives of a terminally illperson. METHOD: Qualitative interviews werechosen as the data collection method and tenpersons were interviewed after participation in thesupport group programme. A strategic selectionwas made with regards to the participants age,gender and relation to the patient in order to get asmany experiences as possible. The analysis wasinspired by the phenomenological method asdescribed by Giorgi (1989). RESULTS: Therelatives’ experiences were categorised into six keyconstituents: confirmation; insight into the gravityof the illness; sense of belonging created by similarexperiences; participation in the care system; beingable to rest; and strength to provide support for thepatient. These six constituents resulted in a sense ofsafety in relation to the patient, the illness, thenursing staff and the care unit. CONCLUSIONS:Relatives to terminally ill persons experiencedsupport in the support group and the participationprovided relief in their day to day life. The study’sfindings show that interventions of this kind maybe integral to the relatives’ ability to handle theirsituation when caring for a terminally ill familymember.

A-97

Screening for Distress in Cancer Patients: The

Italian Society of Psycho-Oncology Multicenter

Study on the Distress Thermometer

Luigi Grassi, Maria Giulia Nanni, Vanessa Magri,SIPO Distress Thermometer Study GroupSection of Psychiatry, University of Ferrara,Ferrara, Italy

OBJECTIVES: The need to facilitate the screeningfro emotional distress has led the NCCN panel todevelop the Distress Management guidelines whichinclude the routine use of the Distress Thermo-meter (DT) as a specific tool. The DT has beenvalidated in several cultural contexts (e.g. French-speaking countries, Japan, Turkey, Netherlands).The aim of the study was to validate the DT in theItalian cultural context. METHOD: In 2 days of anindex- week on baseline (T0)) and follow-up (3months – T1) the DT, the Hospital AnxietyDepression Scale (HADS) and the Brief SymtpomInventory (BSI-18) were administered to cancerout-patients of 38 cancer centers in Italy meetingthe following criteria: Karnofski Performancescore 80, no cognitive disorder, age between 18


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and 70 years, any site and stage. RESULTS: 1,108patients (age 53.2779.27 years; 70% females, 30%males) participated at T0 and 748 (67%) at T1. Norelationship was found between the DT score andage, stage, while DT score was significantlyassociated with HAD-Anxiety, HAD-Depression,HAD-Total, BSI Somatization, Anxiety, Depres-sion and Total. A cut-off score 4.5 on the DTmaximized sensitivity and specificity in identifyingHAD-S cases and BSI-18 cases. CONCLUSIONS:The study indicated that the DT is a easy-to-administer instrument and confirmed previousresults on the DT cut-off score to be employed inorder to identify cases of distress among cancerpatients in Italy. Evaluation of more dimensionsrather than only distress is important in cancersettings, as shown by the ‘aspecific’ correlation ofDT with different emotional areas explored (i.e.anxity, depression, somatization).

A-101

Coping Together: Development and Pilot Testing of

a Self-Directed Coping Skills Intervention for

Patient-Primary Support Person Dyads

Sylvie Lambert1, Afaf Girgis1, Suzanne Chambers2,Kendra Sundquist3

Centre for Health Research and Psycho-oncology(CHeRP), The Cancer Council NSW, University ofNewcastle & Hunter Medical Research Institute,Newcastle, New South Wales, Australia1, GriffithInstitute for Health and Medical Research, GriffithUniversity, Brisbane, Queensland, Australia2,Cancer Council New South Wales, Sydney,New South Wales, Australia3

OBJECTIVES: Patient’s (Pt) and their primarysupport person’s (PSP) distress is partiallymediated by the counterpart’s illness adjustmentand ability to cope with challenges, which in turnsubstantiate the need for holistic psychosocialinterventions targeting the Pt-PSP dyads. To date,effective Pt-PSP dyad-based coping interventionsare delivered by highly trained health professionals,limiting their long-term sustainability and patientreach. To overcome these limitations, the researchteam developed a self-directed coping skills train-ing intervention for Pt-PSP dyads. METHOD: Acoping skills training workbook was developed toprovide Pt-PSP dyads with effective strategies tomanage common physical or psychosocial chal-lenges faced in the early post-diagnosis period.Topics included in the workbook were based on theoutlines of professionally-led, Pt-PSP-based copinginterventions and empirical evidence in this area.Early on in the development process, the work-book was presented to 25 Pt-PSP dyads participat-ing in an interview to evaluate its suitability andstrengths/weaknesses. RESULTS: The workbookaddresses five topics: symptom management,

information-seeking, feelings and emotions, com-munication, and decision-making/problem-solving.This resource goes beyond mere provision ofinformation by suggesting strategies that Pt-PSPdyads can use to address independently, as much aspossible, their concerns. This is achieved byengaging them in exercises that encourage theapplication of knowledge to their situation. Pt-PSPdyads (n5 25) are currently reviewing this resourceand findings will be available at the time of thispresentation. CONCLUSIONS: A novel, evidence-based, self-directed coping skill straining interven-tion, which is acceptable to Pt-PSP dyads, wasdeveloped. This workbook is anticipated to providedyads with the resources needed to appraise morepositively the challenges they face and their abilityto cope with these. This workbook translatescutting-edge psychosocial research and makes itavailable to Pt-PSP dyads. In 2010, the workbook’seffectiveness in decreasing Pt-PSP dyad’s anxietywill be evaluated.

A-107

Sexual Dysfunction After Breast Cancer: Predictors

and Patients’ Needs for Counseling

Judith Alder, Rosanna Zanetti, Bitzer Johannes,Wight EdwardUniversity Hospital Basel, Basel, Switzerland

OBJECTIVES: Several treatment-related and psy-chosocial factors have been identified for theexplanation of sexual dysfunction (SD) after breastcancer. However, not all women develop SD andlittle is known in what they are different from thesymptomatic patients. The purpose of the presentstudy was to identify characteristics and counselingneeds of patients with SD after breast cancertreatment as a prerequisite to improve quality ofcare in psycho-oncology. METHOD: Internet-based survey including N5 292 breast cancerpatients containing three sections: (1) sociodemo-graphic and medical history, (2) validated ques-tionnaires assessing subjectively reportedmenopausal complaints (MRS), anxiety and de-pression (HADS), body image (EORTC-QLQ-BR23), sexuality (FSFI) and relationship satisfac-tion (PFB) and (3) patient’s experience and needswith regard to counseling on sexuality. Multiplelogistic regression analysis was used to identify theimpact of treatments and psychological factors(entered blockwise) on sexuality in patients withand without SD. RESULTS: According to FSFIcut-off score, 76% of the respondents showedclinically relevant levels of SD. The impact ofchemotherapy and antihormonal therapies for thedevelopment of SD was lost after entering psycho-logical factors. Most significantly, climactericsymptoms, relationship problems and lower levelsof anxiety contributed to SD. Patients with SD


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most often express their wish to talk aboutsexuality with partners and physicians while 30%wish for psychological support together with thepartner. CONCLUSIONS: The present surveypoints to the role of psychological factors for theexplanation of SD after breast cancer. Patientswith high levels of climacteric complaints andrelationship difficulties are prone to have SD. Withthe contraindication of hormone replacementtherapy after breast cancer, non-medical andpsychobehavioral and partner including therapieshave to be found and evaluated to support thepatient in her sexual adaptation process afterbreast cancer.

A-108

Beyond Communication: A Training Package for

Hospital Staff in the Detection and Management of

Psychological Distress: Can Nurses Be Trained to

Deliver This Package as Successfully as Clinical

Psychologists? - Preliminary Results

Kate Jenkins1, Sarah Pestell1, Jane Daniel1, VivienNorth1, Nigel North1, Shirley Crofts2, WendyWhite3, Shelagh Goddard4

Salisbury NHS Foundation Trust, Salisbury, UnitedKingdom1, Southampton University Hospital Trust,Southampton, United Kingdom2, Portsmouth Hos-pital, Portsmouth, United Kingdom3, BasingstokeHospital, Basingstoke, United Kingdom4

OBJECTIVES: In the UK, a Four Tier model ofPsychological Support suggests staff at Level 2,such as nurses and doctors should be proficient inthe detection and management of psychologicaldistress. A training package was developed, admi-nistered across the region, and evaluated thor-oughly. A significant increase in staff confidencewas evidenced through pre and post question-naires. This study investigates whether other staffcan be trained to administer the programme aseffectively as the authors. METHOD: Senior staffincluding Nurse Specialists, Occupational Thera-pists, Counsellors and Psychologists were trainedby the author to deliver the package, in order toincrease access to the programme. The pre and postquestionnaires were used to assess increases in staffconfidence. All facilitators retained access to theauthor (a Psychologist) for advice and support.Three modalities are compared - Nurse led, Nurseand Psychologist led (not the author Psychologist)and those run by the author. RESULTS: Staffconfidence significantly increased in all areasassessed, in all three modalities. There is nosignificant difference in the level of increase inconfidence between the groups (F5 0.16, p5 0.85).CONCLUSIONS: These are preliminary resultswith small numbers, however, they suggest thatfacilitators can be trained to deliver the programmeas effectively as the author, even if facilitators are

not Psychologists but nurses with access to supportand advice. This has far reaching implicationsgiven the shortage of Psychologists in cancer carein the UK. Six month follow-up data is beingcollected as well as further data as more courses arerun around the country.

A-110

Women’s Constructions of the ‘Right Time’ to

Consider Decisions about Risk-Reducing

Mastectomy and Risk-Reducing Oophorectomy

A. Fuchsia Howard1, Joan L. Bottorff2, Lynda G.Balneaves3, Charmaine Kim-Sing4

University of British Columbia, Vancouver, BritishColumbia, Canada1, University of British ColumbiaOkanagan, Kelowna, British Columbia, Canada2,University of British Columbia, Vancouver, BritishColumbia, Canada3, University of British Columbia,British Columbia Cancer Agency, Vancouver,British Columbia, Canada4

OBJECTIVES: Women who carry a BRCA1/2mutation are presented with surgical options toreduce their risk of breast and ovarian cancer,including risk-reducing mastectomy (RRM) andoophorectomy (RRO). Growing evidence suggestsa sub-group of women do not make decisionsabout RRM and RRO immediately followinggenetic testing, but rather, consider these decisionsyears later. The purpose of this research was todescribe how women construct the ‘right time’ toconsider decisions about RRM and RRO.METHOD: In-depth interviews were conductedwith 22 BRCA1/2 carrier women and analyzedusing qualitative, constant comparative methods.RESULTS: The women constructed the ‘right time’to consider these decisions to be when: (1) decisionsfit into their lives, (2) they had enough time to thinkabout decisions, (3) they were ready emotionally todeal with the decisions and the consequences, (4) allthe issues and conflicts were sorted out, (5) therewere better options available, and (6) the health caresystem was ready for them. CONCLUSIONS:These findings offer novel insights relevant to healthcare professionals who provide decision support towomen considering hereditary breast and ovariancancer risk-reducing surgeries.

A-111

Preserving the Self: The Process of Decision Making

about Hereditary Breast and Ovarian Cancer Risk-

Reduction

A. Fuchsia Howard1, Lynda G. Balneaves1, JoanL. Bottorff2, Patricia Rodney1

University of British Columbia, Vancouver, BritishColumbia, Canada1, University of British ColumbiaOkanagan, Kelowna, British Columbia, Canada2


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OBJECTIVES: Women who carry a BRCA1 orBRCA2 gene mutation have up to an 88%lifetime risk of breast cancer and up to a 65%lifetime risk of ovarian cancer. Strategies toaddress these risks include cancer screening andrisk-reducing surgery (i.e. mastectomy and salpin-go-oophorectomy). METHOD: A grounded theo-ry study with 22 BRCA1/2 mutation carrierwomen was conducted to understand how womenmake decisions about these risk-reducing strate-gies. RESULTS: The process of preserving the selfwas the overarching decision-making processevident in the participants’ descriptions. Thisprocess was shaped by contextual conditionsincluding the characteristics of health services,the nature of hereditary breast and ovarian cancerrisk-reduction decisions, gendered roles, and thewomen’s perceived proximity to cancer. Thewomen engaged in five decision-making stylesand these were characterized by the use of specificcognitive and emotional decision-making ap-proaches. CONCLUSIONS: These findings pro-vide theoretical insights that could inform theprovision of decisional support to BRCA1/2carriers.

A-114

Some Couples Find Sex to be Satisfying While on

Androgen Deprivation Therapy for Prostate Cancer

Lauren M Walker1, John W Robinson2

University of Calgary, Calgary, AB, Canada1, TomBaker Cancer Centre, Calgary, AB, Canada2

OBJECTIVES: Androgen deprivation therapy(ADT) is a common treatment for both localizedand advanced prostate cancer. ADT is associatedwith many life changing physiological andpsychological side effects for patients, includingerectile dysfunction, loss of libido, reducedphysical ability, increased emotional labilityand bodily feminization. As a consequence ofthese side effects, many couples report a loss ofsexual intimacy and an erosion of the relation-ship bond. METHOD: A qualitative study wasconducted to determine how patients and theirpartners adjust to the changes brought about byADT. Transcripts from interviews with eighteenpatients and their partners were analyzed using agrounded theory methodology. RESULTS: Mostpatients were told that continuation of a sexualrelationship would likely be impossible while theman is androgen deprived. Some couples wereable to maintain satisfying sex despite alterationsin sexual function. A second group accepted thatsex was not possible and were content with thischange. A third group was distressed because,while they could not accept the end of theirsexual relationship, they were unable find a

satisfying way to maintain sex. CONCLU-SIONS: These findings raise questions aboutwhat information men and their partners shouldbe given, regarding potential changes in sexualfunctioning while on ADT. It may be beneficialfor all couples to learn how some couples are ableto maintain satisfying sex while the man isandrogen deprived.

A-115

A Preemptive Educational Intervention to Reduce

the Psychological Distress of Androgen Deprivation

Therapy on Prostate Cancer Patients and Their

Female Partners: Results of an RCT

John W. Robinson1, Richard Wassersug2, LaurenM. Walker1, Bejoy C. Thomas1, JoAnne Phillips2,Lindsay Duncan2

Tom Baker Cancer Centre and University ofCalgary, Calgary, Alberta, Canada1, DalhousieUniversity, Halifax, Nova Scotia, Canada2

OBJECTIVES: Improved prostate cancer detec-tion has resulted in more patients beginningandrogen deprivation therapy (ADT) earlier andremaining on it for extended durations.ADT isassociated with many distressing side effectsincluding weight gain, loss of muscle mass, breastgrowth, loss of libido, erectile dysfunction, genitalshrinkage and depression. Currently, little is doneto help patients and their partners manage withthis life altering treatment. METHOD: Researchquestions: Do patients and partners fare betterwhen fully informed of the possible side effectsand provided with suggestions for adjusting toADT? Is the intervention more effective whengiven before vs. after initiation of ADT? Proce-dure: Couples completed baseline questionnairesassessing QoL, ADT knowledge, sexual function,and intimacy. After stratification by sexualactivity, couples were randomized to receive theintervention immediately after beginning ADT,or in six months. Couples were reassesed at 3, 6, 9and 12 months. RESULTS: The lives of couplesin both groups were improved by a two partintervention. The first part consisted of providingcouples with a comprehensive booklet thatexplained the various side effects associated withADT and potential solutions for each. Thesecond part was an educational sessions with amale and female counsellor where the issuesin the booklet pertinent to the couple werediscussed. A preference for receiving the inter-vention immediately was express by both groups.CONCLUSIONS: Although ADT may delay theonset of cancer symptoms, life without testoster-one can be profoundly challenging for both thepatient and his partner. Providing information atthe time of treatment initiation about what to


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expect, as well as suggestions for management,has been found to help couples successfully adjustto ADT.

A-122

Hidden Behind the Cultural Curtains: Betel Quid as

a Surrogate for Smokeless Tobacco Use Among

South Asian Immigrants in British Columbia

Ajit Auluck1, Greg Hislop2, Lewei Zhang1, MiriamRosin3, Joan Bottorff4

Faculty of dentistry, University of British Columbia,Vancouver, Canada1, British Columbia CancerResearch Center, Vancouver, Canada2, SimonFraser University, Vancouver, Canada3, Universityof British Columbia, Okanagan, Canada4

OBJECTIVES: Oral cancer is a leading cancerin South Asian (SA) countries which is largelyattributed to betel quid (BQ) chewing in addi-tion to alcohol and tobacco. In British Colum-bia (BC), oral cancer incidence rates among SAmen and women are higher than the generalpopulation and more commonly involve thegums and cheeks (sites associated with BQchewing). However little is known about pat-terns of access, marketing and usage of BQ.METHOD: Using an interpretative ethno-graphic approach, data were collected throughparticipant observations and semi-structuredinterviews in a SA community situated in anurban setting in BC. Observations were made atSA restaurants, stores and shops where BQ wassold. Interview participants were recruited fromthese settings. Research team meetings were heldto develop a coding framework, discuss analysisand interpretations of these data. N-vivo soft-ware was used to facilitate data analysis.RESULTS: Field work revealed that BQ wasreadily available in SA stores and restaurants,its frequent use was supported as a commoncultural practice following meals and at socialfunctions because of its qualities as mouthfreshener. However, forms of BQ includedsmokeless tobaccos which were marketed as a‘safer’ and socially acceptable alternative tosmoking. Packaging for BQ (with tobacco) didnot include health warnings; and no salesrestrictions for minors were evident. CONCLU-SIONS: BQ with or without smokeless tobaccois a risk factor for oral cancer. There is a needto include BQ into tobacco control policy: forexample, appropriate taxation; packaging withlanguage-appropriate health warnings; advertis-ing bans; limits on purchase by minors; and novisibility on store shelves. This study generatesnew knowledge that can be used for targetedoral cancer prevention and health promotionprograms for SA in BC.

A-125

Identification of Patient Reported Distress by

Clinical Nurse Specialists in Routine Oncology

Practice: A Multicentre UK Study

Alex J Mitchell1, Nadia Hussain2, Lorraine Grain-ger3, Paul Symonds1

University of Leicester, Leicester, United Kingdom1,University of Leicester, Medical School, Leicester,United Kingdom2, University Hospitals of Leicester,Leicester, United Kingdom3

OBJECTIVES: There is uncertainty regarding howwell cancer clinical nurse specialists are able toidentify distress in routine care. We aimed toexamine the recognition of patient reported distressby nurse specialists across three sites in the EastMidlands (UK). METHOD: We approached over100 nursing staff who reported on 433 interactions.Of these we received 350 clinical opinions (80.8%).Clinicians were asked to report on their clinicalopinion using two methods i. a precise narrowfocus and ii. An intentionally broad focus. Distresswas defined by the Distress Thermometer (DT) at acut-off of four or higher. Nurses opinion waswithout the aid of scales or tools. RESULTS:Looking for just distress, detection sensitivity was11.2% (95% CI 6.9% to 16.9%) and detectionspecificity 98.3% (95% CI 95.2 to 99.7%). Lookingfor any mental health complication sensitivity was50.6% and specificity 79.4%. There was signifi-cantly better performance using the broad ap-proach. Clinicians had better ability to recognizehigher severities of distress but no differenceaccording to the stage or type of cancer.CONCLUSIONS: Nurses working in cancer set-tings have difficulty identifying distress using theirroutine clinical judgement but may benefitfrom looking for broadly defined mental healthproblems rather than distress alone. Evidencebased strategies that improve detection of mildand moderate distress are required in routinecancer care.

A-126

What Is the Optimal Screening and Case Identifica-

tion Tool for Depression in Cancer and Palliative

Settings: A Meta-Analysis of Diagnostic Validity

Studies

Alex J Mitchell1, Nicholas Meader1

University Hospitals of Leicester, Leicester, UnitedKingdom1, University College London, London,United Kingdom2

OBJECTIVES: Despite many reviews there is stilluncertainty about which is the optimal tool foridentification of depression. We examined allpossible instruments in both a screening capacityand a case-finding capacity. Screening refers to the


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systematic application of a test in order tooptimally rule-out those without the disorder withminimal false negatives. Case-Finding refers to theapplication of a test in order to optimally identifythose with the disorder with minimal false posi-tives. METHOD: There were 41 valid analysesinvolving almost 5000 patients, 29 in oncologysettings and 12 in palliative settings. We reviewedthe following methods: BDI, BDI fast screen,PHQ-9, PHQ-2, the two stem questions, GHQ-12and GHQ-28, CES-D, GDS, GDS-15, Zung,HADS-D, HDRS. Unfortunately most had notreceived independent validation. RESULTS: From29 non-palliative analyses there were three studieson the BDI-II, 4 studies using the DT andremainder of studies involved the HADS. Theoptimal method was the BDI-II although the DTwas good in a screening capacity. Across 12palliative analyses there were 6 studies of a singlequestion, three studies involving two Questions and3 studies of the EPDS. The optimal initial methodwas the two question approach. CONCLUSIONS:Although no single method is flawless, consideringaccuracy and efficiency, a simple two-questionapproach (followed by the BD) appears to be theoptimal case-identification method for depressionin cancer settings from published data. However apositive finding must be followed by further clinicalaction.

A-127

Witnessing Suffering Transforms Suffering: Apply-

ing Video and Documentary Film in End-of-Life

Counseling

Shih-Ming ShihKoo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan

OBJECTIVES: The purpose of this study is toillustrate the rationale and demonstrate the utilityof video/film as a medium in End-of-Life counsel-ing. Facing the reality of death is not only an once-in-a-lifetime experience for advanced cancer pa-tients, but also an experience that goes beyondwords. End-of-Life counseling is conducted underthe conditions of patients’ physical deterioration,declining cognitive ability, and uncertain lifespan.Developing efficient and effective methods to fulfillthe psycho-spiritual needs of advanced cancerpatients and their families is critically important.METHOD: Utilizing video/film in facilitatingadvanced cancer patients’ psycho-spiritual trans-formation was developed at the Heart LotusHospice Palliative Care Ward at Tzu-Chi BuddhistHospital in Taiwan from 2002 to 2005. More thanten short films describing patients’ psychologicalgrowth and pursuit of life’s meaning were madeand applied in End-of-Life counseling. This studyarticulates the theoretical and practical frameworks

underlying the development of using video/film inEnd-of-Life counseling and attempts to proposevarious dimensions in applying video/film inclinical work. RESULTS: Three practical frame-works include Healing in Actions, Healing in Re-building Relationships and Healing through Trans-personal Connection. Assessment before utilizingvideo/film is proposed. Eight dimensions of apply-ing video/film are summarized with examplesincluding helping patients gain an understandingof the future, regulating family relationships,extending meanings of limited life, facilitatingdiscussion through images, providing families adifferent perspective to see their beloved ones,witnessing existential experience, and facilitatingreflection and transcendental understanding. Therole of psychotherapist and ethical issues arediscussed. CONCLUSIONS: This study demon-strates that video/film serves as a vehicle whichdeepens advanced cancer patients’ perception ofliving and dying, and facilitates patients’ psycho-spiritual changes. Video/film can be applied inindividual, family, and group counseling and canbe integrated into the holistic care given by aMulti-disciplinary team in a palliative care unit orhospice setting. ‘Witnessing others’ suffering trans-forms the witness’ own suffering’ is not only aconcept in Buddhism but can be concretelypracticed in End-of-Life counseling.

A-128

What is the Physicians’ Perception on Giving Bad

News in Oncology? Qualitative Analysis of the

Quality Criteria Regarding the Disclosure of Bad

News

Armelle Desauw1, Veronique Christophe1,Pascal Antoine1, Stephane Cattan2, Jean-LouisNandrino1

Universite Charles-de-Gaulle - Lille 3, Villeneuved’Ascq, France1, Centre Hospitalier RegionalUniversitaire, Lille, France2

OBJECTIVES: In order to decrease psychologicalimpact of bad news on cancer patients and improvephysician-patient communication, protocols forbreaking bad news have been developed. Despitethese protocols, there still seems to be a gapbetween physicians’ perception on giving bad newsand patients’ preferences regarding the disclosureof bad news in oncology. The aim of this study wasto explore the physicians’ perception on qualitycriteria regarding the disclosure of bad news inoncology. METHOD: A qualitative exploratorydesign was adopted to capture physicians’ percep-tion on giving bad news in oncology. Using semi-structured interviews, thirty-one physicians facingthe disclosure of bad news in their practice wereasked to explain us the way they deliver bad news,and their quality criteria regarding the disclosure of


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bad news. Interviews were audiotape-recorded andsubsequently transcribed verbatim. Data collectedwere coded according to thematic analysis.RESULTS: Giving information to the patient isthe most important quality criteria reported byphysicians, concerning the disclosure of bad news.Physicians also pay attention to their patients’reactions. They want to ensure their patients’understanding. Surprisingly, physicians are notsatisfied of their disclosure if patients’ emotionalreactions are too intensive. Nothing is reportedregarding empathy or emotional support providedto patients. CONCLUSIONS: For physicians, thequality criteria concerning the disclosure of badnews lies in giving the information and ensuringthat this information is understood by patients.Despite an improvement concerning informationgiven to patients, there is still a lack of emotionalsupport provided by physicians to their patients.These first results bring us to question the effect ofthe way the bad news is broken on the patients’psychological wellbeing.

A-129

Quality of Life and Psychological State in Patients

with Choroidal Melanoma: A Longitudinal Study in

a French Cancer Centre

Suchocka-Capuano Agnieszka3, Bredart Anne3,Dolbeault Sylvie1, Lumbroso-Le Rouic Livia1,Levy-Gabriel Christine1, Desjradins Laurence1,Flahault Cecile3, Bungener Catherine2

Institut Curie, Paris, France1, Universite ParisDescartes, Paris, France2, Institut Curie,UniversiteParis Descartes, Paris, France3

OBJECTIVES: To describe patients ‘quality of lifeand psychological state during the course ofconservative treatment for choroidal melanoma(CM), the most common primary intraocularmalignant cancer in adults. Mortality rate isaround 50% by 10 years after treatment. Treat-ments for CM generate largely unknown conse-quences on the level of the quality of life (QoL) andpsychological status. Prospective published work isrelatively rare and their results are not consistent.METHOD: Population: 69 patients treated for CMby conservative treatment (proton beam irradiationor iodine plaques) in a French cancer centre ofreference for a CM. Tools: QoL (EORTC–QLQ-C301QLQ-OPT-30), adjustment to cancer (MAC-44), anxiety and depression (STAI-B, HADS), Fearof Cancer Recurrence (FCRI) were administratedat each evaluation. Collection: prospective studywith four evaluations: T0: before treatment, T1: 1month after treatment, T2: 6 months after treat-ment, T3: 12 months after treatment. RESULTS:Preliminary results of the first two evaluations willbe presented. The QoL’s general and functioninglevels remained relatively good and stable except

for the social functioning which decreased aftertreatment (p5 0,0319). The problems with appear-ance decreased (po0,0001) and the FCR wasstable. More than half of the patients (median at8) had a moderated rate of anxiety before treat-ment which decreased significantly a month later(p5 0, 0099). The depressive symptoms were lowerand remained stable after treatment. CONCLU-SIONS: The first results of this study confirm theimportance of exploration of the anxiety’s and fearof cancer recurrence’s (FCR) evolution amongpatients treated for CM. These dimensions werechanging in a different way and this could testifythat FCR assesses a construct close to but never-theless distinct from psychological distress andcancer specific anxiety. The FCR requires furtherinvestigation and screening in CM patients formake possible a better prevention in mental health.

A-133

It’s Like Being a First Class Patient: A Pilot Study

Examining the Experiences of Patients Participating

in a Cancer-Related Clinical Trial

Addie, C. Wootten1, Jo. M. Abbott1, Heather, M.Siddons1, Mark, A. Rosenthal2, Anthony, J.Costello1

Department of Urology, Royal Melbourne Hospital,Parkville, Victoria, Australia1, Department ofMedical Oncology, Royal Melbourne Hospital,Parkville, Victoria, Australia2

OBJECTIVES: To explore the experiences andidentify the psycho-social support needs of patientsenrolled in a cancer-related clinical drug treatmenttrial. METHOD: This paper outlines a two-phasedpilot study. Fourteen participants were recruited tophase one in which 3 focus groups and twointerviews were conducted. The focus groups andinterviews were audio-recorded, transcribed andcoded according to emerging themes. Nineteenparticipants were recruited to phase two in whichlongitudinal data was collected across three timepoints. RESULTS: Participants experienced amixture of hope, uncertainty and apprehension asthey considered whether to take part in a clinicaltrial. Trial participation was also associated with anumber of emotional and practical challenges. Theend of the trial was associated with a mix ofemotions, including relief, disappointment, hope offuture help, uncertainty and abandonment. Gen-erally participants were very positive about thesupport they received from health professionals,family and friends. CONCLUSIONS: Clinical trialparticipation is, in general, a positive experience formany patients with cancer, although there are anumber of associated practical and emotionalchallenges. Trial participants may benefit fromcloser follow-up from clinical trial staff, especiallythe treating doctor, assessment of support needs,


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and help in re-evaluating the meaning of their trialparticipation if their initial hopes and expectationsare not met.

A-135

Factors Influencing Treatment Choices in Patients

with Newly Diagnosed Breast Cancer

Dennis Citrin1, Diane Bloom2, Christopher Lis3,James Grutsch4, Sara Mortensen5

Cancer Treatment Centers of America at MidwestRegional Medical Center, Zion IL, United States1,InFocus Research, Chapel Hill NC, United States2,Cancer Treatment Centers of America at MidwestRegional Medical Cente, Zion, IL, United States3,University of Illinois, Chicago IL, United States4,Cancer Treatment Centers of America at MidwestRegional Medical Center, Zion, IL, United States5

OBJECTIVES: Although breast cancer is a highlytreatable disease, a significant number of womeneither delay seeking a diagnosis despite breastsymptoms, or reject conventional treatment afterdiagnosis, opting for alternative regimens alone,and potentially denying themselves a chance for acure. This study sought to understand thesewomen’s decisions and identify messages andapproaches that would have led to more appro-priate treatment. METHOD: This study exploredtreatment decision-making through in-depth inter-views with sixty breast cancer patients. Thirtyinterviews were conducted with women whodelayed seeking a diagnosis or refused recom-mended conventional treatment in favor of alter-native therapies (‘Refusers’); thirty were conductedwith control subjects, who accepted conventionaland alternative treatments. Each woman alsocompleted the Beck Anxiety Inventory and theRotter Locus of Control Scale to identify differ-ences in generalized anxiety and Locus of control.RESULTS: Fear and negative experiences withdoctors were the main factors that women rejectedpotentially life-prolonging conventional therapy.Refusers believed that chemotherapy and radio-therapy were riskier and less beneficial than didcontrols (p5 0.007). Controls perceived alternativemedicine alone as riskier than did refusers becauseits value for treating cancer is unproven(po0.0001). From their own research, refusersconcluded they could heal themselves from cancerwith even simple holistic treatments (raw fruits/vegetables; juicing; supplements). CONCLU-SIONS: Some women reject conventional breastcancer treatment, opting for alternative regimensalone, despite physician warnings that this couldcost them their lives. This decision is apparentlydue to a combination of fear, despair, negativeexperiences with doctors and misinformation.According to these women, a caring, compassio-nate approach to cancer care and physicians who

acknowledge their fears, communicate hope andencouragement, and educate them about theiroptions would have led them to make bettertreatment choices.

A-141

Psychometric Testing of the Spiritual Well-being

Scale on a Terminally Ill Cancer Sample in Taiwan

Woung-Ru TangChang Gung University, Tao-Yuan, Taiwan

OBJECTIVES: Terminally ill cancer patients’spiritual well-being is an important indicator forhospice care, but appropriate assessment tools areunavailable in Taiwan. This study therefore testedthe psychometric properties of the Spiritual Well-being Scale Mandarin version (SWBS-M) interminally ill patients in Taiwan. METHOD: Thiscross-sectional study recruited 241 cancer patientsfrom 5 teaching hospitals throughout Taiwan.Patients’ spiritual well-being and quality oflife were assessed using the SWBS-M andMcGill Quality of Life Questionnaire (MQOL).RESULTS: The SWBS-M had internal consistencyreliability of 0.89. Exploratory factor analysisshowed 4 underlying factors explaining 60.03% ofthe variance. SWBS-M scores correlated moder-ately with MQOL (r5 0.48, po0.01). Cancerpatients’ SWBS-M was inversely related to theiraverage pain in the past 24 hours (r5�0.183,p5 0.006). Cancer patients’ SWBS-M also differedsignificantly with their pain experience (t5�3.67,po0.001). Terminally ill patients with pain in thepast 24 hours had worse spiritual well-being thanthose without pain. CONCLUSIONS: Accordingto the findings of this study, clinicians can improveterminally ill patients’ QOL by improving theirspiritual well-being. In addition, a better painmanagement may improve terminally ill cancerpatients’ spiritual well-being and their QOL.

A-150

A Website for Children and Their Families When a

Family Member Has Cancer

Gina MacKenzie, Susanna Ruebsaat, CarlyFleming, Karen JanesBC Cancer Agency, Vancouver, Canada

OBJECTIVES: There is a growing body ofresearch which documents the impact of parentalcancer on children. To help families cope, a websitewas created for children aged 6 to 12 years. The siteprovides support for parents, health care profes-sionals and school personnel. The website wasdeveloped to provide access to support for familieswith geographical challenges, for parents who areunable to attend counselling, and for families toaccess support when they need it. METHOD: An


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interdisciplinary team, including clinicians, multimedia and web design experts, were involved in thedevelopment of the site. In designing the site, thecancer literature on the impact of a parentaldiagnosis on children was reviewed. Additionally,knowledge about the learning characteristics ofchildren, the cognitive developmental level and the‘digital behavior’ of this age group was integratedinto the design. Children, parents and clinicianstested the site at key points during its development.RESULTS: The site integrates the psychosocialand medical aspects of care, key messages arecommunicated through visual language and em-bedded in the site, and the focus is on learning, notinformation. The site helps children explore non-verbal ways of expressing feelings about cancerthrough interactive, expressive and playful activ-ities. It helps them to learn some basic informationabout cancer and treatment. Parents can accesstools to help them talk more openly with theirchildren about cancer. CONCLUSIONS: In thefirst month of launching, there were 1256 visits tothe site. 25% of these visits were international. Thesite has received a national interactive applied artsaward, educational category. Although the websiteis not designed as therapy, all aspects of the site aremeant to be therapeutic. This presentation willinclude an overview of the key elements and ademonstration on how to use it.

A-153

Impact of Nueva Vida’s Model on Self-Efficacy in

Latinas with Breast Cancer

Karlynn BrintzenhofeSzoc1, Larisa Caicedo2,James R. Zabora1, Claudia Campos2, MarcelaBlinka1, Leslie Kaliner2

Catholic University of America, Washington, DC,United States1, Nueva Vida, Washington, DC,United States2

OBJECTIVES: The goal of this community basedorganization-academic partnership project is toevaluate the impact of Nueva Vida’s model onlevels of self-efficacy, psychological distress, andquality of life. Nueva Vida (NV) was founded in1996 by Latina breast cancer survivors and healthprofessionals to address the lack of culturallysensitive cancer support services for Latinas inthe Washington, DC area. METHOD: This studyis a time-series design with time 1 data collectionon the day of initial contact with NV, time 2 within3–10 days of initial contact, time 3 at 4 months,and time 4 at 12 months. The sample will include90 Latina women diagnosed with breast cancerwho are offered individual counselling, varioussupport group participation, patient navigation,and peer support. Self efficacy, psychologicaldistress and quality of life are measured.RESULTS: Data collection for this study took

place between March 2008 and December 2009.The findings will be presented in regards to the self-efficacy, psychological distress, and quality of lifeover time. The results will guide the development ofa problem-solving intervention which will beimplemented in the third year of the grant.CONCLUSIONS: This study increases awarenessof the impact of breast cancer on Latinas and theimpact of a targeted program for Latinas has onthe study participants. Further, this study illus-trates the ups and downs of collaboration betweena community-based organization and a universityin developing and undertaking a research project.

A-154

Informed Consent in Randomised Clinical Trials

(RCT). What Patients Need in Consultations About

RCT from their Oncologists—A Checklist Derived

from Patients’ Interviews

Christiane Behrendt1, Alexander Wuensch1,Christian Roesler2, Hartmut Bertz1, MichaelWirsching1, Kurt Fritzsche1

University Hospital, Freiburg, Germany1, CatholicUniversity of Applied Sciences, Freiburg, Germany2

OBJECTIVES: When patients are informed abouta possible participation in a RCT, it is an ethicalimperative that patients clearly understand theinformation provided, so they are able to give aclear Informed Consent (IC). Reality shows thatthis imperative is not always met in practice, thus aclear IC is not achieved. This dilemma has to beaddressed and patients’ needs in those consulta-tions have to be assessed. METHOD: Cancerpatients who were asked to participate in arandomised trial were interviewed using a semi-standardised interview which was developed by theauthors to assess patient’s understanding andpatient’s needs in those consultations. The samplecontained eight patients who participated in a trialand two who declined participation. The data wereevaluated on the basis of Mayring’s qualitativeanalysis. The answers from the interview weretransferred to a checklist. RESULTS: The checklistincludes the following items (extract): a prean-nounced, clear and thorough IC, preferably at apoint when their health would be in a stablecondition; taking enough time for the patient;considering the pace of the conversation andavoiding incomprehensible expressions and jargon;giving the patient time to think about his decisionsand inviting the patients to ask questions and to lettheir relatives join the IC conversation. CONCLU-SIONS: Two main goals have been reached by thisresearch: (a) the exploration of patients’ needs inconsultations about clinical trials and (b) above all,patients’ desires were clarified and summarised in auseful, clearly structured checklist to help physi-cians to inform future patients in a more effective


DOI: 10.1002/pon

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and concise way about possible participationin a RCT.

A-157

The Evaluation of the Psychosocial Pathway of

Breast Cancer: Diagnosis, Surgery and Treatments

Ivone Patrao, Isabel Leal, Joao MarocoISPA, Lisbon, Portugal

OBJECTIVES: Women diagnosed with breastcancer are confronted with different stressorsthroughout the illness trajectory, e.g. awaitingdiagnosis, having surgery, anticipating the possibi-lity that the cancer has spread, coping with sideeffects and, finally, facing the risk of recurrence.The aim of this study was to investigate the impactof the psychosocial pathway of breast cancer(phase 1 ‘diagnosis’, phase 2 ‘surgery’, phase 3‘treatments’). METHOD: A total of 360 womendiagnosed with breast cancer were evaluated, on 3separate occasions, in relation to: emotional state,emotional control, neuroticism, social support,coping, quality of life (QoL) and demographiccharacteristics. We used structural equation mod-eling (SEM) to examine the relationships among allthe variables. RESULTS: The structural equationmodels (SEM) indicate that the emotional, cogni-tive response, and the QoL, suffered significantchanges concerning diagnosis (phase 1), surgery(phase 2) and treatments (phase 3). Furthermore,results indicate that an adapted emotional responseis associated to efficient coping strategy, andsatisfaction with the perceived social support andgood QoL at all levels. This is particular the casewhen women are under psychological intervention.CONCLUSIONS: To help breast cancer patientsadjust to their situation the clinical psychologistshould encourage the patient to adopt moreefficient coping strategies (i.e. a fighting spirit). Bydoing so, patients may indeed experience lesspsychological distress and a higher quality of life,thereby increasing their overall sense of well-being.

A-158

The Psychosocial Adjustment of Breast Cancer

Women at Diagnosis, Surgery and Treatments:

A Longitudinal Study

Ivone Patrao, Isabel Leal, Joao MarocoISPA, Lisbon, Portugal

OBJECTIVES: Distressing events can lead tonegative outcomes, such as post-traumatic stresssymptoms (PTSS), but they can also lead topositive outcomes, an experience termed post-traumatic growth (PTG) or Benefit Finding (BF).In the context of cancer, PTG may improveimportant psychological outcomes, including de-pression, positive wellbeing, health behaviors and

positive affect. This longitudinal study aims toinvestigate the psychosocial adjustment of breastcancer women (phase 1 ‘diagnosis’, phase 2‘surgery’, phase 3 ‘treatments’). METHOD: Atotal of 30 women diagnosed with breast cancerwere evaluated, on 3 separate occasions, in relationto: emotional state, emotional control, neuroticism,social support, body image perception, coping andquality of life (QoL). We used the non-parametricFriedman test to compare the variables in eachoccasions. RESULTS: The analysis of the changesoccurred in the variables throughout the psycho-social pathway of breast cancer illustrated a slightimpact of the breast cancer, as a negative life event.This results show a good adjustment at all levels(emotional, social and physically). The levels ofneuroticism and body image perception indicatedsignificant changes all the way throughout time.CONCLUSIONS: The results show that findingpositive meaning in response to a distressingevent, such as breast cancer, is psychologicallyprotective and thus may be indirectly influence thelong-term occurrence of depressive symptoms andimpaired QOL. In light of the rapidly growingpopulation of cancer survivors it’s important tounderstand their treatment experiences in furtherstudies.

A-159

Examining Ethnic and Neighborhood Variation in

Cervical Cancer Survival Outcomes

Kimlin Ashing-Giwa, Jung-won LimCity of Hope, Duarte, CA, United States

OBJECTIVES: Earlier detection and more effectivetreatment have resulted in a tremendous increase insurvival from cervical cancer over the last decade.However, ethnic and neighborhood variation mayinfluence survival outcomes among cervical cancersurvivors (CCS). The purpose of this study was toinvestigate: (1) the differences in survival status byethnicity and neighborhood median income level;and (2) predictors influencing survival statusamong a population based cohort diagnosed withinvasive cancer of the cervix uteri. METHOD: Thisstudy is based on data from 1,847 multiethnic CCS(395 European-, 187 African-, 980 Latina-, and 285Asian-Americans) recruited through the CaliforniaCancer Surveillance Program. The dependentvariable was days of survival from date of cancerdiagnosis. Neighborhood income was obtainedfrom the zip-code-based median income categor-ized by ethnicity to consider the neighborhoodcontext. The Kaplan-Meier, univariate and multi-variate Cox Proportional Hazards Regressionwere used to determine associations of thepredictors with the outcome. RESULTS:Ethnicity was significantly associated with thesurvival (X2 5 23.652; po0.001), indicating that


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African-Americans showed the shortest survival.Differences in the survival between high- and low-income regions were not observed. However, whenethnicity was considered, Asian-Americans wholive in the high-income region showed a longersurvival than women in the low-income region(X2 5 4.531; po0.05). After controlling for clinicalinformation, ethnicity was a significant factorinfluencing survival (HR5 0.698; po0.05). Ageat diagnosis, cancer stage, and the scope ofsurgery also remained highly significant factors.CONCLUSIONS: Asian-Americans with cervicalcancer have the best survival outcome, whileAfrican-American showed the shortest survival.In addition to cancer characteristics, contextualdimensions such as neighborhood or socio-ecolo-gical stress may be important correlates of survival.The findings support the need for greater examina-tion of the unique contribution of ethnicity andneighborhood contexts on cancer survival as wellas a fuller appreciation of the contextual dimen-sions of survivorship outcomes.

A-160

Enhancing Chinese Cancer Patients Safety and

Access to Support - Development of Cultural and

Language Specific Bilingual Patient Materials

Sandy S.H. Kwong, Gina MacKenzieBC Cancer Agency (Vancouver Centre), VancouverBC, Canada

OBJECTIVES: Chinese population is a majorvisible minority group in Canada, particularly incities such as Vancouver and Toronto. However,culturally and linguistically specific cancer supportis limited. Research on barriers to cancer care inthe Chinese community has found that manyChinese cancer patients are unfamiliar with thesupports available and lack information on cancerillness. This presentation shows how patientmaterials could enhance Chinese patients’ safetyand their access to support. METHOD: Informa-tion on gaps was gathered from focus groups withthe Chinese community, research with members ofa support group, and key informant interviewswith health care professionals working with thecancer population. In the developmental phase,materials were reviewed, revised and piloted.Best practice guidelines for developing bilingualadult education materials and for culturallyspecific materials were used. Patients and healthcare providers were asked to give feedback.RESULTS: Bilingual materials including a re-source guide, screening instrument and naviga-tional guide are available to be used by bothChinese speaking patients and English speakingcare providers. The presentation will discuss theprocess, quality indicators, challenges and success

in developing culturally sensitive, languagespecific materials for non-English speakingpatients. CONCLUSIONS: Quality patient educa-tion materials for Chinese speaking patientsenhance patient safety and access to support.The possibility of transferring the experience toother provinces with significant proportions ofChinese-speaking patients, and the development ofcultural and language specific patient materialsfor other non-English speaking groups will bediscussed.

A-162

Prevalence Rates of Anxiety and Depressive Dis-

orders in Adult Cancer Patients - A Consecutive

Complete Assessment at the Time Point of Cancer

Diagnosis

Andrea Vodermaier1, Wolfgang Linden1, DuncanGreig1, MacKenzie Regina3

University of British Columbia, Vancouver, BC,Canada1, University of Munich, Munich, Germany2,BC Cancer Agency, Vancouver, BC, Canada3

OBJECTIVES: Rates of anxiety and depressivesymptoms in cancer patients vary widely acrossstudies. Variability may be mainly attributed tosample characteristics, types of cancer, assessmentinstrument used, and choice of cutoff. This studyevaluates rates of anxiety and depressive disordersat the time point of cancer diagnosis and initiationof treatment in a large consecutive cohort of cancerpatients. METHOD: From 2004 to 2008 all newlydiagnosed cancer patients entering two cancer carecenters in British Columbia were screened foremotional distress using the PSSCAN question-naire. Data from a total of 11,284 patients withvarious cancer types were collected in the respectivetime frame. RESULTS: On average, 16.2% ofpatients exceeded cut-offs for a diagnosis suggest-ing an anxiety disorder and 12.5% of a depressivedisorder. Patients with gynecological cancer(23.4%) reported the highest level of anxiety,followed by lung (20.1%), breast (19.5%), andneuro-endocrine neoplasms (19.2%). Gynecologi-cal (18.8%), lung (17.2%), neuro-endocrine(15.6%), and head and neck (15.5%) cancerpatients were among the most depressed. Age andgender related prevalence rates will also bepresented. CONCLUSIONS: Prevalence rates ofsymptoms suggestive of anxiety and depressivedisorders were relatively low. However, femaleswere almost two times more likely to developclinically relevant symptoms. In addition,middle aged patients were more anxious anddepressed as were those with specific cancertypes. Patients with more unfavorable tumor typeswere more likely to experience an anxiety ordepressive disorder.


DOI: 10.1002/pon

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A-165

How women feel after attending the Look Good Feel

Better Program

Haryana M Dhillon1, Heather L Shepherd2,Melanie Price3

Centre for Medical Psychology & Evidence-basedDecision-making, University of Sydney, SydneyNSW, Australia1, The SAX Institute, School ofPublic Health, University of New South Wales,Sydney NSW, Australia2, Psycho-OncologyCooperative Research Group, University of Sydney,Sydney NSW, Australia3

OBJECTIVES: The Look Good Feel Better(LGFB) Program has run free cosmetic workshopsfor Australians receiving cancer treatment since1990. The purpose of this study was to evaluate theimpact of the LGFB Program on the self-con-sciousness of appearance of people with cancerwho attended a LGFB workshop. METHOD: Thiswas a prospective cohort study, with consentingparticipants completing questionnaires before, and1-, and 4-months after attending a workshop. Theprimary outcome was change in self-consciousnessof appearance measured by the Derriford Appear-ance Scale (DAS24). RESULTS: 267 English-speaking females 28–84 years (mean5 57) partici-pated (response rate 43%). 65% were partnered,47% tertiary educated, most diagnosed with breastcancer (63%), o12 months ago (69%). 73%reported concerns regarding appearance, com-monly hair, breast, or weight. While no significantchanges were detected in self-consciousness ofappearance, quality of life, anxiety, depression,stress, or adjustment, over time, most reported theworkshop enjoyable and helpful (95%), practical(94%), relevant (83%), although some found itconfronting (21%). CONCLUSIONS: The LGFBprogram was enjoyable, helpful and practical toparticipating women diagnosed with cancer, butdid not significantly change their self-confidence ofappearance and other psychosocial outcomes.

A-166

Patient Denial; Family Caregivers are Frustrated

and Angry Too

Naomi Kogan1, Michelle Dumas2, Robin Cohen3

Jewish General Hospital, Montreal, Quebec,Canada1, Ottawa General Hospital, Ottawa,Ontario, Canada2, McGill University, Montreal,Quebec, Canada3

OBJECTIVES: It is widely accepted that cancerimpacts the family of a person with cancer,particularly affecting their family caregivers. Pa-tient denial of some aspect of the illness is notuncommon, yet we know little about how patient

denial affects these family caregivers. The purposeof this project was to explore the way in which acancer patient’s denial is perceived, experienced,and understood by the patient’s family caregivers.METHOD: A prospective phenomenologicalmethodology guided the study. Family caregiversof cancer patients who clinical oncology staffbelieved were in denial were purposefully sampledto achieve a heterogeneous sample in terms of age,gender, and relationship to the patient. Data wascollected via semi-structured interviews with 19family caregivers. Sixteen were retained, as threedid not contain clear evidence of patient denial.Data were analyzed by a team consisting of a socialworker, nurse, and psychologist. RESULTS: Care-givers described their experience of the patient’sdenial in terms of: the strategies they used tounderstand it (e.g. knowing the patient’s usual wayof coping and communicating); the various sourcesof burden it added (e.g. patients endangeringthemselves by not following medical advice); itsemotional impact on them (e.g. feeling frustrated,angry, alone, disenfranchised); and strategies theyused to cope with it (e.g. avoiding confrontingdenial; using nonverbal cues to communicate withdoctors). CONCLUSIONS: Cancer patients’ de-nial had an impact on their family caregivers inmany important ways; affecting the caregivers’well-being, as well as undermining their ability toprovide care. Our results have implications forstrategies health care providers can use [if patientspermit] to enable family caregivers to compensatefor the barriers to care imposed by patient denial,so they may be better able to fulfill their caregivingroles, and preserve their own well-being.

A-167

Neuropsychological Assessment in Patients with

Head and Neck Cancer After Radiotherapy or

Chemo-Radiotherapy

Lori J Bernstein, Hui K Gan, Jennifer Brown, JolieRingash, Mehrdad Vakilha, Lisa Wang, David PGoldstein, John J Kim, Andrew J Hope, BrianO’Sullivan, John N Waldron, Albiruni Razak, EricX Chen, Lillian L SiuPrincess Margaret Hospital, Toronto, Canada

OBJECTIVES: Evidence from neuropsychologicalstudies in breast cancer patients suggests thatcancer and/or its treatment can affect cognitivefunctioning. Patients with head and neck cancermay be particularly vulnerable to cognitive dys-functions because of the treatment these patientsreceive (radiotherapy5RT, or chemo-radiothera-py5CRT) and pre-cancer risk factors such asalcohol and smoking history. Here we examinewhether there is evidence of cognitive dysfunctionin head and neck cancer patients. METHOD:Ten relapse-free patients after curative-intent


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RT (n5 5) or CRT (n5 5) for squamous cellcarcinoma of the head and neck underwent acomprehensive neuropsychological battery, ques-tionnaires of subjective cognitive functions, qualityof life (QOL) and affect; and blood tests to assesshematological, biochemical, endocrine and cyto-kine status. Retrospectively, the dosimetry ofincidental radiation to the brain was determinedin all patients and the dose intensity of cisplatinwas determined in chemo-radiotherapy patients.RESULTS: Mean time since treatment was 20months. Patients showed reduced cognitive func-tioning compared with pre-morbid estimates, withmemory most affected. Severity of memory impair-ment correlated significantly with radiation dose tothe temporal lobes, suggesting that at least somedeficits may be treatment related. CRT patients didnot show more dysfunction than RT patients.There was no association between measures ofobjective cognitive functioning and subjectivecognitive functioning, QOL, affective, hematologi-cal, biochemical, endocrine and cytokine status.CONCLUSIONS: The relationship between radia-tion dose and degree of memory disturbanceprovides evidence that cognitive dysfunction ob-served in these patients is in part related to theircancer treatment. Further examination is war-ranted because cognitive dysfunction can nega-tively impact on patients’ lives and contribute toproblems in post-treatment rehabilitation. We arecurrently recruiting participants for a prospectivestudy with a larger sample of patients and controlparticipants to assess if and how cognitive abilitieschange over time.

A-172

Spiritual Care Delivery for Elders with Cancer

Anne Belcher1, Margaret Griffiths2

Johns Hopkins University, Baltmiore, Maryland,United States1, University of Pennsylvania,Philadelphia, PA, United States2

OBJECTIVES: More than 60% of cancers in theUnited States now occur in older adults and thenumber of new cancer diagnoses in elders isexpected to rise during this century. Elders presentwith unique physical and spiritual needs. Theexpertise of the healthcare team addresses physicalneeds; however, spiritual care delivery frequently islacking in meaning and/or individualization. Thispresentation discusses the competence of geriatricnurses to address spiritual needs of older adultswith cancer. METHOD: The researchers developeda qualitative instrument which elicited geriatricnurses’ perspective of their ability to providecomprehensive, holistic spiritual care that washighly individualized to the patient. Demographicdata was also elicited that addressed level of

education, educational experiences that addressedspiritual care competence, personal spiritual prac-tices and professional roles. A randomized sampleof the membership of the National GerontologicalNursing Association received the survey; 150 of thereturned surveys have been analyzed. RESULTS:Data were analyzed using nVIVO. Results demon-strated that the majority of the respondents werebetween 35 and 50 years of age, received littlepreparation, either academic or professional, forthe delivery of spiritual care, were employed in avariety of settings, and varied considerably in theirpersonal expression of spirituality. Confusionbetween religiosity and spirituality was a consistenttheme as were expressions of discomfort inaddressing spiritual issues and reliance on thepastoral care team. CONCLUSIONS: Geriatricnurses are not well-positioned to provide spiritualcare to elder cancer patients. It is evident thateducational curricula lack attention to this compo-nent of care. Nurses have a professional responsi-bility to develop their competence and confidencein this care component. It also is incumbent uponhealthcare institutions to recognize the value of thisaspect of care in generating optimism that hassignificant benefits for elder’s response to cancerand its treatment.

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Implementation of a Screening Programme for

Cancer Related Distress: Part I - Does Screening

Influence Detection of Distress?

Alex J Mitchell1, Lorraine Grainger2, NadiaHussain1, Paul Symonds1

University of Leicester, Leicester, United Kingdom1,University Hospitals of Leicester, Leicester,United Kingdom2

OBJECTIVES: It is generally accepted that cancerclinicians are unable to accurately identify distressin routine care. We aimed to examine the effects ofa simple screening programme based around theDistress Thermometer (DT) on recognition ofpatient reported distress by nurse specialists acrossthree sites in the East Midlands (UK). METHOD:We asked approximately 100 nurses from threeindependent sites to give us their clinical opinionbefore and after screening 382 patients for distress.Distress was defined by a score of 4 or higher onthe DT. Clinical opinion was by pencil and paper,consecutive judgements returned centrally for blindrating. We analysed quantative and qualitativechange. RESULTS: Without the aid of screening,detection sensitivity was 49.7% and specificity of79.3%. PPV was 67.3 and NPV was 64.1%. Afterscreening detection sensitivity was 55.8% andspecificity was 79.8%. There was a nonsignificanttrend for improved detection sensitivity (Chi5 1.12


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p5 0.29). 43% reported the tool helped themdiscuss psychosocial issues especially in thoseunwell. 28% of clinicians reported the toolinformed their clinical judgement, again mostly inthose unwell. CONCLUSIONS: We conclude fromthese initial results that the introduction of screen-ing for distress makes a small difference to numberof detections and no appreciable difference tospecificity. However screening does appear to helpclinicians talk with their patients and informssubjective clinical judgement especially in peopleconsidered to be unwell.

A-178


Cancer Related Distress: Part II - Does Screening

Aid Clinicians’ Communication, Judgement or

Accuracy of Anxiety and Depression?

Nadia Hussain2, Lorraine Grainger1, PaulSymonds2, Alex J Mitchell2

University Hospitals of Leicester, Leicester, UnitedKingdom1, University of Leicester, Leicester, UnitedKingdom2

OBJECTIVES: It is generally accepted that cancerclinicians are unable to accurately identify distressin routine care. We aimed to examine the effects ofa simple screening programme based around theEmotion Thermometer (ET) on recognition ofpatient reported depression and anxiety by nursespecialists at one UK site. METHOD: We askedchemotherapy nurses of the Leicester RoyalInfirmary to give us their clinical opinion beforeand after screening 269 patients for anxiety anddepression plus anxiety or depression. Depressionand anxiety were defined by a score of 4 or higheron the ET. We measured detection accuracy beforeand after screening and ability of screening toimprove communication and inform clinical judge-ment. RESULTS: Before screening, clinicianssensitivity was 55.4% for depression and 41.7%for anxiety. Specificity was 87.5% and 81.9%,respectively. After screening detection accuracy didnot change. However on 38% of occasions staffrated the instrument as useful in improvingcommunication with the patient. On 28.6% ofinteractions, staff rated the tool as useful forinforming clinical judgement. Nurses did not help51.3% who screened positive vs 67% of thosenegative (Chi5 9.28 p5 0.0023). CONCLU-SIONS: We conclude from these chemotherapyresults that the introduction of screening fordepression or anxiety appears to make noappreciable difference to the actual number ofdetections but screening does appear to helpclinicians ability to talk with patients, it alsoinforms clinical judgement and aids a clinicallyhelpful response.

A-181

Existential Meaning and Adaptation to Cancer

Sylvie Pucheu1, Najoua Oumima2, Cecile You-Harada2, Delphine De Susbielle2, Cecile Roygnan2,Valerie Brasselet2, Anne-Solen Le Bihan2, Silla M.Consoli3

CL psychiatry Dpt and Pierre et Marie CurieUniversity, European Georges Pompidou Hospital,Paris, France1, CL psychiatry Dpt, EuropeanGeorges Pompidou Hospital, Paris, France2, CLpsychiatry Dpt and Paris Descartes University,European Georges Pompidou Hospital, Paris,France3

OBJECTIVES: Cancer induces psychological pro-cesses involving existential meaning. The LifeAttitude Profile-Revised (LAP-R-48; Recker,1992) was developed as a self-administered ques-tionnaire for assessing existential meaning ingeneral or clinical populations; it comprises sixdimensions, leading to two global scores (thepersonal-meaning-index (PMI) and existential-transcendence (ET)). This longitudinal study aimedto highlight whether existential meaning dimen-sions play a favourable or unfavourable role onadaptation to cancer, as regards illness perception,quality of life and treatment experience.METHOD: 64 cancer patients aged 55.4710.4years (75% females; breast (n5 33); colon (n5 13);head and neck (n5 10); ovarian (n5 3); other(n5 5)) were evaluated 2 to 4 months after thediagnosis (T1) and 51 of them one year later (T2).Patients completed at T1 and T2 the LAP-R, theIllness Cognition Questionnaire (ICQ-18), theEORTC-30 Quality of Life (QOL) questionnairefor cancer patients, and a questionnaire on treat-ment experience (T2). Data were controlled forcancer severity. RESULTS: At T1, QOL wascorrelated positively with LAP-R purpose, choice/responsibleness and negatively with existential-vacuum; ICQ-18 helplessness was correlated posi-tively with existential-vacuum and negatively withdeath-acceptance and ET; ICQ-18 perceived-bene-fits was positively correlated with existential-vacuum. At T2, helplessness was correlatedpositively with concurrent and baseline goal-seeking and negatively with concurrent purpose,PMI and ET; ICQ-18 illness-acceptance wascorrelated positively with concurrent ET andnegatively with baseline goal-seeking; perceived-benefits was positively correlated with concurrentpurpose and PMI. CONCLUSIONS: Resultssupport the hypothesis that purpose, coherence,choice/responsibleness, death-acceptance and,more globally, personal-meaning-index and exis-tential-transcendence play a protective role onadaptation to cancer. On the contrary, existential-vacuum and goal-seeking play a detrimental role.The pattern of these relationships changes


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during the follow-up. The opposite direction of theassociations regarding existential-vacuum andgoal-seeking scores among the set of LAP-Rdimensions is congruent with the construct of thequestionnaire. Findings could be helpful forpsycho-oncology practice.

A-184

Helping Children Cope When An Adult Has

Cancer

Devon McGoldrick1, Paula Rauch2, MaryHaggerty3, Claire Neal1, Ruth Rechis1, JacquiDeegan3, Peter Hirsch3

Lance Armstrong Foundation, Austin, Texas, UnitedStates1, Massachusetts General Hospital, Boston,Massachusetts, United States2, WGBH, Boston,Massachusetts, United States3

OBJECTIVES: Talking with children about canceris an increasingly common challenge for adultsaround the world. Research shows that parents,school professionals, and other adults want devel-opmentally appropriate support to help childrencope with a cancer diagnosis and treatment; yetfinding trusted resources to help children ischallenging. The Great MacGrady, the animatedprogram from the award-winning PBS seriesArthur, is an effective tool that engages andeducates children and the adults who care forthem. METHOD: Given what we know about thepower of television to educate, it’s surprising thatso little children’s programming has been devel-oped on the subjects of cancer and survivorship.The Arthur series harnessed this power to create aspecial broadcast with significant community out-reach designed to help kids grapple with the cancerdiagnosis of a loved one. This episode is aneffective springboard to family conversations thatinvite kids to talk about their feelings and fears.RESULTS: Arthur’s producers joined with multi-disciplinary partners in the cancer community tocreate a half-hour episode involving the cancerdiagnosis of a central adult character. The programaddresses the range of reactions child charactershave, and models how adults and children cancome together to support one another. Garnering 4million viewers in its first broadcast week, theepisode was one the series’ highest ratedamong children 9–11. CONCLUSIONS: Thiscollaborative model, bringing together clinicians,multi-media specialists, and outreach experts, hascreated a compelling and accessible suite ofmaterials to support families in need. It is a modelthat leverages the strengths of partners fromdifferent fields to create a program that canempower loving adults to help children cope whena person they care about has cancer or anotherserious illness.

A-186

Barriers to Physical and Psychosocial Rehabilitative

Care for Young Breast Cancer Survivors in Atlantic

Canada

Julie Easley, Baukje (Bo) MiedemaDalhousie University - Family Medicine TeachingUnit, Fredericton, New Brunswick, Canada

OBJECTIVES: A growing number of studies haveshown that younger women have a greaterphysical, psychological and social morbidity andpoorer quality of life after a breast cancer diagnosisthan older women. The purpose of this study wasto assess the rehabilitation needs of young womenunder the age of 50 with breast cancer in AtlanticCanada and to identify factors that impact orprevent cancer rehabilitation utilization post-treat-ment. METHOD: A qualitative study involving in-depth telephone interviews with 39 breast cancersurvivors under the age of 50 in Atlantic Canada(New Brunswick, Nova Scotia, Newfoundland &Labrador, and Prince Edward Island). The inter-views were semi-structured and focused on theyoung women’s overall breast cancer experiences;the physical, psychological and social issues andchallenges faced; and the general awareness,perceptions and experiences with cancer rehabilita-tion services post-treatment. Interviews were re-corded, transcribed and analyzed using thematiccoding. RESULTS: Systemic barriers to rehabilita-tion after breast cancer include lack of availabilityof services and resources; general accessibilityissues (i.e. distance/travel); cost of services; lackof or limited health insurance coverage; limitedsupport available specific to the needs of youngwomen; and the lack of awareness about theservices available. Personal barriers include ap-pointment fatigue, lack of time, patient compli-ance, acceptance of limitations and a fear ofburdening the system or facing long wait times.CONCLUSIONS: A considerable amount ofbarriers exist to receiving physical and psychosocialrehabilitation post-treatment for young breastcancer survivors. Unmet rehabilitative needs canprevent women from returning to their formersocial roles, both within the household and withinthe workforce. Recognizing these needs andaddressing the barriers to receiving support willhelp health care professionals identify ways ofoptimizing the outcomes for this population andimprove their overall quality of life.

A-188

Urinary Symptoms After Gynecologic Cancer

Treatment and Their Impact on Quality of Life

Kristine A. Donovan, Alice R. Boyington, RobertM. WenhamMoffitt Cancer Center, Tampa, FL, United States


DOI: 10.1002/pon

S82 Oral Abstracts

OBJECTIVES: Gynecologic cancer patients are atrisk for bladder dysfunction as a result of surgery,radiotherapy, and factors that predispose them tocancer. Few studies have investigated urinarysymptoms after gynecologic cancer treatment andtheir impact on quality of life. The purpose of thisstudy was to examine the prevalence of urinarysymptoms in gynecologic cancer patients, identifyrisk factors for urinary symptoms, and examine therelationship of symptoms to quality of life.METHOD: Participants in the current study were105 women with recently diagnosed gynecologiccancer who were scheduled to begin treatment.Mean age of participants was 54 years (SD5 14.0;range 27–83). Seventy-eight percent had cervical orendometrial cancer. Fifty-six percent were post-menopausal prior to treatment. Participants com-pleted the urinary symptom subscale of theMenopausal Symptom Scale and the MedicalOutcomes Study-Short Form prior to treatmentand six months after treatment. RESULTS: At sixmonths, 58% of participants reported urinarysymptoms; 30% rated symptoms as moderately toextremely bothersome. Radiotherapy and higherpre-treatment body mass index, but not diseasecharacteristics, chemotherapy, surgery type, age,race, menopausal status or tobacco use weresignificantly associated (po0.05) with urinarysymptoms at six months. Symptoms were signifi-cantly associated (po0.05) with worse physical andmental QOL in all domains even after controllingfor pre-treatment urinary symptoms. CONCLU-SIONS: Findings suggest urinary symptoms arehighly prevalent in gynecologic cancer patientsafter treatment. Potential risk factors for symp-toms include receipt of radiotherapy and higherbody mass index prior to treatment. Symptoms areassociated with significant distress and adverselyimpact women’s physical and mental quality of life.Future research should be designed to elucidatepatients’ efforts to manage symptoms and identifybarriers to seeking help so effective interventionsfor managing symptoms in survivorship may bedeveloped.

A-189

Emotional Reinforcement as Protective Factor for

Healthy Eating in Domestic Settings

Ji Lu, Catherine Huet, Laurette DubeMcGill University, Montreal, Canada

OBJECTIVES: Home meals have been shown tobe healthier than away-from-home ones. Thisstudy hypothesized that part of this protectivehome effect, among other psycho-social factors, istied to more positive emotions being experiencedherein. Through an emotional reinforcement pro-cess, some of the positive affective states experi-enced at home may be associated with food

consumption, and especially with healthier food,which lacks biologically reinforcing qualities com-pared to sweeter, fatter alternatives. METHOD:By using an Experience Sampling Method, thepresent study had 160 non-obese adult womenreported their eating behaviors and emotionalstates six times a day over ten observation days(3950 meal episodes in total, and 24.69 perparticipant). Each participant reported the relativenutritional quality on each meal based on her ownbaseline meal consumption. RESULTS: Hierarch-ical regressions reveal that home meals arefollowed by more intense positive emotions andless anxiety than away-from-home meals. Havinghealthier meals at home result in more positiveemotions compared to baseline meals, with no sucheffects being significantly present in away-from-home settings. Only for home meals, a healthierchoice is more likely to follow a positive pre-mealaffective state. CONCLUSIONS: Results suggestthat the home is a unique environment, wherehealthier food choices trigger and are triggered bymore positive emotions, a pattern of emotionalreinforcement that is not present in away-from-home settings. These findings provide insights intothe development of novel approaches to cancerprevention, which highlights that positive emo-tions, beyond health and nutritional knowledge,can be associated with healthy food consumptionand contribute to healthier eating.

A-190

Depressive Mood Predicts Cancer Diagnosis in

Women Undergoing a Colonoscopy

Silla M. Consoli1, Cedric Lemogne1, GaelleAbgrall-Barbry2, Dominique Lamarque3,Raymond Jian4

CL psychiatry Dpt and Paris Descartes University,European Georges Pompidou Hospital, Paris,France1, Dpt of psychiatry, Hotel-Dieu Hospital,Paris, France2, Dpt of Hepato-Gastro-Enterology,Hotel-Dieu Hospital, Paris, France3, Dpt of Hepato-Gastro-Enterology, Georges Pompidou EuropeanHospital, Paris, France4

OBJECTIVES: In patients presenting with clinicalsigns that may indicate a colorectal cancer,clinicians may interpret the presence of a depressivemood as decreasing the likelihood of cancerdiagnosis, especially in women. This study aimedto examine the association between depressivemood and subsequent diagnosis of cancer incandidates for a colonoscopy. We hypothesizedthat depressive mood would be related to subse-quent cancer diagnosis, after adjusting for con-founding variables. METHOD: Ninety-threepatients (34 men, mean age7SD5 56.679.7 years,59 women, mean age7SD5 54.2712.9 years)were given the 13-item Beck Depression Inventory


DOI: 10.1002/pon

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to assess depressive mood before undergoingcolonoscopy. Psychological, demographic, andclinical covariates were collected, as well as theresult of the subsequent colonoscopy. Cancer wasdefined as advanced neoplasia, or adenomaX10mm, with high-grade dysplasia, villous/tubu-lovillous histologic characteristics, or any combi-nation thereof. RESULTS: The colonoscopy founda cancer in 28 patients (30.1%). Cancer patientswere older (p5 0.007), more likely to be male(p5 0.025), and to present with anemia (po0.001)and unexplained weight loss (p5 0.003). Depres-sive mood predicted cancer diagnosis in women(p5 0.005), but not in men (p5 0.471). In regres-sion analyses both depressive mood and depres-sion�sex interaction predicted cancer diagnosis,even after adjusting for age, anemia, and unex-plained weight loss (p5 0.01 and 0.041, respec-tively, for depression and depression�sexinteraction). CONCLUSIONS: Results suggestthat depressive mood should not be interpreted asdecreasing the likelihood of cancer diagnosis inpatients presenting with clinical signs requiring acolonoscopy. On the contrary, even if depressivemood is frequent in irritable bowel syndromepatients, clinicians should consider depressivemood as increasing the likelihood of cancerdiagnosis when appraising the need for a colono-scopy, to search for colorectal cancer in women.

A-191

The Role of a Multimedia Computer-based Informa-

tional Intervention in Psychosocial Adjustment to

Breast Cancer: A Feasibility Study

Sophie Lauzier1, Ji Lu2, Carmen Loiselle1

School of Nursing, McGill University, Montreal,Quebec, Canada1, Desautels Faculty of Management,McGill University, Montreal, Quebec, Canada2

OBJECTIVES: A breast cancer diagnosis andensuing medical management disrupt many aspectsof a woman’s life and can be associated withsignificant levels of distress and uncertainty.Supportive interventions including targeted cancerinformation can enhance psychosocial adjustmentto cancer. In this feasibility study, we comparedpsychosocial adjustment, perceived informationalsupport and satisfaction with cancer informationbetween women newly diagnosed who eitherreceived usual care or a complementary compu-ter-based breast cancer informational intervention.METHOD: Using a quasi-experimental design, theintervention group (participants from three oncol-ogy clinics) was provided with access to theOncology InteractiveTM Educational Series - CD-ROM version - for 8 weeks as well as a list ofreputable websites and computer technician access.The control group received care and information asusual. Self-report measures of anxiety, depressive

symptoms, quality of life, informational supportand satisfaction were completed at enrolment, 1–2weeks post-intervention, and 3 months later.RESULTS: Two hundred and five women com-pleted the study (intervention group5 120; controlgroup5 85). Repeated-measure analyses of var-iance showed that, when compared to controls, theintervention significantly improved women’s satis-faction with cancer information over time(po0.001), prevented deterioration in physicalquality of life (p5 0.030) and marginally improvedperceived oncologist informational support(p5 0.051). There were no significant differencesin anxiety (p5 0.107), depressive symptoms(p5 0.823), mental quality of life (p5 0.231), orwell-being (p5 0.585). CONCLUSIONS: Compu-ter-based tools represent a promising means ofproviding timely information to large numbers ofindividuals facing cancer. These feasibility findingsprovide preliminary evidence that a high qualitymultimedia computer-based cancer informationalintervention can be supportive. A randomizedcontrolled trial is planned to document the extentto which the enhanced person-centred and clini-cally integrated web-based next OIES generation -the Oncology Interactive NavigatorTM (OIN) - canprovide complementary guidance for patients andfamilies throughout the cancer experience.

A-192

Parental Hope when Facing Poor Prognosis after a

Diagnosis of Childhood Cancer: A Prospective Study

Maru E. Barrera1, David Nicholas1, JennyShaheed1, Eve Brown1, Norma D’Agostino1, EricBouffet1, Laura Beaune1, Jocelyne Volpe1

The Hospital for Sick Children, Toronto, Ontario,Canada1, University of Calgary, Calgary, Alberta,Canada2, Princess Margaret Hospital, Toronto,Ontario, Canada3, The Hospital for Sick Children,Toronto, Ontario, Canada4, Princess MargaretHospital, Toronto, Ontario, Canada5, The Hospitalfor Sick Children, Toronto, Ontario, Canada6, TheHospital for Sick Children, Toronto, Ontario,Canada7, The Hospital for Sick Children, Toronto,Ontario,Canada8

OBJECTIVES: There is an emerging literatureexamining hope in caregivers in the context of a lifethreatening illness, specifically childhood cancer.Although the survival rate for children diagnosedwith cancer has dramatically improved in the lasttwo decades, there are still some children livingwith aggressive disease and poor prognosis. Thisstudy examines longitudinally and prospectivelyparental hope when the child has poor prognosis,for 18 months after diagnosis, considering thechild’s health status. METHOD: 35 parents (26mothers, 9 fathers) of 30 children with poor cancer


DOI: 10.1002/pon

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prognosis, diagnosed mainly with leukemia andbrain tumours, were interviewed individually at 3,6, 9, 12 and 18 months post-diagnosis. 22 parents’children were doing ‘well’ (curative treatment, hadno major complications); 13 parents’ children were‘not well’ (palliative treatment, had major compli-cations). Data from the first three periods (3, 6 & 9months) are presented. Grounded theory metho-dology was used. RESULTS: Parents describedhope as a positive force with expectations forfuture. Parents’ hope was linked to cure andpositive treatment outcomes if child was doingwell. If child was not doing well, hope was seen as amotivator and source of inner strength to enjoy‘the moment’. Means for maintaining hope overtime included: child health, positive demeanor,desire for normalcy, honest communication withhealth professionals, family and friends support,and parental spirituality and optimism. CONCLU-SIONS: This prospective study of parental hope,when their child had poor cancer prognosis andwas undergoing treatment, presents a complex,paradoxical, stable and yet changing concept ofhope. The various faces of hope were related tochild’s prognosis, treatment and health status,positive communication with and support fromthe health care team, parental spirituality andoptimism and their social network. These findingshave important clinical and policy implications,which will be thoroughly discussed.

A-193

Internal Consistency, Face and Construct Validity of

Empowerment-related Scales of the Health Educa-

tion Impact Questionnaire (heiQ) among Canadian

Cancer Patients/Survivors

Sophie Lauzier1, Elizabeth Maunsell3, SharonCampbell4, Richard Osborne2

School of Nursing, McGill University, Montreal,Quebec, Canada1, School of Health and SocialDevelopment, Deakin University, Melbourne,Australia2, Unite de recherche en sante des popula-tions, Social and Preventive Medicine, UniversiteLaval, Quebec, Quebec, Canada3, University ofWaterloo, Waterloo, Ontario, Canada4

OBJECTIVES: Empowerment in the context ofcancer may be described as feelings of being betterable to manage the disease experience, andrepresents a desired effect of information/supportinterventions. However, few empowerment mea-sures exist in the cancer field. We assessedreliability and validity among cancer patients/survivors of five Health Education Impact Ques-tionnaire scales (heiQ: originally developed forchronic diseases) that we considered relevant toempowerment: emotional well-being, construc-tive attitude, skill/technique acquisition, social

integration/support, health services navigation.METHOD: Individual debriefings were first con-ducted with patients/survivors to assess facevalidity. Then, patients/survivors diagnosed o27months earlier with different types of cancer wererandomly selected from the population-basedprovincial Manitoba Cancer Registry or recruitedamong users of the Canadian Cancer Society’stelephone support programs. Participants (n5 731)completed a mailed questionnaire including the fivechosen heiQ scales, other instruments measuringrelated constructs, and questions about personaland medical characteristics. RESULTS: Cronbachalpha (internal consistency) ranged from 0.76 to0.91. Using exploratory factor analysis with thenumber of factors specified, we obtained the samefactor structure as heiQ developers, except for oneitem. The vast majority of a priori hypothesesabout the direction and strength of correlationsbetween heiQ scales and validated measures ofconceptually linked constructs (self-efficacy, intru-sive thoughts about cancer, mental and physicalhealth, coping) were observed. CONCLUSIONS:The internal consistency and construct validity ofempowerment-related heiQ scales among English-speaking Canadian cancer patients/survivors aresupported. Assessing effects of interventions pro-viding information and support may requiremeasures more closely linked to anticipated inter-vention benefits. These heiQ scales are promisingmeasures that may detect desired interventioneffects not easily captured using more distaloutcomes like distress or quality of life. The heiQscales are currently being validated among French-speaking cancer patients/survivors in Quebec,Canada.

A-194

Contextualizing Illness: Exploring the Role of

Gender and Age in Young Adult Women’s Experi-

ences of Cancer

Meridith BurlesUniversity of Saskatchewan, Saskatoon, SK, Canada

OBJECTIVES: Although young adulthood is oftenthought of as a time of good health, approximately10,000 young adults will be diagnosed with cancereach year in Canada (Cancer Care Ontario 2006).However, insufficient research has examined theexperiences of young adults or identified thespecific issues that they face. In response to thisgap, I performed a qualitative study exploring theexperience of serious illness during young adult-hood, the findings of which will be described in thispresentation. METHOD: Using phenomenologicalinterviews and the visual method photovoice, Isought to understand what it is like to be ill fromthe perspectives of young women in their 20s and


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30s who were recently diagnosed with a seriousillness. Participants shared their stories of illness inin-depth interviews, and then were asked to takephotographs that captured further aspects of theirexperiences. Follow-up interviews allowed partici-pants to discuss the photographs that they pro-duced and their meanings. RESULTS: Focusingon the participants in the study who were affectedby cancer, I will describe how the young womenexperienced their illness in the context of socio-cultural understandings of age and gender. Theinterview and photographic data reveal that illnesswas disruptive to participants’ identities as youngadults and as women, leading them to re-examineexpectations for their lives. CONCLUSIONS: Theyoung women affected by cancer identified psycho-social issues related to the impact of illness on theirbodies, identities, and social roles, which werecontextualized by their life stage and gender. Thefindings support the recognition that illness isexperienced and given meaning in relation to thesocial characteristics of affected individuals.Further, the identification of psychosocial issuesspecific to young women can assist those involvedin providing health care and support services.

A-196

Breaking the Silence: Identifying Factors that

Contribute to the Stigmatization of Gynaecologic

Cancer

Meridith Burles1, Kristen Haase1

University of Saskatchewan, Saskatoon, Saskatchewan,Canada1, McGill University, Montreal, Quebec,Canada2

OBJECTIVES: While existing literature indicatesthat social stigma continues to be associated withcancer, there is little discussion of the varyingextent to which individuals affected by differenttypes of cancer encounter stigma. Informed bysociological theories of stigma, this presentationwill describe the findings of a review of the existingliterature on gynaecologic cancer and stigma with afocus on the factors that contribute to thestigmatization of women affected by this group ofcancers. METHOD: A systematic review of exist-ing literature on gynaecologic cancer and stigmawas performed in order to identify factors thatcontribute to stigmatization. Several academicdatabases were searched for journal articles thatreported research on gynaecologic cancers, includ-ing cervical, endometrial, ovarian, uterine, andvulval cancer. Articles selected for inclusion werethose that focused on women’s experiences ofgynaecologic cancer and the perception of stigma,difference, shame, and/or blame. RESULTS: Ex-isting research on gynaecologic cancer indicatesthat there are a number of factors that contribute

to stigmatization. Such factors include: the mysterysurrounding cancer in general, the poor prognosisand late diagnosis of some types of gynaecologiccancer, the association with sexuality and failure totake responsibility for one’s health, the silencesurrounding women’s reproductive health, and theimplications of gynaecologic cancer for women’sbodies and social roles. CONCLUSIONS: There isa need to increase awareness and informationabout gynaecologic cancer in order to decrease theextent that women affected by this group of cancersare stigmatized, as stigma can profoundly affectwomen’s everyday lives and psychosocial well-being. Awareness of the factors contributing tothe stigmatization of gynaecologic cancer can assisthealth care providers and others in understandingand supporting women and their families dealingwith such a cancer diagnosis.

A-201

Discord of Measurements in Assessing Depression of

African American Cancer Patients

Zhang Amy, Faye GaryCase Western reserve University, Cleveland,United States

OBJECTIVES: This study examines the consis-tency among the Center for Epidemiologic Stu-dies–Depression Scale (CES-D), the HamiltonRating Scale for Depression (HAM-D), the BeckDepression Inventory (BDI-II) and observer’srating in assessing depression of African Americancancer patients. METHOD: 75 breast and prostatecancer survivors (33 men and 42 women) wererecruited as a convenience sample, including 58African Americans (AA) and 17 Caucasians. Theywere interviewed for 40 to 60 minutes. The inter-views were audiotaped, transcribed and analyzed.The CES-D, HAM-D and BDI-II were adminis-tered and the interviewer’s rating of depression wasobtained. Nonparametric tests were performed.RESULTS: CES-D identified depression in Cau-casians more than HAM-D, BDI-II and observer’srating by 29%, 38% and 6%. CES-D alsoidentified depression in AA more than HAM-D,BDI-II and observer’s rating by 12%, 24% and9%, but under-identified 7% and 10% depressedAA than HAM-D and observer’s rating. Similarly,the observer’s rating identified more depressedCaucasians by 25% and AA by 9% and 22% thanHAM-D and BDI-II, but under-identified 9%depressed AA than HAM-D. CONCLUSIONS:The surprising finding is that CES-D as a screeningtool identified less depressive cases in AA thanHAM-D and observer’s rating. It is known that theCES-D and BDI-II emphasize affective symptoms,while HAM-D contains somatic symptoms and theobserver’s rating relies on nonverbal clues. The


DOI: 10.1002/pon

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study findings suggest that a certain symptomscaptured by observation and the HAM-D tap atdepressive manifestation unique to AA cancerpatients, reflecting their unique life experienceand culture.

A-209

Breaking Bad News in China: The Dilemma Between

Patients’ Rights to be Informed and Traditional

Norms. A First Communication Skills Training for

Chinese Oncologists

Lili Tang1, Alexander Wuensch2, Tanja Goelz2,Yening Zhang1, Sara Stubenrauch2, Lili Song1,Ye Hong1, Haiwei Zhang1

Key Laboratory of Carcinogenesis and TranslationalResearch (Ministry of Education), the Dept., ofPsycho-Oncology, Peking University School ofOncology, Beijing Cancer Hospital & Institute,Beijing, China1, Psychooncological Service of De-partment of Psychosomatic Medicine and Psycho-therapy & Department of Internal Medicine I(Hematology and Oncology), University HospitalFreiburg, Freiburg, Germany2

OBJECTIVES: Breaking bad news in China is todisclose information first to family members, whothen decide whether the patient should be in-formed. However, the patients right to be informedhas been laid down by law. Oncologists findthemselves in a dilemma and have to come upwith an appropriate way to respect cultural andlegal demands. This way should be conveyed incommunication skills training (CST) which havenot been established in China so far. METHOD: Afirst CST about breaking bad news took place atthe Beijing Cancer Hospital in April 2009. 31physicians were trained. The workshop includedinteractive presentations and role-play. To assesthe acceptance of the workshop we used estab-lished questionnaires assessing (i) the acceptance(by rating scale from 1–6) and (ii) the feeling ofcompetence of participating physicians before andafter the workshop (by VAS of 10 cm). RESULTS:The workshop worked well: (i) the overall evalua-tion was rated very good (mean5 1.2), the learningenvironment (m5 1.3), practice orientation(m5 1.4) and role play (m5 1.4) (selection). (ii)After the workshop the physicians felt more securein all domains, e.g. they had a higher theoreticalknowledge (13.9) and could apply it more easily(13.1), they felt more secure talking about deathwith the patient (12.1) and talking about prognosiswith the family (11.3). CONCLUSIONS: Theworkshop works also for Chinese culture. It showshigh acceptance and can improve the feeling ofcompetence of participating physicians in manydomains. However, it also shows that some ideashave to be better adapted to Chinese culture.Communication workshops can address important

issues of breaking bad news and can trigger morediscussion about finding the best way of breakingbad news in China.

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Individualized Communication Skills Training On

Explaining Clinical Trials In Oncology. Results of a

Randomized Controlled Trial

Alexander Wuensch1, Tanja Goelz2, HartmutBertz2, Michael Wirsching1, Kurt Fritzsche1

University Hospital Freiburg, Dept. of Psychoso-matic Medicine and Psychotherapy, Freiburg,Germany1, University Hospital Freiburg, Dept. ofInternal Medicine I (Hematology and Oncology),Freiburg, Germany2

OBJECTIVES: When oncologists disclose infor-mation about randomized clinical trials (RCT),they have to address requirements of high researchstandard and respect patients’ rights. This is one ofthe most difficult communication tasks and physi-cians lack adequate training. Only few Commu-nication Skills Training (CST) concerning thistopic have been developed. Results show the needfor further improvement: focusing on individualneeds of participants and evaluation in a rando-mized design. METHOD: We developed an in-dividualized CST, focusing on individual learninggoals derived from video-assessment, and inte-grated a coaching after the workshop. For evalua-tion, 40 physicians were randomly assigned totraining or waiting control group. Training successwas evaluated by blinded rater using a specificchecklist to evaluate video-recorded standardizedconsultations with actor-patients (1). The physi-cians’ feeling of competence in general (2), aftereach consultation (3) and the satisfaction of actor-patients (4) were assessed using questionnaires.RESULTS: (1) Objective evaluation show signifi-cant improvements in communication techniqueson content specific items (p5 0.001) and basiccommunication skills items (p5 0.038) assessed bya checklist. (2) Physicians rated their feeling ofcompetence significantly higher after the CST inmost items. (3) The feeling of competence aftereach single consultation was higher in the traininggroup. (4) Some significant improvements in theratings of actor-patients can be reported, e.g.explaining randomization. CONCLUSIONS: Theworkshop causes significant improvements in con-sultations concerned with disclosing informationabout clinical trials. The feeling of competence ofparticipating physicians can be increased. Theindividualized concept works well and providesinformation about how future training can befurther developed. The results of actor patientshave to be discussed and provide ideas on howfuture evaluation of those workshops can beimproved.


DOI: 10.1002/pon

Oral Abstracts S87

A-212

Reliability of the Hereditary Nonpolyposis Color-

ectal Cancer Self-concept Scale Assessed in Three

Countries

Helle Vendel Petersen1, Katarina Domanska2, Par-Ola Bendahl2, Jiahui Wong3, Christina Carlsson1,Mef Nilbert1, Mary-Jane Esplen3

Copenhagen University, Clinical Research Centre,Hvidovre Hospital, Copenhagen, Denmark1, LundUniversity, Department of Oncology, Lund,Sweden2, University Health Network, Division ofBehavorial Science and Health, Toronto, Toronto,Canada3

OBJECTIVES: Hereditary nonpolyposis colorectalcancer (HNPCC) renders high risks of colorectaland gynecological cancer and implies life-longsurveillance. Knowledge of an increased risk ofcancer offers possibilities for prevention, but mayalso influence self-perception and increase psycho-logical distress. A 20-item self-concept scale hasrecently been developed with the aim to captureHNPCC-specific psychosocial difficulties. We as-sessed the reliability of this instrument, using datafrom three HNPCC populations in Denmark,Canada, and Sweden. METHOD: Self-conceptscores were available from 591 individuals withHNPCC-predisposing germline mutations. Thesubgroups included 415 Danes, 108 Canadians,and 68 Swedes without differences in sex and agebetween the populations and with 43–63% beingaffected with cancer. ANOVA analyses were usedto test for differences in the subgroups and principalcomponent analysis was used to explain variance.RESULTS: Overall, the HNPCC self-concept scaleprovided similar results in the three countries,though differences were recognized for individualquestions. Danes expressed lower degrees of guilt,but more pronounced worries for cancer, whereasCanadians more often expressed feelings of isola-tion and loss of privacy. PCA analysis demon-strated that all 20 items contribute to variabilitywith questions related to gastrointestinal anxietybeing major determinants. CONCLUSIONS: TheHNPCC self-concept scale was found to be validand reliable. Subtle differences in feelings of guilt,worries for cancer, isolation, and loss of privacywere identified between the countries. All itemscontributed to the variation in scores with itemslinked to gastrointestinal anxiety central.

A-213

Combining Self-Report Levels of Impulsivity with

fMRI Among Smokers to Improve Lung Cancer

Prevention Approaches

Deborah Tang, Carmen G. Loiselle, Brian Hello,Lesley Fellows, Alain DagherMcGill University, Montreal, QC, Canada

OBJECTIVES: Smokers have higher levels of self-reported impulsivity than non-smokers. Objectivemeasures to further support these findings areneeded. The purpose of this study was to use fMRIto corroborate self-report impulsivity with neuralresponses to smoking cues, an objective proxy ofbehaviour. Because previous research has demon-strated that smokers are more responsive tosmoking cues, we hypothesize that increasedimpulsivity in smokers will be correlated with astronger neural response to cues. METHOD:Thirty-one smokers were recruited. Participantswere first administered the BIS/BAS, a self-reportmeasure of impulsivity. During fMRI, individualswatched videos that included smoking and non-smoking cues. We then generated brain maps forassessing differences in cue reactivity (smokingminus non-smoking) for each group and comparedthem using a priori brain Regions of Interest(ROI). ROI were based on a previous studyconducted by our lab using the presentation ofthe same smoking and non-smoking cues.RESULTS: As predicted, smokers who reportedhigher levels of impulsivity showed significantlygreater activation in response to smoking cues inbrain regions including the insula, middle frontalgyrus and anterior and posterior cingulate cortex.These brain regions have been previously asso-ciated with cigarette craving and self-monitoring ofbehaviour, suggesting that increased impulsivity isrelated to greater cigarette craving followingexposure to smoking cues. CONCLUSIONS: Agoal of psychosocial oncology research is toimprove cancer prevention by reducing highcancer-risk activities (i.e. Smoking). Additionalwork is needed to further document why andhow smoking persists despite well-known healthrisks. Our results suggest that, for instance,impulsive individuals should avoid smoking cuesto assist in boosting abstinence. Future work willcontinue using fMRI to better understand whatdrives craving and smoking choices, leading to thedesign of more targeted interventions.

A-216

Validation of an Empowerment Questionnaire in

Breast Cancer Survivors

Sanne van den Berg, Marieke Gielissen, JudithPrinsRadboud University Nijmegen Medical Centre,Nijmegen, Netherlands

OBJECTIVES: Research in the field of psychoso-cial oncology has done quite well in demonstratingproblems patients encounter during and aftercancer treatment, but research illuminating aspectsof patients own strengths towards these problems israre. The purpose of this study is to further defineand operationalize the construct of empowerment


DOI: 10.1002/pon

S88 Oral Abstracts

from the perspective of breast cancer survivors byvalidating an empowerment questionnaire.METHOD: In the Netherlands a questionnairehas been developed to measure Empowerment inpsychiatric patients. Empowerment is defined as aprocess in which patients (re)discover their ownpower, develop and augment this power and use itto the fullest potential. The questionnaire consist of40 items divided in six subscales: Health care,Social support, Self-esteem, Feeling connected,Self-management and Community support and atotal empowerment score. This questionnaire willbe validated in breast cancer survivors. RESULTS:This study involved non-metastatic breast cancerpatient who were treated with curative intent with amean of 5.5 years ago. Questionnaires werecompleted at home and 155 of the 258 breastcancer survivors returned them by mail (60%). Theresults of validation, such as content validity(factor-analysis), convergent and discriminant va-lidity (intercorrelations), internal consistency (re-liability, Cronbach’s alpha) will be presented at thecongress. CONCLUSIONS: By using the empow-erment questionnaire in routine oncology care,structural attention will be given not only toproblems (care as usual) but also to the resourcesof patients. In this way, patients strengths can bebuilt and not just their problems corrected.

A-229

Percentiles Curves: To Assess, Predict and

Characterize the Distress

Cristiane Sant’Anna Decat, Marco Murilo BusoCentro de Cancer de Brasılia (CETTRO), Brasılia,DF, Brazil

OBJECTIVES: Distress has been long identifiedand well documented as a significant issue forpatients with cancer over the years. Despite thisreality, less than 5% of distressed patients in busyclinics are recognized and receive any psychosocialtreatments. The goal of this study was to developan instrument based standard for individualassessment - percentiles curves of distress - toassess, compare and predict the distress in differentmoments of treatment. METHOD: A prospectivestudy was done to chart the percentiles curves ofdistress, using the data of patients, from July 2007to November 2009, from an oncology center,located in Brasilia, the capital of Brazil. A totalof 267 patients, between 14 and 86 years of age(M5 56), 35.6% male and 64.4% female, answeredthe Distress Thermometer (DT) in three distinctstages of the chemotherapy protocol: beginning,middle and last day of treatment. RESULTS: Thedistress found allowed the chart of the percentilescurve. Considering patients with severe distress, atthe beginning 61.80% were concentrated betweenthe distress 5 (percentile 50%) to 10 (percentile

99%). At the middle and at the last day, the curveprogressively decreased, 30.37% of the patientswere between the score 4 (percentile 75%) to 8(percentile 99%); and 18.24% were in the distress 5(percentile 90%), 6 (percentile 95%) and 8 (per-centile 99%), respectively. CONCLUSIONS:The percentiles curves make it easy to monitorthe distress during the pre-established stages in thetreatment, identifying not only those patients witha severe distress, but also those who are on theverge of having it. This deviation is especiallyimportant if the difference of the percentile occursoutside the existing standard in this sample. Thus,the health team may quickly identify and anticipateclinical problems, as it is worldly done with thegrowth curves.

A-235

Improving Decision-making In Ovarian Cancer:

Development And Evaluation Of Decision Aids To

Help Women Make Informed Treatment Choices

Ilona Juraskova1, Carissa Bonner1, GabriellaHeruc1, Caroline Anderson1, Kathryn Nattress2,Jonathan Carter2

Centre for Medical Psychology & Evidence-basedDecision-making (CeMPED), The University ofSydney, Sydney, NSW, Australia1, Sydney Gynae-cologic Oncology Group, Sydney Cancer Centre,Sydney South West Area Health Service, Sydney,NSW, Australia2

OBJECTIVES: Women with ovarian cancer (OC)face difficult treatment decisions with uncertainQoL and survival outcomes. Decision Aids (DAs)have been shown to improve informed decision-making, but no such tools are available to womenwith OC. Study 1 involves an RCT to evaluate theeffectiveness of a DA for asymptomatic womenwith rising CA-125 following initial treatment;Study 2 involves a pilot study to develop andassess a DA for women with resistant or refractoryOC. METHOD: In Study 1, 178 women arerandomised to receive either the DA or a generalCancer Council booklet, and complete standar-dised measures at baseline and 4-month follow-up.This DA helps women decide whether to startimmediate treatment or wait for further evidence ofcancer recurrence. In Study 2, 20 women providefeedback on the newly developed DA via aquestionnaire and telephone interview. This DAhelps women decide whether or not to continueactive treatment. RESULTS: Overview and currentprogress on both studies will be presented. CON-CLUSIONS: This research program addresses aneglected area in the management of women withOC. It is anticipated that the DAs will lead toimproved understanding of treatment options,reduced decisional conflict and regret, and in-creased satisfaction with the decision-making


DOI: 10.1002/pon

Oral Abstracts S89

process. If effective, this relatively simple interven-tion has the potential to improve the clinical care,and ultimately quality of life, of women with OC.

A-236

First Randomised Controlled Trial Of A Decision

Aid In A Clinical Trial Setting (IBIS-II)

Ilona Juraskova1, Phyllis Butow1, Ben Smith1,Margaret Seccombe2, Allan Coates2, Fran Boyle3,Nicole McCarthy4, Linda Reaby2, John F. Forbes2

Centre for Medical Psychology & Evidence-basedDecision-making (CeMPED), School of psychology,The University of Sydney, Sydney, NSW,Australia1, Australian New Zealand Breast CancerTrials Group (ANZ BCTG), The University ofNewcastle, Newcastle, NSW, Australia2, PamMcLean Cancer Communications Centre, The Uni-versity of Sydney, Sydney, NSW, Australia3,Department of Medical Oncology, Royal BrisbaneHospital, Brisbane, QLD, Australia4

OBJECTIVES: Recruitment to clinical trials isgenerally suboptimal, with both patients/consu-mers and clinicians reporting difficulties with theconsent process. Decision Aids (DAs), whichpresent evidence-based information in a cleargraphical form and facilitate participation indecision making, may improve this process byensuring patients/consumers make decisions thatare informed and value-sensitive. This RCTevaluated the efficacy of a DA for womenconsidering participation in the IBIS-II Preventiontrial for women at high risk of breast cancer.METHOD: Women eligible for IBIS-II, who hadnot decided about participation, were invited totake part in the DA study. Participants from 12Australian and New Zealand IBIS-II centres wererandomised to receive either the standard IBIS-IIinformation and consent materials alone (Controlgroup, n5 89), or in combination with a DAbooklet (DA group, n5 89). Participants com-pleted standardised and purpose-designed mea-sures 1 week and 3 months after deciding whetheror not to participate in IBIS-II. RESULTS: Themajority of women (84%) reported the DA made iteasier to understand IBIS-II than reading theinformation sheet alone, and 89% recommendedproviding both the DA and the information sheetto potential IBIS-II participants. No group differ-ences were detected in levels of decisional conflictor knowledge of IBIS-II/clinical trials in general,due to floor and ceiling effects respectively.Similarly, no group differences were found in levelsof decisional regret and satisfaction at 3-monthfollow-up. CONCLUSIONS: This is the first studyto assess the effectiveness of a DA in a clinical trialsetting. The use of DA was strongly endorsed byparticipating women and clinicians. Challenges ofevaluating DAs in a Prevention trial setting will be

discussed. An RCT of a DA for the DCISarm of IBIS-II is currently underway. The DAshave the potential to enhance the process ofinformed consent and reduce dropout rates inclinical trials.

A-237

What Information Do Cancer Genetic Counselees

Prioritize?

Afsaneh Roshanai1, Karin Nordin2, CharlottaIngvoldstad1, Claudia Lampic1, RichardRosenquist2

Department of Public Health and Caring Sciences,Uppsala University, Uppsala, Sweden1, Departmentof Public Health and Primary Health Care,University of Bergen, Bergen, Norway2, Departmentof Genetics and Pathology, Uppsala University,Uppsala, Sweden3

OBJECTIVES: The study objective was to explorecounselees’ expectations prior to the geneticcounseling, and the preferred issues to be discussedduring the first cancer genetic counselling session.Counselees had attended genetic counseling due toa personal and/or familial history of breast, breast/ovarian or colorectal cancer. METHOD: 110counselees attending the cancer genetic counsellingin 2009 constituted the study sample. The data wascollected using Q-methodology and the QUOTE-GENEca questionnaire. Counselees ranked 30items, based on the order of importance to them.The responses were forced onto a quasi-normaldistribution, asking the participants to identify the3 most important, 3 least important, 7 veryimportant, 7 next to least important and 10 itemsthat were neither important nor unimportant.RESULTS: The counselees expected the counsellorto be skilled, provide clear explanations and riskestimations. The most important issues for coun-selees were to receive regular clinical examinationsand information about symptoms that are impor-tant to be attentive to and seek further medicalfollow-up for. To receive general information ongenetics, to be reassured, discussing emotionalissues, and receiving supportive telephone calls orreceiving support in communication with relativeswas regarded as the least important topics.CONCLUSIONS: Unlike previously assumed,emotional and communicative difficultiesrelating to cancer genetic information, was notamong the most important issues for the counse-lees. The highest priority appeared to be thepractical aspects of the cancer susceptibility, sincethe counselees preferred to receive counsellingincluding medical and risk information and sugges-tions as how to reduce their risk. Receivingemotional support or help in communicating theinformation to at-risk relatives was regarded asleast important.


DOI: 10.1002/pon

S90 Oral Abstracts

A-239

Quality of Life, Emotional Distress, and Relationship

Adjustment in Spousal Caregivers of Primary Malig-

nant and Non-Malignant Brain Tumor Patients

Guy Pelletier1, Tracy Wormsbecker2, Sara Beattie3,Bejoy Thomas4

Alberta Health Services - Cancer Care, Departmentof Psychosocial Resources, Calgary, Canada1, Uni-versity of Calgary, Calgary, Canada2, Departmentof Psychology, University of Ottawa, Ottawa,Canada3, Department of Oncology, University ofcalgary;Alberta Health Services - Cancer Care,Department of Psychosocial Resources, Calgary,Canada4

OBJECTIVES: Primary brain tumors (PBT) aretreatable, but deemed incurable. The neurocogni-tive and psychosocial consequences of these dis-eases pose unique challenges for spousal caregivers,and declines in their quality of life (QOL)heightened emotional distress and relationshipproblems are well documented. However, there isonly scant evidence as to the extent and severity ofthese problems. This study explores this and someof their determinants in caregivers of malignantand non-malignant brain tumor patients. METH-OD: This cross-sectional study compares twosamples of convenience: spousal caregivers ofmalignant PBT patients (N5 32) and spousalcaregivers of non-malignant PBT patients(N5 27). The caregivers completed a demographicform and questionnaires on QOL (CQOL-C),emotional distress (BSI-18), and dyadic adjustment(DAS). Patients gave permission to extract demo-graphic and medical information from their med-ical files. Questionnaires were administered inperson or by mail, according to the participants’preferences. RESULTS: QOL and emotional dis-tress scores were significantly worse for caregiversof malignant PBT patients than for caregivers ofnon-malignant PBT patients, caregivers in otherpalliative cancer settings, and the general popula-tion. Relationship adjustment scores were compar-able between the two groups and not significantlydifferent from the validation sample of the ques-tionnaire. Emotional distress and dyadic satisfac-tion significantly predicted QOL outcomes.CONCLUSIONS: This is a first study comparingthe QOL, emotional adjustment, and dyadicadjustment of caregivers of patients with malignantand non-malignant PBTs. Caregivers of malignantbrain tumor patients experience greater distress anpoorer quality of life compared to caregivers ofnon-malignant brain tumor patients and to thestandardization samples of respective question-naires. Clinicians should monitor carefully thepsychosocial status of caregivers of malignantPBT patients, and all caregivers should be askedabout their satisfaction with their relationship.

A-245

Navigation and Survivorship Education Sessions

Josee CharleboisThe Ottawa Hospital Cancer Centre, Ottawa,Canada

OBJECTIVES: A study by The Canadian CancerSociety (2003) showed that 89% of patientsidentified a need to obtain general informationabout services. Oncology research highlights thatinformation needs are greatest at the time of initialdiagnosis and again after treatment. Moreover,increased knowledge improves general coping(McQuellon et al., 1998). For these reasons, wedeveloped two education sessions: One targets allnewly diagnosed patients (Navigation) and thesecond targets all patients finishing active treat-ments (Survivorship). METHOD: A literaturereview was conducted to determine the informationneeds of those initially diagnosed and thosecompleting treatments. Material, which will beshared during this presentation, was developed toensure the answers to these needs forming the basisof the hour long Navigation and Survivorshipsessions. Both sessions are held on a regular andongoing basis to ensure that all patients are able toattend. Community and clinic resources are alsoincluded in these sessions. RESULTS: Theliterature review showed that patients and theircaregivers need information about general services.i.e.: who to contact, where to go for emotionalsupport and how to deal with financial problems.These core needs were identified at both keyinformational time points and therefore providethe foundation for both the Navigation andSurvivorship educational sessions. The focusis on providing resources while normalizing experi-ences in the hope of improved general coping.CONCLUSIONS: Literature suggests that ourNavigation and Survivorship educationalsessions should improve patient’s and caregiver’sgeneral coping at the time of initial diagnosis andafter treatment. Furthermore, providing theseeducational sessions assists in the early identifica-tion of those patients who need more intenseintervention and facilitates referral to theappropriate professional earlier in the illnesstrajectory.

A-246

Initial Findings of a New Measure to Assess The

Unmet Psychosocial Needs of Adolescents and

Young Adults Who Have a Parent with Cancer

Pandora Patterson1, Angela Pearce1, PhyllisButow2, Kate White2

CanTeen Australia, Sydney, Australia1, Universityof Sydney, Sydney, Australia2


DOI: 10.1002/pon

Oral Abstracts S91

OBJECTIVES: This paper reports the developmentof the first comprehensive psychosocial needsmeasure for young people (12–24 yrs.) who havea parent with cancer - the Offspring Cancer NeedsInstrument (OCNI). Items were based on aprevious qualitative study and literature review.In this study, the psychometric properties of OCNIand the relationship between unmet needs andpsychological health were explored. METHOD:Young people aged 12 to 24 years who had aparent diagnosed with cancer within the past twoyears or currently on treatment were recruited tothe study. Participants were recruited throughmedical oncology centres and existing peer supportorganisations. Participants were asked to completea survey which included the 65 item OCNI (across6 conceptual domains) and a measure of depressionand anxiety (K-10). RESULTS: Unmet needdomains from highest to lowest were: informationabout parent’s cancer, family issues, ‘time-out’/recreation, support from friends and other youngpeople, dealing with feelings, and practical assis-tance. The top three unmet needs related toinformation. A strong positive correlation wasfound between the OCNI and psychologicaldistress scores, attesting to validity. The instrumentalso exhibits high reliability (Cronbach’s alpharanged from 0.90 to 0.95). Overall, depression andanxiety levels were elevated in this sample. CON-CLUSIONS: The development of the OCNI takesan important step towards redressing the dearth ofresearch into the psychosocial needs of youngpeople through direct needs-based research. In-formation on where needs are not currently beingmet by service providers will assist in qualityservice delivery, with the view to promoting healthand wellbeing outcomes for young people whoexperience the protracted illness of a parent whohas been diagnosed with cancer.

A-247

‘Breasts Do Not A Woman Make.’ Breast Cancer,

Femininity, and the Competitive Sport of Dragon

Boat Racing

Rhona M. ShawUniversity of Saskatchewan, Saskatoon, Canada

OBJECTIVES: Embedded within medical andpopular discourses on breast cancer is the beliefthat breast amputation is an emotionally devastat-ing experience that threatens women’s self identityas feminine/female. In contrast, the findings of thisstudy illustrate that not all women experiencebreast loss as a threat to their gender identities.Rather, for most women a stable identity offeminine/female remained, and for the women inthis study, their dragon boat racing experiencesalso played an important role in this experience.METHOD: A qualitative study involving

Grounded Theory, two data collection techniqueswere utilized. The first consisted of twenty-six (26)in-depth face-to-face interviews with members of abreast cancer survivor competitive dragon boatteam located in a mid-sized city in southwesternOntario. The second technique involved partici-pant observation that continued for five (5) yearsand involved multiple locales. RESULTS: Integralto the ways in which women responded to the lossof their breast was the importance that breasts hadfor women in regards to their self definitions asfeminine/female, how they physically experiencedtheir breasts, and the roles their breasts played intheir relationships with others. For these women,team membership exposed them to others who heldantithetical views concerning the loss of theirbreast, and whose self presentations reinforcedpopular representations of femininity. CONCLU-SIONS: Needed is a more thorough understandingof the complex ways in which some womenexperience the loss of their breast as a threat totheir sense of self as feminine or female while otherwomen do not, and to listen to women’s ownperspectives and concerns regarding their experi-ences of breast cancer.

A-248

‘I Look Forward To The Call’: Evaluation Of A

Telephone-Based Support Group

Allison Boyes1, Paula Vallentine2, Alison Zucca1,John Friedsam2

Centre for Health Research & Psycho-oncology(CHeRP), Cancer Council NSW, University ofNewcastle, Hunter Medical Research Institute,Newcastle, NSW, Australia1, Cancer Support Unit,Cancer Council NSW, Sydney, NSW, Australia2

OBJECTIVES: The use of emotional and socialsupport interventions, such as support groups, canfacilitate positive adjustment amongst those af-fected by cancer. Interest in telephone-basedsupport groups (TSG) is increasing, and these arenow being offered as an alternative to traditionalface-to-face support groups. We assessed theCancer Council NSW telephone support groupsto determine their acceptability to participants andfacilitators, impact on participants’ psychosocialwellbeing, and levels of burnout amongst groupfacilitators. METHOD: 136 TSG members (14former, 82 current, 39 new) completed a computer-assisted telephone interview assessing utility (re-ferral sources, reasons for joining the group) andacceptability (structure, content, leadership, be-tween-member support and overall satisfaction) ofthe groups. New members also completed a surveyassessing their psychosocial wellbeing before parti-cipating in their first group session and again 12weeks later. All 11 group facilitators completed aburnout survey and interview exploring their


DOI: 10.1002/pon

S92 Oral Abstracts

experiences of the groups. RESULTS: Lack ofaccess to face-to-face support groups was the mainreason for members participating in TSG. Therewas a significant reduction in new members’ levelsof depression (p5 0.013), and improvement inoverall mental health (p5 0.023) and emotional/informational support (p5 0.031) from pre- topost-group assessment. Members praised the TSGservice and 96% would recommend it to others.Although facilitators identified challenges (work-load, skills, group size), they reported significantlylower levels of burnout compared to referencevalues. CONCLUSIONS: TSG is highly acceptableto people affected by cancer. Preliminary evidenceusing a quasi-experimental design suggests TSGmay contribute to improvements in some aspects ofemotional wellbeing. These findings emphasise thevalue of including telephone-based support groupsas part of the suite of supportive care servicesavailable to people affected by cancer. Attentionshould be directed to selecting, training andsupporting group facilitators given their criticalrole in the success or not of the group.

A-253

OMSORG - Dealing With BereavementImplemen-

tation of Training Groups for Bereaved Children in

Public School Settings in Denmark

Per Bøge1, Jes Dige1

Danish Cancer Society, Copenhagen, Denmark1,Danish Cancer Society, Aalborg, Denmark2

OBJECTIVES: A very efficient way of helpingbereaved children in coping with the sad feelings ofloss and despair is to establish Training Groupslead by one or two responsible adults. In the groupthe children can meet with peers who are in asituation very similar to their own. They can listento one another, discus similarities, differences andproblems. For once they can be in a forum whereeveryone can say: ‘I know exactly how you feel’.METHOD: Since the start in the early 90’s theDanish Cancer Society has managed to establishmore than 200 training groups nationwide. Stillthis is far too few to meet children’s needs, but it isa successful beginning. As a consequence of this wehave just finished a two years pretesting pro-gramme on the benefits of implementing theTraining Groups into Public School settings.RESULTS: One of the basic conditions in workingwith children in loss and grief is that theresponsible adult person involved in the child’sunbearable situation makes space for the child tobe heard, seen and understood. For many reasonsthe Primary Schoolteachers are such persons. Andthe results of the pretesting clearly states the factthat schools in many ways are the perfect forum forrunning Training Groups for bereaved children.CONCLUSIONS: Every year more than 2,500

Danish children under the age of 18 experience theloss of a parent by death. Another 42,000 childrenexperience that their mum or dad is acutehospitalized with a severe illness. These childrenare in great need of adult help. Therefore it is ourgoal that within 10 years time, at least 50 percent ofall Danish Public Schools has established one - ormore - training groups for bereaved students.

A-259

Improving Communication During The Transition

To Palliative Care In Oncology: A Concise And

Individualized Communication Skills Training

Demonstrates Content Specific Effects In A Rando-

mized Controlled Trial

Tanja Goelz1, Alexander Wuensch2, SaraStubenrauch1, Marcelo de Figueiredo1, HartmutBertz1, Michael Wirsching2, Kurt Fritzsche2

Department of Internal Medicine I, UniversityHospital Freiburg, Freiburg, Germany1, Departmentof Psychosomatic Medicine and Psychotherapy,University Hospital Freiburg, Freiburg, Germany2

OBJECTIVES: Improving communication skills inconsultations addressing the transition from cura-tive to palliative care is necessary. Patients andrelatives want to be informed about medical issuesand need emotional care from their oncologists.However, physicians experience these consultationsas difficult and distressing and lack communicationskills training on this topic. We therefore con-ceptualized a content specific but individualizedcommunication skills training (CST) addressing thechallenges of the transition to palliative care.METHOD: The CST focuses on learning goals ofparticipants derived from video assessment. Thesewere the basis for practicing communication skillsin role play in a 1.5 day workshop plus a coachingafterwards. The CST was evaluated in a RCT with41 physicians with little/no CST experience. Objec-tive evaluation was achieved by ratings of con-sultations with actor patients. Blind raters used atarget-oriented checklist (COM-ON-Checklist).Two standardized scenarios were analyzed: acuteand chronic palliative situation. RESULTS: Theobjective evaluation of the effects of our CST inconsultations with actor patients using the COM-ON-Checklist shows significant improvement ofthe training group on content specific items(p5 0.02). Concerning basic communication skills,we found no significant effect. There are hypoth-eses that factors like setting or length of theconsultation modify results. Detailed analyses willbe presented. CONCLUSIONS: Our CST ad-dresses a crucial and difficult issue in physician-patient communication: the transition to palliativecare. With a duration of 1.5 days it is quite shortand focuses strongly on individual learning goals.Nevertheless, it proves to be effective in RCTs in


DOI: 10.1002/pon

Oral Abstracts S93

improving content specific communication skills ofphysicians rather inexperienced in CST. We con-clude that it is also possible to practice commu-nication skills concerning difficult topics, for whichphysicians feel that they require training.

A-260

Presymptomatic Genetic Testing in Minors: The

Experience of Preparatory Consultations

Khadija Lahlou-Laforet1, Silla M. Consoli2,Xavier Jeunemaitre3, Anne-Paule Gimenez-Roqueplo4

AP-HP, Hopital Europeen Georges Pompidou,Consultation multidisciplinaire d’oncogenetique destumeurs endocrines - Service de Psychologie Cliniqueet Psychiatrie de Liaison, Paris, France1, APHP,Hopital Europeen Georges Pompidou - Service dePsychologie Clinique et Psychiatrie de Liaison -Universite Paris Descartes, Paris, France2, APHP,Hopital Europeen Georges Pompidou, Departementde Genetique, Universite Paris Descartes, Paris,France3, APHP, Hopital Europeen GeorgesPompidou, Consultation multidisciplinaire d’onco-genetique des tumeurs endocrines - Departement deGenetique, Universite Paris Descartes, Paris,France4

OBJECTIVES: Presymptomatic genetic testing inminors is based on an immediate medical benefit.Testing procedure influences the psychologicalimpact. In our multidisciplinary approach we haveintroduced preparatory consultations for parents,aimed at thinking about the decision to realise thetest for their child. The second step is theconsultation with the minor and blood sampling,when he/she agrees. During the third step, thegenetician announces the result to the minor andhis parents. METHOD: Our multidisciplinaryteam undertook presymptomatic testing for 30minors (mean age5 9.9874.92 years) at risk forneuroendocrine tumors. Eighteen minors weretested (15 have already received the result). Theprocedure is ongoing for 12 children. We per-formed a preliminary retrospective qualitativeanalysis of the course of these 30 procedures inthe aim to define criteria for ‘good proceedings’,limiting the traumatic impact of the result.RESULTS: We identified four criteria: 1- Decisionis taken by both parents when they are ready toperform the test for their child; 2- Parents receiveadvice on the way to talk to their child about thehereditary disease; 3- Appropriate time for testingis discussed for each child, taking into accountmedical benefits, minor’s school and personalschedules; 4- Periods of medical examinations oruncertainty for the carrier parent are avoided.CONCLUSIONS: Our experience regarding pre-symptomatic genetic testing in minors led us to givean important focus on the preparatory step with

the parents. Preparatory consultations aimed at theparents provide them with the possibility to thinkabout their decision and to accompany theirchildren during the procedure of genetic testing.The four criteria above-mentioned should beevaluated in a further prospective study, aspotential predictors of emotional acceptance ofthe test result.

A-262

Intuitive Expectation and Emotional Impact of

Genetic Testing in Hereditary Endocrine Tumors

Khadija Lahlou-Laforet1, Anne-Paule Gimenez-Roquelo2, Xavier Jeunemaitre3, Silla Consoli4

AP-HP Hopital Europeen Georges Pompidou -Consultation multidisciplinaire d’oncogenetique destumeurs endocrines - Service de Psychologie Cliniqueet Psychiatrie de Liaison, Paris, France1, AP-HPHopital Europeen Georges Pompidou - Consultationmultidisciplinaire d’oncogenetique des tumeursendocrines - Departement de Genetique - UniversiteParis Descartes, Paris, France2, AP-HP HopitalEuropeen Georges Pompidou - Departement deGenetique - Universite Paris Descartes, Paris,France3, AP-HP Hopital Europeen GeorgesPompidou - Service de Psychologie Clinique etPsychiatrie de Liaison, Universite Paris Descartes,Paris, France4

OBJECTIVES: Paragangliomas and pheochromo-cytomas are rare neuroendocrine tumors, inheritedin 30% of cases. The hereditary form of the diseaseis characterized by an early onset with a higher riskof recurrency and/or malignancy. Genetic testingof patients and their families opens to earlierdiagnosis and treatment of asymptomatic tumorsin mutation carriers, but has also an emotionalimpact. Our study aimed at evaluating emotionalimpact of genetic testing in patients met duringoncogenetic multidisciplinary consultations.METHOD: Baseline state and trait-anxiety(STAI), depression (BDI-13) and intuitive expecta-tion of being carrier of the mutation (evaluated bya question), were assessed before the blood samplein 50 consecutive subjects (17 males, 33 females,mean age 44.2714.9 years, 31 index cases and 19relatives). A second assessment of state-anxiety,depression and traumatic impact of the announce-ment (IES-R) was performed directly after thedefinitive test result. RESULTS: 50 subjects wereinvolved in the first assessment and 38 in thesecond. Psychological scores were not associatedwith subject’s status (index case or relative).Intuitive expectation before the blood sample wasnot associated with psychological scores. Nopsychological score was associated with the testresult. Final state-anxiety was higher than initial(po0.001). A higher score of IES-R was found insubjects who expected to be carriers (p5 0.009),


DOI: 10.1002/pon

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even after adjusting for the result. CONCLU-SIONS: The statistical risk of being a mutationcarrier is 50% (autosomal dominant model), buteach subject perceives this risk with his ownintuitive expectation. Our data encourage toevaluate the intuitive expectation of being amutation carrier before the test. This sub-groupmay have a higher emotional impact of the testresult, independently of the nature of the result.

A-264

Delirium: Epidemiology and Risk Factors in Early

Pos-op of Head and Neck Cancer Patients

Andreia Ribeiro, Zaida Pires, Cristina Vale, LuciaMonteiroLisbon Oncology Institute, Lisbon, Portugal

OBJECTIVES: The authors’ main goals are todetermine incidence in early pos-op (1st 14 days) ofHead and Neck and ORL cancer patients in anOncology Institute and identify risk factors andtheir prevalence. Secondary goals are socio-demo-graphic profile of study population and character-ization of delirium time of onset, duration andcourse. METHOD: Prospective Cohort Study,including all adult patients admitted for electivesurgery, in H&N and ORL wards, from 1 January2010 until it’s reached a total of 274 patients. Thispopulation will be characterized and evaluatedaccording to the authors’ protocol variables by theinvestigation team. Patients who develop deliriumwill be selected as cases and will be furtherevaluated during hospitalization and at discharge.Those with partial delirium remission will befollowed up as outpatient. RESULTS: The authorsstarted recruiting the sample at January 1st andexpect to reach the end point in a 4 months period.The data will be analyzed by descriptive statisticalmethods and applied chi2 test. Multivariablelogistic regression model will be used to test thepredictive variables. CONCLUSIONS: Delirium isan organic neuropsychiatric entity that reflects aglobal cerebral dysfunction. It requires a clinicaldiagnosis with multiple organic evaluations. Usual-ly with an acute onset and fluctuating course, itincreases morbid-mortality in H&N patients. Un-diagnosed cases reach 66%. Correction of under-lying etiological factors can reverse the course ofthis syndrome, with total symptoms remission. Thestudy’s data will allow prevention, earlier diagnosisand better clinical management in this population.

A-266

Developing a sense of Meaning and Hope in Cancer

Patients through Hypnosis.

Teresa Tupholme1, Rosario Bacalhau1

Portuguese Institute of Oncology, Lisbon, Portugal1,Portuguese Institute of Oncology, Lisbon, Portugal2

OBJECTIVES: For several years we have foundthat some patients undergoing psychotherapeuticinterventions incorporating cognitive-behaviouraland psychopharmacological interventions experi-ence several relapses. This study aimed to examinethe effect of incorporating hypnotherapy techni-ques which go beyond the thinking rational mindto explore patient’s deep personal intrapsychicissues through self discovery (having a glimpse ofthe authentic self, experiencing strong emotionalrelease and achieving new levels of mastery)ultimately helping the patient to discover his/hermeaning and purpose. METHOD: The followinghypnotic techniques were integrated into theexisting psychotherapeutic interventions; Inducingrelaxation and teaching Self-Hypnosis, Egostrengthening (dealing with feelings of guilt, self-blame,hopelessness, loss of self-esteem), Imagery(to strengthen adaptation mechanisms, inducepositive feeling states, release of strong repressedemotions like anger, hurt and to bolster self-controland hope) Gestalt in Trance (verbalizing feelingsthat need to be expressed) finding ‘The HealerWithin’ (to fuel a sense of personal power andmeaning). RESULTS: A sample of 6 cancerpatients with ongoing psychotherapeutic interven-tions and subsequent relapses was chosen.(Although these patients have learned to rationa-lize, and can generate alternatives, they still cannotresolve meaningful family communications, reveal-ing high levels of distress, depression, anxiety andanger (Emotion Thermometers Tool, Mitchell etal., 2007). Hypnosis implemented over the last 3months has provided a new technique for uncover-ing repressed material, helping these patientsachieve new levels of mastery hope and meaning.CONCLUSIONS: Adjunctive hypnotic treatmentof cancer should be integrated into existingpsychotherapeutic interventions to assist in theuniquely personal adjustments each patient has tomake to his illness. Through Hypnosis patients canengage in magical thinking and experience ‘strongemotional release ‘which they could not allowthemselves in more cognitively oriented therapy.Patients can learn to transcend many of theirnegative conditions,reaffirming the integrity oftheir self-image and finding a sense of ultimatemeaning in their suffering.

A-271

Emotional Adjustment and Coping in Elderly

Couples During Prostate Cancer Treatment

Sylvie Petit1, Jean Bouisson2, Anaıs Lafaye2,Florence Cousson-Gelie2, Joel Swendsen3

CNRS- EPHE-UMR 5231, Bordeaux, Aquitaine,France1, EA 4139-Laboratoire de psychologie,Bordeaux2, Aquitaine, France2, CNRS- UMR5231, Bordeaux, Aquitaine, France3


DOI: 10.1002/pon

Oral Abstracts S95

OBJECTIVES: Old age is characterized by increas-ing difficulties in coping with stressful events and inthe onset of certain diseases, such as prostatecancer. However, few studies have been able todirectly examine the daily behaviors and emotionalexperience of couples during treatment for thiscondition. The aim of the present research is toexamine coping strategies used by elderly spousesto cope with prostate cancer treatment usingambulatory assessment methods. METHOD: Thecurrent study examines data from the daily lives of96 elderly French couples using the ExperienceSampling Method (ESM). Participants completed 3assessments per day over three distinct 4-dayperiods (beginning, middle, and end of radiationtreatment). The principal advantages of ESM arethat it allows researchers to establish the temporalrelationship between coping strategies, anxiety anddepression, and to examine both effects betweensubjects and within the couple. RESULTS: Multi-level regression analyses demonstrated that usingemotion-focused coping increased psychologicaldistress for both patients and spouses, and thatproblem focused coping decreased happiness inpatients. Concerning coping strategies within cou-ples, spouses used less emotion-focused copingstrategies than patients during treatment, but usedmore problem-focused coping and social supportseeking (particularly at the beginning of treat-ment). CONCLUSIONS: This study was fundedby the National League for the Fight againstCancer, France, and contributes to understandingemotional adjustment and quality of life in patientsand their spouses faced with prostate cancer. Thefindings underscore the importance of taking intoaccount the couple in developing psychologicalinterventions or supportive strategies.

A-272

Is it Possible to Improve Residents’ Breaking Bad

News Skills in a Simulated Three-Person Consulta-

tion? A Randomized Study Assessing the Efficacy of

a Communication Skills Training Program

Aurore Lienard1, Isabelle Merckaert2, YvesLibert1, Isabelle Bragard3, Nicole Delvaux4,Anne-Marie Etienne3, Serge Marchal5, JulieMeunier5, Christine Reynaert6, Jean-LouisSlachmuylder5, Darius Razavi2

Institut Jules Bordet, Bruxelles, Belgium1, Univer-site Libre de Bruxelles, Bruxelles, Belgium2, Uni-versite de Liege, Liege, Belgium3, Hopital Erasme,Bruxelles, Belgium4, C.A.M. training and researchgroup, Bruxelles, Belgium5, Universite Catholique deLouvain, Louvain-La-Neuve, Belgium6

OBJECTIVES: Although patients with cancer areoften accompanied by a relative during breakingbad news consultations, little is known regardingthe efficacy of training programs designed to teach

residents the communication skills needed tobreak bad news in a three-person consultation.METHOD: Residents were randomly assigned to a40-hour training program or to a waiting list.A breaking bad news simulated three-personconsultation was audiotaped at baseline and aftertraining for the training group, and 8 months afterbaseline for the waiting-list group. Transcripts wereanalysed by tagging used communication skillswith a content analysis software (LaComm) and bytagging phases of bad news delivery: pre-delivery,delivery and post-delivery. Training effects weretested with GEE and MANOVA. RESULTS:Ninety-five residents were included. Trained resi-dents used more assessment (RR5 1.83; po0.001),and more supportive utterances (RR5 1.58;po0.001) than untrained residents. The simulatedpatient and simulated relative who interacted withtrained resident used more psychological words(RR5 1.88; po0.001 and RR5 1.80; po0.001).Duration of the pre-delivery phase was longer fortrained (1min 6 s, at baseline and 2min 9 s, aftertraining) compared with untrained residents (1min22 s, at baseline and 52 s, eight months afterbaseline) (po0.001). CONCLUSIONS: This studyshows the efficacy of a training program designedto improve residents’ breaking bad news skills in athree-person consultation. After training, residents’communication becomes more centred on thesimulated patient and relative, and allows them toexpress more concerns. This type of trainingprogram should therefore be included in residentcurriculum.

A-275

A Large Scale Pragmatic Validation of the HADS

for Major Depression in an Ethnically Diverse

Cancer Population

Alex J Mitchell1, Karen Lord1, Elena Baker-Glenn2, Paul Symonds1

University of Leicester, Leicester, United Kingdom1,Nottinghamshire Healthcare NHS Trust, Nottingham,United Kingdom2

OBJECTIVES: There is considerable interest in theaccuracy of the Hospital Anxiety and DepressionScale in cancer. The HADS is the single mostcommonly applied tool for depression, tested todate in 22 analyses against major depressivedisorder (MDD). However, only one previousstudy had a sample size over 300 (Walker et al.2007 J Psychosom Res 63: 83–91). METHOD: Weanalysed data collected from Leicester CancerCentre from 2007–2009 involving approximately1000 people approached by a research nurse,research physician and two therapeutic radio-graphers. The researcher applied DSMIV criteriaof major depressive disorder (MDD). We collatedfull data on 690 patient assessments of whom


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12.9% had MDD, 121 were palliative and 115(16.7%) were from ethnic minorities (largelyBritish South Asian of India descent). RESULTS:Sensitivity and specificity were as follows HADS-A87.6%/72.3; HADS-D 86.5%/80.1% and HADS-T95.5%/76.3%. The AUC was highest for HADS-T4HADS-D4HADS-A. In ethnic minorities sen-sitivity and specificity were as follows HADS-A93.1%/66.3%; HADS-D 86.2%/65.1% andHADS-T 96.6%/66.3%. AUC was poor forthe HADS-D from the ethnic group andHADS-A/HADS-T were preferred. There was nodifference by cancer stage. CONCLUSIONS: This isthe largest validation study of the HADS in cancerand suggests that in an ethnically diverse populationthe HADS-T may be the optimal version based onaccuracy alone; regardless of cancer stage. TheHADS-D may have weaker validity in patients fromethnic minority populations.

A-276

A Large Scale Validation of the Emotion Thermo-

meters as a Screening Tool for Major Depression in

an Ethnically Diverse Cancer Population



OBJECTIVES: We previously reported initialvalidation of the Emotion Thermometers a simple5-domain visual analogue scale inspired by theDistress Thermometer (Psychooncology. 2009 Mar18; Epub). We aimed to report more definitivevalidation in a large ethnically diverse sampleagainst DSMIV criteria of major depressive dis-order (MDD). METHOD: We analysed datacollected from Leicester Cancer Centre from2007–2009 involving approximately 1000 peopleapproached by a research nurse, research physicianand two therapeutic radiographers. The researcherapplied criteria for MDD. We collated full data on660 patient assessments of whom 12.9% had MDDand 14.8 were from ethnic minorities (largelyBritish South Asian of India descent). RESULTS:Sensitivity, specificity and AUC were as followsDT - 82.4%; 68.6%, 0.811; AnxT - 85.9%; 56.2%,0.774; DepT - 80.0%; 78.2%, 0.853; AngT - 83.5%; 66.1%, 0.782 and HelpT -68.2%; 79.1%, 0.799. Inthe ethnic minority DepT results were 80.0%;69.4%; 0.770. Thus in the parent sample the DepTwas the optimal thermometer for screening fordepression. However the DepT lacked specificity inthe BSA population and thus the DT was superior.CONCLUSIONS: This is the largest validationstudy of the ET in cancer and suggests that in mostsettings including ethnically diverse population theDepT may be the optimal thermometer stage.

However when screening exclusively in ethnicminorities additional care must be taken andincreasing emphasis may be placed upon distress.

A-278

The Role Of Primary Care In Cancer Care: The

Views And Experiences Of Patients And Family

Members

Eila Watson1, Eike Adams1, Mary Boulton1, PeterRose2, Alison Richardson3, Susi Lund4, SueWilson5, Bill Savage6, John Belcher7, AnnetteRauf6

Oxford Brookes University, Oxford, UnitedKingdom1, University of Oxford, Oxford, UnitedKingdom2, University of Southampton, Southamp-ton, United Kingdom3, East Berkshire Primary CareTrust, East Berkshire, United Kingdom4, Universityof Birmingham, Birmingham, United Kingdom5,Thames Valley Cancer Network, Oxford, UnitedKingdom6, Macmillan Cancer Support, Manchester,United Kingdom7

OBJECTIVES: In the UK the role of primary carein the provision of cancer care is poorly defined.Practices are offered a financial incentive toconduct a review with new patients within sixmonths of diagnosis, but the extent to which theseoccur and the scope and perceived usefulness isunknown. The purpose of this study was to explorethe role of primary care in caring for andsupporting patients with cancer and their families.METHOD: Semi-structured interviews were con-ducted with 38 patients, diagnosed within the lastthree years, and 24 family members. Patients werestratified by time since diagnosis, and a maximumvariation sampling strategy was employed toachieve heterogeneity in terms of cancer type andsocio-demographic variables. We interviewed 19males and 19 females, with a range of 14 differentcancers. Patients were invited to ask their partner/relative if they would like to participate in thestudy. RESULTS: Most patients were unaware ofhaving had a review of their cancer-related care,despite records indicating the contrary. Whilstsome participants were satisfied with the care theyhad received, others felt isolated following treat-ment completion and most would have welcomedpro-active involvement from their GP practice anda formal review. Preferences varied regardingoptimal timing, content and mode of delivery forthis review. Some family members expressed apreference for greater inclusion. CONCLUSIONS:Although patients and family members can see animportant role for primary care in providing cancerfollow-up care this is not universally beingdelivered at present and there is real scope forimproving practice in this area. Providing GPs withguidance on conducting a structured review, which


DOI: 10.1002/pon

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covers areas important to patients and families,may be a useful way forward.

A-280

Soul Medicine In Cancer Treatment

Helen BattlerLondon Health Sciences Centre, London, Ontario,Canada

OBJECTIVES: To present on the development,implementation and evaluation of a Spiritual Caresupport group providing ‘Soul Medicine’ to aug-ment physical treatment. Soul Medicine draws ondiverse spiritual/wisdom traditions for group andindividual experiential processes that foster emo-tional/spiritual resilience. Participants’ experiencesof these right brain orientated processes reveal thatthe journey towards a sense of personal wholeness/inner wisdom has an ultimate value that even cure,in and of itself, does not guarantee. METHOD:Groups provide same gender peer support. Experi-ential processes include meditation, mindfulnesspractice, collaging, image work, dreamwork, story,poems, alongside more standard processes of groupsharing, paired dialogue and readings. The multi-dimensional group process enhances right brain/spiritual resiliencies where individuals experiencetheir innate wisdom/strengths that are untouchedby cancer. The Patient Dignity Inventory [1] astandardized, peer-reviewed tool is used as amarker by individuals at the beginning and endto evaluate subjective changes. RESULTS: Out-comes will presented through story, participant’scollages and summary of evaluation data includinganalysis of PDI findings. Participants discover theycan relate differently with fear, depression, hope-lessness, anxiety, uncertainty and mortality actu-ally turning those experiences into ‘teachers’ thatcompel them to live more full, enriching lives.Participants also report significant changes in theirrelationship with the cancer itself. CONCLU-SIONS: Soul Medicine is critical to cancer treat-ment by integrating image and body orientatedexperiential processes to activate spiritual dyna-misms such as:

body-mind awarenessintuitionnon-dual wisdommindfulness practisepresent moment awarenessinterconnectedness with life’s web beyond se-paration/isolation

These change individual’s capacity to live withemotional/spiritual challenges of cancer. Cancerbecomes a catalyst for accessing inner strengths/wisdom fostering personal meaning/hope. ‘Soul

medicine’ is an invaluable component in cancertreatment and survivorship.

A-288

Transforming the Experience of Cancer Care:

Evaluation of a Hospital-Based Volunteer Psycho-

social Support Service

Rinat Nissim, Robin Forbes, Rebecca Wong,Camilla Zimmermann, Anne Rydall, AndreaChan, Gary RodinUniversity Health Network, Toronto, Ontario,Canada

OBJECTIVES: Volunteer support may help bothcancer patients and their caregivers to better copewith the disease and its treatment. The presentstudy was designed to evaluate an innovativehospital-based volunteer psychosocial support ser-vice, and to identify specific dimensions of volun-teer support that patients and their informalcaregivers find most helpful. METHOD: A patientsurvey evaluating the specialized volunteer servicewas conducted five months after its introductioninto the Radiation Clinic. All patients attending theclinic were asked by a research assistant tocomplete a demographic questionnaire and asurvey of satisfaction with care provided byvolunteers in the clinic. In addition, daily shiftlogs were collected from clinic volunteers, in whichthey described their interactions with patients andcaregivers during their shifts. RESULTS: Of 182patients, 93 (51%) recalled meeting a volunteer,with whom most (54%) spent 10–30minutes. Basedon 1595 interactions documented by 33 volunteers,most interactions (88%) were initiated by volun-teers and most included both patient and informalcaregivers (52%). Over 85% of men and of womenreported benefit from these interactions, althoughmen placed more value on informational supportand women on emotional support (po0.05).CONCLUSIONS: Specialized psychosocial sup-port provided by trained volunteers is equallyvalued by male and female cancer patients,although there are gender differences in the typeof support received or identified. Further researchis needed, but these findings suggest that psycho-social support provided by trained volunteers couldbe an effective component of best practice guide-lines for psychosocial care in cancer treatmentcenters.

A-293

Patients’ Evaluation of Psycho-Oncological Care in

Certified Breast Centers in Germany

Juergen M. Giesler, Joachim WeisTumor Biology Center Freiburg, Freiburg, Germany


DOI: 10.1002/pon

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OBJECTIVES: Current national guidelines require‘Certified Breast Centers’ (CBCs) in Germany tooffer psychological support during all stages ofbreast cancer treatment. Being part of a largerresearch project on the quality of psycho-oncolo-gical care, the present study intended to determinewhich sorts of psycho-oncological care are actuallyoffered in these centers and how they are used andevaluated by their patients. METHOD: In 2008,218 locations (clinics) constituting 174 differentCBCs were listed as fulfilling the standards of theGerman Cancer Society and the certifying agency,OnkoZert. From 80 of these locations 975 breastcancer patients could be recruited to answer aquestionnaire asking, e.g. whether they had beenoffered psycho-oncological support, how muchsupport they had received, and how satisfied theyhad been with it. Data analysis used frequencycounts, correlations, and comparisons of means.RESULTS: Patients’ mean age was 55 years. 86%of them had been diagnosed with cancer for thefirst time. 80% had been informed about thepossibility of receiving psycho-oncological support,with the psycho-oncologist being the main sourceof information (55%). Individual support aimingat emotional relieve proved to be the most frequentform of support (43%). Contact with members ofself-help groups was rare, however (10%). Gen-erally, patients were satisfied with the amount ofsupport received. CONCLUSIONS: Results sug-gest that psycho-oncological care is being madeavailable for a significant proportion of thepatients of CBCs in Germany and that it isevaluated positively by those making use of it. Atthe same time, informing a higher percentage ofpatients about the option of psycho-oncologicalsupport, informing about the possibility to contactmembers of self-help groups, and expandingsupport options to include group and educationformats appear to be tasks for the future.

A-299

Patient Experience of Total Gastrectomy Surgery:

Factors Involved in Decision-making, Treatment

Impact and Quality of Life

Sheila N. Garland1, Joshua Lounsberry2, GuyPelletier2, Oliver F. Bathe3

Department of Psychology, University of Calgary,Calgary, AB, Canada1, Department of PsychosocialResources, Alberta Health Services - Cancer Care,Calgary, AB, Canada2, Departments of Surgery andOncology, University of Calgary, Calgary, AB,Canada3

OBJECTIVES: Surgical removal of the stomach,also called total gastrectomy (TG), is presently theonly curative treatment available to patients withstomach cancer. Some individuals at high risk, or

with a genetic predisposition, are opting to under-go prophylactic TG to reduce their chance ofdeveloping cancer. Considering the impact such aprocedure may have, very little is known aboutwhat factors influence an individual’s decision-making, treatment outcomes and quality of life.METHOD: Participants included one 37 year-oldmale with multiple polyps in his stomach and afamily history of stomach cancer, one 18 year-oldmale with a confirmed CDH1 mutation and afamily history of stomach cancer, and one 33 year-old male with confirmed metastatic gastricadenocarcinoma. Patients were interviewed ap-proximately 12.6 months post surgery. Semi-structured interviews were analyzed using contentanalysis, a qualitative analytic approach forreporting combined subject responses. RESULTS:Subjective patient experience was categorized into:1. making the decision, 2. treatment impact and3. life after TG. Prior to surgery, all patientscarefully evaluated their perceived risk comparedto the treatment consequences and indicated that acertain event triggered their decision. The largesttreatment impacts were learning to eat again andadjusting to the physical changes. Each patientendorsed that their experience made them appreci-ate and make the most of life. CONCLUSIONS:This currently represents the only study to inves-tigate the lived-experience of TG for prophylaxis orpalliation in individuals with and without geneticrisk for stomach cancer. Understanding thisprocess will allow all members of the cancer careteam, and the patients themselves, to better under-stand the factors involved in decision-making andpost-operative adjustment. The experience of thesethree patients provides valuable information thatcan be used to direct further research and improvepatient outcomes.

A-300

Life-Events Synergistically Interact With Cortisol in

Relation to the Prostate-Specific Antigen Tumor

Marker in Men

Yori Gidron1, Bibiana Fabre2, Halina Grosman2,Carlos Nolasco3, Viviana Mesch2, OsvaldoMazza3, Gabriela Berg1

Faculty of medicine & pharmacy, Free University ofBrussels (VUB), Brussels, Belgium1, Facultad deFarmacia y Bioquimica, Universidad de BuenosAires, Buenos Aires, Argentina2, Hospital deClinicas, Universidad de Buenos Aires, BuenosAires, Argentina3

OBJECTIVES: Objectives: Psychosocial factorsare independently related to the onset of lungcancer and to prognosis of multiple cancers.However, we are far from understanding theneurobiological mechanisms of such relations in


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depth and whether stress synergistically interactswith biological factors in relation to oncogenesis.This study tested whether life events (LE) inter-acted with cortisol, a major stress hormone, inrelation to the tumor marker prostate specificantigen (PSA). METHOD: This study used across-sectional design. N5 142 men underwentassessment of LE concerning the past 1–5 yearsand their levels of cortisol, PSA and otherconfounders were measured as well. RESULTS:LE were unrelated to PSA in the total sample.However, LE did interact with cortisol in relationto PSA, such that LE were inversely related to PSAin patients with low cortisol (r5�0.323,p5 0.005), while LE were positively related toPSA in patients with high cortisol (r5 0.362,p5 0.002), independent of age and body massindex. CONCLUSIONS: Stress and cortisol inter-act synergistically in relation to an importanttumor marker of prostate cancer, namely PSA.This informs us that cortisol moderates the possibleeffects of psychosocial stress on cancer-relatedprocesses, and that both stress and cortisol needto be taken into account. We will offer somepossible explanations for the observed pattern ofresults. Future studies must replicate these findingsin a longitudinal design before its findings may beapplied into practice.

A-301

Effects of an Interactive Cancer Communication

System on Lung Cancer Caregivers’ Quality of Life

and Negative Mood: A Randomized Clinical Trial

Lori L. DuBenske1, David H. Gustafson1, KangNamkoong1, Robert P. Hawkins1, Roger L.Brown1, Fiona McTavish1, Cindy L. Carmack2,Mary K. Buss3, Ramaswamy Govindan4, James F.Cleary1

University of Wisconsin, Madison, Wisconsin,United States1, University of Texas MD AndersonCancer Center, Houston, Texas, United States2,Beth Israel Deaconess Medical Center, Boston,Massachusetts, United States3, Siteman CancerCenter, Saint Louis, Missouri, United States4

OBJECTIVES: To fully address cancer suffering,we must address the patient’s social system,including family members and others who careabout the person with cancer. We tested anInternet based Interactive Cancer CommunicationSystem that provided advanced lung cancer care-givers information, management tools and support,and connected them to the clinical team. This studyreports findings from a randomized control trialexamining the impact of this website on caregivers’negative mood and quality of life. METHOD: 285caregivers were randomized into website interven-tion or Internet control groups. Computer and

Internet service was provided if needed. Writtensurveys were completed at pretest and 2 monthintervals for up to 24 months. ANCOVA analysesexamined treatment effects at 6 months oncaregiver negative mood (POMS) and quality oflife (Burden and Disruptiveness scales of CQOLC),controlling for caregiver gender, age, caregiver’srating of patient symptom status (ESAS), andpretest values of outcome variables. RESULTS:Study attention, including patient deaths, yieldedonly 105 completed 6-month surveys. Thosereceiving the website (N5 48) had less caregiverburden (F(1,88)5 2.94, p5 0.045, 1-tailed) andnegative mood (F(1,90)5 3.82, p5 0.027, 1 tailed)at 6 months than the Internet control (N5 57).There was no effect for caregiver disruptiveness.CONCLUSIONS: The nature of caregiving for aloved one with terminal illness may likely disruptthe caregiver’s lifestyle. However, Interactive Can-cer Communication Systems offering information,management tools and support services, and a linkto the clinical team may impact coping andunderstanding such that one’s subjective sense ofburden accompanying caregiving demands andnegative mood is lessened.

A-303

Heightened Distress and Quality of Life Concerns in

Individuals with Head and Neck Cancer

Catherine Bornbaum1, Kevin Fung2, Philip Doyle1

The University of Western Ontario, London,Ontario, Canada1, Department of OtolaryngologyHead & Neck Surgery, Schulich School of Medicineand Dentistry, London, Ontario, Canada2, VoiceProduction & Perception Laboratory, London,Ontario, Canada3

OBJECTIVES: Both short- and long-term out-comes for those diagnosed with head and neckcancer (HNCa) are influenced by multiple factors.More specifically, identification of distress second-ary to a diagnosis of HNCa may provide a criticaldimension that influences perceived quality of life(QoL). Thus, the present investigation assessedperceived levels of distress and QoL using validatedmeasures in those diagnosed with HNCa. METH-OD: The study was a cross-sectional, self-report,survey design. Forty-eight adults (43 to 78 years)diagnosed with a primary malignancy (non mela-noma) of the head and neck were evaluated; allwere treated with curative intent. At assessment,the period of time post-diagnosis ranged from 3 to12 months. All participants completed a validateddistress screening measure, the Brief SymptomInventory 18 (BSI-18) and the EORTC generalQoL assessment tools (EORTC-QLQ-C30) andthe HNCa module (EORTC-QLQ-H&N35).RESULTS: Data revealed that approximately


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one-fourth of participants (23%) demonstratedsignificant levels of distress based on the thresholdestablished for the BSI-18. Additionally, distresswas found to be significantly related to perceivedQoL status. Further, the psychological dimensionof QoL was identified as the area most significantlyimpacted by heightened levels of distress in thisgroup. CONCLUSIONS: Screening for distressprovides an important and valuable measure thatpermits early identification of problems that mayinfluence QoL outcomes in those with HNCa.The ability to identify distress early also mayfacilitate timely intervention to reduce distress andoptimize QoL outcomes. In doing so, long-termoutcomes may be enhanced in this unique clinicalpopulation.

A-304

Screening For Psychological Distress And Psychia-

tric Morbidity Among Patients With Advanced

Cancer: Preliminary Findings From An Irish Valida-

tion Study

Dermot Ryan1, Pamela Gallagher1, ShelaghWright1, Eugene Cassidy2, Tony O’Brien3, AnnBowler2

School of Nursing, Dublin City University, Dublin,Ireland1, Cork University Hospital, Cork, Ireland2,Marymount Hospice, Cork, Ireland3

OBJECTIVES: Patients with cancer are at risk forexperiencing severe distress. This risk can increasein advanced disease. Because cases of distress oftengo unrecognised and untreated in clinical settings,effective screening methods are a key component ofcomprehensive cancer care. This study examinesthe validity of two brief screening tools inidentifying distress among patients with advancedcancer: the Distress Thermometer (DT) and a two-item depression screening tool with an additional‘help’ question. METHOD: A consecutive sampleof adult patients with advanced cancer wererecruited from an acute hospital and a hospice.The study is ongoing (current N5 131; targetN5 205). In a face-to-face interview participantscompleted the DT (single item; 0–10 scale), anddepression screening items (‘depressed, down orhopeless’; and ‘little interest or pleasure’) and helpquestion. These were followed by an interviewusing selected modules from the SCID-I.RESULTS: There were 14 cases (10.7%) of MajorDepression (MD), Adjustment Disorder (AD) orPanic Disorder (PD). The DT (sensitivity 100%,specificity 55%) performed better than the depres-sion screen (sensitivity 86%, specificity of 59%).Combining the DT and help question gave asensitivity of 50% and specificity of 93%. Thepost-test odds indicate that 4 in 5 patients whoscore above the DT cut-off and want help will have

a diagnosis of MD, AD and/or PD. CONCLU-SIONS: Preliminary findings suggest that theDT is a highly sensitive instrument in detectingclinically significant distress among patients withadvanced cancer. Its higher level of sensitivity incomparison with the two-item depression screenmay reflect its use of non-stigmatizing language.Because of its low specificity, the DT could beused in combination with a help question. Thiscombination may allow clinicians to identifypatients who both need and want professionalsupport.

A-305

From Hospital To Community - Directing Cancer

Patients Into A Seamless Service Network In

Hong Kong

Yuk Chun Tammy Leung1

The Hong Kong Professional Counselling Associa-tion, Hong Kong, Hong Kong1, Social WorkersRegistration Board, Hong Kong, Hong Kong2

OBJECTIVES: There are more than 24,000 peoplediagnosed with cancer every year in Hong Kong.Patients and their family members enter thehospital system for medical treatment but thedisease, its associated treatment side effects andanxiety of relapse often place these individuals andfamilies into a state of turmoil. Their commonunderstanding and perceived sense of security,manageability and meaningfulness of their per-ceived world are turned upside down. METHOD:Leaving hospital after treatment is another crisispoint of loss and uncertainty. Their sense ofsecurity from intense care from hospital teamloosened as they are finished scheduled treatment.With the advancement in medical treatment, canceris no longer a deadly disease. Majority of thepatients are cured and yet they have to live withlong term consequences of the cancer treatment aswell as emotional distresses such as fear, anxietyand depression. RESULTS: With an effectivehospital and community service network, weensure that no one faces cancer alone. In thispresentation, the user’s profile in our CancerLink(community-based support service centre) will bereviewed. The service user profile and the programprofile will demonstrate a strategic focus of how tocater for needs of newly diagnosed patients andlong term survivors in the community. CONCLU-SIONS: Hong Kong Cancer Fund is the largestcancer support organization in Hong Kong. Theteam together with volunteers provides free in-formation and professional support to peopletouch by cancer. Our community education unit,the two CancerLink Support Centers in thecommunity as well as Cancer Patients’ ResourcesCenters in the hospitals form a closely knitted


DOI: 10.1002/pon

Oral Abstracts S101

network to create a seamless community supportsystem for cancer patients and their familymembers in Hong Kong.

A-307

Repressive Coping Styles and Emotional Expression

of Women with Metastatic Breast Cancer during the

Trier Social Stress Task (TSST)

Janine Giese-Davis1, Rie Tamagawa2, Maya Yut-sis3, Suzanne Twirbutt3, Karen Piemme3, EricNeri3, Barr Taylor3, David Spiegel3

University of Calgary, Department of Oncology,Calgary, Canada1, Tom Baker Cancer Centre,Alberta Health Services, Calgary, Canada2, Stan-ford University School of Medicine, California,United States3

OBJECTIVES: Previous studies demonstrate thatrepressors exhibit high physiological arousal whileconsistently not reporting negative affect. Thistrait-like coping style is linked with rapid breastcancer progression and physiological markersindicative of poor prognosis. However, we knowlittle about how repressors actually express andwithhold their emotions in response to stressfulsituations. This study used Specific Affect forCancer to code the emotional expression ofrepressors with metastatic breast cancer comparedwith others by using videotaped TSST sessions.METHOD: Based on Weinberger’s AdjustmentInventory, 18 repressors, 16 low-anxious, 19 high-anxious, and 38 non-extreme women participatedin the TSST. They performed a 5minute jobinterview and a 5minute mental math task in frontof two non-responsive judges. Participants’ verbaland facial expression were coded, and each codedtape passed above a 0.60 kappa before it wasretained as data. We predicted that repressors andhigh-anxious groups would express more defensivehostility than the other groups. RESULTS: In apriori Kruskal-Wallis omnibus tests of hypotheses,repressors expressed greater defensive-hostility, inparticular tension in planned comparisons, andneutral relative to non-extreme individuals.A combined repressor and high-anxious groupexpressed greater hostility and micromoment-contempt relative to the combined low-anxiousand non-extreme group. However, groups did notdiffer on positive affect, constrained anger, orprimary negative affect. CONCLUSIONS: Incontrary to previously reported behavioralcharacteristics, the repressors in this study ex-pressed high levels of defensive and hostile affect.The results of this study suggest that codingemotional expression may be particularly usefulin understanding the concurrent emotionalexpression and the coping experience of repressorsunder stress.

A-309

The Experiences of Cancer Nurses’ Existential and

Palliative End-of-life Care within the Culture of

Cure

Doris Leung1, Elizabeth Peter1, Doris Howell2,Gary Rodin2, Margaret Fitch3, MaryJane Esplen2

Lawrence S. Bloomberg Faculty of Nursing, Uni-versity of Toronto., Toronto, Canada1, UniversityHealth Network, Toronto, Canada2, SunnybrookHealth Sciences Centre, Toronto, Canada3

OBJECTIVES: Recent definitions of palliative end-of-life care encourage a philosophy that addressesexistential concerns from the point of diagnosis ofa life-threatening illness. However, research aboutthe experience of clinicians working with patientsin this circumstance is still scarce. The purpose ofthis first author’s doctoral thesis was to explorenurses’ experiences of being with cancer patientswho faced the threat of mortality. METHOD: Thisqualitative study used Benner’s interpretive phe-nomenology to analyze data from observations andinterviews with 19 front-line nurses working on twoinpatient bone marrow transplant units of oneinstitution in Canada. The study was guided byYalom’s (1980) understanding of the threat ofmortality, encompassing four existential domains:fear of death, isolation, freedom, and meaningless-ness. This approach informed analysis of the dataobtained from interviews with these nurses abouttheir experience and nursing practice. RESULTS:Nurses experienced conflicting intentions aboutfighting cancer, while simultaneously preparingpatients to let go. Letting go did not necessarilyreflect giving up or abandoning life but more oftenrepresented nurses’ intentions to release patientsfrom the perceived requirements of the curativeculture. In the context of responsive relationships(patients and their families and healthcare collea-gues), nurses reported learning to accept andexplore the threat of patients’ mortality and theprocess of dying. CONCLUSIONS: Results in-dicate a potential to enhance nurses’ supportiveand basic palliative end-of-life practice in theirresponsibility to existential care. Moreover, thisstudy paves the way for more attention not only topolicy, education, and research that focuses onpatients’ existential well-being, but to the well-being of healthcare providers.

A-310

Tracking the Outcomes and the Use of a Wellness

Centre by Cancer Survivors: A Feasibility Study

Linda Edgar1, Jean Remmer2, Kim Davidman3

Hope & Cope, Jewish General Hospital, Montreal,Canada1, McGill University, Montreal, Canada2,Brock University, St. Catherines, Canada3


DOI: 10.1002/pon

S102 Oral Abstracts

OBJECTIVES: Wellness centres are a popularapproach to providing lifestyle tools to assist inthe recovery from a cancer diagnosis yet have notbeen well evaluated in the literature. This studyexplored effectiveness of providing healthy lifestyleactivities (nutrition, physical activities such asstrength training, yoga, tai chi, qi gong, etc.) andcoping skills (support groups, cognitive training,and arts programming such as music, art therapy,and journaling, etc.) to participants in a wellnesscentre. METHOD: Shortly after the opening of thewellness centre in January 2007, 117 activeparticipants were recruited over 18 months andinterviewed four times over a year. A prospectivenon-randomized design was used and included thestandardized measures of self-esteem, depression,functional assessment and life orientation. Demo-graphics, clinical variables, outside resources usedand qualitative information were also collected.Final interviews were completed in September2009. RESULTS: Of the 117 sample, 74% com-pleted four interviews with a total of 420 inter-views. Final results are pending and will correlatemeasure outcomes over time in participants withfrequency and kinds of services used. Preliminaryinformation found that 66% of the sample werestill active at the Centre eight months postregistration. Twenty-seven % attended with afrequency of four times a month or more, higherthan the average at this Centre and most others.CONCLUSIONS: The outcome information fromthis study will provide a baseline for subsequentresearch approaches to further validate the inte-gration of wellness and cancer recovery programsas part of standard care in oncology. Implicationsand strategies will be discussed to promote the useof such programs - with both the health care teamand with patients - and ensure as many patients aspossible may benefit.

A-312

Methodological Challenges In Assessing Levels Of

Psychological Distress And Psychiatric Morbidity

Among Patients With Advanced Cancer: What Does

The Literature (Not) Tell Us?

Dermot Ryan1, Shelagh Wright1, Pamela Gallagher1,Eugene Cassidy2

School of Nursing, Dublin City University, Dublin,Ireland1, Cork University Hospital, Cork, Ireland2

OBJECTIVES: Research on levels of psychologicaldistress among cancer patients is a key part of theknowledge base that guides the development ofpsychosocial oncology services. Conducting suchresearch can be challenging among patients withadvanced disease because of their poorer physicaland cognitive status. This paper examines the keymethodological challenges researchers face, andtheir reporting of such challenges, in conducting

studies of levels of psychological distress orpsychiatric morbidity among patients with ad-vanced cancer. METHOD: A systematic literaturereview was conducted of papers describing surveysin which a stated aim was the determination oflevels of psychological distress or psychiatricmorbidity among patients with advanced cancer.We also included papers that focused on thedevelopment of assessment tools, since such studiesalso strive to obtain accurate estimates of distresslevels. Relevant English-language studies wereidentified through computerised (Medline andPsycINFO) and manual searches for the years1995–2009. RESULTS: Nineteen papers met theinclusion criteria (prevalence studies n5 10, psy-chometric/validation studies n5 9). They describefindings for a total of 3,142 patients. Sample sizesranged from 45 to 422 (M5 165.4, SD5 122.9).The key methodological challenge in this body ofresearch is obtaining representative samples (oradequate external validity). Significant portions ofthe advanced cancer population are excluded fromdistress studies or are refusing to take part.CONCLUSIONS: The evidence base on distresslevels among advanced cancer patients is small andmore representative of patients with higher levels ofphysical and cognitive functioning. Researchersneed to broaden their focus from issues of internalvalidity (e.g. psychometric properties of scales) todeveloping more flexible methods of assessingdistress among patients with advanced disease.Authors could improve our understanding of thechallenges here by presenting more detailed ac-counts of the sampling and data collectionprocesses.

A-313

Differences in Health Related Quality of Life (QoL)

Levels of Women with Gynecological Cancer -

Implications for the Psycho-Oncological Care

Meyer Alexandra1, Einenkel Jens1, Roessiger Ina2,Briest Susanne1, Peuker Mareike1, Braehler Elmar1

Clinical Center of University, Leipzig, Germany1,Hospital, Bautzen, Germany2

OBJECTIVES: The health related QoL as well asthe psycho-oncological care are important factorsin the treatment of cancer patients. One-third ofthese patients displays psychological comorbiditiesand up to 50 percent suffer from subclinicalpsychological symptoms. The demands reflectedin these figures are not equally met for all patientgroups: while breast cancer patients can rely on awell established psycho-oncological support sys-tem, psychological problems of women withcarcinoma of the uterus often go undetected.METHOD: The study investigates and comparesthe health related QoL of women with differentgynecological carcinoma. In a multicenter


DOI: 10.1002/pon

Oral Abstracts S103

longitudinal study 95 women were interviewed (48breast cancer patients, 47 cervical or endometriumcarcinoma patients). Data was collected at threeconsecutive times: in the beginning of the treatment(1), at its end (2) and six months after dischargefrom the hospital (3). The health related QoL wasmeasured using a standardized questionnaire(EORTC QLQ-C30). RESULTS: Time 1: Breastcancer patients show significantly lower scores onthe ‘emotional functionality’ scale (Z5�1,976;p5 0,048). All other differences are non significant.Time 2: The uterus carcinoma group scoressignificantly higher on the pain-scale (Z5�2,193;p5 0,028) while all other differences betweengroups are non significant. Time 3: No significantdifferences between patient groups. In general,QoL scores drop during the hospital stay. Within6 month after discharge scores improve, reachingthe initial scores. CONCLUSIONS: While inhospital the QoL level of women with cancerdecreases - independently of the type of cancer.Women with breast cancer display higher degreesof emotional burdens previous to the treatmentwhile women with carinoma of the uterus statehigher pain levels after treatment. According tothese findings, psycho-oncological care needs to beimplemented as an integral part of oncologialtreatment plans for all patient groups withgynecological cancer.

A-316

Analysis of Distress Indicators in an Academic Head

and Neck Surgical Oncology Practice

John Conlee1, Luke Buchmann2, Kyle Murdock1,Jason Hunt2, Shelley White1

Huntsman Cancer Institute, Patient and FamilySupport, University of Utah, Salt Lake City, Utah,United States1, University of Utah School ofMedicine, Division of Ototlaryngology-Head andNeck Surgery, Huntsman Cancer Institute, SaltLake City, Utah, United States2

OBJECTIVES: Depression decreases both thequality of life (QOL) and length of survival withhead and neck cancer (HNC). The timely detectionand treatment of depression are vital in thesuccessful management of HNC patients. Thisstudy was undertaken to assess the prevalence ofpsychosocial distress in patients during the earlystages of diagnosis and treatment for HNC, andthe relationship of distress to depression and otherpsychosocial stressors potentially amenable toimmediate intervention. METHOD: A retrospec-tive chart review was undertaken to collect datafrom 89 new HNC patients who completed anEmotional Needs Questionnaire (ENQ). The ENQcontains both a distress thermometer used to self-report the level of emotional distress on a scale of0–10, and a checklist of concerns across five

discrete problem domains: emotional, family,physical, practical and spiritual. Demographicand clinical information was also collected fromeach chart. RESULTS: Eighty-nine patients withHNC were studied. Males had a mean distressscore of 3.53 (72.87). Females had a mean distressscore of 4.10 (72.33). Depression was positivelycorrelated with self-reported level of distress (0.404,po0.000, n5 89) and anti-depressant use (0.673,po0.000, N5 89). The mean distress score forpatients with a history of depression was 5.52(72.56) compared to 3.18 (72.41) in non-depressed patients. This difference was statisticallyreliable (Chi-Square5 6.25, df5 1, po0.012).CONCLUSIONS: Psychosocial distress is signifi-cantly higher in HNC patients with depression.Unfortunately, depression is underdiagnosed anduntreated in most cancer patients. This is evenmore regrettable given the evidence that depressionsignificantly decreases QOL and length of survivalwith cancer. Studies have shown that QOL predictssurvival with HNC. Models describing the inde-pendent predictors of distress in HNC patients withand without depression will be presented.

A-321

Getting Back on Track-Group: A Single-Session

Psychoeducational Group Intervention for Women

with Early Stage Breast Cancer Completing Adju-

vant Treatment

Jennifer Jones, Terry Cheng, Maureen Jackman,Susan Haines, Gary Rodin, Pamela CattonPrincess Margaret Hospital, Toronto, Canada

OBJECTIVES: Women with breast cancer transi-tioning from primary cancer treatments to theirfollow-up period face a number of significantchallenges including restoring and maintainingtheir health and overall well-being and confrontingmultiple adaptive tasks. To address this, a single-session psychoeducational intervention entitledGetting Back on Track-Group was developed andevaluated in a large randomized controlled trial.METHOD: Participating women (n5 441) com-pleted the baseline questionnaire package (T0) andwere then randomized to either: (1) standard printmaterial (CRL group n5 225); or (2) standardprint material and the Getting Back on Track-Group intervention (INT group n5 216). Partici-pants in both groups completed the questionnairepackage again at 3 months (T1) and 6-months (T2).Primary endpoints were perceived preparedness forre-entry, knowledge regarding re-entry transition,and self-efficacy. Secondary end points were moodand health related distress. RESULTS: 86% ofparticipants completed T1 and 86% completed T2assessments. GEE and ANCOVA were used toevaluate whether the mean change in scoresdiffered across the INT and CTL groups for


DOI: 10.1002/pon

S104 Oral Abstracts

primary/secondary outcomes. The mean changefrom T0�T1 and T0�T2 in knowledge scores andperceived preparedness was significantly higher inthe INT vs CTL groups (po0.001 all). Meanchange scores for self-efficacy, mood and health-related distress scores were not significant betweengroups during any time interval. CONCLUSIONS:The development of effective, relevant, and feasiblepsychosocial interventions that are evaluated anddescribed in the cancer literature is a crucialcomponent of any effective, holistic, oncologyservice. GBOT-G, a brief one-session psychoedu-cational session designed to support womentransitioning from primary cancer treatment, wasfound to significantly improve women’s knowledgeregarding re-entry transition and their feelings ofpreparedness for re-entry compared to providing abooklet alone.

A-323

Rural And Northern Families’ Pediatric Cancer

Journey

Denise Gauthier-Frohlick1

Laurentian University, Sudbury, Ontario, Canada1,Supportive Care Oncology Research Unit, RegionalCancer Program, Hopital regional de SudburyRegional Hospital, Sudbury, Ontario, Canada2

OBJECTIVES: This presentation will reveal, fromthe perspective of rural and northern families, thehuman experience of childhood cancer. In thisprovince, all children who receive a pre-diagnosisof cancer are referred to one of five PaediatricTertiary Cancer Centers where they receive theirtreatments. This requires families to leave theirhome for an extended period of time and to travelgreat distances to access these specialized services.METHOD: Through the use of photovoice,parents and caregivers (n5 30) are invited toparticipate in an interview where they present thephotographs they have chosen to give voice to theirfamily’s cancer journey. The interview is semi-structured and flexible so that participants can takecharge as the ‘experts’ and highlight their experi-ences. These participants are then invited toparticipate in a focus group where they meet oneanother and comment on the preliminary results.RESULTS: Using photographs and narrativesfrom mothers, fathers and caregivers, a portrayalof rural and northern families’ experiences,strengths, and challenges is created. Successes andchallenges with recruitment and participation offamilies in the study and traveling in rural northerncommunities to do the data collection will bediscussed. Preliminary results will focus on thefamilies’ experiences of participating in an inter-view. CONCLUSIONS: This study attests to thepower of qualitative research to bring to ‘life’through photographs sensitive and emotive human

experience. This methodology provides a richtapestry from which insight is gained. It offers anopportunity to examine and reflect upon access toor the lack of health and psychosocial care andhow it can add to or detract from the quality offamilies’ lives as they care for and support theirchildren.

A-324

Changes in Close Relationships between Cancer

Patients and their Partners

Natalie Drabe1, Lutz Wittmann1, Diana Zwahlen2,Stefan Buchi3, Josef Jenewein1

Department of Psychiatry, University Hospital ofZurich, Zurich, Switzerland1, Department ofMedical Oncology, University Hospital of Berne‘Insel’, Berne, Switzerland2, Clinic for Psychother-apy and Psychosomatics ‘Hohenegg’, Meilen,Switzerland3

OBJECTIVES: Stress is a threat to maritalsatisfaction and its longevity. Distress caused bycancer might reduce the quality of communicationin a couple. Open spousal communication, pro-blem solving skills and dyadic coping leads topositive progression in relationship. The presentinvestigation examined individual and dyadicchanges in close relationships in a sample of cancerpatients and their partners, accounting for theaspects of gender and role. METHOD: 224patients with different cancer types and stagesand their partners completed questionnaires re-flecting psychopathology (Hospital Anxiety andDepression scale, HADS), quality of life (EURO-HIS-QOL 8-item index) and questions aboutpartnership. When the subjects declared that theirrelationship had changed, they were asked by 8further items to indicate the nature of this change.These items were then attributed to the categoriespositive (3 items) or negative (5 items) dyadicchanges. RESULTS: 71 patients (31.7%) and 66partners (29.5%) reported that the diagnosis ofcancer has changed their relationship. Perceptionof change was congruent in 68% of the couples.The nature of relationship changes (positive vs.negative) was unrelated to gender and role(patients vs. partner). In male patients and partnersnegative dyadic changes were strongly associatedwith low quality of life and high HADS values.This finding was replicated in female partners, butnot in female patients. CONCLUSIONS: Ourfindings indicate that dyadic changes are commonin couples facing cancer. Negative changes inrelationships are strongly related to low quality oflife and high levels of anxiety and depression in allparticipants, except for female patients. Our resultsunderline the importance of couple interventionsthat enhance communication and problem solvingskills in couples facing cancer.


DOI: 10.1002/pon

Oral Abstracts S105

A-327

National Initiatives in Cancer Rehabilitation in

Denmark

Bo Andreassen RixPatient Support. Danish Cancer Society, Copenhagen,Denmark

OBJECTIVES: The survival rate of cancer is increas-ing due to a more successful treatment, and thenumber of cancer cases is increasing due to demo-graphic factors. It is estimated that up to two thirds ofcancer survivors have problems and late effects suchas fatigue, lymfoedema, depression, sexual problems,incontinence etc. This leaves a huge rehabilitationburden on society. We investigated national efforts inDenmark at state as well as community level to meetthis challenge. METHOD: We collected data fromnational authorities concerning planning activities aswell as data and reports from counties and 11 cancerrehabilitation projects at community level. Wecollected original data on submission rates, demo-graphic data as well as evaluation reports andqualitative data from a variety of projects. The datawas analyzed in order to give a comprehensive pictureof challenges in meeting rehabilitation needs of cancersurvivors. RESULTS: The study showed obstacles inidentifying and meeting rehabilitation needs in Den-mark. Depending on diagnosis, only between 5% and50% of cancer patients were admitted to a rehabilita-tion program. About 75% of patients referred werewomen and low income patients were rarely referred.Among health care professionals, no consensus wasfound concerning screening procedures. The rehabi-litation programs were very diverse and it was difficultto evaluate if rehabilitation needs were met andcoordination challenges were identified. CONCLU-SIONS: Demands for cancer rehabilitation serviceswill increase dramatically in the coming years.Experiences from Denmark show that proceduressuch as referral, screening, comprehensive rehabilita-tion programs and coordination are not in placein a high income country witha free public healthcare sector.

A-329

Hope at End of Life: Terminally Ill Patients’

Experiences of Meaning, Uncertainty and Authentic

Caring

Cheryl NekolaichukUniversity of Alberta, Edmonton, Alberta, Canada

OBJECTIVES: Although terminally ill patients andcaregivers acknowledge the therapeutic value of hopein advancing disease, systematic frameworks forassessing hope remain under-developed. The purposeof this qualitative study was to explore patientexperiences of hope in advanced cancer, using ahope assessment framework as a guide. This study

was an extension of a larger mixed-methods studythat included the quantitative validation of this hopeassessment framework. This presentation will focuson the qualitative findings. METHOD: A descriptivequalitative design and purposeful sampling approachwere used to select participants with diverse hopeexperiences. Fifteen advanced cancer inpatients, intertiary palliative care or hospice settings, completeda semi-structured interview, over one (n512) to two(n53) sessions. A Hope Assessment Framework,focusing on meaning, uncertainty and authenticcaring, was used as an interview guide. Specificmetaphors were incorporated to elicit patient experi-ences. Data were analyzed for common themes usingthe constant comparative method. RESULTS: Thekey themes of meaning, uncertainty and authenticcaring, within the hope assessment framework,resonated with patient experiences. Sub themesemerging from their experiences included a dynamicprocess of waiting, watching and wondering. Patientsfurther described perceptual changes between hopeand suffering, pain and time, as well as a prioritiza-tion of different ‘sizes’ of hope. Practical examples foreliciting patients’ hope experiences through meta-phor, using stories, images and color, will also bepresented. CONCLUSIONS: The progressive declineof advancing disease may impede patients fromconnecting with their experiences of hope, which areoften closely tied to their experiences of suffering,pain and perceptual changes in time. As demon-strated in this study, the intentional use of a hopeassessment framework, focusing on meaning, uncer-tainty and authentic caring, can facilitate patients’explorations of hope at end of life. The use ofmetaphor can further assist with this process.

A-330

Living With Dying: An Interpretative Phenomen-

ological Analysis Of The Experiences Of Palliative

Care Oncology Patients In A General Hospital

Louise Kinsella1, Paul D’Alton2, Michael Guilfoyle3

Health Service Executive, Dublin, Ireland1,St. Vincent’s University Hospital, Dublin, Ireland2,Trinity College, Dublin, Ireland3

OBJECTIVES: The majority of palliative oncologypatients are cared for and die within generalhospitals (Grande, 2009; Kuebler, Lynn, & VonRohen, 2005). Despite this there is a dearth ofresearch evaluating the experience of palliative carepatients particularly within a hospital setting(Addington-Hall & O’Callaghan, 2009). The pur-pose of this research was to explore the subjectiveexperience of patients with terminal cancer receiv-ing specialist palliative care in a general hospital.METHOD: Semi-structured interviews were con-ducted with 7 in-patients who were under the careof the oncology and palliative teams at a generalhospital. Participants were required to be aware of


DOI: 10.1002/pon

S106 Oral Abstracts

their status as terminally ill and to have anexpected prognosis of no more than 6–9 months.Interviews were analysed using interpretative phe-nomenological analysis. RESULTS: Three inter-related themes described participants’ experiencesof living with terminal illness and included, makingsense of one’s experience as a dying person, theprocess of accepting one’s prognosis, and a desireto live the remainder of one’s life meaningfully. Afinal theme offered insights into participants’experiences of specialist palliative care and ofbeing in a general hospital. CONCLUSIONS:The inter-connectedness of the findings highlightsthe dynamic and finely nuanced nature of partici-pant’s subjective experience. The research supportscalls for a theoretical approach to death and dyingwhich more fully allows for the complexity ofexperience described by patients. It is proposedthat a narrative or dialogical framework is bestplaced to meet this need and should be forwardedby future theoretical efforts. Implications for futureresearch and clinical practice are also elucidated.

A-331

User Satisfaction And Needs Among Danish Cancer

Survivors Seeking Psycosocial Councelling

Bo Andreassen RixPatient Support Dept. Danish Cancer Society,Copenhagen, Denmark

OBJECTIVES: The Danish Cancer Society offerspsychosocial councelling to cancer patients, survi-vors and relatives in 15 councelling centers nation-wide. The councelling center have more than75,000 contacts to users per year. We conducteda survey to evaluate satisfaction and needs amongusers in the centers. METHOD: A questionnairewas distibuted to all users attending psychosocialcouncelling. The questionnaire included questionsconcerning the reason for seeking councelling,councelling needs, satisfaction with services andexpectations to future services. 894 answered andthe response rate was 76%. Data was analyzedusing regression analysis. RESULTS: The descrip-tive data showed that respondents were primarilywomen (76%) and higher educated, reflecting theuser profile in the councelling centers. 51% werepatients and 46% were relatives. 71% came forpsychosocial councelling, 39% came to meet peersand 23% came for information. 90% expressedsatisfaction with the services provided and twothirds experienced better coping skills after coun-celling. Users with a low education were leastsatisfied. 50% of users were helped to contact otherrelevant services. CONCLUSIONS: The surveyshowed that a professional short time psychosocialcouncelling service can meet the needs of cancerpatients, survivors and relatives and generate highuser satisfaction and increase coping skills.

However most users recruited were middle classwomen. The needs of other users groups such asmen and low income users must be explored further.

A-332

Basic Body Awareness Therapy As A Physiother-

apeutical Rehabilitation Method For Women

Having Undergone Breast Cancer Treatment -

A Pilot Study

Ylva Hedin LarssonSydsvenska Gymnastikinstitutet, Lund, Sweden

OBJECTIVES: To study the influence of thephysiotherapeutical rehabilitation method BasicBody Awareness Therapy (BBAT) on body aware-ness and quality of life in a group of women havingundergone breast cancer surgery and adjuvanttreatment. To explore if BBAT could act as anintermediary in the transition from post treatmentfatigue and return to activity levels as before onsetof illness. BBAT can be described as movementsenhancing mindful presence in movement and rest.METHOD: Nine women aged 43–62 years havingundergone breast cancer surgery within the last twoyears received ten sessions of BBAT led by aphysical therapist. The patients were evaluated forbody movement using the Movement Quality BodyAwareness Scale (MQ-BAS) and answered aQuality of Life (QoL) questionnaire, the EORTC-C30 before and after the intervention. RESULTS:All patients showed a significant change in bodyfunctions and body awareness as measured withthe MQ-BAS scale. There was a significant changein the overall QoL scoring as measured with theEORTC-C30. Global Health increased and therewas also an increase in physical, emotional andcognitive functioning. Pain and dypnoea decreased.Fatigue increased somewhat. CONCLUSIONS:There was a positive change on body functions,body awareness and QoL for the group. In a largerstudy a control group should be used and patientsfollowed during a longer period with attention toconnections beween return to work and increasingfatigue. Using techniques of deep interview wouldincrease the value of the study and further explainand penetrate the results and also study the impacton the patients of being in a peer-group.

A-334

Personality, Appraisal, and Emotional Reaction to

Cancer Diagnosis: A Systematic Review of Their

Correlation with Psycho-social Outcome

N J Hulbert-Williams1, S Williams1, R Neal2, VMorrison3, C Wilkinson2

University of Wolverhampton, Wolverhampton,England, United Kingdom1, Cardiff University,Cardiff, Wales, United Kingdom2, Bangor Univer-sity, Bangor, Wales, United Kingdom3


DOI: 10.1002/pon

Oral Abstracts S107

OBJECTIVES: Models of illness adjustment fre-quently suggest a role for personality and bothcognitive and emotional reaction in determiningthe likelihood of positive or negative adjustment.Those studies which have looked at correlationalor predictive relationships frequently report incon-sistent and sometime contradictory findings, andare criticised for poor methodology. A compre-hensive review of the literature was carried out in2006. This paper presents an update of that reviewto include literature up to end-2009. METHOD:The search strings used in the original review (pilotfindings presented at IPOS 2006) were re-run intheir entirety. Run through ten key psychological-and medically-based electronic databases theseidentified relevant literature published in the period2006–2009. Search results are currently beingindependently assessed for relevance by twoindependent reviewers against the original pre-defined inclusion criteria. Whilst only a fewadditional studies are expected to be integrated,these will methodologically strengthen the review.RESULTS: The findings from the original reviewdemonstrated inconsistency in findings on relation-ships between these psychosocial variables andvarious outcome, including anxiety, depression andquality of life. A number of research questions werehighlighted as worthy of further research. Fewfindings were suitable for statistical meta-analysis.We expect this update to highlight further studiesto enable more meta-analyses to be conducted inorder for the findings to tell a more coherent andapplicable story. CONCLUSIONS: Prior to sub-mitting the review for publication, the researchteam felt that it was important that the datacontained within it were as up-to-date as possible.The initial searches did not achieve this aim.This review update will ensure that the evidencebase considered is fully up-to date and thatthe conclusions are an accurate representation ofthe current literature. Implications shall bedrawn for both research development and clinicalapplication.

A-335

Expression of Primary Negative Affect during

Supportive Expressive Group Therapy Sessions

Reduces Trauma Symptoms in Metastatic Breast

Cancer Patients

Janine Giese-Davis1

University of Calgary, Calgary, AB, Canada1,Stanford University, Stanford, CA, United States2,Tom Baker Cancer Centre Psychosocial Resources,Calgary, AB, Canada3

OBJECTIVES: A long history identifies bothpsychological and physiological risk associatedwith restrained or dysregulated affect expressionfor women with breast cancer. To examine whether

behaviorally coded emotional expression duringgroup psychotherapy is related to these outcomes,we carefully coded emotional expression of grouptherapy sessions. The goal of the current analysis isto test whether expressing more fear, anger, andsadness (primary negative affect) over time will berelated to decreasing trauma and depressionsymptoms. METHOD: We selected 16 sessionsper woman for their first year in supportive-expressive group therapy and used Specific Affectfor Cancer to code each woman’s speaking time.We used the mean duration of a moment of 23specific coded affects broken into 4 summarycategories: primary negative, positive, constrainedanger, and defensive-hostile affect. Slopes ofchange over time in each summary category wereused as independent variables predicting the slopeof trauma and depression symptoms. RESULTS:These initial results demonstrate that when theslope of primary negative affect increased over theyear, trauma symptoms declined. When the slopeof constrained anger increased over the year,trauma symptoms increased. Positive affect anddefensive-hostile affect were unrelated to change.We did not find significant associations for depres-sion change. CONCLUSIONS: As predicted,expressing more primary negative affect over timein supportive-expressive group therapy signifi-cantly predicted a decline in trauma symptoms.Expressing these vulnerable emotions may allowpatients to process their distress effectively, expressthese emotions long enough for group members tointervene, and may increase cognitive processing ofactive plans to relieve their distress. By contrast,constraining anger had the opposite effect, increas-ing trauma symptoms over time. These insights canhelp improve group therapy effectiveness.

A-336

Distress Screening and Psychosocial Referral in

Patients with Head and Neck Cancer

Janet Ellis1, Madeline Li1, Jolie Ringash1, LianneTrachtenberg2, Rebecca Withers1, CarmineMalfitano3, Anne Rydall1, Camilla Zimmerman1,Robert Maunder1, Gary Rodin1

University of Toronto, Toronto, Ontario, Canada1,Queen’s University, Kingston, Ontario, Canada2,University of Milan, Milan, Italy3

OBJECTIVES: Patients with head and neck cancerfrequently undergo disfiguring treatments and havehigh suicide and substance use rates. Rates ofreferral for psychosocial care are low in thispopulation and the barriers to accessing such careare not well understood. The objective of this studyis to evaluate the prevalence and nature ofdistress in this population, the acceptability ofdistress screening, and the presence of and desirefor referral for specialized psychosocial care.


DOI: 10.1002/pon

S108 Oral Abstracts

METHOD: Consecutive outpatients undergoingactive treatment were recruited from radiationclinics in a comprehensive cancer centre. Theassessment included measures of social difficulty(Social Difficulties Inventory-SDI), depression (Pa-tient Health Questionnaire-PHQ-9) and anxiety(Generalized Anxiety Disorder Measure-GAD-7).Participants provided information about currentprofessional psychosocial support and desire forpsychosocial referral, and gave feedback onwhether the battery of study questionnaires wasacceptable to them (yes/no) and the impact it hadon them (positive/negative/none). RESULTS: Of152 patients approached, 78(51%) consented, and62(41%) completed the distress screening. Scoreswere above the clinically significant cut-off in22(35%) on the SDI, 13(21%) on the PHQ-9, and9(15%) on the GAD-7. Scores were above the cut-off on at least one measure in 25/62(40%). Ofthese, 9/25(36%) had professional psychosocialsupport; 4/25(16%) desired referral. Of 47/62(76%) who provided feedback, 38/47(81%)found the questionnaires acceptable, 20/47(43%)reported positive impact from participating; nonereported negative impact. CONCLUSIONS: Thesefindings indicate that a substantial minority ofpatients with head and neck cancer report psycho-logical distress or psychosocial difficulty. Althoughdistress screening was generally acceptable to thesepatients, almost half of the distressed patients didnot want psychosocial referral. Further research isneeded to understand and maximize the clinicalutility of distress screening, and to ascertainwhether clinic-based or alternate methods ofsupport would be more acceptable or beneficial tosuch patients.

A-340

The Development and Pilot Testing of a Web-based

Support Group for Women with Sexual Problems

due to Gynecologic Cancer

Catherine Classen1, Sarah Ferguson2, MeredithChivers3, Sara Urowitz2, Lisa Barbera4, DavidWiljer2

University of Toronto/Women’s College ResearchInstitute, Toronto, ON, Canada1, Princess MargaretHospital, Toronto, ON, Canada2, Queen’s Univer-sity, Kingston, ON, Canada3, Sunnybrook HealthSciences Centre, Toronto, ON, Canada4

OBJECTIVES: The psychosexual problems ofgynecologic cancer patients are well documentedbut there have been few investigations of interven-tions for this population. An Internet-based sup-port group may be especially efficacious forgynecologic cancer patients with psychosexualproblems given its relative anonymity. This pre-sentation describes the development and pilottesting of an online group for this population. This

presentation will describe: 1) the 12-week, web-based support group, 2) recruitment and retentionefforts, and 3) preliminary findings. METHOD:Women were randomly assigned to immediatetreatment or to a waitlist condition. The interven-tion was 12 weeks long and each week participantswere provided with a new topic for discussionalong with high quality health information. Abulletin board format was used enabling participa-tion 24/7 and a chat session was offered in week 10.Participants completed outcome measures at base-line, 3-month and 6-month follow-ups, a programevaluation questionnaire to assess satisfaction, anda debriefing interview. RESULTS: At the time ofsubmission, data collection is complete and dataanalysis is underway. We will describe the lessonslearned in facilitating this online support group,including the challenge of engaging women intalking about their sexual concerns. Preliminaryfindings based on the Female Sexual Distress Scale-Revised, the Hospital Anxiety and DepressionScale, the Illness Intrusiveness Scale, and theSexual Adjustment and Body Image Scale will bepresented. Feedback regarding the intervention willbe described. CONCLUSIONS: A professionallyfacilitated web-based support group that alsoprovides high quality health information may bebeneficial for women suffering from psychosexualconcerns following treatment for gynecologiccancer. In considering such groups, it is importantto be aware of the challenges in facilitating onlinegroups on such sensitive topics.

A-341

The Potential Utility of Acceptance and Commit-

ment Therapy (ACT) in Psychosocial Oncology

N Hulbert-Williams1, L Storey2, K Wilson3

University of Wolverhampton, Wolverhampton,England, United Kingdom1, Queen’s University,Belfast, Northern Ireland, United Kingdom2, Uni-versity of Mississippi, Mississippi, United States3

OBJECTIVES: Being diagnosed with cancer isboth physically and psychologically stressful, put-ting the patient at increased risk of distress andpsychological comorbidity. Published research failsto demonstrate conclusive evidence of the long-term benefits of psychologically-based interven-tions. Acceptance and Commitment Therapy(ACT) is a relatively new third-wave cognitivebehavioural therapy (CBT) that may add compo-nents not emphasized in traditional CBT ap-proaches. This study aimed to review the currentliterature supportive of this proposal. METHOD:A systematic search for ACT literature withinoncology revealed three intervention studies; allwere methodologically weak. A wider searchingstrategy of the psychosocial oncology literature, inaddition to a systematic search of the fighting spirit


DOI: 10.1002/pon

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literature, enabled a larger evidence-base to begathered on studies relevant to each individualcomponent of ACT. These are integrated into adiscussion paper on the current state of evidencefor this specific intervention within the cancersetting. RESULTS: Current findings from psycho-logical interventions for cancer patients haveproduced mixed results. Theoretically based re-search demonstrates a clear link between someACT components and improved psychosocial out-comes within this patient group, in particular thecomponents of Acceptance, Mindfulness and Va-lues-based living. The evidence to date of ACTinterventions in cancer and other physical healthconditions seems promising and worthy of futureresearch. CONCLUSIONS: ACT-based interven-tions are worthy of further research attentionwithin oncology settings. However, these need tobe both more methodologically rigorous anddesigned to be more cost effective than thosealready published. The ACT philosophy andapproach to intervention is somewhat at odds withfighting spirit models o adjustment which havebeen so prominent in the field and pilot research toestablish the extent to which they are opposedwould be worthwhile.

A-344

Decrease in Depression Symptoms is Associated

with Longer Survival in Metastatic Breast Cancer

Patients

Janine Giese-Davis1, Kate Collie4, Kate Rancourt4,Eric Neri1, Helena Kraemer1, David Spiegel1

Stanford University, Stanford, CA, United States1,University of Calgary, Calgary, AB, Canada2,Tom Baker Cancer Centre Psychosocial Resources,Calgary, AB, Canada3, University of Alberta,Edmonton, AB, Canada4

OBJECTIVES: Numerous studies have examinedthe co-morbidity of depression with cancer, andsome have indicated that depression may beassociated with cancer progression or survival.However, few have assessed whether changes indepression symptoms are associated with survival.In the current study, we hypothesized that adecrease in depression symptoms in metastaticbreast cancer patients (MBC) over the course ofthe first year of a randomized clinical trial would beassociated significantly with survival. METHOD:In a randomized trial of supportive-expressivegroup therapy, 125 women with MBC completeda depression symptom measure (CES-D) at base-line and were randomized to receive treatment or toa control group that received educational materi-als. At follow-up, 101 of these women completed adepression symptom measure and were availablefor a Cox Proportional Hazards analysis toexamine whether decreasing depression symptoms

over the first year of the study would be associatedwith longer survival. RESULTS: Median survivaltime was 53.6 months for those decreasing on CES-D over one year and 25.1 months for thoseincreasing. There was a significant effect of changein CES-D over the first year on survival out to 14years (p5 0.007), but no significant interactionbetween treatment condition and CES-D changeon survival. We could not demonstrate that eitherdemographic or medical variables explained thisassociation. CONCLUSIONS: Decreasing depres-sion symptoms appear to be associated with longerlife for women with metastatic breast cancer in thissample. Further research would be necessary toconfirm this hypothesis in other samples, andcausation cannot be assumed based on thisanalysis. However, in the current study, we haveevidence that the course of depression over oneyear predicts subsequent survival time, and thatadjustment for co-morbid prognostic variables didnot alter significance.

A-349

Peer Counseling Improves Quality of Life for

Women with Breast Cancer: A Randomized Trial

Janine Giese-Davis3, Caroline Bliss-Isberg2, LynneWittenberg1, Maya Yutsis1, Path Star1, MatthewCordova5, Debra Houston2, David Spiegel1

Stanford University, Stanford, CA, United States1,WomenCARE, Santa Cruz, CA, United States2,University of Calgary, Calgary, AB, Canada3, TomBaker Cancer Centre Psychosocial Resources,Calgary, AB, Canada4, VA Medical Center, PaloAlto, CA, United States5

OBJECTIVES: In a community/research colla-boration between WomenCARE in Santa Cruzand Stanford, we evaluated whether matching awoman newly diagnosed with breast cancer for 3 to6 months after diagnosis with a trained (andsupervised) volunteer who is herself a breast cancersurvivor improves quality of life over the first yearpost-diagnosis. METHOD: We trained 36 peercounselors (Navigators) in training sessions em-phasizing active listening skills and access toresources in the community for women with breastcancer. In addition 104 newly diagnosed women(within 2 months of dx) were randomized (52receiving a match with a Navigator). We createdslopes over baseline, and 3, 6, and 12 moassessments and used multiple regressions to testwhether group assignment affected outcome. RE-SULTS: We found women receiving a Navigatorsignificantly increased on marital satisfaction(p5 0.02), and breast-cancer-specific quality of life(p5 0.01) while those in the control groupdecreased. Women receiving a Navigator who werehighly distressed at study entry also experienced asignificantly greater reduction in anxiety (p5 0.03),


DOI: 10.1002/pon

S110 Oral Abstracts

distress (p5 0.04). However, those not matchedwith a Navigator who were low on Post-TraumaticGrowth at baseline significantly increased to agreater extent than did those matched. CONCLU-SIONS: This first randomized clinical trial of anextensive peer counseling program demonstratesthat being matched with a Peer Navigator appearsto mitigate the distress newly diagnosed womenoften experience as they are undergoing treatmentfor breast cancer. It is also clear that not having apeer counselor may stimulate women to perhapsput more thought and energy into self-motivatedgrowth post-diagnosis.

A-351

Persistence of Symptoms in Cancer Survivors

Teresa Deshields1, Patricia Potter1, Sarah Olsen1,Kathryn Trinkaus2

Siteman Cancer Center, St. Louis, Missouri, UnitedStates1, Washington University School of Medicine,St. Louis, Missouri, United States2

OBJECTIVES: Patients diagnosed with cancertypically experience symptoms from their diseaseand side effects associated with treatment. Ascancer care evolves, newer treatments generallyoffer better survival or lower side effect profiles. Inthis study, we examined the persistence of symp-toms reported by 367 cancer survivors over a oneyear period. METHOD: We sent the MemorialSymptom Assessment Survey (MSAS) to patientswith the 5 most common cancer diagnoses in ourcancer center (breast, colorectal, gynecologic, lung,and prostate cancers). 367 patients completed abaseline MSAS and a follow-up MSAS one yearlater. We examined the severity scores (range5 0–4)for the 10 most frequently reported symptoms atbaseline and compared this to the severity scores forthe same symptoms at one year follow up.RESULTS: The 10 most commonly reportedsymptoms at baseline were: problems with sexualinterest/activity, numbness/tingling in the hands/feet, lack of energy, difficulty sleeping, sweats, pain,itching, lack of appetite, feeling drowsy, and drymouth. We compared baseline severity scores forpatients who completed follow-up and those whodidn’t, and the group completing follow-up demon-strated lower symptom severity. Comparison ofbaseline and follow-up severity scores demonstrateda small but statistically significant decline in severity(p5 0.04). CONCLUSIONS: Patients reportinghigher symptom severity at baseline were morelikely to drop out of the study. This raises thequestion as to whether symptom studies with longfollow-up periods retain representative samples.While symptoms persist over time, the severity ofsymptoms declines, suggesting that troublesomesymptoms may resolve over time or may bereasonably addressed by the medical team.

A-357

Making Hard Choices Easier: Fertility and Breast

Cancer

Michelle Peate1, Bettina Meiser1, Martha Hickey2,Belinda Thewes3, Phyllis Butow3, ChristobelSaunders4, Sue Rovelli5, Helen Zorbas6, MichaelFriedlander1

Prince of Wales Clinical School, University of NSWand Department of Medical Oncology, Prince ofWales Hospital, Sydney, NSW, Australia1, Schoolof Womens and Infants Health, University ofWestern Australia, Perth, WA, Australia2, Centrefor Medical Psychology and Evidence Based Deci-sion-Making, University of Sydney, Sydney, NSW,Australia3, Department of Surgery, University ofWestern Australia, Perth, WA, Australia4, RoyalHospital for Women, Sydney, NSW, Australia5,National Breast adn Ovarian Cancer Centre,Sydney, NSW, Australia6

OBJECTIVES: Patients diagnosed with cancerneed to weigh up the benefits and side-effects oftreatment. For many young women the effects oftreatment on future fertility are of enormousimportance, yet women are often not fully in-formed or fail to take in the potential adverseeffects of treatment. The aim of this research was todevelop a fertility-related decision aid, assess theunderstanding of fertility-related issues and evalu-ate the tool amongst younger women with breastcancer. METHOD: Stage 1: The decision aid (DA)was developed and pilot-tested retrospectivelyamongst 17 young breast cancer patients recruitedthrough 2 tertiary hospitals. Stage 2: A prospectivenationwide study was undertaken to assess theefficacy of the decision aid, compared to usual care.Women aged p40 years with early breast cancerwere recruited prior to commencement of adjuvanttherapy. Psychological and decision-related datawas collected at recruitment, one and 12 months,via self-administered questionaries. RESULTS:Participants prioritised fertility-related informationaround the time of diagnosis but had relativelypoor knowledge. Information needs varied andwomen felt conflicted about fertility-related deci-sions. Those who were actively seeking informationhad better knowledge, lower decisional conflict andwere more intent to pursue IVF. The DA was well-received by the retrospective sample. In womenwith high decisional conflict at diagnosis, the DAreduced decisional conflict and anxiety and in-creased informed choice, compared to usual care.CONCLUSIONS: This research resulted in theproduction of a high-quality and detailed DA thatshould be targeted at women with high levels ofdecisional conflict at the time of diagnosis. Thestudy also demonstrated that assumptions aboutwomen’s preferences for fertility informationshould not be based on socio-demographic


DOI: 10.1002/pon

Oral Abstracts S111

characteristics or family planning intentions. Thisresearch also highlights the importance of assessingthe efficacy of educational tools in a clinical setting.Funding: Cancer Council of NSW.

A-358

Psychosocial Healthcare for Cancer Patients and

Their Families: Framework and Guideline

Gale Turnbull1, Fulvia Baldassarre7, Pat Brown3,Jane Hatton-Bauer4, Madeline Li5, Esther Green2,Lisa Durkin5, Sophie Lebel6

London Regional Cancer Program, London HealthSciences Centre, London, Ontario, Canada1, CancerCare Ontario, Toronto, Ontario, Canada2, OdetteCancer Centre, Sunnybrook Health Sciences Centre,Toronto, Ontario, Canada3, Grand River RegionalCancer Centre, Kitchener, Ontario, Canada4, Uni-versity Health Network, Toronto, Ontario, Canada5,University of Ottaw, Ottawa, Ontario, Canada6,McMaster University, Hamilton, Ontario, Canada7

OBJECTIVES: Cancer patients and their familiesneed psychosocial support but there are barriers toobtaining this care. Services are often fragmented;and care advocated in theoretical models is notalways reflected in practice. In our province theneed for an advice document to address these gapswas identified. The creation of a psychosocial careframework can direct improvements in service, andprovide recommendations on specific strategies tomeet psychosocial healthcare needs at the providerand system level. METHOD: The 2008 Institute ofMedicine (IOM) standard Cancer Care for theWhole Patient: Meeting Psychosocial Health Needswas adapted to create the advice document for theprovince. A team of experts in psychosocial careand research methodologists collaborated withinthe Practice Guideline Development Cycle, usingthe ADAPTE process. The recommendationscontained in the IOM document were adapted togenerate the framework. The evidence contained inthe IOM document was used to create specificrecommendations. RESULTS: An 8-domain fra-mework was created which included the followingrecommendations: a) raising awareness: under-standing and defining psychosocial healthcare; b)standard of care; c) healthcare providers; d) patientand family education; e) quality oversight andmonitoring progress; f) workforce competencies; g)standardized nomenclature; and h) research prio-rities. Within these domains, 36 actionable recom-mendations were identified to support high qualitypsychosocial services. CONCLUSIONS: The psy-chosocial care framework can be used to developperformance measures. These can be used to judgethe quality of practice, and will render cancer care,in particular the psychosocial component, morehomogeneous across the province. Promotion anduptake of these specific recommendations will

improve timely access to quality psychosocial careand help reduce psychosocial morbidity amongpatients and their families.

A-359

Effects of a Group Education and Skills Intervention

on Neurocognitive Functioning in People Treated for

Cancer

Heather J. Green, Alana SchuursGriffith University, Gold Coast, Queensland,Australia

OBJECTIVES: This project aimed to test thefeasibility of a group psychological interventionthat was designed to improve cognitive perfor-mance in people who have completed treatmentsfor cancer. It was hypothesised that group cogni-tive rehabilitation would improve objective cogni-tive performance, subjective cognitive function andquality of life. METHOD: Eighteen adult cancersurvivors who were at least 6 months post-treatment participated in a group cognitive beha-vioural intervention led by two psychologists. Themanualised intervention, developed for this study,involved four 2-hour sessions and between sessionhomework. Sessions involved education, skillstraining and skills practice on topics such asmemory, attention, and fatigue. Participants com-pleted neuropsychological assessments and self-report measures of subjective cognitive function,quality of life, and emotional distress at pre- andpost-treatment. RESULTS: Preliminary resultsshowed that participants significantly improved intheir total score on the Repeatable Battery forAssessment of Neuropsychological Status, despitecompleting an alternate form at post-test. Im-provements at retest were much greater forintervention group participants than for a compar-ison group of community participants who had nothad cancer and who did not attend cognitiverehabilitation. Participants were highly satisfiedwith the intervention. CONCLUSIONS: Theseresults support further testing of the intervention.For the first time, we have demonstrated thatcognitive rehabilitation strategies which have pre-viously been reported in the published literatureonly as individual interventions in this populationalso have promise when delivered in a groupformat.

A-361

Melanoma Care Pathway Improves Psychosocial

Care

Tina Plat-DeKoter, Heather Shaddick, GaleTurnbull, Helen Battler, Carla GarciaLondon Regional Cancer Program, London HealthSciences Centre, London, Ontario, Canada


DOI: 10.1002/pon

S112 Oral Abstracts

OBJECTIVES: To discuss the development, im-plementation and evaluation of an interprofes-sional care pathway developed for patients withmelanoma who are undergoing Interferon Atreatment. METHOD: A care pathway for patientsundergoing Interferon A treatment for melanomawas implemented within a Regional Cancer Pro-gram. All patients are screened and assessed by thesocial worker as per the care pathway. The PatientDignity Inventory and the Distress Thermometerare screening tools utilized in the Social Worker’sassessment. Screening for depression is of particu-lar concern. The Social Worker may provideongoing counseling or refer to other servicesincluding spiritual care or psychiatry. Physicalconcerns are communicated to the interdisciplinaryteam members. RESULTS: Proactive screeningand assessment resulted in the early identificationof patients with increased risk factors for depres-sion, which led to pre-treatment assessment byPsychiatry. Patients were placed on prophylacticmedications and monitored for the remainder oftheir treatment, as appropriate. The improvedintegration of psychosocial professionals into themelanoma team resulted in timely identificationand resolution of patient’s concerns. Enhancedinterdisciplinary communication contributed toaddressing psychosocial concerns and increasingthe patient’s ability to cope. CONCLUSIONS: Theinterprofessional care pathway helps to ensure thatthe appropriate professionals are involved in thepatients’ care at critical time points, including keydecision making points. Key learnings from theimplementation of the care pathway will bepresented giving evidence that proactive interven-tions have proven to be an important aspect ofpatient care.

A-362

Burnout, Demoralization, and Spiritual Well-Being

of Physicians Who Had Cared Cancer Patients

Chun-Kai Fang1, Yuh-Cheng Yang2, Hong-WenChen3, Pei-Yi Li4, Ming-Liang Lai5

Department of Psychiatry, Mackay MemorialHospital, Taipei, Taiwan1, Department of Obstetricsand Gynecology, Mackay Memorial Hospital,Taipei, Taiwan2, Hospice and Palliative CareCenter, Mackay Memorial Hospital, Taipei,Taiwan3, Department of Educational Psychologyand Counseling, National Taiwan Normal Univer-sity, Taipei, Taiwan4, Department of Neurology,National Cheng Kung University Hospital, Tainan,Taiwan5

OBJECTIVES: Previous studies expressed theseverity about burnout among oncologists indifferent countries, but few cared the phenomenonof demoralization or spiritual well-being. Tounderstand burnout, demoralization, and spiritual

well-being of physicians who had cared cancerpatients, the survey was a pilot study for thedevelopment of continue medical education(CME). METHOD: The study was supported byNational Science Council of Taiwan (NSC 98-2511-S-195-001-) and conducted in Mackay Mem-orial Hospital, over 600 physicians, from Octoberto December 2009. Three hundred and twenty fivephysicians signed the informed consent after theinvitation. Maslach Burnout Inventory-HumanService Survey (MBI-HSS), Demoralization ScaleMandarin Version (DS-MV), and Physician’s Well-Bing Scale (PWBS) were used as the instruments.All the data was analyzed using SPSS 18.0.RESULTS: The sample included 232 male. 31.7%physicians had experienced hospitalization(H),83.7% had experienced important relativesdied(RD), and 22.5% had cared relatives at end-of-life(RE). In MBI-HSS, 2 had significant differ-ence among H, 4 among RD, and 2 among RE. InDS-MV, 1 item had significant difference among H,and 4 among RE. In PWBS, 2 had significantdifference among H, 4 among RD, and 2 amongRE. Female experienced more emotional distressand demoralized than male. CONCLUSIONS: Theresults of current study show different experiencesand gender make physicians different amongburnout, demoralization, and spiritual well-being.The CME for physicians to prevent burnout and topromote spiritual well-being is necessary.

A-366

Validation of the Needs Assessment for Advanced

Cancer Patients - Short Form (NA-ACP-SF38) in

people with advanced lung cancer

Penelope Schofield1, Anna Ugalde1, Karla Gough1,Lara Dolling1, Sanchia Aranda1, Rob Sanson-Fisher2

Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia1, University of Newcastle,Newcastle, New South Wales, Australia2

OBJECTIVES: Psychometrically rigorous mea-sures of unmet needs are required to assess theprevalence and impact of treatments design toimprove patient outcomes. The Needs Assessmentfor Advanced Cancer Patients (NA-ACP) is a 142-item self-report questionnaire designed to assessthe 7 needs domains of patients with advanced,incurable cancer: medical communication; psycho-logical/emotional; daily living; financial; symp-toms; spiritual and social. This study aimed tovalidate the short form (NA-ACP-SF38) in ad-vanced lung cancer patients. METHOD: Itemfactor loadings, test-retest data and responsedistributions were factors that influenced thedecision to retain or reject items from the originalNA-ACP scale. This resulted in 38 items beingmaintained, preserving the original subscales. 108


DOI: 10.1002/pon

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people with inoperable lung cancer commencing anew treatment regimen completed the shortenedNA-ACP-SF38 with measures of psychologicaldistress (HADS, DT) and quality of life (EORTCQLQ-C30). A-priori predictions were made fordivergent, convergent and discriminative validity.RESULTS: The survey was completed with littlemissing data (40.01%). Internal consistency coef-ficients were satisfactory for 6 subscales (range 0.71to 0.95); and marginal for the spirituality subscale(0.57). Correlations between NA-ACP-SF38 andHADS, DT and EORTC-QLQ-C30 providedsupport for 11 of the 22 divergent (r5 0.13–0.27)and convergent predictions (r5 0.45–0.71). Discri-minative predictions were made for demographicand clinical variables (age, gender, ECOG, treat-ment) however only 4 of 16 predictions weresupported. CONCLUSIONS: The NA-ACP-SF38was found to have demonstrated internal reliabilitywith subscales consistent with the original NA-ACP-SF. A priori predictions for divergent andconvergent validity provided evidence for accepta-ble validity. However, few a priori predictions fordiscriminative validity were confirmed. This studyprovides evidence that the NA-ACP-SF38 psycho-metrically robust, easily understood and faster toadminister than the original version in lung cancerpatients.

A-368

Screening for Distress in the Private Sector:

Establishing a Screening Protocol and Referral

Pathway

Jane Fletcher1, Sue Burney1, Kelly Chipperfield1,Preetha Madhavan1, Ilana Kornhauser1, PeterLowthian2

Cabrini Monash Psycho-Oncology Research Unit,Cabrini Health, Melbourne, Australia1, CabriniInstitute, Cabrini Health, Melbourne, Australia2

OBJECTIVES: The utility of screening for distressin oncology patients has been well documented.With the view of establishing screening for distressas part of routine clinical practice the feasibilityand acceptability in chemotherapy patients at aprivate centre was established. METHOD: Onehundred and twenty-three patients receiving che-motherapy completed a self report questionnairebetween May and September 2009. The projectutilised the National Comprehensive Cancer Net-works Distress Thermometer (DT) and problemchecklist, the Kessler Distress Scale (K10), ques-tions relating to satisfaction with the distressmeasures and a series of medical and demographicitems. Participants included those with a breast(29%), haematological (22%), bowel (20%), lung(12%) and gynaecological (10%) cancer diagnosis.RESULTS: Based on the clinical cut off scores fordistress, 38% were classified as distressed using the

DT and 24% using the K10. Both the DT and K10were seen as being ‘easy’ or ‘very easy’ to use by inexcess of 80% of the sample. Results from the DT’sproblem checklist identified a range of physicalconcerns (fatigue 71%, constipation 41%), psy-chological problems (worry 41%, sadness 30%)and practical concerns (getting around 28%).CONCLUSIONS: Given the level of distressidentified in patients undergoing chemotherapy atCabrini Health and the satisfaction with and utilityof the DT and problem checklist, the establishmentof routine screening for distress in chemotherapypatients is seen as not only feasibility but accep-table to both patients and nursing staff.

A-370

The Development of a Nurse-Led Psychosocial

Intervention with Peer Support for Women Being

Treated with Radiotherapy for Gynaecological

Cancer (GC)

Penelope Schofield1, Rebecca Bergin1, SuziGrogan1, Kerith Sharkey1, Ilona Juraskova2,Linda Mileshkin1, Meinir Krishnasamy1, AlisonHocking1, David Bernshaw1, Sanchia Aranda1

Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia1, University of Sydney, Sydney,New South Wales, Australia2

OBJECTIVES: Radiotherapy for GC has numer-ous potentially distressing side effects which impacton psychosocial functioning and intimate relation-ships. Distress associated with diagnosis andtreatment can be ameliorated by comprehensivepreparation for treatment and addressing informa-tional, physical and psychosocial needs duringtreatment. The proposed intervention combinestailored specialist nursing consultations with peersupport (GC survivor). The objective is to develop,refine and pre-test an intervention package toensure its relevance and acceptability to patientsand clinicians. METHOD: Drawing on extensiveliterature reviews and consumer input, a 3-stageprocess for developing complex interventions,based on UK Medical Research Council Frame-work, was used. This comprised: (1) Problemdefinition: the nature and extent of unmet suppor-tive care needs. (2) Refining the intervention byiterative clinician, and consumer review: evidence-based content; complexity and tailoring; deliveryand dose; and integrity. (3) Pre-testing the inter-vention with 10 women and conduct interviews toassist in finalizing the intervention RESULTS: Thelist of unmet needs was combined with bestavailable evidence for self-care to draft twointervention manuals. The nurse manual specifiedthe content of three nurse-led consultations at thepre-, mid- and end of treatment to provide tailoredinformation, self-care coaching and MDT care-coordination. The peer manual specified the


DOI: 10.1002/pon

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content of five phone calls (pre-, mid-, end oftreatment and twice post-treatment) to providepsychosocial support and encourage adherence tothe self-care plan. CONCLUSIONS: The interven-tion package was well-received by consumers andclinicians. The consumer feedback provided indi-cates that access to accurate and timely medicaland self-care information from nurses is criticallyimportant, and the unique perspective of a peerlends authenticity to support that facilitates shar-ing, practical, emotional and meaning-based cop-ing. The next stage is to conduct a multi-site RCTto test the effectiveness of the intervention toreduce psychological distress, psychosocial needs,psychosexual difficulties and symptoms.

A-375

Cancer Treatment Survey (CaTS): A New Instru-

ment to Assess the Adequacy of Communication to

Prepare Patients for Chemotherapy and Radio-

therapy

Penelope Schofield1, Karla Gough1, MarikoCarey2, Anna Ugalde1, Sanchia Aranda1, RobSanson-Fisher2

Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia1, University of Sydney, Sydney,New South Wales, Australia2

OBJECTIVES: Cancer patients experience highlevels of pre-treatment anxiety. Chemotherapy andradiotherapy are threatening medical procedures.Randomised controlled trials demonstrate thattreatment preparation which includes the timelycommunication of sensory/procedural informationand addressing fears reduces anxiety, pain anddistress. This study aimed to develop a new andunique instrument, the Cancer Treatment Survey(CaTS) to assess the adequacy of communicationto prepare cancer patients for chemotherapy andradiotherapy. METHOD: Items were generated byexperts and piloted with cancer patients. Theinstrument, with 36 items, was administered to192 cancer patients commencing chemotherapy forlymphoma, breast or colon cancer. Participantsalso completed the Hospital Anxiety and Depres-sion Scale (HADS). Basic medical and demo-graphic variables were collected. Statisticalanalysis involved the removal of items, the defini-tion of factors, establishing internal reliability anddivergent validity via correlation with HADS.RESULTS: Item selection removed 11 items.Factor analysis indicated a two-factor solution:14 items representing sensory/psychological con-cerns and 11 items representing procedural con-cerns. Both subscales demonstrated a high degreeof internal consistency (Cronbach’s alpha 40.90).Weak correlations (r5 0.13 to 0.26) between CaTSand HADS subscales provided clear support forthe divergent validity of both subscales. Younger

participants (under 65 years of age) had signifi-cantly greater procedural concerns (p5 0.001).CONCLUSIONS: The CaTS is a two factor, 25-item measure that assesses adequacy of commu-nication relating to sensory/psychological andprocedural concerns. The results indicate that thisnew measure is reliable and valid. Further inves-tigation of psychometric properties, particularlyvalidity, is warranted. It is critically important tocommunicate, educate and prepare patients forthreatening procedures including new cancer treat-ments, especially in younger patients. This instru-ment provides a tool to investigate the adequacy ofthat preparation.

A-379

Alerting Clinicians to Caregiver’s Ratings of Cancer

Patient Symptom Distress: A Randomized Compar-

ison of the Clinician Report (CR) Service

Lori L. DuBenske, David H. Gustafson, Ming-Yuan Chih, Robert P. Hawkins, Susan Dinauer,James F. ClearyUniversity of Wisconsin, Madison, Wisconsin,United States

OBJECTIVES: Caregivers play a key role inmonitoring and managing patients’ symptoms inadvanced cancer. Clinicians could benefit fromtimely updates between clinical encounters on theclinical and psychosocial status of patients, and thecaregiver’s ability to support patient’s needs. Suchinformation exchange may trigger timely treatmentadjustments and symptom management. Thissecondary analysis from a randomized clinical trialexamined whether providing clinicians e-mail alertsof caregiver’s ratings of patient symptom distressleads to symptom improvement. METHOD: 235advanced lung, breast, and prostate cancer care-givers received access to an Internet-based Inter-active Cancer Communication System (ICCS)either with or without Clinician Report. CR e-mailed the clinician when caregivers rated patients’symptom levels above preset threshold. Using webserver data, threshold reports were coded asimproved or not based on whether subsequentreport had lower symptom rating. Percentage ofimproved threshold symptoms were calculatedacross 2-month intervals and compared betweenICCS and ICCS1CR groups. RESULTS: Due toattrition, including patient death, 217 caregivers(107 ICCS versus 110 ICCS1CR) remained for 12month intervention. Area under the curve analysiscompared the proportional differences of improvedthreshold symptoms out of total threshold symp-toms between the groups. Across all 2 monthintervals, caregivers in ICCS1CR group reporthigher percentages of improved threshold symp-toms (42.9%–55.4%) than those in ICCS group(23.6%–29.3%). The proportional differences of


DOI: 10.1002/pon

Oral Abstracts S115

AUCs is significant, t5 11.9, po0.001. CONCLU-SIONS: The clinician report alerted clinicians toareas where the caregiver perceived the patient haddistress. While both groups showed some symptomimprovement, the likelihood of symptoms improv-ing was greater if the clinician had been notified. Itis hypothesized that the clinicians responded tothese alerts by adjusting treatments or managingsymptoms, leading to greater proportion of im-provement in the group with the clinician notifica-tion. While such mechanisms of effect warrantexamination, results are promising.

A-381

Predicting Distress in Cancer Survivors: Develop-

ment of a Theoretical Model

Kerryann Lotfi-Jam, Penelope Schofield, SanchiaAranda, Michael JeffordPeter MacCallum Cancer Centre, Melbourne,Australia

OBJECTIVES: Many post-treatment cancer survi-vors experience significant distress due to physicaland psychosocial consequences of treatment. Forsome, this distress does not decrease over time,hence there is a need to identify those at high riskof ongoing distress for targeted intervention.Theory can guide this process, however there iscurrently no established theoretical framework forsurvivorship researchers. This study aimed todevelop a theoretical model that predicts patternsof distress in cancer survivors. METHOD: Athorough review of theoretical frameworks usedin health and psychological research was under-taken, including stress and coping, crisis andtransition, behaviour change and quality of lifemodels, in addition to empirical evidence. Adopt-ing a clinical pragmatist approach, predictorfactors were included in the model if they were a)an individual factor (not social or environmental),b) quantitatively measurable using a validatedinstrument, c) amenable to change over time orwith intervention. RESULTS: The developedmodel illustrates four pathways of distress experi-enced by cancer survivors. Predictors of higherdistress include worse treatment side-effects, poorsocial support, poor coping/adjustment styles, lackof finding benefit/meaning in the experience andhaving more unmet needs. Coping strategies andadoption of health behaviours are likely to mediatethese relationships. Each factor adopted in themodel has been mapped to a validated outcomemeasure for pilot testing in a longitudinal study ofsurvivor distress. CONCLUSIONS: Theory is vitalfor identifying factors which contribute to pro-blems and developing interventions that are likelyto be successful in practice. Reducing distress, the6th vital sign, is an important endpoint because itemphasises survivors’ experiences during this

phase. This model brings together several poten-tially modifiable factors which may predictsurvivor distress and inform intervention develop-ment. This model serves as a key step towards atheoretical foundation for considering survivorshipoutcomes and other psycho-oncology research.

A-383

Unmet Needs, Psychological Distress and Quality of

Life in Men Commencing Radiotherapy for Prostate

Cancer

Kerryann Lotfi-Jam1, Lara Dolling1, KerithSharkey1, Karla Gough1, Paul Dudgeon2, SanchiaAranda1, Penelope Schofield1

Peter MacCallum Cancer Centre, Melbourne,Australia1, University of Melbourne, Melbourne,Australia2

OBJECTIVES: Prostate cancer is the second mostcommon cancer in men worldwide. Commencingradiotherapy is a particularly difficult time, whenthere is a high need for information and support tomanage physical and psychosocial symptoms.However, these needs and concerns are oftenunreported by men and undetected by healthprofessionals, potentially resulting in elevateddistress. This project examined unmet needs,distress and quality of life in a large sample ofmen commencing radiotherapy for prostate cancer.METHOD: A consecutive sample of 330 men(response rate 70%) with prostate cancer commen-cing potentially curative radiotherapy for the firsttime participated in a randomised controlled trialtesting the effectiveness of a psycho-educationalintervention. Baseline data is reported. Question-naires assessed unmet needs using Supportive CareNeeds Survey (SCNS), anxiety and depressionusing Hospital Anxiety and Depression Scale(HADS), distress using the Distress Thermometer(DT) and quality of life using the ExpandedProstate Cancer Index Composite (EPIC).RESULTS: 20% reported probable anxiety and8% reported probable caseness for depression onHADS. 19% reported clinically significant distresson the DT. 93% reported at least one unmet need(mean5 13 of total 34 needs). The highest unmetneed was having a staff member to discuss allaspects of cancer and treatment (36%). High needscorrelated with higher anxiety, depression anddistress across all domains (po0.01). 36% reportedsexual functioning as a significant problem on theEPIC. CONCLUSIONS: This study indicates thatmany men with prostate cancer experience highlevels of unmet needs, psychological distress andpoor sexual functioning prior to commencingradiotherapy, despite an absence of treatmentside-effects and a good prognosis. This is particu-larly evident in the psychological, health systeminformation and sexuality domains. This study


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highlights the need for better methods for detectingunmet needs at treatment commencement andtailored interventions to reduce needs and distressfor this vulnerable group.

A-385

Body Image Disturbance and the Impact of Surgery

Amongst Patients with Colorectal Cancer

Tracey Bullen1, Louise Sharpe1, Catalina Lawsin1,Deepa Chauhan1, Les Bokey2, Stephen Clarke1

University of Sydney, Sydney, Australia1,Concord Repatriation General Hospital, Concord,Australia2

OBJECTIVES: Body image disturbance (BI) canbe a significant difficulty among cancer patients,particularly when treatment requires invasivesurgery or chemotherapy that can alter one’sappearance, such as in the formation of a stomain colorectal cancer (CRC). This study aims toinvestigate predictors of body image disturbance inCRC and the impact of on psychopathologyfollowing surgery and the changes in BI over timewhilst evaluating White’s model of body image(BI). METHOD: Patients with a primary diagnosisof CRC (N5 35, male5 15, female5 17, meanage5 58.4yrs) were recruited prior to surgery andcompleted a range of questionnaires associatedwith BI and pre-existing levels of psychopathology.Patients were followed up three months aftersurgery to examine the influence of surgery andstoma placement on BI. RESULTS: Baselinemeasures showed BI significantly contributed toanxiety and depression levels prior to surgery F(1,32)5 5.68, po0.05, (Adjusted R25 0.124,5 0.334, po0.05)Repeated measures analysis re-vealed a significant change in BI over timefollowing surgery F(1, 23)5 126.86, po0.01,25 0.847 There was a significant interactionbetween BI and whether these patients had a stomaF(1, 23)5 11.508, p5 0.003, 25 0.333 independentof illness. Lastly, a significant interaction effect wasdemonstrated between self evaluation schema andstoma status F(1, 23)5 4.819, p5 0.039, 25 0.173.CONCLUSIONS: The interaction between self-evaluation and stoma status demonstrated theobjective change of stoma formation followingsurgery may indicate that pre-existing beliefs aboutthe self are vulnerable to alteration following aphysical change. This relationship suggests thatpatients maybe particularly vulnerable to poor self-worth during recovery. CRC patients demon-strated significant investment in their appearancewhich was significantly related to depression levels,suggesting pre-existing self perceptions which maybe already maladaptive may worsen over time,potentially leading to poorer adjustment followingstoma formation.

A-390

Psychosocial Conditions of Cancer Patients When

They Go Through the Public Healthcare System in

Hong Kong

Nikki Cheng, Bowie Cheung, Tammy LeungCancerLink Support Centre, Hong Kong CancerFund, Hong Kong, China

OBJECTIVES: The number of new cancer casescontinued to rise at a rate of around 2% per annumin Hong Kong. (Hong Kong Cancer Registry1983–2007). Patients have to deal with a widevariety of stressors at different stages of cancer.(Weisman AD, Worden JW) We conducted aquantitative survey to study cancer patients’psychosocial conditions when they go through thepublic hospitals in 2009. METHOD: We collected1172 data from patients with cancer who partici-pated in self help groups in Hong Kong with aresponse rate of 15%. It focused on 3 areas ofconcern of patients experiences when they gothrough the public health care system: 1. Emo-tional status in the waiting period of first diagnosticconsultation; 2. Coping of Medical burden intreatment period; 3. Communication with medicalpractitioners. RESULTS: 70% of respondents werefemale while 30% are male. There is a positiverelationship between the length of waiting time andnegative emotions before first consultation. Over50% respondents were distressed resulting from thefinancial burden. Some were terminated theirmedical follow up in public hospital and 17.3%respondent switched to private medical institutionsdue to long waiting time. Less than 50% respon-dents claimed they were satisfied on communica-tion with medical professionals. CONCLUSIONS:The survey reflected the structural reality thatcancer patients experience additional emotionalstresses when they enter the public health caresystem in Hong Kong in which it should suppose toprovide safety net to them. Only those can affordseek timely private health care. From ecologicalperspective, we are the supportive system whichaims to minimize cancer patients’ suffering throughproviding suitable community-based care psycho-social services to address the service gaps.

A-394

Risk Factors for Distress: Predictors of Depression

and Anxiety among Australian Head and Neck

Cancer Patients at Diagnosis

Karen Mead1, David Smith1, Kate Neilson2,Annabel Pollard2, Ann Boonzaier2, June Corry2,David Castle3, Marcelle Gray1, John Reece1,Jeremy Couper2

RMIT University, Melbourne, Australia1, PeterMacCallum Cancer Centre, Melbourne, Australia2,Saint Vincent’s Hospital, Melbourne, Australia3


DOI: 10.1002/pon

Oral Abstracts S117

OBJECTIVES: Patients with head and neck cancer(HNC) are known to be at increased risk ofpsychological distress. As symptoms of distress -including depression and anxiety - have a negativeimpact on patients’ treatment outcomes andpsychological well-being, early identification ofat-risk patients may improve subsequent qualityof life in HNC patients. Thus, the purpose of thisstudy was to identify risk factors associated withdepression and anxiety among Australian HNCpatients at diagnosis. METHOD: An observationalstudy of consecutive HNC outpatient referrals at atertiary cancer centre in Australia. Eligibilitycriteria included a new HNC diagnosis where thepatient agreed to undertake treatment with cura-tive intent. Data were collected at diagnosis, priorto the commencement of treatment, (n5 109). Theassociation between 14 empirically-derived riskfactors, and the primary outcome variable ofdistress - assessed on the Hospital Anxiety andDepression Scale (HADS) - was then explored.RESULTS: Four risk factors were significantlyassociated with distress at diagnosis: younger age,children agedo21, and two coping styles (helpless/hopeless, and anxious preoccupation). Coping stylepredicted 23% and 31% of the variance indepression and anxiety measures, respectively.After controlling for coping style, age accountedfor an additional 7.5% of the variance in theHADS anxiety subscale. The presence of depen-dant children (o21 years) did not moderate therelationship between age and anxiety. CONCLU-SIONS: Four risk factors were associated withdepression and/or anxiety at diagnosis. However,younger age was considered to be the mostclinically useful predictor. The presence of childreno21 years old did not significantly increase therisk of anxiety-related distress among youngerpatients. Given these findings, it is suggested thatyounger HNC patients may benefit from earlypsychological support, in order to preventfurther distress and enhance subsequent treatmentoutcomes.

A-396

Caring Beyond Cancer: The Unmet Needs Of The

Partners And Close Family Members of Long-term

Cancer Survivors

Daniel Turner1, Eila Watson1, Mary Boulton1,Eike Adams1, Sian Harrison2, Peter Rose2

Oxford Brookes University,Oxford,United Kingdom1,University of Oxford, Oxford, United Kingdom2

OBJECTIVES: There are over 2 million cancersurvivors in the UK. Cancer can have a profoundeffect on the well-being of the patient, but also amajor impact on family members, an area relativelyneglected in current research. This project aims to

assess the experiences and unmet supportive careneeds of the partners or close family members ofpeople who have survived breast, colorectal orprostate cancer for five years or more. METHOD:Cancer survivors recruited for a linked studynominated a partner or close relative to receive aquestionnaire which assessed anxiety and depres-sion (HADS), health status (EQ-5D), unmet needs(CaSPUN), post-traumatic growth, as well asopinions on discharge and primary care. Semi-structured interviews with a subset of respondentsadded depth, context and validation of question-naire responses. RESULTS: To date, 230 survivorsnominated a partner/relative to take part, and 149carers have returned questionnaires. Respondersgenerally recorded few current issues, but aconsiderable subset (�20%) did report significantlevels of both anxiety and unmet needs. Fear ofrecurrence and concern about coordination be-tween different medical professionals were the mostreported issues. Interviews indicated general satis-faction with primary care, but complex familysituations contributed to periods of stress andanxiety for family members. CONCLUSIONS:While a majority of partners/family members areable to return to normal lives, primary care has animportant role to play in recognizing the role offamily members and developing strategies toidentify and support those with ongoing unmetneeds.

A-397

Service Review of Psychosocial-Oncology Commu-

nity Services in Hong Kong

Yuk Chun Tammy LeungHong Kong Cancer Fund, Hong Kong, Hong Kong

OBJECTIVES: As a pioneer in provide cancerpatient community care service in Hong Kongsince 1997, CancerLink Cancer Support Centresprovide people-oriented as well as community-based psychosocial oncology care. CancerLink is ahaven of community care where we help peopleadjust to living with cancer by a wide range of freeprofessional support and rehabilitation pro-grammes. Our professional carers help clientsmanage the physical, emotional, psychologicaland social challenges brought about by a cancerdiagnosis. METHOD: 11 focus groups (77 partici-pants in total) were held to gather informationabout the existing services quality. Potentialparticipants were recruited randomly from cancerpatients who had involved at least one of the 6categorized services, classes or talks in CancerLink.If we failed to contact the target participant, asubstitute would be found under the same rando-mization method. The target participants werecancer patients in all stages. RESULTS: The 11


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focus groups highlighted a lot of strengths andsome rooms for improvement. Most of them havereceived services from Cancerlink for years andexperienced a big improvement. Discussions re-vealed their appreciations on the services ofCancerlink. The presentation will cover the detailsof comments collected for the service users in whichwe concluded that no doubt the participantssatisfied on existing services especially the rehabi-litation programs and psychotherapeutic service.CONCLUSIONS: CancerLink has become one ofthe most successful cancer support services in HongKong, leading 15 cancer patient support groupsand serving thousands of patients. The data fromthis study warrant a more in-depth qualitativeresearch should be conducted to explore the rolesof different psychosocial-oncology community ser-vices. They tended to ask for more rather thancomplaint on what we were providing such as‘Need more venue for activities,’ ‘increase classquota’ etc.

A-398

The Investigation of Posttraumatic Growth and

Effecting Factors in Cancer Patients

Mine Ozkan, Seda Bayraktar, Sedat OzkanIstanbul University, Istanbul, Turkey

OBJECTIVES: The main aim of this study is todeal with positive transformations which occurafter the diagnosis and experience of cancer in adefinite period. Within this scope of investigationsocio-demographic and illness related factors,coping and illness perceptions impact on posttrau-matic growth were evaluated. METHOD: Datawere collected by administering an interview formand 3 scales (Posttraumatic Growth Inventory,Ways of Coping Inventory and Illness PerceptionScale-R) to 78 cancer outpatients in IstanbulUniversity Oncology Institute. Data were evalu-ated with using one way ANOVA, independentsample t-test and regression analysis. RESULTS:Results showed that cancer patients in this samplehave higher posttraumatic growth levels to themean. Time since diagnosis and informationsufficiency about illness and treatment variablesare related with posttraumatic growth. As a resultof stepwise regression analysis, it was found thatself-controlling, accepting responsibility, escape-avoidance coping style, positive reappraisal, seek-ing social support, distancing and illness coherencewere significant predictors of posttraumaticgrowth. CONCLUSIONS: Results showed thatways of coping and illness perceptions wereimportant variables on posttraumatic growth.The results of the study will be discussed withinthe literature, shortcomings of the study andproposals for future research will be presented.

A-400

Caregiving Ideals and Family Caregivers’

Challenges when Caring for a Dying Family

Member at Home

Ida Carlander1, Eva Sahlberg Blom3, IngridHellstrom3, Britt-Marie Ternestedt5

Departement NVS, Division of Nursing KarolinskaInstitutet, Stockholm, Sweden1, Department ofPalliative Care Research, Ersta Skondal UniversityCollege, Stockholm, Sweden2, School of Health andMedical Sciences, Orebro University, Orebro,Sweden3, Department of Social and Welfare Studies,Linkoping University, Linkoping, Sweden4,Research and Developement Unit, StockholmsSjukhem Foundation, Stockholm, Sweden5

OBJECTIVES: It is well known that family care-givers are exposed to challenges in their daily liveswith a dying family member. Examination ofcaregiving situations may provide additional insighton the impact these have on the caregivers self. Theaim of this study was to explore situations in dailylife that challenge caregivers’ self-image when caringfor a dying family member at home. METHOD: Indesigning the study, an interpretive descriptionapproach was chosen. The purpose was to reach acoherent conceptual description that draws fromthematic patterns characterising the phenomenon, inthis case challenging situations and family caregivers’self-image. Ten family caregivers who cared for adying family member at home with support from anadvanced homecare team were interviewed 6–12months after the death of the family member.RESULTS: Situations that challenged the care-givers’ self-image were connected to experiences suchas not recognising themselves, specifically in terms ofhow they acted and felt in different situations.Thoughts raised by the situations could be char-acterized as ‘forbidden’ when there were a discre-pancy between the caregivers experiences and theirown ideals of a caregiver. This was understood tohave an influence on the caregivers’ self-image andidentity. CONCLUSIONS: It is important torecognise the impact of caring for a dying familymember at home. From a clinical perspective thepresent study emphasizes the significance of creatinga climate, which allows family caregivers to expressthoughts and experiences. Sharing experiences suchas ‘forbidden thoughts’ can be one way of handlingthe profoundly changed every day life.

A-406

What Influences HPV Vaccination? Underlying

Cognitions of Vaccine Recipients and non-Recipients

Rebekah Powell, Ilona Juraskova, Kirsten McCafferyCentre for Medical Psychology & Evidence-basedDecision-making (CeMPED), The University ofSydney, Sydney, New South Wales, Australia


DOI: 10.1002/pon

Oral Abstracts S119

OBJECTIVES: HPV is a common STI, causallyassociated with genital warts and cervical cancer.In 2007, school- and population-based HPVvaccination programs were introduced to preventthese conditions amongst women aged 12–26 years.Using the Social Cognitive Theory (SCT), thisstudy aimed to investigate the knowledge, self-efficacy, perceived facilitators, perceived impedi-ments, outcome expectations, and goals amongstHPV vaccine recipients and non-recipients. Post-vaccination cognitions (vaccination autonomy andrisk compensation) amongst school-based versuspopulation-based recipients were also explored.METHOD: 161 female university students (102recipients and 59 non-recipients) under the age of26 completed web-based purpose-designed ques-tionnaires, informed by a pilot study (n5 20) andliterature. All scale had high internal consistency(Cronbach’s Alpha 40.85). RESULTS: HPVvaccine recipients scored significantly higher thannon-recipients on self-efficacy, perceived facilita-tors, outcome expectations, and goals (allpo0.001); and significantly lower on perceivedimpediments (po0.001). A relative lack of knowl-edge (mean5 52%) was evident amongst partici-pants in both groups. Perceived facilitators(p5 0.010) and impediments (p5 0.030) were keypredictors of uptake, with the SCT model explain-ing 41% of variability in vaccine uptake. School-based vaccine recipients were significantly lessautonomous in their vaccination decision thanpopulation-based recipients (p5 0.001). CON-CLUSIONS: The current study explored cogni-tions underlying the uptake of the HPV vaccineamong one of the first vaccinated cohorts in theworld. The results suggest that health communica-tors/professionals need to focus on publicising thefacilitating factors, whilst fostering self-efficacy ineffectively overcoming HPV vaccination barriers.School-based initiative coordinators and healthprofessionals should be aware of the lack ofautonomy or active participation in the vaccinationdecision amongst many school-aged vaccinerecipients.

A-407

The Clinical Course of Hospice Patients with Cancer

Winson Cheung1, Robert Glynn2, Raisa Levin2,Soko Setoguchi3

British Columbia Cancer Agency, Vancouver,British Columbia, Canada1, Brigham and Women’sHospital, Boston, Massachusetts, United States2,Harvard School of Public Health, Boston,Massachusetts, United States3

OBJECTIVES: Hospice services play an integralcomponent in the management of terminal cancer.However, little is known about the clinical trajec-tories of cancer patients after hospice enrollment,

even though this information may help to optimizedelivery of palliative care for future cancer patients.Our aims are to 1) describe patterns of referral,acute services utilization, and sites of death ofhospice patients with cancer and 2) identify clinicalfactors associated with sub-optimal hospice use.METHOD: Using linked data from US Medicareand state cancer registry, we identified patients whowere diagnosed with 1 of 4 common solid tumors(breast, lung, colorectal or prostate cancer) be-tween 1997 and 2004, admitted to hospice at leastonce following their diagnosis, and died during thestudy period. Multivariate logistic regression mod-els were constructed to determine predictors for 1)the use of and death in acute care and 2) latehospice enrollment. RESULTS: We identified 3,840 patients. They were commonly referred tohospice from home (67%) and less likely fromacute care hospitals (ACH) (24%), nursing homes(7%) or emergency departments (ED) (2%). Use ofACH and ED, and death in acute care settings wereinfrequent (6, 10, and 2%, respectively). Approxi-mately 24% of patients were admitted p7 daysbefore death. Patients from ACH were more likelyto enroll late, but had decreased odds of using anddying in acute care. CONCLUSIONS: Hospicecare appears well integrated into the managementof end-of-life cancer patients. Use of acute careservices after hospice enrollment was minimal, buttiming of referrals can be further optimized.

A-409

Psychosocial Consequences of Working with Dying

Patients

Semra Ulusoy Kaymak1, Eylem Sahin Cankurtaran2,Elvan Ozalp3, Ersin Hatice Karslioglu4, HaldunSoygur1

Ankara Oncology Training and Research Hospital,Ankara, Turkey1, Ankara Oncology Training andResearch Hospital, Ankara, Turkey2, AnkaraOncology Training and Research Hospital, Ankara,Turkey3, Ankara Oncology Training and ResearchHospital, Ankara, Turkey4, Ankara OncologyTraining and Research Hospital, Ankara, Turkey5

OBJECTIVES: It is hard to work with cancerpatients and to deal with their relatives. Toinvestigate the psychosocial reactions of the staffworking with dying patients gains importance. Thepurpose of this study was to determine the levels ofanxiety, depression, burnout, work satisfaction,quality of life and attitudes about death of the staffworking at palliative care unit and to compare withstaff working at medical oncology and psychiatryclinics. METHOD: This study was carried out onthree groups; staff working at palliative care unit,medical oncology clinic and psychiatry clinic inAnkara Oncology Training and Research Hospital.Nurses and health technicians were included.


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Socio-demographic information form, Beck De-pression Inventory, Beck Anxiety Inventory, Ma-slach Burnout Inventory, Minnesota WorkSatisfaction Measurement, the Attitude Scaleabout Euthanasia, Death and Dying Patient andWHO Quality of Life Scale were administered tothe sample. RESULTS: Three groups are compar-able in terms of age, gender, marital status,education and years in the occupation. Levels ofdepression, quality of life, burn out, work satisfac-tion were statistically different when we comparedthree groups by using one way ANOVA. Workingat palliative care unit and medical oncology clinichas prominent disadvantages in work satisfactionand quality of life when compared with working atpsychiatry clinic by using post hoc scheffe tests.CONCLUSIONS: Further studies should evaluatethe organizational and personal factors whichcould improve the psychosocial sources of thehealth staff that are face to face with dyingpatients.

A-410

Impact Of Risk Perception And Emotion Regulation

Strategies on Cancer Screening Practices of Young

Unaffected Non-carriers Women Within BRCA1/2

Mutation–Positive Families

Christelle Duprez1, Veronique Christophe1, Isa-belle Milhabet2, Astrid Mignon1, Aurelie Krze-minski2, Philippe Vennin3, Claude Adenis3,Pascaline Berthet4, Guy Launoy5, Jean-PhilippePeyrat6

Universite Lille Nord de France, Universite de Lille3, URECA EA 1059, Villeneuve d’Ascq, France1,Universite de Nice Sophia-Antipolis, LPCS EA1189, Nice, France2, Departement de Senologie,Centre Oscar Lambret, Lille, France3, Equipemultidisciplinaire d’oncogenetique, Centre Franc-oisBaclesse, Caen, France4, Equipe ERI3 INSERMCancers et population, Centre Hospitalier Universi-taire, Caen, France5, Laboratoire d’Oncologie Mo-leculaire Humaine, Centre Oscar Lambret, Lille,France6

OBJECTIVES: About 5 to 10% of breast/ovariancancers are linked with mutations on BRCA1/2genes. Recent Anglo-Saxon epidemiological studiesshowed that young unaffected non-carrier womenbelonging to BRCA1/2-mutation-positive familieshave overscreening practices for breast/ovariancancer. This study aims at evaluating the influenceof risk perception, in terms of comparativepessimism related to the fact of developing abreast/ovarian cancer, and emotion regulationstrategies on these screening practices. METHOD:One hundred and four unaffected non-carrierwomen, aged under 50 and who had received theirnegative mutation result at least one yearbefore the beginning of the study completed a

self-administrated questionnaire. Besides sociode-mographic data, the questionnaire assessed 1) thescreening practices adopted since the disclosure ofthe genetic testing result, 2) the risk perception ofevents related to illness, and 3) emotion regulationstrategies. RESULTS: Most participants reportoverscreening practices and express comparativepessimism. They especially consider having higherrisks of experiencing negative illness-related events(e.g. having breast or ovarian cancer during theirlife) than a woman from the general population.Comparative pessimism is an explaining factor ofoverscreening practices by mammography andbreast ultrasound. Links also appear betweenemotion regulation strategies and screening prac-tices. Expressive suppression is associated withovarian ultrasound, and cognitive reappraisal withbreast self-examination. CONCLUSIONS: Thesepreliminary data suggest that participation togenetic testing has a significant impact, even onnon-carrier women. Far from being reassured bytheir genetic test result, these women adopt nonrecommended screening practices. Since this rea-soning is based on their uncertainties and pessi-mism regarding the future, a monitoring followingthe genetic test disclosure would permit to ensurethat women correctly perceive their cancer risksand adopt recommended screening practices.

A-411

Sexuality, Communication and Emotions: Explora-

tory Study with Women Affected by Gynaecological

Cancer

Cristina Pallı1, Jun Lluch1, Miquel Beltran2, PilarBarretina1, Elena Alvarez3, Eduard Sala3, AnaFlorensa3, Carme Viladrich4

Department of Psycho-oncology. Institut Catalad’Oncologia, Girona, Spain1, Department ofMedical Oncology, Girona, Spain2, Department ofGynecology, Girona, Spain3, Department ofMethodology. Faculty of Psychology. UniversitatAutonoma de Barcelona, Barcelona, Spain4

OBJECTIVES: Sexuality, as a natural expressionof quality of life, has become a topic of concern forpsycho-oncology in the last years. Surprisingly,only a few studies have directly approached sexualdysfunction after gynaecological cancer (GC). Ourstudy identifies sexual dysfunction symptoms,mediating factors and rehabilitative needs forwomen affected by ovarian, endometrial andcervical cancer. No such study has been previouslycarried out in Spain. METHOD: We interviewed202 women with GC. 105 had quitted sexualrelationships before cancer diagnosis, 33 forcancer-related reasons. Sixty-four sexually activewomen (SA) answered a) HADS and b) FSM(Woman Sexual Functioning Questionnaire, vali-dated in Spanish population, yielding a global


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score of sexual functioning (SF)). Any type ofsexual activity was included, not only penetration.Retest was conducted in 4 months. Group supporton sexuality was offered to all women. SPSS wasused for analysis. RESULTS: Symptoms amongSA women are: decreased lubrication, frequency ofrelations and desire (62%, 58%, 52% respectively);difficulties with excitation, orgasm and penetration(47%, 49%, 33% respectively). SF diminishes withdepression (p5 0.002) (trend for anxiety p5 0.087).Longer time free of treatment tends to improve SF.No differences were observed depending on cancersite, disease stage and menopause status. Having apartner and age influence whether a womanremains sexually active (p5 0.017). CONCLU-SIONS: Despite caution because of small sample,results show that GC and its treatments affectsexuality. Not surprisingly, 94% of interviewedwomen expressed their desire for more informationregarding sexual consequences of illness andtreatment. Further research should clarify the roleof specific treatments. Psychological issues such asdistress, quality of previous sexual and partnerrelationship, feeling of loss of femininity andinterruption of maternity also play a role, andshould be therapeutically dealt with.

A-414

Role of Cancer Survivorship Discussions in Affecting

Patient and Physician Expectations and Receipt of

Follow-Up Care

Winson Cheung1, Bridget Neville2, Craig Earle3

British Columbia Cancer Agency, Vancouver,British Columbia, Canada1, Dana Farber CancerInstitute, Boston, Massachusetts, United States2,Institute for Clinical Evaluative Sciences, Toronto,Ontario, Canada3

OBJECTIVES: Because of heavy emphasis on theprimary cancer diagnosis, significant attention maybe shifted away from other essential aspects ofgeneral medical care. Prior studies suggest that thereis a wide disconnect between patients and physi-cians, and among physicians themselves about theirroles during the cancer survivorship care process.Our aims are to explore the impact of cancersurvivorship discussions on patient-physician ex-pectations and receipt of follow-up care amongcancer survivors. METHOD: We surveyed cancersurvivors about their care, including (1) expectationsof their providers’ roles (2) whether discussions witha physician had occurred and (3) follow-up patterns.Primary care providers (PCPs) and oncologists werealso surveyed for their own perceived roles. Wedeveloped a scoring system to evaluate the agree-ment in expectations between patients and physi-cians and between physicians themselves (05mostdiscordant and 45most concordant). Regressionanalyses were conducted to examine the relation-

ships among discussions, expectations, and follow-up. RESULTS: In total, 535 (54%) patients and 378(62%) physicians responded. Survivorship expecta-tions were most discrepant between PCPs andoncologists (mean score 1.78), moderate betweenpatients and oncologists (mean score 1.97), andmost similar between patients and PCPs (meanscore 2.82). Having a conversation about cancerfollow-up was associated with better agreement.Higher concordance in patient-oncologist expecta-tions also correlated with greater odds of receivingcertain aspects of follow-up, but only if a discussionabout cancer survivorship care had occurred.CONCLUSIONS: A discussion about cancer fol-low-up may affect survivorship care through itsprimary influence on patient-oncologist expecta-tions. Further work is required to clarify the aspectsof survivorship discussions that are important foroptimal cancer survivorship care planning.

A-415

Goals and Goal Attainment in Inpatient Rehabilita-

tion of Breast Cancer Patients

Fritz A. Muthny, Juergen TrippUniversity Hospital Muenster, Muenster, Germany

OBJECTIVES: Mutual agreement between doctorsand patients on rehabilitation goals is consideredto be important in cancer rehabilitation. Inaddition to somatic and educative objectives, thedefinition of goals in terms of psychosocialadaptation is also necessary. Main objective ofthe study was assessing rehabilitation goals at thebeginning of the inpatient stay and investigatingwhether these goals were attained at the end.Patients’ and doctors’ perception of goals and goalattainment was also compared. METHOD: 172breast cancer patients (36–56, no metastases) wereexamined during their three-week inpatient reha-bilitation stay. The patients received a 20-item listof possible goals and rated their relevance at thebeginning of their stay, and attainment at the endof rehabilitation (3-point scale each). The spectrumincluded somatic, informational and psychosocialgoals. For every single patient, the doctors alsogave a rating for relevance and attainment of eachgoal at the beginning and end of rehabilitation,respectively. RESULTS: On average, the patientsrated 8 of the 20 goals to be relevant at thebeginning and attained at the end (lower ratings bythe doctors for relevance and attainment). Thehighest correlation between doctors’ and patients’ratings was found with respect to the relevance ofthe goal ‘better coping with anxiety’ (r5 0.44) andthe attainment of ‘better physical fitness’ (r5 0.37).The average goal attainment shows substantialnegative correlation with anxiety and depression.CONCLUSIONS: The limited correlation betweendoctors’ and patients’ ratings of the relevance and


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attainment of goals speaks in favour of a greaterexchange and common definition of goals bydoctors and cancer patients in rehabilitation. Inaddition, the process of goal attainment shouldreceive much more attention in the course ofrehabilitation and play a more important role indoctor-patient communication.

A-416

Illness Perceptions, Coping and Psychological Ad-

justment in Informed and non-Informed Indian

Cancer Patients

Mahati Chittem, Paul Norman, Peter HarrisUniversity of Sheffield, Sheffield, South Yorkshire,United Kingdom

OBJECTIVES: Disclosure of cancer diagnosis hasbeen found to increase patients’ levels of hope andquality of life. Yet non-disclosure of cancer diag-nosis continues to be a common practice in someAsian cultures. Moreover, little is known about theimpact of non-disclosure (versus disclosure) onpatients’ illness beliefs, coping behaviour andpsychological adjustment. METHOD: Indian pa-tients who had been informed (n5 151) or non-informed (n5 178) of a cancer diagnosis completedthe Brief Illness Perception Questionnaire, the Waysof Coping (Revised) and the Hospital Anxiety andDepression Scale. RESULTS: Discriminant func-tion analysis indicated these variables significantlydistinguished between the informed and non-in-formed patients, 2 (14)5 116.94, po0.001. Correla-tions between the predictor variables and thediscriminant function revealed that non-informedpatients reported having poorer illness understand-ing, and were less likely to engage in problem-focused coping, self-blame and positive reappraisal.Regression analyses indicated that illness percep-tions and coping explained large amounts ofvariance in anxiety and depression in both groups(R2s5 0.62, 0.63). CONCLUSIONS: Informed andnon-informed Indian cancer patients have differentreactions to their illness which, in turn, can lead topoor illness adjustment. In order to overcome thelong-term repercussions of non-disclosure and im-prove quality of care for patients, healthcareprofessionals in Asian cultures should be trainedin cancer disclosure and communication skills.

A-418

Severe Fatigue In Patients With Advanced Cancer,

Preliminary Data

M.E.W.J. Peters1, M.M. Goedendorp2, C.A.H.Verhagen1, G. Bleijenberg2

Radboud University Nijmegen Medical Centre, depart-ment of Medical Oncology, Nijmegen, Netherlands1,Radboud University Nijmegen Medical Centre, ExpertCentre Chronic Fatigue, Nijmegen, Netherlands2

OBJECTIVES: Many cancer patients experiencesevere fatigue as the most distressing symptom witha profound, not seldom invalidating effect on theirdaily life. Research, with fatigue severity as maintopic in patients with advanced, non curable cancerhas seldom been done. Besides investigating pre-valence and severity of fatigue, we hypothesizedthat patients receiving 1st line palliative cancerdirected therapy experience less fatigue comparedto patients in 2nd and further line treatments.METHOD: During 12 months, patients with noncurable cancer (and their Informal Care Givers)from the department of Medical Oncology of aUniversity Hospital and a regional Hospital wereasked to complete questionnaires with fatigue asmain topic. Fatigue was measured by the subscalefatigue severity of the Checklist IndividualStrength (7–56). The validated cutoff score of 35was used to determine severe fatigue. Analysis weredone by non parametric tests (MW U test)RESULTS: Based on the first results of thisongoing study, 114/140 patients returned thequestionnaires. Over 60% of the patients had 1stline treatment for non curable cancer. Severefatigue was experienced in 50% of all patients.Patients in 1st line treatment were significantly lessfatigued (p5o0.025) than patients in further linetreatment. In 1st line treatment 43% of the patientsexperienced severe fatigue, in further line treatment68% of the patients. CONCLUSIONS: Half of thepatients during systemic palliative interventions forincurable cancer suffer from severe fatigue. Theseverity of fatigue increases significantly withfurther line treatments. The clinical implicationsof this finding should be included in decisionmaking when patients choose for systemic therapyin the palliative stage of their disease. Morepreliminary results of this ongoing study will bepresented.

A-421

An Evaluation of the Effectiveness of Psychosocial

Group Programmes for Treating Insomnia in

Chinese Cancer Patients

Raymond, Chi Leung ChanCancerLink Support Centre, Hong Kong CancerFund, Hong Kong, China

OBJECTIVES: Insomnia has been reported morefrequently by cancer patients than the generalpopulation. Cancer patients with insomnia havehesitation to adopt pharmacological means forimproving sleep as they are concerned about theside-effects of the drug on their cancer treatmentand general health. Psychological interventionseems to be a viable alternative. The objective ofthis study was to assess the efficacy of a six sessionpsychosocial group programme for Chinese cancerpatients with insomnia. METHOD: Sixty four


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participants were recruited (from May 2007 toMarch 2009) in seven groups with multimodalpsychosocial intervention which included sleephygiene education, relaxation training, cognitiverestructuring and emotional-stress reduction. Amultiple-baseline experimental design was used toevaluate the efficacy of treatment. Pre- and post-treatment measures consisted of the InsomniaSeverity Index (ISI), the Dysfunctional Beliefsand Attitudes about Sleep Scale (DBAS), BeckAnxiety Inventory (BAI), and the General HealthQuestionnaire - 12 items (GHQ-12). RESULTS:Results showed significant improvements in allmeasures. CONCLUSIONS: This study suggeststhat the integrative psychosocial group interven-tion is of clinical benefit for improvement ofinsomnia among Chinese cancer patients in HongKong. Further qualitative studies are recom-mended for evaluating the relationship of perceivedgroup effects and the characteristics of cancerpatients from the Chinese culture.

A-422

Screening for Anxiety and Depression in Australian

Head and Neck Cancer Patients: Comparison of the

HADS and DASS21

Marcelle Gray1, Kate Neilson2, Annabel Pollard2,Ann Boonzaier2, June Corry2, David Castle3,Karen Mead1, David Smith1, John Reece1, JeremyCouper2

RMIT University, Melbourne, Victoria, Australia1,Psycho-Oncology Research Unit, Peter MacCallumCancer Centre, Melbourne, Victoria, Australia2,St Vincent’s Hospital, Melbourne, Victoria, Australia3

OBJECTIVES: Head and neck cancer (HNC)patients experience elevated psychological distress,including symptoms of depression and anxiety.Accurately identifying distressed patients is impor-tant, so that they can be linked with appropriateservices. Doctors can underestimate patient distressduring routine medical consultations; thereforescreening is useful in assisting with the accurateidentification of distressed patients. The purpose ofthe current study is to validate and compare twoscreening tools for depression and anxiety, inAustralian HNC patients. METHOD: Observa-tional study of consecutive HNC outpatients in atertiary cancer centre in Australia. Eligibilityincluded a new diagnosis of a cancer in the headand neck region, where the patient agreed toundertake cancer treatment with curative intent.Data were collected around diagnosis, prior tocommencement of treatment, from 102 HNCpatients. Screening tools examined for validityand reliability were: Hospital Anxiety and DistressScale (HADS) and Depression Anxiety and StressScale, short form (DASS21). RESULTS: The

Psychometric properties of the HADS andDASS21 in this study population include: Accep-table internal consistency (Cronbach’s alpha p0.7)for HADS and DASS subscales; Strong positiverelationships between the HADS and DASS21measurement of depression and anxiety, (r5 0.65and r5 0.55 respectively); Factor analysis con-firmed a two-factor structure of the HADS(Anxiety and Depression) and also suggested analternative three-factor solution for DASS21.CONCLUSIONS: HADS and DASS21 are reliableand effective screening tools for identifying prob-able ‘caseness’ of depression and anxiety inAustralian HNC patients. Results of the currentstudy suggest that routine use of these screeningtools, particularly the HADS, will assist withidentification of patients experiencing symptomsof depression and/or anxiety and would enableappropriate referrals to mental health services.

A-425

Finding Meanings in Coping with Cancer in Old Age

and Self-Reported Benefits of Participation in

Online Cancer Support Groups

Gul SeckinUniversity of Maryland, Baltimore County,Baltimore, Maryland, United States

OBJECTIVES: To examine whether there aresignificant associations between participation inonline cancer support groups and a) positiveappraisals of cancer experience b) finding meaningin illness experience and c) post-traumatic growthoutcomes in old age. METHOD: This paperexamines self-reported benefits of online psycholo-gical support among a sample (N5 189) of middleaged and older (M5 58.1, SD5 6.6) cancer pa-tients. Online survey was employed to collectresearch data. The outcome variables includeappraisal of coping with cancer, finding a meaningin cancer experience, and self-reported post-trau-matic growth outcomes. Bivariate and hierarchicalmultiple regression analyses were performed toexamine the data. The conceptual model of theresearch was tested using a path model.RESULTS: The study shows that there aresignificant associations between participation inonline patient support groups, finding meanings incoping with cancer, positive appraisal of illnessexperience and post-traumatic growth in old age.The research results also indicate that the negativeimpact of cancer-related stressors can coexist withpositive cognitive appraisals of cancer and post-traumatic growth. Perceived contributions of on-line patient support groups to find a meaning inillness experience were commonly reported amongthe respondents. CONCLUSIONS: With availabil-ity of Internet technology, online patient groups


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have become an additional resource to findaffective support for cancer patients. Longitudinalresearch may prove particularly fruitful in under-standing how Internet technology can be targeted astrategic tool to improve health related quality oflife and psychological well-being among olderindividuals over time when coping with chronicillness stressors.

A-430

Direct and Indirect Effect of General and Specific

Social Support on Quality of Life After Breast

Cancer: A Longitudinal Study

Florence Cousson-Gelie1, Marion Barrault2, Em-manuel Bussieres2

University of Bordeaux 2, Bordeaux, France1,Bergonie Institute, Bordeaux, France2

OBJECTIVES: Most investigations have concen-trated on general perceived support but only a fewstudies have dealt with social support fromparticular individual relations. The objectives are(1) to evidence the way in which general socialsupport, specific relationship support may influ-ence the quality of life in patients with first breastcancer and (2) to investigate the mediationalpathways by which general social support, relation-ship specific as contributers to variability inpatients’ quality of life. METHOD: A total of115 breast cancer patients were included. Socialsupport was measured by the Social SupportQuestionnaire (SSQ-6), the specific relationshipby the quality relationship Inventory (QRI) andquality of life by the QLQ-C30. All these variableswere assessed one month after surgery (diagnosis),and every three months during the first year (6times of measure). Separate hierarchical regressionanalyses were conducted and to test the multiplemediation hypotheses, we used a bootstrappingapproach. RESULTS: Women high in intensityspecific relationship were predicted to have lowerfatigue and higher emotional quality of life 4months after diagnosis. We founded a direct effectof general social support on emotional. An indirecteffect was found: quality relationship was mediatorof satisfaction of general social support and qualityof life. The conflict relationship is the onlysignificant mediator. CONCLUSIONS: Our find-ings suggest that women unsatisfied about generalsocial support relying on an appraisal of conflict intheir close relationship are at risk for pooreremotional quality of life after treatment for a firstbreast cancer. Interventions could aim at educatingrelevant support providers. If they know how tosuit the patients’ needs for social support in termsof quantity and quality, an additional promotingeffect should be achieved, on patients’ emotionalquality of life.

A-431

Changing The Culture And Experience Of Cancer

Patients In An Acute Hospital: The Distress

Education And Management Programme

Paul D’Alton1, Conor O’Malley1, Eileen O’Don-nell2, Finola Gill3, Aine Canny2

Psycho-oncology Service, St. Vincent’s UniversityHospital, Dublin, Ireland1, Social Work Depart-ment, St. Vincent’s University Hospital, Dublin,Ireland2, Nursing Department, St. Vincent’s Uni-versity Hospital, Dublin, Ireland3

OBJECTIVES: The benefits of early identificationand intervention for psychological distress arerecognised as an integral part of best-practice cancertreatment. The Distress Education and ManagementProgramme (DEMP) was designed to test out amodel of service delivery that would improveidentification, management and treatment of psycho-logical distress in cancer patients (n5228) in an acutehospital setting. METHOD: There are four phases tothe DEMP project. Firstly, a series of focus groupswere undertaken with cancer nursing staff. Secondly,a distress management training programme fornursing staff was developed and implemented.Following this, the self-assessment Distress Thermo-meter (DT) was introduced to patients at the point ofinitial presentation, over a period of three months.Finally, interviews were conducted with the patientsand medical staff. RESULTS: 34% of assessedpatients required intervention from a specialistservice. The biggest predictors of high distress levelswere emotional problems. Younger patients werefound more likely to rate their distress as higher thanolder patients. The most common concerns high-lighted in the interviews were a lack of understandingof psychosocial services available within the hospital.Participating nursing staff, medical staff and patientsunanimously reported the DT as a successful way tohighlight psychological distress. CONCLUSIONS:The DEMP proved a successful way to identifypsychological distress in a busy acute hospital. Theresults of the DEMP reflect international findingsconcerning the rate of typical distress among cancerpatients. It impacted on the hospital system in termsof providing nursing and medical staff with aninfrastructure to manage patient distress. Further-more it provided a different experience of hospitalcare for patients where they reported feeling moreholistically cared for.

A-432

Planting Something Special: Developing A Vegeta-

ble Garden (Allotment) Project For Men Living with

Cancer

Paul D’Alton, Conor O’MalleyPsycho-oncology Service, St. Vincent’s UniversityHospital, Dublin, Ireland


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OBJECTIVES: The international literature refersfrequently to the challenges of engaging male cancerpatients in the psychosocial support services. Thebenefits of accessing psychosocial services are welldocumented, reportedly leading to improvements inmental health, less psychological distress and evenprolonged survival. The allotment project is in-tended to provide a meaningful and engagingcommunity based psychosocial service for men livingwith cancer. Allotment involves planning andmaintaining a vegetable garden while providing peerand clinical support. METHOD: An Action-Basedresearch strategy was adopted to design, implementand evaluate a project that would provide psycho-social support for men living with cancer. Partici-pants gathered weekly, over a seven-month period,at the allotment. Here, they engaged in informalgroup support, over morning tea. This was followedby a mindfulness exercise, and work on theallotment. The evaluation of the project involvedsemi-structured interviews, measurements of anxiety,depression, and quality of life. RESULTS: Qualita-tive analysis has identified impacts of the interven-tion in a number of key areas, including feelings ofpeer support, willingness to discuss illness, feelings ofworth and newfound enthusiasm for learning anddevelopment. Problems identified included feelingsof uselessness, feeling a burden, low energy levelsand feelings of isolation. Benefits of the interventionincluded the impact of social support, physical andexistential benefits; a focus on learning and livingwith cancer; relaxation, perspective and acceptance.CONCLUSIONS: The action research model pro-vided a framework to design, implement andevaluate a project that met the psychosocial needsof men living with cancer. Horticultural therapy andmindfulness, a combined intervention, merits con-sideration as a form of psychosocial intervention.Participation in an energetic and supportive workenvironment, combined with mindfulness activitiescan successfully shift patient’s focus from illness toachievement and personal development due toincreased social contact, increased feelings of im-portance, optimism and usefulness.

A-435

The Impact of Children’s Illness Perceptions on

Paediatric Cancer Patients’ Quality of Life

Marta Fonseca1, Pierre Missoten2, Anne-MarieEtienne2, Gilles Dupuis3, Fabienne Lemetayer1,Elisabeth Spitz1

Universite Paul-Verlaine Metz, Equipe de Psychologiede la Sante, Metz, France1, Universite de Liege,Departement de Personne et Societe, Liege, Belgium2,Universite du Quebec a Montreal, Departement dePsychologie, Montreal (Quebec), Canada3

OBJECTIVES: The study of children’s illnessperceptions has been widely developed over de last

decade (Chateaux, 2005). More recently researchhas focussed on the impact of illness perceptions onQuality of Life (QoL). The present communicationaims to analyse the impact of illness perceptions ofchildren with cancer on Generic and ModularQoL. Authors put forward the hypothesis thatthe several dimensions of children’s illness percep-tions may influence QoL in different ways.METHOD: The Brief Illness Perception Question-naire (Broadbent et al., 2006) and the Quality ofLife Systemic Inventory for Children - Module forCancer (Missotten et al., 2008) were administeredto 40 children with cancer, aged from 8 to 12 years,at a paediatric hospital. Specifically developed forchildren from these ages, the QoL measure is a self-assessment questionnaire that provides a generaland a modular score (general domains of QoL anddomains of QoL related with cancer). RESULTS:Multiple regressions highlighted that five dimen-sions of children’s cancer perceptions are signifi-cant predictors of QoL, namely illnessconsequences, identity, concerns, coherence andtimeline. The most predictable dimension of bothgeneral and modular QoL is cancer consequences:it explains 36% (Beta5 0.51; p5 0.01) of thegeneral and 47% (Beta5 0.70; p5 0.01) of themodular QoL variance. Children reporting aless threatening view about the consequencesof cancer in their lives reveal a better QoL.CONCLUSIONS: The framework of the presentstudy has its fundamentals on recent literaturedevelopments by presenting a modular approach toQoL assessment. Results revealed that illnessperceptions of children with cancer play animportant role both on general QoL and QoLmore directly related with cancer and treatments.Through the analysis of the influence of cancerperceptions on QoL, findings provide informationto design intervention to promote QoL amongpaediatric cancer patients.

A-439

Innovative Ways to Inform Women About Breast

Health & Breast Cancer: The Successes of Bridges

to Better Breast Health Project

Carole Mayer, Val Allison, Shari Brown, DeniseGauthier-Frohlick, Carolyn Jackson, CrystalLarose, Lisa Lepage, Leigh MacEwan, MaureenMcMillan, Irene Nicoll, Jami van HaaftenRegional Cancer Program, Hoptial regional deSudbury Regional Hospital, Sudbury, Ontario,Canada

OBJECTIVES: Educating women about breasthealth and supporting the information needs ofwomen diagnosed with breast cancer can bechallenging when a population of 600, 000 peopleis spread across 310, 000 kilometres. We willillustrate through this presentation some of the


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strategies applied to the project Bridges to BetterBreast Health that proved to be successful inproviding women of all ages with access to accurateand timely information about breast health andbreast cancer. METHOD: Members of a breastcancer coalition collaborated with health careprofessionals in a cancer centre to write a proposaland successfully secure funding for the project. Asteering committee was formed with the participa-tion of breast cancer survivors, health care profes-sionals and researchers from the cancer centre, andcollaborators from the community and region.Conducting focus groups, consulting media expertsand working with a plain language consultant werepart of the overall working plan. RESULTS:oResults: Four objectives were accomplished: (1)A breast health awareness campaign reaching over3 million adults; (2) Development of a new breasthealth passport distributed to over 14, 000 womenin the region; (3) Revising a breast cancer guidedistributed yearly to over 300 women diagnosedwith breast cancer and; (4) A newly redesignedwebsite going from 2, 200 hits to 381, 000 hits. Allfour initiatives were pulled together with a brandedlook and feel. CONCLUSIONS: A strong com-munity partnership is attributed to the success ofthis project with over 100 volunteers involved.Women living in this large geographical area haveimproved access to information about breasthealth and breast cancer due to the commitmentof many women and men who contributed to thesuccess of this project. Acknowledgement: Thisproject was funding by the Canadian Breast CancerFoundation-Ontario Region.

A-440

Mindfulness-based Cognitive Therapy (MBCT) in

Psycho-oncology: A Mixed Methods Study

Aisling Curtin1, Paul D’Alton2, Mary Creaner1

Trinity College Dublin, Dublin, Ireland1, St. Vincent’sUniversity Hospital, Dublin, Ireland2

OBJECTIVES: The number of people diagnosedwith and surviving from Cancer is rising (NationalCancer Registry, 2006, 2008). Much research hashighlighted the potential benefit of adopting Mind-fulness-based approaches in psycho-oncology set-tings (Ott, Norris, & Bauer-Wu, 2006; Smith,Richardson, Hoffman, & Pilkington, 2005). Thereis an apparent absence of qualitative and mixedmethods research within mindfulness studies(Mace, 2008). METHOD: The current studyemployed a mixed methods concurrent triangula-tion design. The design aimed to deepen under-standing of changes in psychological well-beingand the general change processes underlying theeight-week Mindfulness-based Cognitive Therapy(MBCT) program. A combination of pre-,mid-, and post-quantitative measures and weekly

qualitative measures of helpful events of tenparticipants (M Age5 54.3 years) and semi-struc-tured interviews (M time5 112.67minutes) forthree participants were analyzed. RESULTS: Anintegrated interpretation of findings suggestschanges over the course of MBCT occurred.Changes in levels of mindfulness, psychologicalwell-being, depression, and anxiety, in addition toparticipant’s subjective experiences are explored.Participants reported more accepting relationshipswith oneself, others, and a shift in perspective, orimproved ability for self-regulation, in relation tonegative events. CONCLUSIONS: It appears thatMBCT provides a cost effective program, whichhas a positive impact on psychological well-beingwithin a Psycho-oncology setting. This studyprovides insight into the experiences of MBCT onperceptions of personal growth and purpose in lifepost-cancer treatment. Through weekly measures,this is the first known study to qualitatively explorehelpful events over the course of the eight-weekprogram.

A-446

Being Ashamed Of a Cancer Diagnosis: A Determi-

nant of Coping Style & Quality Of Life

Ikechukwu Benedictus Awusah1, Chioma C. Asuzu1,Tolulope T. Bella2

University of Ibadan, Ibadan, Oyo State, Nigeria1,University College Hospital, Ibadan, Oyo State,Nigeria2

OBJECTIVES: The study aims to identify the mostpreferred coping mechanisms of cancer patients, toidentify the relationship between being ashamed ofa cancer diagnosis and coping styles adopted bycancer patients and to determine if there is asignificant difference in the functional wellbeing,emotional wellbeing, and social/family wellbeing ofcancer patients that are ashamed of having cancerand those that are not. METHOD: This is anexploratory study involving the selection of con-venience sample comprised of 213 cancer patientssuffering from different types of cancer. Theassessment instrument used was the brief COPEquestionnaire by Carver, C. S. (1997) and thequality of life questionnaire developed by the worldhealth organization. RESULTS: Most cancerpatients relied heavily on Religion (9.33%), fol-lowed by The Use of Emotional Support (8.70%)and Active coping (8.20%), and a significant linearrelationship was found between coping styles andbeing ashamed of cancer diagnosis. While nosignificant difference was found in the functionalwellbeing, emotional wellbeing, and social/familywellbeing of cancer patients that are ashamed ofcancer diagnosis and those that are not (withp40.05). CONCLUSIONS: Patients that areashamed of their diagnosis, who come for


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treatment without much social support due to theirfear of discrimination by an unenlightened societycan now be rest assured that their situation is nothopeless. The fear has been that these few peoplemay not adjust properly to life with cancer becauseof their shyness, but the result of this study showthat they can have hope of surviving, living anadjusted life.

A-448

Developing a Successful Oncology Clinical Practice

Leader Role

Genevieve CoteThe Ottawa Hospital, Ottawa, Canada

OBJECTIVES: The Oncology Clinical PracticeLeader role has existed for several years in ourAcademic Health Science Centre. Recently, itsmandate was aligned with the goal of increasedcontinuity of care through the standardization ofpractice to ensure a quality patient-centred colla-borative approach along the full continuum of careamong in-patient, out-patient and palliative caresocial workers. The purpose of this presentation isto share the processes, strategies, and tools devel-oped to achieve this goal. METHOD: The goal ofincreased continuity of care was achieved throughthe collaborative standardization of processes andclinical tools and the development of proceduralguidelines. Examples of these concrete and trans-ferable tools and strategies, which will be shared,are formal supervision with the aid of social workcore competencies document, chart audits, teampractice guidelines and cross training. RESULTS:We have achieved higher levels of team cohesionand trust among the Social Workers. There hasbeen an increased satisfaction with our processesand this in turn has enhanced the seamlesstransition of care from one team member toanother as the patients move forward on thecontinuum of care. CONCLUSIONS: Several ofthese tools and processes are easily transferableand could be decidedly useful to other leaders ofpsychosocial oncology teams to improve theseamlessness of transitions for our patients, toenhance collaborative practice amongst profes-sionals and to achieve a consistently high level ofquality in the care delivered.

A-450

Breast Cancer Young Women’ Involvement In

Treatment Decisions: Is It Treatment Related?

Valerie Seror1, Sebastien Cortaredona1, Marc-Karim Bendiane2, Patrick Peretti-Watel1,Dominique Rey2, Yolande Obadia2

Inserm UMR912, Marseille, France1, ORS Paca,Marseille, France2

OBJECTIVES: To investigate the patients’ invol-vement in the decisions possibly involved in breastcancer care, ie. surgery, chemotherapy, and endo-crine adjuvant treatment (EAT). METHOD: SinceJuly 2005, all women included in the registry of theFrench Health Insurance Fund for breast cancer,o41 years and living in South-Eastern France havebeen asked to participate in a 5 years follow-up. InJanuary 2010, 353 women answered a self-admini-strated questionnaire in the month followingdiagnosis and a phone interview 10 months later.Logistic regressions were used to assess the impactof different factors on self-reported involvement indecision-making about treatments. RESULTS: Allwomen had surgery, 75.1% chemotherapy and55.2% EAT. At enrollment, 20.9% of the womenpreferred a physician-based treatment decision-making. 32.6%, 64.0%, and 75.6% experiencedpassive involvement in decision about surgery,chemotherapy, and EAT, respectively. Multivari-ate analyses showed that satisfaction with theinformation provided by physicians involved indecision-making was more likely to be associatedwith active involvement in decision. Other factorsexplaining involvement in treatment decisionsdiffered depending on treatments (surgery, che-motherapy or EAT). CONCLUSIONS: Patients’actual involvement in surgery decision-making wasassociated with their desired involvement. Experi-enced involvement in initial treatment decision-making was a main predictor of the level ofinvolvement in further treatment decision-making(chemotherapy and EAT), as well as depressionscore (CES-D). Cancer severity, as well as socio-demographic characteristics were not related toinvolvement in decision-making. Physicians shouldbe aware that paternalistic relationships in the firsttreatment decision-making is likely to determinefurther involvement in decision-making.

A-451

The Parenting Concerns Questionnaire: Scale

Development, Properties and Utility

Cynthia W. Moore1, Lee Baer1, Elyse R. Park1,Alice B. Kornblith2, Holly Prigerson2, WilliamPirl1, Jennifer Ing2, Rebecca Babcock1, Paula K.Rauch1, Anna C. Muriel2

Massachusetts General Hospital, Boston,Massachusetts, United States1, Dana Farber CancerCenter, Boston, Massachusetts, United States2

OBJECTIVES: Clinicians and researchers routi-nely assess the impact of cancer on daily function-ing, work, marriage, finances and spirituality.Clinical experience and data suggest that patientsalso have concerns about cancer affecting theirdependent children. No instrument exists toidentify such concerns, so we developed, refinedand empirically tested a new Parenting Concerns


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Questionnaire (PCQ). The development and psy-chometric properties of the PCQ, and its clinicaland research utility for identifying and addressingparental concerns are discussed. METHOD: An 11item version of the PCQ piloted with 30 patientsdemonstrated face validity. Transcripts from threefocus groups of patients were analyzed usingcontent analysis to develop major and minorthemes of concerns about parenting with cancer.Items were refined and created to capture emergingthematic content, resulting in 38 items rated on a 5-point Likert-type scale. 194 outpatients anon-ymously completed the revised questionnaire, andfactor analysis was conducted with Varimaxrotation. RESULTS: Participants were 194 out-patients, at 2 urban cancer centers, with a range ofcancers, mean age 46 years, 73% female, 95%white, and 89% married. Alpha factoring yielded athree factor solution with interpretable factors thatcaptured themes found in the qualitative analyses.Items with low communalities (o0.40), items thatloaded onto more than one factor, or had noloading of at least 0.32 were dropped, yielding a 14-item scale with Cronbach’s alpha of 0.82. CON-CLUSIONS: Little is documented about cancerpatients’ concerns about their dependent children,making it more difficult to adequately meetpatients’ needs in this arena. Given that approxi-mately of adults with cancer have school-agechildren (NCI, 1992), parenting concerns shouldbe better understood. The PCQ is a new, 14-itemmeasure with good psychometric properties andthree clinically relevant subscales. Clinicians andresearchers are encouraged to use the PCQ to aid inassessing patients’ concerns about parenting.

A-455

The Effectiveness of Patient Reported Outcomes

(PRO’s) in Pediatric Oncology Practice: Results

from the QLIC-ON Study

Vivian Engelen1, Symone Detmar2, HendrikKoopman3, Martha Grootenhuis1

Psychosocial Department, Amsterdam, Netherlands1,TNO Prevention and Health, Leiden, Netherlands2,Medical Psychology, Leiden, Netherlands3

OBJECTIVES: Several studies have shown thatchildren with cancer can experience health relatedquality of life (HRQOL) problems. These problemsare not always systematically discussed or knownby their pediatric oncologist (PO). Aim of thisstudy is to develop an intervention to make POsaware of these problems and study the effectivenessin terms of increased referrals and advices,satisfaction and identification and discussion ofQoL topics. METHOD: In multicenter sequentialcohort study (QLIC-ON) children with cancerimmediately after end of treatment participated.Shortly before the first three follow-up

consultations with the physician, the child (8–18years) or parent (about child aged 0–8 years)completes a digital HRQOL questionnaire. TheQLIC-ON PROfile is presented to the physician asa PRO in the intervention group, to help identifyand discuss HRQOL problems. To maximize theeffect of the QLIC-ON PRO POs received atraining. RESULTS: In total n5 275 patients (fourcentres) were approached, n5 190 participated(response 69%) of which n5 80 completed thecontrol and n5 85 completed the interventionperiod. Most of the parents (74%) and POs(63%) considered the PROfile useful. First analysisshowed POs to be more satisfied in the interventionperiod (po0.05), to be able to provide moreinformation to parents (po0.05) and to pay moreattention to desires of parents (po0.05) and child(po0.01) CONCLUSIONS: The results are pro-mising. Parents and pediatricians are positiveabout the use of the PROfile. In the future thePROfile can be used for different patient groupsand also by different users (e.g. psychologists,nurses or social workers) in clinical practice. Withadaptations for internet the PROfile will be easy toimplement in clinical practice and helpful infacilitating communication about QoL.

A-458

Dyadic Effects Of Social Support On Quality Of

Life Of Patients With Prostate Cancer And Their

Spouse

Anaıs Lafaye, Sylvie Petit, Florence Cousson-GelieUniversity of Bordeaux 2, Bordeaux, France

OBJECTIVES: Several studies showed that duringtreatment of prostate cancer and the followingmonths, social support is beneficial, both patientsand spouses. Although evidence suggests thatsocial support received by patients and spousesimproves their own quality of life, the degree towhich each person’s social support has an effect ontheir partner’s quality of life, is unknown. Thisstudy aimed to examine the dyadic effects of socialsupport on quality of life of couples. METHOD: Alongitudinal study was carried on 100 Frenchcouples with men with first prostate cancer. Socialsupport (QSS, Segrestan et al., 2007), physical andmental quality of life (SF-12, Gandek et al., 1998)were assessed at the beginning (T1), middle (T2)and end of treatment (T3), and four months after(T4). Statistical analyses were performed withdyadic analysis proposed by Kenny et al. (2006)showing actor and partner effects. RESULTS:Actors’ effects: High patients’ perceived negativesocial support decreases their physical and mentalquality of life. Spouses’ perceived informativesocial support reaches their mental quality oflife. Spouses’ perceived negative social supportdecreases their mental quality of life. Partners’


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effects: Patients’ perceived emotional social supportincreases spouses’ physical and mental quality oflife. Spouses’ perceived informative social supportdecreases patients’ physical quality of life althoughnegative social support increases patients’ physicalquality of life. CONCLUSIONS: The main resultof this research is the negative effect of spouses’perceived informative social support on patients’quality of life. So, it seems that an active behaviorfor obtain information on the illness by spousesharms patients. Health caregivers would helppatients for being more active in seeking informa-tion on illness. It needs furthermore researches tograsp better spouses’ seeking informations need, instudying for example the role of anxiety anddepression.

A-461

The Power of Global Collaboration in the Fight

Against Cancer

Ruth Rechis, Devon McGoldrick, RebekkahSchear, Nicole BorgstadtLance Armstrong Foundation, Austin, Texas,United States

OBJECTIVES: Cancer is a challenging emotionalexperience for all whom it touches. Personsengaged in the fight against this disease at alllevels- as a patient, an advocate, or a practitioner,need support to persevere. By empowering peoplearound the world to make a commitment toreducing the burden of cancer, collaborate acrosscultural barriers, and actively engage as part of aglobal community, we can dispel misconceptions,reduce stigma and increase awareness about thisdisease. METHOD: After 18 months of researchillustrating a global event’s potential, a two daySummit on cancer was convened, bringing togetherleaders, corporations, organizations and survivorsfrom 65 countries. Workshops demonstrated thevalue of cross-cultural collaboration and the powerof media in the mobilization of global action in thefight against cancer. To assess participant experi-ence, both paper and electronic surveys wereadministered at the Summit’s conclusion measur-ing satisfaction with logistics, content, and psycho-social impact. RESULTS: Of the 108 responsescollected, 84% indicated that they felt supported toachieve their goals to change the way cancer isaddressed, while 86% of respondents felt empow-ered with new ways of engaging others. Perhapsmost importantly, 77.1% said that they wouldcharacterize attending the Summit as a strong,positive emotional experience. CONCLUSIONS:The challenges associated with working to addresscancer on a global level have a profound emotionalimpact, and an event like the Summit serves tosupport and empower stakeholders by providing

them with a deep, personal experience of connec-tion with others sharing in that challengingenvironment. It is our hope that delegates willbuild upon their experience to continue mobilizingin this cross-cultural movement by sharing theircommitment to addressing cancer in their respec-tive countries.

A-462

A Safe and Comprehensive Community-Based

Cancer Exercise Model

Judi Perry-Brinkert, Holly BradleyWellspring Cancer Support Foundation, Toronto,Ontario, Canada

OBJECTIVES: To present a safe, effective andcomprehensive intervention model for exerciseduring treatment or survivorship phases. Thismodel was developed from emerging literature onthe multiple benefits of exercise, such as symptommanagement, secondary prevention and enhancedsense of well-being. The program uses highlyqualified professional leadership, additional cancerrehab leadership training, personalized assessment,built-in safety protocols, and delivery within a cost-effective group format. METHOD: Research in-dicates that exercise is one of the most importantways that patients can improve overall health,reduce symptoms, manage side-effects and, forsome cancers, reduce the risk of recurrence.However, many patients can lack knowledge,confidence or motivation to undertake exercise ata difficult time of their lives. The Cancer Exerciseprogram was developed and piloted to an inclusivegroup of patients (all cancers, and at any stage) in acommunity-based setting. RESULTS: The successof the Cancer Exercise program was outstanding.All key elements of the program design wereimplemented effectively, and demand was high.Evaluation data indicated impressive capacity forprogram intake and completion, as well asindicators of improved wellness, confidence andself-esteem. In this presentation, the profile ofprogram users (e.g. age, gender, diagnosis, etc.) willbe presented. Challenges of program implementa-tion and oversight, and how they were overcome,will also be described. CONCLUSIONS: A diversegroup of cancer patients benefited from aprofessionally-led, comprehensive cancer exerciseprogram offered in a community-based setting.Sustainability for customized programmingdelivered within a group model was a key outcomeof the pilot. Satisfaction was high, and demandeven higher. The program could be a modelfor other organizations for effective, safe andsustainable delivery that actualizes the benefits ofexercise that are emerging from the researchliterature.


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A-464

Screening For Anxiety And Depression In An

Unselected Population Of Oncology Patients

Annika Thalen-Lindstrom, Gunnel Larsson, BengtGlimelius, Birgitta JohanssonUppsala University, Uppsala, Sweden

OBJECTIVES: The aim of the study was toevaluate feasibility of systematic screening oncol-ogy patients for anxiety and depression withHADS in a clinical setting. Another aim was tocompare patients with potential initial anxiety ordepression to patients with no initial anxiety ordepression with regard to changes from baseline to6 months. METHOD: All patients, regardless ofdiagnosis, stage of disease or time since diagnosiswere asked to participate in the study at their firstvisit to the oncology clinic between September 2005and June 2006. HADS were completed at baselineand at 1, 3 and 6 months. A score47 on any of theHADS subscales was regarded as potential anxietyor depression. RESULTS: A total number of 547(85% of 644) patients accepted participation in thestudy, 495 answered baseline assessments (52discontinued before answering baseline assessment)and 337 (68%) patients answered 6-months follow-up assessments. One-hundred and seventy-seven(36%) patients were identified with potential orclinical anxiety or depression. Changes from base-line to 6 months and comparison between patientswith potential initial anxiety or depression andpatients with no initial anxiety or depression will bepresented. CONCLUSIONS: A large amount ofpatients agreed to complete the HADS at their firstvisit to an oncology clinic. Systematic screening foranxiety and depression is feasible in clinical settingswith oncology patients and may increase thepossibility for staff to recommend clinical assess-ment and psychosocial support.

A-465

Communication to Children about Mother Breast

Cancer: How Can Physicians Help?

Dominique Rey-Herin1, Valerie Seror2, Anne-Deborah Bouhnik2, Cyril Berenger3, Julien Mancini4,Marc-Karim Bendiane1, Patrick Peretti-Watel2

ORS PACA/INSERM UMR 912, Marseille,France1, INSERM UMR 912, Marseille, France2,ORS PACA, Marseille, France3, Universite de laMediterannee -APHM, Marseille, France4

OBJECTIVES: A quarter of French breast cancercases are diagnosed in women o50 years old. Amajority of them have got children living at home.Communication about illness is known to beassociated with more favourable outcomes inchildren of parents with cancer. Our objectiveswere to determine timing of first communication to

children about the mother’s breast cancer, fre-quency of further discussions about mother illness,and factors that may influence communication tothe children. METHOD: Since July 2005 allwomen included in the registry of the FrenchHealth Insurance Fund for a breast cancer, o41years and living in South-Eastern France have beenasked to participate in a 5 years follow-up. UntilDecember 2009, 274 women with one child or morehave been included. 10 months after diagnosis,frequency of discussions with children about illnesswas studied in relation to socio-demographicfactors, clinical variables, and children’s character-istics using logistic models. RESULTS: 65% ofchildren were told about mother disease atdiagnosis, 30% after treatment and 5% never.51% of women reported frequent discussions withchildren, 40% few discussions and 9% no discus-sion at all. In multivariate analysis communicationwith children was more frequent in women highlyeducated, with a family history of breast cancer,with chemotherapy and adjuvant endocrine ther-apy and who had the opportunity to ask questionsabout their disease at the time of diagnosis.CONCLUSIONS: Our results suggest that mater-nal factors, but also physician’s factors stronglyinfluence communication with the children. Physi-cians and psychologists on charge of cancerannouncement should be aware of the importanceof the information they provide to women to helpthem to better communicate with their children.

A-469

Patients and Their Family’s Priorities for Indicators

of Quality End-of-Life Care: Communication, Com-

munication, Communication

Amy Folkes1, Robin Urquhart1, Eva Grunfeld2

Cancer Outcomes Research Program, Cancer CareNova Scotia, Halifax, Nova Scotia, Canada1, TheOntario Institute for Cancer Research and theDepartment of Family and Community Medicine,University of Toronto, Toronto, Ontario, Canada2

OBJECTIVES: Measuring quality of care at end-of-life (EOL) has been identified as essential toimprove and monitor EOL care. We explored theperspectives of patients at EOL and bereavedfamily caregivers to identify important indicatorsof quality EOL cancer care. METHOD: Six focusgroups were held in Nova Scotia and Ontario,Canada, with patients with metastatic breastcancer (2 groups/province) and with bereavedfamily caregivers (1 group/province) to obtaintheir views on indicators of quality EOL care. Athematic analysis was conducted, and five commu-nication domains important to EOL care emerged.A literature review was completed to identifypatient, family member, and heath professional-reported questionnaires to measure these specific


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communication domains. RESULTS: Five com-munication domains relevant to quality EOL carewere identified as important to EOL care: 1)communicating information, 2) interpersonal com-munication, 3) communicating available suppor-tive care services, 4) communicating transitions incare, and 5) interprofessional communication.Based on specific criteria, including validity andevidence base, ten questionnaires were located thathave the potential to measure and monitor thequality of communication during EOL cancer care.No single questionnaire measured all five commu-nication domains. CONCLUSIONS: Cancer pa-tients and their family caregivers considercommunication to be an important indicator ofquality EOL care. The development of toolswith the potential to measure communicationdomains that are important to cancer patientsand their families at EOL should be a priorityas we move towards a well-defined andaccepted system of quality indicators for EOLcancer care.

A-470

Psychosocial Distress and Parenting Concerns

among Adults with Cancer

Anna C. Muriel1, Cynthia Moore2, Lee Baer2,Elyse R. Park2, Alice B. Kornblith1, HollyPrigerson1, William Pirl2, Jennifer Ing1, RebeccaBabcock2, Paula Rauch2

Dana-Farber Cancer Institute, Boston, Massachu-setts, United States1, Massachusetts General Hospi-tal, Boston, Massachusetts, United States2

OBJECTIVES: A significant number of adults withcancer are parenting children under 18 years old,and yet psycho-oncology clinicians and researchersdo not routinely ask about concerns that patientsmay have about their children. A new ParentingConcerns Questionnaire (PCQ) has been developedto assess for a range of concerns that can be usefulto researchers and addressed clinically. Externalvalidity and correlates for the scale scores arepresented. METHOD: Qualitative and quantitativescale development methods were used to create a14-item instrument with 3 subscales: practicalimpact of the illness on child, emotional impactof the illness, and concerns about co-parent. ThePCQ is scored on a 5-point Likert scale; higherscores indicate greater concern. Outpatients with arange of cancers at two urban cancer centersanonymously completed the PCQ, demographicsand standardized measures: Distress Thermometer,Hospital Anxiety and Depression Scale, andFACT-G. RESULTS: 173 subjects; mean-age 46years, 72% female, 97% white, and 93% married.Mean PCQ score: 2.35 (range 1–4.54, sd5 0.69).Scores correlated significantly in expected direc-tions with all standardized measures. T-tests

indicated that recurrent or metastatic disease,current mental health treatment, female gender,living alone, diagnosis within one year, and medicaltherapy within one month were associated withsignificantly higher scores. Scores were not sig-nificantly correlated with education, income, orfrequency of clinic visits. CONCLUSIONS: Thismostly white, socio-economically stable subjectpool demonstrated mild to moderate concernsabout their children, with higher PCQ scoresassociated with female gender, recent diagnosis,severity of disease, and mental health co-morbidity.Further research is indicated to assess concernsin a diverse population. Psycho-oncology research-ers and clinicians may use this tool to assessparenting concerns and potentially identify thesubset of more vulnerable families coping withparental cancer that could benefit from targetedintervention.

A-474

The Course-of-Life of Young Adult Survivors of

Childhood Cancer

Marta Correia1, Ivone Patrao1, Maria de JesusMoura1

Ispa - Higher Institute of Applied Psychology,Lisbon, Portugal1, Ispa - Higher Institute of AppliedPsychology, Lisbon, Portugal2, IPO - PortugueseInstitute of Oncology Francisco Gentil in Lisbon,Lisbon, Portugal3

OBJECTIVES: Although several studies have beenmade, the psychosocial consequences in adultsurvivors of childhood cancer are not fully under-stood. The objective of this study is the evaluationof the course-of-life of young adult survivors ofchildhood cancer, with ages ranging from 18 to 30years, in regard to peers with no history of cancer.METHOD: Survivors were selected from anOncological Institute. The course-of-life question-naire (Stam, Grootenhius, Last, 2005) was appliedto 58 survivors of childhood cancer as well as to 58peers in the comparison group with no history ofcancer, paired by gender, age and area of residency.RESULTS: The results of this study indicate thatthe course-of-life of survivors is hampered. Survi-vors achieved less, or at a later stage, develop-mental milestones than their peers in respect toautonomy, psychosexual and social development.Survivors also participated in less risk behaviorsthan their peers. CONCLUSIONS: The knowledgethat the course-of-life of young adult survivors ofchildhood cancer is hindered draws special atten-tion to the developmental flaws they present. Thisfact stresses the need for health services tocontribute more for the survivor’s favorablecourse-of-life during and after treatment. Inparticular, the need to stimulate children withcancer to socialize, participate in activities


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alongside their peers as well as to help parents inpromoting the autonomy of their offspring.

A-475

Biased Symptom Attribution and Radiation Therapy

for Breast Cancer: Prevalence, Changes over Time

and Impact on Distress.

Bonamis O.1, Lienard A.1, Merckaert I.1, CouckeP.3, Scaillet P.2, Van Houtte P.1, Delvaux N.1,Etienne A.-M.3, Reynaert C.2, Razavi D.1

ULB, Brussel, Belgium1, UCL, Louvain-la-Neuve,Belgium2, ULG, Liege, Belgium3

OBJECTIVES: Attribution of symptoms appear-ing in the context of radiation therapy (RT) has notbeen studied sufficiently. The first aim of this studyis to assess the frequency of biased symptomsattributions (symptoms unrelated to RT andattributed to RT) and to describe their evolutionover time. The second aim is to assess the impact ofmaking biased attributions at the beginning of RTon distress at the end of treatment. METHOD:Women with primary breast cancer were assessedduring the first (T1) and the last (T2) week of theirRT treatment. Symptom attribution was assessedat both assessment times with a Symptom andAttribution Questionnaire especially developed forthis study. Patients were invited to report whetherthey attributed perceived symptoms to RT or not.RT unrelated symptoms that were attributed bypatients to RT were considered as biased attribu-tions. RESULTS: First, the number of patientsreporting at least one biased symptom attributions(BSA) increased over time, p5 0.007. Among the246 patients 37% made at least one BSA at T1 and48% at T2. The mean number of BA increasedover time (respectively 2.10 (SD5 1.4) and 2.54(SD5 1.9); po0.001). Second, patients making atleast one BSA at T1 were more distressed at T2,p5 0.007. CONCLUSIONS: Making biasedsymptom attributions is frequent among patientsand increases during RT. Biased symptom attribu-tions are associated with distress at the end oftreatment. Special attention should be paid topatients reporting biased attributions at the begin-ning of treatment. Correcting their biased symptomattribution may thus prevent development ofdistress.

A-476

Africa’s Standards For Providing Quality Palliative

Care Services

Fatia Kiyange1, Faith Mwangi-Powell1, AnneAslett2

African Palliative Care Association (APCA), Africa,Uganda1, Elton John AIDS foundation, Europe,United Kingdom2

OBJECTIVES: Palliative care provision acrossAfrica is inconsistent, often provided from isolatedcentres of excellence rather than integrated into themainstream healthcare system. To address thischallenge, African palliative care standards havebeen developed. This abstract outlines their devel-opment process, key underpinnings, structure,content outline and plans for implementation ofthe standards at different levels of service deliveryacross the continent. METHOD: The standardswere developed through wide consultation withcommittee-based service beneficiaries and provi-ders, national policy and professional bodies, aswell as regional and international palliative careand home-based care experts. The standards, basedon research undertaken in African countries, areview of existing standards and other relevantdocuments worldwide and existing experiencebased-evidence, were developed through consen-sus-based drafting and review meetings. Thedetailed process will be shared at the conference.RESULTS: Standards for the provision of qualitypalliative care services in Africa have been devel-oped. These suit different levels of service delivery,from primary to tertiary and are applicable toeveryone with a life-threatening illness and theirfamilies. They cover the whole continuum of care,including prevention, care and support, and treat-ment and end-of life care within the context ofpalliative care. CONCLUSIONS: Standards forthe provision of quality palliative care services arenew in Africa and are designed to meet the qualityneeds of all service providers. They provide a clearpathway for service providers to progress along acontinuum as they strive for quality improvement.African countries will be supported to adopt andadapt the standards and lessons will be shared withother parts of the world.

A-479

Development of the Lacomm, a French Medical

Communication Analysis Software: A Study Asses-

sing its Sensitivity to Change

Anne-Sophie Gibon1, Jean-Franc-ois Durieux2,Isabelle Merckaert1, Nicoles Delvaux4, ChristineFarvacques2, Yves Libert3, Serge Marchal2,Angelique Moucheux2, Jean-Louis Slachmuylder2,Darius Razavi1

Universite Libre de Bruxelles, Brussels, Belgium1,C.A.M (training and research group), Brussels,Belgium2, Institut Jules Bordet, Brussels, Belgium3,Hopital Universitaire Erasme, Brussels, Belgium4

OBJECTIVES: To assess the efficacy of commu-nication skills training programs, there is a growingdemand for communication analysis systems sensi-tive to change. This study aims to compare thesensitivity to change of a French medical commu-nication analysis software (Lacomm) to the


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sensitivity to change of the Cancer ResearchCampaign Workshop Evaluation Manual(CRCWEM) in the context of a training programdesigned for nurses. METHOD: Nurses wererandomly assigned to a 105-hour communicationskills training program or to a waiting list. Theassessment included the recording of a two-personsimulated consultation at baseline and after train-ing for the training group, and 3 months afterbaseline for the waiting list group. Transcripts wereanalysed with the LaComm and with theCRCWEM. The respective sensitivity to changeof the Lacomm and the CRCWEM was assessedusing Generalized Estimating Equations. RE-SULTS: One hundred and nine nurses wereincluded. The Lacomm detected several group-by-time changes: open directive questions (po0.001),acknowledgements (p5 0.029), and empathy(p5 0.026) for utterances types, negative emotion(p5 0.047), positive emotion (p5 0.011) and sec-ondary process words (p5 0.021) for utterancescontents. The CRCWEM detected several group-by-time changes: open, open directive and screen-ing questions (po0.001) for utterances forms,eliciting information, clarification and checking(p5 0.045), information before investigation(p5 0.002), and premature reassurance (p5 0.006)for utterances functions. CONCLUSIONS: Thisstudy shows that the Lacomm has a goodsensitivity to change. It is thus a precise andreliable alternative to the CRCWEM for theassessment of the efficacy of communication skillstraining programs. As opposed to a tool that usesan observer rating system, such as the CRCWEM,Lacomm is easier to use (less time consuminginterrater reliability training and assessment pro-cedures) and less expensive. For futher informationplease visit www.lacomm.be.

A-480

Body Image Among Breast Cancer Survivors:

Theoretical and Methodological Considerations in

an Oncology Context

Jennifer Brunet1, Catherine M. Sabiston1, MeghanH. McDonough2, Valerie Hadd3, Peter R. E.Crocker3

McGill University, Montreal, Quebec, Canada1,Purdue University, West Lafayette, Indiana, UnitedStates2, The University of British Columbia,Vancouver, British Columbia, Canada3

OBJECTIVES: Although breast cancer-specificmeasures of body image are emerging, they arerarely theoretically-based and are often unidimen-sional. The purpose of this study was twofold: (1)present a theoretical perspective on the concept ofbody image in an oncology context, and (2) test thepsychometric properties of the MultidimensionalBody Self-Relations Questionnaire - Appearance

Scale (MBSRQ-AS) within a sample of breastcancer survivors. METHOD: A sample of breastcancer survivors (N5 470, M age5 57.1 years,SD5 7.95) completed a self-report questionnairewhich included the 34-item MBSRQ-AS, a measurethat assesses several dimensions of body image.Participants were a mean of 5.91 years (SD5 4.97)post treatment. RESULTS: Following a review ofthe literature, White’s (2000) heuristic model ofbody image in oncology appears appropriate toexamine the multidimensional nature of bodyimage. In terms of body image measurement, theMBSRQ-AS subscales demonstrated acceptablereliability (5 0.76–0.85), except for the overweightpreoccupation subscale (5 0.66). Confirmatoryfactor analysis supported the five factorscorresponding to the scale: appearance evalua-tion, appearance orientation, body areassatisfaction, overweight preoccupation, and self-classified weight (x2(517)5 1620.94, CFI5 0.93,NNFI5 0.93, RMSEA5 0.07). CONCLUSIONS:From the presented framework, researchers need torecognize that body image is multidimensionalconstruct and should be measured using multi-dimensional measures that are theoretically-grounded. Findings suggest the MBSRQ-AS servesthis purpose. Adopting a universal definition andmeasure of body image will permit meaningfulcomparisons across studies and help advanceconceptually-driven research.

A-481

Prevalence of Mental Health Conditions in Cancer

Patients in Acute Care - A Meta-analysis

Susanne Singer1, Jayati Das-Munshi2, ElmarBrahler1

University of Leipzig, Leipzig, Germany1, King’sCollege, London, United Kingdom2

OBJECTIVES: To what extent is professionalpsychosocial care of cancer patients in acutehospitals necessary? In a previous meta-analysis,prevalence of psychological sequelae was found tobe the same as in the general population. Newstudies with advanced methodology have beenpublished since; therefore, an updated meta-analy-sis was needed. METHOD: We systematicallyreviewed studies assessing the prevalence of mentalhealth conditions in acute care hospitals withcomprehensive structured clinical interviews. RE-SULTS: Of 46 retrieved manuscripts, 8 weredeemed eligible for this meta-analysis. Within thestudies, 1448 cancer patients had been assessed,whereby 456 were diagnosed having a mentalhealth disorder. The prevalence rates rangedfrom 23% (breast cancer patients in Turkey) to53% (elderly cancer patients in Uganda). Thecombined prevalence estimate is 32% (95% CI27%–37%). CONCLUSIONS: A third of the


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cancer patients in acute care hospitals are sufferingfrom mental health disorders and need appropriatetreatment.

A-483

Quality of Care and Emotional Support from the

Inpatient Cancer Patient’s Perspective

Susanne Singer1, Heide Gotze1, Christian Mobius1,Helmut Witzigmann2, Rolf-Dieter Kortmann1,Johann Hauss1

University of Leipzig, Leipzig, Germany1, HospitalDresden-Friedrichstadt, Dresden, Germany2

OBJECTIVES: Patient satisfaction and emotionalsupport are crucial elements of cancer care. Little isknown however about which areas of care areimportant from the patient’s perspective and theroles emotional distress and support play in thiscontext. METHOD: Multi-center prospectivestudy (n5 396 cancer patients; t15 after admissionto hospital, t25before discharge). Quality of carewas measured with the ‘Quality of Care from thePatient’s Perspective’ questionnaire and emotionaldistress with the ‘Hospital Anxiety and DepressionScale’. Additional questions regarding emotionalsupport wished (at t1) and provided (at t2) wereadministered. RESULTS: Domains of care mostimportant to the patients were: respect andcommitment of the physicians, information beforeprocedures, care equipment, and medical care. Theareas where improvements are most obviouslyneeded were: nutrition, participation, clarity aboutwho is responsible, and having the possibility ofspeaking in private with nurses and psycho-oncologists. 56% of the patients were highlyemotionally distressed, 84% wanted support fromphysicians, 76% from nurses, 33% from psychol-ogists, 7% from a pastor. CONCLUSIONS:Emotional support is a crucial part of patientsatisfaction and should be provided by severalmembers of the oncological team, especiallypatients’ physicians. In turn, it is crucial thatmedical professionals be equipped with goodcommunication skills.

A-488

Life and Death at Bedside: An Interpretative

Phenomenological Analysis of Death Attitudes and

Caring Experience of Palliative Care Nurses

Melanie Vachon1, Lise Fillion2, Marie Achille1

Universite de Montreal, Montreal, Quebec, Canada1,Laval University, Quebec City, Quebec, Canada2

OBJECTIVES: The Quebec policy on end-of-lifepalliative care underlines the importance of in-creasing caregiver’s awareness of inevitability ofdeath, considering that death attitudes challengepalliative care development. However, no study

explored in details death attitudes and caringexperience in nurses who provide palliative care(PC). This study aims at better understanding (a)death attitudes and (b) caring experience in PCnurses. It also aims at (c) exploring potential linksbetween death attitudes and caring experience.METHOD: Eleven nurses who provide PC indifferent settings (PC unit, oncology unit, hospice,home care delivery) were invited to participate insemi-structured interviews in which they wereasked to discuss the way they see death, both at apersonal and professional level. They were alsoinvited to share significant caring experience inrelationship to death perception. Interviews wererecorded, transcribed and imported into N’vivo forcodification. Data were analysed using interpreta-tive phenomenological analysis (Smith, 2004).RESULTS: Interpretative phenomenological ana-lysis allows different level of interpretation. Thefirst level analysis allowed a description of theemerging themes of nurses’ attitudes towards deathand caring attitudes. The second level analysis ledto the emergence of a typology, that accounts forthree different patterns of death attitudes (integrat-ing death, fighting death and suffering death) inrelationship to three different caring experience(empathic resonance, dissonance and consonance).CONCLUSIONS: This exploratory study provideda better understanding of death attitudes andcaring experience in PC nurses. Although thequalitative design doesn’t allow deriving correla-tions, the findings suggest that personal deathattitudes may be related to caring experience in PCnurses. Those findings should eventually be testedempirically. Nevertheless, the present work hasheuristic value. It may also lead to design inter-ventions for nur’ses in order improve their level ofcomfort in caring for dying patients.

A-490

Older Women and Home Death in Botswana

Mark Lazenby1, Howard Moffat2, Tish Knobf1,Marjorie Funk1, Tony Ma1, Ruth McCorkle1

Yale University, New Haven, CT, United States1,Ministry of Health, Gaborone, Botswana2

OBJECTIVES: To ascertain place of death (homeor hospital) and potential influencing factors inBotswana. METHOD: Death records for years2005 and 2006 were obtained from the Registry ofBirths and Deaths in Botswana for adults (418yrs.) with non-traumatic deaths. Fields collectedwere cause of death, age, gender, occupation, anddistrict of residence. Cause of death was takenfrom the death records as listed, some of which wasnot an ICD-9 diagnosis. RESULTS: Home deathsaccounted for 36% of all 18, 869 evaluable deathrecords. The cause of death for home deaths waslisted as ‘unknown’ 82% of the time. Mean


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age: 53.2 years (SD 20.9). Home deaths wereassociated with 61 years (SD 22.5). Logistic regres-sion revealed unknown cause of death, female, 480years of age, and residing in either a city or rural areapredicted home death (po0.05). CONCLUSIONS:Unlike other research in western countries thatfound that gender did not play a significant role indetermining place of death and older age predictedhospital death, being female and480 years of age atthe time of death predicted home death in Botswana.The lack of documented cause of death for homedeaths is a study limitation. However, the findingsmerits further study to determine their needs,including cancer care, at the end of life.

A-491

Fruit and Vegetable Consumption, Diet-related

Stress, and Healthcare Practitioner Involvement

Among Breast Cancer Survivors

NA Khalil, CM Sabiston, J Brunet, K Gray-Donald, RE AndersenMcGill University, Montreal, Quebec, Canada

OBJECTIVES: Breast cancer survivors (BCS)consume an average of 4.1–4.3 servings/day offruits and vegetables (FV), considerably less thanthe 7–8 servings/day recommended by Canada’sFood Guide (CFG). Furthermore, diet-relatedstress is recognized as an important stressor formany BCS. The purpose of this study was toexamine the proportion of BCS who meet the CFGrecommendations for FV and to identify associa-tions with diet-related stressors. Healthcare practi-tioner involvement in providing dietary advice wasalso assessed. METHOD: Fifty BCS who haverecently completed treatment were recruited forthis study. Mean (7SD) age and body mass index(BMI) were 52.079.5 years and 27.476.8 kg/m2,respectively. Diet-related stressors were assessedusing self-report questionnaires. Fruit and vegeta-ble consumption was assessed using validatedquestions from the Behavior Risk Factor Surveil-lance System. Height and weight were measuredusing a stadiometer and balance beam scale andwere used to calculate BMI. RESULTS: AverageFV consumption was 6.072.5 servings/day, with68% of BCS failing to meet CFG recommenda-tions. Concerns for making healthy dietary choicesand meeting dietary recommendations were re-ported stressors for 85% and 83% of BCS,respectively. In addition, 75% of those concernedabout meeting recommendations actually failed tomeet them. Forty-two percent of BCS reported notreceiving dietary advice from their healthcarepractitioners. CONCLUSIONS: Despite BCS con-cerns for eating a healthy diet, mean FV intake waslower than CFG’s recommendations. The findingthat the majority of BCS failed to meet FVrecommendations, coupled with their frequent

concern for making the right dietary choices andmeeting recommendations highlights the need fornutrition education among BCS. Healthcare prac-titioners may need to place additional emphasis onnutrition to educate patients and reduce diet-related stress.

A-493

Presentation of a Explicative Model of Quality of

Life and Distress in Portuguese Women with Breast

Cancer and in Their Partners

Maria Joao Cunha, Joao Paulo PereiraInstituto Superior da Maia, Maia, Portugal

OBJECTIVES: The aims of this report is toidentify the distress and quality of life predictorsin women with breast cancer and their partners.METHOD: Using predictive statistical analysis theauthors tested a explicative model of Quality ofLife and distress in Portuguese women withconfirmed diagnosis of breast cancer, residing andbeing followed up in health care services in thenorthern area of Portugal, and their partners.Instruments: 23 QVS, Brief-Cope R, BSI, GHQ12,WHOQOL and IESSD. RESULTS: From 208participants, 46, 6% are vulnerable to stress, 25%present emotional disorders criteria, the majoritywith low Quality of Life perception. The generalconceptual model shows that psychological andexistential suffering are predictors of the stressvulnerability, being explained by the developmentof emotional disorders and low quality of lifeperception. CONCLUSIONS: Physical sufferingdoesn’t explain stress vulnerability. The build ofmeaning about the disease experience is crucial forthe stress coping resources. A positive appraisal ofthe situation protects and facilitates personaldevelopment. The stress vulnerability explains thedistress in the female population, but not in themale population. The stress vulnerability explain-ing in the partners, in contrast with ill women, anegative evaluation of environmental and socialrelations domains of quality of life.

A-494

The Beneficial Role of Attachment Security in

Children in Promoting Healthy Eating

Aida Faber, Laurette DubeMcGill University, Montreal, Quebec, Canada

OBJECTIVES: This paper investigates how attach-ment styles impact healthy eating in children, andparticularly how attachment security contributes inbridging the consumption gap between boys andgirls. The Canadian Cancer Society recommendsmaintaining a healthy weight by reducing fatintake, among others, to prevent cancer. Secureattachment, as opposed to avoidant and anxious


DOI: 10.1002/pon

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attachment, has been linked with eating compe-tency in infancy, better self-control, and theadoption of health prevention and promotionbehaviors. METHOD: 235 children (155 girls; 79boys) aged between 8–12 years old (Mage 5 10.15)filled out an online questionnaire. Children hadnormal BMI’s (M5 25.48, SD5 0.48) and theirmother tongue was primarily French (N5 207).Participants filled out an adapted version of theAttachment Style Measure which yields twoattachment indexes namely, avoidant/secure andanxious/nonanxious. Measures of high caloric meal(HCM) and snack (HCS) consumption were alsocollected. RESULTS: Children who scored high onsecurity and low on anxiety, respectively, con-sumed less HCS and HCM, pso0.0001. Moreover,avoidance/secure index by gender interactions weresignificant for HCS consumption, po0.05, andmarginally significant for HCM consumption,p5 0.08. As such, secure boys consumed lessHCM and HCS than avoidant boys, while therewas no difference in HCS and HCM consumptionbetween secure and avoidant attached girls. CON-CLUSIONS: This paper shows the importance ofconsidering attachment security as a protectorfactor against cancer risk to maintain a healthyweight. Attachment security and low anxiety wereboth associated with lower consumption of highcaloric meals and snacks in children. Moreover, asecure attachment style benefitted more boys thangirls by lowering their caloric intake of fatty snacksand meals and bringing it closer to the girls’consumption of such foods.

A-495

Reducing the Burden of Breast Cancer among

African American and Latina American Survivors

Kimlin Ashing-GiwaCity of Hope, Duarte, California, United States

OBJECTIVES: The less favorable survivorshipoutcomes of ethnic minorities and paucity ofliterature documenting culturally and linguisticallyresponsive intervention studies add to the urgencyof this research. This study investigates the effec-tiveness of a clinically responsive psycho-educa-tional intervention with African-American andLatina-American breast cancer survivors (BCS).METHOD: Participants were recruited from theCalifornia Cancer Surveillance Program, hospitals,community health clinics, and BCS supportgroups. Eligible participants included women 18years of age and older, within 1–6 years of a breastcancer diagnosis, and diagnosed with stages 0-III.Participants were assigned to the low intensity(LiTx) or high intensity (HiTx) condition based onlevel of psychological burden. LiTx participantsreceived survivorship materials only and HiTxparticipants received 8 telephone sessions and

survivorship materials. RESULTS: Results basedon 312 (88 African American, 224 Latinas) BCSare described. Significant differences in demo-graphic characteristics include: Latinas reportedlower education, income and were less likely towork outside the home. Repeated measure analysesrevealed significant differences in HRQOL bycondition. HRQOL scores improved from baselineto follow up for the HiTx group (po0.01) whilescores were generally unchanged for the LiTXcondition. The intervention did not show signifi-cant differential effects based on ethnicity. CON-CLUSIONS: Findings on the efficacy of thepsychosocial intervention reveal significant im-provements in HRQOL as measured by theFACT-B. Findings suggest that long-term and lateeffects persist among BCS, but symptoms areresponsive to intervention. Results provide evi-dence that culturally and clinically responsiveinterventions are effective for improving QOLoutcomes and reducing life burden among low-income and minority populations. Similar inter-ventions if implemented early may alleviate andprevent some negative outcomes among survivorsat greatest risk.

A-497

Pain Narratives Among Breast Cancer Survivors

Laura Spica2, Marc-Karim Bendiane2, DominiqueRey2, Patrick Peretti-Watel1

Inserm UMR912, Marseille, France1, ORS PACA,Marseille, France2

OBJECTIVES: First, we documented breast cancersurvivors’ experience of chronic pain and wecompared in-depth interviews and answers to theWHOQOL-BREF questionnaire regarding chronicpain and its impact on everyday activities. Sec-ondly, in order to understand the discrepanciesrevealed by this comparison, we focused onrespondents’ attitudes toward pain, and especiallyhow they gave meaning to pain and how they dealtwith it in their daily life. METHOD: In-depthinterviews were conducted with 25 women recruitedamong a regional cohort of breast cancer survivors(ELIPPSE), and analyzed with an inductive ap-proach based on grounded theory. Interviews wereconducted in participants’ homes and lasted be-tween 1 and 4hours. All participants also com-pleted the WHOQOL-BREF questionnaire. Wefocused on items related to self-rated quality oflife, activity limitation due to pain and satisfactionin everyday activities. RESULTS: Among inter-viewed women, iatrogenic pain was not systematicbut very frequent even several months after cancertreatment had been completed. Its impact oneveryday life was not captured by a standardquality-of-life scale, probably because participantsput pain into perspective (by comparing themselves


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to other patients) and normalized it (for example,as a necessary step to cure). Most of the time, thispain was not treated by health care professionals,but self-managed by participants. CONCLU-SIONS: Our results point out the necessity tobetter inform breast cancer patients’ on iatrogenicpain and the ways to deal with it, and to underminesome common beliefs related to the meaningof such pain, as such beliefs may preventpain treatment. Health professionals should bespecifically trained on these issues. Moreover,pain management should combine pharmacologi-cal and non-pharmacological approaches, includ-ing the promotion of patients’ self-managementtechniques.

A-499

Challenges in the Psychological Support of Pallia-

tive Patients in a Pain Clinic - Walking on Thin Ice

M. Rosario Bacalhau, Teresa TupholmePortuguese Institute of Oncology Lisbon, Lisbon,Portugal

OBJECTIVES: The major goal of palliative care isthe achievement of the best quality of life forpatients and their families. Considering that thereis an expanding appreciation for the sensitivity andprofessionalism with which issues of death anddying need to be approached, this study focuses onthe difficulties felt by psychologists in a Pain Clinicof a Major Cancer Hospital, who are dealing withpalliative patients that are unaware of theirdeteriorating health condition. METHOD: Bymeans of various clinical cases we will try toillustrate the difficulties encountered and how wehave strived to address the psychosocial andexistential distress among these patients; there is aneed to elicit, understand, empathize, and respondto the complex manifestations of these patients;what is the reality of the patient’s clinical situationand how do we deal with their expectations? Howcan we help these patients achieve or maintain asense of meaning and dignity? RESULTS:Although the palliative care movement has becomea reality and is being regulated, numerous barrierspersist. The most notorious of these being, thedifficulty encountered by health-care professionalsin the referral procedure since palliative carecontinues to be seen by health-care professionals,particularly, by medical doctors, as a failure intheir healing capacities. These patients are con-tinuously referred to the Pain Clinic on falseassumptions; namely to keep hope alive and avoidpsychological suffering and the patient’s inabilityto understand the news. CONCLUSIONS: Webelieve that palliative interventions must reachbeyond the realm of pain and symptom manage-ment to be fully responsive to a broad and complexrange of expressed needs. For this to be possible,

the psychologist should incorporate the cancerpatient’s health-care team from the time ofdiagnosis to the end of life phase. This will enhancethe patient’s psychosocial adjustments during thecourse of the disease, as well as, a sense of meaningand purpose in the final stages of the disease.

A-500

Men Talking To Men About Prostate Cancer: An

Educational DVD

Susan Cadell, Kathleen Wilson, Kimberly KennedyManulife Centre for Healthy Living, Faculty ofSocial Work, Wilfrid Laurier University, Kitchener,Ontario, Canada

OBJECTIVES: The Men talking to Men project wasundertaken in response to an identified gap in patienteducation in psychosocial oncology. The primary aimof this project was to design an educational toolreflective of the needs of men diagnosed with prostatecancer. The purpose of this presentation is to reporton the issues identified and to introduce the educa-tional tool currently in development. METHOD:Focus groups were conducted with men diagnosedwith prostate cancer. Participants were recruitedthrough a local cancer center and through patientsupport groups. A total of 5 focus groups whichincluded the voices of 31 men were conducted. Menwere asked specifically about information they founduseful or wish they had been told prior to, or during,their cancer journey. RESULTS: Men living withprostate cancer expressed that they wish that they hadbeen more informed about a number of issues, bothphysical and emotional, at various points along thecancer trajectory. It also was clear that such informa-tion was best delivered by other men who had beenthrough diagnosis and treatment themselves. Theseidentified issues were then used to script and developan educational DVD by men for men with prostatecancer. CONCLUSIONS: The DVD ‘Men Talking toMen About Prostate Cancer’ will serve to disseminateknowledge and information to men who have beendiagnosed with prostate cancer. The informationconveyed will benefit men at any point in their cancerjourney and will be available to a broad audience thatotherwise may not have access to this information.Production is expected to finish Summer 2010.Funding for this project is gratefully acknowledgedfrom Canada’s Motorcycle Ride for Dad.

A-501

The Secrets Of Success: How Couples Maintain

Sexual Intimacy After Prostate Cancer Treatment

Andrea Beck1, John Robinson2, Linda Carlson2

University of Calgary, Calgary, Alberta, Canada1,Tom Baker Cancer Centre, Holy Cross Site,Calgary, Alberta, Canada2


DOI: 10.1002/pon

S138 Oral Abstracts

OBJECTIVES: This qualitative study aimed tounderstand the processes by which heterosexualcouples adapt to the side effects of localizedprostate cancer (PrCa) treatments in an attemptto maintain sexual intimacy. The goal was todevelop a theory to explain how some couplesmanage to successfully maintain sexual intimacyafter treatment while others do not. METHOD:Ten couples (20 individuals) who successfullymaintained sexual intimacy after PrCa treatmentand seven couples (14 individuals) who did notparticipated in semi-structured interviews. Eachindividual participated in one interview with theirpartner followed by one interview alone (i.e. 3interviews per couple, 51 interviews total). Inter-views focused on the challenges faced and strate-gies used in the couples’ attempts to maintainsexual intimacy. Interviews were audio recorded,transcribed, and analyzed using grounded theoryqualitative methods. RESULTS: The common andunique challenges experienced by men and womenafter PrCa treatment, such as changes in libido, theredefinition of sex, and changes in sexual identity,will be presented. In addition, a theory explaininghow some couples were able to successfully adaptto the side effects of PrCa treatments and maintainsexual intimacy while other couples were not willbe presented, along with supporting quotes andcase examples from the interviews themselves.CONCLUSIONS: Previous research has documen-ted that most couples are unsuccessful in theirefforts to maintain sexual intimacy even whenerectile aids work. No theories currently exist toguide clinical interventions for improving successrates. This research provides an understanding ofthe key factors that enable couples to maintainsexual intimacy and will help clinicians appreciatethe specific challenges faced by couples and betterassist struggling couples to maintain sexual in-timacy after PrCa treatments.

A-502

The Utility of the Hopelessness Assessment in Illness

(HAI) as a Psychotherapy Intervention Outcome

Measure in Advanced Cancer

Hayley Pessin1, Barry Rosenfeld2, WilliamBreitbart1, Elissa Kolva2, Julia Radomski1

Memorial Sloan Kettering Cancer Center,New York, New York, United States1, FordhamUniversity, New York, New York, United States2

OBJECTIVES: The HAI is a new brief measurespecifically developed to measure hopelessness inadvance cancer. It was recently validated for thispurpose and demonstrated considerable, uniqueexplanatory power in predicting important psycho-social outcome variables such as desire for has-tened death and suicidal ideation (Rosenfeld et al.,under review), yet it has never been utilized in an

intervention study. We sought to use the HAI as aprimary outcome measure in a group psychother-apy intervention. METHOD: As part of a largerNIH R01 funded intervention trial, 43 participantswho had advanced cancer completed an 8-weekgroup psychotherapy treatment. Patients wererandomly assigned to an existential meaning basedtreatment, Meaning Centered Group Psychother-apy (MCGP, n5 24) or Supportive Group Psy-chotherapy (SGP, n5 19). Participants completedthe Hopelessness Assessment in Illness (HAI, 8-items) as part of a larger pre/post assessmentbattery. Within group differences in pre/postchanges on the HAI were analyzed using One-Sample T-tests. RESULTS: Preliminary resultsshowed significant pre/post changes on the HAIfor MCGP (p5 0.009) but not SEP (p5 0.399). Atthe item level, MCGP participants endorsedsignificant improvements on 3 of the 8 items:discouragement about the future, ability to thinkabout things besides their illness, and sense ofcontrol over their life, whereas SGP showed nosignificant changes on any of the items. Pre/postchange on the HAI was significantly correlatedwith change in desire for death (SAHD, r5 0.46).CONCLUSIONS: The HAI is sensitive to changesin hopelessness and can be used effectively as anoutcome measure in intervention studies withadvance cancer patients. On the item level, theHAI was able to distinguish between the specificaspects of hopelessness that were impacted bytreatment and may be suggestive of the potentialmechanisms of action targeted in MCGP. Pre-liminary results suggest that a meaning basedtherapy (MCGP) is an effective intervention forsymptoms hopelessness.

A-504

Impact of the Yoga Bali Method on Quality of Life

and Depressive Symptoms among Women Diagnosed

with Breast Cancer Undergoing Chemotherapy

Lanctot Dominique, Dupuis Gilles, AnestinAnnelie, Bali Madan, Dube Pierre, Martin GinetteUniversite du Quebec a Montreal, Montreal,Quebec, Canada

OBJECTIVES: The use of yoga as an interventionin psycho-oncology to improve quality of life (QL)has considerably increased in the last decade. Thepurpose of this research is to evaluate the efficiencyof a yoga program (Bali method) on the QL anddepressive symptoms of women diagnosed withbreast cancer undergoing chemotherapy. METH-OD: 101 women diagnosed with stage 1–3 breastcancer randomly assigned to a yoga group (n5 58)or to a waiting list control group (n5 43). Yogaprogram was taught by accredited teachers in Balimethod. The method includes: postures, visualisa-tion, relaxation, meditation, breathing exercises.


DOI: 10.1002/pon

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Sessions (1:30 hr) were given weekly over a periodof eight weeks. A video was given for daily homepractice. Instruments used: the Quality of lifesystemic inventory; the Beck depression inventory.RESULTS: Repeated measures Anovas: improve-ments for QL global score (p5 0, 005), emotionaland cognitive subscales (p5 0, 006; 0, 005) and adecrease in depressive symptoms (p5 0, 10) foryoga group. Waiting list : depressive symptomsincreased (p5 0, 006), no change on global QLscore and on emotional subscale, and deterioration(p5 0, 029) on cognitive subscale. Post treatmentAncovas: waiting list group showed more depres-sive symptoms (p5 0, 034) than yoga group and apoorer QL on the three scores (p5 0, 12; 0, 026; 0,07) CONCLUSIONS: Yoga Bali method improvesQL and diminishes depressive symptoms in womendiagnosed with breast cancer undergoing che-motherapy. Implementation of this 8 week yogaprogram in hospital settings should be consideredas a complementary intervention for women withbreast cancer. Further research could evaluate theimpact of this program on physiological measuresas well as on other types of cancer.

A-505

Registered Dietitians are Essential in an Interprofes-

sional Psychosocial Oncology Program (PSOP)

Tanguay-Gordon Julie, Marcil SoniaThe Ottawa Hospital Cancer Center, Ottawa,Ontario, Canada

OBJECTIVES: Research indicates that cancer hasa profound impact on patients’ metabolic, physical,functional, psychological & social status (MarinCaro et al. 2007). Up to 60% of people receivingcancer treatments have at least one symptom thatcan make eating more difficult (Dixon. 2005). Thispresentation will describe the role of the Dietitianwithin a newly formed Psychosocial OncologyProgram. Referral indicators & improvements inthe service following integration in an interprofes-sional team will be discussed. METHOD: Aliterature review was conducted to evaluate theneed and the role of the Dietitian. Referrals toDietitians are made through a program referralprocess. Interventions are provided in individual orgroup sessions by dietitians with expertise inoncology. RESULTS: Nutrition support by aDietitian improves patient care, quality of life,and cost to the health care system.(Isenring et al.,2007; Ravasco P et al., 2005, 2007; Marin Caroet al., 2007). Studies have shown that managementof cancer patients is complex and individuals needto have access to the full range of psychosocialspecialists, including Dietitians. CONCLUSIONS:Following the integration of Dietitians within aPsychosocial Oncology Program, Dietitian FTEswere increased from 0.8 to 2.4 FTE. As a result,

1042 new referrals were received in 2009. Dietitiansnow collaborate closely with other team members,and patient care and wait times have improved.

A-506

Oncology Patient Navigation: The Current State of

the Science

Allison Pedersen, Thomas HackUniversity of Manitoba, Winnipeg, Manitoba,Canada

OBJECTIVES: The complex labyrinth of care thatgreets many patients diagnosed with cancer hasbecome the impetus behind the development ofoncology patient navigation programs. As theseprograms have become popular, program man-agers have been challenged to create both costeffective and efficient patient navigation ap-proaches to care. This presentation will reviewthe rationale behind the development of patientnavigation programs, and the current state of thescientific literature surrounding the oncology pa-tient navigator role. METHOD: A thoroughreview of the scientific literature pertaining topatient navigation was performed to highlight thenumerous programs, models and rationale avail-able to support the development of an oncologypatient navigator role. A review of the recentliterature pertaining to program development andtraining was also performed. RESULTS: Patientnavigation programs remain context specific andthe role of the navigator continues to be been filledby a variety of individuals including nurses, socialworkers and other trained personnel. Recentdevelopments in oncology patient navigation in-clude initiatives by the Canadian PartnershipAgainst Cancer to promote and develop nationalnavigation programs, the establishment of TheHarold Freeman Patient Navigation Institute inthe United States, and the creation of the NationalCoalition of Oncology Nurse Navigators. CON-CLUSIONS: Patient navigation programs willcontinue to develop and receive attention as manyhealth care program goals include amelioratingpatient outcomes and streamlining programs ofcare. Notwithstanding the developments within thedomain of oncology patient navigation, furtherresearch is required in measuring the success andfeasibility of these programs within the area ofcancer care.

A-508

Self-Rated Health in the Context of Oncology:

Understanding the Individual’s Holistic Experience

and Relationship to ‘Health’

Martin Picard, Catherine M. SabistonMcGill University, Department of Kinesiology andPhysical Education, Montreal, Quebec, Canada


DOI: 10.1002/pon

S140 Oral Abstracts

OBJECTIVES: An individual’s global assessmentof health using a single-item question – called self-rated health (SRH) – is strongly predictive of allcause and cancer mortality in the general popula-tion. Despite extensive research, an understandingof the mechanisms explaining the longitudinalassociation between SRH and mortality remainspoor. This abyss results most likely from theinadequacy of current conceptual and theoreticalframeworks, and from the poor integration ofknowledge into practice (i.e. knowledge synthesisand translation). METHOD: A growing body ofliterature outlines the need for integrative trans-disciplinary approaches to understand the com-plexities of health processes beyond the limitationsimposed by academic disciplines in isolation. Inthis work, we compiled quantitative and qualitativeevidence from the study of SRH and integrated itusing a transdisciplinary global perspective. RE-SULTS: ‘Health’ emerges as a concept closelyrelated to an individual’ subjective experience,transcending the classical biological, psychosocial,behavioral, and spiritual classifications of experi-ence. The rating of ‘health’ appears to be anindependent, individualized process; therefore,health should be seen as an personal phenomenon.In this theoretical presentation, we present findingsfrom published work on SRH, terminal cancer, andother chronic diseases to support our results.CONCLUSIONS: Self-rated health, which repre-sents an individual’s holistic and personal experi-ence, is closely linked to health outcomes. Thisconclusion outlines the need for individualizedmethods of assessment and intervention valuingindividual experiences, in both research and clinicalpractice.

A-509

Mothers’ Uncertainty about their Daughters’ Breast

Cancer Risk and Prevention Strategies

Carma Bylund1, Carla Fisher2, Dale Brashers3,Richard Brown4, Shawna Edgerson1, David Kissane1

Memorial Sloan-Kettering Cancer Center, New YorkCity, New York, United States1, Arizona StateUniversity, Tempe, Arizona, United States2, Univer-sity of Illinois, Urbana, Illinois, United States3,Virginia Commonwealth University, Richmond,Virginia, United States4

OBJECTIVES: The inherent uncertainties of lifeare often increased significantly in light of a geneticdiagnosis or genetic risk information. UncertaintyManagement Theory highlights types of uncer-tainty and different ways in which individuals andfamilies may choose to respond to these. Using thisapproach, the objective of this study is to describehow women considering genetic testing commu-nicate with clinicians about uncertainty regarding

their adolescent daughters’ cancer risk and preven-tion strategies. METHOD: We video-recorded 14consultations of genetic healthcare practitionersand women considering genetic testing for theBRCA1 or BRCA2 mutation due to their ownbreast cancer diagnosis or family history. Eligibleparticipants had at least one biological daughter12–20 years old. All consultations were transcribedand analyzed using the constant comparative forsources of uncertainty about daughters’ breastcancer risk. Sources of uncertainty were analyzedfrom the mothers’ talk and the genetic healthcarepractitioners’ talk. RESULTS: Sources of mothers’uncertainty included: uncertainty about commu-nication with their daughters (when, how muchand what to tell); the likelihood of daughters’ risk;and age appropriateness for cancer screening fordaughters. Themes of genetic healthcare practi-tioners’ communication mirrored the mothers’sources - they gave mothers information abouteach of the three categories. In addition, genetichealthcare practitioners also spoke about theuncertainty of present and future scientific andgenetic knowledge. CONCLUSIONS: Womenconsidering genetic testing discussed multiple issuesof uncertainty with genetic healthcare practitionersabout their daughters’ risk, screening, and how tocommunicate with them. This study is the first toapply Uncertainty Management Theory to geneticcounseling consultations. Future work will exam-ine how genetic healthcare practitioners work withmothers to help them manage the uncertainty theyface about their daughters’ cancer risk.

A-510

The Development and Implementation of an Institu-

tion-based Communication Skills Training Program

for Oncologists

Carma Bylund1, Philip Bialer1, Richard Brown2,Tomer Levin1, Maura Dickler1, Bernie Park1,David Kissane1

Memorial Sloan-Kettering Cancer Center,New York City, New York, United States1, VirginiaCommonwealth University, Richmond, Virgina,United States2

OBJECTIVES: Communication skills training(CST) has been shown to improve clinical commu-nication. However, advanced CST programs inoncology have lacked institutional integration, andhave not attended to institutional norms andcultures, the ‘hidden curriculum,’ that may coun-teract explicit communication skills training. Thegoals of this project were to develop an evidenced-based CST curriculum; address the ‘hidden curri-culum’ through faculty development; implementthe program for the institution’s fellows, residentsand faculty; and assess the program’s effectiveness.


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METHOD: We developed an advanced CSTprogram, made up of nine teaching modules.Training included didactic presentations and ex-periential small group work. Key faculty wereidentified to serve as facilitators and role models inthe implementation phase. Trainees included re-sidents, fellows, and faculty. Anonymous courseevaluations and pre-post self-efficacy were com-pleted at the end of each module. Skills uptake andbehavior change were evaluated through coding ofpre-post video recordings of actual and simulatedpatient encounters. RESULTS: Since 2006, 473clinicians have participated in this training pro-gram. Course satisfaction was rated as Agree/Strongly agree in a range of 92%–97% for allmodules. Pre-post self-efficacy significantly in-creased (po0.01) across modules for both attend-ing physicians and trainees. The use of Establishthe Consultation Framework and Checking com-munication skills were shown to significantlyincrease from baseline (po0.01). CONCLU-SIONS: Our initial work in this area demonstratesthe implementation of such a program at a majorcancer center to be feasible, acceptable, andbeneficial.

A-512

A Qualitative Study of Diagnostic Delay in Recently

Diagnosed Colorectal Cancer Patients

Laura A. Siminoff, Heather L. RogersVirginia Commonwealth University, Richmond,Virginia, United States

OBJECTIVES: To examine factors associated withdiagnostic delay, defined as the time between apatient’s first medical visit and diagnosis or as thetime between and individual’s recognition ofsymptoms and diagnosis. METHOD: Individualsfrom Virginia and northeast Ohio diagnosed withcolorectal cancer (CRC) in the past 6 months whoexperienced symptoms prior to diagnosis arerecruited for an on-going qualitative researchstudy. All participants are administered a semi-structured, cognitive interview about the eventsleading up to their diagnosis and completenumerous questionnaires. The qualitative interviewdata is themed and coded. Self-report informationis verified via chart review. Data from 50 codedinterviews (of 200 conducted) were analyzed.RESULTS: Longer diagnostic delay was signifi-cantly associated with: not seeking medical atten-tion for initial symptoms (po0.05), behavioraldelay in acting on a decision to seek medicalattention (e.g. due to procrastination and interfer-ing life events) (po0.05), having a HCP believethat the symptoms were not serious (po0.01), and/or having a HCP who failed to fully explore patientsymptoms (po0.05). Patients whose physicians

attributed symptoms to a non-cancer cause tendedto have longer diagnostic delay (p5 0.06). CON-CLUSIONS: In this sample, both patient andphysician factors contributed to diagnostic delay,while system-level factors did not. Patient-centeredfactors included not appraising initial symptoms asserious or requiring medical attention and beha-vioral delay scheduling an appointment. Physician-centered factors included not thoroughly investi-gating patient complaints nor deeming symptomsas serious and possibly indicative of cancer.Findings suggest that we need to have a morenuanced understanding of how individuals use andaccess the health care system.

A-517

The Effectiveness of Cybercounselling: A Compar-

ison Study

Lawrence Murphy1, Dan Mitchell2

Worldwide Therapy Online Inc., Guelph,Ontario, Canada1, Worldwide Therapy Online Inc.,North Vancouver, British Columbia, Canada2

OBJECTIVES: Research makes plain that manypeople with psychological needs do not seekcounselling. Reasons range from anxiety anddiscomfort over disclosing issues to another personto physical or medical challenges that preventtravel. In all cases e-mail counselling represents aviable and economical solution. But first the basicquestion must be answered: does it work? Thisstudy seeks to answer that question by comparingface to face and online clients in terms ofcounselling outcomes. METHOD: Two groups ofclients, one receiving face to face counselling andthe other receiving online counselling, were com-pared on GAF outcome scores and client satisfac-tion surveys. Both groups were drawn from a poolof clients who sought counselling through a majorCanadian Employee Assistance Program. Counsel-ling was provided by two non-overlapping groupsof therapists with equivalent levels of training andexperience. Analyses of variance were conducted toexamine differences between the two counsellingmodalities. RESULTS: Global Assessment ofFunctioning (GAF) is a generally accepted meansof assessing change in counselling. Both modalitiesevidenced positive change in GAF indicating thatboth were effective in engendering change. Analysisshowed no statistically significant difference in theamount of change between the two modalities. Inaddition, analysis of the responses to the clientsatisfaction survey showed no statistically signifi-cant differences for the questions focusing on thetherapeutic alliance; the connection between clientand counsellor. CONCLUSIONS: This researchprovides compelling evidence that online counsel-ling has the potential to be the equal of face to


DOI: 10.1002/pon

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face counselling. Clients connect with their coun-sellors, discuss their problems, plan solutions andexperience change. And it all happens via e-mailonline. The implications for working with cancerpatients and their families is clear. Challengesdue to geographic location, health, stage oftreatment and a host of other issues can be easilyovercome.

A-518

The Stress-Deflecting Effects of Relationship Qual-

ity in Cancer Patients and their Partners

Danielle C. Brosseau1, Marvin McDonald1, JoanneStephen2

Trinity Western University, Langley, BritishColumbia, Canada1, British Columbia CancerAgency, Surrey, British Columbia, Canada2

OBJECTIVES: Relationship quality has beendemonstrated to buffer cancer patients’ stressreactions. Although investigations of distressamong partners of cancer patients show promise,these studies commonly employed individual ratherthan dyadic designs. This is problematic becauseindividual conceptualizations of distress do notaccount for the influence of relational and patient-partner interactions. Using a dyadic framework,this study examined relationship quality as amoderator of traumatic and secondary traumaticstress responses in cancer patients and theirpartners. METHOD: Participants (N5 85 dyads)were recruited through the British ColumbiaCancer Agency using direct mail, advertisementsand referrals. Participants were over eighteen yearsold (M5 59), diagnosed with breast (64%), lym-phoma (7%), gynecological (9%), head and neck(10%) or gastrointestinal (10%) cancer within thepast two years and involved in a committedrelationship (e.g. dating, married, common law)of at least one year. Data were collected online,using psychometrically sound self-report surveyinstruments. RESULTS: Regression analyses re-vealed a trend for the moderating effect of relation-ship quality on the association between patients’and partners’ stress reactions (DR2 5 11, p5 0.14).Direct effects confirmed the importance of patients’stress levels and couples’ relationship quality onintimate partners’ stress (R2 5 0.25, po0.001;DR2 5 0.10, po0.05). Relationship quality becamea significant moderator when predictors not con-tributing to the main effects were excluded(DR2 5 0.04, po0.05). CONCLUSIONS: Thisstudy was the first to investigate secondary trau-matic stress reactions in partners of cancer patients,expanding our understanding of the type anddegree of distress experienced. The trend towardmoderation suggests that it is beneficial forpractitioners to attend to relationship quality

factors when treating couples coping with cancer.The dyadic analysis implemented here also con-tributes to the refinement of empirical methods andconceptual models needed to strengthen developingsystemic health care models.

A-521

Efficacy of a Self-Help Treatment for Acute

Insomnia Comorbid with Cancer

Lucie Casault1, Lucie Casault2, Lucie Casault3,Josee Savard1, Josee Savard2, Hans Ivers1, HansIvers2

School of Psychology, Universite Laval, Quebec,Quebec, Canada1, Laval University CancerResearch Center, Quebec, Quebec, Canada2,Hotel-Dieu de Quebec, Quebec, Quebec, Canada3

OBJECTIVES: Approximately 60% of cancerpatients report insomnia symptoms. Numerousnegative consequences are associated with insom-nia, especially when chronic. Thus, it appearsclinically important to offer effective sleep manage-ment strategies before the difficulties becomechronic. This study’s goal was to evaluate theeffect of a minimal cognitive-behavioral therapy(CBT) for acute insomnia on subjective sleepindices, utilization of hypnotic medications, psy-chological distress, fatigue, quality of life, sub-jective cognitive functioning and dysfunctionalbeliefs and attitudes about sleep. METHOD:Thirty-eight cancer patients with insomnia symp-toms for less than 6 months were randomlyassigned to CBT (n5 20), or to a no-treatmentcontrol group (n5 18). The treatment consisted of6 booklets to read at the rate of one/weekcombined with 3 brief phone contacts (30min.),twice/month. A battery of self-report scales anddaily sleep diaries were completed before and afterthe treatment. Follow-up evaluations were carriedout at 3–6 months after the completion of thetreatment. RESULTS: CBT patients had signifi-cantly greater improvements of sleep indices on thesleep diary and the Insomnia Severity Index (ISI) atpost-treatment compared with control patients (ISIscores:CBT group from 12.1 to 5.3; control group:from 12.1 to 11.3; F(3, 94)5 6.39, p5 0.001).Moreover, CBT patients had significantly greaterdecreases in scores of anxiety, depression anddysfunctional beliefs about sleep, and greaterimprovements of cognitive functioning. Treatmenteffects were well maintained up to 6 months afterthe treatment. CONCLUSIONS: These findingssuggest that a minimal cognitive-behavioral ther-apy is effective to treat acute insomnia comorbidwith cancer. Hence, it appears highly beneficial totreat insomnia symptoms in their acute phase toprevent the incidence of chronic insomnia and itsnegative consequences.


DOI: 10.1002/pon

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A-525

BRCA1/21 Parents’ Disclosure of Cancer Risk to

Offspring: A ‘Teachable Moment?’

Linda Patrick-Miller1, Brian Egleston2, Olufunmi-layo Olopade3, Mary Daly2, Christopher Daught-erty3, Colleen Sands2, Helen Schmidheiser2,Kimberly Pawlowski3, Colleen Gulden3, AngelaBradbury2

Robert Wood Jphnson Medical School/Cancerinstitute of New Jersey, New Brunswick,New Jersey, United States1, Fox Chase CancerInstitute, Philadelphia, Pennsylvania, UnitedStates2, University of Chicago, Chicago, Illinois,United States3

OBJECTIVES: Many BRCA mutation carriers(BRCA1) report discussing their genetic testresults with offspring o25YO. Mediators ofdisclosure and content have potential to informinterventions to facilitate adaptive response togenetic risk for adult onset cancers. METHOD:61 BRCA1 parents completed a survey of com-munication of genetic risk to offspring (73 female;61 male). Parents reported general disclosure (DIS/NONDIS) of their BRCA1/2 result, and 25 contentspecific questions. Response proportions describecontent disclosed. Regression analyses identifiedpredictors of disclosure and content. RESULTS:79(59%) offspring learning (DIS), & 55(41%) notlearning parent’s BRCA1 status (NONDIS)learned parent (DIS5 97%; NONDIS5 31%)and offspring (DIS5 77%; NONDIS5 13%) can-cer risk. Offspring learned parent risk reductionstrategies (PRR) (DIS5 76%; NONDIS5 36%)and offspring risk reduction recommendations(ORR) (DIS5 63%; NONDIS5 35%). Older off-spring age predicted DIS (OOA) (po0.01). OOA(po0.01), offspring gender (FOGp5 0.03), CADX(p5 0.004) and 4education (p5 0.03) predictedoffspring cancer risk. OOA (p5 0.003), FOG(p5 0.01) and FPG (p5 0.007) predicted PRR.OOA (p5 0.03), FOG (p5 0.06), CADX (p5 0.06)and nonwhite ethnicity (p5 0.07) predicted ORR.Frequent ORR recommendations: diet (80; 60%),nonsmoking (63;47%) and exercise (60;45%).CONCLUSIONS: What BRCA1 parents share,with whom, about hereditary cancer risk, appearsmediated by parent (gender, cancer history,education) and offspring (age, gender) factors.BRCA1parents who disclose, frequently shareoffspring’s cancer risk, but less frequently, riskreduction options. Many parents who don’tdisclose BRCA1/2 results do make riskreduction recommendations, suggesting that parentBRCA1/2 testing, independent of result disclosure,may provide a ‘teachable moment’ to fosteroffspring health behaviors. Further analyses willinform interventions to optimize offspring’sresponses to genetic risk.

A-528

Assessing Patients’ Representations of Cancer-

Related Fatigue: Implications for Practice

Maria M. Pertl1, David Hevey1, Sonya Collier2

Trinity College Dublin, Dublin, Ireland1, St. James’sHospital, Dublin, Ireland2

OBJECTIVES: A considerable number of patientsexperience prolonged fatigue after their cancertreatment has been completed. Such chronicfatigue can have a significant negative impact ontheir quality of life. The aim of this study was todevelop and validate a measure for assessingpatients’ beliefs about the nature and causes oftheir cancer-related fatigue (CRF) and to explorethe relationships between patients’ beliefs, coping,and fatigue severity. METHOD: Patients withtreatment-related and post-treatment cancer fati-gue were recruited through hospital referral andcancer support groups. Participants completed theBrief COPE, a fatigue coping strategies question-naire, the FACT-F fatigue scale, and the ‘FatigueSymptom Perception Questionnaire’ (FSPQ), anewly developed measure based on Leventhal’sSelf-regulation model. RESULTS: The reliabilityand validity of the FSPQ were supported. Overall,patients perceived their fatigue to be serious anduncontrollable, and they felt that they had a poorunderstanding of this symptom. Fatigue symptomrepresentations were associated with fatigue sever-ity, coping styles, and type of coping strategy used.CONCLUSIONS: The findings suggest that theFSPQ is an appropriate and effective method foreliciting patients’ fatigue representations and forscreening for maladaptive cognitions in bothclinical and research settings. The idea thatpatients’ own beliefs play a key role in their fatigueoutcomes, either directly or through coping beha-viours, was supported. Patients’ representations oftheir fatigue should be assessed and incorporatedinto interventions that challenge maladaptivebeliefs in order to enhance psychological andfunctional outcomes.

A-530

Psychosocial Functioning in Women With Mastect-

omy, With or Without Breast Reconstruction

Kelly Metcalfe1, John Semple1, Claire Holloway1,Steven Naros1

University of Toronto, Toronto, Canada1, Women’sCollege Hospital, Toronto, Canada2, SunnybrookHealth Sciences Centre, Toronto, Canada3

OBJECTIVES: To assess pre and post surgicalpsychosocial functioning in women undergoingmastectomy with or without breast reconstruction,and to compare changes in psychosocial function-ing on year post surgery between women with


DOI: 10.1002/pon

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mastectomy alone, mastectomy with immediatebreast reconstruction, or mastectomy with delayedreconstruction. METHOD: Eligible participantswere approached at their pre-operative appoint-ment by the study coordinator for participation inthe research study. Each participant completedseveral standardized questionnaires at baseline andat one year following surgery. These included theQuality of Life Index, Body Image after BreastCancer, Impact of Event Scale, Decisional ConflictScale, Miller Behavioural Style Scale, Brief Symp-tom Inventory, and Sexual Activity Questionnaire.RESULTS: Data collection is complete with pre-liminary results. The full analysis will be completedand presented at the conference. 190 womencompleted the baseline questionnaires. 107 subjectshad mastectomy, 24 underwent immediate recon-struction, and 59 underwent delayed reconstruc-tion. The mean age of the subjects was 52.5 years.81% of the subjects completed the one year follow-up. Baseline and follow-up psychosocial scores,and changes in scores, will be presented andcompared between the three groups of subjects.CONCLUSIONS: This is the largest prospectivestudy comparing psychosocial functioning in wo-men with mastectomy alone, those with mastect-omy plus immediate reconstruction, and those withdelayed reconstruction. This information will beuseful for health care providers who counselwomen regarding surgical decisions related tobreast cancer surgery. In addition, it will provideinsight to women who are making surgicaldecisions related to mastectomy and/or breastreconstruction.

A-531

Phenomenological Study on the Experience of

Women Who Were Victims of Incest as Children

and Are Diagnosed with Cervical Cancer as Adults

Louise Picard1

Laval University, Quebec City, Quebec, Canada1,Research Center of centre hospitalier de Quebec(CHUQ), Quebec City, Quebec, Canada2

OBJECTIVES: Certain women encountered inoncology demonstrate that the onset of cervicalcancer seems to be a symbolic life event thatawakens old memories of incest and initiates aneffort to understand the tie between the twoexperiences. A phenomenological study conductedon women who experienced cervical cancer inadulthood and were victims of incest in childhoodor adolescence has shed new light on the psychoe-motional aspects of their experience. METHOD:This phenomenological study was conducted onfive women who have experienced these two events.Data was collected through written descriptionsand clarification interviews. The women’s

statements were analyzed using Amedeo Giorgi’sphenomenological analysis method. RESULTS:The results highlight the way these womenexperience and understand these two experiences.They relate feeling overcome with fear, imprisonedby feelings of guilt, dispossessed of their identity aswomen, abandoned in unspeakable distress, andalienated. However, this same experience awakensa feeling of hope in them, as well as the desireand will to reconcile with their own humanity.CONCLUSIONS: This phenomenological studyreveals how the trauma surrounding the onset ofcervical cancer is experienced as violence sufferedin the wake of the past incest experience. It alsoprovides new insight on the nature of the existentialshift in positioning these women experience as theyseek to understand past and present experiences, aswell as their own identity. It also points topotentially useful methods for supporting them intheir search for meaning.

A-534

Partnering with Cancer Registries to Measure and

Understand the Unmet Needs of Survivors

Helen Sharon Campbell1, Robin Burkhalter1,Stephanie Filsinger1, Jill Taylor-Brown2, DonnaTurner2, Sunny Wang3, Rob Sanson-Fisher4

Propel Centre for Population Health Impact,University of Waterloo, Waterloo, Ontario,Canada1, Cancer Care Manitoba, Winnipeg,Manitoba, Canada2, St. Francis Xavier University,Antigonish, Nova Scotia, Canada3, University ofNewcastle, Newcastle, New South Wales, Australia4

OBJECTIVES: Providing appropriate psychoso-cial care for the growing population of cancersurvivors requires accurate and reliable informa-tion about the level and type of unmet needs.Identifying, at a population level, those with thehighest unmet needs is critical for planning forcare. The purpose of our research was to recruitrepresent sample of the survivor population andcreate a method for identifying those who have thehighest unmet needs. METHOD: Cancer survivorsdiagnosed 12 to 60 months earlier were randomlyselected from three provincial, population-basedcancer registries. Deceased, in-situ and those notwanting to be contacted were removed and samplerepresentativeness was compared to the survivorpopulation before mailing pre-notification letters,survey packages, and two follow-up reminders.Unmet needs were scored from none to very high.An algorithm was applied to the scores forclassifying respondents’ level of unmet services aslow, moderate and high. RESULTS: Survivorrespondents (n5 550) were representative of thepopulation in the province for type of cancer andgender but not age. Most survivors had some level


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of unmet need. However, when we analyzed thedata using the Unmet Needs Algorithm to classifyrespondents’ level of unmet need, a small percen-tage had very high unmet needs. Follow-up dataprovides information on the relationship betweenhighest unmet needs and quality of life, distress,anxiety, depression and stress. CONCLUSIONS:Understanding the prevalence of survivors with thehighest unmet needs is critical for evidence-basedhealth care planning and resource allocation.Partnering with population-based cancer registriesenabled the development of methodology formeasuring problems common to all survivors,and for identifying those who desire a high degreeof help in managing those problems. This studyoffers promising results for addressing the increas-ing prevalence of cancer survivorship.

A-536

Current Status of Work and Cancer Patients/

Survivors: Implications for Canada

Maureen Parkinson1, Patricia Nitkin2, Izabela Z.Schultz2

B.C. Cancer Agency, Vancouver, British Columbia,Canada1, University of British Columbia, Vancouver,British Columbia, Canada2

OBJECTIVES: The purpose of the presentation isto summarize and discuss the findings of aCanadian Association of Psychosocial Oncology(CAPO) commissioned review of the internationalliterature and research on the impact of cancer onwork. This includes a survey of factors thatfacilitate or impede successful return to work orjob maintenance and a review of interventions,practices, programs and recommendations relatedto vocational rehabilitation and cancer survivors.METHOD: Literature and research were reviewedusing a scoping procedure framework (Arksey,O’Malley, 2005). Over 100 article and papers werereviewed from 13 countries. In order to update theinformation on oncology based vocational pro-grams and services available in Canada, an e-mailinquiry was sent to over 300 members of theCanadian Association of Psychosocial Oncology.RESULTS: To date most of the literature on workand cancer is related to the impact of cancer onwork, positive and negative outcomes and pre-dictors, with sparse attention to intervention andclinical practice. An integrative biopsychosocialconceptual model of the relationship betweencancer and work outcomes has been proposed toguide future research and program development.CONCLUSIONS: Conclusion: There needs to begreater emphasis on intervention studies and thedevelopment of evidenced based clinical practiceguidelines for vocational rehabilitation incancer care.

A-538

Predictors of the Unmet Needs of Persons Support-

ing People with Cancer

Jill Taylor-Brown1, Donna Turner1, SharonCampbell2, Stephanie Filsinger2, RobinBurkhalter2, Sunny Wang3, Rob Sanson-Fisher4

Cancer Care Manitoba, Winnipeg, Manitoba,Canada1, Propel Centre for Population HealthImpact, University of Waterloo, Waterloo, Ontario,Canada2, St. Francis Xavier University, Antigonish,Nova Scotia, Canada3, University of Newcastle,Newcastle, New South Wales, Australia4

OBJECTIVES: The impact of cancer on thosecaring for someone undergoing treatment is grow-ing but very little is known about those who are theprimary support persons for cancer survivors aftertheir initial treatment is complete. The purpose ofour research was to understand who cancersurvivors identified as their primary support person,what problems and issues the support personsexperience, and the level of help they desire tomanage those problems. METHOD: A representa-tive sample of cancer survivors (n5 550) participat-ing in a population based survey of unmet needsinvited their primary support person to completethe Support Persons’ Unmet Needs Survey. Sup-port persons (n5 382) provided data on their levelof need for assistance with 78 specific concerns/problems covering six domains of need. Informa-tion about their own and the survivors’ health andrecent use of health services, as well as demographiccharacteristics were provided. RESULTS: Not allsurvivors had support persons but among thosewho do, spouse and family member are themajority. Most of those who support a cancersurvivor report they have unmet needs (i.e. neededhelp with at least one issue but could not get thathelp). A small percentage of support persons havevery high unmet needs. We will report on thecharacteristics and predictors for those supportpersons with the highest unmet needs. CONCLU-SIONS: The psychosocial impact of cancer is notonly experienced by the survivor, but also theirprimary support person. This study provides dataon the characteristics of those supporting survivorsand the types of concerns / problems they need helpmanaging. Additional studies are underway todetermine the relationship between unmet needsand related constructs like distress, quality of lifeand depression, anxiety and stress.

A-539

Spirituality and End of Life Issues: Viewpoints of 24

Persons, Gathered by a Team in Home Palliative

Care

Cecile Charbonneau, Bruno BelangerCentre hospitalier Affilie, Quebec, Canada


DOI: 10.1002/pon

S146 Oral Abstracts

OBJECTIVES: To gain better knowledge of thespiritual and religious needs of persons receivingpalliative care at home.

- To set priorities among the various emergingspiritual and religious needs.

- To find the spiritual and religious resources ofpersons.

METHOD: Twenty-four patients in home palliativecare accepted to participate in a research projectand were interviewed on the basis of a semi-structured questionnaire. A qualitative approachwas taken for this research. Then an in depth studyof interviews made it possible to identify the contentof the various themes dealt with. Finally, the usualprocedures were followed in analyzing the thematiccontents of all the material gathered. RESULTS:We classified our results under three (3) generalcategories. The spiritual needs emerged in connec-tion with: 1. the past (search for meaning, revisitingone’s life, etc.), 2. the present (relationships, needfor understanding, etc.), 3. the future (fears,existential questions, etc.). CONCLUSIONS: -Better understanding of the spiritual and religiousneeds of persons in home palliative care.

� Better understanding of the various spiritualresources claimed as needs by the personsthemselves.

� Identification of needs linked to the past, thepresent and the future of persons accompa-nied in home palliative care.

A-540

Acceptability and Applicability of a Multi-Faceted

Intervention to Improve Continuity of Care for

Patients with Cancer

Michele Aubin1, Lucie Vezina1, Rene Verreault1,Yves Lacasse1, Lise Fillion1, Sebastien Simard1,Eveline Hudon2, Serge Dumont1, Andre Tourigny1,Serge Daneault2

Laval University, Quebec City, Quebec, Canada1,University of Montreal, Montreal, Quebec, Canada2

OBJECTIVES: Many authors have recognized thelack of continuity in the services needed by cancerpatients to fulfill their global needs, physical andpsychosocial. At the treatment phase, communica-tion and collaboration between family physicians(FP) and oncologists appear limited, also contri-buting to fragmented cancer care. A multi-facetedintervention was developed to overcome thisdifficulty. This study assessed the acceptabilityand applicability of this intervention for FP andmembers of a pulmonary oncology team (OT).METHOD: The intervention includes: 1) systema-tic appointments with FP; 2) transmission to FP of

standardized summaries of patients’ medical andpsychological condition; 3) systematic transmissionto the OT of patients’ information resulting fromFP visits; 4) development of a priority access to FP.Two rounds of focus groups were conducted with10 members of the OT and 18 FP to present theintervention, adapt it according to their commentsand reach agreement for its implementation.RESULTS: Focus groups with the different healthprofessionals were useful to clarify and adapt thecontent of standardized summaries for FP and OT,in order to mutually respond to their respectiveneeds in the follow-up of cancer patients. Someaspects of the intervention were dropped ormodified to better suit FP and OT respectivepractice. Discussion with FPs resulted in identifica-tion of strategies to facilitate contact and access ofpatients to them whenever needed. CONCLU-SIONS: The long-standing nature of FP-patientrelationship and FPs’ usual familiarity with theirpatients’ social context put them in a strategicposition to contribute to patient’s adjustment tocancer, reinforcing the importance of keeping themin the loop at all phases of cancer management.Prior to implementation, any intervention toimprove communication and collaboration be-tween FP and OT needs to be accepted andendorsed by involved health professionals.

A-544

Delivering Cancer Transitions in Maggie’s Centres:

A Pilot Study

Amanda McMahan, Monique Proudlove, LesleyHowellsMaggie’s Centres, Edinburgh, United Kingdom

OBJECTIVES: Maggie’s Centres provides innova-tive evidence-based programme of psycho-educa-tional support for all stages of the cancerexperience using a multi-professional team includ-ing cancer support specialists, welfare rightsexperts, and clinical psychologists. The presentstudy sought to investigate the feasibility ofimplementing Cancer Transitions, a workshopsprogramme aimed at helping people take an activerole in their physical and emotional well-beingfollowing cancer treatment. METHOD: CancerTransitions, a 6-week workshop programme of theWellness Community and Lance Armstrong Foun-dation, was piloted in four Maggie’s Centres(Dundee, Edinburgh, Fife, London). Nine menand 24 women who completed cancer treatmentwithin the past two years participated in theprogramme. Each week participants engaged in30minutes of physical activity followed by aninformation and group discussion session on post-treatment topics including exercise, nutrition,emotional well-being, and medical management.RESULTS: Participants reported finding the


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support and encouragement; and direct advice,suggestions, and education to be the most valuableof their experiences of the group. At the end of thegroup, participants felt more connected with otherswith cancer and confident they could make positivehealth changes in their life. Participants alsoreported feeling a greater sense of understandingof their follow-up care and what they need to do tostay healthy. CONCLUSIONS: Maggie’s mainpurpose is to help people help themselves and gainconfidence in their ability to manage their physicaland emotional well-being throughout their cancerexperience. This pilot study demonstrates thatworkshop programmes such as Cancer Transitionscan be delivered effectively within a Maggie’sCentres setting and existing programme of cancersupport.

A-546

Depressive Symptoms are More Strongly Associated

with Cortisol Levels than Bioavailable Testosterone

Levels in Men with Prostate Cancer

Severine Hervouet1, Josee Savard1, Hans Ivers1

School of Psychology, Universite Laval, QuebecCity, Quebec, Canada1, Laval University CancerResearch Center, l’Hotel-Dieu de Quebec (CHUQ),Quebec City, Quebec, Canada2

OBJECTIVES: Studies of healthy individuals havefound a relationship between depression andhormonal levels such as testosterone and cortisol.Prostate cancer and its treatment may lead tohormonal alterations, which may be related todepression. This study conducted in men withprostate cancer treated by radiation therapy (RTH)with or without androgen deprivation therapy(ADT) aims at investigating whether the changesin bioavailable testosterone and cortisol levels arelinked to changes in depressive symptoms. METH-OD: Sixty men with prostate cancer composed thesample, divided into two groups: RTH (n5 32) andRTH-ADT (n5 28). Participants were evaluatedbefore initiating treatment and at repeated inter-vals during 16 months, using the Structured Inter-view Guide for the Hamilton Depression RatingScale (SIGH-D), the Hospital Anxiety and Depres-sion Scale (HADS) and the Beck DepressionInventory-II (BDI-II). Blood samples of hormonelevels were taken at each assessment. RESULTS:Greater scores on all depression measures weresignificantly related to higher cortisol levels in bothgroups, (rs ranging between 0.14 and 0.43,pso0.05). Greater depressive symptoms were sig-nificantly associated with lower testosterone levelsin the RTH group but not in the RTH-ADT group.Testosterone levels were significantly related tosomatic BDI-II items in both groups (rs rangingbetween 0.22 and 0.33, pso0.01), but not tocognitive-affective items. CONCLUSIONS: These

findings suggest that depression is more impor-tantly related to changes in cortisol than to changesin testosterone levels. In addition, somatic symp-toms of depression are more strongly related withtestosterone levels than are cognitive-affectivesymptoms. Future investigations are needed toshed some light on distinct hormonal mechanismsunderlying the development of depressive symp-toms in men with prostate cancer.

A-552

Gender Differences in Self-Reported Late Effects,

Quality of Life and Satisfaction with Consultations

in Survivors of Lymphoma

Emily Arden-Close1, Kate Absolom2, DianaGreenfield3, B W Hancock4, Rob Coleman4,Christine Eiser1

Department of Psychology, University of Sheffield,Sheffield, United Kingdom1, St James’ Institute ofOncology, Leeds, United Kingdom2, SheffieldTeaching Hospitals NHS Trust, Sheffield, UnitedKingdom3, Academic Unit of Clinical Oncology,University of Sheffield, Sheffield, United Kingdom4

OBJECTIVES: Gender differences in perceivedvulnerability to late effects and views about followup among cancer survivors have rarely beenconsidered. Since prevalence of lymphoma isrelatively equal between genders, we comparedthe consequences of cancer (late effects, perceivedvulnerability and quality of life), and satisfactionwith clinic visits between men and women.METHOD: A cohort of 115 younger adults(18–45 years, 45 years disease-free survival) whohad been treated for lymphoma participated. 91completed questionnaires before and 62 afterroutine consultant-led appointments. 24 survivorswere recruited by post. Questionnaires includedmeasures of quality of life (QoL), late effects,perceived vulnerability, issues survivors wanted todiscuss and reported discussing in clinic, timewaiting to see the doctor and satisfaction with theconsultation. RESULTS: There were no genderdifferences in number of late effects or perceivedvulnerability. More late effects were associatedwith worse psychological QoL in men only(r5 0.50, po0.001). While men wanted to discussmore topics than they discussed, women were ableto discuss the topics they wanted (ANOVA,p5 0.01). Multiple regression demonstrated ashorter wait in clinic (r5�0.46, p5 0.009) anddiscussing more topics (r5 0.34, p5 0.06) ex-plained 30.6% of the variance in consultationsatisfaction for men. CONCLUSIONS: Issuessurrounding follow-up provisions are increasinglyimportant given the length of survival inyoung adults following treatment for lymphoma.Men may experience poor psychological well-beingdue to distress about unanswered concerns.


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Consideration to their concerns needs to beprioritized, given satisfaction and ultimately con-tinued attendance at clinic and quality of life maybe dependent on the extent to which follow-upmeets survivors’ expectations.

A-555

Post-Treatment Regret among Young Breast Cancer

Survivors

Sara Fernandes-Taylor, Joan BloomUniversity of California, Berkeley, Berkeley,California, United States

OBJECTIVES: The study addresses: (1) whatwomen regret about their breast cancer treatmentfive years later, and (2) what characteristics ofdisease and treatment predict post-treatment regret.METHOD: Interviews were conducted with breastcancer survivors in the San Francisco Bay Area.Participants were interviewed following diagnosis.Five years later, women were asked whether theyhad any regrets about their cancer treatment(N5 449). Qualitative analysis was used to identifyregret content, and logistic regression was used todetermine what characteristics of treatment pre-dicted regret. RESULTS: 42.5% of women re-gretted some aspect of treatment. Common regretswere primary surgery (24.1%), chemotherapy and/or radiation (21.5%), reconstruction (17.8%), andproblems with providers (13.1%). Logistic regres-sion revealed that women who were anxious aboutthe future (OR5 1.32; p5 0.03) or had problemscommunicating with physicians (OR5 1.26;p5 0.02) during treatment were more likely toexpress regret 5 years later. Additionally, womenwith new/recurrent cancers were more likely toregret some aspect of their primary treatment(OR5 5.81; po0.001). CONCLUSIONS: This re-search supports addressing the psychosocial aspectsof cancer care and improving physician-patientcommunication. Evidence is also provided foraddressing the unique emotional needs of womenwith recurrent cancers, who may experience anundue burden of regret.

A-556

The Acceptability and Usability of the Support,

Education and Advocacy (SEA) Intervention for

Women with New Diagnosis - Metastatic Breast

Cancer (NDMBC)

Margaret Rosenzweig, Heidi Donovan, KathleenSlavishUniversity Of Pittsburgh School of Nursing,Pittsburgh, Pennsylvania, United States

OBJECTIVES: To: 1) Develop theoretically con-gruent intervention materials according to sensory(what will this feel like) and coping (evidenced

based strategies for self care) needs for womennewly diagnosed with metastatic breast cancer and2) Utilize key patient informants to evaluate theacceptability and usability of the Sensory andCoping Intervention for Women with NewlyDiagnosed Metastatic Breast Cancer. METHOD:Descriptive pilot study, twenty women with adiagnosis of metastatic breast cancer recruitedfrom a large urban, NCI designated breast cancercenter. Sampling included women with knownMBC (regardless of time since diagnosis), bothwhite and black race, and high and low incomeranges. Race and income were determined bypatient self report. Women with MBC evaluatedthe intervention using a Likert scale and semistructured interviews grading acceptability andpotential usability at MBC diagnosis. RESULTS:Content analysis of interviews identified twothemes: 1) Positive and concrete information metneeds 2) Discomfort with expressions of uncer-tainty or negative emotion. Participants agreedthrough a 7 point Likert scale that the interventionprovided sensory (Mean 6.1, SD 0.8) and copinginformation (Mean 5.8, SD 1.1) and the interven-tion felt like it was ‘designed for me,’ (mean 5.4, SD1.9). Patients felt any mention of sadness oruncertainty may negatively impact their cancercourse. CONCLUSIONS: Women with metastaticbreast cancer require preparatory information toreduce distress. The Sensory and Coping Interven-tion was rated favorably by key patient informants.This evaluation informed intervention modifica-tion. The revised Sensory and Coping Interventionexpands on the favorably rated material whilesoftening the potentially negative content.

A-567

Using Strength-Based Clinical Approaches to

Promote Resiliency

Matthew Loscalzo, Karen ClarkCity of Hope, Duarte, California, United States

OBJECTIVES: Elevated levels of disabling distressin cancer patients have been well documentednationally and internationally. Though statisticsare robust and have important implications forpatients, families, health care professionals andsociety at large, the majority of patients and theirfamilies will adapt to the many vicissitudes of thecancer experience. The purpose of this presentationis to share three practical strength-based clinicalapproaches to promote resiliency. METHOD:Using a highly interactive group exercise model,the presenter will focus on three practical areaswhere strength-based approaches are evident andfor which there is supporting data. Gender-basedcouples support, the COPE Model of problemsolving and social support will be discussed withinintegrated case narratives outlining the connection


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to the foundations of resiliency. RESULTS: Boththe literature and clinical experience supports theimportance of focusing on the inherent strengths ofpeople confronting series illness. Regardless of thenumber, severity and etiology of the problems anddistress that patients and families confront, ulti-mately it is necessary to develop approaches thatencourage a sense of control, predictability, con-nection and meaning. CONCLUSIONS: In prac-tical terms, helping the patient, family and healthcare team to cognitively integrate complex andambiguous information, support emotional regula-tion, stabilize or enhance social support, andpromote problem-solving through shared deci-sion-making. This process connects the presentsituation to a life narrative that alchemizes intohealthy meaning-making. This is the therapeuticmilieu that heals wounds, encourages meaningfulaction and creates fertile opportunities for personalgrowth.

A-568

SupportScreen-Automated Screening for Identifying

and Triaging Problem-Related Distress in Cancer

Settings

Karen Clark, Matthew Loscalzo, Jeff Dillehunt,Redmond Rinehart, Rex Strowbridge, Daniel SmithCity of Hope, Duarte, California, United States

OBJECTIVES: City of Hope (COH) has developedand implemented an automated touch screensystem called SupportScreen. SupportScreen iden-tifies and triages patient biopsychosocial problemsin real-time.SupportScreen refers to the entireprocess-from initiation of patient responses to thegeneration of referrals and provision of resourceand educational information. The purpose of thispresentation is to describe the features, process,hardware, compatibility, reporting and implemen-tation of SupportScreen. METHOD: The clinicstaff administers SupportScreen to the patient.SupportScreen takes approximately 12minutes tocomplete. A Summary Report (both printed and e-mail) is generated in real-time listing all problemstriggering referrals or requests to talk with theteam. Requested educational materials are alsoprinted and handed to the patient prior to theirconsultation with the physician. Simultaneously,the raw data is sent to a flat file easily available forreporting and analysis. RESULTS: Partnering withour in-house ITS team, we successfully developedand implemented a patient-friendly touch screenstandalone program that integrates screening,triage, data management and reporting. Programcontent, triage criteria, tailored educational mate-rials were built into the automated system.Patient’s and Staff’s overall evaluation of theprocess, time spent, clarity, readability andnavigation of SupportScreen was extremely

favorable.SupportScreen has been implemented inmedical oncology, HEM/HCT and Surgery clinics.CONCLUSIONS: Touch screen technology is aneasy and efficient way to screen patients and triagereferrals. SupportScreen has national and interna-tional implications for the enhancement of clinicalencounters in real-time by creating a model forother institutions.

A-571

Tobacco and Breast Cancer Messaging for Younger

Women: A Gender Analysis

Rebecca J Haines1, Joan L Bottorff2, StephanieBarclay McKeown2, Erin Ptolemy2, JoanneCarey2, Kelli Sullivan2

School of Nursing, University of British Columbia,Vancouver, British Columbia, Canada1, Institute forHealthy Living and Chronic Disease Prevention,University of British Columbia Okanagan, Kelowna,British Columbia, Canada2

OBJECTIVES: Evidence linking both active smok-ing and secondhand smoke exposure to premeno-pausal breast cancer means the development ofhealth messages specific to younger women is apressing priority. The aims of this study were todetermine how cancer education and preventioninitiatives targeting adolescent girls and youngwomen construct and present breast cancer risks,and to offer direction in designing effective messa-ging regarding breast cancer and tobacco exposure.METHOD: This qualitative study involved twomethods of data collection. To determine how tocommunicate information about this modifiablebreast cancer risk to young women, a selection of32 recent English-language breast cancer cam-paigns (in print, internet, video, and pamphletformats) that targeted young women was analyzed.In addition, we obtained young women’s responsesto three breast cancer campaign images duringfocus group discussions. RESULTS: A criticalanalysis of campaign images points to an explicitlygendered discourse that can entail conflictingmessages regarding breast cancer, health, femininebeauty and risk. Although the intent may be toeducate and empower young women, paradoxicallysome messages employ imagery that objectifiesyoung women’s breasts and bodies. Focus groupfindings also pointed to young women’s awarenessof gender stereotyping and feminine appearanceimperatives present in some breast cancer messa-ging. CONCLUSIONS: Recommendations aremade for messaging about tobacco and breastcancer risk to avoid reproducing one dimensionalor stereotypical presentations of gender andfemininity. Indeed, some of the ‘tried and true’strategies used in health messaging may need to berevised so that we are more mindful of theirgendered implications for the young women who


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are the target audience for the emerging breastcancer and tobacco message.

A-577

New Reflections on Spousal Bereavement Following

Cancer: A Critical Update of the Literature

Fasse Leonor1 presenting Sultan Serge1 FlahaultCecile1 Dolbeault Sylvie2

Universite Paris Descartes, Paris, France1, InstitutCurie, Paris, France2

OBJECTIVES: Although bereaved spouses areconsidered by public authorities as vulnerablepersons, there have been few empirical studiesexploring their daily widow life and process ofadjustment to loss. Heterogeneity of studies couldbe problematic for professionals trying to improvequality of care in palliative care units, where thequestion of grief is acute. Precise models andexisting evaluated support programs remain un-recognized, while no recent review of literatureabout spousal bereavement through cancer exists.METHOD: Using PsyInfo and PubMed, wesystematically searched the literature with key-words and retrieved relevant literature. PsycINFOand PubMed � cancer � and � grie�: respec-tively yielded 470 and 561 references (tallying) and� cancer � and � bereav�’ yielded 352 and 529references. (1917 to 2009). We read throughabstract to detect main problematics about griefand full texts (1986 to 2009) were retrievedwhen specificities of spousal bereavementthrough cancer where mentioned. RESULTS:

� Adjustment to spousal loss is impacted bysome specificities of cancer care (caregivingexperience, treatments, social and individualrepresentations of cancery).

� These specificities are not systematically presentin the main models of grieving process.

� Variability in sample size, design and relia-bility of measures hinders synthesis of results.

� The question of complicated or prolongedgrief is pervasive and prevents researchers totap other topics like support or interventionprograms.

CONCLUSIONS: Few empirical studies target spou-sal bereavement specifically following cancer. Litera-ture dealing with cancer concerns inadapted grief.Little is known about phenomenology of grievingamong bereaved spouses through cancer along yearsafter the decease. Although references about supportprograms have emerged, few of these programs havebeen scientifically evaluated. This review underlinesthat more studies are needed with prospective, andqualitative research, and on common grief, needs andexpectations of bereaved spouses.

A-578

Cancer Patient’s Quality of Life: Importance of

Goal’s and Hierarchy’s Adjustment

Anne-Marie Etienne1, Gilles Dupuis2, SandrineConradt1, Isabelle Bragard1, Isabelle Merckaert3,Yves Libert3, Serge Marchal3, Nicole Delvaux3,Christine Reynaert4, Darius Razavi3

University, Liege, Belgium1, University, Montreal,Quebec, Canada2, University, Brussels, Belgium3,University, Louvain, Belgium4

OBJECTIVES: There is a growing interest formental health and quality of life of cancer patients.The aims were: to understand cancer patients’mental health adjustment process, through anxiety,depression, coping strategies and quality of life andto identify intervention procedures that mayimprove cancer patients’ quality of life (QoL).METHOD: Patients (180) referred for an oncologyconsultation completed: Karnofsky Index(KARN), Hospital Anxiety and Depression(HADS), State-Trait Anxiety Inventory (STAI),Revised Way of Coping Checklist (WCC) andQuality of Life Systemic Inventory (QLSI). TheQLSI global gap score measure the distancebetween a person’s current condition and his goalin 28 life domains. The QLSI also provides a globalgoal score and a global rank score giving patients’rank of priority for each life domain. RESULTS:Significant correlations (Pearson) were foundbetween HADS, STAI, emotional coping andQLSI Gap (r5 0.45; 0.29; 0.20; all p levelso0.01);between KARN, HADS, STAI and QLSI Goal(r5�0.20; 0.28; 0.22; all po0.01) and betweenKARN, Problem coping, emotional coping, socialcoping and QLSI Rank (r5 0.17; 0.24; 0.17, 0.14;all po0.06). CONCLUSIONS: Greater gap (i.e.poorer QoL) is associated to depression, anxietyand poor emotional coping. Lower goal is asso-ciated to depression, anxiety and low functionalcapacities. Higher life priorities are associated tobetter functional capacities and to better copingstrategies. Therefore working on life goals and lifepriorities may be of some help in the adaptation todisease process.

A-579

Anxiety And Depression In Patients With Testicular

Cancer: Surveillance Vs. Radiation Treatment

Andrew G. Matthew, Peter Chung, PadraigWarde, David Hogg, John Trachtenberg, MichaelJewett, Wei Xu, Kristen L. Currie, Alyssa Louis,Lianne Trachtenberg, Mary-Ellen HartmanUniversity Health Network, Toronto, Ontario,Canada

OBJECTIVES: Low stage seminoma testicularcancer is highly treatable. Research comparing


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post-orchiectomy adjuvant radiation to surveil-lance reveals nearly identical survival rates, andsuggests that 85% of patients receiving adjuvantradiation are being over-treated. Given that there isa dearth of research examining the impact oftreatment modality on psychological well being,this retrospective, cross-sectional study examinedthe influence of adjunctive radiation versus sur-veillance on the psychological outcomes of pa-tients. METHOD: A consecutive set of patientswere identified who received an orchiectomycombined with adjuvant radiation (n5 18) orsurveillance (n5 103) between September 1997and December 2009 and who have no evidence ofcurrent disease. Participants provided informationon health worries and completed validated instru-ments for the assessment of anxiety and depression(HADS, POMS), sexual functioning (BSFI), andillness intrusiveness (IIS). Means and frequencieswere compared using the Wilcoxon rank sum testand Fisher’s exact test respectively. RESULTS:Comparisons between adjuvant radiation andsurveillance found no significant differences. Atrend for greater ‘worry about future health’ wasdetected in the adjuvant radiation group. Exam-ination of the surveillance group found no sig-nificant differences between participants less thantwo years (n5 31) versus greater than two yearssince orchiectomy (n5 68). A trend for greaterillness intrusiveness on the relationship and perso-nal development subscale of the IIS was found inparticipants greater than two years since surgery.CONCLUSIONS: This ‘pilot’ study suggests thatthe psychological sequelae of adjuvant radiationand surveillance do not differ. In the surveillancegroup, time since orchiectomy does not effectpsychological outcomes. This lack of evidence fordistressing psychological outcomes combined withthe physical/medical benefit of a less invasivetreatment modality contributes to the literature insupport of surveillance within this patient popula-tion. These findings require confirmation throughfurther studies with enough power to applyequivalence testing.

A-580

Designing a Weight Loss Intervention for Breast

Cancer Survivors

Bernardine Pinto1

W. Alpert Medical School of Brown University,Providence RI, United States1, Miriam Hospital,Providence RI, United States2

OBJECTIVES: Women who gain weight or areoverweight/obese after breast cancer (BCA) treat-ment are at increased risk for cancer recurrence,cardiovascular disease and other chronic diseases.Little is known about changing both dietary intakeand increasing physical activity to achieve weight

loss among these survivors. There is growinginterest in examining the potential benefits ofintentional weight loss among BCA survivors.However, little is known about their needs andpreferences in changing two risk behaviors.METHOD: We interviewed a group of 10 BCAsurvivors (n5 10, mean age5 55.9 years, SD5 9.8;mean years since diagnosis5 3.6, SD5 3.1;95White, 15African American, meanBMI5 30.4, SD5 4.9) to help design a weight lossintervention. Women were asked questions aboutthe preferred modality, content, sequence of chan-ging two risk behaviors and the nature of a viablecomparison/control group for an efficacy study totest the effects of a weight loss intervention.RESULTS: The group was enthusiastic about aweight loss intervention. All the women preferredindividual meetings with a nutritionist to learnabout changing their diet and to receive feedback.Six women endorsed focusing first on one behaviorrather than changing two behaviors simulta-neously. Regarding the sequence of behaviorchange, 8 of the 10 women expressed preferenceto begin with dietary changes before startingexercise. A majority endorsed offering recipes andgeneral nutrition information for the controlgroup. CONCLUSIONS: Understanding the ef-fects of weight loss among overweight/obese BCAsurvivors may have implications for their risk ofcancer recurrence. Changing two risk behaviors(sedentary behavior and unhealthy diet) may bemore challenging after BCA treatment. These datacan be used to design appropriate weight lossinterventions (e.g. content, sequence of behaviorchange, viable comparison groups) to meet theneeds and preferences of BCA survivors prior toconducting efficacy studies among these survivors.

A-591

Experiencing the Challenges of Cancer Care in

Botswana

Julia Bidonde, Anne Leis, Rachel Engler-StringerUniversity of Saskatchewan, Saskatoon, Saskatch-ewan, Canada

OBJECTIVES: Cancer has emerged as a majorhealth problem in Africa. Although Botswana isconsidered a middle-income country within theAfrican community, little attention has been paidto cancer care in the past while most cancers aredetected at stages III or IV. The purpose of thepresentation is to report on perceptions, experi-ences and meaning of cancer care and control inBotswana as gathered by the first author during aninternational cancer care internship. METHOD:Through the Student Without Borders program,the first author worked at the Cancer Associationof Botswana (CAB) from September-December,2009. Using an ethnographic lens, data were


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collected by becoming immersed in the culture andactively participating in health promotion pro-grams offered by the Association. Interviews withdecision-makers, patients and health care providerswere conducted and field notes were kept.RESULTS: Findings indicate that lack of cancereducation and minimal resources constitute sig-nificant hurdles for cancer care in the country.Traditional healers represent the first line oftreatment and are perceived as delaying access to‘Western’ medicine. Lack of oncology training inthe nursing field is the second main obstacle toearly diagnosis. Access to treatment is limited.Patients suffer pain, loneliness, and isolation fromfamily and friends when they seek treatment farfrom their homes. Follow-up support is notavailable. CONCLUSIONS: Cancer patients inthis African country face considerable bio-psycho-social challenges and little hope of recovery.Education initiatives, resources and health policiesneed to be developed and implemented concur-rently. Collaboration among local organizations tostrengthen the quality of services and a vision for acomprehensive approach to patient care within thiscontext are critical in order to instill hope for thefuture.

A-592

The Fatigue Symptom Inventory: A Systematic

Review of Its Psychometric Properties

Kristine A. Donovan, Paul B. JacobsenMoffitt Cancer Center, Tampa, Florida, UnitedStates

OBJECTIVES: Fatigue is among the most com-mon problems experienced by cancer patients. TheFatigue Symptom Inventory (FSI), first publishedin 1998, is a 14-item self-report measure assessingthe severity and frequency of fatigue, the perceivedinterference associated with fatigue, and the dailypattern of fatigue in the past week. The purpose ofthe current study was to review and evaluate thepsychometric properties of the FSI based on its usein published research studies. METHOD: Asystematic review of the literature was conductedand identified 55 studies reporting results for theFSI. Alpha coefficients were summarized to char-acterize internal consistency reliability of multi-item FSI scales. Test-retest correlations weresummarized to characterize test-retest reliability.Correlation coefficients between FSI scales andother published measures were summarized tocharacterize concurrent, convergent, and divergentvalidity. Finally, the mean difference statistic (d)was calculated to characterize sensitivity to changeand discriminative validity of the FSI. RESULTS:Alpha coefficients for the interference scale rangedfrom 0.91 to 0.96. Most items demonstrated low tomoderate test-retest correlations. Correlations with

other fatigue measures ranged from 0.50 to 0.86.Correlations with depression and anxiety measureswere positive (range5 0.23 to 0.76). Correlationswith measures of vitality and vigor were negative(range5�0.28 to �0.77). Effect sizes for sensitivityto change and discriminative validity ranged fromsmall to very large and trivial to very large,respectively. CONCLUSIONS: Since its publica-tion in 1998, the FSI has been widely used to assessfatigue. Its psychometric properties include highinternal consistency and low to moderate test-retestreliability. Concurrent validity for the scale ismoderate to high and there is good evidence forits convergent and divergent validity. Evidence forits sensitivity to change and discriminative validityis limited but generally positive. Taken together,these findings encourage the use of the FSI infuture studies.

A-595

When Parents Disclose BRCA1/2 Test Results:

Their Perceptions of Offspring Response

Angela Bradbury1, Linda Patrick-Miller2, BrianEgleston1, Olufunmilayo Olopade3, ColleenSands1, Helen Schmidheiser1, Preethi Kondamudi1,Maia Feigon3, Kimberly Pawlowski3, ComfortIbe3, Fay Hlubocky3, Mary Daly1, ChristopherDaugherty3

Fox Chase Cancer Center, Philadelphia, PA,United States1, The Cancer Institute of New Jersey,New Brunswick, New Jersey, United States2,The University of Chicago, Chicago, Illinois,United States3

OBJECTIVES: Testing minors for BRCA1/2mutations is not currently recommended, as riskreduction measures and screening are not generallyrecommended before 25YO. However, many par-ents share their BRCA1/2 results with minor andyoung adult offspring. Offspring responses to thiscommunication have not been described. METH-OD: 163 parents who had BRCA1/2 testing andoffspring 5-25YO at the time of parent testing (323offspring total) completed semi-structured qualita-tive interviews regarding communicating theirBRCA1/2 results to offspring. 52 parents had aBRCA1/2 mutation (POS). Parent reports of off-spring reactions to disclosure were coded. Re-sponse proportions are utilized to summarize theresults. RESULTS: 107 parents reported disclosureto 201 offspring. Frequently reported responseswere neutral (39%) or relief (26%). Poor under-standing (11%), scared/anxious (11%) and concern(10%) were less frequent. Neutral was morefrequent with negative (NEG) results (45% v.26% POS), and older offspring (42% 14–25YO v.32% 10–13YO). Misunderstanding was morefrequent with POS (20% v. 8% NEG) and inoffspring o10YO (15%). Fear/anxiety were most


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frequently reported with POS (18%) and offspringo10YO (22%). CONCLUSIONS: Parent reportssuggest that most offspring may not experienceadverse reactions to disclosure, although responsesmay vary according to content and offspring age.Younger offspring and those learning of a parent’sBRCA1/2 mutation or variant of uncertain sig-nificance may be more susceptible to poor under-standing and/or initial negative responses.Longitudinal evaluation of offspring reports ofcognitive, affective and behavioral responses isneeded to inform interventions to optimize adap-tive responses to early communication of heredi-tary risk.

A-596

Teaching Men and Women How To Get the Best

Out of Each other in Times of Stress

Matthew Loscalzo, Karen ClarkCity of Hope, Duarte, California, United States

OBJECTIVES: Research has clearly demonstratedthat the intellectual differences between women andmen are very small compared to their manysimilarities. But when it comes to coping withcancer, frequently small differences have a bigimpact. This presentation will offer a new paradigmfor the recruitment and engagement of men andwomen focused on a strengths-based problem-solving approach used to identify men andwomen’s unique contributions to coping andmaking meaningful connections during times ofstress. METHOD: The four week 2-hour sessionsare manualized courses that are interactive andbased on the C.O.P.E problem-solving model.Approximately 90% of the meeting time iscomprised of interactive exercises in which womenand men learn to identify and communicatemotivations behind their attempts to manage theirown emotional responses and help each otherovercome barriers to meaningful connections.Any man-woman pair coping with illness isencouraged to participate. RESULTS: Over theyears, our team has developed an effective strategyfor the recruitment and engagement of men andwomen in a highly interactive manualized programof problem-solving. The COPE Model of problem-solving has consistently been shown to reducedistress in men and women affected by cancer. Menattend and rate this program as frequently andhighly as do the women. CONCLUSIONS:Although there is considerable extant data thatdocuments the distressing misalignments betweenwomen and men under stress, there are extremelyfew models for practical interventions that can beeasily applied in acute care settings. This successfulgroup helps to maximize the potential that menand women’s expectations and demands arealigned through enhanced understanding and

knowledge about gender-based perceptions andresponses.

A-598

Effects of a Weekend Retreat for Young Adult

Cancer Patients

Lynne Robinson1, Robert Rutledge1

Dalhousie University, Halifax, Nova Scotia,Canada1, Nova Scotia Cancer Centre, Halifax,Nova Scotia, Canada2

OBJECTIVES: There is evidence that peer supportcan reduce distress and improve quality of life.However, little is known about effectiveness ofinterventions to provide peer support to youngadults with cancer. The purpose of this study wasto evaluate whether a weekend retreat specificallyfor young adult cancer survivors can help toimprove the quality of life, quality of mood andsense of support and hope for cancer survivors whoparticipate in it. METHOD: Participants were 57(45 female, 12 male) young adult cancer survivors,ranging in age from 19–38 years, who took part inone of three weekend retreats. Retreat participantswere asked to complete a questionnaire assessingself-rated health, overall quality of life, hope, senseof community, sense of support and mood, onceprior to the weekend retreat and again immediatelyafter the retreat. RESULTS: On all indicesmeasured, using paired t-tests, there was a sig-nificant difference between pre and post-retreatscores. Self-rated health and quality of life im-proved post retreat as did sense of community,support and hope. Total mood disturbance wasdecreased. CONCLUSIONS: A weekend retreattailored specifically to the needs of young adultswith cancer can provide immediate and significantbenefit in a number of key areas of quality of life.The study is limited by lack of a control group butsuggests that this relatively simple and low costintervention can result in benefits to this under-served population. Further research is needed toidentify which aspects of the retreat contributedmost to which outcome.

A-599

‘I Am Not Alone’: How a Weekend Retreat Helps

Cancer Survivors to Cope

Lynne Robinson1, Robert Rutledge1

Dalhousie University, Halifax, Nova Scotia,Canada1, Nova Scotia Cancer Centre, Halifax,Nova Scotia, Canada2

OBJECTIVES: There is strong evidence for thevalue of using groups to discuss the impacts ofcancer and even brief interventions can have long-lasting effects. The purpose of this study was toevaluate whether a weekend retreat for cancer


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survivors can help to improve the quality of life,quality of mood and sense of support and hope forcancer survivors who participate in it. METHOD:Participants were 47 attendees at each of twoweekend retreats for cancer survivors and suppor-ters, and were widely diverse in cancer diagnosisand stage. After the retreat participants were askedto describe how the retreat affected them. Theywere asked to describe effects again at 4 month and12 month follow-ups. About half of the originalrespondents responded during follow-up. Theopen-ended responses were analysed using the-matic analysis, at a descriptive level. RESULTS:Two major, interrelated, themes emerged fromresponses: ‘I am not alone’ and ‘I can manage’.Participants felt more supported by others and feltthey were better able to give support. Theyreported being able to manage emotions and tocope better, as well as learning new skills and newinformation. These themes continued to appear inresponses from 4 and 12 months after the retreatand corresponded to the objectives of the work-shop organizers. CONCLUSIONS: A weekendretreat, led by experienced facilitators, can be oflong-lasting benefit for many adults with cancer.Since feelings of support and management ofemotional response are key to quality of life, thisrelatively low-cost and easy to deliver interventionappears to be useful for those who self-select intothe intervention. As well, increasing the sense ofsupport and improved coping appear to beimportant objectives for cancer retreats.

A-603

The Impact of Social Support on Survival in Young

Women with Breast Carcinoma

Ann Chou1, Susan Stewart2, Robert Wild3, JoanBloom4

University of Oklahoma, Oklahoma City, Oklahoma,United States1, University of California, SanFrancisco, California, United States2, GeorgiaState University, Atlanta, Georgia, United States3,University of California, Berkeley, California,United States4

OBJECTIVES: Previous evidence has shown thatwomen diagnosed with cancer who have significantsocial support are more likely to survive. However,little information is available about the way socialsupport may change during illness and how thatimpacts survival. This study examines the relation-ship between social support and survival amongwomen diagnosed with breast carcinoma at age 50or younger, specifically assessing the effect ofnetwork size and changes in social contact post-diagnosis. METHOD: A population-based sampleof 594 women diagnosed with breast cancer wasfollowed for up to 12.5 years (median follow-uptime5 10.3 years). Half of the women were

between ages 45–50 at diagnosis, over 80% weremarried, and 29% were racial/ethnic minorities.Cox regression analysis was used to estimatesurvival as a function of social support, diseaseseverity, treatment, health status, and socio-demo-graphic factors. Changes in social contact and thesize of social support were both evaluated.RESULTS: Fifty-four-percent of the women hadlocal and 44.1% had regional stage disease. About52% had a mastectomy, 68% received chemother-apy, 55% had radiation, and 29% had hormonetherapy. Regression results showed that diseasestage, estrogen receptor status, and mastectomywere associated with greater risk of dying.Although network size was not related to survival,increased contact with friends/family post-diagno-sis was associated with lower risk of death, with aratio of 0.31 (95% CI: 0.16–0.54). CONCLU-SIONS: Findings from this study have identified animportant aspect of a woman’s social network thatimpacts survival. As an increase in the network ofrelationships is correlated with greater socialsupport, greater support may have increased thelikelihood of the women’s survival by enhancingtheir coping skills, providing additional emotionalsupport, and expanding opportunities for obtain-ing information.

A-606

Do You See Light? Hope, Social Support and

Distress among Younger and Older Women

Diagnosed with Advanced Breast Cancer

Ilanit Hasson-Ohayon1, Gil Goldzweig2

Bar-Ilan University, Department of Psychlogy,Ramat-Gan, Israel1, School of behavioral sciencesTel-Aviv-Yaffo Academic College, Tel-Aviv, Israel2

OBJECTIVES: Hope and social support werefound to be important resources in coping withpsychological distress among cancer patients. Onthe last decade research findings support thehypothesis that older women cope differently withcancer in comparison to younger women. Thepurpose of the current study was to assess the inter-relations between hope and social support andtheir role as protective factors against depression,among groups of younger and older womendiagnosed with advanced breast cancer.METHOD: Participants were 150 Israeli womendiagnosed with advances breast cancer. Theparticipants were divided to two age groups:younger group (age 54 or less) and older group(age 55 or above). All participants completed abackground (demographic and medical) question-naire, psychological distress questionnaire: BriefSymptoms Inventory (BSI), Social support ques-tionnaire: The Cancer Perceived Agent of SocialSupport (CPASS) and Hope questionnaire.RESULTS: Among the younger group social


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support was found to be significantly related to bothhope and depression (higher social support wasrelated to lower levels of depression and higher levelsof hope). The relation between hope and depressionin this group was not significant. Among the oldergroup social support was found to be significantlyrelated to hope and hope was found to bedirectly related to the depression. CONCLUSIONS:Younger and older women tend to utilize differentpatterns of coping. Younger women rely directly onexternal resources (social support) in order to copewith psychological implications of cancer. On theother hand, older women utilize their externalresources in order to benefit from their internalresources (hope). Clinical implications are discussed.

A-607

Put Your Hand in Mine: Hope, Social Support and

Anxiety among Younger and Older Spouses of

Women Diagnosed with Advanced Breast Cancer

Gil Goldzweig1, Ilanit Hasson-Ohayon2

The academic college of Tel-Aviv Jaffa, School ofBehavioral Sciences, Tel-Aviv, Israel1, Bar IlanUniversity, Department of psychology, Ramat-Gan,Israel2

OBJECTIVES: Hope and social support werefound to be important resources in coping withpsychological distress among cancer patients andtheir primary caregivers. On the last decaderesearch findings support the hypothesis that oldermen cope differently with cancer in comparison toyounger men. The purpose of the current study wasto assess inter-relations between hope and socialsupport and their role as protective factors againstanxiety, among groups of younger and older mencaregivers. METHOD: Participants were 150 Is-raeli men spouses of women diagnosed withadvances breast cancer. The participants weredivided to two age groups: younger group (age 54or less) and older group (age 55 or above). Allparticipants completed a background (demo-graphic and medical) questionnaire, psychologicaldistress questionnaire: Brief Symptoms Inventory(BSI), Social support questionnaire: The CancerPerceived Agent of Social Support (CPASS) andHope questionnaire. RESULTS: Among theyounger caregivers social support was significantlyrelated to hope and hope was significantly relatedto anxiety (higher levels of support were related tohigher levels of hope and higher levels of hope wererelated to lower levels of anxiety). In this group wefound no direct relation between social supportand anxiety. Among the the older caregivers bothhope and social support were found to besignificantly directly related to anxiety. CONCLU-SIONS: Younger and older men caregivers tend toutilize different patterns of coping. Older men relyindirectly on external resources (social support) in

order to benefit from their internal resources (hope)while coping with the psychological implications oftheir spouses’ cancer. On the other hand, older menrely directly on both external resources (socialsupport) and internal resources (hope) in order tocope. Clinical implications are discussed.

A-608

Developmental Perspective of Feminine Caregiving -

Strategies and Constraints

M. Rosario Bacalhau, Marcia Lopes Fernandes,Madalena Feio, Paulo Reis Pina, Sandra Neves,Pedro Soares, Francisca Coimbra, Sofia LupiPortuguese Institute of Oncology Lisbon, Lisbon,Portugal

OBJECTIVES: What is the psycho-social impactof the confrontation with the imminent loss for thecaregiving family member and in its relationshipwith the remaining relatives, how the socio-familiarand economic changes that are necessary for aproper care for the patient are experienced, takinginto account the distinct developmental stages(teenager/young adult, adult and aged)? METH-OD: Asking the daughters to care for their mothersrepresents a change in the life-styles, a change inthe goals and life projects and the change of theongoing developmental tasks. These challenges ofbeing a ‘caregiver’ shall be illustrated using threefemale patients, referenced to, and consulted at, theIn-Patients Palliative Care Support Team, at thePortuguese Institute of Oncology (Cancer Hospi-tal) and subsequently discharged home having theirdaughters as main caregivers. RESULTS: A briefstudy of these cases enables the reflection onsubjects such as the level of school drop outs, theshifting in professional goals, the care for youngerbrothers, the mending of interpersonal/familyrelationships and the thoughts about prior lossesand the cultural and social impositions of thisfeminine care giving. CONCLUSIONS: Severalstudies demonstrate that around 70% of thepalliative patient caregivers are women/daughters.These individuals perform most of the non-medicaltasks the patient requires when at home, eventhough they may relay on the support of thirdparties from NGOs/volunteers. There is a need forstudies that confirm these constraints or reveal theexistence of others so that some situations thatcould irreversibly alter the life of the femalecaregivers can be prevented.

A-609

Need for Psychooncological Care as seen by Cancer

Patients in Primary Care

Fritz A. Muthny1, Wilhelm Schweidtmann2

Dept. of Medical Psychology, Muenster, Germany1,Gesundheitszentrum, Bad Waldliesborn, Germany2


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OBJECTIVES: The majority of patients andcaregivers agree, that psychosocial care should beoffered to cancer patients and this is justified by theimage of cancer, the threats patients perceive andthe impacts of disease and therapy. But there arestill limited data on the need for particularinterventions in primary therapy. Accordingly,the study investigates which psychosocial servicesare important for patients and what role they feelthese services should play. METHOD: 265 cancerpatients were investigated during their primary carein two hospitals. The patients were on average 61years old, 58% female, educational level of 54%primary, 22% secondary, and 17% high school.The cancer had been diagnosed on average 33months ago. 36% were in primary care, 32% inafter care and 24% in relapse treatment. Maindiagnoses were breast cancer (30%), colon cancer(13%), lymphoma/leukaemia (12%) and lungcancer (6%). RESULTS: As the most importantinterventions, the patients rated ‘psychologicalindividual counselling’ (50%), psychological paintherapy (49%), social counselling (45%) andrelaxation training (37%). Patients expect from apsychooncological service, that it helps them ‘torecognize what is important in life’ (66%), ‘to seethe good things in life’ (58%), to support copingand to help the patients to understand what cancermeans for him or herself (53%). CONCLUSIONS:The fact that more than half of the patients stressthe importance of psychological as well as socialcounselling indicates that having a team of psycho-therapists and social workers would be the bestsolution. Based on the fact that 61% of the patientswould like a close cooperation between the psycho-social service and medical doctors, an integrationalcare model or a liaison service would best meet theneeds of cancer patients.

A-610

An Examination of Attachment Styles, Distress, and

Oscillation Among Parents Who Have Lost a Child

to Cancer. Description and Findings of the Study

Philip DomingueThe Catholic University of America, Washinton,DC, United States

OBJECTIVES: This study of bereaved parentswhose child died of cancer, investigated howretrospective insecure attachment and social sup-port impact the individual and the couple indimensions of marital satisfaction, grief, andpsychological distress. The impact of levels ofdiscrepancy in retrospective attachment stylesbetween spouses, on marital satisfaction, grief,psychological distress, and social support wereexamined. The study also explored the impact ofinsecure attachment on grief oscillation (Dual

Processing Model of Grief) (DPM). METHOD:The study was a cross-sectional correlationalsurvey design. The sample was bereaved couplesin the U.S. and Canada, who were living togetherat the time of diagnosis of the deceased child. Theseven standardized instruments used were: Retro-spective Attachment Questionnaire, Brief Symp-tom Inventory, Dyadic Adjustment Scale, HoganGrief Reaction Checklist, Inventory of DailyWidowed Life, and Social Support Index. Multipleregression analysis using SPSS was utilized to testthe hypotheses. RESULTS: Eighty-six individualand thirty-two couple surveys were used in themultivariate analysis of three hypotheses. Retro-spective attachment was a stronger predictor ofgrief and of psychological distress than gender andsocial support. The reverse was true for maritalsatisfaction. Social support influenced psychologi-cal distress and marital satisfaction and someaspects of grief. Time since death played amoderating role on the impact of discrepancy ofattachment style in grief. Retrospective insecureattachment influenced grief oscillation. CONCLU-SIONS: Retrospective insecure attachment, socialsupport, gender, and time since death influencevarious aspects of the parental grieving experience.Discrepancy in attachment styles in couples did notshow the results expected. This study supportsaspects of the DPM, in particular the claim thatattachment styles have an impact on individualgrief and to some extent on couples grievingoutcomes. Implications for theory development,psychosocial interventions, and the need for futureresearch will be discussed.

A-612

Opening the Psychological Black Box in Genetic-

Counselling: The Counsellees’ Perception Explains

the Psychological Impact of DNA-testing, Patho-

genic-Mutations the Medical Impact

Joel Vos1, Reinoud Stoel2, Jan Oosterwijk3,Encarna Gomez4, Fred Menko5, Christi VanAsperen1, Anne Stiggelbout6, Aad Tibben1

Department of Clinical Genetics, Center for Humanand Clinical Genetics, Leiden University MedicalCenter, Leiden, Netherlands1, Netherlands ForensicInstitute, The Hague, Netherlands2, Department ofClinical Genetics, University Hospital Groningen,Groningen, Netherlands3, Department of ClinicalGenetics, Maastricht University Medical Center,Maastricht, Netherlands4, Department ofClinical Genetics, VU University Medical Center,Amsterdam, Netherlands5, Department of MedicalDecision-Making, Leiden University MedicalCenter, Leiden, Netherlands6

OBJECTIVES: We tested the hypothesis that theOutcomes of DNA-testing (O) are better predictedand/or mediated by the counsellees’ Perception (P)


DOI: 10.1002/pon

Oral Abstracts S157

than by the actually communicated genetic-Infor-mation (I). Four perception-variables were in-cluded (P): the counsellees’ recollections andinterpretations of both the cancer-risks and thelikelihood that the cancer in their family isheritable. METHOD: Women tested for BRCA1/2 5 years before (sd5 2.0), participated in aretrospective questionnaire study. CommunicatedInformation included (I): cancer-risks and BRCA1/2-test result, i.e. unclassified-variant testresults(n5 76), uninformative (n5 76) or pathogenic-mutations (n5 51). The 25 outcome-variables (O)included life changes, medical decision-making,BRCA-self-concept, current psychological well-being and quality-of-life. Bootstrapping mediationanalyses determined whether relationships weredirect (I-4O or P-4O) or indirect via themediation of perception (I-4P-4O). RESULTS:Only the communication of pathogenic mutationsor uninformatives directly predicted medical-out-comes (I-4O), viz. performed and intended sur-gery. All other outcomes were predicted by thecounsellees’ recollection and interpretation oftheir own cancer-risks and heredity-likelihood(P-4O), or this perception mediated all effects(I-4P-4O). The counsellees’ perception was sig-nificantly different from actually communicatedcancer-risks (I-4P). The misperception of unclassi-fied-variants predicted both psychological outcomesand radical medical decisions. CONCLUSIONS:Genetic-counsellors need to explicitly address thecounsellee’s interpretations and intended medicaldecisions. In case of rigid misinterpretations addi-tional psychological counseling might be offered.Communication of unclassified-variants needs closeattention given the pitfall of ambiguity.

A-613

A Whisper-Game Perspective on the Family Com-

munication of DNA-test Results: A Retrospective

Study on the Communication Process of BRCA1/2-

test Results Between Genetic-Counsellor, Proband

and Relatives

Joel Vos1, Anna Jansen1, Fred Menko2, AnneStiggelbout3, Aad Tibben1

Department of Clinical Genetics, Center for Humanand Clinical Genetics, Leiden University MedicalCenter, Leiden, Netherlands1, Department ofClinical Genetics, VU University Medical Center,Amsterdam, Netherlands2, Department of MedicalDecision-Making, Leiden University MedicalCenter, Leiden, Netherlands3

OBJECTIVES: We analyzed how DNA-test resultinformation was communicated and perceivedwithin families. METHOD: We conducted a retro-spective descriptive study in 13 probands with anunclassified variant, 7 with a pathogenic mutation,

5 with an uninformative result, and in respectively44, 14, and 12 of their relatives. We examineddifferences and correlations between: (a) informa-tion actually communicated by genetic-counsellors,(b) probands’ perception, (c) relatives’ perception.The perception consisted of recollections andinterpretations of both cancer-risks and heredity-likelihood. RESULTS: Differences and low corre-lations suggested few similarities between theactually communicated information, probands’and relatives’ perception. Probands recalled theinformation differently compared to what wasactually communicated(R5 0.40), and reinter-preted this differently(R5 0.30). The relatives’perception correlated best with the proband’sinterpretation(R5 0.08), but also differed signifi-cantly from this. Relatives reinterpreted thisinformation differently(R5 0.25), and this reinter-pretation only slightly correlated with the originalmessage from the genetic-counsellor(R5 0.15).Low correlations between proband’s and relatives’perceptions were explained by the proband’s wayof communicating. CONCLUSIONS: Like in achildren’s whisper-game, many errors occur in thetransmission of DNA-test result information infamilies. More attention is required for howprobands disseminate information to relatives.Genetic-counsellors may directly communicate torelatives, e.g. via letters.

A-614

Post-Traumatic Stress in Patients with Acute

Leukemia

Gary Rodin, Christopher Lo, Anne Rydall,Andrea Chan, Jaklyn Andrews, Mark Minden,Aaron Schimmer, Joseph Brandwein, CamillaZimmermannPrincess Margaret Hospital, Toronto, Ontario,Canada

OBJECTIVES: Acute leukemia is a potentiallyfatal condition associated with considerable mor-bidity and mortality. The disease course is markedby discrete, life-threatening events (diagnosis,relapse and refractory disease), which may evokesymptoms of post-traumatic stress (PTS). How-ever, PTS has not been evaluated systematically inthese patients. This study was undertaken toevaluate PTS in acute leukemia patients todetermine the impact of physical distress, psycho-social factors and communication with the medicalteam on this outcome. METHOD: Patients withnew onset or relapsed acute myeloid, lymphocyticand promyelocytic leukemia were recruited fromhematology clinics and inpatient units at a cancercentre. Using multivariate regression analysis weevaluated demographic factors, past psychiatrichistory, disease/treatment variables (leukemia type,


DOI: 10.1002/pon

S158 Oral Abstracts

new onset/relapse, active treatment/supportivecare, duration of illness), and communication withthe medical team as predictors of PTS. Measuresincluded: Stanford Acute Stress Reaction Ques-tionnaire (SASRQ), Memorial Symptom Assess-ment Scale and CARES Medical InteractionSubscale. RESULTS: Subjects were 118 adults,mean age 51.4115.1 years, 61% male, 82% newonset leukemia, and 97.5% in active treatment. Atbaseline, subjects reported a mean of 8.214.1physical symptoms, including lack of energy(78%) and pain (44%). Mean SASRQ was 26.71

20.3, and 9.3% met criteria for acute stressdisorder. In regression analyses, PTS was predictedby higher physical distress (po0.0001), pastpsychiatric history (po0.01), and poorer commu-nication with the medical team (po0.002) (adj.R25 0.29). CONCLUSIONS: PTS has not pre-viously been evaluated systematically in patientswith acute leukemia. Findings suggest that asignificant minority of these patients suffer fromPTS, and that it is associated with higher physicaldistress, past psychiatric history, and poorercommunication with medical caregivers. Futurelongitudinal findings will allow testing of acausal model for the emergence and course ofPTS and help to identify timing and targetsfor proactive palliative care intervention in thispopulation.

A-618

Comparison of Physical and Psychological Distress

in Patients with Acute Leukemia and Advanced

Solid Tumours

Camilla Zimmermann, Christopher Lo, AnneRydall, Andrea Chan, Jaklyn Andrews, MarkMinden, Aaron Schimmer, Joseph Brandwein,Gary RodinPrincess Margaret Hospital, Toronto, Ontario,Canada

OBJECTIVES: Acute leukemia (AL) is a poten-tially fatal condition associated with considerablemorbidity and mortality. However, the palliativecare needs of AL patients are not well established.The present study was undertaken to evaluateillness-related physical distress and its relation topsychological distress in patients with AL (acutemyelogenous, lymphocytic or promyelocytic leuke-mia). Findings are compared to an earlier study inwhich similar factors were examined in patientswith advanced solid tumour (AST) cancers.METHOD: In a longitudinal study of physicaland psychological distress, 118 adults with ALhave been recruited from outpatient clinics/inpa-tient units at a cancer centre. In an earlier study,751 adults with AST were recruited from out-patient clinics at the same centre. Measures

included: Beck Depression Inventory-II (BDI-II),Beck Hopelessness Scale (BHS), and MemorialSymptom Assessment Scale. Symptom profiles inthese two samples were compared controlling forage and gender. RESULTS: Mean duration ofillness was 0.1 vs. 2.4 years (AL vs. AST); 97.5%vs. 52% were in active treatment. Physical symp-toms included lack of energy (78% vs. 74%,p5 0.38), nausea (30% vs. 42%, p5 0.06), pain(53% vs. 44%, po0.005) and lack of appetite (55%vs. 29%, po0.0001). Clinically-significant symp-toms of depression (BDI-II415) and hopelessness(BHS48) were less common among leukemiapatients (19.8% vs. 26.2%, po0.01, and 9.6% vs.21.5%, po0.0001, respectively). CONCLUSIONS:Results suggest that AL patients report lesspsychological distress than those with AST, despitea similar prevalence of physical distress. Theshorter duration of illness and emphasis oncurative treatment in the hematology setting maycontribute to better psychological well-being inthese patients, although longitudinal research isneeded to determine whether such outcomes aresustained.

A-621

Epidemiology of Insomnia Comorbid with Cancer:

An 18-Month Longitudinal Study

Josee Savard, Julie Villa, Aude Caplette-Gingras,Hans IversUniversite Laval, Quebec City, Quebec, Canada

OBJECTIVES: The goal of this large scaleepidemiological study was to assess the prevalenceand incidence of insomnia comorbid with cancerover an 18-month period. METHOD: All patientsscheduled to undergo surgery after a first diagnosisof non-metastatic cancer were solicited at their pre-operative visit. Among the 3196 patients ap-proached, 1681 were found eligible and 962(57%) accepted to participate. The participantscompleted a semi-structured interview for insomniaat baseline (T1), 2 (T2), 6 (T3), 10 (T4), 14 (T5) and18 months (T6). RESULTS: The prevalence ofinsomnia symptoms decreased steadily and signifi-cantly over time (T1: 60%; T2: 48%; 46%; T3:46%; T4: 41%; T5: 38%; T6: 37%; po0.01). Thedecrease was significant between T1 and T2 andbetween T3 and T4 (pso0.01). Rates were thehighest in breast (42–69%) and the lowest inprostate (25-38%) cancer patients. The incidenceof insomnia was 20% at T2, 22% at T3, 17% at T4,17% at T5, and 14% at T6. CONCLUSIONS:Insomnia is highly prevalent in cancer patients,particularly at the time of cancer surgeryand then decreases progressively over time.Despite this overall pattern, insomnia symptomsdevelop in a significant proportion of patients


DOI: 10.1002/pon

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during the cancer care trajectory, thussuggesting distinct patterns of evolution acrosspatients.

A-622

Exercise Compliance And Intensity (MET-hours/

week) Related To Stage Of Disease And Fatigue

(BFI) In Young Adults With Cancer

Mary-Ann Dalzell1, Shirin Shallwani1, PetreKavan1, Thiery Muanza1, Richard Dalfen1, MarkKaranofsky1, Scott Adams1

JGH Hope & Cope Wellness Center, Montreal,Quebec, Canada1, Segal Cancer Center, Montreal,Quebec, Canada2

OBJECTIVES: Young adult (YA) patients withcancer undergo aggressive disease and treatmentand have difficulty maintaining function andquality of life. Exercise has been shown to decreaseisolation, provide a sense of empowerment, im-prove quality of life and increase survival in largepopulations of cancer patients. The primaryobjective of this study is to identify the extent towhich stage of disease and fatigue relate to exercisecompliance in the YA population of cancerpatients. METHOD: A convenience sample of 97consecutive YA patients (mean age5 33.7 years)with breast (15.5%), central nervous system(20.6%), gastrointestinal (30.9%), sarcoma(13.4%), testicular (10.3%) and other (9.3%)miscellaneous tumors were screened for exerciseeligibility at a hospital-based oncology clinic.Active lifestyle coaching and individualized ex-ercise programs at a community-based wellnesscentre were offered. Activity levels (MET-hours/week) and Brief Fatigue Inventory (BFI) scoreswere recorded at baseline and 6-month follow-up.T-tests were used for analysis. RESULTS: 42.3%of patients had recurrent or advanced disease.Compliance with exercise prescription was 70%.Exercisers had significantly higher baseline activity(p5 0.0002). No differences in exercise compliance,MET-hours/week and BFI scores related to stageof disease were recorded. Exercisers significantlyincreased activity levels to 27.71 MET-hours/week(p5 0.0004) Non-exercisers reduced activity levelsto 0.71 MET-hours/week (p5 0.05). BFI severityand impact scores did not significantly change, butmoderately correlated with activity levels (r5�0.3and �0.26, respectively). CONCLUSIONS: Thisstudy demonstrates that YA patients with cancerare highly motivated to exercise regardless ofdisease location or stage and can safely do so withappropriate guidance. They benefit from fatiguemanagement, decreased isolation, and the sense ofempowerment shown to be related to exercise in acommunity-based setting. Non-exercisers decreasetheir activities to negligible levels and are at risk forgreater disability and social isolation.

A-623

Development of a Psychosocial Risk Screening Tool

for Genetic Testing

MJ Esplen1, M Cappelli2, J Wong3, J Bottorff4, NTaylor1, B Wilson5, J Hunter6, A Summers7, MDorval8, K Semotiuk6, J Allanson9, M Aronson6,T Power10, J Millar11, L Bordeleau12

University Health Network, Toronto, Ontario,Canada1, Children’s Hospital of Eastern Ontario,Ottawa, Ontario, Canada2, de Souza Institute,Toronto, Ontario, Canada3, UBC Okanagan,Kelowna, British Columbia, Canada4, University ofOttawa, Ottawa, Ontario, Canada5, Mount SinaiHospital, Toronto, Ontario, Canada6, North YorkGeneral Hospital, Toronto, Ontario, Canada7, LavalUniversity, Quebec City, Quebec, Canada8, EasternOntario Regional Genetics Centre, Ottawa, Ontario,Canada9, Alberta Health Services, Calgary, Alberta,Canada10, Nova Scotia Department of Health,Halifax, Nova Scotia, Canada11, McMasterUniversity, Hamilton, Ontario, Canada12

OBJECTIVES: To develop a reliable and validgenetic-testing psychosocial risk screening tool(GPRS) to help health care providers determinewhich of their patients undergoing genetic testingfor adult-onset hereditary disease are at increasedpsychological risk. METHOD: The developmentof the GPRS included two phases. Phase I: ItemGeneration and Refinement, and Phase II: InitialValidation. In Phase I the candidate scale wasgenerated from a literature review and expertfeedback. It was then further refined amongindividuals with a history of cancer or Huntingtondisease who were awaiting genetic test results. InPhase II the instrument was evaluated using aseparate sample of individuals from 6 cancercentres across Canada. RESULTS: Phase I analy-sis of 141 participants indicated that the 25 itemGPRS has a high internal consistency (Cron-bach’s5 0.8) with four factors: Current Mood,Perceived Impact, Past Trauma and Worry AboutChildren. Phase II analysis focused on the ability ofthe instrument to identify individuals at risk foranxiety and depression. Psychological assessmentresults from 586 participants (490% of thesample) who would have received genetic testresults by May 2010 will be presented. CONCLU-SIONS: Reliability analysis showed that the GPRSdemonstrated good internal consistency. WhenPhase II data from the full sample becomesavailable in fall, we will assess GPRS for itssensitivity, specificity, and predictive value inidentifying psychiatric distress related to genetictesting. If shown to be effective, the GPRS will beimplemented clinically and examined for its ex-ternal validity to identify psychosocial risk earlyon, to facilitate timely intervention and to increaseprovider and patient satisfaction.


DOI: 10.1002/pon

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A-625

Development and Validation of an Instrument to

Measure the Impact of Genetic Testing on Self-

Concept in Hereditary Non-Polyposis Colorectal

Cancer (HNPCC)

MJ Esplen1, N Stuckless2, J Wong3, S Gallinger4,M Aronson4, H Rothenmund4, K Semotiuk4,J Stokes5, J Green5, K Butler1

University Health Network, Toronto GeneralHospital, Toronto, Ontario, Canada1, YorkUniversity, Toronto, Ontario, Canada2, de SouzaInstitute, Toronto, Ontario, Canada3, Mount SinaiHospital, Toronto, Ontario, Canada4, MemorialUniversity, St John’s, Newfoundland, Canada5

OBJECTIVES: The purpose of the study was todevelop and validate a scale for measuring theimpact of receiving a positive genetic test result forHNPCC on an individual’s self-concept. METH-OD: The study was conducted in two phases: Phase1) Supplemental item generation and refinement,and Phase 2) Scale selection and initial validation.Canadian adult HNPCC carriers with or without ahistory of colon cancer were recruited to the study.During Phase 1, specific colorectal self-conceptitems were generated with patient interviews andwith genetic health professionals. Phase II invited160 HNPCC carriers and tested scale reliability andvalidity against a set of validating measures.RESULTS: Phase I generated a specific colorectalself-concept scale with 24 items. In Phase 2, 115(72%) carriers completed the proposed candidatescale and a battery of validating measures. Thefinal self-concept scale consists of 20 items with twodimensions: stigma/vulnerability and gastrointest-inal anxiety. The scale demonstrated good relia-bility (Cronbach’s a5 0.93) and correlatedmoderately with validating measures supportingsatisfactory convergent and criterion validity. Thescale’s performance was stable across variousparticipant characteristics. CONCLUSIONS: Anew scale for measuring self-concept among adultswith HNPCC mutations has been developed and isavailable for further testing. The instrument haspotential use as a clinical screening tool and as aresearch measure, contributing to the empirical andtheoretical literature.

A-627

Does Every Cloud Have A Silver Lining? Finding

Benefit After A Diagnosis Of Cancer Of The Head

And Neck

CD Llewellyn1, DJ Horney1, M McGurk2, JWeinman2, J Herold3, K Altman3, HE Smith1

Brighton & Sussex Medical School, Brighton,United Kingdom1, King’s College London, London,United Kingdom2, Brighton & Sussex UniversityHospital NHS Trust, Brighton, United Kingdom3

OBJECTIVES: Some individuals are able to gainpsychological benefits from illness and adversity,such as a greater sense of purpose and closerrelationships. This is termed ‘benefit finding’ (BF).The main aim of this study was to explore the extentto which BF is reported in head and neck cancer(HNC) patients. Secondary aims were to establishthe relationships between BF, other patient re-ported outcomes and predictive factors such ascoping strategy and levels of optimism. METHOD:This longitudinal (repeat measures design) studywas conducted in a sample of 103 newly diagnosedpatients with HNC. Self-completion questionnaireswere used to assess BF (Benefit Finding Scale) pre-treatment and 6 months after treatment, and pre-treatment coping (Brief COPE), optimism (LOT-R), quality of life (SF-12v2, EORTC QLQ-C30Global QoL/health score), anxiety and depression(HADS). Sixty-eight patients (66%) completed thepost-treatment follow-up measure. Correlationcoefficients, regression models, principal componentanalyses and cluster analyses were conducted.RESULTS: Moderate to high levels of BF werereported. Anxiety, depression and QoL were notrelated to BF. Regression models of BF Total Scoreand three new factor analysed BF scales indicatedthat use of emotional support coping and activecoping strategies were predictive of finding morepositive consequences. A protective effect of opti-mism and living with a partner were also found. Theamount of variance in BF explained by these pre-treatment factors was 32–41%. CONCLUSIONS:These findings demonstrate that moderate to highlevels of benefit finding were reported after treat-ment, and that both dispositional and potentiallymodifiable factors, in particular optimism andcoping strategies, were associated with the identifi-cation of positive consequences. Components ofBF, either directly or via coping strategies, could betargeted for intervention before and after treatmentin order to maximise longer-term patient relatedoutcomes and adaptation.

A-628

The Role of Nurse Navigation in Supporting

Patients Through the Diagnostic Phase of Cancer

Care

Julie Gilbert1, Esther Green1, Sara Lankshear4,Erin Hughes5, Vanessa Burkoski6, Carol Sawka1

Cancer Care Ontario, Toronto, Ontario, Canada1,University of Toronto, Toronto, Ontario, Canada2,McMaster University, Hamilton, Ontario, Canada3,Releve Consulting Services, Penetanguishene,Ontario, Canada4, Erin Hughes Consulting,Toronto, Ontario, Canada5, Ministry of Healthand Long-Term Care, Toronto, Ontario, Canada6

OBJECTIVES: The process of diagnosing canceroften involves tests, exams, appointments and


DOI: 10.1002/pon

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lengthy waits. Waiting for a diagnosis and fortreatment to start can be very distressing forpatients. The objective of this work was to explorethe role of patient navigation in improving thepatient’s experience during the diagnostic process.Of specific interest was the impact of having anurse in the role to identify and address bothphysical and psychosocial needs of the patient.METHOD: A literature review was carried out tosummarize the information available on models ofpatient navigation, preparation for the role andevidence for its effectiveness on the patient’sexperience in cancer care. Interviews and focusgroups were conducted with navigators, otherclinicians and healthcare managers to gain furtherinsight into patient navigation and the role ofnurses in providing patients with psychosocial andother support, with a specific focus on thediagnostic phase of care. RESULTS: The literaturereview and consultation with 17 individual stake-holders revealed that navigation during the diag-nostic phase of care gives patients access toinformation and support, thereby reducing theirdistress around the diagnostic process. Whilenavigation activities may be provided by layper-sons, clerical staff or other clinicians, nurses addvalue to navigation through their ability to assesspsychosocial and physical symptoms, managecomplexity, provide supportive care and integratewith other healthcare professionals. CONCLU-SIONS: The intensity of care required duringnavigation depends on individual patient needs.For those patients with mild psychosocial distress,informational navigation may be sufficient. Pa-tients at higher risk or with more severe symptomsmay require more intensive support and/or clinicalintervention by a nurse, perhaps with advancedpractice skills. Identifying those individuals whorequire more clinical intervention is essential sothat symptoms can be addressed and the diagnosticexperience optimized.

A-630

The Impact of Race on Reasons for Ineligibility and

Refusal to Cancer Clinical Trials

Richard Brown, Lynne Penberthy, Laura Siminoff,Lisa Shickle, Bassam DahmanVirginia Commonwealth University School ofMedicine, Richmond, Virginia, United States

OBJECTIVES: Cancer clinical trials (CTs) are keyto new drug development, yet less than 5% of alladult cancer patients enter Phase I - III CTs whileminority enrollment is much lower. Low accrual isthe biggest barrier to speeding progress to newtreatments. Differences between African American(AA) and Caucasian Americans’ trial ineligibilityand reasons for trial refusal are under-researched.We aimed to compare these to inform future

interventions to aid accrual. METHOD: TheClinical Trials Eligibility Database (CTED), anovel system for evaluating trial eligibility andtracking patient status, was used to identify trialeligible patients. Reasons for ineligibility andrefusal were recorded by the research staff at thetime of eligibility assessment using a pull downmenu. The selections for ineligibility and refusalreasons were derived from the literature and theexperience of the research staff. RESULTS: Of 2,431 patients evaluated over three-years, 38% wereAA. 49% of AAs were ineligible compared with41% of Caucasians. AAs tended to refuse moreoften than Caucasians. (F5 1.277; p5 0.07) Ratesof refusal reasons differed significantly.(p5 0.0025) The rate of AA’s refusals due to‘trial/research concerns’ and ‘issues of decisionmaking’ was double that of Caucasians. Cauca-sians refusal due to the ‘extra burden’ and‘treatment preference’ was double that of AA’s.CONCLUSIONS: Real time longitudinal collec-tion of information on ineligibility and refusalcomparing AAs and Caucasians revealed thattraditionally cited reasons for refusal such as ‘fearof research’ were not key factors. Rather, morepractical reasons emerged as of greater importance.This offers an opportunity to target these differentbarriers to enhance CT enrollment.

A-634

‘New Ways’ Project: Changing the Way Profes-

sionals Interact with Oncologic Patients Experience

in Hospital de Santo Antonio, Centro Hospitalar do

Porto, Portugal

Sara Moreira, Margarida BrancoCentro Hospitalar do Porto, Hospital de SantoAntonio, Psychiatry and mental Health service,Liaison Psychiatry and Health Psychology Unit,Oporto, Portugal

OBJECTIVES: Gather relevant information toidentify critical intervention areas in several ser-vices (Haematology, Day-Hospital, Oncology andSurgery), define and implement actions to put thePatient/Family in the centre of professionals’attention according to the ‘Patient Centric’ ap-proach (Patient-Centered Care concept, whichimplies a ‘respectful of and responsive to individualPatient preferences, needs, and values and ensuresthat Patient values guide all clinical decisions’.METHOD: Our approach consisted of threephases: ‘Read the Reality’ - Diagnosis: collectinformation through observation, interviews andsurveys to Patients, Family and Health CareProfessionals. ‘Change the Reality’ - Action Plan:development of an Action Plan by a multidisci-plinary group of Professionals (workshops, newinformational handouts, redesign of patient’s


DOI: 10.1002/pon

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circuit in the Hospital to assure a better support).Implementation of the Action Plan by an internalgroup of professionals from the services involved.RESULTS: Better coordination/communicationbetween services/professionals, several profes-sionals participating actively in the project, Hospi-tal Administration support, implementation of aCommunication Skills Programme to all profes-sionals involved in the project. CONCLUSIONS:The implementation of this Project motivatedprofessionals from other services that were notinvolved since its begining, and now want toimplement it on their services. n a near future, itwill improve patients’, families’ and professionals’empowerment, patients’ quality of life, conductingto more efficient processes and lower costs perPatient.

A-639

Assessing the Complementary Medicine (CAM)

Information and Decision Support Needs of Patients

and Health Professionals at a Canadian Cancer

Agency

Lynda Balneaves1, Tracy Truant2, Marja Verhoef3,Brenda Ross2, Antony Porcino1, Margurite Wong2

School of Nursing, University of British Columbia,Vancouver, British Columbia, Canada1, BritishColumbia Cancer Agency, Vancouver, BritishColumbia, Canada2, Dept. of Community HealthSciences, University of Calgary, Calgary, Alberta,Canada3

OBJECTIVES: The purpose of this study was toexamine the information, education and decisionsupport needs related to CAM of cancer patientsand their health care professionals (HCPs) at aregional cancer agency in Canada. The overall aimof this was to inform the development of astructured CAM education and decision supportinterventions for implementation in conventionalcancer care settings. METHOD: Survey methodol-ogy, including closed and open-ended items, wasused to conduct a needs assessment of patientsattending a regional cancer centre and oncologyHCPs. Patients were asked about CAM use, relatedinformation needs, and the type of CAM educationand decision support strategies that would behelpful. HCPs’ current practice related to CAMand their CAM information and education needswere assessed. Descriptive statistics and qualitativecontent analysis was used to summarize the data.RESULTS: 408 patients and 91 HCPs participated.50% of patients were using CAM and hadinformation needs about the safety/efficacy ofCAM. 28% had spoken to a HCP about CAM,but under 10% had their information needs met.Patients preferred booklets, websites and groupsessions to learn about CAM. Over 60% of HCPsreported a patient disclosure about CAM in the

past month, but struggled to provide support andinformation. HCPs requested on-line CAM educa-tion. CONCLUSIONS: These findings providenew evidence of the significant gap that existsrelated to CAM education and decision support inCanadian conventional cancer care settings. Edu-cation is required for both cancer patients andHCPs and must be offered through a variety ofeasily accessible resources. In addition, HCPsrequire specialized training to support cancerpatients in making informed CAM decisions.Specific education and decision support interven-tions currently under developed will be discussed.

A-641

A Definitive Meta-analysis to Ascertain the Optimal

Screening Method for Depression in Cancer and

Palliative Care. Part I - Single Test Application

Alex J Mitchell1, Gregory Carter3, NicholasMeader2

University of Leicester, Leicester, United Kingdom1,University College London, London, United Kingdom2,University of Newcastle, Newcastle, Australia3

OBJECTIVES: We aimed to examine the validityof screening and case-finding tools used in theidentification of depression following cancer, asdefined by an ICD10 or DSMIV criterion standardfor any depression diagnosis. In this part, we lookat the merits of using each screening tool alone.METHOD: 52 analyses tested 16 tools to helpclinicians identify depression in cancer settings. Weexcluded those without at least two independentvalidity attempts, leaving 8 tools for comparison.These were one and two verbal questions, theDistress Thermometer (DT), the Hospital Anxietyand Depression Scale (HADS) (in three formats),the Edinburgh Postnatal Depression Scale (EPDS)and the Beck Depression Inventory (BDI-II). Wesubdivided results into mixed oncology settings,palliative care and any cancer setting. RESULTS:From 33 analyses in mixed oncology settings(n5 6564) the optimal tool was the BDI-II(sensitivity 91.2%, specificity 86.1%). Across 16analyses (n5 2458) conducted in palliative settingsthe optimal method in palliative care was the 2verbal questions (sensitivity 94.9%, specificity91.1%). At a prevalence of 19% out of 100consecutive cancer patients, two questions wouldfacilitate detection of 18 cases, missing only 1 casewith 74 correctly reassured and 7 false positives.CONCLUSIONS: Using stringent standards only8 methods have been well validated in cancer andpalliative settings. However without a second-stepexamination (see part II) there are significantnumbers of false positives. The main caution ininterpretation of these findings is the reliance onDSMIV definitions of major depression.


DOI: 10.1002/pon

Oral Abstracts S163

A-642

Reduced Distress And Pain Among Oncology Out-

patients Following The Introduction Of Routine

Screening

Kerrie Clover1, Gregory Leigh Carter2,Kerry Rogers1, Catherine Adams1, PatrickMcElduff3

Calvary Mater Newcastle, Newcastle, New SouthWales, Australia1, Centre for Brain and MentalHealth, The University of Newcastle, New SouthWales, Australia2, CReDItSS HMRI, TheUniversity of Newcastle, New South Wales,Australia3

OBJECTIVES: Untreated distress can lead tounnecessary suffering, more pain and fatigue,higher health service utilization, reduced cognitivefunction and disrupted immune and endocrinefunction 1. Up to 94% of distress goes unnoticedby health professionals and therefore remainsuntreated. Routine screening combined with ap-propriate management is a recommended standardof care. However, there have been only a handfulof published reports of large scale (41,000patients) clinical implementation of screening.METHOD: Patients complete a brief, computer-ized assessment of their pain and distress prior tooutpatient appointment. The screening algorithmutilizes the Distress Thermometer with a secondquestionnaire (SPHERE PSYCH) for patients overthreshold. A Clinician Alert is generated if aproblem is flagged. Cancer Care Coordinatorsaccess patients’ results electronically and referralpathways have been agreed with allied health. Over10,000 occasions of screening involving nearly5,000 patients were undertaken from October2007 to June 2009. RESULTS: The percentage ofpatients over threshold for distress on their firstoccasion of screening decreased from 29% to 10%.Similarly, the percentage of patients over thresholdfor pain decreased from 35% to 11%. Regressionanalysis demonstrated that the likelihood ofbeing over threshold for distress was reducedfollowing the introduction of routine screeningafter accounting for gender, clinic type, andcurrent treatment (po0.001). The effect was great-er among women than men. CONCLUSIONS:The prevalence of pain or distress over thresholdlevels has decreased significantly since theintroduction of routine screening. This decreasewas maintained after controlling for severalvariables commonly associated with distress.While this is a service evaluation and not arandomised trial, the data are consistentwith a positive effect of routine screening incontributing to decreased pain and distress amongpatients.

1 Institute of Medicine, 2008

A-645

Cancer, Aging, and Death: Older Adults Reflecting

on Illness and Later Life

Chad Hammond, Ulrich TeucherUniversity of Saskatchewan, Saskatoon, Saskatch-ewan, Canada

OBJECTIVES: Many cancer patients have concernsrelating to life and death that they find areimportant to address and resolve (Bolmsjo, 2002;Jacobsen et al., 2000; Lee, 2008; Moadel et al.,1999). These ‘existential’ reflections may endureover an extended period of time and may also beexacerbated by aging, which can involve similardifficulties to cancer (e.g. pain, fatigue, disability).The purpose of this research is to explore how agingcancer patients experience existential concerns.METHOD: I used a qualitative research methodol-ogy known as interpretative phenomenologicalanalysis (IPA) to analyze 20 interviews with agingcancer patients. IPA is a cyclical process, in whichthe researcher tries to make sense of the partici-pants’ interpretations (Smith & Osborn, 2003). Myinterpretation of the transcripts will be informed bytheoretical perspectives in existential and interpre-tive phenomenology. RESULTS: For some indivi-duals, reflecting on life and death evoked fear andanxiety while for others it was a source ofconsolation and meaning. People’s understandingsof the relation between life and death, their values oftime and how it should be lived, and the projectsthey pursued for the remainder of their lives are justsome examples of the salient existential concernsthat took on different forms and held differentmeanings for the participants. CONCLUSIONS:The prevalence of existential concerns can be seen inthe research interviews, as well as other, publishedbiographical narratives of aging cancer patients (deBeauvoir, 1983; Stephaniuk, 2007); however, themeaning of existential concerns changes bothbetween and within different narratives. I will utilizesome anthropological research (Becker, 1997) andphilosophical insights (Frankl, 1984; Gadamer,1989) to help explain these differences. I will thenrelate these existentialist and phenomenologicalinsights to possible intervention strategies.

A-647

Social Support and Psychosocial Outcomes among

Cancer Patients: Ethnic and Sex Differences in a

Multicultural Population

Maria Fais1, John Robinson2, Linda Carlson2,Shannon Groff3, Barry Bultz2, Bejoy Thomas2

Department of Psychology, University of Calgary,Calgary, Aberta, Canada1, Tom Baker CancerCentre and University of Calgary, Calgary, Aberta,Canada2, Tom Baker Cancer Centre, Calgary,Aberta, Canada3


DOI: 10.1002/pon

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OBJECTIVES: This study examined the role ofsocial support, particularly in regards of the use ofconfidants and role of people living with thepatients as moderators of distress in the contextof a multicultural cancer population. METHOD:The study was based on a sub-sample of patients inan ethnically stratified patient Screening for Dis-tress RCT database. Cancer patients were inter-viewed and asked about whom they lived with(family partners, etc) and the people they confidedin about their personal and health issues. RE-SULTS: A sample of 142 patients were inter-viewed. Patient ethnicity was significantlyassociated with the number of confidants usedand their likelihood of living with adult children.Additionally, significant interactions were foundbetween living with a spouse and lower depressionscores, and between living with adult children andhigher anxiety scores over time. CONCLUSIONS:Results indicated that there are certain ethnic andsex differences related to specific dimensions ofsocial support which may have an influence on thepatients’ psychosocial outcomes. These differences,therefore, need to be taken into consideration forthe delivery of more personalized cancer care.

A-648

The Role of Age and Motherhood on Fear of Cancer

Recurrence in Breast Cancer Survivors

Sara Beattie1, Isabelle Ares1, Beth Richardson2,Catherine Bielajew1, Sophie Lebel1

University of Ottawa, Ottawa, Ontario, Canada1,Carleton University, Ottawa, Ontario, Canada2

OBJECTIVES: While fear of cancer recurrence(FCR) is a frequently cited unmet need of cancersurvivors, few studies have examined psychologicaldeterminants of this phenomenon. The relationbetween age and FCR is well documented, but theeffect being a mother has on FCR remains to beinvestigated. This study examined the (1) effectmotherhood had on FCR (2) differences in FCRscores in women of different ages, and (3) interac-tion between age and motherhood on FCR.METHOD: A sample of 3239 women with breastcancer (mean time since diagnosis: 6.6 years)completed the Concerns About Recurrence Scale(CARS) as well as a series of demographicquestions within a larger web-based study. Womenwere divided into four groups based on theircurrent age: 34 and younger, 35 to 49, 50 to 64,and 65 and over. RESULTS: Univariate analyseswere performed with motherhood and age categoryas the independent variables and the CARS overallfears sub-scale as the dependent variable. Resultsindicated that age category and having childrenwere related to FCR (F5 78.88, po0.01;F5 10.61, po0.01). Follow-up tests indicatedsignificant differences between each age category;

specifically women under 34 expressed the highestlevels of FCR and women 65 and over reported thelowest levels of FCR. No significant interactionwas found. CONCLUSIONS: Consistent withprevious research, younger age was associated withmore distress. Regardless of age, having childrenwas also related to higher levels of FCR. Womenunder 34 with children reported the highest levelsof FCR suggesting that they may be a morevulnerable subgroup of breast cancer survivors.Due to the large sample size in this study,statistically significant results may not be clinicallysignificant; thus, clinical implications must beinterpreted with caution.

A-650

Person-centred Multimedia Information and Navi-

gation Support: An Exploration of Perceptions

among Individuals with Colorectal Cancer

Okimi Peters1, Carmen Loiselle1

McGill University, Montreal, Quebec, Canada1,Jewish General Hospital, Montreal, Quebec, Canada2

OBJECTIVES: Information seeking is identified asa significant component in engaging and empower-ing individuals affected by cancer as they strive tomanage illness demands. In response, the OncologyInteractive Navigator TM (OIN) was designed toprovide comprehensive informational support toindividuals with cancer. Embedded within aCanada-wide study, the present qualitative inquiryexplored the role of the OIN, as a complement tousual care, in addressing the needs of individualsnewly diagnosed with colorectal cancer. METH-OD: A subset of participants (n5 10), who wereprovided unrestricted access to the OIN for sixweeks, were interviewed individually in person orby phone. The interviews lasted between 40 and67minutes. Digital recordings of the interviewswere subsequently transcribed verbatim and con-tent-analyzed as per the study’s purpose. RE-SULTS: Rich descriptions were obtained on howthe OIN filled important information gaps forparticipants. They indicated that the OIN served asa significant and reliable source of information thatallowed them to feel more competent as partici-pants in their care. For some, the OIN was used topace their exposure to colorectal informationaccording to their readiness and preferences.Furthermore, participants underscored the impor-tance of introducing the OIN early (i.e. at the pointof diagnosis). CONCLUSIONS: The OIN is apromising intervention that is reported to bebeneficial in meeting the information needs ofparticipants in the present study. The qualitativedata obtained in the study will be useful in guidingthe ongoing development and implementation ofthe OIN as an integrated and comprehensiveapproach to person-centred care.


DOI: 10.1002/pon

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A-651

How do I ‘sell’ Psycho-Oncology to the Adminis-

trators, Oncologists and Surgeons?

Catherine AdamsThe Breast Centre, Newcastle, New South Wales,Australia

OBJECTIVES: This presentation will discussstrategies that may be effective in convincingsceptical cancer specialists and administrators ofthe benefits of a psycho-oncology service. It isrelevant to all psycho-oncology clinicians, but willbe particularly useful for people who are establish-ing new psycho-oncology positions. METHOD:The experience of the author over the past 9 yearsin establishing two psycho-oncology services willbe presented. One of these is located in a largeregional public cancer centre, and the other in aprivately run Breast Centre for women with breastcancer, both of them are located in New SouthWales, Australia. Both settings employ surgeons,medical, and radiation oncologists. Both settingsuse computerised screening for pain and distress.Strategies useful for both individuals and systemswill be discussed. RESULTS: Results of strategiesemployed will be presented in both qualitative andquantitative terms. These include increasing num-bers of referrals, provision of ongoing and in-creased funding, and requests for psycho-oncologysupport from various medical specialties. CON-CLUSIONS: It is possible to convert even the mostsceptical medical specialist or administrator into asupporter psychosocial care. It is important tospeak to them in their own language. Often this willbe an unfamiliar language such as medical costoffsets, or reduced bed days, or reductions in timespent in consultations. The secret of success can beseen to be developing the ability speak the rightlanguage to the right people, at the right time.

A-655

The Meaning of Surviving Cancer for Latino

Adolescents and Emerging Young Adults

Barbara Jones1, Debbie Volker1, YolandaVinajeras2, Linda Butros2, Cynthia Fitchpatrick3,Kelly Rossetto4

University of Texas at Austin, Austin, Texas, UnitedStates1, University of New Mexico, Alberquerque,New Mexico, United States2, Dell Childen’s MedialCenter, Austin, Texas, United States3, BostonCollege, Boston, Massachusetts, United States4

OBJECTIVES: The purpose of this project was todiscover the experiences and meaning of survivingcancer for this population. Childhood cancersurvival rates have steadily increased in the U.S.over the past 20 years to record highs of 80%survival. However, Hispanic adolescents with

cancer have poorer outcomes and receive moreinconsistent care than their non-Hispanic counter-parts. Due to disparities in access to health care,Hispanic adolescents with cancer have been under-served /understudied. METHOD: This pilot studyexplored the meaning of cancer survivorship for 10Hispanic/ Latino adolescent cancer survivors.Participants were interviewed using a phenomen-ological approach about the meaning of survivingcancer. Participants ranged in age between 14 and22 years old, and years since diagnosis rangedbetween two and six years. Interviews were audiotaped, transcribed, and entered into Atlas.ti, aqualitative software program. Data were analyzedfor themes of experience. RESULTS: Data analysisproduced seven themes that emerged as salient forthese Latino adolescent cancer survivors as theydiscussed what this experience meant to them andhow they coped with it: gratitude, humor/positiveattitude, empathy for younger children with cancer,god/faith, cancer happens for a reason/cancerchanged my life/, familial support, staff relation-ships. CONCLUSIONS: The results of this pilotstudy highlight the importance of family, commu-nity, spirituality and gratitude for Hispanic/Latinoadolescent cancer survivors as they struggle tosurvive the treatment and make meaning out oftheir cancer experience. The results provide oppor-tunities for program developers and health careprofessionals to begin to address this group ofyoung people.

A-656

Cancer and Aging: ‘Learning to live finally’

Ulrich Teucher, Chad HammondUniversity of Saskatchewan, Saskatoon, Saskatch-ewan, Canada

OBJECTIVES: Much quantitative psycho-medicalliterature presents aging as a decline, e.g. inphysical and cognitive abilities, as well as vulner-ability to psychological distress; these effects aresaid to be exacerbated by cancer (e.g. NIH CCS2009, ACS 2009). Indeed, some cancer patientshave called cancer and aging an ‘unholy alliance’(Lerner 1990). This qualitative study explores thedifficulties with which older cancer patients strug-gle as they try to make meaning of theirexperiences. METHOD: We conducted 20 com-prehensive interviews with aging cancer patients. Arange of texts on aging, time, and mortality formedan interdisciplinary conceptual framework, includ-ing Bengtson et al. (2009), Randal & McKim(2008), Charmaz (1997), Heidegger (1993), Liess-man (2004), Tugendhat (2007), and Ricoeur (2009).Qualitative text analysis was grounded in Inter-pretive Description (Thorne 2008), informed byInterpretative Phenomenological Analysis (Smithet al., 2009), Narrative Analysis (e.g. Charon 2006;


DOI: 10.1002/pon

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Bal 2007), and Metaphor analysis (Teucher 2000,2007). RESULTS: One of the greatest surprises inthe new data on offer here was how little agingplayed a role in the interviews. Except for onewoman, all cancer patients (ages 63–87) spokeabout being ‘young in heart and mind, ‘ that theyhave ‘lots of living to do, and that ‘aging meansfailure’ (80 yr. old f). While some viewed cancer,e.g. as a ‘wake-up call, ‘ others referred to their(double) cancer as ‘minor health problem.’ CON-CLUSIONS: Indeed, gerontologists have recentlyredefined aging as a period of generativity andrenewed self-esteem (e.g. Gross & Fagetti 2008;Randall & McKim 2008). But, in aging cancerpatients, this renewal may have come with a lostsense of aging in the context of the lifespan andmortality. The focus of most of these patients’,having survived death by cancer, is on ‘learning tolive finally’ (Derrida 2007), thus hoping to post-pone death by aging.

A-660

Cognitive Function and Fatigue in Colorectal Cancer

Patients: Interim Analysis of a Longitudinal Pro-

spective Study

Janette Vardy1, Haryana Dhillon1, Wei Xu2, AnnaDodd2, Corrinne Renton1, Sean Rourke3, StephenClarke1, Ian Tannock2

Sydney Cancer Centre, University of Sydney,Sydney, New South Wales, Australia1, PrincessMargaret Hospital, University of Toronto, Toronto,Ontario, Canada2, St Michael’s Hospital, Universityof Toronto, Toronto, Ontario, Canada3

OBJECTIVES: A subset of cancer patients hascognitive impairment and fatigue after chemother-apy (CTh). The incidence and cause of thisimpairment is unknown. Here we present interimdata from our longitudinal prospective studyevaluating neuropsychological (NP) performance(using classical NP tests and CANTAB) andfatigue, in patients with colorectal cancer (CRC)aged up to 75 years. Putative underlying mechan-isms of cognitive impairment and fatigue areinvestigated. METHOD: Cognitive function wasevaluated at baseline (pre-CTh), 6, 12, 24 months.Group A (Stage II/III) received CTh, group B(Stage I/II) received no CTh. All patients com-pleted NP assessment, with impairment definedusing global deficit scores, and concurrent ques-tionnaires for fatigue, QOL, anxiety/depression,and perceived cognitive function (PCF). Weevaluated cytokines, clotting factors, sex hor-mones, CEA and apolipoprotein genotyping aspotential causal factors. Associations betweenresults, demographic and disease-related factorswere sought. RESULTS: Baseline 341 patients,follow-up 239, 194, 97 respectively. Median age 58;

60% male. Baseline NP impairment: classical tests36%. No significant NP group differences werefound. PCF impairment: baseline 10%; 6 months16% vs 9%; 12 months 17% vs 7%. Fatigue wasgreatest in CTh pts. Fatigue, QOL, anxiety/depression & PCF were strongly associated witheach other (r5 0.46–0.76), but not with NPperformance. Cognitive function was not asso-ciated with cytokines, sex hormones, clottingfactors, CEA or apoE. CONCLUSIONS: Cogni-tive impairment was present in 36% of CRCpatients prior to receiving adjuvant CTh; with anon-significant difference between CTh and non-CTh groups at 12-months (23% vs 18%). PCFimpairment was substantially lower than in breastcancer survivors, but highest in those who receivedCTh. Fatigue was greatest at 6 months inpatients receiving CTh (71% vs 36%). Cytokinelevels were elevated compared to healthy volun-teers, but levels were not associated with cognitivefunction.

A-661

Mortality and Cause Specific Mortality among

Danish Baptists and Seventh Day Adventists

Lau Caspar Thygesen1, Niels Christian Hvidt2,Christine Tind Johannessen-Henry3, ChristofferJohansen1

University of Southern Denmark, Copenhagen,Denmark1, University of Southern Denmark,Odense, Denmark2, The Danish Cancer Society,Copenhagen, Denmark3

OBJECTIVES: Denmark is a relatively secularnation in which religion plays only a minor role inpublic life. We found it of interest to investigate therelation between religious belief and mortalityexperience in this context. By their religious beliefmembers of Seventh Day Adventists (SDA) andBaptists (BAP) do not consume tobacco, alcoholand live by a vegetarian lifestyle. In this study, wereport the mortality experience among members ofSDA and BAP in Denmark. METHOD: Weobtained information on all members of the DanishSDA since 1920 and for member files in localBaptist churches and linked this with Causes ofDeath registry and Danish Central Civil Registra-tion System to identify the members. We identified86% of SDA records and 96% of BAP recordsresulting in a sample of 7.491 Adventists and 3.942Baptists. Comparisons of all-cause and causespecific with the general Danish population stan-dardized according to age and period werecomputed. RESULTS: The standardized mortalityrates among Adventists and Baptists compared tothe Danish general population will be presented atthe conference. CONCLUSIONS: The conclusionwill be presented at the conference.


DOI: 10.1002/pon

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A-662

Patient Satisfaction Instruments for Cancer Clinical

Research or Practice: A Systematic Review

Anne Bredart1, Serge Sultan2, Antoine Regnault3

Institut Curie, Paris, Ile-de-France, France1, UniversityParis Descartes, Boulogne Billancourt, I le-de-France,France2, MAPI Values, Lyon, Rhone Alpes, France3

OBJECTIVES: Cancer patient satisfaction assess-ment is increasingly considered accounting for theneed to assess evolving patterns of care organisationand delivery, or to test new cancer treatments andinterventions. Satisfaction or dissatisfaction with carecan also influence patient behaviour and consequentlyimpact on care results. This presentation will reviewpatient satisfaction questionnaires specifically vali-dated for the field of oncology, using key methodo-logical criteria for assessing patient-reported outcomemeasures. METHOD: Questionnaires were identifiedfrom 2 previous literature reviews and a literaturesearch undertaken on Medline with the search terms‘patient satisfaction’ combined with ‘outcome assess-ment (health care)’ or ‘outcome and process assess-ment (health care)’ and ‘neoplasms’ (2006-April2009), limited to adults aged more than 18 years oldand of English language, excluding questionnairesaddressing the cancer genetic testing and screeningservices; surveillance phase of cancer; patients’preferences; or one aspect of care only. RESULTS:Seventeen cancer patient satisfaction instrumentswere identified. Most of these were developed withthe input of the target population, bearing onvarious cancer care contexts or treatments, demon-strating reasonable psychometric robustnessalthough reproducibility or responsiveness were lessoften demonstrated. Among the 8 instrumentsavailable cross-culturally, little information wereprovided on the translation/adaptation results.Seven instruments were used in studies or psycho-metrically revised. CONCLUSIONS: Given thecurrently existing standardised cancer patient satis-faction instruments, rather than creating new tools itmay be wise to build on these to allow forcomparisons and interpretation of satisfaction scoresacross cultures/languages, cancer treatment or careprograms. Satisfaction measures have to be relevant tothe context and purpose of each particular situation.Therefore, measures could encompass core/genericitems complemented by new ones designed forparticular cancer treatment or care experience.

A-663

Consumers’ Involvement in Optimizing Written

Information in Clinical Cancer Trials - Experiences

from Using Patient Advocate Focus Groups

Pia Dellson, Mef Nilbert, Christina CarlssonDepartment of Oncology, Institute of ClinicalSciences, Lund University, Lund, Sweden

OBJECTIVES: Interest in involving people af-fected by cancer in research is growing worldwidebut, apart from in the USA, the UK, Canada andAustralia, publications about this are scarce.Written patient information is important in clinicalcancer trials but is often unnecessarily complex. Tooptimize this information, we wanted to investigatea method for collecting consumers’ opinions onwritten information using focus group interviewswith patient advocates, recruited through Swedishpatient associations. METHOD: We invited pa-tient associations to recruit informants withexperience of breast or colorectal cancer withinthe last three years to participate in focus groups.The groups were to examine seven written patientinformation texts for clinical trials with a palliativeand adjuvant intent. The informants received thetexts a few days prior to the interviews, as this isthe time given to participants in the clinical settingto decide whether they wish to participate.RESULTS: The patient associations were able toprovide us with suitable informants rapidly andefficiently, according to our specifications. Basedon their own cancer experience, the informantswere able to contribute valuable patient aspects.The information extracted from the focus groupinterviews covers a wide range of concrete view-points on written information that can be highlyuseful for guiding authors in writing patientinformation in the future. CONCLUSIONS: Usingpatient associations for recruiting informants tofocus group interviews proved to be a rapid andefficient way to collect proposals for improvementsof written patient information for clinical cancertrials, based on patients’ experience. This can be auseful method for developing consumers’ involve-ment in oncology research.

A-664

Caregivers, especially males and the young, often do

not perceive they have emotional support from their

spouses and family. Who does provide it?

Catherine M Burns1, Jane Whelan1, Bryan Burme-ister1

Palliative & Supportive Care, School of Medicine,Flinders University, Adelaide, South Australia,Australia1, Department of Radiation Oncology,Princess Alexandra Hospital, Brisbane, Queensland,Australia2, Department of Radiation Oncology,Princess Alexandra Hospital, Brisbane, Queensland,Australia3

OBJECTIVES: To describe the sources of emo-tional support available to the family caregiverincluding a specific examination of the nature ofemotional support that the caregiver indicates isavailable from the patient diagnosed with cancerfor whom they are providing care. METHOD:Subjects were caregivers of advanced cancer


DOI: 10.1002/pon

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patients identified consecutively when presenting ina Radiation Oncology clinic. Questionnaires werecompleted by 110 caregivers using an array ofstandardised instruments. Additionally, subjectscompleted a questionnaire to obtain socio-demo-graphic data and patients’ medical data wascollected from their medical records. The care-givers were also asked if they had any currenthealth conditions. RESULTS: While 92% ofpeople could share their feelings only 60% ofpeople identified their spouse or partner. Thesenumbers were higher when the spouse was thepatient. The family was an important resource for80% but significantly less so for males (62%,p5 0.032). Friends were important for two thirds,the doctor for one third of males and females andolder people but significantly less so for the young(6.3% p5 0.049). Presentation will expand. CON-CLUSIONS: Many couples have difficulty provid-ing emotional support to each other. Many menand younger people do not use the familyemotional resources. Doctors are an importantemotional resource not only for patients but alsotheir caregivers. Young caregivers however con-tinue to be invisible in the health sector. Continu-ing review of psychosocial assessment aproaches isrequired to identify the vulnerable together withconsideration of just what interventions may reallyhelp.

A-667

Anxiety and associated Factors in Women at High

Risk of Breast Cancer due to a Familial or Genetic

Predisposition initiating Intensive Surveillance

Anne Bredart1, Jean-Luc Kop2, MouhamadouFall1, Sylvie Dolbeault1, Sandra Pelissier1, CecileSimondi1, Alain Livartowski1, Anne Tardivon1

Institut Curie, Paris, Ile-de-France, France1, NancyUniversity, Nancy, Lorraine, France2

OBJECTIVES: Intensive surveillance in women athigh risk of breast cancer due to a familial orgenetic predisposition is currently investigated in aFrench magnetic resonance imaging (MRI) screen-ing prospective multi-centre study in which annualstandard screening with mammography is com-pared to mammography combined with MRI,provided to women depending on their level ofbreast cancer risk. This study assesses psychologi-cal distress and associated factors in these womeninitiating intensive surveillance. METHOD: 1561women were invited to complete generic (STAIState Anxiety Inventory), cancer specific psycholo-gical distress (IES Impact of Event Scale) and riskperception questionnaires within one week beforethe first screening. Socio-demographic (age, educa-tion level, professional, marital status) and clinicalinformation (personal or family breast cancerhistory plus: for the ‘MRI’ group, possible

BRCA1/2 genetic result, previous breast or anyMRI, prophylactic oophorectomy or hormonetreatment; for the ‘Mammography’ group, border-line lesions history) were collected. RESULTS:Response rates were high (491%). Mean ages(47.6 for ‘MRI’/53.1 for ‘Mammography’) differedsignificantly so as education level with ‘MRI’women of higher education level (48.8% versus37.7%). High levels of state anxiety were observed(40.9 for ‘MRI’ and 41.6 for ‘Mammography’).‘MRI’ women perceived a higher breast cancerrisk. In multivariate analyses, personal history ofbreast cancer, standard mammography screeningmodality, higher cancer specific distress and riskperception significantly increased state anxietyscores (31.3% variance explained). CONCLU-SIONS: Psychological variables and personalcancer experience predominantly affect anxiety inwomen at high risk of breast cancer initiatingintensive surveillance. However, anxiety was alsorelated to the modality of breast cancer screening:although of lower breast cancer risk, womenundergoing the standard mammography evidencedhigher levels of anxiety compared to those about toreceive a complementary MRI, suggesting moreapprehension for breast cancer discovery in thesewomen or reassurance in women selected for MRI.

A-671

Soft Handling: Reiki Intervention for the Italian

Inpatients With Breast Cancer

F Lagattolla, R Montanaro, F Romito, C Cormio,V Trojano, G Colucci, V MattioliNational Cancer Institute ‘Giovanni Paolo II’, Bari,Italy

OBJECTIVES: Psychological distress associatedwith mastectomy includes anxiety due to the lost ofa gender symbolic part of the body. The purpose ofthis study was to improve the well-being in breastcancer inpatients undergoing mastectomy by thecomplementary Reiki treatment, and to evaluatethis technique in reducing the levels of anxiety.Reiki treatment was proposed like a psycho-bodyintervention to promote deep relaxation and tosupport the surgical inpatients. METHOD: Asample of 40 women from 26 to 70 years(MD5 55) with breast cancer was enrolled. Theindividual Reiki treatment was carried on in acomplementary therapy setting of the Breast Unit.Every patient received three Reiki sessions lastedabout 1.5 hour each one: two sessions before andthe last one after surgery. The effects of thesetreatments were controlled by S.T.A.Y - Y1administered before and after each treatment.RESULTS: The findings of this study showed animprovement of the perceived well-being in thesample of these breast cancer inpatients, with asignificant decrease of the anxiety (p5 0, 000) after


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the soft handling Reiki treatments. The paired Ttest evidenced these changes in the average; thelevels of anxiety between before and after the threeReiki treatments changed significantly: beforeM5 92%, M5 86%, M5 71%; after M5 60%,M5 54%, M5 27%. CONCLUSIONS: At theend of this trial, many women expressed positiveopinions about this supportive care and describedthe feelings of sweet heat through the Reikicontact. The emotional distress felt by the womenundergoing mastectomy, could be lightened withReiki giving the patients a sensation of reassuring,soft, psychological holding and caring. Reikishould be integrated with standard care because itimproves well-being and accompanies the patientalong such a traumatic journey in woman’s life.

A-676

Humanization of Care in a Decentralized Oncology

Attendance Model

S.M. Santiago, M.G.G. AndradeState University of Campinas, Campinas, SaoPaulo, Brazil

OBJECTIVES: The oncology attendance modelfocused on specialized facilities places obstacles tothe care of the ones who live far from them,producing difficulties for access and suffering,mainly in palliative care. The purpose of the studywas to analyze change perception of patients andhealth professionals related to treatment conditionsand entailment observed in an experience ofpalliative chemotherapy decentralization to ahealth facility close to their homes. Communica-tion with referral service was emphasized. METH-OD: Health professionals (doctors, nurses,technicians) and 18 cancer patients of the decen-tralized facility were interviewed. The approachedthemes were: meaning of decentralization assis-tance; advantages and disadvantages perceived;care quality; patients perceptions of their healthcondition; relationship between decentralized facil-ity and referral regional service. Recommendedethical procedures for qualitative research wereobserved. The material was submitted to thethematic analysis of contents to capture patients’and workers’ opinions. RESULTS: Quality oftechnical attention delivered in the decentralizedservice was observed by the sensible use of sameprotocols from the referral service, their supportand fluid communication. Doctor and nurses teamconsidered the work rewarding for the humaniza-tion and recognition of patients and families.Patients related that closeness to workers helpedthe treatment to be more bearable and trustful andthere was a perception of comfort in a painfulphase of illness and life. CONCLUSIONS: Theexperience calls for the enlargement of access to theoncology comprehensive care and the strategic role

of the relationship among health professionalsfrom different assistance levels. It valorizes the lifequality of patients and the entailment enlargementwith the health professionals. The humanizedaccess to qualified health care needs the construc-tion of a closer relationship between the healthteams from specialized services and local systemallowing support to patients, families and healthprofessionals.

A-680


Cancer Related Distress: Part III - Does Screening

Aid Clinicians’ Quality of Care?

Alex J Mitchell1, Nadia Hussain1, LorraineGrainger2, Paul Symonds1

University of Leicester, Leicester, United Kingdom1,University Hospitals of Leicester, Leicester, UnitedKingdom2

OBJECTIVES: Cancer clinicians are often unableto accurately identify distress or treat distress inroutine care. We aimed to examine the effects of asimple screening programme based around theEmotion Thermometers (ET) on clinicians qualityof care, specifically their willingness to offerappropriate treatment or referral. METHOD: Weasked chemotherapy nurses of the Leicester RoyalInfirmary to give us their clinical opinion beforeand after screening 352 patients for distress,anxiety/depression. Each were defined by a scoreof 4 or higher on the ET. We measured theinfluence of patient and clinician reported distresson the willingness of clinicians to offer reasonablequality psychosocial care across all nurse-patientinteractions. RESULTS: No action was taken in59.4%. Of those helped, a referral was made in25.9% of cases. In those who screened high vs low,34.9% vs 14.8% received reasonable care (ChiPo0.001). 55 patients expressly wanted help, andof these 54.5% were helped. In 140 whom cliniciansconsidered unwell 50% were helped (vs 34% ChiPo0.001). In those with neither patient reported orclinician evaluated distress 10/90 (11.1%) wereoffered help. CONCLUSIONS: The introductionof screening programme for distress appears toincrease the quality of care provided to patientswho have self-reported distress, by clinicians whorecognize this distress. However even with theprogramme about half of patients who want helpmay not receive it.

A-681

Long-Term Follow-Up Of Childhood Cancer

Survivors In Quebec

Caroline LaverdiereCentre Hospitalier Universitaire Sainte-Justine,Montreal, Quebec, Canada


DOI: 10.1002/pon

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OBJECTIVES: The progress of the treatments forchildhood cancer has been such that the survivalrate of children treated for cancer is now over 75%.These treatments are however associated long-termmorbidity. Approximately 75% of childhoodcancer survivors develop chronic medical compli-cations, and 40% have at least one severecomplication. Medical follow-up of these patientsis therefore very important. METHOD: The long-term follow-up program of the Centre HospitalierUniversitaire Sainte-Justine, in Montreal, Quebec,was started in 2005. 350 patients are now followedin the program. Based on our experience, weidentified successful initiatives, problems and chal-lenges. RESULTS: Several successful initiativeswere developed, including one-day informationsessions for survivors of children cancer who arenow young adults or teenagers, a financial assis-tance program for long-term complications ofchildhood cancer, a hiking trip in the AdirondackMountains for cancer survivors, diverse educationactivities and research studies. Problems encoun-tered are related to both physicians and patients,and are especially important when transferring thecare of a young adult childhood cancer survivor toan adult hospital. CONCLUSIONS: Future pro-jects and challenges include the development of amultidisciplinary clinic for the follow-up of adultsurvivors of childhood cancer, and the creation ofprovincial and national databases. Because of thefrequent and potentially serious complications ofchildhood cancer treatment, long-term medicalfollow-up of childhood cancer survivors is veryimportant. In addition to medical care, a long-termfollow-up program should include social initiativesand activities, to improve the quality of life of thesepatients.

A-682

Maximizing Your Patient Education Skills

(MPES): A Multi-site Evaluation of an Innovative

Patient Education Skills Training Course for

Oncology Health Care Professionals

Jennifer M. Jones1, Janet Papadakos1, CathyBennett5, Susan Blacker3, Pamela Catton1, TamaraHarth2, Jane Hatton-Bauer4, Krista McGrath6,Farrah Schwartz8, Gale Turnbull7, Tara Walton1,Audrey Jusko-Friedman1

Princess Margaret Hospital, Toronto, Ontario,Canada1, Odette Cancer Centre, Toronto, Ontario,Canada2, St. Michael’s Hospital, Toronto, Ontario,Canada3, Grand River Regional Cancer Centre,Kitchener, Ontario, Canada4, Juravinski CancerCentre, Hamilton, Ontario, Canada5, Carlo FidaniPeel Regional Cancer Centre, Mississauga, Ontario,Canada6, London Regional Cancer Centre, London,Ontario, Canada7, Toronto Rehabilitation Institute,Toronto, Ontario, Canada8

OBJECTIVES: Many oncology HCPs lack theknowledge and skills needed to communicateeffectively with and to identify and support thelearning and informational needs of patients andfamilies, and few programs offer sufficient trainingin this area. In response, an innovative and inter-professional course, Maximizing Your PatientEducation Skills (MPES), was developed. Thecurrent study evaluated the acceptability andrelevance of MPES and its impact on knowledgeregarding PE and communication theory, self-assessed competencies, and skills. METHOD:Multi-site (n5 7), one-group, pre-post interven-tion. All participants participated in the 4-hourMPES course. Baseline (Pre-course T0) and 3-month post course (T1) assessments included a PEknowledge questionnaire, the Self-Assessed PECompetency Questionnaire, and 2 clinical casevignettes. In order to inform the results and gatherfurther feedback on the course, a focus group wasalso conducted with a sub-set of participants.RESULTS: 130 HCPs completed T0 measuresand took the MPES course; 98 (75%) completedthe T1 post-course assessment. Participants werehighly satisfied with MPES and found it to berelevant. There were highly significant improve-ments (po0.001) on all outcomes. Effect sizes forpre-post mean change scores on knowledge andself-assessed competencies �1 SD and 0.5–0.70 SDfor skill change. Focus group data providedvaluable information on how MPES affectedpractice and feedback on the course format.CONCLUSIONS: Given the evidence that well-planned education and support can contribute to anumber of positive health outcomes and theevidence that HCPs may lack the skills to teachand support patients and their families effectively,these results suggest that MPES course may be ofvalue to oncology professionals. Efforts to furtherdevelop this course include exploring alternativefunding models and using different learningplatforms.

A-687

The Experiences of Patients Referred for Colorectal

Symptoms on a Rapid Referral ‘Two Week Rule’ -

An Examination of Quantitative and Qualitative

Data from Two Hospitals

Nenna Ndukwe1, Kate Jenkins2, GrahamBranagan2, Lydia King2

James Cook University Hospital, South Tees,United Kingdom1, Salisbury Foundation NHS Trust,Salisbury, United Kingdom2

OBJECTIVES: The UK Department of Healthintroduced the two week rule for all suspectedcancer referrals in 2000. Little work has exploredpatient experience and the psychological impact of


DOI: 10.1002/pon

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this in the context of colorectal referrals, despitethe role that psychological issues may play in thedevelopment and exacerbation of symptoms. Thisresearch aims to improve understanding of theissues that surround investigation of colorectalsymptoms by exploring the experience and psycho-logical impact on patients. METHOD: HADScales were administered to over 800 patientsattending four Colorectal Clinics (Outpatients -for a palpable mass or change in bowel habit,Rectal Bleeding, Colonoscopy and Barium Enema)under the two week rule. Semi-structured inter-views were also conducted with a purposive sampleof ten participants (two men and eight women)aged between 37 and 78 years old. Qualitative datawere analysed using interpretative phenomenologi-cal analysis (IPA). RESULTS: 18.2% of patientsscored in the clinical range for anxiety and 7.1%for depression. When divided by clinic type, thoseattending Rectal Bleeding and Outpatients ap-pointments showed the highest anxiety levels (21.5and 31.3% respectively). Four super-ordinatethemes emerged from the interview data with anumber of sub-themes which highlighted anxiety,uncertainty and the sense of vulnerability asso-ciated with the two week rule process, withmeaningful information as a potential mediatingfactor. CONCLUSIONS: Health care services needto support and meet the information needs ofpeople referred by the two week rule in order toreduce the psychological effects of this process. It ispossible that information regarding the implica-tions of the two week rule and certain symptomscould be improved. Understanding mediatingfactors enables services to provide the best carefor patients and also improve adherence to thereferral process and overall satisfaction withservices provided.

A-689

The MUHC Psychosocial Oncology Program: An

Innovative Program Meeting the Needs of Oncology

Patients and Family Members

Hamel Marc, Mehta AnitaMcGill University Health Center, Montreal,Quebec, Canada

OBJECTIVES: Innovative psychosocial oncologyprograms need to be created to meet the needs ofpatients and family members. The McGill Uni-versity’s Health Center (MUHC) PsychosocialOncology program has been in operation sinceJanuary 2008. While still in its infancy, thisprogram has been driven by the specific needs ofthe patients and their family members. This talkwill present the development of this innovativeprogram, its’ team composition and descriptionof the population its serves. METHOD: The

Psychosocial Oncology program is available to allMUHC cancer patients and family members whoare experiencing: 1) problems with mood (e.g.depressed and/or anxious) and/or 2) problems withcoping. The program employs a standardizedtriage process once a referral is made. All patientsand family members who are referred to theprogram are contacted within 48 hours of receivingthe referral. Appropriate interventions are offeredbased on the needs of the referred person.RESULTS: The MUHC Psychosocial Oncologyprogram receives over 500 referrals per year. First,the uniqueness of this program including its triageprocess will be highlighted. Second, data will bepresented on the types of referrals received andprovide a description of the psychosocial profiles ofthe patients and family members seen. Third, dataon patients and family member’s satisfactionwith the program will be presented. Finally,interventions inherent in our program will bepresented. CONCLUSIONS: Since its inception,the MUHC Psychosocial Oncology program hasbecome an integral part of oncology care at theMUHC. Psychosocial interventions are geared tohelp patients and family members to helpreduce distress and foster hope in meeting thechallenges that living with cancer presents. Theprogram has also helped to build greater inter-disciplinary collaboration between the diversedisciplines to meet the needs of the patients andfamily members.

A-690

Finding Meaning of the Loss: Bereaved Cancer

Caregivers

Youngmee Kim1, Rachel Spillers2, Charles Carver1

University of Miami, Coral Gables, Florida, UnitedStates1, American Cancer Society, Atlanta, Georgia,United States2

OBJECTIVES: Substantial proportion of familycaregivers has reported difficulty in finding mean-ing of the death of the relative with cancer. Thisstudy examined the demographic and psychologi-cal predictors of the extent to which cancercaregivers report diverse aspects of finding meaningout of their bereavement experience. METHOD:Bereaved caregivers (n5 180) were identified froma larger longitudinal cancer caregiver study at the8-year follow-up phase (time since the death5 3.8years). Demographic predictors included age,gender, education, and spouse to the care recipient;Psychological predictors included the extent towhich caregivers perceived caregiving stress (Pear-lin’s stress overload scale) and self-esteem as acaregiver (CRA caregiver esteem scale). Diverseaspects of finding meaning were measured usingthe Benefit Finding (BF) scale targeting for


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bereaved populations. RESULTS: Multivariatehierarchical general linear modeling on the sixaspects of BF revealed that the bereavementexperience brought female caregivers to be moreempathic, appreciating life, having positive self-view, and re-prioritizing values in life (pso0.04);and spouses to be more accepting what happenedand getting closer to family members (pso0.03).Additional variance in become more empathicwas predicted above and beyond the demographicsby caregivers’ competence in the caregiver rolewhile they were providing care (po0.04). CON-CLUSIONS: Results suggest that male andnon-spousal caregivers would have more difficultyin finding meaning from the bereavementexperience. Psychosocial programs for caregivers,particularly targeting male and non-spousalcaregivers, aimed to improve competence andmastery in cancer caregiving may help themfind meaning after the death of their carerecipient.

A-694

Child Mental Health Prevention In The Context Of

Adult Medicine: A Randomized Controlled Trial Of

A Manualized Preventive Counseling Program For

Children Of Parents With Cancer

Birgit Moeller, Thomas Krattenmacher, GeorgRomerUniversity Medical Center Hamburg, Hamburg,Germany

OBJECTIVES: Evidence shows children of cancerpatients are at a high risk for developing mentalillnesses. A preventive counseling program forpopulation was developed and positively evaluatedby both parents and children (process/outcome).Efficacy of this manualized preventive counselingprogram for children and adolescents of cancerpatients is to be tested in a randomized controlledtrial with measurements before and after treatmentas well as a 6 month follow-up to assess treatmentsuccess stability. METHOD: Design: Two-grouprandomized trial with intervention and wait-list-control comparison conditions and a 6-month-follow-up. Setting and participants: 140 familiesare recruited within a two years period. Outcomemeasures and analysis: a) in children: health relatedquality of life, emotional symptoms or strain; b) inparents: parental competence, depression, anxiety;c) in family: family functions (communication,emotions, affective responsiveness, general level offunctioning, family coping, reduction of parentifi-cation); d) furthermore therapeutic attitudes, clin-ical practice, manual coherence. RESULTS:Preliminary results will be presented at the meeting.CONCLUSIONS: Preliminary conclusions will bepresented at the meeting.

A-695

The Relation of Meaning in Life, Quality of Life,

Distress, Coping, and Social Support in a Sample of

Austrian Colon Cancer Patients and Healthy Controls

Gabriele Dietmaier1, Elisabeth Andritsch2,Hellmut Samonigg2

University of Graz, Department of Psychology,Graz, Austria1, Medical University Clinic Graz,Clinical Division of Oncology, Graz, Austria2

OBJECTIVES: Colon cancer is the most commonmalign disease for both: men and women. Thispotentially life threatening illness implicates anextreme physical and emotional burden for thepatients and their partners. This study tries toascertain, if it is possible to perceive one’s life assatisfying and meaningful, notwithstanding theexistential anxiety being initiated through thediagnoses colon cancer. Do distress, coping styles,and the social support of partners influence patient’squality of life? METHOD: 112 colon cancerpatients, stage I and II, without stoma, a KarnofskyIndex of 80 to 100, being in remission were recruited5 years after diagnosis. 51 healthy controls werematched to a subsample of patients, who lived in apartnership, in age, gender, and education. Distress,coping styles, social support, quality of life andsubjective fulfilment in meaning of life were assessedwith standardized instruments. Data were analysedwith MANOVAs and linear regression analyses.RESULTS: Patients living in a partnership reportmore social support. Male patients gain more socialsupport than female ones, who have a higheranxious preoccupation. Quality of live of thepatients can be explained (R5 0.799) by lowerdistress, avoidance, and better social support. Mean-ing in life is predicted (R5 0.776) by lower obses-siveness and paranoia and better cognitive and bodyfunctions. Patients report a higher level of meaningin life than healthy controls. CONCLUSIONS: It ispossible to perceive one’s life as satisfying andmeaningful, notwithstanding the existential anxietybeing initiated through the diagnoses cancer. Inaddition, the results of this study punctuate thenecessity for further research with colon cancersurvivors to learn more about their needs years afterthe diagnoses. The results of this study emphasizethe importance of a bio-psycho-social model intreatment and support of colon cancer patientsincluding the social environment of the patients.

A-697

Physical, Psychological and Social Difficulties Ex-

perienced by Cancer Patients: Correct and False

Detection by their Primary Caregivers

Yves Libert1, Isabelle Merckaert2, Darius Razavi2

Institut Jules Bordet, Brussels, Belgium1, UniversiteLibre de Bruxelles, Brussels, Belgium2


DOI: 10.1002/pon

Oral Abstracts S173

OBJECTIVES: Family caregivers are increasinglyinvolved in cancer care and are often an importantsource of information for clinicians as regardspatients’ difficulties. The aim of this study is toassess primary caregivers’ correct and false detec-tion of patients’ physical, psychological and socialdifficulties and to investigate patients’ and care-givers’ sociodemographic and psychological vari-ables associated with correct and false detection.METHOD: This is a multicentered, cross-sectionalstudy. Consecutive patients and caregivers com-pleted the Hospital Anxiety and Depression Scale,the Ways of Coping Checklist and the CAncerRehabilitation Evaluation System (CARES). Care-givers reported their perception of patients’ diffi-culties on an adapted CARES version. Correctdetection rates are the percentage of difficultiesexperienced by patients and reported by caregivers.False detection rates are the percentage ofdifficulties not experienced by patients butreported by caregivers. RESULTS: Caregivers’correct detection rates were 67% for physicaldifficulties (SD5 29), 69% for psychological diffi-culties (SD5 31) and 40% for social difficulties(SD5 38). False detection rates were 28% forphysical difficulties (SD5 24), 37% for psycholo-gical difficulties (SD5 31) and 22% for socialdifficulties (SD5 27). Significant correlations werefound between all correct and false detectionrates (r ranging from 0.347 to 0.548; po0.001).Other variables collected are only weakly asso-ciated with these caregivers’ levels of detection.CONCLUSIONS: Although caregivers perceivedcorrectly two third of physical and psychologicaldifficulties experienced by cancer patients, theyminimized their social difficulties. Moreover, pri-mary caregivers falsely detected physical, psycho-logical and social difficulties. Clinicians should beaware that primary caregivers’ correct detection ofpatients’ difficulties also leads them to falsely detectdifficulties not experienced by patients. Caregiverssupport should take these results into account.

A-703

Complementary Medicine Decision Support in the

Conventional Cancer Care Setting: Application of

the Supportive Care Framework

Lynda Balneaves2, Tracy Truant1, Marja Verhoef3,Brenda Ross1, Margurite Wong1, Antony Porcino2

British Columbia Cancer Agency, Vancouver,British Columbia, Canada1, University of BritishColumbia School of Nursing, Vancouver, BritishColumbia, Canada2, University of Calgary, Depart-ment of Community Health Sciences, Calgary,Alberta, Canada3

OBJECTIVES: A gap in care exists in many cancersettings where patients do not receive the necessary

support to make safe and informed decisions aboutcomplementary medicine (CAM). Little is knownabout how best to address this gap. This presenta-tion will outline how the Supportive Care Frame-work (SCF) (Fitch, 1994) has informed thedevelopment of a research program addressingthe CAM information, education and decisionsupport needs of patients, embedded within aconventional cancer setting. METHOD: Usingthe SCF as a guiding framework and a variety ofquantitative and qualitative methodologies, amulti-project CAM education and decision supportresearch program was conceptualized and estab-lished within a provincial cancer agency. Applica-tion of the SCF led to the development of acontinuum of patient interventions that addresseda range of information and decision support needsfrom basic to complex. These interventions arecurrently being tested within a living laboratorycontext. RESULTS: The SCF and findings suggestthat most patients have basic CAM informationneeds that can be addressed through general CAMinformation resources. Those patients with morespecific CAM information and decision supportneeds require tailored group education programs,decision aids, and workbooks. A structured one-on-one decision support program is appropriatefor those few patients with complex CAM in-formation and decision support needs. Theseinterventions have shown positive effect on thequality of patients’ CAM decisions. CONCLU-SIONS: The SCF is an effective conceptual frame-work to conceptualize, develop, evaluate andprovide CAM information and decision supportinterventions within conventional cancer caresettings. This framework also provides an impor-tant tool for cancer care organizations to efficientlyplan and allocate decision support services, inalignment with the range of CAM needs experi-enced by patients with cancer.

A-705

Caregivers and Peer Support

Heather SinardoCanadian Cancer Society, Toronto, Ontario, Canada

OBJECTIVES: This research was undertaken inorder to better understand the needs and expecta-tions of caregivers related to peer support.Through focus groups with caregivers from thegeneral population, the study sought to betterunderstand caregivers’ expectations of peer sup-port, what criteria should be considered whenmaking a match with a peer volunteer, timing ofthe support and how to promote the programeffectively. METHOD: In 2007 eighteen focusgroups were held in six Canadian cities (N5 69).Later that year 21 more focus groups were held


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(N5 106). Participants were 18 and over andcaring for someone diagnosed with cancer in thepast five years. Recruitment ensured minimumnumbers of male participants and a variety ofcancer diagnoses, levels of caregiving and phaseson the cancer continuum. Participants were com-pensated $60 upon completion of the focus group.RESULTS: There was consistency across all focusgroups regarding their need for peer support.Participants identified three main supportive careneeds - emotional, bereavement and informationalsupport. Caregivers want a ‘good listener’, some-one who can empathize with their situation and isnon-judgemental. They want someone who is goingto be honest, yet offer hope when appropriate.The most common matching criteria identifiedwere life situation, cancer diagnosis, relationshipto patient and geography. CONCLUSIONS:There is a tremendous demand for caregiver peersupport. On an unaided basis, participants con-sistently expressed a desire to speak with someonewho had been through a similar experience.Participants expressed concern that there areprograms available but they were not aware ofthem. They identified word of mouth referralsfrom people who have used the service orrecommendations from health care professionalsas the most effective ways to promote peer supportprograms.

A-707

Program Impact of a Cancer Information and Peer

Support Program

Heather Sinardo1, Barbara Zupko2

Canadian Cancer Society, Toronto, Ontario, Cana-da1, Propel Centre for Population Health Impact,Waterloo, Ontario, Canada2

OBJECTIVES: Program evaluations were carriedout for the information and peer support programsof a Canadian charitable organization during 2008.They were designed to identify client-perceivedimpacts of receiving service and measure clientsatisfaction. Findings demonstrate how theseprograms can augment help available within thetraditional health care setting. They also help theorganization continue improving the programs.METHOD: To evaluate the information service, a10–15minute structured telephone interview wasconducted with eligible clients. Recruitment wasdone by the service and the interviewing wascarried out by a third-party research groupassociated with a major Canadian university. Allpeer support clients whose service ended during theyear were mailed a survey to respond to anon-ymously, measuring satisfaction and impact of theprogram using closed and open ended questions.RESULTS: Information Service: N5 1010. Most

(92.3%) said their contact with the service helpedin at least one of a variety of ways includingcoping, anxiety or stress. Nearly all respondentstook at least one positive action (96.4%) as a resultof contact with the service. Peer Support: N5 762.Respondents reported an increase in their sense ofhope (97.3%), decreased anxiety (94.9%), in-creased sense of efficacy to cope (95.7%) orincreased feeling of being supported (96.2%).CONCLUSIONS: Information and peer supportprograms help clients understand living withcancer and help them feel more comfortabletalking to health care providers and family. Theprograms increased hope, decreased anxiety andmade clients feel better able to cope. This sessionwill provide an understanding of the credibilityand effectiveness of the supports availablethrough this organization. It will also share howresults are being used to continually improve theseprograms.

A-708

An Investigation Of The Effect Of A Coping

Strategies Intervention In People With Head And

Neck Cancers

Paul J Allison, Katia Muller, Linda EdgarMcGill University, Montreal, Quebec, Canada

OBJECTIVES: The study aim was to investigatethe effect of a psycho-educational intervention onpeople with head and neck (H&N) cancers. Thetest intervention is designed to foster copingstrategies in people with cancer and comprises apackage delivered by a trained therapist deliveredover 3–4 sessions during a 3–4 week period. Theoutcomes of interest were coping strategies, symp-toms of anxiety and depression and quality of life.This paper reports results concerning copingstrategies. METHOD: A placebo-controlled, ran-domized study design was used. Subjects werepatients with a confirmed first H&N cancer,recruited in Montreal hospitals, after their cancerablative therapy, 6–12 months following diagnosis.To be included, subjects had to have a score of 8 onone or both of the anxiety and depression scales ofthe HADS. Outcomes were evaluated at 2 and 4months following randomization. Coping strate-gies were evaluated using the Ways of CopingChecklist (WOCC). RESULTS: The original sam-ple comprised 85 subjects, randomized approxi-mately equally into test and placebo groups.Sample numbers at 2 and 4 month evaluationpoints were 57 and 46 respectively. WOCC scoresat baseline were the same for test and placebogroups. At 2 months, the ‘blamed self’ strategywas used significantly less in the test group, andat 4 months, the ‘wishful thinking’ strategywas used significantly less by the test group.


DOI: 10.1002/pon

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CONCLUSIONS: This study shows the limited,short term benefits of a psycho-educational inter-vention in H&N cancer patients. Of the 5 copingstrategies evaluated by the WOCC, two wereimpacted by the test intervention in the hypothe-sized manner.

A-712

Addressing Cancer Patient Needs: Provision Of

Care By Specific Health Providers

Reena S. Hansen1, Konrad Fassbender2, ArmineeKazanjian3, Richard Doll4

University of Alberta, Edmonton, Alberta, Canada1,University of Alberta, Edmonton, Alberta, Canada2,University of British Columbia, Vancouver, BritishColumbia, Canada3, BC Cancer Agency, Vancouver,British Columbia, Canada4

OBJECTIVES: Improved knowledge of the extentto which health providers meet the different needsof cancer patients can help define objectives of carefor specific health providers (Rasmussen B.H. andSandman P.O., 1998), and identify needs whichmight be better addressed by other initiatives(Mojtabai R. et al., 2002). The aim of this studywas to determine how cancer patients perceive thetime spent with specific health providers in addres-sing their care and information needs. METHOD:A framework was developed to characterize careand information needs into four categories: directphysical care, psychosocial care, education, andnavigation. Patients in active treatment for cancerwere asked to report their use of health servicesduring two telephone interviews. The amount oftime spent addressing the four categories of careand information needs was determined for ap-pointments with the following health providers:nurse, family physician, oncologist, and socialworker. RESULTS: Eighty-five percent of partici-pants were female and average age was 57. A totalof 20 patients reported 203 patient-clinician en-counters (137 nurses, 17 family physicians, 47oncologists and 2 social workers). Face-to-facetime with clinicians averaged 58.6, 18.1, 23.8 and32.5minutes, respectively. Patients report that allhealth providers address varying amounts ofpsychosocial care and education. Nurses and socialworkers, however, provide the majority of naviga-tion services. CONCLUSIONS: Understanding thedegree to which specific health providers addressparticular care and information needs can helptarget delivery of services to cancer patients. Theseresults show that patients perceive specific healthproviders spend comparatively more or less timeaddressing needs within the four categories.Further research can help promote a continuityof care where the unique aims of specific health

providers combine to comprehensively address theneeds of cancer patients.

A-714

An Inter-professional Model of Care to Improve

Surgical Outcomes in Thoracic Oncology

Liane Murphy, Christine Blais, Chantal Bornais,Paul ChamberlandThe Ottawa Hospital, Ottawa, Ontario, Canada

OBJECTIVES: Traditional pre-operative teachingmethods in the pre-admission unit were resulting inpatient anxiety, families being unprepared to carefor their loved ones on discharge and staffdissatisfaction related to lack of communication.To address these issues, we developed a novelmethod of pre-operative teaching to engagepatients and families in their own care and recoveryfrom lung cancer surgery or metastatectomy.METHOD: Population: Lung cancer patients andpatients with lung metastases who have a plannedlung resection and their families/signifigant others.Patient age has ranged from sixteen years tooctogenarians. A teaching program, based onfeedback from patients/families received from2007 to 2009, was developed to:

� address the psychoeducational needs of bothpatients and families

� assess the pre-operative preparation needs ofthe patient

� introduce what is expected in the recoveryphase of care

� initiate discharge planning.

RESULTS: Patients and families are reporting agreater sense of preparation and active involve-ment in surgical and discharge planning. Inpatientstaff verbalize patients arrive on unit prepared toparticipate in the work of the recovery phase ofcare and as a result, in some cases, patients arebeing discharged sooner. Important unexpectedbenefits have been engagement of families/signifi-gant others in helping patient to prepare forsurgery and discharge planning. CONCLUSIONS:In preparing the outpatient teaching sessions,our focus was on the patient having access toappropriate information to facilitate surgical re-covery. The newly developed session provides aninter-professional focus involving nursing, socialwork and physiotherapy to maximize patientcomprehension and involvement. Assessmentand intervention of discharge barriers at timeof teaching has become an important addedbenefit from this session. In addition, communica-tion between the inpatient and outpatient teamshas evolved to problem prevent rather thancrisis solve.


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A-719

Searching For Hope In Brain, Lung, and Pancreatic

Cancers: A Collaborative Qualitative Research Study

Amy Pearson1, Maureen Rigney1, Anitra Engeb-retson2, Johanna Villaroel2, Jenette Spezeski3,Harriet Patterson3

Lung Cancer Alliance, Washington, DC, UnitedStates1, Pancreatic Cancer Action Network, El Segun-do, California, United States2, National Brain TumorSociety, San Francisco, California, United States3

OBJECTIVES: Literature on hope and cancerindicates that serious questions remain about therole of hope in advanced cancer, however thisresearch has primarily focused on end-of-life experi-ence. Our exploratory study examines the experienceof hope in long-term survivors of lung, brain, andpancreatic cancers - cancers of poor prognosis. Wewish to better understand the meaning of hope, therole hope plays, and what contributes to hope ortakes it away from these patients. METHOD: Semi-structured interviews of 30–60minutes with fivesurvivors of each of these three cancers wererecorded, transcribed and coded thematically todetermine how hope is conceptualized, what factorsgive or take away hope, and what role it playsthrough diagnosis, treatment, and survivorship.Participants completed an online version of theHerth Hope Index, a validated 12-item hope scale.RESULTS: Results confirmed a literature reviewfinding: there is no one definition of hope, but alsothat hope does not always mean ‘cure.’ Ourpreliminary analysis identifies major themes acrossdiagnosis groups and provides insight into themeaning, source, and role of hope in long-termsurvivors. Participants expressed an array of inter-pretations of and uses of hope, and indicatedactivities and communities that helped them buildand maintain hope, while also identifying triggersthat threatened hope. CONCLUSIONS: Manyparticipants emphasized the importance of feelinghopeful and participating in hope-fostering activities.For most, hope is a vital part of their cancerexperience, from early diagnosis to long-term survi-vorship. Health professionals should be aware of therole hope plays, especially in cancers of poorprognosis. They can promote hope by assessing somevery basic needs and directing patients to resourcesand supportive and psychosocial services that helpsurvivors understand and cope with their illnesses.

A-721

Understanding Racial/Ethnic Disparities in Quality

of Life in Young Women with Breast Cancer

Ann Norris1, Ann Chou1, Julie Stoner1, Joan Bloom2

University of Oklahoma, Oklahoma City, Oklaho-ma, United States1, University of California, Berke-ley, California, United States2

OBJECTIVES: Breast cancer diagnosis and treat-ment significantly impact women’s daily function-ing. However, little information is available thatdescribes health-related quality of life (QOL) inmulti-racial population cohorts. This study exam-ines differences in QOL outcomes among breastcancer patients by race/ethnicity, controlling forsocio-demographics, disease and treatment char-acteristics, social support and intrusiveness ofillness factors. METHOD: The population-basedcohort included 391 women diagnosed with breastcancer at age 50 years or younger. All subjects wereidentified by Rapid Case Ascertainment andcompleted questionnaires at baseline, four- and12-month follow-up. Change in QOL was mea-sured using the eight subscales and two compositescales from the SF-36 Medical Outcomes Survey.Associations between minority status and changein each of the ten QOL scales over the 12-monthperiod were estimated using linear regressionmodels. RESULTS: Race/ethnicity significantlyaffected all QOL scales, except the mental healthcomposite scale. Minority women saw a smallerimprovement in the QOL domains of physicalhealth composite, physical role functioning, emo-tional role functioning, emotional health, socialfunctioning, bodily pain, and vitality, compared totheir white counterparts. However, they saw alarger improvement in physical functioning andgeneral health. Other predictors in QOL changeincluded chemotherapy, radiation, greater intru-siveness of illness, and increased symptom severity.CONCLUSIONS: As probability of survivalamong women diagnosed with early stage breastcancer continues to rise, younger women withbreast cancer will have to deal with psychologicaland physiological stresses from their illness forlonger periods of time. Our findings identifiedimportant predictors for positive changes in QOLin minority women, enabling health care providersto develop strategies to address QOL concerns ofthese patients.

A-722

Treatment Decision Making among Older Indivi-

duals with Cancer: Exploration of the Concept and

Relational Context

Fay J. Strohschein, Howard Bergman, Franco A.Carnevale, Carmen G. LoiselleMcGill University, Montreal, Quebec, Canada

OBJECTIVES: Individuals with cancer face manydecisional tasks throughout the illness trajectory.For older individuals, variations in health andfunctional status, physiologic aspects of aging, andtension between quality and quantity of life presentunique challenges to cancer-related decision mak-ing. A better understanding of their decisionalprocesses is needed to offer optimal support. This


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presentation examines the concept of treatmentdecision making among older individuals withcancer in the existing literature, particularly attend-ing to relational context. METHOD: Throughcomputer-generated searches of scholarly works,relevant articles published between 1986 andDecember 2009 were identified. Articles consideringpatient decision making in general were identifiedand analyzed with consideration of the existingempirical papers examining treatment decisionmaking from the perspective of elderly individualswith cancer. Analysis and clarification of theconcept was done using the methods of pragmaticutility developed by Morse and colleagues. Sig-nificance of the relational environment was notedand explored. RESULTS: In-depth analysis sug-gests that among older individuals, cancer treat-ment decision making is an ongoing process,modified over time through personal and relationalfactors, integrating analytic and emotional compo-nents. Salient aspects of the relational environmentinclude family, interaction with health care profes-sionals and the broader socio-political system. Therole of family is particularly important for elderlycancer patients where limitations related to cogni-tion, functional status, and/or health literacy oftenimplicate family directly in cancer-related decisionmaking. CONCLUSIONS: Assumptions frequentlyassociated with ‘patient decision making’ are notconsistent with empirical literature consideringolder individuals with cancer. Decisions may notappear ‘rational’ in the way usually assumed byhealth professionals. Individuals’ choices areshaped by, and shape, their relational environment.Conceptual clarification and considerationof relational context are central to developing ascience that captures the meaning of cancer-related decision making for older individualsand their families, providing guidance forsupportive interventions and targeted follow-upcare.

A-730

Immediate and Long Term Effects of an Inpatient

Rehabilitation Programme on Emotional State and

Body Image in Breast Cancer Patients as Compared

to Appropriate Controls

Gertraud Gallhofer1, Sandra Schoene2, Petra Netter2

Clinic Taunus Rehabilitation Centre Bad Nauheim,Bad Nauheim, Germany1, Institute of PsychologyUniversity of Giessen, Giessen, Germany2

OBJECTIVES: So far no studies have investigatedrehabilitation effects in breast cancer patients byusing controls matched for identical motivation forparticipating in a hospital rehabilitation pro-gramme. Furthermore, previous studies in rehabi-litation have rarely addressed effects on the

deteriorated body image accompanying breastcancer surgery, chemotherapy and irradiation.Therefore the present study investigates rehabilita-tion effects on emotional states and body imagecomparing an inpatient sample with a postopera-tive control awaiting an inpatient rehabilitationprogramme. METHOD: 130 breast cancer patientswere tested after admission to a rehabilitation clinic(t1), after 3 weeks of treatment (t2), and 4 weeksafter discharge (t3) by questionnaires on bodyimage and emotional states, and at t1 and t2 a bodyimage computer test. Identical questionnaires wereapplied to 50 postoperative controls after comple-tion of radiotherapy and 3 weeks later beforeadmission to inpatient rehabilitation. Several de-mographic variables were additionally obtained inboth samples. RESULTS: There was a clearimprovement in positive emotionality and bodyimage from t1 to t2 compared to controls indicat-ing beneficial effects of rehabilitation. After dis-charge (t3) positive scores had decreased, but werestill significantly higher than upon admission.Interestingly, the computer test revealed positiverehabilitation effects not only for dissatisfactionwith, but also for perceptual distortion of thepatients’ own body. Measures of a negative bodyimage were significantly correlated with negativeaffective states. CONCLUSIONS: The study de-monstrates that an appropriate control group canhelp to obtain unbiased results of beneficialimmediate and long term effects of inpatientrehabilitation treatment. Furthermore, self ratedas well as objectively assessed measures of anegative body image can be improved which wasshown to be independent of surgical techniques.However, ratings on body image are highlyconfounded by affective states which physicianshave to consider when assessing physical com-plaints of patients.

A-731

Family Nursing Rounds in Oncology Settings:

Collaborating to Enhance Person-Centered Care

Fay J. Strohschein1, Kimberly Gartshore2, TaraJesion2, Linda McHarg1, Carmen G. Loiselle1,Antoinette Ehrler2, Lynne McVey2

McGill University, Montreal, Quebec, Canada1,Jewish General Hospital,Montreal, Quebec, Canada2

OBJECTIVES: Nurses often face challengingclinical situations as they strive to support patientsand families in the context of their cancerexperience. Integrating current evidence into thispractice is not always straightforward. We describethe development of a forum for nurses to shareclinical challenges with their peers for feedback andsupport, with the goal of enhancing evidence-basedperson-centered care throughout the trajectory of


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care at a large university-affiliated cancer center.METHOD: Monthly lunchtime, hour-long roundstake place wherein a nurse presents a complexfamily case for discussion and feedback from peers.Case summary sheets focus discussion on familystructure, patient’s and family’s greatest concern,and primary nursing care challenges. In- and out-patient nurses and students from across thetrajectory of care attend. Facilitators and guestswith academic expertise in family approachesencourage discussion and use of relevant evidenceintegrated with the McGill Model of Nursing.RESULTS: Each meeting involves 5–13 partici-pants. Identified concerns include: cross-culturalcare, multiple individuals with cancer within onefamily, effective responses to anxiety, anger orguilt, implementing family assessment, barriers toestablishing therapeutic relationships, and identifi-cation of appropriate resources/referral for patientsand families. Formal feedback from participantsreaffirms the value of the rounds and led tomodifications in format and location. The roundsare now open for videoconferencing with cancercare nurses practicing in remote areas. CONCLU-SIONS: Family-focused rounds effectivelyprovide peer guidance and support in comprehen-sively addressing the needs of individualstouched by cancer. They serve to target and tailoroptimal psychosocial nursing interventions andenhance continuity of care across multiple special-ties. Within this context of intra-professionsupport, interprofessional collaboration is encour-aged and supported. Overall, family rounds pro-vide nurses with the opportunity to sharechallenges, integrate evidence, and work togetherto optimize person-centered care for patients andtheir families.

A-733

A Better Understanding Of Stress Factors

Experienced By Nurses When Providing End-of-Life

Care In The Intensive Care Unit (ICU)

Celine Gelinas1, Marie-Anik Robitaille2, LiseFillion3, Manon Truchon1

School of Nursing, Faculty of Medicine, McGillUniversity, Montreal, Quebec, Canada1, MaisonMichel-Sarrazin, Laval University Cancer ResearchCenter, Quebec City, Quebec, Canada2, MaisonMichel-Sarrzin, Laval University Cancer ResearchCenter, Quebec City, Quebec, Canada3, Departmentof Industrial Relations, Laval University, QuebecCity, Quebec, Canada4

OBJECTIVES: The objective of this study was todescribe the stress factors experienced by nurseswhen providing end-of-life care in the IntensiveCare Unit (ICU). This study is part of a largerresearch project which is aimed to validate a

conceptual framework to better understand jobsatisfaction and well-being of nurses, and toimprove the context within which end-of-life careis provided. METHOD: A descriptive qualitativedesign was used for this study. A total of 42 ICUnurses working on different shifts (e.g. day,evening, night, rotation) from five clinical settingsof three different cities in the province of Quebecparticipated. Ten focus groups (duration:40–60mi-nutes) were completed using a semi-structuredinterview guide. Discussions were audiotaped,transcribed, and analyzed using the InVivo soft-ware. In order to increase fidelity and validity ofdata analysis, a double codification was alsoperformed. RESULTS: Stress factors were clus-tered into three categories as previously found in apalliative care study: Organizational, professionaland personal. However, some stressors werespecific to the ICU. According to organizationalstressors, e.g. lack of intimate area for family, andlack of accessibility to the palliative care team werehighlighted. Regarding professional stressors, thelack of experience with end-of-life care wasfrequent. Finally, communication issues with fa-milies were major personal stressors for ICUnurses. CONCLUSIONS: Providing end-of-lifecare is a great challenge, and the nurses’ experiencemay vary depending on the context within whichthey are practicing. The Intensive Care Unitappears to generate specific stressors related tothe nurses’ experience which should be consideredin developing strategies to improve end-of-life carein this particular context.

A-737

Burnout Syndrome in Medical Staff Working with

Children in Cancer Hospital (still under analysis)

Mohammad ElShami1, Samir Aboualmagd2,Mohamed Ezat2, Mohamed Nasr1

Children cancer hospital Egypt 57357, Cairo,Egypt1, School of Medicine Cairo University, Cairo,Egypt2

OBJECTIVES: The medical staff treating childrenwith cancer is subjected to many stressors duringtreating these suffering children, in addition to therelapsing nature of cancer and the presence ofterminal cases requiring palliative treatment as wellas the frequent loses of patients may aggravate theburden over the treating staff which make morethem vulnerable for developing burnout syndrome.The psychosocial department in children cancerhospital Egypt 57357 carried this study on thehospital’s staff. METHOD: This study wasconducted on a sample of the nurses working atthe hospital. 55 nurses completed the Arabicversion of the Maslach Burnout scale. The scaleconsists of 3 subscales: 1- Emotional exhaustion


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(EE), 2- Depersonalization (D), 3- Personalaccomplishment (PA). RESULTS: Results showedthat 92% of nurses had significantly high score onthe PA category and 45% had high scores of EEcategory, while only 21% of the sample had highscores on the D category. CONCLUSIONS:Nurses working with children suffering from cancerare manifesting symptoms of burnout syndromespecially on the depersonalization subscale. Thesenurses need to go therapeutic interventions in orderto continue treating these children inspirinng hopeand psychological well being to these patients andtheir families.

A-739

The Unique Psychosocial Needs of Recurrent

Cancer Patients: A Qualitative Study

Lisa M. Thornton, Anna O. Levin, Chien-NiChang, Tanesha L. WalkerOhio State University, Columbus, Ohio, United States

OBJECTIVES: Recurrence is a distinct phase inthe cancer continuum, but psychological treat-ments offered to patients with recurrence havegenerally been those designed for patients with andinitial diagnosis of advanced disease. Data areneeded to identify the unique needs of recurrentcancer patients. We undertook a qualitative studyto explore the ways in which psychological inter-vention should be tailored to the recurrenceexperience. METHOD: Women with recurrentbreast or gynecologic cancer (N5 35) participatedin semi-structured interviews. Participants werediagnosed with breast (n5 17), ovarian (n5 10),endometrial (n5 6), fallopian (n5 1), or cervical(n5 1) cancer recurrence. The mean age was 61years (SD5 9); 89% were Caucasian (9% African-American, 3% Hispanic). Patients were asked todiscuss challenges of the recurrence diagnosis,differences from initial diagnosis, and useful copingstrategies. Interviews were recorded and tran-scribed, and the transcripts were analyzed usingAtlas.ti. RESULTS: Consistent with our quantita-tive research, patients described prominent physi-cal symptoms with recurrence. Emotionally, thefirst diagnosis was characterized by shock and anew sense of physical vulnerability. In contrast, therecurrence diagnosis was characterized by disap-pointment and frustration. Fear was noted for bothdiagnoses. We commonly noted decreases inphysical and social resources from initial diagnosisto the recurrence. Regarding coping with recur-rence, many patients endorsed appreciating ‘gooddays’ and suspending future expectations. CON-CLUSIONS: Some components of interventionsdesigned for initially diagnosed patients (e.g.disease-related education) may not be relevant forrecurrence patients, whereas other components

(e.g. utilization of social support) continue to beuseful. While some recommend unstructured sup-port interventions for those with advanced disease,these data suggest that education and skill buildingfor specific topics (e.g. physical symptoms) may bemore useful. Interventions that promote a focus onthe present (e.g. acceptance, mindfulness), areindicated.

A-743

Capturing the Oncology Interactive Navigator

(OIN) Contributions to Individuals’ Experiences

with Cancer: A Pilot Study

Laurence Girouard1, Carmen G. Loiselle1, AnnettKoerner1, David Wiljer3, Margaret Fitch2

McGill University, Montreal, Quebec, Canada1,Odette Cancer Centre, Toronto, Ontario, Canada2,Princess Margaret Hospital, Toronto, Ontario,Canada3

OBJECTIVES: The purpose of this study was tobegin documenting contributions of an innovativeweb-based information support tool, the OncologyInteractive Navigator (OIN) among individualsnewly diagnosed with colorectal cancer or melano-ma. As a promising means to complement person-centred care approaches, high quality multimediainteractive tools offer readily accessible, easilyupdated and tailored cancer informational supportand guidance. METHOD: Guided by Self-Deter-mination Theory (SDT) and related concepts ofpersonal competence, knowledge and the need forsupportive environments, this study employed apre-post intervention design in 8 Canadian cancercentres. Eligible participants were offered unrest-ricted access to the OIN for 6 weeks. Theycompleted self-report measures at baseline (T1)and at T2 (within 7 days of completing theintervention) to capture potential changes in keyvariables. Automatic OIN tracking also providedusage data. RESULTS: Findings for the colorectalsample who completed the study to date (n5 53)show an average of 67.3minutes spent on the OIN.Most popular topics include decisions and treat-ments as well as coping and support. 70% ofparticipants shared the OIN with family andfriends. Repeated measures analysis shows signifi-cant changes in cancer knowledge (p5 0.001) andcancer competence (p5 0.011) between T1 and T2.Additional results will be presented for themelanoma sample. CONCLUSIONS: Preliminaryevidence gathered so far suggests that the OIN is anengaging repository of cancer supportive informa-tion that enhances cancer knowledge and cancercompetence among newly diagnosed individuals.Further qualitative and quantitative inquiry isunderway to continue documenting the potentialadded-value of the OIN among diverse patient


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groups. A planned randomized clinical trial alsowill allow causal inferences to be made regardingthe effects of the OIN as well as its cost-effectiveness.

A-744

Terminal Cancer Patients’ Psycho-social Assessment

at the Activation of Palliative Care Unit

Samantha Serpentini1, Elena Pasquin1, PaolaCastellan1, Lisa Dal Sasso4, Miria Bittante2,Amedeo Buzzo1, Francesca Busa3, DanielaLazzarotto1, Flavio Zarpellon1, Stefano Zizzetti1

Nucleo Cure Palliative, U.O. Cure Primarie - Az.ULSS 3, Bassano del Grappa, Vicenza, Italy1,Ufficio Statistica, Azienda ULSS 3, Bassanodel Grappa, Vicenza, Italy2, CoordinamentoDistretti, Distretto N. 1, Azienda ULSS 3, Bassanodel Grappa, Vicenza, Italy3, AssociazioneOncologica San Bassiano, Bassano del Grappa,Vicenza, Italy

OBJECTIVES: The aim of the study is thepsychosocial evaluation of oncological terminalpatients’ condition at the intervention of thePalliative Care Unit (PCU). In this phase patientsare hospitalized and PCU is activated in order todefine a personalized palliative care program athome or in hospice using multimodal integratedmodalities. METHOD: From July 2004 to Decem-ber 2008, we evaluated terminal patients affectedby advanced oncological disease before hospitaldischarge. The evaluation has been conductedthrough semi-structured interview, built to assessthe following dimensions: state of consciousness,interactive abilities, communication, diagnosisawareness, prognosis awareness, anxiety and de-pression symptoms. The variables are described bypercentage. RESULTS: We evaluated 290 terminalpatients (male: 163, female: 127; range age: 50–95).Regarding consciousness, 29.2% are vigilant,51.4% conscious, 13.2% confused and 6.3%unconscious. Interactive abilities are spontaneousin 66.8%, mediated by the family in 13.1%,following stimulation in 15.2%, absent in 4.8%.Communication is truthful in 27.7%; only 26.5%are aware of diagnosis and 5.9% of prognosis.Anxiety was detected in 36.3%, depression in12.9% and a state of pessimism and sadness in41.2%. CONCLUSIONS: Psycho-social condi-tion’s evaluation of terminal cancer patients athospital discharge reveals a state of intensevulnerability; critical factors seem to be diagnosisand prognosis, awareness and communicationbetween patients, professionals and family. ThePCU starts up at the disease’s final phaseand is marked by particular communicationstyles regarding cancer and prognosis. Theseobservations and the understanding of patient’s

emotional suffering imply several bioethicaland psychological considerations in order toimplement structured and personalized palliativeprograms.

A-745

Adapting The MOS Social Support Survey:

Incorporating Spiritual Support For Cancer Survivors

Ellen Levine1, Stephen Vong1, Grace Yoo1, CarynAviv3, Cheryl Ewing4, Alfred Au4

San Francisco State University, San Francisco,California, United States1, Walden University,Minneapolis, Minnesota, United States2, DenverUniversity, Denver, Colorado, United States3, Uni-versity of California-San Francisco, San Francisco,California, United States4

OBJECTIVES: Although spiritual support is im-portant for cancer patients, few validated ques-tionnaires ask about it. Qualitative in-depthinterviews, from a larger study examining socialsupport in cancer survivors, indicated that spiritualsupport was an important, but missing, componentin the MOS Social Support Survey. Therefore, thepurpose of this study was to validate a spiritualsupport subscale for the MOS Social SupportSurvey (Sherbourne & Stewart, 1991). METHOD:The full study utilized a mixed method approachincluding an in-depth qualitative interview andother quantitative survey measures including theInterpersonal Support Evaluation List (Cohen, &Hoberman, 1983), Social Network Index (Cohen,Doyle, Skoner, Rabin, & Gwaltney, 1997), and theMOS Social Support Survey. The women (n5 176,mean age 57, two years post treatment, Stages 0-IIcancer) consisted of 45 African Americans, 52Asian/Pacific Islanders, 54 Caucasians, and 25Latinas. RESULTS: Initial internal-consistencyreliability was similar to the original study (alpha40.92). With the inclusion of the spiritual sub-scale, MOS reliability was 0.95 and the spiritualsubscale itself was 0.86. Exploratory factor analysisfound that spiritual support loaded onto its one, asdid emotional/informational, affectionate, andtangible support (loadings 40.72). Positive socialinteraction had cross loadings (.45–.65) betweenemotional/informational and tangible support. Thesubscale significantly correlated with the FACIT-Sp subscale (Brady, Peterman, Mo & Cella, 1999).(.18–.23, po0.05). CONCLUSIONS: The spiritualsubscale for the MOS Social Support survey isreliable and valid. Furthermore, with only threeadditional items examining an essential aspect ofsocial support within cancer survivors, the briefand simple approach of the original MOS ispreserved. This study contributes to the continuingefforts of developing a short, yet comprehensivetool that examines social support in cancer


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survivors. However, validation studies should beperformed for people with other cancers andmedical conditions.

A-752

A One-year Program to Empower Adolescent and

Young Adult Survivors to Offer Critical Support to

their Peers Fighting Cancer

Katie RizviLittle People Association, Cluj-Napoca,Romania

OBJECTIVES: The results achieved in impactingcurrent AYA patients’ behaviour in treatmentcompliance and hopefulness measures by invitingthem to interactive programs of a cancer survivorgroup were significant on the wards of threehospitals. A comprehensive nation-wide plan wasneeded to aid the formation of local focus groupsand facilitate the networking of adolescentcancer survivors with current cancer patientsacross the country, especially the less supportedregions of Romania. METHOD: Forty youngpeople ages 14–24 were recruited to design anation-wide information and peer-based supportprogram specifically targeting AYA cancer pa-tients. 24 survivors of paediatric cancer made upfour focus groups of six participants. Foursiblings, four current patients and eight patientsupport volunteers contributed with feedback oncontent. The program involved the creation ofinformation messages, short films and commu-nication posters and AYA cancer survivorshosting discussions in 11 rural hospitals. RE-SULTS: 500 cancer patients and their familiesbenefited from the messages of hope and encour-agement shared by the cancer survivors nation-wide. Information that is especially relevant forthe AYA demographic is now available in allpediatric treatment units. Registered members ofthe adolescent and young adult community hastripled since the onset of the program. The shortmovies of personal survivorship accounts as wellas the media posters are downloadable from aspecifically created website. CONCLUSIONS:When empowered and supported through orga-nised means, AYA cancer survivors are the mosteffective in conveying helpful attitudes, promot-ing coping and sharing advice from personalexperience. Their testimonials combat the un-helpful myths of mass media and provideinformation in an age-appropriate way. Whileworking with survivor youth whose psychosocialdevelopment is affected by their earliercancer experience can be challenging, theirinvolvement can help increase confidenceand helps the transition process towards theirindependence.

A-754

What Can We Learn From Cancer Patients’

Reflections On Life As Death Approaches? Analysis

Of Dignity Therapy Transcripts

Thomas F Hack1, Susan E McClement1, Harvey MChochinov1, Beverley Cann2, Tom Hassard1,Linda Kristjanson3, Mike Harlos1

University of Manitoba, Winnipeg, Manitoba, Ca-nada1, CancerCare Manitoba, Winnipeg, Manitoba,Canada2, Curtin University of Technology, Perth,Australia3

OBJECTIVES: Over the past decade our researchteam has delved into the cancer patient experienceof dignity as death approaches. Out of theseempirical research efforts, a conceptual frameworkof patient dignity was developed, followed by thecreation of a dignity therapy intervention. Dignitytherapy is a novel, manualized, therapeutic ap-proach designed to decrease suffering, enhancequality of life and bolster a sense of dignity forpatients approaching death. METHOD: In ourearlier work, the benefits of dignity psychotherapywere documented in a sample of 100 dying cancerpatients (50 from Canada, 50 from Australia). Inthis qualitative study, a random sample of 50 of 100dignity therapy transcripts was analyzed usinginterpretive description. All 50 transcripts wereindependently coded by three individuals. Meetingswere held regularly after each successive 5 tran-scripts had been coded, so that the coding categoriescould be discussed and refined. RESULTS: Thefindings revealed that dignity therapy providedpatients with a safe, therapeutic means to reviewthe most meaningful aspects of their lives in amanner that revealed their core values. Core valuesare defining and permeating features of a patients’whole life. The most commonly expressed valuesincluded ‘Family’, ‘A Sense of Accomplishment’,‘True Friendship’, ‘Pleasure’, ‘Rich Experience’, and‘Caring’. Exemplars of each of these values illustratethe defining role of values in our lives. CONCLU-SIONS: Findings are discussed in terms of valuestheory, our conceptual framework of dignity, andthe practical ways that health care providers canenhance the dignity of dying cancer patients.

A-757

Hope and Transformation in the Face of Death: An

Examination of the Lived Experience of Adult

Children Living at Home whose Parent has Cancer

Carmen C. Almarza1, Stephen J. Smith1

Simon Fraser University, Burnaby, British Colum-bia, Canada1, Simon Fraser University, Burnaby,British Columbia, Canada2

OBJECTIVES: The purpose of this qualitativestudy was to explore the lived experience of adult


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children living at home whose parent has beendiagnosed with, and treated for, cancer. Thequestion that this study sought to address was:What is it like to have a parent diagnosed with, andtreated for, cancer for an adult child living athome? Little is known about how adult childrenliving at home experience their parents’ illness.METHOD: The present study used a hermeneutic-phenomenological methodology. A purposefulsampling design was used. Participants were adultchildren living at home, between the ages of 21 and35, whose parent had cancer. Participants tookpart in an in-depth interview, from one to threehours long. Interviews were audio-taped, tran-scribed verbatim, and themes and sub-themes wereidentified. RESULTS: Four themes emerged fromthe participants’ stories: 1) Getting the diagnosis:Confronting death, 2) Experiencing the impact oftreatment, 3) The need for emotional support, and4) The cancer legacy. Despite the multiple demandsof cancer, and the emotional suffering, adultchildren drew experiences of personal growth andtransformation. It was described as a journey ofself-understanding, strength, self-confidence, em-pathy, and awareness of the sensitivities and plightsof others. CONCLUSIONS: The study revealedthat although adult children have been ignored inthe psycho-oncology research, in the practicalrealities of the home and the hospital, they areintegral part of the caregiving work. Adult childrenexperienced death-fear, anger, shock, anxiety, andhelplessness. The study also shows that adultchildren assign some form of positive meaning totheir experiences. Clinicians need awareness thatsupport services must include all members of thefamily, not only the spousal caregiver.

A-759

Toward a True Person-Centred Partnership: Recon-

ciling Healthcare System Innovation with Active

Patient Engagement.

Murray G. Rochonjack digital productions inc., Toronto, Ontario,Canada

OBJECTIVES: A person-centred care model in-volves a fundamental shift in the ways thehealthcare workforce operates. This shift requiresa comprehensive understanding of and support forthe diverse needs of patients and families withintheir social context. The Oncology InteractiveNavigator (OIN) is an evidence-based tool thatwas conceived to enable a participatory partner-ship between providers and individuals affected bycancer. The potential of the OIN is exploredthrough a ‘hands on’ demonstration. METHOD:This innovative web-based platform fuses technol-ogy with rigorous content and clinical integration.The OIN as a web-based platform provides clear,

comprehensive and actionable content tailoredusing a natural intelligence model. By integratingclinical and psychosocial aspects within hospitalsand community settings, the OIN supports self-management and empowerment. A pan-CanadianCPAC funded study has begun evaluating the OINcontributions to the cancer experience. RESULTS:Preliminary evidence shows that the OIN offerscancer information which is supporting a patient’scompetence and engagement. Of the 216 newlydiagnosed individuals invited to participate in thepilot study, 149 used the OIN (94 with colorectalcancer, 55 with melanoma), averaging 56 minutesof use per patient. In addition, patients returned tothe OIN on numerous occasions (mean5 4.1visits), increasing the overall content accessed to91%(melanoma) and 93%(colorectal cancer) overtheir cancer journey. CONCLUSIONS: Evidencegathered so far suggests that the OIN is filling animportant information gap in cancer care. Ongoingwork incorporates findings from the pilot to guidethe completion of an additional 23 OIN cancertitles. Future research will be undertaken todocument implementation strategies and cost-effectiveness among diverse populations at differentstages of the cancer trajectory.

A-760

Age of Onset and Vocational Behavior of Young

Adult Brain Tumor Survivors

David Strauser1, Fong Chan2, Deirdre O’Sullivan3,Stacia Wagner4, Alex Wong1, Alo Dutta5

University of Illinois at Urbana-Champaign,Champaign, Illinois, United States1, University ofWisconsin-Madison, Madison, Wisconsin, UnitedStates2, Penn State University, College Park,Pennsylvania, United States3, Children’s BrainTumor Foundation, New York, New York,United States4, Southern University, Baton Rouge,Louisiana, United States5

OBJECTIVES: Career development and employ-ment is a significant problem for young adult CNSsurvivors. Research has suggested that young adultsurvivors of CNS cancer are almost five times morelikely to be unemployed as adults (OR, 4.74[95%CI 1.21–18.65]). This presentation will provide anoverview of the initial results of an exploratorystudy that examined the impact of age of onset andvocational behavior in young adult CNS survivors.METHOD: For this study 65 CNS young adultssurvivors (18–30) completed a career/vocationalsurvey to obtain information regarding careerdevelopment and vocational behavior. In addition,informed consent and demographic informationincluding age of initial diagnosis, treatment proto-cols (radiation, chemotherapy, and surgery), dura-tion of treatment, educational background, andemployment history were obtained at the time of


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survey completion. RESULTS: Results indicatethat young adult CNS survivors who were diag-nosed between the ages of 6 and 12 reported lowerlevels of productive vocational behavior thenindividuals who were diagnosed before the age of6 and after the age of 12. In addition, young adultCNS survivors as a whole also reported lowerlevels of productive vocational behavior whencompared to young adults without a disability orcancer diagnosis. CONCLUSIONS: Findings areconsistent with research suggesting that this age ofonset and disability status negatively impact careerand work behavior. These findings highlight theimportance of providing career and vocationalservices as part of the psycho-social treatmentprogram for young adult CNS survivors. Moreresearch is needed addressing the psychological,physical, and diagnosis specific factors that impactvocational behavior. Emphasis should be on long-itudinal studies and clinical randomized trialsemploying career and employment interventions.

A-762

Role Of Psychosocial, Genetic And Treatment

Modalities Variables In Adaptation Problems Fol-

lowing Cancer: Results From A Pediatric Experi-

ence

Sophie Marcoux1, Philippe Robaey1, MajaKrajinovic1, Caroline Laverdiere1, Albert Moghrabi2

CHU Ste-Justine, Universite de Montreal,Montreal, Quebec, Canada1, Centre hospitalieruniversitaire de Verdun, Montreal, Quebec, Canada2

OBJECTIVES: Recent improvement in childhoodleukemia treatment protocols have led to signifi-cant increase in survival rates. However, severalphysical, psychological and social problems, havebeen documented in these patients. Researcheshave mainly focused on neuropsychological impact(eg.: IQ) while the literature on neurobehaviouraloutcomes is scarce. This study focused on quanti-fying prevalence of adaptation issues in thispopulation, and risk factors associated. Betterevidence-based personalized interventions couldpotentially lead to increased quality of life in theseyoung cancer survivors. METHOD: Patients diag-nosed with acute lymphoblastic leukemia wereinvited to participate in a longitudinal study.Patient’s parents fulfilled a questionnaire regardingtheir perceived child adaptation problems fivetimes during the study. Genotypes of the patientswere also obtained to assess the presence ofpolymorphisms in genes involved in chemother-apeutic agents metabolism. A focus was made onthe role played by corticosteroids (CS) and poly-morphisms in CS metabolism-related genes. Ana-lyses were done by linear multiple regressionstatistical modeling. RESULTS: The patients

proportion reaching clinical range for adaptationproblems 4 years post-diagnosis was higher thanexpected (20, 8% vs 15, 9%). In addition to age atdiagnosis, adaptation problems can be predicted bymeasures of perceived familial well-being (p5 0,005) one year post-diagnosis. When also assessing apolymorphism in NF-kB1 gene (p5 0, 008) and itsinteraction with the CS dose received duringinduction (p5 0, 035), the proportion of explainedvariance increases significantly (overall model:p5 0, 002). CONCLUSIONS: These preliminarydata suggest that genetic as well as psychosocialfactors should both be assessed when trying tooptimize adaptation outcomes predictions in thispopulation. They highlight the importance ofproviding further support specifically to parentsfor which their role of caregiver of a child withcancer put their familial well-being more at stakethan typically observed. Not doing so may other-wise reflect on the patients’ ability to achieve fullpotential as a cancer survivor.

A-765

The Psychosocial Impact of Being a Caregiver to a

Hematopoietic Stem Cell Transplant Patient: A

Review of the Literature

Sara Beattie1, Beth Richardson2, Sophie Lebel1

University of Ottawa, Ottawa, Ontario, Canada1,Carleton University, Ottawa, Ontario, Canada2

OBJECTIVES: While hematopoietic stem celltransplant (HSCT) has become a well-establishedtreatment for hematological malignancies, it is ademanding treatment with associated physical andpsychological sequelae that can affect patients andtheir family members. Caregivers to HSCT patientsnot only have to cope with the life-threateningnature of the disease and treatment, they haveadded care-giving responsibilities. This studyaimed to review the literature on the psychosocialimpact of being a caregiver to a HSCT patient.METHOD: A critical review of the literature wasconducted over the past 20 years up untilDecember 2009. Databases searches includedCINAHL, Medline, PsycInfo, and AcademicSearch Complete. Studies were excluded if theypertained to caregivers of children (under the ageof 18) undergoing a HSCT. The search revealednine original quantitative research articles withover 20 participants and two qualitative researcharticles that were reviewed and analyzed. RE-SULTS: Distress among caregivers is highest pre-transplant and then decreases over time, but care-giving responsibilities remain elevated several yearspost-transplant. In one study comparing distress inboth patient and caregiver, caregivers reportedhigher levels of distress than patients six monthsand one year post-transplant. Predictors of distress


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include being a female caregiver, higher levels ofsubjective burden, and patient symptom distress.Caregivers also reported uncertainty, fear of thefuture, and difficulties adapting to role changes.CONCLUSIONS: The experience of being acaregiver to a HSCT patient is one of uncertainty,learning to adapt to changing roles, and distress.As only three of the 11 studies reviewed examinedpatients and caregivers as dyads, research thatincludes both members of the dyad is needed toevaluate the reciprocal relation between caregiverand patient variables. Larger sample sizes arenecessary to identify caregivers that are morevulnerable to adjustment difficulties over thetransplant trajectory.

A-768

A Mobile Social Networking Approach to a Cancer

Survivorship Intervention for Young Adults

Margaret McLaughlin1, Jessica Gould1, YujungNam1, Scott Sanders1, Matt Weber1, CourtneySchulz1, Li Xiong1, Kathy Meeske1, KathyRuccione2, Janet Fulk1, Vikki Katz3, HayeonSong4, Eric Qi5

University of Southern California, Los Angeles,California, United States1, Childrens Hospital LosAngeles, Los Angeles, California, United States2,Rutgers University, New Brunswick, New Jersey,United States3, University of Wisconsin-Milwaukee,Milwaukee, Wisconsin, United States4, AwarenessTechnologies Inc., Los Angeles, California, UnitedStates5

OBJECTIVES: Childhood cancer patients whohave completed treatment need to manage thetransition from the pediatric to the adult healthcare system. Mobile social networking approachprovides them with the resources required forsuccessful survivorship. This study attempts todetermine which factors of young cancer survivorsare associated with higher rates of participationin mobile social networking intervention thatbuilds health social capital and enables easy accessto useful resources for successful cancer survivor-ship. METHOD: Participants were issued a pre-paid cell phone with MMS capabilities as wellas an integrated video camera which can takeshort videos. They produced unstructured visualnarratives with the phone, posted to the socialnetworking website for sharing with the group.Pre-intervention measures such as depression,social support, evaluation of the services used,information needs and information seeking habits,and survivorship self-efficacy were analyzed inconjunction with study activities via cell phone.RESULTS: Linear regression analyses evaluatedthe prediction of the participation to socialnetworking activities from the pre-intervention

measures for childhood cancer survivors. Socialsupport composite index is linearly related to threevariables, number of (1) private in-site messagessent to other participants, F(1, 7)5 3.854, t(7)5

�1.963, po0.05, (2) comments, F(1, 7)5 1.935,t(7)5�3.455, po0.05, and (3) total login to thesystem, F(1, 7)5 7.712, t(7)5�2.777, po0.01,such that as overall social support increases theoverall interaction and activities for the participantincreases. CONCLUSIONS: Participant’s percep-tion of a close social support network is a keycomponent in building health mobile networkingfor childhood cancer survivors. Social networkingwith cell-phone based multimedia messaging andvideo-sharing model can be highly effective ingetting the young engaged in disseminating healthinformation and connecting to others with similarhealth concerns. Mobile-based social networkingintervention programs for successful cancer survi-vorship needs to employ network-building ap-proach and be responsive to the individual’sexisting social network.

A-771

The Relationship between Pain and Posttraumatic

Stress Symptoms in Palliative Care

Maya Roth1, Ingrid Harle2, Joel Katz3

Operational Stress Injury Clinic, ParkwoodHospital, St. Joseph’s Health Care, London, London,Ontario, Canada1, Palliative Care MedicineProgram, Queen’s University, Kingston, Ontario,Canada2, Department of Psychology, Faculty ofHealth, York University, Toronto, Ontario, Canada3

OBJECTIVES: Pain and psychological distress,including posttraumatic stress disorder (PTSD),are considerable concerns for palliative carepatients. According to the chronic pain literature,pain and PTSD co-occur and are mutually main-tained by several psychosocial variables. This studyinvestigated the relationship between pain andposttraumatic stress symptoms (PTSS) in palliativecare. The objectives were (1) to examine psychoso-cial predictors of PTSS; and (2) assess whetherpsychosocial mutual maintenance variables med-iate the relationship between pain interference andPTSS. METHOD: One hundred palliative care in-patients and out-patients (63 female) were recruitedwith a mean age of 63.4 years. Consenting patientswere administered a mental status exam prior tocompleting measures of PTSS, pain, anxiety anddepressive symptoms, pain catastrophizing, andpain anxiety at their bedside or in their examina-tion rooms. Symptom distress scores and palliativefunctional status, as well as other demographic andmedical information, were collected from theirmedical charts. RESULTS: Objective 1: Usinghierarchical multiple regression, pain anxiety


DOI: 10.1002/pon

Oral Abstracts S185

emerged as the most significant predictor of PTSS,after controlling for pain intensity, pain interfer-ence, and symptom distress (F(7, 65)5 6.97,po0.01). Objective 2: Using multiple regressionand bootstrapping to assess for mediation, paincatastrophizing (F(2, 82)5 17.55, po01) andpain anxiety (F(2, 82)5 28.43, po0.01) emergedas significant mediators of pain interferenceand PTSS. Subsequent analysis showed painanxiety to be the stronger mediator of paininterference and PTSS (F(3, 81)5 19.60, po0.01).CONCLUSIONS: This is the first study to examinepredictors of PTSS, and the relationship betweenpain interference and PTSS in palliative care. Theresults suggest that pain interference and PTSS areconcerns and co-occur for palliative care patients.The also findings indicate that pain anxietymediates this relationship, lending partial supportto the existence of mutually maintenance variablesin this population. These findings suggest avenuesthat may improve the assessment and treatment ofpalliative care patients.

A-776

Do I have Choice in Caregiving? Does It Matter?:

Caregivers’ Perspective

Youngmee Kim1, Richard Schulz2

University of Miami, Coral Gables, Florida,United States1, University of Pittsburgh, Pittsburgh,Pennsylvania, United States2

OBJECTIVES: Although the effect of perceivedlocus of control has been well documented inpatients’ adjustment, similar information in care-givers’ remains sparse. This study examined thedemographic and caregiving characteristics thatassociated with perceived choice in caregiving roleand investigated the association between choice incaregiving and diverse aspects of adjustment out-comes. METHOD: A total of 1229 caregiversparticipating in a national survey for caregiversthat used random digit dialing sampling method(99 were cancer caregivers) in the United States.Caregivers were unpaid and who were caring for afamily member who is 455 years old within thepast 12 months when participating in the survey.Questions on various demographics and caregivingwere asked via telephone. RESULTS: Multinomiallogistic regression analyses revealed that older ageand female gender were significantly related tochoice-in-caregiving. Among caregiving character-istics, caregivers who were currently providing careat the time of the survey were more likely,whereas caregivers who had provided care for thepast 5 to 9 years were less likely to report choice-in-caregiving. Finally, lack of choice-in-caregivingwas strong and consistent predictor of physicalstrain, emotional stress, and financial burden.

CONCLUSIONS: Results suggest that caregiverswho are involved in caregiving for family memberswith chronic illness without having a sense ofpersonal control and choice would suffer from poorquality of life. Younger, male, and caregivers whoare currently in providing care will benefit frompsychosocial programs designed to help themincrease the sense of control in their caregivingrole, thereby minimize the burden of care andimprove their quality of life.

A-785

Addressing the Quality of Care Issues for Chamorro

Women Diagnosed with Cancer: A Community

Partnership Approach

Evaon Wong-KimCalifornia State University, East Bay, Hayward,California, United States

OBJECTIVES: This project is a joint partnershipbetween a California State University, East Bayfaculty and the Guam Communications Network.The purpose of the project is to understand qualityof care as perceived by Chamorro women living inGuam who are diagnosed with breast cancer and todesign a culturally appropriate intervention. To-day, the Chamorro represent one of the threelargest Pacific Islander groups in the United States,and 92, 000 Chamorro reside in the continentalU.S. METHOD: A qualitative approach is used togather information to explore this topic. Sixinterviews were conducted with Chamorro cancersurvivors in Guam from September 2008 to June2009. The interviews were taped and then tran-scribed in English for analysis. A report backfinding session was conducted where the researcherreported the findings of the study and solicitedinformation to assist in designing an intervention.RESULTS: One important quality of care aspectrepeatedly addressed by different key informantswas limited resources to treat cancer in Guam. Theonly hospital in Guam was not accredited by theJoint Commission. Besides limited access andinconsistent quality of care, survivors had to traveloff-island for cancer treatment and have to copewith being away from family members, fear andrecurrence, and difficulties in accessing follow-upcare. CONCLUSIONS: In order to improve thequality of life for Chamorro women diagnosedwith breast cancer in Guam, the quality of care forthose in Guam needs to be improved. Althoughthese key informants complained about thehealth care system on their island, they consideredthemselves fortunate when compared to otherPacific Islanders in the Mariana Islands.This is an interesting coping mechanism forChamorro women that warrants further researchand exploration.


DOI: 10.1002/pon

S186 Oral Abstracts

A-787

The Relation between Emotional Expression Styles

in Mothers and Anxiety in Children with Cancer

Sheyda Dibaei1, Masoud Janbozorgi2, MasoudArefnazari1, Emad Ashrafi3

Islamic Azad University, Science and ResearchBranch, Tehran, Iran, Islamic Republic of1, TheResearch Institute of Hawzeh va Daneshgah, Qom,Iran, Islamic Republic of2, Tarbiat ModaresUniversity, Tehran, Iran, Islamic Republic of3

OBJECTIVES: The important role of emotion incommunication between parents and children withcancer is emphasized in the literatures. Previousresearches have demonstrated that the communica-tion about the disease between the child withcancer and parents is mainly about treatment andmedical procedures and not about the emotionalimpact of the situation which can cause morepsychological problem for sick child. Therefore,this study examined the role of mother emotionalexpression styles in anxiety of children with cancer.METHOD: The sample is 84 children (8–17 yearsold) with cancer (in and out patient) and theirmothers who were in hospital. Emotional Expres-sion Questionnaire (EEQ), Emotional ControlQuestionnaire (ECQ) and Ambivalence over Emo-tional Expression (AEQ) for mothers and RevisedChildren’s Manifest Anxiety Scale (RCMAS) forsick children were used. RESULTS: Data analysesrevealed that children whose mothers were high inambivalence over emotional expression and low inemotional expression reported higher level ofanxiety. But significant relation between emotionalcontrol of mothers and children anxiety were notfound. Also, mother emotional expression styles(all together) accounting for 11% of the variance inchild anxiety. CONCLUSIONS: These findingsshow that emotional expression and ambivalenceover emotional expression in mother may con-tribute to sick child anxiety which can lead longertreatment or improvement. This study suggeststhat emotional states of mothers can have an

important factor in understanding cancer pediatricpatients’ experience of anxiety.

A-795

Development and Evaluation of a Decision Aid for

Hereditary Breast and Ovarian Cancer Mutation

Carriers in Considering Disclosure to Offspring

Susan Clarke1, Mary Jane Esplen2, Brenda Toner2,Margaret Fitch3, Louise Bordeleau4

de Souza Institute, University Health Network,Toronto, Ontario, Canada1, Department of Psychia-try, Faculty of Medicine, University of Toronto,Toronto, Ontario, Canada2, Sunnybrook HealthSciences Centre, Toronto, Ontario, Canada3,McMaster University, Hamilton, Ontario, Canada4

OBJECTIVES: This study in progress is designing& testing a decisional aid, targeted arounddissemination of genetic risk information byHBOC carriers to their offspring between ages12–25 years, in determining when and how to shareemotionally laden genetic information. BRCA1/2carriers can experience challenges around commu-nicating complex genetic issues, and are oftenuncertain around ‘when’ and ‘how much informa-tion’ to share with young offspring which can resultin significant distress. METHOD: A mixed modelis being utilized to design the intervention with apre post design. RESULTS: The study is ongoing.A literature review and the decisional tool will bepresented with preliminary findings around itsuptake and patient and clinic staff responses tothe tool. The psychosocial intervention consists ofa decisional aid guiding BRCA1/2 carrier parentsin determining when and how to share genetic riskinformation with offspring between ages 12–25years. Qualitative findings from focus groups willbe presented that informed the development of thepsychosocial tool. CONCLUSIONS: This studywill contribute to the rapidly emerging field ofcancer genetics with a validated tool in supportingcarriers in determining when and how to sharegenetic information with their biological children.


DOI: 10.1002/pon

Oral Abstracts S187

POSTER ABSTRACTS

P-1

A Model of Oncologist-Patient Attachment

Ann StephensColon Cancer STARS, Issaquah,WA, United States

OBJECTIVES: The goal of this paper is to enhancethe current understanding of attachment theory ofthe doctor-patient relationship, by providing amodel and detailed patient perspective into howattachment development occurs in the oncologysetting. Understanding the oncologist-patient at-tachment provides a better understanding of thedynamic for the goal of better treatment adherenceand less patient psychiatric distress. METHOD:This is an observational descriptive study, examin-ing attachment development from a patient per-spective. It is a longitudinal assessment based onpatient interview interview and emails. RESULTS:A four-stage, chronological model—initial, devel-oping, connecting, and mutual—emerged as anorganizing mechanism. In the Initial Stage, thepatient enters the relationship with a pre-disposi-tion to needs and how they should be satisfied. Inthe Developing Stage, the logistics of the relation-ship are defined. In the Connecting Stage, thepatient’s trust in the oncologist is total. In theMutual Stage, a partnership develops based onknowledge and experience. CONCLUSIONS:Using this model it provides a better understandingof the attachment process, yielding better outcomesand experiences for both patient and oncologist.

P-5

Examining Predictors of Psychosocial Support

Seeking

Scott M. Sellick2, Liane S. Kandler1


OBJECTIVES: Although previous research hasindicated a clear relationship between cancer stageand support seeking as well as emotional distress

and support seeking (those with a higher stage ofdisease or higher level of distress are more likely toseek support), research has yet to examine the rolethat distance from a health care centre plays inpotentially adding to an individual’s distress.Further, might distance impede the ability ofpatients to seek psychosocial support services?METHOD: Patients admitted to the Cancer Centrecomplete a ‘consent to release information form’ attime of admission, as well as a Hospital Anxiety andDepression Scale (HADS; Zigmond and Snaith,1983). Using this, Supportive Care has been updat-ing a database of all cancer patients on variablesrelated to distress (HADS), medical status (cancertype, disease stage), demographics (age, gender,marital, distance from the TBRHSC), and supportseeking (appointments with Supportive Care). RE-SULTS: Pearson Product Moment correlationsyielded significant relationships between distressand support seeking, r5�0.101, p5o0.001, stageand support seeking, r5 0.108, po0.001, anddistance and support seeking, r5�.076, po0.001.When entered into a regression analyses, thesevariables emerged as significant predictors ofsupportive care use. CONCLUSIONS: Individualsliving further from the hospital centre are less likelyseek supportive care services, despite similar distresslevels. These results support the need for furtherinvestigations into whether the psychosocial needs ofthose living greater distances from the hospitalcentre are being left unmet. Results are discussed inreference to patient and family centred care initia-tives, and further research directions are addressed.

P-9

Some Factors Relating to the Personal and Profes-

sional Characteristics of the Doctor that Affect the

Correctness of Communication of Diagnosis of

Cancer in Elderly Patients

F Buda1, P Tomasello1, F Romanello1, L Pagani11Dpt of Internal Medicine and Medical Oncology andPostgraduate School Of Geriatry, Udine School ofMedicine University, Udine, Udine, Italy1, Depart-ment of Statistics University of Udine, Udine, Italy2


S188 Poster Abstracts

OBJECTIVES: Communicating a diagnosis ofcancer or a terminal prognosis is a complex anddifficult task that requires a specific preparation. Itstill remains an open problem for doctors inhospitals of different specialties(HM, oncologists,hematologists, surgeons, internists), as well as forfamily doctors (GPs). In Italy, recent investigationshave shown that the trend is still that the doctordoes not ask how much the patient wants to knowabout his sickness. METHOD: From January 2008to June 2009 we conducted an observational studyof 255 physicians(59/F1184M,25 to 74 years)which have been posted 3 closed questions withfree answers: a) do you communicate the diagnosisof malignancy in the elderly patient and consider-ate the advice of family members? b) for thediagnosis which kind of terms do you use(malignancy,cancer?) c)If you do not use theseterms which other terms do you use? RESULTS:51% use the terms cancer for the diagnosis, 49%use mass, lump, cyst, polyp. The women doctorsare more reluctant to disclose the diagnosis thanthe male medicals (X2:p5 0.0045) and overall theproper communication is influenced by the type ofdoctor and their age(X2:po0.05).Moreover, im-portant disturbance in both groups(HM plus GPs)the elevated age of the physician decreases thepropensity to provide a diagnosis to the elderlypatient(index of K-tau-b:-0,225). CONCLU-SIONS: There is a greater tendency than in thepast to inform the elderly of the diagnosis usingappropriate terms, but in our view is still very lowpercentage of doctors who communicate thecorrect diagnosis in a clear and comprehensible tothe elderly patient.

P-15

Psychospiritual Analysis as Predictor of the Efficacy

of Chemotherapy and Immunotherapy

Giuseppina Messina1, Paolo Lissoni2, PaoloMarchiori2, Erio Bartolacelli3

Fondazione I.R.C.C.S. Policlinico MaggioreHospital, Mangiagalli and Regina Elena, Milan,Italy1,� Institute of Biological Medicine, Milan,Italy2, Bassini Hospital, Cinisello Balsamo, Milan,Italy3

OBJECTIVES: The prognosis of the cancer isinfluenced by the psychoneuroendocrinoimmuneconditions of patients. If it is true that the psycho-neuroimmune status may influence the prognosis oftumor, it is probable that the psychospiritualcondition may affect the prognosis of cancer andthe efficacy of the different conventional antitumortreatments. On this basis this study was carried outto analyze the relation between the psychospiritualprofile and the response to chemiotherapy andimmunotherapy in cancer patients. METHOD:The psychological profile was investigated by the

Rorschach’s test. The spiritual status was analyzedin terms of spiritual faith by a specific scoreevaluating five criteria and giving a value of 20points for the single parameters. We have eval-uated 30 metastatic non-small cell lung cancerpatients treated by chemiotherapy (cisplatin plusgemcitabine) and 30 metastatic renal cell cancerpatients treated by immunotherapy (subcutaneouslow-dose IL-2). RESULTS: The tumor responserate achieved in the patients with a faith scoreequal to or greater than 60% was significantlyhigher than that found in the patients with afaith score less than 60%, in both cancer patients.The tumor response rate obtained in patients withpsychospiritual identity at the Rorschach’s test wassignificantly higher with respect to that observed inpatients who had no psychospiritual identity, inboth cancer patients. CONCLUSIONS: This pre-liminary psychological studies would seem tosuggest that the pre-treatment analysis of thepsychological and spiritual status may predict theefficacy of the both chemotherapy and immu-notherapy in advances cancer patients. If thesuccessive studies will confirm this results thepsychological and spiritual investigations beforethe onset of the conventional anticancer treatmentwould have to be included within the commonclinical examination in the medical oncology.

P-16

Knowledge of Health Care Providers on Cancer in

Magu District, Mwanza-Tanzania

Diocles Kaimukilwa, Piter Chami, HaliethKaimukilwaRugalo medical center, Dar es salaam, UnitedRepublic of Tanzania

OBJECTIVES: Cervical cancer is by for the mostcommon cancer of women in development coun-tries, with the highest rates found in LatinAmerica, sub Sahara Africa and South East Asia.In Tanzania, systematic cervical cancer screeningprogrammes do not currently exist and detection ofthe of the disease relies mostly on case presenta-tion. The aim of this study was to determine thelevel of knowledge of health care provider incervical cancer rural district in Tanzania. METH-OD: Visits were made to all health facilities inMagu district. The principal investigator andtrained research assistant collected the datathrough interviews and observation. Those healthcare providers who were found absent in theirhealth care facilities in the first time were re-visited.By using a ‘0–17’ scale structured questionnaire, 54health care providers were interviewed in 43 healthcare facilities. The availability of basic facilities forgynaecological examination was assessed by usinga checklist. RESULTS: Out of 54 health careproviders in the district, 22 (40.7%) health care


DOI: 10.1002/pon

Poster Abstracts S189

providers had heard of a Pap smear with the levelof awareness being highest among the highercadres. Their level of knowledge on cancer of thecervix ranged from 1 to 13 on a score scale of ‘0 to17’ (mean score 4.63). Knowledge on symptoms,risk factors and prevention were significantlyhigher among the higher cadres than those inlower cadres. CONCLUSIONS: Health care pro-viders had poor knowledge on cancer of the cervixand this was more on lower cadres. The availabilityof basic facilities for gynaecological examinationwas encouraging. A more organized continuingeducation of health care providers is recommendedto provide adequate knowledge on risk factors,symptoms, treatment and prevention of the disease.Health care providers should be encouraged toprovide health education to the community, thusraising the level of awareness about the disease.

P-17

Needs, Expectations and Attendance Among Infre-

quent Users of a Cancer Wellness Centre in

Montreal, Quebec

Tanya R. Fitzpatrick1, Jean Remmer1

Jewish General Hospital, Montreal, Quebec,Canada1, McGill University, Montreal, Quebec,Canada2

OBJECTIVES: Statistics from the use of aMontreal Cancer Wellness Centre in 2008 reportthat out of nearly 500 cancer survivors whoattended, 27% came only once, 20% came 2–3times, and nearly half the attendees came less than3 times. The purpose of this study was to examinethe relationship between goals, expectations, andattendance among infrequent users of the centre tobetter access future programming. METHOD: Weinterviewed 13 cancer wellness centers in Canadaand the U.S. to assess if our attendance expecta-tions were realistic. Second, from a total sample(N5 134) from our wellness center, we randomlyselected individuals who registered and neverreturned (n5 16), and who registered and returned1–3 times (n5 17). We used a phenomenologicalapproach to assess the meaning of attendance usingtelephone interviews focusing on attendance bar-riers plus questions focusing on their specific goalsand needs. RESULTS: Other Wellness Centersrevealed similar attendance patterns; 30% ofregistered participants never returned or attendedvery infrequently. At our center, four themes wererevealed from non-users and infrequent users;health and fitness goals, emotional needs, reasonsfor poor attendance, and suggestions. Reasons fornot attending centered on health complications,scheduling conflicts, child care, wanting moreFrench groups, and parking barriers. Fewdifferences were observed on the main themes

between the non-users and the infrequent users.CONCLUSIONS: The results have implicationsfor health care providers working with cancersurvivors, for service interventions, and for futureresearch on wellness center programming. Sugges-tions from the participants will be used to improveand address present and future needs of partici-pants such as addressing parking limitations,providing healthy snacks, addressing age dispari-ties and language barriers, accommodating perso-nalized requests in programming and addressingscheduling complications between staffing, day,and evening hours, and providing more groupscentered on health education.

P-19

Family Burden: Caregiver’s Perceptions in a Rural

Area

Luisa Bonetti1, Cinzia Moleri1, Chiara Lazzari1,Veronica Tresoldi1, Mary Cabiddu2, Mara Ghilardi2,Karen Borgonovo2, Fausto Petrelli2, Sandro Barni2

Psychoncology Service, Oncology Dpt, AziendaOspedaliera Treviglio/Caravaggio, Treviglio,Bergamo, Italy1, Oncology Dpt, AziendaOspedaliera Treviglio/Caravaggio, Treviglio,Bergamo, Italy2

OBJECTIVES: Cancer is considered a familiarillness. Illness is an event that throw patients (pts)and caregivers (cgs) off balance. It changes familiarand inner settings. Caregivers have an active role inassistance and they can be tired both from apsychological and physical point of view. Our aimis to value the effects of psychological distress andfatigue on burden of care in caregivers (cgs) ofpatients (pts) undergoing chemotherapy treat-ments. METHOD: 38 cgs were asked to undergoa psychological interview. Cgs: mean age 50 yearsold (range 23–75), 52% males, 54% are partners,28% children, 72% live with the pts. In order toaccompany pts to the hospital, 24% cgs ask forholidays, 16% for a paid leave, 6% for a unpaidleave. 6% have economic problems due to illness.Prevailing feelings linked to illness are: worry (72%), hope (38%), powerlessness (20%) and fear(16%). RESULTS: 38% of cgs change habits in therelationship with pts: 79% spend more timetogether. Data analysis shows cgs are not worriedabout the activities they have to do for the pts(>71%), about practical problems occurredamong the members of the family (63,1%) orabout the administration of therapy (>52%). Cgssuffer more psychological feelings: 60% of them arenot able to accept illness, 10% have problems ofcommunication with pts. CONCLUSIONS: Cgshave high levels of unmet needs. Cgs showdifficulties in the changes of the relationship(>45%). 57,4 % of them think that they need toexpress their emotions and feelings. 72,7% cgs


DOI: 10.1002/pon


wants to speak with other members of their family,45 % with the pts, 5% with the psychologist. Thereis an increasing recognition of the importance ofproviding support for cancer cgs with evidence thatcgs can be as distressed as pts.

P-20

Couple Types and Coping Strategies: A Research

About Conjoint Drawing

Luisa Bonetti1, Veronica Tresoldi1, Cinzia Moleri1,Chiara Lazzari1, Mara Ghilardi1, Mary Cabiddu2,Karen Borgonovo2, Fausto Petrelli2, SandroBarni2

Psychoncology Service, Oncology Dpt, AziendaOspedaliera Treviglio, Caravaggio, Treviglio,Bergamo, Italy1, Oncology Dpt., Azienda Ospeda-liera Treviglio/Caravaggio, Treviglio, Bergamo,Italy2

OBJECTIVES: Recent studies (Green et al, 2000;Kayser, Scott, 2008) show that a supportiverelationship between oncological patients (pts)and their caregivers (cgs) improve pts copingstrategies. 56 couples composed of oncological pts(mean age 58,4 [range 34/72])undergoing che-motherapy treatment and their cgs (53,6% werepartners, 19,6% children, 8,9% brothers or friends,5,4% parents) were asked to paint together apicture about their relationship. METHOD: Weused the Conjoint Drawing Graphic (CDG) and itsProjective Analysis (Bing, 1970) to identify differ-ent types of couples and to evaluate the correlationbetween them and pts’ coping strategies. In orderto investigate the interactive process behind CDGwe used the Observational Scheme (Saita, 2006)that describes Cooperative, Non-Cooperative andAmbiguous couples. With the ‘Couple Life Space’Scheme (Zavattini, 2007) we classified couplesgovernment space form into: Dynamic Balance,Individual, Fragmentation, Filling, Measurementand Grouping-Redaction. RESULTS: Pts copingstyle is: Reactivity (60%), Fatalism (14,5%) andDenial (12,7%). Cooperative couples are more(45,5%) than Non-Cooperative (32,7%) and Am-biguous (21,8%). Couples government space is:Individual (54,5%), Dynamic Balance (18,2%),Fragmentation (18,2%), Measurement (5,5%),Filling (3,6%). The study displays high levels ofcorrelations between Cooperation and Reactivity(29%) and Non-Cooperation and Reactivity(23,6%). Data show links between IndividualProduct and Reactivity (25,5%), Fragmentationand Reactivity (14,5%) and Dynamic Balance andReactivity (12,7%). CONCLUSIONS: Resultsshow the positive effects of a Cooperative andBalanced relationship on the coping strategies. Alot of pts with reactive coping style decided not toinvolve cgs in their paints, even if the picture

illustrates a situation that pts and cgs live together(home, couple) maybe in order to protect them socgs are involved in the illustration even if in aindirect way. Our aim is to improve samples toverify our data.

P-23

‘Chasing Rainbows—Young Adults Living With

Cancer’: An Innovative Documentary Film Resource

Pat TaylorChasingrainbowsproduction.com, Vancouver, BC,Canada

OBJECTIVES: 1. To offer emotional and practicalsupport, hope and meaning to young adult cancerpatients, their families, caregivers and medicalsupport teams through a documentary film entitled‘Chasing Rainbows: Young Adults Living WithCancer’ 2. To foster dialogue and promote actionsurrounding the need for resources targeted atyoung adults, to improve quality and accessibilityof cancer care for this age group. 3. To support thevoice of young adults in the global cancercommunity METHOD: Chasing Rainbows: YoungAdults Living with Cancer is an upbeat 43-minutedocumentary built around a living-room conversa-tion between six young adults: four women andtwo men. With passion and humour, they discusshope, fear, faith, sexuality, infertility, familyrelationships, finances, the future and more. Theirstories are an invaluable source of information,inspiration and hope—both for other young adultsfacing life-threatening illness, and for their families,friends, caregivers and medical support teams.RESULTS: Producer Pat Taylor has screenedChasing Rainbows across Canada, in the US andin Mumbai (India), and has had requests forscreenings in the UK, Italy, the Netherlands andAustralia. In the course of the film’s travels it hasbecome abundantly clear that there is a great needfor resources targeted specifically at young adultsin the cancer community. CONCLUSIONS: In aneffort to make this resource as widely accessible aspossible, Pat has completed the French-languageversioning of Chasing Rainbows, and is in theprocess of translating the film into Spanish,Chinese, Arabic, Malay, Hindi, Portuguese andItalian.

P-25

Caring for the Family Caregivers of People With

Brain Cancer: Laying the Groundwork for a

Caregiver Intervention to be Delivered Across a

Wide Geographic Region

Michael Weber1, Ann-Louise Ellwood1, MyrnaTracy1, Brigitte Wagner1,BC Cancer Agency, Kelowna, BC, Canada1,UBC-Okanagan, Kelowna, BC, Canada2


DOI: 10.1002/pon


OBJECTIVES: The purpose of this feasibilitystudy was to identify a suitable psychoeducationalintervention for family caregivers of people livingwith brain cancer across a wide geographic region.Proposed interventions included a weekend work-shop, a telephone support group, a video confer-encing group, and an internet caregiver group.METHOD: Intervention preferences were gatheredthrough structured telephone interviews with 22caregivers, and evaluated using thematic analysis.Participants were prompted to indicate, (1) if aproposed intervention was the kind of programthat they would want to join (acceptability), and (2)if they thought that they could join this program,even if they did not want to (accessibility).RESULTS: The weekend workshop was identifiedby participants as most acceptable (70.55%) andleast accessible (63.6%). Participants were mostlikely to access a telephone support group (72.7%),video conferencing group (77.3%) or internetcaregiver group (81.8%), while only 50.8% onaverage would accept one of these telehealthinterventions. Participants cited the use and im-personal nature of telehealth technologies as beinga barrier to these interventions. Participantsidentified financial and practical barriers to attend-ing a weekend workshop. CONCLUSIONS: Care-givers in this catchment area desire informationabout the impact of the CNS tumour, managinghome and finances, and how to access emotionalsupport. This study provides potentially valuableinformation about how to deliver a psychoeduca-tional intervention to CNS caregivers, that is likelyto succeed across a wide geographic region.

P-27

Relationships of Social Support, Psychological and

Physical States Among Japanese Elderly Women

with Breast Cancer: Focused on Predictive Factors

on Psychological States

Reiko Makabe1, Tohru Ohtake2, Tadashi Nomizu3

Fukushima Medical University, Fukushima, Japan1,Fukushima Medical University, Fukushima, Japan2,Hoshi General Hospital, Fukushima, Japan3

OBJECTIVES: In Western cultures, it has beenreported that relationships of social support andpsychological and physical states among elderlywomen with breast cancer. Few studies reportedrelationships of these variables in Japanese elderlywomen with breast cancer. Thus, the purpose ofthis study was to investigate the relationships ofsocial support and psychological and physicalstates among Japanese elderly women with breastcancer. METHOD: A descriptive, comparative andcorrelational study was designed. A conveniencesample of Japanese elderly women with breastcancer participated in this study. Four instrumentswith established reliability and validity were

used: 1) the Social Support Scale for JapaneseElderly, 2) the General Health Questionnaire, 3)the Visual Analogue Scale of Social Support, and4) the Physical States Interview Form. Data wereanalyzed using t-tests, Pearson’s correlations, andstepwise multiple regression analysis. RESULTS:Significant differences were found in conflict(t5 2.00, p5 0.05) and in physical states (t5 2.29,p5 0.03) between the women who contacted withother patients and who did not. Psychologicalstates showed significant correlations with socialsupport network (r5 0.28, p5 0.025) and withconflict (r5 0.275, p5 0.037). Stepwise multipleregression analysis showed that conflict(beta5 0.274) was most influencing factor onpsychological states, followed by social supportnetwork (beta5 0.266). CONCLUSIONS: Thefindings suggest that conflict and social supportnetwork were important factors for the women’spsychological states. Healthcare professionalsshould provide information of social support asan important factor. Findings from this study pointto a need for additional research to investigate therelationships of these variables among Japaneseelderly women with breast cancer as a process ofbreast cancer experiences. ACKNOWLEDGE-MENT OF FUNDING: Japan Society for thePromotion of Science: Grant-in-Aid for ScientificResearch (C): ]MO19592503.

P-28

Practical Use of Psychiatric Unit for Oncology

Patients with Psychiatric Symptoms in Terms of

Palliative Medicine

Tokuzo Matsui1, Hisato Matsunaga, YasunoriMatsuda, Nobuo KiriikeDept of Neuropsychiatry Osaka City Univ., Osaka,Japan

OBJECTIVES: Basic Law for Cancer in Japaneffective in 1996 emphasizes psychological supportfor oncology patients in the field of palliativemedicine. Previous reports have focused mainly onvisiting surgery or internal medicine ward bypsycho-oncologist when oncology patients devel-oped mental disorders. However, when delirium orsuicidal ideation have developed severely, movingto psychiatric unit would be desirable. We presentfour oncology patients who moved to psychiatricunit and showed substantial recovery. METHOD:All the four oncology patients had admitted tosurgery or internal medicine ward to undergochemotherapy. During their chemotherapy term,they have complained depressive mood, suicidalidea, hallucination or delusion. They were forcedinvoluntary hospitalization from their originalward to psychiatric ward after detailed assessmentby psycho-oncologist. Administration of appropri-ate anti-depressants and atypical antipsychotic


DOI: 10.1002/pon


drugs had begun based on APA guideline. Allpatients had given us informed consent to partici-pate in the case report. RESULTS: They werediagnosed as major depressive disorder withpsychotic episode (two patients), delirium and briefpsychotic disorder by DSM-IV-TR. Appropriatepharmaco-therapy and psycho-therapy led allpatients to remission state within a few weeks ora few months in collaboration with physicians whotook care of physical status in psychiatric ward.They have returned to their original ward andresumed chemotherapy or transferred to homehealthcare system. CONCLUSIONS: Previously,use of psychiatric unit for oncology patients withpsychiatric symptoms had been limited because ofprejudice among patients and medical personnel,inexperience in oncology patients among psychia-trists and small number of facilities. However,under the robust collaboration with psycho-oncol-ogist and physicians, to transfer patients withpsychiatric symptoms to psychiatric unit tempora-rily is shown to be a good practice of palliativemedicine. It is essential that we accumulate similarcases to provide more evidence.

P-39

Randomised Controlled Trial (RCT) of a Compre-

hensive Post-Treatment Support Package (Survivor-

Care) for Bowel Cancer Survivors

Michael Jefford1, Penelope Schofield1, SanchiaAranda1, Jane Young2, Phyllis Butow3

Peter MacCallum Cancer, Department of Nursingand Supportive Care Research,Melbourne, Victoria,Australia1, University of Sydney, Surgical OutcomesResearch Centre, Sydney, New South Wales,Australia2, University of Sydney, School ofPsychology and Centre for Medical Psychologyand Evidence-based Decision-making, Sydney,New South Wales, Australia3

OBJECTIVES: Bowel (or colorectal) cancer (CRC)is the most common cancer affecting Australianmen and women. The illness and its treatments cancause distressing physical side-effects, impact onthe person’s emotional and psychological state andadversely affect social, occupational and relation-ship functioning. This presentation will report onthe effectiveness of an innovative supportive careprogram (SurvivorCare) for people with potentiallycurative CRC, aiming to reduce psychologicaldistress and unmet needs. METHOD: Patients willbe randomised to receive usual care or theSurvivorCare package, which comprises: (a) survi-vorship educational materials; (b) a tailoredsurvivorship care plan for the patient, GP andspecialists; (c) a nurse-led end of treatmentconsultation, followed by telephone-based followup 1, 3 and 7 weeks post-treatment session. Thisstudy will aim to recruit 334 patients from up to 12

Australian cancer treatment centres. Psychologicaldistress will be the primary study outcome.RESULTS: The study is due to commence recruit-ment in early 2010. In pilot testing, 10 peoplereceived the complete package. All survivorsconsidered it appropriate, relevant and useful.Survivors and staff found the intervention to behighly acceptable. CONCLUSIONS: The pilotstudy supported the intervention’s suitability andfeasibility. The intervention was well-received bypatients and can potentially help them managetheir concerns and worries. If SurvivorCare isshown to reduce distress and unmet needs, it will bepossible to quickly and broadly disseminate thismodel of care.

P-43

Improving the Psychosocial Health of People

with Cancer and Their Carers: A Community-Based

Approach

Suzanne Chambers1, Afaf Girgis2, Stefano Occhi-pinti1, Sandy Hutchison3, Jane Turner4, RobertCarter5, Jeffrey Dunn1

Griffith Institute for Health and MedicalResearch, Griffith University, Brisbane, Queensland,Australia1, Centre for Health Research andPsycho-oncology (CHeRP), The Cancer CouncilNSW, University of Newcastle & Hunter MedicalResearch Institute, Newcaslte, New South Wales,Australia2, Viertel Centre for Research in CancerControl, Cancer Council Queensland, Brisbane,Queensland, Australia3, School of Medicine,University of Queensland, Brisbane, Queensland,Australia4, Deakin Health Economics, DeakinUniversity, Melbourne, Victoria, Australia5

OBJECTIVES: Although clinical practice guide-lines advise routine screening for psychologicaldistress to facilitate referral to evidence-based care,this frequently does not occur in practice. Thispresentation presents the design of a two-armrandomised controlled trial with distressed patientsand carers, comparing minimal contact self-man-agement versus an individualised tele-based cogni-tive behavioural intervention. Uniquely, the studywas undertaken within a practice-based setting tofacilitate rapid translation into practice after studycompletion and to ensure ecological validity.METHOD: Patients (n5 280) and carers(n5 280) contacting the participating community-based cancer Helplines during the study period andscreening positive for distress were recruited andrandomised to 1) a nurse-led 30–45minute tele-phone support session and given a self-manage-ment manual or 2) a tele-based, psychologistdelivered cognitive behavioural intervention. Parti-cipants’ anxiety and depression, cancer specificdistress, unmet supportive care needs, positiveadjustment, and overall QOL are assessed at


DOI: 10.1002/pon


baseline and 2, 6 and 12 months post-recruitment.RESULTS: The presentation will discuss thechallenges of undertaking this work within apractice setting, including competing workloads,unfamiliarity with research protocols, and helpgiving attitudes. Baseline data outlining the adjust-ment problems experienced by these patients andcarers will be presented. CONCLUSIONS: CancerHelplines are highly accessed by distressed patientsand carers and provide a unique point of articula-tion for distress screening and evidence-based care.However, there are skill and attitudinal barriers tobe overcome in order for distress screening tobecome standard care; and the heterogeneousnature of the psychological problems these clientsdisplay presents challenges for both research andpractice.

P-49

Decisions in Palliative Care: Individual Factors

Influencing The Physician-Elederly Patient-Care-

giver Triad

Lamontagne Julie, Beaulieu Marie, Arcand MarcelCSSS-IUGS-Centre de recherche sur le vieillisse-ment, Sherbrooke University, Sherbrooke, Quebec,Canada

OBJECTIVES: In the elderly who receive palliativecare, deterioration of health status is generallydifficult to predict. Hence, the decisions regardingtreatment become complex and may generateconflicts between participants. The philosophybehind palliative care leads the physician to workin concert when choices are being made. Thepurpose of this presentation is to specify the factorsthat influence the elderly patient, his caregiver, andthe physician in the decision-making processregarding the choice of treatment. METHOD: Inthis case study, we followed three triads in theMaison de soins palliatifs and one in Long-TermCare Centre, for a period of 9 to 14 days. Ourresults are based on: semi-structured individualinterviews that were held with each of theparticipants in the triad; and the recording ofmeetings among the physician, the patient, and/orthe caregiver. The analysis was carried out usingthe mixed thematic approach of Huberman andMiles. RESULTS: We present separately in thisposter session the individual factors specific to eachparticipant. For example, the patient is influencedby his definition of the situation, his personalexperiences, and his values. The caregiver is furtherinfluenced by the decision-making ability of thepatient. As for the physician, although noticeablyinfluenced by the same factors as those of theother members of the triad, he takes into con-sideration the standards of palliative care practice.CONCLUSIONS: Although the factors for theelderly patient, the caregiver, and the physician are

appreciably similar, divergence in their content ispossible. For an efficient dialogue, a better under-standing of these individual factors would help tograsp the challenges faced by each member of thetriad and would allow the latter to reach aconsensual decision, thus avoiding conflicts.

P-53

Translation and Trans-Cultural Adaptation from

French to English of an Instrument Measuring Self-

Perceived Palliative Care Nursing Competencies

Jean-Franc-ois Desbiens1, Deborah Sherman2,Lise Fillion1

Laval University, Quebec, QC, Canada1, Universityof Maryland, Baltimore, MD, United States2

OBJECTIVES: To promote nursing competencies,one needs to take into consideration self-perceptionof competencies, a determinant of achievement.However, there is a lack of reliable and validinstruments to measure self-perceived palliativecare nursing competencies. There are strongadvices from the literature to use a simultaneousdevelopment approach for new instruments. Thisstudy was designed to provide a simultaneoustranslation and trans-cultural adaptation fromFrench to English of an instrument measuringself-perceived palliative care nursing competencies.METHOD: The instrument was first developed inFrench in the Province of Quebec, Canada. After awhile, an advisory committee of four Englishspeaking nursing palliative care experts in theUSA revised the content and the semantic of anEnglish translation of the instrument. The Frenchversion was simultaneously modified to maintainsemantic and conceptual equivalence. Individualcognitive interviews were conducted in English andin French to review the clarity and comprehensionof the items. RESULTS: To ensure conceptual,cultural and linguistic equivalence between theFrench and English version, one domain has beenmodified, the definition of palliative care has beenrevised, and the scale values have been changed.Also, 15 items out of 65 have been deleted, 16 newitems have been proposed and the content of 9items has been improved. The semantic ofthe French version has been also reviewed tomaintain equivalence with the English version.CONCLUSIONS: Instruments may use idiosyn-cratic expressions or social norms that could not betranslated into different languages. Using a simul-taneous approach gives the possibility to reformu-late the items at an early stage of the development,which reduce the risk of cultural bias. Translatingand adapting from French to English a newinstrument designed to measure self-perceivedpalliative care nursing competencies provided twoconceptual and linguistic equivalent versions thatmight be used all across North America.


DOI: 10.1002/pon


P-57

Patient’s Perceived Need and Psychological Distress

and/or Quality of Life in Ambulatory Breast Cancer

Patients

Tatsuo Akechi, Toru Okuyama, ChiharuEndo, Ryuichi Sagawa, Megumi Uchida,Tomohiro Nakaguchi, Terukazu Akazawa,Hiroko Yamashita, Toyama Toyama, ToshiakiA. Furukawa,Nagoya City University Graduate School of MedicalSciences, Nagoya, Japan

OBJECTIVES: A needs assessment can be used asa direct index of what patients perceive they needhelp with. The purposes of this study were toinvestigate the association between patients’ per-ceived needs and psychological distress and/orquality of life and to clarify the characteristics ofpatients with a high degree of unmet needs.METHOD: Randomly selected ambulatory femalepatients with breast cancer participated in thisstudy. The patients were asked to complete theShort-form Supportive Care Needs Survey ques-tionnaire, which covers five domains of need(health system and information, psychological,physical, care and support, and sexuality needs);the Hospital Anxiety and Depression Scale; and theEuropean Organization for Research and Treat-ment of Cancer QLQ-C 30. RESULTS: Completedata were available for 408 patients. The patients’needs were significantly associated with bothpsychological distress (r5 0.63) and quality of life(r5�0.52). A multivariate analysis revealed thatemployment status, duration since diagnosis, ad-vanced stage, and a lower performance status weresignificantly associated with higher total needs.Only sexuality needs were significantly associatedwith a younger age, while the other domains weresignificantly associated with duration since diag-nosis, advanced stage, and a lower performancestatus. CONCLUSIONS: Moderate to strongassociations exist between patients’ needs andpsychological distress and/or quality of life. Thecharacteristics associated with patients’ needs aremulti-factorial, and interventions to respond topatients’ needs may be one possible strategy forameliorating psychological distress and enhancingquality of life.

P-58

Feasibility and Usefulness of the ‘Distress Screening

Program in Ambulatory Care’ in Clinical Oncology

Practice

Ken Shimizu1, Yosuke Uchitomi2

National Cancer Center Hospital, Japan, Tokyo,Japan1, National Cancer Center East Hospital,Japan, Chiba, Japan2

OBJECTIVES: Although the implementation ofroutine screening for distress is desirable, doing sois difficult in today’s busy clinical oncologypractice. We developed the ‘Distress ScreeningProgram in Ambulatory Care’ (DISPAC program)as a practical means of screening for and facilitat-ing the treatment of major depression and adjust-ment disorders in cancer patients. This studyassessed the feasibility and usefulness of theDISPAC program in actual clinical situations.METHOD: As part of the DISPAC program,nurses administered a psychological screeningmeasure, the Distress and Impact Thermometer(DIT), to consecutive cancer patients visiting anoutpatient clinic in the waiting room. The attend-ing physician then recommended psycho-oncologyservice referral to all positively screened patients.We compared the proportion of patients referredto a psycho-oncology service during the DISPACperiod with the usual care period. RESULTS: Ofthe 491 patients during the DISPAC period, 91.9%(451/491) completed the DIT; the results werepositive in 37.0% (167/451), recommendations forreferrals were given to 93.4% (156/167), and 25.0%(39/156) accepted the referral. Ultimately 5.3%(26/491) were treated by psycho-oncology serviceas having major depression or adjustment dis-orders, a significantly higher proportion thanduring the usual care period (0.3%; po0.001).The nurses required 132758 seconds per person toadminister the DIT. CONCLUSIONS: The DIS-PAC program is useful for facilitating the care ofcancer patients with psychological distress. Never-theless, the acceptance of referrals by patients andthe reduction of the burden placed on nurses areareas requiring improvement.

P-59

Economic Impact of Cancer Diagnosis and Treat-

ment on Radiotherapy Patients and Their Families

Chioma Asuzu, I.K AwusaUniversity of Ibadan, Ibadan, Nigeria

OBJECTIVES: Cancer is a devastating and frigh-tening disease. It evolves a lot of emotions rangingfrom anger to guilt feeling to fear of death. Theexperience of cancer presents a number of demandson the individual and his family that has psycho-social and financial implications. The aim of studyis to assess the economic impact of cancer diagnosison the patients and their families. METHOD: Thestudy consisted of an interviewer-administeredsurvey instrument of 213 patients who willingparticipated in the study following a duly appliedinformed consent procedure. The questionnairewas developed by the researchers, consulting withother questionnaires and validated in a privatecancer hospital in Ibadan. It has internal consis-tency reliability of 0.76. RESULTS: The subjects


DOI: 10.1002/pon


consisted of 61 males and 152 females. Married162, single 43. 57 of the patients earn below 20,000Naira, 64 earn between 20,000 and 50,000 while 68earn above 50,000 thousand Naira per month (1USD5 150 Naira). The study revealed that theeconomic cost of cancer diagnosis and treatmenthad significant impact on the patients coping andadjustment as this constituted a large percentage oftheir family earning. CONCLUSIONS: The resultof this study shows the negative impact of theeconomic hardship experienced by cancer patientsand their families as it affects their ability to copeand adjust to their cancer situation. This has a lotof implications for psycho-oncology, the healthpersonnel, hospital administrators and policymakers in the health services.

P-62

Aerobic versus Resistance Exercise Training for

Prostate Cancer Patients on ADT

Daniel Santa Mina1, Shabbir Alibhai1, MeysamPirbaglou1, Andrew Matthew1, John Trachtenberg1,Neil Fleshner1, Mike Connor2, George Tomlinson1,Paul Ritvo2

University Health Network, Toronto, Ontario,Canada1, York University, Toronto, Ontario, Canada2

OBJECTIVES: Androgen deprivation therapy(ADT) is an effective treatment for advanced-stageprostate cancer. Unfortunately, ADT has severalside-effects that significantly impair health-relatedquality of life (HRQOL). In patients receivingADT, resistance training has been shown toimprove important physical and psychosocial out-comes. However, little is known about the effects ofaerobic exercise in this population. This pilot studycompares the effect of aerobic and resistanceexercise interventions on HRQOL and fitness in a24-week randomized trial. METHOD: 60 menreceiving ADT for prostate cancer are beingrecruited for this prospective, randomized trial.Participants are assigned to either a resistance oraerobic home-based, moderate-intensity exercise3–5 times per week for 30–60minutes/session.Primary outcomes include fatigue, HRQOL, andexercise adherence. Secondary outcomes includeaerobic and musculoskeletal fitness, body composi-tion, and biomarkers associated with tumorigenesis(leptin, adiponectin, and IGF-1). Outcomes areassessed at baseline, 12, 24, and 48 weeks.RESULTS: Preliminary findings are presented.746 patients have been screened, yielding 257eligible participants. To date, 47 participants haveagreed to randomization, 4 of whom have sincewithdrawn (85% retention). Preliminary findingsfrom baseline to 12 weeks for all participantsindicate a significant improvement in body fatpercentage, VO2 peak, weekly physical activity

volume (po0.05). No obvious differences haveemerged in physical or psychosocial outcomesbetween groups. CONCLUSIONS: Preliminaryfindings suggest that significant improvements inbody composition and aerobic fitness can beobtained with 12 weeks of aerobic or resistancetraining, with no difference between groups. Thehigh retention rate and improvements in weeklyphysical activity volume indicate a highly adherentpopulation supporting the feasibility of a large-scale studies comparing aerobic and resistanceexercise training.

P-64

Gender Differences in Dealing with Emotional

Aspects and the Desire to Receive Professional

Psychological Help, in Cancer Patients at the First

Visit to an Oncology Service

Concepcion Leon1, Esther Jovell3, Gloria Arenas1,Jordi Alfaro1, Remei Blanco1, Aleidys Pisa1,Emma Dotor1, Tomas Blasco2, Adrian Gaytan3,Angeles Arcusa1

I.O.V. (Institut Oncologic del Valles), Terrassa,Barcelona, Spain1, Universidad Autonoma deBarcelona, Bellaterra, Barcelona, Spain2, Hospitalde Terrassa, Terrassa, Barcelona, Spain3

OBJECTIVES: The main goal of the study is toexplore gender differences in perceived self-con-fidence to cope with cancer, emotional distress, anddesire to receive professional psychological help, incancer patients at their first visit to the OncologyService. METHOD: From September to December2009, all the patients receiving their first visit in theOncology Service were assessed, using a structuredquestionnaire. Patients included in the study were40 (Men5 19; Women5 21). Inclusion criteria:Adult cancer patients.Gender differences and theother variables were evaluated. ASSESSMENT:Socio-demographical and medical variables. Emo-tional distress (mood, tension, fear, anger), Desireto receive psychological help and Perceived self-confidence were evaluated with a Likert scale with4 levels of response. RESULTS: Preliminary resultsshows: Mean age was 61 (range5 36–82). Breastcancer (34%) and colorectal cancer (22%) were themost frequent diagnoses. There were not genderdifferences in emotional distress, self-confidence tocope with cancer. Of all those seeking psychologi-cal help, 64% said that they need much effort toface their status (p5 0.02). However, 82% ofwomen would receive psychological help, whereasonly 29% of men expressed this will. Thesedifferences were statistically significant (p5 0.03).CONCLUSIONS: In our study we can concludethat at their first visit to the Oncology Service: 1)There are not gender differences in emotionaldistress nor in self-confidence to cope againstillness. 2) Women express more their desire to


DOI: 10.1002/pon


receive psychological help than men. 3) It could bewaited for statistically significant differences afterincluding all subjects and analyzed the sample.

P-66

Using Participatory Action Research Techniques,

Healthy BRCA Mutation Carriers Design a Model

of Care

Pnina MorShaare Zedek Medical Center, Jerusalem, Israel,Machon Tal School of Nursing, Jerusalem, Israel

OBJECTIVES: To identify the unmet medical andpsychological needs of healthy women testing positivefor BRCA gene mutations and define programs tomeet these needs in the context of the Israeli healthcaresystem. METHOD: The study was conducted usingParticipatory Action Research (PAR) techniques.PAR involves a spiral of steps, each encompassing acircle of planning-action-fact finding. Using PARtechniques involving a series of focus group interviewsand intensive discussions, we worked closely with onegroup of eleven health professionals from diversedisciplines and three focus groups of 23 healthy femaleBRCA carriers recruited from a genetics clinic. Focusgroups were led by a trained moderator and theresearcher. RESULTS: Through their narratives,carriers described dilemmas and ongoing stressassociated with the constant threat of illness, mixedmessages from caregivers, practical barriers to care,and a lack of psychosocial support that affect andsometimes radically change life perspectives. Partici-pants suggested a ‘one-stop’ center to providemedical and psychological care. Their ideas werepresented to focus groups of health care profes-sionals who manage care for healthy carriers. Amultidisciplinary outpatient clinic for healthy car-riers was opened. CONCLUSIONS: The primarystudy outcome was inception of a one-stop multi-disciplinary clinic incorporated into an existinghealthcare setting. The clinic provides medical andpsychosocial services, including improved access toimaging surveillance, as well as expert medicalconsultation and counselling. In addition to provid-ing a response to the healthcare issues presented bythe healthy BRCA mutation carriers, the studyfindings strengthened interdisciplinary connectionsamong participating nurses, genetic counsellors,and physicians, and psycho-oncologists.

P-67

Enhancing Empathy Among Medical Students To-

wards Psychosocial Needs of Cancer Patients and

Their Families Through Micro-Skills Interview

Training


OBJECTIVES: This quasi experimental studyassessed and compared the effectiveness of fa-culty-supervised and self-instructional listeningmicro-skills training in increasing the responsive-ness of medical students to the psychosocial needsof cancer patients and their families during medicalstudent-patient-family member interviews. METH-OD: Seventeen final year medical students wererandomly assigned to conditions for training andto baselines within each condition. Training con-ditions were identical in informational content andtime requirements. Self-instructional training in-corporated two videotapes developed for the study.Data from the training conditions were analyzedseparately through the use of graphs, statisticalanalyses, and t-tests, comparatively, and on thebasis of overall training effectiveness across allparticipants. The standard for significance was.05.RESULTS: Faculty-supervised training was moreeffective than self-instructional training in increas-ing responsiveness as measured by (a) observa-tional data from videotaped interviews, (b) patientand family member ratings of interviews, and (c)number of psychosocial needs recognized onmedical student dictation reports. Overall use oftraining was effective in increasing (a) appropriateuse of four interview micro-skills, (b) patient andfamily member interview ratings, and (c) number ofpsychosocial needs recognized on dictation reports.CONCLUSIONS: The two training conditionswere hypothesized to be equally effective inincreasing responsiveness as measured by a con-tent-based mastery test. However, graphed dataand t-test results indicated that faculty-supervisedtraining was effective in increasing scores and self-instructional training was not. T-test resultsindicated that overall training was effective inincreasing scores on the mastery test.

P-68

The Effectiveness of Delivering Unfavorable News to

Patients Diagnosed with Cancer Training Program

for Future Oncologists in Orissa, India


OBJECTIVES: Collaborative communication,rather than one-way authoritarian, physician-ledmedical interview, is significant in navigatingdifficult circumstances like delivering ‘bad news’to patients diagnosed with cancer. Additionally,the potential psychological effects of breaking badnews in an abrupt and insensitive manner can bedevastating and long-lasting for both the patientand family. Delivering the unfavorable news topatients is a challenging task and is now getting theattention of medical professionals in many coun-tries like India. METHOD: The purpose of thisstudy was to investigate the effectiveness of a pilot


DOI: 10.1002/pon


training program ‘Delivering Unfavorable News toPatients Diagnosed with Cancer’ conducted inOrissa province of India. A total of 44 oncolo-gists-in-training from the state (N5 44, n5 22[treatment], n5 22 [control]) completed Self-Effi-cacy, Interpersonal skills, Empathy, and PhysicianBelief, and demographic instruments before, im-mediately after, and then two weeks after thetraining intervention. RESULTS: Results ofMANOVA and bivariate statistical analyses re-vealed significant differences in self-efficacy,empathy, and Physician Belief scores withinthe experimental group, but not within thecontrol group, from pre-test to post-test.CONCLUSIONS: The follow-up data analysissuggested that participants maintained the level ofchange that occurred immediately after the trainingintervention. It is recommended that such trainingshould be an integral part of the course programfor the oncology residents.

P-70

Information Seeking Behaviors Among Breast Can-

cer Survivors with Limited English Skills

Jenny Yi, Krystal Luong, Kathy YeoungUniversity of Houston, Houston, Texas, UnitedStates

OBJECTIVES: Attempts to acquire informationabout their disease are very common among cancerpatients and the Internet has become a majorsource of health information. Little attention hasbeen focused on the use of Internet for breastcancer survivors with limited English skills. Thepurpose of this study is to describe the healthinformation seeking behaviors and the use of theInternet by Asian American breast cancer survi-vors. METHOD: Chinese and Vietnamese breastcancer patients diagnosed within the previous 5years participated in face-to-face interviews with abilingual interviewer. Participants were recruitedfrom media, hospitals, clinics, and cancer supportgroups. A total of 98 breast cancer survivorsparticipated in the survey. RESULTS: The meanage was 56 years old. The mean time since breastcancer diagnosis was 29.8 months. We found that42.9% of participants reported never using theInternet for health information. Internet users tendto be of higher socioeconomic status, acculturated,younger age and Chinese ethnicity. Only 9.2% ofstudy participants have used email or gone towebsite to communicate with a doctor’s office or toget advice from an online health care provider.CONCLUSIONS: Electronic communication mayhelp patients to ask questions, facilitate under-standing and reduce unnecessary appointment.However, health providers who want to reachnon-English speaking cancer patients need to takeinto account the low use of Internet resources.

Findings from this study can be used to assist in thedevelopment of culturally appropriate and effectivetools to encourage cancer survivors with limitedEnglish skills to learn more about their disease.

P-71

Spirituality, Symptom Distress, Depression and

Quality of Life of Advanced Cancer Patients

Arun Kandasamy, Santosh Kumar Chaturvedi,Geetha DesaiNational Institute of Mental Health and Neuros-ciences (Nimhans), Bangalore, Karnataka, India

OBJECTIVES: To study Spiritual Well being (SpWB) and its influence on symptoms of distress,depression and other dimensions of Quality of lifein advanced cancer patients undergoing palliativecare. METHOD: The study was cross sectional innature where 50 patients with advanced cancerfrom a Hospice were recruited and they have beenassessed with Visual analogue scale for pain, M.D.Anderson symptom inventory (MDASI), HospitalAnxiety Depression Scale (HADS), Functionalassessment of cancer therapy–Palliative Care(FACT-pal) and Functional assessment of chronicillness therapy-spiritual well-being (FACIT-sp).Spirituality was correlated with differentvariables of other scales. RESULTS: Depressionis negatively correlated with Spiritual well-being (Sp WB). Sp WB was significantly correlatedwith fatigue (r5�0.423, p5 0.002), symptomdistress (r5�0.717, po0.001), memory distur-bance (r5�0.520, po0.001), loss of appetite(r5�0.399, p5 0.004), drowsiness (r5�0.400,p5 0.004), dry mouth (r5�0.381, p5 0.006)and sadness (r5�0.720, po0.001). Sp WBwas strongly positively correlated with all theother aspects of QOL. Palliative care well-being (t5 2.840, p5 0.008), distress (t5�2.582,p5 0.015), sadness (t5�2.765, p5 0.010) weresignificantly correlated with SpWB after regressionanalysis. CONCLUSIONS: This study suggeststhat Spiritual well being is an important compo-nent of quality of life of advanced cancer patients,and is closely related to physical and psychologicalsymptoms of distress. It should be addressedappropriately and adequately in palliative caresettings.

P-73

The Name of the Illness is Cancer: On Disclosures

and Secrets in the Family

Shlomit Perry, Efrat TzairyDavidoff Center, Beilinson Hospital, Petach-Tikva,Israel

OBJECTIVES: Parents facing death need guidanceand support when sharing the information with


DOI: 10.1002/pon


their children. Most investigations focused on theimpact of parental cancer diagnosis during earlystage disease and rarely in advanced and terminalstages. We produced a film to encourage discussionabout the gap between the unmet needs of theparents, and this lack of knowledge amongstprofessionals. METHOD: ‘The Name of the Illnessis Cancer: On disclosures and secrets in the family’,is a 25 minute film, based on narratives of sixfamilies in which one of the parents has a terminalillness. It was produced by the Psycho-OncologyUnit in a comprehensive cancer center in Israel, foreducational purposes. The film deals with dilem-mas, fears and the complexity of telling youngchildren about the imminent death of a parent.RESULTS: The film was produced within the lasttwo years based on the narrative method and sincethen has been presented to a number of profes-sional conferences and seminars. Although the filmis free only few families have taken it home.CONCLUSIONS: The film has been enthusiasti-cally embraced nation-wide by healthcare profes-sionals who felt it filled a gap in their knowledge.The film emphasizes the need for further studies inthis area emphasizing communication betweenprofessionals and families. The film is only onestep in the process of exploring and debatingpainful and sometimes secretive issues. We believethat this film can help professionals from othercountries and therefore added English subtitles.

P-78

Designing an Online Training Platform for Promo-

tores

Haley JusticeLance Armstrong Foundation, Austin, Texas,United States

OBJECTIVES: In 2006, LIVESTRONG createdan in-person cancer survivorship training curricu-lum for Promotores. The goal of the training is toprovide Promotores the knowledge, skills andconfidence to work with cancer survivors in theircommunity. After disseminating the curriculum toPromotores and Community-based Organizations,we learned that Promotores oftentimes face bar-riers to completing in-person training, such as timeto participate in an 8-hour training, lack of trainingin their communities and inability to travel totraining. METHOD: LIVESTRONG created anonline version of the training. The method ofdelivering the training was discussed among agroup of Hispanic/Latino advisors, many of whomare Promotores or work with Promotores. Advi-sors determined that the online training needed toaccomplish the same goals as the in-person trainingand also engage the participants to ensure that theycomplete the training. The most effective formatto accomplish this would be a video training,

supplemental videos and quizzes. RESULTS:LIVESTRONG created a video version of thetraining using a facilitator and Promotores. Wealso created a supplemental video of interviews withPromotores and the cancer survivors they serve.Throughout the online training, users are trainedusing videos and key concepts are reinforcedthrough in-session quizzes. Additional videos ofcancer survivor’s stories are also interspersedthroughout the training. To successfully completethe training, users must pass a final, cumulative quizat 70%. CONCLUSIONS: 100% of Promotoreswho have completed the training said the trainingwould improve their work with cancer survivors andthey would recommend the training to otherPromotores. LIVESTRONG has also receivedrequests from international audiences to completethe training. As the number of Promotores con-tinues to increase, it is important to explore onlinemodalities as a form of training delivery. Thisformat is also provides an opportunity to educate aglobal audience on cancer-related topics.

P-79

Struggling Without Relief from Inconclusive BRCA

1/2 Results: Psychological Impact on Individuals at

Risk for Hereditary Cancer

Christine Maheu, Aronela BeneaYork University, School of Nursing, Toronto,Canada

OBJECTIVES: Currently, little knowledge existson the psychological impact of receiving incon-clusive results to BRCA1/2 among women affectedwith cancer. Current literature revealed the factthat genetic testing in the context of inconclusiveresults is mostly under investigated calling forresearch to explore the psychological consequencesof continuing uncertainty. This study aimed toaddress the aforementioned gap by describing theemotional reactions of women affected with cancerto the receipt of inconclusive BRCA 1/2 results.METHOD: A retrospective descriptive interpretivedesign was used. Analysis consisted of identifyingcommon themes among the 21 open interviewsconducted with women at risk of hereditary breastand ovarian cancer who received inconclusiveBRCA1/2 genetic test results. All women wererecruited from one hereditary cancer program inCanada. RESULTS: Lack of relief from the receiptof inconclusive BRCA1/2 results was expressed by17 of the women. Lack of relief came from notknowing the etiology of their own cancer diagnosis;why there were so many cancers in their family; notknowing if their family was truly at risk ofhereditary cancers, and from not knowing if theyhad passed down an inherited cancer mutation totheir children. CONCLUSIONS: Contrary topotential assumptions of clinicians that the


DOI: 10.1002/pon


recipients of inconclusive genetic test resultsexperience relief similar to people who test true-negative, the findings from this study revealed thateven among those who felt relief, the relief was onlytemporary.

P-82

Effect of Religion and Spirituality in Adjusting

Quality Of Life of Patients with Cancer in Saudi

Arabia

Amani Khalil, Shatha AlhabibKFSH, Dammam, Saudi Arabia

OBJECTIVES: The study’s main purpose is toexamine the role of religion and spirituality inadjusting quality of life of patients with cancerSaudi Arabia population. METHOD: Structuredinterviews will be conducted with 100 patientsrecruited from Oncology center at KFSH. Bothpositive religious coping (e.g. benevolent religiousappraisals), negative religious coping and multipledimensions of QOL (physical, psychological, ex-istential and support) will be studied. This mea-sures will be used: (McGill QOL questionnaire),Pargament Brief Religious Coping Scale, Multi-dimensional Measure of Religion/Spirituality, self-efficacy, socio-demographic variables, FunctionalAssessment of Chronic Illness Therapy-SpiritualWell-Being and Profile of Mood States-Short Form(POMS-SF). RESULTS: Expected Results: Signif-icantly positive religious coping associated withbetter QOL as well as higher scores on theexistential and support QOL dimensions will beobserved. In contrast,greater use of negativereligious coping will result in poorer overall QOLand lower scores on the existential and psycholo-gical QOL dimensions. Spiritual decline will beassociated with poorer adjustment, greater depres-sion and poorer spiritual well-being. Negativereligious coping will be related to poorer overallQOL and psychological QOL dimensions. CON-CLUSIONS: Expected Conclusions: Findings willshow that religious coping plays an important rolefor the QOL of patients and the types of religiouscoping strategies used are related to better orpoorer QOL.

P-86

The Trajectory of Costs over the Participation in a

Palliative Care Program: A Canadian Perspective

Veronique Turcotte1, Serge Dumont1, Philip Ja-cobs2, Donna Anderson3, Franc-ois Harel1

Laval University Cancer Research Center, Quebec,Quebec, Canada1, University of Alberta, Depart-ment of Medicine, Edmonton, Alberta, Canada2,Centre for Interdisciplinary Research in Rehabilita-tion and Social Integration, Quebec, Quebec,Canada3

OBJECTIVES: The study aimed to highlight thetrajectory of costs over the participation in apalliative care program in five Canadian urbanregions. METHOD: A cohort of 160 patientsnewly enrolled in a palliative care program andtheir main informal caregivers were consecutivelyrecruited. The participants were followed every twoweeks until the patient’s passing. They were askedquestions on the goods and services they usedrelated to the patient’s health condition. Informalcaregivers were also asked questions on the timethey spent on providing care and assistance to thepatient. RESULTS: The overall costs of caregradually increased from the fifth to the last monthof the patients’ life. Inpatient care constituted thelargest component of this cost increase. Amongoutpatient care, home care sustained the largestincrease in costs over time. Informal care costswere particularly high over the last three months ofthe patients’ life. CONCLUSIONS: The studyfindings indicate that programs and services thatoffer some sort of financial assistance are mostneeded during the final three months of life. Theknowledge gained from this study could be usefulto policy makers when developing policies that aimto support families taking care of a terminally illloved one at home.

P-90

Nurses in Outpatient Chemotherapy Center May

Have Difficulty in Assessing Their Patients’ Symp-

toms and Supportive Care Needs

Toru Okuyama1, Tatsuo Akechi2, HirokazuKomatsu3, Chiharu Endo2, Ryuichi Sagawa1,Ryuzo Ueda3, Toshiaki Furukawa2

Palliative care and psycho-oncology Nagoya CityUniversity Hospital, Nagoya, Aichi, Japan1,Department of Psychiatry and Cognitive-BehavioralMedicine, Nagoya City University Graduate Schoolof Medical Sciences, Nagoya, Aichi, Japan2,Department of Medical Oncology and Immunology,Nagoya City University Graduate School of MedicalSciences, Nagoya, Aichi, Japan3

OBJECTIVES: Accurate evaluation of symptomseverity as well as supportive care needs is crucialto the provision of optimal supportive care. Thepurpose of this study was to investigate how wellnurses in an outpatient chemotherapy centerrecognize their patients’ physical and psychologicalsymptoms and supportive care needs in routineclinical practice. METHOD: Nurses and a sampleof randomly sampled patients undergoing che-motherapy at an outpatient chemotherapy centerparticipated. This study was approved by theInstitutional Review Board and full written in-formed consent was obtained. Patients reportedthe severity of their symptoms and supportivecare needs using validated questionnaires. Nurses


DOI: 10.1002/pon


completed a survey in which they indicated theirrecognition of each patient’s level of these pro-blems immediately following their consultation.These two data were compared statistically. RE-SULTS: Complete data were available from 211patients. Among them, 69% had advanced cancer.Prevalence of most of symptoms reported bynurses were much lower than that patientsreported, resulting sensitivity was less than 50%and specificity was greater than 85% for allsymptoms except fatigue, appetite loss and hairloss. Nurses recognized physical and psychologicalneeds relatively better than other domains of needs.Kappa index was generally low (o0.49). CON-CLUSIONS: Nurses in outpatient chemotherapycenter may not recognize their patients’ physicaland psychological symptoms and supportive careneeds. Incorporating standard symptom and needsassessment in clinical practice may heighten nurses’awareness of their patients’ symptoms.

P-93

Psychological Aspects of Doctors Who Work with

Oncology Patients

Marılia Sper de Albuquerque1, Silvia Santiago1

UNICAMP, Campinas, Sao Paulo, Brazil1,UNICAMP, Campinas, Sao Paulo, Brazil2

OBJECTIVES: This work had the objective toknow which psychological aspects are present inthe doctor who takes care of patients with cancer,and also to identify which personal and institu-tional strategies are used to support them, startingfrom that professional’s perspective. METHOD:The methodology used was a qualitative research.It was used the procedures of the field diary anddirected interviews with semi-open questions. Theinterviews were accomplished with doctors whotakes care of oncology patients from a publichospital in Brazil. RESULTS: The results wereanalyzed from thematic content analysis, usingtheoretical references of the psychoanalysis and thepublic health. The main results were investigativeand scientific interests, appreciation of the doctor-patient relationship, support in the multidisciplin-ary team, difficulty in communicating the cancerdiagnosis and death possibility. The most ofdoctors found difficult to identify their ownfeelings, but some related feelings of impotence,anguish, fear of recurrence, difficulty to handlewith death and for looking help. CONCLUSIONS:That is necessary training medical students anddoctors in professional practice about psychologi-cal approach. Most of the results points to the needto create spaces of meaning production of medicalpractice in oncology. Like to speak in death,suffering and other feelings, communication inthe relationship doctor and patient. Care for thecaregiver can assist the professional in under-

standing the your own needs and the self-knowl-edge, understanding the illness process, reflecting inthe quality care to patients with cancer in thepublic health system in Brazil.

P-94

Depression, Anxiety and Decisional Regret in

Cytogenetic Prognostication for Patients with Uveal

Melanoma

Isabel Schuermeyer, Anca Maican, Arun Singh,Richard SharpCleveland Clinic, Cleveland, OH, United States

OBJECTIVES: This study was undertaken to furtherunderstand the effect of cytogenetic prognosticationin patients with uveal melanoma with regard tomood and anxiety. Further, to understand anydecisional regret that these patients may experienceeither immediately after making the decision to havetesting or later, after the results of the testing havebeen known. METHOD: Patients diagnosed withuveal melanoma were offered enrollment in an IRBapproved study for cytogenetic testing of the tumorto determine prognosis. These patients were asked tocomplete the Hospital Anxiety and Depression Scale(HADS) along with a decision regret scale at threetime points—pre-operatively, at post operative timepoints of 3 and 12 months. RESULTS: Results arecurrently being obtained and preliminary findings(i.e. pre-operative and 3 month follow up) will beavailable at time of conference. CONCLUSIONS:We suspect finding higher anxiety with low decisionregret pre-operatively. Post-operatively, we believethere will be higher depression and continued lowdecision regret. Again, current findings will bepresented at the meeting.

P-95

Using a Logic Model for the Implementation of a

Psychosocial Oncology Telehealth Program

Elaine ShearerBC Cancer Agency, Vancouver, BC, Canada

OBJECTIVES: In response to the growing body ofresearch that supports telehealth as a way toprovide equitable, cost-saving, patient-centeredcancer care, BC Cancer Agency, Patient andFamily Counseling Services formed a workinggroup with an aim to increase the use of telehealthwith patients living in rural and remote locations.A logic model articulates the cultural shift involvedin helping both clinicians, patients and referringprofessionals gain awareness and increase usage ofthis innovative technology. METHOD: A bestpractices review was conducted, a vision, goalsand a logic model were developed to help articulateand evaluate the change process involved in


DOI: 10.1002/pon


meeting desired outcomes. Several pilot projectswere identified based on existing experiments withuses of telehealth to deliver psychosocial services.The working group meets to specifically to nurturethe development of these pilot projects as well aspromote the overall awareness and use of tele-health within multidisciplinary cancer care system.RESULTS: This initiative is currently in the earlystages of fostering knowledge exchange among keystakeholders including practice leaders and staffwithin the program, other disciplines, administra-tors and the community oncology network. Fourpilot projects have been identified. This initiative’ssuccess depends on an effective partnership be-tween BCCA and referring professionals in thecommunity to identify specific priorities for pilotprojects establish work plans and draft protocolsfor the implementation of a psychosocial oncologytelehealth program. CONCLUSIONS: The com-plexity of the cultural shift to increase the use oftelehealth requires a tool such as a logic model toprovide a framework for common understandingand measurable change. Initiating and supportingpilot projects which increase the use in 2 way videoconferencing for patient and family counseling willadd to the growing body of research that supportsthe effective use of telehealth in rehabilitation andsupportive cancer care.

P-103

Evaluation of Trait Anxiety as Predictors of

Psychological Distress and Low HRQL Among

Breast Cancer Patients

Yujiro Kuroda1, Takashi Kawaguchi2, SatoruIwase1, Naoko Sakata1, Takuhiro Yamaguchi1,Kaori Muto1, Osamu Sakura1, YoshinoriNagumo3, Keiichi Nakagawa1

The University of Tokyo, Tokyo, Japan1, TokyoUniversity of Pharmacy and Life Sciences, Tokyo,Japan2, Nagumo Clinic, Tokyo, Japan3

OBJECTIVES: Cancer patients frequently experi-ence multiple and co-occurring problems due totheir illness and therapies. Only few studies havesuggested the contribution of specific psychologicalfactors during cancer therapy. We have focused ontrait anxiety, which is a general tendency to exhibitanxiety, as an important factor when consideringpsychological distress in breast cancer patients.METHOD: A total of 157 women participated inthis study. All patients that were referred to amedical oncologist were asked to complete fivequestionnaires (STAI, HADS, EORTC QLQ-C30,BR23, and KKSI) at baseline, three month, and sixmonth. STAI-Trait score were divided into twogroups with a median cut off point (41). Then, weperformed one-way ANOVA to determine theSTAI-Trait scores as independent variables forpossible predictors of psychological distress and

low HRQOL. RESULTS: Our response rate was 99percent (156/157 patients). The ANOVA resultsshowed a statistically significant difference in lowrole functioning, cognitive functioning, emotionalfunctioning, social functioning, future perspectiveand high fatigue score, which were high STAI-Traitscores when compared to the low STAI-Trait scores(po0. 01). Patients who had a high trait anxietywere found to have a low HRQOL compared tothose with a low trait anxiety. CONCLUSIONS: Inconclusion, out results suggest that patients with ahigh trait anxiety are at risk of a low HRQOL, andtrait anxiety could be used to screen and identifypatients at the highest risk of experiencing psycho-logical distress during cancer therapy.

P-106

Cancer in the Elderly: The Influence of Life Stage on

Psychosocial, Supportive and Informational Needs

Sue Davolls2, Sue Ashley1, Sarah Shepherd1,Maggie Watson1

The Royal Marsden NHS Foundation Trust, Sutton,Surrey, United Kingdom1, The Institute of CancerResearch, Sutton, Surrey, United Kingdom2

OBJECTIVES: Elderly (o65 yrs.) cancer patientsare perceived to be an under-served group but willbecome majority users of future cancer services.Research on the specific needs of older patients isneeded. Study questions are: (i) Do psychosocial,informational and support care needs in the elderly(o65 years) differ from younger patients?; (ii) Isthere evidence during the year after diagnosis thatolder patients’ psychosocial, supportive and infor-mational needs are being met? METHOD: Using aprospective questionnaire design, patients are ap-proached at 3 and 9 months following primarydiagnosis. Comparisons are between non-seniors(o64 yrs.) and seniors (651) in the majordiagnostics groups (Breast, Colorectal, GU, Lungcancers). Assessment is made using the SupportCare Needs Survey and the Information Satisfac-tion Questionnaire. Co-morbidity data are collectedusing the EORTC QLQ Functional Status sub-scale. Patients with a prognosis of o12 months orinability to complete questionnaires are excluded.RESULTS: Recruitment and follow up is continu-ing. N5 191 patients have been enrolled to dateThe commonly reported needs across the sampleare ‘psychological support’ (74%), ‘Health systemsand information’ (62%) and physical and dailyliving (61%). Needs appear to be met in the area ofpatient care and support and sexuality. 47% ofpatients reported a need for easier access to services.Comparisons between senior and non-senior groupswill be presented. CONCLUSIONS: The morecommonly reported concerns were ‘fears aboutcancer spreading’ (50%), ‘concerns about theworries of those close to you’ (47%), ‘fears about


DOI: 10.1002/pon


cancer returning’ (42%) and ‘uncertainty about thefuture’ (42%). Comparisons between senior andnon-senior groups will be presented. Preliminaryanalysis across the whole cohort highlight severalareas of unmet need. Age specific comparisonswhile not available at present will be reported.

P-109

Long-term Neurocognitive Outcomes in Adult

Survivors of Childhood Medulloblastoma

Kim Edelstein1, Brenda Spiegler2, Sharon Fung1,Tony Panzarella1, David Hodgson1, DonaldMabbott2, Normand Laperriere1, Uri Tabori2, EricBouffet2, Warren Mason1

Princess Margaret Hospital, Toronto, Ontario,Canada1, The Hospital for Sick Children, Toronto,Ontario, Canada2

OBJECTIVES: Medulloblastomas are the mostcommon malignant brain tumors that occur inchildhood. This disease used to be fatal, but withthe advent of craniospinal radiation (CSI) treat-ment, survival rates improved. However, CSI isassociated with progressive neurocognitive andphysical deterioration, and younger children aremost vulnerable to these late effects. Survivors arethought to be at risk for accelerated aging, but littleis known about the first generation of survivors asthey approach middle age. METHOD: In thisretrospective cohort study, we assessed 17 adults,8–42 years (median 20 years) after diagnosis ofmedulloblastoma in childhood, treated with surgeryand radiation. Six patients also received chemother-apy. We conducted a cross sectional analysis oftheir current neurocognitive and physical status.Data from prior neuropsychological assessments1–31 years (median 6.6 years) after diagnosis wereavailable for 15, and we used growth curve analysesto model individual change over time for thoseparticipants. RESULTS: All participants exhibitedhealth problems including hearing impairment,second cancers, diabetes, hypertension, and endo-crine deficiencies. Fourteen were single and livingwith their parents, only three were competitivelyemployed. The group was below average acrossmultiple neurocognitive domains (e.g. meanIQ5 87.13, SD5 15.03) and 88% required accom-modations at school for learning disorders. Long-itudinal analyses revealed stable verbal abilities andprocessing speed decades after treatment wascomplete, but working memory (7SE:�0.570.2,p5 0.02) and mathematics (7SE:0.9670.18,po0.0001) continued to decline. CONCLUSIONS:Medulloblastoma survivors face ongoing physical,psychosocial, and neurocognitive challenges inadulthood, including progressively impaired work-ing memory and persistently slow processing speed.They have limited resources with which to confrontthe challenge of aging, given diminished physical,

cognitive, and neural reserve. These survivors willrequire social and economic support when theiraging parents are no longer able to care for them.

P-113

Anticipatory Mourning: The Unrecognized Grief in

an Acute Care Setting

Heather Bousada, Emily TysonThe Ottawa Hospital, Ottawa, ON, Canada

OBJECTIVES: This poster presentation will focuson the process undertaken by our Palliative CareSocial Workers to address the gap evident in ouracute care hospital when helping patients andfamilies deal with an anticipated loss. Our goalwas to assist these individuals to decrease feelings ofisolation, alienation and hopelessness. In addition,we hoped to facilitate their exploration and naviga-tion of the meaning and significance of anticipatorygrief. METHOD: Through our clinical experience,literature review and presentations we recongizedAnticipatory Grief both as an instrumental compo-nent of mourning, as well as a process that lackssufficient information for health care workers,patients and families. This is particularly evidentwithin The Ottawa Hospital and the ChamplainLocal Health Integration Network (LHIN). Afterreceiving information from various Canadian Pal-liative Care programs, we were able to ascertain therelevance of having clear and concise informationreadily available. RESULTS: Based on informationfrom the Victoria Hospice bereavement package, wedeveloped a psycho-educational pamphlet on An-ticipatory Grief for use at The Ottawa Hospital thatis user friendly. It was primarily designed to providepatients and their families facing terminal illnesswith a clear definition and understanding of thisparticular type of grief, how it might be impactingthem, as well as preliminary coping strategies.CONCLUSIONS: The pamphlet entitled ‘What isAnticipatory Grief’ has been printed locally to beutilized by our Palliative Care team at The OttawaHospital. We will pilot this pamphlet over a sixmonth period and obtain feedback from ourpatients, families and staff members. Our plan isto review and revise as required.It is being pilotedwith the intention of potential use throughout ourChamplain Local Health Integration Network forall palliative patients and families.

P-117

The Effects of Chemotherapy on the Appearance of

Delirium in Cancer Patients

Hiromichi Matsuoka, Masatomo Otsuoka, AtsukoKoyama, Minoru Niki, Kiyohiro Sakai, RyoSakamotoSakai Hospital, Kinki University School ofMedicine, Osaka, Japan


DOI: 10.1002/pon


OBJECTIVES: Delirium is one of the mostcommon neurophychiatric complications seen inhospitalized patients with cancer, occurring in upto 90% of cancer patients in the last weeks of life.However, the mechanism of delirium has not beenclarified enough. There are few patient-reporteddata regarding delirium after chemotherapy. Theobjective of this study was to investigate the effectsof chemotherapy on the appearance of delirium.METHOD: This study was conducted by means ofcase control study. The subjects of this study werecancer patients who were hospitalized and died inour hospital between September 2007 and Decem-ber 2009. The presence of delirium was analyzedbetween a chemotherapy group (Group 1) and anon-chemotherapy group (Group 2). We examinedthe diagnostic criteria of the delirium outlined byDSM- -TR. We also excluded patients withdelirium during the last week of their life, andhypoactive type of delirium. RESULTS: Betweenboth groups, there were no significant differences inthe age, sex and the use of opioids and steroids. In151 cases, Group 1 were 99 cases, and delirium haddeveloped in 32 cases(32%), and had not developedin 67 cases(68%) Group 2 were 52 cases, anddelirium had developed in 8 cases(15%), and hadnot developed in 44 cases(85%). We found asignificant difference between both groups(p5 0.04). CONCLUSIONS: We did not investi-gate the difference among PS, the duration of theillness, coexisting illness, the combination ofdifferent medicine, the quantity and the durationof opioids and steroids, and the psychosocialbackground. Further studies should be undertakento clarify these problems. However, our findingssuggest that chemotherapy might be a risk factor ofthe delirium in the cancer patients.

P-118

The Significance of a Specific Outpatient Service for

Cancer Patients by Psychosomatic Doctors in Japan

Atsuko Koyama, Minoru Niki, HiromichiMatsuoka, Rikako Jinnai, Kaori Miyamoto,Kyoko Tochihara, Mayako TsuchiyaSakai Hospital, Kinki University School ofMedicine, Osaka, Japan

OBJECTIVES: Psycho-oncological practice is car-ried out mainly by psychiatrists as a part of liaisonpsychiatry all over the world. In Japan, Psychoso-matic medicine has been developed specifically ininternal medicine. We set up a new outpatientservice for cancer patients in our department. Theaim of this study is to evaluate a specific outpatientservice for psycho-oncology by psychosomaticdoctors from the view of multidisciplinary teammedicine. METHOD: Multiple factors such as age,sex, affiliation, cancer type, chief complaint, thereason for consulting, psychiatric diagnosis and

therapy of cancer patients who visited our specifiedoutpatient service for psycho-oncology were ana-lyzed. Both the advantages and issues concerningpsychosomatic doctors and specific outpatientservice for psycho-oncology that should be im-proved in the future, were discussed. RESULTS:Various types of cancer patients from both out-patient and inpatient departments such as surgery,gynecology and palliative care medicine visited ourspecific outpatient service for psycho-oncology.The reasons for consultation were various, forexample: psychological support for receiving badnews, operation and chemotherapy, controlling ofdelirium, and for terminal care and family care.Physical and mental conditions and the relation-ship between patients and their main doctors wereimproved by the intervention by psychosomaticmedical doctors. CONCLUSIONS: Psychosomaticmedical doctors can serve an important role in thisfield in both the physical and mental aspects ofcancer treatment. The advantages of a specificoutpatient service for psycho-oncology are that itcan provide an open door to patients who belongto other departments and hospitals and it can dealwith cancer patients efficiently. However, theshortage of budget and trained staff, and author-ization by the government should be furtherdiscussed.

P-119

Influence of Perceived-Actual Risk and of Role

Preference on Risk Management Interests Among

Women at High Risk for Breast Cancer

Lise Paquet1, Shailendra Verma2, Amanda White1,Sandra Lowry3

Carleton University, Ottawa,Ontario, Canada1, TheOttawa Hospital Cancer Centre, Ottawa, Ontario,Canada2, The Ottawa Hospital Women BreastHealth Centre, Ottawa, Ontario, Canada3

OBJECTIVES: Perceived risk is central to health-protective behaviour models which assume thatadopting such protective behaviour is based uponperception of being highly susceptible to a disease.These models predict that a high sense of suscept-ibility to breast cancer may motivate womenseeking advice from high risk clinics. Our objectiveis to determine the influence of perceived andactual risk and of preference for participation inpreventive decision on pre-counselling risk man-agement preferences. METHOD: We retrospec-tively analyzed a pre-counselling questionnaireroutinely administered. So far, 200 women con-sented. Items for calculating risk, questions con-cerning interests in risk management strategies,perceived risk (‘What do you think the likelihood-in %- is of you developing breast cancer in yourlifetime?’, and role (‘What role would you like totake in making your decision?’ with ‘I make final


DOI: 10.1002/pon


decision, I and doctor make final decision, anddoctor makes final decision’) are reported. RE-SULTS: Actual risk had no effect. Perceived riskonly affected women who wanted to make the finaldecision themselves. Their levels of interest intamoxifen and trials were low and affected byperceived risk. These women had high level ofinterest in lifestyle choices which was also affectedby perceived risk. Role preference also influencedinterest in pharmacoprevention and in participa-tion in clinical trials, women wanting shared-decision being more interested in these options.CONCLUSIONS: Breast cancer preventiondecision making is complex. Our study is the firstto demonstrate that pre-counselling rolepreference influences the breast cancer preventivestrategies that high-risk women are considering.We also demonstrate the moderating effectof role on the impact of perceived risk onprevention decisions. When recommending riskmanagement strategies, it may be particularlyimportant to discuss risk perception with womenwho want to make the final decision about theircancer prevention options.

P-121

The Impact of Menopausal Symptoms on Quality of

Life Among Post-Menopausal Early Breast Cancer

Survivors: The Role of Personality

Lise Paquet1, Dominique Frechette2, Susan Dent2,Xinni Song2, Shailendra Verma2

Carleton University, Ottawa, Canada1, The OttawaHospital Cancer Centre, Ottawa, Canada2

OBJECTIVES: Menopausal symptoms (MenS)affect quality of life (QoL) and are common amongpost-menopausal early breast cancer(EBC) survi-vors. There is a paucity of data concerning the roleof psychological factors on MenS and their impacton QoL. We prospectively evaluated whether traitanxiety (a personality construct) is a moderatingfactor of the influence of symptoms on QoL in 200women treated for EBC or colon cancer. We reportfindings from the EBC cohort at baseline. METH-OD: Eligible patients were postmenopausal (ab-sence of menses X12 months) prior to diagnosis.Assessment was done prior to hormonal therapyand, for those receiving systemic therapy, within 1month of completing chemotherapy. The Func-tional Assessment of Cancer Therapy-EndocrineSubscale was used to evaluate QoL and MenS andthe Spielberger State-Trait Anxiety Inventoryassessed anxious predispositions. The study beganin February 2009 and of 70 patients currentlyenrolled, half have now completed the baselinequestionnaires. RESULTS: Our preliminary ana-lyses indicate that 61% of patients experiencedMenS. Regression analyses confirmed the negative

association between the report of MenS and QoL(po0.01). Trait anxiety had a considerable impacton symptom reports (po0.01) and on QoL(po0.01). Among women who experienced MenS,greater anxiety was associated with lower QoL(po0.01). More importantly, there was no influ-ence of symptoms on QoL for women who scoredlow on anxiety. CONCLUSIONS: Our key findingis that personality appears to minimize the negativeimpact that MenS have on QoL. Survivors withlow anxiety reporting MenS had equivalent QoL assurvivors who did not experience MenS. Clinicianinvolved in follow-up care should take into accountthe personality of the survivor for the effectivemanagement of MenS. Support aimed at improv-ing QoL may be most beneficial for highly anxioussurvivors with MenS.

P-123

Screening Breast Cancer Survivors with the Hospital

Anxiety and Depression Scale and the Distress

Thermometer

Ging-Long Wang, Shih-Ming Shih, An-ChenFeng, Sheng-Hui Hsu, Yi-Chen Hou, Shih-HaoChen, Chih-Tao ChengKoo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan

OBJECTIVES: Screening for psychosocial distress,the Hospital Anxiety and Depression Scale(HADS) has been reported to have good sensitiv-ities and specificities for breast cancer survivors.However, it has not been established for theDistress Thermometer (DT). This study evaluatesthe validity of the DT as compared to the HADS inbreast cancer survivors. METHOD: The HADS isa 14-item instrument that has been widely used inpsycho-oncology researches and practices. The DTis a one-item distress screening recommended bythe National Comprehensive Cancer Network(NCCN) for cancer patients, but not yet for cancersurvivors. 215 consecutive outpatient breast cancersurvivors completed packets of questionnaires,including the DT and the HADS. RESULTS:Using a HADS total score (HADS-t) of \gt 5 15 asthe gold standard, Receiver Operating Character-istic (ROC) analysis identified a DT score of \gt5 3 as the optimal cut-off, with sensitivity andspecificity of 80% and 78%. The area under theROC curve (AUC) was 0.85, indicating gooddiscriminative accuracy. The concordant rate ofthese two scales is 78.6%. At this cut-off point, 38.6% of the patients were judged to be significantlydistressed. CONCLUSIONS: This study demon-strates that, compared with the HADS, the DT canbe a valid screening tool for breast cancer survivorswith satisfactory sensitivity and specificity. A lowercut-off than normally recommended for cancerpatients was identified.


DOI: 10.1002/pon


P-124

Defining Mild, Moderate and Severe Distress on the

Distress Thermometer—A Pooled Analysis of Inter-

national Raw Data

Alex J Mitchell, Paul SymondsUniversity of Leicester, Leicester, United Kingdom

OBJECTIVES: There has been much research on theDT but current cut-offs are somewhat arbitrary. In2007 the NCCN suggested a cut-point of 4v5 forsignificant distress; in 2008 this was revised to 3v4. Wewished to clarify appropriate thresholds for significantdistress as well as defining minimal, mild, moderateand severe distress using the Distress Thermometer.METHOD: We pooled published raw data from DTvalidation studies and requested data from authors.Data was pooled from eight independent studiesinvolving over 2000 people with cancer. We usedpreviously reported large scale studies involving theHADS applied to 20,000 individuals to establish themost likely distribution of distress from least severe(but most common) to most severe (but leastcommon). RESULTS: Across all studies 37.5% ofpatients would be defined as significantly distressedusing the 2007 NCCN definition (46% for 2008).Applying a simple algorithm suggests that thefollowing severities of distress are appropriate: insig-nificant (0–1); minimal (2–3); mild (4–5); moderate(6–7); severe (8–10). From the pooled raw data theproportion of patients in each category are as follows:insignificant—29%; minimal—25%; mild—21%;moderate—15%; severe—10% CONCLUSIONS: Asimple categorical threshold on the DT can andshould be improved. We suggest that definitions ofminimal (2–3); mild (4-5); moderate (6-7); severe (8-10) are considered in future work. Insignificant1minimal can be considered below threshold and mild,moderate1severe combined above threshold.

P-130

Distribution and Severity Thresholds of Domains in

Emotion Thermometers Screening Tool: Analysis of

the First 700 Cases

Alex J Mitchell1, Karen Lord1, Lorraine Grainger2,Paul Symonds1

University of Leicester, Leicester, United Kingdom1,University Hospitals of Leicester, Leicester,United States2

OBJECTIVES: The innovative 1998 Distress Ther-mometer helped confirm the value of simple screen-ing tools in clinical practice. The EmotionsThermometer screening tool (Psycho-oncology2009), a simple five domain patient-rated visual-analogue scale attempts to improve on the DT byincorporating additional domains of anxiety, depres-sion and anger. Its completion time is less than 2min.Although we previously reported validity data we

hereby report frequency distribution from the first716 screened cases. METHOD: We analysed datacollected from Leicester Cancer Centre from2008–2009 involving approximately 1000 peopleapproached by clinical nurses specialists for permis-sion to apply screening. Screening was part of a self-report screening programme. 715 consented tocomplete the scale and gave full data. RESULTS:Insignificant levels of emotional difficulty are seen inthe following proportions: distress 39%, anxiety25.6%, depression 50%, anger 55.7%. Mild, mod-erate or severe levels are seen in 40.8% (distress);51.9% (anxiety) ; 31.5% (depression) and 30.6%anger. Regarding need for professional help 30%want help, 12% slightly, 7% moderately and 11%severely. Combining all four emotional domains59.4% had some significant emotional difficultycompared with 40.8% for distress alone. CON-CLUSIONS: The Emotion thermometers scaleoffers valuable information beyond distress thatincludes anxiety, depression and anger. Approxi-mately 60% of cancer patients have a significantemotional problem based on self-report although inthis analysis only 201 of 425 such individuals wantedprofessional help for this problem.

P-131

Reliability of the Emotion Thermometers Screening

Tool: Principal Component and Cronbach Alpha

Results from the first 700 Cases

Alex J MitchellUniversity Hospitals of Leicester, Leicester,United Kingdom

OBJECTIVES: We recently developed the Emo-tions Thermometer screening tool (Psycho-oncol-ogy 2009), a simple five domain patient-ratedvisual-analogue scale that can be applied byspecialists and non-specialists. Its completion timeis less than 2 min. Although we previously reportedvalidity data we hereby report reliability data fromthe first 716 screened cases. METHOD: Principalcomponents analysis (PCA) is based uponcorrelation or covariance, and Cronbach’scoefficient alpha for scale reliability or internalconsistency. Interpretation an alpha 40.75

reasonable, 40.85 good 40.95 excellent internalconsistency. If the deletion of an element causes aconsiderable increase in alpha then one subscalemay be redundant. RESULTS: The overall scalereliability was Scale reliability alpha5 0.909 (95%lower confidence limit5 0.900). Dropping any ofthe domains had an insignificant change (changescore �0.02 to 0.01) suggest all subscales should bepreserved. In terms of principal components(covariance) the eigenvalue of distress was largestaccounting for 73% of variance and that of helpthe least (4%). CONCLUSIONS: The Emotionthermometers scale in its original five domain


DOI: 10.1002/pon


format appears to offer excellent reliability and allfive domains should where possible be retained.

P-132

Factors Related to Social Competence Outcomes in

Survivors of Childhood Brain Tumors

Fiona Schulte1, Maru Barrera2

Alberta Children’s Hospital,Calgary,Alberta,Canada1,SickKids Hospital, Toronto, Ontario, Canada2

OBJECTIVES: It is now well established thatsurvivors of childhood brain tumors develop socialcompetence deficits. Little has been discerned, how-ever, with respect to the source of these socialcompetency deficits among this population. Thepurpose of the current study, therefore, was toidentify factors that may be associated with socialcompetence outcomes in survivors of childhood braintumors. The factors examined were: 1) disease/treatment; 2) child; and 3) family factors; and theinteractions among each. METHOD: Participantswere 96 childhood brain tumor survivors (51 males,45 females). The mean age of participants at time ofstudy was 13.10 (SD52.90) years. Disease/treatment(age at diagnosis, tumor type and location, treatment,time off treatment), child (age, gender, IQ, global-selfworth [GSW]), and family (mother and father age,Socioeconomic Status [SES]) characteristics wereobtained. Survivors and parents completed the SocialSkills Rating System (SSRS)(Gresham & Elliott,1990). RESULTS: Bivariate correlation analysesrevealed a significant positive relationship for IQ(r50.37) and negative relationships for SES(rho5�0.37) and time off treatment (r5�0.31)for parent reported SSRS. Tests of moderationrevealed an interaction between IQ and SES thatwas significantly associated with SSRS (t5�3.66,po01), with lower SSRS scores related to low IQand low SES. No significant relationships werefound for survivor reported SSRS. CONCLU-SIONS: This is the first study to examine factorsthat may be related to social competence outcomesin survivors of childhood brain tumors. It identifiesimportant child (IQ) and family factors (SES) aspossible determinants of social competence deficits inthese survivors. These findings suggest there is a needfor targeted interventions addressing social compe-tence deficits in childhood brain tumor survivors thatconsider cognitive and family variables as riskfactors for social outcomes after surviving treatment.

P-134

Mental Health of Different Healthcare Professionals

in a Cancer Hospital

Chih-Tao Cheng, Sheng-Hui Hsu, Yi-Chen Hou,An-Chen Feng, Ging-Long Wang, Shih-Hao ChenKoo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan

OBJECTIVES: Cancer care professionals areprone to stress-related mental health problems.This study aims to identify the high prevalencegroups for psychiatric morbidity among cancerhospital employees of different professions.METHOD: We used a 5-item Brief SymptomRating Scale (BSRS-5) as a screening tool formental problems. 751 employees including doctors,nurses, administrative and ancillary staffs in acancer hospital were screened and also asked toidentify their stressors. RESULTS: Nurses had asignificantly higher prevalence of mental problemsthen other health professionals in the cancerhospital. Subgroup analysis showed that it wasthe nurses who worked at inpatient units, but notthose at ambulatory care units, had a higherprevalence of mental problems. A higherprevalence of mental problems was associatedwith work-related stressors but not family-relatedstressors. CONCLUSIONS: This study indicatesthat in a cancer hospital, nurses working atinpatient units are more likely to suffer frommental health problems, which may be linked towork stress. This calls for our attention andintervention.

P-136

Factors Associated with Psychological Distress in

Early Breast Cancer Survivors in Taiwan

Sheng-Hui Hsu, Shih-Ming Shih, An-Chen Feng,Ging-Long Wang, Yi-Chen Hou, Shih-Hao Chen,Chih-Tao ChengKoo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan

OBJECTIVES: 38.6 % of breast cancer survivors(BCS) were screened to be significantly distressed inTaiwan. The objective of this study is to investigatethe influence of demographic variables, perceivedsupport and Posttraumatic Growth on Psycholo-gical distress. METHOD: 206 consecutive stage Iand stage II outpatient BCS, who had completedtreatment for 3 to 24 months, completed packets ofquestionnaires, including demographic data, theHospital Anxiety and Depression Scales (HADS),Perceived Support and Posttraumatic GrowthInventory (PTGI). Chi-square test and logisticregression test were used to examine whether stageof breast cancer, marital status, perceived supportand posttraumatic growth were associated withpsychological distress, which was identified byHADS-Total X15. RESULTS: Logistic regressionanalyses showed that less perceived support(Po0.001), low Posttraumatic Growth Inventory-total score (p5 0.002) and being divorced orwidowed (p5 0.008) were significant factors asso-ciated with HADS-Total X15. CONCLUSIONS:Taiwanese culture is regarded as a more collective


DOI: 10.1002/pon


one in which interpersonal interdependentrelationship plays an important role in one’scoping with illness. The influence of perceivedsupport on distress confirms this observation.Posttraumatic growth might indicate better copingstrategies in post-treatment phase. Havingbreast cancer, going through treatments, andbeing divorced or widowed, may be consideredas repeated experiences of loss. These factorsappear to be associated with higher levels ofdistress.

P-142

Does Diversity of Individual Coping Skills Relate to

Psychological Adjustment in Breast Cancer Patients

and their Partners?

Serge Sultan1, Caroline Besancenet2, CecileFlahault3

Universite Paris Descartes, Paris, France1,Universite Paris Descartes, Paris, France2, InstitutCurie, Paris, France1

OBJECTIVES: The end of treatments for breastcancer is a challenging period requiring a varietyof coping resources in patients and their partnersas well. Coping research suggests that diversityof coping is beneficial for adjustment, in additionto flexibility and using active strategies. Thisstudy addresses the association between (1)diversity of coping skills as reported by patientsand their partners and (2) individual emotionaladjustment. METHOD: In a cross sectionaldesign, 74 breast cancer patients and theirpartners (37 couples) recruited from a cancercare unit in Paris (France) at the end of theirtreatment completed self-report measures ofcoping (WCC, Vitaliano et al., 1985) andemotional adjustment (GHQ-28, Goldberg,1978 and PANAS, Watson & Clark, 1988).Quantitative measures of coping diversity wereelaborated, based on variance of coping skillsscores at an individual level. RESULTS: Weused hierarchical regression models to predictemotional outcomes by coping and copingdiversity, adjusted for personal and clinical data.Results suggest that coping diversity was un-iquely associated with adjustment, above andbeyond coping itself. A higher diversity wasrelated with higher distress and lower emotionalwell-being, although this was found in partnersonly. CONCLUSIONS: Contrary to expecta-tions, results suggested that lower diversity ofcoping (as reflected by preference for one or tworesponse modes) was associated with betteradjustment. Moreover, results suggest a protec-tive effect of active coping and a deleteriouseffect of avoidance coping in patients as well asin partners.

P-146

Evaluation of the Implementation of a Systematic

Screening of Distress with Ambulant Cancer

Patients

Sabien Bauwens1, Catherine Baillon1, WillemDistelmans1, Peter Theuns3

Universitair Ziekenhuis Brussel, Oncology Centre,Department of Supportive and Palliatiative Care,1090 Brussels, Belgium1, Universitair ZiekenhuisBrussel, Department of Clinical Psychology, 1090Brussels, Belgium2, Free University of Brussel,Faculty of Psychology, 1050 Brussels, Belgium3

OBJECTIVES: In 2006, a short screening instru-ment for distress, called ‘the Distress Barometer’(DB) has been developed and validated in UZBrussel. Beyond a good sensitivity and specificityof the instrument, a multicentric study indicated agood acceptability by doctors and patients as well.In a third step, this study aims to examine whethera systematic screening with the DB is enough toguarantee an efficient detection of distress in everyday oncology practice. METHOD: Therefore it isnecessary to evaluate if the proportion of correctlydetected patients with distress is higher whenmaking use of this instrument in comparison with‘practice as usual’. Also, does the referral beha-viour of oncologists to supportive care have beeninfluenced? Finally, what are the benefits for thepatients? During two months, ambulant cancerpatients will be randomly allocated to ‘thesystematic screening by DB condition’ versus ‘theclinic as usual condition’. RESULTS: Detectionrate of distress in the two conditions will beexamined as well as differences in referral beha-viour to psychosocial and other supportive care.Facilitators and pitfalls in the systematically use ofa screening instrument will be analysed. Also thecompliance rate of patients to a referral will belooked at. CONCLUSIONS: This study will givefurther indications about how to improve thedetection rate of distress. Furthermore, it couldbe expected that this study reveals some dynamicsin referral difficulties and compliance. This mayhelp to develop directions for oncologists on how‘to sell’ a referral to their patients if necessary.

P-149

Colorectal Cancer Screening in New Brunswick:

How Often do Family Physicians Screen Their Adult

Patients who are 50 Years of Age or Older?

Baukje (Bo) Miedema, Sue Tatemichi, Tashina vanVlack, Anthony ReimanDalhousie University, Fredericton, Canada

OBJECTIVES: According to the Canadian Com-munity Health Survey data, in 2005 only 14% ofNew Brunswickers 50 years of age and older were


DOI: 10.1002/pon


in compliance with colorectal cancer (CRC) screen-ing guidelines. The study objective is to assess howoften family physicians order colorectal cancerscreening for their asymptomatic adult patientpopulation 50 years of age and older. METHOD:An 8 question survey of colorectal cancer screeningpractices was mailed to 760 physicians currentlypracticing in New Brunswick. Dichotomized vari-ables ‘yes’ and ‘no’, allowed for basic statisticalanalyses utilizing frequencies. RESULTS: Fortypercent of family physicians responded. Sixty-twopercent reported that they order Fecal OccultBlood Tests (FOBT) every 2 years for theirasymptomatic patients 50 years and older. Otherscreening procedures were ordered less frequentlywith 36% ordering a colonoscopy every 10 yearsfor their patient population 50 years and older. Thefamily physicians estimated that 46% of thepatients in their practice over 50 years of agewere ‘up-to-date’ with CRC screening guidelines.CONCLUSIONS: Comparing the populationhealth data and responses of a sample ofNew Brunswick family physicians, we have founda discrepancy between CRC screening ratesaccording to the Canadian Community HealthSurvey and family physicians’ understanding oftheir own screening patterns for their patients 50years and older. It is important to gain a betterunderstanding of the nature of this discrepancy inorder to enhance CRC screening rates.

P-155

Psycho-Economic Impact of Cancer Diagnosis on

Family Relationships and Coping Strategies Among

Radiotherapy Patients

Chioma Asuzu, Ikechukwu AwusaUniversity of Ibadan, Ibadan, Nigeria

OBJECTIVES: The aim of study is to assess theeconomic impact of cancer diagnosis on the familyrelationships and identify the coping strategiesamong radiotherapy patients. METHOD: Thestudy consisted of an interviewer-administeredsurvey instrument of 213 patients who willinglyparticipated in the study following a duly appliedinformed consent procedure. The questionnaire,called psychosocial, economic and family relation-ship assessment inventory, was developed by theresearchers and validated. It has internal consis-tency reliability coefficient of 0.76. Brief copeinstrument by Carver et al. (1997) was also usedto assess their coping strategies. Data was analyzedusing the SPSS software. RESULTS: The subjectsconsisted of 61 males and 152 females. The studyfound significant difference in the economic impactof cancer diagnosis on cancer patients and familiesbased on their income. p5 0.0.000. While theeconomic impact of cancer diagnosis was found

to be the potent variable responsible for theprediction of coping styles of cancer patients.Religion was found to be the most significantcoping mechanism used by the patients and theirfamilies. CONCLUSIONS: It was recommendedthat economic assistance in the form of treatmentand accommodation subsidization for out-of-townpatients be provided, and that psycho-oncotherapyservices should consider marital status, involvereligious considerations and spousal counseling.Psychologists are also encouraged to enterthe field of psycho oncology to help in giving hopeand meaning to life through counselling thegrowing population of cancer patients in thecountry.

P-156

Creative Expressions of Loss and Healing: A

Bereavement Support Group

Anna Maria Buhr, Ruth EliasonSt. Paul’s Palliative Care Unit Saskatoon HealthRegion, Saskatoon, SK, Canada

OBJECTIVES: Expressive arts are used to facil-itate the expression and exploration of grief, lossand healing within a group context. The ‘CreativeExpressions of Loss and Healing’ bereavementsupport group creates a safe environment in whichthose who have lost a loved one can process theirgrief and move towards healing. The goal of thegroup is to invite participants to connect with theirartist self and creatively explore their experiencethrough a variety of mediums. METHOD:Through music (singing, improvisation, drum-ming), art (painting, collage, mandalas), writing(journaling, letter writing) and storytelling, groupmembers connect with their creativity. Facilitatorsemploy a heterogeneous, closed group model overa six-week period that is process orientated andmember-driven. The time frame of loss for groupadmission is no less than eight weeks and no morethan twelve months. The theoretical underpinningis based on relational and strength modelswith a focus on a experiential perspective. RE-SULTS: Clinical feedback through anonymousevaluations completed over the span of fourgroups indicates positive participant experienceand self-identified movement through the lossexperience and initiation of the healing process.Practice knowledge supports the value of expres-sive arts as a medium to process loss experiences,as well as create meaning and a healingenvironment. CONCLUSIONS: The use of ex-pressive arts in the context of bereavement nurturescreativity, a sense of meaning, healing and connec-tion to one’s inner artist. The positive nature ofclinical outcomes suggest a research project isindicated.


DOI: 10.1002/pon


P-164

Social Support Buffers Against Emotional Distress

Only if Support is Wanted: Evidence from a Large

Sample of Newly Diagnosed Cancer Patients

Linden Wolfgang, Vodermaier AndreaUniversity of BC, Vancouver BC, Canada

OBJECTIVES: We know that perceived socialsupport serves as a buffer against stress and helpspatients with chronic and/or life threateningdiseases better cope with their ill health. However,not all individuals low in support seek moresupport and this raises the question for healthprofessionals whether or not lack of social supportshould automatically become a target for interven-tion. METHOD: To test this question we evaluateda match-mismatch model in a large sample of 9506adult cancer patients who came consecutively intofirst contact with two large urban cancer clinics.We assessed perceived support, desired support,anxiety and depressive symptoms, and quality-of-life (QOL) with the PSSCAN questionnaire.RESULTS: High perceived and high desired socialsupport were both independent predictors ofemotional well-being. Respectively, these patientsexperienced fewer anxiety and depressive symp-toms (R2 5 0.12 and R2 5 0.11, respectively). Inaddition, patients who wished more social supportthan they experienced reported significantly higheranxiety and depression symptoms as comparedto patients whose support needs were met(R2 gain5 0.01 and R2 5 0.01, respectively) orthose who neither received nor sought support.CONCLUSIONS: The results support thehypothesized match-mismatch model such thatpatients with unmet support needs experience thehighest distress levels. With respect to practicerecommendations, we advocate for routine assess-ment of patients’ social support presence andsupport needs when they are faced with chronicand life threatening diseases. We posit that ‘push-ing’ support onto patients who don’t want or needit may be a potential waste of resources.

P-168

Psycho-oncology Referrals—A Single-Centre Review

From Malaysia

Nor Zuraida Zainal1, Salina Mohamed1, SharmillaKanagasundram1, Anita Zarina Bustam2

Department of Psychological Medicine, Universityof Malaya, Kuala Lumpur, Malaysia1, OncologyUnit, University Malaya Medical Centre, KualaLumpur, Malaysia2

OBJECTIVES: To recognize and treat the occur-rence of psychiatric problems via psycho-oncologyreferrals in managing cancer patients. METHOD:This review is looking at all the referrals received

by the Psycho-oncology unit made by the Oncol-ogy unit in University Malaya Medical Centre,Kuala Lumpur, Malaysia over a 2-year period. Allthe patients filled in a proforma to indicate theirdistress level and problem checklist. The psychia-tric diagnosis and treatment offered were obtainedfrom patients’ case notes. RESULTS: There were43 referrals received. Of all, 58% had breast cancerand the rests had other types of cancer. The meanage was 53 years and 74% were females. Majorityof them knew and understood their diagnosis andprognosis. The mean distress level was 7.112.5.There were high reports on worries, sadness,nervousness, fatigue, sleep and eating problems.37% had a psychiatric diagnosis of major depres-sion. Majority of the depressed patients receivedmirtazepine or escitalopram. CONCLUSIONS:Although the psycho-oncology unit was still at aninfantile stage, the cancer patients had started toreceive some form of psychological attention for abetter quality of life at any stages of cancer.

P-170

The Experience of the End of Treatment: Interest of

a Systematic Psychological Consultation

Patrick Ben SoussanInstitut Paoli-Calmettes, Marseille, France

OBJECTIVES: This communication report a re-search whose purpose was to measure, at the end ofthe treatments, the impact of a systematic psycho-logical follow up on the patients’ subjectiveexperience and the psychic process dynamics ofhis ‘psychic recovery’. The main hypothesis of sucha work confirms how important is for patients to beable to link the onset of their cancer with theirhistory of life and with their social and culturalrepresentations of illness. METHOD: We estab-lished a systematic psychological consultation at theend of treatments for women with breast cancer andfor men with prostate cancer, both non-metastatic.The recruitment concerned 100 patients during 1year. We took in consideration the psychodynamicdeterminers of this ‘work of the disease’ a monthafter the end of treatment and 6 months later, a newinterview will be proposed in order return back tothe entirety of his experience, work through andreformulate thoughts. RESULTS: This study high-lights the important work of ‘psychic digestion’which is necessary to patients at the end of theirtreatment. Considering the major anxiety anddepressive symptoms’ repercussions on the patient’ssocial and personal life, this study providedrecommendations in terms of public health, as asystematic psychological counselling at end oftreatment, to improve the frame of the posttreatments follow up, for patients who have been‘cured’ of their cancer. CONCLUSIONS: Patientstestify through out regular follow up their distress


DOI: 10.1002/pon


and confusion that often occur at the end of theirtreatment. Some of them feel ‘lost’, ‘abandoned’.‘How to live after the disease?’ ‘How is to live withthe threat of a recurrence?’ ‘How to get back towork, social, cultural investments,even more, howto return to ordinary family life and sexualactivity?’ New practices, such as this ‘consultationof cloture’, at the end the treatments are necessary.

P-173

The Role of the Physiotherapist on the Psychosocial

Oncology Team

Kitty Martinho, Renee Leahy, Jenna GreganThe Ottawa Hospital, Ottawa, Canada

OBJECTIVES: The purpose of this presentation isto highlight the role of the physiotherapist in theassessment, treatment and rehabilitation of peopleliving with and surviving cancer and its manage-ment. It is also to establish the position of thePhysiotherapist as a key member of a psychosocialoncology team, when requiring a multidisciplinaryapproach to care and support of patients. METH-OD: A literature review of current Clinical PracticeGuidelines and existing Frameworks for rehabilita-tion and the continuum of care will be presented.An identification of physiotherapeutic interven-tions specific to the requirements of the oncologypopulation will be offered and defined. RESULTS:A better and more complete understanding of boththe clinical and professional role of the Phy-siotherapist in the unique setting of oncology willbe an objective. To justify a role for Physiotherapyon the Psychosocial Oncology multidisciplinaryteam will be the target. CONCLUSIONS: Byincluding the Physiotherapist as a member of thePsychosocial Oncology team we are betterequipped to minister to the holistic needs ofpatients as they navigate their way through ademanding and stressful time in their lives.

P-174

Improving Outcomes for Families Facing Cancer:

A Four Phase Treatment Approach

Patricia FennellAlbany Health Management Associates, Inc.,Albany, NY, United States

OBJECTIVES: In the past 30 years, the number ofpeople surviving cancer has tripled, from 3 millionto 9.8 million, and 14–96% of cancer survivorsexperience disabling fatigue. Chronic illnesses suchas cancer, depression and disabling fatigue can betraumatizing, life-changing experiences. The Four-Phase Treatment approach helps patients, thera-pists and other healthcare providers integrate thenew realities of chronic illness into cancer survi-vors’ lives. METHOD: The Four-Phase model is

an empirically validated treatment model thatrecognizes the influences of cultural, psychosocial,and physical factors in assessment and treatment.It is a multi-phased approach that provides anarrative framework and cognitive map for under-standing the adaptations in chronic illnesses andsyndromes, including cancer, post-cancer treat-ment, and disabling fatigue. It addresses thecomplexity of cancer by matching interventions(medical, psychosocial, OT, PT, etc.) to theindividual’s phase of adaptation to illness. RE-SULTS: Traditional methods alone frequently failin treating chronic illness because they create falsedichotomies between mind and body, chronic andacute illness, and the patient’s illness experienceand the clinician’s participation. However, whentraditional methods and established techniques areused within the Four-Phase framework, they aremore readily accepted and demonstrate increasedeffectiveness. CONCLUSIONS: The Four-Phasemodel offers a step-by-step approach grounded inclinical practice to help people with chronicillnesses solve problems and create positive change.Assessing the patient’s illness phase and selectinginterventions matched to the phase of illness leadto more effective coping and management andbetter overall outcomes.

P-176

Existential Meaning Is Altered by Cancer Experi-

ence

Silla M Consoli1, Sylvie Pucheu2, Najoua Oumima3,Cecile You-Harada3, Cecile Roygnan3, Delphine DeSusbielle3, Valerie Brasselet3, Anne-Solen Le Bihan3

CL psychiatry Dpt and Paris Descartes University,European Georges Pompidou Hospital, Paris,France1, CL psychiatry Dpt and Pierre et MarieCurie University, European Georges PompidouHospital, Paris, France2, CL psychiatry Dpt,European Georges Pompidou Hospital, Paris,France3

OBJECTIVES: Existential meaning is supposed toconstitute a stable trait characterizing individual’scapacity to transcend daily life experience and tosuccessfully cope with harmful life events. It isnevertheless unclear whether cancer experiencecould modify existential meaning and which vari-ables could account for this potential modificationdue to cancer diagnosis and treatment. Our studyaimed at answering this question by assessing twiceexistential meaning during the first year of follow-up in patients suffering from cancer. METHOD: 49cancer patients aged 55.4710.5 years (77.6%females; breast (n5 27); colon (n5 10); head andneck (n5 8); ovarian (n5 3); lung (n5 1)) wereevaluated 2 to 4 months after the diagnosis (T1)and one year later (T2). Patients completedat T1 and T2 the Life Attitude Profile-Revised


DOI: 10.1002/pon


(LAP-R-48) questionnaire (Recker, 1992), whichcomprises 6 scores (purpose, coherence, choice/responsibleness, death-acceptance, goal-seeking,existential-vacuum), pooled into 2 global scores:the personal meaning index (PMI5purpose1coherence) and the existential transcendence(ET5purpose1coherence1choice/responsibleness1death-acceptance1goal-seeking1existential-va-cuum). RESULTS: From T1 to T2 most of LAP-R48 scores changed. Impairments were observed forpurpose, choice/responsibleness, PMI, ET, and anincrease for existential-vacuum (all po0.01); goal-seeking also decreased. No existential meaningchange was related to cancer severity. Changes incoherence and PMI differed according to sex, withalterations in women and no change or a slightimprovement in men. Existential-vacuum increasedespecially in young patients (r5�0.30; p5 0.038).Choice/responsibleness decreased only in patientswho underwent chemotherapy. CONCLUSIONS:Findings suggest that a life-threatening experiencelike a cancer can alter existential meaning, at leastone year from the initial treatment. Women andyoung people appear more sensitive to cancerimpact. Despite no control group, the experienceof cancer looks more important in these changesthan the degree of disease severity. The burden ofchemotherapy may also have a specific impact.Assessment of long-term evolution of existentialmeaning in cancer survivors would be warranted.

P-179


Cancer Related Distress: Part IV—What Deter-

mines Willingness of Nurses to Offer Help for

Unmet Needs?

Alex J Mitchell2, Nadia Hussain3, LorraineGrainger1, Paul Symonds2

University Hospitals of Leicester, Leicester, UnitedKingdom1, University of Leicester, Leicester, UnitedKingdom2, University of Leicester, Medical School,Leicester, United Kingdom3

OBJECTIVES: It is generally accepted that cancerclinicians frequently overlook unmet needs andtend not rely upon their own clinical skills. Weaimed to examine what factors influence clinicians’willingness to give professional help to patients forpsychosocial or physical problems. This formedpart of screening programme based on the Emo-tion Thermometer (DT) delivered by chemother-apy nurses. METHOD: Chemotherapy nurses gavetheir clinical opinion before and after screeningpatients for distress, anxiety and depression (scoreof 4 or higher on the ET). We asked nurses torecord who they helped for unmet needs why. Wereport data on 269 nurse-patient interactions.where some form of help was given to only 24%.Of those helped 23 received a referral to a specialist

service which was 16.7% of those screeningpositive for an emotional complication.RESULTS: Of 204 not helped 150 had a ‘meetableunmet need’ but without treatment. The mostpowerful influences upon nurses willingness to offerhelp were 1. patient desire for help 2. number ofunmet needs 3. clinicians confidence and 4. patientreported anger (all po0.01). Anxiety, depression,distress, receipt of training, baseline clinical im-pression, impression after screening and stage ofillness were not influential. CONCLUSIONS:About of people with cancer are not offeredexplicit help and about half have a meetable unmetneed. Clinicians with greater confidence decide tohelp patients who most ask for help or who areangry as well as those with most needs.

P-180

Does Clinician Confidence Influence Ability to

Detect Depression, Anxiety or Distress in a Cancer

Setting?

Nadia Hussain1, Alex J Mitchell1

University of Leicester, Leicester, United Kingdom1,University of Leicester, Medical School, Leicester,United Kingdom2

OBJECTIVES: It is generally accepted that cancerclinicians are unable to accurately identify distressin routine care. Yet some staff have high confidenceand skills whilst others do not. We aimed toexamine the influence of staff skills and confidence(with psychosocial issues) on their ability todetection patient reported depression, anxiety anddistress. METHOD: We asked chemotherapynurses to give us their clinical opinion on 269patients who also rated their anxiety and depres-sion or distress. Depression, anxiety and distresswere defined by 4 or higher on the ET. Cliniciansrated their own confidence levels and their ownskill levels and returned the data anonymously forblind analysis. We stratified confidence into a 4point scale: high>above average>average>belowaverage>low. RESULTS: 15% of staff rated theirconfidence as ‘high’; 33% as ‘above average’ and37% as ‘average.’ Only 9% of staff reportedreceiving training to improve skills. In those withhigh confidence, detection sensitivity was 71.4%compared with 49% in the above average groupand 27.8% in the average group. However detec-tion specificity was 53.3% in the high confidencegroup versus 81.6% and 93.3% in the averageconfidence group. There was insufficient data toanalyze skills. CONCLUSIONS: We conclude thatconfidence levels do influence clinical judgement byimproving sensitivity but reducing specificity. Inshort high confidence staff tend to over-diagnosedepression with more false positives whilst under-confidence staff tend to under-diagnose with morefalse negatives.


DOI: 10.1002/pon


P-182

Internal Structure of Illness Cognition

Questionnaire Depends on the Time Elapsed Since

the Diagnosis of Cancer

Sylvie Pucheu1, Delphine De Susbielle2, NajouaOumima2, Cecile You-Harada2, Cecile Roygnan2,Valerie Brasselet2, Anne-Solen Le Bihan2, Silla M.Consoli3

CL psychiatry Dpt and Pierre et Marie CurieUniversity, European Georges Pompidou Hospital,Paris, France1, CL psychiatry Dpt, European GeorgesPompidou Hospital, Paris, France2, CL psychiatryDpt and Paris Descartes University, EuropeanGeorges Pompidou Hospital, Paris, France3

OBJECTIVES: Illness Cognition Questionnaire(ICQ-18; Evers et al., 2001) was developed forassessing illness perception and adaptation toillness. Its factorial structure led to 3 scores:helplessness, acceptance and perceived-benefits.Positive correlations were found in populationssuffering from various chronic diseases betweenacceptance and perceived-benefits, and negativeones between these both dimensions and help-lessness. Our study explored whether such aninternal structure was replicable in cancer patients,according to the time elapsed since the diagnosis.METHOD: 64 cancer patients aged 55.4710.4years (75% females; 25% males; cancer site: breast(n5 33); colon (n5 13); head and neck (n5 10);ovarian (n5 3); other (n5 5)) were evaluated 2 to 4months after the diagnosis (T1) and 51 of them oneyear later (T2). Patients completed at T1 and T2the ICQ-18. Severity of cancer was divided in threeclasses: stage I (n5 24), stage II (n5 21) and stageIII to IV (n5 19). RESULTS: No significantchange was observed from T1 to T2 for the threeICQ-18 dimensions. At T1, acceptance and per-ceived-benefits were positively correlated (r5 0.41;p5 0.001) and both were positively correlated withhelplessness (respectively r5 0.33; p5 0.008 andr5 0.43; po0.001), whereas at T2, acceptance andperceived-benefits were still positively correlated(r5 0.53; po0.001) but both were negativelycorrelated with helplessness (respectivelyr5�0.28; p5 0.043 and r5�0.27; p5 0.055).Controlling for cancer severity did not change thepatterns of these correlations. CONCLUSIONS:14 to 16 months after the cancer diagnosis, theinternal structure of ICQ-18 resembles to thatfound in different chronic but not life-threateningdiseases: helplessness is opposed to acceptance andperceived-benefits, which are positively associatedwith each other. On the contrary, early after acancer diagnosis, these three aspects of adjustmentto illness are not opposed, but coexist in the samepatients, possibly due to the trauma of theannouncement and uncertainty.

P-183

The Dynamics of Factors That Facilitate

or Hinder Volunteer Contribution to End-

of-life Home Care for Seniors: Preliminary

Results

Andree Sevigny1, Michele Aubin2, AndreTourigny2, Serge Dumont2, Manal Guirguis-Younger3, Mireille Fortier1

Centre d’excellence sur le vieillissement deQuebec, Quebec, Canada1, Universite Laval,Quebec, Canada2, Universite Saint-Paul, Ottawa,Canada3

OBJECTIVES: Volunteers play a key role inCommunity Action Organizations (CAOs) andare a mainstay of the palliative care movement.Despite their considerable involvement in healthinstitutions, development of volunteering inhome care remains challenging. This multisitestudy aimed to better understand the factorsfacilitating or hindering volunteer participationin end-of-life home care with elderly patients,while taking into account the context in whichthese factors arise and the dynamic that linksthem. METHOD: Qualitative methods wereused, based on Giddens’ theory of structuration,which takes into consideration the dynamicinteractions between the actions undertaken byindividuals and the socio-structural contextwithin which these actions take place. Sixty-four (N5 64) individual semi-structured inter-views were conducted with four groups of socialactors: 1) seniors receiving end-of-life homecare; 2) informal caregivers of these seniors; 3)professionals giving home care or support; and,4) volunteers that are members of a CAO.RESULTS: Factors that encourage or impedevolunteer participation were identified. It wasfound that each factor has the capacity to eitherfacilitate or hinder volunteer participation,depending on context. Further, it appears thatequilibrium between factors is key to under-standing volunteer participation. For example,two factors might seem to oppose each other(building trust and maintaining a distance),however it is the reaching a balance betweenboth that facilitates volunteer participation.CONCLUSIONS: In order to improve theintegration of volunteers into the health andsocial network of care intended for seniorsreceiving end-of-life home care, a better under-standing of the dynamic relationship betweenfactors that help or impede access to the supportthey provided must be gained. In this sense,the results of this study could contribute todecision-makers’ and professionals’ efforts todevelop integrated, complete and coordinatedend-of-life home care.


DOI: 10.1002/pon


P-185

Relationships Between Existential Meaning,

Coping and Perceived Social Support in Cancer

Patients

Sylvie Pucheu1, Cecile You-Harada2, NajouaOumima2, Delphine De Susbielle2, CecileRoygnan2, Valerie Brasselet2, Anne-Solen LeBihan2, Silla M. Consoli3

CL psychiatry Dpt and Pierre et Marie CurieUniversity, European Georges Pompidou Hospital,Paris, France1, CL psychiatry Dpt, European GeorgesPompidou Hospital, Paris, France2, CL psychiatryDpt and Paris Descartes University, EuropeanGeorges Pompidou Hospital, Paris, France3

OBJECTIVES: Existential meaning is supposed tomoderate the adaptation to stressful life changessuch as cancer. Potential mechanisms for suchmoderation are the ways of coping and the qualityof social support according to individual’s existen-tial meaning. We aimed to study the relationshipsbetween these three types of variables in apopulation suffering from cancer. METHOD: 52cancer patients aged 55.6710.5 years (75%females; cancer site: breast (n5 30); colon(n5 11); head and neck (n5 9); other (n5 2)) wereevaluated 2 to 4 months after the diagnosis (T1)and 6 months later (T2). Patients completed at T1the Life Attitude Profile-Revised (LAP-R; Recker)and at T2 the 21 item Cancer Coping Question-naire (CCQ, Moorey), including measures ofperceived stress and thoughts about cancer, andthe 12 item Perceived Social Support Questionnaire(PSSQ, Blumenthal). RESULTS: Perceived stresswas negatively correlated with LAP-R existential-transcendence and positively with existential-va-cuum and goal-seeking. Thoughts about cancerwere negatively correlated with LAP-R existential-transcendence and death-acceptance. CCQ positivefocus was positively correlated with LAP-R pur-pose and choice/responsibleness. LAP-R existen-tial-transcendence also predicted higher PSSQ totalperceived social support and better support fromfamily members and close relationships. Positiveassociations were additionally found betweenPSSQ scores and LAP-R purpose or coherenceand negative ones with existential vacuum. CON-CLUSIONS: Existential meaning is both asso-ciated with positive focus coping and higherperceived social support, potentially contributingto attenuate or avoid thoughts about cancer and toalleviate perceived stress in patients suffering fromcancer. As predicted by LAP-R construct, purpose,coherence, choice/responsibleness play a favour-able role, whereas existential-vacuum play anunfavourable one. It is however impossible toknow if existential meaning scores reflect previousindividual’s characteristics or already an impact ofcancer diagnosis.

P-187

A New Model of Cancer Follow-up Care for Young

Adult Cancer Survivors in Atlantic Canada

Krystle Hussey, Baukje Miedema, Lynne RobinsonDalhousie University, Halifax, Nova Scotia, Canada

OBJECTIVES: Young adulthood is often charac-terized as a transition period towards adulthoodand is associated with the quest for emotional andfinancial independence. A cancer diagnosis duringthis time may present unique psychological, sexu-ality-related, financial, social and physical chal-lenges. The purpose of this study is to identify theneeds of young adult cancer survivors and tounderstand and address any gaps in the currentmodel of cancer follow-up care for this populationin Atlantic Canada. METHOD: The study willinclude young adults who are 1–5 years post-diagnosis and were between 18–34 years of age atthe time of the diagnosis. This mixed methodsresearch project involves an interview and a survey.The interview will focus on cancer follow-up care,psychosocial issues and suggestions for improve-ment in cancer follow-up care. The survey focuseson attitudes and the impact of cancer on sexualfunctioning. RESULTS: The study was reviewedand approved by the Dalhousie University Re-search Ethics Board. Recruitment via social net-working websites, online message boards, and thedistribution of information posters has com-menced. CONCLUSIONS: This study will be thefirst step towards an evidence-based cancer follow-up care model in Atlantic Canada. The modifiedCFC model may be very applicable to otherregions of the country, particularly in regions withrural areas.

P-195

Tobacco Exposure and Breast Cancer: Perspectives

of Young Women

Erin PtolemyUBC Okanagan, Kelowna, British Columbia, Canada

OBJECTIVES: Tobacco exposure during adoles-cence has been established as a risk factor forpremenopausal breast cancer. The purpose of thisstudy was to extend knowledge about youngwomen as a target audience for health messagingregarding this new evidence. METHOD: Youngwomen (n5 125) aged 15–24, smokers and non-smokers, completed an online survey from Sep-tember 2008–July 2009. Measures include ques-tions about participants’ smoking habits and SHSexposure, interest in and perceived importance ofinformation about tobacco exposure as a riskfactor for breast cancer, and young women’sinterest in risk reduction behaviours. Questionswere included to assess perceived barriers for


DOI: 10.1002/pon


raising awareness about this risk information andrecommended strategies. RESULTS: The majorityof participants reported that this risk informationis important to them; with 78% consideringreducing their SHS exposure and 28% of smokingwomen considering changing their smoking habits.Perceived barriers to raising awareness includedwomen not thinking about the long term healtheffects and not being motivated to find out thisinformation. Preferred strategies for raising aware-ness included hearing about it from breast cancersurvivors and using TV ads. CONCLUSIONS:Results will provide guidance in developing tai-lored health messages and interventions about thismodifiable risk factor for breast cancer, andprovide direction to influence the tobacco choicesand habits of young women.

P-198

The Impact of a Child’s Death on Family and

Dyadic Functioning

Julie C. Grossenbacher1, Amii Corbisiero1, MaruBarrera2, Bruce E. Compas3, Betty Davies4, DianeL. Fairclough5, Terrah L. Foster3, Mary JoGilmer3, Nancy S. Hogan6, Kathryn Vannatta1

The Research Institute at Nationwide Children’sHospital, Columbus, Ohio, United States1, TheHospital for Sick Children, Toronto, Canada,Canada2, Vanderbilt University, Nashville, Tennessee,United States3,University of Victoria, Victoria, BritishColumbia, United States4, University of Colorado atDenver and Health and Sciences Center, Denver,Colorado, United States5, Loyola University Chicago,Chicago, Illinois, United States6

OBJECTIVES: Families may undergo significantchange following the death of a child. Family andmarital relationships may decline as bereavedparents have reported increased parenting stress.Bereaved siblings have also reported less commu-nication, availability, and support from parents.However, previous research is limited by ascertain-ment bias, the use of single informants, andretrospective design. Thus, we examined multipledomains of family functioning in bereaved andcomparison families. METHOD: Three to twelvemonths after a child’s death from cancer(M5 11.09 months, SD5 3.66), families with asurviving child (n5 55) and matched comparisonfamilies (n5 48) were recruited from three partici-pating institutions in the US and Canada. Partici-pants completed measures of family functioning(i.e. general, marital, parent-child) during a homebased assessment. Bereaved siblings were 8–17years old and, on average, attending 6th grade.RESULTS: Preliminary analyses revealed thatbereaved and comparison families differed onmeasures of parent-child relationships, however,marital and overall family functioning were similar.

Bereaved siblings reported lower maternal warmth,and siblings and mothers reported less open andtotal communication. Small to medium effects wereidentified for bereaved siblings’ and father’s reportof paternal openness, problems, and total commu-nication. No differences were found on measures ofmarital functioning. Time since death was notassociated with family functioning. CONCLU-SIONS: Results indicate that there may be somedecline in maternal warmth and parent-childcommunication following the death of a child.However, marital and overall family functioningmay remain intact. These data support previousfindings in the literature and may reiterate thenotion that bereaved parents are preoccupied withtheir own grief, and thus ‘overlook’ their survivingchildren. The development and evaluation ofinterventions that target maternal parenting andfamily communication is needed.

P-199

Coping, Information Preferences, and Mental

Health in Men Newly Diagnosed with Prostate

Cancer

Anna Levin, Joyce Davison, Wolfgang LindenUniversity of British Columbia, Vancouver, Canada

OBJECTIVES: Individual differences in monitor-ing coping style (or orientation toward threat) havebeen proposed to underlie information seekingpreferences aimed at uncertainty reduction whenfacing medical threats. Distress may result wheninformation is unavailable to meet patient needsand uncertainty remains. There are also differencesin the extent to which individuals find uncertaintiesintolerable- and this intolerance may impactmental health. The current project examines theserelationships in men newly diagnosed with prostatecancer. METHOD: This longitudinal study in-cludes two data collection periods. The first occursafter men are diagnosed with prostate cancer, atthe time of treatment decision-making. The secondoccurs approximately four months later, after atreatment decision has been made. Patients com-plete a package of questionnaires including mea-sures of monitoring coping style (Miller BehavioralStyles Scale), IUS (Intolerance of UncertaintyScale), and depression, anxiety, and quality of life(the Psychosocial Screening Instrument for Can-cer). RESULTS: Data indicate stability of anxiety(r5 0.449, po0.001, n5 72), depression (r5 0.526,po0.001, n5 72), quality of life (r5 0.504,p5 0.052, n5 72), IUS (r5 0.767, po0.001,n5 60) and monitoring (r5 0.489, po0.001,n5 72). At treatment decision-making, monitoringcoping style is a good reflection of patientinformation needs (r5 0.232, p5 0.009, andr5 0.365, po0.001, n5 125). Individual differences


DOI: 10.1002/pon


in IUS may be related to patients’ psychologicaldistress (r5 0.350, po0.001 for anxiety,r5 0.329, po0.001 for depression, r5�0.184,p5 0.052 for perceived quality of life, n5 112).CONCLUSIONS: Although monitoring predictsinformation needs at the time of diagnosis, mon-itoring is not a good indicator of information-seeking over time. IUS may be an importantvariable underlying men’s psychological functioningat diagnosis. When men experience distress, it issustained four months later, even after a treatmentdecision is made. It is important to continuallyevaluate the emotional status and informationrequirements of men throughout their cancertrajectory in order to best meet their changing needs.

P-200

Psychological Tests in Oncological Patients: A Tool

to Improve Communication with the Medical Team

Luisina Onganıa1, Marina Paula Bramajo2,Marcelo Blanco Villalba2, Pini Alejandra2, EduardoSerra2, Alejandra Mancini2, Vilma Kalman2,Guillermo Streich2

Sociedad Argentina de Cancerologıa, Ciudad deBuenos Aires, Argentina1, Asociacion Argentina deSalud Mental, Ciudad de Buenos Aires, Argentina2

OBJECTIVES: Making a complete psychologicaldiagnosis in oncological patients, at the beginningof medical treatment enriches the approach ofinterdisciplinary teams. It gives important informa-tion that may be used to decide future interven-tions. In this study, we try to demonstrate thatmaking psychological diagnosis is a tool thatimproves communication with the medical team,and to relate psychological characteristics withtype of tumor or moment of illness. It alsoevaluates, the need of mental health assistance.METHOD: Instruments: Semi-estructured inter-view, HTP test, Test de Persona Bajo la Lluvia,SCL-90 of Derogatis, EVS-25 y ESG of Zukerfeld,Test de Apercepcion Tematica. Sample: 40 patients(Ushuaia and Buenos Aires city) for the periodfrom april, 2008 to april, 2009. RESULTS: Sampleshowed high levels of anxiety, anguish, disinte-grated body image and somatic vulnerability.Anguish and anxiety were higher when patientsfinished their medical treatments and were onfollow up. Mayor difficulties appeared in one test:Test de Persona Bajo la Lluvia. There were sinister,depressive and over-adaptated stories. The sponta-neous reaction was to place the body under the rainand to not get protection. CONCLUSIONS:Psychological tests enrich communication betweenmedical team and the psychoncology unity becausethey give empirical information for discussion. Allof the patients accepted the indication of treat-ment: they report improvement in their life qualityand tolerance to medical treatment. In our

experience, making psychological diagnosis to allof our patients becomes a great tool to makeprevention, and to orientate and avoid that some-thing that appears as a reaction get cronified.

P-202

Exploring the Psychosocial Experience of Sexuality

in Young Adult Cancer Survivors and Implications

for Sexual Health

Emily Murray, Lynne RobinsonDalhousie University, Halifax, Nova Scotia, Canada

OBJECTIVES: To explore how a history of cancerin adolescence or young adulthood affects thepsychosocial experience of sexuality in young adultcancer survivors. METHOD: A purposive sampleof volunteer participants were recruited throughonline cancer websites and forums. The followingcriteria determined eligibility to participate: anEnglish speaking, Canadian, female, male ortransgender individual who was initially diagnosedwith cancer between the ages of 13 and 30, and whowere between the ages of 18 and 30 at the time ofdata collection. Participants also had to havecompleted their cancer treatment. Data werecollected through semi-structured telephone inter-views. RESULTS: Audio-taped interviews weretranscribed verbatim, entered into qualitativeanalysis software and then analyzed using inter-pretive phenomenology. Major themes found in theinterview transcripts will be discussed and implica-tions for supporting the sexual health of youngadult cancer survivors will be outlined. CONCLU-SIONS: This study provides new information onhow young adult cancer survivors experience theirsexuality.

P-203

Desired and Perceived Participation in

Medical Decision-Making in Patients with

Haemato-oncological Diseases

Jochen Ernst1, Nicole Roberts2, DietgerNiederwieser3, Christina Schroder1, Elmar Brahler1

Independent Department of Medical Psychology andMedical Sociology, University of Leipzig, Leipzig,Germany1, McGill University, Montreal, Quebec,Canada2, Division of Hematology and Oncology,University of Leipzig, Leipzig, Germany3

OBJECTIVES: Today, the field of oncology isexperiencing a growing demand to actively con-sider the preferences of patients in the treatmentprocess. This shared decision-making processappears most relevant for patients with malignanthaematological illnesses, as their treatment optionsare protracted, risky, and burdensome. Beingactively involved in decision-making can poten-tially diminish psychological stress, improve


DOI: 10.1002/pon


medical compliance and patient satisfaction withtreatment. However, it remains unclear as towhether haemato-oncological patients desireshared decision-making in practice. METHOD:Between 2005–2008, 177 adult patients wererecruited and surveyed (on their desired decision-making role) at the commencement of theirtreatment (T1) at the hospital or haematologicalclinic in Germany. Three months later (T2) afollow-up survey was conducted, where informa-tion regarding patients’ perceptions and experienceof the decision making process were obtained.RESULTS: The majority of all respondentsreported that at the beginning of treatment theydesired to be in a passive decision-making role(60.2%), 28.3% reported a preference for acollaborative role, and the remainder of thesample (11.5%) reported a desire to take an activerole. Approximately 56% of those at follow-up(T2) indicated accordance with their desiredand realized role of decision-making preferences.CONCLUSIONS: The results coincide with otherstudies that determine limited patient partici-pation in the medical decision-making process inhaemato-oncology. Additionally, this study de-monstrates that approximately 44% of patientsreported disparity between their perceived anddesired decision making role. These findings high-light the importance of further comprehension ofpatients’ need for information about the medicaltreatment procedures, as well as their inclusion inthe decision-making process, in an effort toenhance well-being and reduce conflicts regardingtreatment.

P-206

The Relationship Between the Self-esteem and Mood

States in Patients Undergoing Hematopoietic Stem

Cell Transplantation

Nobuyuki Miyazaki1, Kazuhiro Yoshiuchi1,Yoshiyuki Takimoto1, Maki Hachizuka1, ShujiInada1, Yasuhito Nannya2, Keiki Kumano3,Tsuyoshi Takahashi2, Mineo Kurokawa2, AkiraAkabayashi1

Department of Stress Sciences and PsychosomaticMedicine, The University of Tokyo, Tokyo,Japan1, Department of Hematology/Oncology, TheUniversity of Tokyo, Tokyo, Japan2, Department ofcell Therapy and Transplantation Medicine, TheUniversity of Tokyo, Tokyo, Japan3

OBJECTIVES: Hematopoietic stem cell transplan-tation (HSCT) is an alternative to conventionaltreatment for adults with hematological malignantdiseases. Because HSCT is associated with life-threatening physical morbidity, lengthy convales-cence, and social isolation, the potential forsignificant psychosocial morbidity is high. Theaim of this study was to investigate whether it

would be possible to predict mood states afterHSCT by self-esteem before HSCT in Japanesepatients undergoing HSCT. METHOD: Subjectsconsisted of 77 adult patients with hematologicalmalignancy receiving HSCT between September,1996 and February, 2008 at the University ofTokyo Hospital. Patients were asked to completethe self-esteem scale before HSCT and Profile ofMood States (POMS) about one week after HSCT.POMS consists of tension/anxiety (T-A), depres-sion (D), anger/hostility (A–H), vigor (V), fatigue(F) and confusion (C).Correlations coefficients ofthe self-esteem scores with scores of six subscales ofPOMS were calculated. RESULTS: The subjectswere 51 male (M5 30.6 years, SD5 6.8) and 26female (M5 31.2 years, SD5 7.0) patients. Theself-esteem summary score had significant negativecorrelation with only confusion(C) (p5�0.406) infemale patients, while the self-esteem summaryscore was significantly correlated with depression(D) (p5�0.345), anger/hostility (A–H)(p5�0.355) and confusion (C) (p5�0.303) inmale patients. score. CONCLUSIONS: Overall,low self-esteem before HSCT may be associatedwith poor mood states after HSCT, which suggeststhat it maybe important to assess self-esteem beforeHSCT and low self-esteem could predict negativemood states after HSCT.

P-207

The Development and Implantation of Psycho-

oncology Training Program for Cancer Care

Professionals in Taiwan

Chia-Hui Chen1, Hong-Wen Chen2, Jun-Hua Lee2,Pei-Yi Li3, In-Fun Li4, Chun-Kai Fang5

Department of Psychiatry, Taipei MedicalUniversity-Shuang Ho Hospital, Taipei County,Taiwan1, Hospice and Palliative Care Center,Mackay Memorial Hospital, Taipei City, Taiwan2,Department of Educational Psychology andCounseling, National Taiwan Normal University,Taipei City, Taiwan3, Department of Nursing,Mackay Memorial Hospital, Taipei City, Taiwan4,Department of Psychiatry, Mackay MemorialHospital, Taipei City, Taiwan5

OBJECTIVES: Psycho-oncology is an importantarea in cancer treatment. However, there was norelated training course in Taiwan. We developedthe first training program in Taiwan to providecancer care professionals with core knowledge inkey areas of psycho-oncology. The program wasgranted by the Bureau of Health Promotion,Taiwan, and it was free to all participants. Theobjective of this poster is to report the develop-ment, implementation and assessment of thetraining program. METHOD: First, to establishtopics suitable for cancer care staff in Taiwan, wecollected available lecture curriculum from online


DOI: 10.1002/pon


resources and previous similar lectures in othercountries. Then we held two expertise consensusesmeeting to modify the course to fit in our country.Finally, after approval by all psycho-oncologyexperts, we developed a 14-hour-lecture programfocusing on comprehensive introduction psychoso-cial oncology. We also designed satisfaction ratingqueries for evaluation of this program. RESULTS:Two lectures were held last year. Totally 285 cancercare professionals (166 and 119, respectively)participated in this psycho-oncology training pro-gram. More than 80 percents of the participantsreported that the found the program helpful toimprove their profession. Average satisfactionscore was 3.9 points in a 5-point-rating scale. Inthe analysis of after-class questionnaire, the mosthelpful topic was Communication and interperso-nal skills in cancer care, and Mood and Anxietydisturbance in cancer patients. CONCLUSIONS:The program produced significant knowledgeuptake in a group of cancer medical staff. Futureprogram should focus on the training necessary toachieve comprehensive skills and the knowledge ofclinical care that may improve patient outcomes.

P-208

A Case with Hodgkin Lymphoma and Front-

Temporal Lobular Degeneration (FTLD)-like

Dementia Facilitated by Chemotherapy

Ryuichi Sagawa, Ryuta Katsumata, TatsuoAkechi, Toru Okuyama, Toshiaki FurukawaNagoya City University Graduate School of MedicalSciences, Nagoya, Aichi, Japan

OBJECTIVES: Anti-cancer chemotherapy is ac-companied by various adverse events includingcognitive function impairment. In general, how-ever, changes in cognitive function associated withchemotherapy are slight and temporary. We reportthe case of a 39-year-old man with Hodgkinlymphoma. He was finally diagnosed as havingfronto-temporal lobular degeneration (FTLD)-likedementia facilitated by Adriamycin, bleomycin,vinblastine and dacarbazine (ABVD) chemother-apy. METHOD: We obtained an oral consent fromthe patient’s family to report this case. RESULTS:The patient developed depressive symptoms afterstarting ABVD chemotherapy and later exhibitedsexual disinhibition in addition to cognitive dys-function (mainly executive dysfunction). An in-spection of brain images revealed significant brainatrophy, and decrease in the blood flow to thefrontal lobe and near temporal lobe. We diagnosedthe patient as having FTLD-like dementia basedon these imaging findings, the decrease in his socialinterpersonal skills, apathy, and his unawareness ofhis disease. CONCLUSIONS: The present casesuggests that chemotherapy may cause executive

dysfunction and/or dementia. This case points tothe importance of being attentive to the appearanceof neuropsychiatric symptoms and evaluating brainfunctions properly when performing anti-cancerchemotherapy.

P-211

Psychosomatic Consultation-Liaison Services for

Patients with Melanoma at the General Medical

Hospital–A Comprehensive Cancer Care Approach

Annett Koerner1, George Radiotis1, Kurt Fritzsche2

Counselling Psychology & Oncology, McGillUniversity/Segal Cancer Centre, Montreal, Quebec,Canada1, Department of Psychosomatic &Psychotherapeutic Medicine, University Freiburg,Freiburg, Germany2

OBJECTIVES: Individuals diagnosed with melano-ma face significant practical and psychologicalchallenges including existential fears, pain anddiscomfort associated with treatment, as well asbody image change caused by disfiguring surgery. Toenhance psychological adjustment, patients receivepsychotherapeutic interventions from psychosomaticconsultation-liaison services (C–L) within the generalmedical hospital. But little is known about the use ofthose services in routine clinical care. This studyenhances the knowledge about psychotherapeuticC–L services provided to melanoma patients.METHOD: The study includes all patients referredto the psychosomatic C–L service of a large Germanuniversity hospital between 2005 and 2008(N53658). Data were recorded using the C–Ldocumentation form (CL-BaDo) developed by theGerman College for Psychosomatic Medicine, Ger-man Society of Psychosomatic Medicine and Psy-chotherapy and the General Medical Society forPsychotherapy. Descriptive and inferential statisticsare employed to compare melanoma patients withother cancer patients and patients with otherdermatological diseases. RESULTS: Melanoma pa-tients differ significantly from the other groups intheir reasons for requesting C–L services, psychoso-cial functioning, mental diagnoses, amount and kindof psychological interventions received and in therecommendations by the CLS team for furtherpsychosocial treatment after the hospital stay. Thesefindings contradict the common perception ofdermatologists that melanoma patients are lesspsychologically distressed than patients with otherdermatological diseases. CONCLUSIONS: Whencomparing the psychotherapeutic C-L servicesamongst patient groups, differences in clinical andsociodemographic characteristics are taken intoconsideration. Our results highlight the need forprofessional psychosocial support in individualsdiagnosed with melanoma. These findings arediscussed in regards of current models of integratedcare. Furthermore the emotional distress and the


DOI: 10.1002/pon


psychosocial needs of our melanoma patients arereviewed regarding their impact on health-relateddecision making.

P-218

Distress Management: Comprehensive and Humane

Practices after Changes in Routine of Cancer Care

Cristiane Sant’Anna Decat, Alexandre Nonino,Joao Nunes MatosNeto, Jorge Vaz PintoNeto,Marco Murilo BusoCentro de Cancer de Brasılia (CETTRO), Brasılia,DF, Brazil

OBJECTIVES: The NCCN guidelines of DistressManagement specify the standards of care andrecommend intervention modalities. The aim of thisresearch was to make a retrospective and comparativestudy between two different moments of the routine(Before and After changes) of an oncology center, inBrasilia, Brazil. Thus, the changes correspond to amonthly meeting between psychologist and assistantdoctor to discuss level of distress and interventions, aswell as changes in the technical/administrative man-agement. METHOD: The incidence of distress wasrecognized through the use of the Distress Thermo-meter in three stages: beginning, middle and last dayof chemotherapy; relating them to two differentmoments of routine. The first group (Before)consisted of 100 patients, between 17 and 86 years,39% male and 61% female, from July 2007 to April2008. The second (After) comprised 100 patients, 18and 86 years, 35% male and 65% female, fromJanuary to October 2009. RESULTS: Before: In thefirst stage of evaluation most participants (82%)presented a severe distress; that percentage progres-sively decreased to 36.4% at the middle, and to 18.2%at the last day. After: The incidence of distress at thebeginning (52%) decreased over the first moment ofroutine evaluation; these decrease trends were main-tained in the middle (25%) and in the last day ofchemotherapy (16.7%). CONCLUSIONS: The highincidence of distress showed in the first group (Before)brought the need for changes in the health teamroutine and the technical/administrative management.Thereafter, the distress management becomes anintegral part of cancer care. After changes, the lowincidence of distress was attributed to screening andmonitoring routine for identifying the level and natureof distress; medical and psychological interventiontailored to each case. A humane practice wasobserved from this comprehensive assistance.

P-223

Sense of Coherence and Survival Among Brazilians

with Head and Neck Cancer: Is There an Association?

Paul Allison, Larissa VilelaMcGill University, Montreal, QC, Canada

OBJECTIVES: Head and neck (H&N) cancer isoften considered a burdensome disease. Theliterature suggests that both biological and psy-chosocial factors may affect H&N cancer survival.Sense of coherence (SOC), a psychosocial measure,has been associated with cancer survival. However,no study on SOC and H&N cancer survival hasbeen conducted. This study aimed test the hypo-thesis that people with H&N cancer with higher(SOC) have longer survival than those with lowerSOC. METHOD: A prospective study was con-ducted at a Brazilian hospital among a convenientsample of 162 subjects with newly diagnosed H&Ncancer. SOC, sociodemographic, psychosocial, andclinical characteristics and smoking and drinkinghabits were collected at baseline. Survival data wascollected at the end of the study. One-year survivalanalysis and Kaplan-Meier curve were conducted.RESULTS: 162 subjects were recruited, 152 werefollowed for up to 39 months from cancerdiagnosis. 1-year survival status was obtained for140 subjects. No association was found betweenSOC and either 1-year survival status or survivallength. Higher survival probability was observedfor those who had a partner (compared to nothaving one), those who were at early stage cancer(compared to late stage), and those with oralcancer (compared to other cancer sites). CON-CLUSIONS: The results of this study indicate thata high SOC, compared to lower SOC, does notseem to improve 1-year survival or survival lengthamong this sample of Brazilians with H&N cancer.

P-225

Adjustment to Cancer: Association Between Age and

Distress

Cristiane Sant’Anna Decat, Paulo Gustavo Bergerot,Patricia Werlang Schorn, Marco Murilo BusoCentro de Cancer de Brasılia (CETTRO), Brasılia,DF, Brazil

OBJECTIVES: Studies suggest that adults find thediagnosis of cancer more traumatic than elderlypatients, but they are able to adapt as well as theirolder counterparts once the initial stress hassubsided. Furthermore, elderly patients may beless likely to suffer extreme or prolonged emotionaldistress. In view of such reality, the present studyexamines the association of age and emotionaldistress in patients from an oncology service,located in the capital of Brazil. METHOD: 200patients participated in this research answering tothe Distress Thermometer in three stages of thechemotherapy protocols: beginning, middle andlast day. The sample was shared in two groupsspecified by age range. A sample of 100 patients forthe first group (Adult), between 40 and 59 years ofage, 30% men and 70% women; and another 100patients, for the second (Elderly), between 60 and


DOI: 10.1002/pon


86 years, 39% men and 61% women. RESULTS:In fact the present study replicates findings that anadult with cancer shows more distress during thetreatment. In this group, the incidence of distress inthe beginning of chemotherapy was 73%, 31% atthe middle stage and 25% at the last day oftreatment. Already, among the elderly cancerpatients the incidence was lower – 57% presenteda meaningful distress at the beginning, 30% at themiddle and 11% at the last stage of evaluation.CONCLUSIONS: Many considerations can bemade from these findings. Unfortunately, it isnecessary to consider that, as the adults have a liveahead of them, the elderly patients live a phase inwhich there is a confluence of diminishing function,comorbid disorders, and decrease in social sup-ports and economic resource. The quality of caremust consider the differences between phases of lifeand the health team needs to integrate the areas ofknowledge in comprehension of such phenomena.

P-226

Determinants and Changes in Psychological Adap-

tation and Quality of Life During Chemotherapy for

Diffuse Large B Cell Non-Hodgkin’s Lymphoma in

the Vulnerable and Frail Elderly

Florence Cousson-Gelie1, Priscilla Allart1, PierreSoubeyran2, Gregory Ninot3, Colette Aguerre4,Serge Sultan5

University of Bordeaux, Bordeaux, France1, InstitutBergonie, Bordeaux, France2, University ofMontpellier, Montpellier, France3, University ofTours, Tours, France4, University of Paris V, Paris,France5

OBJECTIVES: The principal aim of the ‘Psy-Frail’study is to assess the impact of psychosocial factorson responsiveness of treatment, the fatigue, thequality of life and psychological adaptation onolder patients living with a non-hodgkin’s lympho-ma. We hypothesize that elderly patients with lowdepression, low routines, high fighting spirit, lowhelplessness/hopelessness and high perceived socialsupport report higher quality of life, lower fatigueand better outcome during treatment and posttreatment follow-up. METHOD: One hundred andtwenty patients aged 70 years old and more will beincluded in 2009 to 2011. Depression (MADRSand MINI), fatigue (MFI), quality of relationships(QRI), routinization (EPR) and coping (WCC-R)are assessed before, during and after treatment bychemotherapy. Regression analyses will be carriedout in order to explore the relation betweenpatients’ sociodemographics, psychological char-acteristics and responsiveness of traitement, qualityof life and fatigue at each time of measure.RESULTS: If we demonstrate that coping strate-gies, anxiety, depression, routinization and socialsupport have an impact of the responsiveness of

treatment and changes in quality of life and fatigue,this could be useful and relevant for the cliniciansin discussing the effects of chemotherapy withpatients and family. CONCLUSIONS: ‘Psy-Frail’represents a major advance which would allowunderstanding the relationships between psychoso-cial factors and cancer outcome in older, frail andvulnerable patients. This research could allow abetter comprehension of psychological predictorsof a good quality of life and survival. Thus, theclinicians could adapt their global care in order toreduce anxious and depressive symptoms, if fre-quent during the hematological cancer.

P-227

The Impact Of An MRSA Diagnosis On Patients In

The Specialist Palliative Care Setting

Aoife Gleeson, Philip LarkinOur Lady’s Hospice, Dublin, Ireland, TrinityCollege Dublin, Dublin, Ireland

OBJECTIVES: The purpose of this study was togain a greater understanding of the impact that anMRSA diagnosis has on patients with advancedcancer and their families, as little is known aboutthis phenomenon. To date, research on MRSA inthe palliative care setting has had a quantitativefocus. No study has yet focused on the psycholo-gical impact of MRSA on patients with advancedcancer. METHOD: This study used a qualitativeapproach. Interviews were conducted with apurposive sample: five with patients and four withfamily members (n5 9). Patients with advancedcancer admitted to the specialist palliative care unitwho were found to have a laboratory confirmeddiagnosis of MRSA colonisation, were consideredfor inclusion in the study. Family members of thesepatients were also considered for inclusion. Datawere then analysed using Framework Analysis.RESULTS: Data saturation was achieved. The keyfinding in this study was the magnitude of thepsychological impact of an MRSA diagnosis, asmany participants reflected the comparable devas-tation that both a cancer and an MRSA diagnosiscould cause. Another key finding was the need fortransparency when patients are found to be MRSApositive, as participants reflected that this helpedthem in dealing with the news. CONCLUSIONS:MRSA has a significant impact on advancedcancer patients and their families in the specialistpalliative care setting. This impact may be under-estimated but early and careful face to faceexplanation about MRSA and its implicationscan help patients and their families to cope betterwith it. This and other findings will aid policydevelopment in relation to MRSA managementand infection control in specialist palliative caresettings.


DOI: 10.1002/pon


P-228

Examining the Relationship Between Gender and

Distress among Cancer Patients: Preliminary Finds

Cristiane Sant’Anna Decat1, Tereza Cristina Ca-valcanti Ferreira Araujo2, Marco Murilo Buso1

Centro de Cancer de Brasılia (CETTRO), Brasılia,DF, Brazil1, Universidade de Brasılia, Brasılia, DF,Brazil2

OBJECTIVES: Men and women create differentstructures in their caregivers roles. Women aremore socio-centric and assembled, and the experi-mental content of their relationship with others arebasic relevant. As men enter the world of instru-mental and emotional care giving, all known ruleschange. The current study aimed to investigate therelation between gender and distress amongpatients in chemotherapy. METHOD: This studywas developed in an oncology center, located inBrasilia, Brazil. The data of 267 patients, of medianage 56 (14 to 86 years old), were assessed with theDistress Thermometer during three different stagesof the chemotherapy protocol: beginning, middleand last day. This sample was shared according tothe gender of the patients. Thus, two groups wereformed: Men group, with 35.6% of the sample andthe Women group corresponding to 64.4%. RE-SULTS: There were significant differences betweengroups in all stages of evaluation: beginning(po0.05), middle (po0.01) and last day(po0.05). The men group reported 50.5% of severedistress at the beginning, 20.5% middle and 12.7%last day of treatment. By the time, the incidence ofdistress in the women group was higher: 66.9% atthe beginning, 35.5% middle and 20.9% last day ofchemotherapy. CONCLUSIONS: The findingsshowed that the women group had a higherincidence compared to the men group. The genderproved to be an important moderate factor, witheffects on the ability to cope. Furthermore, it doesnot exist a sole determinant factor and neither onestrategy that is the most efficient. The copingstrategies chosen are related to the characteristic ofthe disease, reaction to the treatment, patient’sdynamic and cultural and social context.

P-230

A Critical Discussion of the Application of

Existential Thought in Palliative Care: Back to the

Basics

Henry Melissa1, MacKinnon Christopher J.2,Chan Lisa S.3

McGill University, Jewish General Hospital, LouiseGranofsky Psychosocial Oncology Program,Montreal, Quebec, Canada1, McGill University,Montreal General Hospital, Montreal, Quebec,Canada2, McGill University, Montreal, Quebec,Canada3

OBJECTIVES: Several therapeutic interventionswhich draw on existential theory have beendeveloped to support cancer patients. The objectiveof this poster presentation is to critically discuss theways in which some of the current assumptionsguiding existential interventions for cancer patientshave diverged from some of the underlyingprinciples of both existential philosophy and theirmanifestations in existential psychology. The ben-efits of moving towards a more integrated existen-tial approach in treating cancer patients will behighlighted. METHOD: It is argued that theapplication of existential theory in a structured,time-limited, manualized and empirical context canbe at odds with some of the major tenets ofexistential philosophy and psychology (Cooper,2003). RESULTS: These tenets include:1) ‘Exis-tence precedes essence’:living in the moment defineswho we are, with an emphasis on the pursuit offreedom, responsibility, making choices andauthenticity. 2)Existentialism encourages self-reflection in the pursuit of an individual’s genuinewishes and desires, as opposed to a preoccupationwith obtaining approval from others. 3)Existentialangst results from these pursuits and is acknowl-edged. 4)Emphasis is placed on living in themoment, relatively free of preoccupations withwhat was or what will be. CONCLUSIONS: Theexistential approach will be compared and con-trasted with the current context of realism, science,research, RCTs and medicine. Clinical implicationsdiscussed will include an emphasis on respectingcancer patients’ lived experience, the freedom ofengaging (or not) in the process of existentialreflection and the need for clinicians to createsufficient therapeutic space to allow for discussingexistential angst. Limitations of the existentialapproach will also be considered.

P-232

An Examination of Changes in Relationship

Dynamics and Roles Between People with Cancer

and Their Primary Informal Carer

Jane Ussher1, W.K. Tim Wong1, Janette Perz1,Phyllis Butow2, Gerald Wain3, Gillian Batt4,Kendra Sundquist4

University of Western Sydney, New South Wales,Australia1, University of Sydney, New South Wales,Australia2, Westmead Hospital, New South Wales,Australia3, Cancer Council New South Wales, NewSouth Wales, Australia4

OBJECTIVES: The diagnosis of cancer can changethe relational dynamics between people with cancerand their family members, in particular theirintimate partners, which can have an impact ontheir subjective well-being and ability to cope. Theaim of this study was to adopt a relationalperspective to examine accounts of change in roles


DOI: 10.1002/pon


and interpersonal dynamics between the personwith cancer and their primary carer, from theperspective of informal carers. METHOD: Sixtytwo informal cancer carers (42 women & 20 men),across a range of cancer types, stages and relation-ship dyads, living in New South Wales (NSW),Australia, took part in the study, part of a largermixed-method study examining the gendered ex-periences of cancer carers. Semi-structured inter-views were used to examine relationship change,analysed through thematic analysis. RESULTS:Results indicated that cancer had precipitated achange in roles and in the dynamics of therelationship, including increased responsibilities inthe home, carers having to take on quasi-medicaltasks and decisions, changed patterns of commu-nication, and changes to sexuality and intimacy.Negative consequences of the changed relationshipincluded sadness, anger and frustration. However,many participants also reported increased feelingsof love, closer together and reward from providingcare, resulting in relationship enhancement.CONCLUSIONS: Cancer caring should be con-ceptualised within a framework of intersubjectivity,rather than separating the ‘carer’ and the ‘caredfor’ into autonomous, unitary subjects. Womenwere more likely to mourn the previous relation-ship, whilst more men reported relationshipenhancement, supporting suggestions that depres-sion in women carers is linked to being obligated tocare, in contrast to men who perform a role that isnot expected of them and thus experience a greatersense of reward.

P-233

Self-Silencing and Psychological Distress in

Informal Cancer Carers: A Gendered Analysis

Jane Ussher1, Janette Perz1, W.K. Tim Wong1,Phyllis Butow2, Gerald Wain3

University of Western Sydney, New South Wales,Australia1, University of Sydney, New South Wales,Australia2, Westmead Hospital, New South Wales,Australia3

OBJECTIVES: The pattern of communicationadopted by couples living with cancer can influencetheir coping and psychological well-being. Coupleswho are mutually responsive, attend to each othersneeds, and talk openly about stress, are more ableto engage in effective emotion and problem focusedcoping, whereas couples who adopt ‘disengagedavoidance’ report greater distress. This studyexamined gender differences in self-silencing, therelationship between self-silencing and psychologi-cal distress, and reasons for self-silencing, ininformal cancer carers. METHOD: Using a mixedmethod design, 484 informal carers (329 womenand 155 men), across a range of cancer types andstages, completed the Self-Silencing Scale (STSS)

and the Hospital Anxiety and Depression Scale(HADS), to examine communication patterns andpsychological distress. 53 carers also took part inan individual interview to examine the patterns ofself-silencing, with the qualitative data analysedusing thematic decomposition, within a frameworkof positioning theory. RESULTS: Men reportedgreater self-silencing than women, however, wo-men reported higher depression and anxiety, eventhough depression and anxiety were significantlycorrelated with self-silencing. This reflects genderdifferences in patterns of self-silencing. Both menand women reported self-silencing to prioritisepatient needs, or to protect them from conflict.However, women also positioned self-silencing as arequisite for coping, demonstrating awareness ofexternal judgement, whilst men positioned self-silencing as a normal aspect of masculine behaviour.CONCLUSIONS: The significant association ofself-silencing with depression and anxiety confirmsthat it is not an adaptive behaviour for carers,supporting previous reports that avoidance ofemotional discussion in couples living with canceris detrimental to coping and to mental health.These findings also demonstrate the utility of self-silencing theory for understanding gender differ-ences in cancer carer distress, and provide insightinto reasons why self-silencing occurs in womenand men.

P-234

Sexuality and Intimacy Following the Diagnosis and

Treatment of Cancer: The Experience of Partners of

a Person with Cancer

Emilee Gilbert1, Jane Ussher1, Yasmin Hawkins1,Janette Perz1, W.K. Tim Wong1, KendraSundquist2, Phyllis Butow3

University of Western Sydney, New South Wales,Australia1, Cancer Council New South Wales,New South Wales, Australia2, University of Sydney,New South Wales, Australia3

OBJECTIVES: Previous research findings haveshown that a cancer diagnosis and related treat-ments can affect the sexual and intimate aspects ofa relationship. Sexuality and intimacy issues areoften unacknowledged as major and negativeconsequences of cancer, leading to unmet needson the part of couples experiencing cancer. Thisstudy examined changes in sexuality and intimacyfollowing cancer from the perspective of partnersof people with cancer, across a range of cancertypes and stages. METHOD: Using a mixedmethod design, changes in sexuality and intimacyfollowing cancer were examined using a surveycompleted by 156 Australian carers (55 men, 101women) who were partners of a person with cancer,across both reproductive and non-reproductivecancer types. Interviews were also conducted with


DOI: 10.1002/pon


a representative sample of 20 participants toexamine these changes in depth, analysed usinggrounded theory. RESULTS: 76% of those caringfor a person with ‘non-reproductive’ cancersreported an impact on the sexual relationship, asdid 84% caring for a person involving ‘reproduc-tive’ sites (gynaecological, prostate, breast). 70% ofParticipants reported self-blame, rejection, sadness,anger, and lack of sexual fulfilment associated withsuch changes. 30% reported acceptance, increasedcloseness and intimacy. Only 20% of partners haddiscussed sexuality with a health professional, andonly 37% of those were satisfied with the discus-sion. CONCLUSIONS: Sexuality is central toquality of life and to couple closeness in thecontext of cancer. Cessation or reduction of sexualintimacy following cancer is associated withdistress, whilst sexual re-negotiation is associatedwith couple closeness. Health professionals need toacknowledge the sexual needs of intimate partners,as well as people with cancer. This is an issue acrossall cancer types, not simply those affecting repro-ductive organs, which have been the focus ofprevious research.

P-238

Disclosing Cancer Genetic Information within Fa-

milies: Perspectives of Counselees and Their At-risk

Relatives

Afsaneh Roshanai1, Karin Nordin2, ClaudiaLampic1, Richard Rosenquist2

Department of Public Health and Caring Sciences,Uppsala University, Uppsala, Sweden1, Departmentof Public Health and Primary Health Care,University of Bergen, Bergen, Norway2, Departmentof Genetics and Pathology, Uppsala University,Uppsala, Sweden3

OBJECTIVES: The aim of the present descriptivestudy was to investigate the experience of sharinggenetic information among cancer genetic counse-lees, and their at-risk relatives who had attendedgenetic counseling between 2003 and 2007. METH-OD: In total, 147 counselees (133 female, 14 male),affected by cancer and/or with a familial history ofbreast, breast/ovarian or colorectal, and 81 of theirat-risk relatives (57 female, 24 male) answered to aquestionnaire and/or were interviewed. Counselees’communication of genetic information to at-riskrelatives was assessed with regard to who theyinformed, how they felt, and how they perceivedtheir relatives’ reactions. In addition, at-riskrelatives’ experiences of receiving genetic informa-tion were studied. RESULTS: Most of thecounselees had shared the genetic information withtheir at-risk relatives personally. The majority ofthe counselees (68%) reported positive or neutralfeelings about sharing the information withtheir relatives, while 9% stated negative feelings.

Counselees mostly interpreted the relatives’ reac-tions as positive or neutral, and in few cases asnegative (14%). About half of relatives reportedpositive or neutral reactions (54%) to the receivedinformation, while about one-fifth reported nega-tive reactions (22%). CONCLUSIONS: Sharinggenetic information within at-risk families appearsto be accomplished without any major difficultiesor negative feelings. However, more assistance maybe needed to optimize the communication of thegenetic information within at-risk families.

P-241

The Abbreviated PSWQ is a Reliable Screening

Tool for Elevated Worry in Breast and

Gynecological Cancer Patients

Salene Wu1, Tammy Schuler1, Dokyoung SophiaYou1, Barbara Andersen2

The Ohio State University Department ofPsychology, Columbus, OH, United States1, TheOhio State University Department of Psychology;The Ohio State University Comprehensive CancerCenter and Solove Research Institute, Columbus,OH, United States2

OBJECTIVES: The high prevalence of psycholo-gical distress among cancer patients (Zabora et al.,2001) indicates a need for reliable distress screen-ing, for intervention referral. We used itemresponse theory (IRT) to evaluate the Penn StateWorry Questionnaire (PSWQ), a 16-item question-naire (with 5 reverse-scored items) which screensfor excessive worry, and its abbreviated form(PSWQ-A). The PSWQ screens for GeneralizedAnxiety Disorder (GAD) since excessive worryacross several domains is a primary GAD symp-tom. METHOD: Women (N5 333) with breast(28%) or gynecological (71%) cancer completedthe PSWQ at their initial post-operative appoint-ment. The PSWQ-A contains 8 of the non-reverse-scored items. The average participant was middle-aged (mean5 56; SD5 10), Caucasian (87.1%),and married (64.6%). A graded response modelwas used for IRT analyses, which tests each item’sability to reliably discriminate different levels ofworry and levels of worry at which a measure ismost reliable for screening. RESULTS: MeanPSWQ and PSWQ-A scores were 43.3(SD5 13.1) and 19.98 (SD5 8.29) respectively.Analyses showed insufficient discrimination ofworry level for the 5 reverse-scored PSWQ items.All other PSWQ/PSWQ-A items showed sufficientdiscrimination of worry. Both the PSWQ andPSWQ-A were most reliable for moderate to highlevels of worry. CONCLUSIONS: Adequate relia-bility for the non-reverse-scored items of thePSWQ/PSWQ-A was shown. Both measures weremost reliable at moderate to high levels of worry,which is crucial to differentiate between those who


DOI: 10.1002/pon


may or may not benefit from intervention. Theshorter form may be optimal to screen for general,excessive worry in oncology clinics.

P-242

Breast Cancer Survivors among Young Francophone

Women in New Brunswick: Impact of Diagnostic

and Treatment on Various Aspects of Life

Pierrette Fortin, Anne CharronUniversite de Moncton, Edmundston Campus,Edmundston, New Brunswick, Canada

OBJECTIVES: The purpose of this study is toexamine personal, marital, familial, professional,financial and psychosocial issues of young franco-phone women diagnosed with breast cancer be-tween 2000 and 2006 and who received treatment(surgery and/or chemotherapy and/or radiother-apy) in a small and mostly rural province of themaritimes. METHOD: A retrospective study wasundertaken. Audio-taped qualitative interviewswere conducted with francophone women agedbetween 30 and 50 years. In a 5-month period, 15women from different areas in New Brunswickwere interviewed individually in French, using asemi-structured canvas and open questions. Wo-men were invited to share their experience ofillness. Verbatim was transcribed, a categorizationscheme was developed and then coded in NVivo 8.Constant comparative process was used for dataanalysis. RESULTS: Major themes emerged, suchas information seeking, positive thinking, bodyimage, increased need of social support and theneed to take more time for themselves. Contrary towhat is found in the literature, alopecia is not amajor concern for our sample of women, but is asource of preoccupation for husbands and children.Financial difficulties are a burden, especially forthose who must travel long distances to receiveradiotherapy. CONCLUSIONS: The experience ofliving with breast cancer seems to be as hard,if not harder, in young women than in older ones,mostly because of their unwanted but necessaryleave of absence from work and ongoing familyresponsabilities, especially caring for young chil-dren. It is important to note again that theirperceptions towards their body image are closelylinked to the family circle perceptions’ of theirphysical appearance.

P-249

A Temporal Model for Optimizing Meaning-

Making Interventions Along the Cancer Care

Continuum

Virginia Lee1, Carmen G. Loiselle2

McGill University Health Centre, Montreal,Quebec, Canada1, Jewish General Hospital,Montreal, Quebec, Canada2

OBJECTIVES: To date, therapeutic approachesthat promote existential meaning have not beensynthesized into an integrative framework thatrecognizes the temporal course of the cancerexperience. The cancer control continuum offers adescriptive template to conceptualize phase-specificpsychosocial issues pertaining to primary, second-ary, tertiary, and quaternary prevention (Milleret al., 2008). The purpose of this poster is toexplore how existing clinical approaches to mean-ing making can be organized and informed by thecancer control continuum. METHOD: A temporalmodel of meaning making is proposed based on areview of the current empirical evidence abouttherapeutic meaning making approaches within thecontext of cancer. A content analysis of thestrategies contained within the Meaning-Makingintervention (MMi ) (Lee, 2004, 2006a,b, 2008) willbe used for illustrative purposes. RESULTS: Theproposed model highlights the critical meaningmaking issues that pertain to each phase of thecancer control continuum (i.e. predisease, earlydisease, clinical disease, and survivorship). Themodel also describes how therapeutic approachesto meaning making, organized by type, timing, andobjective, can be applied to phase specific issues,such as during genetic counseling, at time ofdiagnosis, during treatment, post-treatment, andtransitioning to end of life. CONCLUSIONS: Theproposed temporal model of meaning makingcharacterizes and organizes a range of innovativemeaning making techniques that may provideuseful guidelines to the clinical application ofmeaning making approaches, and the generationof propositions for further testing.

P-250

Psychosocial Daily Difficulties in Japanese

Childhood Cancer Patients after Discharge from

Medical Treatment

Yuko Takei1, Akiko Ogata2, Miwa Ozawa3,Hiroshi Moritake4, Atushi Manabe3, Kei Hirai5,Shinichi Suzuki6

Graduate school of Human Sciences, Waseda univ.,Saitama, Japan1, Faculty of Education and Culture,Miyazaki univ., Miyazaki, Japan2, St. Luke’sInternational Hospital, Tokyo, Japan3, Departmentof Reproductive and Development Medicine, Facultyof Medicine, Miyazaki univ., Miyazaki, Japan4,Graduate school of Human Sciences, Osaka univ,Osaka, Japan5, Faculty of Human Sciences, Wasedauniv., Saitama, Japan6

OBJECTIVES: Advances in the treatment ofchildhood cancer led to dramatically improvedlong-term survival rates. Although the expectedoutcome is cure, cancer still remains a constantthreat; it is experienced by young patients as a


DOI: 10.1002/pon


major crisis at a biological, psychosocial, andspiritual level (Servitzoglou et al., 2008). Thepurpose of this study was to explore the dailypsychosocial difficulties in Japanese childhoodcancer patients after discharge. METHOD: Sub-jects were 25 childhood cancer patients attendingthe pediatric outpatient clinics (8 male and 17female, mean age at survey5 17.073.6 yrs.).Approximately 18 patients had leukemia and 4each suffered from malignant lymphoma and bonetumor, respectively. They were asked to participatein a semi-structured interview regarding the diffi-culties they faced in daily life after their discharge.The data was analyzed with the content analysis,chi-square test, and correspondence analysis. RE-SULTS: A total of 19 attributes were extracted andcategorized as follows: physical difficulties, inter-personal difficulties, behavioral difficulties, anduncertainty about the future. The attributes in-dicated by over 50% of the participants were‘feeling of unwellness,’ ‘painful treatment,’ ‘beingphysically active,’ ‘being absent from school orwork because of illness,’ and ‘being left behindacademically.’ Some attributes of interpersonaldifficulties and uncertainty about the future weresignificant differences among age, sex, and the typeof diagnosis. CONCLUSIONS: This study identi-fied the important components of daily psychoso-cial difficulties in Japanese childhood cancerpatients after their discharge. Most patients suf-fered from physical and behavioral difficultiesbecause of cancer treatment and its side effects.In addition, interpersonal difficulties were uniquefindings that had not been well revealed in previousWestern studies. It is important for Japanesechildhood cancer patients to get those aroundacross their disease.

P-252

Ovarian Cancer: Patients’ Experiences with the

Onset of Symptoms

Lene Seibaek1, Lone K Petersen1, Jan Blaakaer1,Lise Hounsgaard2

Department of Gynecology, Aarhus, Denmark1,Research Unit of Nursing, Odense, Denmark2

OBJECTIVES: Diagnosis of ovarian cancer in anearly stage significantly improves the chances of thefive-year survival. However, the non-disease speci-ficity of the early symptoms has made it verydifficult to diagnose in time. By analysing datafrom research interviews dealing with the patients’personal and bodily experiences with the onset oftheir symptoms, it was possible to obtain a deeperunderstanding of the patients’ health-seeking pro-cess and to rethink some of the diagnosticdifficulties. METHOD: Participants were women,who underwent surgery on the suspicion of ovarian

cancer in 2008–2009. The informants were strate-gically selected representing the existing populationof ovarian cancer patients concerning age, stage,socio-economic status and general health. Eachinformant was interviewed at the hospital theevening before the operation and eight weeks laterin their private home, following a semi-structuredguide. A phenomenological-hermeneutic interpre-tation methodology inspired by the philosophy ofRicoeur was used in the analysis. RESULTS: Anumber of 19 research interviews were conductedwith 10 women. One informant was solely inter-viewed preoperatively due to postoperative death.All invited informants accepted to participate inthe study. The theme constituting the patients’experiences with the onset of symptoms arose fromthe initial analysis. Subsequently three subthemeswere identified: ‘When the stomach startedgrowing’; ‘When you feel something is very wrong,not knowing what it is’; ‘To react adequately tobodily changes’. CONCLUSIONS: The patientshold personal and embodied knowledgeabout the development of their symptoms whichdeserves systematic investigation and validation.As there is no screening procedure for thedisease, it is the women’s own reflections andresponse to that specific kind of physicaldiscomfort preceding ovarian cancer, which initi-ally brings her to the doctor. So the capability ofdoing so is crucial for her survival. The diagnosis-seeking process is involving both nature andculture.

P-254

Prognostic Disclosure In The Palliative Phase

Of Breast Cancer, Quality Of Communication From

A Patient Perspective: An Experimental Study

Protocol

L. M. van Vliet1, J. M. Bensing1

NIVEL, Utrecht, Netherlands1, NIVEL, Universityof Utrecht, Utrecht, Netherlands2

OBJECTIVES: When receiving prognostic infor-mation, palliative (breast) cancer patients say theywant complete information, but when receivingthis, they are often overwhelmed by it. Addition-ally, they say they want realistic information, whileat the same time they need hope. This often placesoncologists for dilemmas: they do not know howexplicit or general, and how hopeful or realisticthey should be in their communication. Thisproject will explore these communication elementsfrom a patient perspective. METHOD: To studythe effects of these elements, systematic controlledstudies are needed. An experimental video-vignettestudy will be created in which oncologists’ levels ofexplicit and hopeful prognostic information areeither high or low. The different video-vignettes


DOI: 10.1002/pon


will be role-played by actors and watched byanalogue patients; breast cancer survivors andhealthy women who put themselves in the shoesof the breast cancer patient in the video. Theirperceptions of the communication strategies areassessed. RESULTS: This project has just startedand empirical results are not yet available. Instead,we will discuss the (dis)advantages of experimentalversus clinical studies. While clinical studies haveecological validity, conducting a proper RCT inthis situation is difficult, communication is aninteractive process, so cannot be standardized.Besides, clinical studies often use communicationas a container concept, with little interest in thespecific elements it consists of. The currentexperimental study overcomes these problems.CONCLUSIONS: By using this rigorous studydesign, we aim to provide oncologists concretetools for how to discuss prognostic information interms of explicitness of information and expressedhope to satisfy patients’ high and ostensiblycontradictory needs, taken into consideration theinfluence of personal dispositions and copingstyles. More insight into the usefulness of experi-mental communication studies will be providedopposed to clinical studies. Additionally, moreknowledge on the validity of analogue patients willbe obtained.

P-255

Mood State Profile and Coping Strategies During

the Genetic Screening for BRCA-1/2 Genes: A

Comparison between the Testing and the Outcome

Disclosure Phase

Barbara Muzzatti, Sara Mella, Daniela Narciso,Alessandra Viel, Riccardo Dolcetti, MariaAntonietta Annunziata, Luigi GrassiCentro di Riferimento Oncologico, Aviano(Pordenone), Italy

OBJECTIVES: Cancer risk increasing due toBRCA1/2 genes together with the possibility oftransferring genetic heritage suggest that under-taking a genetic screening (GS) for these mutationsand receiving a positive response can provoke apeculiar emotional state and pattern of coping. Themain emotional states and coping patterns ofsubjects undertaking the GS (T1) and receiving itsresults (T2) were registered and compared. METH-OD: Thirty-seven users of a preventive diagnosis/genetic counseling service of a Cancer Institutewere requested to fill out both a mood state (i.e. theProfile of Mood States) and a coping (i.e. theCoping Orientations to Problems Experienced)profile twice: during the genetic screening (T1)and a month from genetic testing disclosure (T2).RESULTS: From T1 to T2, the percentages ofusers overcoming the normality range (40–60) in

Anger-Hostility (11.8% vs. 16.2%; p5 0.034),Depression-Dejection (11.8% vs. 21.6%; p5

0.004), Fatigue-Inertia (14.6% vs. 22.2%; p5

0.018), (less) Vigor-Activity (17.6% vs. 29.7%;p5 0.003) increased, whereas no significant differ-ences were found in Confusion-Bewilderment(14.7% vs. 13.5%; p5 0.084) and Tension-Anxiety(17.6% vs. 13.5%; p5 0.071). Small differenceswere found in comparing coping patterns ofusers in T1 and T2. CONCLUSIONS: Despite itslimitations, present preliminary data show thatnot a marginal percentage of enrolled subjectsdisplayed levels in negative emotional statesthat overcame normality ranges and that thispercentage increased, progressing from T1 to T2.From a clinical point of view they manifest therelevance of psycho-emotional screening. Associa-tions of clinical factors (e.g. proband/non-probandstatus, genetic results outcome) with the measureddimensions should be tested in more large sampleresearch.

P-256

Defining Cancer Survivorship: Clinical and Research

Implications

Maria Antonietta Annunziata, Barbara Muzzatti,Lorena Giovannini, Katia Bianchet, MassimilianoBerretta, Arben Lleshi, Umberto Tirelli, LuigiGrassiCentro di Riferimento Oncologico, Aviano(Pordenone), Italy

OBJECTIVES: Definitions help in framing andunderstanding concepts and domains. The firstdatum on cancer survivorship literature regards thelack of a single definition of this condition. Inaddition cancer survivors are compared withgeneral as well as oncological populations. Thepresent work summarizes the definitions of cancersurvivorship and discusses their main implicationsfrom both clinical and research perspectives.METHOD: Combinations othe words ‘cancer’,‘oncology’, ‘neoplasm’, ‘survivor�’ were used toselect records in MedLine and PsycInfo databases.Files about children, school aged subjects and teenswere dropped. RESULTS: Seven different defini-tions of cancer survivorship were identified; theycan be visualized on a continuum from ‘receiving acancer diagnosis’ to ‘being a cancer patient’srelative’. Both validity and reliability of the toolsdesigned for cancer and healthy populations, thekind of norms (i.e. healthy or ill population) shouldbe used in comparisons, the suitability of toolsspecifically tailored upon this condition are themain questions drawn from this scenario. CON-CLUSIONS: Since cancer survivorship is nowa-days a reality for a growing number of persons,research and clinical practice in this field would


DOI: 10.1002/pon


benefit from more clarity and precision in termsand definitions.

P-257

Psychiatric Disorders of the Bereaved who Lost

Family Members Due to Cancer: Experiences of

Outpatient Services for Bereaved Families in a

Cancer Center Hospital-The Second Report

Mayumi Ishida1, Hideki Onishi2, Mei Wada2,Tomomi Wada2, Makoto Wada2, MasaruNarabayashi3, Yasutsuna Sasaki4, ShinobuNomura5

Graduate School of Human Sciences, WasedaUniversity, Tokorozawa-city, Saitama, Japan1,Department of Psycho-Oncology, SaitamaMedical University International Medical Center,Hidaka-city, Saitama, Japan2, Department ofPalliative Medicine, Saitama Medical UniversityInternational Medical Center, Hidaka-city,Saitama, Japan3, Department of Medical Oncology,Saitama Medical University International MedicalCenter, Hidaka-city, Saitama, Japan4, Faculty ofHuman Sciences, Waseda University, Tokorozawa-city, Saitama, Japan5

OBJECTIVES: With the aim of alleviating psy-chological distress in the bereaved, our hospitalstarted an outpatient service for bereaved families.The purpose of this study was to examine patternsof referral, psychiatric disorders, backgroundcharacteristics, and psychosocial interventionsamong the bereaved who lost a loved one due tocancer. METHOD: In this retrospective study, allpatients who consulted the outpatient service forbereaved families in our hospital between April2007 and September 2009 were reviewed. Thisstudy was approved by Institutional Review Boardof Saitama Medical University International Med-ical Center. RESULTS: During the study period,51 patients consulted the outpatient service forbereaved families. The ages ranged from 17 to 76years (mean: 51715). The most common psychia-tric disorder among the bereaved was majordepression (n5 20, 39%), followed by adjustmentdisorders (n5 14, 28%). Six patients (n5 6, 12%)experienced dissociative disorders in addition totheir psychiatric diagnosis. Females (n5 44, 86%),and spouses (n5 26, 51%), were the mostcommon users of the service. CONCLUSIONS:This is the second report of consultation dataregarding the bereaved who lost family membersdue to cancer. Most of the patients who consultoutpatient services for bereaved families sufferfrom psychiatric symptoms related to thedeath of close family members, and need somehelp. Psychiatric interventions including psy-chotherapy and medications are required for thesefamilies.

P-258

A Longitudinal Perspective on Post-Traumatic

Growth Following the Diagnosis of Breast Cancer:

The Mediating Role of Mindfulness and Attachment

Security

Naama Hirschberger1, Tamar Peretz1, MarioMikulincer2

Hadassa Medical Center. Ein Kerem Campus,Jerusalem, Israel1, Interdisciplinary Center,Herzliya, Israel2

OBJECTIVES: The current prospective longitudi-nal study examined the role of psychologicalresources (i.e. attachment security, Mindfulness)on the post-traumatic growth of women diagnosedwith breast cancer employing multiple measure-ments over a period of two years. The diagnosis ofcancer makes existential questions salient, and thecurrent research demonstrates that women high inpsychological resources (those who are high inattachment security and/or in mindfulness) are ableto reconstruct meaning and experience growthfollowing a traumatic crisis. METHOD: Twogroups of women were followed over two years:The study group consisting of 45 women betweenthe ages of 40–65 who were diagnosed with stage Ior II breast cancer in the preceding 12 months. Amatched control group of 45 women were exam-ined to determine that changes occurring in thestudy group are unique to cancer. Both samplescompleted self-report questionnaires and wereinterviewed on two occasions. Medical and demo-graphic information were obtained from hospitalrecords. RESULTS: The results of this research arecurrently being analyzed and will be presented atthe conference if accepted. CONCLUSIONS: Theresults of this research are currently being analyzedand the conclusions will be presented at theconference, if accepted.

P-261

Assessing Caregiver Experiences For Modeling

Team Interventions—An Evidence Based Approach

To Palliative Care Planning And Delivery

Ambika RajvanshiCanSupport, New Delhi, India

OBJECTIVES: The diversity of palliative careservices has important implications for the designof an assessment system of quality of care. Ratherthan a ‘cast-iron’ approach, palliative care assess-ment needs to be receptive, responsive, adaptable,multi-pronged and tailor-made to individual needs.The aim of this project was to integrate familycaregiver feedback in comprehensive quality as-sessment and care improvement, allowing careteams to identify distinct needs, customize inter-ventions and establish networks to bridge gaps in


DOI: 10.1002/pon


comprehensive care. METHOD: A caregiver feed-back form was developed after review of interna-tional literature and inputs from palliative careprofessionals, cancer patients and their caregivers.This 30-item questionnaire assessed overall carecoordination and solicited response under six corecategories; whether care was (1) Patient centeredand family oriented (2) Beneficial (3) Sensitive (4)Safe (5) Timely (6) Effective. In a pilot survey,volunteers interviewed family caregivers of de-ceased cancer patients looked after by Home Careteams. RESULTS: The survey provided detailedand unbiased caregiver feedback. A graphicrepresentation of the core categories, especially‘benefits’ in terms of symptoms, function, inter-personal, well-being and transcendent (perceived asdimensions of quality of life) revealed areas ofstrength as well as unmet needs and deficiencies inquality of care. The study reinforced that certainprocess elements of team functioning are influencedby caregiver involvement, especially assessment,care planning, implementation of plans and net-working for holistic care. CONCLUSIONS: Theproject recognizes that retrospective informationby caregivers is an effective intervention in pallia-tive care allowing continuous quality improvement.Integration of such evidence-based guidelineschallenges and steers care teams to bridge identifiedgaps through personal capacity building, palliativecare education for healthcare workers, and effectivenetworks in community for mobilizing resources.Assessing caregivers proves to be a translationaltool as it is based on the practical implementationof a theoretical framework of their experience.

P-263

Teaching Communication Skills in Southern Europe:

Preliminary Report from a Pilot-Program in

Portugal

Luzia Travado

Clinical Psychology Unit, Central Lisbon HospitalCentre-Hospital S. Jose, Lisbon, Portugal

OBJECTIVES: Communication skills trainingprograms for oncologists (CSTO) in SouthernEuropean countries are poorly developed. In spiteof the scientific evidence for the benefits of anadequate doctor-patient communication, provisionof this training has been reported as being none orminimal during medical education. To overcomethis gap a model of CSTO has been developed andapplied as Pilot-Program in Portugal under theumbrella of the National Coordination for Onco-logical Diseases, Ministry of Health. METHOD:Medical doctors working in cancer care over thecountry were invited to attend a Symposium onthe importance of communication skills trainingin clinical oncology. International specialists

presented its scientific evidence and practicalbenefits. Attendants were invited to register forfree workshop on CSTO, in any of 3 sites anddates. The CSTO model consisted of 4 modules(12h), on basic and advanced skills, how torecognize distress and SPIKES for BBN. RE-SULTS: From 103 participants expressing will-ingness to participate at workshops, 24 attend it.Attendants were mainly oncologists and surgeons.Satisfaction with workshops was high (4.7/5), andits interactive and practical methodology the mostappreciated features. All participants considertrained techniques relevant and beneficial for theirclinical practice. Data from pre and post workshopquestionares on clinical variables namely, confi-dence in communication skills, psychosocial be-liefs, communication dilemmas, is being analysedand will be presented. CONCLUSIONS: Frompreliminary data showing an improvement in mostof the variables assessed and in the high satisfac-tion with the workshops we are encouraged toproceed with this program and enlarging it toinclude other professionals.

P-267

Psychosocial Intervention and Prostate Cancer –

What Do Danish Men Operated for Primary

Prostate Cancer and Their Spouses Need to Cope

with Disease and Treatment Related Side Effects?

Randi Valbjoern Karlsen, Christoffer JohansenDanish Cancer Society, Copenhagen, Denmark

OBJECTIVES: To explore psychosocial needsamong men operated for prostate cancer and theirspouses in relation to diagnosis, treatment andtreatment effects. On basis of reported psychosocialneeds we sought to clarify which types of psycho-social interventions were appealing to men andspouses. The aim was to develop a psychosocialintervention to men surgical treated for prostatecancer and their spouses to improve coping abilitiesand strengthen patients and spouses adaption totheir different life situation. METHOD: Six patientswere recruited from the surgical department,purposefully selected to obtain information aboutthe first year following prostatectomy. Patients wereoperated 3, 6 and 12 months before the interviewand ages ranged from 48–70 years. The interviewguide focused on themes related to diagnosis andtreatment of prostate cancer and qualitative semi-structured couple interviews were conducted. Inter-views were transcribed and analyzed primarilyusing grounded theory and secondly withintheoretical framework combining coping andrehabilitation. RESULTS: After initial analysisof the interviews eight different themes emerged:1) diagnosis and treatment decision, 2) commu-nication with health professionals, 3) incontinence,4) impotence, 5) dyadic communication,


DOI: 10.1002/pon


6) PSA-control, 7) CAM (complementary andalternative medicine), 8) use of patient organiza-tions. Second cycle of analysis resulted in followingcoping related themes: to strive for control, to strivefor appreciative relations, to adapt to a different lifesituation, together reflecting the psychosocial reha-bilitation needs of the couple. CONCLUSIONS:Interviews revealed patients and spouses need ofdetailed information about disease and support inrelation to treatment decision. Incontinence andimpotence influenced men’s self-esteem and patientsreported loss of manhood. Spouses experienceddifficulties in dyadic communication concerningdisease and sexual problems and stressed need ofsupport to facilitate couple communication. Somecouples experienced problems in taking up sexualactivity and healthy dyadic communication was acrucial factor in promoting sexual recovery afterprostate cancer.

P-268

Assessing The Awareness and practice of Papsmear

Screening Among Christian Women

E. O. Akin-Odanye, C. C. AsuzuUniversity of Ibadan, Ibadan, Oyo State, Nigeria

OBJECTIVES: Cancer of the cervix is the secondmost common cancer among our women. Mostwomen with this disease present late for treatment.Women from different works of life often dominatemost religious gatherings and this study set out toassess Christian women’s awareness of cancer of thecervix and their practice of papsmear screening as away to detect cancer of the cervix early. METHOD:Subjects for this study were females selected byrandom sampling from an interdenominationalcongregation of Christian worshippers from differ-ent parts of the country attending an annualconvention. The researchers went from woman towoman during breaks between sessions assessingthe women’s awareness of cervical cancer and theirpractice of papsmear screening using a structuredquestionnaire. Those who filled the questionnaireswere educated on what cancer of the cervix andpapsmear were all about. RESULTS: 101 womenparticipated in the study. Their average age was31.50. 71.3 percent of them had tertiary education.47.5 percent have not heard of cancer of the cervixbefore. 83.2 percent did not know what test to do todetect cancer of the cervix early, 80.2 percent didnot know where to go for the test, 93.1 percent havenever done a papsmear test and 89.1 percent did notknow anyone who had cancer of the cervix before.CONCLUSIONS: Though women’s awareness andpractice of papsmear screening have been variouslyassessed, no assessment has been directed at theChristian religious woman who seeks hope andmeaning in life from her religious practice. Thefindings of this study indicate that the Christian

woman is not empowered with enough informationfor preventive and curative care against cancer ofthe cervix. The church should educate women whomake up her larger proportion on issues related totheir health.

P-270

Which Physical and Social Problems Predict

Distress in Ethnically Diverse Cancer Patients:

Comparison of two Cultural Groups

Karen Lord, Paul Symonds, Alex J MitchellUniversity of Leicester, Leicester, United Kingdom

OBJECTIVES: Distress is well documented incancer settings but its underlying predictors areless understood. We examined 32 potential pre-dictors of distress in a large sample of British White(BW) and British South Asian (BSA) (largelyIndian) according to self-rated ethnicity. METH-OD: We analysed data collected from LeicesterCancer Centre from 2008–2009 involving approxi-mately 1000 people approached by a research nurseand two therapeutic radiographers. There were 277BW and 80 BSA individuals. Patients completedthe Emotional Thermometer (ET) tool and aproblem list. 95% BSA completed the question-naires in English; the remaining completed aGujarati version (back to back translation). RE-SULTS: Using a checklist locally adapted from thedistress thermometer, in the larger group, work/school issues; mouth sores, nose dry/congestion,faith, pain and sleep were associated with distress.In the ethnic minority group only mouth sores,issues with God and problems getting around weresignificant. Surprisingly most checklist items werenot predictive of distress. CONCLUSIONS: Thereappear to be significant differences in the influenceof physical and social complaints on perceiveddistress according to ethnicity. Many items werenot predictive. Our results could be influenced bylow sample size in the minority group.

P-273

The Psychosexual Effects Of Treatment Modality in

Gynecological Cancer

Indrani BasumallikCancer Centre Welfare Home & Research Institute,Calcutta,West Bengal, India

OBJECTIVES: Gynecological cancer and variousoncological treatments often cause psychologicaltrauma and sexual dysfunction,which need to beidentified and quantified for appropriate supportand rehabilitation. METHOD: 300 women from age25 to 55, who had undergone various oncologicaltreatment were studied. The psychological stressfactors were quantified by standard psychologicaltools and questionnaire. The sexual factors were


DOI: 10.1002/pon


quantified by the frequency of intimacy withpartners after treatment and this frequency wascompared with their self reported frequency ofintimacy at their prediagnosed state (considered asthe control group). RESULTS: Stress level wasacute at diagnosis, but was moderate to mild evenafter 3-8 years of disease free state. Fear ofrecurrence came down with increased duration ofdisease free state. Patients who had primarycurative surgery had minimum problems. Patientsreceiving chemotherapy (Ca ovary and GTT) wereless affected psychosexually. Radiated patients(generally cancer cervix) were more affected. Worstaffected were those who had undergone surgery,radiation and chemotherapy combined. Sexualmorbidity was 34% CONCLUSIONS: Mostpatients sufferred from anxeity and fear of recur-rence, which diminished with increase in duration ofdisease free state. Patients with sexual dysfunctionsneeded medical (vaginal dilation,use of hormones,lubricants) and psychological intervention andsupport. Patients undergoing fertility preservingsurgery needed extra psychological support duringpregnancy. Nulliperous patients having radicalsurgery also needed extra support. The psychosex-ual problems when identified and addressed prop-erly with necessary measures, the patients were ableto lead a better and normal life at disease free state.

P-274

Naturalistic Course of Distress, Depression and

Anxiety following initial Cancer Treatment—

Influence of Treatment-As-Usual


OBJECTIVES: There is considerable potential forpsychological treatment to improve wellbeing incancer. However such interventions have to showbenefit above and beyond ‘treatment-as-usual’.Here we aim to document the extent of improve-ment in emotional domains under routine clinicalconditions. METHOD: We analysed data collectedfrom Leicester Cancer Centre from 2008–2009involving approximately 1000 people approachedby a research nurse and two therapeutic radio-graphers. Of those approached 225 consented to abaseline interview soon after the start of oncologytreatment, 221 consented to a re-interview at about3 months and 194 consented to a follow upinterview at 9 months. The mean time fromdiagnosis to the first interview was 7 weeks.RESULTS: Emotional symptoms improved over9 months. The most significant improvement wasin depression measured by the PHQ9 whichimproved by 64%, compared with 59% on theHADS-D and 25% on the DepT. Anxiety im-proved by 56% on the HADS-A compared with33% on the AnxT. Distress improved by 25% on

the DT. However MDD did not improve 13.1%had MDD at baseline (mean PHQ95 17.3) and14.7% at 9 months (mean PHQ95 18). CONCLU-SIONS: Symptoms of distress appear to improvemore than the syndrome of MDD. Substantialimprovement of at least 25% and up to 65% inemotional domains can be anticipated over the first3 months of treatment even under routine condi-tions, involving treatment-as-usual.

P-277

The First Two Years of A Newly Settled Outpatient

Unit of Psycho-oncology

Elvan Ozalp, Ersin, Hatice Karslioglu, BurcuManysali Erkek, Semra Ulusoy Kaymak, EylemSahin Cankurtaran, Haldun SoygurAnkara Oncology Training and Research Hospital,Psychiatry Clinic, Ankara, Turkey

OBJECTIVES: In 2002, the Psychiatry ClinicAnkara Oncology Research and Training Hospitalwas established to serve as a general psychiatryclinic. 6 years later the psycho-oncology unit wasestablished to reach the target population with apsychiatric approach, evaluation, treatment, andpsychosocial intervention. The purpose of thisstudy is to show some data about cancer patientsand to investigate this data impact on the quality ofpsychological care of cancer patients. METHOD:Eighty- eight patients attending the unit betweenNovember 2008 and January 2010 were to haveparticipated in the study. The clinical data of thepatients were taken from the hospital outpatientquestionnaires retrospectively. RESULTS: Themost common cancer diagnosis was breast carci-noma (42.1%) and genitourinary carcinomas(18.4%). The overall level of psychiatric morbidityin this sample was 70.6%: Of these diagnosis,50.0% were major depression, 11.8% anxietydisorder, 5.9% adjustment disorders., 25.3 % ofpatients had previous psychiatric diagnosis. Themean total HADS score of the patients was16.5979.85, the mean distress thermometer scoreof the patients was 6.6572.28, the mean HAMDscore of the patients was 14.0879.25. CONCLU-SIONS: The establishment psycho-oncology unit isvery important development in our hospital.Obtaining information about the patients psycho-social difficulties could lead to further clinicalinterventions.

P-279

The Giocamico Project, Project Of Expressive-

playtime-relationship Active In Paediatric Wards

Capretto Stefano2, Izzi Giancarlo1, Vecchi Corrado2

Azienda Ospedaliero-Universitaria, Parma, Italy1,Cooperativa Sociale Le Mani Parlanti, Parma,Italy2


DOI: 10.1002/pon


OBJECTIVES: The project, inside a model ofglobal care in Paediatric and Oncohemothologydepartment, is aimed to: Activate gratifying andpleasant elements for hospitalized children; En-courage socialization and social integration; Offercontinuity with ‘normal’ everyday life; Activatemoments of playtime also with therapeutical goals;Prepare children that undergo surgery, MRI, CVCapplications, lumbar puncture, bone marrow as-piration and scintigraphies through playtime that isoriented in information preparation; Form hospitalvolunteers. METHOD: The Giocamico project isthe result of a collaboration of a social cooperative,the paediatric medical staff and local administra-tion. The project is composed by 7 play specialistsand more than 200 volunteers. The main activity isfree play with the presence of a volunteer oroperators and it takes place in the hospitals child’sroom 7 days a week. Preparatory activities insteadare carried out only by the play specialists.RESULTS: 13348 children in the year 2009 metwith the operators of the Giocamico project. TheGiocamico project formed 915 volonteers from theyear 1998 until now. 25249 the number of hours inthe year 2009 that operators and volonteers werepresent in paediatric wards and 197835 hours sincethe year 1998. In 2009 the operators prepared 120children for surgery, 150 children to use non-pharmacological pain management techniques and140 children for MRI. CONCLUSIONS: TheGiocamico project highlighted how playtime forhospitalized children can mitigate the distressassociated to extended hospital stay and howthrough play the child can show his fears, anxietyand emotions using imagination. The Giocamicoproject has shown how the population canparticipate actively towards the wellbeing of thepatients. The project has shown the way tointegrate medical staff and non medical staffwithout hampering the normal life of the hospital.

P-281

A Demographic and Thematic Overview of the Brain

Tumour Patient and Caregiver Support Groups at

the Princess Margaret Hospital, Toronto, Canada

Cheryl Kanter1, Maureen Daniels1, Alyson Stone1,Kim Edelstein1, Norma D’Agostino1

Princess Margaret Hospital, Toronto, Ontario,Canada1, University of Toronto, Toronto, Ontario,Canada2

OBJECTIVES: The diagnosis of a brain tumourimposes an extraordinary burden on patients andtheir families. This disease is often associated withneurological sequelae, including cognitive, psycho-logica and functional impairments, that createunique challenges for patient and their caregivers.Few studies have examined the role of psychosocialsupport in this population. In this presentation, we

identify demographic and medical informationabout PMH brain tumour support group partici-pants and common themes of group discussion.METHOD: Monthly, open, separate supportgroups for patients and caregivers have beenconducted at PMH since 1999. A retrospectivereview of patient medical records, in addition toattendance and process notes recorded by groupfacilitators were analyzed from 1999–2006. Char-acteristics of group participants were identified inrelation to attendance frequency (ie. those whoattended 1 versus \gt 1 session). Common themesof discussion were extracted and comparisonsmade between the patient and caregiver groupthemes. RESULTS: 137 patients and 238 care-givers attended the group with �50% attendingonly once. Male patients and female caregiversattended the groups more frequently. Most atten-dees were married. 54% of patients were diagnosedwith glioblastoma multiforme, and most patientsattended their first group within 3 months ofdiagnosis. Themes of discussion in the patientgroup emphasized physical, cognitive and emo-tional changes associated with the disease, whilethe caregiver themes focused on self care andcaregiver burden. CONCLUSIONS: Content ofdiscussion in patient and caregiver support groupsappear to be different, with patients focusing onsymptom management and caregivers on theemotional and practical implications of the illness.This finding suggests that there is benefit inmaintaining separate groups for patients andcaregivers. To further understand differences inattendance rates, the benefits and barriers tosupport group attendance for both patients andcaregivers is currently under investigation.

P-282

The Experience of Control Related to the Procedure

of Non-pharmacologic Pain Management in Paedia-

tric Oncology and Heamatology

Capretto Stefano2, Izzi Giancarlo1, Vecchi Corrado2

Azienda Ospedaliero-Universitaria, Parma, Italy1,Cooperativa Sociale Le Mani Parlanti, Parma,Italy2

OBJECTIVES: Give information and instrumentsto patients, from 0 to 18 years old, undergoinginvasive painful medical procedures (ex. Lumbarpuncture, bone marrow aspiration) suitable toconduct non-pharmacologic techniques to controlanxiety, fear and pain (distraction, relaxation,hypnosis and guided imagery);Unite patients andparents to become active subjects in medicaltreatments; create an environment where the childand his family can find help and comfort.METHOD: The intervention is carried out withthe collaboration of the paediatric medical staffand four specialists in play and imaginative


DOI: 10.1002/pon


techniques. The project has two different proce-dures: invasive procedures (lumbar puncture, bonemarrow aspiration) undertaken by specialists;medication and ‘standard’ injection undertakenonly by the medical staff. We collect information‘self-report’ about the child, valuation of hisdistress and about his behaviour before andafter the procedure with behavioural checklists.RESULTS: From 2005 until 2009 we have carriedout 532 procedures with non-pharmacologic painmanagement. Behavioral checklist data haveshown low anticipatory anxiety before invasiveprocedures and self-report data highlight thatdistress perception is very low. We noticed adecreasing distress in children undergoing repeatedprocedures and a better ‘awakening’ from sedationthat was used when the anesthetist believed it wasnecessary, rather than children that didn’t undergothe procedure with non-pharmacologic techniques.CONCLUSIONS: The techniques related to a non-pharmacologic pain management procedure areassociated to an adequate pharmacological paincontrol, became very important to control invasiveprocedures in paediatric oncology; children haveshown low distress levels and seems to be decreas-ing the impact that those procedures could have inthe hospitalization life of our little patients. The useof non-pharmacological pain control techniquesdidn’t hamper the hospital organization and theanesthetists job.

P-283

Factors Influencing Academic Achievement in

Survivors of Pediatric Brain Tumors

Emily L. Ach1, Diane L. Fairclough2, Cynthia A.Gerhardt1, Maru Barrera5, Andrea Farkas-Patenaude4, Christopher Turner4, Mary Jo Kupst3,Kathryn Vannatta1

The Research Institute at Nationwide Children’sHospital and The Ohio State University, Columbus,OH, United States1, Preventive Medicine andBiometrics, University of Colorado Health SciencesCenter, Aurora, CO, United States2, MedicalCollege of Wisconsin, Madison, WI, United States3,Dana-Farber Cancer Institute, Boston, MA, UnitedStates4, Hospital for Sick Children, Toronto,Ontaria, Canada5

OBJECTIVES: To evaluate the academic achieve-ment of survivors of pediatric brain tumors relativeto case-control classmates and determine the extentto which deficits are moderated by type oftreatment, family socioeconomic status, parentaleducation level, and quality of family environment.Survivors are known to be at risk of cognitive andacademic impairments following treatment, how-ever the degree of impairment varies and limitedresearch examining the role of these factorsand possible interactions between them exists.

METHOD: Survivors, ages 5–18 and 1–5 yearspost treatment, were recruited from tumor regis-tries at four pediatric hospitals in the US andCanada to participate in data collection in eachchild’s school and home. A case-control classmatematched for age, gender, and race was identifiedfor each survivor. Measures included the WideRange Achievement Test, parent demographicquestionnaire, and Family Environment Scale.Medical data was obtained via chart review.Preliminary analyses include 164 pairs. RESULTS:Survivors demonstrated significantly lowerachievement than controls in reading, spelling,and arithmetic, (p5 0.01). Survivors who receivedchemotherapy (with or without neurosurgery)demonstrated lower reading and arithmetic scoresthan survivors treated with neurosurgery only.Results also suggest that the discrepancy inacademic achievement scores between survivorsand controls across all 3 academic domains maybe moderated by family support and conflict.Final analyses will also examine possible interac-tions between family environment and treatment.CONCLUSIONS: This study supports frequentlynoted concerns about the potential impact oftreatment for pediatric cancer on survivors’ qualityof life. Findings substantiate the documenteddetrimental impact of cranial radiation; we alsofind evidence that survivors who do not receiveradiation may also experience academic difficultiesand could benefit from support services andcollaboration between medical and school systems.Finally, aspects of family environment may impactsurvivors’ achievement, which offers tremendouspotential for targeted interventions.

P-284

Needs and Discomforts Of Oncology and Haemato-

Oncology Patients Undergoing Chemo or Radiation

Treatment

Marta Belle, Filippo Gherlinzoni, AlessandroGava, Eleonora Cason, Giovanni RostiDepartment of Oncology, Ca Foncello Hospital,Treviso, Italy

OBJECTIVES: Purpose of the present survey wasto assess needs, discomforts, and consequent issuesrelated to therapies in a sample of patients under-going chemotherapy or radiation therapy at theTreviso Ca’ Foncello Hospital. In July 2009, 262questionnaires were administered to patients refer-ring to Oncology (102), Radiation Therapy (100)and Haematology (60). METHOD: A purposebuilt—three section—questionnaire was designedto inquire into patients’ needs. The first set of itemsfocused on their social–relational setting, on thehealth system and care, and on media information.Economic, organizational and transport discom-forts were inquired in section two, whereas the last


DOI: 10.1002/pon


section dealt with side effects, pain, nausea-vomit-ing, fatigue, anxiety, depression, sexual and sleep-ing disorders. RESULTS: Results show thatpatients’ needs are primarily oriented to a goodrelation with nurses and paramedics (97%), goodcommunication with medical doctors (95%), andfamily support (92%). With regards to discom-forts, work organization is a major concern,strongly felt by 36% of patients. At last, in thethird section, relative to treatment, fatigue is themost recorded at 51%, while sleeping disordersaccount for 31% of patients. CONCLUSIONS:Peculiarity of our work is that through a shortquestionnaire we were able to investigate intopatients’ needs relative to a numbers of fields(GP, family, acquaintances, religious faith, psy-chologist, informational material, medical doctors,voluntary associations, friends, mass media,nurses, testimonials), and to discomforts and issuesrelated to undergoing treatment. Furthermore,questionnaires were administered in the sameperiod in three separate units of the same hospital.

P-285

Enhancing The Quality of Life For Patients And

Families Through Raised Awareness

Patricia Brown, Julie Burnett, Denise Bilodeau,Elaine Rapp, Tamara HarthOdette Cancer Centre, Sunnybrook Health SciencesCentre, Toronto, Canada

OBJECTIVES: The treatment of cancer is bor-dered by psychosocial, functional and palliativeconsiderations requiring interprofessional teamexpertise. To meet these needs, social work,psychology, psychiatry, spiritual care, occupationaltherapy, physiotherapy, speech language pathol-ogy, nutrition, drug reimbursement and palliativecare amalgamated forming the Patient and FamilySupport Program. Creating four task groups toachieve our mutual goals, the ‘Increasing Aware-ness’ group’s purpose is to educate staff, patientsand families regarding the unique skill set of eachdiscipline. METHOD: Each year our cancer centretreats over 11,000 new patients annually. In aneffort to increase the visibility of our program toeach of these patients and their families, our taskgroup embarked on an awareness raising cam-paign. Our method to increase the transparency ofthe program and its distinct roles encompassedthree strategic themes: visual awareness, educationand technology. RESULTS: While results of ournewly amalgamated strategic efforts are pendingand methods of evaluation are being considered,we hypothesize our efforts will result in identifyingand improving access to the vast and complexneeds of our patient and family population.CONCLUSIONS: Our presentation will conclude

with shared experiences and lessons learned inpursuit of enhancing our current profile as acomprehensive and interprofessional program,which extends beyond the traditional medicalmodel.

P-286

The Prevalence of Demoralization Syndrome among

Cancer Outpatients on a Medical Center in Taiwan

Cheng-Yang Lee1, Hong-Wen Chen2, Chun-KaiFang1

Department of Psychiatry, Mackay MemorialHospital, Taipei, Taiwan1, Hospice and PalliativeCare Center, Mackay Memorial Hospital, Taipei,Taiwan2

OBJECTIVES: We try to explore the characteristicsof demoralization among cancer outpatients and tryto understand the association among demoralizationand psychosocial issues in Taiwan. METHOD: Thesurvey was conducted in a medical center, 2060beds, from October 2008 to May 2009. Threehundred and twenty cancer outpatients were invitedto participate. The Demoralization Scale MandarinVersion, Patient Health Questionnaire, Beck Hope-lessness Scale, McGill Quality of Life Questionnairewere used as the instruments. All the data wasanalyzed using SPSS 16.0. RESULTS: The sampleof 320 patients comprised 61 men and 167 women.The cancer type were breast 39.2%, cervical 26.6%,head and neck 15.9%, gastrointestinal 10.3%, lung3.0%, hematologic 3.0%, testis 1.0%, skin 0.3%and others 0.7%. For the Demoralization Scale, themean total score was 30.75(SD 15.38), and range ofresults 0–77. The results of the ANOVA ofDemoralization Scale showed a significant effectof education F(8.298)5 2.983, p5 0.003, occupationF(5.298)5 8.134, po0.005, income F(4.302)5

4.532, p5 0.001, and diagnosis F(8.279)5 2.123,p5 0.034. CONCLUSIONS: The results of currentstudy show that, demoralization seems to associatedwith psychosocial issues and different physicalillness. It proved the further viewpoints to managethe cancer patients with demoralization.

P-290

Supply and Demand in Psycho-oncology: How the

Psycho-oncologist Can Support the Patients and

Respect Their Choices?

David OgezCliniques Universitaires Saint-Luc, Brussels,Belgium

OBJECTIVES: The question of supply and de-mand is the main point in psychology. In oncology,this interest is quiet different. The patient just wantto fight this serious illness, the psychological aspectcomes after. Getting better is the patient’s first


DOI: 10.1002/pon


worry. Moreover, a psychological support isoften interpreted as a weakness. That’s why wewanted to propose a systematic consultation toallow the patients to formulate their latent demand.METHOD: A systematic psycho-oncology consul-tation is proposed in Cliniques Saint-Luc inBrussels. After this one, the patient can decide ifhe wishes a follow-up. It permits the patient’sdemand to emerge. Two studies assess that kind ofconsultation. The first one consists to send a surveyto 300 patients suffering of a breast cancer. Thesecond one consists to submit anxiety, depressionand coping questionnaires to patient some daysafter they receive the diagnosis of cancer.RESULTS: The result of the first study shows usthe interest of 85 percent of the women for thatkind of consultations. They need a consultationwith a psychologist to talk about the announcementof the diagnosis, the anxiety related to the treat-ments, the body image and their life after thecancer. The second study has not been finished yet.We will collect results soon. CONCLUSIONS: InCliniques Universitaires St LUC in Brussels, thecancer’s centre is composed of 15 multidisciplinaryteams. Six Psychologists are included in theseteams. Actually, we propose a systematic consulta-tion after the announcement of the diagnosis ofcancer in every multidisciplinary teams. We wouldlike to prevent as far as we can considerableconsequences in patients and his family’s life.

P-291

Appraisal of a Systematic Psycho-oncologist

Consultation with Patients who Suffer of a Breast

Cancer

David Ogez, Frederique Lieutenant, MaudColmant, Leila Rokbani, Guillaume Gascard,Emilien MorelCliniques Universitaires Saint-Luc, Brussels, Belgium

OBJECTIVES: Since 2008, a psychologist is inte-grated in the multidisciplinary consultation forwomen who have a breast cancer. The patient meeta psychologist after the operation and during theothers potentials treatments. We ponder on theinterest of a systematic follow up with the psychol-ogist. Across our survey, we would like to study thepercentage of patient who call a psychologist aftertheir first contact and understand why they wouldlike to have another consultation. METHOD: Wesent our survey by mail to the patients who met apsychologist during the multidisciplinary consulta-tion of the breast cancer clinic. This survey includequestionnaires relating to socio-demographic andclinic informations and questionnaire relating to theevaluation of the systematic follow up. The surveywas sent to 150 women who was diagnosed a breastcancer and who was operated in ‘Cliniques Uni-versitaires Saint Luc’. This survey is anonymous.

RESULTS: 94% of this population received theirfirst diagnosis of cancer, 56 % had a mastectomyand 59% get other treatments for their cancer.During this consultation, these women want to talkabout the diagnosis of cancer and the anxiety aboutsurgical operation and chemotherapy. Moreover,They need to assure a potential support if necessary.85 percent of these women are satisfied with theproposition of a systematic follow-up. CONCLU-SIONS: Our aims was to evaluate the psychologicalneeds of the patients who have a breast cancer.Actually, we propose a systematic assistance of apsychologist to improve adaptation of patients tocancer and prevent them from suffering frompsychiatric ailments.

P-297

Influence of Anaemia on Clinical Symptoms, Quality

of Life and Cognitive functions in Chemotherapy

Naive Cancer Patients

Duska Petranovic1, Renata Dobrila Dintinjana1,Antica Duletic Nacinovic1, Marijan Dintinjana2,Davor Petranovic1

Clinical Hospital Center, Rijeka, Croatia1, GeneralPractice, Rijeka, Croatia2

OBJECTIVES: Anaemia, bad Quality of Life (QoL)and cognitive dysfunctions are commonly present incancer patients (pts). Previous studies mainly evalu-ated these problems during chemotherapy (CHT) orunder influence of eritropoetic agents (EPO). Weevaluated influence of anaemia ‘per se’ on QoL,clinical symptoms and especially on cognitive func-tions in chemotherapy naıve cancer patients and ifcorrection of anaemia could improve this functions.METHOD: 200pts (100 anaemic and 100 withoutinitial anaemia) in very early phase of diagnosticprocedure which finally resulted in diagnosis ofmalignancies were evaluated by FactAn QoL Ques-tionnary and five point scale for subjective clinicalsymptoms. Cognitive functions have been measuredby Complex Reactiometer Drenovac (CRD). Patientswithout malignant disease presented control group.All parameters have been measured twice: before andafter therapy for anaemia. RESULTS: Haemoglobinlevel significantly influence on QoL, clinical symptomsand cognitive functions. Haemoglobin level (morethan gender, age and education) is the most effectivevariable on cognition functions analysed by betaweights. Anaemia and cancer have additive negativeeffect. Correction of anaemia significantly improveQoL and cognitive functions but not in all categories(visual orientation and memory). Subjective feeling ofcognitive disturbances are not in correlation withreal cognitive achievement measured by CRD.CONCLUSIONS: Anaemia in cancer pts profoundlyaffects cognition, psychological well-being and QoL.Correction of anaemia in cancer patients has positiveinfluence on their cognitive functions and QoL.


DOI: 10.1002/pon


P-314

Evolution of Cancer-Related Psychological

Symptoms Over An 18-Month Period

Trudel-Fitzgerald Claudia, Savard Josee, IversHansCancer Research Center, Universite Laval, Quebec,Quebec, Canada

OBJECTIVES: Cross-sectional studies haverevealed high rates of depression, anxiety, insom-nia, fatigue and pain in cancer patients. However,much less is known about the natural course ofthese symptoms throughout the cancer treatmenttrajectory. In addition, the contribution of medicalfactors such as cancer site, stage and treatments inexplaining changes in these symptoms has yet to beestablished. METHOD: As part of a largerepidemiological research, this study investigatedlongitudinal changes of these symptoms in patientsscheduled to undergo surgery for cancer (n5 828).The patients completed the Hospital Anxiety andDepression Scale, the Insomnia Severity Index, theMultidimensional Fatigue Inventory, and a painquestionnaire developed by our research team atsix time points: at baseline (T1), as well as 2 (T2), 6(T3), 10 (T4), 14 (T5) and 18 (T6) months later.RESULTS: Analyses of variance showed reduc-tions of depression, anxiety and insomnia levelsover time (pso0.0001). Fatigue was fairly stablewhereas pain increased progressively (pso0.0001).Prostate cancer patients had lower levels ofanxiety, insomnia, fatigue and pain (pso0.001 orless). Patients having received chemotherapy dis-played the greatest levels of insomnia and fatigue(pso0.05 or less), whereas patients treated bysurgery only showed the lowest levels of anxietyand insomnia (pso0.001 or less). CONCLU-SIONS: In summary, cancer patients reported anoverall decrease in depression, anxiety and insom-nia symptoms, stable levels of fatigue and anincrease in pain over the 18-month period follow-ing surgery. This study also revealed some differ-ences across cancer sites and treatment regimensreceived, but not between cancer stages. Furtherlongitudinal investigations are needed in order toidentify additional factors associated with changesin cancer-related symptoms over time.

P-315

Fear of Recurrence in the First Year After

Diagnosis: Results of a Registry-Based Study

Belinda Thewes1, Allison Boyes1, Afaf Girgis1

Centre for Medical Psychology and Evidence-BasedDecision-Making, School of Psychology, Universityof Sydney, Sydney, Australia1, Centre for HealthResearch and Psycho-Oncology, University ofNewcastle, Newcastle, Australia2

OBJECTIVES: Previous studies have shown thatdealing with fear of cancer recurrence (FCR) is oneof the most prevalent areas of concern amongstcancer survivors. Few studies have examinedunmet need for help (UN) with FCR. The aimsof this study were to a) describe the prevalence ofUN with FCR in a representative sample ofpatients b) to explore the course of UN withFCR and c) identify factors associated with UNwith FCR. METHOD: Participants were 1442adult cancer survivors who were diagnosed withthe most incident forms of cancer. A secondaryanalysis was undertaken of data gathered as partthe Cancer Survival Study, a prospective study ofthe needs and adjustment of Australian cancersurvivors. Participants completed mailed self-re-port questionnaires approximately 6 and 12months post-diagnosis. This analysis includedselected items from the SCNS-SF34 and theMini-MAC. RESULTS: Lung and breast cancerpatients had the highest proportion of patientsreporting moderate to high UN with FCR at both6 and 12 months post-diagnosis. Overall, 10%percent of patients report high or increasing levelsof UN with FCR between 6 and 12 months afterdiagnosis. Factors that were consistently associatedwith UN with FCR included: receiving chemother-apy or radiotherapy, being a public patient, lowerfamily income and younger age. CONCLUSIONS:Although many cancer survivors experience FCR,compared to studies of prevalence of FCR,relatively fewer patients report high levels of UNwith FCR. Results identify groups of patients whoneed help with FCR, which can in turn assist thedevelopment of FCR interventions. Future datacollection in this study will document the course ofUN with FCR in the first 5 years after diagnosis.

P-317

Too Young For Breast Cancer! Providing Meaning

To Breast Symptoms

Shirley Manly-Lampkin1, Joan Bloom1

University of California San Francisco, School ofNursing, San Francisco, CA, United States1,Univeirity of California, Berkeley, Berkeley, CA,United States2

OBJECTIVES: This study investigated breastcancer diagnosis in young women under 40 yearsof age. Its purpose explored women’s healthseeking behavior, determine if delay occurred andwhether it differed by race/ethnicity. METHOD: Adescriptive, qualitative design was used to interviewthirty women using narrative analysis to analyzethe women’s breast cancer stories. The women wererecruited from the San Francisco Bay Area andinterviews were conducted in a location convenientfor each individual woman RESULTS: Thewomen’s stories revealed they self discovered their


DOI: 10.1002/pon


breast symptoms, gave meaning to them, andsought immediate medical attention. Breast symp-toms prompting a response were categorized asphysical, visual, or emotional. Pain, an uncommonsymptom, was the number one symptom identifiedleading to medical attention. For the same reason,it led to health care provider delays. AlthoughAfrican American women sought early attentionthey experienced longer delays, were diagnosedyounger, and at a late stage. CONCLUSIONS:The narratives revealed that women reactedquickly to self-discovered breast symptoms andsought medical attention. This was especially true iftheir discovery coincided with that of a friend orcelebrity, was discovered with a visual cue, or theyfound a breast change. However, women and theirhealth care providers interpreted breast symptomsas normal or diagnosed with other breast healthconditions, as they believed the women were ‘tooyoung to have cancer.’

P-318

The Cedric Hele Institute: Flemish Institute For

Psychosocial Oncology: A Reference For Profes-

sionals In Oncology

Sofie Eelen1, Sabien Bauwens2, Wim Distelmans2,Bernard Hensmans3, Eva Jacobs1, Wim Schrauwen4,Lieve Vanderlinden5, Angelique Verzelen6

Cedric Hele instituut, Mechelen, Belgium1,Universitair Ziekenhuis Brussel, Brussels, Belgium2,Monster.be, Vilvoorde, Belgium3, UniversitairZiekenhuis Gent, Ghent, Belgium4, UniversitairZiekenhuis Leuven, Louvain, Belgium5, The HumanLink, Antwerp, Belgium6

OBJECTIVES: In Belgium the need to expand andto improve psychosocial care in oncology wasgreat. A lot of caregivers wished to enhance and toimprove the quality of their interventions. In anattempt to respond to these needs, a small group ofcaregivers joined their strengths and knowledge byestablishing a multidisciplinary Flemish institutefor psychosocial oncology, called the Cedric Heleinstitute (CHi). All of this found place in closecorporation with care providers and policy agents.METHOD: A focus of CHi is to organize andcoordinate training in psychosocial care and tocreate networks of caregivers. The CHi organizesseveral courses and workgroups for different targetgroups. Many information is published on theCHi-website. In contacts with the caregivers CHioften observes needs in psychosocial care. Anotherfocus is to indicate these needs to policy agents.CHi was involved in coordination platformsand workgroups of the National Cancerplan ofthe Belgian government. RESULTS: 131 onco-professionals participated in one of the 12 CHicourses or workgroups in 2009. In association withthe universities the institute organised again a

two-year training in psycho-oncology. In 2010 thegovernment finances the subscription of 75 psy-chologists. CHi organised an event about burnoutin oncology, 140 participants were present. TheCHi website has 2400 visitors per month. TheBelgian government provides funding so in 2010CHi can organise free courses on developing andpracticing communication skills for 150 onco-professionals. CONCLUSIONS: The CHi hasbecome a reference for many professionals inoncology, for training and networking in psycho-social oncology. In 2010 the CHi wants to create aninternet community and forum to further improvenetworking and to gather more knowledge andinformation. CHi also aims to become a referencefor scientific research in psychosocial oncology inFlanders. We want to encourage more research inthe clinic of oncology.

P-319

A Study Of Burnout Among Oncology

Professionals: Oncologists Are At Risk Of Burnout

Sofie Eelen1, Catherine Baillon2, Sabien Bauwens

2,

Wim Distelmans2, Eva Jacobs

1

Cedric Hele instituut, Mechelen, Belgium1,Universitair Ziekenhuis Brussel, Brussels, Belgium2

OBJECTIVES: International research shows thatoncology staff suffers more from stress andburnout than other health care professionalsdo.Burnout is common amongst oncologists. Theprevalence of emotional exhaustion, depersonalisa-tion and low personal accomplishment appears tobe significantly higher among physicians. A na-tional study on the prevalence of burnout inoncology was until now not conducted in Flanders(Dutch speaking part of Belgium). The Cedric Heleinstitute, Flemish institute for psychosocial oncol-ogy (Chi), started a study. METHOD: The Chispread questionnaires amongst 923 health careworkers in oncology in Flanders. The question-naire consisted of two parts. A first part containedquestions concerning demographic and job fea-tures. In the second part, the Dutch version of theMaslach Burnout Inventory (UBOS-C), was used.UBOS-C is a valid and reliable self reporting scaleto measure burnout. It contains 20 questions and isdivided in 3 subscales: emotional exhaustion,depersonalization and personal accomplishment.RESULTS: 550 subjects participated in the survey(response rate of 59,5%). 51,2% of the medicaloncologists suffer from emotional exhaustion and31,8% from depersonalization. Univariate analysisconfirmed a significant elevated level of emotionalexhaustion and depersonalization in doctors com-pared to other health care workers. Logisticregression shows that the following variables havepredictive value: gender, profession, combining


DOI: 10.1002/pon


work in a university hospital with work in a privatehospital and having the opportunity to performresearch. CONCLUSIONS: The Chi-researchshows a problematic level of burnout-componentsin onco-professionals, especially in medical oncol-ogists. More research should be conducted on thefactors which can cause and prevent burn-out. Alsopossible post-traumatic stress complaints should beinvestigated. Hospital management and policymakers should take into account that oncologyprofessionals have a lot to endure and should beconcerned about prevention and support in orderto avoid burnout symptoms. Implementation oftraining could be an important action.

P-320

Patient Reported Outcomes Among Women With

Breast Cancer–A Population-based Cross-sectional

Study In Central Sweden

Marie Hoyer1, Birgitta Johansson2, Karin Nordin3,Claudia Lampic4

Regional Oncologic Centre, Uppsala UniversityHospital, Uppsala, Sweden1, Department ofOncology, Uppsala University Hospital, Uppsala,Sweden2, Department of Public Health and CaringSciences, Uppsala University, Uppsala, Sweden3,Department of Neurobiology, Care Sciences andSociety, Karolinska Institutet, Stockholm, Sweden4

OBJECTIVES: The purpose was to describehealth-related quality of life (HRQoL), anxiety,depression, and satisfaction with care amongwomen with breast cancer shortly after diagnosis.Furthermore, the purpose was to investigate theinfluence (association and contribution) of medical,demographic and socio-economic factors as well asof social support on HRQoL, anxiety, depression,and patient satisfaction. METHOD: The study wasconducted as a cross-sectional questionnaire studybased on a breast cancer quality register in centralSweden. All newly diagnosed women registeredwithin a one-year period (2007–2008) were in-cluded. Of 1574 eligible women 70% (N5 1094)accepted participation. Participants completed aquestionnaire including the EORTC QLQ-C30 andBR23, the HADS, a study specific instrumentmeasuring patient satisfaction, and questionsregarding individual characteristics. Descriptivestatistics and sequential multiple linear regressionwere used for analysis. RESULTS: The womenexperienced problems in few HRQoL dimensions,clinically significant anxiety and depression werefound among 13.8% and 5.7%, respectively, andthere was a high degree of patient satisfaction.Certain medical factors and a younger age wererelated to more problems/symptoms and lesssatisfaction. Adding other demographic factors,social support, and socio-economic factors signifi-cantly improved the explained variances, but only a

few associations with age remained. The explainedvariances varied from 6–45%. CONCLUSIONS:The results provide new generalizable knowledgeabout patient reported problems/symptoms andsatisfaction with care among women undergoingmodern breast cancer treatment in Sweden. Theresults show that patient reported outcomes arecomplex phenomena as they are only partlyexplained by established medical and individualfactors. The present study has created newhypotheses as part of a longitudinal study aimingat improving the care of breast cancer patients.

P-322

Adjustment of Parents after the Death of a Child to

Cancer

Amii Corbisiero1, Julie C. Grossenbacher1, MaruBarrera2, Bruce Compas3, Betty Davies4, DianeFairclough5, Terrah L. Foster3, Mary Jo Gilmer3,Nancy S. Hogan6, Kathryn Vannatta1, Cynthia A.Gerhardt1

The Research Institute at Nationwide Children’sHospital, Columbus, Ohio, United States1, TheHospital for Sick Children, Toronto, ON, Canada2,Vanderbilt University, Nashville, TN, UnitedStates3, University of California San Francisco,San Francisco, CA, United States4, University ofColorado at Denver Health Sciences Center,Denver, Colorado, United States5, LoyolaUniveristy, Chicago, Il, United States6

OBJECTIVES: Bereaved parents are at risk formultiple psychosocial difficulties that can endurefor years. Internalizing difficulties, such as depres-sion, anxiety, guilt, and post-traumatic stresssymptoms, have been reported frequently. How-ever, research has often been limited by ascertain-ment bias, the use of single informants, andretrospective designs. Thus, during the first yearafter a child’s death from cancer, we compared theadjustment of bereaved mothers and fathers toparents who had not lost a child. METHOD:Parents were recruited from three children’shospitals in the United States and Canada 3–12months after their child died of cancer (M5 11.09months, SD5 3.66). Fifty-five families with asurviving child (55 mothers, 37 fathers) agreed toparticipate (60%) along with 48 matched compar-ison families (48 mothers, 30 fathers). Parentscompleted measures of psychosocial adjustment(i.e. Adult Self Report, Impact of Events Scale)separately during an assessment in their home.RESULTS: Preliminary analyses revealed thatbereaved and comparison families did not differon demographic variables. Bereaved mothers andfathers reported significantly higher scores forfriendships (d5 0.48, d5 0.56). Bereaved mothersreported more internalizing symptoms (d5 0.66)and total problems (d5 0.52) than comparison


DOI: 10.1002/pon


mothers. Bereaved parents also had significantlyhigher post-traumatic stress symptoms. Parent ageand time since death were generally not related toadjustment. CONCLUSIONS: Bereaved parentsexperienced significant post-traumatic stress symp-toms in the first year after the death of a child tocancer. Bereaved mothers may have additional riskfor other internalizing difficulties. Research shouldcontinue to focus on the development and evalua-tion of interventions to improve adjustment duringthe first year after the loss of a child, particularlyamong mothers. Healthcare providers shouldfollow and reassess bereaved families to screenfor difficulties and offer appropriate resources.

P-326

Validity of the FACIT-Spirituality (FACIT-Sp)

Questionnaire’s Use of ‘Peace’ with Arab Muslim

Cancer Patients: A Qualitative Exploration

Mark Lazenby1, Jamal Khatib1

Yale University, New Haven, CT, United States1,King Hussein Cancer Center, Amman, Jordan2

OBJECTIVES: To identify an appropriate instru-ment to describe the role of spirituality in the well-being of Muslim cancer patients in Arabia. Giventhat in Arabic the words ‘peace’ and ‘Islam’ sharethe same root, it was uncertain whether the word‘peace’ in the FACIT-Sp, which assesses emotionaland mental peacefulness, would carry the meaningnecessary to refer to emotional and mental states orwhether it would refer to theological ideas.METHOD: Qualitative exploration. Fifteen ArabMuslim patients at the King Hussein CancerCenter, Amman, Jordan, were interviewed duringDecember 2009, to identify the references thatcame to mind for the word ‘peace’ as used in theFACIT-Sp. RESULTS: Mean age was 46.2 years(15.8); 8 were female; tumor types were breast(n5 3), lung (n5 2), and multiple others (n5 8).Respondents identified the following meanings for‘peace’: stability and security (n5 5), freedom fromproblems (n5 2), love (n5 2), being cared for(n5 2), freedom from fear (n5 2), psychologicalrest, and the opposite of anxiety. No differences bycancer type or stage were noted, but more men(n5 4) identified ‘stability’ and ‘security.’ CON-CLUSIONS: While all references point to innerstates, ‘stability’ and ‘security’ carry with themexternal, theological references: a theological un-derstanding of the term ‘Islam’ is that Muslimsexperience stability and security because all Mus-lims alike submit to God, which ensures a stableand secure community. This poses no problems forthe FACIT-Sp, as the notions of stability andsecurity carry with them emotional and mentalreferences as well. The difference in gendersupports further study.

P-338

The Importance of Attachment in Adjustment to

Cancer Diagnosis for both Patients and Their

Family

W Nicholls, N Hulbert-WilliamsUniversity of Wolverhampton, Wolverhampton,England, United Kingdom

OBJECTIVES: There is clear evidence that havinga secure attachment relationship is associated withless stress following negative life events. It issuggested that secure familial attachments can helpboth the cancer patient and their supportive familynetwork to deal better with diagnosis, and to adjustmore positively in the long-term. This study aimsto comprehensively review the literature to estab-lish the extent to which familial attachment may beassociated with cancer adjustment. METHOD:Any design of study investigating the associationbetween attachment and a range of psychosocialoutcomes (including anxiety, depression, coping,quality of life, continuity of relationship) areincluded in this review. Only studies of a dyadicrelationship are included where at least one of themhas been diagnosed with cancer. A number ofelectronic databases were searched including Med-line, CINAHL, BNI, and PsychINFO. RESULTS:Electronic searches have been completed andsearches are being scrutinised by two independentreviewers against pre-defined inclusion criteria.Data will be extracted from relevant papers andmeta-analysed where possible (following the Hun-ter and Schmidt method). Each included study willalso be systematically quality assessed. CONCLU-SIONS: It is anticipated that the findings from thisreview will inform the development of evidence-based psychosocial interventions for cancer pa-tients and their families. Support groups arefrequently evidenced to help patients and theirfamilies cope with the demands of cancer and weexpect the findings of this review to lead toevidence-based recommendations for how thesemay most effectively support the entire family unit.

P-339

Psychological Adjustment in Women After First

Breast Cancer Diagnosis and Breast Cancer

Recurrence Announce: A Comparative Study

Carole Zozaya, Florence Cousson-GelieUniversite de Bordeaux 2—Laboratoire psychologie‘sante et qualite de vie’—EA 4139, Bordeaux,France

OBJECTIVES: The aim of the current study is tocompare the role of psychological factors whichcould be explained emotional distress and qualityof life differences between patients with first breastcancer and with first breast recurrence. The


DOI: 10.1002/pon


hypothesis is that the announcement of recurrencecould revive same emotions but more intensivelythan the announcement of first breast cancer, withbetter control sense and patients could use moreemotional and less problem coping strategies.METHOD: This study included 30 patients withbreast cancer recurrence and 30 patients with firstbreast cancer. These are issued from a cohort studyand were selected according to matched-up age,employment, familial status. They have completedone month after diagnosis validated self-question-naires of optimism (LOT-R), control disease(C.L.C.S.), coping (MAC), emotional distress(HAD), and quality of life (EORTC-QLQC-30).Linear regression analysis permitted to test ourhypothesis. RESULTS: There are no significantdifferences between groups in sense of diseasecontrol, optimism and emotional distress. But thequality of life of patients with recurrence breastcancer is lower than the patients with first breastcancer, and they use more emotional copingstrategies (helplessness/hopelessness and anxiouspreoccupations) than patients with first breastcancer. Moreover, emotional distress is morepredicted if patients use emotional coping strate-gies and less predicted if patients use controldisease. CONCLUSIONS: Thus to study thepsychological adjustments of women during differ-ent stages of treatment, the temporal dimension infirst breast cancer or recurrence appears as funda-mental. This research permits to glimpse theinterest of a better qualification of emotionaldistress which can be considered as criterion,transactional variable or predictor. Another viewto consider is the depression: more than 30 % ofthe patients said suffering of depressive syndromebefore the announce of cancer.

P-342

Quality of Life, Anxiety and Body Image of Patients

with Breast Reconstruction: First Results of a

Comparative Study

Carole Zozaya, Florence Cousson-GelieUniversite de BOrdeaux2—Laboratoire psychologie‘sante et qualite de vie’—EA 4139, Bordeaux,France

OBJECTIVES: The aim of the current study is toundertake a qualitative and quantitative evaluationof three factors: quality of life, body image,anxiety, throw through the different methods ofbreast reconstruction proposed to women after firstbreast cancer. The assumption is that these are notdifferent methods of breast reconstruction pro-posed that determine the choice whether or not ofbreast reconstruction, but decreased anxiety, im-proved body image and quality of life. METHOD:This study included 50 patients who were seekingbreast reconstruction and 50 patients who didn’t

have breast reconstruction (six months to one yearafter the breast treatment). We used face to face,semi-structured interviews and patients also havecompleted self-questionnaires of quality of life(WHOQOL-26) body image (MBSRQ-AS) andanxiety (STAI). The transcripts of the participants’responses were subjected to a content analysis andANOVA was performed in order to show differ-ences between groups. RESULTS: Women withbreast reconstruction are inclined to have betterphysical and psychological quality of life and loweranxiety. 56 % of them said that their choice ofbreast reconstruction was been done at theannounce of cancer, 30 % would like find againsense of femininity and had a sensation of revival.More than 80% affirmed they have been sustainedby theirs close relatives. Most of them remainedtraumatic dimension of the announce of cancer.CONCLUSIONS: Despite of the fact that thenumber of women seeking breast reconstructionafter cancer has risen during the last decade from10% to 30%, this percentage remains low. Butnevertheless, outcomes from studies about mas-tectomy patients with or without reconstructionare mixed. This work shows that women who chosebreast reconstruction seem to be more motivatedby getting a better body image and quality of lifethan breast reconstruction methods.

P-345

Exploring the Psychosocial Needs of Children

Whose Parent Has Cancer: Child and Parent

Perspectives

D Wilson-Smith, N Hulbert-WilliamsUniversity of Wolverhampton, Wolverhampton,England, United Kingdom

OBJECTIVES: The impact of cancer diagnosisextends beyond the patient. Little conclusiveevidence exists on how children cope with thedisruption caused by their parent having cancer.The literature is further confused by those usingparental-report over self-report due to inherentpsychometric biases. This study aimed to investi-gate the child’s lived experience of parental cancer,and their psychosocial and supportive needs.METHOD: Three parent-child dyads were re-cruited. In each case, the parent had been recentlydiagnosed with breast cancer. The children were 8to 11 years old. Semi-structured interviews wereconducted with the parent and child independently.Interviews transcripts were analysed using Inter-pretative Phenomenological Analysis (IPA), amethod particularly suited to exploration of howpeople make sense of their personal and socialworld. Play activities were used in the childinterviews to help elucidate verbal responses.RESULTS: Results provide further evidence ofdisagreement between parent and child reports of


DOI: 10.1002/pon


adjustment difficulties. Children’s interviews re-vealed themes of internalised psychosocial pro-blems including anxieties over the possible parentaldeath parent, separation anxiety and worriesregarding contracting the illness. Parent’s inter-views identified more practical issues includingpicking children up from school, ensuring the childcontinues with hobbies and other activities, andproblems with initiating physical contact withchildren due to pain and other cancer symptoms.CONCLUSIONS: By highlighting the child’sexperience and needs from their own perspective,this work will form the basis for future researchinto effective and evidence-based supportive inter-ventions for children of cancer patients.

P-348

Breast Cancer Awareness for Young Women

Lorna LarsenTeam Shan Breast Cancer Awareness for YoungWomen, Woodstock, Ontario, Canada

OBJECTIVES: To review the needs assessment,recommendations from statistics and literaturereviews, results of the focus testing of draftawareness materials with young women (15–29years of age) and the formal evaluation of a multi-faceted breast cancer awareness campaign targetingyoung women implemented in southwestern On-tario. To share the breast cancer knowledge level ofyoung women both pre and post campaign, processoutcomes, lessons learned and strategies identifiedto raise awareness with the targeted population.METHOD: A comprehensive social marketingapproach was developed and implemented for theawareness campaign. Activities included printmedia, radio and television spots, disseminationof resource materials, billboards, bus ads andcommunity presentation opportunities. Commu-nity partnerships with public health, communityhealth, education and other professionals andmedia links were established. The theme of theproject, Breast Cancerynot just a disease of olderwomen, was reflected throughout the campaignresources and activities. RESULTS: Self reportingof some breast cancer knowledge increased post-campaign and significant increases in both breastcancer facts and risk factors were reported by thetarget population. The project was successful indeveloping a variety of strategies to inform youngwomen about their risk of breast cancer. Youngwomen responded positively to the informationand the use of a specific person and her story madea difference in communicating the message toyoung women. CONCLUSIONS: The vast major-ity of comments from young women in response tothe campaign were extremely positive and sug-

gested more awareness and education. Youngwomen appreciated not being forgotten in breastcancer messaging. Young women need informationand awareness about their risk of breast cancer.Knowledge of symptoms and self help strategiesprovide young women with the opportunity for selfdetection and earlier medical diagnosis. The multi-faceted approach undertaken addressed theseneeds.

P-352

Evaluation of an End-of-Life Peer Support Group

Intervention for Cancer Information Specialists at a

National Cancer Information Call Center

Kevin Stein, Pamela Villars, Katherine SharpeAmerican Cancer Society, Atlanta, Georgia,United States

OBJECTIVES: Cancer Information Specialists(CIS) who receive calls to cancer information callcenters are trained to attend to a wide range ofrequests. Some of the most challenging calls involveend-of-life (EoL) issues for patients, caregivers, andfamily members. Previously conducted focusgroups with CIS had indicated a need for specia-lized training in handling EoL calls. In response tothis identified need, call center staff designed,implemented, and evaluated an EoL Peer SupportProgram. METHOD: 40 CIS met monthly for sixmonths in hour-long sessions focusing on: Active/Reflective Listening, EoL Resources, Stress Man-agement, Understanding Grief, Compassion Fati-gue, and Self-Care. Social workers, counselors, andtenured CIS developed and delivered the curricu-lum. Pre and post-intervention surveys providedbaseline and follow-up data regarding: skill-build-ing, self-care, secondary trauma, job satisfaction,and workplace cohesion. An additional 39 CISserved as controls, completing both surveys, butnot participating in the peer support sessions.RESULTS: Participants reported high satisfactionwith the program and making valuable gains inhandling EoL calls and self-care. There was someindication that the intervention group had greatergains in self-care compared to controls, but bothgroups improved over time in all domains. Possibleexplanations include increased call center-widesupport and other organizational processes affect-ing all CIS equally. Sharing of information betweenintervention and control participants may haveled to improvement over time in both groups.CONCLUSIONS: Handling EoL calls is a challen-ging, and at times, difficult job. Providing peersupport may improve morale, reduce distress, andminimize burnout. Participants’ reactions to thispeer support program were overwhelmingly posi-tive and a majority participated due to a desire forknowledge or support. For many, the peer supportand normalization of their experiences were as


DOI: 10.1002/pon


important as the curriculum content itself. Futureresearch is needed to identify the optimal method ofdelivering such support.

P-353

The Importance Of Meaning Orientation For The

Quality Of Life Of Women Suffering From Breast

Cancer

Harald MoriMFA - Medical Viktor Frankl Associaton Vienna,Vienna, Austria

OBJECTIVES: 12 women suffering from breastcancer were investigated in a qualitative study.Topic was the connection of meaning orientationaccording to the foundings of Viktor Frankl for thequality of life of these women. Field of interest wasalso the relation between meaning in life anddifferent coping strategies and the sense of coher-ence. METHOD: 12 women while or after medicaltreatment due to breast cancer were interviewed bythe psychooncologist. Interviews were interpretedand based on a grounded theory. RESULTS: 9from 12 women showed a significant connectionbetween the inner attitude towards their diseaseand fate in dependence to the meaning in life theyfound during the time of treatment of breastcancer. Quality of life appeared to be stronglyconnected with the inner feeling of having meaningorientation towards future goals in life. 3 womenpresented importance of meaning orientation atleast to keep their level of quality of life stable.CONCLUSIONS: Indications could be found thatquality of life especially for women suffering frombreast cancer depends in a significant way from themeaning orientation as Viktor Frankl postulated itin his Logotherapy and Existential Analysis.Having purpose in life helps these women tocope the special gynecooncological problemsfrom the female point of view. Psychooncologyin gynecooncology seems to have a specialneed of meaning orientated psychotherapeuticapproaches.

P-356

Are Literature Reviews Stronger with a

Multidisciplinary Approach?: Measuring the Impact

of Collaborating with a Clinical Librarian

Bejoy Thomas1, Admasu Tachble2, Yongtao Lin3

University of Calgary Department of Oncology;Tom Baker Cancer Centre, Alberta Health ServicesCancer Care, Calgary, Alberta, Canada1, Psycho-social Resources, Tom Baker Cancer Centre andCommunity Oncology Alberta Health ServicesCancer Care, Calgary, Alberta, Canada2, HealthInformation Network, University of Calgary; TomBaker Cancer Knowledge Centre, Alberta HealthServices Cancer Care, Calgary, Alberta, Canada3

OBJECTIVES: Evidence-based practice integratesrelevant and current clinical evidence with clinicalpractice. Garnering the relevant literature for areview or meta-analysis is dependent on the skillsand knowledge of the researcher. However, are wedoing due diligence in our search for evidence andliterature reviews? Might working with a ClinicalLibrarian improve our outcomes and thus theevidence? This study examines and comparesbetween the literature generated by researchersand a researcher - Clinical Librarian combination.METHOD: The topic in question was ‘patientcentered care’ and the inclusion and exclusioncriterions were set aprori. The control groupcontained the lead researcher and his researchteam, and the experimental group involved thesame lead research in combination with the ClinicalLibrarian. The lead researcher served as a neutralsubject expert for both groups and did not sharethe search techniques or the databases betweengroups. RESULTS: The study is an ongoing oneand documents the apparent benefits of workingwith a Clinical Librarian. The impact of theinvolvement of the Librarian scientist was mea-sured by the relevance of the literature retrieved,the extent of overlap and the proportion ofvariance between the two groups. Further analyseswill demonstrate the impact a Clinical Librarianhas on the output of a literature review.CONCLUSIONS: In this day of advanced tech-nology and specialization, a single scientist cannotplay a robust multi-dimensional role. The divi-dends of functioning as part of a multidisciplinaryteam is greater than working within the exclusivityof one’s discipline. The present study measures theimpact of this team work and collaboration inimproving the quality of research outcomes.

P-360

Finding Hope and Meaning: Group Music Therapy

for Women with Breast Cancer

Stephanie ThompsonUniversity of Melbourne, Victoria, Australia

OBJECTIVES: Psychosocial interventions havebecome an integral part of healthcare treatmentin order to address cancer patients’ emotionalstates and quality of lie. Music therapy has gainsignificant recognition as a psychosocial therapeu-tic intervention in cancer care. This paper willdescribe how as six week music therapy programdesigned to support the needs of women living withbreast cancer also fostered hope and meaning. Casevignettes will be used to illustrate the potential inthis area. METHOD: This study is designed fortwenty four patients diagnosed with breast cancer,who receive weekly group music therapy sessionsover six weeks lasting for one hour. Data will bepresented on seventeen participants who have


DOI: 10.1002/pon


completed the program. Session data includesmusical interations, patient conversations,qualitative interviews and observable behaviour.RESULTS: Data on four music therapy groupswill be presented. Qualitative data analysisindicates the following emergent themes:isolation, the impact of cancer on identity, theimpact of cancer on relationships, the effects oftreatment, living and coping with uncertainty, lifeafter treatment and hope. CONCLUSIONS:Results indicate that group music therapy forwomen with breast cancer addresses and reducesfeelings of isolation, it offers psychological andpeer support, together with practical techniques forcoping with the effects of treatment. The resultsalso illustrate how women living with breast cancerfind hope and meaning through participating ingroup music therapy with other women who alsohave breast cancer, irrespective of their cancerstage.

P-364

HPV Knowledge, Health Value and Health Self-

Efficacy and Men’s Intentions to Receive the HPV

Vaccine

K Petrovic1, S Burney1, J Fletcher1

Cabrini Monash Psycho-oncology Research Unit,Cabrini Health, Melbourne, Australia1, School ofPsychology and Psychiatry, Monash University,Melbourne, Australia2, Melbourne Psycho-Oncology Service, Melbourne, Australia3

OBJECTIVES: The aim of the present study was todetermine whether HPV knowledge, health beliefsand health self-efficacy could predict intention toreceive the HPV vaccine in an Australian malesample. METHOD: One hundred and twenty onemales, aged 18 to 26 (M5 22.3, SD5 2.06) yearsand residing in Australia, completed an onlinesurvey assessing HPV-related knowledge, healthbeliefs and health self-efficacy. RESULTS: Amultivariate linear regression analysis revealedthat, as hypothesised, HPV knowledge andhealth self-efficacy were significant independentpredictors of vaccine acceptance at the p less than0.05 level. Contrary to previous findings, healthvalue did not significantly predict vaccinationintentions. In addition, a moderating effect wasfound between HPV knowledge and health self-efficacy. CONCLUSIONS: Previous research re-garding HPV vaccination intentions has largelyfocused on females, and as a result the factorsthat influence males to undertake HPV vaccinationwere largely unknown. This study, despite itslimitations, has offered some useful insightsinto some of the factors that are associatedwith HPV vaccine intentions in a sample ofAustralian men.

P-365

Perception of Cancer and Symptoms: How Impor-

tant are they in the Construction of Meaning and as

a Determinant of Distress and Health Behaviour

Doris Howell1, Shu Li Guo1

Princess Margaret Hospital, Toronto, ON, Canada1,University of Toronto, Toronto, ON, Canada2

OBJECTIVES: Distress is common in response toa diagnosis of cancer and its treatment. Individualvariation in distress is not fully explained bydemographic or disease variables. The subjectivenature of symptoms and the contribution of illnessperceptions as a determinant of distress and healthbehaviour have received little empirical attentionbut are shown theoretically to be an importantvariable in determining patient response to illnessand the threat posed by cancer and relatedsymptoms. METHOD: We conducted a systematicreview of the literature using the followingdatabases: HealthStar, Medline, CINHAL, Em-base and PsychINFO through to 2009 using termssuch as illness perception, beliefs, self-regulation,common-sense models, attributions combined withspecific terms for symptoms (pain, fatigue), symp-tom distress, adjustment, chronic illness, cancer.RESULTS: A wealth of literature was identifieddemonstrating the role of illness perception inchronic conditions such as heart disease, diabetesand arthritis on important clinical outcomesincluding psychological adjustment, pain, andhealth behaviour. Of the few studies identified incancer, illness perception was an important deter-minant of diagnostic delay, uptake of cancerscreening, and psychological adjustment but itsrole on symptoms is less clear. CONCLUSIONS:An individual’s interpretation and attachment ofmeaning and significance to cancer and relatedsymptoms is a potentially important contributor todistress that requires further examination. Thepurpose of this paper is to present a descriptivesynthesis of the findings of this systematic literaturereview on illness perceptions and highlight implica-tions for practice and further research.

P-367

Home Sweet Home: Safety For The Palliative

Patient, Their Family And Providers At Home

Serena Corsini-Munt1, Ariella Lang1, RobinCohen2, Tony Easty3, Kelli Stajduhar4, AllisonWilliams5

VON Canada, Montreal, Quebec, Canada1, McGillUniversity, Montreal, Quebec, Canada2, UniversityHealth Network, Toronto, Ontario, Canada3,University of Victoria, Victoria, British Columbia,Canada4, McMaster University, Hamilton, Ontario,Canada5


DOI: 10.1002/pon


OBJECTIVES: Providing end-of-life care in thehome can often be a challenging time of transitionfor palliative cancer patients and their caregivers.The challenge is to bring this important piece of thefull continuum of healthcare into the community.The purpose of this study is to explore experiences,challenges, and insights regarding the safety(i.e. physical, functional, and psychosocial safety)of those receiving and providing palliative home-care services in Quebec urban settings. METHOD:Informed by a socio-ecological perspective, thismixed-method study utilizes interpretive descrip-tion to capture social, emotional, functional andphysical contexts that influence the health-illnessexperience for palliative homecare clients. Span-ning several sites in Montreal and Quebec City,data collection and analysis includes the use ofaudio-taped interviews, photographic walkaboutsutilizing human factors techniques in the client’shome, and focus groups with homecare providers.Interviews were conducted with clients, familymember, caregivers, and providers. RESULTS:The unique nature of individual homes, familydynamics and collaboration with health care teamsoften comprised of multiple care providers, inaddition to the challenges of documentation andcommunication, makes safety in palliative home-care complex. Findings are intended to contributeto further development of homecare standards.Preliminary findings highlight the importance ofcommunication and decision negotiation as keycomponents to safer homecare for all parties.CONCLUSIONS: The increasing expectation thatthe palliative population will remain at home isbeing met with the practicalities of caring forpatients who may have end-of-life spans that areless predictable, longer and more complicated thanthe small window of time that many consider thedying phase. This mixed-methods research offersnew pathways for researchers to discover andexchange knowledge about homecare safety withclients, family caregivers, practitioners, and healthsystem decision-makers.

P-369

Group Interventions for Children Whose Parents

Have Cancer: Results of an Environmental Scan of

Canadian Cancer Institutions

Laura E. Labelle1, John Robinson2, Linette Lawlor2

Department of Psychology, University of Calgary,Calgary, Alberta, Canada1, Department of Psycho-social Resources, Tom Baker Cancer Centre,Calgary, Alberta, Canada2

OBJECTIVES: The psychosocial impact of par-ental cancer on children is well-documented,however little is known about the effectiveness ofgroup support and education programs for chil-dren whose parents have cancer. Identifying the

practical challenges and successes of implementa-tion, as perceived by program facilitators, will helpinform future program development and evalua-tion. The present study is an environmental scan ofgroup programs for children and adolescentswhose parents have cancer, currently offered byCanadian cancer institutions. METHOD: Thesupportive care/social work departments of allmajor publicly-funded Canadian cancer care insti-tutions (N5 32) were first contacted via email ortelephone. An interview was conducted with aprogram facilitator, or clinician most knowledge-able of such group programs offered at theirinstitution. Information gathered during the inter-view included group format and content, andperceived program effectiveness. RESULTS: Outof 32 cancer centres, 10 are currently runninggroup programs for children and/or adolescents.Programs are offered in multiple-session andsingle-session formats, however nearly all havebeen experiencing lower enrollment in recent years.Most provide a balance of education and support,and cover a range of topics related to cancer in thefamily. Several programs include a parent compo-nent. Based on facilitator observation and feed-back from participants, programs are meeting aneed for families. CONCLUSIONS: Most pro-gram facilitators identified that in order to optimizeenrollment and effectiveness, group interventionsfor children and adolescents need to be flexible interms of format, provide education about cancerand its treatment, normalize emotional reactions tocancer-related changes in the family, encourageopen communication between parents and chil-dren, and incorporate creative arts modalities.Qualitative and quantitative needs assessmentsand intervention research are lacking, and wouldinform changes leading to enhanced programeffectiveness and accessibility.

P-373

Revisiting the Shared Decision-Making Model for

Cancer Patients

Jennifer BellUniversity of British Columbia, Vancouver, BC,Canada

OBJECTIVES: Increasingly, shared decision-mak-ing (SDM) is replacing paternalism as the preferredmodel of the physician-patient relationship incancer care. SDM is seen as the ‘gold standard’because it enhances patient autonomy andencourages patient participation. Questions re-main, however, concerning the meaning of‘participation’ in the model and how participationis understood by cancer patients. This paperexplores how participation in SDM has beenconceptualized and develops a refined and morallydefensible model. METHOD: Philosophical


DOI: 10.1002/pon


inquiry methodology is used to gain conceptualclarification regarding how participation is under-stood within the health literature and acrossexisting SDM models. Empirical evidence ofSDM in the context of cancer is examined toincrease understanding of how SDM is enactedwithin cancer care settings and to test the adequacyof the theory. A feminist lens is utilized throughoutthe inquiry process to gain insight into women’sunique experiences of SDM and participation.RESULTS: ‘Participation’ has strong and weakmeanings in existing SDM models. Whereas‘strong participation’ involves the exercise ofconsiderable authority on the part of the cancerpatient, ‘weak participation’ merely involves thestatement of preferences, which the physician thenuses to make a final treatment decision. Empiricalevidence suggests women living with cancer en-dorse a weak interpretation of participation andthat their ability to participate in treatmentdecisions is hindered by a range of contextualfactors. CONCLUSIONS: A moral model of SDMmay require both strong and weak conceptions ofparticipation. Including weak participation withinthe model provides room for genuinely autono-mous decision-making, allowing patients to deferto physician authority. Acknowledgement isneeded, however, that weak notions of participa-tion may be the product of unjust social circum-stances. In addition, gender differences, powerrelationships, and contextual factors are importantto consider in revising the SDM model andunderstanding patient participation for clinicalpractice.

P-380

School-Related Difficulties After Discharge In

Japanese Childhood Cancer Patients

Hitomi Ishida1, Yuko Takei1, Akiko Ogata2, MiwaOzawa3, Hiroshi Moritake4, Atsushi Manabe3, KeiHirai5, Shin-ichi Suzuki6

Graduate school of Human Sciences, WasedaUniversity, Tokorozawa-shi, Saitama, Japan1,Faculty of Education and Culture, MiyazakiUniversity, Miyazaki-shi, Miyazaki, Japan2,St. Luke’s International Hospital, Chuo-ku, Tokyo,Japan3, Division of Pediatrics, Department ofReproductive and Developmental Medicine, Facultyof Medicine, Miyazaki University, Miyazaki-gun,Miyazaki, Japan4, Graduate school of HumanSciences, Osaka University, Suita-shi, Osaka,Japan5, Faculty of Human Sciences, WasedaUniversity, Tokorozawa-shi, Saitama, Japan6

OBJECTIVES: Medical advances in childhoodcancer therapy have brought about a markedimprovement in survival rates. However, the healthstatus of a significant number of long-term survi-vors suffers owing to cancer or its treatment

(Hudson et al., 2003). In particular, after dischargefrom hospital, patients experience school-relateddifficulties (Barrera et al., 2005). This study aims toexplore the psychosocial difficulties concerningschool life after discharge in Japanese childhoodcancer patients. METHOD: Subjects included 21childhood cancer patients suffering from who areoutpatients for the pediatrics (6 male and 15 female,mean age at survey5 15.671.7 yrs). Diagnosisincluded leukemia (n5 15), bone tumor (n5 3), andmalignant lymphoma (n5 3). Through the open-ended questionnaire and semi-structured interview,they were asked to answer the questions about theirschool-related difficulties after discharge. The datawas analyzed using a descriptive analysis byundergraduate and graduate students majoring inpsychology. RESULTS: School-related psychoso-cial difficulties were classified into four categories:‘difficulties in education’, ‘difficulties in extracurri-cular activities’, ‘difficulties in relations withfriends’, and ‘difficulties in relations with teacher’.The attributes indicated that over 30% of theparticipants were ‘attending physical education,’‘lagging behind at school,’ ‘attending class exceptphysical education,’ ‘joining club activities,’ and‘attending school events.’ CONCLUSIONS: Thesefindings suggest that most of the patients sufferingfrom childhood cancer face difficulties in education,extracurricular activities, and relations with friends.It is difficult for patients to adapt to school lifeowing to long-term cancer treatments. The categoryof difficulties in relations with friends was not seenin the previous study of foreign countries. In Japan,how patients communicate about their disease tofriends is also important.

P-382

Psychosocial Effects of Mastectomy on Married

Woman in Southern India

Kirushnakumar Kosanam Subramanian, UmaJayaraman, Chitra nagarathinam, VijayabhaskarRamakrishnanMeenakshi Mission Hospital and Research Centre,Madurai, Tamilnadu, India

OBJECTIVES: Background: Many studies haveexamined the psychosocial impact of Breast Cancerand its treatment on women who are from a poorand uneducated background in developing coun-try. The aim of this study is to find out thepsychosocial effects in married Breast cancerpatients in southern India. METHOD: Semistructured Questionnaires were given to 118 con-senting women treated with Mastectomy for anoperable Breast cancer at our Institution. Ques-tionnaires were answered at least 4 months afterMastectomy and the questions were about theconjugal relationship and how the woman’s senseof femininity was affected. Marital status was also


DOI: 10.1002/pon


traced up to 2 years. RESULTS: 4 months aftersurgery, the survey revealed 63 patients (53.3%)felt inadequate as a woman because of mastect-omy, they also felt that their self esteem was alsolow. 35 patients (29.6%) experienced a decrease infrequency of their sexual relation ship due tomastectomy. 94 patients (79.6%) were still marriedand 24 patients (20.3%) were separated / divorcedat the end of 2 years. CONCLUSIONS: This is oneof the very few reports of the psychosocial aspectsof Breast cancer and its treatment on women in thisregion of India. The results indicate that themarried woman face significant physical, emotionaland social changes following breast cancer treat-ment. Counseling should be established to helpsuch women with Breast cancer and their familiesto understand, cope up with their disease and theirlong term health and quality of life implications.

P-384

Development of Communication Skills Training

Program for Oncologists Based on the Patient

Preferences for Communicating Bad News in Japan

Maiko Fujimori1, Yuki Shirai1, Kaoru Kubota1,Noriyuki Katsumata2, Mariko Asai1, NobuyaAkizuki1, Yosuke Uchitomi1

National Cancer Center Hospital East, Kashiwa,Chiba, Japan1, National Cancer Center Hospital,Chuo-ku, Tokyo, Japan2

OBJECTIVES: To develop a communication skillstraining (CST) program for oncologists, on how todeliver bad news based on the patient preferencesand to evaluate the program preliminarily byoncologists’ behaviors, self-efficacy and satisfaction.METHOD: Sixteen oncologists attended a newlydeveloped two-day CST. This program was based onthe previous surveys on patient preferences, stressingthe oncologists’ emotional support. Participantswere assessed their communication performancesduring simulated consultation at the pre- and post-CST. Participants were also asked to rate their ownconfidence communicating with patients at the pre-,post-, and 3-months after CST, burnout at pre andthree months after CST, and the helpfulness of theprogram at post-CST. RESULTS: On the basis of apre-post measure, oncologists showed improvementof their communication behaviors, especially skills ofemotional support and delivering information. Theirconfidence in communicating bad news was ratedhigher after the CST and was persisted at 3-monthsafter the CST. Emotional exhaustion scores de-creased at 3-months after CST, however, personalaccomplishment also decreased. In addition, partici-pants were satisfied with all components of theprogram. CONCLUSIONS: A newly developedCST program based on patient preferences seemedfeasible and potentially effective on communicationbehaviors of oncologists, confidence in communicat-

ing with patients, and emotional exhaustion. Arandomized control study to conclude the developedCST program is effective was needed further.

P-386

Problems Faced by Breast Cancer Patients Treated

in Southern India

Kirushnakumar kosanam subramanian, UmaJayaraman, Chitra Nagarathinam, VijayabhaskarRamakrishnanMeenakshi mission Hospital and Research Centre,Madurai, Tamilnadu, India

OBJECTIVES: The aim is to assess the problemsfaced by the breast cancer patients with regards tospousal support, the changes occurring in the family,psychological factors, effects on the body image andthe attitude towards sexuality. METHOD: Totally771 cases of nonmetastatic breast cancer were treatedbetween 2001 and March 2009 at our institution. Outof which, 132 cases who came for follow up betweenOctober 2009 and December 2009 were taken up foranalysis by using a semi-structured Questionnaire. Itwas designed to address the quality of life, in patientswho had completed curative treatment. The followup period ranged from 6 months to 8 years.RESULTS: Assessing the changes in their familyrevealed that 84(63.6%) patients had faced severeEconomic crisis. 33(25%) patients had conductedurgent marriages for their children. 45(34.1%)patients were neglected by either the Spouse,Relative, Colleagues or friends etc. With relation tosexual attitude, 55(41.7%) patients had negativeimpact. 35 patients attributed to mastectomy. Inter-estingly, 24 patients out of this 35, were in thepurview of breast conservation. 95(71.9%) patientsfelt their body image was affected. CONCLUSIONS:Problems faced by these patients in this part of theworld is mostly due to Financial reasons, there is nosupport from the relatives or friends as well. Qualityof life derangements are common in Breast cancerpatients necessitating the provisions for patient accessto psycho social services. Awareness about screeningand Insurances should be taught as most of thepatients in this study faced severe financial problemsand negative impact on body image.

P-389

Psychiatric Symptoms and Quality of Life for

Patients with Terminal Cancer in Palliative Care

Ward

Seon Young Kim1, Sung Wan Kim2, Jae MinKim2, Il Seon Shin2, Jin Sang Yoon2

Department of Psychiatry, Chonnam NationalUniversity Hwasun Hospital, Hwasun,Republic of Korea1, Depression Clinical ResearchCenter, Chonnam National University Hospital,Gwangju, Republic of Korea2


DOI: 10.1002/pon


OBJECTIVES: Patients with terminal cancer aredistressed by variable psychiatric symptoms. How-ever, psychiatric approach for the symptoms is notsufficient, and often overlooked. This study in-vestigated the prevalence and negative effect ofpsychiatric symptoms in terminal cancer patientswho hospitalized in palliative care ward (PCW) inKorea. METHOD: The subjects were patientshospitalized in the PCW at Chonnam NationalUniversity - Hwasun Hospital. To investigatepsychiatric symptoms and it’s negative effects,Psychiatric interviews, Montgomery Asberg De-pression Rating Scale (MADRS), Socio-Occupa-tional Functioning Assessment Scale (SOFAS),Confusion Assessment Method(CAM), EuroQol-VAS were carried out by one psychiatrist. Depres-sion was diagnosed and defined severity byMADRS.(o 9: No depression, 9�30 : Mild tomoderate depression, X31 : Severe depression)RESULTS: In all, 108 patients was participatedresearch. They stayed PCW for mean 17 days. Theform of discharge was expired(52.4%), transferredto another hospital(16.2%), and retuned tohome(31.4%). Only 9.9% of patients was notdepressed, and prevalence of mild to moderatedepression was 69.1%, severe depression was21.0%. For other psychiatric symptoms, each wasdiagnosed by delirium 30.2%, insomnia 69.9%.Depression was significantly related with lowquality of life(p5 0.01), functional disability(-po0.01). CONCLUSIONS: Patients in terminalcancer undergo depression, delirium, insomniawhich prevalence was so high. Moreover, depres-sion has negative effect to quality of life andincreasing disability. This study was limited by thesmall number of patients. Future investigationswith more participants are needed. And clinically,more psychiatric approach for terminal cancerpatients should be encouraged.

P-391

Effect of Treatment Modality on Psychological

Stress in Gynecological Cancer

Biman ChakrabartiCCWH&Research Centre, Calcutta, WB, India

OBJECTIVES: Various treatment modalities areutilised in treatment of gynecological cancer e.g.surgery,radiotherapy, chemotherapy etc.Objectiveis to find out whether treatment modality by itselfmodifies the psychological stress. METHOD: 300patients & their next of kin were councelled abouttheir options of treatment modality(where theoption was possible) and the reason of choosingthe option.They were interviewed before start oftreatment & again after completion of treatment.RESULTS: 75 Patients had only surgery, 125 hadconcurrent chemoradiation,50 had chemotherapy

with or without surgery. 50 had all the three-chemotherapy,surgery,radiotherapy. Patients whohad only surgery were most satisfied with theoutcome. Chemotherapy patients suffered greatpsychological stress due to loss of hair and otherside effects. Patients who had concurrent chemor-adiation were also greatly distressed. Patients whoneeded all the three modalities were most affectedpsychologically. CONCLUSIONS: Gynecologicalcancer treatment does not usually affect the bodyimage and many patients are not also keen to knowthe diagnosis of cancer. Often the loved ones wantto hide the diagnosis from the patient.Surgicaltreatment for removing a diseased organ is lessstressful. Both chemotherapy and radiation aresynonymous with malignancy and the patient feelsexposed. Early diagnosis & surgical removal ofcancer causes minimum psychological stress topatient.

P-395

A Community Care Model for Cancer Patients in

Hong Kong: Mobilizing Public to Rectify Miscon-

ception and Soften Stigmatization

Yuk Chun Tammy Leung, Chung Man Zoe ChoiHong Kong Cancer Fund, Hong Kong, Hong Kong

OBJECTIVES: We have a mission to providepsyshosocial-oncology services to people touch bycancer in the community by mobilizing volunteersfrom different disciplines to create a publicempathy to learn how hard a cancer diagnosiscan be - emotionally, practically, and physically;and to advocate for public participation inprevention, early diagnosis as well as help makelife better for anyone touched by cancer i.e. care bythe community and care to the community.METHOD: Our model ensures the needy canobtain services and care & support in the commu-nity by: 1. mobilizing volunteers to take care of theneedy; 2. training of the cancer survivors, familymembers and those has been affected by cancer toprovide caring service back to the community. Wehave seven different types of volunteers: informa-tive hotline operators; service ambassadors; peercounselor; home care supporters; program assis-tants; professional volunteers; and public campaigneducators. RESULTS: We have more than 300volunteers: 80% are cancer survivors; 10% arefamily members, 5% are public and 5 % areprofessional volunteers. We will share our well-defined structure of volunteers system, trainingstandards of quality services and coaching &appraisal system. We have successfully utilizedthe ability and talent of volunteers; enhancedthe growth and facilitated the life transcendprocess of volunteers; and built up andmaintained caring values in the community.


DOI: 10.1002/pon


CONCLUSIONS: Community care to peopletouch by cancer through ‘care by’ and ‘care to’the community strategies is demonstrated to be agood community caring model in the past decadeof service provided by CancerLink Support Centrein the community. By day to day interactions andservices networking, the public and the peopletouch by cancer are well mingled in the communitythat help to reduce cultural prejudice and mis-conceptions of cancer in Chinese community.

P-399

Comparison of Marital Satisfaction between Parents

of Childhood Cancer Survivors and those of healthy

Control

Min Hee Kim1, Min Jung Shin1, Myung Ah Rhee1,Kyong Mee Chung1, Sung Chul Won2, SeungYeon Kwon2, Chuhl Joo Lyu2, Yoon Jung Shin3

Department of psychology, Yonsei University,Seoul, Republic of Korea1, Yonsei University Collegeof Medicine, Seoul, Republic of Korea2, YonseiUniversity College of Nursing, Seoul,Republic of Korea3

OBJECTIVES: Previous studies reported thatparents of childhood cancer survivors experienceincreased marital distress during and even after thetermination of treatment. In the present study,marital satisfaction of parents of childhood cancersurvivors in Korea was compared with those oftypically developing children and possible predic-tors for marital satisfaction were investigated.METHOD: Participants were 78 mothers of child-hood cancer survivors and the same number ofmothers of typically developing children. Survivorswere recruited from a Long-term Follow-up Clinicat a hospital in Seoul, Korea. All motherscompleted Beck Depression Inventory, Korean-Child Behavior Checklist, and Korean-MaritalSatisfaction Inventory. ‘General marital dissatis-faction’ from K-MSI was dependent variable andmother’s BDI score, K-CBCL total score andtreatment related factors of survivors were inde-pendent variables in the hierarchical multipleregression. RESULTS: No significant differenceswere found in the general marital dissatisfactionscale of the K-MSI between parents of survivorsand healthy control. The result of hierarchicalmultiple regression revealed that the overall modelsignificantly predicted general marital dissatisfac-tion. It accounted 40.5% of variance. R2 signifi-cantly increased at each level when BDI score,Total behavior problems score, and type of cancerwere added (po0.05). CONCLUSIONS: Parentsof child with cancer survivors showed no differencein marital satisfaction compared with parents ofhealthy child. Rather, marital satisfaction wasmore related to parents’ depression and child’s

behavioral problems. This result should be con-sidered for more helpful psychological interventionin the field. The type of cancer was significantlyrelated to the marital satisfaction. Further studieswith parents of various cancer survivors should beproceed.

P-401

Emotion Dysregulation As An Indicator Of Anxiety

And Depression In Cancer Patients

Leroy Tanguy1, Christophe Veronique1, AntoinePascal1, Cattan Stephane2, Nandrino Jean-Louis1

Unite de Recherche en Sciences Cognitives etAffectives URECA EA 1059, Univ Lille Nord deFrance, Universite Lille 3, Villeneuve d’Ascq,France1, Cliniques des maladies de l’appareil digestifet de la nutrition, hopital Huriez, CHRU de Lille,Lille, France2

OBJECTIVES: Patients who suffer from cancerfrequently have to deal with stressful situations.Then, they have to implement emotion regulationprocesses so as to cope with stress. However,anxiety and depression are frequently observed incancer patients and reduce patients’ compliancewith medical cares. This may be due to deficits ofemotion regulation processes. This study aims toassess the links between emotion dysregulation anddeficits of psychological adjustment (anxiety anddepression) in cancer patients. METHOD: 47cancer patients from the North of France partici-pated to this study. All of them completed twoquestionnaires assessing their state anxiety (STAI-Y-A) and their depressive symptoms (CES-D).They finally filled out the DERS-24, a thirdquestionnaire assessing six emotion dysregulationfactors: non acceptance of emotional responses,lacks of emotional awareness and clarity, anddifficulties to engage in goal directed actions, tocontrol behaviours and to implement emotionregulation strategies. RESULTS: Five of the sixfactors of emotion dysregulation are highly posi-tively linked to the scores of state anxiety anddepression (R>0.50, po0.001). However and notsurprisingly, there is no link between the lack ofemotional awareness and the scores of anxiety anddepression: the self-assessment of emotional dis-tress requires people to be able to tell how they feeland, accordingly, to be aware of their emotionalstate. CONCLUSIONS: As expected, emotiondysregulation seems to be an indicator of emo-tional distress in cancer patients: its early assess-ment after a cancer diagnosis may point out therelevance of specific psychological interventions forat-risk patients. Then, it may help to preventemotional distress and to increase compliancewith medical cares. Finally, comparisons withhealthy people are being conducted to check how


DOI: 10.1002/pon


situational emotional dysregulations are by asses-sing the impacts of cancer on emotion regulationabilities.

P-402

Psychosocial Adjustment of Childhood Cancer

Survivors: Comparison among Brain Tumor, Wilms’

Tumor and Healthy Control

Min Jung Shin1, Min Hee Kim1, MyungAh Rhee1, Kyong Mee Chung1, Sung ChulWon2, Seung Yeon Kwon2, Chuhl Joo Lyu2, YoonJung Shin3

Department of psychology, Yonsei University,Seoul, Republic of Korea1, Yonsei UniversityCollege of Medicine, Seoul, Republic of Korea2,Yonsei University College of Nursing, Seoul, Republicof Korea3

OBJECTIVES: Thanks to the medical and phar-macological advances, survival rates of varioustypes of childhood cancer increased significantly inrecent years, which have facilitated researches fortheir psychological adjustments. Previous studieshave demonstrated inconsistent results acrossdifferent types of cancers regarding their psycho-logical maladjustment, academic underachieve-ment, and functional impairment. The purpose ofthis study was to compare psychological adjust-ment of survivors of childhood brain tumor,Wilms’ tumor, and age-matched healthy control.METHOD: Participants were 57 children (18survivors of brain tumor, 19 survivors of Wilms’tumor, 20 control group), between the ages of 7 to16 years old. Survivors were recruited from a Long-term Follow-up Clinic, at a university affiliatedhospital in Seoul, Korea. Childhood DepressionInventory(CDI), Revised Children’s Manifest An-xiety Scale(RCMAS), and Child Behavior Check-list(CBCL) were administered to measurepsychological adjustment. RESULTS: Significantgroup differences were found across 3 groups forboth depression and anxiety. Scores of the twocancer groups were significantly higher than con-trol group (po0.05), yet no differences were foundbetween two cancer groups. On the other hand, nosignificant differences were found in the total scoreand all subscales of the K-CBCL among threegroups except social-immaturity. The two cancergroups’ social-immaturity scores were significantlyhigher than control group, po0.05. CONCLU-SIONS: Regardless of cancer type, survivorsexperience more depression and anxiety than theirhealthy peers. However, any group difference wasnot reported on parental reports of their child’sproblem behaviors. These results suggest thatpsychological counseling to prevent survivors’depression and anxiety disorders and parentaleducation to increase parents’ awareness abouttheir children’s mental health issues. Replication

with large sample size and other cancer types areneeded in the future.

P-403

The Efficacy Of Communication Skills Training: Is

It Possible To Predict Assessment And Supportive

Skills Learning Among Residents?

Isabelle Bragard1, Isabelle Merckaert2, YvesLibert2, Nicole Delvaux2, Anne-Marie Etienne1,Serge Marchal3, Aurore Liienard2, Julie Meunier2,Christine Reynaert4, Jean-Louis Slachmuylder3,Darius Razavi2

Universite de Liege, Faculte de Psychologie, Liege,Belgium1, Universite Libre de Bruxelles, Faculte dePsychologie, Bruxelles, Belgium2, Centre Bruxelloisde Psycho-Oncologie, Bruxelles, Belgium3,Universite Catholique de Louvain, Faculte dePSychologie, Louvain-la-Neuve, Belgium4

OBJECTIVES: Assessment and supportive skillshave been recognized as core clinical skills. Nostudy has yet explored variables which may predictthe learning of these skills. This study aims todetermine which variables (among residents’ char-acteristics and communication skills) may predictthe learning of assessment and supportive skills inthe context of a communication skills training.METHOD: Learning of assessment and supportiveskills was measured in a simulated interview beforeand after a communication skills training. Simu-lated interviews were recorded and transcripted.Communication skills were tagged with a computerassisted program (LaComm). Residents’ character-istics (sociodemographic, professional, andpsychological characteristics assessed by question-naires) and communication skills were measuredbefore training. Linear regressions were conductedto assess the associations between baseline resi-dents’ characteristics and communication skills,and consequent learning of assessment and sup-portive skills. RESULTS: Fifty-six residents wereincluded. Assessed variables explained 49% of thevariance in assessment skills learning and 38% insupportive skills learning. At baseline, both poorassessment and supportive skills predicted therespective learning of these skills. Certain types ofresidents’ coping styles (high level of social supportcoping) and certain attitudes (low level of deperso-nalization) predicted better assessment skillslearning. A higher attendance rate and a lowerprofessional experience predicted better supportiveskills learning. CONCLUSIONS: Predictors ofassessment and supportive skills learning arequite different. Future research related to theefficacy of communication skills training programsshould consider these key predictors. Trainers andtrainees should be aware that the learning processof assessment and supportive skills is quitedifferent.


DOI: 10.1002/pon


P-404

Validation Of The French Version Of The Maslach

Burnout Inventory Among Physicians

Isabelle Bragard1, Anne-Marie Etienne1, IsabelleHansez1, Yves Libert2, Isabelle Merckaert2, NicoleDelvaux2, Christine Reynaert3, Darius Razavi2

Universite de Liege, Faculte de Psychologie, Liege,Belgium1, Universite Libre de Bruxelles, Faculte dePsychologie, Bruxelles, Belgium2, UniversiteCatholique de Louvain, Louvain-la-Neuve, Belgium3

OBJECTIVES: No study has validated the Frenchversion of the Maslach Burnout Inventory-HumanServices Survey (MBI) among physicians. More-over, many studies plead for the removal of someitems from the 22-item original version of thisinventory. This study thus aims to examine thepsychometric properties (factorial validity, internalconsistency and external validity) of the Frenchversion of the MBI among physicians. METHOD:One hundred and ninety-four physicians completeda sociodemographic questionnaire, the MBI andthe Job Stress Survey (JSS). Factorial validity ofthe MBI was investigated with confirmatory factoranalyses. Internal consistency was analyzed foreach MBI factor. Correlations between MBI andJSS scores were analyzed to test external validity.RESULTS: Factorial analyses confirm the three-factor structure of the MBI (emotional exhaustion,personal accomplishment, and depersonalization)and plead for the removal of 4 items (6, 12, 16 and22). This 18-item version presents similar factorcorrelations to those of the original version of theMBI and very good internal consistency indices.Moreover, the results confirm its external validity.CONCLUSIONS: This 18-item French version ofthe MBI has good psychometric properties amongphysicians and confirms the original three-factorstructure. Although the 22-item and 18-itemversions of the MBI have quite similar psycho-metric properties, it could be hypothesized that theremoval of 4 items (6, 12, 16, and 22) may improvetest-retest reliability and consequently sensitivity tochange of each factor.

P-408

The Role of the Psycho-Oncologist with Head and

Neck Cancer Patients: Difficulties and Specificities

of His Work

Frederique LieutenantCliniques universitaires St Luc, Brussels, Belgium

OBJECTIVES: Cancer provokes an impairment ofthe body integrity and causes disturbances of themental equilibrium. The aim of this presentation isto consider the specific work of the psychologistwithin a service allowing head and neck cancerpatients (H&N). METHOD: We propose a brief

literature review about the specific difficulties andemotional symptomatology presented by H&Npatients. We also discussed the necessity of asetting adjustment for the psychologist taking intoaccount the patient’s physical sequelae (speech,breathing, chewingy), pre-existing characteristics(depression, anxiety, alcoholismy) and possiblecognitive impairment (alcohol related). RESULTS:A quarter of cancer patients will develop anaffective disorder within 2 years after the diagnosis,these rates raise up to 57% for H&N patients. Themost common troubles presented by these patientsare adjustment disorder, major depression, alco-holism and delirium. They faced specific difficulties,including a significant impairment of quality of lifedue to the alteration of basic functions (speech,breathing) and their physical appearance, whichrequires appropriate care. CONCLUSIONS: In theCliniques universitaires Saint Luc in Brussels, thepsycho-oncologist is integrated into a multidisci-plinary team, working in concert with surgeons,oncologist, radiotherapist and with a liaisonpsychiatrist and the alcohol unit. The psychologistpropose a systematic consultation with H&Npatients quickly after the diagnosis to assess thepatient’s emotional status and to provide anadapted psychological support.

P-413

‘L’ospedale Lo Conosco Anch’io’: Educational-

didatic Journey Aimed At Kindergarten Children

To Counter With The Fears Of The Hospital As A

Place Of Suffering

Valentina Vignola1, Nella Capretti2, Maria TeresaBacchi3, Giancarlo Izzi1

Azienda Ospedaliero Universitaria, Parma, Italy1,Associazione Noi per Loro ONLUS, Parma, Italy2,Scuola in Ospedale, Parma, Italy3

OBJECTIVES: The project, inside a model ofglobal care in Paediatric and Oncohematologydepartment, is aimed to: help children to face withawareness the illness and an admission to aneventual hospitalization; promote the image ofthe hospital as a serene and care healing place;emphasize feelings and emotions related to illness;offer useful information to the family for aneventual child’s admission; promote collaborationbetween school-family-hospital. METHOD: Theproject was carried out by the ward in collabora-tion with the School in Hospital and the kinder-garten children’s teachers and supported by aVoluntary Association. A story was written as aplayful stimulation to embark on a journey ofreflection and comparison with children, organizedin single classes, under the supervision teachers.Children documented their own interpretation ofthe hospital world with drawings and written


DOI: 10.1002/pon


thoughts that have been exposed in a travelingexhibition. RESULTS: The project was undertakenin two phases (2004–2005 and 2008–2009) andinvolved overall approximately 3400 childrenbetween 4 and 5 years old enrolled to kindergartenchildren. Large sections of society were involvedand sensitized by meetings with healtcare opera-tors, guided tours of the hospital, travelingexhibitions with children’s drawings and writtenthoughts and the realization and distribution of aCD, a playful journey with steps to accompanychildren through the discovery of the hospital.CONCLUSIONS: The innovative aspect of theproject is prevention of psychological distressrelated to the widespread image of the hospital asa place of fear and suffering. Children, theirteachers and parents could experiment this conceptwhile were in a psycho-physical well-being thatallowed them a serene reflection around the topicsof ‘illness’ and ‘hospital’.Thanks to the awarenessgained, it has been observed a positive behavioralfeedback in involved children that then suffered anhospitalization.

P-417

The Life End Information Forum (LEIF) in

Belgium: Creation of a National Forum on End-of-

Life Decision Making

Wim Distelmans2, Darius Razavi4, DominiqueLossignol5, Paul Destrooper1, Sabien Bauwens3

LEIF, 1780 Wemmel, Belgium1, UniversitairZiekenhuis Brussel, Supportive & Palliative Care,1090 Brussels, Belgium2, Cedric HIele institute,Flemish institute for psycho-oncology, 2800Mechelen, Belgium3, Institut Jules Bordet(Psycho-oncology, Pain Treatment and SupportiveCare Clinic) and Universite Libre de Bruxelles,1000 Brussels, Belgium4, Institut Jules Bordet(Pain Treatment and Supportive Care Clinic) andUniversite Libre de Bruxelles, 1000 Brussels, Belgium5

OBJECTIVES: Since 2002, three important billshave been implemented in Belgium i.e. on patient’srights, palliative care and euthanasia respectively.Few health professionals were familiar with thecontent of these laws. In order to get both theprofessionals and the general public more in-formed, a Life End Information Forum (LEIF)has been launched in 2003 in Flanders and Brussels(Dutch speaking). METHOD: From 2003 on-wards, ‘LEIF- artsen’ (Life End InformationForum - physicians) have been trained in end-of-life care issues in Flanders. They are also skilled togive the compulsory second opinion on a requestfor euthanasia. Since spring 2010, a similar traininghas been set up in Wallonia and Brussels (Frenchspeaking). RESULTS: Preliminary results of theimpact of LEIF-physicians on the quality of end-of-life issues will be presented. CONCLUSIONS:

According to the third report of the FederalCommittee on Euthanasia (June 2008), theexistence of the LEIF-platform may contribute tothe much higher willingness for registering eutha-nasia by Dutch speaking physicians (more than80 %) in contrast with their French speakingcolleagues. It is hoped that extension of LEIFtowards the French speaking part of the countrywill improve these data.

P-419

Depression And Quality Of Life In Hospitalized

Haematological Patients

Filipe Barbosa, Antonio BarbosaCentral University Hospital/Hospital Santa Maria,Lisbon, Portugal

OBJECTIVES: Patients undergoing treatment forhaematological malignancies suffer from high levelsof undetected anxiety and depression. Increasingly,very intensive treatments are being proposed,namely chemotherapy and bone marrow transplant.Psychological adaptation to such treatments ishighly individual, but a proportion of patients willexperience a marked deterioration in quality of life(QOL) and/or will develop clinical depression that isthe aim of our study. METHOD: 48 sequentialhaematological patients were admitted in a generaluniversity hospital, with an average age of 42.31,60.4 % were male, 50 % had leukaemia diagnosisand 25 % had lymphoma diagnosis. These patientswere observed by a psycho-oncology team (NIPSO),and were psychologically assessed by means ofHADS, QLQ C30 and a socio-demographic andclinical questionnaire. RESULTS: We found highlevels of depressive psychopathological symptoms(22.9 %) not correlated with length of disease. Asignificantly statistical correlation was found withsome functional and symptom scales of QLQ C30.By means of multiple regression analyses, we foundthat the variables age, anxiety symptoms and globalhealth status had the major influence on depressivesymptoms. CONCLUSIONS: As expected theprevalence of depressive symptoms is high in thissample. These patients, besides having a diagnosis ofa malignant disease, are hospitalized and under-going aggressive treatments, enhancing psychologi-cal distress, particularly depressive symptoms thatmust be early managed.

P-423

From Hopelessness to Being Hopeful for Advanced

Cancer Patients: Fostering Hope for Palliative Care

Patients through Home Care Support Services in

Hong Kong

Amy YanCancerLink Support Centre, Hong Kong CancerFund, Hong Kong, China


DOI: 10.1002/pon


OBJECTIVES: Cancer is the leading cause ofdeath in Hong Kong. The mortality is 50% of totalnew cases in 2007. (HK Cancer Statistic 2007).Process of dying is hopeless and helpless causingdistress. Hope is a psychosocial and spiritualresource (Herth, 1990; Cutcliffe, 2002) help inimproving life quality in advanced cancer. Purposeof the abstract is to illustrate how to run ‘homecare service’ with strategies of hope to improve lifequality of advanced cancer patients. METHOD:Home care service was established in 2008. Patientsin palliative stage, isolated, without family supportare being served. Research findings supported(Herth, 1990, Rando, T. 1984, Jevne, R.1993) thathope can be promoted by several strategies,including establishing interpersonal connection,setting attainable aims, being honest to indivi-dual’s, supporting meaningful spiritual practices,uplifting of memories, affirming to worth, control-ling pain and encouraging time refocusing. Thosestrategies are being adopted when carrying outservice. RESULTS: 72 patients received the serviceof Home Care since April, 2008. A list of varietyservices with hope fostering strategies were ten-dered. Qualitative data were collected to evaluatepatients’ physical and psychological well-being.Over 60% reported they obtained timely andimmediately care while 51% expressed that lifequality was enhanced and life became more mean-ingful. Real stories will be elaborated of how clientscan improve life quality and be instilled with hopein this presentation. CONCLUSIONS: Comparingwith home-help services offered by local socialservice providers, we are much able to fill theservice gaps and achieve the spirit of seamless care.It is tailored made, timely, flexible, irrespective ofgeographic locations, personalized and alwaysclients centred that cannot be replaced by otherhome-help teams. Despite, limitation is existed aspain control in palliative patients is always apredominate problem. Join efforts with nursingprofession will be the future direction.

P-426

Quality of Life of Parents with Cancer

Jochen Ernst1, Diana Richter1, Zofia Czajkowska2,Ricarda Schmidt1, Annett Koerner2, Elmar Braehler1

University of Leipzig, Department of MedicalPsychology and Medical Sociology, Leipzig,Germany1, McGill University, CounsellingPsychology & Oncology, Montreal, Quebec, Canada2

OBJECTIVES: A cancer diagnosis can seriouslyaffect not only the patient but also the whole familysystem. Caring for underage children could in-crease the patients’ distress. Thus far research hasprimarily focused on the perspective of the affectedchildren paying little attention to the associationbetween parenthood and cancer. Little is known

about the effects of parenthood on the quality oflife (QoL) therefore, the aim of the current study isto address that gap. METHOD: Within theframework of a multicentre project a sample of200 patients, theirs spouses and children up to 18years of age will be interviewed at three time points(six months apart from each other). Patients withdifferent cancer diagnoses are included. QoL ismeasured with the EORTC -QLQ and comparedwith an age-matched control group (patients with-out children). The influence of sociodemographicvariables and characteristics of the disease areexplored via an analysis of variance. RESULTS:Data is currently collected of 60 patients at thebaseline. The results indicate that being a parenthas negative effects on social and emotionalfunctioning as compared to not having children.On the other hand, parental status appears to havea protective effect on cancer patients’ QoL byputting the person in a clearly defined social role.Being confronted with familiar tasks of supplyingand caring for minors might help patients refocus.CONCLUSIONS: The effects of cancer on theQoL of patients with children up to 18 years of ageneed to be differentiated from the QoL of thosewho have no children. The QoL of parents ischaracterized by major restrictions and lowerfunctionality. Further analyses in our study explorethe correlation of QoL of the patients and thepsycho-social situation of their children andspouses in a longitudinal perspective.

P-427

The Distress Thermometer Transleted into Serbian

Tamara KlikovacNational Institut for Oncology and Radiology,Beldrade, Serbia

OBJECTIVES: Screening for Distress or using theDT in oncology practice. Cancer experience is anegative life event that requires an enormousamount of effort from patients and their families.Negative psychological states such as stress,anxiety, and depression are frequently associatedwith the diagnosis and treatment of cancer. Under-standing the psychosocial aspects of cancer and itstreatment has become an important and necessarypart of cancer care treatment. METHOD: Theinvestigation was conducted at the Institute forOncology and Radiology of Serbia, Belgrade,during the year 2009. The sample consisted of50 cancer patients (35 female, 15 male) (differentdiagnosis and stages of illness). We used DT.RESULTS: A significant majority of patientsreported practical problems related to financialproblems (45%) and transportation (30%).Patients also reported family problems like pro-blems which can cause extremedistress (55% ofpatients). 45% of patients quoted sadness and


DOI: 10.1002/pon


worry like most common emotional problems. Thephysical problems quoted by most most patientwere eating, nausea, sexual problems and sleeping.CONCLUSIONS: Psychooncology is a relativelynew scientific discipline in Serbia. Taking intoconsideration that assessment of different psycho-logical reactions of cancer patients can be helpfulfor organizing adequate psycho-educational andpsychosocial support, and psychotherapy for can-cer patients and their families.

P-428

Sense of Coherence and Acceptance of Illness by

Patients with Head and Neck Cancer

Anna Blogosz, Marta PorebiakCancer Centre Institute, Warsaw, Poland

OBJECTIVES: Research was planned to estimatecomponents of coherence(comprehensibility, man-ageability, meaningfulness)and illness acceptancein cancer patients. Research questions concern: 1.Level of comprehensibility (belief that thingshappen in a predictable sequence) 2. Level ofmanageability (belief that patient has the resourcesnecessary to take care of life events) 3. Level ofmeaningfulness (belief that things happening inpatient’s life are worthy to care about them) 4.Relationship between components of coherenceand illness acceptance. METHOD: 30 hospitalizedpatients with head and neck cancer waiting for thesurgery, voluntary took part in the research. Therewere used following assessment tools: Sense ofCoherence Scale (SOC) and Acceptance of IllnessScale (AIS). In the statistical analysis we used acomputer program SPSS.RESULTS: Level ofcoherence positively correlates with level of illnessacceptance. However high level of coherence isn’talways followed by the belief that life events areunderstandable and worthy manage them. CON-CLUSIONS: The conclusion suggests, which ele-ments could be advantageous for betterfunctioning and patients’ adaptation before thesurgery and which elements could be disadvanta-geous. It is important in wisely planning thepsychological and medical treatment, support andcare in this particular group.

P-429

Perceptions of Benefit Finding Following Childhood

Cancer in a Sample of Spanish Adolescent Survivors

Carmina Castellano1, Marta Perez - Campdepadros2,Tomas Blasco1, Cristina Dıaz de Heredia2, PilarBastida2, Lluıs Capdevila1

Universitat Autonoma de Barcelona, Bellaterra,Barcelona, Spain1, Hospital Universitario Valld’Hebron, Barcelona, Spain2

OBJECTIVES: Theoretical and descriptiveaccounts suggest that adolescents struck by cancerusually experience a number of good as well as badconsequences of the disease in survivorship withpotentially different effects on their Health-RelatedQuality of Life (HRQoL). This study aims todescribe the prevalence of perceptions of positiveand negative consequences with regard to cancer ina sample of Spanish cancer survivors; and toexplore whether these perceptions are related totheir current HRQoL. METHOD: Twenty-twosurvivors (12 males, 10 females) aged between13–19 years old were assessed in a cross-sectionalstudy after being X1 year off-treatment. HRQoLwas assessed with the KIDSCREEN-52, whereasperceptions of positive and negative consequencesin survivorship with regard to the whole oncologi-cal experience were answered by means of a semi-structured interview based on categories proposedby Sundberg and colleagues (Sundberg, Lampic,Bjork, Arvidson & Wettergren, 2009). RESULTS:hree participants (13.6%) reported only positiveconsequences, three participants reported onlynegative consequences (13.6%), and 16 partici-pants (72.72%) reported both positive and negativeconsequences. There were no significant differencesrelated to gender with regard to the number or thetype of consequences reported. HRQoL scoreswere equivalent to normative values. Furthermore,no significant relationship between HRQoL out-comes and perceptions of positive and negativeconsequences could be identified. CONCLU-SIONS: HRQoL results indicate that survivorsare getting along quite well. The majority ofsurvivors reported positive as well as negativeconsequences at assessment point. However, theseperceptions have not shown to be significantlyrelated with any values on HRQoL. Nevertheless,the present study is currently still in progress andthe small sample size limits the scope for drawingany firm conclusions. These results can improve theknowledge about the psychological impact ofcancer in survivors.

P-433

Development Of An Online Psycho-Educational

Group Intervention For Children With Cancer

Martha Grootenhuis1, Linde Scholten1, Riannevan der Zanden2, Barbara Conijn2, Anouk deGee2, Bob Last1

Psychosocial Department, Emma Children’sHospital, Amsterdam, Netherlands1, TrimbosInstitute, Utrecht, Netherlands2

OBJECTIVES: Considering the adverse effects ofpediatric oncology treatments, the uncertaintyabout the further course of the disease and otherpsychosocial implications of childhood cancer,there is need for disease-specific interventions for


DOI: 10.1002/pon


survivors of childhood cancer. Development of anonline course would expand the accessibility forespecially adolescents. Objectives are: to studywhether the development of an online groupprogram (www.opkoersonline.nl) is feasible andeffective and how satisfied participants and trainersare with the program. METHOD: Children treatedfor cancer, between 12–18 years and havingfinished treatment were eligible. The course (6sessions) utilizes the principles of cognitive beha-vioral therapy. Children completed questionnaresabout disease related skills and psychosocialfunctioning before and 0–4 weeks after the inter-vention. They were asked about the sign-inprocedure, the course, the home-work programand the chat-box utilities. Every session evaluationof the content and utility took place. Psycho-logists who provide the course were interviewed.RESULTS: Until now two courses took place with6 participants (n5 4 girls; n5 2 boys). They werefrom different pediatric oncology centres. Allparticipants participated during all sessions andwere positive about the course. The four psycho-logists were also positive. Several adaptations weremade to the course based on the reactions. Twonext courses are scheduled, and another specificallyfor children with a retinoblastoma. Preliminaryresults show positive changes on the psychosocialoutcome questionnaires. CONCLUSIONS: E-mental health technologies are developed over thepast years, with most e-health interventions focuss-ing on adults, and to a lesser extend for children.First results are promising for this online chat-course for children with cancer. This course willgive many young childhood cancer survivors theopportunity to profit from this preventive chat-group intervention at home on an individual basis.

P-436

The Modern Methodology of Psychological Help

and Psychological Diagnostics in Breast Cancer

Patients

Julia MalovaRussian Scientific Center of Radiology, Moscow,Russian Federation

OBJECTIVES: The improvement of breast cancertreatment and reduction of side effects changestructure of the targets of the psychological help.Among the most evident psychological problems inbreast cancer patients under the treatment coursewe should consider today the stress of diagnosisand possible prognosis; decision-making regardingoptions of treatment process; the psycho-emotionalchanges in patients with the post-castration syn-drome after ovarian ablation or tamoxifen use.Phological help includes psychotherapy and psy-chological diagnostics. METHOD: The complexesof diagnostics were a: multifactorial personality

test (Leongard-Shmishek), depressive scale (DSM-IV), anxiety scale (Spilberger), Level of SubjectiveControl test, Personal Defence mechanism Test; b:clinical conversation, partly formalized interview,projective methods. Using the results of diagnosticssupportive psychological help was provided. Thediagnostics and psychological help were managedbefore the diagnosis manifestation (1), before thetreatment options decision2, in the beginning of thetreatment process in ovarian ablation (3.1) andtamoxifen (3.2). RESULTS: The use of complex bis related with higher level of reported psychologi-cal well-being in groups 2 and 3.1. In groups 1 and3.2 complex a was more related with the patient’ssatisfaction. Experts match complex a with moreeffective psychological help in group 2. CONCLU-SIONS: There is an evidence of the possibility touse the optimal complex of psychological helpaccordingly to the different target psychologicalproblems and stadiums of treatment experience inbreast cancer patients. The individual medicalpsychological diagnostics is the necessary back-ground of the effective psychological help.

P-437

Validation Of The Benefit And Burden Scale for

Children (BBSC) In A Sample of Young Cancer

Survivors

Martha Grootenhuis1, Anna Broek1, JantienVrijmoet-Wiersma2, Esther Meijer-van den Bergh3,Alice van Dijk4, Heleen Maurice-Stam1

Psychosocial Department, Emma Children’sHospital, Amsterdam, Netherlands1, PediatricDepartment, Leiden, Netherlands2, Department ofMedical Psychology, Radboud University MedicalCenter, Nijmegen, Netherlands3, Department ofMedical Psychology, VU University MedicalCenter, Amsterdam, Netherlands4

OBJECTIVES: Understanding of survivor-specificquality of life issues such as disease-related burdenand benefits could yield a more complete picture ofthe impact of cancer on (daily) life of survivors. Todate, a survivor-specific Dutch questionnaire is notavailable, which is why the Benefit and BurdenScale for Children (BBSC; Phipps, 2008) wasvalidated in the Netherlands. The aim of the studyis to find out whether the BBSC has goodpsychometric characteristics in Dutch population.METHOD: Children aged 8 to 18, who hadsuccessfully finished their cancer treatment sixmonths to three years before the start of the study,completed eight questionnaires measuring psycho-logical outcomes (benefit and burden of the disease,quality of life, self esteem, cognitions about thedisease, PTSS, anxiety, behavioural functioningand coping). For measuring test-retest reliability ofthe BBSC, it was administered again after 2 weeks.


DOI: 10.1002/pon


RESULTS: 127 Children were approached, 78children responded (response rate 61%). Responserate for retest was 81%. Subscales of the BBSCdemonstrated good internal consistency and test-retest reliability was high. Benefit finding andburden scores do not differ as a function of gender,race/ethnicity, socioeconomic status and treatment.Diagnostic category (brain tumour vs. otherdiagnosis) and short time elapsed since treatmentwere relate to higher levels of burden. Especiallyburden was related to negative psychological out-comes. CONCLUSIONS: The BBSC appears tohave similar characteristics as the original version.It has the potential to be used as a measure ofbenefit finding and illness-related burden in Dutchpaediatric survivors of childhood cancer andpossibly as a screener in clinical practise.

P-441

Optimizing Team Members’ Communication Skills

in Radiation Oncology : Content and Feasibility of A

Belgian Interuniversity Curriculum

Emilie Caps1, Anne-Marie Etienne1, IsabelleBragard1, Yves Libert4, Isabelle Merckaert2,Aurore Lienard2, Julie Meunier3, AngeliqueMoucheux6, Serge Marchal6, Nicole Delvaux5,Christine Reynaert3, Darius Razavi2

Universite de Liege, liege, Belgium1, UniversiteLibre de Bruxelles, Bruxelles, Belgium2 UniversiteCatholique de Louvain, Louvain-La-Neuve,Belgium3, Institut Jules Bordet, Bruxelles, Belgium4,Hopital Universitaire Erasme, Bruxelles, Belgium5,Centre Bruxellois de Psycho-Oncologie, Bruxelles,Belgium6

OBJECTIVES: Radiation oncology treatment isadministered by teams including various disciplines.In this context, optimizing communication withpatients and their relatives requires optimizingmultidisciplinary, interdisciplinary and transdisci-plinary communication among team members. Atraining curriculum aiming at improving teammembers’ communication skills (patients and rela-tives oriented skills and team members orientedskills) was therefore designed. The objective of thispaper is to describe a Belgian training curriculumdevoted to radiation oncology teams. METHOD:The 38-h training curriculum included two parts.The first 16 hours aimed to improve team members’communication skills with patients and their rela-tives through role plays organized for professionalsof the same discipline. The following 22 hours aimedto improve team members’ communication skillswith their colleagues through role plays organizedfor professionals of all disciplines. The objective wasto optimize communication by avoiding gaps orredundancy in information and support given byteam members. RESULTS: Four departments ofradiation oncology accepted to participate in this

randomized study. Forty-four percent of teammembers of these departments registered to thetraining (96/217): 74% registered for the experi-mental group (65/88) and 24% registered for thecontrol group (31/129). Barriers to participationincluded time limitations, concerns about participat-ing to role plays and team dynamic. The hetero-geneity of motivation may also be explained bynumerous reasons: attitudes of the hierarchy,different organizational contexts and work condi-tions. CONCLUSIONS: These data highlight thefeasibility of implementing this type of curriculum.The different registration frequencies reported showthe heterogeneity of healthcare professionals’ moti-vation to participate to the curriculum. The efficacyof interventions designed to improve team commu-nication needs to be tested.

P-442

Improvement of Physicians’ Patient-Centeredness:

An Empirical Evidence of the Benefits of a

Communication Skills Training Program

Benedicte Jonius1, Isabelle Merckaert2, IsabelleBragard1, Nicole Delvaux6, Anne-Marie Etienne1,Yves Libert5, Serge Marchal4, Christine Reynaert3,Jean-Louis Slachmuylder4, Darius Razavi2

Universite de Liege, Liege, Belgium1, UniversiteLibre de Bruxelles, Bruxelles, Belgium2, UniversiteCatholique de Louvain, Louvain-La-Neuve,Belgium3, Centre Bruxellois de Psycho-Oncologie,Bruxelles, Belgium4, Institut Jules Bordet,Bruxelles, Belgium5, Hopital Universitaire Erasme,Bruxelles, Belgium6

OBJECTIVES: No study has yet assessed thebenefits of a communication skills training programon patient-centeredness. The purpose of this studyis to assess the relation between patients’ character-istics and physicians’ communication skills beforeand after a communication skills training program.METHOD: Correlations between physicians’ com-munication skills and patients’ characteristics werecategorized as absent or present: the number ofpresent correlations indicates the level of patient-centeredness. Communication skills were assessedduring a consultation before and after a commu-nication skills training program. Consultations wereaudio-recorded and transcripted. Communicationskills were rated according to the Cancer ResearchCampaign Workshop Evaluation Manual. Patients’characteristics (sociodemographic, physical andpsychological) were measured before and after thetraining program. RESULTS: Sixty-three physi-cians were included. Before training, physicians’communication skills were associated with 2 pa-tients’ sociodemographic characteristics and with 1psychological characteristic. After training, physi-cians’ communication skills were associatedwith none of the patients’ sociodemographic


DOI: 10.1002/pon


characteristics and with 4 psychological character-istics. CONCLUSIONS: This study highlights thatphysicians’ patient-centeredness may be improvedthrough a communication skills training program.After training, physicians are more centered onpatients’ psychological characteristics and not onpatients’ sociodemographic characteristics any-more. This study underlines the need to designcommunication skills training which may furtherimprove patient-centeredness.

P-444

Women’s Experiences of Encounters Regarding

Return-To-Work After Breast Cancer

Marie Nilsson, Mariann Olsson, Agneta Wennman-Larsen, Lena-Marie Petersson, Kristina AlexandersonKarolinska Institutet, Stockholm, Sweden

OBJECTIVES: To gain knowledge on women’sexperiences of encounters concerning return to workafter breast cancer surgery. METHOD: Qualitativeanalyses of data from four focus group interviews of23 Swedish women 2 to 8 months after breast cancersurgery. Groups were strategically composed withregard to treatment (chemotherapy/not) and age(o55, X55), respectively, to increase homogeneity.The interviews were audio taped, transcribedverbatim, and analysed inductively through contentanalysis. RESULTS: Three main categories wereidentified in the statements of encounters withprofessionals: Flexibility involved statements onrelevant changes in e.g. matters of care planningor sickness benefits. Information concerned infor-mational content in encounters, e.g. where to turn inmatters of return-to-work, rehabilitation, and reg-ulations regarding sickness benefits. Attitudes con-tained judgements of the woman’s return to workand the women’s perception of attitudes directedtowards themselves. CONCLUSIONS: Flexibility,information and attitudes are experienced inencounters regarding return to work. The state-ments point to relevant areas and needs whenreturning to work. It is important to specificallydiscuss relevant adjustments, to ascertain that theinformational content in an encounter is perceivedand relevant, and there needs to be an awareness ofthe perceived attitude in such encounter as this mayeffect the future interaction.

P-445

Sceening, Assesment and Management of Distress in

Breast Cancer Patients Having Chemotherapy

Ana Maria Boeru1, Laura Monica Radu1, MonicaLaura Saed1, Alina Iulia Rusu1, Daniel Rusu1

Romanian Association for Cancer Pain, Bucharest,Romania1, Privacy, Bucharest, Romania2,Privacy, Bucharest, Romania3, Student, Bucharest,Romania4, Student, Cluj Napoca, Romania5

OBJECTIVES: Distress is a multifactorial unplea-sant emotional experience of a psychological,social, and spiritual nature that may interfere withthe ability to cope effectively with cancer, itsphysical symptoms and its treatment. Usingscreening tools for measuring distress like: StressAssessment Questionnaire, Emergencies impactscale(Horowitz, Wilner and Alvarez 1979) andDistress Thermometer, we hope to do an earlydetection and treatment of distress leading to betteradherence to treatment, avoidance of severeanxiety or depression. METHOD: A number of60 wemen with local, advanced and metastaticbreast cancer, stage II, III and IV was assessed fordistress in the start of chemotherapy,during thechemotherapy, 4 times, and after they finished. Wework in psysho-education and group therapy,psychosocial interventions, cognitive behavioraltherapy, family and couples therapy, with Erickso-nian hypnosis,relaxation techniques and controlledmental imagery. Patients was divided in 2 groups :first group 27–47 years old and the second between47–67 years old. RESULTS: Preliminary resultsshows high levels of distress in younger patientsversus older, need for a better evaluation,theyreported significantly more and higher levels ofneeds for support and more psychooncologicalinterventions techniques, more medications tomanage symptoms like analgesics, anxiolytics,hypnotics, antidepressants, more family supportand counseling. CONCLUSIONS: To meet pa-tients needs screening instruments assessing distressand management in a multidimensional way shouldbe routinely and repeatedly administered in clinicalpractice for all cancer patients hospitalised, out-patiens or in palliative care institutions.

P-447

Depression Screening Practices at a Tertiary Care

Cancer Centre

Genevieve Marie Breau, Lynne M. BreauDalhousie University, Halifax, NS, Canada

OBJECTIVES: Depression is a serious problemaffecting cancer patients, one which significantlyinfluences patients’ prognoses and outcomes. Con-sequently, international guidelines recommend thatpatients be routinely screened for depression. Thereis little research investigating the frequency ofdepression screening and treatment in cancerpatients, thus this study will investigate thesepractices at a tertiary care cancer centre. TheTheory of Planned Behaviour (TPB) will also beused gain a better understanding of these beha-viours. METHOD: This research is taking place ata tertiary cancer centre that provides radiation andsurgical oncology treatment. All oncologists andoncology nurses at this centre will be invited totake part in this study, which consists of a 20 to 30


DOI: 10.1002/pon


minute structured interview. The interview willinvestigate clinician’s current depression screeningand treatment practices, and will also explorewhether TPB can be used to better understandthese practices. RESULTS: Given the exploratorynature of this study, data will be analyzed usingsimple descriptive and inferential statistics. T-testswill investigate whether profession affects partici-pants’ depression screening and treatment prac-tices. Chi-square tests will be performed todetermine if type of treatment varies by profession.Pearson correlations will explore whether TPBcomponents are related to participants’ past inten-tion to screen and past screening behaviour.Thematic analysis will be used to analyze theresults of open-ended questions. CONCLUSIONS:Preliminary results will be presented, including thequantitative analysis and the initial results of theopen-ended questions. This study will serve as acase study of depression screening and treatment ata centre with no existing screening and treatmentprotocol in place, and will thus provide a bench-mark for programs developing such protocols.Clinicians’ attitudes and beliefs about depressionscreening, within the context of the TPB, will alsobe explored.

P-449

The Experiences of Young Adult Cancer Survivors

Resuming an Occupation

Elizabeth Sharpe, Lynne RobinsonDalhousie University,Halifax, Nova Scotia, Canada

OBJECTIVES: Young adulthood is generally atime when an individual completes post-secondaryeducation, decides on a career, and enters theworkforce. When an individual is diagnosed andtreated for cancer during this stage in life, returningto an occupation of school or work may bedifficult. The aim of this study was to gain a richerunderstanding of the experiences of young adultcancer survivors who are returning to school orwork following cancer treatment. METHOD: TenCanadian young adult cancer survivors, aged 21 to35 years, were interviewed by telephone. Partici-pants included 4 males and 6 females, 5 of whomhad resumed school and 5 of whom had resumedwork. Interviews were audio-recorded, transcribedverbatim, coded, and analyzed inductively todevelop emerging themes. An interpretative phe-nomenological approach was the qualitative re-search method of inquiry, as it allows for the studyof individuals’ lived experiences. RESULTS: Anaccount of participants’ experiences will be pre-sented. Master themes, with sub-themes, will beintroduced in turn, each described in rich and thickdetail, supported by evidence from participants’verbatim transcript quotations. CONCLUSIONS:Findings may be informative for cancer patients

and survivors, as they often have access to limitedresources. The findings may allow health profes-sionals, employers, and school administrators togain a better understanding of the challenges youngadult cancer survivors are facing, therefore en-couraging them to provide appropriate informa-tion for promoting healthy transitions whenresuming occupations, as the workforce may belosing their labour and young adults may be losingmuch needed wages.

P-453

Social Support Moderates the Relationship between

Fear of Cancer Recurrence and Depressive

Symptoms in Mothers with Breast Cancer

Marie-Eve Couture-Lalande, Isabelle Ares, SophieLebel, Catherine BielajewUniversity of Ottawa, Ottawa, Canada

OBJECTIVES: Fear of cancer recurrence is one ofthe most prevalent sources of distress and a riskfactor for depression. In this study, we hypothe-sized that social support would act as a protectivefactor and would lessen the strength of therelationship between concern of a recurrence ofbreast cancer and depressive symptoms. Mothersand non-mothers were analyzed separately giventhe finding that surviving mothers generally presentmore distress related to cancer. METHOD: A web-survey was completed by 3670 breast cancersurvivors (Mean age5 55, range 20 to 89; averagetime since diagnosis5 6.5 years, range 1 month to40 years; 75% were mothers; mean number ofchildren5 2, range 1 to 6), predominantly Amer-ican. Beck Depression Inventory, Concern aboutRecurrence Scale, and Northouse Social SupportQuestionnaire were used and the results analyzedvia hierarchical linear regression analyses followingthe Aiken & West (1991) method. RESULTS:Results suggest that social support buffers theharmful relationship between fear of cancer recur-rence and depression in mothers (Beta5�0.131,po0.01) but not in non-mothers (Beta5�0.115, p.n.s.). When social support is high (Beta5 0.446,po0.01), the relationship between fear of recur-rence and depressive symptoms is lessened com-pared to when social support is low (Beta5 0.205,po0.01) in mothers only. CONCLUSIONS: Whilea high fear of recurrence appears to be a risk factorfor depression in both surviving mothers and non-mothers, low social support has a greater impacton mothers. Furthermore, analysis of the nature ofsocial support indicates that all forms of socialsupport are relevant to mothers but onlyspousal support in the case of non-mothers. Theseresults emphasize the importance of identifyingthe specific needs of mothers and non-mothersseparately.


DOI: 10.1002/pon


P-454

A Large Scale Validation of the Emotion

Thermometers as a Screening Tool for Distress in

an Ethnically Diverse Cancer Population



OBJECTIVES: We previously reported initialvalidation of the Emotion Thermometers, a simple5-domain visual analogue scale inspired by theDistress Thermometer (Psychooncology. 2009 Mar18; Epub), against depression. Here we aimed toreport a definitive validation in a large ethnicallydiverse sample against Hospital Anxiety andDepression Scale (HADS) defined distress. METH-OD: We analysed data collected from LeicesterCancer Centre from 2007–2009 involving approxi-mately 1000 people approached by a researchnurse, research physician and two therapeuticradiographers. The researcher applied the HADSand used a HADS-T \gt 14 to signify distress. Wecollated full data on 660 patient assessments ofwhom 12.9% had MDD and 14.8 were from ethnicminorities (largely British South Asian of Indiadescent). RESULTS: In the parent sample of 660,sensitivity, specificity and AUC were as follows:DT - 71.9%; 78.4%; 0.814; cut point5 4 AnxT -75.7%; 73.4%; 0.821; cut point5 5 DepT - 77.6%;82.2%; 0.855; cut point5 3 AngT – 77.5%; 77.6%;0.823; cut point5 2 HelpT -69.1%; 80.8%; 0.809;cut point5 3. Thus DepT was optimal and hassuperior sensitivity and specificity to the DT. Therewas no significant difference by ethnicity. CON-CLUSIONS: In this large scale validation of theET against cancer related distress (on the HADS-T) the DepT may be the optimal thermometer. Theoptimal cut-point appears to be5>3. The DepTalso performs well in those in an ethnic minoritynamely British South Asian patients.

P-457

Fatigue in Patients with Advanced Cancer and

Social Support: An Explorative Research

Serena Barello1, Emanuela Saita1, Giulia Lamiani2,Guendalina Graffigna1, Elena Vegni2, Egidio AldoMoja2

Universita Cattolica del Sacro Cuore, Milan, Italy1,Universita degli Studi di Milano, Milan, Italy2

OBJECTIVES: Fatigue compounds cancer patientsand caregivers’ quality of life as well as patients’survival. It can be considered a behavioural markerof the inability to cope with the stressors associatedwith cancer and its treatment. As previously

demonstrated, the nature and experience of Fati-gue may vary across countries. The aim of thisstudy is to investigate the definition of Fatigue inItalian cancer patients and explore the influence ofsocial support on Fatigue’s experience. METHOD:According to the method of Ethnoscience, 15patients with advanced cancer in active treatmentand/or palliative care were interviewed 2–3 times.In the first interview, patients were asked abouttheir Fatigue experience and about their socialsupport using the Inclusion-of-the-Other-in-the-Self Scale. In the second, patients sorted Fatigue-related key-words, emerged from the first inter-views, into categories. The researchers merged thecategories into a taxonomy of Fatigue which waschecked with some patients in a third interview.RESULTS: Data analysis is still ongoing butpreliminary results suggest that a lack of socialsupport could increase Fatigue severity. CON-CLUSIONS: Results will allow us to better under-stand the concept of Fatigue and the role of socialsupport in experiencing Fatigue. Social supportmight have a protective function and decreaseFatigue severity by preserving the patient’s psy-chological integrity. Our findings could be alsouseful to implement culturally based interventionsto manage Fatigue.

P-463

Stress, Emotional Disorders and Quality of Life in

Portuguese Breast Cancer Women Submitted to a

Mastectomy or a Different Types of Chirurgic

Intervention

Maria Joao Cunha, Isabel Araujo, Joao PauloPereiraInstituto Superior da Maia, Maia, Portugal

OBJECTIVES: Our aim is to study the vulner-ability of stress, coping, emotional disorders andthe quality of the life of the women submitted to atumorectomy and a mastectomy; understand inwhich way the time after the diagnostic makes adifference in the wellbeing. METHOD: We havefollowed a transversal investigation design, with 4descriptive study’s. The inclusion criteria in thesample were: women with breast cancer confirmeddiagnosis followed in north area of Portugal healthcare services, submitted to a tumorectomy or amastectomy. Instruments: 23QVS, BRIEF-COPE-R, BSI and WHOQOL-briefRESULTS: 103 parti-cipants, 60 -mastectomy and 43 -tumorectomy.34% are vulnerable to stress and 27.5% have acriteria for emotional distress. The women who hadbeen submitted to mastectomy make greater use ofa pattern of denial coping, whereas womensubmitted to a conservative chirurgic interventionshowed higher intakes of substances and higherexit behaviour. The time past to the diagnosis,


DOI: 10.1002/pon


made a difference in the way how the stress wasmanaged. CONCLUSIONS: The results empathizethe importance of the breast cancer psycho-oncology services and show that this importancewas not restrict to the disease beginning and thetreatments phases. The time past after the diag-nosis, seems have not a protect-function withthese women’s, comparing to the way howthey interpret and build a meaning to theirexperience.

P-468

The Contribution of Psychological and Spiritual

Care to the Holistic Approach to Palliative Patients’

Care

Klelija Trancar1, Tanja Agar1

Institute of Oncology Ljubljana, Slovenia, Slovenia1,Institute of Oncology Ljubljana, Slovenia, Slovenia2

OBJECTIVES: Maintenance and development ofspiritual well being is a key element of coping withterminal illness. Therefore in palliative care psy-chological and spiritual care are often included,which is one of the indicators of the quality of care.The main aim of our research is to identify thedimensions of psychological and spiritual wellbeing. We also discuss the overlapping of psycho-logical and spiritual approach to patient care andthe contribution of both approaches. METHOD:We included 50 patients who received psychologi-cal and spiritual care from June to December 2009.We defined their psychological and spiritual needsthrough clinical interviews and patients’ narratives.We used qualitative approach to categorize thepatients’ descriptions and quantitative approachfor descriptive statistics. In relation to specificneeds we discuss the intervention we used andthrough interviews we evaluated the benefit of thespecific approach: psychological interventions andspiritual care interventions. RESULTS: The psy-chological and spiritual needs were recognized in83% of patients. Results have shown associationbetween psychological and spiritual symptoms ofdistress (phi5 0.94, p5 0.00). The most commonoverlapping dimensions of psychological and spiri-tual well being were: fear, existential concerns/suffering, withdrawal, hope, denial, anxiety/worry,sadness, fighting spirit, humor, searching for mean-ing of being ill, for meaning of life, restlessnessloneliness, anger, uncertainty, loss of dignity,distrust. CONCLUSIONS: The overlapping ofpsychological and spiritual approach (dimensionsof psychological and spiritual well-being) topatients’ care has a great meaning for the qualityof care. A more holistic approach encourages hopeand decreases the sense of abandonment. Dealingwith symptoms only and not with the person as awhole in the context of patients’ life represents a

danger to deal only with the particularity andtherefore to miss the wholeness of the person.

P-472

Facilitation of Health Behaviors among Individuals

with a Family History of Cancer

Maija Reblin1, Lee Ellington1, Seth Latimer1,Debra Roter2, Bert Uchino1, Margaret Clayton1

University of Utah, Salt Lake City, UT,United States1, Johns Hopkins University,Baltimore, MD, United States2

OBJECTIVES: According to the Social CognitiveProcess Model, health care providers’ (HCP)communication style can impact patients’ under-standing, likelihood of taking action, and adjust-ment. Facilitative communication may invitepatient thought and emotion, whereas directivecommunication may inhibit these. Facilitation ofpatient processing is especially important forpatients with a cancer family history given thepotential impact on screening, detection and otherhealth decisions. Therefore, we analyzed twocommunication patterns and their differentialimpact on patient intentions. METHOD: 119participants with a cancer family history wereassigned to facilitative or directive simulatedclinical HCP encounters to discuss stress manage-ment and cancer prevention strategies. Followingthe encounter, participants rated how likely theywere to engage in the discussed health behaviors.Encounters were recorded and dialogue was codedusing Roter’s Interaction Analysis System.RESULTS: As expected, facilitative encountershad significantly lower nurse dominance, closedquestions, and biomedical information, but moreemotion and partnering statements (Fs>4.17,df5 1,105, pso0.04), and marginally more patientemotion (F5 3.49, df5 1,105, p5 0.06). Control-ling for condition, HCP, and patient gender,multiple regression analyses revealed intention tofollow stress/diet plans was significantly predictedby lower nurse dominance, closed questions andpsychosocial information, more patient questions(ts>2.00, betas>0.218, pso0.048) and marginallypredicted by greater patient emotion (t5 1.726,beta5 0.167, p5 0.087). CONCLUSIONS: Con-sistent with the Social Cognitive Processing Model,our findings demonstrate that for patients with afamily history of cancer, HCPs are likely topromote adherence by asking questions, providingpatients room to speak and express theiremotions, rather than blocking discussion withclosed questions or giving general information.Given that HCPs receive little training in how tofacilitate patient health behaviors, thesefindings have implications for communicationskills training.


DOI: 10.1002/pon


P-477

Psychological and Decision Making Impact of On

Line Adjuvant! Software among Early Breast

Cancer Patients

Michel Reich1, Veronique Christophe2, PhilippeVennin1, Emmanuelle Fournier2, Severine Linerol2,Veronique Servent1, Laurence Vanlemmens1,Jacques Bonneterre1

Centre Oscar Lambret, LILLE / NORD, France1,Universite LILLE NORD de FRANCE-UniversiteLille 3-URECA EA 1059, LILLE /NORD, France2

OBJECTIVES: In France, 50000 new breast cancercases per year are diagnosed. Risks/benefits ratioexpected from adjuvant systemic treatment remainoften unclear. Adjuvant! on line computer programallows physicians to assess risks and benefits at tenyears regarding treatment options chosen. Till now,data are missing about the impact of this program interms of psychological aftermath’s and decision choiceamongwomenwith an early breast cancer.METHOD:This study was done among 59 women with nonmetastatic breast cancer split in two different groups:one with 24 women received classical informationabout treatment procedure and side effects and theother one with 35 women received both classical andAdjuvant! on line program information shown duringthe consultation. Besides socio-demographic data,anxiety and depression dimensions were respectivelyassessed by Spielberger STAI sacle and Radloff CES-D-scale. RESULTS: Results show the usefulness ofAdjuvant! as a tool in clinical practice in order toencourage support, decision making by patients,discussion about risk of recurrence and facilitateinformed consent while preferences of each other aretaking into account. No differences between the twogroups were found in terms of comprehension ofmedical information. Anxiety and depression para-meters do not seem to influence patient’s comprehen-sion and decision choice. CONCLUSIONS: Despitethe small size, Adjuvant! on line computer programmight be an interesting tool froma clinical point of viewin terms of decision making process help and facilitat-ing discussion about risks and benefices expected fromthe treatment. Considering women’s choices variabilityand their values, the medical relation with them remainparamount. The computer program remains a tool thatmust not ruled out the individual subjective patientchoice which must always be respected.

P-478

Quality of Life and Cognitive Functioning in a Sample

of Survivors of Central Nervous System Tumours

M Perez-Campdepadros1, C Castellano2,T Blasco2, L Gros1, A Llort1, T Sabado1

Onco-Hematological Paediatric Service. HospitalUniversitari Vall d’Hebron, Barcelona, Spain1,Facultat de Psicologia. UAB, Barcelona, Spain2

OBJECTIVES: Survivors of Central NervousSystem (CNS) tumours are at risk of severalsequelaes in survivorship. For that reason, theirHealth - Related Quality of Life (HRQoL) hasemerged as an important field of research. Theaims of this study are: (1) to assess HRQoL in asample of Spanish adolescent cancer survivors, (2)to describe their neurocognitive functioning, and(3) to explore the relationship between theirHRQoL values and their neurocognitive outcomes.METHOD: The present study is still in datacollection. Until now, a total of 10 Spanish CNSsurvivors (4 males, 6 females) aged between 12 - 19years old (mean age5 15.40, SD5 2.71), wereassessed in a cross - sectional design using theWechsler Intelligent Scales and the generic HRQoLmeasure KIDSCREEN - 52, after being X 1 yearoff - treatment. RESULTS: (1) Three dimensionsof HRQoL such as physical well - being, mood &emotions, and bullying, showed lower mean scoresthan normative values. (2) Up to 80% of survivorsexperience neurocognitive impairment in 1 or morespecific domains. Among them, verbal comprehen-sion was impaired in 60% cases, perceptual reason-ing and working memory in 40%, and processingspeed in 50% cases. (3) At present, no significantrelationship between HRQoL and neurocognitivefunctioning was revealed. CONCLUSIONS: Datasuggest that in the sample of Spanish survivors ofCNS tumours some HRQoL dimensions could beimpaired as well as some domains of theirneurocognitive functioning. However, a significantinteraction between these variables could not beidentified; it could be explained because of thesmall sample size. Nevertheless, some interactionmight be showed with a larger sample.

P-482

Breast Cancer Follow-Up Care: Breast Cancer

Oncologists’ Preferences for Knowledge Translation

Regarding Arm Morbidity

Rhona M. Shaw, Roanne Thomas-MacLeanUniversity of Saskatchewan, Saskatoon, Canada

OBJECTIVES: According to Gigliardi et al.,‘There are clear gaps in our understanding aboutthe care received by breast cancer patients so thatthe flow of knowledge from ‘bench to bedside’ maybe incomplete.’ This study addresses one of thesegaps by discerning the information needs andmedia preferences of clinicians involved in theafter-treatment care of women living with breastcancer in order to provide them with the latestresearch findings regarding arm this condition.METHOD: A qualitative study involvingGrounded Theory. In-depth telephone interviewswere conducted with fifteen breast cancer oncolo-gists from across the province of Saskatchewan,Canada. Clinicians were recruited via letters of


DOI: 10.1002/pon


invitation with the intent of creating a diversesample with respect to gender, location (urban/rural/remote), seniority and area of specialisation(medical/surgical,radiation oncology). RESULTS:Differences were evident among clinicians in termsof their perceptions of the prevalence of armmorbidity and what they regarded as arm morbid-ity; the kinds of arm morbidity issues that were ofinterest to them (i.e. etiology, symptom manage-ment, psycho-social impacts); and the kinds ofinformation media they used and preferred(pamphlets and journals vs. podcasts, emails andwebsites). CONCLUSIONS: A range of informa-tion media pertaining to breast cancer related armmorbidity needs to be made available to breastcancer clinicians in order to better facilitateknowledge transfer and uptake of arm morbidityfindings into breast cancer practice. However,preliminary findings from our study also foundthat more awareness and education around theissue of arm morbidity and psycho-social impacts isneeded.

P-484

Evaluation of Alexithymia in Heavy Chronic

Smokers Women Engaged in Smoking Cessation

Therapy

Aglaee, Ariele, Cousson-Gelie, FlorenceUniversity of bordeaux 2 (France), ANPAA(France), institut Bergonie (France), BORDEAUX,France

OBJECTIVES: To help out the heavy chronicsmokers women quitting smoking, healthcareproposed smoking cessation therapy. In associa-tion with smokers, practitioners determined events,cognitions and feelings, which came out smokingbehaviours. Alexithymia describes inability expres-sing our own feelings. It’s often associated withsubstance abuse. Nevertheless, studies found noassociation between alexithymia and tobaccoabuse. Studies used to compare all smokers withnon-smokers or ex-smokers. Our hypothesis washeavy chronic smokers are more alexithymics thanthe others. METHOD: A sample of 20 smokerswomen engaged in cigarette smoking cessationtherapy filled a questionnaire on substance abuse(Fagerstom, FACE), smoking behaviours (QCT 2),alexithymia (TAS 20) and prior smoking cessation.They were evaluated at the first meet withpractitioners. Descriptive statistic, correlationsamong the measure, comparison of averages andhierarchical regression analysis were performed fordetermine if alexithymia predicts high level ofnicotine dependence and high numbers of priorfailure smoking cessation. RESULTS: As expectedthe results showed that heavy chronic smokerswomen scored higher prior failure smoking cessa-

tion than the others smokers. Alexithymia alsoappeared to be unrelated to nicotine dependence.As unexpected, considering each field of alexithy-mia, heavy chronic smokers women scored highestlevel in external oriented thinking scale than theothers and more often used cigarette as a vector ofsocial integration. CONCLUSIONS: Although theexternally oriented thinking doesn’t predict nico-tine dependence, it remains associated with highlevel of nicotine dependence. Further studies haveto be conduct among bigger sample of heavychronic and hard score smokers women whoreceived clinical service for treatment of nicotinedependence. Assess separately the 3 fields ofalexithymia and carry out specific interventionsmay be useful clinically by assisting healthcareproviders in helping those smokers to enhanceoutcomes.

P-489

Assessing Psychological Well-being, Daily

Functioning, and Quality of Life in Gynecological

Cancer Patients

Joan BraninUniversity of La Verne, La Verne, CA,United States

OBJECTIVES: The purpose of the study was toevaluate the psychological well-being, daily func-tioning, and quality of life of cancer patientsrecently diagnosed with various gynecologicaltumors who had undergone surgery, chemother-apy, or radiation cancer therapy. METHOD: Theparticipants were fifty-two female patients whowere recently diagnosed with cervical, ovarian, orendometrial cancer and who had undergonesurgery, chemotherapy, or radiation cancer ther-apy. Psychological well-being, daily functioning,and quality of life were measured using thePsychological Well-Being Index (PWB), the DailyFunctioning Activities Questionnaire (ALLTAG),and the Spitzer Quality of Life (QLI) before andafter six months treatment. RESULTS: Psycholo-gical well-being improved significantly after treat-ment. Six months post treatment there was apositive correlation between psychological wellbeing and quality of life and daily functioning.Stage of treatment was associated with decreasedpsychological well-being, declining ability to per-form daily functioning activities, and reducedquality of life. Type of treatment was modestlyassociated with psychological well-being and qual-ity of life. There was no significant change in dailyfunctioning. CONCLUSIONS: Cancer treatmentcan significantly improve the psychological well-being of newly diagnosed gynecological cancerpatients even though their ability to perform dailyactivities had not changed significantly.


DOI: 10.1002/pon


P-492

Sister Survivor: African American Breast Cancer

Coalition

Kimlin Ashing-GiwaCity of Hope National Medical Center-CCARE,Duarte, CA, United States

OBJECTIVES: Five grassroots support groups andDr. Ashing-Giwa formed the African-AmericanBreast Cancer Coalition (AABCC). The coalitionimplemented this study using the CBPR frameworkand qualitative methodology with the followingobjectives: 1) identify the elements of structure andprocess for Arican-American peer support groupsand 2) the most culturally-appropriate paradigm fordeveloping AABCS peer support groups. METH-OD: AABCS were interviewed in focus groups (5with peer support group members, 4 with non-support group members); peer support groupleaders were individually interviewed to get a clearidea of the structure and process of the groups. Apreliminary guide on ‘how to’ develop AABCS peersupport groups was developed. The coalition wasinvolved in all study activities including studyplanning, instrumentation, study implementation,data interpretation and dissemination. RESULTS:75 AABCS participated. The qualitative analysisunveiled 3 themes: 1) Emotional Impact of BreastCancer, 2) Emotional Stressors, and 3) EmotionalBoosters. The findings suggest the groups arecritically important to the survivors’ family func-tioning and emotional well-being. The importanceof peer support groups becomes more evident in thepost-treatment/survivorship phase when emotionaland social support from family, friends and medicalproviders dwindles. The themes of acceptance,belonging, and validation were woven throughoutthe interviews. CONCLUSIONS: The supportgroups provide a cultural, empathetic, emotionaland supportive care safety-net. These groups func-tion as an extension of a prescribed way of lifeincluding spirituality and a fictive-kin-networkwoven together through the breast cancer experi-ence. Our findings and Coalition outcomes demon-strate the community-research-partnerships’potential to address survivorship needs and healthdisparities through coalition-building, prioritizingdirect community benefit, bi-directional training andcapacity building when these values and practicesare rooted in cultural and sociecological contexts.

P-498

Psycho-social Needs of Breast Cancer Patients

Maria G.G. Andrade, Silvia M. Santiago,Guilherme M. Carvalho, Fiorentino Fonte Neto,Debora RecchiState University of Campinas, Campinas, SaoPaulo, Brazil

OBJECTIVES: The objective of this research wasto identify the psycho-social needs perceived bybreast cancer patients, related to their social,cultural and religious situation, and also theassistance trajectory until they get the diagnosis.A deeper comprehension of these matters can helpto enhance the patients care at the health system.METHOD: This research took place from June toOctober of 2007, with patients followed at thegynecological and breast cancer university hospital,reference for 4 million inhabitants. 21 patients wereinterviewed and the recommended ethical proce-dures for qualitative research were observed. Thematerial was submitted to the thematic analysis ofcontents to capture the womens’ representations.RESULTS: The medium age of the patients was55, the majority had an incomplete basic scholar-ship, were employed and without companion. Mostof them missed to have a referral health profes-sional. Financial difficulties to be treated werereferred, although none have abandoned treat-ment. They expressed fear related to the che-motherapy side effects, depressive feelings anddifficulties to develop home activities. Most ofthem associated the cancer to some strong andnegative events, specially breaks and familieslosses. CONCLUSIONS: After diagnosis, the careprocess is demanding and needs emerge. It isimportant a coordinated action between the localand specialized health services to attend them,evolving resources to facilitate the timely andsuitable treatment. It is also important the psycho-logical support for the understanding of this lifetime, helping to keep the quality of life and theaffective relationships.

P-511

Psychological Distress and Coping Strategies in

Patients with Non-melanoma Skin Cancer

Nicole Roberts, Annett Koerner, Zofia Czajkowska,George RadiotisMcGill University, Montreal, Quebec, Canada

OBJECTIVES: Non-melanoma skin cancer(NMSC) is the most common type of cancer, ofteninvolving an area of the body that is visuallyconspicuous to self and others; 80% occur in theface. NMSC is a unique cancer in that the concernsare less about mortality and disease gravity butrather of disfigurement, discomfort, and illnessperception. Surprisingly, few studies have investi-gated the psychosocial implications of the NMSCdiagnosis on patients. METHOD: The current studywas designed to provide an account of the distressexperienced and coping strategies used by NMSCpatients. One-hundred and two patients, at any stagewithin their illness trajectory, participated in thiscross-sectional study. During their regular visit tothe dermatology clinic, all participants completed


DOI: 10.1002/pon


questionnaires measuring quality of life, distress,coping and psychosocial needs. RESULTS: Theresults of the current study show a significant level ofdistress is experienced by individuals suffering fromnon-melanoma skin cancer - especially when theNMSC is located on the face and head. Further-more, the distress is associated with suboptimalcoping strategies, and is dependent on where thepatient is situated in their illness trajectory. CON-CLUSIONS: To our knowledge, this is the firststudy to demonstrate a clinically significant level ofdistress in patients with non-melanoma skin cancer.Our findings highlight the importance and need ofdeveloping services to improve the clinical care forthis patient population, as the majority of them arenot presently offered psychosocial interventions.

P-513

Window to the Soul: Art and Meaning in Cancer

Care

Moira ToomeyThe Ottawa Hospital, Ottawa, Ontario, Canada

OBJECTIVES: In acute care, medical oncology,many patients experience physical discomfort aswell as emotional and spiritual distress. Thehospital environment is often drab and depersona-lized. The literature suggests that visual artimproves patients’ sense of well-being, provideshope, and aids communication between staff andpatients. This quality care project was designed tobrighten patients’ rooms with personalized art andto describe the paintings’ effects on those living,visiting and working in this hospital environment.METHOD: A feasibility study described the impactof providing personalized visual art into hospitalrooms, with the patients’ glass windows acting asthe painters’ canvas. High school art studentsexecuted the paintings, the communication wasfacilitated by an occupational therapist, and thepatient directed the process. Results were collectedby questionnaire from the patients, their familiesand the staff. The occupational therapist alsointerviewed several patients and documented theirresponses. RESULTS: A pilot study is now under-way to confirm the results in this feasibility study.The preliminary responses indicated that the paint-ings distracted patients, often anchoring themduring distressing moments, providing hope.Patients who ‘inherited’ the paintings used themin their own unique way, and staff reported that thepictures facilitated communication beyond thepatients’ illness. For several patients their indivi-dualized paintings assisted in their transitionfrom active cancer treatment to end of life care.CONCLUSIONS: Personalized art work is a signi-ficant adjunct to health, healing and the alleviationof suffering. Occupational Therapy is ideally situatedto facilitate such a modality in an acute care setting:

Thus enhancing their clients’ physical and psychoso-cial environments. These transformative, spiritualand emotional, processes will be described.

P-514

How Anxiety, Depression and Physical Side Effects

Predict Fear of Recurrence in Breast Cancer

Survivors in Taiwan

Shih-Ming Shih, Ging-Long Wang, An-ChenFeng, Sheng-Hui Hsu, Yi-Chen Hou, Shih-HaoChen, Chih-Dao ChengKoo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan

OBJECTIVES: Psychological and physical factors areassociated with fear of recurrence in cancer survivors.The degree of their individual effect is unknown. Theobjective of this study is to examine the separaterelationship of anxiety, depression and physical sideeffects to the fear of recurrence of breast cancersurvivors (BCS)in the early stage of survivorship.METHOD: 211 stage I or II outpatient BCS who hadfinished treatments for 3 to 24 months, completedpackets of questionnaires including the HospitalAnxiety and Depression Scales (HADS), the Ratingof Physical Side Effects and Mini-MAC. The item of‘I worry about the cancer returning or getting worse’is used to represent fear of recurrence. Multipleregression is utilized to examine how anxiety,depression and the severity of physical side effectspredict the outcome of fear of recurrence. RESULTS:The results indicated that the three-factor model cansignificantly predict fear of recurrence, explaining23.4% of the variance (R50.48, F(3, 207)521.04,po0.01). Although all three factors are associatedwith fear of recurrence (all pso0.01), anxiety is theonly one significant predictor of fear of recurrence(t (207)55.48, po0.01). CONCLUSIONS: Anxietyassessed by HADS can serve as a good predictor toBCS’ fear of recurrence. Depression might beregarded as a different construct from fear ofrecurrence. When BCS perceive more severe sideeffects, they do not attribute them to the sign ofrecurrence. This might be due to the high survival ratein early stage of breast cancer. Other possible factorssuch as age, coping patterns, social support deserve tobe tested in future researches.

P-516

Comparing Quality of Life Between Childhood

Cancer Survivors and Healthy Control and

Indentifying Factors Affecting QOL

M.A. Rhee1, M.H. Kim1, K.M. Chung1, S.Y.Kwon2, S.C. Won2, Y. J. Shin2, C. J. Lyu2

Departments of Psychology, Yonsei University,Seoul, Republic of Korea1, Pediatric Hematologyand Oncology, Yonsei University Health System,Seoul, Republic of Korea2


DOI: 10.1002/pon


OBJECTIVES: The purpose of this study was toassess the QOL in childhood cancer survivors incomparison with the QOL in healthy peers. Also,relative impact of psychological variables as well asother treatment related factors on physical, psy-chosocial, and overall QOL was also investigated.Four variable groups were demographic variable-s(age at diagnosis, survival time), diagnosis andtreatment (diagnosis, duration of treatment, com-bination of treatments), late effect(the severity) andpsychological variables(self-concept and problembehavior). METHOD: Participants were 110 child-hood cancer survivors ages from 8–18 years oldand their parents, who were recruited from Long-term follow-up Clinic run by a cancer center at oneof the major university affiliated hospital in Seoul.Also age and gender matched healthy controlgroup was recruited via internet advertisementsand school counselors/teachers. Youth completedthe Korean Pediatric Scale of Quality of Life 4.0,and the Self Concept Inventory, and parentscompleted the Korean-Child Behavior Checklist.RESULTS: Survivors reported significantly lowerQOLs than control group in all domains (po0.5).Results of hierarchical multiple regression analysisshowed that four groups of variables explainedmore than 49 % of variables on QOL though somedifferences were found across sub-domains ofQOL(po0.001). Also R2 was significant at alllevels of analysis except demographic variable inphysical QOL. Psychosocial variables indepen-dently accounted for 36–49% of total explainedvariance of QOL(po0.01): physical (DR2 5 0.18),psychosocial (DR2 5 0.273), overall(DR2 5 0.282)CONCLUSIONS: Relatively lower level of QOLamong survivors suggested continuous efforts areneeded to identify factors influence QOL. Unlikedemographic and treatment related factors, psy-chological factors are flexible to change, hencebecome a promising domain to focus on toimprove QOL among pediatric cancer survivors.Psychosocial support and education to survivorsand their parents could be one of the options to try.More attention should be given to other psycho-logical factors impacting on QOL.

P-519

Using a Short Range of Neuropsychological Tests in

the Assessment of Cognitive Function Among Breast

Cancer Patients

Svetlana Prokasheva1, David Geffen2, Yifat Faran1,Prof. Julie Cwikel1

Department of Social Work and The Center forWomen’S Health Studies, Ben Gurion University ofThe Negev, Beer Sheva, Israel1, Department ofOncology, Soroka University Medical Center, andBen Gurion University of The Negev, Beer Sheva,Israel2

OBJECTIVES: Assessment of cognitive functionamong breast cancer patients can be adverselyaffected when a broad range of neuropsychologicaltests is used, which may cause fatigue and increasethe chances of a Type A error. In this fashion, thechance of finding significant differences betweenthe control and cases increases. Thus, we wished totest the efficacy of a shorter battery to test forcognitive function among breast cancer patients.METHOD: Cognitive function of 20 women whowere newly diagnosed with breast cancer, beforethe commencement of chemotherapy treatmentwere compared with 20 women survivors of breastcancer that had completed chemotherapy treat-ment 2 to 5 years earlier. The tests included:atten-tion (simple reaction time), and the ‘Doors andPeople’ (D&P) test of visual and verbal recall andrecognition. The overall score of the D&P test is asensitive index of episodic memory performance.RESULTS: The two groups of breast cancerpatients did not significantly differ regarding age,level of education, BMI and family status. Theresults indicated that women newly diagnosed withbreast cancer and women survivors of breastcancer were not significantly different in generalepisodic memory performance (p5 0.675) but weresignificantly different in non-verbal recall(Po0.017). There were no differences on attentiontests measured by simple reaction time. CONCLU-SIONS: The differences in cognitive functionappear to be less profound than others have foundin the past. There is a need to continue to collectdata over time to see if cognitive differences appearat a later date after chemotherapy.

P-520

Narration In Psycho-Oncology Of Longtime

Surviving Patients

Daniela Barberio, Maurizio Montella, MariaBruno, Nana Corsicato, Francesco de FalcoIstituto Nazionale Tumori, Fondazione ‘G. Pascale’.,Naples, Italy

OBJECTIVES: The man shapes continuously hisown world by narrating it and narration hasfundamental role in defining the self-identity.Therapy can be seen as a tale and autobiographicalnarration can be a mean of change. The project‘Narration in psycho-oncology of longtime surviv-ing patients’ comes from the awareness of thetherapeutic value of narration. Specifically in thisresearch project are collected and narrated storiesof women that have undergone to a partial or totalbreast. METHOD: For this study, a total numberof 30 patients, women that have undergone tosurgical breast ablation and have been tumor freefor about 5 years, have been enlisted. They aregathered in groups, composed by an average of 5/7women, a moderator a vice-moderator, specifically


DOI: 10.1002/pon


a psychologist, and a counselor. The study, begunin 2009, is still ongoing. The evaluation tools usedare autobiographic card, STAI ( State TraitAnxiety Inventory) and projective drawings.RESULTS: The descriptive and qualitative analy-sis of narrations and drawings has shown recurrentthemes: seeking of religious consolation, earlysplits, adverse relation with their femininity, ‘ thecrippled body’ and the sexuality, anxiety of notbeing in control over their own body and thedisease. These women feel a split in their life: abefore and an after the disease, with frequentoccurrence of experiences of abandon, sense ofguilt and splits after the disease. CONCLUSIONS:This study has shown the importance of theavailability of a personal space to reshape andprocess their own life experiences. To tell their ownstories, to narrate themselves becomes a way toredefine the sense of self and enables them tointegrate the experience of the disease in the contestof their lives in a more harmonic way, giving back afeeling of continuity to their existence and ofpsychological well-being.

P-526

Managing Cancer-Related Symptom Distress and

Improving Well-Being Through Human-Nature

Connections

Adam M.B. Day, Philip C. DoyleUniversity of Western Ontario, London, Ontario,Canada

OBJECTIVES: Nature and the natural environ-ment represent under developed resources thatexhibit the potential to improve health and well-being for individuals who experience ill-health. Inconsidering this potential, relationships betweennature and decreased symptom distress in thosetreated for cancer and who experience the resultantside-effects may emerge. This presentation centreson the potential roles of nature in promoting healthand well-being, and decreasing symptom-relateddistress in individuals being treated for cancer.METHOD: Current evidence highlighting therestorative potential of human-nature connectionswill be synthesized and presented. The applicationsof this evidence in clinical and rehabilitationsettings will be discussed relative to promotingwell-being and decreasing symptom-related distressin individuals being actively treated for cancer.Data will be presented from a proof-of-conceptstudy that utilized home-based slideshows ofnatural restorative environments for individualswho were actively receiving chemoradiation ther-apy for head and neck cancer. RESULTS:Preliminary evidence supports the potentialfor human-nature connections to contribute posi-tively to symptom reduction and improved self-perceived well-being and quality of life. Further,

human-nature connections have been reported topromote general restoration, improved directedattention, increased positive affect, and decreasedstress in healthy populations. Improved clinicaloutcomes in hospital settings have also beenreported. Therefore, fostering such ‘green experi-ences’ during treatment and rehabilitation couldhelp to decrease the negative impact(s) of cancertreatment. CONCLUSIONS: Humans are inextric-ably linked to nature and the natural environment;however, current practices generally do not ac-knowledge the potential role of nature in promotinghuman health and well-being. Integrating human-nature experiences in clinical and rehabilitationcontexts could provide valuable respite and help todecrease the negative impact of cancer treatment.This presentation will discuss how fostering human-nature connections can be integrated into treatmentand rehabilitation contexts to promote enhancedwell-being in individuals with cancer.

P-527

Assessing the Awareness and Practice of Pap Smear

Screening among Redeemed Christian Church of

God Women in Nigeria

Elizabeth Oluwatoyin Akin-Odanye, Chioma C.AsuzuUniversity of Ibadan, Ibadan, Oyo State, Nigeria

OBJECTIVES: Cancer of the cervix is the secondmost common cancer among our women. Mostwomen with this disease present late for treatment.Women from different walks of life often dominatemost religious gatherings and this study set out toassess Christian women’s awareness of cancer of thecervix and their practice of Pap smear screening as away to detect cancer of the cervix early. METHOD:Subjects for this study were females from aninterdenominational congregation of Christian wor-shippers from different parts of the country attend-ing an annual convention. The researchersdistributed the structured questionnaire betweensessions to all the women who were willing toparticipate in study after their consent haveobtained. Data collected were analyzed by the useof SPSS. Those who filled the questionnaires wereeducated on what cancer of the cervix and Papsmear. RESULTS: 101 women participated in thestudy. Their average age was 31.50. 71.3 percent ofthem had tertiary education. 47.5 percent had notheard of cancer of the cervix before. 83.2 percent didnot know what test to do to detect cancer of thecervix early, 80.2 percent did not know where to gofor the test, 93.1 percent had never had a Pap smeartest and 89.1 percent did not know anyone who hadcancer of the cervix before. CONCLUSIONS: Nostudy on women’s awareness and practice of papsmear screening have been directed at the Christianreligious woman. The findings of this study


DOI: 10.1002/pon


indicated that Christian women do not have enoughinformation to take actions for prevention andcontrol of cancer of the cervix. Christian womenseek hope and meaning in life through religiouspractice; there is need to empower them with enoughinformation on cancer prevention and control whenthey come for such programmes.

P-529

Decision-making About Inherited Breast-Ovarian

Cancer Risk: Dimensions of Genetic Responsibility

Holly Etchegary1, Fiona Miller2, Sonya DeLaat3,Brenda Wilson4, June Carroll5, Mario Cappelli6

Memorial University, St. John’s, NL, Canada1,University of Toronto, Toronto, ON, Canada2,McMaster University, Hamilton, ON, Canada3,University of Ottawa, Ottawa, ON, Canada4,MountSinai Hospital, Toronto, ON, Canada5, Children’sHospital of Eastern Ontario, Ottawa, ON, Canada6

OBJECTIVES: To describe how women’s motiva-tions for undergoing BRCA1 or BRCA2 testing isstrongly influenced by notions of genetic responsi-bility. METHOD: 20 semi-structured interviewswere conducted with women from three cancergenetics clinics serving Southern and Central Ontar-io. All had undergone genetic testing for HBOC andreceived results. Interviews covered broad topicareas including genetic test decisions, the impact oftest results, and risk management behaviours.RESULTS: Qualitative data analysis revealed thepervasive significance of genetic responsibility in testdecisions. We highlight three dimensions of geneticresponsibility: 1) to know about the self for self; 2)to know about the self for others; 3) to know aboutthe self to oblige others to know. CONCLUSIONS:Dimensions of genetic responsibility have implica-tions for test decisions, family relationships andother family members’ desire to know (or not know)and to act (or not act) with respect to their owngenetic risk. In particular, genetic responsibility mayplay out as a framing of a relative’s moral obligationto know their risk that could obviate any interestthey might have in not knowing. Perceptions ofresponsibility should be thoroughly explored ingenetic counseling sessions.

P-535

Yoga for Women with Arm Morbidity after Breast

Cancer

Roanne Thomas-MacLean, Susan Robertson,Elizabeth Quinlan, Kent Kowalski, Rita Hamoline,Paul SpriggsUniversity of Saskatchewan, Saskatoon, Saskatchewan,Canada

OBJECTIVES: Arm morbidity remains the pri-mary cause of disability post breast cancer. Women

report both physiological and psychosocial impli-cations that impact paid work, unpaid work,leisure activities and relationships. However, thereare few rehabilitation programs in place forCanadian women. Our research uses a multi-method approach to quantitatively measure andqualitatively evaluate the physical and psychosocialimpact of a gentle yoga program on the well-beingof women with arm morbidity after breast cancer.METHOD: 17 women participated in one of two 8week yoga programs. Three types of arm morbidity(pain, lymphedema, range of motion) were assessedusing the McGill Pain Questionnaire, circumfer-ential and goniometer measurements. Psychosocialimpact of the program was gauged using the Profileof Mood States, Yoga Self Efficacy and SocialImpact of Arm Morbidity questionnaires. Partici-pant journals and two qualitative interviewsgenerated data related to both physical symptomsand psychosocial well-being. RESULTS: With thisposter presentation, we share the findings of thequalitative data, with an emphasis on the partici-pants’ journals. Key themes which emerged fromthe journal analysis include: 1) a need forrehabilitation addressing physical, psychologicaland social interventions; 2) positive experiences ofgroup based exercise interventions; and 3) agrowing and positive awareness of embodimentvia yoga. While different aspects of these themeswere discussed by participants, most journalsdemonstrated improvements in well-being. CON-CLUSIONS: Gentle yoga programs offer muchpotential for improving the overall well-being ofwomen experiencing disability after breast cancer.Our research shows an expansion of this explora-tory study is warranted.

P-537

Using Photovoice in Medical Communications with

Women Breast Cancer Patients in Ontario

H. Burcu Baba, Annette BurfootQueen’s University, Kingston, Canada

OBJECTIVES: The purpose of the project is tounearth significant factors in a short-term, non-structured and qualitative study of the experienceof cancer from the patient perspective to improveour understanding of the psychosocial dynamicsinvolved. Not only may these factors contribute toa holistic understanding of the illness treatmentcycle, they may be used in quantitative, larger scaleand longitudinal studies into quality of care andpatient-based communication in the medical set-ting. METHOD: Participants drawn from a localbreast cancer support group are chosen with thefollowing criteria: female gender; aged from 18 to65 (excluding amendments); diagnosis of malignantbreast cancer or DCIS within six months to nomore than five years; received chemotherapy,


DOI: 10.1002/pon


and/or radiation, and/or radical tumour removal.Each participant will take 36 shots of whateverthey wish and discuss in-group or individually theirfavourite five. Discussions are recorded and noted.RESULTS: Selected images and discussions arecoded and analysed using Atlas.ti software withreference to the discursive framework developedby A. Burfoot (http://www.queensu.ca/sociology/?q5people/faculty/full-time/burfoota) on the basisof her study into mass communication and cancer.This work also forms part of an internationalcollaboration with similar groups in Italy andSaskatchewan. The work here is to be comparedlater to initial results from the 2009 study byJennifer Poudrier and Roanne Thomas MacLeanon breast cancer. CONCLUSIONS: Building onprevious research in media representation of cancerand Photovoice in medical communication, thisresearch reports initial findings from a projectbased in a mid-sized Ontario city of women’sexperience with breast cancer. Discoveries includenew factors in patient-based experience of breastcancer; facilitation of communication betweenhealthcare workers and patients; greater compli-ance with proposed treatment; evaluation ofpatients’ perception of healthcare effectiveness;patient reinsertion in everyday and family life,relationships and work.

P-543

First Experiences With Psychosocial Care Of

Children With Cancer In Croatia

Jelena Roganovic1, Dunja Skoko-Poljak2

Department of Hematology and Oncology,University Children’s Hospital Rijeka, Rijeka, Croatia1,Ministry of Health and Social Welfare, Governmentof the Republic of Croatia, Zagreb, Croatia2

OBJECTIVES: Croatia is a Central European andMediterranean country with a population of about4.4 million people. Each year approximately 150children and adolescents younger than 20 years arediagnosed with cancer. Over the last decades, thecure rate in Croatian pediatric oncology achieveddramatic improvements, with overall survival ofmore than 75%. However, very little attention hasbeen paid to emotional, spiritual and psychosocialcare of affected children and their families. METH-OD: In year 2007, Ministry of the Family, Veterans’Affairs and Intergenerational Solidarity of theGovernment of the Republic of Croatia started thenational program of the psychosocial care ofchildren with cancer and their families. The maingoal is to assure that psychosocial care is integratedinto routine pediatric cancer care in hospitals. Thefinancial resources are provided by the The CroatianHealth Insurance Institute and the Government ofthe Republic of Croatia. RESULTS: In the periodof two years, only two of four centers follow the

program, with psychologists and occupationaltherapists being employed. These centers reportbenefits for the whole family and the staff.Psychologists collaborate with other health careproviders and provide consultation to communitypartners and schools. Two other centers are stillfacing problems with their local hospital manage-ment administration. CONCLUSIONS: Althoughproclaimed as the national strategy, the progress ofpsychosocial care of children with cancer in Croatiais slow. An insufficient number of experts are willingto work in this area as providers and teachers. Aparticular concern is that Croatia lacks comprehen-sive childhood cancer treatment. The Ministry ofHealth and Social Welfare plays a crucial role in thestrategic planning and policy development ofpediatric psycho-oncology at the national level.

P-545

Effective Conflict Management: Implications for

Caregiver/Family Communication and Treatment

Decision Making

Michael Van Slyck, Marilyn SternVirginia Commonwealth University, Richmond,United States

OBJECTIVES: The topics of caregiver/family com-munication and treatment decision-making havebeen addressed through research and practice froma variety of perspectives. However, one domain ofscientific investigation and professional application,with clear implications for each of these topics hasreceived less attention than is warranted. This is thearea of the management of interpersonal conflict asdescribed by Contemporary Social Conflict Theory(CSCT) the potential value of which has beenunderestimated. METHOD: CSCT is contrastedwith conventional views of conflict equating it withbehavior (fighting), viewing it as ‘bad,’ and advocat-ing avoidance to prevent violence. This view is likelyto be the operating stereotype when caregivers andfamilies interact and make decisions and mayinterfere with each of these processes. CSCT viewsconflict differently, considering it to be a cognitivelybased process deriving from individuals’ beliefsabout their needs and interests and their expecta-tions for satisfying them. RESULTS: Conflict isdefined as ‘a perceived opposition of needs andinterests.’ From this perspective, conflict is ubiqui-tous, inevitable–even necessary for change–and thusnot necessarily bad. It is the response to conflict thatis ‘good’ or ‘bad.’ For CSCT, contention (e.g.‘fighting’), is just one of five patterns of responsemodalities or strategies - accommodation, avoid-ance, compromise, and problem solving–are theother ‘conflict management styles’ (CMSs).CONCLUSIONS: The use of each of these CMS’shas implications for how caregiver/family issuesare handled, the manner in which important


DOI: 10.1002/pon


(e.g. treatment) decisions are made, and for com-munication in general. This poster will provideinformation on the CSCT perspective, contrasting itwith conventional views of conflict, and indicatingits implications for and applications to the issues ofcaregiver/family interaction, treatment and otherdecision making, and general communication.

P-548

Psychological Distress Of Women After

Mastectomy: A Follow-Up Study

Ines Giorgi1, Veronica Borelli1, Annalisa Lanza1,Elisabetta Scoccia1, Natale Salvatore Bonfiglio2

Maugeri Foundation IRCCS, Pavia, Italy1, Depart-ment of Psychology University of Pavia, Pavia, Italy2

OBJECTIVES: The principal aim of this work wasto identify the psychological distress in patientswith breast cancer after mastectomy surgery andbreast reconstruction. Furthermore the impact onthe quality of life of different treatments (che-motherapy vs hormonal therapy) was evaluated.METHOD: After a period of six months from thesurgery, a sample of patients was assessed usingBeck Depression Inventory second form (BDI II)and quality of life test (SF 12). The sample wassplit into due groups with different pharmacologi-cal treatments. By t Student test for independentsample we evaluated differences in the investigatedsubgroups. RESULTS: Of our 64 patients (meanage 46, 377, 3), 44 received chemotherapy and 20hormonal therapy. We found high levels ofdepression only in the 20.3%. The cognitive aspectsof depression (25%) are more relevant than thesomatic ones (10.9%). At SF12 the samplereported a mean score of 58.6 in the physical index(PCS) and a mean score of 64.6 in the mental index(MCS). We didn’t find significant differencesbetween groups. CONCLUSIONS: 6 months afterthe surgery, there were depressive symptoms in aquarter of the sample according to the literature.However, on average the sample shows a goodlevel of quality of life. This result probably isinfluenced by the fact that women were assessedduring the final step of reconstruction surgery andthey were free from any pathology and they hadfinished their therapy.

P-549

Mediating Factors in the Relationship between

Insomnia and Cognitive Functioning in Women

Treated for Breast Cancer

Aude Caplette-gingras1, Josee Savard2,Marie-Helene Savard3, Hans Ivers1

Universite Laval, Quebec, Quebec, Canada1, Centrede recherche en cancerologie de l’Universite Laval,Quebec, Quebec, Canada2, Centre hospitalier affilieuniversitaire de Quebec, Quebec, Quebec, Canada3

OBJECTIVES: Recent data from our researchteam suggests that breast cancer patients withinsomnia have poorer cognitive functioning com-pared to good sleepers, but little is known aboutthe factors explaining this relationship. This cross-sectional study, conducted among women withbreast cancer, aimed to assess the mediating role ofPSG-assessed sleep architecture, psychological dis-tress, fatigue and stress in the relationship betweeninsomnia and cognitive functioning, measuredobjectively and subjectively. METHOD: Sixty-seven women treated for breast cancer withsurgery, chemotherapy and radiation therapy andcurrently receiving hormone therapy completed abattery of neuropsychological tests and the follow-ing self-report scales: Cognitive Failures Question-naire, Actual State Scale, Performance RatingScale, Hospital Anxiety and Depression Scale,Multidimensional Fatigue Inventory and twomeasures of life events. Sleep was assessed usingone-night of ambulatory polysomnography record-ing. RESULTS: Number of awakenings (sleeparchitecture) contributed significantly to the rela-tionship between insomnia and objectively assessedverbal and visual memory (betas5 0.11 and 0.04,pso0.05), while anxiety (psychological distress)partly explained the association between insomniaand subjective cognitive functioning (betas5 0.07to 0.31, pso0.05). Fatigue and stress were sig-nificant mediators in the relationship betweeninsomnia and both objective (betas5 0.04 to 0.12)and subjective (betas5 0.07 to 0.24, pso0.05)cognitive measures. CONCLUSIONS: These find-ings raise the possibility that insomnia may inducecognitive impairments in women with breast cancerthrough the influence of numerous variables,including sleep architecture, fatigue, psychologicaldistress and stress. Moreover, mediators varyaccording to the cognitive variable measured, withobjective cognitive functioning being mostly asso-ciated with objective sleep, while subjective cogni-tive functioning is mostly related to subjectiveindices of psychological functioning (anxiety,stress). Future research should assess the contribu-tion of other potential mediators.

P-550

Dyadic Coping Profiles and Adjustment in Couples

at the End of Breast Cancer Treatments

Caroline Besancene, Serge Sultan, Cecile Flahault,Emilie BoujutUniversity Paris Descartes - Laboratoire dePsychopathologie et Processus de Sante (EA4057), Boulogne Billancourt, France

OBJECTIVES: Experiencing breast cancer is achallenge for the patient and the couple, particu-larly at the end of treatments. This study exploresthe association of couples’ coping processes with


DOI: 10.1002/pon


breast cancer adjustment in patients and theirpartners. Marital relationship is conceptualizedwithin systemic communication theory. This studyaims at (1) determining dyadic coping profiles; (2)relating the dyadic coping profiles with dyadicadjustment (emotional distress and negative affectsat the couple level). METHOD: In cross-sectionalstudy, 37 breast cancer patients and partnersrecruited from a specialized unit in Paris (France)completed self-report measures. Coping was mea-sured by the WCC, and psychological and emo-tional dyadic adjustment by mean of each partnerscores from GHQ-28 and PANAS. We used clusteranalysis to define groups based on individualcoping reactions and hierarchical regression topredict dyadic adjustment by dyadic coping clus-ters and congruence/incongruence of individualcoping skills between patients and partners.RESULTS: Results suggest the presence of 3coping clusters in patients (well-balanced, passive,self-sufficient) and 3 other profiles in partners (well-balanced, active, emotional dominant feature), andtherefore 9 possible dyadic associations. Theassociation of ‘self-sufficient’ in patients x ‘active’in partners was related with better psychologicaland emotional adjustment in the overall system.Association of individual coping skills explains asignificant part of dyadic emotional distress.CONCLUSIONS: Dyadic functioning and copingskills should be considered in cancer care andresearch when dealing with breast cancer patients.If we wish to promote dyadic adjustment, it isnecessary to take dyadic coping match into accountto explain adjustment in the overall system.

P-551

Parental Cancer and Caregiving: Burden, Traumatic

Stress and Electrodermal Reactivity

R.J. Teixeira, M.G. PereiraUniversity of Minho - Psychology School, Braga,Portugal

OBJECTIVES: A diagnosis of cancer affects notonly the patient but also their significant others,especially when caregiving tasks are involved.Some caregivers perceive care as a burden, whileothers consider it a challenge. The purpose of thisstudy was to describe how parent’s cancer affectsadult children caregivers, particularly in terms ofpsychosocial and physiological variables includinggender and perception of parent’s dependency.METHOD: A total of 78 adult children of cancerpatients, receiving chemotherapeutic treatment,participated in the study. The average age is34.18 (SD5 9.32), 77% were female. Instrumentsused were: Impact of Event Scale-Revised (Weiss &Marmar), Burden Assessment Scale (Reinhart &Horwitz, 1992) and Posttraumatic GrowthInventory (Tedeschi & Calhoun, 1996) and a

biofeedback display (Physiolab) using the Interna-tional Affective Picture System (Lang, Bradley, &Cuthbert, 2008). RESULTS: A negative correlationbetween posttraumatic growth and skin conduc-tance baseline (po0.05) was found. Also, percep-tion of level of parent’ dependency was related totraumatic stress (po0.01), burden (po0.01) andpost traumatic growth (po0.05). Significant differ-ences were found on adult children caregivers basedon gender i.e. women presented higher levels oftraumatic stress (po0.05), burden (po0.05), andelectrodermal reactivity (po0.01) compared tomen. CONCLUSIONS: Caregiving has been asso-ciated with risks of stress-related psychological andphysical illness over the life span. Skin conductanceis considered a good indicator of perception ofstimuli stressors and is associated with deregulatedphysiological stress responses that may represent amechanism linking caregiving, especially on wo-men, to health outcomes. These results reveal theimportance of intervention on adult children ofcancer patients, especially in terms of stressmanagement and family burden.

P-558

Knowledge, Attitude and Behavioural Practices among

Illegal Immigrants Commercial Motorcycle Riders

Towards Tobacco Smoking and Cancer in Ibadan

Mcivir Joyce Tondo, Chioma C. Asuzu,Ikechukwu B. AwusahUniversity of Ibadan, Ibadan, Oyo State, Nigeria

OBJECTIVES: To assess the level of awareness oftobacco smoking as a predisposing factor to cancerdiagnosis among illegal commercial motorcycleriders. To determine the attitude of these commer-cial motorcycle riders to tobacco smoking as itrelates to cancer diagnosis. To identify if there isany relationship between knowledge that tobaccosmoking is a predisposing factor to cancer diag-nosis and the behavioural practices of thesecommercial motorcycle riders. METHOD: Due tomigration status, access to the population for thestudy was limited thereby bringing the total samplesize to 41 participants. A 38-item-questionnairewas developed and used for the study, Knowledge,Attitude and Behaviour Questionnaire (KABQ).RESULTS: The study found 75–93% of partici-pants to be ardent smokers. There was a significantlinear relationship between knowledge and attitudeat (po0.05). There was no significant relationshipbetween knowledge and behaviour at (p40.05).CONCLUSIONS: This study reveals that, theillegal immigrants are generally illusive due to theirproblems with the law. A mode for interventionand counselling to aid habit cessation was recom-mended as most of these illegal immigrantsindicated a desire for positive change in behaviourif there are supportive incentives.


DOI: 10.1002/pon


P-570

A Randomized, Double-blind Placebo-Controlled

Study Evaluating the Efficacy of lovaza (Omega-3-

acid-ethyl esters) Compared to Placebo for the

Treatment of Depressive and Anxiety Symptoms in

Patients with Breast Cancer

Jayesh Kamath, Alok Banga, Susan Tannenbaum,Kevin Claffey, Wanli Zhang, Andrew WinokurUniversity of Connecticut Health Center,Farmington, Connecticut, United States

OBJECTIVES: Depression in cancer patients has beenassociated with significant morbidity and devastatingeffects on quality of life. Evidence suggests a role forinflammation in the pathophysiology of cancer-depression. Anti-inflammatory effects of omega 3FA are well documented and studies have reportedbeneficial effects of omega 3 FA on depression. In thepresent study, we plan to evaluate the efficacy ofomega 3 FA compared to placebo to treat depressionin patients with breast cancer. METHOD: This is apilot, randomized, double-blind, placebo controlledstudy. Women, 18 years or older, with breast cancerare eligible if determined to experience clinicallysignificant depression based on interview and HospitalAnxiety and Depression (HADS) depression subscalescore X10. Patients are treated over a 12-week periodwith flexible dosing for lovaza (2–4gms) and escita-lopram (10–20mg). Primary outcome measures in-clude HADS and the Montgomery-AsbergDepression Rating Scale (MADRS) assessed everytwo weeks. RESULTS: We plan to enroll 95 patientsover a two year period. Patients are being enrolled andare randomized into one of the three groups i.e. thelovaza (omega 3 FA) group [n538], the placebo[n538], and the antidepressant control, escitalopram,group [n519]. Samples (blood and serum) are beingcollected to measure cytokine and other markers ofinflammation and salivay cortisol levels. Literaturereview supporting study hypotheses, study design, andpreliminary findings will be presented. CONCLU-SIONS: Evidence supporting anti-inflammatory ef-fects of omega 3 FA and its role in the treatment ofcancer-related depression will be discussed. Patientexperiencing cancer are often unwilling to considerprescription antidepressants but are open to naturalproducts such as omega 3-FA. To our knowledge, thisis the first study evaluating the role of omega 3 FA inthe treatment of depression in patients with cancer andis the first step towards larger, long term studies.

P-572

What is the Prevalence of Depression in Cancer and

Palliative Care? A Meta-analysis of Studies Using

ICD10 and DSMIV Definitions

Alex J Mitchell1, Nick Meader1

University of Leicester, Leicester, United Kingdom1,University College London, London, United Kingdom2

OBJECTIVES: There have been several narrativereviews and many opinions about the prevalence ofdepression in cancer settings. In particular it isoften thought that depression is substantially morecommon in late stage cancers. We aimed toundertake a definitive meta-analytic summary ofsuch studies. METHOD: We searched for studiesthat used a robust DSMIV or ICD10 standard. ForDSMIV a minimum of 5 symptoms is required formajor depressive disorder (MDD) and in ICD10 aminimum of 4 symptoms is required for adepressive episode (F32). We identified 36 uniquestudies, although only 7 used ICD10 criteria.RESULTS: Across all 36 studies the prevalenceof depression was 21.7% (95% CI5 17.4% to26.3%). In mixed stages mostly early) the pre-valence rate was 21.6% (95% CI5 15.8% to28.0%) and in late stages (mostly palliative)21.8% (95% CI5 16.3% to 27.8%). For DSMIVdefined MDD the prevalence was 20.9% (95%CI5 16.0% to 26.2%) and for ICD10 23.5% (95%CI5 16.9% to 30.8%). CONCLUSIONS: Largedifferences in prevalence according to stages ofcancer may be a methodological artefact that nolonger applies when examined by robust methods.We had insufficient data to look at type of cancer.There may be a slight difference according to thedefinition of depression in DSMIV vs ICD10.

P-573

Do Disease or Cultural Variables Influence

Perceived Distress in Cancer? A Path analysis of

Predictors from an Ethnically Diverse UK Setting


OBJECTIVES: Despite much research describingdistress there is relatively little on predictors ofdistress. Here we aim to examine basic disease,demographic and cultural predictors of distress.Distress was patient rated by the Distress Thermo-meter (DT) and analysis adjustment for allsuspected interactions between predictors usingPath analysis technique (AMOS5). METHOD:We analysed data collected from Leicester CancerCentre from 2008–2009 involving approximately1000 people approached by a research nurse andtwo therapeutic radiographers. Of those ap-proached we collected data on 469 presentations,that is people seen up to three times over 9 monthsduring treatment for cancer. We had complete dataon 444. We examined the following factors:treatment intent (radical vs palliative), gender,ethnicity, cancer type, cancer duration. RESULTS:After adjustment for internal inter-correlations, themost powerful independent predictor was ethnicity(estimate5 0.284; po0.001), followed by gender(estimate5 0.175; po0.001). Treatment intent(a proxy for cancer stage) had a small influence


DOI: 10.1002/pon


(estimate5 0.122;po0.05). Disease type and dura-tion were not appreciable influences. CONCLU-SIONS: In our clinically representative diversesample, severity of distress appears to be relatedmore to ethnicity and gender than disease relatedvariables. Further work is required to understandwhy cultural variables strongly influence distress.

P-574

Feelings, Coping Strategies and Health Behaviours

After Breast Cancer Diagnosis

Tayebeh Fasihi Harandi1, Fazlollah Ghofranipour1,Ali Montazeri2

Department of Health Education, Faculty ofMedicine, Trabiat Modares University, Tehran,Islamic Republic of Iran1, Department of MentalHealth, Iranian Institute for Health Sciences Re-search, ACECR, Tehran, Islamic Republic of Iran2

OBJECTIVES: To explore feelings, coping strate-gies and health behaviors after cancer diagnosisamong a sample of Iranian breast cancer survivors.METHOD: This was a qualitative study. In-depthsemistructured interviews conducted with 39 breastcancer survivors (at least one year after diagnosis)to collect data. Patients were no longer undergoingactive invasive treatment. RESULTS: Almost allparticipants believed that anxiety, stress, a sensitivepersonality and stressful life events were respon-sible causes for their disease on sent. However,most patients attributed their cancer to the will ofGod. In addition it was found that most partici-pants held strong spiritual position and used thisforce to help them accept that their cancer might becured. Most women indicated that they have beenactively engaged and showed adherence to theirmedical treatment. CONCLUSIONS: Religiousityand spirituality play an important role for Iranianbreast cancer patients to cope with their diseaseand even actively pursue their treatment. The ideaof an external health locus of control was notsupported in this study.

P-575

Clinical Experience of the Modified Nurse-Assisted

Screening and Psychiatric Referral Program

Ken Shimizu1, Yosuke Uchitomi2

National Cancer Center Hospital, Tokyo, Japan1,National Cancer Center Hospital East, Kashiwa,Japan2

OBJECTIVES: We previously reported that thenurse-assisted screening and psychiatric referralprogram (NASPRP) facilitated the psychiatrictreatment of depressive patients, but the highrefusal rate was a problem even though referralwas recommended all positively screened patients.We modified the program so that the nurses could

judge the final eligibility of referral using the resultof the screening. This study assessed if the modifiedNASPRP led to more psychiatric referral ofdepressive patients. METHOD: We retrospectivelyevaluated the annual change of the psychiatricreferral proportion, and compared the findingsamong the usual care term, the NASPRP term, andthe modified NASPRP terms. RESULTS: Thereferral proportions of the modified NASPRPterms were 4.4% and 3.9%. These were notsignificantly higher than the usual care term(2.5%), and significantly lower than the NASPRPterm (11.5%). CONCLUSIONS: The modifiedNASPRP did not facilitate psychiatric treatmentof depressive patients and other approach isneeded.

P-576

Health Related Quality of Life of Children and

Adolescents with Cancer Immediately after end of

Treatment

Vivian Engelen1, Hendrik Koopman2, SymoneDetmar3, Marianne van de Wetering4, Paul Brons5,Robert Bredius6, Floor Abbink7, Hein Raat8,Martha Grootenhuis1

Psychosocial Department Emma Children’sHospital, Amsterdam, Netherlands1, MedicalPsychology, Leiden, Netherlands2, TNO Preventionand Health, Leiden, Netherlands3, PediatricOncology Department, Amsterdam, Netherlands4,Radboud University Medical Center, PediatricOncology Department, Nijmegen, Netherlands5,Leiden University Medical Center, Leiden,Netherlands6, VU University Medical Center,Amsterdam, Netherlands7, Department of PublicHealth, Erasmus University, Rotterdam, Netherlands8

OBJECTIVES: Health related quality of life(HRQOL) in children and adolescents with cancer,immediately after end of treatment, has only beenstudied to a limited extend. Aim of this study is togain more knowledge in parent-reported and self-reported HRQOL of children and adolescents thathave recently finished cancer treatment. METH-OD: Children or parents aged 0–18 years wererequested to complete HRQOL questionnaires 0 to2 months after finishing treatment: 0–4 years:ITQOL, proxy report 5–7 years: CHQ PF-50,proxy-report; 8–18 years: Kidscreen, self-report.Parental impact is also measured for the 0–7 yearolds. HRQOL data of children with cancer werecompared with the Dutch norm populations bymeans of independent t-tests and one-sample t-tests. RESULTS: In total, 272 children with cancerfrom four academic medical centers in the Nether-lands were approached. Eventually, 190 (70%)children (M5 9.2 years of age, 47.9% girls)completed the HRQOL questionnaires. Youngchildren have decreased HRQOL scores, however


DOI: 10.1002/pon


older children and adolescents show no differencesor even score better than the norm. This contrastbetween proxy and self-report, children scoringhigher than parents is shown again. Moreover,parents report lower HRQOL on health percep-tion, emotional and time scales. CONCLUSIONS:Parental worries are dominantly reflected in theITQOL and the CHQ, and childhood resilience ismirrored in the Kidscreen. Parents haveconcerns about the future, while children seem tolook back and are eager to continue their normallives again.

P-584

Psychological Distress in Patients with Benign and

Malignant Breast Diseases

Mariam Vahdaninia1, Iraj Harirchi2, SepidehOmidvari3, Ali Montazeri3

Department of Social Medicine, Iranian Institute forHealth Sciences Research, ACECR, Tehran, IslamicRepublic of Iran1, Department of Surgery, TehranUniversity of Medical Sciences, Tehran, IslamicRepublic of Iran2, Department ofMental Health, Iranian Institute for HealthSciences Research, ACECR, Tehran, Islamic Re-public of Iran3

OBJECTIVES: To compare anxiety and depres-sion among patients with benign and malignantbreast diseases. METHOD: This was a prospectivestudy of psychological distress among all womenwith breast diseases attending to the breast clinic ofa large teaching hospital during one completecalendar year in Tehran, Iran (n5 316). Psycholo-gical distress was measured using the HospitalAnxiety and Depression Scale (HADS) at twopoints in time: at attendance (pre-diagnosis) and 3months follow-up. Scores for anxiety and depres-sion range from 0–21, with higher scores indicatinggreater symptoms. RESULTS: 167 patients diag-nosed with breast cancer and 149 patients as havingbenign breast diseases. At pre-diagnosis there wereno significant differences in anxiety between twogroups while breast cancer patients showed higherdepression (p5 0.01). At 3 months assessment,breast cancer patients showed higher scores onboth anxiety and depression(mean anxietyscore:10.3 vs. 5.1, po0.001; depression: 6.2 vs.1.6, po0.001). However, anxiety and depressionremained unchanged among breast cancer patientsbefore and after diagnosis whereas in benignbreast diseases anxiety and depression decreased(po0.001). CONCLUSIONS: The findingssuggest that perhaps cancer diagnosis itself doesnot impose additional anxiety and depressionand rather psychological distress might be apredisposing factor for developing breast cancerlater in life.

P-588

A Study of Compassion Fatigue, Compassion

Satisfaction and Spiritual Health among Nursing

Staff in Hospital Ward

Ya Hua Hsu, Mei ching ChenFu-Jen Catholic University College of Medicine,Taipei, Taiwan

OBJECTIVES: This study explored the compas-sion fatigue, compassion satisfaction, burnout andspiritual health among nursing staff in hospitalward. METHOD: The questionnaire was used tocollect data. The 200 participants were recruitedfrom hospice, pediatrics, intensive care unit andmedical ward nursing staff that has been workingin northern and eastern area of Taiwan. A total of250 questionnaires were distributed and 200 ofthem were counted valid. RESULTS: The result ofthis study showed that participants have extremelyhigh risk of compassion fatigue, extremely low riskof burnout, and modest potential for compassionsatisfaction. There is significant relationship be-tween compassion fatigue and self-appraisal stateof health among nurse. Self-appraisal state ofhealth, family support played significant impacton Compassion satisfaction. This research alsorevealed that a significant positive correlationbetween compassion fatigue and burnout; and asignificant negative correlation between compas-sion fatigue and spiritual health. CONCLUSIONS:Further findings were compassion fatigue couldincrease burnout risk, but spiritual health couldreduce burnout risk and increase compassionsatisfaction. It indicated that compassion fatiguewas a better predictor to burnout; and betterspiritual health reduce burnout among nursingstaff. Therefore spiritual health can buffered theburnout arise.

P-590

Cancer Under the Radar: A Book Project to Raise

Awareness About Young Adult Cancer

Gwynneth Gorman, Jane ShulmanCedars CanSupport, Montreal, Canada

OBJECTIVES: Young adults are a minoritypopulation within the adult oncology world, there-fore having their voices heard is paramount tothem feeling a sense of hope with regards toincreasing the resources available to them while intreatment. In response to this need a two partproject was initiated, to first produce a book, thento publicly launch it. METHOD: This book is acollection of art, photos, poetry and prose sub-mitted by 15 young adult oncology patients as amethod of communicating in a creative way aboutthe impact of cancer at this stage in their lives. Thecoordination of a book launch not only promoted


DOI: 10.1002/pon


the book itself but also provided a platform forraising awareness regarding the unique psychoso-cial needs of young adult oncology patients.Attendees included multidisciplinary medicalprofessionals and the Montreal community.RESULTS: Both qualitative and quantitative datawill be provided to highlight the impact of thisprocess for the contributing young adult authorsbut also to discover in what way this processincreased awareness within the medical and publiccommunities. CONCLUSIONS: Delegates willhave an opportunity to view this creative resourceand gain information about an effective mediumfor connecting the medical community and alteringpublic perceptions about young adult cancer.Ultimately this will work towards providing amore tailor-made approach when working withthis population.

P-593

Benefit Finding In The Pediatric Oncology

Experience - Caregivers and Patients

Janine V. Moseley-Giannelli1, Wolfgang Linden1,Dina McConnell2, Joanna Chung2

University of British Columbia, Vancouver, Canada1,BC Children’s Hospital, Vancouver, Canada2

OBJECTIVES: Due to new multimodal treatmentapproaches, survival rates for pediatric cancerpatients have dramatically improved. Unfortu-nately, survivorship status comes with its ownstressors for this population and their caregivers.Positive thinking is increasingly being appreciatedfor its ability to cope with stress and elevate mood.This study explores the impact of several positivepsychology variables in caregivers and adolescentpatients. Benefit finding as a predictor of goodadjustment was explored in depth. METHOD:One-hundred fifty-six caregivers of pediatric oncol-ogy patients (aged 2 to 17 years) were recruited forthis study. This sample is evenly divided into ‘on’versus ‘off’ acute treatment populations, and‘urban’ versus ‘rural’ populations, resulting in foursubgroups (n5 39). Forty interested adolescentpatients also responded. Questionnaires sampleddemographic variables, various types of positivethinking, and emotional adjustment. RESULTS:Caregivers and teens typically endorsed ‘moderate’benefit finding (‘BF’). BF scores did not differaccording to treatment status or proximity ofresidence. Caregiver BF correlated significantlywith feelings of mastery (r5 0.17), hope(r5 0.34), and happiness (r5 0.29). After adjust-ment for demographic variables, BF together withperceptions of ‘challenge’, ‘mastery’, and ‘hope’explained significant additional variance inhappiness (R5 0.549). Adolescent BF did notcorrelate with quality of life but did significantlycorrelate with caregiver-matched BF scores

(r5 0.39). CONCLUSIONS: Data support theassociation between positive thinking and moodenhancement. As for patient quality of life, morethan positive thinking is likely needed to yieldmaximal psychological adjustment. Having one’sneeds met in areas of information provision,emotional and instrumental support, and resourceallocation is likely critical. We also accumulatedthese data for future in-depth analyses.

P-597

Impact of a Mindfulness-Based Stress Reduction

(MBSR) Program on Posttraumatic Growth (PTG),

Spirituality, and Mindfulness in Cancer Patients:

A Waitlist-Controlled Study

Linette Lawlor-Savage1, Laura Labelle1, TavisCampbell1, Linda Carlson1

University of Calgary, Calgary, Alberta, Canada1,Department of Psychosocial Resources, Tom BakerCancer Centre, Calgary, Alberta, Canada2

OBJECTIVES: Previous research suggests thatMindfulness Based Stress Reduction (MBSR), an8-week group psychosocial intervention, may en-hance spirituality and Posttraumatic Growth(PTG) in cancer patients. Enhanced spiritualityand PTG may contribute to improvements in longterm psychosocial adjustment. Mindfulness isposited as a key mechanism of action of MBSRhowever this hypothesis has not been adequatelytested. This aim of this study is to assess the impactof MBSR on PTG, spirituality and mindfulness incancer patients. METHOD: A longitudinal wait-list-controlled study was conducted to test thehypothesis that increased mindfulness would med-iate the impact of MBSR on spirituality and PTG.One hundred and six patients (mostly female) witha diagnosis of cancer (mostly breast) were assessedpre-, mid-, and post-MBSR intervention (n5 62)or 8-week waiting period (n5 44). Five key aspectsof mindfulness were measured using the Five FacetMindfulness Questionnaire (FFMQ) subscales.RESULTS: Results indicated that MBSR partici-pation compared to the waitlist condition wasassociated with increased spirituality (F5 10.67,po0.001) and mindfulness (FFMQ-Observe:F5 15.70, po0.001; FFMQ-Describe: F5 8.51,po0.001; FFMQ-Act: F5 4.78, po0.05; FFMQ-Nonjudge: F5 12.86, po0.05; FFMQ-Nonreact:F5 16.87, p5 0.001) but not PTG. Changes in fourmeasures of mindfulness partially mediatedchanges in spirituality (FFMQ-Observe: t5 4.44,po0.001; FFMQ-Describe: t5 3.47, po0.001;FFMQ-Act: t5 2.08, po0.05, FFMQ-Nonreact:t5 2.59, po0.05). CONCLUSIONS: This is thefirst controlled study to demonstrate an associationbetween MBSR participation and enhanced spiri-tuality in cancer patients. Findings suggest thatspirituality may be enhanced through learning to


DOI: 10.1002/pon


maintain awareness of moment-to-moment experi-ence in an accepting manner.

P-604

Supportive Care in Oncology: Effectiveness Evidence

for the Schultz’s Autogenic Training

Sara Mella, Daniela Narciso, Barbara Muzzatti,Maria Antonietta Annunziata, Luigi GrassiCentro di Riferimento Oncologico - National CancerInstitute, Aviano (PN), Italy

OBJECTIVES: Reduction in anxious and depres-sive states, relaxation, body functions’ regulation,pain control, self-determination facilitation areseveral effects of the Schultz’s Autogenic Training(AT) described in literature that encourage its usein oncology as a supportive care. In the presentwork the published experimental literature aboutthe application of AT in oncology is reviewed tocollect data about its both diffusion and effective-ness in this domain. METHOD: Combinations ofthe words ‘autogenic training’, ‘cancer’, ‘oncology’,‘neoplasm’, were used to select records in MedLine,PsycInfo, Scopus, and Cinahl databases. Filesabout children, school aged subjects and teenswere dropped. RESULTS: Despite more frequentcitations of TA in papers about supportive care inoncology and more numerous clinical reports(usually published in journals not accessible bythe mentioned databases), three papers met theinclusion criteria and they were presented in theircontents an limitations. Many reasons (e.g. poorknowledge about TA; methodological problems inclinical psychology research and intervention as-sessment; needs for technique adaptations) canhelp in understanding this datum. CONCLU-SIONS: Although TA seems to be a usefulsupportive care in oncology from both a theoreticand clinical point of view, more empirical researchis recommendable. In general TA suffers from thesame problems in effectiveness assessment comingfrom other psychological interventions, includingpsychotherapy.

P-605

Psychosocial Service Utilization By Cancer Patients

Chih Huei Choo, Ming Hui Cheryl Ng, RoshayatiMingoo, Julia OngKK Woment’s and Children’s Hospital, Singapore,Singapore

OBJECTIVES: There is plan to start a psycho-oncology service in our institution to meet theneeds of cancer patients. The aim of this study is tosurvey the use of psychosocial interventions bylooking at referrals to psychiatrists, medical socialworkers and psychologists. The results of this studywill help to project resources required for the new

psycho-oncology service. Outcome of the newservice can be compared with this baseline datato measure the impact of the new services.METHOD: This is a retrospective case notes studyof the utilization of mental health services in cancerpatients seen at our institution over a one yearperiod in 2008. The cases are identified by newcases referral registers kept by the respectivedepartments. The case notes will be traced andthe relevant data extracted. The data will beanalysed using SPSS. RESULTS: The results of176 cases analyzed showed the referral rates to thevarious professionals are: medical social worker146(83%), psychiatrist 20(11%) and psychologists22(13%), with 12 patients having referrals to morethan one professional. The reason for referrals aremainly for practical issues - financial difficulties85(48%) and care arrangement/referral to externalagencies 21(12%). There are 41(23%) referrals foremotional distress. There were 764 newly diag-nosed cases, out of which 95(12%) cases werereferred. CONCLUSIONS: The referral rate forpsychosocial intervention is low. Most of thereferrals are to the medical social workers forpractical issues such as financial problems, carearrangement/referral to external agencies. There ishidden morbidity among this group of patients forwhich psychosocial interventions can be beneficial.The challenges for planning the new service includeincreasing the awareness of roles of psychosocialinterventions in cancer care and balancing theincrease in referrals with limited resources.

P-611

Psychosocial and Psychological Needs of Rectal

Cancer Patients Treated with Brachytherapy: A

Prospective Observational Cohort Study

Sylvain Neron1, Rosberger Zeev1, Niazi Tamim2,Raz Amir3, Benc Renata2, Vuong Te2

Louise Granofsky Psychosocial Oncology Program -Segal Cancer Centre - Jewish General Hospital,Montreal, Quebec, Canada1, Radiation OncologyDepartment - Jewish General Hospital, Montreal,Quebec, Canada2, Clinical Neuroscience andApplied Cognition Laboratory - Department ofPsychiatry - Jewish General Hospital, Montreal,Quebec, Canada3

OBJECTIVES: A literature review demonstratedan absence of studies examining the psychosocialneeds of rectal cancer patients while receiving highdose rate brachytherapy. Existing research hasfocused on the long-term treatment side effectsand on quality of life as opposed to the experienceof these patients during the brachytherapy.This poster will present the development of aprospective observational study to provide adescriptive profile of their emotional, cognitiveand physical experience during the brachytherapy.


DOI: 10.1002/pon


METHOD: 25 patients will complete self-reportquestionnaires and visual analogue scale of moodand anxiety before and after the brachytherapy,and verbal anxiety and pain rating scales will beadministered at 4 time points during treatment. Ontreatment completion, patients will be assessedusing a semi-structured interview. The interviewdata will first will read independently by tworesearch team members and categorized accordingto emergent themes. The data will be analyzedusing an interpretive description method. RE-SULTS: Basic descriptive descriptions will includecohort and bivariate analysis and test for internalconsistency of self-report questionnaires. Quanti-tative analyses of socio-demographic data, self-report questionnaires and analog scales will be usedto test for pre-post, and intra-procedure in painand anxiety. Using descriptive and interpretivemethods, qualitative data analysis will examinepatients’ subjective description of discomfort.CONCLUSIONS: The results from the mixedmethod of data analysis will be used as a basis todesign interventions to reduce discomfort experi-enced by rectal cancer patients during brachyther-apy. Adding to the quantitative observations, thequalitative data will provide a detailed, richexperiential profile of the brachytherapy proce-dure. This study will also be the first to investigateand report on the experience of rectal cancerpatients during brachytherapy.

P-619

Smoking Cessation is Associated with Transient

Aggravation of Insomnia Comorbid with Cancer

Josee Savard, Hans IversUniversite Laval, Quebec, QC, Canada

OBJECTIVES: Nicotine withdrawal increases therisk for insomnia in the general population, butthis question has never been investigated in cancerpatients, who are strongly advised to quit smokingin order to decrease the risk of cancer recurrence.This presentation aims at investigating the effect ofnicotine withdrawal on insomnia in cancer pa-tients. METHOD: All patients scheduled to under-go surgery after a first diagnosis of non-metastaticcancer were solicited at their pre-operative visit.Among the 3196 patients approached, 1681 werefound eligible and 962 (57%) accepted to partici-pate. The participants completed the InsomniaInterview Schedule, a health behavior question-naire and the Insomnia Severity Index (ISI) atbaseline, 2, 6, 10, 14 and 18 months. The sleepquality of quitters and non-quitters was comparedusing split-plot mixed models. RESULTS: WhileISI scores decreased in non-quitters (n5 120; from9.5 to 9.3 at post to 8.3 four months later), inquitters (n5 55) they increased from 8.5 to 9.5

(p5 0.20, ES5 0.16) and then returned to baselinelevels (8.1). Among quitters, those who were goodsleepers at baseline had a significantly greaterincrease of ISI scores (from 5.2 to 8.3; po0.02,ES5 0.57) as compared to those with insomnia(from 10.7 to 10.6; ns). CONCLUSIONS: Nicotinewithdrawal appears to be associated with atransient aggravation of insomnia symptoms,in particular in patients having good sleep atbaseline.

P-620

A Proposed Coping Skills Intervention Program for

Adolescents and Young Adults with Cancer

(AYAC): Results of a Preliminary Survey

Aubin Sylvie, Rosberger ZeevLouise Granofsky Psychosocial Oncology Program,Jewish General Hospital, Montreal Quebec, Canada

OBJECTIVES: Recent studies have consistentlyshown that AYAC face unique physical (i.e.unabated high levels of morbidity and mortality)and psychosocial challenges (e.g. fertility, sexual-ity). Moreover, over 50% of the psychosocial needsof AYAC remain unmet and interventions pro-grams specialized in AYA oncology are lacking.We present preliminary results of a survey askingAYAC to evaluate a proposed coping skillsintervention program aimed at enhancing theirmanagement of cancer-related challenges.METHOD: The proposed intervention programconsists of 3 sessions. Session 1 focuses onnavigation of the medical system and effectivedecision-making/problem-solving. Session 2focuses on emotional management, and Session 3focuses on fertility, sexuality and relationshipsissues after cancer. In addition, AYAC are pairedwith other age-matched AYAC for further sup-port. The proposed intervention program wasevaluated by AYAC seen at the McGill Adolescentand Young Adults Oncology clinic using ananonymous survey. RESULTS: Twenty-eightAYAC age (range 21–43; mean5 30.33) rated thecontent and potential impact of the proposedintervention program on a number of dimensions.The results showed mean expected improvement indomains of self-confidence, mood and relationshipswith family, friends and the spouse/partner. More-over, the majority (68%) of AYAC desired to meetwith an aged-matched AYAC. Location and timeconstraints were reported as the main obstacles toparticipation. CONCLUSIONS: Survey resultsprovided valuable information about the potentialbenefits of a coping skills intervention programdesigned for AYAC. Overall, the proposed inter-vention was appealing to our target population forits potential to improve their quality of life. Moreimportantly, identified obstacles to participation


DOI: 10.1002/pon


present new opportunities to integrate currenttechnologies used by AYA (e.g. texting, twittering,webcams, etc), and to evaluate their utility asmodalities for the delivery of the interventionprogram.

P-631

Recruitment Challenge in an Existential

Psychotherapy Intervention

Gagnon, P4, Fillion, L3, Blais, M-C5, Tardif, F1,Benoit-Bousquet, L2

Maison Michel-Sarrazin, Quebec city, Quebec,Canada1, Laval University Cancer Research Centre,Quebec city, Quebec, Canada2, Research Center ofcentre hospitalier universitaire de Quebec (CHUQ) -l’Hotel-Dieu de Quebec, Quebec city, Quebec,Canada3, Departement/Faculty of pharmacy,Laval University, Quebec city, Quebec, Canada4,Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada5

OBJECTIVES: Background: recruitment rates inpsychotherapy studies often compromise theachievement of significant results. However, onlya few reports dealt directly with this problematicissue. Purpose: To describe recruitment methodsused in a randomized cognitive-existential study fornon-metastatic cancer patients. METHOD: Wedescribe the strategies and difficulties encounteredin the recruitment of 99 patients for a randomized12-session cognitive-existential intervention. Thesestrategies were (1) Local Advertising: posters/flyers, informing local organizations/associations.(2) Promoting the study to the public: Interviews intelevision/radio/newspapers, advertising in news-papers, mailing lists. (3) Promoting the study tomedical staff. (4) Indirect methods: word of mouth,recruiting in waiting rooms. (5) Follow-up meth-ods: Letters to related medical staff followingenrollment, reminders E-mail. RESULTS: Amongthe 84 participants who reported how they heardabout the study, more than half (55%, n5 47) ofthe participants said they were recruited throughthe second method, especially publicity in news-papers. 18% (n5 16) of the participants wererecruited with local advertising (1) compared to8% (n5 7) through medical staff (3) and 16%(n5 14) with the indirect method. CONCLU-SIONS: Promoting the study to the public(2) is the most efficient mode of recruitment inour psychotherapy intervention so far (64%).Direct recruitment coming from cancer units andmedical staff, while necessary, remain a scaresource of participants. These strategies should beconsidered seriously and revised periodically toavoid a poor recruitment rate which wouldjeopardize otherwise carefully designed and im-portant studies.

P-633

Innovations in Interdisciplinary Care Delivery:

Integrating a Comprehensive Psychosocial Oncology

Program in an Expanding Cancer Care Centre

Neron Sylvain, Strohschein Fay J., Ptack Allan,Aubin Sylvie, Bond Sharon, Henry Melissa, KleinTobi, Loiselle Carmen G., Minorgan Judith,Rosberger ZeevLouise Granofsky - Psychosocial OncologyProgram, Segal Cancer Centre, Jewish GeneralHospital, Montreal, Quebec, Canada

OBJECTIVES: There is an increasingly importantneed to establish clinical psychosocial oncologyprograms which integrate expert clinical knowledgeand research in the provision of high quality,timely psychosocial care to oncology patients andtheir families. We describe innovations in caredelivery by an interprofessional, interdisciplinaryteam of psychosocial oncology professionals de-signed to meet patient and family needs in anexpanding urban university-affiliated cancer centerserving local, regional and provincial needs.METHOD: We established an interdisciplinaryprogram within the cancer centre’s organizationalstructure to provide both psychosocial care andconsultation to tumour site teams. An InteractiveElectronic Health Record (IEHR) allows for realtime communication, and the generation of adatabase from which quality of care informationand best practice audits are obtained. The datafacilitate efficiencies in consultation response time,and outcomes analysis, both in terms of under-standing referral population demographics andquality assurance. RESULTS: Implementation ofthe IEHR led to innovations including a compre-hensive referral form designed to enhance aninnovative triage system. Additional developmentsinclude a distress screening program, monthlyclinical/academic team meetings to achieve con-sensual, coordinated case management, and weeklyadministrative meetings. These innovations servedto optimize patient and family access (in- and out-patient) to expertise of psychosocial oncologyprofessionals capable of addressing their specificconcerns and to provide timely crisis managementwhen appropriate. CONCLUSIONS: This com-prehensive model of interprofessional interdisci-plinary communication brings togetherpsychosocial oncology professionals (e.g. psychol-ogists, social workers, nurses, psychiatrists, sexol-ogists and chaplaincy, etc.) with significantexpertise to foster mutual support, innovation,cross-fertilization, quality and continuity in clinicalcare and research. Ongoing work strives to developteam identity while supporting integration ofpsychosocial care to patients and families withintumour site teams, as a critical component of thecancer care centre’s overall mission.


DOI: 10.1002/pon


P-637

Delirium Subtypes In Hospitalized Cancer Patients:

Prevalence And Evolution

Jean-David Gaudreau1, Pierre Gagnon1, Marc-Andre Roy2, Finn M. Radtke3

Centre de Recherche en Cancerologie de l’UniversiteLaval and Centre de recherche du Centre HospitalierUniversitaire de Quebec (CHUQ) - L’Hotel-Dieu deQuebec (HDQ), Quebec City, Canada, Quebec City,Canada1, Centre de Recherche Universite LavalRobert-Giffard, Institut universitaire en sante mentale,Quebec City, Canada, Quebec City, Canada2, Klinikfur Anasthesiologie mit Schwerpunkt operativeIntensivmedizin, Charite - Universitatsmedizin Berlin,Campus Virchow-Klinikum und Campus, ChariteMitte, Augustenburger Platz 1, Berlin, Berlin,Germany3

OBJECTIVES: Delirium is a psychiatric complica-tion frequently seen in hospitalized cancer patients.Delirious patients can be classified in three subtypesbased on their psychomotor activity: hypoactive,hyperactive, and mixed. Based on the NursingDelirium Screening Scale (Nu-DESC) validationstudy, we have developed an algorithm thataccurately classified all delirious patients regardingtheir psychomotor subtype in comparison to theMemorial Delirium Assessment Scale. We haveendeavored to establish delirium subtype preva-lence and evolution based on this algorithm.METHOD: We have determined the prevalence ofeach subtype in 140 consecutive incident cases ofdelirium in a post-hoc analysis. We have alsofollowed-up in survival analyses 113 hypoactive/mixed of these patients with repeated assessmentsusing the Nu-DESC for incident hyperactivedelirium since a first hypoactive/mixed event. Theassociations between baseline variables and theoccurrence of hyperactive delirium were computedusing Cox regression models. RESULTS: Of 140incident delirium cases, 15 were hyperactive, 25 hadmixed features, and 100 were hypoactive. Fifteenpatients developed hyperactive delirium (13.3%).The 14-day cumulative probability of hyperactivedelirium was 17.4%. Fifteen of the other 98 patientsdid not later present other delirium events, whilemost patients presented X5 hypoactive/mixedevents. Hyperactive delirium was significantlyassociated with advanced age (p5 0.0214) andmarginally associated with a first event in theevening (p5 0.0517) in multivariate analyses.CONCLUSIONS: Most delirious hospitalized can-cer patients are hypoactive. After a first hypoactive/mixed delirium event, only a few patients progressto hyperactive delirium and these tend to be olderand prone to present a first delirium event in theevening. Given the high recurrence rate of deliriumduring hospitalization, detection and monitoringshould be performed continuously.

P-638

A Multidisciplinary Approach in the Haematology

Service of a General Hospital on a Terminally Ill

Woman with Young Children - A Proposed Model

Based on a Clinical Case

Sara Moreira, Claudia CasaisHospital de Santo Antonio, Porto, Portugal

OBJECTIVES: We propose a model for a multi-disciplinary approach to reduce the psychologicaldistress of terminally ill inpatients in a smallhaematology unit. The model also aims to reduceburnout and distress levels of staff members and leadto their progressive empowerment in difficult com-munication issues. It can be applied in situationsof diminished human and logistic resources.METHOD: We assessed difficulties experienced by:(1) a terminally ill mother of four aged 5 to 17 in oursmall haematology unit in: openly expressing herfeelings; shifting to palliative care; talking aboutdeath and dying; giving up her parental role; ‘lettinggo’. (2) the haemotology team, who were insuffi-ciently confident to deal with either the emotions ofthe patient or their own, were unable to discussdifficult end-of-life issues, and resorted to maintain-ing active treatment. RESULTS: Instead of provid-ing direct assistance exclusively to the patient, theliaison-psychiatrist held a weekly meeting with thehaematologist and nurse in charge about thepsychological challenges faced by patient andmedical team. Strategies were worked out andapplied throughout the week, facilitating commu-nication, self expression, the shift to palliative care,the transfer of parental responsibilities, and theinvolvement of the children. 3 months after death,the grieving process was seen to be non-pathological.CONCLUSIONS: This weekly meeting, now ex-tended to all patients, improves doctors’ and nurses’confidence and communication skills, so reducingtheir distress and thereby increasing the quality ofcare they can offer, without the need for costly orlengthy formal training sessions or additional staffrequirements. The psychiatrist can focus primarilyon specialised interventions while contributing to thecontinuous development of the team. Consequently,we provide support conducive to a ‘better death’ andan uncomplicated grieving process.

P-643

A Definitive Meta-analysis to Ascertain the

Optimal Screening Method for Depression in Cancer

and Palliative Care. Part II - Algorithmic Test

Combinations

Alex J Mitchell1, Gregory Carter3, NicholasMeader2

University of Leicester, Leicester, United Kingdom1,University College London, London, United Kingdom2,University of Newcastle, Newcastle, Australia3


DOI: 10.1002/pon


OBJECTIVES: We aimed to examine the validityof screening tools for any defined depressionfollowing cancer, according to an ICD10 / DSMIVcriterion. In this part, we look at the merits of eachscreening tool in combination with oncologists’judgement (data from Br J Ca 2001; 84, 1011–1015)or in an algorithmic combination. The latter is atwo step approach applying the initial screen to allbut the second step only in those who scorepositive. METHOD: After excluding those toolswithout at least two independent validity attempts,there were 8 tools for comparison plus clinical skillsalone. Assuming a maximum of two applicationsper tool in order to make a clear diagnosis therewere 81 possible combinations of tests of tools. Wetested each method at a prevalence of 19%, usingthe fraction correct statistic which shows overallaccuracy (TP1TN / all cases). RESULTS: After 81combinations, the optimal test algorithm fordiagnosing depression was repeat application ofthe two screening questions (for example PHQ2).This achieved a sensitivity of 91.4% and aspecificity of 98.8% and an overall accuracy(fraction correct) of 0.974. The least accuratealgorithmic strategy was oncologists’ clinical jud-gement (unaided) applied twice. Other methodsand combinations achieved intermediate accuracy.CONCLUSIONS: An algorithmic combination oftwo tests can have superior accuracy to one testapplied alone. The optimal method so far studiedappears to be a two question test, applied on twooccasions. Clinician judgement alone, even aftertwo consultations, is usually unsatisfactory.

P-646

Describing Sexual Health in Women Treated for a

Gynaecological Cancer: A Qualitative Exploration

Megan McCallum1, Monique Lefebvre2, SophieLebel1, Lynne Jolicoeur2, Jennifer Fotheringham2,Christine Maheu3

University of Ottawa, Ottawa, Ontario, Canada1,The Ottawa Hospital, Ottawa, Ontario, Canada2,Breast Cancer Survivorship Program, UniversityHealth Network, Toronto, Ontario, Canada3

OBJECTIVES: To gain a better understanding ofthe sexual health of gynaecological cancer (GC)patients. Current literature highlights numerouscomplications and unmet psychosocial needs.However, little is known about specific sexualhealth-related needs and the extent to whichpatients desire help with these needs. The goals ofthe present study were to explore patients’ 1)difficulties experienced and their impact on sexu-ality, and 2) unmet needs, desire to receive help,and suggestions for intervention format and con-tent. METHOD: Six women who had been treatedfor a GC were offered the opportunity to partici-pate in a semi-structured interview on their cancer

experience, its impact on their sexuality, andsuggestions about the development of services. Ascurrent literature suggests the difficulties experi-enced in GC patients are diverse, recruitment wasstratified based on cancer type, treatment type, andmenopausal status at diagnosis. Recruitment willcontinue until a sample size of sixteen participantsis obtained. RESULTS: To date, preliminaryfindings suggest the participants experienced diffi-culty coping with the common physical andpsychological challenges instigated by the cancerand its treatment. Common themes include sig-nificant informational needs, body image-relateddifficulties, decreases in sexual arousal and desire,grievance (i.e. of past life, loss of fertility), as wellas benefit finding (i.e. new appreciation of life).Many patients felt that problems amongst GCpatients differed based on age, relationship status,cancer site, and treatment. CONCLUSIONS:Participants reported a wide range of difficultiesand needs and expressed a desire for services fromtheir health care team before and after treatment.The variety of needs reported emphasizes theimportance of undertaking a multidisciplinaryapproach in providing supportive, holistic care toGC patients. The results will support improvedquality of care by informing the development offuture informational and supportive services.

P-652

The Supportive Care Needs Beyond the End of

Treatment in Colorectal Cancer Outpatients

Shiow-Ching Shun, Yeur-Hur Lai, Kun-Huei Yeh,Jin-Tung LiangNational Taiwan University, Taipei, Taiwan

OBJECTIVES: To explore the levels of symptomdistress and supportive care needs after the end oftreatment and further identify predictors of sup-portive care needs in patients with colorectalcancer. METHOD: Outpatients with colorectalcancer were recruited from outpatient clinics in ateaching hospital in Northern Taiwan. Data wascollected using a set of structured questionnaire tomeasure supportive care needs, symptom distress,anxiety and depression, and demographic anddisease related information. Significant factorsrelated to overall needs and each domain wereidentified by using generalized estimating equa-tions. RESULTS: Of the 114 participants com-pleted the survey, most of them (62.3%)were male.The time since completed treatment was 25.9months. The major results showed that fatiguewas the most reported symptom, following bynumbness and insomnia. The highest level of needswas health system and information domaine.Overall care needs were related to age, time sincecompleted treatment, symptom distress, and de-pression. Symptom distress and time since


DOI: 10.1002/pon


completed treatment were the major factors relatedto the most domains of care needs. CONCLU-SIONS: The results suggest supportive care needs isdynamic and changing by the time since beyond theend of cancer treatment. Symptom distress was themajor factors to affect the level of supportive careneeds. Therefore, routinely assess cancer survivor’ssymptom distress and supportive care needs issuggested.

P-658

Psychological Distress During Treatment for

Primary Ovarian Cancer: Factors Associated With

Consent for Mental Health Services

Cynthia O’Sullivan, Elizabeth Ercolano, RuthMcCorkleYale University School of Nursing, New Haven, CT,United States

OBJECTIVES: Psychological distress in cancer isfrequently reported, but inadequately treated.Although clinicians may refer cancer patients formental health (MH) services, some distressedpatients refuse treatment. Ovarian cancer patientsare prone to distress due to aggressive regimenswith uncertain outcomes. This study comparespatient demographics, problems, and nursinginterventions of two groups of distressed womenafter ovarian cancer surgery, those who receivedand those who refused MH services within theintervention arm of a clinical trial. METHOD: Asecondary analysis of data from 24 distressedwomen was performed from study records of acompleted clinical trial investigating QOL out-comes in gynecologic cancer. Eighteen records perpatient for six months following surgery werecoded by content analysis, using the OmahaSystem to categorize patient problems and nursinginterventions. Group demographic and clinicalcharacteristics, patient problems, and nursinginterventions were compared using chi-square andt-tests. RESULTS: Of 24 subjects, 18 consented, 6refused MH evaluations. Mean Distress Thermo-meter Scores: 6.94 for consenting, 5.67 for non-consenting subjects. Group demographic andclinical characteristics not significantly different.Mean numbers of contacts: 17.56 (72.20) forconsenting, 14.17 (73.87) for non-consentingwomen. The Mental Health Problem most frequentand of longest duration for both groups. Nursinginterventions most frequent for Physical Problems.Non-consenting subjects had higher proportion ofinterventions for Environmental Problems. MHevaluations identified 8 women with psychiatricdiagnoses. CONCLUSIONS: Psychological issuesrepresent important clinical problems for womenwith ovarian cancer. Women who refuse MHservices for distress may suffer from uniquechallenges that are not well-addressed within our

current healthcare system. Nurses may play acritical role in helping to identify and promotetreatment for MH problems for these patients.

P-659

Efficacy of Reminiscence Therapy for Cancer

Patients with Recurrence

Kazumi Ueno, Hitoshi OkamuraHiroshima University, Hiroshima, Japan

OBJECTIVES: The purpose of this study was toassess the efficacy of reminiscence therapy on thepsychosocial aspects of the cancer patients withrecurrence. METHOD: After randomly assigningthe patient to two groups, an intervention groupand a control group, reminiscence therapy wasconducted in a total of 8 sessions (about 1 hour persession) in the intervention group and only ques-tionnaire was conducted in the control group.Psychosocial aspects were assessed using the Profileof Mood States (POMS), the Rosenberg Self-Esteem Scale and the Functional Assessment ofChronic Illness Therapy-Spiritual, at baseline andimmediately after completion of the intervention.RESULTS: Among 52 cancer patients with recur-rence, written consent was obtained from 45(86%), and the final evaluation was conductedwith 20 subjects in each group.About each score ofthe intervention group and the control groupcompared the mean of the quantity of change inintervention before and after. The t-test showedsignificant difference between the two groups fortension-anxiety (p5 0.02), depression-dejection(p5 0.02) and vigor (p5 0.04) on the POMS.CONCLUSIONS: The results suggested that re-miniscence therapy is feasible and may be effectivein improving psychosocial aspects of the cancerpatients with recurrence.

P-665

Psychophysiological Assessment Of Psychological

Defense Of Breast Cancer Patients

MS Kurchakova, NV TarabrinaLaboratory of Psychology of Posttraumatic StressInstitute of Psychology of Russian Academy ofSciences, Moscow, Russian Federation

OBJECTIVES: The diagnosis of breast cancer(BC) is very strong traumatic stress for eachperson. Degree and the form of mental desadapta-tion, caused by this stress, depends on mechanismsof psychological defense. The purpose of presentresearch is further development of psychophysio-logical assessment directed to definition of psycho-logical consequences of stress experience amongBC patients. METHOD: The method is the ERPrecording in reply to presentation of photosconcerning various spheres of life. Photos from


DOI: 10.1002/pon


International Affective Picture Systems (IAPS,CSEA-NIMH, 1995) as well as photos related topsychological trauma situation (‘breast examina-tion’) were used. EEG was recorded in frontal,temporal and parietal leads of both hemispheres.Besides, all patients were examined by a Mississippiscale (MS), SCL-90-R and LSI questionnaires. 48women have taken part in research with BC.RESULTS: Activation of back area of the righthemisphere corresponds to emotional activity,activation of frontal area of the left hemisphere –anxiety. It is shown that decrease of left frontalactivity with increase of time of an exposition oftraumatic stimuli correlates with ‘suppression’defense mechanism. This type of defense reaction,characteristic for BC patients, is formed at increaseof the time period after diagnosis and operations.CONCLUSIONS: The results received by thedescribed approach reflect psychological problemsituations existing among BC patients. It wasshown that patterns of local brain activity reflectfeatures of subjective experience and individualadaptation to stress situation. These data can behelpful for psychological assistance and socialrehabilitation of such patients.

P-666

Distress, Depression, Anxiety and Coping Strategies

in Breast Cancer Patients on Chemotherapy

Nor Zuraida Zainal, Saniah Abdul Rahim, AnitaZarina BustamUniversity of Malaya, Kuala Lumpur, Malaysia

OBJECTIVES: The objectives of the study were todetermine distress, depression and anxiety amongbreast cancer patients on chemotherapy and toassess their coping strategies. METHOD: Breastcancer patients underwent out patient chemother-apy at the Oncology Unit, University MalayaMedical Centre were invited to participate in thestudy. They were assessed on their socio-demo-graphic profiles, clinical history, distress level asmeasured using the ‘Distress Thermometer’, andproblems checklist on practical, family, emotionaland physical symptoms. The Hospital AnxietyDepression Scale (HADS) was used by patients toreport anxiety and depression. Brief COPE Scalewas used to assess coping strategies. RESULTS: Atotal of 141 patients with mean age of 50 yearsparticipated in the study. The prevalence ofpsychological distress was 36.9%. Prevalence ofdepression or anxiety was 29.0%. Distress andanxiety were significantly associated with practical,family, emotional problems whereas depressionwas associated with practical problems. In addi-tion, distress, depression and anxiety were asso-ciated with some of the physical problems.Distressed patients used denial while depressedpatients used self blame as their coping strategies.

CONCLUSIONS: Breast cancer patients on che-motherapy experienced high level of distress,depressive and anxiety symptoms. Denial andself-blame were used as their coping strategiesagainst feeling distress and depression.

P-668

Evaluation Of Quality Of Life And Coping Strate-

gies Of Cancer Patients: A Longitudinal Study

Lucio Sarno, Maria Monica Ratti, TamaraQuaranta, Valentina Di Mattei, Chiara MottaOspedale San Raffaele, Milano, Italy

OBJECTIVES: The main goal of this study is toevaluate the variation over time of Quality of Life incancer patients, related to coping strategies and tothe presence of specific resources. It is meaningfuland remarkable the role of psychological implica-tions in physical illness and so the importance toaddress them in cancer treatment, even in terms ofpatient’s Quality of Life. METHOD: The sample ismade up of 34 cancer patients. The patients gaveinformation about the seat of the pathology, thetherapies and the presence of psycho-social re-sources. The psycho-oncologic survey battery con-sisted of: SF-36; Mental Adjustment to Cancer(MAC); Psychological Distress Inventory (PDI);Hospital Anxiety and Depression Scale (HADS).The retest was made after a follow up (at least of 6months). The results are analyzed by the multivariateanalysis of variance using SPSS. RESULTS: Weobserved the presence of a main time effecton the improving of QoL in cancer patients,F(1.27)511.58, po0.05. There is a significantcorrelation between QoL and how to adapt ‘Spirit-combatant’ (r5 0.377, po0.05). Statistically signifi-cant correlations are those among the copingstrategies ‘Anxious-preoccupied’ and ‘helpless-hope-less’ (r5 0.466, po0.05) and ‘fatalistic’ (r50.537po0.001), and between ‘fatalistic’ and ‘fightingspirit’ (r50.666, po0.001). CONCLUSIONS: Thepurpose of this research was to evaluate thecorrelation between specific adaptive mechanismsused by cancer patients in comparison with theQuality of Life perceived. Resources available to thethe patient, connected to the QoL, were also tookunder consideration Our results could be used byprofessionals to work in detail on those dimensionsthat could potentially reduce the negative impact ofthe disease on patient’s life.

P-669

Music Therapy In Supportive Care for Cancer

Inpatients. An Italian Pilot Study

F Lagattolla, R Montanaro, F Romito, C Cormio,V Trojano, C D’Amico, G Colucci, V MattioliNational Cancer Institute ‘Giovanni Paolo II’, Bari,Italy


DOI: 10.1002/pon


OBJECTIVES: In Complementary and AlternativeMedicine (CAM), Music Therapy (MT) effectivelycan improve physical and emotional well-being incancer inpatients, with benefits in managingsymptoms along the cancer journey. Among othersymptoms the anxiety is the primary one associatedwith cancer and its treatments. This pilot study wasdrawn to evaluate the effectiveness of the MT incontrolling the anxiety due to the medical proce-dures and the influence of MT on mood duringhospitalization. METHOD: The study was carriedon breast cancer inpatients proposed for surgery,and on colorectal cancer inpatients to the first lineof chemotherapy. They underwent MT session,lasted about 1.5 hour, the day before the proce-dures, with 5 patients per session who interactedthrough musical instruments and their voices. Thecontrols were performed before and after MT byS.T.A.Y.-Y1 and a list of mood’s frames (agitated,worried, sad, bored, pessimistic, calm, serene,satisfied, happy, hopeful). RESULTS: 79 inpati-ents, 59 women and 20 men, ranging in age from 20to 75 years (MD5 51) were enrolled. Findingsshowed a significant decrease of anxiety (p5 0.000)on the average of the responses measured by pairedT test, with significant positive mood changesbefore and after MT: 92.5% of the ‘agitated’answers decreased to 7.5%; 69.3% of the ‘sad’answers decreased to 30.7%; 24% of the ‘hopeful’answers increased to 76.3%. CONCLUSIONS:The results of this pilot study suggest that MusicTherapy represents an helpfulness experience witheffective, positive impact on cancer inpatients thatconfirms being a supportive intervention forcontrolling and reducing anxiety related to clinicalprocedures in cancer inpatients. The musicalexperience in interactive MT facilitates the nonverbal communication of strong feelings andemotions beyond the words, so the MT might beintegrated into a multidisciplinary approach inpsycho-oncology.

P-670

Predicting Post-traumatic Growth in Cancer

Patients: A Longitudinal Study

Marta Scrignaro1, Sandro Barni2, Maria LuisaBonetti2, Maria Elena Magrin1

University of Milan-Bicocca, Milan, Italy1, TreviglioHospital, Treviglio, Italy2

OBJECTIVES: The aim of the present study is toinvestigate the role of social support and copingstrategies in enhancing post-traumatic growth(PTG) in cancer patients. The study focused onboth avoidance and approaching coping and onfour distinct types of social support: a) perceivedavailability, b) actual received, c) satisfaction withreceived support and d) the competence ofcaregiver to satisfy the patient’s basic psychological

needs of autonomy, competence and relatedness.METHOD: A longitudinal study was conductedwith a group of 41 cancer patients currently in thetreatment and management phase of their illness.Data were collected by means of a writtenquestionnaire, at two time points (T1 and T2) thatwere six months apart. Social support was assessedusing the Interpersonal Support Evaluation Listand the Need Satisfaction in Relationship Scale.Coping strategies were assessed using the BriefCOPE questionnaire. RESULTS: Regressionanalyses showed that autonomy-supportive care-givers (5 0.42��) and a problem-focused strategyof coping (5 0.55��) significantly predictedgreater post-traumatic growth at T2 (R5 0.47).CONCLUSIONS: The current study contributes toa deeper understanding of the type of socialsupport that may specifically aid cancer patientsin surpassing the level of functioning they experi-enced prior to diagnosis. Further, findings confirmthe important role of problem-focused copingstrategies in growing psychologically.

P-672

To Think, To Feel, To Talk and To Realize: A

Construction of a Psychoanalytical Work Developed

with Health Professionals Dealing with Cancer

Patients

S.N. Rezende, M.G.G. Andrade, S.M. SantiagoState University of Campinas, Campinas, SP, Brazil

OBJECTIVES: This study aims to reflect about thepsychoanalytical setting developed to analyzedifficulties of the health team dealing with cancerpatients, and its role as a device to take care of thehealth professionals. It was also a goal to point outto the specialized health services managers thetherapeutic possibilities for taking care of healthprofessionals to prevent sickness in their workprocess. METHOD: It was organized an inter-disciplinary work group in the oncology service,coordinated by a psychoanalyst and developedfrom 2006 to 2007 in the referral service for aregion of 4 million inhabitants. The participants ofthe group were oncologists, public health specia-lists, nurses, psychologists, psychoncologists, nu-tritionists, physiotherapists, social workers andmanagers. The group content produced in biweeklymeetings was analyzed under the psychoanalyticalorientation. RESULTS: At the beginning wasobserved high levels of stress in the group, withintense psychological suffering; emotional oscilla-tions when dealing with the duality life and death;worries with the non compliance treatment; diffi-culties in recognize and nominate their owndemands and those from the patients; communica-tion obstacles and inside team conflicts. Thegroup worked in the oscillation omnipotence-impotence, changing what was causing suffering


DOI: 10.1002/pon


to a thoughtful emotional experience, inside learn-ing, and extending the thinking. CONCLUSIONS:The therapeutic group with psychoanalytical or-ientation showed efficacy in reducing the psycho-logical suffering of health professionals and a toolof understanding about the nature of their work,helping in the search for more powerful actions.This listening process and the psychoanalyticalintervention allowed the relief of an extraordinaryload of pain and, consequently, the possibility of amajor integration with patients, families and theother workers.

P-674

Returning to Work After Cancer in Italian

Survivors: Is That Possible?

Francesca Romito, Rosanna Montanaro, ClaudiaCormio, Antonio Mazzei, Emanuele Naglieri,Giuseppe Colucci, Vittorio MattioliNational Cancer Institute, Bari, Italy

OBJECTIVES: It is well known that cancersurvivors are living longer after diagnosis, thanksto screening programs, increased early diagnosisand improvement in treatments. In Italy, the 5-yearrelative survival rate for all cancers has nowreached 49.8% in men and 59.7% in women. Thisunderlines the need of enhancing research on allreturning to life issues, including work-relatedactivities. METHOD: Cancer survivors (CS) wereface to face interviewed after their follow uproutine visit. Data were collected regarding:physical and psychological well being (SF-12),fatigue (Brief Fatigue Inventory-BFI), social sup-port (Multidimensional Scale of Perceived SocialSupport-MSPSS), and patterns of work-relatedactivities. RESULTS: 46% out of 166 CS inter-viewed had a working activity before cancer.Among them, 46% stopped working or retiredafter diagnosis, 29% had no changes in work-related activities, and 14% moved to a bettersituation; 43% felt they were penalized to whatconcerns their job. Factors associated with negativechanges were age and education. Physical andpsychological well-being (but not fatigue) ac-counted for negative work related patterns: thosewith worse status felt a stronger discrimination.CONCLUSIONS: While health care system inItaly allows people to get appropriate cancer care,little is still done to help people to return to theirlives. Next steps in the agenda of employmentfor CS in Italy should be: to make largepopulation studies to understand patients’ andinstitutions’ barriers on facilitating returning towork; to give patients appropriate informationon their rights at work; to create surveillanceagencies to help survivors when experiencingdiscriminations.

P-679

Psychoeducational Group Intervention in Patients with

Early Breast Cancer: Is there a Waiting Group Effect?

Silke Zloklikovits1, Thomas Augustin2,Stefanie Stanzer1, Hellmut Samonigg1, ThomasBauernhofer1, Elisabeth Andritsch1

Medical University Graz, Division of ClinicalOncology, Graz, Austria1, University of Graz,Department of Psychology, Graz, Austria2

OBJECTIVES: In psycho-educational interventionstudies with a waiting group design in cancer patients,the question about a possible effect of the waitingtime on different psychosocial parameters as well asthe efficiency of the later intervention is discussed.The purpose of this investigation in patients withearly breast cancer was to compare psychosocialparameters of patients who entered immediately intoan eight week psycho-educational intervention withpatients who began the group intervention after a sixmonths waiting period. METHOD: Fiftyone womenwere randomized to either receive an interventionupfront or after a waiting period. Patients in theintervention group (IG, n529) were tested at twodifferent time points (before and after intervention).Twenty-two patients in the waiting group (WG) wereevaluated at three different time points (baseline,before and after intervention). Semi-structured inter-views with standardized questionnaires were con-ducted at each time point: EORTC QLQ-C30 (globalhealth status, emotional functioning), IES (intrusion,avoidance). RESULTS: Repeated measures MAN-OVAs and t-tests were computed. For the IGsignificant improvements over time were found forintrusion (p50.009), emotional functioning(p50.027) and global health status p50.010) aswell as a statistical trend for avoidance (p50.058).During the waiting period of the WG a trend towardsworsening of global health status (p50.079) wasobserved whereas all other parameters did not changesignificantly. By the intervention after the waitingperiod, only intrusion improved significantly(p50.019). CONCLUSIONS: The anticipation ofprofessional support during a waiting period had nobeneficial waiting group effect on the outcomevariables studied. Furthermore, the study showedthat a waiting period prior to psycho-educationalintervention did not demonstrate the significantimprovements in selected quality of life parametersdocumented in the upfront intervention.

P-683

Characteristics of Breast Cancer Survivors With and

Without Children: Results of a Large Web-Based

Survey

Jacinthe Faucher, Isabelle Ares, Sophie Lebel,Catherine BielajewUniversity of Ottawa, Ottawa, Ontario, Canada


DOI: 10.1002/pon


OBJECTIVES: Little is known about the effects ofparenting in combination with a breast cancerdiagnosis on coping and other psychosocial fac-tors. A survey investigation of breast cancersurvivors using sociodemographic and other psy-chosocial questionnaires related to stress, depres-sion, and social support was conducted todetermine the factors that moderate stress insurviving mothers versus non-mothers. The datapresented here focus on the characteristics of breastcancer survivors and the differences betweenmothers and non-mothers. METHOD: Just under3700 breast cancer survivors completed a compre-hensive web-based survey, including sociodemo-graphic variables related to age, education, income,number and age of children at diagnosis, time sincediagnosis, cancer stage and treatment, and overallphysical and psychological well-being. Of theparticipants, 73% were mothers. Descriptive andsimple means analyses were used to distinguish anysociodemographic differences between the surviv-ing mothers and non-mothers. RESULTS: Theaverage age of participants was 5579.9 with 776.3years since diagnosis. The number of children atdiagnosis ranged from 0 to 6 and most were adult.Most participants had no breast cancer recurrence,had not been diagnosed with another cancer,reported no serious mental illness and indicatedno chronic illness. Non-mothers had significantlymore years of education (16 versus 15). Themothers had a slightly higher stage of breast cancer(more at stage 2). CONCLUSIONS: To ourknowledge, this is the largest survey of its kind toexamine the profile of breast cancer survivors in thecontext of parenting with the overall finding that atleast early stage breast cancer survivors remainrelatively healthy years after diagnosis. Morebreast cancer survivors are using the internet forgathering information and seeking support, repre-senting a valuable research resource. Furthermore,the literature indicates that survey participantsexpress strong feelings of empowerment andsatisfaction.

P-684

A Symptom Level Exploration of the PHQ9 in a UK

Cancer Setting: Which is the Optimal Single

Question that Predicts DSMIV Major Depression?

Alex J Mitchell, Karen Lord, Paul SymondsUniversity of Leicester, Leicester, United Kingdom

OBJECTIVES: There is considerable interest indeveloping ultra-short methods of screening con-sisting of one or two items. The Patient HealthQuestionnaire (PHQ) is a relatively simple 9 itemself-report tool focussing on the DSMIV symptomsof depression. It is often abbreviated into thePHQ2. However the validity of the PHQ2 com-

pared to other simple combinations of questionshas not been previously studied in oncology.METHOD: We analysed data collected fromLeicester Cancer Centre from 2008-2009 involvingapproximately 600 people approached by a re-search nurse and two therapeutic radiographers.The researcher asked patients to self-complete thePHQ9. We used DSMIV major depression (MDD)as the gold standard. We analysed the accuracy ofsingle items and combinations of two items.RESULTS: A logistic regression suggested items1, 2, 5, 6 and 7 were most influential as follows(sensitivity, specificity and AUC listed) Q1 -81.5%; 91.2%; 0.884 [interest]Q2 - 81.2%; 96.2%;0.887 [depression]; Q5 - 76.6%; 81.5%; 0.790[appetite]; Q6 - 68.7%; 95.4%; 0.821 [self-esteem];Q7 - 73.4%; 91.9%; 0.832 [concentration]. We thenanalysed conjoint questions with two items, theoptimal ones were (sensitivity, specificity and AUClisted) Q1 or Q2 - 100%; 92.2%; 0.960 [interest ordepression] Q2 or Q5 - 100%; 78.9%; 0.895[depression or appetite] CONCLUSIONS: In fairlylarge UK sample the optimal simple questions todetection DSMIV MDD appear to be Q1 or Q2 4Q2 or Q5 4 Q2 alone 4 Q1 alone. Notably thefirst two combinations may achieve near 100%sensitivity.

P-685

Psychological Intervention With Serious Ill Patients:

Perspectives And Limits

Lucio Sarno2, Serena Giuliani1

San Raffaele Hospital, Milan, Italy1, Vita-salutePsychology Universiy, Milan, Italy2

OBJECTIVES: The theme of hope is strictlyconnected to psychological intervention with ser-ious ill patients: especially when clinical conditionsare severe, the psychological intervention has topromote patient’s desires and projects, threatenedby severe physical limitations, but crucial to keephis compliance and promote his well being. Theaim of this work is to achieve a better under-standing of the clinical process involved in workingwith these patients, focusing on the implications onthe psycho-oncologist’s practice. METHOD: Areview of clinical materials (quantitative andqualitative measures) from clinical practise withsevere ill patients was made in order to identify thefactors which can promote the psychological wellbeing in these disease stages. All these materialswere collected from hospital clinical work startingin 2000 with patients with oncological severediagnosis. RESULTS: These clinical materialssuggest that patient’s hope and compliance to histreatment are promoted by his perception ofmaintaining cognitive, affective and emotionalfunctions, despite of his physical impairment: this


DOI: 10.1002/pon


perception is enhanced by the relationship with theclinician that gives the patients the opportunity toexperiment all (thoughts, feelings, emotions)that promote the feeling of being still alive.CONCLUSIONS: Psycho-oncologist’s interven-tions with serious ill patients should includeclinical interviews, not only quantitative instru-ments, to let the patient perceive that hispsychological function is still effective: clinicalinterviews help the patient to find that his desires,his projects and his wishes are still there, even if thedisease and his body pain seem to have erasedthem.

P-686

Clinical Utility Index - A New Method to Calculate

the Clinical Value of Diagnostic & Screening Tests:

Proof of Concept Study

Alex J MitchellUniversity of Leicester, Leicester, United Kingdom

OBJECTIVES: To develop a method to helpinform clinicians as to the clinical value of adiagnostic or screening tests. Conventionally suchtests are evaluated using sensitivity (SE) orspecificity (SP). SE and SP are simple measures ofoccurrence. Positive predictive value (PPV) andnegative predictive value (NPV) are measures ofdiscrimination. To be clinically useful a test shouldscore high on occurrence and high discrimination.METHOD: A method was developed called theclinical utility index (UI) which provides rule-inaccuracy (also known as case-finding) using the UI1 as well as rule-out accuracy (also known asscreening) using the UI�. UI combines discrimi-natory ability and occurrence such that the positiveutility index (UI1)5 sensitivity�PPV and thenegative utility index (UI�)5 specificity�NPV.As proof multiple alternative measures of accuracyin a simulation model were calculated. RESULTS:If a hypothetical screening test [A] yielded a truepositive in 9/10 positive tests (90% PPV) and yetwas positive in 1/5 of cases (20% sensitivity) thenthe UI1 would be 0.18. The clinical value of [A]would be much inferior to [B] with 90% PPV and90% SE (UI1 5 0.81). A qualitative interpretationof UI is 0.81 excellent 40.64 good 40.49 adequate40.36 poor and o0.36 very poor. CONCLU-SIONS: The interpretation of diagnostic andscreening tests can be improved by combiningoccurrence with discrimination. The clinicalutility index offers this with a simple qualitativeand quantitative interpretation. When comparingdiagnostic tests using the UI, it is advisedto adjust for differences in prevalence. Utilityindex can be combined with acceptability and costto further enhance the interpretation of testaccuracy.

P-688

Evaluation of The First Year of a Pilot Study of a

New Graduate Diploma/MSc in Psycho-Oncology

Through The School of Nursing & NICB, Dublin

City University, Ireland

Shelagh Wright, Anthony Staines, Robert O’ConnorDublin City University, Dublin, Ireland

OBJECTIVES: In Ireland, psychosocial care for theperson with cancer is recognised in the NationalCancer Strategy (2006). However, psychosocial oncol-ogy service provision is currently ad hoc andhealthcare professionals working in the oncologysetting have often received minimal education inpsychosocial aspects of cancer care. The GraduateDiploma/MSc in Psycho-oncology aims to provide aninternational standard third level accredited pro-gramme of education in psycho-oncology to help todrive the development of psycho-oncology services inIreland. METHOD: The pilot with seven studentsbegan in October 2009, one day per week. The firstyear focused on the development of students’ knowl-edge and skills relevant to assessment of distress andpain in patients with cancer, along with appropriateinterview and referral skills. Other subjects coveredwere the science of cancer, communication skills forempathic listening, explaining cancer treatments in layterms and recruiting patients to clinical trials, as wellas research skills for psycho-oncology. RESULTS:Each lecture/ workshop was evaluated by students ona weekly basis using the LecTrain evaluation form,comprising a Likert scale and a pre post selfevaluation of learning outcomes and qualitativecomments. At the end of each semester a moredetailed School of Nursing module evaluation formwas completed by each student. Students werecontinuously assessed with both written and practicalassignment (video and self assessment of communica-tion and assessment skills; classroom presentation)components. CONCLUSIONS: So far the psycho-oncology programme has been evaluated positively bystudents, particularly the provision of online Moodleand general support, assessment and CBT workshops,as well as video and classroom practicals. Students’learning outcomes are reflected in the high standardof their assignments. The motivation and enthusiasmof students to transfer psycho-oncology knowledge tothe clinical setting will assist their preparation for theresearch dissertation for the Masters degree inPsycho-oncology next academic year.

P-691

Anxiety, Depression and PTSD in Colorectal

Cancer after Differentiated Treatments: A study

with Portuguese Patients and Partners

M. Grac-a Pereira1, Ana Paula Figueiredo1

University of Minho, Braga, Portugal1, OncologyPortuguese Institute, Oporto, Portugal2


DOI: 10.1002/pon


OBJECTIVES: Colorectal cancer is the secondleading cause of cancer mortality in Westerncountries. In Portugal, the incidence of colon canceris 15.15% for females and 22.09% for males(Gouveia, Anthony & Veloso, 1993). The purposeof this study was to describe the influence oftreatment type (i.e. surgery; surgery and chemother-apy; surgery and radiotherapy) on both patientswith colorectal cancer and their spouses particu-larly, on quality of life, depression, anxiety and posttraumatic stress. METHOD: 141 patients (62%males and 38% females) and 67 spouses (39%males and 61% females) participated in the study.All patients were diagnosed with colorectal cancer.Instruments used were: a) patients: ‘HospitalAnxiety & Depression Scale’, (Zigmund & Snaith,1983); b) spouses: Beck Depression Inventory(Beck, Mendelsohm & Mock 1961) and State-TraitAnxiety Inventory (Spielberger, Gorush, Lushene,Vagg & Jacobs 1983); c) patients and spouses:Impact of Events Scale Revised (Weiss & Marmer,1977). RESULTS: Significant differences werefound on anxiety, depression and post-traumaticstress among treatment groups. Spouses of patientswho underwent surgery presented lower levels ofstate anxiety and post-traumatic stress whencompared with spouses of the other two groups.The only significant variable between patients andspouses, from all variables studied, was depression.Patients who were diagnosed more than a year hadmore PTSD than the other two groups (less than 6months; between 6 months-12 months). CONCLU-SIONS: This study highlights the importance ofproviding support for cancer patients and theirspouses since they show post traumatic stress,depression and anxiety regardless of treatment.Patients who undergo surgery followed by che-motherapy are the ones more at risk and those withthe disease diagnosed more than one year.

P-696

Feasibility and Acceptability of a Canadian Program

of Counselor-Led Online Support Groups for People

Affected By Cancer: A National Cohort Study

Joanne Stephen1, Kate MacGregor1, MichaelSpeca2, Joyce Lee3, Jill Taylor-Brown4, RichardDoll1, Arminee Kazanjian3, Kate Collie6,Jill Turner6, Karen Fergus7, Deborah McLeod8,Margaret Fitch5

BC Cancer Agency, Surrey and Vancouver, BritishColumbia, Canada1, Tom Baker Cancer Center,Calgary, Alberta, Canada2, University of BritishColumbia, Vancouver, British Columbia, Canada3,Cancer Care Manitoba, Winnipeg, Manitoba,Canada4, Sunnybrook Health Sciences Center,Toronto, Ontario, Canada5, Cross Cancer Center,Edmonton, Alberta, Canada6, York University,Toronto, Ontario, Canada7, Dalhousie University,Halifax, Nova Scotia, Canada8

OBJECTIVES: Internet technology can enableaccess to professional psychosocial support tothose who are socially, physically, or geographi-cally isolated. This prospective cohort studyexplored 1) the feasibility of providing counselor-led synchronous online support groups (OSG’s) forPAC across 5 Canadian provinces and 2) perceivedacceptability of the OSG’s among diverse popula-tions of cancer patients (e.g. young and ruralsurvivors, patients with head and neck cancers,prostate, and metastatic disease) and familycaregivers. METHOD: Experienced psycho-oncol-ogy counsellors were trained for ten weeks tofacilitate synchronous online support groups inchat rooms. A national program was established torecruit and enroll patients and family caregivers.Participant cancer burden, support resources,expectations, and preferences were assessed. Asubset of participants took part in a semi-struc-tured post-intervention telephone interview. Aqualitative content analysis was used to analyzeparticipant perceptions of the technology, theprofessional facilitator, and group dynamics. RE-SULTS: 180 participants enrolled in 24 OSG’s (6-8participants each). The primary reason for with-drawal was scheduling or work conflicts (26%).More than 2/3 of females (N5 157), median age of47, were patients or survivors (80%) with breastcancer (90%). Male participants (N5 23) weremainly older (median5 61 years) caregiverspouses. Analysis of 52 interviews found the largemajority of participants appreciated the OSG’s,reported positive impressions with technology, theprofessional facilitator and group dynamics. CON-CLUSIONS: OSG’s are feasible and acceptable.People affected by cancer, including those withhigh cancer burden, unmet psycho-social needs andfrom very isolated communities can receive profes-sional psycho-oncology support through theinternet. Furthermore, they describe benefits com-parable to those associated with face-to-faceprofessional-led support groups. Ongoing researchwill identify who receives most benefit, and ifmeasures of distress, social support and illnessintrusiveness are affected by participation in theonline group.

P-698

Psychosocial Support in Pediatric Palliative Care: A

Model of Care

Emily Edlynn, Kathleen IngmanChildrens Hospital Los Angeles, Los Angeles, CA,United States

OBJECTIVES: To develop a model of interdisci-plinary psychosocial care for a pediatric palliativecare consultation service in a large urban children’shospital. Staff who provide psychosocial supportoften have difficulty with clearly differentiating


DOI: 10.1002/pon


their roles in order to work in a collaborative andcomplementary manner. The purpose of thispresentation is to delineate a model of care thatintegrates the roles of psychologist, socialworker, and chaplain in pediatric palliative care.METHOD: Palliative care team members consid-ered options for differentiating roles. Throughclinical experience and ongoing discussion in weeklyteam meetings as well as adjunctive administrativemeetings, they determined the most effective com-position of psychosocial team members on theservice. Attention was given to how to integratethe roles of these psychosocial providers within thepalliative care service in order to maximize benefitsfor the families from each discipline. RESULTS:The psychosocial disciplines included in the pallia-tive care service are psychology, social work, andspiritual care. Psychology primarily addresses themental health and support needs of the child/adolescent patients, including assessing and treatingpsychopathology; social work focuses on familysupport, assisting with concrete needs, and bereave-ment follow-up; and spiritual care addresses spiri-tual needs of patients and families. Thesepsychosocial team members collaborate regularlyin order to better inform each person’s servicedelivery. CONCLUSIONS: Although roles ofpsychosocial team members often overlap, it isimportant to make distinctions in order to ensurethat patients and families receive optimal benefitsfrom the range of disciplines. In conjunction withthe development of an inpatient pediatric palliativecare service, a model of care was developed toachieve this goal. Thus, team members have theopportunity to collaborate without confusion ofroles that can be disruptive to service delivery.

P-699

Integrating a Palliative Care Consult Service into a

Childrens Cancer Center: Lessons Learned

Kathleen Ingman, Emily EdlynnChildrens Hospital Los Angeles, Los Angeles, CA,United States

OBJECTIVES: To facilitate acceptance and utili-zation of an external palliative care team within acomprehensive pediatric cancer center and toeducate oncology physicians, nurses, and staffregarding the value of specialized palliative careconsultation. Challenges included building rela-tionships, trust, and correcting misconceptionsabout palliative care. METHOD: An inpatientpalliative care consult team was hired and theservice was piloted in the division of pediatriconcology in a large, urban children’s hospital. Tofacilitate a link between palliative care andoncology, a psychologist was hired from withinoncology to serve as consultant to the palliativecare service. Palliative care team members built

relationships with oncology clinicians and solicitedinformal feedback on performance. Palliative teampractices were revised based on this feedback.RESULTS: Many issues were addressed includingmisconceptions that palliative care is relegated toend-of-life, how the palliative team should interactwith patients, their role as consultants with regardto patient care, and best practices for communica-tion and collaboration with the medical team. Aftera year of providing consultation to oncology, aswell as formal and informal education, referrals topalliative care have increased and palliative teaminput has become sought after on a more regularbasis. CONCLUSIONS: Although the launch of anew palliative care service meets many obstacles, itis essential that this task be approached withflexibility, communication, and openness to feed-back so that needed adjustments can be made to fitthe culture of the existing oncology program.

P-701

Symptom Concerns and Quality of Life in Breast

and Prostate Cancer Survivors Receiving Hormonal

Therapy

Gloria Juarez, Virginia Sun, Betty Ferrell,Przemyslaw TwardowskiCity of Hope, Duarte, CA, United States

OBJECTIVES: Describe symptom concerns andquality of life of breast and prostate cancersurvivors receiving hormonal agents. METHOD:Patients were followed at baseline prior to treat-ment and at 1 and 4 months post-accrual.RESULTS: Overall QOL is moderate both groups.Symptoms such as hot flashes, fatigue and anxietywere reported. CONCLUSIONS: Survivors sufferfrom multiple symptoms related to HT that placesthem at higher risk for diminished QOL.

P-702

Strategies Used by Women to Deal with the

Financial Costs Associated with Non-metastatic

Breast Cancer

Pascale Levesque1, Sophie Lauzier2, ElizabethMaunsell1

Unite de recherche en sante des populations, Socialand Preventive Medicine, Universite Laval, Quebec,Quebec, Canada1, School of Nursing, Faculty ofMedicine, McGill University, Montreal, Quebec,Canada2, Unite de recherche en sante des popula-tions, Social and Preventive Medicine, UniversiteLaval, Quebec, Quebec, Canada3

OBJECTIVES: Women experience out-of-pocketcosts from getting treated for breast cancer, andworking women may also have wage lossesresulting from work absences. Indicators of finan-cial burden resulting from these costs include


DOI: 10.1002/pon


reducing expenditures and using financial savings.We evaluated whether these strategies were usedfor dealing with cancer costs during the first yearafter diagnosis of non-metastatic disease, andcharacteristics associated with these strategies,among women reporting that cancer was costly tosome degree. METHOD: Participants came from aprospective study based on consecutive series ofwomen with newly diagnosed, non-metastaticbreast cancer from eight Quebec hospitals in2003. Data here came from the final telephoneinterview conducted 12 months after treatmentstart. This interview included questions on per-ceived costliness of cancer, and strategies used toface costs such as reducing expenditures and usingsavings. Multivariate log-binomial regression wasused to identify determinants of use of thesestrategies. RESULTS: Among 800 women (83%of eligibles), 660 (83%) said cancer was costly tosome extent. The strategies most commonly usedwere reducing usual expenses (36%), delayingmajor purchases (27%) and using savings (25%);50% used at least one such strategy. Women withpre-diagnosis family income o$50, 000/year (com-pared to X$50, 000) and those who experiencedwage losses because of cancer (compared to nowage loss) were more likely to use X1 strategies(po0.0001 for both). CONCLUSIONS: Use ofthese strategies provides evidence that breastcancer costs necessitate some readjustment in themanagement of financial resources for somewomen and their families. Our results indicate thatthis is particularly so for two groups of women:those who come to breast cancer with morerestricted financial resources, and those subse-quently challenged by wage losses because ofbreast cancer.

P-706

Being a Psychologist in Paediatric Oncology with

the Experience of Cancer in One’s Own Child

Susana Novais AlmeidaInstituto Portugues de Oncologia do PortoFrancisco Gentil, EPE, Porto, Portugal

OBJECTIVES: Reflect about the human experi-ence of cancer in a child, being a health profes-sional in the field of Paediatric Oncology andhaving that same experience in a personal level.Observe some implications to professional practicethat might emerge from this professional-personalinterface. METHOD: Supported by the construc-tivist vision of human experience, which empha-sizes the active participation of individuals,permanently in development and in relationship,in the organization of their own life, troughcreation of meaning (Mahoney, 2003), someemotional implications for the clinical practice areidentified from the personal experience of having a

child with cancer. It is revised the necessity ofconsidering the experience of the disease as ahuman global experience, valuing meaning andexistential variables. RESULTS: The experience ofhaving a child with cancer, being a psychologist inthe field of Paediatric Oncology, is a very challen-ging path. It’s possible to identify emotional taskssimilar to any other parent in these circumstancesand at the same time, to identify specific tasks,namely in the exercise of professional functionsafter the death of one’s own child. Some of thesedemands are recognized, as the importance ofpersonal meanings in the cancer experience.CONCLUSIONS: The cancer experience is acomplex human experience, therefore it can notbe reduced or separated in its physical, psycholo-gical, social, spiritual dimensions. The healthprofessional that works in the field of PaediatricOncology can be confronted, as any other humanbeing, with a personal experience with child cancer.From the demanding challenges which can beimposed by the situation, it is possible to becomeenriched as a person and evolve considerably ashealth professional.

P-710

The Quality of Friendships Reported by Pediatric

Brain Tumor Survivors and Comparison Classmates

Jennifer Acker1, Christina Salley2, Larissa Hewitt3,Keith Yeates2, Andrea Farkas Patenaude4,Kathryn Vannatta1

The Research Institute at Nationwide Children’sHospital, Columbus, OH, United States1, TheResearch Institute at Nationwide Children’sHospital and The Ohio State University, Columbus,OH, United States2, Dana-Farber Cancer Institute,Boston, MA, United States3, Dana-Farber CancerInstitute and Harvard Medical School, Boston, MA,United States4

OBJECTIVES: Studies suggest that survivors ofpediatric brain tumors experience deficits in socialfunctioning, including lower peer acceptance andnumber of friendships than comparison peers,however surprisingly little is known about thequality of friendships they do establish. Researchsupports that the attributes of high quality friend-ships have a positive impact on quality of life. Theaim of this study is to examine the quality offriendship experienced by brain tumor survivorsand comparison peers. METHOD: Brain tumorsurvivors (n5 42), ages 9–18 and 1–6 years posttreatment, were recruited from two pediatriconcology centers. Classmates (n5 37) matchedfor gender, race, and age were recruited for acomparison group. Data included self-report onthe Friendship Quality Questionnaire-Revised(Parker & Asher, 1989). This measure assesses theextent of Companionship and recreation, Help and


DOI: 10.1002/pon


guidance, Validation and caring, Conflict andbetrayal, Conflict resolution, and Intimate disclo-sure characterizing the relationship with a bestfriend. RESULTS: There were no differences in thenumber, gender, age, length of acquaintance, orfrequency of contact with identified best friends.Survivors were more likely to meet their best friendat school (76%), while comparison peers wereequally likely to meet their best friend at school(54%) or outside of school (46%). No significantgroup differences were found on subscales measur-ing friendship quality. CONCLUSIONS: Althoughsurvivors experience deficits in social functioning, itappears that when compared to other children theyperceive having similar quality relationships withtheir best friend. Although we were unable tocapture the best friend’s perspective of the friend-ship, results suggest that survivors may benefitfrom the qualities within a friendship in the sameway as other children. This may be protective forsurvivors and enhance their overall quality of life,but further research is warranted.

P-711

Differencies In Personality Traits And Emotional

Functioning Of Children With Cancer Due To The

Strategy Of Treatment

Marzena E. Samardakiewicz, Jerzy R. KowalczykMedical University in Lublin, Lublin, Poland

OBJECTIVES: Initial phase of ALL treatmentrequires patients to remain in the hospital fromapproximately four weeks, and therapy continuesfor two to three years. It is in contrary to HDwhere an initial hospitalisation is few days andtreatment lasting 6-8 months requires only shortchemotherapy cycles. The treatment regimens inALL are associated with an increased risk of toxiceffects. The aim of the study was to assessemotional functionning of children in relation tothe treatment strategy. METHOD: 169 childrenwith cancer diagnosis entered the study. Themedian age for the whole group was 12.6 years.All patients were devided into two groups due tothe strategy of treatment: 40 children with Hodg-kin’s disease (HD Group) and 129 children withleukemia (ALL Group). Evaluation of patients’emotional functioning was conducted in the firstmonth of treatment (the median time was 29.2days). Both groups received equal programme ofbiopsychosocial support during initial treatmentphase. RESULTS: The patients with HD presentedfeatures of better emotional adaptation thanchildren with ALL. The results had shown thatHD patients have more ongoing tendency(po0.001), can better use their talents (po0.004),have larger emotional stability (po0.001), revealedtendency to dominance (p.o016), are more cheer-ful (po0.003) and more adventurous (po0.005),

have higher secondary extraversion and indepen-dence (po0.001), and lower level of secondaryanxiety (po0.05). Tendency to witholding difficul-ties in ALL vs HD group is signifacantly higher(po0.011). CONCLUSIONS: 1. Children with HDduring initial period of treatment disclosed lessfeatures of the emotional burden than childrenwith ALL. 2. Children diagnosed with leukemiashould received more intensive and personalizedbiopsychosocial support. 3. Overall time of hospi-talisation of children with cancer diagnosis shouldbe strictly observed.

P-716

Knowledge of High-Risk Human Papillomavirus

Status and Risk Behaviors in Women With a

History of Cervical Intraepithelial Neoplasia

Catriona Buick, Kelly MetcalfeUniversity of Toronto, Toronto, Canada

OBJECTIVES: The High-risk Human Papilloma-virus (HPV) are the major risk factor for cervicalcancer; 99.7% of cervical cancers contain HPV-DNA (Walboomers et al., 1999). However, thereare also exogenous factors that influence the risk ofprogression from an HPV (high risk) infection tocervical cancer (Castellsague & Munoz, 2003).These factors are: smoking, high parity, the use oforal contraceptive pills, and the presence of othersexually transmitted infections (Castellsague, Bosch& Munoz, 2003). METHOD: Many studies haveshown that three factors protect against persistentHPV and therefore prevent cervical cancer: Safersex practices, cessation of existing tobacco use, andcompliance with cervical cytology screening (Cas-tellsague & Munoz, 2003). Before designing treat-ment interventions to reduce the risk of progressionfrom persistent HPV to cervical cancer for womenwith a positive high risk HPV status it is essential tounderstand any risk relevant behaviors thesepatients may be participating in. RESULTS: Aprospective longitudinal study has been proposed todetermine if any changes occur in risk-relevantbehaviors after receiving a positive high-risk HPVresult in women with a history of cervical intrae-pithelial neoplasia. The development of interven-tions to decrease the incidence of persistent high-risk HPV infections requires an understanding ofthe characteristics and risk-relevant behaviors ofHPV positive women that has not currently beenexamined. CONCLUSIONS: This study proposesto provide valuable insights into the relevantbehaviors of HPV (high-risk) positive womenfollowing diagnosis. This presentation will presentthe literature review and methods of this proposedwork in progress, including a review of theexogenous factors and of the proposed variablesthat may influence a change in behavior following adiagnosis of high-risk HPV.


DOI: 10.1002/pon


P-717

Colorectal Cancer Survivors: Hard to Reach?

Bernardine M. Pinto1, Nancy Farrell1, Michael G.Goldstein1, Bess H. Marcus1

Miriam Hospital, Providence RI, United States1,W. Alpert Medical School of Brown University,Providence RI, United States2

OBJECTIVES: Exercise adoption has been found toincrease fitness, improve mood, and reduce fatigueprimarily among breast cancer survivors. Less isknown about the feasibility of exercise adoption andits effects among colorectal cancer survivors (CRCs).Recruitment of cancer survivors into randomizedclinical trials (RCTs) is challenging, particularly instates where legislation precludes use of state tumorregistries for study recruitment. We examined theresponses among CRCs to various recruitmentapproaches for an exercise RCT. METHOD: Weutilized informational mailings from physicians,referrals, in-person clinic recruitment, electronic,print and radio media to reach sedentary CRCswithin 10 years post-treatment. In response torecruitment efforts, 315 responses were received:113 were not eligible prior to phone screens, 102(eligibility unknown) were not interested, and 100individuals completed phone screens. RESULTS:The most common reasons for ineligibility were: noCRC diagnosis, 410 years post-diagnosis, etc.(33%), too physically active (21%) and othermedical contraindications (12%) (n5147). Amongthose who completed phone screens, 66% (n5 66)were eligible and 70% (n546) of eligible CRCs wererandomized. Mailings from physicians (n527,41%), electronic, print and radio media (n518,27%), and physician referrals (n59, 14%) weremost effective in identifying eligible participants. In-person recruitment yielded 9% (n56) of eligibleparticipants. CONCLUSIONS: These data helpidentify barriers to study enrollment among CRCssuch as eligibility criteria and lack of interest. Weidentified effective avenues for enrolling participantsdiagnosed with the third most common cancer intoRCTs aimed at improving their functioning andrecovery. It appears that these avenues may differacross subgroups of cancer survivors: surprisingly,in-person recruitment was relatively ineffective,compared to prior experience in recruiting breastcancer survivors for exercise RCTs.

P-718

Social Support and Distress: The Mediating Role of

Meaning in Life for Cancer Survivors with Major

Depressive Disorder

Eleshia JP Morrison, Chien-Ni Chang, Brittany MBrothersThe Ohio State University, Columbus, Ohio, UnitedStates

OBJECTIVES: Meaning in life and social supportare associated with reduced distress in cancersurvivors. Meaning has been shown to mediatethe relationship between social functioning anddistress (Jim & Andersen, 2007). Up to 50% ofcancer patients experience depressive symptoms,therefore examining mediators of social support iscritical to reducing distress. This cross sectionalstudy examines whether meaning mediates therelationship of social support and distress insurvivors with Major Depressive Disorder(MDD). METHOD: Thirty-six cancer survivors(92% female, 91% Caucasian, mean age 49) ofvarious sites (42% breast; 21% ovarian, 2.6%prostate) and stages of disease were eligible. AnMDD diagnosis was determined with the SCID.Participants completed assessments of distress(Profile of Mood States-short form), social supportfrom family and friends (Perceived Social Support-Family & -Friends) and meaning in life (Meaningin Life Scale-subscales: harmony/peace; life per-spective; faith/spirituality; confusion/lessenedmeaning). RESULTS: Correlation and mediationanalyses, using the bootstrapping approach, wereconducted. Support from friends did not predictdistress and was removed from further analyses.Mediation analyses of direct and indirect effectsshowed that the relationship between familysupport and distress was partially mediated by:harmony/peace (5�0.397, p5 0.01); life perspec-tive (5�0.231, p5 0.039); and confusion/lessenedmeaning (5 0.460, p5 0.009). Faith was notsignificant (5�0.103, p5 0.250). CONCLU-SIONS: Family support, rather than support fromfriends, was associated with reports of greater senseof meaning in depressed cancer survivors. De-pressed individuals who perceive less support mayexperience greater distress due to a decreased senseof meaning in their lives. Treatments for depressionfocusing on increasing one’s sense of meaningthrough gaining a sense of peace and reducingconfusion concerning the cancer experience may beparticularly helpful.

P-720

Self-actualization, Social Support, Anxiety and

Depression in Parents of Children with Cancer

Susana Almeida1, Magda Oliveira2, MarinaGuerra2, Raquel Murias2

Instituto Portugues de Oncologia do Porto FranciscoGentil, EPE, Porto, Portugal1, Faculdade dePsicologia e de Ciencias da Educac- ao da Universi-dade do Porto, Porto, Portugal2

OBJECTIVES: Characterize the parents of chil-dren with cancer of a Paediatric Oncology Service,by the assessment of anxiety, depression, socialsupport and self-actualization. Proceed to thereframing of these data in Guerra model (1994,


DOI: 10.1002/pon


1998), which integrates the dimensions of sense oflife, creative life, internal orientation and existen-tial dimension, associating them to the socialsupport variable. Relate the clinical variables withthe meaning variables. METHOD: Retrospectivestudy achieved by the administration of thefollowing questionnaires: Sheet of demographicdata and clinical data of children, Hospital Anxietyand Depression Scale (Zigmond & Snaith, 1983,translation and adaptation of Baltar & Ribeiro,1999), Social Support Scale (Guerra, 1995) andSelf-actualization Scale (Guerra, 1992). The in-formed consent was obtained from all the partici-pants. The statistical analysis was done with thesupport of SPPS, trough descriptive and inferentialmethods. RESULTS: The sample was constitutedby 80 parents, 89% females, 92% married, with amean of ages of 38, 11 years; 62, 5% of theparticipants’ children were female, 62, 3% had thediagnostic of Leukemia or Limphoma, 51% werein an acute phase of the disease and their mean ofages were 7, 98 years. The mean of Self-actualiza-tion obtained by these parents was 116, 6. Themean of Social Support, 80, 4. The remainingstatistical treatment is still on course. CONCLU-SIONS: The study of meaning variables is bringinglight to its importance in the adaptation of humanbeings to situations of normal development, crisisand illness. The inclusion of these kind of variablesin the study of the experience of parents of childrenwith cancer might promote their quality of life, aswell as the development of hope and meaning inthe process of adaptation to their child’s disease.

P-723

Temperament And Social Behavior In Pediatric

Brain Tumor Survivors And Comparison Peers

Christina Salley1, Larissa Hewitt2, DianeFairclough3, Keith Yeates1, Cynthia Gerhardt1,Andrea Farkas Patenaude4, Kathryn Vannatta1

The Research Institute at Nationwide Children’sHospital and The Ohio State University, Columbus,OH, United States1, Dana-Farber Cancer Institute,Boston, MA, United States2, University of ColoradoHealth Sciences Center, Denver, CO, UnitedStates3, Dana-Farber Cancer Institute and HarvardMedical School, Boston, MA, United States4

OBJECTIVES: It is well documented that pediatricbrain tumor survivors experience social difficulties.Intracranial treatment has been consistently linkedto poorer psychosocial outcomes, but the specificmechanisms involved are largely unknown. Treat-ment for brain tumors may detrimentally effectcore neurobiological processes that underlie tem-perament. Thus, we will explore differences insocial behavior among survivors and comparisonpeers and examine whether differences in attentionand temperament (i.e. surgency, negative affect,

effortful control) contribute to social outcomes.METHOD: Children (n5 76) ages 8–16 (M5 12.2)were recruited from two pediatric oncology centerspost-treatment for intracranial tumors to partici-pate in a classroom and home based study.Classmates (n5 67) matched for gender, race, andage were recruited for a comparison group. Peerreport of social behavior was collected in class-rooms. Data collected in participants’ homesincluded parent and self-report of temperament aswell as a performance-based measure of attention.RESULTS: Data is currently being analyzed. Weexpect to replicate previous findings from ourresearch group indicating survivors are perceivedby classmates as exhibiting greater social sensitiv-ity-isolation and victimization as well as lessaggression-disruption and leadership-popularitythan comparison peers. Independent t-tests willexamine group differences in social behavior,attention, and temperament. Using hierarchicalregression, we will test several moderated-media-tion models to examine the contribution oftemperament and attention to the prediction ofsocial behavior. CONCLUSIONS: It is expectedthat survivors will differ from comparison peers ondimensions of attention and temperament and that,in combination, these variables will explain differ-ences in social behavior. The final presentation willexamine these analyses and provide recommenda-tions for future research and clinical care toimprove the quality of life for survivors.

P-724

Gynecologic Oncology Patients: Pre- and Post-

Operative Relationships Between Social Support

and Body Image

Kathleen Shanahan, Michael Zevon, NefertitiDuPontRoswell Park Cancer Institute, Buffalo, NY,United States

OBJECTIVES: While there have been numerousinvestigations of the psychological impact ofsurgery for benign gynecological conditions, fewerstudies have examined gynecological cancer pa-tients (Anderson & Carpenter, 2003). Given thenature of gynecological cancer surgery, sequelaespecific to body image disturbance and it’s relationto adjustment are of particular interest. Thepresent pilot study investigates the relationshipbetween social support as a potential stress-buffering factor for body image disturbance in asample of gynecological surgery patients. METH-OD: Participants included 15 women (mean age58.9 years) undergoing gynecologic surgery forendometrial cancer. Participants completed theENRICHD Social Support Instrument (ESSI;Vaglio, J, et al., 2004), a validated seven itemself-report measure of social support, and the Body


DOI: 10.1002/pon


Image Scale (BIS; Hopwood, P et al.,) a validatedquestionnaire assessing body image changes inpatients with cancer. Patients completed thesemeasures at three time points, before surgery, and2 weeks and 6 weeks post-operatively. RESULTS:Correlational analyses examined relationships be-tween social support and body image disturbancewithin each time point. Analyses found a non-significant relationship between social support andbody image concerns pre-operatively (r5 0.27;p5ns). Strikingly, however, social support andbody image were significantly negatively correlatedduring the post-operative time period, both at thetwo week assessment (r5�0.74, p5 0.003) and atthe six week assessment (r5�0.61, p5 0.048).CONCLUSIONS: Results of our ongoing pilotstudy showed a significant association betweensocial support and body image during the postsurgical period for women undergoing treatmentfor gynecological cancer. Greater levels of bodyimage disturbance were associated with lower levelsof social support at both the two week and six weekevaluations. These findings highlight the need forassessment of existing social support resources andprovision of supportive interventions targetingbody image concerns for at-risk patients.

P-725

Coping Scales in Cancer Patients: A Systematic

Review of Instruments

Mona Daryaafzoun, Ensie Enjedany, FatemeAghaie Meybodi, Bahare Babayi, Nasim Kiayi,Mehrnoush HamzelouiyanPsycho-oncology research group university ofTehran, tehran, Islamic Republic of Iran

OBJECTIVES: Assessment of coping strategies isbecoming more common in cancer care andtreatment during last decade. The aim of thisreview is to identify instruments used to assesscoping in cancer patients, emphasizing cancerspecific coping instruments. METHOD: A sys-tematic review of MEDLINE and EMBASEdatabase from 1968 to 2010 was performed by asensitive search strategy using set of keywords(such as coping, cancer, tumor, carcinoma, neo-plasm). 540 articles were selected and 10% of themmet inclusion criteria in this review. Evaluationcriteria of these articles were validity, reliability,and utility. RESULTS: Reviewing included articleswe can divide coping questionnaires to twocategories: 1) generic questionnaires. 2) Cancerspecific questionnaires. Most of articles usedgeneric coping questionnaires. Among these arti-cles 3 instruments were especially developed forcancer patients: Ways of Coping-Cancer Version(WOC-CA), 21-item Cancer Coping Questionnaire(CCQ), and Coping with Cancer Instrument. All of

them have 5 dimensions and acceptable reliabilityand validity, but only the interpersonalscale of CCQ doesn’t have adequate validity.CONCLUSIONS: With comprehensive searchstrategies, we found that most of the articles hadused generic coping instruments. However theseinstruments are not enough qualified to assesscoping in chronic diseases such as cancer. Wesuggest that some cancer specific coping question-naires should be developed or validated for betterassessment of coping in these patients. Comparingthe mentioned three instruments, it seems becauseWOC-CA develops from valid questionnaire itsdimensions better describe cancer patients’ copingstyles.

P-726

The Impact Of Caregiver Age On Distress, Quality

Of Life And Preparedness For The Caregiving Role:

A Longitudinal Study Of Leukemia Patients’

Caregivers

Andrew Wurl, Teresa Johnson, Megan PaillerRoswell Park Cancer Institute, Buffalo, New York,United States

OBJECTIVES: While distress in response to illnessis common among caregivers, adjustment amongcaregivers of leukemia patients may be especiallydifficult due to the sudden onset of the disease andsignificant ongoing caregiver burden. This burdenmay be particularly difficult for older caregiversfacing these challenges with somewhat diminishedresources. This study examined the impact ofcaregiver age on preparedness, distress and qualityof life over time in a sample of leukemia patientcaregivers. METHOD: To date, 21 caregivers havebeen enrolled (age range 33 to 60 years). Completefollow-up data is presently available for 12caregivers. Caregivers completed the Brief Symp-tom Inventory (BSI-18), Caregiver Quality of Life-Cancer (CQOL-C), and Caregiver Preparednessmeasure within 72 hours of a patient’s diagnosis oradmission for treatment (T1). All measures wererepeated at 2 weeks after diagnosis (T2), with 6week (T3) and 12 week (T4) follow-ups for the BSI-18 and CQOL-C. RESULTS: While there was nosignificant relationship between age and prepared-ness at T1, a significant negative correlation wasobserved at T2 (r5�0.708, p5 0.001), with oldercaregivers reporting less preparedness. A trendtoward younger age being associated with lowerquality of life (r5 0.384, p5 0.085) and higherdistress (r5�0.340, p5 0.131) was observed at T1.Preliminary results suggest that this pattern re-verses over time for quality of life (r5�0.458,p5 0.134) and distress (r5 0.419, p5 0.175) by T4.CONCLUSIONS: The current study suggeststhat older and younger caregivers have different


DOI: 10.1002/pon


support needs at different time periods. Theseresults indicate that younger caregivers may havemore difficulty around the time of diagnosis, oldercaregivers may be more vulnerable to caregiverburden over time and as caregiving responsibilitiesincrease. Given these findings, interventions shouldbe tailored to address the specific needs manifestedby younger and older caregivers.

P-727

The Effects of Age and Children on Psychosocial

Outcomes in Women with Breast Cancer

Isabelle Ares, Katherine A. Collins, Sophie Lebel,Catherine BielajewUniversity of Ottawa, Ottawa, Ontario, Canada

OBJECTIVES: Research has shown that havingbreast cancer can lead to psychological distress andreduced quality of life in many women both in theshort- and long-term, particularly for womendiagnosed at a younger age. This study exploresdifferences in psychosocial outcomes betweenwomen who were diagnosed with breast cancer ata younger (o45 years old) versus older age (445years old), with particular attention paid to theeffects of having children on such outcomes.METHOD: A sample of 2, 377 women diagnosedwith stage 0–3 breast cancer (mean time sincediagnosis: 5.8 years) completed a web-based surveyconsisting of self-report instruments assessingquality of life, illness intrusiveness, fear of cancerrecurrence, social support, depression, stress, andanxiety. A principal axis factor analysis was used toexplore the different patterns of psychosocial out-comes in multiple groups, including youngerwomen with and without children and olderwomen with and without children. RESULTS:Four factors emerged in each group: mental health,fear of cancer recurrence, physical health, andillness intrusiveness. Differences in factor structuresand correlations between factors were observedamong the groups. Physical health and mentalhealth were more correlated in younger comparedto older women. Illness intrusiveness and mentalhealth were more correlated in younger womenwith children and in older women without childrencompared to younger women without children andolder women with children. CONCLUSIONS:Consistent with prior studies, these results confirmthat women diagnosed at a younger age have apoorer psychosocial profile compared to thosediagnosed at an older age. Furthermore, the resultssuggest that having children may be a protectivefactor in older women, but a vulnerability factor inyounger women. These findings indicate thathaving children has a separate but interactive effectwith age of diagnosis on the psychosocial outcomesof breast cancer.

P-732

Hope and Support in Cancer Related Articles of

Two Iranian Nationwide Newspapers

Mehrnoush Hamzelouiyan, Fateme AghaieMeybodi, Mona Daryaafzoun, Ensie Enjedany,Bahare Babayi, Sima SadeghiPsycho-oncology Research Group, University ofTehran, Tehran, Islamic Republic of Iran

OBJECTIVES: Public newspapers are popularsources of cancer information and have a remark-able effect on opinions and feelings of patients andtheir families. Hope and support are importantissues for cancer patients that could affect qualityof life of patients and even the outcomes of diseaseand treatments. The objective of this research is todescribe what has been reported about hope andsupport of cancer patients in two most famousIranian newspapers during 2002–2009. METHOD:Searchable version of the mentioned newspapersarchive was used to identify cancer related issues byusing ‘cancer’ and some synonym words as key-word. 750 Related articles which met our inclusioncriteria were included. Reviewing these articles,data were coded for cancer type, hope & supportand publication date among other variables.RESULTS: Content analysis of 750 includedarticles showed that only 2.25 percent of the cancerrelated articles considered hope as the importantpoint of the article. 72.7 percent of hope relatedarticles published in 2008–2009. From includedarticles, 12.65 percent described support and mostof these articles published in 2008–2009. Informa-tion support, emotional support and financialsupport respectively had most articles. There isno article related to social, physical and spiritualsupport in cancer. CONCLUSIONS: An increas-ing trend in frequency of hope and support relatedarticles has been observed during recent two years.It seems although we can see more related articlesin this era, but the total number of these articlesespecially about hope in cancer patients, is very lowand such messages should be considered more innew policies of these famous newspapers. Insuffi-cient and Inaccurate media coverage may becontributing to public misunderstanding and dis-appointment about cancer.

P-735

Development Of A Symptom Distress Reduction

Model For Stem Cell Transplant Patients

Prisco Salvador1, Doris Howell1

Princess Margaret Hospital, Toronto, Ontario,Canada1, University of Toronto, Toronto, Ontario,Canada2

OBJECTIVES: The purpose of this poster pre-sentation is to describe one’s unit experience in the


DOI: 10.1002/pon


conceptualization of a model to guide interventionsaimed at reducing symptom severity and distress(i.e. oral mucositis) in stem cell transplant patientsundergoing high-dose chemotherapy. Oral muco-sitis, characterized by an inflammation and ulcera-tion of the oral and oropharyngeal mucosa,remains a significant problem that impacts physicaland psychological wellbeing and quality of life ofpatients with cancer and their families. METHOD:A master-prepared staff nurse, with assistance fromthe Chair of the Oncology Nursing Research, tooka leadership role in this effort. Staff nursesidentified oral mucositis as a priority clinicalproblem that warranted change in their practice.Critical inputs from clinical educators, physicians,nutritionists, pharmacists, and nurse manager wereviewed as crucial to the implementation andsuccess of the project. Internal evidence, profes-sional practice knowledge, and relevant theoriesand models were synthesized. RESULTS: Theresultant model has three components with sup-porting concepts: (A) Problem-persons with can-cer/families, identified stressors, and stressorreactions; (B) Process-prevention as intervention,goal of care, intervention characteristics (e.g. self-efficacy) and oral health; and (C) Outcomes--patient, healthcare system, and quality of life. Thismodel has afforded us a proactive approach tomucositis prevention with an evidence-based oralcare guide and achieved a significant reduction ofmucositis severity/distress through a pilot rando-mized trial. CONCLUSIONS: The development ofthis model is an important step towards preventionfor oral mucositis severity and distress. It providesan effective framework to understand the nature oforal mucositis and identify intervention character-istics that may predict the adherence of an oral self-care protocol in order to achieve optimal out-comes. It may also contribute to the advancementof clinical practice in mucositis prevention andmanagement and to add evidence-based knowledgeof effective interventions.

P-736

A Comparison Of Written Versus Video Informa-

tional Presentations Designed To Enhance Human

Papillomavirus Vaccine Acceptability In Young

Adults: A Randomized Controlled Intervention

Study

Andrea Krawczyk1, Vanessa Delisle2, ZeevRosberger3

McGill University, Montreal, Quebec, Canada1,Jewish General Hospital, Montreal, Quebec,Canada2, Segal Cancer Centre, Jewish GeneralHospital, Montreal, Quebec, Canada3

OBJECTIVES: The Human Papillomavirus (HPV)is sexually transmitted and the principal cause ofcervical cancer. HPV vaccines are known to reduce

the likelihood of infection in the young adultpopulation, which is especially at high risk. Theaims of the present study were: 1) to exploreacceptability of the HPV vaccine among youngadults; 2) to investigate predictors of vaccineacceptability; and 3) to evaluate the comparativeefficacy of two informational intervention modal-ities on vaccine acceptability. METHOD: Under-graduate university students (N5 97; meanage5 20.3 years, SD5 2.3) were randomly as-signed to one of two experimental conditions(video or written information about HPV), or toa control condition (written information aboutgeneral cancer prevention strategies). Students alsocompleted a questionnaire assessing predictors ofvaccine acceptability pre- and post-intervention(e.g. HPV and HPV vaccine knowledge; perceivedHPV susceptibility and severity; and perceivedbenefits and barriers to receiving the vaccine).RESULTS: At baseline, 34.3% of participantsindicated intentions to receive the HPV vaccine,with 54.5% intending post intervention. Perceivedseverity of HPV and perceived benefits and barriersto receive the vaccine were correlated with vaccineacceptability. The two experimental interventionsresulted in increased HPV and HPV vaccineknowledge, perceptions of HPV susceptibility andseverity and perceptions of benefits to receiving thevaccine as compared to the control. None of theconditions were related to increased acceptability.CONCLUSIONS: Educational interventions ap-pear to increase knowledge about HPV and theHPV vaccine in university students, but thisincrease is not related to acceptability. It appearsthat perceived HPV severity and perceivedbenefits to receiving the vaccine may be moreimportant in influencing acceptability. Futureinterventions should perhaps focus on the potentialseverity of HPV and on the beneficial aspects of theHPV vaccine, such as the reduction of cervicalcancer risk.

P-738

The Psycho-oncologist’s Place In The Diagnosis

Disclosure Procedure In France

Michel Reich, Fazya Ait-Kaci, Anne-Laure Sedda,Jean-Christophe NeuCentre Oscar lambret, Lille, France

OBJECTIVES: Establishment in France of specia-lized consultations in cancer diagnosis called diag-nosis disclosure procedure was a key measure of theFrench Cancer Plan 1 (Measure 40). It becameincreasingly widespread in France since 2007. It isintended to formalize and harmonize medicalpractices in the announcement of a diagnosis ofcancer, not considered appropriate and beingtraumatic for patients, in order to humanizeand professionalize process’ announcement.


DOI: 10.1002/pon


METHOD: Under this procedure, the patient maybe referred to a psycho-oncologist, member of thesupportive care team, through a form generallyfilled by the consulting nurse which will screenpsychosocial needs. The psycho-oncologist will beable to help the patient to perform an elaborationwork focused on thoughts and affects paralyzed bythis traumatic disclosure. A cognitive restructuringand an additional pharmacological support regard-ing psychiatric issues related to the disease an-nouncement might be done. RESULTS: During themeeting with the psycho-oncologist, different ele-ments will be discussed and evaluated such as theexperience of the announcement, the identificationof the defense mechanisms and the coping strategies.Moreover, a screening for psychological difficultiesand / or psychopathological disorders encounteredby the patient will be implemented. Finally,psychosocial resources available by the patient andits surroundings will be assessed. CONCLUSIONS:This moment shared between the psycho-oncologistand the patient is part of the prevention and theearliest care of the psychological distress so frequentduring consultations announcement. It mightalso have a preventive role against anxiety anddepressive disorders occurrence during the cancertrajectory.

P-740

The Effect of Spirituality And Religiosity on Mental

Health And Quality of Life In Cancer Patients

Ensie Enjedany, Mona Daryaafzoun, HadiZamanian, Maryam Karbasi Motlagh, FaezehFatolah Beigy, Marzieh Beheshtipsycho-oncology research group university ofTehran, Tehran, Islamic Republic of Iran

OBJECTIVES: It has been shown that cancerpatients sometimes use their spiritual and religiousbeliefs to cope with cancer and their problems. Theaim of this study is to investigate the role ofspirituality and religion in patient’s mental healthand their quality of life. METHOD: 101 consecu-tive cancer patients were included in this study,mean age: 44 and female/male ratio was 3:1.Patients completed 3 validated questionnaires toassess quality of life, spirituality, mental health.RESULTS: Most of patients (98%) consideredreligion to be somewhat important. 78.2 percent ofpatients reported that their spiritual activities wereincreased after their diagnosis. 97 percent of all,believed that if God want, they will survive andabout 75 percent thought that their disease is akind of God exam for them to be closer to God.With statistical analysis, spirituality was signifi-cantly associated with patient’s quality of life (p-value5 0.02), and mental health (p-value5 0.04).CONCLUSIONS: Many cancer patients use

spirituality for coping with their disease. Ourresults emphasize and confirm on the role ofspirituality and religious belief on enhancingquality of life and mental health improvement.

P-741

Impact of Spirituality on QOL of Lower Income

Predominantly Minority Cancer Survivors

Michelle Martin, Polly Kratt, Robert Oster,Mary Evans, Hwanseok Choi, Shiquina Andrews,Maria PisuUniversity of Alabama at Birmingham, Birmingham,AL, United States

OBJECTIVES: The spiritual side of an individualis increasingly acknowledged as having an impacton that individual’s health and well-being. Weinvestigated spirituality and its impact over time onthe well being of a lower income predominantlyminority sample of cancer survivors. METHOD:Cancer patients in treatment or follow-up weresurveyed by telephone at baseline, approximately2-months later, and again at 8-months. The FACT-G [Emotional Well Being (EWB), Social WellBeing (SWB) and Functional Well Being (FWB)subscales] as well as FACIT-Spirituality (Meaningand Faith subscales) were administered at all timepoints. Regression analyses, controlling for poten-tial confounders (e.g. time since diagnosis), wereused to test the hypotheses that Meaning and Faithpredicted well-being. RESULTS: At baseline,survivors (N5 140) were predominately AfricanAmerican (80%), not married (73%), unemployed(89%), and low income (average o$15, 000).Twenty-two percent had o HS education. Meanbaseline Spirituality subscales (Meaning5 25.3(max5 32); Faith5 14.6 (max5 16)) were stableover time. Meaning in life, measured at baseline,predicted each of 2-month and 8-month EWB,SWB and FWB (po0.02). The models for 2-monthand 8-month EWB accounted for the greatestvariability with adjusted r2 5 0.29 and r2 5 0.35respectively. CONCLUSIONS: Spirituality factorsappear stable over time. In a sample of cancersurvivors for whom Faith was important, patientshigh in Meaning (e.g. feelings of peace, sense ofpurpose in life, belief that life had been productive),reported better cancer-related quality of life at 2and 8 months post-baseline. Interventions that willhelp patients find meaning in their life experiencesmay further improve QOL for cancer survivors.

P-747

Social Difficulties Screeners: How to Systematically

Detect Patients Social Difficulties?

Emmanuel BuchotInstitute Gustave Roussy, Villejuif, France


DOI: 10.1002/pon


OBJECTIVES: Cancer patients meet various diffi-culties in daily life. The disease increases previousproblems like existing financial, housing or em-ployment problems, loss of autonomy or access tohelp services. Besides, hospital stay in our institu-tion are often shorter. Finally, the temporality isnot the same from the point of view of the patient,of the family, of the hospital or of the society. Inthis context, anticipating social difficulties isrequired to maintain efficient social services.METHOD: A procedure of systematic anticipationof social difficulties was set up within the frame-work of the Long Diagnosis Disclosure Consulta-tions. Doctors have to answer to 5 followingquestions (Y/N): Living alone? Responsible forchildren or handicapped? Handicapped? Havingrisk to lose autonomy? Having financial problems?A positive answer to 2 items automaticallyactivates a social alert, with diverse modalities ofanswer: mailing, appointment, participation in amedical consultation. RESULTS: During a trialphase realized on 335 CLA, 140 gave place to aneffective intervention of the Social services depart-ment. 46% of the CLA ENT and 64% of the CLAbrain tumours generated social alerts. These inter-ventions consisted of the implementation: preser-vation at home for 100% of brain tumours; grantsfor 49% of the patients ENT and helps for homemaintenance for 90% of them. CONCLUSIONS:The social alert procedure is at present effective onall the long cancer diagnosis disclosure consulta-tions and was opened more recently to thepalliative care consultations. Our global objectiveallows for the anticipation of potential socialdifficulties in patients and contributes to a reduc-tion of hospital stay duration while taking intoaccount patients’ everyday life with the objective ofan optimal preservation of their quality of life.

P-750

Barriers And Facilitators In Adherence to Treatment

In Cancer Patients

Fateme Aghaie Meybodi, Bahare Babayi, HadiZamanian, Faezeh Fatolahbeigi, Maryam KarbasiMotlagh, Nasim KiayiPsycho-Oncology Research Group University ofTehran, Tehran, Islamic Republic of Iran

OBJECTIVES: Adherence to treatment is the mainissue in treatment outcome and recovery of cancerpatients. The aim of this study is to investigatesome barriers and facilitators of adherence totreatment in cancer patients. METHOD: 97 cancerpatients were included in our study. Data wascollected with investigator-designed questionnairesfor adherence, barriers’ and facilitators’ factors.Chi square and correlation analyses were usedto investigate the relations between variables.RESULTS: Some facilitators considered to have

effect on patients’ adherence were: doctor andfamily recommendations, hope to recovery, cue toaction (successful recovery in other patients), andfear from metastasis. Some barriers were anhedo-nia, hopeless to treatment, costs of treatment,complications of treatment, family inconvenienceand some other negative thoughts. The mostmentioned facilitator was hope to recovery (75percent) and the most mentioned barrier was costof treatment. CONCLUSIONS: The result sug-gests although physicians’ recommendations, fa-vorable outcomes, and familiar supports positivelyrelated to adherence, hopelessness, costs, treatmentequipments, and treatment side effects negativelyrelated to adherence. It seems high adherence totreatment could be as a result of hope increasingtrend in Iranian cancer patients because of treat-ment advances in Iran and also successful copingstrategies in patients.

P-753

Distress In Couples Affected By Cancer: Prevalence,

Gender-specific Patterns And Longitudinal Predictors

Michael T. Moser1, Alfred Kunzler2, FridtjofNussbeck3, Angela Zindel4, Mario Bargetzi2, HansJ. Znoj4

Klinische Forschung Aargau, Aarau, Switzerland1,Kantonsspital, Aarau, Switzerland2, KlinischePsychologie, Universitat Zurich, Switzerland3,Klinische Psychologie, Universitat Bern, Switzerland4

OBJECTIVES: Findings on distress in couplesaffected by cancer are heterogeneous, but tend toindicate that women have a greater chance to bemore distressed than men regardless of being thepatient or the partner. We want (1) to assess theamount of distress couples experience after cancerdiagnosis, (2) to explore by which individual anddyadic factors distress is influenced and (3) want toget a better understanding of the factors ‘gender’and ‘role’. METHOD: A representative sample of137 heterosexual couples with one partner affectedby cancer was recruited in a regional hospital inSwitzerland at diagnosis, 6 month, 12 month and 3years later. Distress (HADS, IES, GSI), QoL (SF-12) and coping styles (EMOREG, BriefCOPE)were assessed. Mixed models were used to evaluatetime and group effects. Cross-lagged effects wereestimated with structural equation modelling, usinga multilevel-multigroup path model within theframework of the Actor-Partner InterdependenceModel (APIM). RESULTS: Female partners pre-valence rates and scores for anxiety are mostlyhigher compared with patients (m/f)) and malepartners. Similar patterns were found for depres-sion rates, posttraumatic symptoms and distress.Distress and QoL was related to precedingadaptive coping in patients and partners (r5 |0.31to 0.49|). Adaptive coping in female patients


DOI: 10.1002/pon


predicts better Qol/less distress in spouse (r5 0.43/�0.40). Adaptive Coping and less distress in femalepartners predicts better QoL and less distress inmale patients (r5 0.28/�0.24). CONCLUSIONS:Our cross-lagged findings showed, that on the onehand female partners experience the highest dis-tress in contrast with male or female patients andmale spouses, and on the other hand women,regardless of their role, are the persons who activemodulate the psychological well-being of theirpartners. This double role bears important encum-brances and should be considered as an importantstarting point in planning and conceptualizing ofpsycho-oncological interventions.

P-756

The Long Term Follow Up of Survivors of Child-

hood Cancer at the McGill University Health Centre

Sharon AbishMontreal Children’s Hospital, McGill UniversityHealth Centre, Montreal, Canada

OBJECTIVES: Improvements in treatment forchildhood cancers over the past 3 decades haveled to a major improvement in prognosis for mostof these patients. Approximately 75% of newlydiagnosed cases can now expect to be long-termsurvivors (defined as over 5 years). The diagnosisand treatment received, which may include surgery,chemotherapy and radiation therapy, may lead tolong-term health issues. METHOD: While most ofthese individuals lead full lives with good quality,several recent publications indicate that up to 75%of them will suffer at least one chronic healthcondition. Thus, long term follow up by a team ofprofessionals with knowledge of their diagnoses,treatments received and potential health issues isessential. This is also important for those providingcare to newly diagnosed children, as some mod-ifications of current treatment regimens maydecrease these late effects. RESULTS: The expec-tations of the professional team, the survivor andthose of his/her parents in participating in long-term follow up clinics may differ. Many models oflong term follow up of survivors of childhoodcancer now exist. One of the obstacles to providingcare in the province of Quebec is the shortage ofprimary care physicians. CONCLUSIONS: At theMcGill University Health Center (MUHC), wehave a dedicated clinic for long term follow upwithin the Montreal Children’s Hospital until theage of 18, with a transition to the MontrealGeneral Hospital, an adult institution within theMUHC, after that time. There are manystrengths, but also weaknesses, of our currentprogram, which we hope to address in the nearfuture.

P-758

Differences in Developmental Personality, Locus of

Control and Work Behavior Self-Efficacy: Implica-

tions for Young Adult Cancer Survivors’ Employment

Fong Chan1, David Strauser5, Stacia Wagner2,Deirdre O’Sullivan3, Alex Wong5, Alo Dutta4

University of Wisconsin-Madison, Madison WI,United States1, Children’s Brain Tumor Foundation,New York, NY, United States2, Penn StateUniversity, College Park, PA, United States3,Southern University, Baton Rouge, LA, UnitedStates4, University of Illinois at Urbana-Champaign,Champaign, IL, United States5

OBJECTIVES: The continuing advancement ofmedical technology has dramatically increased thenumber of cancer survivors able to return to work.Cancer survivors often regard returning to work asindicative of complete recovery. However, relativelyfew studies have specially assessed the vocational needsof this population. The purpose of this study is toexamine differences in three work-related constructsbetween young adult CNS cancer survivors and othercategories of disability. METHOD: A total of 107participants with physical disabilities, psychiatric dis-abilities, learning disabilities or young adult CNScancer completed the measures representing develop-mental work personality, work locus of control, andself-efficacy work behaviors. RESULTS: Results in-dicate significant difference in various types of disabilityacross measures of developmental work personality,work locus of control, and self-efficacy work behaviorsinwhich gender was found to be a significant covariate.Follow-up analyses further indicated that males withdifferent types of disability demonstrated differences ondevelopmental work personality and self-efficacy workbehaviours whereas females with different types ofdisability demonstrated differences on developmentalwork personality and work locus of control. CON-CLUSIONS: This study further verified previousfindings which people experiencing different types ofdisability would have different vocational and careerneeds (O’Sullivan, Strauser, & Wong, submitted).More research is needed to address the impact offactors regarding developmental work personality,work locus of control, and self-efficacy at work, whichseem to play an important role in cancer survivors’employment. Research does highlight the need forvocational and career interventions to be incorporatedinto psycho-social rehabilitation programs.

P-763

Patient Reports: Evaluating Satisfaction with

Medical and Supportive Care Services

Liane S. Kandler1, Scott M. Sellick1



DOI: 10.1002/pon


OBJECTIVES: In line with patient and familycentred care initiatives, we aim to assess whetheryoung adult cancer patients feel satisfied with theirmedical and supportive care services. The psycho-social needs of young adults are now know to beunique, rendering it necessary to evaluate whethertheir needs in particular are being met. Our goal isto briefly address these questions and to formulatepolicy recommendations based on the responses.METHOD: Young adult cancer patients (18–44years) seen since September 2004 were invited toparticipate in a questionnaire mailing. A subset ofquestions assessed satisfaction with medical treat-ment, and the ability to have questions answer bydoctors (each rated on a 5-point Likert scale)Awareness of, and use of, supportive care serviceswas also assessed (yes or no questions). For thosewho did access services, satisfaction with suppor-tive care was also questioned (5-point Likert scale).RESULTS: Questionnaire mailing took placeJanuary 6th, 2009, therefore results are pending.At present, 40 completed questionnaires have beenreturned. Data entry and analysis will be completedby March 15th, 2010. Results relating to medicaland supportive care satisfaction will be analyzed inreference to basic demographics (gender, age,education, income, marital status) and type ofcancer. CONCLUSIONS: As professionals, it isour responsibility to ensure that the needs of youngcancer patients are being met to the best of ourability, and that concerns are being heard andaddressed. Although brief, this subset of questionsallows for a general overview of satisfaction (ordissatisfaction). Results will be discussed in rela-tion to patient and family centred care initiatives,policy recommendations, and research directives.

P-764

Leveling the Playing Field: Increasing Participation

of non-MD Clinicians in Multidisciplinary Suppor-

tive Care Medicine Rounds

Jennifer GottoCity of Hope Cancer Center, Duarte, CA,United States

OBJECTIVES: This abstract demonstrateschanges we made in our Supportive Care Medicinepatient rounds in order to increase participation ofnon-MD clinicians, improve interdisciplinary com-munciation, and to better integrate SupportiveCare clinical services. METHOD: Clinican satis-faction with rounds is associated with participa-tion; our feedback demonstrated physicians talkedmore often than non-MD clinicians during usualrounds. Physician-led rounds emphasized medicalover psychosocial, and neglected to establish aclear treatment plan for biopsychosocial problems.To increase non-MD participation, changes weremade to room layout, patient list, method and

focus of case presentations, expectation for leadingdiscussion, responsibility for developing biopsy-chosocial treatment plan, and level of account-ability for carrying out treatments. RESULTS:Clinicians like the new rounding format and find itmore useful. More non-MD clinicians present casesand pose challenging questions. All disciplinesparticipate in problem solving and treatmentplanning discussion. We expect increases in con-fidence, satisfaction and team cohesiveness; in-creases in use of clinical language and recognitionof psychiatric symptomotology by nonMD practi-tioners. We hope for a shift in rounds style fromtraditional medical hierarchy to open, ‘equalopportunity to lead discussion’ format. CONCLU-SIONS: Psychiatric need exceeds psychiatristsavailable for cancer patients. A variety of profes-sional degrees populates our department, andinterdisciplinary communication needs to be clear.Practitioners need equal opportunity to presentdifficult patient problems to the entire team. Thisvariety is the essence of multidisciplinary medicine,whose uneven edge is both the challenge and thepayoff in developing a truly integrated clinicalprogram.

P-769

The Value of Patient Education in Laryngeal Cancer

Rehabilitation and its Influence on Quality of Life

(QoL)

Marie-Eve Caty, Philip C. DoyleThe University of Western Ontario, London,Ontario, Canada

OBJECTIVES: The literature suggests that patienteducation directly influences one’s ability to copewith a diagnosis of cancer and its subsequentimpact on perceived well-being and associatedQuality of Life (QoL). The purpose of thispresentation is to outline recent advancements in1) laryngeal cancer treatment and 2) healthprofessional education and consider their potentialinfluences on patient education practices providedto those with head and neck cancer. Implicationsfor future research will also be discussed. METH-OD: Contemporary methods of treatment forlaryngeal cancer have diversified with the advance-ment of organ preservation therapy (radiotherapyand/or chemotherapy). In addition, health profes-sional education and practice have changed overthe last decade with more emphasis given toevidence based-practice, client-centered practice,interprofessional education, and reflective practice.In light of the current literature, new perspectiveson the impact of these changes and considerationswill be discussed relative to patient education andtheir QoL. RESULTS: Previous research exploringeducational preferences of individuals with laryn-geal cancer suggest that information provided


DOI: 10.1002/pon


should interdisciplinary, coming from a variety ofhealth professionals, and should be provided onmultiple occasions throughout the rehabilitationprocess. Findings also indicate that continuedefforts are needed to improve the quality of serviceand information provided to individuals treatedwith laryngeal cancer since these individuals maynot be receiving the level of information and servicethey need. CONCLUSIONS: Individuals withlaryngeal cancers may experience voice loss orcompromise which limits their ability to self-advocate for their health care needs. Thus,concerns relative to individuals diagnosed andtreated for laryngeal cancer persist regardingpatient education and its effect QoL. Healthprofessional education is suggested as one avenueto better prepare health care professionals to workwith individuals diagnosed with laryngeal cancer aswell as other malignancies of the head and neck.

P-770

Interest of Individuals with Severe Mental Illness in

Improving Health Behaviors and Reducing Cancer Risk

Marne L. Sherman1, David D. Barnum2, Leah K.Gensheimer1

University of Missouri - Kansas City, Kansas City,MO, United States1, The Guidance Center,Leavenworth, KS, United States2

OBJECTIVES: Individuals with severe mental illness(SMI) have higher rates of premature mortality fromcancer compared to the general population, and arelikely to have lifestyles that increase the risk forcancer. Little has been reported regarding theinterest of individuals with SMI in interventionsthat promote healthy behaviors and reduce cancerrisk. The present study examines the interest ofindividuals with SMI in obtaining information andinstruction to improve health behaviors and reducecancer risk. METHOD: This study includes indivi-duals with SMI attending a psychosocial programwithin a community mental health center. Partici-pants are assessed regarding their interest in learningabout healthy lifestyle and cancer risk reduction.Interest in enhancing a variety of health and cancerprevention behaviors is assessed. RESULTS: Sampledemographics and psychiatric diagnostic informa-tion will be reported. The level of interest in learningabout and improving behaviors associated withcancer risk and cancer control, including tobaccouse, nutrition, exercise, cancer screening, and com-munication with physicians, will be reported. CON-CLUSIONS: Implications for the tailored design ofa cancer prevention and health promotion programfor individuals with SMI will be discussed. Recom-mendations for the integration of such programs inthe comprehensive treatment of individuals withSMI within a community mental health center willbe provided.

P-772

Perceived Cognitive Function after Cancer Treat-

ment: Considerations for Future Research

Samantha MayoLawrence S. Bloomberg Faculty of Nursing,University of Toronto, Toronto, ON, Canada

OBJECTIVES: Neuropsychological testing providesvaluable data regarding cognitive performance aftercancer treatment. However, it provides limitedinformation regarding individuals’ experiences oftheir day-to-day functioning. As part of a largerproject to examine cognitive outcomes amongrecipients of allogeneic stem cell transplantation, aliterature review was conducted to: 1) develop anunderstanding of perceived cognitive function aftercancer treatment; and, 2) identify important con-siderations for future research in this area.METHOD: A literature search was conducted forprimary studies and systematic reviews in 5 electronicdatabases: Medline, CINAHL, Embase, PsycINFOand Cochrane Library. Studies were included if theyinvestigated perceived cognitive function (includingsubjective or self-reported cognitive function, cogni-tive complaints, etc.) among adult cancer patientsfollowing the completion of treatment. Studies ofpatients with cancers involving the central nervoussystem were excluded. RESULTS: Reviewed studiessuggest that cancer patients’ perceptions of cognitivefunctioning after treatment do not correlate withperformance on neuropsychological testing, but morestrongly reflect psychological factors and fatigue.However, issues regarding operational definitions ofperceived cognitive function, choice of neuropsycho-logical measures and methodological rigor wereevident as important areas for consideration inplanning future studies. CONCLUSIONS: Perceivedcognitive function has recently gained attention as animportant factor in the dialogue surrounding thecognitive outcomes of cancer treatment. Futureresearch that employs a theoretically-driven andrigorous approach to the study of perceived cognitivefunction among cancer survivors will further ourunderstanding of their experiences and supportivecare needs in this phase of the cancer continuum.

P-773

A New Tool for Assessing the Needs of Children

with Siblings Requiring Palliative Care: The Content

Validity Study

Marianne O.-d’Avignon1, Marianne O.-d’Avignon2,Marianne O.d’Avignon3, Serge Dumont1, SergeDumont2, Serge Dumont3

Laval University, Quebec, Quebec, Canada1,Maison Michel-Sarrazin, Quebec, Quebec, Canada2,Research Center of Centre hospitalier Universitairede Quebec (CHUQ) – L’Hotel-Dieu-de-Quebec,Quebec, Quebec, Canada3


DOI: 10.1002/pon


OBJECTIVES: All family members are involved inmany ways in the care of a child facing a life-threatening illness, such as cancer. Siblings experi-ence a variety of feelings and therefore have variedneeds. A new tool, which specifically assessessiblings’ needs within the palliative care context iscurrently being systematically developed and vali-dated. The first step of this research program isgoing to be presented. More specifically, itemselection and content validity procedures will bedescribed. METHOD: A sibling-needs typologyhas been developed from a qualitative study amongfocus groups whereby siblings and their parentswere assessed separately. A pool of 135 items hasbeen generated from this 43 needs typology, whichwas then subdivided in 10 domains. Four cate-gories of experts (psychometricians, researchers,clinicians and siblings), recruited through snowballprocedure, were involved in validity procedurebased on the criteria of relevance and clarity.Missing needs were also identified. RESULTS:Content-validity study recruited 21 experts. Quan-tification of content validity was performed withContent-Validity Index (CVI). 38 items from theinitial pool reached criterion of 0.80 CVI (28%).CVI gives a proportion of agreement betweenexperts on item relevance and on item clarity. Eightitems were deleted because they bring discomfortor redundancy. Experts identified 12 missingsiblings needs. This content validity study hasallowed selection of 48 items, which were includedin the first version. CONCLUSIONS: Item selec-tion and expert opinion are relevant aspects of tooldevelopment. A panel of experts provides con-structive feedback about the quality of the newlydeveloped measure and represents an objectivecriterion with which to evaluate each item.Qualitative approach underlying the need-typologyand content experts will improve the instrument bya mixed-method. Indeed, siblings are activelyimplicated in this instrument development study.They are judged expert at the same level asclinicians or researchers.

P-775

Screening for Psychological Distress among

Sesotho-speaking South African Patients Diagnosed

with Breast or Cervical Cancer

E. N. Shino1, D. A. Louw2

University of Namibia, Windhoek, Namibia1,University of the Free State, Bloemfontein, SouthAfrica2

OBJECTIVES: Although international researchindicates that cancer patients suffer psychologicaldistress, research in southern Africa is still in itsinfancy stage. The objective of this study was toscreen for psychological distress of Sesotho-speak-ing South African women with breast or cervical

cancer. The study further aimed to explore thefeasibility of the use of the Distress Thermometer(DT) and the Hospital Anxiety and DepressionScale (HADS) as distress screening tools withinSouth African oncology settings. METHOD: Thesample consisted of 126 Sesotho-speaking patientswith histologically confirmed breast- or cervicalcancer. Data was collected at the out-patient clinicof the Universitas Academic Hospital in Bloem-fontein, South Africa. The study was approved bythe Ethics Committee of the Faculty of HealthSciences at the University of the Free State. TheDT and the HADS were used, and both tools weretranslated into Sesotho. RESULTS: The mean agewas 52.21 (12.56) and the time since diagnosis inmonths was 12.60 (12.65). The HADS identified33% of the subjects as distressed, whereas 34% and33% were identified as experiencing anxiety anddepression respectively. ROC analysis suggests acut-off score of 3 as ideal on the DT. At this cut-offscore, 44% of the patients were identified asdistressed. The DT correlates positively andsignificantly with the HADS. CONCLUSIONS:The results of the study suggest that a substantialnumber of Sesotho-speaking cancer patients ex-perience significant psychological distress, andsupport international research. Given their easeof administration, both the DT and the HADScould be useful screening tools for psychologicaldistress in busy and under-staffed South Africanoncology settings. The study highlights the poten-tial need for routine screening for psychologicaldistress, the management thereof, and the improve-ment of quality of care of cancer patients.

P-777

Various Methods Of Tabocco Use in India, Leading

To Cancer

Srikanta Basu Mallik1

Revive, Kolkata, West Bengal, India1, ChittaranjanNational Cancer Institute, Kolkata, West Bengal,India2

OBJECTIVES: Tobacco use (Cigarette smokingand other methods) is the single largest cause ofCancer. 35% of Cancer mortality can be preventedby stopping various types of Tobacco use. Use ofTobacco is mainly smoking and non-smokingtypes. Both types of tobacco use varies extensivelyworldwide. It is important to know the variousmethods of tobacco consumption, in order to planand programme its prevention. METHOD: Themajor types/means of tobacco use, both smokingand nonsmoking in India were probed into. Thevarious parts of the country associated withvarious methods of tobacco use was also studiedupon. The parts of the country were dividedbasically into 5 zones namely North, South, East,West and Central. Both Urban and Rural areas


DOI: 10.1002/pon


were considered for the study. RESULTS: 38different types of tobacco use (15 types of smokingtobacco and 23 types of non-smoking tobacco)werefound in various parts of India. The non-smokingtobacco use involved inhalation, chewing and oralapplication. It was found that the various forms oftobacco use varied from one part /state toanother part/state of the country. Identificationof the type of use in different parts of India hadbeen made CONCLUSIONS: As the site andtype of Cancer varies with the variation of tobaccouse, the knowledge of various forms of tobaccouse in various parts of India is essential toformulate and plan proper health education andawareness programmes about the hazards oftobacco consumption in relation to Cancer.Proper awareness will only help in preventing thesingle largest cause of premature death, due toCancer.

P-778

Hope, Support and Healing for Siblings Who are

Bereaved

Deborah Bond BerkDana Farber-Children’s Hospital Cancer Care,Boston, MA, United States

OBJECTIVES: The presentation will provideprofessionals with a better understanding of howthis sibling program supports the brothers andsisters of the children and adolescent patients wecare for through end of life and into bereavement.This, in turn, facilitates better family-centered care.Psychosocial professionals will be provided withevidence-based recommendations tailored specifi-cally to the sibling grief and healing experience.METHOD: During individual and group psycho-social interactions, approximately 20 school-agedand adolescent siblings were invited to participatein expressive and creative activities focusing on endof life and bereavement issues. This yielded written,verbal and creative information that qualitativelyillustrates key issues encountered by this popula-tion. RESULTS: Siblings benefitted from theopportunity to discuss end of life and bereavementissues with psychosocial clinicians, parents andextended family. Siblings reported the ameliorationof immediate psychosocial distress. Reduction inemotional and behavioral difficulties was alsoobserved. Providing emotional support throughoutthis significant loss, while understanding culturaland religious beliefs, enabled siblings to begin tocope more adaptively with their grief. CONCLU-SIONS: Evidence indicates a traumatic and persis-tent developmental impact of losing a brother orsister to cancer. Targeted and prescriptive psycho-social support is highly beneficial as siblings faceend of life with their brother or sister. This can help

soften the impact of the loss. Findings will aid infurther developing effective grief comfort servicesprovided by practitioners serving families facingpediatric cancer.

P-779

Canadian Cancer Society’s Cancer Information

Service Follow-Up Program: Helping Clients Navi-

gate the Journey to Hope and Meaning

Tara BilashCanadian Cancer Society - Cancer InformationService, Regina, SK, Canada

OBJECTIVES: Results of a Canadian CancerSociety needs assessment survey of clients (cancerpatients and caregivers) affirmed that informationand communication needs ranked high among themajority of clients, with between only 40–50% ofclients reporting having these needs met.Continu-ously striving to meet clients’ needs, the CanadianCancer Society’s Information Service developed apilot Follow-Up Program in October 2008. Thepilot program identified and reinforced the infor-mation and communication needs of Canadians.METHOD: The Follow-Up Program was pilotedfrom October through December 2008. Clientswere offered a callback from Information Specia-lists 7–10 days after the client’s initial call. Feed-back from both clients and Information Specialistsrevealed the untapped range of impact of theFollow-Up Program. After overwhelming positiveresponse to the 2008 pilot, the Canadian CancerSociety officially launched the Cancer InformationService Follow-Up Program in English in July 2009and in French in December 2009. RESULTS:Impact upon follow-up contact with a client iscategorized across several categories. Since itslaunch, the Cancer Information Service Follow-Up Program has empowered approximately 1, 000clients by increasing their awareness of resources;helping them understand cancer and cope better;decreasing their stress and anxiety; and helpingthem communicate better with family, friends, andtheir oncology teams. Completion of a formal thirdparty evaluation of the Follow-Up Program isplanned for December 2010. CONCLUSIONS:Cancer patients or friends/family enrolled in theFollow-Up Program receive enhanced supportfrom the Cancer Information Service in the formof a follow-up call(s) to help ensure informationand support needs are met throughout the cancerjourney. The Cancer Information Service’s Follow-Up Program cultivates client-centred relationshipsthat help clients navigate their journey throughcancer to hope and meaning. The Follow-UpProgram propels the Canadian Cancer Societycloser to creating a world where no Canadian fearscancer.


DOI: 10.1002/pon


P-781

Responses of Patients with Malignant Brain

Tumours and their Families’ to Expanded Psycho-

social Services

Douglas Ozier, Maureen ParkinsonBC Cancer Agency, Vncouver, BC, Canada

OBJECTIVES: People living with malignant braintumours and their families are a very high needsgroup that has historically been underserved. Tohelp meet these needs more effectively, a multi-disciplinary team is currently implementing a newmodel with the goal offering more comprehensivecare. The purpose of this ongoing research study isto measure the value of the services offered throughthis new program and to gain insight into ways thatit can be improved. METHOD: All new malignantbrain tumour patients in our centre and theirfamilies will be offered an increased range ofservices including earlier assessment, more inten-sive practical supports, and increased counsellingaccessibility. Service usage will be tracked as abehavioural indicator of perceived value. Ratingscales will be administered and interviews con-ducted to measure subjectively perceived value, tomonitor quality of life, and lessened barriers totreatment, and to solicit any recommendations forimproved care. RESULTS: The research study willgenerate a combination of qualitative and quanti-tative results that together will provide deepenedinsight into the lived experience and psycho-socialneeds of patients living with malignant braintumours and their loved ones. In turn, thisincreased awareness should improve service deliv-ery and inform best practice in this domain.CONCLUSIONS: The expanded Psychosocialservices have been already been offered in ourclinic to over 40 people living with malignant braintumours. This poster will report preliminary dataon patient and family responses served to date.This data will offer an initial window into howthese clients have responded to a range ofexpanded Psychosocial services.

P-783

Psychoneuroimmunology and Biopsychosocial

Model - Implications for Oncology

Kizior AleksandraMedical University of Warsaw, Warsaw, Poland

OBJECTIVES: Key words: psychoneuroimmunol-ogy, personality, stress, cancerThis paper focuses on psychoneuroimmunologystudies published since 1939, particularly those that

were clustered according to key themes includingpersonality, stress and responsiveness of theimmune system to behavioral interventions.METHOD: In recent years it underlines theimmune system plays role in the onset andprogression o the neoplastic disease. This revivedescribes psychoneuroimmunological pathways in-volved in cancer disease is a major determinant ofpathophysiological mechanism accounting for theassociation between psychological risk factors,immune systems parameters and acute cancerdisease. RESULTS: Although psychological mod-ulation of immune function is now a wellestablished-phenomenon, much of the relevantliterature has been published within the lastdecade. CONCLUSIONS: I this article we specu-lated on future directions for psychoneuroimmu-nology research after, after reviewing the history ofthe field.

P-790

Communication Adjustment and Experiences of

Patients with a Laryngectomy in Turkey

Paul Evitts1, Fikret Kasapoglu2, Ugur Demirci2

Towson University, Towson, MD, United States1,Uludag University, Bursa, Turkey2

OBJECTIVES: The purpose of this poster pre-sentation will be to delineate the communicationexperiences and degree of adjustment for people inTurkey that have had a total laryngectomy andnow use an alternate voice source. Comparisonswill be made to patients with a laryngectomy in theUnited States. METHOD: Twenty-five personswith a laryngectomy (n5 20 with TE prosthesis,55oesophageal) completed the Self-Evaluation ofCommunication Experiences after Laryngectomy(SECEL; Blood, 1993) in Turkey. The SECEL is avalid and reliable measure that reports patientfactors related to three subscales: general, environ-ment, and attitude and has been shown to be ableto distinguish those patients that are adjusting wellto their new voice with those that may needadditional support. RESULTS: Data on 20patients has been collected and is currently beingtranslated to English for data analysis. Data on tenmore patients is anticipated. CONCLUSIONS:Results will be discussed in terms of comparisonsto patients in the United States and the continueduse of the SECEL in a clinical setting to identifythose patients that may need additional support.For any significant differences observed, additionalinsight will be offered from a cultural perspectiveon why those differences may exist.


DOI: 10.1002/pon


WORKSHOPS

W-8

Finding Hope and Meaning after Prostate Cancer:

The Science and the Art of Healing

Anne Katz1,2

CancerCare Manitoba, Winnipeg, MB, Canada1,University of Manitoba, Winnipeg, MB,Canada2

OBJECTIVES: The treatment of prostate cancerinvolves several modalities, all of which impacton erectile functioning. No matter the stage ofthe cancer–early localized to advanced hormonerefractory disease–the treatments universallyaffect erectile functioning, orgasmic capacityand sexual satisfaction. As important howeveris the effect on male self concept, perceivedmasculinity, and sexual self-confidence. Thepartner too is affected. METHOD: This work-shop will trace the sexual changes and challengesbeginning with the diagnosis of prostate cancer,the decisions around treatment, and some chal-lenges for men with advanced disease treatedwith hormone ablation and their partner. Usingcase studies, the presenter will highlight theunique challenges facing these couples as wellas make suggestions for counseling. The latestadvances in treatment and the side effects ofthese will also be discussed. RESULTS: Studiesshow that partners experience more distress thanthe man with prostate cancer. Problems in thesexual relationship result in communicationchallenges which in turn influence the couple’sability to cope with the changes brought on bythe diagnosis and treatment. CONCLUSIONS:Recent advances in treating erectile dysfunctionprovide hope and healing to these men howeversome will have to learn to adapt to an alteredreality for many years following treatment.Psychosocial clinicians, nurses and other mem-bers of the health care team must be aware ofthese issues which profoundly affect the man, hisrelationship and quality of life.

W-22

‘Chasing Rainbows - Young Adults Living With

Cancer’: French-Language Premiere of Documentary

Film, and Discussion with Film Director, Young

Adult Cancer Survivor and Psycho-Social Oncologist,

Addressing the Need for Multi-Lingual Resources

Pat TaylorChasingrainbowsproduction.com, Vancouver, BC,Canada

OBJECTIVES: 1. To offer emotional and practicalsupport, hope and meaning to francophone youngadult cancer patients, their families, caregivers andmedical support teams through the French-lan-guage version of ‘Chasing Rainbows: Young AdultsLiving With Cancer’ 2. To foster dialogue andpromote action surrounding the need for multi-lingual resources, to improve quality and accessi-bility of cancer care 3. To support the voice ofyoung adults in the global cancer community.METHOD: Chasing Rainbows: Young AdultsLiving with Cancer is an upbeat 43-minute doc-umentary built around a living-room conversationbetween six young adults: four women and twomen. With passion and humour, they discuss hope,fear, faith, sexuality, infertility, family relationships,finances, the future and more. Their stories are aninvaluable source of information, inspiration andhope - both for other young adults facing life-threatening illness, and for their families, friends,caregivers and medical support teams. RESULTS:Producer Pat Taylor has screened Chasing Rain-bows across Canada, in the US and in Mumbai(India), and has had requests for screenings in theUK, Italy, the Netherlands and Australia. In thecourse of the film’s travels it has become abun-dantly clear that there is a great need for resourcesin languages other than English. CONCLUSIONS:Having now completed the French-language ver-sioning of Chasing Rainbows, Pat is in the processof translating the film into Spanish, Chinese,Arabic, Malay, Hindi, Portuguese and Italian.


Workshops S301

W-33

Mini-Symposium Benefits of National Cancer Con-

trol Programs for Establishing Full Integration of

Psychosocial Care in Oncology-Europe

Margot Remie, Hanneke de Haes, Mecheline vander LindenDutch Psychoscial Society, Amsterdam, Netherlands

OBJECTIVES: In this round table meeting theresults and possibilities for promotion and integra-tion of psychosocial care through NCCP areilluminated. Examples from different countries willbe presented. Results regarding structural imple-mentation of distress screening, integration ofpsychosocial issues in medical treatment guidelinesand after care programs, bench marking andincorporation of psychosocial oncology in Na-tional Oncology Care Standards will be presented.Pitfalls and strategies for further cooperation andimplementation will be discussed. METHOD:Representatives from European countries (invitedare: Belgium, Portugal, Sweden, Scotland and theNetherlands) will present their National Standards.Other countries will be invited in a interactivediscussion. RESULTS: Clinical Implications:Through a successful implementation of the NCCPpatients will increasingly benefit from adequatesupport as a result of systematic screening, devel-opment of treatment guidelines and the organisa-tion of psychosocial care programmes nationwide.Research Implications: The implementation of aNCCP can promote cooperation of research teams,development of a common research agenda andfacilitate funding. Sharing with trailblazers: Learn-ing through exchanging programs, sharing experi-ence (pitfalls and success policy), gaining (further)inspiration for NCCP implementation. CONCLU-SIONS: Full integration of psychosocial aspects inoncology care can be highly facilitated by beingincorporated in National Cancer Control Pro-grams. Through optimal cooperation of all partiesinvolved it stimulates the true integration ofpsychosocial care in oncology.

W-36

Facilitating the Implementation of the Palliative

Care Needs Assessment Guidelines and the Needs

Assessment Tool: Progressive Disease - Cancer in

Clinical Practice

Afaf Girgis1, Amy Waller1, David Currow2

Centre for Health Research & Psycho-oncology(CHeRP), Cancer Council NSW, University ofNewcastle & Hunter Medical Research Institute,Newcastle, NSW, Australia1, Flinders University,Adelaide, South Australia, Australia2

OBJECTIVES: The workshop will introduce thePalliative Care Needs Assessment Guidelines and

Needs Assessment Tool: Progressive Disease -Cancer (NAT:PD-C) to multidisciplinary interna-tional attendees to facilitate their systematic use inclinical practice. METHOD: Evidence supportingthe acceptability and impact of use of the Guide-lines and NAT:PD-C will be presented. Workshopparticipants will then watch segments of a DVDdeveloped by the research team which demonstratehow a health professional discusses issues coveredin the NAT:PD-C with a simulated patient and acaregiver. Group discussion will focus on how bestto utilise the NAT:PD-C and the optimal timing ofits use in the respective clinical settings of work-shop participants. RESULTS: The Guidelines andNAT:PD-C were developed with funding from theAustralian Government Department of Health &Ageing. The evaluation completed in 2008 suggeststhat the tool is helpful for assisting busy healthprofessionals to identify issues of concern, parti-cularly in areas not routinely well addressed inconsultations; is a highly acceptable and efficientneeds assessment tool, with a high rate of comple-tion by health care providers and no impact on thelength of consultations. CONCLUSIONS: Noother national or international guidelines or screen-ing tools currently exist to concurrently assesspatient, caregiver and professional carer’s needs toprompt needs based referrals to palliative careservices. By incorporating these resources as partof the care at an early stage of their advancingdisease, health professionals can identify those withgreater needs who may require targeted earlyinterventions, thus reducing burden and improvingquality of life.

W-60

Management of Difficult Personality Traits and

Disorders in Cancer Patients

John David Wynn1,2

Swedish Cancer Institute, Seattle, WA,United States1, University of Washington Schoolof Medicine, Seattle, WA, United States2

OBJECTIVES: This workshop will introduce anew structure and method for collaborative con-sultation with oncology clinicians in the identifica-tion and management of cancer patients withdifficult personality traits and disorders. METH-OD: The workshop will open with an overview ofthe existential challenges that evoke dysfunctionalinteractions in oncology settings. This is followedwith a review of the DSM classification ofpersonality disorders, including the clinicalshortcomings of this system. Fundamental featuresof clusters A, B and C are used to structuregeneral clinical understanding and intervention.A clinically-based typology is then introducedwith examples of specific interactions that canbe performed and taught by psycho-oncology


DOI: 10.1002/pon

S302 Workshops

consultants. RESULTS: Patient-clinician interac-tions are divided into Diagnosis, Dominant features,Typical Caregiver Interactions, Helpful Interven-tions and Diagnostic Confounds. Interventionsemphasize empathic relevance, clinical utility, andease of communication with collaborating cliniciansin a multidisciplinary setting. Recognizing patient-clinician interactions is emphasized over nosologicalclassification, recognizing that most difficult patientsdo not have DSM Axis II diagnoses. CONCLU-SIONS: Beyond DSM-IV we need an approach todifficult patients that respects their diverse presenta-tions and needs. Understanding the perceptions andmisunderstandings common to complex medicalcare settings will enhance clinical interactionsbetween psycho-oncology consultants, cancer pa-tients and the diverse clinicians who care for them.

W-116

What Children Need to Know When a Parent or

Sibling Has Cancer

Andrea WarnickMount Sinai Hospital, Toronto, Ontario, Canada

OBJECTIVES: This workshop will identify: Com-mon experiences and concerns among children andadolescents’ when a loved one has cancer; Overviewof the research on children’s experience of a familymember’s cancer; Strategies for health care profes-sionals to support parents’ communication withtheir children about the illness and prognosis;Creative interventions to directly support childrenwhen a family member has cancer; Strategies tosupport families if the diagnosis becomes palliative;Literary and web resources available to supportchildren and adolescents through a family member’scancer experience. METHOD: The objectives forthis workshop will be achieved through a combina-tion of interactive exercises and lecture format.RESULTS: It is the intent of the presenter toprovide the participants with communication strate-gies and creative interventions that can be used tosupport a child or adolescent when a family memberhas cancer. CONCLUSIONS: While the currentbody of research on children experiencing the cancerdiagnosis of a parent advises a policy of honesty andinclusion, many health care professionals are una-ware of this knowledge, thus are left unsure of therole that they can play to support these families. Thisworkshop will include a review of the current bodyof research as well as strategies that can be used tosupport children when a family member has cancer.

W-145

Systemic Family Therapy in Psycho-oncology.

The Genogram Technique

Marta Irena Porebiak, Anna BlogoszCancer Centre Institute, Warsaw, Poland1

OBJECTIVES: This is planned as a comprehensiveworkshop for psychotherapists who want to learnhow to apply systemic approach and genogramtechnique in therapy of cancer patients. Systemictherapy is based on Bertalanffy’s works to increaseattachment bonds, healthy communication andrelationships between relatives. Family as a systemis a set of interacting elements (family members),characterized by relationships between them, form-ing integrated whole, which is more than just a sumof its parts. METHOD: We present wide range ofsystemic constructs-family bonds (according toMinuchin’s structural approach), family life circle(according to Haley’s concept), loyalties (Boszor-menyi-Nagy’s approach). We focus on the techni-que of genogram, which best helps to assess notonly present family functioning, but also family’spast experience–patterns of support giving, careproviding and grief management. Case studies offamilies of patients suffering from cancer arepresented to show those phenomena. RESULTS:It is very important for clinicians to learn how towork on family resources and to teach the family tocollaborate to support good psychological well-being and high quality of life. We expect that afterthis presentation/workshop clinicians will haveenough knowledge to use systemic approach andthey will be able to apply genogram method in theirwork with cancer patients and their familymembers. CONCLUSIONS: As a workshop–thispresentation is based on exercises in assessment offamily functioning, potential resources and threatswithin family system and interventions planning. Itis a practical experience and short trainingprogram for psychologists, psychotherapists andclinicians interested in genogram technique incancer patients’ therapy.

W-152

The Impact of a Positive Self-Talk Intervention on

Breast Cancer Survivors Coping Skills and Psycho-

logical Well-Being - Workshop Demonstration and

Discussion of Results

Ryan Hamilton, Baukje Miedema, Julie Easley,Leslie MacIntyreDalhousie University - Family Medicine TeachingUnit, Fredericton, NB, Canada

OBJECTIVES: Cancer survivorship is a distinctphase of the cancer continuum and can have amyriad of associated stresses and challenges. Thepurpose of this study was to evaluate the effective-ness of a positive self-talk (PST) intervention inenhancing the coping skills and psychological well-being of breast cancer survivors. In this workshop,the elements of the intervention will be presented indetail to illustrate exactly what was done and solicitsuggestions for improvement. METHOD: Partici-pants (N5 38) were recruited from five support


DOI: 10.1002/pon

Workshops S303

groups in a small Eastern Canadian province.Support groups were randomly assigned to either acontrol (N5 18) or intervention (N5 20) condi-tion. Intervention participants were pre-tested,received a two hour PST intervention, a 15minutebooster session by telephone and completed a posttest questionnaires one month later. Measuresincluded the POMS, HADS, RSOPAC, and aworkshop evaluation questionnaire. RESULTS:Intervention participants reviewed the workshopfavorably. Nearly all participants used the inter-vention in their everyday lives, were able toaccurately describe how PST works and foundthat it had a considerable impact on their ability tocope with cancer and related sequelae. However,the descriptive findings from the workshop evalua-tion did not translate into significant differencesbetween intervention and control groups on thepsychometric measures employed. CONCLU-SIONS: The PST intervention, delivered in acommunity group model, was positively receivedand effective in teaching participants about PSTand and it’s applicability. The intervention, how-ever, did not promote significantly greater levels ofchange in anxiety, depression, mood disturbance orcoping ability for intervention participants. Theunique challenges of community level psychologi-cal intervention will be discussed, as will futuresteps to building on the initial successes of thisproject.

W-220

Money Matters–A Canadian Model Of Service

Compilation And Service Delivery To Address The

Financial Impact Faced By Cancer Patients

Pamela Bowes, Holly BradleyWellspring Cancer Support Foundation, Toronto,Ontario, Canada

OBJECTIVES: Cancer can have a significantfinancial impact that adds a serious burden topatients’ disease management. This workshop willidentify common evidence-based sources (e.g. lostincome, drug expenses), and the systemic tabooand other reasons that prevent patients fromgetting the help they need. A program model thatis a targeted and comprehensive intervention onthe financial impact of cancer will be described.Case studies, evaluation data and leaders’ feedbackwill be presented. METHOD: To respond to theidentified financial needs of patients, a comprehen-sive program was developed. The unique aspects ofthe program include the participation of experts,wide array of services, and comprehensive one-stopassistance. Extensive program development workfocused on building partnerships and relationshipswith government programs, community servicesand legal resources. Professional case managers

assist patients to navigate through and accessneeded resources to meet financial needs, andadvocate on their behalf when challenges arise.RESULTS: Evaluation data from patients indi-cates significant help with the majority citing theprogram as the only resource available. Thedemographics of program users, and the multiplesources of financial concerns show diversity ofneed. Most new patients are referred by oncologyprofessionals. The program continues to gainrecognition in the oncology community andbeyond. Today the program includes legal clinics,income tax clinic, government program staff on siteconducting intakes and comprehensive case man-agement. CONCLUSIONS: This program is amodel for supportive services to meet the financialconcerns of cancer patients. When the stigma ofmoney worries is reduced, and comprehensiveservices are offered, money worries can be mana-ged. As one patient said ‘dealing with cancer waseasy compared to dealing with money concerns’.The presentation will offer participants the oppor-tunity to explore how money worries can bemanaged for their patients, and learn about aproven, comprehensive intervention model.

W-224

Cancer Patients and Workplace Programs:

Community Based Psycho-Educational Programs

for Patients

Holly Bradley, Pamela BowesWellspring Cancer Support Foundation, Toronto,Ontario, Canada

OBJECTIVES: Cancer patients face many fearsand anxieties associated with returning to work orbeing back at work. There are many broadanxieties e.g. coping abilities, physical/emotional/cognitive deficits, stamina, workplace accommoda-tion, communication, health management strate-gies. Instrumental interventions were developedbased on workplace literature and patients’ experi-ences. The programs have had positive andsignificant results. Program highlights, challenges,outcomes and lessons learned will be explored inthis presentation. METHOD: Two eight-weekprograms were developed–for cancer patientsthinking about returning to work and patientsnow back at work. Participants attended to learnnew coping strategies, reduce isolation and reducefears. The programs followed specific content toteach new skills and gave participants ampleopportunities to share. Expert speakers addressedkey topics including employment law, governmentprograms and workplace accommodation. Exten-sive evaluation was completed at the end of theprogram and six months later. RESULTS: Overallhigh attendance and low drop-out rate. Expert


DOI: 10.1002/pon

S304 Workshops

speakers, especially legal experts, were well receivedwith needed information. We expected participantsto be more engaged in the homework assignmentsand contemplating various workplace/career op-tions. Participants noted high satisfaction fromconnecting with other patients. Managing thereturn to work or managing workplace issues is acomplex process requiring time and well thought-out process. Outcome affirmed need for stringentleaders’ credentials and additional applied training.CONCLUSIONS: These two programs are modelsfor helping cancer patients manage workplaceissues. Anxiety and fear is high for patientsthinking of returning or those back at work.Learning new skills and sharing with others helpsto reduce anxiety and create action plans. Expertsprovided valuable information. Participant satis-faction was high. Leaders required more training tobetter understand the emotional, practical andvocational needs of participants.

W-244

Using Somatic Psychology To Decrease Distress

and Find Meaning After A Cancer Diagnosis

Marita PollBC Cancer Agency, Victoria, BC, Canada

OBJECTIVES: Cancer diagnoses and treatmentare often associated with psychological distress forpatients. Cancer, by definition, is at the very leasta threat to one’s physical integrity, and at the most,a threat to one’s life. People react instinctively to athreat to one’s body or life with the flight/fightresponse, a physiological defensive response thatallows a person to defend or mobilize against athreat. This physiological response is often over-whelming and confusing for patients. METHOD:In this workshop, cancer will be viewed through atrauma lens, and patients’ reactions to cancer areconsidered as normal responses to danger andthreat. Somatic Psychology, informed by the fieldsof neuroscience and Interpersonal Neurobiology, isa trauma theory and treatment approach. Ageneral overview of Somatic Psychology principleswill be presented. Then Somatic Interventions,including somatic inquiry, optimal arousal zone,movement, and meaning-making questions, will bereviewed. RESULTS: These tools allow Psychoso-cial Clinicians to help cancer patients resolve andmake meaning of thwarted defensive responses(e.g. a flight or fight response that did not lead toavoidance of danger or life threat). Through areview of a real life case study, participants will bepresented with an example of a thwarted defensiveresponse, along with ways of working with theseinstinctive responses. CONCLUSIONS: There willalso be an opportunity to practice these skills withfellow participants.

W-251

A Workshop To Identify Strategies To Support

Hope

John Kearsley1, Judith Lacey2, Frank Brennan2,Simone Connell2, Elizabeth Lobb2, Christine San-derson2, David Thomas1

St. George Hospital - Cancer Care Centre,New South Wales, Australia1, Calvary Health CareSydney - Palliative Care Services, New SouthWales, Australia2

OBJECTIVES: This workshop will examine hopefrom the perspective of the clinician and the patientand will identify strategies for health professionalsto create an environment where hope can besupported. Hope and hopelessness are importantconcepts for patients and families in palliative care.Conversations with patients that are truthful yetcapable of engendering hope have the potential toimprove patients’ quality of life, lessen their will todie and increase satisfaction with care. METHOD:In this workshop a brief film where a patientdiscusses hope is shown. A film of a paneldiscussion on hope from the perspective of theoncologist, the surgeon, the palliative care physi-cian and a patient will then be presented. Work-shop participants will be invited to respond to thefilms and the views they present. Individualstrategies used by the disciplines represented atthe workshop to support hope will be identifiedand discussed. RESULTS: This workshop isfocused on health professionals involved in thecare of patients with life threatening illness. It willprovide participants with the opportunity to: a)reflect on their own definitions of hope; b) shareexperiences from their own clinical practice; c)discuss the role of hope in whole person care; andd) identify additional strategies to extend thepsychological, spiritual and clinical care ofpatients. CONCLUSIONS: Hope is a multidimen-sional concept. It is defined as a positive futureorientation and is an important coping strategyin critical stages of life. Hope is a way ofthinking, feeling and acting that may help cancerpatients and their families cope with a difficultsituation. Hope can help patients move forwarddespite bad news and disappointment. This work-shop will identify strategies that may supportpatient hope and bring about positive psychologi-cal outcomes.

W-328

Finding Hope and Meaning in Uncertain Times:

Lessons Learned from End of Life Journeys

Cheryl Nekolaichuk, Sheila Killoran, Bette Emery,Zinia PritchardGrey Nuns Hospital, Edmonton, Alberta, Canada


DOI: 10.1002/pon

Workshops S305

OBJECTIVES: A terminal illness propels patientsand families onto a pathway of uncertainty,marked by debilitating symptoms, multiple lossesand marginalized roles. Despite progressive dis-ease, people who are terminally ill and theirfamilies search for hope and meaning within healthcare provider relationships. The purpose of thisworkshop is to describe experiences and providepractical strategies for dealing with uncertainty,based on lessons learned from journeying withpatients and families at end of life. METHOD: Thelessons that will be presented are based on theexperiences of four members of an interdisciplinarypsychosocial-spiritual team - a social worker, musictherapist, psychologist and chaplain - who providecare to patients and families on a tertiary palliativecare unit. A variety of multi-media and creativearts methods will be used to share these experi-ences, including dialogue, case scenarios, photo-graphy, music and poetry. RESULTS: Participantswill have an opportunity to explore the followingquestions: How do patients and families experienceuncertainty at end of life? What are some of thechanges that may occur in terms of their spiritualpractices? What type of strategies can patients,families and health care providers use to find hopeand meaning amidst the uncertainty? CONCLU-SIONS: Terminally ill patients and their familiesmay have difficulty expressing and dealing withtheir experiences of fear, anxiety and sadness,which often accompany profound physical changesand decline. The creation of a safe environment,supported by an integrated interdisciplinary team,can help patients and families search for and findhope and meaning in the uncertainty. Many of thelessons learned at end of life can be transferred toother transitions and uncertain times in life.

W-346

Psychosocial Assessment and Intervention Strategies

for Adolescents and Young Adults with Cancer

Sylvie Aubin1, Norma D’Agostino2, Kim Edel-stein2

Jewish General Hospital, Montreal Quebec,Canada1, Princess Margaret Hospital, TorontoOntario, Canada2

OBJECTIVES: Adolescent and young adults withcancer (AYAC) face unique medical and psycho-social challenges, including emotional/psychologi-cal distress, financial hardship, social isolation, andthe impact of cancer treatments on fertility,sexuality and self/body image. The objective ofthis clinical workshop is to provide assessment andintervention strategies addressing AYAC psycho-social issues. Based on the comprehensive cancercare model, the workshop is relevant to medicaland mental health providers involved in the care of

AYAC. METHOD: This workshop will be dividedin two parts structured around the presentation ofcore assessment and intervention strategies forAYAC. Part I will focus on the assessment ofbiopsychosocial factors, including medical/physi-cal, mental/emotional, neurocognitive, social, ca-reer/education, financial issues as well as fertility,sexuality and body/self-image. Part II will focus onintervention strategies such as communication/assertiveness, problem-solving/decision making,dating, sexuality and couple intervention strategies.RESULTS: Assessment and intervention modal-ities will be discussed in light of their benefits anddrawbacks, and suggestions will be made forpotential adaptations for use with AYAC. Theseinclude interview guidelines, self-report question-naires and the differing roles of individual, familyand group therapy for AYAC. Moreover, follow-ing the comprehensive cancer care model, anemphasis will be placed on illustrating howpsychosocial interventions are integrated withadjunctive oncology services provided by otherproviders of the care team. CONCLUSIONS: Theworkshop will benefit both the clinician and theAYAC. Participants will thus have the opportunityto not only learn about the key psychosocial issuesand reality of AYAC but also about the interven-tion strategies and guidelines most indicated toaddress issues. Moreover, the provision of re-sources and materials specific to AYA oncologymay serve as documents of reference for partici-pants and as a result, lead to improved care.

W-350

‘Getting the Best Bang for the Buck’ - or, Realizing

the Value of our Work. Making a Business Case

John ChristophersonB.C. Cancer Agency, Vancouver, B.C., Canada

OBJECTIVES: An examination of methodologyand challenges of examining psycho oncologythrough an economic lens. The workshop objec-tives include increasing the capacity of the partici-pants about the application of economics to ourfield, a discussion of current issues in psychosocialeconomics, and where we need to go from here.METHOD: Economics are about choice. There isan opportunity cost to choosing one interventionover another. In these days of increasingly scarceresources we have to ensure that we can provideevidence that allocating resources to psychosocialoncology is the optimum choice. This workshopwill examine methodolgies of measuring the valueof our work. We will discuss approaches taken inother fields of oncology, and in other clinical fields.RESULTS: The challenge can be described astrying to compare apples and oranges. Comparinga psychotherapeutic intervention to a medical one


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presents difficulties - what units should one use,what are the units worth, and are they a fairrepresentation of the value of that intervention?CONCLUSIONS: There are two approaches tomeasuring the value of psychosocial interventions -medical cost offsets and patient utility measures.The former is fairly well understood and docu-mented. Patient utility instruments are typicalyfocussed on disease adaptation and treatment sideeffects, and fall short of being adequate measuresof quality of life. Today the competition forresources is becoming increasingly intense, we needto have the appropriate tools to justify the value ofour contributions.

W-487

An Experiential Workshop For Pyscho-Oncology

Professionals: Enhancing Meaning In Our Work

Through Mindfulness Based Stress Reduc-

tion(MBSR) Interventions:

Sarah Sample, Michael SpecaBC Cancer Agency, Vancouver, BC, Canada1, TomBaker Cancer Centre, Calgary, AB, Canada2

OBJECTIVES: This experiential workshop willprovide psycho-oncology professionals with directexperience of MBSR so that they may incorporateit into their lives and professional practise.METHOD: Mindfulness refers to the practice ofdirecting awareness, in the form of non-judgmentalattention, to that which arises, moment bymoment, in lived experience. Over 25 years ofstudies have demonstrated that MBSR is helpful inrelieving stress in day to day life and its use as anoncology intervention is growing. This particularway of paying attention to process can fostercompassion, evoke a greater sense of grace andease in life. RESULTS: Through mindfulnesspractice we may come to understand the processand context of shifting thoughts and feelings. It candeepen our connection with ourselves and others.One can cultivate new skills in facing difficultchallenges such as illness, pain and loss moreeffectively thus strengthening innate capacities forhealing. MBSR can bring us a refined ability todiscern and discard unhelpful patterns of relationto ourselves and to others with mindfulness as ourcompanion. CONCLUSIONS: This workshop willprovide an opportunity to experience the gifts ofmindfulness directly as you are gently guided byexperienced instructors through a range of mind-fulness practices designed to refresh and renew asense of peace, joy and gratitude. There will be timedevoted to questions and open discussion of theexperiences provided. Time will also be giventowards the end of the workshop for addressingspecific considerations of teaching mindfulnesswith cancer patients.

W-496

Building a Case for Canadian Virtual Hospice in

Psychosocial Care

Harvey Max Chochinov2, Shelly Cory3, FredNelson4, Glen Horst1, Brenda Hearson4

Canadian Virtual Hospice, Winnipeg, Manitoba,Canada1, University of Manitoba, Winnipeg, Man-itoba, Canada2, CancerCare Manitoba, Winnipeg,Manitoba, Canada3, Winnipeg Regional HealthAuthority, Winnipeg, Manitoba, Canada4

OBJECTIVES: Increasingly people access the Internetfor health information and to connect with others.Likewise, health care professionals access on-lineinformation to support practice. Based on key infor-mant interviews, visitor surveys and web analytics, theCanadianVirtualHospice (CVH)websitehasexpandedits ability to meet the needs of patients, families, healthcare professionals, regardless of geography.Combiningtechnological advances and palliative care expertise, thesite provides evidence-based information and supporton palliative care and bereavement. METHOD: TheCVHclinical team (physicians, clinical nurse specialists,social worker and spiritual care advisor) uses aninterdisciplinary approach to develop evidence-basedcontent and respond to ‘Ask a Professional’ (AAP)questions. CVH leverages the latest advances ininformation technology to enhance access to palliativecare information, inter-professional collaboration andhealthliteracy.Websitevisitorscanbrowseinformation,ask questions and receive confidential, individualizedresponses from the clinical team, and connect in acommunityofsupport.RESULTS:CVH’sAAPserviceisunique in theworld.The siteaverages25,000visitspermonth fromCanadaand154countries.The largest usergroupsarehealthprofessionalsandfamilies.Theclinicalteam has responded to over 1000 AAP questions fromhealth professionals (40%) and patients/families(60%).Satisfactionresults indicate that87%arehighlysatisfiedwith their visitor experience. Other countries haveapproached CVH about replicating its model. CON-CLUSIONS: In this interactive presentation you willparticipate in building case examples that facilitateexploration of the features of the site from patient,family and health care perspectives. We will alsoexamine the unique online interdisciplinary collabora-tive process involved in providing information andsupport in aweb-based environment, aswell as benefits,challenges, nuances and lessons learned related tovirtual communication.

W-507

Managing Cancer and Living Meaningfully

(CALM): A Brief Individual Psychotherapy for the

Treatment of Patients with Advanced Cancer

Gary Rodin, Christopher Lo, Virginia Boquiren,Emily Freeman, Sarah HalesPrincess Margaret Hospital, Toronto,Ontario,Canada


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OBJECTIVES: Psychological well-being is chal-lenged in patients with advanced cancer because ofthe multiple and progressive stresses, burdens andlosses associated with it. These include physicalsuffering and disability, the requirement of depen-dency, the challenge to the sense of meaning andpurpose, and the threat of mortality. We havedeveloped a 3–6 session individual psychotherapyto alleviate distress and to promote psychologicalwell-being and growth in this population. METH-OD: CALM is a manualized, individual psy-chotherapeutic intervention based on longitudinalresearch and the principles of supportive-expres-sive, existential and relational/attachment theory.It consists of 3–6 individual sessions delivered over3 months by trained mental health staff, withoptional booster sessions. Treatment modulesaddress: 1) symptom management and commu-nication with health care providers; 2) changes inself and relations with close others; 3) spiritualwell-being; and 4) preparing for the future,sustaining hope and facing mortality. RESULTS:In this interactive workshop, we will describe andillustrate the treatment framework and the trainingand supervisory process. Video excerpts of therapysessions will demonstrate CALM in action anddiscussion will focus on clinical challenges andopportunities. Quantitative and qualitative out-come data obtained from therapists and patientswill be presented, based on the research pilot phasewith 25 CALM therapy participants. CONCLU-SIONS: The educational goals of this workshopare to describe the rationale, training and treat-ment process of a newly developed individualpsychotherapeutic intervention for patients withadvanced and terminal disease. Such an interven-tion has the potential to transform the experienceof advanced disease for patients and therapists andto promote psychological growth in individualswho are facing what is most often the greatestchallenge of their lives.

W-532

Finding Hope and Meaning through Cancer Reha-

bilitation

Pasqualina Di Dio, Virginia LeeMcGill University Health Centre, Montreal,Quebec, Canada

OBJECTIVES: Cancer affects multiple aspects ofan individual’s functioning. Cancer rehabilitationcan instill hope to help patients and their familyreturn to the task of living and find meaning intheir disrupted lives. The aim of this workshop is todiscuss the strategies used by the interdisciplinaryteam of the Cancer Rehabilitation Program topromote hope and meaning in cancer patientssuffering from multiple symptoms, loss of function,

and psychological distress. METHOD: The 8-weekCancer Rehabilitation Program consists of a teamof physicians, nurses, physiotherapists, a nutri-tionist, a psychologist, and a social worker.Interventions for managing distress, promotingautonomy and self-management, instilling hope,and finding meaning will be discussed withinthe context of diet, exercise, work and leisureactivities, and symptom management for cancer.RESULTS: Clinical examples will be used toillustrate interventions and some of the challengesencountered. An interactive discussion willfollow with opportunity to practice andreflect on real life and hypothetical case studies.CONCLUSIONS: A comprehensive yet focusedapproach to cancer rehabilitation can facilitate,revive, and sustain a sense of hope andmeaning for cancer patients along the cancer carecontinuum.

W-533

An Experiential Workshop Demonstrating the Use

of Drama Therapy Techniques to Cultivate Hope

Gwynneth GormanCedars Cansupport, Montreal, Quebec, Canada

OBJECTIVES: Qualitative feedback and Likertscale quality control survey data have revealed thevalue and power of using drama therapy withoncology patients as a way to build resilience,enhance self-expression, and find meaning todifficult personal material. This in turn hasreinforced the priority to develop psychosocialsupport groups which emphasize the use of thismodality. METHOD: Drama therapy methodolo-gies incorporate techniques from psychodrama,Gestalt therapy, art therapy and other supportiveexpressive therapies. It is recognized as activeproblem solving due to its ability to bypass theblocks in verbal therapy and move straight to coreissues. The use of projective techniques, metaphor,improvisation, creative play, storytelling and artassist in this process. RESULTS: These methodshave been successfully practiced specifically withpost-treatment and young adult oncology popula-tions. This presentation will outline key principlesand basic concepts of how to use this modality,along with a description of limitations andchallenges. Practical intervention techniques willbe described in relation to the core themesaddressed these groups. CONCLUSIONS:Through active engagement participants will havethe opportunity to experience the dynamics ofdrama therapy interventions. This workshop isdesigned for those who are curious about how toweave elements of drama therapy into their ownsupport group practice. Please wear comfortableclothing.


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W-547

Quality Decision Making in Health Care Settings:

The Contribution of Contemporary Social Conflict

Theory

Michael Van Slyck1, Marilyn Stern1

Virginia Commonwealth University, Richmond, VA,United States1, Virginia Commonwealth University,Richmond, VA, United States2

OBJECTIVES: It is suggested that the science andpractice of Contemporary Social Conflict Theory(CSCT), with its focus on conflict managementthrough problem solving can add a set of skills tohealth care providers when working with patientsand their families. The primary goal of the work-shop is to provide the participant with a compre-hensive overview of conflict as it is viewed andunderstood by CSCT contrasting it with conven-tional views of conflict as fighting. METHOD:Provided with this information participants willknow that they have a variety of strategies withwhich to respond to conflictual decision makingsituations as a basis for making optimal decisions -especially with regard to treatment. The primaryexperiential goal of the workshop is to provide theparticipants with a basic set of skills necessary toimplement positive conflict management stylesproposed by CSCT as a basis for optimal decisionmaking. RESULTS: The session begins withadministration of a conflict management inventory.Participants are then paired in dyads and engage ina structured conflict task. At the end of the taskthey will debrief with the other member of thedyad. A question and answer period will be used toexplain the nature of the task and introduce theparticipants to the concepts of CSCT. Participantswill nominate difficult decision making events fromtheir experience. CONCLUSIONS: Groups ofthree will be established, two participants roleplaying a patient and a health care provider. Thethird participant will be an observer and takenotes. After 15minutes the participants will stopand process their experience. The entire group willthen reconvene and participants will be asked tonominate and discuss aspects of their interactionswhich worked or did not in their effort to make adecision in the face of disagreement.

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Developing Brief Training Programs in Psycho-

Oncology. How Can a One or Two Day Workshop

be used to Increase Access to Psycho-Oncology

Support?

Catherine AdamsCalvary Mater Newcastle, Newcastle, NSW, Australia

OBJECTIVES: This workshop will describe twoeducational programmes, one for psychologists,

the other for general practitioners, that providebasic training in psycho-oncology for people notworking in the oncology field. The aim of theseprojects was to increase access to psychosocialsupport for patients living away from treatmentcentres. Opportunities will be provided for partici-pants to develop ideas for similar training pro-grams in their own countries. METHOD: Theworkshops described were for psychologists inrural areas of NSW, Australia, and for generalpractitioners in a regional area in NSW, Australia.The psychologists workshops considered basiconcology as well as common psychological reac-tions in cancer patients and their families. Trainingin effective interventions was also given. The GPworkshop was breast cancer specific and concen-trated and recognising psychosocial distress inthese patients and providing adequate support,either from the GP or via referral. RESULTS:Results from the psychologists workshops werevery positive and highlighted some of the fearsprofessionals have about working with cancerpatients. These results were presented previously1.The GP workshops are yet to be completed, butresults will be available during the workshop.Methods of evaluating such training will bediscussed. Adams, C.A., Gianacas, L., Levick, W.(2009) Expanding Psycho-Oncology support torural areas in NSW, Australia. Psycho-Oncology,18, S55. CONCLUSIONS: In order to increaseappropriate and timely access to psychosocial careit is necessary to think outside the square in termsof service provision. This workshop demonstratesthat it is relatively easy to increase service accessthrough brief, targeted training sessions for med-ical and allied health professionals who may notbe working in the oncology system but nonethelessare able to provide psychosocial care. Participantswill be encouraged to develop training ideas fortheir area.

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Imagery As Currently Used In The Simonton

Program In Addressing Both Emotional And

Physical Distress

Mariusz Wirga1,2

Todd Cancer Institute, Long Beach MemorialMedical Center, Long Beach, CA, United States1,Simonton Cancer Center, Malibu, CA, United States2

OBJECTIVES: The purpose of this workshop is tofamiliarize participants with the evolution of theuse of mental imagery in the Simonton Programand how it relates to the recent discoveries incognitive neuroscience. Emphasis will be placed onthe practical applications of imagery to reduceboth emotional and physical distress. METHOD:The participants will be introduced to the con-ceptual and practical applications of mental


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imagery in the Simonton Program and how itrelates to the recent discoveries in cognitiveneuroscience. The participants will be able toincorporate these techniques into any modernpsycho-oncology practice, including supportgroups and particularly cognitive-behavior ther-apy. RESULTS: At the end of the workshop theparticipants will be able to teach mental imagery totheir patients to recognize distressing cognitions aswell using this form of mental practice to decreaseanxiety, physical pain, nausea, fatigue and othernegative symptoms of illness or side effects oftreatment. CONCLUSIONS: Late Dr O. CarlSimonton (1942–2009), radiation oncologist, intro-duced imagery in the treatment of his patients in1971. It quickly emerged as one of the mostpopular alternative treatments utilized by cancerpatients. However, most patients and practitionersdo not know the modern applications of thisversatile, refined yet easy to apply set of techniques.This workshop will fill this gap.

W-678

Communication Skills Training in Oncology : How

can it be Helpful in Your Professional Life ? Let’s

Try ...

Patrice Guex1, Anne Bredart2, Sylvie Dolbeault3

Centre Hospitalier Universitaire Vaudois, Lausanne,Switzerland1, Institut Curie; Laboratoire de Psy-chopathologie et Neuropsychologie clinique, UnivParis V, Paris, France2, Institut Curie; InsermU669; Univ Paris-Sud et Univ Paris Descartes,Paris, France3

OBJECTIVES: The communication skills training(CST) workshop consists of a 90minutes session,where participants are trained by means of casediscussions, role play and video analyses of�simulated� patient interviews. Trainers haveextensive experience in psycho-oncology; theirprofessional background is psychiatry, psychology,internal medicine and all of them have been trainedin psychoanalytic, systemic or cognitive-behaviour-al psychotherapy or in psychosomatic medicine andsupervision. METHOD: Participants should con-duct a short video-taped interview with a simulatedpatient role-played by attendee. Short writteninstructions are given to the clinician and the�actor� (simulated patient) prior to the interview,specifying the patient age, cancer type (differentscenarios possible), treatment type (curative orpalliative) and the objectives of the interview.RESULTS: Different communication situationswill be explored, adapted to each attendee. Forphysicians, it will be for example : communicatingthe diagnosis of a curable cancer, lymphoma ortesticular cancer, or explaining transition fromcurative to palliative treatment for stomach cancer.For nurses, it will be : preparing the patient for

curative or palliative chemotherapy for the samecancers mentioned before. These exercises will givethe opportunity to introduce simple and helpfulcommunication tools. CONCLUSIONS: This CSTprovides only a very limited amount of theory; it ismainly based on interactivity and practical exercisesby means of different clinical settings presentations.Participants are given the opportunity to experienceof their way of interacting with patients, to analysehow some communication tools can facilitate thepatient - health professional interaction, and to feelmore comfortable in difficult communicationsissues such as delivering bad news.

W-692

Psychological Interventions Regarding Preschoolers:

Clinical Illustrations

Melanie St-OngeCHU Sainte-Justine Mother and child UniversityHospital Center, Montreal, Quebec, Canada

OBJECTIVES: Due to the rising number ofchildren surviving cancer, pediatric oncology teamsare increasingly confronted to the short-, medium-and long-term psychological after-effects of cancer.For preschoolers, psychological assistance is parti-cularly relevant due to their vulnerability, theirdependence and to the fact that their psychoemo-tional development is in progress. In the context ofa serious illness, the psychological interventionaims to first and foremost help the child make senseof their own reality and reactions as well as those oftheir family. Therefore, psychologists work towardestablishing or maintaining a close and secureattachment between the child and the parents; aswell as supporting parents so that they areprepared to deal with their child’s reactions; and,finally, mobilizing and respecting any defensemechanism helping child to better cope with thedisease, treatments, hospitalization and prognosis.RESULTS: Play therapy serves to create a non-threatening space where the children can commu-nicate their experience and where they can attachfeelings to their reality. Psychotherapy at theintrapsychic level will dominate, but the psychol-ogist will never lose sight of the reality of the vitalcare; and will assist, whenever needed, thechild, parents and medical team to developthe framework that will foster collaboration.CONCLUSIONS: Clinical illustrations take intoaccount: 1) the psychologist’s role in pediatriconcology, specifically regarding children underfive, 2) the needs and reactions of preschoolers,3) psychotherapy, and 4) interventions withparents. The objective is to equip psychologists inpediatric and adult oncology as well as otherpsychosocial care providers who deal with thepsychological distress of children and parents livingwith cancer for a psychological recovery hope.


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W-704

The Mindfulness Based Stress Reduction In Cancer

Tatiana MelnykPrincess Margaret Hospital, Toronto, Canada

OBJECTIVES: This workshop will provide thebasis for understanding the philosophy and re-search behind the Mindfulness Based Stress Re-duction Program, and will expose participants toits application in cancer. Participants will be able toidentify patients suitable for this approach, andwill learn some of the techniques used with cancerpatients. METHOD: This workshop will be basedon the presenter’s experience with the MindfulnessBased Stress Reduction Program as well as on areview of the current literature which suggests theusefulness of the program in cancer care. RE-SULTS: The Mindfulness Based Stress Reductionprogram has been used to help cancer patientsaddress sadness, fear, anger, disfigurement orphysical disability related to cancer, as well as tohelp them cope better with pain. In addition, thisprogram has helped cancer patients address theexistential concerns that arise with this illness,including making sense of their experience, makingsense of death, and of suffering. There is researchevidence supporting the use of MBSR for alleviat-ing cancer distress. CONCLUSIONS: The MBSRprogram is a viable and effective program forcancer patients wishing to address emotionaldistress, physical change and existential concernsas a result of cancer.

W-715

Managing Distress in Cancer Patients with Person-

ality Disorders

Lana M. Pratt, Marc Hamel, Pasqualina Di DioMcGill University Health Center, Montreal,Quebec, Canada

OBJECTIVES: The psychological distress thataccompanies a cancer diagnosis is often influencedby pre-existing conditions, such as personalitydisorders. Co-morbid personality disorders in-crease the complexity of treating distress in cancerpatients. The aims of this workshop are to providehealth care professionals with a) the basicsnecessary to identify common personality disor-ders, b) evidence based strategies to manageproblematic behaviours using a time-limited ap-proach and c) the impact of some personality traitson medical care. METHOD: Based on clinicalobservations from the MUHC Psychosocial On-cology program, case examples will be presented onhow personality traits can impact the psychologicalfunctioning of cancer patients. It will also bedemonstrated that a poor understanding of theseinfluences can impact the care of the patients and/

or the relationship with the treating team members.RESULTS: Common personality disorders withtheir typical key features will be presented. Specificcase examples will be provided to help illustratestrategies and specific interventions that teams canadapt in order to help them manage these cases.CONCLUSIONS: Effective management of pa-tient distress involves recognizing and managing,although not necessarily treating, pre-existingpersonality disorders. Personality disorders makethe management of oncology patients more chal-lenging, and can influence adherence to treatmentrecommendations, frequency of hospital visits orphone calls, time spent per visit, as well as thealliance between the patient and health careprofessional(s).

W-729

Development of an Experiential Elective in Spiri-

tuality For a Palliative Care Fellow: A Pilot Project

June Mawhinney, Sharon KonyenCanadian Association of Pastoral Practice andEducation, Toronto, Ontario, Canada

OBJECTIVES: For people with terminal illnesses,hope contributes to an improved quality of life,identified as the primary objective of palliativecare. Health care professionals through theirrelationships, if experienced as meaningful, have aprofound opportunity to facilitate hope. TheSpiritual Care Department created an elective inspirituality with the objective to promote reflectionand self-awareness as a means for a physician toenhance the meaningfulness of his relationshipswith palliative patients. METHOD: The educa-tional process designed for spiritual care profes-sionals was modified for a palliative care fellowinterested in developing spiritual care competen-cies. Curriculum design was based on the experi-ential learning cycle model and reflective learning(action-reflection-action). The 50 hour elective in-tegrated role-play, reflection, shadowing spiritualcare professionals, participation in rituals andgroups, didactics and review and presentation ofrecommended readings. RESULTS: Commentsfrom the palliative care fellow who completed thespiritual care elective- ‘yit’s about helping pa-tients identify that which is hopeful in their lives,and renew that hope, belief, or faith, in a time whentheir beliefs are being challenged in a way thatthey may never have been challenged before.’A curriculum has been developed and deliveredwhich can be adapted as an inter-professionaleducation tool for other health sciences students.CONCLUSIONS: There is value in an experientialand reflective model of learning. We need a widersample to formally evaluate the capacity of themodel to enhance hope through meaningfulrelationships. We plan to offer this elective to


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family medicine residents and pre-clerkship medi-cal students.

W-742

Take It and Go! Turn-key Training for Palliative

Care Volunteers

Suzanne O’Brien, Zelda FreitasCouncil on Palliative Care, McGill University,Montreal, Canada

OBJECTIVES: Volunteers are the cornerstone ofhospice palliative programs yet their training isoften underfunded and not all programs have accessto training materials. A ‘Take It and Go!’ packageof videos and training guides, highlighting realsituations volunteers may face in their daily practiceis an easy resource for both basic and advancedvolunteer training. Key themes include confidenti-ality, privacy, trust, boundaries, risk managementand cultural issues. METHOD: This is a funinteractive workshop using videos as well as stories,exercises and shared discussion to examine andchallenge conventional wisdom about the role ofthe volunteer on the team, both in hospital andhomecare settings and to facilitate interdisciplinarydiscussion about the role of the volunteer in patient-centred care and program delivery. RESULTS: Wewill discuss whether volunteers can be trained moreefficiently, and with a higher level of comprehensionthan previously achieved through traditional teach-ing methods, thereby improving both their effec-tiveness and confidence in their work with theterminally ill and bereaved. Many of the issues inthe videos are equally relevant to health care staff.CONCLUSIONS: Volunteer Training is importantand there is a need for easy-to-use, accessibleresources to help skill development in the volunteerand to stimulate dialogue around their role withinthe health care team. A comprehensive teachingpackage will be available to all attendees. It includes2 DVDs -- one with instructions for running aworkshop and one with four bilingual trainingvideos showing the issues and challenges faced byvolunteers in hospital and home-care settings.

W-767

Helping Families Find Hope and Meaning in the

Face of Loss: Redefining the Family Unit

Kimberley Thibodeau, Anita Mehta, Marc HamelMcGil University Health Center, Montreal, Canada

OBJECTIVES: Hope and meaning are two im-portant concepts that have become an integral partof supportive therapy for families who are copingwith a loved one who is dying. A cancer diagnosisaffects the entire family unit and families may differgreatly in how they navigate the dying process. Thegoal of this workshop will be to present how a

psychosocial oncology program can play a vital rolein assessments and interventions related to theseconcepts. METHOD: This workshop will focus onthe assessment of families facing the death of aloved one and will highlight interventions used bothprior and after their loss. We will provide clinicalexamples of families and encourage participants toperform the assessments and suggest interventions.Interventions specific to hope and meaning will behighlighted. RESULTS: It has been documentedthat hope fluctuates over time for both the patientand the family in the palliative care phase. Hope-lessness is often linked to the loss of meaning infamilies. Additionally, the literature suggests that afamily’s attempt to search for meaning at the end oflife is a normal but distressing psychologicalprocess. Therefore both hope and meaning havebecome important areas for family therapy. CON-CLUSIONS: The Psychosocial Oncology Programworks with patients and families in supporting themthrough their anticipatory grief, and helping themin their search for hope and meaning. Bereavementsupport is also a critical part of the program.

W-780

Healthy Hope versus False Hopelessness: Addres-

sing the Meaning of Illness and Issues of Spirituality

in the Simonton Program

Mariusz Wirga1,2

Todd Cancer Institute at Long Beach MemorialMedical Center, Long Beach, California, UnitedStates1, Simonton Cancer Center, Malibu,California, United States2

OBJECTIVES: The purpose of this workshop is tohelp participants gain an understanding of theconcept of healthy hope, and ways of supportingpatients’ hopefulness at all stages of life andtreatment. Practical ways of addressing trust andfaith as well as purpose and meaning of life will bepresented. Particular focus will be placed onlearning nondenominational and nonjudgmentalways of addressing spiritual and deeply philosophi-cal beliefs. METHOD: The participants will beintroduced into the role of doubt, hopelessness, lossof purpose and meaning in patients’ overall sufferingas taught in the Simonton Program. Practicalexercises are going to be conducted in applyingcognitive-behavioral techniques to help patients andtheir family members to assess the health value oftheir own spiritual and existential beliefs andfostering those that are healthy. RESULTS: At theend of the workshop the participants will be able toteach CBT techniques effectively and non-intru-sively addressing spiritual and deeply philosophicalbeliefs of patients and their family members.Participants will learn how to protect patients’ hope-fulness while promoting realistic treatment expecta-tions. CONCLUSIONS: Dr O. Carl Simonton, an


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early pioneer of psycho-oncology, devoted his wholeprofessional career of 38 years to addressing themost difficult issues facing cancer patients and theirfamilies. He taught effective ways of helping patientsresolve spiritual suffering across cultures andreligions. In this workshop participants can partakein Dr Simonton’s pragmatic approach to the area ofhope, meaning and spirituality.

W-788

Psychosocial Research Ethics In The Online World:

Virtual Or Real?

Greta Greer, Kevin SteinAmerican Cancer Society, Atlanta, GA, United States

OBJECTIVES: The focus of this workshop is on theethical considerations and implications of conduct-ing psychosocial oncology research over the internet.A brief review of the evolution of ethics inpsychosocial research and core concepts of soundresearch practices for the protection of researchparticipants will be provided. This workshop willemploy a slide presentation, actual case examples,and active discussion as teaching modalities. Atten-dees will receive a comprehensive bibliography andresource list. METHOD: The historical developmentof ethical standards for research on human subjectswas studied and a thorough review of the literatureconcerning online psychosocial research was con-ducted. Ethical violations by psychosocial research-ers in a large, well-established online community ofcancer survivors and caregivers were reviewed toidentify the primary ethical issues, concerns, anddilemmas. RESULTS: Oncology researchers andother health professionals are increasingly turning toonline methods of surveying cancer survivors andtheir families. Several professional associations havedeveloped general guidelines for the online deliveryof therapeutic services and research, but standardsare still emerging as experience is gained. In theinterim, ethics violations are surprisingly frequent inthe large online community of cancer survivors andcaregivers for which the authors are responsible.CONCLUSIONS: There is a strong need to educateusers, providers, and researchers of online cancersupport services about ethics standards, concerns,and dilemmas in conducting and participating inweb-based psychosocial research. As knowledge andexperience is gained, clear standards should continueto be developed, disseminated, and applied.

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The Truth of It: Talking About Cancer

Michael Evans1, Margaret Fitch2, Anna Green-berg2, Leanne Kitchen-Clarke2, Wendy Rowland3

Health Design Lab of the Li Ka Shing KnowledgeInstitute at St. Michael’s Hospital1, CanadianPartnership Against Cancer2, Film Director3

OBJECTIVES: This special workshop is an op-portunity to preview a unique patient video seriesof unscripted, open-ended interviews with Cana-dians who have experienced a cancer diagnosisranging in age from 20–73. Directed by film makerWendy Rowland, the interviews asked individuals,‘What would you tell your best friend if he or she hadto go through the experience you have had withcancer?’ Workshop participants will inform theoutreach plans for the series including how such aresource could be used by psychosocial oncologyprofessionals, as well as potential future directions.METHOD: Funded by the Canadian PartnershipAgainst Cancer to develop a Canadian knowledgebase of cancer patient experiences, the video serieswas developed in partnership with the Li Ka ShingKnowledge Institute at St. Michael’s Hospital. Theseries will be showcased on Cancer View Canada(www.cancerview.ca) a web-based portal that linksCanadians to resources, information and tools toimprove cancer control. Individuals who had beendiagnosed with cancer at any age, background andexperience were invited to be interviewed oncamera so that their story could be shared with abroad public audience in order to inform andsupport other patients and caregivers, and clinical,psychosocial and patient education professionals.RESULTS: The personal stories of almost 40cancer patients, including young adults, membersof First Nations communities, men and women,individuals from both rural and urban regions ofCanada and over ten different types of cancer areincluded in the series. The themes that emergedfrom these experiences included how patientscoped with getting the news, telling friends andfamily, talking to their kids, returning to work,being their own advocate, the worst aspects oftreatment, fear of recurrence, and body imageamong many other themes. CONCLUSIONS: Thispatient-centred series is a virtual supportive careresource that contributes to new knowledge inpsychosocial oncology.


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Listed by Author and Abstract Number

The following pages display the authors of the abstracts selected for the IPOS Abstract book together withtheir abstract numbers

Aaronson N A-37

Abbink F P-576

Abbott JM A-133

Abbott M S1832-2

Abdallah – Mabjish A A-61

Abgrall-Barbry G A-190

Abish S P-756

Aboualmagd S A-737

Absolom K A-552

Ach EL P-283

Achille M A-488

Acker J P-710

Adams C A-642, A-651,

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Adams E A-278, A-396

Adams J A-26

Adams S A-622

Adenis C A-410

Agar T P-468

Agnieszka S-C A-129

Aguerre C P-226

Ait-Kaci F P-738

Aitken J A-42

Akabayashi A P-206

Akazawa T P-57

Akechi T P-57, P-90,

P-208

Akin-Odanye EO P-268, P-527

Akizuki N P-384

Alam R S1841-1

Alder J A-107

Aldridge L S1810-3

Alejandra P P-200

Aleksandra K P-783

Alexanderson K P-444

Alexandra M A-313

Alfaro J P-64

Alhabib S P-82

Alibhai S P-62

Alidina K A-12

Allan P P-633

Allanson J A-623

Allart P P-226

Allison P P-223

Allison PJ A-708

Allison V A-439

Almarza CC A-757

Almeida S P-720

Almeida SN P-706

Altman K A-627

Alvarez E A-411

Amir R P-611

Amy Z A-201

Andersen B P-241

Andersen RE A-491

Andershed B A-92

Anderson C A-235

Anderson D A-85, P-86

Andrade MGG A-676, P-498,

P-672

Andrews YJ A-614, A-618

Andrews S P-741

Andritsch E A-695, P-679

Anita M A-689

Anne B A-129

Annelie A A-504

Annunziata MA P-255, P-256,

P-604

Antoine P A-128

Arab M S1919-3

Aranda S A-366, A-370,

A-375, A-381,

A-383, P-39,

S2000-4

Araujo I P-463

Araujo TCCF P-228

Arcand M P-49

Arcusa A P-64

Arden-Close E A-552

Arechiga A S1816-3

Arefnazari M A-787

Arenas G P-64

Ares I A-648, P-453,

P-683, P-727

Ariele A P-484

Armay Z S1829-1

Aronson M A-623, A-625

Asai M P-384

Ashing-Giwa K A-159, A-495,

P-492

Ashley S P-106

Ashrafi E A-787

Aslett A A-476

Asuzu CC A-446, P-59,

P-155, P-268,

P-527, P-558

Au A A-745

Aubin M A–540, P–183

Aubin S W-346

Augustin T P-679

Auluck A A-122

Aviv C A-745

Awad M S1837-4

Awad NMN A-24

Awusah IB A-446, P-59,

P-155, P-558

Azaiza F S1837-3, S1837-4

Baba HB P-537

Babayi B P-725, P-732,

P-750

Babcock R A-451, A-470

Bacalhau MR A-266, A-499, A-608

Bacchi MT P-413

Bacque M-F S1846-1, S1846-2,

S1846-4

Baer L A-451, A-470

Baezconde-Garbanati L S1837-2

Baider L S1916-2, S1928-2

Baillon C P-146, P-319

Baker-Glenn E A-275, A-276,

P-454

Baldassarre F A-358

Balneaves LG A-110, A-111,

A-639, A-703

Banga A P-570

Barbera L A-340

Barberio D P-520

Barbosa A P-419

Barbosa F P-419

Barello S P-457

Bargetzi M P-753

Barnett J S1919-1

Barni S P-19, P-20, P-670

Barnum DD P-770

Barrault M A-430

Barrera ME A-192, P-132,

P-198, P-283,

P-322, S1841-1,

S1841-2, S1841-3

Barretina P A-411

Barrington V A-65

Bartolacelli E P-15

Bastida P P-429

Basumallik I P-273

Bathe OF A-299

Batt G P-232

Batterby E S1832-2

Battler H A-280, A-361

Bauernhofer T P-679

Bauwens S P-146, P-318,

P-319, P-417

Bayraktar S A-398

Beattie S A-239, A-648,

A-765

Beatty L A-26

Beaulieu M P-49

Beaune L A-192

Beck A A-501

Beheshti M P-740

Behrendt C A-154

Beigy FF P-740

Beith J S1832-2

Belanger B A-539

Belcher A A-172

Belcher J A-278

Belkic K S1837-1, S1837-2

Bell J P-373

Bella TT A-446

Belle M P-284

Beltran M A-411

Bendahl P-O A-212

Bendiane M-K A-446, A-465, A-497

Benea A P-79


S314 Author Index

Bennett C A-682

Benoit-Bousquet L P-631

Bensing JM P-254

Benzein E A-92

Berenger C A-465

Berg G A-300

Bergerot PG P-225

Bergin R A-370

Bergman H A-722

Berk DB P-778

Berman AH S1837-1

Bernshaw D A-370

Bernstein LJ A-167

Berretta M P-256

Berthet P A-410

Bertz H A-154, A-210,

Besancenet C P-142, P-550

Bialer P A-510

Bianchet K P-256

Bidonde J A-591

Bielajew C A-648, P-453,

P-683, P-727

Biggs K S1847-2

Bilash T P-779

Bilodeau D P-285

Bittante M A-744

Blaakaer J P-252

Blacker S A-682

Blais C A-714

Blais M-C P-631, S1919-4

Blanco R P-64

Blasco T P-64, P-429, P-478

Bleijenberg G A-418

Blinka M A-153

Bliss-Isberg C A-349

Blogosz A P-428, W-145

Blom ES A-400

Bloom D A-135

Bloom J A-555, A-603,

A-721, P-317

Boeru AM P-445

Bøge P A-253

Bokey L A-385

Bonamis O A-475

Bonetti L P-19, P-20

Bonetti ML P-670

Bonfiglio NS P-548

Bonner C A-235

Bonneterre J P-477

Boonzaier A A-29, A-394,

A-422

Boquiren V W-507

Bordeleau L A-623, A-795

Borelli V P-548

Borgonovo K P-19, P-20

Borgstadt N A-461

Bornais C A-714

Bornbaum C A-303

Bottorff JL A-110, A-111,

A-122, A-571,

A-623, S1842-3

Bouchard K A-51

Bouffet E A-192, P-109

Bouhnik A-D A-465

Bouisson J A-271

Boujout E P-550

Boulton M A-278, A-396

Bousada H P-113

Bowes P W-220, W-224

Bowler A A-304

Boyes A A-248, P-315,

S1810-2

Boyington AR A-188

Boyle F A-236

Boyle M S1847-1, S1847-3,

S1847-4

Bradbury A A-525, A-595

Bradley H A-462, W-220,

W-224

Braehler E P-426

Bragard I A-272, A-578,

P-403, P-404,

P-441, P-442

Brahler E A-481, P-203

Bramajo MP P-200

Branagan G A-687

Branco M A-634

Brandwein J A-614, A-618

Branin J P-489

Brashers D A-509

Brasselet V A-181, P-176,

P-182, P-185

Braun M S1924-2, S1924-3

Brazel F S1832-2

Breau GM P-447

Breau LM P-447

Bredart A A-662, A-667,

W-678

Bredius R P-576

Breitbart W A-502, S1808-1,

S1928-3

Brennan F W-251

Breyer J S1824-3

BrintzenhofeSzoc K A-153

Broadfield L S1847-2

Broek A P-437

Brons P P-576

Brosseau DC A-518

Brothers BM P-718

Brown E A-192

Brown J A-167

Brown P A-358, P-285

Brown R A-509, A-510,

A-630

Brown RL A-301

Brown S A-439

Brunet J A-480, A-491

Bruno M P-520

Buchi S A-324

Buchmann L A-316

Buchot E P-747

Buda F P-9

Buhr AM P-156

Buick C P-716

Bullen T A-385

Bultz B A-647, S1918-1,

S1918-2, S1918-3

Burfoot A P-537

Burkhalter R A-534, A-538

Burkoski V A-628

Burles M A-194, A-196

Burmeister B A-664

Burnett J P-285

Burney S A-368, P-364

Burns CM A-664

Busa F A-744

Buso MM A-229, P-218,

P-225, P-228

Buss MK A-301

Bussieres E A-430

Bustam AZ P-168, P-666

Butler K A-625

Butow P A-236, A-246,

A-357, P-39,

P-232, P-233,

P-234, S1810-3,

S1832-2

Butros L A-655

Buzaglo J S1910-2

Buzzo A A-744

Bylund C A-509, A-510

Cabiddu M P-19, P-20

Cadell S A-500

Caicedo L A-153

Campbell HS A-534

Campbell M S1861-1

Campbell S A-193, A-538

Campbell T P-597

Campos C A-153

Cankurtaran ES A-409, P-277

Cann B A-754

Canny A A-431

Capdevila L P-429

Caplette-Gingras A A-621, P-549

Cappelli M A-623, P-529

Capretti N P-413

Caps E P-441

Carey J A-571

Carey M A-375

Carlander I A-400

Carlson L A-501, A-647,

P-597, S1918-1,

S1918-2, S1918-3

Carlsson C A-212, A-663

Carmack CL A-301

Carmen GL P-633

Carnevale FA A-722

Carroll J P-529

Carter G A-641, P-643

Carter GL A-641, A-642, P-643

Carter J A-235

Carter R P-43

Carter W S1921-2, S1921-4

Carvalho GM P-498

Carver C A-690, S1816-1

Casais C P-638

Casault L A-521

Cason E P-284

Cassidy E A-304, A-312

Castellan P A-744

Castellano C P-429, P-478

Castellanos E S1837-1, S1837-2

Castellanos M S1837-1, S1837-2

Castle D A-29, A-394,

A-422

Catherine B A-129

Cattan S A-128

Catton P A-77, A-321,

A-682

Caty M-E P-769

r 2010 The Authors. Journal compilation r 2010 John Wiley & Sons, Ltd. Psycho-Oncology 19(Suppl. 2):S314–S325 (2010)

DOI: 10.1002/pon

Author Index S315

Cavanagh M S1832-2

Cecile F A-129, A-577,

P-550

Chadwick D A-18

Chakrabarti B P-391

Chamberland P A-714

Chambers S A-38, A-42,

A-44, A-45,

A-101, P-43

Chami P P-16

Chan A A-288, A-614,

A-618

Chan CL A-421

Chan F A-760, P-758

Chang C-N A-739, P-718

Charbonneau C A-539

Charlebois J A-245

Charron A P-242

Chaturvedi SK P-71

Chauhan D A-385

Chen C-H P-207

Chen EX A-167

Chen H-W A-362, P-207,

P-286

Chen Mc P-588

Chen S-H P-123, P-134,

P-136, P-514

Cheng C-D P-514

Cheng C-T P-123, P-134,

P-136

Cheng N A-390

Cheng T A-321

Cheung B A-390

Cheung W A-407, A-414

Chih M-Y A-379

Chipperfield K A-368

Chittem M A-416

Chivers M A-340

Chochinov HM A-754, S1808-2,

W-496

Choi CMZ P-395

Choi H P-741

Choo CH P-605

Chou A A-603, A-721

Christine L-G A-129

Christophe V A-128, A-410,

P-477

Christopher J P-230

Christopherson J W-350

Chung J P-593,

S1847-2

Chung KM P-399, P-402,

P-516

Chung P A-579

Citrin D A-135

Claffey K P-570

Clark K A-567, A-568,

A-596

Clarke S A-385, A-660,

A-795, S1861-1,

S1861-3

Classen C A-340

Clayton M P-472

Cleary JF A-301, A-379

Clover K A-642

Clutton S A-44, A-45

Coates A A-236

Cohen M A-61, S1816-2,

S1837-1, S1837-2,

S1837-3, S1837-4

Cohen R A-166, P-367

Coimbra F A-608

Coleman R A-552

Collacutt V S1847-1, S1847-3,

S1847-4

Collie K A-344, P-696,

S1910-1

Collier S A-528

Collins KA P-727

Colmant M P-291

Colucci G A-671, P-669,

P-674

Compas BE P-198, P-322

Conijn B P-433

Conlee J A-316

Conlon M S1919-2

Connell S W-251, S1810-3

Connor M P-62

Conradt S A-578

Consoli SM A-181, A-190,

A-260, A-262,

P-176, P-182,

P-185

Cook S S1822-2, S1822-3,

S1822-4, S1919-3

Corbisiero A P-198, P-322,

S1841-3

Cordova M A-349

Cormio C A-671, P-669,

P-674

Corrado V P-279, P-282

Correia M A-474

Corry J A-29, A-394,

A-422

Corsicato N P-520

Corsini-Munt S P-367

Cortaredona S A-446

Cory S W-496

Costello AJ A-52, A-133

Cote G A-448

Couban S S1921-1, S1921-3

Coucke P A-475

Couper J A-29, A-394,

A-422

Cousson-Gelie F A-271, A-430,

A-455, P-226,

P-339, F P-342

Couture-Lalande M-E P-453

Creaner M A-440

Crocker PRE A-480

Crofts S A-108

Csaba DL A-3

Cunha MJ A-493, P-463

Curran J S1861-2

Currie KL A-579

Currie S S1847-1, S1847-2,

S1847-3, S1847-4

Currow D W-36

Curtin A A-440

Cwikel J P-519

Czajkowska Z P-426, P-511

Dagher A A-213

D’Agostino N A-50, A-192,

P-281, S1841-1,

W-346

Dahman B A-630

Dalfen R A-622

D’Alton P A-330, A-431,

A-432, A-440

Daly M A-525, A-595

Dalzell M-A A-622

D’Amico C P-669

Damore-Petingola S S1919-2

Daneault S A-540

Daniel J A-108

Daniels M P-281

Daoud F S1837-4

Daryaafzoun M P-725, P-732,

P-740

Das-Munshi J A-481

Dauchy S S1824-1

Daugherty C A-595

Daughterty C A-525

Davidman K A-310

Davies B P-198, P-322,

S1841-2, S1841-3

D’Avignon MO P-773

Davison J P-199

Davolls S P-106

Day AMB P-526

de Albuquerque MS P-93

de Falco F P-520

de Figueiredo M A-259

de Gee A P-433

de Haes H W-33

de Heredia CD P-429

de Jesus Moura M A-474

de Serres M S1822-2, S1822-3,

S1822-4, S1919-4

De Susbielle D A-181, P-176,

P-182, P-185

Decat CSA A-229, P-218,

P-225, P-228

Deegan J A-184

DeLaat S P-529

Delisle V P-736

Dellson P A-663

Delvaux N A-272, A-475,

A-479, A-578,

P-403, P-404,

P-441, P-442

Demirci U P-790

Dent S P-121

Deodhar J A-75

Desai G P-71

Desauw A A-128

Desbiens J-F P-53

Deshields T A-351

D’Este C S1810-2

Destrooper P P-417

Detmar S A-455, P-576

Devins GM S1832-4, S1842-2,

S1843-1, S1843-2,

S1843-3

Dhillon HM A-165, A-660

Di Dio P W-532, W-715

Di Mattei V P-668

Dibaei S A-787

Dickler M A-510


DOI: 10.1002/pon

S316 Author Index

Dietmaier G A-695

Dige J A-253

Digout C S1847-1, S1847-3,

S1847-4

Dillehunt J A-568

Dinauer S A-379

Dintinjana M P-297

Dintinjana RD P-297

Distelmans W P-146, P-318,

P-319, P-417

Dodd A A-660

Dolbeault S A-667, W-678

Dolcetti R P-255

Doll R A-712, P-696,

S1822-2, S1822-3,

S1822-4

Dolling L A-366, A-383

Domanska K A-212

Domingue P A-610

Dominique L A-504

Donovan H A-556

Donovan KA A-188, A-592

Dorval M A-51, A-623

Dotor E P-64

Doumit MAA A-4

Doyle PC A-303, P-526,

P-769

Drabe N A-324

Dube L A-189, A-494

DuBenske LL A-301, A-379

Dudgeon P A-383

Duggal-Beri P S1810-3

Duggleby W A-88

Duijts S A-37

Dumas M A-166

Dumont S A-85, A-540, P-86,

P-183, P-773,

S1861-2

Duncan L A-115

Duncan V A-88

Dunn J A-44, A-45, P-43

DuPont N P-724

Duprez C A-410

Dupuis G A-435, A-578

Durieux J-F A-479

Durkin L A-358

Dutta A A-760, P-758

Earle C A-414

Easley J A-186, W-152

Easty T P-367

Edelstein K P-109, P-281,

W-346

Edery L S1846-1

Edgar L A-310, A-708

Edgerson S A-509

Edlynn E P-698, P-699

Edward W A-107

Eelen S P-318, P-319

Egleston B A-525, A-595

Ehrler A A-731

Eisenbruch M S1810-3

Eiser C A-552

El Saghir N A-4

Eliason R P-156

Eliott J S1836-1

Ellington L P-472

Ellis J A-336

Ellwood A-L P-25

Elmar B A-313

Elsaid AA A-24

Elsass P A-48

El-Shafei H A-24

ElShami M A-737

Emery B W-328

Endo C P-57, P-90

Engebretson A A-719

Engelen V A-455, P-576

Engler-Stringer R A-591

Enjedany E P-725, P-732, P-740

Ercolano E P-658

Erkek BM P-277

Ernst J P-203, P-426

Ersin P-277

Esplen MJ A-212, A-309,

A-623, A-625,

A-795, S1847-2,

S1861-1, S1861-3

Etchegary H P-529

Etienne A-M A-272, A-435,

A-475, A-578,

P-403, P-404,

P-441, P-442

Evans M P-741, W-904

Evitts P P-790

Ewing C A-745

Ezat M A-737

Faber A A-494

Fabre B A-300

Fairclough D P-322, P-723,

S1841-2, S1841-3

Fairclough DL P-198, P-283

Fais M A-647

Fall M A-667

Fang C-K A-362, P-207,

P-286

Faran Y P-519

Farkas-Patenaude A P-283

Farouk M A-24

Farrell N P-717

Farvacques C A-479

Fassbender K A-85, A-712

Fatolahbeigi F P-750

Faucher J P-683

Fay JS P-633

Feigon M A-595

Feio M A-608

Fellows L A-213

Feng A-C P-123, P-134,

P-136, P-514

Fenn K S1919-3

Fennell P P-174

Fergus K P-696, S1910-1,

S1921-2, S1921-4

Ferguson M A-42, A-44, A-45

Ferguson N S1919-1

Ferguson S A-340

Fernandes ML A-608

Fernandes-Taylor S A-555

Ferrell B P-701

Figueiredo AP P-691

Fillion L A-488, A-540,

A-733, P-53,

P-631, S1813-2,

S1822-2, S1822-3,

S1822-4, S1919-4

Filsinger S A-534, A-538

Fisher C A-509

Fitch MI A-309, A-743,

A-795, P-696,

W-904, S1822-1,

S1847-2

Fitchpatrick C A-655

Fitzpatrick TR P-17

Flahault C P-142

Fleming C A-150

Fleshner N P-62

Fletcher J A-368, P-364

Flood K S1910-3

Florence C-G P-484

Florensa A A-411

Flyger HF A-48

Folkes A A-469

Fonseca M A-435

Forbes JF A-236

Forbes R A-288

Fortier M P-183

Fortin P P-242

Foster TL P-198, P-322,

S1841-2, S1841-3

Fotheringham J P-646

Fournier E P-477

Frechette D P-121

Freeman E W-507

Freitas Z W-742

Fried G S1816-2

Friedlander M A-357

Friedsam J A-248

Fritzsche K A-154, A-210,

A-259, P-211

Fujimori M P-384

Fulk J A-768

Fung K A-303

Fung S P-109

Funk M A-490

Furukawa TA P-57, P-90, P-208

Gagin R S1816-2

Gagliese L S1924-2, S1924-3

Gagnon P P-631, P-637,

S1813-3

Galinsky D S1924-3

Gallagher P A-304, A-312

Gallhofer G A-730

Gallinger S A-625

Gan HK A-167

Garcia C A-361

Gardiner RA A-42, A-45

Garland SN A-299

Gartshore K A-731

Gary F A-201

Gascard G P-291

Gaudreau J-D P-637

Gauthier-Frohlick D A-323, A-439

Gava A P-284

Gaytan A P-64

Geffen D P-519

Gelinas C A-733

Gensheimer LK P-770

Gerhardt CA P-283, P-322,

P-723, S1841-2,

S1841-3

Gerin-Lajoie C S1820-1

Gessert A S1910-2, S1910-3


DOI: 10.1002/pon

Author Index S317

Gherlinzoni F P-284

Ghilardi M P-19, P-20

Ghofranipour F P-574

Giancarlo I P-279, P-282

Gibon A-S A-479

Gidron Y A-300

Gielissen M A-216

Giese-Davis J A-307, A-335,

A-344, A-349,

S1918-1, S1918-2

Giesler JM A-293

Gilbert E P-234

Gilbert J A-628

Gill F A-431

Gilles D A-504

Gilmer MJ P-198, P-322,

S1841-2, S1841-3

Gimenez-Roquelo A-P A-260, A-262

Ginette M A-504

Giorgi I P-548

Giovannini L P-256

Girgis A A-38, A-101, P-43,

P-315, W-36,

S1810-1, S1810-2,

S1810-3

Girouard L A-743

Giuliani S P-685

Gleeson A P-227

Glimelius B A-464

Glynn R A-407

Goddard S A-108

Goedendorp MM A-418

Goelz T A-209, A-210,

A-259

Golant M S1910-2

Goldstein DP A-167, S1810-3

Goldstein MG P-717

Goldzweig G A-606, A-607

Gomez E A-612

Gorman G P-590, W-533

Goswami S A-75

Gotto J P-764

Gotze H A-483

Gough K A-366, A-375,

A-383

Gould J A-768

Gould R S1816-3

Govindan R A-301

Graffigna G P-457

Grainger L A-125, A-177,

A-178, A-680,

P-130, P-179

Grassi L A-97, P-255,

P-256, P-604,

S1808-3, S1829-3,

S1916-4

Gravelle D S1847-2

Gray M A-394, A-422

Gray-Donald K A-491

Green E A-358, A-628,

S1847-1, S1847-2,

S1847-3, S1847-4,

S1861-1

Green HJ A-359

Green J A-625

Greenberg A W-904

Greenfield D A-552

Greer G W-788

Gregan J A-87, P-173

Greig D A-162

Grey M A-29

Griffiths M A-172

Groff S A-647, S1918-1,

S1918-2, S1918-3

Grogan S A-370

Grootenhuis M A-455, P-433,

P-437, P-576

Gros L P-478

Grosman H A-300

Grossenbacher JC P-198, P-322

Grunfeld E A-469

Grutsch J A-135

Gsell-Herold G S1846-4

Guerra M P-720

Guex P W-678

Guger S A-50

Guilfoyle M A-330

Guirguis-Younger M P-183

Gulden C A-525

Guo SL P-365

Guruge S A-77

Gustafson DH A-301, A-379

Haase K A-196

Hachizuka M P-206

Hack T A-506, S1847-1,

S1847-2, S1847-3,

S1847-4

Hack TF A-754

Hadd V A-480

Haggerty M A-184

Haines RJ A-571

Haines S A-321

Hales S W-507, S1924-1,

S1924-2, S1924-3

Halford K A-45

Hamel M W-715, W-767,

S1847-2

Hamilton R W-152

Hammond C A-88, A-645,

A-656

Hamoline R P-535

Hamzelouiyan M P-725, P-732

Hancock BW A-552

Hanley B A-44

Hans I P-314

Hansen RS A-712

Hansez I P-404

Harandi TF P-574

Harel F A-85, P-86

Harirchi I P-584

Harle I A-771

Harlos M A-754

Harris C S1820-3,

S1832-4

Harris P A-416

Harrison M S1847-1, S1847-3,

S1847-4

Harrison S A-396

Harth T A-682, P-285

Hartman M-E A-579

Hassard T A-754

Hasson-Ohayon I A-606, A-607,

S1924-3

Hatton-Bauer J A-358, A-682

Hauss J A-483

Havaldar R A-75

Hawkins RP A-301, A-379

Hawkins Y P-234

Haynes WM A-65

Hearson B W-496

Heber D S1816-3

Hello B A-213

Hellstrom I A-400

Henriksson A A-92

Hensmans B P-318

Herold J A-627

Heruc G A-235

Hervouet S A-546

Hevey D A-528

Hewitt L P-710, P-723

Hickey M A-357

Hirai K P-250, P-380

Hirsch P A-184

Hirschberger N P-258

Hislop G A-122

Hlubocky F A-595

Hocking A A-370

Hodgson D P-109

Hoffman L S1847-1, S1847-3,

S1847-4

Hoffmann M A-84

Hogan NS P-198, P-322,

S1841-3

Hogg D A-579

Holland J S1922-1

Holloway C A-530

Holtslander L A-88

Hong Y A-209

Hope AJ A-167

Horney DJ A-627

Horst G W-496

Hou Y-C P-123, P-134,

P-136, P-514

Hounsgaard L P-252

Houston D A-349

Howard AF A-110, A-111

Howell D A-309, P-365,

P-735, S1847-1,

S1847-2, S1847-3,

S1847-4, S2000-3

Howells L A-544, S1910-3

Howes J S1919-3

Hoyer M P-320

Hsu S-H P-123, P-134,

P-136, P-514

Hsu YH P-588

Hudon E A-540

Huet C A-189

Hughes E A-628

Hughes J S1921-1,

S1921-3

Huijer HAS A-4

Hulbert-Williams NJ A-334, A-341,

P-338, P-345

Hunt J A-316

Hunter J A-623, S1861-1

Husain A S1924-2

Hussain N A-125, A-177,

A-178, A-680,

P-179, P-180

Hussey K P-187

Hutchison S P-43

Hvidt NC A-661


DOI: 10.1002/pon

S318 Author Index

Ibe C A-595

Ina R A-313

Inada S P-206

Ing J A-451, A-470

Ingman K P-698, P-699

Ingvoldstad C A-237

Irish JC S1843-2, S1843-3

Ishida H P-380

Ishida M P-257

Ivers H A-521, A-546,

A-621, P-549,

P-619

Iwase S P-103

Izzi G P-413

Jackman M A-321

Jackson C A-439

Jacobs E P-318, P-319

Jacobs P A-85, P-86

Jacobsen PB A-592

Janbozorgi M A-787

Janes K A-150

Jansen A A-613

Jayaraman U P-382, P-386

Jean-Louis N P-401

Jefford M A-381, P-39,

S1810-3

Jenewein J A-324

Jenkins K A-108, A-687

Jens E A-313

Jesion T A-731

Jeunemaitre X A-260, A-262

Jevne R S1836-4

Jewett M A-579

Jian R A-190

Jinnai R P-118

Johannes B A-107

Johannessen-Henry CT A-661

Johansen C A-48, A-661,

P-267

Johansson B A-464, P-320

Johnson T P-726

Johnston P S1847-2

Jolicoeur L P-646

Jones B A-655

Jones G S1847-1, S1847-3,

S1847-4

Jones JM A-321, A-682

Jonius B P-442

Jovell E P-64

Juarez G P-701

Judith M P-633

Julie T-G A-505

Juraskova I A-235, A-236,

A-370, A-406

Jusko-Friedman A A-682

Justice H P-78

Kaal KJ S1841-3

Kaimukilwa D P-16

Kaimukilwa H P-16

Kaliner L A-153

Kalman V P-200

Kamath J P-570

Kanagasundram S P-168

Kandasamy A P-71

Kandler LS A-2, P-5, P-763

Kanter C P-281

Karanofsky M A-622

Karlsen RV P-267

Karslioglu EH A-409, P-277

Kasapoglu F P-790

Katsumata N P-384

Katsumata R P-208

Katz A W-8

Katz J A-771

Katz V A-768

Kavan P A-622

Kaw C S1832-3

Kawaguchi T P-103

Kaymak SU A-409, P-277

Kazanjian A A-712, P-696,

S1822-2, S1822-3,

S1822-4

Kearsley J W-251

Keller-Olaman S S1847-2

Kelley J A-4

Kelly B S1922-2

Kennedy K A-500

Khalil A A-13, P-82

Khalil M A-13

Khalil NA A-491

Khatib J P-326

Kiayi N P-725, P-750

Killoran S W-328

Kim JJ A-167

Kim JM P-389

Kim MH P-399, P-402,

P-516

Kim SW P-389

Kim SY P-389

Kim Y A-690, A-776,

S1816-1

Kim-Sing C A-110

King L A-687

King M S1810-3

Kinsella L A-330

Kiriike N P-28

Kirst M A-77

Kissane D A-509, A-510,

S1816-5

Kitchen-Clarke L W-904

Kiyange F A-476

Klikovac T P-427

Knobf T A-490

Koerner A A-743, P-211,

P-426, P-511

Kogan N A-166

Kolva E A-502

Komatsu H P-90

Kondamudi P A-595

Konyen S W-729

Koopman H A-455, P-576

Kop J-L A-667

Kornblith AB A-451, A-470

Kornhauser I A-368

Kortmann R-D A-483

Kowalczyk JR P-711

Kowalski K P-535

Koyama A P-117, P-118

Kraemer H A-344

Krajinovic M A-762

Kratt P P-741

Krattenmacher T A-694

Krawczyk A P-736

Krishnasamy M A-370

Kristjanson L A-754

Krzeminski A A-410

Kubota K P-384

Kumano K P-206

Kunzler A P-753

Kupst MJ P-283

Kurchakova MS P-665

Kuroda Y P-103

Kurokawa M P-206

Kuten A S1816-2

Kwon SY P-399, P-402,

P-516

Kwong SSH A-160

Kylma J A-88

Labelle LE P-369, P-597

Lacasse Y A-540

Lacey J W-251

Lafaye A A-271, A-455

Lagattolla F A-671, P-669

Lahlou-Laforet K A-260, A-262

Lai M-L A-362

Lai Y-H P-652

Lamarque D A-190

Lambert S A-38, A-101,

S1810-1

Lamiani G P-457

Lamontagne J P-49

Lampic C A-237, P-238,

P-320

Lang A P-367

Lankshear S A-628

Lanza A P-548

Laperriere N P-109

Lapointe J A-51

Larkin P P-227

Larose C A-439

Larsen L P-348

Larsson G A-464

Larsson YH A-332

Last B P-433

Latimer S P-472

Launoy G A-410

Laurence D A-129

Lauzier S A-191, A-193,

P-702

Laverdiere C A-681, A-762

Lavoie S S1813-2

Lawlor L P-369

Lawlor-Savage L P-597

Lawsin C A-385

Lazenby M A-490, P-326

Lazzari C P-19, P-20

Lazzarotto D A-744

Le Bihan A-S A-181, P-176,

P-182, P-185

Leahy R A-87, P-173

Leal I A-157, A-158

Lebel S A-358, A-648,

A-765, P-453,

P-646, P-683,

P-727, S1832-4,

S1843-2

Lecathelinais C S1810-1

Lee C-Y P-286

Lee J P-696

Lee J-H P-207

Lee RNF S1843-2, S1843-3


DOI: 10.1002/pon

Author Index S319

Lee V P-249, W-532

Lefebvre M P-646, S1832-4

Leiberman M S1910-2

Leis A A-591

Lem-tayer F A-435

Lemogne C A-190

Leon C P-64

Leonor F A-577

Lepage L A-439

Lepore S S1910-2

Lethborg C A-83

Leung D A-309, S1813-2

Leung T A-390

Leung YCT A-305, A-397,

P-395

Levesque P P-702

Levin A P-199

Levin AO A-739

Levin R A-407

Levin T A-510

Levine E A-745

Levy K S1919-1

Li I-F P-207

Li M A-336, A-358

Li P-Y A-362, P-207

Liang J-T P-652

Libert Y A-272, A-479,

A-578, A-697,

P-403, P-404,

P-441, P-442,

S1816-4

Lichtenthal W S1813-1

Lienard A A-272, A-403,

A-475, P-441

Lieutenant F P-291, P-408

Lim J-w A-159

Lin Y P-356

Linden W A-162, P-199,

P-593

Linerol S P-477

Lingard L S1845-1

Lipton JH S1843-1

Lis C A-135

Lisa S P-230

Lissoni P P-15

Livartowski A A-667

Livia L-LR A-129

Lleshi A P-256

Llewellyn CD A-627

Llort A P-478

Lluch J A-411

Lo C A-614, A-618,

W-507, S1924-2,

S1924-3

Lobb E W-251, S1810-3

Lohman D S1916-1

Loiselle CG A-191, A-213,

A-650, A-722,

A-731, A-743,

P-249, S1842-1

Lord K A-275, A-276,

P-130, P-270,

P-274, P-454,

P-573, P-684

Loscalzo M A-567, A-568,

A-596

Lossignol D P-417

Lotfi-Jam K A-381, A-383

Louis A A-579

Lounsberry J A-299

Louw DA P-775

Lowry S P-119

Lowthian P A-368

Lu J A-189, A-191

Lund S A-278

Luong K P-70

Lupi S A-608

Lyu CJ P-399, P-402,

P-516

Ma T A-490

Mabbott D P-109

MacEwan L A-439

MacGregor K P-696, S1910-1

MacIntyre L W-152

MacKenzie G A-150, A-160

Mackenzie K S1919-2

Madan B A-504

Madhavan P A-368

Magri V A-97

Magrin ME P-670

Mah K S1843-1, S1843-2,

S1843-3

Maheu C A-77, P-79, P-646

Maican A P-94

Makabe R P-27

Malfitano C A-336

Mallik SB P-777

Malova J P-436

Manabe A P-250, P-380

Mancini A P-200

Mancini J A-465

Manii D S1820-2

Manly-Lampkin S P-317

Marc H A-689

Marchal S A-272, A-479,

A-578, P-403,

P-441, P-442

Marchiori P P-15

Marcoux S A-762

Marcus BH P-717

Mareike P A-313

Marie D S1846-2

Maroco J A-157, A-158

Marquez M S1837-1, S1837-2

Martin M P-741

Martinho K A-87, P-173

Marx E S1846-3

Mason W P-109

Mather J S1844-1

Mathieu J S1919-4

MatosNeto JN P-218

Matsuda Y P-28

Matsui T P-28

Matsunaga H P-28

Matsuoka H P-117, P-118

Matthew AG A-579, P-62

Mattioli V A-671, P-669,

P-674

Maunder R A-336

Maunsell E A-193, P-702

Maurice-Stam H P-437

Mawhinney J W-729

Mayer C A-439, S1919-2

Mayo S P-772, S1847-1,

S1847-3, S1847-4

Mazza O A-300

Mazzei A P-674

McCaffery K A-406

McCallum M P-646

McCarthy N A-236

McClement SE A-754

McConnell D P-593

McCorkle R A-490, P-658,

S2000-2

McDonald M A-518

McDonough MH A-480

McDougall A S1845-1

McElduff P A-642

McGoldrick D A-184, A-461

McGrane J S1810-3

McGrath K A-682

McGurk M A-627

McHarg L A-731

McKeown SB A-571

McLaughlin M A-768

McLeod D P-696, S1847-1,

S1847-3, S1847-4

McLeod D S1861-1, S1861-2,

S1910-1, S1919-3,

S1921-1, S1921-2,

S1921-3, S2000-1

McMahan A A-544

McMillan M A-439

McTavish F A-301

McVey L A-731

Mead K A-29, A-394,

A-422

Meader N A-126, A-641,

P-572, P-643

Medeiros J A-89

Meeske K A-768

Mehta A W-767

Meijer-van den Bergh E P-437

Meiser B A-357

Melchor-Beaupre R S1845-2

Melissa H P-230, P-633

Mella S P-255, P-604

Melnyk T W-704

Menko F A-612, A-613

Merckaert I A-272, A-475,

A-479, A-578,

A-697, P-403,

P-404, P-441,

P-442, S1816-4

Mesch V A-300

Messina G P-15

Messner HA S1843-1

Metcalfe K A-530, P-716

Meunier J A-272, P-403,

P-441

Meybodi FA P-725, P-732,

P-750

Michaux G A-84

Miedema B A-186, P-149,

P-187, W-152

Mignon A A-410

Mikulincer M P-258

Mileshkin L A-370

Milhabet I A-410

Millar J A-623


DOI: 10.1002/pon

S320 Author Index

Miller F P-529

Milner S A-44

Mina DS P-62

Minden M A-614, A-618

Mingoo R P-605

Mints M S1837-1

Missoten P A-435

Mitchell AJ A-125, A-126,

A-177, A-178,

A-275, A-276,

A-641, A-680,

P-124, P-130,

P-131, P-179,

P-180, P-270,

P-274, P-454,

P-572, P-573,

P-643, P-684,

P-686

Mitchell D A-517

Miyamoto K P-118

Miyazaki N P-206

Mobius C A-483

Moeller B A-694

Moffat H A-490

Moghrabi A A-762

Mohamed S P-168

Moja EA P-457

Moleri C P-19, P-20

Montanaro R A-671, P-669,

P-674

Montazeri A P-574, P-584

Monteiro L A-264

Montella M P-520

Moore C A-470

Moore CW A-451

Mor P P-66

Morck A S2000-1

Moreira S A-634, P-638

Morel E P-291

Mori H P-353

Moritake H P-250, P-380

Morrison D S1916-3

Morrison EJP P-718

Morrison V A-334

Mortensen S A-135

Moseley-Giannelli JV P-593

Moser MT P-753

Motlagh MK P-740, P-750

Motta C P-668

Moucheux A A-479, P-441

Muanza T A-622

Muller K A-708

Murdock K A-316

Murias R P-720

Muriel AC A-451, A-470

Murphy L A-517, A-714

Murray E P-202

Muthny FA A-415, A-609

Muto K P-103

Muzzatti B P-255, P-256,

P-604

Mwangi-Powell F A-476

Nacinovic AD P-297

Nagarathinam C P-382, P-386

Naglieri E P-674

Nagumo Y P-103

Nakagawa K P-103

Nakaguchi T P-57

Nam Y A-768

Namkoong K A-301

Nandrino J-L A-128

Nanni MG A-97

Nannya Y P-206

Narabayashi M P-257

Narciso D P-255, P-604

Naros S A-530

Nasr M A-737

Nassar N A-4

Nattress K A-235

Ndukwe N A-687

Neal C A-184

Neal R A-334

Neilson K A-29, A-394,

A-422

Nekolaichuk C A-329, W-328

Nelson F W-496

Neri E A-307, A-344

Neron S P-611

Neto FF P-498

Netter P A-730

Neu J-C P-738

Neves S A-608

Neville B A-414

Ng MHC P-605

Nicholas D A-192, S1841-1

Nicholls W P-338

Nicolas V A-10

Nicoll I A-439

Niederwieser D P-203

Niki M P-117, P-118

Nilbert M A-212, A-663

Nilsson M P-444

Ninot G P-226

Nissim R A-288

Nitkin P A-536

Nolasco C A-300

Nomizu T P-27

Nomura S P-257

Nonino A P-218

Nordin K A-237, P-238,

P-320

Norman P A-416

Norris A A-721

North N A-108

North V A-108

Novy D A-6

Nussbeck F P-753

Obadia Y A-446

O’Brien S W-742

O’Brien T A-304

Occhipinti S A-45, P-43

O’Connor R P-688

O’Donnell E A-431

Ogata A P-250, P-380

Ogez D P-290, P-291

Ohtake T P-27

Okamura H P-659

Okuyama T P-57, P-90, P-208

Oldenburg H A-37

Oliveira M P-720

Oliver J S1919-1

Oliver T S1847-2

Olopade O A-525, A-595

Olsen S A-351

Olsson M P-444

Olver I A-47, S1836-1,

S1836-2, S1836-3

O’Malley C A-431, A-432

Omar AM A-24

Omer W S1924-3

Omidvari S P-584

Ong J P-605

Onganıa L P-200

Onishi H P-257

Oosterwijk J A-612

Oppenheim D S1824-1

Osborne R A-193

Oster R P-741

O’Sullivan B A-167

O’Sullivan C P-658

O’Sullivan D A-760, P-758

Otsuoka M P-117

Oumima N A-181, P-176,

P-182, P-185

Owen J S1910-2

Ozalp E A-409, P-277

Ozawa M P-250, P-380

Ozier D P-781

Ozkan M A-398, S1829-2

Ozkan S A-398

Pagani L P-9

Pailler M P-726

Pallı C A-411

Panzarella T P-109

Papadakos J A-682

Paquet L P-119, P-121,

S1832-4

Park B A-510

Park ER A-451, A-470

Parkinson M A-536, P-781

Pascal A P-401

Pasquin E A-744

Patenaude AF P-710, P-723

Pati S A-91, P-67, P-68

Patkau T S1910-1

Patrao I A-157, A-158,

A-474

Patrick-Miller L A-525, A-595

Patterson H A-719

Patterson P A-246

Pawlowski K A-525, A-595

Pearce A A-246

Pearson A A-719

Peate M A-357

Pedersen A A-506

Pelissier S A-667

Pelletier G A-239, A-299

Penberthy L A-630

Pendlebury S S1832-2

Pereira JP A-493, P-463

Pereira MG P-551, P-691

Peretti-Watel P A-446, A-465,

A-497

Peretz T P-258

Perez-Campdepadros M P-429, P-478

Perry S A-74, P-73

Perry-Brinkert J A-462

Pertl MM A-528

Perz J P-232, P-233,

P-234

Pessin H A-502


DOI: 10.1002/pon

Author Index S321

Pestell S A-108

Peter E A-309

Peters MEWJ A-418

Peters O A-650

Petersen HV A-212

Petersen LK P-252

Petersson L-M P-444

Petit S A-271, A-455

Petranovic D P-297

Petrelli F P-19, P-20

Petrovic K P-364

Peyrat J-P A-410

Phillips J A-115

Picard L A-531

Picard M A-508

Piemme K A-307

Pierre D A-504

Pina PR A-608

Pinto BM A-580, P-717

PintoNeto JV P-218

Pirbaglou M P-62

Pires Z A-264

Pirl W A-451, A-470

Pisa A P-64

Pisu M P-741

Plat-DeKoter T A-361

Poll M W-244

Pollard A A-29, A-394,

A-422

Poppito S S1844-3, S1845-3

Porcino A A-639, A-703

Porebiak MI P-428, W-145

Potter P A-351

Powell R A-406

Power C A-65

Power T A-623

Pratt LM W-715

Price M A-165

Prigerson H A-451, A-470

Prins J A-216

Pritchard Z W-328

Prokasheva S P-519

Proudlove M A-544

Ptolemy E A-571, P-195

Pucheu S A-181, P-176,

P-182, P-185

Pugh A S1861-3

Qi E A-768

Quaranta T P-668

Quinlan E P-535

Raat H P-576

Radiotis G P-211, P-511

Radomski J A-502

Radtke FM P-637

Radu LM P-445

Rahim SA P-666

Rajvanshi A P-261

Ramakrishnan V P-382, P-386

Rancourt K A-344

Rapp E P-285

Ratti MM P-668

Rauch PK A-184, A-451,

A-470

Rauf A A-278

Raymond A-421

Razak A A-167

Razavi D A-272, A-475,

A-479, A-578,

A-697, P-403,

P-404, P-417,

P-441, P-442,

S1816-4, S1928-1

Reaby L A-236

Reblin M P-472

Recchi D P-498

Rechis R A-184, A-461

Reece J A-394, A-422

Regina M A-162

Regnault A A-662

Reich M P-477, P-738

Reiman A P-149

Remie M W-33

Remmer J A-310, P-17

Renata B P-611

Rennie H S1910-3

Renton C A-660

Rey D A-446, A-497

Rey-Herin D A-465

Reynaert C A-272, A-475,

A-578, P-403,

P-404, P-441,

P-442

Rezende SN P-672

Rhee MA P-399, P-402,

P-516

Ribeiro A A-264

Richardson A A-278

Richardson B A-648, A-765

Richter D P-426

Rigney M A-719

Rinehart R A-568

Ringash J A-167, A-336

Ritvo P P-62

Rix BA A-327, A-331

Rizvi K A-752

Robaey P A-762

Robert F S1919-4

Roberts N P-203, P-511

Robertson S P-535

Robinson J A-501, A-647,

P-369

Robinson JW A-114, A-115

Robinson L A-598, A-599,

P-187, P-202,

P-449

Robitaille M-A A-733

Rochon MG A-759

Rodin G A-288, A-309,

A-321, A-336,

A-614, A-618,

W-507, S1843-2,

S1843-3, S1924-1,

S1924-2, S1924-3

Rodney P A-111

Roesler C A-154

Roganovic J P-543

Rogers HL A-512

Rogers K A-642

Rokbani L P-291

Romanello F P-9

Romer G A-694

Romito F A-671, P-669,

P-674

Rosberger Z P-736

Rose P A-278, A-396

Rosenfeld B A-502

Rosenquist R A-237, P-238

Rosenthal MA A-133

Rosenzweig M A-556

Roshanai A A-237, P-238

Rosin M A-122

Ross B A-639, A-703

Rossetto K A-655

Rosti G P-284

Roter D P-472

Roth M A-771

Rothenmund H A-625

Rourke S A-660

Rovelli S A-357

Rowland W W-904

Roy M-A P-637

Roygnan C A-181, P-176,

P-182, P-185

Ruccione K A-768

Ruebsaat S A-150

Rusu AI P-445

Rusu D P-445

Rutledge R A-598, A-599

Ryan D A-304, A-312

Rydall A A-288, A-336,

A-614, A-618

Sabado T P-478

Sabiston CM A-480, A-491,

A-508

Sabo B A-46, S1921-1,

S1921-3

Sadeghi S P-732

Saed ML P-445

Sagawa R P-57, P-90, P-208

Saita E P-457

Sakai K P-117

Sakamoto R P-117

Sakata N P-103

Sakura O P-103

Sala E A-411

Salley C P-710, P-723

Salvador P P-735

Samardakiewicz ME P-711

Samonigg H A-695, P-679

Sample S W-487

Sanders S A-768

Sanderson C W-251

Sands C A-525, A-595

Sanson-Fisher R A-366, A-375,

A-534, A-538

Santiago SM A-676, P-93,

P-498, P-672

Sarno L P-668, P-685

Sasaki Y P-257

Sasso LD A-744

Saunders C A-357

Savage B A-278

Savard J A-521, A-546,

A-621, P-314,

P-549, P-619,

S1832-1, S1832-4

Savard M-H P-549

Sawka C A-628

Scaillet P A-475

Schear R A-461

Schimmer A A-614, A-618


DOI: 10.1002/pon

S322 Author Index

Schmidheiser H A-525, A-595

Schmidt R P-426

Schneiderman G S1841-1

Schoene S A-730

Schofield P A-366, A-370,

A-375, A-381,

A-383, P-39,

S1810-3

Scholten L P-433

Schorn PW P-225

Schover L A-45

Schrauwen W P-318

Schroder C P-203

Schryer C S1845-1

Schuermeyer I P-94

Schuler T P-241

Schulte F P-132

Schultz IZ A-536

Schulz C A-768

Schulz R A-776

Schuurs A A-359

Schwartz F A-682

Schweidtmann W A-609

Scoccia E P-548

Scrignaro M P-670

Seccareccia D A-21

Seccombe M A-236

Seckin G A-425

Secord S A-77

Sedda A-L P-738

Seibaek L P-252

Sellick SM A-2, P-5, P-763

Semotiuk K A-623, A-625

Semple J A-530

Seror V A-446, A-465

Serpentini S A-744

Serra E P-200

Serrano E S1919-1

Servent V P-477

Setoguchi S A-407

Sevigny A P-183

Shaddick H A-361

Shaheed J A-192

Shallwani S A-622

Shanahan K P-724

Sharkey K A-370, A-383

Sharon B P-633

Sharp R P-94

Sharpe E P-449

Sharpe K P-352

Sharpe L A-385

Shaw RM A-247, P-482

Shearer E P-95

Shepherd HL A-165

Shepherd S P-106

Sherman D P-53

Sherman ML P-770

Shickle L A-630

Shih S-M A-127, P-123,

P-136, P-514

Shimizu K P-58, P-575

Shin IS P-389

Shin MJ P-399, P-402

Shin YJ P-399, P-402,

P-516

Shino EN P-775

Shirai Y P-384

Shulman J P-590

Shun S-C P-652

Sibbritt D A-26

Siddons HM A-52, A-133

Simard J A-51

Simard S A-540, S1832-1,

S1832-4

Siminoff LA A-512, A-630

Simondi C A-667

Simpson J S1847-1, S1847-3,

S1847-4

Sinardo H A-705, A-707

Singer S A-481, A-483

Singh A P-94

Siu LL A-167

Skoko-Poljak D P-543

Slachmuylder J-L A-272, A-479,

P-403, P-442

Slavish K A-556

Smith B A-236

Smith D A-29, A-394,

A-422, A-568

Smith HE A-627

Smith SJ A-757

Soares P A-608

Song H A-768

Song L A-209

Song X P-121

Sonia M A-505

Sonkusare L A-75

Soubeyran P P-226

Soussan PB P-170

Soygur H A-409, P-277

Speca M P-696, W-487,

S1910-1

Spezeski J A-719

Spica L A-497

Spiegel D A-307, A-344,

A-349

Spiegler B P-109

Spillers R A-690, S1816-1,

S1832-3

Spitz E A-435

Spriggs P P-535

Stacey A-M S1847-2

Stacey F S1810-1

Staines A P-688

Stajduhar K P-367

Stanzer S P-679

Star P A-349

Stefano C P-279, P-282

Stein K P-352, W-788,

S1832-3

Stephan J S1847-3

Stephane C P-401

Stephen J A-518, P-696,

S1910-1, S1910-2

Stephens A P-1

Stern M P-545, W-547

Stewart S A-603

Stiggelbout A A-612, A-613

Stoel R A-612

Stokes J A-625

Stone A P-281

Stoner J A-721

St-Onge M W-692

Storey L A-341

Strada EA S1808-4, S1813-4

Strauser D A-760, P-758

Streich G P-200

Strohschein FJ A-722, A-731

Strowbridge R A-568

Stubenrauch S A-209, A-259

Stuckless N A-625

Subramanian KK P-382, P-386

Sullivan K A-571

Sultan S A-577, A-662,

P-142, P-226,

P-550

Summers A A-623

Sun V P-701

Sundquist K A-38, A-101,

P-232, P-234

Susanne B A-313

Suzuki S P-250

Suzuki S-i P-380

Swendsen J A-271

Swinton N S1847-2

Sylvain N P-633

Sylvie A P-620, P-633

Sylvie D A-129, A-577

Syme A S1847-2, S1919-1

Symonds P A-125, A-177,

A-178, A-275,

A-276, A-680,

P-124, P-130,

P-179, P-270,

P-274, P-454,

P-573, P-684

Sze M S1810-3

Tabori U P-109

Tachble A P-356

Tait GR S1845-1

Takahashi T P-206

Takei Y P-250, P-380

Takimoto Y P-206

Tamagawa R A-307

Tamim N P-611

Tang D A-213

Tang L A-209

Tang W-R A-141

Tanguy L P-401

Tannenbaum S P-570

Tannock I A-660

Tarabrina NV P-665

Tarcatu D S1844-2

Tardif F P-631

Tardivon A A-667

Tatemichi S P-149

Taylor B A-307

Taylor N A-623

Taylor P P-23, W-22

Taylor-Brown J A-534, A-538,

P-696, S1910-1

Te V P-611

Teixeira RJ P-551

Teran L S1837-2

Ternestedt B-M A-92, A-400

Tettero I A-12

Teucher U A-645, A-656

Thalen-Lindstrom A A-464

Theuns P P-146

Thewes B A-357, P-315,

S1832-2

Thibodeau K W-767


DOI: 10.1002/pon

Author Index S323

Thomas BC A-115, A-239,

A-647, P-356,

S1918-3

Thomas D W-251

Thomas-MacLean R P-482, P-535

Thompson A S1841-3

Thompson D A-18

Thompson S P-360

Thornton LM A-739

Thygesen LC A-661

Tibben A A-612, A-613

Tirelli U P-256

Tobi K P-633

Tochihara K P-118

Tomasello P P-9

Tomlinson G P-62

Tondo MJ P-558

Toner B A-795

Toomey M P-513

Tourigny A A-540, P-183

Toyama T P-57

Trachtenberg J A-579, P-62

Trachtenberg L A-336, A-579

Tracy M P-25

Trancar K P-468

Trauer T A-29

Travado L P-263, S1916-5

Tremblay A S1919-4

Tresoldi V P-19, P-20

Trinkaus K A-351

Tripp J A-415

Trojano V A-671, P-669

Truant T A-639, A-703

Truchon M A-733

Trucotte V A-85

Trudel-Fitzgerald C P-314

Tsuchiya M P-118

Tupholme T A-266, A-499

Turcotte V P-86

Turnbull G A-358, A-361,

A-682

Turner C P-283

Turner D A-396, A-534,

A-538

Turner J P-43, P-696, S1910-1

Twardowski P P-701

Twirbutt S A-307

Tyson E P-113

Tzairy E P-73

Uchida M P-57

Uchino B P-472

Uchitomi Y P-58, P-384, P-575

Ueda R P-90

Ueno K P-659

Ugalde A A-366, A-375

Urowitz S A-340

Urquhart R A-469

Ussher J P-232, P-233,

P-234

Vachon M A-488, S1813-2

Vahdaninia M P-584

Vakilha M A-167

Vale C A-264

Vallentine P A-248

Valteau-Couanet D S1824-1

Van Asperen C A-612

van Beurden M A-37

van de Wetering M P-576

van den Berg S A-216

van der Linden M W-33

van der Zanden R P-433

van Dijk A P-437

van Haaften J A-439

Van Houtte P A-475

Van Slyck M P-545, W-547

van Vlack T P-149

van Vliet LM P-254

Vanderlinden L P-318

Vanlemmens L P-477

Vannatta K P-198, P-283,

P-322, P-710,

P-723, S1841-2,

S1841-3

Vardy J A-660

Vegni E P-457

Veillette A-M S1822-3, S1822-4

Vennin P A-410, P-477

Verhagen CAH A-418

Verhoef M A-639, A-703

Verma S P-119, P-121,

S1832-4

Veronique C P-401

Verreault R A-540

Verzelen A P-318

Vezina L A-540

Viel A P-255

Viellette A-M S1822-2

Vignola V P-413

Viladrich C A-411

Vilela L P-223

Villa J A-621

Villalba MB P-200

Villaroel J A-719

Villars P P-352

Vinajeras Y A-655

Vodermaier A A-162, A-164

Vodolazsky N A-84

Volker D A-655

Volpe J A-192

Vong S A-745

Vos J A-612, A-613

Vrijmoet-Wiersma J P-437

Wada M P-257

Wada T P-257

Wade T A-26

Wagner B P-25

Wagner S A-760, P-758

Wain G P-232, P-233

Waldron JN A-167

Walker LM A-114, A-115

Walker TL A-739

Waller A W-36

Walton T A-682

Wang G-L P-123, P-134,

P-136, P-514

Wang L A-167

Wang S A-534, A-538

Warde P A-579

Warnick A W-116

Wassersug R A-115

Watson E A-278, A-396

Watson M P-106

Weber M A-768, P-25

Wein S A-74

Weinberger M S1922-3

Weinman J A-627

Weis J A-293

Weiss E S1910-2

Wellisch D S1816-3

Wenham RM A-188

Wennman-Larsen A P-444

Whelan J A-664

White A P-119

White K A-246

White M S1861-2

White S A-316

White W A-108

Whitford H A-47, S1836-2

Wiener L S1824-2

Wilczek B S1837-1, S1837-2

Wild R A-603

Wiljer D A-340, A-743

Wilkinson C A-334

Williams A A-88, P-367

Williams S A-334

Wilson B A-623, P-529

Wilson K A-341, A-500

Wilson S A-278

Wilson-Smith D P-345

Winokur A P-570

Wirga M W-677, W-780

Wirsching M A-154, A-210,

A-259

Withers R A-336

Wittenberg L A-349

Wittmann L A-324

Witzigmann H A-483

Wolfgang L P-164

Won SC P-399, P-402, P-516

Wong A A-760, P-758

Wong AYM S1843-1, S1843-2,

S1843-3

Wong J A-212, A-623,

A-625, S1861-1,

S1861-3

Wong M A-639, A-703

Wong R A-288

Wong WKT P-232

Wong-Kim E A-785

Wong TWK P-233, P-234

Wootten A A-52

Wootten AC A-133

Wormsbecker T A-239

Wright S A-304, A-312,

P-688

Wu S P-241

Wuensch A A-154, A-209,

A-210, A-259

Wurl A P-726

Wurtzen H A-48

Wynn JD W-60

Xenocostas A S1843-1

Xiong L A-768

Xu W A-579, A-660

Yamaguchi T P-103

Yamashita H P-57

Yan A P-423

Yang Y-C A-362

Yates P S1810-3


DOI: 10.1002/pon

S324 Author Index

Yeates K P-710, P-723

Yeh K-H P-652

Yeoung K P-70

Yi J P-70

Yoo G A-745

Yoon JS P-389

Yoshiuchi K P-206

You DS

You-Harada C A-181, P-176,

P-182, P-185

Young J P-39

Yue K S1919-1

Yutsis M A-307,

A-349

Zabora JR A-153

Zaider T S1816-5

Zainal NZ P-168, P-666

Zamanian H P-740, P-750

Zanchetta M A-77

Zanetti R A-107

Zarpellon F A-744

Zeev R P-611, P-620,

P-633

Zevon M P-724

Zhang H A-209

Zhang L A-122

Zhang W P-570

Zhang Y A-209

Zidan J A-61

Zimmerman C A-336

Zimmermann C A-288, A-614,

A-618, S1924-1,

S1924-2, S1924-3

Zindel A P-753

Zizzetti S A-744

Zloklikovits S P-679

Znoj HJ P-753

Zorbas H A-357

Zozaya C P-339, P-342

Zucca A A-248, S1810-2

Zupko B A-707

Zwahlen D A-324


DOI: 10.1002/pon

Author Index S325

Distress Management: Comprehensive and Humane Practices after Changes in Routine of Cancer Care

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