Gastrointestinal Cancer: Distress and Emotional Disorder Among Patients in Chemotherapy

Psycho-OncologyPsycho-Oncology 20(Suppl. 2): 105–300 (2011)Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.2078

Abstracts of the IPOS 13th World Congress of Psycho-Oncology, 16–20 October 2011, Antalya, Turkey

POSTER ABSTRACTS

P1-1

Lectures on Grief Care for the Bereaved by Cancer

and Medical Staffs in Japan

Kanako AmanoShiga Medical Center for Adults, Ashiya/Hyogo,Japan

BACKGROUND: As one of selft-help groupsfor the bereaved by cancer in my hospital‘‘KIRARA-KAI’’ members wanted to learn themeaning of grief care, I and members of this groupplanned to hold four series of lectures on grief carefor the bereaved, especially the bereaved by cancer,and medical staffs. This is the first trial in Shigaprefecture of Japan. The purpose of this study is toinvestigate the effectiveness of lectures on griefcare. METHOD: Participants of lectures: 1stlecture N5 73, 2nd lecture N5 60 Participants ofquestionnaire: 1st lecture N5 41,2nd lectureN5 42 Lecturers: The bereaved and specialists ongrief care (psychiatrist, palliative care doctor,clinical psychologist, nurse) Schedule: 1st and 2ndlectures were held 28/8/2010 and 13/11/2010respectively. 3rd one will be 30/4/2011, and 4thone will be sometime this year. Contents oflectures: grief process, the most useful supportthat the bereaved experienced, narrative of thebereaved, many kinds of grief care, the words thatwould hurt the bereaved, etc. Questionnaire:Participants answered impression and understand-ing on lectures and wrote free comments, etc.RESULTS: The result of Questionnaire: Accordingto questionnaires on 1st and 2nd lectures, over93% participants of questionnaires answered‘‘Very good ‘‘and ‘‘Good’’. And over 88%participants of questionnaires answered ‘‘easy tounderstood’’ and ‘‘understood’’. Free comments ofparticipants: The examples of comments are asfollows: ‘‘I have ever suffered from my grief,but now I can understand that my reaction isnormal and I require my story listening forrecovering.’’ ‘‘The lecture was concrete and I reallyunderstood the lecture on checking my experience.

I embarrassed to tear in my eyes during lecture.’’CONCLUSIONS: Lectures were positively im-pressed and understood well by participants. Inthe lecture on grief care, it is necessary to explainthe grief response, concrete cases, and advices onself-care. And the lecture promotes the bereavedgrief and it is opportunity to help their grief. Inaddition, the bereaved can get new social networkby meeting other participants. Medical staffs alsocan understand the bereaved grief. Consequently,the lectures on grief care are useful for not only thebereaved but also medical staffs. RESEARCHIMPLICATIONS: Future studies will investigatethe effectiveness on other lectures, needs ofparticipants on lectures and mental health ofthe bereaved on pre-post lectures. CLINICALIMPLICATIONS: Lectures can be one of griefcares for the bereaved and can be psycho-educationfor the bereaved, self-help groups, and medicalstaffs. I hope to expand numbers of medicalstaffs who can support from family to thebereaved. Clinically, lectures on grief care areuseful for the bereaved and medical staffs.ACKNOWLEDGEMENT OF FUNDING: None.

P1-2

Spousal Experience of Cancer Patients’ End-of-Life:

A Qualitative Study

Leonor Fasse1,2, Cecile Flahault1,2, Serge Sultan2,Sylvie Dolbeault1, Anne Bredart1,21Institut Curie, Paris, France, 2Universite ParisDescartes, Paris, France

BACKGROUND: Although spouses of cancerpatients in end-of-life are considered by publicauthorities as vulnerable persons, there have beenfew empirical studies exploring their daily caregiverexperience coping with impending death. Theirvoice concerning their relations with their illpartner is not always heard to explain burden oradaptation. This study aims at: exploring thevery nature of potential burden, investigatingperceived risk/protective factors of spouses’

r 2011 The Authors. Psycho-Oncology r 2010 John Wiley & Sons, Ltd.

emotional adjustment, capturing their insight ofend of life. METHOD: Individual semi-structuredinterviews with spouses of cancer patients in end-of-life (1 to 6 months before death) were conductedto capture the subjective experience of caregivingand the relation both pre-existing to the illness andimpacted by cancer. Data are analysed with theGrounded Theory (Charmaz, 2006; Strauss &Corbin), a systematic and standardized method ofsemantic analysis. QDA Miner, a qualitative dataanalysis software, is used to identify patterns incoding, and to detail the Grounded Theory.Emerging themes and theory are confronted withstyles of attachment assessed with the Experiencesin Close Relationship Scale (Brennan, Clark andShaver, 1998). RESULTS: 30 semi-structuredinterviews were conducted with spouses of end-of-life cancer patients (20 men, 10 women, mean age:62). Data are now being analysed. Preliminaryanalyses suggest that: 1/different types of burden(often interwove) could be distinguished, particu-larly an emotional one linked with feelings ofhelplessness and loneliness, and a more practicalone based on management of characteristic symp-toms of cancer. 2/Familial supportive communica-tion with medical staff, supportive and satisfyingmarital relation, are reported to be helpful to copewith caregiving experience. 3/‘‘Life without he/she’’is a particularly vivid and frequent theme,not always associated with emotional distress.CONCLUSIONS: Although spouses-caregivers ofend-of-life cancer patients have to cope withburden and distress caused by the disease and deepchanges in their relations with the patients, most ofthem adjust progressively. Moreover some of themreport an important satisfaction linked with thisexperience and even personal growth. Anticipatingthe death of their spouses is not sufficient toprepare themselves to the decease and life withouttheir partner. The management of pain at homeand the intestinal disorders are described as themost difficult symptoms of cancer to cope with:medical staff must have a particular insight on thisissue. RESEARCH IMPLICATIONS: Factorsupstream from death, like styles of attachment, orspousal experience of illness and end-of-life,strongly impact on the emotional and socialadjustment of the spouse-caregivers. More studiesare thus needed on incidence of these factors afterthe decease, on spousal adjustment to grief, withboth quantitative and qualitative methods. Indeedqualitative studies have the interest of making thespouses’voice heard, while enriching in some pointsquantitative studies, in a dialectic perspective.CLINICAL IMPLICATIONS: Precise identifica-tion of these upstream-from-death factors wouldcontribute to the provision of primary andsecondary prevention, and the creation of ther-apeutic intervention for bereaved spouses throughcancer. With regard to the severe burden reported

by spouse-caregivers, counselling and socialsupport can reduce the distress they felt.ACKNOWLEDGEMENT OF FUNDING: None.

P1-3

Distress of Bereaved Who Lost Family Members

with Cancer, and Asked for Medical Help

Mayumi Ishida1,2, Hideki Onishi3, ShinobuNomura1, Yosuke Uchitomi41Waseda University, Tokorozawa City, Saitama,Japan, 2Research Fellow of the Japan Society forPromotion of Science, Tokyo, Japan, 3SaitamaMedical University International Medical Center,Hidaka City, Saitama, Japan, 4Okayama Univer-sity, Okayama City, Okayama, Japan

BACKGROUND: The death of a loved one has astressful impact on the physical and psychologicalwell being of the bereaved. There have been severalstudies focusing on bereavement-related distress,but none of the previous studies examiningbereavement-related distress specifically excludedwith distress derived from their own psychiatricsymptoms. The aim of this study was to investigatethe bereaved who lost their loved one with cancerand asked for medical help, and reveal theircharacteristic distress. METHOD: We conducteda retrospective survey of people consulting theoutpatient services for bereaved families at theDepartment of Psycho-Oncology at SaitamaMedical University International Medical Centerbetween April 2007 and September 2009. Wespecifically excluded the bereaved who showedsevere psychiatric symptoms, because theirbereavement-related distress might be exacerbatedby psychiatric symptoms. Data were obtained frommedical records at initial consultation and qualita-tively analyzed by content analysis using allstatements related to their distress. This studywas approved by the Institutional Review Board ofSaitama Medical University International MedicalCenter. RESULTS: Fifty-one bereaved individualswere surveyed. After excluding individuals whosedistress might be derived from psychiatric symp-toms, 21 bereaved (43.1%) fulfilled the criteria. Thestatements were classified into 11 categories, whichwere further classified into 6 themes. The maincategories of bereavement-related distress were: (1)Guilt; (2) Anger; (3) Memory; (4) Loneliness; (5)Anxiety; (6) Hopelessness. CONCLUSIONS: Inthis study, we identified significant and character-istic components of distress of the bereaved askingfor medical help after losing a loved one withcancer. We grouped these components as ‘‘Guilt’’,‘‘Memory’’. ‘‘Guilt’’ and ‘‘Memory’’ are stronglyrelated to observations of their loved one’s cancertrajectory. Therefore, when we treat bereaved whohave lost a loved one with cancer, we might askabout their perception of the death considering the

r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd. Psycho-Oncology 20(Suppl. 2): 105–300 (2011)

DOI: 10.1002/pon

106 Poster Abstracts

cognitive aspects as well as the medicaltreatment. Their distress might be associated withtheir view of their loved one’s cancer trajectoryand cognitive perception of the death.RESEARCH IMPLICATIONS: None. CLINICALIMPLICATIONS: This retrospective study demon-strated the characteristics of bereavement-relateddistress in individuals asking for medical helpfollowing the death of a loved one from cancer.Their distresses might be associated with their lovedone’s cancer trajectory and their cognitive perceptionof the death. ACKNOWLEDGEMENT OFFUNDING: This study was supported by theThird-Term Comprehensive 10-Year Strategy forCancer Control and Research of the JapaneseMinistry of Health, Labor and Welfare and Grant-in-Aid for Scientific Research.

P1-4

Emotional Distress Among Family Members after

the Death of Cancer Patients in Japan

Masatoshi Nakao1,2, Masahiro Suzuki1, NatsukiHori1, Yutaka Matsui21NTT Medical Center Tokyo, Tokyo, Japan,2Institute of Psychology, Graduate School of Com-prehensive Human Sciences, University of Tsukuba,Tsukuba, Japan

BACKGROUND: Emotional distress experiencedby family members after the death of a loved one isan important factor that contributes to compli-cated grief (CG). Most studies assess this distressby retrospective questions to the bereaved. In thisstudy, palliative care nurses assessed it immediatelyafter a patient’s death and analyzed the causes ofdistress in terms of demographics of patient andfamily, physical pain of patient and care processvariables. METHOD: Data were obtained from theclinical records of 398 patients who died at apalliative care unit in Tokyo between April 2009and February 2011. Following patient death,nurses assessed and recorded the distress, patient’sphysical pain, and possibility of CG in familymembers. Multiple regression analyses were usedto determine the influence of patient factors (age,sex, admission durations, physical pain), familyfactors (relationship with patient: wife, husband,parents, daughter, son, sibling), and care processfactors (use of an End-of-life care pathway,presence at deathbed, participation in bed bathafter death) on family distress and possibility ofCG. RESULTS: The level of distress was moderatein 42.2%, less moderate in 35.2%, painful in16.8%, and severely painful in 5.6% families.Possibility of CG was detected in 11.6% families.Physical pain (Po0.01) and relationship with thepatient(wife, husband, parents and daughter)(Po0.05) were associated with higher distress,whereas presence at deathbed and use of an

End-of-life care pathway were associated withlower distress. The family distress was consideredto be the only factor that contributed to CG(Po0.01). CONCLUSIONS: The most importantfinding is that the preparation for death (use of anEnd-of-life care pathway and presence at deathbed)and control of physical pain mitigate distress levels.Interestingly, the factor of the possibility ofCG may be different from that of distress.RESEARCH IMPLICATIONS: Family distressrevealed in this study may be important for furtherresearch on CG. Further studies are needed toclarify the relationship between distress and CGafter bereavement, which could be useful to planinterventional strategies prior to patient death toprevent the possibility of CG in family members.CLINICAL IMPLICATIONS: The results ofour study justify the significance of the following.First, interventional strategies to counsel thefamilies on impending patient death and toencourage psychosocial preparation for deathare important to mitigate family distress levelsafter death. Second, the challenges faced bymedical staff in constantly controlling thepatient’s physical pain for the sake of the familyshould be considered. ACKNOWLEDGEMENTOF FUNDING: None.

P1-5

Impact of a Communication Skills Training on

Nurses Communication Efficiency: A Qualitative

Analysis of an Encounter with Mrs Gudule, a

Simulated Cancer Patient Anxious About Taking

Morphine

Delphine Canivet1,2, Nicole Delvaux1,2, Anne-SophieGibon1,3, Jean-louis Slachmuylder4, Darius Razavi1,21Universite Libre de Bruxelles, Brussels, Belgium,2Hopital Universitaire Erasme, Brussels, Belgium,3Institut Jules Bordet, Brussels, Belgium, 4Centre dePsycho-Oncologie, Brussels, Belgium

BACKGROUND: Nurses are often dealing withcancer patient’s anxiety, in particular in the contextof taking morphine. Optimizing communicationbetween nurses and anxious patients requirestraining. This study aims to assess in a randomizedstudy the efficacy of a 105-hour CommunicationSkills Training Program (CSTP) specificallydesigned for nurses. This study is based on aqualitative analysis of encounters transcriptsbetween nurses and a simulated cancer patientanxious about taking morphine called Mrs Gudule.METHOD: Nurses were randomly assigned to atraining (TG) or to a waiting list group (WLG).The assessment included the recording of anencounter at baseline (T1) and after training forTG, and 3 months after baseline for WLG (T2).An independent rater blinded to the assessmentand to the allocated groups rated the encounters

Poster Abstracts 107


DOI: 10.1002/pon

transcripts qualitatively. Rating method was basedon different dimensions of patient centeredness.Transcripts were ranked from 1 (for not-centered)to 7 (for highly centered). Group-by-time effectswere measured using t-test and Mann-Whitney-Wilcoxon non-parametric test. RESULTS: Ninety-six nurses were included. Preliminary resultsshowed that, at baseline, WLG (M5 3.7) didn’tdiffer from TG (M5 3.5) in their communicationskills (t5 0.611; p40.05). Nevertheless, TG usedsignificantly more simulated patient centred com-munication skills (M5 5.0) after training(U5 641.5; po0.001), compared to WLG(M5 3.7). It suggests that, in contrast to thewaiting list group, trained nurses showed higherability to lead a simulated patient centred encoun-ter (U5 582.5; po0.001). CONCLUSIONS: Thisstudy shows the efficacy of a CSTP designed toimprove nurses’ patient centeredness in anencounter with a simulated patient. RESEARCHIMPLICATIONS: This randomized study assessesprecisely the size effect of a CST on simulatedpatient centeredness improvement with a qualita-tive method. CLINICAL IMPLICATIONS:The results of this study may help to developmore precise guidelines designed to improvenurses’ patient-centeredness in cancer care.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is supported by the Belgian National CancerPlan.

P1-6

The Life End Information Forum (LEIF) in

Belgium: Impact of Peer Review on the Quality of

End-of-Life Decision Making

Wim Distelmans, Paul Destrooper, SabienBauwensUniversity Hospital Free University of Brussels,Brussels, Belgium

BACKGROUND: Three important bills have beenimplemented in Belgium since 2002 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 moreinformed, a Life End Information Forum (LEIF)has been launched in 2003 in Flanders and Brussels(Dutch speaking part of Belgium) METHOD: Asfrom 2003, ‘‘LEIF- artsen’’ (Life End InformationForum - physicians) have been trained in end-of-life care issues (includig palliative care) in Flanders.They are also skilled to give the compulsory secondopinion on a request for euthanasia. Following themain collective training course subsequent peerreviews have organized throughout Flanders. Thevarious local peer review groups are moderated bya skilled trainer and a senior LEIF-physician.Information and advices are shared on a interactive

basis A selection of the main pitfalls is madeavailable to the other groups. RESULTS: Pre-liminary results of the impact of peer review(two times a year) of LEIF-physicians on thequality of end-of-life decision making will bepresented. CONCLUSIONS: Following the5-days basic training of LEIF physicians inend-of-life decision making, regular peer reviewsdefinitively have a beneficial impact on thequality of support in difficult end-of-life decisions.ACKNOWLEDGEMENT OF FUNDING:None.

P1-7

The Information Needs of Egyptian Newly Diag-

nosed Breast Cancer Women Undergoing Surgery

and their Levels of Satisfaction with the Provision of

Information

Karima Elshamy1, Omar Farouk2, We’amMostafa3, Adel Denewer21Adult Nursing Department, Faculty of Nursing,Mansoura University, Egypt, 2Surgical OncologyDepartmnet, Oncology Center, Mansoura Univer-sity, Egypt, 3Psychological Care Unit, OncologyCenter, mansoura University, Egypt

BACKGROUND: Breast cancer is a significanthealth problem worldwide and a complex diseaseboth physically and psychologically. Breast surgerymay impact psychologically on a woman’s bodyimage and sexuality. Effective managementrequires a professional and holistic approach.Understanding cancer patients’ information needsis the crucial first step in designing interventions tomeet the needs of cancer patients. METHOD:A descriptive prospective study was to: 1-Identifythe expectations and information needs ofEgyptian newly diagnosed breast cancer womenundergoing surgery.2-Explore why they believedthis information was important, and 3- Identify thelevels of satisfaction with the provision of informa-tion provided by healthcare professionals. Fortyfour newly diagnosed breast cancer women under-going surgery from surgical wards at oncologycenter; Mansoura University Hospitals during sixmonths were recruited based on including andexcluding criteria. The study was conducted in twosuccessive phases, the preparatory and data collec-tion. Two tools were used in the study: 1- Selfadministered information needs of Egyptian newlydiagnosed breast cancer women undergoing sur-gery questionnaire. 2- Satisfaction with the provi-sion of information provided by the health careprofessionals’ questionnaire. Demographic datasheet was attached at the end page of the scale.Patients rated their desire in obtaining theinformation about each item on a 5-point Likert-type scale, with 1 denoting ‘strongly disagree’ and5 denoting ‘strongly agree’. Number 3 was



DOI: 10.1002/pon

a neutral comment for patients who desired not tocomment as to whether they agreed or disagreedwith the statement. RESULTS: The findings of thisstudy indicated that patients rated highly the needfor all types of information. They rated most highlythe need for information about surgery -relatedinformation especially postoperative complicationsand when to seek medical help. Patients did notrate as highly, information regarding why thedoctor believes the surgery is important, treatmentalternatives and explanation of the procedure.Patients were not satisfied with the informationthey were provided. CONCLUSIONS: The studyconcluded that women are desirous of a range ofrelevant information as they often not given theinformation they need by health care professionals.There was incongruence between the informationthat women want and the information that wasgiven to them by health care professionals. Womenwere found to have high information needs andthey felt that often the individualized nature oftheir needs was not given the attention theyrequired. This study will aid health care profes-sionals in planning care by providing a morethorough understanding of the challenges womenface as the phenomenon of expressed informationneeds unfolds, it provides recommendations to helpenhance the practice of nurses as they draw onexisting theoretical and experiential knowledge,and will support the development of future work,and provide an impetus for such work to becompleted. These findings will hopefully bringabout greater understanding of a mature topic thatwill enable nurses to learn more about thephenomena of informational needs expressed bywomen undergoing breast cancer surgery.

P1-8

Communication Satisfaction with Treatment Team

in Cancer Patients with Completed Treatments

Sibel Eyigor, Onur Korkmaz, Ruchan UsluEge University Faculty of Medicine, Izmir, Turkey

BACKGROUND: Cancer patients encounter manyproblems in the post-diagnosis period and they wantto establish a good contact with the treatment teamin order to get better information about theircondition. Specific data revealing satisfaction-relatedfactors in cancer patients, and manuals providinginformation about how to approach patients are stillunavailable. This study aims to introduce thecommunication satisfaction of the patients, whosetreatments are completed at oncology clinic, aboutinformation provision, treatment and treatmentteam. METHOD: The archive of Medical OncologyDepartment comprising 4622 patients was randomlyscreened. Only 2051 patients could be reached, sincetelephone numbers in some files were missing andsome files were incomplete. It was observed that

34 patients were not eligible for the study, 697 patientswere dead, and 792 patients could not be reached.Charts of 528 patients were analysed. Patients wereasked questions on the phone about the diagnosis,treatment and treatment period. Their status ofsatisfaction about the treatment and treatment teamwas assessed using a Likert Scale. The duration oftelephone interviews was approximately 10 minutes.RESULTS: The mean age of the patients was foundto be 56.22710.99 year. The average hospitalizationwas 13.29710.12 days. Approximately 78.8% of thepatients had been informed about their disease. Thenumber of patients, who believed that informationprovision had been sufficient, was higher in theuniversity group (po0.05). The satisfaction rate ofthe informed patients about the treatment, treatmentteam and the physician was observed to be highercompared to the ones who were not provided withinformation (po0.05). Some 11.1% of the patientsnoted inconsistencies between the information theyreceived from different physicians in the treatmentteam. CONCLUSIONS: At the end of our study, itwas observed that most of the patients followed upin our oncology clinic were provided with informa-tion about the disease and its treatments, yetnecessary attention was not paid to the issue.RESEARCH IMPLICATIONS: Consequently, thedata obtained at the end of this study have revealedthat we have some deficiencies in the quality ofinformation provision in cancer patients, and thesupport treatment system is insufficient in the periodwhen patients return to their social life after thecompletion of their primary treatment. However,the basic approach should aim to detect and resolvethese problems. CLINICAL IMPLICATIONS:We believe that the multi-disciplinary supportunit founded in our oncology department willreduce these deficiencies and insufficiencies to theminimum level. Our study will provide newapproaches with relation to the importanceand method of communicating with and infor-ming patients. ACKNOWLEDGEMENT OFFUNDING: None.

P1-9

To Facilitating the Communication Skill Training of

Bad News Telling for Cancer Care as a National

Health Policy in Taiwan

Chun-Kai Fang1,2, Guan-Yu Chen2,3, Sheng-HuiHsu2,4, Woung-Ru Tang2,51Department of Psychiatry & Suicide PreventionCenter, Mackay Memorial Hospital, Taipei,Taiwan, 2Taiwan Psycho-Oncology Society, NewTaipei City, Taiwan, 3Department of Psychiatry,Taipei City Hospital, Songde Branch, Taipei,Taiwan, 4Department of Psychiatry, Koo Founda-tion Sun Yat-Sen Cancer Center, Taipei, Taiwan,5Graduate Institute of Nursing, Chang GungUniversity, Taoyuan, Taiwan



DOI: 10.1002/pon

BACKGROUND: Communication skill training(CST) of bad news telling for cancer care,always SPIKES model recently, has beenpracticed in western countries over 20 years,but does not become the national healthy policy.Japan is the first Asian country to promotethe CST by the SHARE model as a nationalhealth policy. The article is to report how topromote the CST of bad news telling forcancer care as a national health policy in Taiwan.METHOD: Taiwan Psycho-Oncology Society(TPOS) was organized on October 2009. Forfacilitating the CST as a national healthpolicy, TPOS got the authorization from JapanPsycho-Oncology Society (JPOS) to use theSHARE model. In 2010, TPOS began to trainthe facilitator for the CST with the SHAREmodel. Then, TPOS invited the grand andsemi-grand facilitators of JPOS to certificateTPOS to practice the SHARE model. Finally,TPOS hope Taiwanese government to promotethe CST as a national health policy. RESULTS:There were 29 members of TPOS invited tobe the candidates from January to April in2010. From May to August, all candidateshad to attend the training program at least 7 days.After the 7-day training program, all candidateshad to be the facilitators in a 1-day workshop ofCST. On September 4 and 5, a 2-day workshopof CST, 22 candidates become the certificatedfacilitators by the grand and semi-grand facilitatorsof JPOS. All the process was supervised by TaiwanBureau of Health Promotion. Finally, theBureau of Health Promotion entrusted TPOS topromote the CST in 2011. CONCLUSIONS:Following Japan as the first Asian country in2007, Taiwan is the second Asian county topromote the CST of bad news telling with theSHARE model for cancer care as a nationalhealth policy in 2011. Physicians have the respon-sibility to tell truth to cancer patients and family.The health departments of the government havethe responsibility to supervise the quality ofmedical care. We hope the national health policyis a good beginning to enhance the quality ofcancer care in Taiwan. RESEARCH IMPLICA-TIONS: All the processes were recorded andanalyzed by a research team of TPOS. Thepreliminary effect of the CST was statistic sig-nificant improvement. CLINICAL IMPLICA-TIONS: Communication between physicians andpatients/family is the very important issue tofacilitate the quality of cancer care. All physiciansneed to lean the skill to help their patients andfamily. ACKNOWLEDGEMENT OF FUND-ING: Taiwan Psycho-Oncology Society appreciateto Taiwan Hospice Organization and TaiwanBureau of Health Promotion to support theprocess, and thank Japan Psycho-Oncology Societyto share the SHARE model.

P1-10

Effect of Communication Skills Training Program

for Oncologists Based on the Patient Preferences for

Communicating Bad News: A Randomized Control

Trial

Maiko Fujimori1, Yuki Shirai1, Kaoru Kubota2,Noriyuki Katsumata2, Mariko Asai1, YosukeUchitomi11National Cancer Center Hospital East, Kashiwa,Chiba, Japan, 2National Cancer Center Hospital,Chuo-ku, Tokyo, Japan

BACKGROUND: In clinical practice, communi-cation between patients and physicians has beenviewed as a core clinical skill. Patients preferredcommunication features were linked with lowerpsychological distress and higher satisfactionlevels. Therefore, the interventions in enhancingphysicians’ communication skills included thepatients’ preferences are needed. The aims of thisstudy are to report the efficacy of a communicationskills training programme which was developedbased on patients’ preferences through a rando-mised trial. METHOD: Thirty oncologists wererandomly assigned to either an intervention (a2-day CST workshop) group or a control group.Participants were assessed their communicationperformances during simulated consultation atbaseline and follow-up (post-CST or one-weekafter baseline). They rated their own confidence tocommunicate to patients at baseline and follow-up.Participants of an intervention group were also thehelpfulness of the program at post-CST. Patientswho had a consultation with participants at base-line and follow-up were assessed their distress andsatisfaction of physician’s communication andconsultation after consultation. RESULTS: Atfollow-up, the performance scores of the interven-tion group demonstrated improvement, especiallyemotional support and delivering skills of informa-tion compared with those of the control group. Theconfidence scores of the intervention group wererated higher at follow-up compared with those ofthe control group. Participants of the interventiongroup were satisfied with all components of theCST program. In addition, the distress scores ofpatients who had met with an oncologist who wasthe intervention group had significantly decreasedcompared with those of the control group. Howeverthe satisfaction scores of patients did not show nosignificant difference. CONCLUSIONS: This rando-mized control trial demonstrated the effects of adeveloped CST program for oncologists based onpatient preferences on improving oncologist perfor-mances, confidences, and patient psychologicaldistress. However the CST program has notimpacted patients’ satisfaction. CLINICALIMPLICATIONS: These findings suggest that theCST program developed based on patients’



DOI: 10.1002/pon

preferences is suggested to improve oncologists’communication behaviors what patients prefer, toimprove oncologists’ confidence to communicate topatients, and to decrease patients’ distress. Theeffective communication skills training program willhelp in the education for all physicians workingwithin oncology. ACKNOWLEDGEMENT OFFUNDING: The authors would like to acknowledgethe collaborative support of the staffs at Psycho-Oncology Division, National Cancer Center Re-search Institute East.

P1-11

Immediate Impact on Distress Following

Complications After Implant or Diep Flap Breast

Reconstruction

Jessica Gopie1, Reinier Timman2, MedardHilhorst2, Stefan Hofer3, Marc Mureau2, AadTibben11Leiden University Medical Center, Leiden,The Netherlands, 2Erasmus University MedicalCenter Rotterdam, Rotterdam, The Netherlands,3University of Toronto, Toronto, ON, Canada

BACKGROUND: Few studies have focused onthe psychological impact of postoperative compli-cations after breast reconstruction (BR). As post-operative complications after BR usually lead to aprolonged recovery time and sometimes requireadditional surgery, the short-term impact ondistress was investigated. METHOD: Pre- andpostoperatively, psychological questionnaires weresent to 152 women who underwent either implantBR (ImBR) or Deep Inferior Epigastric arteryPerforator flap BR (DiepBR). In addition, compli-cations during the first 4 weeks after BR werereported. The course of anxiety, depression andcancer-specific distress and the effect of complica-tions on distress were investigated. RESULTS:Women with ImBR experienced more postopera-tive pain than women with DiepBR. ImBR patientsreported decreased anxiety, and both groupsreported declined cancer-specific distress aftersurgery. However, depressive symptoms tended toincrease after DiepBR. In both groups depressivesymptoms increased if patients had complications,and anxiety increased in women with complicationsafter DiepBR. A significant number of patientswith complications reported alarming levels ofdistress. Timing and laterality were not signifi-cantly correlated with distress. CONCLUSIONS:Complications after BR have a significant impacton emotional well-being shortly after surgery,especially in women with a DiepBR. RESEARCHIMPLICATIONS: Future studies regarding theimpact of complications after BR on distressshould focus on the course of distress in the long-term. CLINICAL IMPLICATIONS: As distressaffects quality of life and health outcomes, it is of

great importance to monitor distress during post-surgery consults and to offer mental support topatients, if required. ACKNOWLEDGEMENTOF FUNDING: Dutch Cancer Society.

P1-12

Examination of Conflict Tendencies and Ways of

Coping with Stress of Oncologists

Pinar Isc-en, Guler BahadirIstanbul University, Istanbul, Turkey

BACKGROUND: This study had been conductedwith the aim to compare the tendencies of enteringin to conflict and ways of coping with stress interms of hospital type (university hospital andtraining-research hospital), duration of working inoncology department, age and gender. The secondaim was to evaluate the relationship betweentendency of conflict and ways of coping with stress.METHOD: 60 doctors, 30 from university hospi-tals (IU Oncology Institute and MU MedicalFaculty) and 30 from training-research hospitals(Okmeydany, �i�li Etfal and Kartal Lutfi Kyrdar),contributed to the study in Istanbul. Participantswere given Tendency of Conflict Scale which wasdeveloped by Dokmen and Ways of Coping withStress Scale which was developed by Sahin andDurak. In addition, a personal information formprepared by the researcher was also provided.T-test and Mann Whitney-U tests were used toevaluate the differences among these groups.Pearson correlation was used in the evaluation ofrelationships between psychological factors.RESULTS: Oncologists in university hospitalswere found to be different from the other groupin terms of optimistic approach, but other psycho-logical factors were similar in two groups.Oncologists who have been working 10 or lessyears in oncology had significantly higher scores ofconflict tendency and insufficient coping approachwhen compared with the oncologists who havebeen working more than 10 years in oncology.In addition, while there were positive correlationsbetween insufficient coping with stress and conflicttendency, negative correlations between sufficientcoping and conflict tendency were observed.CONCLUSIONS: Conflict tendency of oncologistsis not effected by organizational structure, but it iseffected by duration of working in oncology.Encountering stressful situations; oncologists whohave been working 10 or less years in oncology aremore likely to have an insufficent approach,whereas oncologists who have been workingmorethan 10 years are more likely to have an optimisticapproach. RESEARCH IMPLICATIONS: InTurkey, the number of researches which are carriedout with doctors working in different hospitals andwhich examine conflict tendency and copingmechanisims of doctors are very limited. For these



DOI: 10.1002/pon

reasons, this study is considered to be complemen-tary. However, the sample of the study is limitedand it only includes oncologists. A wider research isneeded which consist of more doctors who work indifferent units. CLINICAL IMPLICATIONS: It isconsidered that groups which are organized toreduce distress and to improve communicationskills and coping mechanisms might be helpful foryounger oncologists. ACKNOWLEDGEMENTOF FUNDING: None.

P1-13

The Cedric Hele Institute Implements Communica-

tion Training for Physicians, Nurses and Paramedi-

cal Staff in Oncology, Funded by the Belgian

National Government

Eva Jacobs1, Sabien Bauwens2, Wim Distelmans2,Sofie Eelen1, Bernard Hensmans3, Wim Schrauwen4,Lieve Vanderlinden5, Angelique Verzelen61Cedric Hele Instituut, Mechelen, Belgium,2Universitair Ziekenhuis Brussel, Brussels, Belgium,3Monster.be, Vilvoorde, Belgium, 4UniversitairZiekenhuis Gent, Ghent, Belgium, 5UniversitairZiekenhuis Leuven, Louvain, Belgium, 6The HumanLink, Antwerp, Belgium

BACKGROUND: Good communication is re-quired in cancer care. To provide qualitative cancercare many topics (such as diagnosis, treatment,recovery, relapse) need to be discussed with thepatients. However, caregivers education focusesmainly on technical aspects of care. The CedricHele Institute - Flemish institute for psychosocialoncology - coordinates training programs inpsycho-oncology. In 2010 CHi was designated bythe Belgian Government to develop a course incommunication for 150 professionals working incancer care programs. METHOD: CHi developeda 30h training program for nurses, paramedics anddoctors. The program offers a variety of theoreticalmodels, and integrates many interactive methodssuch as (self-) reflection, exercises, homeworkassignments and role-plays. These methods creategood conditions to teach communication skills, topractice skills and to integrate these into clinicalpractice. The focus of the training is on the patientand his family (coping, illness perceptions, com-munication with family members, conflict hand-ling), the teams within which we operate (teamsupport) and our own functioning (self-care).RESULTS: 250 Oncology professionals presentedtheir candidacy. CHi selected 162 professionals: 70Doctors, 76 (specialist-)nurses, 12 social workers en4 other paramedics. Each course was given by twotrainers, this to allow maximum interaction.Evaluations were very positive. Professionals feelmore competent at work after attending the course.They are more aware of their communication, andreflect more. This makes them feel more confident

in difficult situations. The trainees also highlyappreciated the interactions with colleaguesfrom other disciplines and hospitals. In answer,The Belgian Government decided to re-investin training for 150 professionals in 2011.CONCLUSIONS: The communication trainingcontributes to the aim of the Chi to improvepsychosocial care of cancer patients in Flanders.Studies show that effective communication ofhealth care providers improves the welfare oftheir patients, but also their own wellbeing.RESEARCH IMPLICATIONS: The communica-tion program is evidence based: the theoreticalframework is build on scientific research incommunication in oncology. Clinical practice isimplemented in the interactive modules. Thetrainers are all working within the oncologysetting and draw material from their own workingsetting. Trainees bring in clinical cases, difficultiesof the daily work, and results of home workassignments and are trained to implement theevidence into the daily practice. CLINICALIMPLICATIONS: Trainees improved theircommunication skills. The interactive methodologyprovides a good basis for transferring these skillsinto clinical practice. Not only this leads to a bettercare of cancer patients and their relatives. Researchshows that training in communication reduces therisk of burnout. The contacts and exchange ofexperience between different onco-disciplinesand different hospitals was also very valuable.The intra- and interdisciplinary networking createsa good platform for these professionals.ACKNOWLEDGEMENT OF FUNDING: TheCedric Hele instituut could be founded thanks tothe support of the national society ‘VlaamseLiga tegen Kanker’ (the Flemish League againstCancer).

P1-14

A Report of Medical Support for Disaster Victims in

East Japan Earthquake and Tsunami

Ryutaro KomuroDepartment of Psychiatry, National Hospital Orga-nization Kanazawa Medical Center, Kanazawa City,Ishikawa Prefecture, Japan

BACKGROUND: In order to explain the back-ground of ‘‘Disaster and Psychosocial Aspects ofCancer Patients’’, I will report medical support fordisaster victims at Ogatsu district in IshinomakiCity, Miyagi Prefecture, where the damage by theearthquake and the tsunami was worst, as apsychiatrist for contributing medical support teamfor disaster victims. METHOD: We moved fromKanazawa to Ishinomaki Red Cross Hospital bycar on March 23. Only this hospital was notdestroyed by the earthquake and Tsunami inIshinomaki City. We participated in the meeting



DOI: 10.1002/pon

and received medical information at the hospital.We visited two places of large-scale refuges, andthree small districts to see patients who stayed attheir own house without essential utilities such assupplies of water, electricity, or gas. We tried to usethe communication skill developed for Japanesecancer patients, SHARE, to communicate withpatients. RESULTS: We examined 54 patientstotally under a sub-acute phase. As far as weexperienced, the outbreak of diarrhea had not beenseen. Many victims lost their doctor’s clinic andcould not take their medicine because of thedisaster. They told us their hard experience. Wetried to make Supportive environment (S ofSHARE). Reassurance and Emotional support(RE ) reduced their emotional stress and to clearfor us their own need and recognition (H, the headof ‘‘How to deliver the bad news.’’, meanspatient’ s recognition,). We could contributeadditional information (A ) to them immediately.CONCLUSIONS: Although the medical supportfor disaster victims seemed well-organized, theproblem of excreta disposal and the hygiene sidewas big, and infections such as influenza or thenorovirus were concerned about. Exacerbation ofthe chronic disease with the drug deprivation wasextremely concerned about including patients withcancer. Because of severe situation by the disaster,we worried that cancer patients could not expecttheir future and they were very uneasy.We havefound that SHARE is very useful to communicatewith patients under these conditions. Communica-tion skill SHARE could help the support ofthe patients with cancer and other victims.ACKNOWLEDGEMENT OF FUNDING:None.

P1-15

Patient and Caregiver Perceptions of Communica-

tion of Prognosis in High Grade Glioma

Elizabeth Lobb1,2, Georgia Halkett3, Anna Nowak4,51Calvary Health Care Sydney, NSW, Australia,2Cunningham Centre for Palliative Care, NSW,Australia, 3WA Centre for Cancer & PalliativeCare, Curtin University, Western Australia,Australia, 4School of Medicine and Pharmacology,University of Western Australia, Western Australia,Australia, 5Department of Medical Oncology, SirCharles Gairdner Hospital, Western Australia,Australia

BACKGROUND: Malignant High Grade Glio-mas (HGG) are a common primary brain tumorand represent approximately 80% of all primarybrain tumors in adults. Most patients diagnosedwith HGG die from their disease (median survivalo1–3 years), even if they have received the fullrange of treatment available including surgery,chemotherapy and radiotherapy. This study sought

the views of patients and their caregivers on theirexperience of being diagnosed with high gradeglioma. METHOD: Purposive sampling was usedto recruit 19 patients and 21 caregivers from themedical oncology unit of a tertiary hospital inAustralia. A semi structured face-to-face interviewwas conducted in the patient’s home. Interviewswere audio-taped and transcribed verbatim. Datawas analysed based on Grounded Theory andusing the constant comparison method. RE-SULTS: This presentation focuses on patient andcarer perceptions of the initial communicationabout the diagnosis of High Grade Glioma andits prognosis. Themes identified included: a) shockat hearing the diagnosis; b) trying to understandand process prognostic information when still inshock; c) the perception of hope being takenaway; d) individualizing prognostic information;and e) clinicians’ lack of communication skills.CONCLUSIONS: This study shows that the firstcommunication of prognosis to patients with highgrade glioma and their caregivers requires carefulnegotiation. It illustrates the inability of individualsto process detailed prognostic information when ina state of initial shock and distress. The importanceof balancing honesty with hope in the communica-tion of a poor prognosis is highlighted.RESEARCH IMPLICATIONS: Although re-cently published Australian clinical practice guide-lines advocate the implementation of genericcancer communication skills, future research mayrequire the development of guidelines specific tohigh-grade glioma patients and their caregiverswith particular emphasis on methods of informa-tion delivery suitable for people with cognitivedeficits. CLINICAL IMPLICATIONS: We recom-mend that clinicians seek patient preferences forthe amount and type of information they requireand that prognostic information be individualized.Clinicians without detailed knowledge of apatient’s individual disease characteristics or withlimited experience in the field should avoiddamaging discussions of median survival withpatients or their caregivers. Detailed discussionsof prognosis should only take place with seniormedical staff, or advanced trainees who havedemonstrated acceptable communication skills.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by an unrestricted educationalgrant from Schering Plough Pty. Ltd.

P1-16

How to Communicate Bad News to Patients with

Cancer and Their Families: Does Culture Matter?

Gholamhosein Ahmadzadeh1,2, Azadeh Malekian1,2,Hamid Afshar1,21Behavioral Sciences Resaerch Center, Isfahan,Iran, 2Behavioral Sciences Resaerch Center, IsfahanUniversity of Medical Sciences, Iran



DOI: 10.1002/pon

BACKGROUND: This is a narrative review onprotocols and discussions on transcultural aspectsof how to communicate bad news to patients withcancer and their families. METHOD: Having donea comprehensive review on the literature, in thisarticle the authors highlight the trans-culturalaspects of communicating bad medical news.RESULTS: The universal protocols seem to bemodifiable for different socio-cultural settings.CONCLUSIONS: The issue of how to modifythe approved universal protocols to meet differentcultural needs and expectations will be discussedand studies from various socio-cultural contextswill be introduced. ACKNOWLEDGEMENT OFFUNDING: None.

P1-17

Predictors and Correlates of Low Patient Satisfac-

tion with Resident Communication in Clinical

Rounds

Isabelle Merckaert1,2, Jessica Salis3, Yves Libert1,2,Isabelle Bragard4, Nicole Delvaux1,5, Anne-MarieEtienne4, Aurore Lienard2, Serge Marchal1,Julie Meunier2,3, Christine Reynaert6, Jean-LouisSlachmuylder3, Darius Razavi1,21Faculte des Sciences Psychologiques et de l’Educa-tion, Universite Libre de Bruxelles, Brussels,Belgium, 2Institut Jules Bordet, Universite Libre deBruxelles, Brussels, Belgium, 3C.B.P.O. (trainingand research group), Brussels, Belgium, 4Faculte dePsychologie, Universite de Liege, Liege, Belgium,5Service de Psychologie, Hopital UniversitaireErasme, Universite Libre de Bruxelles, Brussels,Belgium, 6Faculte de Psychologie et des Sciences del’Education, Universite Catholique de Louvain,Louvain-La-Neuve, Belgium

BACKGROUND: The aim of this study is toinvestigate patient, visit and communication char-acteristics related to low patient satisfaction withresident communication in clinical rounds. Aspatient satisfaction surveys often report ceilingsatisfaction levels, patients with low satisfactionlevels were compared to patients with highsatisfaction levels. METHOD: Patients’ character-istics and satisfaction with resident communicationwere measured during a half day clinical roundtaking place before and after a communicationskills training program. Patient satisfaction withresident communication was measured using avisual analogue scale. Visits were recorded, tran-scripted and analyzed using a computer assistedprogram (Lacomm). Patients with the lowestsatisfaction levels regarding resident communica-tion (first decile; VAS o70) were compared topatients with highest satisfaction levels(VAS5 100). RESULTS: Three hundred andsixty-six patients out of 857 were included.Eighty-five belonged to the lowest (VAS o70)

and 281 to the highest (VAS5 100) satisfactiongroup. Patients with the lowest satisfaction levelswere significantly younger and were more likely tohave a higher education. They also were morelikely to have a worsening clinical status and hadhigher anxiety and depression levels. They also hadencountered residents with lower supportive skillsand who were more likely to have no previouscommunication skills training. Moreover, lowpatient satisfaction was related to low residentsatisfaction. CONCLUSIONS: This study is thefirst that investigated patient low patient satisfac-tion with resident communication in clinicalrounds. Results showed that some patients’characteristics and specific residents’ communica-tion skills in clinical rounds could predictpatients’ low satisfaction levels. RESEARCHIMPLICATIONS: Resident should be aware ofpatient characteristics related to low satisfactionwith communication in clinical rounds(age, education, clinical status and distress).CLINICAL IMPLICATIONS: As low patientsatisfaction is related to poor resident communica-tion skills, resident communication skills trainingprograms specifically designed for clinicalrounds are needed. ACKNOWLEDGEMENTOF FUNDING: This research program wassupported by the ) Fonds National de laRecherche Scientifique - Section Televie ‘ ofBelgium and by the C.B.P.O, training and researchgroup (Brussels - Belgium).

P1-18

‘‘A Bit Scared to Know Too Much, but Wanting to

Know at the Same Time’’: A Qualitative Study on

the Information Needs in People with Lung Cancer

Hunter Mulcare1, Chris Fox2, Penelope Schofield31Northern Health, Melbourne, VIC, Australia,2Latrobe University, Melbourne, VIC, Australia,3Peter MacCallum Cancer Centre, Melbourne, VIC,Australia

BACKGROUND: Cancer patients typically havehigh needs for information about their disease andtreatment, and many patients seek out muchinformation. Few studies, however, have investi-gated predictors of information needs. In aprevious quantitative study we found an associa-tion between patients’ adjustment to cancer andtheir needs for information. In this current studywe aimed to expand on these findings by exploringhow psychological adjustment and other factorsinfluence information needs. METHOD: Eighty-two lung cancer patients at outpatient radiotherapyclinics were recruited at their first appointmentwith their radiation oncologist. Participants com-pleted two questionnaires one month apart whichincluded qualitative questions about informationneeds. Patients rated their information need on a



DOI: 10.1002/pon

five-point scale and then were asked to expand ontheir rating. Patients were also asked to describehow the way they were feeling influenced theirneed for information. Responses were thematicallycoded by two researchers and major themesidentified. RESULTS: For some patients,negative mood increased needs for information,primarily as information helped them appraisethe situation, make decisions and feel incontrol. Distress also made comprehension ofinformation difficult and thus kept informationneeds high. Conversely, some patients reportedlow needs because they were trying to avoidbecoming distressed or confused. These patientsintentionally limited exposure to threateninginformation and sought out ‘reassuring’ informa-tion. Patients filtered information by havingfamily members ask questions or trusting theirdoctor to give ‘important’ facts. A personalpreference for information could increase needfor information as could limited knowledge orexperience with cancer. CONCLUSIONS: Apatient’s need for cancer-related information isinfluenced by a large range of factors. Thepsychological or emotional state of an individualcan affect their information needs and subsequentbehaviour in complex ways. Information needsare also determined in part by an individual’sknowledge and prior experience of cancer andtheir general preference for information. Thedrive to have more information, avoid information,or seek out reassuring information, can beseen as efforts by an individual to maintain moodand limit confusion so they can cope with the stressof a cancer diagnosis and its treatment.RESEARCH IMPLICATIONS: This studyfurther supports the past reported associationbetween psychological adjustment and informationneeds. This relationship, however, is unlikely to bea simple in nature and future research couldexamine this in more detail. The personal pre-ference for information finding dovetails withprevious research on the Monitoring/Bluntingstyles. To better predict information needs andimprove information delivery, future theoreticalapproaches should account for the multi-factorialnature of influences on a patient’s need forinformation. CLINICAL IMPLICATIONS: Thefindings of this study inform strategies forbetter patient communication and informationdelivery to patients, including prompts foridentifying patients needs when communicatingwith cancer patients. Patients could be askedabout their prior knowledge or experience ofcancer, their personal preference for information,and how the way they are coping is influencingwhat they want to know. The clinician canthen formulate about the oatient’s likely needsfor information and tailor information deliveryaccordingly. ACKNOWLEDGEMENT OF

FUNDING: North Eastern MetropolitanIntegrated Cancer Service.

P1-19

Evaluating and Implementing an Innovative and

Interactive Educational Series on Problem-Solving,

Communication, and Coping to Empower a Cancer

Patient’s Journey and Provide Support for the

Caregivers Who Walk with Them

Blanca Rivas, Lina MayorgaCity of Hope National Medical Center, Duarte, CA,USA

BACKGROUND: A cancer diagnosis can raise amultitude of questions and concerns, and one’s lifecan quickly seem like a jig-saw puzzle. Research todate has suggested that teaching coping andproblem-solving skills is not only beneficial topatients but to caregivers as well; leading toclinically significant improvements in overall well-being, coping, and enhanced problem-solvingthrough treatment (McMillan, 2005). METHOD:Patients/caregivers were involved in developmentand implementation of a three-part series:‘‘Empowering Your Cancer Journey: Communica-tion, Problem-solving and Coping.’’ 1) ‘‘GettingYour Needs Met: Effective Communication Strate-gies,’’ discussed the importance of ongoing andeffective communication with healthcare team andfamily/caregivers. 2) ‘‘Let’s Problem Solve: Tools/Strategies for Solving your Cancer Needs,’’ utilizedproblem-solving model, BRIGHT IDEAS, and‘‘Social Problem-Solving Inventory’’, to demon-strate benefits of problem-solving strategies toreduce stress, improve communication, andenhance one’s overall coping experience. 3)’’Copingwith Cancer: Tips, Tools and Resources,’’ intro-duced resources, programs and services by provid-ing the opportunity to interact with speakers fromprograms within institution and community.RESULTS: The cultural diversity of participantsdemonstrated that all types of cancer patients andcaregivers are in need of problem-solving, commu-nication, and coping skills regardless of SES,diagnosis, or gender. In fact, the series as a whole,attracted male participants (as compared to othersupport/educational programs at the center) whoenthusiastically recruited their loved ones to attendand were actively engaged throughout the series.By the end of the three-part series, facilitatorsobserved participants developing bonds thatevolved into supportive relationships that stretchedoutside the confines of the workshop. Uniqueeffictive teaching modalities included ARSquizze-s(audience response system), BINGO and vin-gettes. CONCLUSIONS: We are currently in theprocess of conducting one-month, follow-up phoneinterviews. However, feedback from participantsindicated they were actively engaged by the unique



DOI: 10.1002/pon

pairing of a social worker and a health educatorapplying teaching modalities (e.g., inventories,vignettes, role-playing, pop-quizzes, and bingo) ina fun, dynamic atmosphere. Also, the healtheducator/social worker pairing provided the bonusof closing the information loop with regard toinformation, resources, support, and advocacy.Next steps involve translating the materials topresent the workshop series in Spanish to investi-gate and identify differences in communication,problem-solving and coping skills/needs/barriers ascompared to the English-speaking population.RESEARCH IMPLICATIONS: The developmentand use of effective problem-solving skills equipspatients, families, and caregivers with the tools tocope with a cancer diagnosis and the multiplechallenges that cancer brings to one’s life. In thisworkshop series, an interactive, problem-solvingapproach was used to assist patients, families, andcaregivers with their overall coping by providing aforum in which to practice and further refineeffective communication and problem-solving stra-tegies in a fun, dynamic atmosphere. CLINICALIMPLICATIONS: Two specific outcomes of thisunique collaboration is the utilization of SocialWorkers and Health Educators to increase(patient) education efforts in the area of problemsolving, communication and coping. Thisnew collaborative relationship benefits the socialwork department and clinicians in providingclinicians with the ability to refer patients andfamilies to the workshop that are experiencingcoping, problem-solving or communication issues.This workshop can be utilized to successfullyeducate both patients/families and professionals.ACKNOWLEDGEMENT OF FUNDING:None.

P1-20

The Difference Between the Opinion of Students of

Department of Medicine on Truth-Telling and their

Observation on the Actual Clinical Practice of

Attending Physicians

Woung-Ru TangGraduate Institute of Nursing, Chang Gung Uni-versity, Tao-Yuan, Taiwan

BACKGROUND: Truth-telling is the transmis-sion of bad news, as well as a problem hasto be faced frequently by doctors. According toliterature review, there is an internationaldifference in the method, attitude, and contentof truth-telling. The main purpose of this studywas to investigate if there is a differencebetween the opinion of students of Department ofMedicine on truth-telling and their observationon the actual clinical practice of attending physi-cians. METHOD: This study was a quantitativecross-sectional study, and the subjects were 278

interns of Department of Medicine at a medicalcenter in the northern Taiwan. This studyused truth telling scale (Fujimori et al., 2007)to understand the opinion of students of Depart-ment of Medicine on truth-telling and theirobservation on the actual clinical practice ofattending physicians. Moreover, this study alsoinvestigated the students’ level of satisfactionwith truth-telling implemented by attendingphysicians and the distress level of cancerpatients when they were told the truth. RESULTS:Most of the students of Department of Medicinehad received relevant training of truth-tellingduring their study (71.3%) or internship (69.8%).The awareness of students was significantlyhigher than the clinical practice of attendingphysicians (t5 11.107, po0.0005) and therewas a moderate difference between them (d5 0.6),especially in three aspects, method, emotionalsupport, and provision of additional information(po0.0005). Regardless of such a difference,students were strongly satisfied with the truth-telling implemented by attending physicians(M7SD5 7.3371.74). However, this study alsoobserved that, when cancer patients were informedof bad news, they all experienced medium andabove level of distress (M7SD5 5.9372.19).CONCLUSIONS: To develop a good ability toimplement truth-telling, it is necessary to receiveregular communication skill training (CST), andeven experienced attending physicians are noexception. This study found that there was asignificant difference between the opinion ofstudents of Department of Medicine on truth-telling and actual clinical practice of attendingphysicians. It was necessary to further investigatethe factors affecting the method of truth-tellingused by attending physicians during clinical prac-tice. RESEARCH IMPLICATIONS: It was neces-sary to further investigate the methods forobjectively assessing the methods of truth-tellingused by attending physicians during clinical prac-tice. If such ability could be assessed comprehen-sively based on the observation from patients,nursing personnel, and attending physicians them-selves, it might be possible to understand moreobjectively the truth-telling ability of attendingphysicians during clinical practice. CLINICALIMPLICATIONS: If attending physiciansneglected the impact of truth-telling method onpatients when revealing bad news and fail toprovide patients and their family with emotionalsupport or the additional information they need,they may trigger emotional distress of patientsand become an improper role model to theinterns learning from them. Hospitals shouldregularly assess the truth-telling ability ofattending physicians and provide them with CSTin time to improve their truth-telling ability.ACKNOWLEDGEMENT OF FUNDING: None.



DOI: 10.1002/pon

P1-21

Promoting Communication Skills for Cancer Physi-

cians in Portugal: Preliminary Results of a National

Pilot Training Program

Luzia Travado1,21Central Lisbon Hospital Centre - Hospital S. Jose,Lisbon, Portugal, 2National Coordination for Oncolo-gical Diseases, Ministry of Health, Lisbon, Portugal

BACKGROUND: Communication skills trainingfor oncologists in Portugal is poorly developed. TheSouthern European Psycho-Oncology Studyreportedthat physicians receive none or minimal CST in theirmedical education. In an effort to improve cancercare the National Coordinating for OncologicalDiseases, Ministry of Health, undertook a CSTnational pilot program targeting cancer physicians.The aim of the present study is to understandlearners’ communication difficulties and to monitorthe impact of CST. METHOD: Medical doctorsworking in cancer care over the country were invitedto attend a Symposium on ‘the importance of CST inclinical oncology’ and offered registration for freeworkshop. The CST model adapted from SEPOS-consisted of 4 modules (basic and advanced skills,how to recognize distress and the additional SPIKESfor BBN) (12h). Participants of the CST wereassessed on: Communication skills difficulties andbarriers (Self-Confidence in Interviewing Skills andExpected Outcomes of Patient CommunicationQuestionnaire), Psychosocial orientation (PhysicianPsychosocial Belief Scale), Burnout (Maslach Burn-out Inventory), Beliefs, attitudes and choices inCommunication with patients & families (MDACCQuestionnaire). RESULTS: More than 100 doctorsattended the Symposium, 80 registered for CSTworkshops, and 24 participated. Participants mainlyoncologists and surgeons, 42,5 1 9.8 years old, 12,81

8.3 years clinical practice, 89% no previous CST.Reported high satisfaction with CST(4.7/5), for itsinteractive methodology and role-playing. 78%firmly believe will introduce learned skills in theirclinical practice. Main CS difficulties were assess/manage denial, help manage uncertainty, promoteopenness, assess anxiety and depression, manageown feelings, BBN. Psychosocial orientation wasintermediate and burnout was high. Participants’beliefs, attitudes and choices, and confidence incommunicating with patients were significantlyimproved with CST. CONCLUSIONS: Our resultswere similar to the SEPO-Study. The positiveoutcomes of this program, namely satisfactionand interest from learners to acquire CS and usethem in their clinical settings, in helping them solvedifficult situations and in supporting their patientsin all disease phases including advanced ones, haveshown its relevance for cancer physicians. Also theimprovement obtained validates the program andencourages its continuation and extending it to other

cancer health professionals. RESEARCHIMPLICATIONS: References: Travado L, GrassiL, Gil F, Ventura C, Martins C, SEPOS Group(2005) Physician-patient communication amongSouthern European cancer physicians: The influenceof psychosocial orientation, and burnout. Psycho-Oncology, 14, 661–670. Grassi L, Travado L, Gil F,Campos R, Lluch P, Baile W (2005) A Communica-tion Intervention For Training Southern EuropeanOncologists To Recognize Psychosocial MorbidityIn Cancer Patients. I - Development Of The ModelAnd Preliminary Results On Physicians’ Satisfaction.J Cancer Education,20(2):79-84. ACKNOWLEDGE-MENT OF FUNDING: National Coordination forOncological Diseases, Ministry of Health, Portugal.

P1-22

Opening the Psychological Black Box in Genetic-

Counselling: A Counselee-Oriented Integrative

Approach

Joel Vos1,2, Christi J. Van Asperen2, Jan C.Oosterwijk3, Encarna Gomez Garcia4, MargrietCollee5, Anne M. Stiggelbout6, Aad Tibben6,51Vrije Universiteit, Dep. of Clinical Psychology,Amsterdam, The Netherlands, 2Leiden UniversityMedical Center, Dep. of Clinical Genetics, Leiden,The Netherlands, 3University Medical CenterGroningen, Groningen University, Dep. of ClinicalGenetics, Groningen, The Netherlands, 4MaastrichtUniversity Medical Center, Dep. of Clinical Genetics,Maastricht, The Netherlands, 5Erasmus MedicalCenter, Dep. of Clinical Genetics, Rotterdam, TheNetherlands, 6Leiden University Medical Center, Dep.of Medical Decision Making, Leiden, The Netherlands

BACKGROUND: In this presentation we willprovide an integrative overview on the results offour nation-wide multicenter studies in the Nether-lands. We will focus on the impact of BRCA1/2test results on tested counselees and their untestedrelatives. We will not merely focus on how geneticinformation is tranferred, but we will discuss froma counselee-oriented, existential perspective howcounselees and their relatives interpret DNA-testresults, and how these interpretations may causepsychological and medical changes in their lives.METHOD: We will discuss three studies in testedcounselees: a pilot study (24 unclassified-variants),a retrospective study (76 unclassified-variants, 76uninformatives, 51 pathogenic-mutations) and aprospective study (16 unclassified-variants, 202uninformatives, 30 pathogenic-mutations). Oneretrospective study was performed in the counse-lees’ untested relatives (44 unclassified-variants, 12uninformatives, 14 pathogenic-mutations). Themethods consisted of questionnaires and inter-views. The questionnaires included reliable, validmeasures and new instruments. RESULTS:1.Counselees reported profound existential changes



DOI: 10.1002/pon

after BRCA1/2-test-results.2.Communication ofBRCA1/2-test-results looks like a whisper-game.3.The counselees’ and relatives’ interpreta-tions and communication-style predicted the noisein the whisper-game.4.The counselees’ perceptionof BRCA1/2-results deviates significantly from theactually communicated information, and consistsof recollections and interpretations of cancer-risksand heredity-likelihood.5.The counselees’ percep-tion of test-results predicts and mediates the impactof genetic-counselling.6.The experience of anunfulfilled need-for-certainty regarding DNA-test-result, heredity and cancer causes denial anddistress.7.Relatives feel strongly involved in genet-ic-counselling, and experience significant impact ofDNA-testing.This was only predicted by theirperception which deviated from actually commu-nicated information.8.Unclassified-variants don’tfulfil the counselees’ needs and evoke distress.CONCLUSIONS: The impact of the disclosure ofBRCA1/2-test results may not only be discussedfrom an information-oriented perspective, i.e.focusing on how information is transferred andhow it directly causes changes in the counselees’lives. The impact can also be understood from acounselee-oriented perspective. The DNA-testresult disclosure seems to involve an existential,interpretative process. Counselees do not seem totranslate the genetic-information one-to-one totheir lives, but they seem to embed the informationflexibly in their lives, within their existential andfamilial context. CLINICAL IMPLICATIONS:Genetic counselling needs to account for thecounselees’ subjective interpretation and existentialneeds regarding genetic-testing. Acceptance of anunfulfilled need for genetic certainty may beincreased by helping counselees to acknowledgeboth the uncertainties and the certainties in theirlife, e.g. by acknowledging that they need certaintyand that they may not actually experience certaintyat the same time. ACKNOWLEDGEMENT OFFUNDING: Dutch Cancer Society.

P1-23

Discussing Prognosis and End-of-Life Issues with

Patients in the Final Year of Advanced Cancer: A

New Question Prompt List and a Model of Patient

Identified Optimising Factors

Adam Walczak1, Phyllis Butow1, Patricia David-son2, Benjamin Mazer3, Frances Bellemore1,Martin Tattersall1, Josephine Clayton1, JaneYoung1, Ronald Epstein31Centre for Medical Psychology and Evidence-basedDecision-making (CeMPED), The University ofSydney, Sydney, NSW, Australia, 2Cardiovascularand Chronic Care Centre, Curtin University ofTechnology, Sydney, NSW, Australia, 3Departmentof Family Medicine, University of Rochester Med-ical Centre, Rochester, NY, USA

BACKGROUND: Communication about prog-nosis and end-of-life care (EoL) issues is oftenimperfectly executed, subsequently influencingquality-of-life at end-of-life. Question prompt lists(QPLs) can assist in overcoming communicationbarriers, yet no QPL exists for patients withadvanced cancer outside the palliative care setting.Further, few studies have explored patients’perspectives regarding optimising communicationabout prognosis and EoL issues and little cross-cultural data describes development or responses tosuch communication aids or patients’ perspectivesabout such communication. METHOD: An expertpanel developed a QPL targeting prognosis andEoL issues and adapted it for use in the USA.Semi-structured qualitative interviews and 1 focusgroup elicited feedback about the QPL andoptimising discussions of prognosis and EoLissues. Participants were from Australia and theUSA and were; a) patients with advanced cancerand a life expectancy, judged by their oncologist, ofless than 12 months or b) oncology and palliativecare physicians and nurses working with suchpatients. Data were transcribed verbatim andanalysed using thematic text analysis with aninductive, data-driven approach, with codingmanaged using NVivo7. RESULTS: Thirty-fourpatients (15 Australian/19 US) and 13 healthprofessionals (7 Australian/6 US) participated.Most endorsed all QPL questions. Analysis identi-fied 4 global themes: positive content and utilityaspects, caution/ambivalence about usage andpotential problems, with the latter two rarelymentioned. Distinct Australian and US final QPLversions emerged. A model of patient identifiedcommunication-optimising factors and benefitsemerged. Cross-cultural differences were apparent.Global themes included readiness for and out-comes of these discussions. Sub-themes includedpatients’ adjustment/acceptance of their condition(with seven promoting factors), doctor/patientcommunication skills, mutual understandings,therapeutic relationship elements, achieving con-trol and ability to move on. CONCLUSIONS:Patients with advanced cancer and health profes-sionals treating such patients found the QPLacceptable and useful. Participants overwhelminglyarticulated positive aspects of the content andutility of the QPL, though some ambivalence,caution and potential problems were also identi-fied. Communication-optimising factors identifiedby patients illustrate how prognosis and EoL issuesmay be discussed with minimised negative impact.Differences emerged between Australian and USparticipants in their approach to these discussionsand to the QPL, despite assumed cultural simila-rities. These cross-cultural differences and theunderlying reasons deserve further investigation.RESEARCH IMPLICATIONS: This study hashighlighted the need to further explore how



DOI: 10.1002/pon

cultural and health system factors impact onattitudes towards discussion of prognosis andEoL issues. It has also underscored the appropri-ateness of tailoring interventions, such asQPLs, to individual populations. CLINICALIMPLICATIONS: This study has provided a newQPL for patients with advanced cancer, a groupnot previously catered for in this way outside of thepalliative care setting. It has also demonstrated thefactors that such patients identify as important inoptimising discussions of prognosis and end-of-lifeissues. Together, the QPL and optimising factorsmay assist oncologists and patients to discussprognosis and EoL care issues with maximumpositive impact. ACKNOWLEDGEMENT OFFUNDING: This research is funded by theNational Health and Medical Research Councilof Australia.

P1-24

Discussing Life Expectancy and End-of-Life Care:

Preliminary Results from a RCT/Pre-Post Trial of a

Communication Training and Support Intervention

for Patients, Carers and Oncologists

Adam Walczak1, Phyllis Butow1, MartinTattersall1, Josephine Clayton1, Patricia Davidson2,Jane Young1, Ronald Epstein31Centre for Medical Psychology and Evidence-basedDecision-making, The University of Sydney, Sydney,NSW, Australia, 2Cardiovascular and Chronic CareCentre, Curtin University of Technology, Sydney,NSW, Australia, 3Department of Family Medicine,University of Rochester Medical Centre, Rochester,NY, USA

BACKGROUND: Communication skills training(CST), question prompt lists (QPLs) and nurse-ledcommunication support have demonstrated somesuccess, however the combined effect of theseinterventions has not been evaluated. This ongoingstudy will evaluate a multi-focal communicationtraining/support intervention targeting life expec-tancy and end-of-life (EoL) care discussions. Theintervention provides communication support topatients and carers through a targeted nurse-ledcomponent and QPL, and one-on-one CST foroncologists utilising academic detailing and simu-lated patient training. METHOD: Participatingoncologists complete baseline assessments andrecruit 14 patient/carer dyads prior to receivingCST. Fourteen additional dyads are then recruitedand oncologists complete follow-up assessments.Patient/carer dyads complete baseline assessmentsand are randomised to receive standard care orcommunication support in addition to standardcare. One oncology consultation is audio-tapedand primary follow-up assessments are completedone month later. Further follow-up assessments arecompleted every 3 months until the patient’s death.

Carers and medical records are consulted 2 monthsafter the patient’s death to elicit details of EoLmedical interventions and quality-of-death.Primary endpoints include patient/carer/oncologistcommunication and patients’ quality-of-life.RESULTS: Eighteen oncologists and 40 of therequired 504 patient/carer dyads have beenrecruited from 5 hospitals in Sydney, Australia.The combined RCT/Pre-Post design will allowevaluation of the nurse-led communication supportfor patients and carers and the CST for oncologistsas individual components and as a combinedintervention. Quantitative and qualitative analyseswill demonstrate the intervention’s impact onoutcomes including communication self-efficacy,shared understanding of EoL treatment prefer-ences, quality-of-life, unmet needs, EoL health careutilisation and comfort with discussing life expec-tancy and EoL issues. Qualitative data on theimpact of the intervention and preliminary out-come data will be presented. CONCLUSIONS:The training/support intervention may improvecommunication between patients, carers and on-cologists about life expectancy and EoL issues. Itmay also positively impact on patients’ EoLquality-of-life, unmet needs and EoL health careutilisation. The nurse-led communication supportcomponent requires approximately 90 minutescontact with patients and carers. The potential totrain existing clinic staff to deliver this componentand the brevity of contact may facilitate integrationinto standard care. Additionally, the brief CST foroncologists, delivered in their consulting roomsover approximately 2 hours, may be more acces-sible and acceptable to time-poor clinicians thanmulti-day retreat style training programs.RESEARCH IMPLICATIONS: Communicationfocussed interventions have traditionally targetedpatients or clinicians individually. If the combinedintervention, including patient and carer directedcommunication support and oncologist directedbrief CST, demonstrates additional benefits overand above the individual components, it mayprovide new direction for interventions targetingmultiple members of the therapeutic relationship.Promisingly high levels of patient/carer satisfactionwith and engagement in the communication sup-port/QPL component seen to date point to thepotential of combined interventions. CLINICALIMPLICATIONS: This intervention has thepotential to improve communication about lifeexpectancy and EoL issues in the advanced cancercontext. The intervention’s brevity and the poten-tial for delivery of the patient/carer componentby existing nursing personnel may facilitateimplementation in clinical settings. Patients’understanding of their life expectancy and theirability to plan and communicate their wishes forEoL care may also be enhanced, potentiallyimproving their EoL quality-of-life and reducing



DOI: 10.1002/pon

aggressive EoL medical interventions.ACKNOWLEDGEMENT OF FUNDING: Thisresearch is funded by the National Health andMedical Research Council of Australia.

P1-25

Quality of Life Determinants for the Caregiving

Family Members of Cancer Patients

Azize Atli Ozbas, Gulsen TerakyeOncology Nursing Society, Ankara, Turkey

BACKGROUND: The aim of the study was todetermine the quality of life in the caregiver familymembers of cancer patients. Eliciting the dimen-sion of life quality in which the problems havearise, would serve as guideline for planninginitiatives. METHOD: The present study has beenconducted with 51 patient relatives in a universityand a state hospital in Ankara. The data collectionwas performed by using Life Quality Index (LQI)and Information form. RESULTS: Mean LQIscore of the group was 5.3. The sub-dimensions ofthe LQI scores were as follows: physical health 4.2;psychological health 5.3; social health 4.5; spiritualhealth 5.6. CONCLUSIONS: It has been shownthat the life quality of caregiving family membersof cancer patients was not well. Furthermore, theirsocial and physical life qualities are found to beworse than emotional and spiritual dimensions.ACKNOWLEDGEMENT OF FUNDING: In thescope of these findings, life quality improvementoriented plannings particularly in physical andsocial dimensions is suggested for the caregiverfamily members of cancer patients.

P1-26

A Study of the Relational Resources and Stress

Factors Linked to the Diagnosis of Cancer

Cristina Civilotti1, Francesca Del Gaudio2,3,Martina Cussino1, Valentina Furno2, Fabio Veglia11University of Turin, Department of Psychology,Turin, Italy, 2MSKCC, New York, USA, 3ColumbiaUniversity, New York, USA, 4Edo Tempia Founda-tion, Biella, Italy

BACKGROUND: The subjective experience ofcancer partly depends on the interpersonal contextof the individual and the relationship with apartner [1]. Partner support helps predict thepatient’s adjustment to the diagnosis [2]. Positiverelationships are often associated with higherquality of life [3]. Additionally, cancer patientsoften view their partners as the most importantsupport [4]. Therefore, there is a need forhealthcare workers to provide adequate psycholo-gical support to couples facing cancer [5].METHOD: Participants were recruited throughthe Edo Tempia Foundation of Biella, Italy and

LILT – Lega Italiana per la Lotta contro i Tumori,Turin, Italy. Thirty patients were screened, andwhen present, partners of at least 6-month relation-ships were included. Fifty-four participants (meanage5 56.2; SD5 5,95) were assessed through:BDI-II [6] to assess depression, STAI [7] to assessanxiety, DAS [8] to assess relationship type, ECR[9] to assess the avoidant attachment style, ScReTS[10] to assess the therapeutic relationship, and AAI[11] to assess the attachment style, which was alsocoded through the RF scale [12]. RESULTS: AAIcoding suggests that cancer patients generallypresent an unresolved state of mind that differsfrom the level found in literature for non-clinicalpatients. While partners show a greater inclinationto irresoluteness, their scores do not vary signifi-cantly from the average. ECR reveals that thecouples screened have higher avoidant attachmentstyles (avoidant scores 4 14% compared to thenormative sample in literature, po0,05). The DASindicate lower scores on the Consensus Scale(Mean5 52,05; po0,05) and on the SatisfactionScale (Mean5 33,94; po0,001). The irresolutenessof attachment and lower RF scores are linkedto greater levels of dysfunction in the couple.CONCLUSIONS: This study examined the rela-tionship and intimacy of couples facing cancer. Inparticular, it focused on aspects previously noted inliterature as important to both the individual andthe dyadic system quality of life. The level ofdepression and anxiety in patients and theirpartners affect their romance, sexuality, and overallquality of life. Also, the dyadic system attachmentstyle impacts the quality of the relationship. Thisstudy demonstrated how the ability to mentalizewas necessary for the couple to understand andsupport each other. Moreover, this study showedwhich aspects of the therapeutic relationshipfacilitate compliance in the patient. RESEARCHIMPLICATIONS: Taking care of a partner withcancer can be challenging on many levels. Howcaregivers approach this challenge may be influ-enced both by their Interpersonal MotivationalSystems [13] – especially caregiving-attachmentsystem – and by their personal orientation to therelationship. This study examined the prediction ofcaregiver well-being based on the relationshipqualities specified by the attachment theory. Italso tried to highlight possible links betweenthe caregiver role and depression and anxiety.CLINICAL IMPLICATIONS: There is extensiverecognition that caregiving partners play key supportroles for cancer patients. Literature suggests thatroughly $18–35% of family members experiencepsychiatric morbidity [14]. Although caring for aloved one provides the potential for a deepened senseof meaning, connection and accompanying positiveaffect [15], caregiving partners are also vulnerableto depression, grief, fatigue, physical healthproblems and changes in social relationships.



DOI: 10.1002/pon

ACKNOWLEDGEMENT OF FUNDING: Studyfunded by the Compagnia di San Paolo and theUniversity of Turin Psychology Doctoral Program.

P1-27

Family Intervention for Cancer Recurrence: A

Multicentric Pilot Study

Denis Walravens1,2, Marie Caillier3, DelphineStaquet3, Nicolas Beauloye4, Cindy Dumoulin5,Mina Milani6, Christine Dumont7, MireilleAimont8, Justine Vignola9, Anne Chevalier9, CathyVan Heer9, Nicole Delvaux2,1, Darius Razavi1,101Free University of Brussels, Brussels, Belgium,2Hopital Universitaire Erasme, Brussels, Belgium,3C.P.O. (Training and Research Group), Brussels,Belgium, 4C.H.U. Brugman, Brussels, Belgium,5C.H.U. Ambroise-Pare, Brussels, Belgium, 6CentreHospitalier Wallonie Picarde, Tournai, Belgium,7Reseau Hospitalier de Medecine Sociale, Baudour,Belgium, 8C.H.U. Saint-Pierre, Brussels, Belgium,9C.H.U. Etterbeek-Ixelles - C.H.U. Moliere-Long-champs, Brussels, Belgium, 10Institut Jules Bordet,Brussels, Belgium

BACKGROUND: Cancer recurrence emotionallyaffects the entire family. Previous studies showedthat emotionally burdened family members ham-pered patient’s adjustment to cancer. Familycaregivers (F.C) of cancer patient reported receiv-ing little support from specialists. A multicentricpsychological intervention led in 10 BelgianFrench-speaking hospitals proposed to F.C. ofpatient facing with the recurrence of cancer (exceptend-of-life context) a crisis psychological support.It consisted of 4 face-to-face sessions speciallyfocused on difficulties met by F.C. METHOD: Acase report, based on the 40 categories ofdifficulties outcomes of the ‘‘Cancer RehabilitationEvaluation System’’ (C.A.R.E.S.) was elaboratedand standardized by participating psychologists.After the first and the fourth session, each difficultyexpressed by the F.C. was written down by thepsychologist in the report. Sociodemographicinformations were collected. Files were analyzedby two independent researchers and classified intothree categories: ‘‘F.C. with cancer specific con-cerns’’ (difficulties mainly related to the patient’smedical situation), ‘‘F.C. with cancer and otherconcerns’’ (accumulation of difficulties related tomedical situation and from personal difficulties)and ‘‘unclassifiable’’. An exploratory analysis wasperformed. RESULTS: 68 F.C. were included (32with cancer specific concerns (C.S.C.), 33 withcancer and other concerns (C.O.C.) and 3 unclas-sified). Qualitative analysis of files and difficultiesexpressed by the caregivers indicates that theybenefit differently from the multicentric psycholo-gical intervention. The 4 sessions frame helps F.C.with C.S.C. to manage their cancer’s related

difficulties but does not seem sufficient for F.C.with C.O.C. because of their personal and non-cancer difficulties. Furthermore F.C. with C.O.C.interrupt less frequently the intervention (1 vs. 10)and wish more frequently pursue it beyond the 4sessions (27 vs. 18). CONCLUSIONS: The 4 face-to-face sessions proposed help F.C. to cope withthe disease when they present cancer specificconcerns. On the other hand, the current interven-tions don’t seem sufficient for F.C. presenting anaccumulation of difficulties (personal difficultiescomplicating difficulties related to the medicalsituation). Consequently, diverse patterns of F.C.suggest varied burden experienced and thus, a needof targeted interventions. Screening all familycaregivers may enable psychologists to offer a crisispsychological support to those who need it andalso to detect earlier F.C. at risk who should bereoriented toward specific psychological interven-tions. RESEARCH IMPLICATIONS: The offer ofan optimal psychological support for F.C. stillremains currently weak. This program presents afirst step in an attempt to understand F.C.psychological adjustments and to propose them astandardized intervention. This exploratory studyshows that there is a need to detect F.C. whopresent cancer and other concerns so thatintervention can be targeted to them. Futuredevelopments should include self-assessmentand post-intervention follow-up in order todeliver research-tested interventions. CLINICALIMPLICATIONS: The multicentric program out-lines the specificity of psychological support forF.C. experiencing cancer recurrence of a close andvarious profiles of F.C. with different psychologicalneeds. Therefore, we recommend a 3-steps inter-vention including, at the first level, systematicscreening of the psychological distress and psycho-education. This first step should be completed by apsychological support strengthened by a specificpsychological intervention according to the level ofdistress and the psychological vulnerability of theF.C. ACKNOWLEDGEMENT OF FUNDING:We acknowledge the valuable assistance wereceived from the Belgian Cell Members of PlanNational Cancer and from the cancer networkcolleagues of the Free University of Brussels.

P1-28

Psychosocials Factors Associated with Patient’s

Communication Difficulties

Denis Walravens 1,2, Nicole Delvaux2,1, IsabelleMerckaert1,3, Yves Libert3, Darius Razavi1,31Free University of Brussels, Brussels, Belgium,2Hopital Universitaire Erasme, Brussels, Belgium,3Institut Jules Bordet, Brussels, Belgium

BACKGROUND: The marital relation constitutesthe main source of support for cancer patient



DOI: 10.1002/pon

confronted with diagnosis or treatments. Couple’scommunication is considered as a mean by whichthe spouses share information and feelings, offerthem mutually support, what allows then a betteradjustment to the disease. This study aims todetermine a profile of patients presenting difficul-ties to communicate with their partner about thedisease. It investigates oncological, psychologicaland social factors associated with those difficulties.METHOD: This study is part of a multicenter,cross-sectional study investigating cancer-relatedpsycho-social problems encountered by patientsand their partner. Patient and partners were invitedto complete the Hospital Anxiety and DepressionScale (HADS), the Ways of Coping Checklist(WCC) and the Cancer Rehabilitation EvaluationSystem (CARES). Sociodemographics informa-tions were also collected. A category ) difficultiesof communication ‘ was elaborated based on thepatient’s or partner’s answers to the items of theCARES investigating this question. Correlationsbetween patient’s difficulties of communicate aboutthe disease and various patient’s or spouse’svariables were calculated. RESULTS: The 144couples report an average-score from ‘‘not’’ to‘‘few’’ difficulties to communicate. Patients’ diffi-culties are associated with patient’s variables:depression (r5 0.17; P5 0.04) physical difficulties(r5 0.17; P5 0.05), pain (r5 0.19, P5 0.02),psychosocial difficulties including communicationwith relatives (r5 0.37, Po0.01), sexual difficulties(r5 0.41, Po0.01); and with partner’s variables:medical interaction difficulties (r5 0.17, P5 0.04),emotion-focused coping (r5 0.17, P5 0.04), sexualdifficulties (r5 0.23, P5 0.01) and psychosocialdifficulties (r5 0.24, Po0.01). CONCLUSIONS:Results suggest that patients who report difficultiescommunicating about the disease with their partnerare also the ones who have difficulties facingphysicals repercussions of their disease. Thosedifficulties to communicate are associated withmarital difficulties and take place in a generalcontext of difficulties to interact or communicateabout the disease with closes relatives (family,children or friends). Furthermore, patient’s diffi-culties to communicate with partner could be seenas a symptom of couple’s misadjustment to thedisease with patient presenting depression symp-toms and partner using less effective coping style.RESEARCH IMPLICATIONS: Results of thisstudy are a first step to determine a profile ofpatients presenting difficulties to communicatewith their partner about the disease and underlinethe links between communication difficultiesand adjustment to the disease. Further researchshould investigate the supportive nature ofmarital exchanges about the disease by focusingon content of communication between couples andfactors which facilitate or block it. CLINICALIMPLICATIONS: Results of this study are

congruent with the literature suggesting the ex-istence of links between the communication withinthe couple and the marital adjustment to thedisease. This study emphasizes the need to supportmarital communication about the disease and toconsider the difficulty of a patient to interact abouthis cancer as a sign of risk to present depressivesymptoms and misadjustment to the disease.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was supported by the ‘‘SPF Sante Publique’’of Belgium (Appel d’offre-2002-16).We acknowl-edge the valuable assistance we received from theBelgian Cell Members of Plan National Cancer.

P1-29

Quality of Life and Psychologic Status in Primary

Caregivers of Cancer Patients

Sibel Eyigor, Hale Karapolat, Onur Korkmaz,Ruchan Uslu, Berrin DurmazEge University Faculty of Medicine, Izmir, Turkey

BACKGROUND: Limited research has been doneon phychologic status and quality of life ofcaregivers to hospitalized patients with cancer. Thisstudy examines anxiety, depression and quality oflife in primary caregivers of hospitalized patientswith cancer. METHOD: Ninety-three hospitalizedcancer patients and their 93 primary caregivers wereincluded in this study. Patient and caregiver queryform has been used to obtain demographical data.History of the disease has been extracted from thepatient records. Quality of life was rated with theShort Form 36 (SF36) and mental health with theHospital Anxiety and Depression Scale (HADS) forcaregivers. RESULTS: The mean age of the patientswas 50,28714,88 in years and the caregivers was43,80713,60 in years. SF36 subscores and HADSscores were affected in caregivers. Significant nega-tive correlations were found between post diagnosisperiod and SF36 subscore of physical role, vitality,mental health, general health, emotional role, socialrole and positive corelations were found betweenpost diagnosis period and HADS scores (p40.05).CONCLUSIONS: Finding from this study supportthat the current program for treating cancer patientsshould also include close monitoring of caregiver’psychological health and quality of life.ACKNOWLEDGEMENT OF FUNDING: None.

P1-30

Exploring Information and Support for Relatives of

Cancer Patients

Claire Foster1, Isobel Scott1, Lucy Brindle1, PhilCotterell1, Mary Sayers2, Judith Robinson2, SheilaPayne3, Jane Hopkinson1, Julia Addington-Hall11University of Southampton, Southampton, UK,2Research Partner, Southampton, UK, 3Universityof Lancaster, Lancaster, UK



DOI: 10.1002/pon

BACKGROUND: Provision of information forpatients and relatives has been highlighted as anarea for improvement . This study exploresrelatives’ experiences of talking about cancer with-in the family and identifies relatives’ informationand support needs in relation to their relative’scancer. METHOD: 22 relatives recruited from thelocal community participated in in-depth qualita-tive interviews. Interviews were analysed using athematic approach. RESULTS: Most felt theylearnt about their relatives’ cancer and how tolook after them as they went along. Detailedinformation about cancer was not wanted at alltimes. Some felt unable to cope with emotionalissues. Some communication about cancer allowedrelatives to support patients’ preferences for care,deal with practical demands, and come to termswith difficult issues. Where information was lack-ing relatives/partners felt unable to offer best careto the patient. Provision of clear information,opportunities to talk with professionals/others in asimilar situation were identified as important.Information was lacking for rarer cancersand the internet was accessed for information.CONCLUSIONS: Relatives indicated that a lackof information made them feel unable to offer bestcare and support to the patient. They also indicatedthat they felt isolated and did not feel entitled toinformation and support as the patient was thepriority. Rather than being left to find things outfor themselves they would have liked guidance.Supporting families is likely to enhance the supportavailable to people living with and beyond cancer.ACKNOWLEDGEMENT OF FUNDING: Mac-millan Cancer Support User Led Grant.

P1-31

The Impact of Gynecologic Cancer on the Family

Relationships: A Case Report

Hulya Guveli1, Cicek Hocaoglu21Rize Training and Research Hospital, PsychiatryClinic, Rize, Turkey, 2Department of Psychiatry,Faculty of Medicine, Rize University, Rize, Turkey

BACKGROUND: The family, not just the patient,experiences the crisis and impact of cancer. Thecomplex feelings and lifestyle changes that follow acancer diagnosis can be almost as overwhelmingfor family members as they are for the person withcancer. When cancer is diagnosed, family membersmay have feelings of sadness, anxiety, anger, andhopelessness. METHOD: Treatment of advancedcancer involves a combination of surgery andchemotherapy, both of which may impact apatient’s physical, social, and emotional well-being.Gynecologic cancer is the fourth most prevalentcancer type in women worldwide. Being presentedwith a diagnosis of a gynecologic cancer is atraumatic event for women and family. The disease

and its associated treatment commonly pose athreat not only to the life of such patients but alsoto their sexual health. RESULTS: In our studywith a diagnosis of gynecologic cancer treated withchemotherapy and radiotherapy for 2 years andoperated with the diagnosis of e endometrial ca,56-year-old female patient is presented in the lightof the literature examining in the framework of thehistory of disease, family relationship and theBACKGROUND: information. CONCLUSIONS:Future studies, including social relations as adeterminant, should ensure a broad and multi-functional view of social support and acknowledgethe family relationship on the perspective of support.RESEARCH IMPLICATIONS:

1. Lee J, Bell K. The Impact of Cancer on FamilyRelationships Among Chinese Patients. JTranscult Nurs. 2011 May.

2. Singh A, Freeman M. The important role fornurses in supporting the Asian Hindu patientand family at end of life: providing culturallysensitive end-of-life care. Can Oncol Nurs J.2011 Winter;21(1):46-9.

3. Francis LE, et al. Relationships and emotionalwellbeing among African American and Whiteadvanced cancer caregivers. Patient EducCouns. 2011 Mar 23.

ACKNOWLEDGEMENT OF FUNDING: None.

P1-32

Cancer and Family: Evaluation of Parental Attitudes

and Characteristcis of Children with Lymphoma and

Leukemia Diagnosis

Serpil Erermis1, Mustafa Kucukkose1, ZekiYuncu1, Burcu Ozbaran1, Nazan Cetingul2,Mehmet Kantar2, Tezan Bildik1, Serap Aksoylar2,Sezen Kose1, Cahide Aydin11Child and Adolescent Psychiatry Department,Consultation-Liaison Unit, Ege University Schoolof Medicine, Bornova/Izmir, Turkey, 2PediatryDepartment, Pediatric Oncology Clinic, EgeUniversity School of Medicine, Bornova/Izmir, Turkey

BACKGROUND: Cancer effects not only thepatient, but also the family system. The parentshave the feelings of hopelessness, fears and anxietyabout the child’s illness and recurrence of theillness. Studies suggest 1/3 of parents of childrenwith cancer diagnosis meet the posttraumatic stressdisorder (PTSD) diagnosis. Childhood cancers leadmany problems in family functions. We aimed toevaluate the psychiatric status and attitudes ofparents of children who are in remission period ofcancer. METHOD: This study was held betweenNovember 2009 and March 2010. The study groupincludes 53 parents of patients’ who were treatedwith lymphoma and leukemia diagnosis in Ege



DOI: 10.1002/pon

University Medical Faculty Pediatric OncologyClinic and are in remission period since 2 years.50 parents of healthy children included to thecontrol group. SCID-NP was used for evaluatingthe psychiatric status of the parents and for familyfunctionality parental attitudes scale was giving.RESULTS: Between fathers of children withchildhood cancer history and control group fathersthere wasn’t any difference on depression andanxiety disorders, but mothers in study group getmore depression and PTSD (15% of mothers getPTSD diagnosis) diagnosis. It was founded thatmothers get more anxiety disorder diagnosis andhave 7.12 times more risk for having psychiatricdisorders. There wasn’t any difference onfamily functions between study and controlgroups. Parents with psychiatric problems hadhigher scores on generally family functionalitythan parents without psychiatric problems.CONCLUSIONS: Studies in literature suggest thatmothers who have an active role in diagnosis andtreatment periods of their children with cancerhave more psychiatric problems and these resultsare consistent with our study results. In these groupof children and parents there are reports thatsuggest the presence of disruption in familyfunctions and also there are opposite results.Our results are similar with the latter results.CLINICAL IMPLICATIONS: The mothers ofthese children got more depression and anxietydisorders diagnosis. Because of the mothers psy-chological well-being is important for children andthey are the primary care-giver, this issue and alsotheir treatment and support is definitely important.ACKNOWLEDGEMENT OF FUNDING:None.

P1-33

Quality of Life of Partners (Closest People) of

Oncology Patients

Veronika Koutna, Marie NosalkovaPalacky University Olomouc, Olomouc, CzechRepublic

BACKGROUND: Although the quality of life isworldwide frequently discussed theme in the fieldof psychooncology at the time, a little is knownabout the impact of cancer and the process of itstreatment to the closest people of the oncologypatients, who provide them social support.METHOD: To analyze the quality of life we usedquantitative questionnaire methods SQUALA andLife Satisfaction Questionnaire (LSQ) becausetheir entries are relevant to the surveyed themeand they are accessible in Czech language. We alsoemphasized low degree of the burden they repre-sent for the people battling with a stressful event intheir lives. The combination of these methodsallowed as considering particular dimensions of the

quality of life in the context of their subjectiveimportance to the respondents. RESULTS: Weperformed statistical analysis (Student’s T-test, chi-square test) of our measurements. The differencebetween the quality of life and the life satisfactionof the partners (the closest people) of the oncologypatients and the respondents, who actually do notbattle with a similarly stressful event in their lives,was not statistically significant (SQUALA: t5 0,21ot0,05 5 2,026; LSQ: t5 0,68 ot0,05 5 2,03).Women provided social support to the oncologypatients statistically significant more often thanmen [C2 5 174C2

0,01(1)5 6,63]. CONCLUSIONS:We did not found statistically significant differencebetween the quality of life and life satisfaction ofthe partners (the closest people) of the oncologypatients and the respondents, who actually do notbattle with a similarly stressful event in their lives.Since the current foreign researches are concernedonly with spousal relationship between the partners ofpatients, we do not have any relevant data to compareour results with. RESEARCH IMPLICATIONS:Actual researches of the quality of life of partners ofoncology patients includes to the surveyed sampleonly wives/husbands of the patients. Our study showsthis type of the relationship is relevant only for lessthan half of respondents. More than one third ofrespondents found relevant the relationship ‘‘parent-child’’. Further research is needed to analyze how thequality of the relationship influences overall quality oflife. CLINICAL IMPLICATIONS: The results ofour study imply the importance of analyzing socialsupport of the patient and understanding for thepatient the most relevant relationship in the socialsupport network to provide appropriate psychoono-cology care to both, patient and partner. Thefact that women provided the social supportmore often than men in connection with generalconcept of coping strategies used by women mayimply the kind of support patients are seekingfor. ACKNOWLEDGEMENT OF FUNDING:None.

P1-34

An Online Relationship Focused Intervention for

Young Couples Affected by Breast Cancer: Findings

of a Feasibility Study

Karen Fergus1,2, Deborah McLeod3,4, WendyCarter5, Sandra Gardner6, Ellen Warner7, LeeatGranek8, Kimberly Cullen11York University, Toronto, ON, Canada,2Sunnybrook Odette Cancer Centre, Toronto, ON,Canada, 3QEII Health Sciences Centre, Halifax,NS, Canada, 4Dalhousie University, Halifax, NS,Canada, 5Women’s College Hospital, Toronto, ON,Canada, 6Ontario HIV Treatment Network,Toronto, ON, Canada, 7Sunnybrook HealthSciences Centre, Toronto, ON, Canada, 8McMasterUniversity, Hamilton, ON, Canada



DOI: 10.1002/pon

BACKGROUND: The purpose of this presenta-tion is to describe the outcomes of a feasibilitystudy of an innovative online intervention foryoung couples facing breast cancer. Couplelinks.cais a custom-designed 6-session online programthat is professionally facilitated and includesinformational, experiential and interactive compo-nents. The intervention aims to educate couplesabout the challenges of breast cancer at a youngage and strategies to manage these, normalizeexperiences and strengthen the relationshipbond and dyadic coping. METHOD: Fifteencouples were enrolled in the program in order totest its feasibility and benefit. The programconsists of six experiential learning modules,informed by dyadic coping theory. Each moduleis designed to be completed over a 1-week period,with individual and dyadic components. Coupleshave access to a professional facilitator whoprovides support and weekly feedback. Allparticipants provided qualitative and quantitativefeedback for each module as well as the overallintervention. RESULTS: Couples identified arange of benefits to the overall intervention, withmean and modal rating of 4 or greater on a5-point scale for general satisfaction, facilitatorhelpfulness and program usability. Benefitsincluded: providing a useful discussion and com-munication tool which helped couples addressimportant issues/topics/feelings that are not gen-erally discussed, fostering emotional expression,and decreasing isolation. Analysis of the data fromthose couples who dropped out (n5 4) suggeststhat couples with higher levels of relational distressor with differential levels of motivation are lesslikely to complete the program. CONCLUSIONS:Our analysis suggests that Couplelinks is both afeasible and acceptable form of psychoeducationalintervention for young couples affected by breastcancer. The majority found the program to bebeneficial but findings suggest a number of direc-tions for improvement. These have been incorpo-rated into a randomized controlled trial of theintervention. Challenges with regard to participantretention and engagement will be discussed.ACKNOWLEDGEMENT OF FUNDING:Canadian Breast Cancer Foundation, OntarioDivision.

P1-35

Psychological Reactions of Parents to the Diagnosis

of Cancer in their Child

Ignacio Mora-Magana1, Luis Alberto Zentella-Hernandez2, Ana Laura Canseco-Torrano2, JoseMendez-Venegas1,31Instituto Nacional del Pediatrıa, Mexico City,Mexico, 2Universidad del Valle de Mexico, Villa-hermosa/Tabasco, Mexico, 3Universidad NacionalAutonoma de Mexico, Mexico City, Mexico

BACKGROUND: Family dynamics are affectedwhen a child has leukemia, parents are oftensuffering, helplessness, showing escape reactionsand anxiety. Self-confidence is diminished becausethe caretakers have to leave their home and soonfind themselves in an unfamiliar place without thesupport of your family or friends, economic costs,the uncertainty of the disease process. Guilt is avery common feeling for parents. METHOD: Acase, mother of a Mental Health Service Commu-nity Hospital Tacotalpa. Interviewing the motherand seeking attention from conflicts in the filialrelationship, due to ongoing discussions. Seenproblems caused by the diagnosis of cancer at hisdaughter for 10 years. We used structured inter-views to understand and observe the emotionalreactions that involve the mother before the cancerdiagnosis of her daughter. RESULTS: Parentsexperienced the news as a negative experience,paralyzing, catastrophic, but subsequently adaptedto the experience, accepting it and thus taking moreoptimistic thoughts and attitudes. In the case studynotes that the relationship and family, wasconsolidated, keeping members together in asupportive relationship, mutual respect andresponsibility, including the roles tend to be fairand flexible. CONCLUSIONS: The most commonemotions parents when they are diagnosed withcancer in your child are: sadness, anger, despair,guilt.The meaning that parents give the diagnosis,initially often of loss, abandonment, much angerand continually questions related to the child’sdeath. Family dynamics showed changes thatstrengthened and become more mature. The prog-nosis is favorable as they have found strongsupport networks to hold the fa. RESEARCHIMPLICATIONS: Parents of a child with cancercan react in a negative way that leads them todestroy their home with a loss of support for thepatient in addition to the guilt over the incident. Inthis case, social networks and financial support,coupled with psychological support gave toparents helped strengthen the family. CLINICALIMPLICATIONS: We need to have on handfinancial media and social networks that supportparents of children with cancer, such as self-helpgroups and private/public institutions of assistance.ACKNOWLEDGEMENT OF FUNDING:None.

P1-37

Family Support and Depression in Patients of

Colorectal Cancer

Shehroo Pudumjee, Bala Shanthi NikkethaChrist University, Bangalore, India

BACKGROUND: Especially in the cases of cancerpatients, family support has been found to beexceptionally influential. This paper aims to assess



DOI: 10.1002/pon

the impact of family support on depression inpatients of colorectal cancer due to the myriad ofpsychosocial issues faced by these patients that isspecific to this type of cancer. METHOD: Toquantify the relationship between family supportand depressive symptoms, a sample of 48 indivi-duals suffering from colorectal cancer was asked torespond to a semi structured interview to obtain abetter understanding of their individual circum-stances and then respond to the Beck’s DepressionInventory - II and the Perceived Social Supportfrom Family Questionnaire (1983) after which acorrelational analysis and content analysiswere performed to further solidify the results.RESULTS: The correlational analysis yielded astrong inverse correlation of r5�0.646. In addi-tion, the prevalence of depression in the sample ofcolorectal cancer patients was far higher thanthat seen in the general population at 45.83%.CONCLUSIONS: By quantifying the significanceof family support in the context of depressionfor patients of colorectal cancer it gives practi-tioners a concrete basis to lay appropriateemphasis on the role of family support whendealing with patients and families alike.RESEARCH IMPLICATIONS: The findings haveimplications for training of professionals and thefurther broadening of therapeutic provisions andresearch in the field of psycho - oncology Beingspecific to colorectal cancer it helps to contribute toan area where psycho social research is required.CLINICAL IMPLICATIONS: This studyprovides grounding for therapeutic interventionsdealing with challenges at the patient and familiallevel. It provides basis for individual, group andfamily based psychotherapy aimed at preventionand reduction of psychiatric symptoms, supportand coping. Various areas of work havebeen highlighted and need to be further assessedsuch as learning about the diagnosis, psychosocialfunctioning and self esteem issues. The studyfocuses on these challenges idiosyncraticallyand inevitably associated with this cancer.ACKNOWLEDGEMENT OF FUNDING:None.

P1-38

Evaluation of a National Counseling Service for

Families with a Parent with Cancer

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

BACKGROUND: More 1000 Danish familieswith children under the age of 18 will each yearexperience a parent with cancer. The DanishCancer Society has implemented a national coun-seling service offering psychosocial counseling forfamilies experiencing cancer. METHOD: A na-

tional organization for the project was establishedby inviting counselors from 15 cancer counselingcenters in Denmark to join the project. Thecounselors were trained as family counselors anda common framework for family counseling ofcancer families was established. The families wereoffered up to 5 counseling sessions with childrenjoining the sessions. The children were offered ameeting place with planned meetings with acounselor. The evaluation included log books fromcounselors and a family questionnaire. RESULTS:58 families out of 85 families (61%) answered thequestionnaire. 52% had 4 or 5 sessions and 20%had more sessions. 78% of families were satisfiedwith the number of sessions and the rest wantedmore sessions. 35% of responders reported a highdegree and 41% some degree of improved psycho-logical status among children in the family after thecounseling sessions. 53% of responders indicated ahigh degree and 31% some degree of improvedunderstanding of reactions among children. 37%of parents reported a high degree and 46% somedegree of new problem handling related to thechildren. CONCLUSIONS: A nationwide counsel-ling service was established for families with aparent experiencing cancer. Based on evaluationsfrom the parents, the service seems feasible andmost families were satisfied with the brief andfocused concept. More than 70% of respondersreported a high or some degree of positive outcomerelated to understanding and handling familydynamics. The counseling sessions worked well.However family structure, changes in the disease ordeath as well logistic difficulties were challenges.RESEARCH IMPLICATIONS: Currently theresearch in family dynamics and psychosocialissues in families with a cancer patient asparent is very limited. Outcome of interventionsshould be evaluated in randomized trials.CLINICAL IMPLICATIONS: It is well knownthat cancer patients suffer from psychosocialdistress, depression and anxiety. However, canceris a burden for the whole family and psychosocialcounseling of cancer families may relieve some ofthe burden. ACKNOWLEDGEMENT OFFUNDING: Funded by a grant from Danske Spiland the Danish Cancer Society.

P1-39

What exactly is a Good Outcome? African American

Perspectives from a Patient and a Nurse

Nicole Alston, Tamara FisherUnited States, NJ, United States Minor OutlyingIslands

BACKGROUND: Through an experiential lens,the purpose of this abstract is to help improvepatient-physician communication and trust amongAfrican Americans in the areas of treatment



DOI: 10.1002/pon

options, expectations of treatment, symptom man-agement, and survivorship. By increasing culturallyrelevant education for health care professionalsabout African Americans, clinicians and research-ers will be better able to inform, prepare, treat, andsupport patients at the time of diagnosis, throughtreatment and into survivorship. METHOD: Thisabstract is drawn from experiential knowledge.RESULTS: N/A. CONCLUSIONS: N/A.RESEARCH IMPLICATIONS: By better under-standing the African American experience, and thelack of trust of health care and research, research-ers can develop a climate of trust with theirsubjects. Researchers will also understand effectiveways to communicate with African Americanpatients. Kooken, W., Haase, J. E., & Russel,K. M. (2011). ‘‘I’ve been through something’’:Poetic explorations of African American Women’sCancer Survivorship. Western Journal ofNursing Research, 29(7), 896–916. CLINICALIMPLICATIONS: African Americans enteringtreatment are more likely to have more financialand familial pressures than their White counter-parts. Additionally, African Americans oftenexperience more adverse reactions to treatmentthan other groups. That said, for clinicians, thereneeds to be an increase culturally competenteducation of issues germane to African Americans.Most importantly, clinicians need a greater under-standing of themselves in order to understand thewhole experience from the African Americanperspective (2011). ACKNOWLEDGEMENT OFFUNDING: None.

P1-40

Breast Cancer: An International Comparison of

Problem-Related Distress

Karen Clark1, Cristiane Decat Bergerot2, MatthewLoscalzo11City of Hope, Duarte, CA, USA, 2CETTRO,Brasılia, Brazil

BACKGROUND: Breast cancer is the mostfrequent malignant disease among women in theworld. There is a dearth of information aboutcultural differences related to distress in womenwith breast cancer. In the US, diagnosis of breastcancer is made earlier than in Brazil. There areother cultural differences that may provide insightsas clinical care becomes more personalized. Thisstudy investigates the incidence of problem-relateddistress between two Cancer Centers (Brasılia,Brazil and California, US). METHOD: The datawas collected from 2008 to 2010 as a part of clinicalcare and research in two different institutions,CETTRO (Brazil) and City of Hope (California).307 breast cancer patients participated in thisstudy. The samples are comparable in theirdemographics. Both were evaluated, using pro-

blem-checklists in the beginning of treatment. Theproblem-checklists address physical, practical,social, psychological and spiritual problems. TheNCCN Distress Thermometer with a problem-checklist (35 items) translated and validated inPortuguese was administered at CETTRO.A touch screen version of the problem-checklist(27 items) in English was administered at COH.Both datasets obtained IRB approval. RESULTS:A sub-set of the problems (10 items) common toboth measures was analyzed. Problems withFear(66.7%) is the most common problem for theCETTRO sample, withFinances/Insurance(48.6%)being the most common for the COH sample.Problems with Sleep (CETTRO5 56.4%vs.)COH5 42.7% ) is the second most commonfor both populations. There is a significantdifference in the percentage of problems withTransportationbetween the two populations (CET-TRO5 11.5% vs. COH5 30.4%). Problems withPhysical Appearance were much higher for theCETTRO (47.4%) population compared to theCOH (22.8%) population. Additional comparisonsof the items were analyzed and will be presented.CONCLUSIONS: The results suggest that thereare similarities and differences in the types andseverity of problem-related distress in the twopatient populations. These similarities anddifferences may be both related to the treatmentas well as cultural issues. In the PhysicalAppearance problem, for example, if these twoinstitutions reproduce what the scientific evidenceshows (early diagnosis in US); surgery may bemore conservative in US, which may result in alower self-image and justify the difference foundbetween in the two samples. RESEARCHIMPLICATIONS: These results demonstrate theimportance of examining psychosocial variablesthat influence the incidence of distress and en-courage development of new multicenter andmulticultural studies. This study offers theopportunity to compare different cultures and tocreate new research hypotheses. It is essential tostudy why patients from some institutions orcultures suffer more in certain aspects, thanothers. Therefore it is possible to identify whatneeds to be changed to improve the quality of care.CLINICAL IMPLICATIONS: This multicenter,multicultural study demonstrates the importance ofapplying screening as a part of routine clinical careto identify the unique needs of women withbreast cancer. This data can be used toimprove communication among the health careteam and patients around common problemsthat women with breast cancer experience.These findings open up opportunities tocreate tailored psychosocial interventions andtreatment as a way to improve cancer care.ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P1-41

Role of Gender and Age Differences in Perceptions

of Cancer Among Resident Indians

Tanmoy Das Lala1, Christina Wagner1, SilviaBigatti21DePauw University, Greencastle, IN, USA,2Indiana University School of Medicine (Dept ofPublic Health), Indianapolis, IN, USA

BACKGROUND: Knowledge is limited regardingdifferences in causal attributions of cancer acrosscultures, especially in countries with lower literacylevels and significant differences in gender roles likeIndia. The aim of this study was to assess thecausal attribution of cancer among residentIndians and investigate whether causal attributionsdiffer as a function of gender and age. METHOD:The sample included 106 participants; residentIndians by birth in Kolkata, India. Majority wereHindu, middle-class, with at least 12 years offormal education and full-time employment.Female participants (n5 58) were significantlyolder than males (n5 43) with average ages of 35yrs and 29 yrs respectively. Participants provideddemographics and completed the Illness PerceptionQuestionnaire-Revised (IPQ-R), which includedquestions asking participants how strongly theyagreed with 23 possible causes of cancer on a 5-point Likert scale (strongly disagree to stronglyagree). Data was collected from participants atdiverse locations to reduce biases. RESULTS: Thehighest scoring causal attribution was injury to thebreast and germ/virus, while altered immunity andpunishment from god received the lowest levels ofendorsement. A one-way analysis of variance(ANOVA) revealed one significant gender differ-ence in causal cancer attributions with womenbelieving more strongly that a blow to the breastcaused cancer; however, this effect disappearedafter controlling for age. Correlations betweenage and causal attributions revealed significantnegative correlations between age and smoking(r5�.25, p5 0.01) and age and alcohol (r5�.23,p5 0.02) as cancer causes. CONCLUSIONS:Participants endorsed false factors (eg. blow tobreast) as contributive to cancer development asstrongly or more strongly than health behaviorssuch as smoking and diet. This suggests that eventhough they may have received accurate informa-tion from the internet, physicians or other sources,a belief in several inaccurate causes of cancer stillexists. Gender did not significantly affect causalattributions of cancer; however, smoking wasendorsed as a cause of cancer most strongly byyounger Indians. RESEARCH IMPLICATIONS:Future interventional studies could focus on thedevelopment of feasible awareness campaigns orcommunity-based interventions to increase aware-ness of legitimate cancer causes. Another investiga-

tion could examine how causal cancer attributionsrelate to health behaviors and screening practicesamong Indians, as it is uncertain whether theyengage in adequate levels of preventative healthbehaviors while knowledge of cancer causes isinaccurate. CLINICAL IMPLICATIONS: Eventhough cancer prevalence is rising, many AsianIndians are unsure of the causes and prognoses ofthe disease. Healthcare interventionists can helporganize cancer awareness campaigns and dispelsome of the misconceptions people have bytailoring them appropriately for non-Americanpopulations. ACKNOWLEDGEMENT OFFUNDING: DePauw University -Douglas B.White Memorial Award and Financial Support(Winter Term) DePauw University

P1-42

Breast Cancer Screening in Cancer Early Diagnosis

Screening and Education Center

Sevda Gursel1, Elif Akar21Health Authority, Sakarya, Turkey, 2Cancer EarlyDiagnosis, Screening and Education Center,Sakarya, Turkey

BACKGROUND: Breast cancer is the mostcommon form of cancer found in women today.Weaim to increase the awareness regarding theimportance of diagnosing breast cancer early withscreening methods by Cancer Early Diagnosis,Screning and Education Center(KETEM), toraise awareness of the importance of early diag-nosis of breast cancer with primary secondarytertiary prevention methods,to reach solution byorganizing education with primary prevention andby applying required process for treatment ofcontrols of cancer diagnosed cases. METHOD:The community based screning in pilot regions, thetarget population 5–-69 years old women wereidentified and were invited. 4235 women were triedto diagnosed by examining the breast of thepatient, self examination education was given toeach women, took mammography to 3605 women,ultrasonography to 1200 of the cases considerednecessary and taking biopsy. RESULTS: Of 4235individuals, 3605 of them were taken mammogra-phy and found; 20 BIRADS-zero; 167 BIRADS-one; 3031 BIRADS-two; 356 BIRADS-three; 28BIRADS-four; 3 BIRADS-five.157 women hadmass complaint, According to ultrasonographyresults of Mammography report of 28 BIRADS-four, 13 of them as cancer to biopsy result andBIRADS five, 3 of them as breast cancer too. 18mammography results were found as BIRADS-four although they didn’t have any complaint.total16 of them Depending on biopsy result, breastcancer was determined. CONCLUSIONS: It is tomake follow up and management of breast cancerscrening on a regular basis to the public to make



DOI: 10.1002/pon

treatment of follow up of cases which breastdisease were found by general surgery specialist,The importance of early diagnosis with mammo-graphy and education should be paid attention inorder to enhance cancer screening conscious so theimportance of KETEM’s is coming to the fore-front. ACKNOWLEDGEMENT OF FUNDING:None.

P1-43

Psychosocial and Cultural Factors Related to Non-

Adherence in Indonesian Women with Breast Can-

cer: A Qualitative Study

Aulia Iskandarsyah1,2, Cora de Klerk1, DradjatSuardi3, Monty Soemitro3, Sawitri Sadarjoen4,Jan Passchier2,11Erasmus MC University Medical Center,Rotterdam, The Netherlands, 2VU University,Amsterdam, The Netherlands, 3Hasan SadikinHospital, Bandung, Indonesia, 4PadjadjaranUniversity, Bandung, Indonesia

BACKGROUND: Breast cancer is the secondmost frequently occurring cancer among Indone-sian women. Although the incidence rate of breastcancer in Indonesia is lower than in developedcountries, the mortality rate is higher. Non-adherence to medical recommendation has beenrecognized as a factor that leads to unfavorableoutcomes. The aim of this study was to explorepotential psychosocial and cultural factors asso-ciated with non-adherence in Indonesian womenwith breast cancer. METHOD: Semi-structuredinterviews were conducted with 50 breast cancerpatients who were treated at the OutpatientSurgical Oncology Clinic of the Hasan SadikinHospital in Bandung, Indonesia. Interviews wererecorded, transcribed verbatim and coded using thequalitative software Atlas.ti. Codes were mergedinto main themes that were subsequently mappedonto the study’s aim. RESULTS: Forty percent ofthe participants had delayed starting medicaltreatment after diagnosis, whereas 20% of theparticipants had skipped two or more consecutivetreatment sessions during their treatment. Mostparticipants mentioned several reasons for non-adherence. Financial burden was not the mainreason for delay in treatment uptake. Otherimportant factors included cancer fatality beliefs,fear of medical treatment, shamed of havingcancer, denial of disease severity and great beliefin Traditional Medicine. Non-adherence duringmedical treatment was explained by financialproblems, lack of information, severe side effectsof treatment and uncertainty about cancer treat-ment. CONCLUSIONS: This study has identifiedseveral modifiable psychosocial and cultural fac-tors associated with non-adherence to medicalrecommendation in Indonesian breast cancer pa-

tients. We argue that not only financial support isneeded to reduce non-adherence in Indonesia, butalso extensive information provision and patienteducation. RESEARCH IMPLICATIONS: Ourstudy sheds light on the importance of psychosocialand cultural factors in explaining non-adherence.The relative importance of these factors should bestudied in future prospective studies. CLINICALIMPLICATIONS: This knowledge about psycho-social and cultural factors associated with non-adherence may be used to develop interventions toreduce non-adherence behavior in this population.ACKNOWLEDGEMENT OF FUNDING: TheDirectorate General of Higher Education (DGHE)of Indonesia.

P1-44

Risk Attitudes in the Detection of Cervical Cancer in

Women 20 to 45 Years

Ignacio Mora-Magana1,2, Nataly Contreras-Mollinedo2, Karymen Miranda2, Saray Contreras-Palacios21Universidad del Valle de Mexico, Villahermosa/Tabasco, Mexico, 2Instituto Nacional del Pediatrıa,Mexico City, Mexico

BACKGROUND: Cervical cancer is a publichealth problem worldwide. Several factors influ-ence the population to be no early diagnostic tests,the result is late detection. The age of firstintercourse, number of sexual partners, history ofsexually transmitted infections and other charac-teristics of sexual activity are related with thelikelihood of getting cancer. The Pap test is ascreening test to detect women who may havelesions in the cervix. Test results are not always‘‘accurate’’. METHOD: We interviewed womenattending bone densitometry and the questionnairewas applied. The questionnaires were administeredby interviewer directly to the patient. Prior in-formed consent of the patient and explaining thattheir responses would be confidential, academicand research use only. RESULTS: We interviewed150 women of childbearing age between 20 and45 years of age. The main factors in descendingorder by which women do not perform Pap smearswere:

1. Feelings of grief (OR 2.5: I to C to 95% from1224 to 5107)

2. Failure to deliver results.

3. Lack of information for the Pap smear.

4. Lack of credibility in health services.Part of the ‘‘grief’’ of women is also due to her mandoes not want to be ‘‘touched’’ in this anatomicalregion. CONCLUSIONS: Given these factors it isclear that we must disseminate more informationabout the Pap smear. Increase the confidenceof the population at risk to health institutions



DOI: 10.1002/pon

by improving turnaround times of results.RESEARCH IMPLICATIONS: The studies doneabout the diagnostic utility of screening for cervicalcancer do not include a group of women who donot come to institutions seeking support for thisdiagnosis, so some of these studies may be has aselection bias. CLINICAL IMPLICATIONS: Wealso reformulate the educational and communica-tion strategies used today to attract women to havethis test, so that address these psychological factorsthat act as a barrier to action. Thus, it may impactmore strongly on the intensity of decline inmortality from cervical cancer. Also, we mustaddress the education of men about cervical cancer,because its ignorance can lead to his wife sufferingfrom this terrible disease. ACKNOWLEDGEMENTOF FUNDING: None.

P1-45

Religious Coping with Acute Leukemia

Andrada Parvu1,2, Rodica Gramma1, StefanaMoisa1, Silvia Dumitras1, Mariana Enache1,Gabriel Roman1, Radu Chirita1, Beatrice Ioan11UMF ‘‘Grigore T Popa’’, Iasi, Romania, 2UMF‘‘Iuliu Hatieganu’’, Cluj-Napoca, Romania

BACKGROUND: Malignant patients develop apsychological adaptation (coping) process whichrelies on patients’ internal or external psychologicalresources (family, hobby, personality, culture,friends). An important resource is faith andreligion. METHOD: Aims: analyze the efficiencyof religious coping of acute leukemia patients, andidentify patterns of religious coping. We haveperformed 89 semi-structured interviews with acuteleukemia patients who were admitted to the ClujHematology Clinic during 2009 and were treatedwith chemotherapy. Study admission criterion waspatient’s acknowledgement of religion as a psycho-logical resource. Interviews were conducted by apsycho-social counselor who is also a clinicalhematologist, and were analyzed by a bioethicscommittee (theologian, physicians, philosopher,law specialist). Patients signed informed consent,and the study was approved by the local EthicsCommittee. The interviews were analyzed qualita-tively using thematic analysis. RESULTS: Out ofthe 89 patients, 37% were Orthodox, 5.6%Catholics, and 6.7% Protestants. (percentagesreflected in general population). All patientsreached an efficient coping. 30% experiencedinefficient coping periods: frantically praying for amiracle, questioning God’s love, hopelessness,blaming God for the disease, resignation (thedisease was God’s will), interpreting cancer as apunishment. Patterns of efficient religious coping:keeping the faith, following Christ’s example bycombining suffering with trusting God. Somepatients became more religious after the diagnosis,

thus entering a process of spiritual awakening,reinterpreting the disease as an opportunity forspiritual growth. CONCLUSIONS: The patientsdescribed bargaining with God as an efficientcoping pattern. This is one of the phases inElisabeth Kubler Ross’ coping model. In ‘‘bargain-ing’’ the patient asks God to prolong his life or toallow him to take part in an important event inexchange for a Christian life. In our group, 38% ofpatients bargained for family-related matters(marrying, having children or grandchildren, seeingtheir children graduate), 7% bargained for profes-sion-related matters, 2% committed to go onreligious pilgrimages, and 17% did not revealthe subject of their bargaining. RESEARCHIMPLICATIONS: Based on the conclusion itcould be designed further studies using analiticregresion to create a model of the patient develop-ing religious coping. Some patients said theirreligious coping was initiated by their priests . Another further study shoul focuse on which priest areimpartial, just supporting patients and which areinfluencing the patient hoping for a miracle orresignation, which are patterns of inefficient cop-ing. CLINICAL IMPLICATIONS: It is importantfor the multidisciplinary team (oncologist, nurse,psychologist, theologian, social worker, family)that provide medical care to malignant patients torealize that religious coping is not always efficient,and to recognize the most common patterns ofreligious coping. It is recommended that when amember of the team identifies patients withinefficient religious coping, to refer those patientsfor specialized psychological or spiritual counseling.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is a part of POSDRU/89/1.5/S/61879 Projectco-financed from European Social Fund throughHuman Resources Development Sectorial Opera-tional Program 2007–2013.

P1-46

Relation Between Distress and Gender: Adaptation

Profiles in Onco-Hematology Patients in Che-

motherapy

Cristiane Decat Bergerot1,2, Tereza CristinaCavalcanti Ferreira Araujo2, Alexandre Nonino1,Jorge Vaz PintoNeto1, Marco Murilo Buso11CETTRO - Centro de Cancer de Brasılia, Brasılia,DF, Brazil, 2UnB - Universidade de Brasılia,Brasılia, DF, Brazil

BACKGROUND: In recent decades there hasbeen a growing interest in medical science to studythe relationship between gender and health status.This relation is influenced by biological, psycholo-gical, social and cultural characteristics. In thecancer context, women feel safer in sharing theirsorrows and fears with others as a way of dealingwith vulnerability feeling. While, men tend to



DOI: 10.1002/pon

choose fight-or-flight response, with a penchant forintrospection to resolve problem, seeking internalresources. METHOD: This study aims to investi-gate the difference between distress and gender in58 patients with lymphoma, 51.7% of whom weremales (Group 1) and 48.3% were females (Group2). In Group 1, the average mean age was 50(SD5 15.8), most of patients were married (62%)and 51.7% had college degree. In Group 2, theaverage age was 56 (SD5 14.3), 48.1% weremarried and 59.3% had college degree. Theinvestigation was authorized by the ethics commit-tee. The Distress Thermometer (DT) was used toevaluate distress in three different stages of treat-ment: beginning, middle and end of chemotherapy.RESULTS: There was a significant differencebetween the two groups, observed in all threestages of evaluation (po0.01). In the beginning oftreatment, the incidence of distress was 34.5% formale and 40.7% for female. During treatment,there was a progressive decline at middle (7.7%male and 25% female) and on the last stage ofevaluation (4.5% male and 19% female). CON-CLUSIONS: The results showed that women had ahigher incidence of distress than men. Thisdifference can be observed in all stages of evalua-tion, suggesting that gender is an important factorto be considered in the assessment of distress, withdifferent implications for the ability to cope withthe diagnosis and treatment. However, men’stendency to minimize and somatize their vulner-abilities through nonverbal and, the impersonalway and short emotional expression can influencethe sample data in this methodology. RESEARCHIMPLICATIONS: According to the literature,there is not a distress assessment strategy that ismost efficient for detection of genders differences.We emphasize the importance of conducting moreresearch to determine the gender influence on thedistress incidence. Since gender is one of the mostbasic biological and psycho-social characteristics ofindividuals, knowledge of gender can be the firststep toward understanding the complexity ofcancer patients. CLINICAL IMPLICATIONS:Gender has been shown to be an importantcomponent in doctor-patients’ communication/relationship, treatments’ efficacy, side effects man-agement, and mood disorder intervention. For abetter health care program and to chooseappropriate intervention it is important tounderstand how to best support women andmen in their experience of cancer treatment.ACKNOWLEDGEMENT OF FUNDING:None.

P1-47

A Pilot Training Program for Health Care Profes-

sionals Providing Palliative and Oncological Care to

Lesbian, Gay and Bisexual (LGB) Patients

Paul D’Alton, Finn CG ReyganSt. Vincent’s University Hospital, Dublin, Ireland

BACKGROUND: There have been a numberimportant advances in lesbian, gay, bisexual andtransgender (LGBT) rights provision in Ireland inrecent years including the Employment EqualityActs 1998 and 2004, the Equal Status Acts 2000and 2004, and the Civil Partnership Act 2010. Intandem with social, cultural and legislative changethere has also been a growing awareness acrosshealth care disciplines of the need for LGBT-related training of health and social care profes-sionals. METHOD: A review of the internationalliterature assessed the experiences of LGB peoplereceiving oncological and palliative care. On thebasis of this literature and on the basis of guidelinesfrom the professional bodies in Ireland a brief, 50minute training module was developed. Trainingworkshops were then delivered and evaluated intwo acute hospital settings and in two hospicesettings in Dublin. As part of the evaluation of thetraining participants completed questionnaires andparticipated in interviews with the external audi-tors. RESULTS: The project developed:� a training program for palliative and oncol-

ogy care professionals (medical, nursing andhealth and social care staff) in both acutehospital and hospice settings

� a set of best practice guidelines for use bypalliative and oncology care staff whoprovide care to individuals who are LGBand who interact with their partners andfamilies in a care setting

� multi-media outputs, including distancelearning formats, to ensure wider delivery ofthe program

The project, which was well received, also presentsa model for delevoping and delivering specialtytraining programmes in healthcare settings.CONCLUSIONS: The project was well receivedin the different settings and by multidisciplinaryaudiences. The training:� supported palliative and oncology care staff

to deliver LGB affirmative care to theirpatients who are LGB

� enabled palliative and oncology care staff tointeract with partners and families of LGBpatients in an affirmative way

� increased palliative and oncology care staffawareness of LGB issues relevant to help-seeking behaviors in hospital and hospicesettings

� provided palliative and oncology carestaff with access to training materialsthat were easily accessible and transferableto other palliative care and oncologyservices

RESEARCH IMPLICATIONS: The pilot projectdeveloped best practice guidelines and a training



DOI: 10.1002/pon

programme for health and social care professionalsproviding palliative and oncological care to LGBpatients in Dublin, Ireland. The project alsohighlighted the need for further research on theexperiences of LGB in oncology and palliative careservices in Ireland. CLINICAL IMPLICATIONS:Recent reports from:� the Irish College of General Practitioners

(ICGP)� the Irish Institute of Mental Health Nursing

(IIMHN)� the Gay and Lesbian Equality Network

(GLEN)Offer guidelines for health care professionalsworking with LGB patients. The project points tothe growing awareness across health and socialcare disciplines in Ireland of the need forLGBT-related training for professionals.ACKNOWLEDGEMENT OF FUNDING: Theproject was funded by the Irish Cancer Society, theIrish Hospice Foundation and by the HealthService Executive (HSE).

P1-48

Cancer and the Risk for Divorce: A Systematic

Review and Meta-Analysis of Gender Effects

Sophie Madsen, Robert ZachariaePsycho-oncology Research Unit, Aarhus UniversityHospital, Aarhus, Denmark

BACKGROUND: Serious illness can lead tosevere distress in couples and in some instances torelationship breakdown. While the risk of divorcedoes not appear to be higher in cancer patientsthan in healthy subjects, it has been debatedwhether female cancer patients are at greater riskof partner abandonment than male patients. Theaim was to investigate gender differences in cancerpatients’ risk for divorce by conducting a systema-tic review and meta-analysis of available research.METHOD: Studies on cancer and divorce riskwere electronically searched for using PubMed,PsycINFO, and CINAHL, using the key termsCANCER or NEOPLASMS in combination withseveral key words, including DIVORCE,SEPARATION, MARITAL or DISSOLUTION.Divorce rates obtained from 3 publicationsdescribing 20 independent samples of 144144 patientswith gender non-specific cancers and 9 publicationsdescribing 17 independent samples of 118236patients with gender-specific cancers were com-pared in two separate meta-analyses. RESULTS:When combining the risks (odds ratios) of womengetting a divorce compared to men found in studieswith non-gender specific cancers, the slightly higherrisk for women did not reach statistical significance(OR5 1.08;95 % CI: 0.98-1.20; p5 0.12;randomeffect). When comparing samples of patients with

gender specific cancers, no overall difference wasfound between divorce rates of men and women(Men: 0.081; Women: 0.077; Random effect, Q:0.008, p5 0.928). The divorce rates for reproductive(0,11; testicular, cervical, ovarian/uterine) vs. non-reproductive (0,05; prostate, breast) revealed a non-significant trend (Q:2.71; p5 0.099, mixed effects).CONCLUSIONS: No overall difference in thedivorce rate between men and women was found,neither for patients with non-gender specific cancersnor for patients with gender-specific cancers. Thus,based on the available research, gender does notappear to play an important role in whether divorceoccurs after a cancer diagnosis. RESEARCHIMPLICATIONS: While we found no differencesin the risk of getting a divorce between men andwomen, the results of this meta-analysis should beinterpreted with caution, partly due to studyheterogeneity and partly due to relatively fewstudies, predominantly from Scandinavian regis-try-based studies. Prospective longitudinal studiesof divorce rates in relatively large groups of maleand female cancer patients with various cancertypes are called for in the future. CLINICALIMPLICATIONS: The present study indicates thatcouples are no more likely to divorce when thewoman is the patient. Although it cannot be ruledout that male partners initiate the divorce moreoften than do female partners, clinicians couldhelp alleviate the fear of partner abandonmentin female patients and address relationshipproblems other than men’s hypothesized inabilityor unwillingness to assume the caregiver-role.ACKNOWLEDGEMENT OF FUNDING:None.

P1-49

Intimacy and Sexual Health Care Program for

Breast Cancer Patients

Tiny Van Keymeulen1, Heidi Roelstraete1, Jan Vanden Haute1, Christian Van Hecke2, Annelies DeGrauwe1, Linde Houbracken1, Ann De Clercq1,Lisa Bonduelle1, Paul Enzlin21OLV Breast Clinic, Aalst, Belgium, 2Institute ofFamilial and Sexological Sciences, Leuven Univer-sity, Belgium

BACKGROUND: Based on study results we aimat efficiently elaborating a multidisciplinary healthcare program related to intimacy and sexual health.This study has a twofold objective, i.e. 1) listing theeffects of breast cancer and its treatment on thesexual functioning, and 2) determining the profes-sional assistance women expect to receive at thehospital. METHOD: 139 follow-up breast cancerpatients (up to 5 years) have been asked tocomplete surveys. Women who did not want toparticipate in the study, have been requested toindicate the reason for their refusal. 74 women



DOI: 10.1002/pon

refused to participate since they are no longersexually active or meet with difficulties in discuss-ing this topic. The survey package comprised aDistress Barometer, HADS, a questionnaire onbreast cancer, intimacy and sexual health, FSFIand SSFS for women. RESULTS: Up to 44% ofthe respondents shows lower sexual arousal,however 22% of them suffer from this problem.There are also problems concerning sexual excite-ment and pain. Women with depressive complaintsreport significantly more sexual dysfunction. 55%of the respondents shows a different experience ofsexuality and intimacy. Being together, caressingand cuddling are experienced as more importantthan kissing and having sexual contact. Sexualsatisfaction is significantly lower after can-cer.47.7% needs professional assistance in findinganswers to their questions on sexual functioning.73.8% believes that more intramural attention is tobe paid to the patient’s perception of sexuality.CONCLUSIONS: These results suggests emergingtendencies. Breast cancer and its treatment have aclear effect on the patient’s intimacy and sexualhealth. The majority of the women would like toreceive more information. They want to talk (indecreasing order of importance) with the gynaecol-ogist, the oncologist, the sexologist and thepsychologist. They also want to receive an infor-mation leaflet, spontaneous discussions on thistopic during contacts with health care professionalsat the hospital and information sessions withcompanions. RESEARCH IMPLICATIONS: Thisstudy already suggests emerging tendencies. How-ever some limitations should be considered beforeinterpreting this result. One is that this study wasbased on a small number of participants. Alsofurther research is necessary into the implementa-tion of a multidisciplinary health care programrelated to intimacy and sexual health. Moreknowledge of the expectations and informationneed of health care professionals can be added.CLINICAL IMPLICATIONS: The elaboration ofa health care program is deemed necessary andstrongly advisable. It is important to involvemedical, sexological and psychosocial health careprofessionals in this process. ACKNOWLEDGE-MENT OF FUNDING: Vlaamse Liga tegenKanker.

P1-50

Relationship Between Serum CA15-3 Tumor Mar-

ker, TNM Staging, Estrogen and Progesterone

Receptors Among Breast Cancer Females

Manar Atoum1, Huda Hourani1, Nisreen Nimer1,Sawan Abdeldayem2, Hamzah Nasr3, SuliemanAl-Hourani11Hashemite University, Zarqa, Jordan, 2King Hus-sein Medical Center, Amman, Jordan, 3ReferenceMedical Laboratories, Zarqa, Jordan

BACKGROUND: Serum tumor marker CA15-3(Cancer Antigen 15-3) widely used in follow-up,and detection of breast cancer recurrence. The aimof this study is to evaluate CA15-3 level amonghealthy, benign and malignant breast cancerfemales, and to investigate the impacts of tumorstage and grade on serum level of this biomarker.METHOD: One hundred and thirty six Jordanianfemales were enrolled in this study: Forty-five werehealthy women with no evidence of any malig-nancy. Seventy-two were female patients histo-pathologically diagnosed with breast cancer andnineteen females with benign breast lesions.RESULTS: Serum CA15-3 levels were elevatedsignificantly among breast cancer patients(37.9576.65) compared to both healthy(14.9770.8) and benign females (12.3071.55). Alower CA15-3 level was significantly associatedwith using hormone replacement therapy and oralcontraceptive consumption among breast cancerpatients group. Significant higher CA15-3 serumlevels Serum CA15-3were found among grade II,III and stage II and III breast cancer femalescompared to normal healthy females. HigherCA15-3 serum levels were also found amongpositive progesterone receptor (35.4877.89) andpositive estrogen receptor (37.0878.22) comparedto healthy control females. CONCLUSIONS:Tumor marker serum CA15-3 level increase asbreast cancer stage increases. RESEARCHIMPLICATIONS: investigate the impacts of serumCA15-3 biomarker level on tumor stage and grade.CLINICAL IMPLICATIONS: Follow up cancertreatment by following serum CA15-3 biomarkerlevel. ACKNOWLEDGEMENT OF FUNDING:This work was financially supported by a grantfrom Hashemite University (Grant number: 55/2005). Special thanks for technical help andassistance, patients, physicians, nurses, and datamanagers who participate in breast cancer clinic atKing Hussein Medical City.

P1-51

Body Image and Psychological Distress After

Prophylactic Mastectomy in Genetically Predis-

posed Women: A Prospective Long-Term follow-up

Study

Mariska den Heijer1, Caroline Seynaeve2, KathleenVanheusden1, Hugo Duivenvoorden1, MadeleineTilanus-Linthorst2, Marian Menke-Pluymers2,Aad Tibben3, 11Erasmus Medical Centre, Rotterdam, TheNetherlands, 2Erasmus MC-Daniel den HoedCancer Centre, Rotterdam, The Netherlands, 3LeidenUniversity Medical Centre, Leiden, The Netherlands

BACKGROUND: Women at risk of hereditarybreast cancer may opt for prophylactic mastectomy(PM) as the most effective risk-reducing strategy.



DOI: 10.1002/pon

Long-term data on the psychological impact of PMis needed for counselling women contemplatingPM. In the current prospective study we aimed to(1) explore the course of psychological distress andbody image in high-risk women at long termfollow-up (6–9 years after PM), and (2) to identify,pre-PM, risk factors for poor body image at long-term follow-up. METHOD: General distress,breast cancer specific distress, general body imageand breast specific body image were assessed in 36women at risk for hereditary breast cancer under-going PM Measurement moments were before PM(T0), and at 6 months (T1) and 6–9 years after (T2)PM. Investigated variables for long-term bodyimage (as assessed at T2) included psychologicaldistress, body image, and coping styles (as assessedat T0). RESULTS: Breast cancer specific andgeneral distress decreased from T0 to T1 as wellas from T1 to T2. Problems regarding breastrelated and general body image were increased atT1 in comparison with T0. Furthermore, problemsregarding breast related body image significantlydecreased from T1 to T2, while the decrease inproblems regarding general body image was notsignificant. Active coping and seeking social sup-port were predictive of decreased scores (i.e. lessproblems) on breast related and general bodyimage at long-term follow-up. Furthermore, in-creased general body image at T0 predicted forincreased general body image at long-term follow-up. CONCLUSIONS: To our knowledge, this isthe first prospective study on long-term psycholo-gical distress and body image after PM inwomen at risk for hereditary breast cancer. Ourfindings indicate that most women experiencedpersistent problems regarding body image afterPM. Furthermore, several risk factors for poorbody image were found in this study, which mayhelp clinicians to identify before PM women mostvulnerable for persistent problems with bodyimage, and offer them additional psychologicalsupport. For example, women may benefit fromextra counseling sessions in order to try to focusvulnerable women on more active coping strate-gies. RESEARCH IMPLICATIONS: Our resultsare relevant in helping to identify women that maybenefit from additional psychological counseling.Further research is warranted to clarify the factorsunderlying persistent problems with body imageafter PM, and to evaluate possibilities for ther-apeutic intervention. CLINICAL IMPLICA-TIONS: Potential negative effects of surgery onbody image should be discussed thoroughly withwomen contemplating PM and their partners.Furthermore, negative consequences should bebalanced with positive outcomes of PM, such asdecreased worries about cancer. Clinicians shouldexplore women’s feelings about her body and herspecific coping styles in the pre-operative counsel-ing in order to identify women at risk for persistent

problems with body image who may benefit fromadditional support. ACKNOWLEDGEMENTOF FUNDING: The study was supported by agrant from the Dutch Cancer Society (KWF EMC2006-3468).

P1-52

Genetic Counselling for Hereditary Breast and

Ovarian Cancer Susceptibility: Emotional States

and Perception of the Risk

Sara Mella1, Barbara Muzzatti1, AlessandraViel1, Riccardo Dolcetti1, Luigi Grassi2, MariaAntonietta Annunziata11Centro di Riferimento Oncologico - NationalCancer Institute, Aviano (PN), Italy, 2Universityof Ferrara, Ferrara, Italy

BACKGROUND: The counselling process aimedat identifying a genetic predisposition to thedevelopment of neoplastic diseases involvesthemes of high emotional valence (illness, death,procreation) and represents a psychologicallychallenging event for any person, both sickand asymptomatic at risk. It is with this knowledgethat this research was born: the purpose is assessingthe psychological characteristics of people whoengage in genetic counselling and the psychologicalimpact of genetic testing disclosure. METHOD: 60users of a preventive diagnosis/genetic counsellingservice of a Cancer Institute were invited tocomplete some questionnaires that investigateemotional states (the Profile of Mood States,the Hospital Anxiety And Depression Scale, thevisual analogue scale related to the principalemotions) and perception of risk (the visualanalogue scale and questions relating to the riskperception of developing/redeveloping a breast/ovarian cancer and to be carriers of the geneticmutation). The psychological evaluation wasproposed at the time of pre-test counselling (T0)and one month from genetic testing disclosure(T1). RESULTS: At T0, 46% of the participantswere possible/probable cases for anxiety and 30%for depression. Among the ten tested emotions,confidence (M5 6.6) and serenity (M5 5.6) werethe most intense. About the risk perception,54% of the participants think to have a probabilitygreater than or equal to 50% of getting sickor of relapsing and 70% to be mutation carriers.No differences were associated with being or notbeing a proband. From T0 to T1 (N5 18) nodifferences were found in the tested dimensionseven though their association with the test outcomehas not been verified. CONCLUSIONS: Thesubjective perception of risk significantly affectsparticipants’ choice to submit to the test. At T0 asignificant proportion of people show anxietyand depression. However, the real value of dataand the impact on the test will be seen when we



DOI: 10.1002/pon

have a greater amount of data, which, havingseen the positive response to the project, showsthe purpose to be reachable. Present data arepreliminary and are estimated to be a subsample ofa wider range who agree to test in the 18 successivemonths to the genetic testing disclosure for anumber of 5 times. RESEARCH IMPLICA-TIONS: From a point of view of researchestimating the impact of the test results overtime is important, but, at the moment is notcompletely possible to do, due to the small numberof subjects that have received communicationof the results. Another aspect that could beimportant to research further regarding thetesting disclosure is the role of moderation playedby other factors (participant’s age, number of sonsattending etc). CLINICAL IMPLICATIONS: Thedata confirm the clinical importance of psycho-emotional screening aimed at people who areundergoing genetic counselling. Moreover, consid-ering that already at T0 a relevant percentage ofpeople manifest anxiety and depression, andassuming that the communication of predispositionis a destabilizing event, establishing a specialpsychological service aimed at people with apersonal or family history of breast/ovarian cancerwho are undergoing predictive genetic testing forBRCA1/2, could not be superfluous. ACKNOWL-EDGEMENT OF FUNDING: This project ofresearch is financed by the Italian Ministry ofHealth.

P1-53

Complexity of Cellular Carcinogenesis vs Macro-

scopic Representations of Illness in Cancer Patients:

Interest of Empirically Supported Psychodynamic

Interventions

Marie-Frederique Bacque, David Marie, PatriceCanNoneUniversity of Strasbourg, Strasbourg, France

BACKGROUND: Although scientific explana-tions of cancer etiology become more sophisti-cated, popular representations have lagged behind.The historical development of collective images ofdiseases, particularly in cancer, doesn’t follow theevolution of diagnosis and curative treatments.Etiological attributions of cancer still result fromthe crossing of individual and collective representa-tions. These interpretations should be retained andtaken into consideration by physicians and care-givers to enhance specific healing relations, under-stand compliance difficulties and give the patientbetter autonomy. METHOD: The gap betweentechnological medicine and emotional expressionof patient is increasing in oncology. There is adistorsion between the patient speech upon hispersonal cancer crisis to his doctor and medicalproposition of treatments with international pro-

tocols. Longitudinal follow-up of patients withpsychologists using same empirical psychodynamicinterview frame helps the patient to find sense tocancer in his life through his heuristic hypothesis ofillness. Furthermore, psychodynamic referred psy-chologist restaures patient competence to think hislife trajectory in introducing a longitudinal possi-bility of narration. RESULTS: Hundred interviewsproposed to cancer patients with psychodynamicsetting helped patients to take their place ‘‘back intheir life’’. Subjective questioning allowed them tocommunicate their archaic representations as themore recent ones. The exogenic model of repre-sentations was currently to think illness as ontolo-gic and totally strange. With the endogenic model,patients felt guilty and depressed. Narration gavethem the feeling of psychological continuity backwhen body image is so often modified by treat-ments. The threatening memory of illness wasintegrated, avoiding the usual phenomenon ofchronical depressed patients even when cancer isdeclared in remission. CONCLUSIONS: Imagin-ary fantasies of cancer patients are shared betweensocial stereotypes and scientific injunctions. But thefrequent oppositions of physicians when patientstell them what they think of their illness etiology, isfrequently followed by silence or even superficialacceptation of scientific causality. With psychody-namic interviews, subjective vision of illness isshared by the patient. This possibility to formulateimaginary attributions to illness facilitates menta-lization of announcement and empowerement ofpatient. The therapeutic alliance with the psychol-ogist allows patient to accept or sometimesrenounce to his treatment, nevertheless to obtainmore personalized program of cure and care.RESEARCH IMPLICATIONS: We propose amethod to assess illness representations withpsychodynamic interviews. With content analysis,we identify different representations of illness andhealing. With the psychoanalytic method of Frenchprojective tests school we use the TAT (RosineDebray for the Murray Thematic ApperceptionTest) study of thinking processes. To analysepsychologists transference and conscious invest-ment we use the Psychotherapy Process Q-Set ofE.E.Jones in Thurin’s single-case design protocol.CLINICAL IMPLICATIONS: With psychody-namic interviews, psycho-oncologists observe thatrespect of subjectivity gives access to deeply hiddenrepresentations and to etiological theories usuallybanished by physicians. Speaking from irrational-ity in cancer attributions helps patients to gothrough sideration and fear and to verbalize ideasconducting to feelings. Even if anxiety is high and ifsome causality links seem close to delusion,psychoanalytic frame helps patients to feel securedand to develop more personal relations withcaregivers and physicians. ACKNOWLEDGE-MENT OF FUNDING: None.



DOI: 10.1002/pon

P1-54

Narratives and Interpreters in Psycho-Oncology: A

Pilot Study

Simone Cheli1,2, Francesca Focardi1, FrancescoVelicogna2, Luisa Fioretto11Department of Oncology, Santa Maria AnnunziataHospital, Florence, Italy, 2Institute of ConstructivistPsychology, Padua, Italy

BACKGROUND: The aims of this pilot-study are:(i) to evaluate a narrative assessment on cancerpatients and professionals; (ii) to evaluate anexpressive writing intervention on the same sample;(iii) to analyse differences and similarities in theconstructions of cancer between patients andprofessionals. METHOD: All the subjects wereasked to describe their personal definitions ofcancer illness, Quality of Life and cancer therapy.Furthermore patients were asked to conjecture howcancer professionals define the same three themesand vice versa professionals were asked to con-jecture how patients define them. Narratives wereanalysed through a specific software. The controlgroup (n5 48) included patients and professionals.The experimental group (n5 16) included patientsand professionals who joined two different expres-sive-writing interventions respectively. In all thesessions participants were asked to write about themost significant phases of cancer diagnosis andtherapy. RESULTS: The intervention shows twomain results: professionals improved their insightinto patients narratives; patients increased theirperceived social support. On one side, we identi-fied, through content analysis software, a lessdiscrepancy (po.005) between the constructionsof patients and professionals. On the otherside, patients showed a higher score (po.005)at the Norbeck Social Support Questionnaire.CONCLUSIONS: In conclusion, a narrative ap-proach seems to be an useful tool in understandingand integrating personal constructions betweenand within groups of patients and professionals.The expressive-writing intervention seems to beeffective in supporting a coping strategy in patientsand a communicative strategy in professionals.RESEARCH IMPLICATIONS: The describedmethodology tries to integrate qualitative andquantitative analysis. Outcome indicators areevalued by psychometric questionnaire, whereasoutput indicators by content analysis. The narra-tive assessment and intervention seems to allow afocused elicitation of personal and professionalassumptions. CLINICAL IMPLICATIONS: Theexpressive-writing intervention seems to promote asharing of personal narratives and a bettercomprehension of personal constraints and possi-bilities in dealing with cancer and its burden.Further studies are needed in order to clarify theeffectiveness of the intervention on coping strate-

gies of patients and on communicative strategies ofprofessionals. ACKNOWLEDGEMENT OFFUNDING: None.

P1-55

Using Emotion Focused Therapy with Psycho-

Oncology Patients: Preliminary Theoretical and

Clinical Considerations

Niamh Coleman, Allison Connolly, NatalieHessionSt. Luke’s Hospital, Dublin, Ireland

BACKGROUND: This presentation reviews thedilemmas, sensitivities and intricacies in workingpsychologically with cancer patients includingissues of living, suffering, death and dying, meaningmaking, knowing and not knowing, power andpowerlessness and balancing the physical demandsof the illness with the psychological. The presenta-tion then considers the parameters of EmotionFocused Therapy and the potential for theapproach to frame and facilitate the diverse andcomplex scope of emotional therapy work inPsycho-Oncology. METHOD: This presentationprovides a clinician’s perspective on thepotential opportunities and barriers in applyingEmotion Focused Therapy (EFT) with Psycho-Oncology patients. The theoretical and clinicalexploration will draw upon the approaches con-tributing to emotionally based therapy work inPsycho-Oncology to date. The presentation con-siders the question of what criteria to apply where achoice of therapies exist. The assumptions andprocedures of EFT will be examined to ascertainwhether this approach offers an additional lens tounderstand and work with individuals with cancerwho wish to explore in depth their emotionalexperience. Contraindications will be discussed interms of patients characteristics and contextualfactors. RESULTS: The presentation offers aframework for understanding the fundamentaldynamics of psychological therapies that focus onthe emotional experience of cancer. It specificallyaddresses the potential role and limitationsthat Emotion Focused Therapy may offer intherapy work with patients with cancer, byoutlining theoretical and clinical considerations.CONCLUSIONS: This discussion paper sets outsome of the important parameters in choice oftherapy with psycho-oncology patients. It asks thatthe questions raised in relation to EmotionFocused Therapy as a potential approach betested in future research studies. RESEARCHIMPLICATIONS: The presentation underlinesthe need for more research in the area of emotionalfocused work with Psycho-oncology patients, andin particular, the need to establish the potentialrole of Emotion Focused Therapy. CLINICALIMPLICATIONS: This discussion paper highlights



DOI: 10.1002/pon

the need to draw on clinical and theoreticalconsiderations as well as research findings as away of contributing to the field of therapy workwith Psycho-Oncology patients. Emotion FocusedTherapy may offer a therapeutic approach thatmeets a sub-group of patients’ psychological needs.ACKNOWLEDGEMENT OF FUNDING:None.

P1-57

A Meaning-Centred Psychosocial Intervention for

Terminally Ill Patients in Hong Kong

Ka Po Lau1, Esther Mok1, Theresa Lai21School of Nursing, The Hong Kong PolytechnicUniversity, Hong Kong, Hong Kong, 2Department ofOncology, The Princess Margaret Hospital, HongKong, Hong Kong

BACKGROUND: A holistic model of end-of-lifecare considers the patient’s needs in all dimensionsof life. The spiritual dimension and the search formeaning in particular, are of vital importance atthe end of life. This study addressed the need forevidence-based practice regarding psychosocialinterventions in end-of-life care. It aimed to explorethe impact of a brief, individualised meaning-centred psychosocial intervention on quality of lifeof patients with advanced cancer. METHOD: Thisis a randomised controlled trial. 84 participantswere recruited from the oncology ward of a localhospital and randomly assigned to the experimen-tal (n5 44) or control group (n5 40). The inter-vention consisted of two sessions. The first sessioninvolved a semi-structured interview that facilitatedthe search for meaning of life according to thecomponents of meaning of life as defined bylogotherapy. The second session involved a reviewof a summary sheet of the interview content.Participants in the control group received usualcare. Outcomes were assessed by the Quality-of-lifein the End of Life Questionnaire (QOLC-E;28-item, 8 sub-scales) at baseline, and immediatelyand 2-week after intervention. RESULTS: Inten-tion-to-treat analysis by repeated measuresANCOVA was conducted. After adjusting forbaseline scores of QOLC-E, the total mean scoreof QOLC-E and the mean score of the sub-scaleexistential distress achieved significant main effects(F(1, 81)5 6.295, p5 .014 and F(1, 81)5 5.824,p5 .018 respectively). The experimental groupshowed a higher level of overall quality of lifeand existential welling than the control group afterparticipating in the intervention. Other sub-scales(value of life, emotions, alienation, physical dis-comfort, healthcare concerns, food-related con-cerns and support) did not achieve significant maineffects. CONCLUSIONS: The improvement ormaintenance of quality of life is the primary goalof palliative care. However, previous interventional

studies focussing on the search for meaning of lifein patients with life-threatening disease seldomused quality of life as the outcome measurement.This study showed that by means of a brief,meaning-centred intervention that was feasible tobe conducted at patients’ bedside during everydaycare, the overall quality of life of a patient withadvanced cancer could be improved. The interven-tion is practical and cost-effective and has thepotential to be integrated into the clinical practiceof palliative care. ACKNOWLEDGEMENT OFFUNDING: This study was funded by the GeneralResearch Fund from the Hong Kong SARGovernment (Project number: 562109).

P1-59

‘‘I was Six Months Ahead of Myself’’: Waiting—

The Experiences of Spouses of Patients Undergoing

Hematopoietic Stem Cell Transplant

Brenda Sabo1,2, Deborah McLeod2,1, StephenCouban21Dalhousie University, Halifax, NS, Canada,2Capital District Health Authority, Halifax, NS,Canada

BACKGROUND: Few studies have explored themeaning given to the emotional experience orperception of waiting by cancer patients, families,or healthcare professionals. This apparent gap maysuggest that the word has a taken-for-grantedmeaning since waiting may be considered auniversal experience. Without a clear understand-ing of its meaning, the potential consequences ofwaiting may include depression, anxiety, andfeelings of panic and/or uncertainty which mayadversely affect the lives of patients and families.METHOD: A pilot study using a mixed methodapproach followed 11 spouses of patients under-going hematopoietic stem cell transplantation(HSCT) over 1 year. Instruments included theCES-D, PRO-QoL-R-IV, and CQOLC. Bothinstruments and interviews were used to capturethe experience of care-giving at 4 points in time(prior to HSCT, 6 weeks post, 6 months post and 1year post HSCT). Descriptive statistical analysisincluded frequencies, correlations and means.Narrative analysis was grounded in the work ofHeidegger and van Manan which brought to lightthe meaning of the experience of care-giving.RESULTS: Part of a larger set of findings, waitingemerged as a theme for spouses across all 4 pointsin time. The experience of waiting reflected adisruption in the normal fabric of daily life, thefrustration of waiting for a return to normalroutine, and the possibility of waiting as unending.Key themes within the context of waiting will bepresented. CONCLUSIONS: In light of existinggaps in knowledge and understanding of themeaning of waiting and its psychological effects,



DOI: 10.1002/pon

research is needed to shed light on this taken-for-granted experience in order that interventions maybe implemented to better support patients andfamilies across the cancer continuum. Further, aclearly articulated understanding of the phenom-enon is necessary to develop education programsfor healthcare professionals to facilitate theirability to understand as well as meet the psycho-logical, emotional, and spiritual needs of cancerpatients and family members within the context ofwaiting. RESEARCH IMPLICATIONS: Giventhe limited research focused on the experienceand meaning of waiting within the context ofcancer beyond ‘wait times’ and ‘decision-making’,studies are necessary to enhance our understandingof this concept and its potential psychosocialimplications. Such research and clarity of under-standing may prove beneficial in the development,implementation and evaluation of psychosocialinterventions to support optimal health and well-being across the cancer continuum from diagnosisto end-of-life. CLINICAL IMPLICATIONS: It isnot uncommon for healthcare professionals toplace certain expectations on waiting patients andfamilies. The ‘compliant’ or ‘good’ patient/family isa desired expectation even when one must wait.Exploring the meaning of waiting within thecontext of cancer will facilitate the developmentof education for healthcare professionals in orderthat they may better support patients and familiesacross the treatment and illness continuum.ACKNOWLEDGEMENT OF FUNDING:Acknowledgement: this pilot study was supportedthrough the International Society for Nurses inCancer Caresmall budget funds.

P1-60

Perceived Positive and Negative Life Change After

Cancer Diagnosis as Assessed by a Modified Version

of the Posttraumatic Growth Inventory (PTGI)

Sigrun Vehling, Anja MehnertDepartment of Medical Psychology, Hamburg,Germany

BACKGROUND: Positive life change andgrowth after cancer diagnosis and treatment isincreasingly documented. However, problemswith the method typically used to assess thesephenomena have been stated. This pilot studyaims to test a modified measurement method,where perceived positive and negative changesare assessed separately but simultaneously withself-rated current standing on various growthdomains. Preliminary cross-sectional dataon the relative extent of perceived change andrelations to distress are presented. METHOD:N5 103 cancer patients were studied duringinpatient treatment. Most frequent tumors werehematologic (34%), lung (12%), prostate (12%)

and gynecologic (12%). 28% were in palliativetreatment. Positive and negative life changeswere assessed using a modified version of thePTGI: each original item was replaced by itsanalogous current standing version (e.g. ‘‘I have asense of closeness with others’’; scale from 15notat all to 55 exactly) and combined with achange question (‘‘Has this changed due to yourillness?’’; scale from �25negative changeto 125 positive change). Distress was assessedby the HADS. RESULTS: The mean totalchange score reported was M5 7.2 (SD5 10.5;range5 -26 to 138) for the whole 21-itemscale. If negative changes were coded 0, theresulting value was M5 8.7 (SD5 9.4), whichequates 21% of the maximum possible positivechange score. 29% of the study sample reportedone or more single negative changes. Regardingcomplete subscales, total negative changeoccurred in 6% (appreciation of life) to 16%(personal strength) of the patients. The mean totalcurrent standing score was M5 80.1 (SD5 11.7;76% of maximum possible score). Total changeand current standing scores were not related todistress. CONCLUSIONS: In this pilot studyemploying a modified version of the PosttraumaticGrowth Inventory, negative changes on variousgrowth dimensions were reported by a notablesubgroup of the cancer patients studied. Assessingperceived life changes as a result of the cancerillness separately from self-rated currentstanding on the same growth domains (inaddition to the mere possibility existing toactually report negative change) resulted in loweroverall positive changes compared to other cancerpatient samples studied with the original PTGI.Former studies may have overestimated the occur-rence of positive life change in cancer patientsthrough the method of measurement applied.RESEARCH IMPLICATIONS: Results strength-en the need for a modified approach assessingpositive life change and growth, where patients a)have the possibility to report positive and negativechanges and b) simply rate their current standingon each growth dimension. The latter will be fullyutilized by prospective longitudinal studies, whereactual change in current standing-ratings can becompared with perceived changes. CLINICALIMPLICATIONS: Psychosocial interventionsaimed at helping patients to find meaning andhope (which often includes perceptions of positivegrowth after cancer diagnosis) are gaining impor-tance. Improving the methodology in assessment ofpositive life change will strengthen their empiricalbasis through providing well-grounded explana-tions for positive and negative changes incancer patients. ACKNOWLEDGEMENT OFFUNDING: This study was funded bya grant from the Deutsche Krebshilfe (DKH),Germany.



DOI: 10.1002/pon

P1-61

Four Perspectives on Bridging the Worlds of Cancer-

Patients and Everyday Life: A Theoretical Review

with Psychotherapeutic Implications

Joel Vos, Irma Verdonck-de LeeuwVrije Universiteit Amsterdam, Dep. of ClinicalPsychology, Amsterdam, The Netherlands

BACKGROUND: Previous studies have shownthat a cancer-diagnosis may intervene in one’s dailylife. A person may become aware of his physicalvulnerability, limitations and uncertainties. Thebody becomes a medical, reflected object instead ofonly being experienced from within. How does onemake this transition and integrate both worlds ofbeing-a-cancer-patient and daily-life?. METHOD:We discuss core concepts of four psychologicaltheories which explicitly focus on the psychologicalintegration-function: phenomenology-existential-ism, psychodynamic, narrative and cognitive the-ories. By means of this literature review, wedevelop suggestions for psychotherapy for cancer-patients focused on how they may be able tointegrate/bridge their cancer-experience and every-day-life. RESULTS: Phenomenologists/existential-ists suggest that cancer makes a person aware ofthe contingency, limitations, connectedness/limita-tions and meaning(lessness) of life.A patient mayflee from this frightening awareness,but may alsoauthentically, meaningfully design his daily-lifefrom the perspective of these cancer-evokedgivens-of-life.Psychodynamic splitting may occur,-i.e. denial or loss of connections between worlds.-People learn as children to integrate opposites/multiple-worlds instead of thinking black-or-white.Some cancer-patients may never have learntthis mechanism or regress to black-or-white-thin-king.Cancer-patients may retell their narrativelife-story from multiple perspectives to find themain thread in multiple worlds. The cognitive-dual-attitude-theory states that people may havemultiple perspectives/attitudes due to differentattention/focuses; people may learn to switch focus.CONCLUSIONS: Some patients may notautomatically integrate their experience of being-a-cancer-patient and daily-life, and may need addi-tional psychological help. RESEARCHIMPLICATIONS: More empirical research isneeded to understand how people actually inte-grate/bridge/switch their cancer experienceand everyday life. Intervention studies should bedeveloped to examine the efficacy of interven-tions that foster a dual attitude in cancerpatients. CLINICAL IMPLICATIONS: Thedevelopment of an integrative ‘dual attitude’seems to be at the core of coping/adjusting tocancer, i.e. acknowledging the existence of twodifferent worlds and start bridge-building. Severaltherapeutic examples of creating such a dual attitude

will be provided. ACKNOWLEDGEMENT OFFUNDING: We thank the Dutch Cancer Society/Alpe d’HuZes for their financial support of thisstudy.

P1-62

Reliability and Validity Study of Illness Perception

Questionnaire

Zeynep Armay, Mine OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: The concept of illness percep-tion had gained importance in the past decadein health psychology.Patients have their ownbeliefs about their illness and plan their actionsto confront or face the problems at hand onthe basis of these beliefs. The main aim of thisstudy is to adapt ‘‘The Illness PerceptionQuestionnaire-Revised’’ to Turkish and conductthe reliability and validity study of the scale.METHOD: After the translation and languageconsistency of the Turkish version, the scalewas applied to 203 cancer patients in IstanbulUniversity Istanbul Medicine Faculty, OncologyInstitute. For the test-retest reliability, thescale had been reapplied to 80 patients after3 weeks. RESULTS: Cronbach alpha values ofthe subscales in the study group were between0.604 and 0.859. Item total correlations andparallel scale correlations were significant level.Cronbach alpha values of the test-retest group were0.651–0.935. In the explanatory factor analysis, 7factors for the perception dimension and 5 for thereasons dimension were found. The dimensions ofthe scale generally showed good stability over timewith correlations ranging from. 49 to.78. Thefindings of the study group and test retest groupwere parallel in most of the analyses and obtainedvalues were very close to the original psychometricstudy of IPQ-R. CONCLUSIONS: Findings of thestudy indicate that Turkish version of the IPQ-R isa reliable and valid tool for cancer patients.ACKNOWLEDGEMENT OF FUNDING:None.

P1-63

Alexithymia Traits in Hospitalized Haematological

Patients

Filipe Barbosa1, Antonio Barbosa21Hospital de Santa Maria, Lisboa, Portugal,2Faculdade de Medicina da Universidade de Lisboa,Lisboa, Portugal

BACKGROUND: Patients undergoing treatmentfor haematological malignancies are subjected tointensive treatments, namely chemotherapy andbone marrow transplant. This life threateningsituation could potentiate the emotional deregula-



DOI: 10.1002/pon

tion, and psychological suffering. Psychologicaladaptation to such treatments is highly individual,however some patients could present an impaircapacity to deal with emotions. Our aim is to studythe prevalence of alexithymia in these patients.METHOD: 83 sequential haematological patientswere admitted in a general university hospital, withan average age of 43.85, 51.8 % were male, 55 %had leukaemia diagnosis and 26 % had lymphomadiagnosis. These patients were observed by apsycho-oncology team (NIPSO), and were psycho-logically assessed by means of TAS-20, HADS,QLQ-C30 and a socio-demographic and clinicalquestionnaire. RESULTS: We found high levels ofalexithymic traits (34.9%), as well depressivepsychopathological symptoms (20.5 %). We didnot found any significant statistical associationbetween alextihymia and clinical variables.However, we found correlations with depressivesymptoms, the symptom scale pain andfinancial difficulties of QLQ C30. By means ofmultiple regression analyses, we found thatthe variables financial difficulties, socialfunctioning and insomnia had the majorinfluence on alexithymia. CONCLUSIONS:We found a high prevalence of alexithymiatraits, suggesting an intense psychologicalsuffering, potentiating difficulties leading withemotions determined by relevant psychosocialfactors. ACKNOWLEDGEMENTOF FUNDING:None.

P1-64

Diagnosis Problems of Depressive Disorders in

Cancer Patients

Krystyna de Walden-GaluszkoRegional Center of Oncology, Gdansk, Pomorskie,Poland

BACKGROUND: The aims of our study were: 1)to determine the frequency of depressive disordersin the whole group of cancer patients treated inRegional Center of Oncology. 2) To asses thediagnosis of depressive syndromes in the group ofcancer patients according to ICD-10 and DSM-IV.3) To determine some factors influenced on thepatients tendency to look for psychiatric help.METHOD: 1100 cancer patients were observed inRegional Center of Oncology in Gdansk duringlast 10 years. They visited psychiatrist sponta-neously or they were sent by oncologists. Thepsychic state of these person was diagnosedaccording to DSM-IV and ICD-10 classification.Psychiatrist analysed also medical documentationand in some cases interviewed with the patient’sfamily. RESULTS: 385 persons from 1100 cancerpatients (35%) revealed the symptoms of depres-sion. Women were the majority of this group(80%) with breast cancer (50%). The half of the

group was treated with chemotherapy or hormo-notherapy. Most of our patients 340 seemed tobelong to the group of ‘‘mood disorders due tocancer (including’’ substance - induced depression).We tried also to differentiate between adjustmentdepressive disorders (F 43.2) - 34%, adjustmentdepressive anxious disorder (F 41.2) - 56% andepisode of depression (F 32) 10% accordingICD-10. CONCLUSIONS:

1. Depression is frequent disorder in the group ofcancer patients.

2. There is the urgent need to standardizedepression diagnosis in cancer patients.

3. The patients with depressive-anxious disordersseems to need special attention and psychoon-cological help.

CLINICAL IMPLICATIONS: The results of thestudy suggest the improvement of the diagnosticprocedure of depression. Due to that fact theeffectiveness of antidepressant treatment willbe better. ACKNOWLEDGEMENT OFFUNDING: None.

P1-65

Supportive Care Needs Survey for Australian

Indigenous Cancer Patients

G Garvey1, VL Beesley1, C Jacka1, M Janda2,L Whop1, P O’Rourke1, AC Green1, PC Valery11Queensland Institute of Medical Research,Brisbane, QLD, Australia, 2Queensland Universityof Technology, Brisbane, QLD, Australia

BACKGROUND: There are several psychometri-cally validated measures to assess supportive careneeds (SCN) in cancer populations, and severalsubscales exist for specific cancer site/groups.However, these have not been validated forIndigenous Australians who generally have highermortality rates from cancer compared to otherAustralians. The aims of this study were to assessthe face and content validity of an existing SCNtool for use within Indigenous Australians andto develop a culturally appropriate subscale.METHOD: Face-to-face interviews with Indigen-ous cancer patients recruited from two hospitals inQueensland, Australia and focus groups withIndigenous key-informants (from four regionsin Queensland) who had involvement and/orexperience with Indigenous cancer patients wereconducted. These discussions were guided by semi-structured questions regarding the appropriateness,cultural acceptability, utility and relevance of eachitem within the supportive care needs survey - shortform34 (SCNS-SF34) for use with Indigenouscancer patients. Participants were also encouragedto suggest any additional items that they felt wereimportant to the supportive care needs of Indigen-



DOI: 10.1002/pon

ous cancer patients. RESULTS: Indigenous pa-tients (n5 30), mainly women (63%), with a meanage of 53 years, resided in accessible areas (59%)and had mostly gynecological (30%) and lung(23%) cancers. Key informants (n5 24), mostlywomen (62%), had a mean age of 44; 44% lived inaccessible areas and 42% were health workers.Participants’ consensus resulted in all items of theSCNS-SF34 being changed to use Indigenousfriendly language (e.g. ‘anxiety’ replaced with‘worry’). Seven items were omitted due to culturalinappropriateness (e.g. item on death) andtwelve were added (e.g. having transport).The sexual items were made optional due topolarization about appropriateness/importance.CONCLUSIONS: This is the first Australian studyto explore the supportive care needs of IndigenousAustralians with cancer and how these needs aremeasured. This study found that Indigenous cancerpatients have language differences and specificneeds that are not accommodated within thestandard SCNS-SF34 tool and necessary amend-ments to the tool were made. RESEARCHIMPLICATIONS: Our results highlight the lackof validity of the SCNS-SF34 to effectively measurethe full range of needs of Indigenous cancerpatients in a culturally sensitive manner. Ourmodified Indigenous-specific survey addresses ac-ceptability, language and cultural issues and isrecommended as the preferred tool for use in futurestudies of Australian Indigenous patients withcancer. CLINICAL IMPLICATIONS: Optimalmanagement and care of Indigenous cancerpatients is a significant public health issue. Ournewly developed Indigenous-specific survey willallow clinicians to screen for supportive careneeds that are specific to Indigenous cancerpatients. By identifying the full range ofpatient’s support needs, cancer care cliniciansand support services will be able to moreappropriately help Indigenous cancer patientsand thus optimize the standard of care providedto this group. ACKNOWLEDGEMENT OFFUNDING: This project was supported underAustralian Research Council’s IndigenousDiscovery Projects funding scheme (ARCDO1989086). PC Valery was supported by anAustralian Research Council Future Fellowship(FT100100511).

P1-66

Cancer Worry Scale: A Screening Instrument for

Fear of Cancer Recurrence

Jose Custers1, Sanne van den Berg1, Hanneke vanLaarhoven2, Eveline Bleiker3, Marieke Gielissen1,Judith Prins11Radboud University Nijmegen Medical Centre,Department of Medical Psychology, Nijmegen, TheNetherlands, 2Radboud University Nijmegen Medi-

cal Centre, Department of Medical Oncology,Nijmegen, The Netherlands, 3The NetherlandsCancer Institute, Amsterdam, Division of Psychoso-cial Research and Epidemiology, Amsterdam, TheNetherlands

BACKGROUND: Fear of cancer recurrence(FCR) is a normal and common concern forcancer survivors who have completed treatmentand are in remission. Even though FCR appears tobe universal, some survivors report fear that iscontinually and excessively elevated and becomesso overwhelming that they have difficulties inperforming daily activities. Adequate care shouldbe given to these patients. However, to identifysurvivors with a dysfunctional level of FCR, a validscreening instrument is needed. METHOD: TheCancer Worry Scale (CWS) is an 8-item instrument(score 8–32) used to measure worry about the riskof developing cancer among individuals at risk forhereditary cancer. In this study the CWS will beinvestigated in breast cancer survivors withouthereditary risk. Women filled out the CWS, twoquestions of the Cancer Acceptance Scale (CAS),questionnaires on empowerment and fatigue.ROC-analysis determined the optimal cut-off pointfor the CWS indicating excessive FCR (CWSversus CAS). Sensitivity, specificity, positive pre-dictive value(PPV) and negative predictive value(NPV) were calculated. Internal consistency, con-vergent and divergent validity were measured.RESULTS: 197 breast cancer survivors returnedthe questionnaires (63% response). Women were57.4 (sd 10.2) years old and mean time sincesurgery was 4.78 (sd 2.5) years. Based on the ROCcurve, the cut-off point was 13 vs 14, withsensitivity of 77%, specificity of 81%, PPV of73% and NPV of 84%. In 80% of the cases therewas agreement between the CWS and the CASconcerning the presence or absence of FCR.Internal consistency was .88. Convergent validity:strong association with the CAS (r5 0.75,po0.001) and moderate association with fatigue(r5 .034, po.001). Divergent validity: weak nega-tive association with empowerment (r5�.019,po0.001). CONCLUSIONS: Overall, this studysupports the reliability and validity of the CWSused in breast cancer survivors. The CWS showedsatisfactory discriminatory power relative to theCAS, indicating that it is an appropriate screeninginstrument to identify those women who experiencesevere levels of FCR with a cut-off point of 13 vs14. RESEARCH IMPLICATIONS: Until now thespecific nature and cognitive mechanisms for FCRare unknown. In spite of the numerous reports ofFCR among clinicians and cancer survivors, therehave been only few studies on this phenomenon.This may be at least partly explained by thecomplexity and the heterogeneity of FCR. TheCWS can identify patients with elevated levels of



DOI: 10.1002/pon

fear, which makes it possible to focus futureresearch on the mechanisms involved in FCR.CLINICAL IMPLICATIONS: The CWSappears to be a short, valid screening instrument.By using the CWS in routine oncology care,structural attention can be given to FCR.Survivors with elevated levels of FCR can beidentified and given adequate psychosocial care.ACKNOWLEDGEMENT OF FUNDING:None.

P1-67

The Mini-MAC Scale: Re-Analysis of Its Psycho-

metric Properties in a Sample of 160 Mixed Cancer

Patients

Nick Hulbert-Williams1, Lee Hulbert-Williams2, Val Morrison3, Richard Neal4, ClareWilkinson41University of Chester, Chester, UK, 2University ofWolverhampton, Wolverhampton, UK, 3BangorUniversity, Bangor, UK, 4Cardiff University, NorthWales Clinical School, Wrexham, UKBACKGROUND: The mini-MAC is designed toassess psychological responses to cancer diagnosisand is widely used in research and clinical practice.Recent evidence demonstrates adequate convergentvalidity, but inconsistent internal consistency andfactor structure. This study aimed to provide aparsimonious factor structure with clinical utility.METHOD: Repeated measures data were collectedfrom 160 cancer patients (mixed illness type) atdiagnosis and three-month follow-up. Principleaxis factoring (PAF) with oblimin rotation wasused. The number of factors was decided usingparallel analysis (PA). The resultant factors werecompared against the recommended five-factorstructure on internal consistency (Cronbach’salpha) and test-retest reliability and convergentvalidity (Pearson’s correlation). RESULTS: PAsuggested that a four-factor model optimally fitsthese data. Two of these—cognitive avoidance andfighting spirit—are equivalent to the originalfactor structure. Redistribution of the remainingitems resulted in factors of cognitive distress andemotional distress. Internal consistency and test-retest reliability of the new four-factor structure areequivalent, but convergent validity is much im-proved overall when compared to a 5-factorstructure, with the exception of the fighting spiritfactor. CONCLUSIONS: The revised four-factorstructure represents a more psychometrically soundmeasure of psychological adjustment in the currentdataset. Findings related to the larger cognitivedistress factor are congruent with data fromforeign-language validation studies. The brevityof this improved measure may make it easier toadminister in the clinical setting. RESEARCHIMPLICATIONS: Differing factor structuresemerging from various empirical psychometric

analysis of this scale evidences the need for cautionwhen scoring data according to the author’soriginal subscales. Further development, includingconfirmatory factor analytical approaches, anddevelopment of the fighting spirit subscales areessential areas of further research. CLINICALIMPLICATIONS: Measures such as the mini-MAC can be useful in clinical practice for thepurposes of charting adjustment over time; risk-stratifying potentially distressed patient cohorts; inplanning new clinical interventions; and, inassessing the effectiveness of clinical interventions.Their use must, however, be predicated by thedevelopment of such tools into highly valid andreliable scales. The mini-MAC does not yet per-form optimally and it should be used withdue caution until further data are available.ACKNOWLEDGEMENT OF FUNDING: Datacollection for this study was supported by a smallgrant from the North Wales Research Committee.

P1-68

How to Reach a Correct Diagnosis of Depressive

Disorder in Breast Cancer Patients: A Comparison

Study Between Different Criteria and Instruments in

Psycho-Oncology

Marinella Linardos, Stefania Carnevale, RiccardoMasettiCatholic University, Rome, Italy

BACKGROUND: depressive disorders in cancerpatients are often misinterpreted and untreatedbecause of the lack of a common definition andcommon criteria and instruments for the diagnosisof a clinical depression. The aim of the study is todemonstrate how the use of multiple criteria andinstruments can help to detect depressive disordersin all clinical and sub-clinical manifestations.METHOD: ninety-two persons, previously sub-mitted to surgery for breast cancer, are included inthis study. The sample is homogeneous for somaticand psychic conditions and phase of medicaltherapies. The somatic elegibility criteria includeall types of breast cancer exept stage IV. Thepsychic elegibiliy criteria exclude the psychiatricdiagnosis of bipolar disorder and psychosis. Adepressive disorder was diagnosed using theDiagnostic and Statistical Manual of MentalDisorders (DSM-IV), the Psycodynamic Diagnos-tic Manual (PDM)and the Beck Depression IIInventory. RESULTS: The study has combineddescriptive, structural and scale criteria using bothclinical interview and self report scale instrument.The descriptive and categorial criteria of the DSM-IV intercept 33% of the clinical sample with clinicalevidence of depressive disorder. The structuralcriterion of PDM describes 42 % of patients withintrojective personality and 58% of patients withanaclitic personality. The Beck Inventory shows a



DOI: 10.1002/pon

very high percentage of depressive disorders. The87% of the sample is over the cut-off of depression.CONCLUSIONS: This study indicates that theexclusive use of categorial instruments as the DSM-IV can not detecte all the forms of depressivedisorder in cancer patients, specially the frequentoligosymptomatic or momosymptomatic forms ofdepression. it can depens on the difficulty todistinguish the somatic side of depression fromthe specific mental condition of depression, bothrelated to illness condition. The self report scalescores show a major deepness in the disordersassessment, putting in evidence the prevalence ofdepressive feeling instead of depressive symptoms.RESEARCH IMPLICATIONS: The standardcriteria use and the depressive disorders definitionare the pre-requisitions for the psychopathologicalresearch in cancer patients. Define and clearlyexpress the used criteria and instruments is the firststep for scientific diagnosis and the necessarycondition to integrate empiric research with clinicalexperience. CLINICAL IMPLICATIONS: Clini-cal implications are related to the treatment ofdepressive disorders in cancer patients. There is awell known risk that general symptoms as asthenia,insomnia, lack of concetntration may be confusedas consequences of the neoplastic disease and notas a specific way of self interpretation of medicalconditions. ACKNOWLEDGEMENT OFFUNDING: This study was supported thanks toa grant of the Italian affiliate of Susan G. Komenfor the cure.

P1-69

How Common are Symptoms of Depression in the

General Cancer Population? Results from an Ethni-

cally Diverse British Population

Alex J Mitchell, Karen Lord, Paul SymondsUniversity of Leicester, Leicestershire, UK

BACKGROUND: There has been much researchon the syndrome of depression, but little on thesymptoms of depression. It is not clear whichsymptoms of depression are most common andwhich are least common. Further it is not clear ifcore symptoms or somatic symptoms are particu-larly common. METHOD: We analysed datacollected from Leicester Cancer Centre from2008–2010 involving approximately 1000 peopleapproached by a research nurse and two therapeu-tic radiographers. Of those approached we col-lected data on 738 presentations, that is people seenup to three times over 9 months during treatmentfor cancer. We had complete data on symptoms in558 contacts. We examined symptoms using thePatient Health Questionnaire (PHQ9) list of 9DSMIV symptoms RESULTS: 96.5% have somesymptoms, 54.1% have at least one significantsymptom. In ranked order the most common

symptoms were: Feeling tired or having littleenergy (35.8%), trouble falling or staying asleepor sleeping too much (31.0%), poor appetite orovereating (27.2%), little interest or pleasure indoing things (15.6%), feeling down depressed orhopeless (15.1%), trouble concentrating on thingssuch as reading (14.9%), moving or speakingslowly (12.7%), feeling bad about yourself or thatyou are a failure (12.2%) and thoughts thatwould be better off dead (2.2%). One of twocore symptoms of depression occurred in 23%.CONCLUSIONS: Clinically significant symptomsof depression occur in more than half of randomlyselected cancer patients. Core symptoms occur innearly a quarter. RESEARCH IMPLICATIONS:The threshold for clinically significant symptoms iscurrent based on frequency but could be re-examined using burden or distress. Further workcomparing depression in cancer patients vs healthcontrols vs other disorders is urgently needed.CLINICAL IMPLICATIONS: Symptoms of de-pression are suprisingly common after cancer.Somatic symptoms are in the top three mostcommon symptoms. ACKNOWLEDGEMENTOF FUNDING: Dr Alex Mitchell in consultantin psycho-oncology in Leicester (UK), author ofwww.psycho-oncology.info and ‘‘Screening forDepression in Clinical Practice’’ OUP ISBN10:0195380193

P1-70

Validation of the Clinical Significance Criterion of

DSM-V Major Depression: How Often Does

Depression Feature Distress or Dysfunction in

Cancer Patients?


BACKGROUND: There is debate about theimportance of the ‘‘clinical significance criterion’’suggested in DSMIV for major depression as wellas GAD, PTSD. The criteria are that ‘‘symptomscause clinically important distress or impair work,social or personal functioning.’’ We aimed to testthe relevance of this criterion in the context ofcancer with a view to informing DSM-V criteria.METHOD: We analysed data collected fromLeicester Cancer Centre from 2008–2010 involvingapproximately 600 people approached by a re-search nurse and two therapeutic radiographers.The researcher asked patients to self-complete thePHQ9. We collated full data on 558 presentationsassessed for major depression. Distress was mea-sured by the distress thermometer; dysfunction wasmeasured using the question ‘‘How difficult havethese problems made it for you to do your work,take care of things at home, or get along with otherpeople? And used a scale ‘‘Not difficult at allSomewhat Difficult Very Difficult Extremely Diffi-



DOI: 10.1002/pon

cult’’. RESULTS: Without taking into account lowfunction and distress, of 558 presentations therewere 72 (12.1%) people with qualifying symptomsof major depression. 7 people with major depres-sion had unimpaired function; 9 people had nosignificant (or minimal) distress (o4 on DT). Only1 person (1.4%) had neither distress or dysfunctionthus only 1 case would not qualify on symptomsalone. 56/72 (77.8%) with major depression hadboth distress and dysfunction. CONCLUSIONS:The clinical significance criterion of ‘‘distress ORdysfunction’’ appears to have a negligible role inthe diagnosis. Major depression could be re-conceptualized as symptoms of depression plusboth distress and impaired function. Minor depres-sion could be re-conceptualized as symptoms ofdepression plus either distress or impairedfunction. RESEARCH IMPLICATIONS: Therole of the clinical significance criterion inDSMV should be re-examined. This is the firststudy to do so in a cancer setting. CLINICALIMPLICATIONS: Nearly everyone with qualify-ing symptoms of major depression has eitherdistress or dyfunction and 4 out of 5 have both.ACKNOWLEDGEMENT OF FUNDING: HopeAgainst Cancer (UK).

P1-71

Towards a New Definition of MDD Following

Cancer: A Fundamental Re-Examination of Symp-

toms for DSMV


BACKGROUND: There has never been a satis-factory empirical examination of the symptoms ofmajor depressive disorder (MDD) suggested byDSMIV. There is an assumption that the coreconcept of depression following cancer is the sameas primary depression. METHOD: We analyseddata collected from Leicester Cancer Centre from2008–2010 approached by a research nurse and twotherapeutic radiographers. We collected data on533 presentations, that is people seen up to threetimes over 9 months during treatment for cancer.We attempted to redefine MDD based on the coreconcept of low mood plus distress plus loss offunction (impairment). The latter can be regardedas modified clinical significance criteria. We exam-ined an item bank of 52 symptoms taken from theHADS, MINI-MAC and PHQ9. RESULTS: Fromthe item bank, the top five symptoms that clusteredmost closely with our new definition of MDD were:Feeling down depressed or hopeless; I get suddenfeelings of panic; Poor appetite or overeating; I feelcheerful; and I can sit at ease and feel relaxed. Thetop three symptoms alone had 83% sensitivity and98% specificity (LR150 LR- 0.17) again thisconcept. CONCLUSIONS: Three simple questions

may be a proxy for a redefined definition ofMDD. However further work using RASCHanalysis may help refine results. RESEARCHIMPLICATIONS: More work needs to be doneto re-examine the concept of MDD in cancerwithout pre-existing concepts. Validation of thenew MDD complex requires longitudinal follow-up. CLINICAL IMPLICATIONS: Low moodtogether with distress and impairment may be afundamental, simplified version of MDD thatrequires further study, and yet remains simple toassess clinically. ACKNOWLEDGEMENT OFFUNDING: Hope Against Cancer (UK).

P1-72

Reading as a Therapeutic Tool

Anne MollerDanish Cancer Society, Roskilde, Denmark

BACKGROUND: As a supplement to otheractions a ‘‘Reading Group’’ is started last year.The group is offered to patients who do not want atraditional therapeutic class, and has raised thequestion: Can patients have the support andtherapeutic effect through a reading group as ifthey have been in a therapeutic group? Patientshave asked for an offer with social interaction andintellectual challenges. METHOD: The group isintended for cancer patients and is open toapproach. Entrance to the group is interest inliterature, the joy of reading books and a desire todiscuss the experience with others. The group hasexisted for 1 year. They meet 1 time per month, theleader is a volunteer with clinical psychiatricexperience. In order to answer my question I havemade participant observation, interviewed projectmanager and group participants. One participanthas been in a therapeutic group. RESULTS: As thereading group has a common frame of reference,being a cancer patient, it allows to bring the diseaseunderstanding and existential considerations inplay. Highlighted as one of the great qualities isthat it’s not basically the individual perspectivethere is discussed, although handling problemswith living with illness and communication withfamily and friends often is debated. Existential anddisease themes with a universal starting point arefrequently discussed. Some patients have difficultycontaining the disease. Through reading anddiscussion in relation to concrete topics make themfeel relieved and give new perspectives on theirsituation. CONCLUSIONS: The group provides anew approach to interaction with others. Partici-pants perceive it as positive that there is somethingtangible to relate to. Participating in this groupprovides content in everyday life and a sense ofnormality, they get something in an intellectual andpersonal level. Participants experience they men-tally are recharged through an understanding of



DOI: 10.1002/pon

others’ problems in a comfortable setting withoutdisclosing themselves. Many patients will benefit inthe same way as in a traditional group, others willwant to be there for the reading experience butanyhow benefit from the interaction in the group.CLINICAL IMPLICATIONS: Many patients findtherapeutic groups too challenging. A readinggroup gives contact to other people, it’s intellectualchallenging and raises existential topics. Evenvery sick patients participate and contribute.It helps to make it easier to bear relapse and focuson using life well and face the future whatever itmay bring. The offer is restricted to patients wholike to read and are interested in literature.ACKNOWLEDGEMENT OF FUNDING:None.

P1-73

The Psychometric Properties of WHOQOL-Brief

on Variety of Turkish Cancer Patients

Ozen Onen Sertoz1, Burc-ak Karaca2, MustafaGul2, Hayriye Elbi1, Erhan Eser3, Ruchan Uslu2,Meltem Uyar41Ege University School Of Medicine Department ofPsychiatry, Izmir, Turkey, 2Ege University Schoolof Medicine Department of Internal Medicine Disionof Oncology, Tulay Aktas Oncology hospital, Izmir,Turkey, 3Celalbayar University School of MedicineDepartment of Public Health, Manisa, Turkey, 4EgeUniversity School of Medicine Department ofAnesthesiology, Izmir, Turkey

BACKGROUND: Quality of Life measures forpatients in oncology clinical trials have becomecommon. They are usually useful when decidingwhich treatment is preferable when survival ratesare similar. In cancer patients usually EORTCquality of life questionnaire is used. We aimed toevaluate the reliability and construct validity ofWHOQOL-Bref among a group of Turkish cancerpatients. METHOD: The study was performed atTulay Aktas Oncology Hospital, Izmir between 1April and 31 August 2006. Total of 232 (men n: 59,%25.4, women n:173, %74.6, meanage:48.3C11.3) patients were recruited. Reliabilityanalysis were based on internal consistency andtest-retest stability (intraclass correlation coeffi-cient-ICC). For construct validity we used factoranalysis with varimax rotation. RESULTS: 48 of232 patients conducted retest after 15 days frombaseline evaluation. 81.5 percent of the patientswere married, half of them (50.6%) had stage 4disease, half of them had metastasis (49.8%) andhalf of them had breast cancer diagnosis. Cron-bach’s alpha coefficients for 3 subscales exceptphysical subscale were acceptable ranging from0.58 to 0.73. ICC for test-retest scores were againacceptable for 3 subscales except physical subscaleranging from 0.69 to 0.78. The WHOQOL-Bref did

not show satisfactory construct validity. Factoranalysis suggested the presence of 7 factors in theWHOQOL-Bref. CONCLUSIONS: WHOQOL-Bref could be accepted as a reliable scale inevaluating global quality of life in cancer patients.The test retest results showed that the questions ofphysical subscale were not reliable. The scale wasnot sensitive to physical health changes related tocancer. Overall WHOQOL-BREF could be appliedto cancer patients, but it does not give informationabout health related quality of life. Therefore,clinicians and researches should carefullydefine their research questions and should choosethe appropriate quality of life instrument.ACKNOWLEDGEMENT OF FUNDING:None.

P1-74

Assessment of Body Image and Sexual Adjustment

in Breast Cancer Patients

Elvan Ozalp, Ersin Hatice Karslioglu, SemraUlusoy Kaymak, Eylem Sahin Cankurtaran, ResitEkinci, Murat Oguz, Haldun SoygurAnkara Oncology Training and Research Hospital,Ankara, Turkey

BACKGROUND: Disturbances in sexuality andbody image are common among women withbreast cancer. However, there are a few scalesdesigned specifically for body image and sexualityin this group of patients. Our purpose was to assessthe body image and sexual adjustment in breastcancer patients by using Sexual Adjustment andBody Image Scale (SABIS) and compare with ahealthy group. The SABIS consists of two separatescales, each of which divides further subscales.METHOD: Fifty-four women diagnosed withprimary breast cancer and 26 healthy women ascontrol group constituted our series. Patients’records were retrieved from the archive in Oncol-ogy Training and Research Hospital, Ankara,Turkey. For the current study, demographic dataof the participants were collected either from theirmedical records or by filling out data acquisitionforms during the interviews. Then, they completedthe SABIS besides some other measures ofpsychological and psychosocial functioning. Datawere analysed for any statistically meaningfulrelationship among the variables considered.RESULTS: The average ages of patients andcontrol groups were 46.3 and 42, respectively.89% of patients were married, while six weredivorced. While the variables including occupation,degree of education and menopausal state slightlydiffered between patient and control groups, othervariables including marital status, being insured,income, tobacco usage, and accompanyingpyschiatric conditions showed any statisticallymeaningful differences. In addition, although not



DOI: 10.1002/pon

very strong, there were some degree of negativecorrelations between HADS total -Sexual Adjust-ment and Body Image Scale, SABIS Body ImageScale - Body Cathexis Scale (BCS), SABIS SexualAdjustment Scale - Arizona Sexual ExperiencesScale. CONCLUSIONS: According to one pre-vious study and our results, we think that theSABIS is an appropriate scale in assessment ofboth body image perception and sexual adjust-ment. RESEARCH IMPLICATIONS: Distur-bances in body image and sexuality in womenrecovering from breast cancer may interfere thequality of life. In our study, we observed that manypatients worried reporting disturbances in bodyimage and sexuality due to embarrassment andthey belived that their physical illness should be themain priority. This may shade the impacts of theorgan loss in sexual functioning and quality of life.Therefore studies are needed to deal with this issue.CLINICAL IMPLICATIONS: The SABIS mightbe a quick self-report screening tool for theidentification of disturbances in sexuality and bodyimage in breast cancer patients following surgery.ACKNOWLEDGEMENT OF FUNDING:None.

P1-75

Portuguese Validation of the Impact of Event Scale-

Revised (IES-R) in Adult Children of Cancer

Patients

Maria da Grac-a Pereira, Ricardo J. TeixeiraUniversity of Minho, School of Psychology, Braga,Portugal

BACKGROUND: The relatives of cancer patients,particularly adult children, may face cancer and itstreatments as a traumatic experience, developingpsychological symptoms consistent with traumaticstress (Ribeiro, 2004). Research on PTSD showthat the IES-R (Weiss & Marmar, 1997), a measureof intrusion, avoidance and hyperarousal, is as avalid measure of PTSD symptoms in adult childrenof cancer patients (Mosher & Danoff-Burg, 2005).This study presents a Portuguese validation of theIES-R in this population. METHOD: A sample of214 adult children of patients receiving chemother-apy completed the IES-R, focusing on the experi-ence of caring for their ill parent (74% women).Participants were recruited from three centralhospitals in northern Portugal. Pearson correla-tions between the subscales and the total score, aswell as internal consistency, were measured. Toassess the construct validity of the IES-R in thesample, a principal components analysis (PCA)was performed on the 22 items of the scale. As anindication of potential PTSD, a cut-off score of 33was used (Creamer et al., 2003). RESULTS:Pearson correlations between the subscales andthe total score were high (po.001), and Cronbach’s

alphas showed that the Portuguese version of theIES-R has good internal consistency: intru-sion5 .74, avoidance5 .70, hyperarousal5 .93,and total score5 .93. The PCA was performedusing an orthogonal rotation with a 3-factor forcedsolution, in accordance with the theoretical struc-ture of the IES-R. The solution explained 57% ofthe variance. Using the cut-off score, 86 partici-pants had a result above 33, indicating thepotential presence of PTSD in a significantproportion (40.2%) of adult children in a parentalcancer situation, especially in women (po.05).CONCLUSIONS: The Portuguese IES-R seemsto be a reliable measure for PTSD symptoms in thepresent sample. The alphas (after PCA) rangingfrom 70. to .93, are comparable with the findings ofprevious validation studies. Although controver-sial, the use of a cut-off point may be useful inexplaining and understanding PTSD symptoms inspecific populations, such as adult children ofcancer patients undergoing treatment.RESEARCH IMPLICATIONS: This validatedPortuguese version of the IES-R is now availableto researchers and clinicians. Future studies shoulduse the IES-R with other caregiver samples,addressing this factor structure and cut-offpoint for comparison and psychometricsupport. CLINICAL IMPLICATIONS: Thefact that there seems to be a higher incidenceof PTSD symptoms in women is importantand should not be neglected, since psychologicalinterventions may, as a result, be directed tomore specific components of PTSD in thispopulation. ACKNOWLEDGEMENT OFFUNDING: This work was supported by agrant from the Foundation for Science andTechnology.

P1-76

Psychometric Properties of the Portuguese Version

of the Posttraumatic Growth Inventory (PTGI) in

Adult Children of Cancer Patients


BACKGROUND: Recent studies have shown thatboth patients and their families can find benefit inthe challenges associated with cancer (Kim et al.,2007). Evidence suggests that the experiencesrelated to cancer may trigger personal growth,not only in patients but also in spouses andchildren (Mosher et al., 2006). This study validatedthe PTGI on a sample of adult children caregiversof cancer patients. METHOD: The sample con-sisted of 214 participants (74% women), all adultchildren of patients receiving chemotherapy, thatcompleted the PTGI focusing on the experience ofcaring for their ill parent. Pearson correlations



DOI: 10.1002/pon

between the subscales and the total score, as well asinternal consistency, were measured. To explorethe factor structure of the Portuguese PTGI, aprincipal components analysis (PCA) with varimaxrotation on the 21 items was conducted, inaccordance with the theoretical structure of theoriginal PTGI. RESULTS: All five subscales ofPTGI were significantly related to each other(po.001). The solution, which explained 68% ofthe variance, showed the following alphas forsubscales: Relating to Others (a5 .87; 6 items);New Possibilities (a5 .85; 5 items); PersonalStrength (a5 .84; 5 items), Spiritual Change(a5 .69; 2 items); Appreciation of Life (a5 .62; 3items) and Total instrument (a5 .94). There weresignificant gender differences in the PTGI (totaland subscales) (po.05), with women revealingmore PTG. Significant positive correlations werefound (po.01) between PTG and a higher level ofdependency of the parent with cancer. CONCLU-SIONS: Many family members, including adultchildren, report experiencing personal growth fromproviding care to their relative with cancer (Mosheret al., 2006). The Portuguese version of PTGIdemonstrated adequate psychometric propertieswith two subscales showing lower alphas than theoriginal version i.e. Spiritual Change (.69 vs. .85)and Appreciation of Life (.62 vs. .67). The presentresults seem to confirm the data of Calhoun andTedeschi (1999) that the strong commitment to astressor (caring for a more dependent parent)facilitates PTG. The upper levels of PTG reportedby women are also supported by scientificliterature (Vishnevsky et al., 2010). RESEARCHIMPLICATIONS: The Portuguese version of thePTGI is now available to researchers. The sub-scales with the lowest alphas (present an alphaclose to .70) should be interpreted withcaution. Future studies should use of PTGIwith other caregiver’s samples, in order tosustain more consistently this factor structure.CLINICAL IMPLICATIONS: These findingssuggest that adult children caregivers in aparental cancer context may benefit frominterventions that enhance their ability to acceptand find meaning and personal growth in thecaregiving experience. ACKNOWLEDGEMENTOF FUNDING: This work was supported by agrant from the Foundation for Science andTechnology.

P1-77

Acculturation and Attitudes of Latinos Toward

Hospice: No Relationship After All

Merydawilda ColonRichard Stockton College, Pomona, NJ, USA

BACKGROUND: The study of attitudes ofLatinos toward hospice and acculturation lacks

attention in the literature. This abstract expandsthe limited amount of research findings availableon the relationship of attitudes of Latinos towardhospice and acculturation. It highlights education,income, and previous knowledge about hospice,but not acculturation correlate with attitudestoward hospice of study participants. Attitudes ofLatinos toward hospice, specifically attitudes ofLatinos that may make them receptive to hospicecare are presented. METHOD: Data were collectedthrough English and Spanish self-administeredsurveys with 380 Latinos (Latin American-descent)from various nationalities in New Jersey, UnitedStates of America, who were in attendance at aLatino cultural event. This study used a purposivesample. This sample strategy allowed the research-er to study a small subset of a larger population ofLatinos. The sample represents a cross section ofsocio-economic groups and various nationalities ofLatinos. A $5.00 bill was offered to each partici-pant who completed the questionnaire. RESULTS:Acculturation and attitudes of Latinos towardhospice had no relationship. Education and incomehad a significant correlation with attitudes towardhospice. More than half (57%, n5 207) of parti-cipants did not know the word ‘‘hospice’’ beforethe study. Participants who knew about ‘‘hospice’’had more positive attitudes toward hospice thanthose who did not know about it. Findings showedthat participants who knew about ‘‘hospice’’ had ahigher household income, had more years ofeducation, and were older. Most participantsagreed with informing the patient about a terminalmedical condition, which may indicate receptive-ness to hospice care. CONCLUSIONS: General-ization of findings to all Latinos is not possible.However, these findings are very important becauseprior studies of acculturation and attitudes towardhospice did not control for sociodemographicvariables and, as this study showed, income andeducation were found significant in their relation-ship to attitudes toward hospice while accultura-tion was not. The findings of this study suggest thatthe quantitative measures used to assess attitudestoward hospice and acculturation were appropriatefor the exploratory nature of this study but futureresearch that employs qualitative measures tostudy the relationship between acculturation andattitude of Latinos toward hospice is necessary.RESEARCH IMPLICATIONS: Findings of thisstudy contradict prior findings about the influenceof acculturation on the attitudes of Latinos towardhospice, as in this study acculturation did not havea relationship with attitudes of Latinos towardhospice. Prior knowledge of Latinos about hospice,education, and income correlated significantly withattitudes of Latinos toward hospice. Qualitativeresearch about the value Latinos attribute to theacculturation process in relation to the use ofhospice would be very informative. CLINICAL



DOI: 10.1002/pon

IMPLICATIONS: Clinicians providing end-of-lifecare need to continue developing policies andpractice interventions that reflect the needs ofLatinos. Clinicians need to move past thebelief that until Latinos acculturate they willnot have a positive attitude toward hospice,and actively educate Latinos about hospice.Materials to educate about hospice need tobe in English and Spanish. It is noteworthythat most participants in this study (69.7%)answered the questionnaire in Spanish.ACKNOWLEDGEMENT OF FUNDING:None.

P1-78

Cancer in the Elderly: The Influence of Life Stage on

Psychosocial, Supportive and Informational Needs

Sue Davolls1, Sue Ashley2, Kabir Mohammed2,Maggie Watson2,12The Institute of Cancer Research, Sutton, Surrey,UK, 2The Royal Marsden NHS Foundation Trust,Sutton, Surrey, UK

BACKGROUND: Elderly cancer patients areperceived 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 elderlydiffer from younger patients?; (ii) Is there evidenceduring the year after diagnosis that older patients’psychosocial, supportive and informational needsare being met? METHOD: Using a prospectivequestionnaire design, patients were approached at3 and 9 months following primary diagnosis.Comparisons were between non-seniors (o64)and seniors (465) in the major diagnostics groups(Breast, Colo-rectal, GU, Lung cancers). Assess-ment was made using the Support Care NeedsSurvey and the Information Satisfaction Question-naire. Co-morbidity data were collected using theEORTC QLQ Functional Status sub-scale.Patients with a prognosis of o12 months orinability to complete questionnaires were excluded.RESULTS: 393 patients completed the baselinequestionnaires and recruitment for the follow upis continuing. 189 seniors and 204 non seniors.Gender data: Males5 160, Females5 233.Commonly reported needs across the sample:‘‘psychological support’’ (77%), ‘‘health systemsand information’’ (63%) and ‘‘physical and dailyliving’’ (64%), ‘‘patient care and support’’ (40%)and ‘‘support on sexuality’’ (28%). 44% overallreported a need for easier access to services.CONCLUSIONS: The analysis across the wholecohort highlights several areas of unmet need. Themore commonly reported concerns overall were‘‘fears about cancer spreading’’ (51%), ‘‘concernsabout the worries of those close to you’’ (51%),

‘‘fears about cancer returning’’ (45%) and ‘‘un-certainty about the future’’ (42%). Comparisonsbetween senior/non-senior groups and baseline/follow up will be presented. RESEARCHIMPLICATIONS: Growth in number of oldercancer patients is expected to substantially increasein the future; the numbers are predicted to doubleby 2030. This brings a growing demand forresearch that addresses the specific needs of olderadults with cancer. CLINICAL IMPLICATIONS:The elderly are perceived to be an under-servedgroup but will become the majority user group forcancer services in the future and the above studywill contribute to recommendations that oncologycentres must have clear policies on the psychosocialand supportive care of elderly patients.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is being funded by The Royal Marsden NHSFoundation Charitable Trust

P1-79

Measurement Properties and Validation of Satisfac-

tion Instruments for Adolescents and Young Adults

(AYA) with Cancer or a Blood Disorder, And Their

Nominated Carer

Jane Ewing1, Narelle Smith2, Madeleine King31University of Technology, Sydney, NSW, Austra-lia, 2University of Technology, Sydney, NSW,Australia, 3University of Sydney, Sydney, NSW,Australia

BACKGROUND: Patient satisfaction is an im-portant outcome in cancer and blood disorders.Specific issues may vary with site and stage ofdisease, treatment and patient age. Althoughmeasurement instruments are available, most aredesigned for adults, some for parent satisfactionbut none for adolescents and young adults (AYA)who have special age-specific concerns. Our aimwas to determine whether Varni’s Pediatric Hema-tology/Oncology Parent Satisfaction Survey couldbe adapted as a patient satisfaction survey suitablefor AYA. METHOD: Varni’s Pediatric Hematol-ogy/Oncology Parent Satisfaction Survey wasmodified for AYA then administered to AYA aged16 to 25 years diagnosed with cancer or a blooddisorder. The original survey was administered totheir nominated carer. An additional 13 itemsderived from previous qualitative research com-prised a second part to both instruments. Validityand reliability of the modified AYA version wereassessed with methods used by Varni for theoriginal instrument, including: Principal Compo-nents Analysis (with Varimax rotation), Cron-bach’s alpha and item-scale correlations.Recruitment was from haematology/oncologyclinics and wards at three Sydney MetropolitanHospitals in person or by telephone. RESULTS:Similar to Varni’s original results, Cronbach’s



DOI: 10.1002/pon

alpha for the caregiver/parent total score was 0.96(0.96 in AYA data). Alpha values for the sixdomainscales ranging from 0.86–0.91 in caregiver/parent (0.87–0.92 in AYA data). For the caregiver/parent data, a four factor solution similar toVarni’s accounted for 74% of total variance (versusVarni’s 72%). For the AYA data, a five factorsolution accounted for 75.5% of total variance,with four technical items comprising a fifthfactor. The additional 13 items introduced a sixthfactor in both the caregiver/parent data (74% ofvariance) and AYA data (70% of variance).CONCLUSIONS: The factor structure of theAYA sample was very similar to that of thecaregiver/parent sample and Varni’s sample. Goodinternal consistency was obtained in both versions,making them suitable for both group and individualcomparisons. The new version of AYA patientsatisfaction and carer satisfaction are reliable andvalid measures of patient satisfaction in those aged16–25 years diagnosed with cancer or a blooddisorder. Further modification and testing may beneeded for the additional 13 items prior to finalinclusion of these in the modified version. RE-SEARCH IMPLICATIONS: This instrument formsone of a set of AYA age-appropriate instrumentsemphasising the multidimensional aspect ofcancer care. Collectively, they are expected tofacilitate the flow of information about AYA withcancer and blood disorders between health profes-sionals globally, improve outreach to this under-served population group, and guidance to improveAYA quality of life. CLINICAL IMPLICATIONS:This AYA self-reported satisfaction measure alongwith the other instruments in the set of AYA age-appropriate instruments is expected to help increasethe knowledge of AYA psycho-oncology amongmedical professionals, help unite oncology andmental health professionals, and equip healthprofessionals to better care for AYA and theircarers. ACKNOWLEDGEMENT OF FUNDING:None.

P1-80

Providing Ongoing Support and Education for

Hispanic/Latino Community Health Workers or

Promotores

Haley Justice-GardinerLIVESTRONG, Austin, TX, USA

BACKGROUND: Cancer rates within the UnitedStates (U.S.) Hispanic/Latino population areexpected by increase by 142% by 2050. With thegrowing incidence of cancer, community-basedoutreach and education through Promotores orHispanic/Latino Community Health Workers isincreasingly important. Since 2006, LIVES-TRONG has trained over 500 Promotores acrossthe U.S. METHOD: In 2010, LIVESTRONG

completed a follow-up study evaluating the bestpractices comparison of LIVESTRONG programto other Promotores training programs, analyzedpre and post trainings surveys from previoustrainings, created and implemented a new onlinesurvey for LIVESTRONG trained Promotores (37respondents), conducted five interviews withLIVESTRONG leadership and staff working withthe program, and hosted a focus group with sevenindividuals that had completed the Promotorestraining. RESULTS: Data analysis from pre andpost surveys showed that training participantslearn new information and reported an overallincrease in emotional, physical, and daily con-fidence after trainings. Findings from online surveyrespondents showed Promotores felt the resourceswere helpful. Survey respondents also felt thatnetworking would be the most useful additionalresource the LIVESTRONG could provide to themand 70% would like the opportunity to connectwith other Promotores that have gone through theLIVESTRONG training. CONCLUSIONS: Theresults from the follow-up study yielded importantinformation that has been used to create anadditional support and education program forLIVESTRONG Promotores. This program in-cludes monthly educational webinars, online net-working opportunities with LIVESTRONG andother LIVESTRONG-trained Promotores and aPromotora mentoring program. RESEARCHIMPLICATIONS: Overall, Promotores seek simi-lar support and information as other trained healthcare providers/professionals and this support canlead to a mutually beneficial relationship for thecommunity-based organization, Promotor(a) andtarget population. CLINICAL IMPLICATIONS:As clinicians provide support and resources tocancer survivors, it is critical that they seePromotores as credible sources of information forHispanic/Latinos. They should develop relation-ships with these trusted leadersand work together to serve the community.ACKNOWLEDGEMENT OF FUNDING:None.

P1-81

Does Mental Illness Adversely Prejudice Receipt of

Mammography Screening for Breast Cancer? A

Meta-analysis of Comparative Studies

Alex J Mitchell1,2, Oliver Lord21University of Leicester, Leicestershire, UK,2Leicestershire Partnership Trust, Leicestershire, UK

BACKGROUND: There is growing evidencepeople with mental illness receive inferior qualityof medical care. Recently this finding has beenextended to encompass mass preventive screeningprocedures. We aimed to quantify to what extentmental illness influences receipt of mammography.



DOI: 10.1002/pon

METHOD: We conducted a systematic search,critical appraisal and meta-analysis of valid data.In order to clarify whether mammography is lesscommon in those with a mental health diagnosis weselected only comparative studies against receipt inthose without mental ill health. We faced severalmethodological issues. We included several mentalhealth diagnoses (psychosis, depression, any men-tal illness) but excluded cases of general distress.We attempted to take into account the period ofstudy which would influence results. An extensivesearch identified 38 analyses, once all subgroupswere taken into account. 3 studies containedinadequate data and 9 concerned general distress.RESULTS: We had 29 valid analyses comprising7x psychosis; 14x affective disorder and 8x broadlydefined mental illness. Across all 29 studies peoplewith mental illness were 0.69 (OR; 95% CI5 0.62to 0.77; Po0.0001) as likely to receive equalmammography screening. Across all 7 studiespeople with psychosis were 0.53 (95% CI5 0.43to 0.65 ; Po0.0001) as likely to receive equalmammography screening. Across all 14 studiespeople with affective disorder were 0.82 (95%CI5 0.73 to 0.93; Po0.001) as likely to receiveequal mammography screening. CONCLUSIONS:After adjustment people with mental ill health aresignificantly less likely to receive a screening mammo-gram and the effect is especially pronounced inthose with psychosis (schizophrenia and relateddisorders). RESEARCH IMPLICATIONS: Morework needs to be done to understand why receipt ofscreening is lower in this group. CLINICALIMPLICATIONS: Clinicians, particularly primarycare physicians should ensure patients with mentalillness attend for scheduled mass screening.ACKNOWLEDGEMENT OF FUNDING: None.

P1-82

Cancer-Related Post-Traumatic Stress Symptoms of

Palestinian Breast Cancer Patients and Survivors

from the Gaza Strip - Associations with Non-Cancer

Traumatic Events and Centrality of Event

Robert Zachariae1,2, Bashir AlHajjar3, MajaO’Connor2, Mimi Mehlsen1,21Psychooncology Research Unit, Aarhus UniversityHospital, Aarhus, Denmark, 2Dept. of Psychology,Aarhus University, Aarhus, Denmark, 3Faculty ofNursing, University of Gaza, Gaza, OccupiedPalestinian Territory

BACKGROUND: The aim was to investigatebreast cancer-related post-traumatic stresssymptoms in a sample of Palestinian breast cancerpatients and survivors and to explore the associa-tions with non-cancer traumatic events, e.g.,witnessing war and combat, and centrality ofevent, i.e. the extent to which a memory for astressful event forms a reference point for personal

identity. METHOD: Participants were 489 women(Age:18–68 yrs; response rate:76%) attendingtreatment or control visits for breast cancer (BC)during a 3-month period at the two main depart-ments responsible for treating cancer patients in theGaza Strip. Assessments included: Demographicand disease- and treatment-related factors,BC-related post-traumatic stress symptoms (Im-pact of Events Scale - Revised (IES-R-BC)), themost traumatic non-cancer event (MTNCE),MTNCE-related post-traumatic stress symptoms(IES-R-MTNCE), centrality of event (CES) for BCand MTNCE, and the order in which the BC andMTNCE were experienced. A cohort of 3343Danish women treated for primary breast cancerserved as comparison group. RESULTS: Palesti-nian breast cancer patients and survivors reportedconsiderably higher levels of cancer-related post-traumatic stress symptoms than Danish womenwith comparable disease severity assessed atequivalent time points following their treatment.Hierarchical multivariate regression showed symp-tom severity (IES-R-BC) as independently asso-ciated with several factors, including: a) Havingmetastatic and recurrent cancer, b) having children,c) having been exposed to another non-cancer-related traumatic event (MTNCE), in particularother life-threatening events, d) the severity ofpost-traumatic stress symptoms associated withMTNCE, and e) centrality of both BC and theMTNCE. The final model explained 59% of thevariance in IES-R-BC. CONCLUSIONS: Palesti-nean women report considerably higher levels ofcancer-related post-traumatic stress than Danishwomen with comparable disease severity. Theirdistress associated with other non-cancer events,especially other life-threatening events, and theperceived centrality of such events were importantindependent predictors of cancer-related post-traumatic stress. RESEARCH IMPLICATIONS:Distress associated with non-cancer traumaticevents and the extent to which such events areperceived as central to personal identity appear tobe important risk factors for developing cancer-related post-traumatic stress. The results suggestthat these factors be included when researching riskfactors for cancer-related distress. CLINICALIMPLICATIONS: The high cancer-related post-traumatic stress symptom level experienced byPalestinian women may in part be due to exposureto other non-cancer traumatic experiences, e.g. warand combat and other life-threatening events.Another reason could be uncertainty associatedwith the difficulties in receiving regular screeningand prompt treatment after diagnosis in theoccupied territories. Not only improved screeningand treatment but also psychosocial supportservices for this group of patients are called for.ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P1-83

Discord of Biological and Psychological Measures in

a Group of Depressed African American and White

Cancer Patients

Amy ZhangCase Western Reserve University, Cleveland, OH,USA

BACKGROUND: Existing literature suggests aracial difference in the presentation of depressivesymptoms. Evidence indicates that depressed Afri-can Americans complained more frequently aboutsomatic symptoms and less frequently aboutaffective symptoms than depressed white Amer-icans. This study examined racial differences in theself-report of depressive symptoms by reference tobiological states. METHOD: The study used aconvenience sample of 20 depressed cancer patients(CES-D 16) (15 African Americans and 5 Whites).Subjects completed depression assessment on abattery of psychological measures and providedblood and saliva samples. Laboratory tests wereperformed on biomarkers (serotonin, cortisol andIL-6). T-test was computed to examine racialdifferences on biological and psychological mea-sures. RESULTS: Depressed Whites had a sig-nificantly higher cortisol level than depressedAfrican Americans, but no significant groupdifference was found on any self-reported psycho-logical measures of depression. There was a trendthat African Americans reported fewer depressivesymptoms on psychological measures but exceededWhites on the domain of somatization; however,such group differences did not approach statisticsignificance in this small sample. CONCLUSIONS:African Americans did not appear to underreportdepression in consideration of their biologicalstates, but had a tendency to report more somaticsymptoms than Whites; this may be attributable tonon-depression diseases or reporting behaviorrather than somatic sensitivity. African Americansexhibited more mistrust in the health care system,which could affect the self-report of depression.There is a discord between biological and psycho-logical measures of depression. Biomarkersprove to be useful for evaluating racial differencein the self-report of depression. RESEARCHIMPLICATIONS: Inclusion of biomarkers pro-vides a biological benchmark for studying the selfreport of depression in cancer patients crosscultures. CLINICAL IMPLICATIONS: Consider-ing biomarkers helps improve clinical assessmentof depression for cancer patients with diverseethnic background. ACKNOWLEDGEMENTOF FUNDING: The study was supported by theNational Institutes of Health/National CancerInstitute (R03 CA115191; PI: Zhang) and a smallgrant from the Comprehensive Cancer Center atCase Western Reserve University.

P1-84

What Precipitates Depression in African American

Cancer Patients? Triggers and Stressors

Amy Zhang, Faye Gary, Hui ZhuCase Western Reserve University, Cleveland, OH,USA

BACKGROUND: African Americans have thehighest cancer mortality and shortest survival aftera cancer diagnosis among all ethnic groups in theUnited States. However, the study of depression, asignificant predictor of cancer mortality, is inade-quate for this underserved population. This studyexamined general and cancer-related stressors ofdepression that are unique to African Americancancer patients based on their lived experience.METHOD: The study used cohort design andmixed methods. Seventy-four breast and prostatecancer survivors including 34 depressed and 23non-depressed African Americans and 17 de-pressed Whites were interviewed. Qualitative dataanalysis identified themes. The thematic codes wereconverted to a SPSS dataset numerically. TheFisher’s exact test was performed to examine groupdifferences in the experience of stress. RESULTS:Significantly more depressed African Americansexperienced a dramatic reaction to a cancerdiagnosis (p5 .03) or had concerns about func-tional decline (p5 .01), arguments with relatives orfriends (p5 .02), and unemployment status(p5 .03) than nondepressed African Americanswho reacted to the cancer diagnosis as a matter ofreality (p5 .02). Significantly more depressedAfrican Americans talked about feeling shockedby a cancer diagnosis (p5 .04) and being unable todo things they used to do (p5 .02) than depressedWhites. Qualitative analysis shed light on theextent of such group differences. ConclusionDistress from the initial cancer diagnosis andfunctional decline were likely to have triggered orworsened depression in African Americancancer patients. This study highlighted racialdifferences in this aspect. It is critical to screenAfrican American cancer patients for depression attwo critical junctures: immediately after the dis-closure of a cancer diagnosis and at the onsetof functional decline. This will enhance thechance of prompt diagnosis and treatment ofdepression in this underserved population.RESEARCH IMPLICATIONS: Identifying criti-cal time windows for depression assessment shedslight for future research on how to improvedetection of depression in African Americancancer patients. CLINICAL IMPLICATIONS:The study findings alert clinicians to thetiming of clinical assessment of depression.This helps promote accurate and promptdiagnosis of depression for these patients.ACKNOWLEDGEMENT OF FUNDING: The



DOI: 10.1002/pon

study was supported by the National Institutesof Health/National Cancer Institute (R03CA115191; PI: Zhang) and a small grant fromthe Comprehensive Cancer Center at Case WesternReserve University.

P1-85

Protocol of Psychotherapeutic Workshops for

Cancer Patients and their Relatives

Edurne Austrich, Maricarmen Gonzalez-MaranaHospital Medica Sur, Mexico City, Mexico

BACKGROUND: Cancer constitutes an impor-tant problem of health in Mexico, since it is thesecond cause of mortality in this country. Theaccess of the population to the psychological andpsychiatric treatment is complex due to the logisticsof the health system and that many patients do notcount on the economic resources to receive thisattention. Time-limited group intervention withWorkshops is a more accessible possibility forpatients and their relatives to receive psycho-oncology treatment. METHOD: This paper de-scribes the Psychotherapeutic Workshops Protocol(PWP). The theoretical foundations of the Work-shops are psychoeducation intervention and WorkGroups described by Wilfred Bion.The generalobjectives were to benefit of the quality of life, theunderstanding of the disease and the adaptation, aswell as the therapeutic adhesion. The Protocol hasten sessions, one hour and a half each, with adifferent theme related to cancer adaptation processand a psychoeducative and a psychotherapeuticintervention. RESULTS: The results of the protocolshow that who attend in greater measurement topsychotherapeutic Workshops are women, in thestage of the development of middle adulthood, theattendance is greater and more regular in therelatives of the patients and patients who are notin active treatment, the most frequent disease basedon the attendance to the factories was the breastcancer. CONCLUSIONS: PsychotherapeuticWorkshops constitute a viable alternative for thepsychooncology intervention for the patients withcancer and its relatives in Mexico. Given to thedifficulties and the symptomatology that the treat-ments cause to the patients, other conclusions arethat Psychotherapeutic Workshops with nonsequen-tial sessions and with duration of two hours wouldbe more suitable for this population. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-86

Canadian Professional Navigation and Person-Cen-

tered Approach: Model, Tools and Competencies

Lise Fillion1,2, Sandra Cook3, Anne-MarieVeillette2, Marie de Serres4, Richard Doll5,6,Margaret Fitch7, Michele Aubin1

1University Laval, Faculty of Nursing, Quebec City,Quebec, Canada, 2Equipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soinspalliatifs (ERMOS), Quebec City, Quebec,Canada, 3Cancer Care Nova Scotia, Halifax, NovaScotia, Canada, 4Centre Hospitalier Universitaire deQuebec (CHUQ), Quebec, Quebec City, Quebec,Canada, 5Sociobehavioral Research Center,Vancouver, BC, Canada, 6BC Cancer Agency,Vancouver, BC, Canada, 7Odette Cancer Centre,Toronto, ON, CanadaBACKGROUND: For many cancer control pro-grams, cancer navigation is a crucial component ofimproving continuity and quality of care. However,literature has failed to describe how specificallyprofessional navigation can contribute to person-centered cancer care. A research program con-ducted in Quebec and Nova Scotia has contributedto address this issue in: designing a conceptualframework describing key functions of professionalnavigators; evaluating the implementation of ascreening for distress tool; mapping competenciesand suggesting training. METHOD: Two Cana-dian models of professional navigation, the PivotNurse in Oncology (PNO) in Quebec and, theCancer Patient Navigator (CPN) in Nova Scotiawere selected. A qualitative evaluative design wasused. Qualitative interviews were conducted withprofessional navigators, patients and family mem-bers, front line staff, family physicians, and healthadministrators to define a conceptual frameworkand compare the two models (study 1); additionaldata collections were conducted among the sameactors before and after the implementation of thetool (study 2). Based on these findings, competen-cies and training components of professionalnavigation were described. RESULTS: In study 1,results have contributed to validate the bi-dimen-sional framework of professional navigation. Thefirst dimension, health-system-oriented, refers tocontinuity of care, including informational, man-agement, and relational continuity. The seconddimension, patient-centered, corresponds to em-powerment, including active coping, cancer self-management and supportive care. Key functionsrelated to a person-centered approach were high-lighted. In study 2, impact of using the screeningfor distress tool on person-centered needs’ identi-fication and coping was documented. Finally,relevant competencies and training components tospecific person-centered cancer care were specified.CONCLUSIONS: The framework brings clarityabout key functions of professional navigators thatcontribute to person-centered care (e.g. globalneeds assessment, empowerment); the implementa-tion evaluation points out the importance ofcombining self-report screening tool and clinicalinterview assessment to identify and addressunmet needs; and the competencies/traininganalysis indicates how oncology nurses



DOI: 10.1002/pon

training could be optimized with furthercomponents (e.g., distress management) to defineprofessional cancer navigation role as amodel of continuity and person-centered cancercare. ACKNOWLEDGEMENT OF FUNDING:This research was funded by the Canadian Instituteof Health Research (CIHR), New EmergingTeam Grant, Access to Quality Cancer care(2007–2011) and the Canadian Partnership AgainstCancer Corp., Cancer Journey Action Group(CPACC-CJAG).

P1-87

Models for Peer/Volunteer Navigation Programs

Margaret I. Fitch1, Alison McAndrew1, KittiePang1, Shaun Lorhan2, Tammy Lindahl2, ElaineLedwell3, Judy Applin-Poole31Sunnybrook Odette Cancer Centre, Toronto,ON, Canada, 2British Columbia Cancer Agency,Victoria, BC, Canada, 6Newfoundland LupinPartnership, NL, Canada

BACKGROUND: Interest in cancer patient navi-gation has been growing rapidly. As cancertreatments become more complex and the cancersystem more fragmented, navigation is seen asassisting individuals to overcome barriers in acces-sing relevant information and services. Variousmodels have emerged for navigation - profession-ally led, volunteer or peer led, and virtualapproaches. Our focus is on volunteer or peernavigation and understanding how this type ofprogram can be integrated within the formal cancersystem. METHOD: Three demonstration projectswere undertaken to develop and implement avolunteer/peer navigation program. Navigationwas defined as an intentional intervention to assistindividuals in overcoming barriers to accessingcancer information and services. Each project teamwas expected to design an approach to navigationthat was appropriate for their setting and identifiedgap in service. Ultimately we wanted to explore thesimilarities and differences in the approaches andoutcomes as well as define a common set offunctional competencies for a volunteer/peer navi-gator. RESULTS: The three projects designed andimplemented a volunteer/peer navigation programspecific to their settings. One was designed to assistwomen who live in rural and remote settings, onefor lung cancer patients before they came to acancer centre, and one for Chinese-speaking cancerpatients upon arrival at a cancer centre. Eachprogram was able to recruit individuals who weretrained to serve as navigators. Each project hadexperience in navigating patients in the selectedpopulation. Despite the variation in patient popu-lations (breast, lung, womens’ cancers) and jur-isdictions (Newfoundland, Toronto, Victoria)common challenges, success factors, and outcomes

were evident. CONCLUSIONS: Based on theevaluation data, the following conclusions can bemade: a volunteer/peer navigation program musthave clearly defined goals and role descriptions forits navigators; the goals ought to be directed tofulfilling a clearly identified gap in service delivery;recruitment is apt to require multiple strategies butmust be specific to the actual role the incumbent isexpected to fulfill; and training of volunteers/peersmust be specific to the role expectations and on-going support of the volunteer/peer is essential.RESEARCH IMPLICATIONS: As cancer patientnavigation programs are designed and implemen-ted, careful evaluation is required to determinewhether the programs accomplish their desiredgoals. There is benefit in moving toward compe-tency based roles for volunteer/peers who serve asnavigators. CLINICAL IMPLICATIONS: Volun-teer/peer based navigation programs offer potentialfor supporting patients in a cancer system that isfacing constraints. Careful assessment of gaps inservice can result in opportunities to design avolunteer/peer program to fill that specific gap. Thevolunteers/peers need clear role responsibilities, tobe recruited for the specified role, trained appro-priately for that role, and on-going support oncethe program is running. Such a program can be anexcellent compliment to professional services.ACKNOWLEDGEMENT OF FUNDING: TheNewfoundland and Ontario Projects were fundedby the Public Health Agency of Canada - CancerProgram - Community Capacity Fund and theBritish Columbia project was supported by theCanadian Partnership Against Cancer - CancerJourney Portfolio.

P1-88

Developing a Sustainable Supportive Oncology Care

Model: A College of Social Work, Huntsman

Cancer Institute, and Mongolian National Cancer

Hospital collaboration

Caren Frost1, Shelley White21University of Utah, Salt Lake City, UT, USA,2Huntsman Cancer Institute, Salt Lake City, UT,USA

BACKGROUND: To describe self-sustaining Sup-portive Care programs that could be replicatedthrough collaborative efforts in other countries.METHOD: In this presentation, we will provide anexploratory discussion about the model of Suppor-tive Care developed at Huntsman Cancer Institute.We will examine the literature around supportiveoncology care as it is currently delivered inMongolia. We will also discuss the collaborativepartnership initiated among Huntsman CancerInstitute, the National Cancer Hospital inMongolia, The Huntsman Cancer Foundation,and the University of Utah College of Social



DOI: 10.1002/pon

Work. RESULTS: We will summarize how thistype of model could be used to provide SupportiveOncology Care in other countries like Mongolia.We will also provide training modules that canbe used in training medical social workers.CONCLUSIONS: In a literature search, we foundcalls for this type of model to be developed anddelivered through social work networks; however,we are not aware of anyone publishing a detailedsupportive care model related to internationalpsychosocial care. With the rise in incidence andprevalence of cancer globally, the need for trainedmedical social workers to provide supportive careis also increasing. CLINICAL IMPLICATIONS:This presentation will serve as a collaborativemodel for medical social workers to implementsupportive oncology care internationally in thecontext of their own countries’ needs. It is our hopethat we will be able to connect medical socialworkers from many countries in better servingcancer patients’ psychosocial needs. ACKNOWL-EDGEMENT OF FUNDING: At the writing ofthis abstract, no funding has been obtained.

P1-89

Developing and Integrating a Cancer Rehabilitation

Process in Order to Achieve a Patient Focused and

Coherent Cancer Care at Hallands Hospital Halm-

stad: A Pilot Project

Patrik GoranssonHallands Hospital, Halmstad, Sweden

BACKGROUND: The purpose of this abstract isto present a government funded endeavor to createand integrate a process for cancer rehabilitation,which is equally available to cancer patients andpeople close to them, independent of the type ofcancer and stage of the disease. The processconsists of assessment, consultation, treatmentand follow-up supported by a cancer rehabilitation team, that is available on short notice, atHalland’s hospital Halmstad in the southwest ofSweden. METHOD: The project, that started inthe fall of 2010 and will be evaluated at the end of2012, will:

� define the process

� develop a network of psychosocial contactnurses

� develop a multidisciplinary cancer rehabilita-tion team consisting of physiotherapists,psychologists, dieticians, social workers, andhospital priests

� provide basic education for hospital staff(1000 individuals)

� develop a support system including printedmanuals, routine for supervision, screeningtools and web based guides for hospital staffand for patients.

The project will be evaluated through pre and postquestionnaires among patients, evaluation of edu-cational efforts, focus groups and measurement ofprocess indicators. RESULTS: The aim of theproject is a hospital all-embracing cancer rehabili-tation process that is patient focused and coherent.The process shall be fully integrated in all cancercare processes and all cancer patients receiving careat Halland’s hospital in Halmstad shall have apersonal plan established for their rehabilitationduring and after cancer including physical, psy-chological, social and existential needs. Hospitalstaff working within the field of cancer treatmentshall have knowledge about responding to patientsbasic needs of cancer rehabilitation. Direct accessto a multidisciplinary cancer rehabilitation teamshall be provided for supervision and advancedassessment and treatment. CONCLUSIONS:Within Swedish cancer care adequate resourcesfor cancer rehabilitation are fragmented andunequally distributed. The result of this pilotproject is of national interest as a step to create amodel for integrated and all-embracing cancerrehabilitation. Experiences drawn from the out-come of this project will be used for planningcontinuing development of the cancer rehabilita-tion process. Including primary care and munici-pality-level care into the process while integratingthe process on a regional level could be the naturalnext step of development. RESEARCH IMPLI-CATIONS: To develop and evaluate a workingprocess for cancer rehabilitation has several im-plications for researchers. While there’s agrowing body of research on basic and advancedrehabilitation needs of cancer patients, there’s agap concerning knowledge on how to meet theseneeds within the Swedish healthcare system.There’s a need for research on models for integra-tion of these services local, regional and national,research that should include i.e. psycho-oncology,industrial economics, informational logistics andmore. CLINICAL IMPLICATIONS: Within theSwedish healthcare system there’s a growing insighton how great the needs of cancer rehabilitationservices are among cancer patients. Clinicians andpatient organizations alike are searching forknowledge and support to be able to addressrehabilitation needs of a physical, psychological,social and an existential nature. This presentationwill inspire to think about how to develop andintegrate services to meet these needs whilst thepresenter searches for inspiration from othersexperiences. ACKNOWLEDGEMENT OFFUNDING: None.

P1-90

The Significance of a Specific Psycho-Oncology

Outpatient Service for Cancer Patients Run by

Psychosomatic Medical Doctors



DOI: 10.1002/pon

Atsuko Koyama, Minoru Niki, HiromichiMatsuoka, Ryo Sakamoto, Kiyohiro Sakai,Rikako Jinnai, Kanae YasudaSakai Hospital, Kinki University Faculty ofMedicine, Sakai City, Osaka, Japan

BACKGROUND: Psycho-oncology has been de-veloped by psychiatrists in consultation liaisonfields. The department of psychosomatic medicine,Sakai Hospital, Kinki University Faculty ofMedicine reopened an outpatient service for cancerpatients. The primary aim of this study is to discussthe role of psychosomatic medical doctors incancer treatment and clinical practice, and thesecondary aim is to discuss the significance of thisspecial outpatient service for cancer patients fromthe viewpoint of psycho-oncology. METHOD: Thestudy period was from April 2010 to January 2011.The data of new patients who had symptomsrelated to cancer and visited the specific outpatientservice for psycho-oncology were collected. Allpatients were at least 16 years old. All the itemsassessed during routine clinical practices wereextracted from the patients’ medical charts. Multi-ple factors such as age, sex, cancer site, clinicalsymptoms, the reason for consulting, psychiatricdiagnosis, in which department patients werehaving physical treatment, whether they werehospitalized and whether patients were takingpalliative care therapy were analyzed. RESULTS:The data of fifty-eight new cancer patients,including two family members of cancer patients,were analyzed. The most common psychiatricdisorders were depression, anxiety disorders andadjustment disorders. The reasons for consultationranged from psychological support for receivingbad news, before/after operation and chemother-apy to control delirium. Our department’s psycho-oncological intervention for cancer patients andtheir families involves a combination of psy-chotherapy and pharmacotherapy. Regarding psy-chotherapy, most patients received brief individualsupportive sessions and autogenic training forrelaxing by psychosomatic medical doctors andcounseling by clinical psychologists. As for phar-macotherapy; anxiolytics, antidepressants and hyp-notic drugs were mainly used. CONCLUSIONS:Psychosomatic medical doctors can play an im-portant role in the field of cancer treatmentthrough psycho-oncological activities. Theadvantages of a specific outpatient service forpsycho-oncology are that it can open the door topatients and their families who belong to otherdepartments/hospitals and it can support cancerpatients intensively and efficiently. However, im-provements are needed, particularly relating to thefinancing of the specific outpatient service and itbeing understaffed. Additionally further research isnecessary. RESEARCH IMPLICATIONS: Thisstudy showed the characteristics of cancer patients

who came to our specific outpatient service. Fromthe results of this study, further examination ofbreast cancer patients might be needed since theyconsist of nearly half of the cancer patientpopulation. The study showed the advantages ofpsychosomatic medical doctors’ intervention fromthe viewpoint of psycho-oncology. CLINICALIMPLICATIONS: This study explained the rea-sons why cancer patients visited our specifiedoutpatient service and what kind of psycho-oncological intervention we can provide that isuseful for them. Depending on these results,we can give more efficient support, includingpsychotherapy and pharmacotherapy, to bothcancer patients and their families in the future.ACKNOWLEDGEMENT OF FUNDING: None.

P1-91

Complementary Therapies Profile in Cancer Pa-

tients: Preliminary Data

Concha Leon-Pizarro1, Esther Jovell2, CristinaPalli3, Rosanna Mirapeix4, Tomas Blasco5, AngelsVives4, Maria Lluisa Prior4, Miguel Angel Segui4,Eugeni Saigi4, Jun Lluch31Institut Oncologic del Valles, Sabadell-Terrassa/Barcelona, Spain, 2Recerca, Hospital de Terrassa,Terrassa, Barcelona, Spain, 3Psicooncologia, Hos-pital Trueta, Girona, Spain, 4Hospital Parc Taulı deSabadell, Sabadell, Barcelona, Spain, 5PsicologiaBasica, Universitat Autonoma de Barcelona,Barcelona, Spain

BACKGROUND: A review of the literatureregarding the use of complementary therapies bycancer patients, indicate a large variability, rangingbetween 7 and 91%. Population surveys also showthat a growing number of people are using thesetherapies with conventional treatment. The objec-tive of this study is to know the extent of use ofcomplementary therapies with cancer patients.METHOD: Subjects: Patients with cancer(N5 60), undergoing chemotherapy who attendthe Day Hospital Oncology Service, Hospital ParcTauli of Sabadell.Study period: From January2010 to September 2010. Measurements: Socio-demographic, clinical, type of complementarytreatments, number of treatments and reasons foruse, and patients preferences about health careresources. RESULTS: The most frequent localiza-tion tumor was colon (33%) and breast cancer(32%). 80% of patients did not use complementarytherapies, being the most common cause confi-dence in conventional treatment (40%). 80% of thepatients surveyed would like to receive informationfrom the hospital on these therapies, 75% believethey should be able to receive these treatments inthe hospital and that public health should take careof complementary treatments. Of the 12 (20%)patients who relied on complementary therapies,



DOI: 10.1002/pon

6 used homeopathy. Six of the patients used asingle complementary treatment and 4 patientshad 2 of them combined. CONCLUSIONS:A large majority of people, despite not usingcomplementary therapies, state they are interestedin receiving information from the conventionalmedical services on such therapies and believethat Public Health should pay for the service. Nodifferences were found in the degree of use ofcomplementary therapies in relation to sex.CLINICAL IMPLICATIONS: Asking for the useof complementary therapy in cancer patients wouldhelp Oncology services to identify patients prefer-ences and needs. ACKNOWLEDGEMENT OFFUNDING: None.

P1-92

Exploring Psychosocial Needs When Implementing

New Models of Care: Assessing the Impact of Rapid

Diagnostic Assessment on Uncertainty, Anxiety and

Stress in Patients with Suspected Breast Cancer

Bridgette Lord1,2, Ruth Heisey1, Doris Howell1,21Princess Margaret Hospital, Toronto, ON,Canada, 2University of Toronto, Toronto, ON,Canada

BACKGROUND: In 2010, an estimated 1.3million women worldwide were diagnosed withbreast cancer. New models of care such as rapiddiagnostic clinics have been created to improvediagnostic wait-times. The literature is unclear as tothe effect a rapid diagnostic process may have onpatient uncertainty, stress and anxiety. The aim ofthis study is to compare uncertainty, stress, andanxiety in women undergoing a rapid diagnosticprocess compared to women receiving the standardprocess. METHOD: A sequential mixed-methoddesign with repeated measures will be used toinvestigate uncertainty, stress and anxiety inwomen undergoing a rapid diagnostic process(with a same-day diagnosis), compared withwomen undergoing the standard investigationalapproach (with a delay in diagnosis of severaldays). Data will be collected at three time points:pre-diagnosis, three days post-diagnosis, and threeweeks post-diagnosis. Uncertainty, stress andanxiety will be measured using: the Mishel Un-certainty in Illness Scale, the Spielberger StateAnxiety Inventory, and the Stanford Acute StressReaction Questionnaire. A qualitative-descriptiveexploration of women’s perceptions of their ex-perience of diagnosis will also be conducted.RESULTS: This study is on-going and up-to-dateresults will be presented at the symposium.CONCLUSIONS: This pilot study will help toassess whether uncertainty, stress and anxiety canbe successfully compared in women undergoing arapid diagnostic process versus the standardinvestigational approach. Women’s perceptions of

their experience of diagnosis will also be presented.RESEARCH IMPLICATIONS: This pilot studywill serve as a feasibility study to assess whetheruncertainty, stress and anxiety can be successfullymeasured and compared in patients undergoing arapid diagnostic process versus the standardprocess for investigation of a suspicious breastabnormality. This information will provide insightinto whether an rapid diagnostic breast process canimprove the diagnostic experience for women.The results may or may not support proceedingwith a similar, larger scale study. CLINICALIMPLICATIONS: This study will help to explorewhether or not women going through a rapiddiagnostic process experience uncertainty, stressand anxiety differently compared to those goingthrough the standard process. The informationgleaned will help clinicians to further understandthe diagnostic process for women with suspectedbreast cancer. By understand the diagnosticprocess the psychosocial needs of womenwith suspected breast cancer can be betteraddressed and met. ACKNOWLEDGEMENTOF FUNDING: Funding for this study wasprovided by the Research in Oncology PracticeScholarship Scheme administered by the Bloom-berg Faculty of Nursing, University of Toronto.

P1-93

Suicide Prevention for Home Care Patients

Wadih Rhondali1,2, Jacques Bagur3, Pierre Saltel4,Marc Magnet5, Jean-Louis Terra3, MarileneFilbet21U.T. M.D. Anderson, Houston, TX, USA,2Hospices Civils de Lyon, Lyon, France, 3CentreHospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France, 4Centre Leon Berard, Lyon,France, 5Soins et Sante, Lyon, France

BACKGROUND: Certification of health carefacilities is an independent evaluation procedurefor all its operations and its practices. Within thisframework, a team of home care has asked us tohelp them thinking about a specific point of theircertification process, suicide prevention. 67 % ofpatients under home care are cancer patients withhalf of them that are palliative care patients.Aim:Develop a strategy for evaluation and man-agement of suicide risk in home care. METHOD:Our methodology is based on the achievement of aliterature review and the development of aflowchart by a working group. For the literaturereview, we searched MEDLINE and BDSPdatabases. A working group was formed compris-ing four psychiatrists, a psychologist, a medicalcoordinator of the home care network and apalliative care physician. The proposalsof the working group were compared with litera-ture data. RESULTS: Fifty items were selected,



DOI: 10.1002/pon

analyzed and discussed individually. Asummary was prepared and submitted to theworking group. After several meetings, thegroup was able to define a strategy for evaluationand management of suicide risk in theform of a flowchart adapted to the home careressources and practice. CONCLUSIONS: Thehome care team will now test the proposedflowchart (effectiveness and acceptability) as partof professional practices assessment and makesome changes regarding to the first results. Thefinal algorithm will be proposed to all the homecare network in France. Ecouter. Lire phonetique-ment. ACKNOWLEDGEMENT OF FUNDING:None.

P1-94

The Health Facility Closer to Patients and their

Communities: Decentralized Attendance Model for a

Comprehensive Care in Oncology

Maria da Grac-a Garcia Andrade, Silvia MariaSantiagoState University of Campinas, Campinas, SaoPaulo, Brazil

BACKGROUND: The purpose was to capture theperception of patients and health professionalsrelated to treatment conditions and entailmentobserved in an experience of palliative chemother-apy decentralized. This health facility is muchcloser to patients communities and communicationwith health professionals and referral service wasemphasized. The experience was organized to facethe attendance model centralized in specializedfacilities far from patients, which places obstaclesto access the care, producing suffering, mainly inpalliative care. METHOD: Health professionals(doctors, nurses, technicians) and 18 cancerpatients of the decentralized facility were inter-viewed. The approached themes were: meaning ofdecentralization assistance; advantages and disad-vantages perceived; care quality; patients percep-tions of their health condition; relationshipbetween decentralized facility and referral regionalservice. Recommended ethical procedures forqualitative research were observed. The materialwas submitted to the thematic analysis of contentsto capture patients’ and workers’ opinions.RESULTS: The sensible use of the protocols fromthe referral service assured technical quality ofattention delivered in the decentralized service. Itwas also negotiated their support and fluid com-munication. Doctor and nurses considered thework in the decentralized facility rewarding forthe humanization and recognition of patientsand families. Patients related that closeness toworkers and home made treatment morebearable and trustful. There was a perception ofcomfort in a painful phase of illness and life.

CONCLUSIONS: It was shown the enlargementof access to the oncology comprehensive care. Itwas also important the strategic role of therelationship and fluid communication amonghealth professionals from different assistancelevels. It was an important value the life qualityand the entailment enlargement with the healthprofessionals. The humanized access to qualifiedhealth care needs the construction of a closerrelationship between the health teams fromspecialized services and local system allowingsupport to patients, families and health profes-sionals. RESEARCH IMPLICATIONS: Thestudy can guide managers of specialized servicesfor cancer care to build bridges with thecommunities, decentralizing the attendance inorder to have comprehensive and humanizedcare. This experience showed the importance toimprove dialogue between health professionalsand patients and their families and local managers.ACKNOWLEDGEMENT OF FUNDING:None.

P1-95

The Socio-Ecological Model of HRQOL

Kimlin Ashing-GiwaCity of Hope National Medical Center, Duarte, CA,USA

BACKGROUND: As current mounting evidencedirects our attention to examine and addressthe impact of socio-ecological determinants ofhealth outcomes, we are challenged to incorporatethis contextual paradigm into psycho-oncologyresearch and practices. Socio-Ecological ap-proaches investigate persons within contexts,their environments, and the interactions as theyshape life and health outcomes. The concept ofHRQOL and the Contextual Model of HRQOLwere re-examined from both the theoretical andconstruct perspective. METHOD: This examina-tion considered the Contextual Model of HRQOLgeneralizability and utility to comprehensivelyexplain survivorship outcomes among underrepre-sented diverse populations (e.g., ethnic andlinguistic minorities). The Contextual Modelconsiders the cultural and socioecologicalcontexts among cancer patients and survivors.The model contains dimensions that include:socioecological, cultural, demographic, health caresystem, and psychological well-being context, andcancer-related medical factors, general healthand co-morbidity, and health care practices. Toexpand the scope of the model to include broadersocietal and community dimensions, the Socio-Ecological Model of HRQOL was developed.RESULTS: This Model includes sociopolitical,socioeconomic, psychosocial, behavioral, environ-mental, biological, and health system contexts.



DOI: 10.1002/pon

This Model informed by the World HealthOrganization articulates multilevel structural andintermediary social determinants of health out-comes. Structural determinants include the socio-political and demographic context that generateand reinforce social stratification (e.g., ethnicity,gender, age, birthplace, discrimination), and socio-economic context (e.g., income, education, occupa-tion, social class). The intermediary determinants(e.g., psychosocial, behavioral, environmental,biological and health system contexts) furthershape health or disease outcomes. The psychoso-cial, behavioral, environmental, biological andhealth system contexts are themselves multidimen-sional and can be further categorized into domains.CONCLUSIONS: The Socio-Ecological Model isan approach that not only outlines how multiplelevels of influence determine health outcomes butalso emphasizes the interdependence of these levelsand their influence on HRQOL outcomes. Themultiple levels include intrapersonal, interpersonal,institutional, community, and policy. The Socio-Ecological Model of HRQOL offer distinct com-ponents that were integrated to draw attention tothe importance of community/neighborhood char-acteristics (day-to-day strain, environmental factors,resources) and institutional-level influences (e.g.,quality and access to medical care) that impactHRQOL and survivorship outcomes. RESEARCHIMPLICATIONS: The Socio-Ecological Model ofHRQOL attends to the lived experience or day-to-day contexts of the person; therefore, the Modeloffers a person-centered approach to examining howcontextual factors influence health outcomes. Thiscontextual approach to examining and understand-ing psychology addresses some of the challenges andnew opportunities presented by the World HealthOrganization through multi level paradigm thatelucidates the impact of societal, behavioral, social,biological, and environmental factor on survivor-ship outcomes. CLINICAL IMPLICATIONS: Theincreasing appreciation of personal and communityfactors suggests that a socio-ecological approachdeepens our understanding of health and survivor-ship outcomes, and can inform more comprehensivetherapeutics by providing multilevel data thatcomplements clinical and supportive care plans.ACKNOWLEDGEMENT OF FUNDING: None.

P1-96

Assessing the Cancer Screening Behaviours of

Female Healthcare Workers in the University

College Hospital (UCH): Ibadan

Chioma Asuzu, Doris InegbenikiUniversity of Ibdan, Ibadan, Nigeria

BACKGROUND: Cancer screening is a preven-tive measure of identifying cancer very early beforespreading of the disease.It reduces motality rate

arising from the disease. This is a descriptive studyinvestigating factors predicting practice of Paps-mear screening and self breast examination amongfemale health workers in the University CollegeHospital, Ibadan aimed at identifying the cancerscreening behaviours of female as role models forother females as clients. METHOD: A total of twohundred (200) participants were sampled out of1312 women that are working in the UniversityCollege Hospital, Ibadan using systematic randomsampling from the staff list obtained. Leyvavalidated test on cancer awareness and barriers totesting for breast and cervical cancer was revali-dated in different hospital used for the study. Thecoefficient reliability of the instrument was 0.672.The data collected was analyzed using descriptiveand inferential. RESULTS: The female healthworkers that participated in the study were nurses130(65%) doctors 60 (30%) and health technician10(5%). About 160 (80%) have not had pap smeartest while 40(20%) have had pap smear test done.Forty percent of the (15%) of the respondents havescreen for cervical cancer while 40% have screeningfor breast cancer.Findings revealed that indepen-dent variable when taken together significantlypredicted the practice of papsmear screening andself-breast examination (Po0-01).However fear oflossing husband to breast cancer, perceived sus-ceptibility to cancer and breast cancer awarenesssignificantly predicted women practicing of breastself examination (Po0.01). CONCLUSIONS: Thisstudy revealed the screening behaviour of femalehealth workers in the University which is indicatedthat they are not knowledgeable and have poorscreening behaviour. There is need to carry outenlightenment program for the hospital femalehealth staff in UCH and in all the healthinstitutions in the country. Furthermore, theenlightment programme be addressed not only towomen but to their husbands as well as theiropinions are important are important to women.RESEARCH IMPLICATIONS: This studyhas implication for research as it could bereplicated in other centres by researchers.CLINICAL IMPLICATIONS: Clinicians need toknow of some factors predicting the practice ofpapsmear screening and self breast examintionamong women especially women working in thehealth care setting. This is important as publicenlightment will not only be addressed towomen but also to their husband as theiropinions are importnt in decision making.ACKNOWLEDGEMENT OF FUNDING: None.

P1-97

The Influence of Social Support on Hematopoietic

Stem Cell Transplantation Survival: A Systemic

Review of Literature

Sara Beattie1, Sophie Lebel1, Jason Tay1,2



DOI: 10.1002/pon

1University of Ottawa, Ottawa, ON, Canada, 2TheOttawa Hospital Research Institute, Ottawa, ON,Canada

BACKGROUND: Hematopoietic Stem cell Trans-plantation (HSCT) is an intensive and complexintervention used in the management of hematolo-gic malignancies. Social Support (SS) is a complexterm that has been variably used to encompassperceived and objective support, including care-giver presence. SS has been associated with super-ior psychosocial outcomes; however the influenceof SS on HSCT outcomes, including survivalremains unclear. We sought to summarize theliterature on the influence of SS on HSCT survival.METHOD: Medline, EMBASE, Cochrane,CINAHL, and PsycINFO were searched (fromthe start date of each database until 10 March2011) using the following search concepts: 1)HSCT, 2) SS, 3) Caregiver, 4) Survival, and 5)Treatment outcomes. We excluded non-Englishstudies, pediatric studies, and studies that did notreport a survival endpoint. Two reviewers (SB andJT) extracted demographic and outcome data fromrelevant articles using a standardized extractionform and any discrepancies were adjudicated by athird party (SL). Finally, study quality wasassessed using the Newcastle-Ottawa Scale(NOS). RESULTS: We identified 6 relevantstudies: 4 publications, 1 dissertation, and 1abstract. Four studies were retrospective and 2,prospective. Sample size ranged between 92–272with a mean/median patient age between 30–55yrs.The duration of follow-up ranged between 13.3-48months. All studies scored well using the NOS. SSwas measured inconsistently: 3 by retrospectiveinvestigator assessment, 2 as patients’ perceivedsupport, 1 as caregiver presence, and 1 includedcaregiver presence and retrospective investigatorassessment. The 4 published studies and 1 abstractdemonstrate an association between better SS andsurvival. However, the unpublished dissertation,with the largest sample size found no association.CONCLUSIONS: There is a paucity of evidenceexamining SS with HSCT survival. Availablestudies are older, with the most recent publicationin 2005. A heterogeneous group of HSCT patientswere studied with variable follow-up times.Further, covariates were variably considered inHSCT survival analyses. Finally, we suggest thatthere may publication bias, given the negativeunpublished study with the largest sample size.RESEARCH IMPLICATIONS: Future workshould focus on prospectively collected data whilestatistically controlling for a standardized set ofcovariates known to influence survival. SS wasinconsistently defined and measured; future re-search should measure both objective and per-ceived support using standardized and validatedscales. Further, the relative effect of caregiver

presence to other forms of SS on survival remainsunclear. Finally, the underlying variables thatexplain the positive influence of SS on HSCTsurvival need to be identified. CLINICALIMPLICATIONS: Given the potential for care-giver presence to positively influence HSCTrecipient’s survival, it is even more imperative thatpsychological supports be available for the care-giver. In the absence or lack of SS, the extendedhealth care team should consider providing themore vulnerable HSCT recipient with enhancedpsychosocial services. ACKNOWLEDGEMENTOF FUNDING: None.

P1-98

Use of Nutritional Supplements and Herbal Medi-

cines among Danish Patients with Metastatic Renal

Cell Carcinoma: Preliminary Results from the

MRC-CAM Study

Sidsel Bekke-Hansen1, Christina Gundgaard Ped-ersen1, Ingeborg Farver1, Kirsten Merete Fode2,Frede Nedergaard Donskov2, Robert Zachariae11Psychooncology and Health Psychology ResearchUnit, Department of Oncology, Aarhus UniversityHospital & Department of Psychology, AarhusUniversity, Aarhus, Denmark, 2Department ofOncology, Aarhus University Hospital, Aarhus,Denmark

BACKGROUND: Nutritional supplements (NS)and herbal medicines (HM) are types of comple-mentary and alternative medicine (CAM) oftenused by cancer patients which may interact withconventional treatments. Little is known aboutprevalence, user motives, and experienced benefitsamong metastatic renal cancer patients. Thepresent study examined the prevalence, usermotives, and perceived influence of NS and HMon quality of life (QoL) and cancer in a sample ofDanish metastatic renal cancer patients. METHOD:Seventy patients with stage IV metastatic renalcell carcinoma treated with tyrosine kinase inhibi-tors at a Danish university hospital oncology unit(response rate: 61%, 72.9% male, age 43–85)completed baseline questions concerning use ofNS/HM and perceived influence of these treat-ments on QoL and cancer rated on a 4-point scale(not at all - very much). Nine predefined usermotives (to fight cancer, strengthen immune system,symptom relief, reduce side effects, improve mentalstate, increase hope/optimism, finding meaning,family member’s wish, shortcomings of conven-tional treatment) and an open category were ratedon 4-point scales (not at all - very much).RESULTS: A total of 27.1% used NS and 8.6%used HM. The main reasons for NS use were: Tostrengthen the immune system (78.9%), symptomrelief (73.7%), and reduce side effects of conven-tional treatment (63.2%). Main HM user motives



DOI: 10.1002/pon

were: Strengthen immune system (83.3%), symp-tom relief (83.3%), lessen side effects (83.3%), andimprove mental state (83.3%). The majority ofusers perceived some influence of NS and HM onQoL (73.7% and 83.3%, respectively). In addition,31.6% perceived an influence of NS on their cancer,whereas only 16.7% perceived an influence of HM.CONCLUSIONS: Approximately one third ofmetastatic renal cancer patients in the present studyused CAM supplements, and the majority of usersreported motives that were related to treatmentsupportive and symptom relief expectancies. Mostpatients perceived a positive influence of their CAMon their quality of life, whereas fewer perceived apositive influence on the disease. RESEARCHIMPLICATIONS: This study demonstrated thatuse of various CAM supplements is relativelyprevalent among Danish metastatic renal cancerpatients. However, NS and HM were treated ascollapsed categories in the present study, and moreresearch is needed on various subtypes of NS andHM in relation to user motives, perceived benefits,and possible interactions with conventional treat-ment. CLINICAL IMPLICATIONS: Several mo-tives may precede use of NS/HM, and the majorityof users experienced improved QoL and some alsoperceived a positive influence on cancer itself.Thus, the use of CAM may be of great importanceto some patients. However, considering thatsome types of NS and HM may cause adversereactions in combination with conventionaltreatment, an open dialogue between physicians,nurses, and patients regarding intended or presentCAM use is warranted. ACKNOWLEDGEMENTOF FUNDING: None.

P1-99

Sleep Disturbances Among Advanced Cancer Pa-

tients as a Function of Cancer Type

Marie Solange Bernatchez1,2, Josee Savard1,2,Hans Ivers1,21Laval University School of psychology, Quebec,QC, Canada, 2Laval University Cancer ResearchCenter, Quebec, QC, Canada

BACKGROUND: A few cross-sectional studieshave revealed high rates of sleep difficulties amongadvanced cancer patients. However, these studiesdid not differentiate between subsyndromal andclinical levels of insomnia. Moreover, the evolutionof insomnia over time after cancer diagnosis hasyet to be investigated. The aim was to assess theprevalence and the evolution of insomnia symp-toms and syndrome in patients with a stage III-IVcancer, and to look at possible differences acrosscancer sites. METHOD: In the context of a largerepidemiological research, 194 patients with anadvanced cancer scheduled to undergo surgerywere recruited. The patients completed the Insom-

nia Interview Schedule during the peri-operativeperiod, as well as 2, 6, 10, 14 and 18 months later.At each time point, patients were categorized intothe following three groups: insomnia syndrome,insomnia symptoms or good sleepers. RESULTS:The prevalence of insomnia symptoms and syn-drome at the peri-operative period were respec-tively 46% and 26.7% for breast cancer patients,20.4% and 14.3% for prostate cancer patients, and31.7% and 23.6 for patients with other cancer sites.A generalized linear mixed model showed asignificant reduction of insomnia symptoms overtime in breast cancer patients only, F(5,722)5 5.44,po.0001. The prevalence of insomnia syndromewas fairly stable over time for all cancer types.CONCLUSIONS: In summary, breast cancerpatients had higher rates of insomnia symptomsand syndrome than patients with other cancertypes, but they were the only group who showed asignificant reduction of their symptoms over time,after cancer diagnosis. The high rates of insomniasymptoms and syndrome found in this studyemphasize the need to develop appropriate inter-ventions for the treatment of insomnia in advancedcancer patients. ACKNOWLEDGEMENT OFFUNDING: This study was supported by trainingawards held by the first author from the CanadianInstitutes of Health Research (CIHR) and thePsychosocial Oncology Research Training programand by a research grant held by the second authorfrom the CIHR (MOP - 69073).

P1-100

Observational Study on the Evaluation of Certain

Symptoms and Psycho-Physical Disorders that

Affect the Quality of Life of Women with Breast

Cancer

Francesco Buda, Katia Casarsa, AlessandroZaccoriDpt of Inernal Medicine,Medical Oncology &Geriatric Oncology, Udine,Friuli V Giulia, Italy

BACKGROUND: The communication of thediagnosis of cancer has a devastating impact onquality of life(QL) of the patient worsens in stagesduring treatment,stage of disease and the prospectof life.This is evident also in women diagnosed withbreast cancer(BC). METHOD: The SymptomManagement Model(SMM)was applied as theconceptual framework of the study From May2008-November 2010,after information and writ-ten informed consent,acceded to the study 82women aged between 42–73 years(mean 55.7years(7SD 8.09), median 55 years) with BCcandidates for neoadjuvant chemotherapy(NC-T)under the DH.To pts were delivered to thefollowing evaluation questions: 4DSQ, FACIT,VAPS, HAM-D, BSDS and IBCSG-QL. Allquestionnaires were completed and delivered. The



DOI: 10.1002/pon

data were processed with Stata Version 9.0and SPSS Version 14.0.and were analyzed withstatistical methods using Stepwise RegressionStatistic(SRS). RESULTS: The predictive powerwas 82% of the variance (po.01) indicating thatthe SMM is a useful guide for Explaining andPredicting quality of life of BC undergoingNCT.The findings revealed that the mean scoresof QL(X5 66.43) was at the moderate level;significantly predictors were depression (po.01),sleep disturbance (po.01), fatigue (po.01) and stageof disease (po.01). CONCLUSIONS: Our resultsindicate that the questionnaires is a useful guide toexplain and predict depression, sleep disturbance,fatigue and disease stage, parameters that wouldsignificantly QL in this select group of patients withBC not treatable in the first instance with surgery.The SMM is a useful guide for explainin andpredicting quality of life in BC undergoing NCT.RESEARCH IMPLICATIONS: Pain, fatigue, anddepression are complex affective, sensory, andcognitive phenomena and all of these symptoms, aswell as sleep disturbances, are common in oncologypts who are receiving cancer treatment. CLINICALIMPLICATIONS: Predict and understand thesedisorders is importafondamentale for the teams inorder to implement assistance and psychologicalsupport and clinical focused on women withbreast cancer is not likely in the first instance ofsurgery. ACKNOWLEDGEMENT OF FUNDING:None.

P1-102

Delusion or Reality? Managing Patients with

Schizophrenia During Cancer Treatment

Jayita Deodhar, Savita Goswami, LekhikaSonkusare, Rohini HavaldarTata Memorial Hospital, Mumbai, India

BACKGROUND: There are a few reports onpatients with schizophrenia who develop cancer,about the medical and psychiatric complicationsthey face and the treatments that they undergo.Our study aims to examine the number andcharacteristics of patients with Schizophrenia whowere referred to the liaison psychiatry service in atertiary care cancer hospital in a developingcountry, their referral patterns, reasons forpsychiatric consultations and management strate-gies used in the group of patients. METHOD: Aretrospective analysis, of all new referrals,inpatient and outpatient, to the Psychiatric Unitof an oncology tertiary care hospital, over a 58month period (March 2005 to December 2009) wascarried out. Review of casenotes of cancer patientswho had schizophrenia, referred to the service, wasdone. A proforma was designed to notedemographic variables, referral methods, psychia-tric diagnoses (by clinical interview and using

International Classification of Diseases version10) and management issues including capacity incare, family support and liaison with treatingteam. Relevant statistical analysis was done fordescriptive statistics and within group compari-sons. RESULTS: Of 2068 patients assessed by theservice in this 58 month period, 44 (0.02 %) hadSchizophrenia, 17 men and 27 women. The meanage was 48 years. The duration of illness was 5months to 38 years at the time of referral to theservice, with most common sites of cancerbeing breast, haematolymphoid and head andneck. More patients were on second generationantipsychotic medications as compared to first (30vs. 14) and polypharmacy was noted (moodstabilizers, antidepressants and sedative-hypnotics). Management strategies included earlypsychiatric evaluation, working with familyand close liaison with treating oncology team.CONCLUSIONS: A small number of patientsseen by the liaison psychiatry service hadschizophrenia who developed cancer. Most hadcapacity to understand regarding treatmentissues and good family support. Early psychiatricevaluation, close liaison with treating oncologyteam and intensive collaboration with family werenoted in the management of these patients.Control of psychiatric symptomatology was donethrough use of psychopharmacological agents withdue precautions, care and with regular follow up.This study highlights the importance of a specia-lized liaison psychiatry service in an oncologysetting for assessment and management of thisvulnerable group of patients and caregivers.RESEARCH IMPLICATIONS: Research onpsychopharmacological interventions used with afocus on interactions with different modalities ofcancer treatments (chemotherapy, hormonaltreatment, immunomodulators, radiationtherapy and surgery) needs to be done. Evaluationof specialized programmes for this vulnerablegroup of patients (including psychotherapy andfamily interventions along with biological ap-proaches) is another area for future research.Concerns and coping skills of caregivers of thesepatients need to be studied too. CLINICALIMPLICATIONS: Creating awareness and betteridentification of patients with dual diagnosis ofcancer and schizophrenia by both psychiatrists andoncologists is of utmost importance. Hence,training programmes for both these groups ofprofessionals should include this topic.Training programmes for healthcare workers inoncology, apart from communication andcounselling skills, should also address thissubject. Clinical practice guidelines, should beprepared for treatment of this group of patientswith local and cultural context in consideration.ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P1-104

Risk Perceptions of Prostate Cancer: Health Pro-

motion Implications for Early Diagnosis

Liz Forbat1, Morag Place1, Danny Kelly2, GillHubbard1, Fiona Winslow3, Kenny Boyd3, KateHowie1, Hing Leung31Cancer Care Research Centre, University ofStirling, Stirling, UK, 2University of Middlesex,London, UK, 3Department of Urology, GartnavelGeneral Hospital, NHS Greater Glasgow and Clyde,Glasgow, UK

BACKGROUND: Early diagnosis of prostatecancer is critical. Since population-based screeningis not supported as an appropriate strategy toreduce mortality, other methods must be adoptedto target men who are most at-risk of developingthe disease. The study’s aim was therefore tounderstand what prompts men to contact healthprofessionals and the factors which men use toaccount for the timing of their presentation andsubsequent diagnosis with advanced disease.METHOD: Embedded mixed-method designinvolving a postal survey (N5 320) and semi-structured interviews with a purposive sub-sampleof men and partners (N5 30). Clinical data (PSA,Gleason and TNM) were also gathered frompathology records. Analysis drew primarily on chisquare and spearman’s correlation, alongsideframework analysis of the qualitative data.RESULTS: The most common route to diagnosisfor respondents was presenting to a healthcareprofessional with symptoms. Indeed, men describerisk in relation to symptoms, despite no relation-ship between type of symptom, duration ofsymptom and high clinical risk (as defined bypathology records). Data indicate that men’sperceptions of risk are not informed by clinicalrisk factors such as age and family history, but bytheir own and friends/relatives’ experiential knowl-edge. Notably friends/relatives are key sources ofinformation on prostate cancer and often prompthelp-seeking behaviour. CONCLUSIONS: Men’srisk perceptions are informed by the views andexperiential knowledge of friends and relatives,rather than known clinical risk factors. Conse-quently, men will delay seeing a GP if they perceiveurinary symptoms as relevant to requesting a testfor prostate cancer. Health promotion messagesshould therefore be refined in the light ofthe evidence that symptoms not known riskfactors inform men’s health-seeking behaviour.RESEARCH IMPLICATIONS: Researchshould now test the hypothesis that relationalsystems provide effective strategies for disseminat-ing health promotion messages. Adopting asystemic/relational approach has the potentialto reach men at higher risk of prostatecancer and contribute to earlier diagnosis.

CLINICAL IMPLICATIONS: Targeting menmost at risk of developing prostate cancer willcontribute to earlier diagnosis and lower mortality.This targeting also has the potential to lead tofewer men being diagnosed with a low-risk tumour(as defined by clinical pathology), and conse-quently resources can be focused on thosemost likely to benefit from treatment.ACKNOWLEDGEMENT OF FUNDING:This study was funded by the Prostate CancerCharity.

P1-106

Fatigue During and After Cancer: A Cross-Sectional

Study Involving Patients and Long-Term Survivors

Maria Antonietta Annunziata1, BarbaraMuzzatti1, Lorena Giovannini1, Daniela Narciso1,Sara Mella1, Luigi Grassi21Centro di Riferimento Oncologico - NationalCancer Institute, Aviano (PN), Italy, 2Universityof Ferrara, Ferrara, Italy

BACKGROUND: Fatigue is one of the mostfrequently reported symptoms by cancer patientsand it tends to accompany the individual during allhis/her disease course: throughout treatments andlater in the survivorship or terminality. In thisresearch, fatigue has been studied in both cancerpatients (undergoing treatments) and long-termcancer survivors (i.e. who has been diagnosed withcancer but is currently disease free and has not hadany active treatment for at least 5 years). METHOD:One-hundred ten Italian oncological inpatientsand One-hundred five Italian long-term cancersurvivors were administered the Italian version ofthe Revised Piper Fatigue Scale (PFS-R) togetherwith a form for the collection of personalidentification and clinical data. PFS-R consists oftwenty-two items (response scale: 0-10), providinga global fatigue score and four partial indices:behavioral severity, cognitive severity, affectivemeaning, and sensory/emotional severity. Higherscores correspond to higher levels in the measureddimension both in global and in partial indices.RESULTS: Patients undergoing cancer treatmentsdisplayed more behavioral severity (po.001),affective meaning (po.001), sensory/emotionalseverity (po.001), and more global fatigue(po.001) than long-term cancer survivors, butnot more cognitive severity. Looking at the fatiguedimensions, behavioral severity (M5 5.2) andsensory/emotional severity (M5 3.2) seemed to bethe most relevant respectively among cancerimpatient and long-term cancer survivors. In bothclinical samples, females showed more generalfatigue than males (inpatients: p5 .047; survivors:p5 .043); in addition, long-term females survivorsshowed higher behavioral severity than malesurvivors (p5 .005). CONCLUSIONS: Fatigue



DOI: 10.1002/pon

seems to characterize treatment phase rather thanlong-term cancer survivorship. However, it canoccur later in the disease trajectory (as a late effect)impairing in particular the sensory/emotionalfunctioning of the person. In both diseasephases (treatment and survivorship) femalesreport more fatigue than males. RESEARCHIMPLICATIONS: Present data suggest furthercomparisons according to other socio-demographic(e.g., age, marital status, occupational status) andclinical (e.g., cancer type, treatment type) variables.In addition, a prospective study that assesses thesame patients’ group since diagnosis till five-yearpost treatment completion will be recommendable.CLINICAL IMPLICATIONS: Active interven-tions to prevent and reduce fatigue should beplanned for cancer patients undergoing treatmentsas well as for who completed treatments inthe past and now are cancer survivors.ACKNOWLEDGEMENT OF FUNDING: None.

P1-107

The Self Assessment of Cognitive Functioning in

Cancer Survivor and Healthy People

Lorena Giovannini1, Barbara Muzzatti1, GuidoLucchini2, Luigi Grassi3, Maria AntoniettaAnnunziata11Centro di Riferimento Oncologico - NationalCancer Institute, Aviano (PN), Italy, 2Health LocalService 6 Friuli Occidentale, Aviano (PN), Italy,3University of Ferrara, Ferrara, Italy

BACKGROUND: Previous study on cognitivefunctioning in cancer patients and cancer survivorsoften show some cognitive deficits in these popula-tions. Nevertheless, anecdotal reports of cognitivedeficits during and after exposure to chemotherapyis increasing. Moreover, long-term cancer survivorsalso appear to complaint new cognitive difficultiesyears after treatments. The aim of this study is tocompare subjective assessment of cognitivefunctioning in long-term cancer survivors andhealthy people. METHOD: 113 long-term adultsurvivors (out of illness and treatment since atleast five years at the moment of the assessment)and 279 healthy controls (matched to survivorsfor gender, age and years of education)participated the survey. All participants wereindividually administered with the CognitiveFunctioning Self-assessment Scale (CFSS), a selfassessment questionnaire dealing with attention,concentration, long term memory, working mem-ory, language, time and space orientation, motorcontrol. It has been itemized into 18 questions towhich participants answer on a five-point scale(15 never; 55 always). RESULTS: Long-termcancer survivor group show higher levels ofcognitive difficulties than healthy control groupthat appear to be a statistically significant

difference (po.05). The CFSS has a monofactorialstructure, thus results are based on generalcognitive profile. Nevertheless, deep observationsseem to include concentration and executivefunctioning as the more frequently complainedcognitive domains. CONCLUSIONS: Although allsurvivors do not suffer for brain injury and are outof cancer, many of them report in the self-assessment questionnaire moderate level difficultiesin remembering just known information, fre-quently tip of the tongue phenomenon, slownessin lexical choice and attention. At the same time,other surveys show treatment negative effects oncognition and in particular widespread memorydeficits. Participants’ performance seem to indicatethat these difficulties persist over time, although atdifferent levels. RESEARCH IMPLICATIONS:Cognitive deficits in cancer survivors are notlargely diffuse, but they often complain difficultiesin different domains. Cognitive alterations canmake it difficult to work effectively in cognitivelychallenging situations. More studies are needed tocomprehensively describe the cognitive impairmentsassociated with adjuvant therapy, particularly longterm after treatment. CLINICAL IMPLICA-TIONS: A specific and high sensitive neuropsycho-logical assessment could be useful for at least cancersurvivors, who complain cognitive difficulties inorder to recognize deficits and undergo specificcompensative training. In this way, the CFSS couldbe very useful in order to easily recognize difficultiesdescribed by patients. Rehabilitation programscould be the new challenge for people working inclinical practice with both cancer patients andcancer survivors. ACKNOWLEDGEMENT OFFUNDING: This original survey was support byfound of Italian Health Minister.

P1-108

Implementation of Psychosocial Screening in Daily

Oncological Practice: Experiences in the North-

eastern Region of the Netherlands

Josette Hoekstra-Weebers1,2, Rianne van deMerwe1, Marrit Tuinman1,2, Stacey Gazendam-Donofrio3, Wim van der Veer11Comprehensive Cancer Center the Netherlands,Groningen/Enschede, Groningen, The Netherlands,2University Medical Center Groningen, University ofGroningen, Groningen, The Netherlands, 3Universityof Groningen, Groningen, The Netherlands

BACKGROUND: Between 25–40% of cancerpatients are reported to suffer from distress. Thesepatients may benefit from professional care.Psychosocial screening has been promoted as away to help identify patients who may be in need ofpsychosocial and/or paramedical care. Little isknown about how to implement screening and onthe successfulness or effectiveness of implementation



DOI: 10.1002/pon

as perceived by health care providers. METHOD:The contact person from each hospital in theNorth-Eastern region of the ComprehensiveCancer Center Netherlands (CCCN) (n5 23,response 91%) was asked to respond to a surveyon the implementation of psychosocial screening,as suggested in the Dutch guideline psychosocialscreening. The survey included questions on thescreening instrument used, communication, refer-ral, and logistical matters. RESULTS: All hospitalsuse the Dutch thermometer and problem list andrely on CCCN support for implementation. Pa-tients most often screened are: breast, followed bycolon, lung, and prostate cancer, and chemother-apy patients. Most often an assigned nurse togetherwith a multidisciplinary group of medical/psycho-social/paramedical care providers formally decidedabout logistical issues, responsibility for screening,how often/when, communication, and referral.Communication on the response pattern is mostoften done by specialized nurses, immediatelyfollowing instrument completion, and is consideredimproved. Referrals increased slightly and were allconsidered justified. Main obstacles perceived arehow often/when to screen, time, and ensuringcontinuation. CONCLUSIONS: Implementationof psychosocial screening is feasible, particularlyfor groups of patients for whom a specialized nurseis available; when endorsed by a multidisciplinarygroup; and with the methods and materialsdeveloped by the CCCN. Through screening,communication with patients improved and pa-tients in need of care were referred adequately.RESEARCH IMPLICATIONS: Studies shouldbe performed to assess facilitators and barriersto successful implementation of psychosocialscreening. Studies focusing on possible beneficialeffects of screening for patients could supportimplementation. CLINICAL IMPLICATIONS:Implementing psychosocial screening asstandard practice for all patients is a slow butsteady process that requires health care providersto be motivated to deliver optimal psychosocial andparamedical care. The process could be helped byincluding psychosocial screening in the developmentof tumour specific care pathways. ACKNOWL-EDGEMENT OF FUNDING: ComprehensiveCancer Center the Netherlands, location Gronin-gen/Enschede.

P1-109

Psychiatric Follow-up of the Children Treated for

Cancer

Burcu Ozbaran1, Mehmet Kantar2, Sezen Kose1,Serap Aksoylar2, Serpil Erermis1, Nazan C- etingul11Child and Adolescent Psychiatry Department,Consultation-Liasion Unit, Ege University Schoolof Medicine, Bornova, IZMIR, Turkey, 2Pediatric

Oncology Unit, Ege University School of Medicine,Bornova, IZMIR, TurkeyBACKGROUND: Pediatric cancers have becamechronic disorders in consequence of the advances inthe treatment methods. The most common psy-chiatric problems encountered in the studies areseperation anxiety, school fear, adjustment disor-ders, treatment incompliance, oppositional beha-viors against family and treatment team, andtreatment refusal. We, therefore, aimed to evaluatepsychiatric status of the inpatient group treated atthe Pediatric Oncology Clinics of Ege UniversitySchool of Medicine. METHOD: The children wereinterviewed at the first visit, and they wereinformed about the psychologic support program.After this first interview, they were consulted bychild psychiatrist upon request of their pediatricianin the follow-up. The sociodemographic features,cancer types, pscyhiatric symptoms, diagnosis, andtreatments were noted by the authors on a specialprepared information chart. RESULTS: 51patients (37 boys, 14 girls) were interviewed.49% of the patients were under 10 years of age;most of the diagnosis were leukemia (25.5%) andlymphoma (25.5%). The common psychiatricsymptoms were depressive in 76.5% andanxiety symptoms in 11.8%. Six patients (11.8%)were found not to have psychiatric diagnosis. 49%of the patients had depressive disorders, 11.8%anxiety disorders, 23.9% comorbid anxietyand depressive disorders, and 3.9% had adjustmentdisorders. There was a correlation betweenpsychiatric symptom frequency and durationof hospitalization. Depressive symptoms’frequency increased with age. CONCLUSIONS:We found that psychiatric symptoms andpsyciatric disorders are frequent among childrentreated for cancer. In general, we found thatpediatric cancer patients benefited from psychiatrictreatment, and their compliance did better.CLINICAL IMPLICATIONS: It is important toevaluate psychiatric status of these population interms of both treatment compliance and quality oflife. ACKNOWLEDGEMENT OF FUNDING:None.

P1-110

Psychiatric Diagnosis and Behavioral Characteris-

tics in Survivors of Childhood and Adolescent

Leukemia and Lymphoma

Sezen Kose1, Serpil Erermis1, MustafaKuc- ukkose1, Burcu Ozbaran1, Burge Kabukc-uBasay1, Nazan C- etingul2, Mehmet Kantar2,Serap Aksoylar2, Tezan Bildik1, NagehanDemiral1, Muge Tamar1, Cahide Aydin11Ege University School of Medicine, Child andAdolescent Psychiatry Department, Consultation-Liaison Unit, Izmir, Bornova, Turkey, 2EgeUniversity School of Medicine, Pediatry



DOI: 10.1002/pon

Department, Pediatric Oncology Clinic, Izmir,Bornova, Turkey

BACKGROUND: Although there are reports thatpsychological evaluations of long-term remissionof cancer patients are nearly normal, also statedthat one fourth to third cases still have seriouspsychological problems. It is reported that somepsychiatric disorders (eg:depressive disorders, post-traumatic stress disorder) are more common.Behavior and adjustment problems are the otherimportant difficulties. We aimed to identify thepsychiatric status and behavior problems of childand adolescent survivors of leukemia and lympho-ma. METHOD: We evaluated 53 patients, between8–16 years of age, treated and followed-up withleukemia/lymphoma diagnosis, and in remissionsince at least 2 years, at Pediatric Oncology Clinicof Ege University Medical School. Healthy chil-dren (n:50) and siblings of children who havechildhood cancer history (n:34) were controlgroups. Socio-demograpic features were evaluatedwith a form including age, sex, school, familial andsocioeconomic-status information. The yllness fea-tures were noted for case group. Psychiatricdiagnosis was assessed using child and parentstructured interview (K-SADS-PL), and Children’sDepression Inventory (CDI), Child BehaviorChecklist (CBCL) and Teacher’s Report Form(TRF) were given. RESULTS: Statistically signifi-cant difference was not found between case, siblingand control groups on K-SADS-PL psychiatricdiagnosis. Oncological diagnosis, age of diagnosis,age of treatment completion, gender and age atincluding of this study were not found to be a riskfactor for psychiatric disorders. There was not asignficant difference between groups on emotional,behavioral, social competence and school achieve-ment dimensions of CBCL and TRF. There wasnot an effect of diagnosis age, stage or risk group ofilness, taking chemo/radiotherapy or not, the timeafter the ending of treatment on CBCL and TRFscores. CONCLUSIONS: It is not found asignificant difference between groups on psychiatricdiagnosis. There are studies suggesting that there isnot a difference between children who have child-hood cancer history and healty control groups whoare at the same age on psychiatric diagnosis in theliterature. Our results are consistent with thesestudies. This study was held between 3,5th and 14th(mean 8 years) years after treatment process ofchildren, so there can be some differences com-pared to other studies. CLINICAL IMPLICA-TIONS: Finding no difference between groups onpsychiatric diagnosis maybe due to the support ofthe families to their children, defensive mechanismsor coping skills of these children. It is important toevaluate defensive mechanisms, coping strategiesand resilience of these population. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-111

Cognitive Profiles of Childhood and Adolescent

Leukemia and Lymphoma in at Least 2 Years

Remission

Mustafa Kucukkose1, Serpil Erermis1, NagehanDemiral1, Burcu Ozbaran1, Gunay Sagduyu1,Hande Kesikci Ergin1, Sezen Kose1, MehmetKantar2, Nazan Cetingul2, Serap Aksoylar2, TezanBildik11Child and Adolescent Psychiatry Department,Consultation-Liaison Unit, Ege University Schoolof Medicine, Bornova/Izmir, Turkey, 2PediatryDepartment, Pediatric Oncology Clinic, Ege Uni-versity School of Medicine, Bornova/Izmir, Turkey

BACKGROUND: There are many studies on theeffects of chemotherapeuthic agents and radio-therapy on cognitive functions yn the literature.Some studies suggest that the patients treated forchildhood cancer were worse than healthy controlon cognitive functions but others found nosignificant difference. It’s being put forward thatthese controversial results are related to themethodological differences. We aimed to identifythe cognitive features of child and adolescentsurvivors of leukemia and lymphoma. METHOD:We evaluated 43 patients, between 8–16 years ofage, who treated and follwed-up with the leukemiaand lymphoma diagnosis at Ege University Facultyof Medicine Pediatric Oncology Clinic, and are inremission period since 2 years. Control groups werecomprised of healthy control children (n:49) andsiblings of children who have childhood cancerhistory (n:27). Socio-demograpic features wereevaluated with a form including age, sex, schooland familial and socioeconomic status informationfor all groups. The yllness features were noted forcase group. WISC-R (Wechsler Intelligence Scalefor Children-Revised) was performed to all chil-dren by psychologist. RESULTS: There was not asignificant difference on verbal IQ scores (VIQ) ofWISC-R between the case and control groups.While there was not a significant difference onperformance (PIQ) and total IQ (TIQ) scoresbetween survivors and siblings, we found thatPIQ and TIQ scores of the survivors were lowerthan healthy controls. We found a significantdifference on Verbal scale of IQ, informationsubtest, and object assembley (PIQ subtest) subtestbetween girls and boys cases. Also, we found thatbeing a girl is a negative factor on VIQ andinformation and similarities subtests. CONCLU-SIONS: The TIQ scores of all 43 children whotreated for childhood cancer was above 70. Themean scores of TIQ, VIQ and PIQ of survivedchildren were also within normal range. PIQ andTIQ scores of the survivors were lower thanhealthy controls. Some studies suggest that thepatients treated for childhood cancer are worse



DOI: 10.1002/pon

than healthy control on cognitive functions. Ourresults are compatible with these findings.RESEARCH IMPLICATIONS: The detailedevaluation is necessary on cognitive functions ofsurvyvors with wider sample size. Therelated factors should also be enlighten.ACKNOWLEDGEMENT OF FUNDING:None.

P1-112

Quality of Life of Children and Adolescents

in Remission Period of Lymphoma and

Leukemia

Burcu Ozbaran1, Serpil Erermis1, MustafaKucukkose1, Serap Aksoylar2, Nagehan Demiral1,Tezan Bildik1, Sezen Kose1, Gokul Er1, InciAltintas1, Mehmet Kantar2, Cahide Aydin11Child and Adolescent Psychiatry Department,Consultation-Liaison Unit, Ege University Schoolof Medicine, Bornova/Izmir, Turkey, 2PediatryDepartment, Pediatric Oncology Clinic, EgeUniversity School of Medicine, Bornova/Izmir,Turkey

BACKGROUND: Since the survival rates in-creased in childhood cancers the researches arefocused on quality of life in long-term follow-up.Studies suggest that the quality of life (QoL) meansare positive in survivors and survivors report agladness and have a purpose in their life, have thesame opportunities with their peers. This studyaims to determine the QoL and related factors ofthe children and adolescents in remission period oflymphoma/leukemia in Turkey. METHOD: Thisstudy includes 53 patients, between 8-16 years ofage, who treated with leukemia and lymphomadiagnosis at Ege University Faculty of MedicinePediatric Oncology Clinic, and in remission periodsince 2 years. Control groups were comprised ofhealthy control children (n:50) and siblings ofchildren who have childhood cancer history (n:34).For all groups a sociodemographic data form wasestablished. Only the patient group filled a detailedform questioning the illness features. KINDL(KINDer Lebensqualitatsfragebogen: ChildrenQuality of Life-Questionnaire) which measuresthe QoL in children and adolescents for generalpurposes was applied to all children and parents.RESULTS: In parental reports a significantdifference was found between patient and controlgroups in QoL subscores; total score, physical andemotional wellness. In self reports of children,there was a significant difference between patientand control groups on their QoL total scores,physical, emotional wellness and family subscores .The reports of children with childhood cancerhistory and their parents on QoL was consistent,except self esteem and friends variables. Afterregression analysis, time period after cancer treat-

ment and having chemo and radiotherapy werenegative risk factors for QoL. CONCLUSIONS:Studies on literature with childhood cancers weremade generally in treatment period or in a limitedtime period after treatment. This study washeld between 3,5th and 14th (mean 8 years)years after treatment process of children, sothere can be some differences compared toother studies. RESEARCH IMPLICATIONS:Since the survival rates increased in childhoodlymphomas and leukemias the researchesshould investigate the negative effects of illnessand intensive treatments in longterm period ofthese children on QoL. We think prospectivestudies have to planed with wider sample sizefocusing on QoL, and risk and protective factors.ACKNOWLEDGEMENT OF FUNDING:None.

P1-113

Quality of Life of Cervical Cancer Patients after

Radical Radio-Chemotherapy with Comparison with

the General Population

Anna Kieszkowska-Grudny1, Monika Rucinska2,3,Sylwia Biedrzycka2, Sergiusz Nawrocki2,31European Health Centre Otwock, Otwock, Poland,2Department of Oncology, University of Warmiaand Mazury, Olsztyn, Poland, 3Departmentof Radiation Oncology, ZOZ MSWiA zWarminsko-Mazurskim Centrum Onkologii,Olsztyn, Poland

BACKGROUND: Cervical cancer is one of themost frequent neoplasms in women. The contem-porary treatment prolongs life of cancer patientsand therefore the quality of life (QoL) becomes thecritical point of evaluation for the clinical andpsychological status of cervical cancer survivors.The aim of this study was assessment of QoL andsome symptoms in cervical cancer survivors afterradical radio-chemotherapy in comparison with thehealthy women. METHOD: 94 women wereincluded to the study between November 2009and May 2010: 47 cervical cancer patients mini-mum 3 months (mean 37 months) after radicalradio-chemotherapy (27–69 years, median 55years) and 47 healthy women (24–64 years, median52 years). Subjects filled out a questionnaire thatincluded the European Organization for Researchand Treatment of Cancer (EORTC) QLQ-C30 (v.3.0), its Cervical Cancer Module EORTC QLQ-CX24, and additional demographic and medicalquestionnaires. In the statistical analysis chi2 testand t-Student test were used. The significance levelwas po0,05. RESULTS: Women after cancertreatment estimated their general health state onlower level than healthy women (po0,05). Howevergeneral QoL and EORTC QLQ-C30 subscalescores were similar for both groups. The majority



DOI: 10.1002/pon

of subjects demonstrated fatigue, seen surprisinglymore often in women without cancer (94% vs 72%,po0,05), but more sleep disorders were observed inthe patients group (po0,01). Patients after radio-chemotherapy had more problems with fecalincontinence, low back pain, pain of vulva andsweats. 38% of cervical cancer survivors and 65%of healthy women were sexually active in the lastmonth. Women after oncologic treatment demon-strated more problems with vaginal narrowing andpain during sexual contact.Cervical cancer survi-vors perceived themselves less attractive (po0,01).CONCLUSIONS: General health status was lowerin cancer patients’ group, the QoL scores did notdiffer significantly in general and in subscales ofEORTC QLQ-C30 among cervical cancer patientsafter radical radio-chemotherapy and the generalpopulation. Cervical cancer patients more oftenexperienced sexual life related problems and hadlower self-esteem as women. Additional support insymptoms management after treatment withradio-chemotherapy is necessary. RESEARCHIMPLICATIONS: Is important to know moreabout difference between cervical cancer patientsand healthy women and any other patients sufferfrom a variety of diseases as well to compare thelevel of quality of life in various groups. It wouldbe interesting to evaluate psychological and med-ical support during treatment in contexts of qualityof life in similar group of patients. CLINICALIMPLICATIONS: The findings of this study showsignificant role of treatment in perceived quality oflife, however it is even more interesting that healthypeople could have similar QoL to patients withcancer. It seems to be essential to plan and developmore studies which will assess difference in QoLbetween cancer patients and healthy population toprepare more convenient schedules of treatmentand health care for patients with cancer.ACKNOWLEDGEMENT OF FUNDING:None.

P1-114

The Relationship Between Communication Skills,

Stress Perception and Mental Symptoms in Nurses

Who Work at Oncology Units

Nevin Onan1, Gul Unsal Barlas1, Semra Karaca1,Nazmiye Kocaman2,1, Ozgul Ta�kyran2, FatmaSumeli11Marmara University, Istanbul, Turkey, 2IstanbulUniversity, Istanbul, Turkey

BACKGROUND: Cancer causes variouspsychosocial problems among patients bysymbolizing death and the constraints on lifecontrol. (1,2). Communication plays animportant role in decreasing the difficulties theprofessionals and the patients/familiesexperience (3,4,5). This research has been carried

out as a descriptive and relationship findingstudy to analyze the relationships between thelevel of stress perceived by nurses, the communica-tion skills and the mental symptoms.METHOD: The study population consisted of190 nurses who work at oncology units of hospitalsin Istanbul. Sample choice was not carried outand the 102 nurses who accepted to participatewere included in the study. Data were collectedusing the Information Form, CommunicationSkills Rating Scale (CSRS), Stress PerceptionScale (SPS) and Short Symptom Inventory (SSI).While SPS and YBDO were assessed through thetotal score, KSE was assessed through the totalscore as well as the sub-dimensions of anxiety,depression, adverse individuality, somatization andhostility. RESULTS: The mean age among thenurses was 30,6077,7. The nurses scored33.1476.08 at SPS; 73.34723.28 at CSRS; and32.68733.13 at SSI. A positive significant relation-ship was found between PSE and CSRS (r5 .28;po0.01) while negative, significant relationshipswere found between SSI total score (r5�.50;po0.01) and all sub-dimensions (anxiety r5�.44;po0.01, depression r5�.50; po0.01, adverseindividuality r5�.44; po0.01, somatizationr5�.39; po0.01, hostility r5�.56; po0.01). Asignificantly negative relationship was found be-tween CSRS and SSI total score (r5�.21;po0.05), and the sub-dimensions of hostility(r5�.55; po0.01) and somatization r5�.39;po0.01). CONCLUSIONS: While the level ofstress perception is high among the nurses, thefrequency of mental symptoms is low and thenurses rate their communication skills as positive.The frequency of symptoms increase with increas-ing levels of stress. The level of stress perceptionincreases as the nurses state higher rates in terms ofpositive communication skills. The nurses rate theircommunication skills as positive, however, theystate that they experience difficulties throughcommunication with the patients and their families.These findings demonstrate that the nurses con-sider that the difficulties they experience with thepatients/families increase the levels of stress theyperceive. RESEARCH IMPLICATIONS: Thefindings of this research, which evaluates therelationships between level of stress perception,communication skills and mental symptoms amongnurses who work at oncology, provide contributionto the literature on emphasizing the importance ofcommunication skills and stress perception onmental well-being. CLINICAL IMPLICATIONS:Improving the communication skills and support-ing their ability to cope with stress may contributeto mental well being of the nurses at oncology unitsas well as providing contribution to quality ofhealthcare given to patients and their families.ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P1-115

An Examination of the Feasibility and Efficacy of

Exercise in Attenuating Symptoms of Anxiety and

Depression Among Breast Cancer Surgical Candi-

dates

Amy Kossert1, Anita Cramp1, Harry Prapavessis1,Muriel Brackstone1,21The University of Western Ontario, London, ON,Canada, 2London Health Sciences Centre, London,ON, Canada

BACKGROUND: The breast cancer diagnosticprocess is associated with anxiety and depression.Physical exercise has emerged as an attractive non-pharmacologic approach to mitigating the psycho-logical and physical sequelae of breast cancer andits treatments, however pre treatment interventionsare not integrated into current practice. This studyaims to determine the effectiveness and feasibilityof a pre treatment exercise intervention in attenu-ating levels of anxiety and depression in breastcancer surgical candidates. METHOD: Partici-pants (N5 75) will be recruited through theDepartment of Diagnostic Imaging in a Canadianhospital after undergoing diagnostic stage corebreast biopsy. Eligible, consented women present-ing with a highly suspicious malignancy will berandomized to one of two treatment conditions: (1)6-week exercise intervention, or (2) 6-week exerciseintervention plus cognitive behavioural training inexercise adherence strategies (CBT). Anxiety,depression, body composition, and social cognitivevariables relating to exercise adherence will beassessed at baseline, midpoint, post interventionand 2 weeks post-operatively. RESULTS: Resultsare forthcoming. CONCLUSIONS: The positiveeffects of exercise on anxiety and depression hasbeen demonstrated in healthy and clinical popula-tions. Furthermore, exercise is a useful adjunct toprimary cancer treatments and may confer greatpsychological benefits to patients during thisstressful yet inevitable waiting period in the healthcare system. A brief CBT intervention has a greaterimpact on exercise initiation and maintenancecompared to exercise alone. Hence, it is importantto supplement exercise programs with theoreticallyderived adherence training strategies. Moreover,this study aims to understand the mechanismsby which social cognitive variables impactexercise uptake in this population. RESEARCHIMPLICATIONS: Results from this randomizedphase II clinical trial will inform the feasibility ofimplementing a pre treatment exercise trainingintervention (with or without CBT) for breastcancer surgical candidates. Collectively, the effec-tiveness of CBT in facilitating adherence to thisexercise program and the examination of treatmentmechanisms have the potential to impact the designof future exercise interventions targeting the

psychosocial needs of women throughout thecancer continuum. CLINICAL IMPLICATIONS:Results from this study will provide valuableinsight into the efficacy of exercise training inattenuating symptoms of anxiety and depressionamong women throughout the breast cancerdiagnostic period. Although exercise initiationcan be challenging, the benefits of physical exerciseto breast cancer patients and survivors are welldocumented and adherence can be enhanced usingCBT strategies. Ultimately, this intervention mayimpact the future screening and exercise behavioursof women undergoing core breast biopsy.ACKNOWLEDGEMENT OF FUNDING: Thisproject was funded by a Doctoral Canada Grad-uate Scholarship awarded to the first author by theSocial Sciences and Humanities Research Councilof Canada.

P1-116

Prevalence of Depression in Cancer Patients during

or after Treatment: A Meta-Analysis

Anne-Marie Krebber1, Laurien Buffart2, IreneRiepma3, Remco de Bree1, Rene Leemans1,Annemarie Becker4, Johannes Brug2, Annemiekevan Straten3, Pim Cuijpers3, Irma Verdonck-deLeeuw1,3

1Department of Otolaryngology-Head and NeckSurgery, VU University Medical Center,Amsterdam, The Netherlands, 2EMGO Institutefor Health and Care Research, VU UniversityMedical Center, Amsterdam, The Netherlands,3Department of Clinical Psychology, VU University,Amsterdam, The Netherlands, 4Department ofPulmonary Diseases, VU University MedicalCenter, Amsterdam, The Netherlands

BACKGROUND: The purpose is to investigatethe prevalence of depression in cancer patientsduring or after treatment. METHOD: A meta-analysis was performed based on a literature searchin 4 databases (PubMed, PsychINFO, EMBASEand CINAHL) including epidemiological studieson the prevalence of depression among adultcancer patients during or after treatment. Weincluded 143 of 1643 studies describing 271cohorts: 77 cohorts on cancer of the breast, 21male genitalia, 41 head and neck, 13 hematologicalmalignancies, 13 digestive tract, 11 respiratorytract, 10 female genitalia, 7 brain, 3 skin, 3 urinarytract, 3 endocrine system, 1 bone and soft tissue.A mixed group was investigated in 68 cohorts.RESULTS: HADS-D 8, CES-D 16 and (semi-)structured clinical interviews were used to definedepression in 47, 28 and 29 studies, respectively.The average prevalence was 19% (95% CI 18-21%), 22% (95% CI 20-25%) and 17% (95% CI14-19%), respectively, which is higher comparedto the general population (8-12%). Based on



DOI: 10.1002/pon

interviews, highest prevalence of depression wasfound in studies on cancer of the female (23%) ormale genitalia (19%) and the breast (10%). Basedon questionnaires, highest prevalence was found instudies on cancer of the respiratory tract (28%),haematological malignancies (26%), and cancer ofthe female genitalia (25%). CONCLUSIONS:Prevalence of depression in cancer patients duringor after treatment ranged between 17% and22% and depended on instruments used andtype of cancer. No differences in prevalence ofdepression were found between the phases ofdisease (during or after treatment). RESEARCHIMPLICATIONS: More prospective research onprevalence of depression in cancer patients isrequired, especially in less frequently studied groups.It is recommended to use uniform assessmentmethods in future studies. CLINICAL IMPLICA-TIONS: Depression occurs more often in cancerpatients compared to the general population. Mon-itoring emotional functioning and adequate referral topsychosocial care during and after cancer treatment istherefore advisable. ACKNOWLEDGEMENT OFFUNDING: Netherlands Organisation for HealthResearch and Development, ZonMw.

P1-117

Cognitive Function of Elderly Patients Treated for a

Localized Breast Cancer: Preliminary Results of a

Multicenter, Prospective Longitudinal Study

Marie Lange1,2, Benedicte Giffard1, AurelieDaireaux2, Chantal Rieux2, Sabine Noal2, JohanLe Fel3, Natacha Heutte4, Olivier Rigal5, FrancisEustache1, Florence Joly2, 61U923 Inserm-EPHE-Universite de Caen Basse-Normandie, Caen, France, 2Unite de RechercheClinique, Centre Franc-ois Baclesse, Caen, France,3EA4306, Universite de Rouen, Rouen, France,4GRECAN EA1772, and IUT de Caen, Universitede Caen Basse-Normandie, Caen, France, 5Departe-ment d’oncologie medicale, Centre Henri-Becquerel,Rouen, France, 6CHU Cote de Nacre, Caen, France

BACKGROUND: Mild cognitive deficits - in parti-cular on episodic memory and executive functions -are often reported by patients receiving chemotherapyfor cancer, but could also be observed beforetreatment, just after the announcement diagnosis.Our goal was to clarify the incidence and nature ofthese disorders among elderly patients, a specificallyvulnerable group to develop cognitive dysfunctions,and to evaluate the impact of chemotherapy and theinfluence of anxio-depressive factors and fatiguebefore and after treatment. METHOD: Episodicmemory, working memory, executive functions, atten-tion, cognitive complaint, anxiety, depression andfatigue were assessed before and after treatment withneuropsychological battery of tests and self-reportedquality of life questionnaires. Cognitive impairment

was defined as a score less than 1.5 standard deviation(SDs) of normative data on two or more tests, or lessthan two SDs on one test. RESULTS: Sixty-threeelderly patients (7174 years) with localized breastcancer were included and 54 of these patients hadcognitive evaluation after adjuvant treatment (17treated with chemotherapy and radiotherapy and 37with radiotherapy only). Before any adjuvant treat-ment 55% of elderly patients had cognitive impair-ments. Global objective cognitive performances weresignificantly correlated with subjective cognitive com-plaint (r5 .29; po.03). Anxiety, depression andfatigue were correlated with cognitive complaint butnot with objective cognitive scores. After treatment,episodic memory performances of the 2 groupsdiffered significantly (po.05) to the detriment of thegroup treated with chemotherapy. CONCLUSIONS:These preliminary results show more than half ofelderly patients with breast cancer presented objectivecognitive impairment before any adjuvant therapy. Incontrast to younger patients, some neuropsychologicalscores and subjective cognitive complaint were related.Consistent with other studies, anxiety, depression andfatigue were related with cognitive complaint but notwith objective cognitive scores. Furthermore, che-motherapy appears to have a deleterious impact onrecovery processes in episodic memory. ACKNOWL-EDGEMENT OF FUNDING: National hospitalresearch grant (PHRC - 2008) and Sanofi Aventis.

P1-118

Quality of Life and Symptom Burden in Patients

with Chronic Myeloid Leukemia Receiving Imatinib

Therapy: A Pilot Study

Yun-Hsiang Lee1, Javier Pinilla-Ibarz2, PatriciaCabrera3, Paul Jacobsen31Department of Nursing, College of Medicine,National Taiwan University, Taipei, Taiwan,2Department of Malignant Hematology, H. LeeMoffitt Cancer Center & Research Institute,Tampa, FL, USA, 3Department of Health Outcomesand Behavior, H. Lee Moffitt Cancer Center &Research Institute, Tampa, FL, USA

BACKGROUND: Imatinib is an oral targetedtherapy that has demonstrated the benefits of lesstoxicity and better survival than previously estab-lished treatments for CML. However, fewstudies have focused on the quality of life (QOL)and symptom burden in CML patients treatedwith imatinib. The purpose of this study was toidentify the relationships between QOL andsymptom burden in CML patients with imatinibtreatment. METHOD: A cross-section study wasconducted with 34 CML patients with at least 6month imatinib treatment (range5 0.8 to 8.3years) recruited from Moffitt Cancer Center.Patients completed the following questionnaires:1) Medical Outcomes Study (MOS) Short-Form



DOI: 10.1002/pon

Health Survey Questionnaire (SF-36); 2) MemorialSymptom Assessment Scale-Short Form (MSAS-SF); and 3) BACKGROUND: informationform. Pearson correlations were calculated toidentify relationships between QOL and symptomburden. The study was approved by the Universityof South Florida Institutional Review Board.RESULTS: The three worse QOL domainswere vitality, general health and the impact ofphysical problems on role functioning. Comparednorms for the same age group, patients had poorerphysical QOL (po.05) but not mental QOL(p4.05). The five most common symptoms werelack of energy (76.5%), feeling drowsy (58.8%),pain (55.9%), difficulty sleeping (52.9%) andnausea (50.0%). Patients reporting higher levelsof difficulty concentrating, pain, lack of energy,feeling drowsy, difficulty sleeping, shortness ofbreath, sweats, problems with sexual interest oractivity and headache were found to haveworse physical and mental QOL (all p valueso.05). CONCLUSIONS: CML patients receivingimatinib therapy report worse physical QOLthan individuals of similar age in the generalpopulation. Vitality or lack of energy isamong the QOL domains most affected and is

also among the most common symptoms.Patients also experience a wide variety of symp-toms that negatively impact both their physicaland mental QOL. RESEARCH IMPLICATIONS:A larger study using a longitudinal researchdesign is needed to identify the changes over timein symptoms and QOL as patients undergotreatment with imatinib. Future researchshould also focus on developing and evaluatinginterventions that could be used to relieve thesymptom burden and improve quality oflife in this patient population. CLINICALIMPLICATIONS: Patients with CML receivingimatinib therapy should be systematicallyassessed for their symptom burden. Earlier detec-tion and management of their problems has thepotential to maintain or improve their quality oflife. ACKNOWLEDGEMENT OF FUNDING:None.

P1-119

Contributing Cutting Edge Knowledge While Men-

toring the Next Generation of Psychosocial Oncol-

ogy Researchers: Is Canada Leading the Way?

Carmen G. Loiselle1,21McGill University, Montreal, QC, Canada, 2JewishGeneral Hospital, Montreal, QC, Canada

BACKGROUND: Comprehensive, culturally-rele-vant and evidence-based initiatives are needed torespond to rapidly evolving and complex psycho-social oncology issues. A Canada-wide researchtraining program called PORT (Psychosocial

Oncology Research Training), a newly endowedResearch Chair (the Christine and Herschel Victor- Hope & Cope Chair in Psychosocial Oncology) atMcGill University, and the latest multimediatechnology combine to promote and sustaintransdisciplinary research and training initiatives.In this presentation, specific scholarly activities andoutputs are outlined. METHOD: Through gener-ous funding from the Canadian Institutes of HealthResearch, PORT unites six Canadian universitiesto offer research training and financial support tonational and international fellows at the masters,doctoral, and post-doctoral levels. Fellows andPORT mentors from a variety of disciplines arepaired to explore key cancer care and survivorshipissues through reliance on quantitative, qualitativeand mixed method approaches. Closely alignedwith the PORT program, the Chair facilitatescollaboration and exposes beginning researchers tosenior researchers, clinicians, and volunteers tobest address complex problems in the field.RESULTS: Since PORT’s launch in 2004, theprogram has hosted 32 transdisciplinary mentorsand 45 fellows, with international graduate stu-dents from 5 countries. Fellows’ output to datetotals 207 peer-reviewed publications and 307scientific presentations. Research activities seek todocument the development, impact, implementa-tion as well as sustainability issues related toperson-centred interventions. The focus is on easilytransferable interventions that are cost-effectiveand span the entire cancer continuum fromprevention to long term survivorship. Researchpriorities include understudied and complex areassuch as patients’ experience navigating the healthcare system, multidimensional survivorship needs,and culturally relevant community models ofpractice. CONCLUSIONS: By underscoring highlevels of competency in pressing areas of cancersurvivorship, the initiatives presented herein illus-trate strong psychosocial oncology leadership inCanada. International partners with representationfrom the National Institute of Mental Health andNeurosciences in Bangalore, India, and MemorialSloan-Kettering Cancer Center in New York Cityadd cross-cultural relevance to these initiatives.RESEARCH IMPLICATIONS: Collectively, ele-ments of this multifaceted model of knowledgegeneration build research capacity in Canada andabroad. Integration of the newly endowedresearch Chair within the established PORTprogram consists of a significant contributionto higher education and serves as a magnet toattract committed stakeholders. CLINICALIMPLICATIONS: The active involvement ofclinicians in the solving of complex cancer careissues is paramount to the successful translation ofresearch findings. Together with academic andcommunity partners, clinicians are key in further-ing the program’s and Chair’s research goals



DOI: 10.1002/pon

and activities. ACKNOWLEDGEMENT OFFUNDING: The Canadian Institutes of HealthResearch (CIHR) (Institute of Cancer Researchand Institute of Health Services and PolicyResearch); Christine and Herschel Victor/Hope &Cope; Fonds de la recherche en sante du Quebec(FRSQ); Canadian Partnership Against Cancer(CPAC); Indo-Canadian Shastri Foundation;McGill Faculty of Graduate Studies; the NewtonFoundation.

P1-120

Anxiety in Cancer Patients: Future Considerations

Catherine ManciniMcMaster University, Hamilton, ON, Canada

BACKGROUND: The experience of cancer ishighly anxiety-provoking. Many studies have ex-amined the presence of psychiatric disorders,particularly depression, in samples of cancerpatients. Relatively less is known about theprevalence of anxiety disorders in this population.Cancer patients may present with reactive anxietythat is related to the stress of a cancer diagnosisand its treatment, or specific anxiety disorders thatpredate the cancer diagnosis and become exacer-bated during illness. METHOD: A retrospectivechart review on 95 cancer patients from a regionalcancer centre and referred for outpatient psychia-tric consultation, was performed. Patients weregiven a semi-structured interview adapted from theStructured Clinical Interview for DSM-IV (SCID).Psychiatric diagnosis, demographic variables, pastand family psychiatric history plus temporalrelationships of their mood and anxiety disorderswere assessed. RESULTS: While Major DepressiveDisorder was present for 66% of the referredpatients, a significant number of patients alsopresented with anxiety disorders. Thirty-two per-cent of the patients had a diagnosis of ObsessiveCompulsive Disorder (OCD), 12% a diagnosis ofSocial Phobia and 5% a diagnosis of PanicDisorder. Thirty four percent were diagnosed withcomorbid OCD and Major Depression. In themajority of cases of patients with depression, theonset of cancer preceded the onset of depressivedisorder (62.5%). Conversely, the onset of anxietydisorders preceded the onset of cancer 79.6% of thetime. CONCLUSIONS: While the majority ofpatients were diagnosed with a major depressiveepisode (66%), this study also gives some pre-liminary information about the type of anxietydisorders identified in cancer patients requiringpsychiatric consultation. In this sample a signifi-cant number of these patients presented with OCD(32%) and comorbid OCD and Major Depression(34%) . Pre-existing anxiety disorder, particularlyOCD, appeared to be a risk factor with respect tothe need for psychiatric consultation in this group

of cancer patients. RESEARCH IMPLICA-TIONS: This study provides some preliminaryevidence that cancer patients with a pre-existingdiagnosis of OCD may have an increased need forpsychiatric involvement and psycho-social supportduring their cancer treatment and follow-up. Theymay be a group at increased risk for the develop-ment of a major depressive episode. Differentpsychological interventions will be reviewed withthe goal of identifying those interventions requiringfurther study. CLINICAL IMPLICATIONS:Although a biased sample, this finding is interestingas it may help to identify patients who requirepsycho-social support following a cancer diagnosis.While patients frequently develop depressionfollowing their cancer diagnosis, anxietydisorder often pre-dates the cancer diagnosis.Patients with OCD may be at increased riskfor OCD symptom exacerbation and thedevelopment of depression with an increasedneed for psycho-social support. Psychologicalinterventions may be particularly helpful forthese patients. ACKNOWLEDGEMENT OFFUNDING: None.

P1-121

The Interprofessional Psychosocial Oncology Dis-

tance Education (IPODE) Project: Three years of

Interprofessional Education Outcomes

Deborah McLeod1,2, Janet Curran3, MaureenWhite2, Serge Dumont4, Grant Charles51QEII Health Sciences Centre, Halifax, NS,Canada, 2Dalhousie University, Halifax, NS,Canada, 3Ottawa Hospital Research Institute,Ottawa, ON, Canada, 4Universite Laval, Quebec,QC, Canada, 5University of British Columbia,Vancouver, BC, Canada

BACKGROUND: To address gaps in psychosocialoncology education, the Canadian Association ofPsychosocial Oncology (CAPO) launched a panCanadian education initiative in 2006. The aim ofthe IPODE project was to create web-based, inter-professional learning opportunities for practicinghealth professionals and graduate students. In thispresentation we report three years of outcomes of ourfirst course, ‘‘Interprofessional Psychosocial Oncol-ogy: Introduction to Theory and Practice’’ with anemphasis on those related to interprofessional colla-boration. METHOD: The course was developed intwo versions: First, as a 3 credit hour, 13-weekgraduate (Masters or PhD) elective, approved by 11Canadian universities; second, as a continuing educa-tion option for practicing health professionals. Eachcourse included a weekly 90-minute real-time seminar.A total of 293 health professionals and studentscompleted this course between 2008 and 2010. Forty-seven percent (n598) completed pre-course (T1) andpost-course (T2) surveys, which included both



DOI: 10.1002/pon

quantitative and qualitative components. A non-parametric Wilcoxon Signed Rank test was used tocompare changes in pre and post course knowledgeand attitudes. Narrative data were thematicallyanalysed. RESULTS: Analyses revealed the coursewas effective and significantly improved knowledge,confidence, and satisfaction with interprofessionalcollaboration and with psychosocial oncology prac-tice. Students particularly noted the use of illnessnarratives, the variety of learning tools, the opportu-nity to interact with others from across the countryand the knowledge and skill of the faculty facilitatorsas valued features of the course. A variety of changesin practice were identified as ‘‘intended’’ in the post-course surveys. Implications with regard to retentionand compassion fatigue were identified for somehealth professionals. CONCLUSIONS: The IPODEproject was successful in creating pan Canadianlearning opportunities across disciplines and univer-sities in a specialized area of practice, psychosocialoncology. Where previously extremely few graduatelevel courses were available, students in 11 universitiesnow have access to elective courses in the field.Practicing health professionals across the country, inurban and in rural or isolated communities also haveavailable education options. While some authorsrecommend blending face-face learning with e-learn-ing in order to address the need for interactivity, wefound that skilfully facilitated virtual seminars withsmall groups of learners, provided a viable alterativeto face-face education. ACKNOWLEDGEMENTOF FUNDING: Health Canada.

P1-122

Major Depression and Demoralization in Cancer

Patients: A Comparative Study Between Two

Countries of South Europe, Portugal and Italy

Maria Giulia Nanni1, Luzia Travado2, AlessandraPalma3, Cinzia Silvestrini4, Luigi Grassi11Section of Psychiatry, University of Ferrara,Ferrara, Italy, 2Clinical Psychology Unit, Hospitalde S. Jose, Lisbon, Portugal, 3Department ofOncology Arnas and Fondazione Giuseppe Alazio,Palermo, Italy, 4Section of Psychiatry, University ofChieti, Chieti, Italy

BACKGROUND: Researches revealed the exis-tence of different suffering dimensions in cancerpatients; in particular, depression and demoraliza-tion are clinical states which are phenomenologi-cally different and independent, both important forincidence and negative consequences. Despite theimportance of cultural component, most studieshave been conducted in Anglo-Saxon context,while no data are available regarding the Medi-terranean context. The study investigated theseissues in countries of Southern-Europe, Portugaland Italy, making also a comparison between thetwo countries. METHOD: The Patient Health

Questionnaire (PHQ), the Hospital Anxiety andDepression Scale (HADS), the Section on Demor-alization of Diagnostic Criteria for PsychosomaticResearch (DCPR) Interview, the DemoralizationIndex (DI) were administered to cancer out-patients, who have been admitted to the ‘‘CentroHospitalar de Lisboa Central’’, Hospital S.Jose ofLisbon, Portugal, and to the Department ofOncology ‘‘Health Hospital University AgencyS.Anna’’ of Ferrara, Italy. The sample of the studymet the following criteria: age between 18 and 70,absence of cognitive disorders, Karnofsky Perfor-mance Score 450, any site and stage of solidtumours. RESULTS: 195 patients (102 Portuguese,95 Italian) were enrolled in the study (age53,4710,3 years; 78% females, 22% males).Administering to the patients PHQ and HADS,they revealed that 21% of the sample hadsymptoms consistent with depression and 24%reported a syndrome of demoralization, assessedby DCPR. Similar results were found within thetwo sub-groups for depression (19% of Portuguesepatients, 23 % of Italians) and for demoralization(24,5% of Portuguese patients and 24% ofItalians). Evaluating the relationship between thedifferences of the mean scores obtained at thescales, no significant relationship was foundbetween the two countries. CONCLUSIONS: Thestudy revealed high prevalences of depression anddemoralization in cancer patients in two Southern-European countries, Portugal and Italy. These datasubstantially agreed with ones existing in literaturefor depression, and better defined the prevalence ofdemoralization, which has been less studied andoften underestimated. Comparing the results with-in the two countries, the prevalences for demor-alization appeared in concordance, whiledepression prevalence is slightly reduced in Portu-guese sample, although not significantly. Themeans of the scores at the administered scales werealso concordant. This evidence can be explainedwith the common cultural roots of the twocountries. RESEARCH IMPLICATIONS: Thisstudy confirmed other literature data that assumedthat demoralization is, like depression, a realimportant extent which needs to be studied andconsidered in medicine. Despite this, diagnosticsystems DSM-IV and ICD-10 do not succeed inseizing adequately demoralization in patients withmedical pathologies. More researches are certainlynecessary to better define diagnostic criteria andvalidate specific assessment instrument. Thisstudy also underlined the need to research on thisissue in different cultural contexts. CLINICALIMPLICATIONS: Possible clinical implicationare: the dissemination in various clinical contexts(for example, oncological ambulatory/Day-Hospi-tal, but also in-patients’ department and hospice)of instrument focused on demoralization, whichtake into account the cultural aspects; early



DOI: 10.1002/pon

diagnosis of Demoralization Syndrome, differentfrom clinical depression, and the possibilityto start a more specific treatment; the improvementof care and quality of life of cancer patients.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was funded by ‘‘Fondazione GiuseppeAlazio’’, Palermo, Italy

P1-123

Web-Based Modules to Educate Social Workers on

Breast Cancer: A Social Work-Nursing Partnership

Julianne Oktay, Sandra McLeskey, DeborahMcGuire, Abby PlusenUniversity of Maryland, Baltimore, MD, USA

BACKGROUND: Breast cancer is the mostprevalent cancer worldwide and in the UnitedStates. In the United States, virtually all womenover 40 are encouraged to get screened for breastcancer. Thus, large numbers of women will needcounseling for breast cancer, and referral for breastcancer screening. Social workers are increasinglyinvolved in breast cancer care, and need knowledgeof breast cancer and its psychosocial aspects.METHOD: The Maryland Affiliate of the SusanG. Komen for the Cure Foundation funded apartnership with the University of MarylandSchool of Nursing to improve the preparation ofnurses regarding breast cancer. Eight web-basedmodules were developed by the Nursing School: 1)Epidemiology, 2) Breast cancer risk, 3) Screening,4) Diagnosis, staging and grading, 5) Treatment, 6)Survivorship, 7) Health Disparities and 8) Meta-static breast cancer. In 2009, this partnership wasexpanded to include the School of Social Work.The Social Work Scholar-in-Residence expandedthe modules to incorporate psychosocial informa-tion (AOSW, 2010; ONS, 2009). RESULTS:Psychosocial content was added so that themodules could be used to educate social workersabout breast cancer. For example, psychosocialinformation added on breast cancer screeningincluded information about barriers to screening,programs to help low income women pay forscreening, and evidence-based programs to increasethe utilization of screening. Other informationadded included the NCCN distress thermometerscreening instrument, and descriptions of evidence-based programs for breast cancer survivors andtheir families. Each section includes a discussion ofthe social work role. In addition, psychosocialinformation important to nurses (e.g. screening fordepression) was added. CONCLUSIONS: Usinginnovative teaching methods and unique commu-nity collaborations, the Komen Partnership hasheightened the awareness, knowledge, and skills ofnursing students about the current state of scienceconcerning the prevention, detection, and treat-ment of people with breast cancer without taxing

faculty members who are teaching a packedcurriculum. The nursing modules had over 1900internet ‘‘hits’’ on the tool from 25 countries across6 continents in one year. The social work enhancedweb modules will be available to social workstudents, and to practicing social workers, in2011. Continuing Education credits will beavailable through the University of Maryland.RESEARCH IMPLICATIONS: The web moduleswill provide data on utilization and evaluations.Also, data on the use of the modules for Continu-ing Educational Units will be collected routinely.This data has potential for future research on thefeasibility and effectiveness of this mode of profes-sional education. CLINICAL IMPLICATIONS:By providing readily assessable information onbreast cancer, social workers will be able to learnabout breast cancer and about the social work roleeasily and without cost. This will be important forsocial work students interested in psycho oncology,as well as for practicing social workers.ACKNOWLEDGEMENT OF FUNDING:Funding for the development of the modules wasprovided by the Maryland Affiliate of the Susan G.Komen Foundation for the Cure.

P1-124

The Monitoring Process Model and Patient Delay

Anette Pedersen, Henry Jensen, Peter VedstedResearch Unit for General Practice, Aarhus Uni-versity, Aarhus, Denmark

BACKGROUND: The influence of coping onpatient delay (PD) is sparsely investigated. Accord-ing to the Monitoring Process Model (MPM), highmonitors attend to threat-relevant informationwhen exposed to a threat. This approach generateshigh levels of intrusive ideation which may promptthe use of avoidant strategies. The purpose of thisstudy was to examine the association between amonitoring coping style and PD and the possiblemediating role of fear of cancer when seeking help.METHOD: A total of 6720 Danish patientsdiagnosed with a first incidence of cancer diseasewere identified by The National Patient Registryand sent a questionnaire. The questionnaireincluded the abbreviated version of the MillerBehavioral Style Scale (MBSS) and a requestfor reporting the date of first recognition ofsymptom(s) and the date of first contact to ahealth care professional. PD was defined as theinterval between these two dates. A PD exceeding60 days was defined as a long PD. Data wasanalyzed with logistic regression analysis and withmediation analysis with binary variables (Stataversion 11.0). RESULTS: The questionnaire wascompleted by 2234 (33%) patients, and 566 (25%)reported a PD longer than 60 days. A high score onthe monitor scale was associated with increased



DOI: 10.1002/pon

risk of a long PD (OR5 1.07; 95% CI5 1.00, 1.15)when adjusting for age and gender. A high score onthe monitor scale was associated with an increasedlevel of fear of cancer when seeking medical help(OR5 1.11; 95% CI5 1.03, 1.19), but resultsrevealed no evidence of a mediating role of fearof cancer on the association between high monitor-ing and increased risk of a long PD (95% CI ofindirect effect5�0.008, 0.001). CONCLUSIONS:The results revealed that high monitoring wasassociated with an increased risk of a long PDand with an increased level of fear of cancerwhen contacting a health care professional.Despite the associations between high monitoringand PD and between high monitoring and in-creased levels of fear of cancer, the resultsof a formal test of mediation revealed no evidenceof a mediating role of fear of cancer on theassociation between high monitoring and along PD. The retrospective study design and thereduced response rate are limitations of thepresent study. RESEARCH IMPLICATIONS:The MPM describes the chain of events: monitor-ing, intrusive ideation, avoidant ideation, anddenial/disengagement. Insofar as PD is seen asdenial and cancer fear as intrusive ideation, theresults of the present study partly support theMPM as high monitoring was associated withincreased levels of fear of cancer and increasedrisk of a long PD. Future studies have toexamine whether avoidant ideation is themissing link between fear of cancer and PD.CLINICAL IMPLICATIONS: High monitorsoften report high levels of health promotingbehaviours. However, the present results suggestthat high monitors display lower levels of diseasedetecting behaviours than low monitors whenconfronted with a real health threat. The interplaybetween intrusion and avoidance in monitors posesa challenge to health campaigns aimed at reducingPD. Thus, there is a risk that health campaigns willincrease levels of intrusive ideation and therebyreinforce avoidant behaviour in high monitors.ACKNOWLEDGEMENT OF FUNDING: Thewriting of this abstract was supported financiallyby the Danish Cancer Society and the NovoNordisk Foundation.

P1-125

In with Both Feet: Developing an Evidence Base for

the Provision of Reflexology in a Day-Cancer-

Centre

Anna Petterson1,2, David Joske1,3, AnneWilliams2,4, Ashley Medcalf11SolarisCare Foundation, Perth, WA, Australia,2Edith Cowan University, Joondalup, WA,Australia, 3University of Western Australia,Nedlands, WA, Australia,4Sir Charles GairdnerHospital, Nedlands, WA, Australia

BACKGROUND: Cancer patients requiring che-motherapy often present to day-cancer-centres in averge-of-panic state. Although the patients’ medi-cal team have explained procedures, many continueto experience distress and anxiety about theirtreatment plan. A pilot study during 2010 revealedthat distress, recently named as the 6th Vital Signby IPOS was experienced by most patients. Wehypothesised that the provision of reflexology,when patients were receiving chemotherapy wouldreduce symptom distress and improve quality oflife. METHOD: Patients presenting for a reflexol-ogy session were given an information sheetoutlining the study and all questions raised wereanswered. They then completed a confidentialconsultation and consent form. Our pilot samplesize was small with eighty-two patients receivingreflexology, fifty-four self-selecting patients filled inQuality-of-Life and Symptom-Distress-Scale ques-tionnaires. Both questionnaires contained seven-items each rated on an eleven-point Likert scale(05no problems, 105worst problem). These arevalidated instruments and used widely in WesternAustralia within cancer populations. They wereadministered prior to and immediately followingpatient’s first, third and sixth reflexology treat-ments. RESULTS: Analyses indicated that patientsquality-of-life significantly improved, (t(51)5

7.894, po.001) and symptom-distress was signifi-cantly reduced, (t(50)5 8.402, po.001). The effectsizes were d5 2.10 and S d5 2.96 respectively.These are both large, with physical symptomsshowing greater improvement than emotional/psychological wellbeing. Scores for fatigue andpain were most reduced for the SDS. The highestQoL scores were given post-reflexology sessionsindicating that the effects of reflexology extendedbeyond their weekly treatments. An increase formost items on the QoL measure indicated a reliefof emotional distress. Results are from a pilotstudy. CONCLUSIONS: These results demon-strate a positive impact on patients’ quality-of-lifeshowing reduced distress and symptomatology forpatients who accessed reflexology while undergoingchemotherapy treatment. Throughout the world anaging and growing cancer population who have anincreasing interest in complementary therapies,demands that researchers address the issue ofintegrating complementary therapies alongsideconventional medical practice to improve cancerpatient outcomes. A diverse approach that includesevidence-based reflexology being available in ter-tiary hospitals day cancer centres, integrated intoroutine cancer care may reduce care costsand improve patient outcomes. RESEARCHIMPLICATIONS: Reflexology claims that differ-ent points on the sole of the foot are connectedwith the body’s internal organ system and that bysystematically applying pressure on these points,symptoms such as pain, constipation and nausea



DOI: 10.1002/pon

can be relieved. Endorphins are reportedly releasedand stimulation of the cutaneo-organ reflexes iscreated; together with the promotion of lymphaticflow and the dissolving of uric acid crystals. Ifproven, reflexology would reduce symptom-distressand improve quality-of-life for cancer patients.CLINICAL IMPLICATIONS: Diminishing fundsand growing demands on health care because of anaging population requires that service providerslook for innovative ways to enhance and deliverservices. The provision of reflexology at Sir CharlesGairdner Hospital’s Day Cancer Centre is part ofan innovative research project that will add to agrowing body of knowledge in the provision ofComplementary Integrated Therapies for cancerpatients. No medical misadventure was recorded inthis pilot study. ACKNOWLEDGEMENT OFFUNDING: None.

P1-126

Are Fatigue, Anxiety and Depression Associated

with the Occurrence of Infections in Cancer

Patients?

Sophie Ruel1,2, Caroline Desautels1,2, HansIvers1,2, Josee Savard1,21School of Psychology, Laval University, Quebec,QC, Canada, 2Laval University Cancer ResearchCenter, Quebec, QC, Canada

BACKGROUND: The psychoneuroimmunologi-cal (PNI) model proposes that psychologicalfactors, such as fatigue, anxiety and depression,can have a negative impact on cancer evolutionthrough immune dysregulation. Although somestudies have found that psychological factors aresignificantly associated with altered immune func-tioning in cancer patients and poorer cancerprognosis, it would appear that a more appropriateoutcome measure in PNI studies would be theoccurrence of infections, which are highly frequentduring cancer treatments. METHOD: The aim ofthis study was to evaluate the role of fatigue,anxiety, and depression in predicting the occur-rence of infectious episodes and symptoms incancer patients throughout their treatment trajec-tory. Patients scheduled to undergo surgery forcancer (N5 962) completed a structured interviewto assess symptoms of infectious illnesses as well asthe Hospital Anxiety and Depression Scale (HADS)and the Multidimensional Fatigue Inventory (MFI)at six time points: at baseline (T1), as well as 2 (T2),6 (T3), 10 (T4), 14 (T5) and 18 (T6) months later.RESULTS: Linear mixed model regression ana-lyses controlling for time and patient effectsrevealed that taken individually, increased anxietyand fatigue were significant predictors of a greaternumber of infectious episodes (B5 0.008,t(3687)5 2.18, p5 .03; B5 0.06, t(3687)5 2.89,p5 .004) and symptoms (B5 0.02, t(3688)5 2.41,

p5 .02; B5 0.19, t(3688)5 3.71, p5 .0002). Whenall three predictors were included in the analyses,only increased fatigue remained a significantpredictor of a greater number of infectiousepisodes (B5 0.06, t(3686)5 2.07, p5 .04) andsymptoms (B5 0.223, t(3686)5 3.32, p5 .0009).CONCLUSIONS: These findings support thepresence of a linear relationship between theseverity of fatigue and the risk of infections incancer patients. Further research is needed todetermine whether there is a causal relationshipbetween fatigue and infections, and inwhich direction. ACKNOWLEDGEMENT OFFUNDING: This study was supported by atraining award held by both the first and thesecond authors from the Psychosocial OncologyResearch Training and by a grant held by thefourth author from the Canadian Institutes ofHealth Research (MOP - 69073).

P1-127

What Doctors Don’t Know About Adherence: A

Qualitative Study of Adherence to Imatinib Amongst

Patients with Chronic Myeloid Leukaemia

Simon Wu1, Desmond Chee1, Anna Uglade2,Phyllis Butow3, John Seymour2, Penelope Scho-field2,11The University of Melbourne, Melbourne, VIC,Australia, 2Peter MacCallum Cancer Centre, EastMelbourne, VIC, Australia, 3The University ofSydney, Sydney, NSW, Australia

BACKGROUND: Continuous, daily use of oraldrug therapy, imatinib, for chronic myeloid leu-kaemia(CML) is critical to treatment success andsurvival. Perfect adherence to imatinib is reportedto be as low as 14%. The study aimed to:understand the experiences of patients with CML,and describe the facilitators and barriers toadherence and strategies useful to encourageadherence to imatinib amongst people with CMLduring the chronic phase, drawing on patients’and health professionals’ (HPs) perspectives.METHOD: Sixteen patients with CMLcurrently prescribed imatinib and ten HPs (4haematologists, 3 nurses, 3 pharmacists) wererecruited. Recruitment ceased when saturationwas achieved. Semi-structured qualitative inter-views of 30-60 minutes were recorded, transcribedand manually analysed for themes using interpre-tive phenomenological analysis. Separate interviewschedules were developed for patients and HPs.However, similar issues were covered: patientexperience of CML; adherence issues and treat-ment toxicities. Two and seven randomly selectedtranscripts were reviewed separately by twoinvestigators (PS, DC) respectively. Disagreementswere discussed and coding guides refined withre-coding of transcripts as required to reflect the



DOI: 10.1002/pon

updated codes. RESULTS: Three broad themesemerged: 1)coping with disease and treatment;2)practical management of medication and facil-itators of adherence; 3)barriers to adherence. 12/16patients reported at least one instance of non-adherence to treatment, but HPs believed non-adherence was not a major issue. Reasons forunintentional nonadherence included forgetfulness,variable daily routine and issues with doctor-patient communication. Reasons for intentionalnon-adherence included: reducing drug impact onlife and inadequate medical knowledge. Patients atrisk of non-adherence were more blase about theirtreatment, felt complacent following a period ofsustained disease control or reported havingreceived inappropriate reassurance from HPsabout missing doses. CONCLUSIONS: Adherenceissues persist throughout treatment, from short-term adverse drug events to long-term chronicmanagement. In contrast to patient reportedfrequency of non-adherence, health professionalsdid not perceive non-adherence as a major issueand were unaware of the complex intentional andnon-intentional reasons for non-adherence. In theabsence of objective methods, health professionalsrely on patient report and tests for disease responseto detect true adherence in patients with CML.Some patients had non-adherent events because ofinsufficient education, or miscommunication com-bined with being unable to access prompt medicalguidance, highlighting potential pathways toimprove to clinical practice. RESEARCHIMPLICATIONS: This study indicates that novelintervention strategies are needed to enhanceadherence and disease control. Currently, thereare no reliable methods to detect patient non-adherence. There is a need to develop and testnovel intervention strategies. Ideally, interventionsshould be tailored to individual patients’ routines,side-effect profiles and personal needs; and toprovide support in real time for the initialdrug management issues, ongoing monitoring oftreatment adherence and side-effects andprovision of self-management advice. CLINICALIMPLICATIONS: There are still major gaps incurrent clinical practice to improve adherence inpatients with CML. The difference in perspectivesamong patients and HPs suggests a lack of effectivediscussion. HPs have a responsibility to initiatediscussions about the facilitators and barriers tomedication adherence, and ensure that patientsunderstand the medical advice that they are given,particularly in relation to interactions with im-atinib, missed doses and complementary andalternative therapy use. ACKNOWLEDGE-MENT OF FUNDING: This study was fundedby the Peter MacCallum Cancer Foundation.Associate Professor Penelope Schofield currentlyholds a National Health and Medical ResearchCouncil Career Development Award, ID 628563.

P1-128

Depressive Symptoms and Life Satisfaction Among

Bereaved Cancer Caregivers: A Longitudinal Inves-

tigation

Youngmee Kim1, Charles Carver1, RachelSpillers2, Jennifer Steel31University of Miami, Miami, FL, USA, 2AmericanCancer Society, Atlanta, GA, USA, 3University ofPittsburgh, Pittsburgh PA, USA

BACKGROUND: Studies have found that be-reaved caregivers report difficulty in psychologicaladjustment to their loss, whereas other studies havefound bereaved caregivers showing resilience. Yet,among this population, negative and positiveindicators of psychological adjustment from beforeto after the loss remains unknown, mainly due tothe disconnect between the survivorship andbereavement literature. This study examined thechanges in prevalence of negative and positiveindicators of psychological adjustment for familycaregivers during the caregiving and bereavement.METHOD: Bereaved caregivers were identifiedfrom a larger longitudinal cancer caregiver studyat the 5-year follow-up phase (n5 52: time since thedeath5 2.7 years). Demographic predictors in-cluded age, gender, education, and spouse to thecare recipient. Psychological predictors were mea-sured at the 2-year assessment when the carerecipients were alive and included perceived car-egiving stress (Pearlin’s stress overload scale),severity of the care-recipient’s cancer, perceivedlevel of social support (ISEL), and caregiver self-esteem (CRA caregiver esteem scale). Outcomevariables were measured at both 2- and 5-yearassessment points and included depressive symp-toms (CES-D) and life satisfaction (Satisfactionwith Life Scale). RESULTS: Half of the samplereported clinical levels of depressive symptomsduring caregiving. Among them, 33% remained atclinical levels of depression at post-loss. Lifesatisfaction at both pre- and post-loss was slightlylower than the norm of older adults. In addition,multivariate hierarchical general linear modelingrevealed that pre-loss depressive symptoms were asignificant predictor of post-loss depressive symp-toms (B5 .55; po.001) but it was not the case forlife satisfaction. Caregivers with a higher educationreported lower levels of post-loss depressive symp-toms (B5 -8.13; po.01). Greater levels ofpre-loss social support related to lower levels ofpost-loss life satisfaction (B5 -1.28; po.05).CONCLUSIONS: Results suggest that bereavedcancer caregivers had high levels of depression andlack of satisfaction with life while they wereengaging in providing care, which remained forsome caregivers three years after their loss. Educa-tion and pre-loss social support played significantroles in caregivers’ psychological adjustment after



DOI: 10.1002/pon

the loss, which effects remained after including theconcurrent levels of social support. RESEARCHIMPLICATIONS: Although strongly and inver-sely correlated with depressive symptom scores(r5�.61), life satisfaction provides a uniquepicture from depression in understanding cancercaregivership. Investigating both positive andnegative adjustment outcomes of cancer experienceis encouraged in future studies. In addition, furtherinvestigation is needed to elucidate the role ofamount and type of support, and optimal distribu-tion of support for caregivers throughout thecaregivership trajectory, particularly for bereavedcaregivers. CLINICAL IMPLICATIONS: Psycho-social programs for caregivers should targetcaregivers with less than high school educationand who display clinical levels of depression duringcaregiving phase. Programs aimed to improvecompetence and mastery in cancer caregiving skillsand knowledge, and in seeking proper socialsupport may help bereaved cancer caregivers havea more positive adjustment experience throughouttheir caregivership. ACKNOWLEDGEMENT OFFUNDING: American Cancer Society IntramuralResearch.

P1-129

Nurses’ Current Psychosocial Care May Fail to

Help Prevent Distress

Kerry Suzuki, Rachel Piferi, Ellen Levine, RebeccaJobeWalden University, Minneapolis, MN, USA

BACKGROUND: Previous barriers to Psychoso-cial Care (PSC) research had presupposed nurses‘‘would if they could’’ provide PSC. However,structural barriers (e.g., lack of time, lack ofeducation, nurses personal stress) may preventthem from giving good PSC. No research has yetexamined nurses’ role beliefs (NRB) about provid-ing PSC designed to prevent Psychological Distress(PD). The purpose of this study was to identifyNRB about providing PSC and determine if NRBswere a barrier to PSC. METHOD: A qualitativedesign and a purposive multinational sample of 10nurses working in Japan were formed into 2 focusgroups. The nurses originated from Africa, Asia,Middle East, and the USA. Discussion narrativeswere coded for psychosocial care, role beliefs,barriers, and solutions to barriers. Provider do-mains were analyzed using Burnard’s thematiccontent analysis method. RESULTS: Nurses main-tained that providing psychosocial care is funda-mental nursing work: NRB could not bedetermined a barrier to PSC. However, nurses’current levels of PSC indicate a gap between PSCbehaviors recommended in the clinical guidelines.Nurses’ knowledge of the clinical significance ofPSC (i.e., evidence based capacity of PSC to

prevent MDD, improve health outcomes, andimprove QoL) also appears to be lacking. Thismultinational sample of nurses produced a‘‘Reminder for Psychosocial Care’’ project titled‘‘Have you talked with your patients today?’’ whichthey translated into several languages and plan todisseminate internationally and locally.CONCLUSIONS: Nurses self-reported as willingproviders of PSC. However, structural variables(e.g. lack of time, systems of care that limit nursepatient contact) keep them from providing it. Inaddition, nurses’ current PSC may fail to detect,treat, or prevent psychological distress even in theabsence of structural barriers. Therefore, efforts atbarrier reduction should address how to synthesizeall nurses’ current PSC with PSC behaviorsrecommended in the clinical guidelines andhow to improve nurse education about PSC.RESEARCH IMPLICATIONS: Future researchshould focus on reducing barriers to PSC, devel-oping a shared definition of PSC, and improvedsynthesis of nurses’ current levels of PSC withclinical guidelines. Studies of the implementationof a Reminder for PSC are also warranted. Thismulticultural sample illustrated the value ofresearch with nurses from various cultures. Moreresearch with nurses from different ethnic groupsshould be encouraged. CLINICAL IMPLICA-TIONS: The results of this study indicate theimportance of all nurses being better educatedabout PSC. Efforts at reducing barriers to provid-ing psychosocial care should also be addressed.ACKNOWLEDGEMENT OF FUNDING:None.

P1-130

Psychophysiological Reactivity, PTSD and Distress

in Adult Children of Cancer Patients


BACKGROUND: Caregiving, an important com-ponent of cancer patient treatment, may set forth acascade of stress responses (Vitaliano et al., 2003).Adult children, particularly, may perceive cancerand its treatments as a traumatic experience.This study focused on whether heart rate (HR)and skin conductance (SC) responses to standar-dized pictures were different between individuals ina parental cancer situation versus a control groupand how these responses were associated with theprediction of more PTSD symptoms. METHOD:Two groups of adult children (with a parent inchemotherapy vs. healthy parents) visualized stan-dardized negative (cancer-related), positive andneutral pictures from the International AffectivePicture System (Lang et al., 2008), while HR andSC responses were recorded. Physiological data



DOI: 10.1002/pon

analysis was performed based on proceduresdescribed in the psychophysiological literaturefor the variables of SC (Venables & Christie,1980; Dawson et al., 2007) and HR (Bradley et al.,2001; Ehlers et al. 2010). Participants also com-pleted self-report measures of PTSD symptomatol-ogy (IES-R), distress (DASS-21) and family burden(BAS). RESULTS: Adult children with an illparent had higher levels of PTSD symptoms,distress and burden when compared to a controlgroup. They also showed greater HR (less pro-nounced mean deceleration and a higher propor-tion of HR acceleration greater than 1 beat perminute) and SC (greater magnitude) responses tocancer-related pictures. Differences between groupsin SC responses to positive and neutral pictureswere found but not regarding HR responses. In thecancer group, peak HR response to negativepictures contributed together with distress andburden to the prediction of more PTSD symptoms.CONCLUSIONS: The results show that there aredifferences in the magnitude of electrodermalreactivity (SC) between groups of caregivers vs.noncaregivers to standardized pictures and suggestthat HR responses towards cancer-related stimulimay help identify a subgroup of caregivers withmore traumatic stress symptoms. The general-ization of reexperiencing triggers found inthis study is consistent with associative learningand cognitive models of PTSD. RESEARCHIMPLICATIONS: This study underlines the im-portance of adding physiological variables to self-report measures used to assess the psychologicaland physical health of caregivers in oncology. Itwould be important, in future studies, to includeother physiological measures, such as immuneparameters in this and other groups of caregivers.CLINICAL IMPLICATIONS: Physiological mea-sures may be relevant in identifying subgroups ofanxiety disorders in caregivers of cancer patientsundergoing treatment. ACKNOWLEDGEMENTOF FUNDING: This work was supported by a grantfrom the Foundation for Science and Technology.

P1-131

Long-Term Experiences from Living with Lynch

Syndrome: A Phenomenological Approach to

Understanding Thoughts and Feelings in Healthy

High-Risk Individuals

Helle Vendel Petersen1,4, Inge Bernstein2, LoneSunde3, Mef Nilbert1,4, Christina Carlsson41Clinical Research Center, Hvidovre UniversityHospital, Copenhagen, Denmark, 2HNPCC-register,Hvidovre University Hospital, Copenhagen, Den-mark, 3Aalborg University Hospital, Aalborg, Den-mark, 4Skane University Hospital, Lund, Sweden

BACKGROUND: Lynch syndrome confers in-creased risks of cancer, particularly related to

gastrointestinal and gynecological cancer. Indivi-duals with high risks of cancer represent a new andgrowing group. Though healthy, these individualsare dependent on the health care system forsurveillance programs that reduce cancer morbidityand mortality. Knowledge about the long-termexperiences of these high-risk individuals is scarceand the aim of our study was to describe andunderstand perspectives and experiences in Lynchsyndrome. METHOD: We performed face-to-face,in-depth interviews with 13 individuals with disease-predisposing germline mutations, who followedsurveillance programs and had not been affectedby cancer. These individuals (7 women and 6 men,aged 32–71 years) had 6–14 years of experiencefrom living with a high risk of cancer. The datawere analyzed using phenomenological methodol-ogy in four steps: text analysis to get a sense of the‘‘whole’’, dividing the text into meaning units, re-description of meaning units and theme formationand description of the structure of the phenomen-on. RESULTS: The level of intrusive thoughts andanxiety experienced at the time of genetic testingdecrease over time. Issues and events related to thehigh risk of cancer risk such as colonoscopies,cancer in family members and informing childrenabout their risk, however, evoke feelings. Knowl-edge about Lynch syndrome, personal experiencesfrom cancer, and individual strategies for handlingthe situation, influenced the impact, in positive aswell as negative terms. CONCLUSIONS: Althoughintrusive thoughts and anxiety related to living witha high risk of cancer decrease over time, thesefeelings are evoked by events related to heredity andincreased risk during life. How an individualperceives a certain event is influenced by knowledgeabout genetic predisposition and possibilities forpreventing cancer, family history, personal experi-ences and personal coping strategies. RESEARCHIMPLICATIONS: Further research should bedirected at randomized interventions, which couldfocus at providing individuals with personal strate-gies for coping with the impact of living with a highcancer risk. CLINICAL IMPLICATIONS: The keyissues identified in healthy at-risk individuals shouldbe taken into consideration at genetic counselling.ACKNOWLEDGEMENT OF FUNDING: Thestudy was supported by the Danish Cancer Society.

P1-132

Evaluation of the First Eighteen Months of the First

Running of an MSc in Psycho-Oncology through the

School of Nursing, Dublin City University, Ireland

ShelaghWright, Anthony Staines, Robert O’ConnorSchool of Nursing, Dublin City University, Dublin,Ireland

BACKGROUND: In Ireland, psycho-oncologyservice provision is endorsed in the National



DOI: 10.1002/pon

Cancer Strategy (2006). However, psychosocialoncology services are currently under developmentand many healthcare professionals working in theoncology setting have little education in this vitalaspect of patient and family care. The MSc inPsycho-oncology, the first in Ireland, aims toprovide an international standard third levelaccredited postgraduate programme of educationin psycho-oncology to help to drive the develop-ment of psycho-oncology services. METHOD: Theaccredited MSc in Psycho-oncology programmewith seven students began running in October2009, one day per week. Students completed theirfirst year over two semesters covering four founda-tion modules specific to psycho-oncology. Modulesfor the first semester of the second year focused onleadership and management in psycho-oncologyand palliative and terminal illness and bereave-ment. During this semester students prepared theirresearch proposals for their Masters’ Dissertations,prior to submission to the School of Nursing EthicsApproval Committee, and submissions to formalresearch ethics committees as required by organisa-tions kindly giving permission for their researchdata collection. RESULTS: Students evaluatedweekly lectures &/or workshops using the LecTrainevaluation form, comprising a Likert scale and apre post self evaluation of learning outcomes andqualitative feedback. A more detailed School ofNursing module evaluation form was completed bystudents at the end of each semester. Students’learning outcomes were formally evaluated duringthe three semesters by continuous assessment, withboth written and practical assignment (video andself assessment of communication and assessmentskills; classroom presentation) components fol-lowed by internal and external examination.CONCLUSIONS: Students’ learning outcomesare reflected in the high standard of their writtenassignments and enthusiastic hardwork to prepareinteresting and relevant research proposals. How-ever, a strongly recommended change is forstudents to begin planning their research proposalsin the first year. The MSc in Psycho-oncologyprogramme has and continues to be evaluatedpositively by students, particularly the provision ofonline Moodle and general support and flexibilityin meeting students’ learning needs. The motiva-tion and enthusiasm of students to transfer psycho-oncology knowledge to the clinical setting con-tributes to their commitment to the programmeand their working cohesively as a group. AC-KNOWLEDGEMENT OF FUNDING: Schoolof Nursing, Dublin City University.

P1-134

The Misunderstanding and Doubt on ‘‘Do Not

Resuscitate’’ (DNR) Order Among Cancer Hospital

Health Professionals

Chihtao Cheng1,21Koo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan, 2National Defense University,Taipei, Taiwan

BACKGROUND: Advance directives, such asDNR, promotes patient autonomy and providespatients opportunities to cope with the dyingprocess. However, its use has been limited becauseof the fear that the DNR may be abused and thatpatients may receive less-than-optimal care oncethey signed the DNR document. This research aimsto look into the understanding and beliefs of theDNR among cancer care professionals in a cancerhospital in Taiwan. METHOD: 129 healthcareprofessionals in a cancer hospital in Taiwan wereasked to answer a questionnaire that included 2questions: (1) a multiple choice question on themedical procedures that a patient forfeits when hesigned a DNR document. The choices includeprocedures encompassed in a DNR order, such ascardiac massage, intubation and use of cardiotro-pic agents; they also include procedures notincluded, such as chemotherapy, nutritional sup-port and antibiotics. (2) a single choice questionasking whether or not the cancer care professionalbelieves that once a patient signed a DNRdocument, he or she may receive less-than-optimalcare. RESULTS: Only 41 percent of all cancer careprofessionals answered correctly on the proceduresencompassed in a DNR order. Most peopleanswered incorrectly either missed cardiotropicagents or mistakenly included chemotherapy. 20out of 129 (16%) cancer care professionals believedthat once a patient signed a DNR document, he orshe may receive less-than-optimal care. Physiciansand cancer care professionals worked over 6 yearshave higher proportions giving such a responsethan their counterparts. CONCLUSIONS: There issubstantial level of misunderstanding and doubt onthe ‘‘do not resuscitate order’’ (DNR) among cancerhospital healthcare professionals. RESEARCHIMPLICATIONS: This study contributed to thelittle investigated area about the knowledge andattitude of cancer care professionals. This survey-based study calls for further qualitative research toclarify its potential effect on the cancer care decisionmaking. CLINICAL IMPLICATIONS: This studyhighlights the misunderstanding and doubt on theDNR order among cancer hospital healthcareprofessionals, which may be a barrier to a betterend-of-life care. ACKNOWLEDGEMENT OFFUNDING: None.

P1-135

Associations Between Pain and Psychosocial Factors

Using a Computerized Ecological Momentary

Assessment Technique in Home Hospice Cancer

Patients



DOI: 10.1002/pon

Maki Hachizuka1, Kazuhiro Yoshiuchi2, HiroeKikuchi3, Yoshiharu Yamamoto4, Satoru Iwase5,Keiichi Nakagawa5, Koh Kawagoe6, AkiraAkabayashi21Department of Psychosomatic Medicine, ShowaGeneral Hospital, Tokyo, Japan, 2Department ofStress Sciences and Psychosomatic Medicine, Grad-uate School of Medicine, The University of Tokyo,Tokyo, Japan, 3Department of PsychosomaticResearch, National Institute of Mental Health,National Center of Neurology and Psychiatry,Tokyo, Japan, 4Graduate School of Education, TheUniversity of Tokyo, Tokyo, Japan, 5Department ofPalliative Care, The University of Tokyo, Tokyo,Japan, 6Clinic Kawagoe, Tokyo, Japan

BACKGROUND: Previous studies have reportedthat cancer pain and psychosocial factor areassociated. However, most of the previous studiesrelied on recalled subjective symptoms, whichcould be affected by recall bias. To overcome thisdisadvantage, it is necessary to collect real-timedata in a natural environment using a computer-ized ecological momentary assessment (cEMA).Therefore, the aim of the present study was tocollect symptoms in cancer patients using cEMA,and to evaluate the relationships between symp-toms. METHOD: The subjects were terminalcancer patients receiving home hospice care.Inclusion criteria were having cancer-related pain,being with analgesics, being 20 and above yearsold, and not having a current or recent history ofcognitive impairment or psychiatric disorder. Theywere asked to record their intensities of symptoms(pain, fatigue, nausea, anxiety, depression, anddrowsiness) on a visual analogue scale (VAS) in apersonal digital assistant (PDA) several timesper day for a week when an alarm sounded andwhen they took rescue medications. In order toinvestigate the relationships between momentarysymptom intensities, multilevel modeling wasperformed. RESULTS: Seventeen patients finishedthe entire schedule. The median age of the patientswas 66 years and the median survival time after thelast day of each study period was 28 days. Theanalysis showed that the momentary pain waspositively correlated with concurrent psychological(anxiety and depression) and physical (nausea,fatigue, and drowsiness) symptoms. The positiveassociation between preceding anxiety and follow-ing pain was also shown. CONCLUSIONS: Usinga cEMA technique with a PDA, we found that painwas positively correlated with concurrent psycho-logical and physical symptoms. In addition, pre-ceding anxiety was correlated with pain. Therefore,adequate management of psychological and physi-cal symptoms, especially anxiety, might be able torelieve pain. RESEARCH IMPLICATIONS: Thisstudy indicates that a cEMA technique might beapplicable to even severe cancer patients to

evaluate symptoms in the natural settings. This isthe first study to evaluate the relationship betweenreported symptoms in terminal cancer patientsreceiving at-home hospice care using cEMA.CLINICAL IMPLICATIONS: A cEMA techni-que might be able to apply even severe cancerpatients to evaluate symptoms, which mightlead to better assessment and management ofsymptoms in cancer patients at home.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was partly supported by Sasakawa HealthScience Foundation.

P1-137

Efficacy and Feasibility Study on the Use of Patient-

Reported Outcomes by Palliative Care Teams in

Japan

Yujiro Kuroda, Naoko Sakata, Satoru Iwase,Mieko Fukui, Mikiko Kaizu, Yoshiaki Kanai,Kaori Muto, Osamu Sakura, Keiichi NakagawaThe University of Tokyo, Tokyo, Japan

BACKGROUND: There is growing interest withregard to using patient-reported outcomes (PROs)in cancer research. Some studies suggest that usingPROs might improve patient-clinician communica-tion and assist in the early detection of toxicities inroutine oncology care. However, currently, PROsare not commonly used to monitor patient status inpatients with advanced cancer. The purpose of thisstudy is to determine the efficacy and feasibilityof the use of PROs by palliative care teams.METHOD: We developed a questionnaire basedon the 15-item European Organization forResearch and Treatment of Cancer Quality of LifeQuestionnaire-Core 15-Palliative Care (EORTCQLQ-C15-PAL) and added 1 question on severityof diarrhea. Patients who had advanced cancer andwere referred to the palliative care team wereincluded in the study; 152 patients were given thequestionnaire. We also conducted semi-structuredinterviews with palliative care clinicians (medicaldoctor, oncology nurse, and clinical psychologist)regarding the clinical implications of PRO dataprovided by the patients. Qualitative analysis wasperformed by a qualitative research specialist byusing a content analysis method. RESULTS: From152 patients with cancer, 132 (mean7SDage5 62.22712.85 years) completed all question-naires, yielding a response rate of 86.8%. For these132 patients, fatigue (68.56731.38) and pain(63.10734.63) were the symptoms most frequentlyreported to the palliative care team. Qualitativeanalysis of data indicated 9 main categories,including the following: PROs improved theusefulness of patient-clinician meetings; PROsprovided information on symptoms that areroutinely inquired about; PROs are useful duringthe follow-up of patients with past symptom issues;



DOI: 10.1002/pon

and patients often misinterpret PRO questions.CONCLUSIONS: The results suggest multidisci-plinary clinician perspectives on the use andusefulness of PROs in palliative care. Despite someresistance to the use of PROs because of issues suchas misinterpretation of questions, our resultsindicate that the PRO tool is likely to improvesymptom assessment and patient-clinician commu-nication. The results suggest that patient-centeredcare will be enhanced by using PROs in palliativecare. ACKNOWLEDGEMENT OF FUNDING:This research was supported by the Grant-in-Aidfor Scientific Research of Ministry of Education,Culture, Sports, Science and Technology, Japan(MEXT Grant), Grant number: 22790488, Projectleader: Yujiro Kuroda.

P1-138

The Influence of Psycho-Existential Profile on

Biomarkers of Immune Response in Advanced

Cancer

Elsa Lau1, Bruno Gagnon2, Sydney Miller11Department of Psychology, Concordia University,Montreal, QC, Canada, 2Faculty of Medicine,McGill University, Royal Victoria Hospital, Mon-treal, QC, Canada

Abstract not available for print.

P1-139

Needs, Priorities, and Concerns of Terminally Ill

Cancer Patients: A Literature Review

Sophie Lelorain1,2, Bredart Anne2,1, SylvieDolbeault2, Serge Sultan11Universite Paris Descartes, Paris, France, 2InstitutCurie, Paris, France

BACKGROUND: Terminally ill cancer patientsface many wearing issues such as the idea of a neardeath and the management of the disease and itssymptoms. They also often have to adapt to thenew environment of a palliative care unit. Our goalwas to review the literature on these specific patientneeds, priorities, and concerns in order to providean overview of what is really important fromthe patient’s perspective near the end of life.METHOD: Using PubMed and PsycInfo data-bases, we carried out the search on cancerpatients with the 2 following entries in forcedcombination: index terms referring to terminally illcancer patients (i.e. ‘terminally ill patients’, ‘term-inal cancer’, ‘palliative care’, ‘hospice’) AND indexor simple terms referring to the patient’s point ofview about what is important to them at thisspecific stage of their life (i.e. ‘priorities’, ‘needs’,‘concerns’, ‘values’, ‘satisfaction’, ‘well-being’,‘quality of life’, ‘adjustment’, ‘person-environmentfit’, ‘goals’, ‘motivation’). Only journal articles

were searched. RESULTS: Twenty-seven returnedhits were kept. Patient priorities and needs were:the management of pain, the maintenance ofdignity, as much independence/autonomy aspossible, involvement in everyday and social life,experiencing personal and emotional control,meaningful personal relationships, and an immedi-ate convivial environment with the expectation of ahelpful and human medical staff. The maintenanceof hope and an optimistic outlook as well as a senseof spirituality and wisdom/acceptance were alsoreported as important components of the currentquality of life. Patients were concerned for theirfamily and did not want to become a burden tothem. CONCLUSIONS: These results should beconsidered in a palliative setting which patientscannot leave. This is why the immediate palliativecare environment seems to play a major role in thiscontext. Indeed, pain relief, patient dignity, con-veying hope, and social life all depend to a greatextent on the palliative care setting, and thus areessential resources for patient well-being andcoping with the difficulties of a terminal disease.RESEARCH IMPLICATIONS: Based on thesefirst results as well as on further studies, ques-tionnaires about the needs and priorities ofterminally ill cancer patients could be created andtested. Such questionnaires could be a usefulalternative to the current quality of life question-naires since the latter have sometimes shownunexpected high scores in the palliative context,revealing the limited relevance of the quality of lifeconcept in such a setting. CLINICAL IMPLICA-TIONS: This review suggests that, as far as theirphysical health allows, patients would welcome alivelier place for a palliative unit. Shared, multi-bedded rooms, and more contact with the outsideenvironment could be implemented, and wouldprobably be a basis for the actualization of positivemental coping and thus a more meaningful end oflife. All mental and social activities that could helppatients to gain control should be envisaged.ACKNOWLEDGEMENT OF FUNDING: Thisreview was supported by INCA SHS 2008 and 2009.

P1-140

Psycho-Spiritual Approach to Cancer Patients

Oznur OzdoganAnkara University, Thelogy Faculty, Ankara, Turkey

BACKGROUND: Healing exists in pure spiritualenergy. Human consciousness is one of the power-ful determining factors in both health and illness.Being aware of finding meaning in our lives andexperiences promote and strengthen the effective-ness of medical intervention. Along with physicalor organic needs, human has spiritual inclinationsand thus spiritual needs. These spiritual tendencieslead the individuals to knowledge, love, meaning,



DOI: 10.1002/pon

hope, transcendence, commitment and compas-sion. METHOD: Since 2000, we have conducted aseries of interviews with 27 cancer patients. In ourmeetings, we shared the perspectives of holy booksand various examples taken from prophets’ livesand scholars of Anatolia. For instance, we madediscussions on 1. The Quran statements like ‘‘Allahdoes not burden someone with any responsibilitythan he/she can bear’’ and ‘‘we have the power andcapacity to cope with all what we live’’.2. Theprophetic statements from prophetic medicineculture like ‘‘Allah does not create an illnesswithout its treatment’’ and ‘‘There is a cure for everyillness’’. RESULTS: At the end of our interventions,we observed visible improvements in the healthconditions of patients with psychological and physi-cal disorders. We observed increased capacity andpower of acceptance, displaying positive attitude,coping with pain, forgiving and loving at the patientand all these eventually contributed the process ofhealing. CONCLUSIONS: Today, holistic ap-proaches have gained more importance in healthissues. Integration of body, mind and spirit hasbecome a primary concern of health systems. Thecancer patients who participated the interviews werein 3 or 4 level of their illness. The spirituality carecould be provided to these patients and its has beenobserved that the spread of disease was stop at thepatients who took this care. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-141

Well-Being in Home-Based Family Caregiving at the

End of Life: Current Conceptualization and Future

Considerations

Jamie PennerMcGill University, Montreal, QC, Canada

BACKGROUND: Families play an essential rolein caring for people with advanced cancer. Much ofthe palliative caregiving literature has been dedi-cated to identifying and examining needs of familycaregivers and is now calling for empirical inquiryregarding effective ways to provide psychosocialsupport for caregivers to maintain or improve theirwell-being. A critical examination of how well-being has been conceptualized in the palliativecaregiving literature and future considerations willbe presented to engage such work. METHOD: Asystematic review of the literature was conductedto facilitate a critical examination of how familycaregiver well-being has been conceptualized in thepalliative caregiving literature. MEDLINE, Psy-cInfo, and CINAHL databases were accessed. Keyterms included: family, informal, or primary andcare, caregiving, or caregiver� and well-being orwellbeing and advanced cancer, palliative care,hospice, or end-of-life. RESULTS: The concept ofwell-being has been poorly conceptualized in the

palliative caregiving literature. Authors often usethe term well-being casually in their discussions oruse it to refer interchangeably to various outcomesbeing examined. Theoretical frameworks that guideresearch with family caregivers in palliative care,measurement tools that include the concept of well-being and several studies claiming to evaluateinterventions to enhance family caregiver well-beingdo not clearly define this concept and most ofteninfer well-being from various objective and sub-jective indicators. Similarly, well-being is oftenalluded to in the qualitative literature without aclear definition or consistent conceptualization.CONCLUSIONS: Providing care to a familymember who is dying includes distinct challenges,burdens, and rewards that may contribute to themeaning of well-being for caregivers in unique ways.A clear and consistent conceptualization of familycaregiver well-being is paramount in order todevelop and test interventions for caregivers thatare meaningful and provide effective support. Thiscritical examination of family caregiver well-beinghighlights gaps in our current knowledge and gleansinsights into specific considerations for caregiverwell-being thus providing a necessary step towards aclear conceptualization of this phenomenon that willcontribute to the development of effective inter-ventions. RESEARCH IMPLICATIONS: Acritical examination of well-being in thepalliative caregiving literature reveals that moreresearch is needed to contribute to a clear andconsistent conceptualization of this phenomenon.Studies aimed at gaining a better understanding ofwhat well-being means to family caregivers inpalliative care would provide a foundational firststep towards this conceptualization. Establishing aclear conceptualization will help guide future inter-vention work aimed at maintaining or improvingthe well-being of family caregivers. CLINICALIMPLICATIONS: A clear and consistentconceptualization of family caregiver well-being isnecessary in order for clinicians to provideeffective and meaningful psychosocial support forcaregivers to maintain or improve their well-being.In so doing, caregivers will potentially be able toprovide care at home for a longer period oftime and be prevented from becoming patientsthemselves. ACKNOWLEDGEMENT OFFUNDING: None.

P1-142

Strategies to Improve End-of-Life Care in the

Intensive Care Unit as Perceived by Nurses

Celine Gelinas1, Lise Fillion2, Marie-Anik Robi-taille3, Manon Truchon41McGill University, School of Nursing, Montreal,QC, Canada, 2Laval University, Faculty of Nursing,Quebec, QC, Canada, 3Laval University CancerResarch Centre, Quebec, QC, Canada, 4Laval



DOI: 10.1002/pon

University, Department of Industrial Relations,Quebec, QC, Canada

BACKGROUND: Nurses are facing many stressfactors when providing end-of-life (EoL) care inthe Intensive Care Unit (ICU). One of their firstchallenges is to shift from curative care to EoL carein a short period of time. While stress factors havebeen well described, less is known about strategiesto improve EoL care in this critical environment.This study was aimed to describe strategies toimprove EoL care in the ICU from the nurse’sperspective. METHOD: A total of 42 ICU nursesworking on different shifts (day, evening, andnight) fromfive clinical settings of three regions ofthe province of Quebec participated in thisdescriptive qualitative study. Ten focus groups(FG) of duration of 40 to 60 minutes werecompleted using a semi-structured interview guide.The content was audiotaped, transcribed, doublecoded, and analyzed using InVivo software.Themes were identified for each category ofstressors. RESULTS: To decrease organizationalstressors related to disagreement and lack ofcommunication between healthcare team members,nurses suggested coaching programs to improveinterprofessional collaboration (9/10FG). Simi-larly, training programs for the development ofknowledge and nursing competences in EoL carewas highlighted (9/10FG) to help overcome profes-sional stressors related to difficulty in interactingwith families and managing symptoms. Finally, tobetter cope with personal issues or emotionalstress, support groups (10/10FG) and debriefingon request (8/10FG) were identified as keystrategies by ICU nurses. CONCLUSIONS: Pro-viding EoL care is stressful for ICU nurses. Whenasked, nurses propose relevant organizational,professional and personal strategies that maycontribute to improve their wellbeing and satisfac-tion at work. Strategies could also have a positiveimpact on the work environment, and improve theappeal of nursing and retention of nurses in theICU. RESEARCH IMPLICATIONS: The strate-gies suggested by nurses to improve their capacityto deliver better EoL care in ICU context arecoherent to interventions and programs designedto support staff in different work areas. Research isneeded to further adapt, implement and evaluateprograms to better support ICU nurses in EoLcare. The impact of such programs, on nurses’ well-being and job satisfaction as well as organizationaland clinical outcomes in patients and families,needs to be documented. CLINICAL IMPLICA-TIONS: Clinical recommendations to improveend-of-life care in the ICU have been recentlypublished by the American College of Critical CareMedicine (2008). Their recommendations includethe development of ICU clinicians’ competenciesin providing this type of care, improved

communication with family, and to offer bereave-ment programs. Based on these recommendations,strategies to improve end-of-life care in theICU can be developed in collaboration with nursesand other members of the healthcare team.ACKNOWLEDGEMENT OF FUNDING:CIHR Canadian Institutes of Health Research;CHSRF Canadian Health Services ResearchFoundation; MSSS Ministere de la Sante et desServices Sociaux; IRSST Institut de rechercheRobert-Sauve en sante et en securite du travail.

P1-143

Evaluating the Economic Loss of Caregiving for

Palliative Care Patients

Veronique Turcotte1, Philip Jacobs2, SergeDumont1, 3, Donna Anderson31Laval University Cancer Research Center, QuebecCity, Quebec, Canada, 2University of Alberta,Edmonton, AB, Canada, 3Laval University, QuebecCity, Quebec, Canada

BACKGROUND: In Canada the shift to commu-nity-based palliative care has led to a redistributionof costs from the formal health care sector to theinformal care sector. The study aimed to provide aunified measure of the economic burden faced byfamilies during the palliative phase of care, and tocompare this measure to the Statistics Canada’sLow Income Cut - Off to judge the impact ofsituations imposed on caregivers. METHOD: Asample of palliative care patients still living athome and their main informal caregivers wereconsecutively recruited in five Canadian regions.We followed these cases from the patient’s entryinto the community palliative care program untildeath or a maximum of six months. We measuredthe economic loss due to caregiving as the sum ofthe values of work loss and outof- pocketexpenses due to caregiving. The family income losswas evaluated for 192 family units. RESULTS:Few palliative periods exceeded 180 days. Mostfamilies (66%) had losses in the $1 to $999category. Seventeen families had losses in excessof 10% of pre-study annual income. Forty familiesin the post - episodic period had daily net incomesbelow the LICO cut-off, as compared with 27prior to their being in the palliative situation.CONCLUSIONS: Our results for the sampleindicate that a relatively small number of personshave large economic losses, but these losses can infact be very large. Social policies currently in placeshould allow for avoiding an end-of-life situationwhich would move some families from above tobelow the poverty (LICO) threshold. This wouldmeet the societal obligation in the healthsystem context in Canada to guarantee a ‘‘fairequality of opportunity’’ to all families.RESEARCH IMPLICATIONS: To our knowl-



DOI: 10.1002/pon

edge, this is the first study providing a unifiedmeasure of economic losses of caregiving that canbe related to a publicly designated low - incomethreshold. CLINICAL IMPLICATIONS: Thestudy results may be useful in identifying familiestaking care of palliative care patients at home whocould be at risk of experiencing financial difficul-ties. When a family is approaching the LICOthreshold, we can assume that they are likely todrop below the poverty line during the episode ofcare, particularly if the palliative care situationcontinues for any length of time. ACKNOWL-EDGEMENT OF FUNDING: This study wasfunded by a grant from the Canadian Institutes ofHealth Research.

P1-145

Palliative Care in Turkey

Ruchan Uslu, Meltem Uyar, Hayriye Elbi,Mehmet Uyar, Sibel Eyigor, Mehmet Kantar,Yasemin YildirimEge University School of Medicine Palliative CareCenter, Izmir, Turkey

BACKGROUND: Palliative care is a therapeuticapproach improving the quality of life of thepatients as well as their relatives, while coping withincurable diseases, by preventing and relieving thesuffering via identification and careful evaluationof the symptoms, management of pain and otherproblems, including physical, emotional and spiri-tual problems. Development of palliative careservice is essential as a basis for improving thequality of care and service continuity. METHOD:Palliative care programs are relatively new addi-tions to the range of services available in ournation’s health care system. The Turkish PalliativeCare action plan had been established within theNational Cancer Control Program in 2008. The targetshave been provided below in accordance with theconditions and priorities of Turkey. OBJECTIVES:

I. The establishment of at least three pilotpalliative care centers

II. The establishment of trained and experiencedprofessional teams in the field of PalliativeCare (practice and management)

III. Facilitating the availability and usability ofopioids

RESULTS: Ege University School of MedicineTulay Aktas Oncology Hospital Palliative CareProgram was launched first in 2005 as a means ofachieving balance in end-of-life care and helpingseriously ill patients find peace and dignity betweenthe extremes of too little care and too much. InDecember 2010, Turkey’s first formal palliativecare center was established in Tulay AktasOncology Hospital. The mission of our center

reflects a patient-centered approach to care.CONCLUSIONS: Our mission is to achieve thebest possible quality of life for the patients throughrelief of suffering, control of symptoms, andrestoration of functional capacity while remainingsensitive to personal, cultural, and religious values,beliefs, and practices. An interdisciplinary teamdirects and provides care. Core team members arethe patient and family plus physicians, nurses, andsocial worker. The team’s health providers assessthe physical, medical, psychological-social andspiritual needs of the patient and family. Basedon the assessment, the team develops a plan of careto provide coordinated care that emphasizessupportive services. Home care is being planned.CLINICAL IMPLICATIONS: Development ofpalliative care skills and services will enablephysicians and the medical staff to assist terminallyill patients coping with physical, psychological andsocial difficulties, as a part of comprehensive careprovided to these patients, in order to enable themto live the last stages of their lives with dignity.It is essential to turn palliative care into anintegral part of all the treatment processes anddisease stages. ACKNOWLEDGEMENT OFFUNDING: None.

P1-146

Model for Providing Supportive Care Services to

Pediatric Patients at a Comprehensive Cancer

Center

Jeanelle Folbrecht, Christina Cabanillas, ToniCarreras-Irwin, Laura Haworth, Terry Irish,Jessica Kubasak, Jo Ann Namm, ShannonPoppito, Carolina Rodriguez, Amy Tafel, DanaTarcatu, Marisol TrujilloCity of Hope National Medical Center, Duarte, CA,USA

BACKGROUND: The psychosocial care of thepediatric patient is both complicated and unique. Apediatric patient is not fully developed cognitively,socially or emotionally and depends upon theparents or caregivers for both their psychologicalneeds and medical decisions. The functioning of thepatient’s family system can directly impact stressand coping. This presentation describes a multi-disciplinary Pediatric Psycho-Oncology modelusing a systems approach to address the psycho-social needs of the pediatric patient. METHOD:The Pediatric Psychosocial Support team at City ofHope National Medical Center, a comprehensivecancer center in the United States, defined theirmodel of providing care to pediatric patientsthrough 3 main projects: 1) comparison of theCity of Hope Pediatric Psychosocial SupportiveCare services to those at other comprehensivecancer treatment centers via: phone, internet, andliterature review searches, 2) definition of respec-



DOI: 10.1002/pon

tive team member roles and using role data todevelop a guide for referrals, 3) data collection onservices provided over 2 months to demonstrateimplementation of the model within a multidisci-plinary team. RESULTS: The findings suggest thatwhile the disciplines providing psychosocial careare consistent among US comprehensive cancercare centers, the organization of services differ. APediatric Supportive Services Reference Guide wasdeveloped to help physicians connect patients inneed with the appropriate resources. Finally, thetracking of services provided allowed examinationof the systems model in practice. Of the servicesrendered, 37% of the services were provided to thepatient only, while 63% of services included afamily member or were provided to the familymember only. Inpatients, who were much fewer innumber, received significantly more services thanoutpatients. CONCLUSIONS: Few would arguethe need for multidisciplinary psychosocial care inpediatric oncology, or the need to care for thepatient in the context of a systems model. Theexecution of those ideals varies depending upon thetype of center providing care. Our team demon-strated that their provision of services reflects asystems model of care. We hope that the descriptionof this model and illustration of its implementationin a multidisciplinary psychosocial team will act as aguide to other cancer programs and assist in theassessment and management of the psychosocialneeds of pediatric patients and their families.RESEARCH IMPLICATIONS: Several implica-tions for research present themselves as a result ofthis project. The impact upon hospital length of stayand emotional well-being of pediatric patients andfamilies receiving a systems approach to psychoso-cial care are among the research questions our teamhopes to see explored in the future. CLINICALIMPLICATIONS: An outcome of this project is aPediatric Supportive Care Reference Guide whichlists disciplines involved in the psychosocial care ofthe patient, roles of each discipline, triggers forreferral, and questions to clarify the need for referral.This tool can be used by treatment programs lackingan integrated multidisciplinary psychosocialteam to make appropriate community referrals.ACKNOWLEDGEMENT OF FUNDING:None.

P1-147

PTSS and Growth Among Parents Whose Child

Have Had a Stem Cell Transplantation (SCT)

Ulla Forinder1, Annika Lindahl Norberg21Deparment of Social Work, Stockholm University,Stockholm, Sweden, 2Karolinska Institutet,Stockholm, Sweden

BACKGROUND: When a child is treated withstem cell transplantation it is well documented that

the treatment has a long term emotional impact onthe whole family. The aim of the presentation is toexplore the appraisal of the event, occurrence ofPTSS (post traumatic stress syndrome) and PTG(post traumatic growth)among parents whose childhad had a stem cell transplantation (SCT).METHOD: A research battery including PCLand PTGI was sent out to a cross-sectionalmulticenter group of parents of children who hadhad a SCt 6 month or more before the study. Theresponse rate was 66% (n5 281 ). RESULTS: Theresults confirms that SCT in childhood is an eventof extreme adversity for the parents. A minority ofthe parents had remaining symptomes of PTSS.The occurrence of PTSS decline in the group eightyears after treatment. A large proportion of theparents had experienced growth. More over datawas analyzed in relation to: gender, age, socio-economic factors, avoidant coping, social support,marital satisfaction and additional traumatic ex-periences. CONCLUSIONS: SCT is a traumaticevent for the parents with emotional impact a longtime after treatment. Both PTSS and PTG arerelevant concepts for parents after pediatric SCT.It is important that the health care to discoverparents in need of help and in general encouragefunctional rumination among the parents. RE-SEARCH IMPLICATIONS: It is important todesign and implement treatment methodes forparents in need of help but also to evaluated thisinterventions. That is also a clinical implication.ACKNOWLEDGEMENT OF FUNDING: TheSwedish Childhood Cancer Foundation.

P1-148

A Longitudinal Study of Parent Caregiver Self-

Efficacy and Parent and Child Coping with Pediatric

Cancer Treatment Procedures

Felicity Harper1,2, Amy Peterson1,2, HeatherlunUphold1,2, Terrance Albrecht1,2, Jeffrey Taub2,3,Louis Penner1,21Karmanos Cancer Institute, Detroit, MI, USA,2Wayne State University School of Medicine,Detroit, MI, USA, 3Children’s Hospital ofMichigan, Detroit, MI, USA

BACKGROUND: Pediatric cancer patients oftenconsider treatment procedures more distressingthan cancer itself. Parents’ and childrens’ short-and longer-term psychosocial outcomes are rootedin treatment experiences. Parents’ behavior beforeand during treatment may influence their own andchildren’s distress. Specifically, parents with highercaregiver self-efficacy have been shown to copebetter with illness and experience less distress. Thisstudy explored how parents’ caregiver self-efficacyaffected parent distress, child distress, and childcooperation during treatment procedures.METHOD: Children (N5 66) were recruited from



DOI: 10.1002/pon

children’s hospitals in the Midwest (n5 36) andSouth (n5 30). Children (21 girls, 45 boys; ages3-12; 76% Acute Lymphobastic Leukemia) and‘‘parents’’ (mothers, fathers, grandmothers) werevideo-recorded during three treatments (P1, P2, P3)over approximately 4 months. Before the firsttreatment, parents rated their confidence in helpingchildren remain calm before and during treatment.Confidence ratings for these items were weightedby parents’ importance ratings; weighted scores forthe two items were summed. Immediately aftertreatments, parents and medical staff indepen-dently rated parents’ distress, children’s distress,and children’s cooperation; and children rated theirown distress. RESULTS: Higher parent caregiverself-efficacy before P1 was significantly associatedwith less child distress (rP15�.33, rP25�.40)and higher cooperation (rP15 .31, rP25 .39,rP35 .50) as rated by parents (all pso.05).Caregiver self-efficacy was also associated withmedical staff ratings of less child distress(rP15�.26) and more child cooperation(rP15 .39) and children’s self-ratings of moredistress (rP25�.42). P1 caregiver self-efficacywas unrelated to parents’ self-ratings of distress(P1, P2, P3, all ps4.05). P1 parent caregiver self-efficacy did not differ by parents’ demographics(age, income, education) or children’s clinicalvariables (recruitment site, existing port, type ofprocedure/sedation, number or type of previousprocedures; ps4.05). CONCLUSIONS: Parents’initial sense of self-efficacy regarding their ability tohelp their child cope with a distressing pediatriconcology treatment procedure was associated withless child distress and more child cooperation, asrated by parents, medical staff, and children,during procedures up to 4 months later. Interest-ingly, parent perceptions of their caregiver self-efficacy showed no significant associations withparents’ rating of their own distress during any ofthe procedures. Paradoxically, these findings maysuggest parents believe that helping their childrenhas a positive impact on children during treatmentprocedures but does not have the same beneficialimpact on them during procedures. RESEARCHIMPLICATIONS: Previous studies have notexamined the relationship between parents’ care-giver self-efficacy and pediatric cancer patients’responses specific to treatments. These findingsclearly show parents’ confidence in helping theirchildren cope is related to children’s level ofdistress as reported by multiple raters. Further,parents’ confidence in caring for their child has acontinued impact on child distress over time.Future research should focus on understandingthe pathways through which parents’ caregiver self-efficacy influences child responses. CLINICALIMPLICATIONS: The relationship betweenparents’ caregiver self-efficacy and child distressunderscores the importance of the treatment

experience in determining children’s short- andlonger-term responses to pediatric oncology proce-dures. Many existing pediatric cancer interventionsoften focus on providing parents with effectivestrategies to help their children cope. Thesefindings suggest that an equal emphasis onincreasing parents’ confidence about their copingefforts is warranted, and ultimately, mayresult in better outcomes for their children.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is part of a larger investigation of caregivers’influence on child coping with cancer treatment(NCI1R01CA138981-01; PI: L. Penner).

P1-149

School (re)entry after Paediatric Cancer: A Quali-

tative Examination

Jordana McLoone1,2, Claire E. Wakefield1,2,Catharine A.K. Fleming1,2, Richard J. Cohn1,21School of Women’s and Children’s Health,University of New South Wales, Sydney, NSW,Australia, 2Centre for Children’s Cancers and BloodDisorders, Sydney Children’s Hospital, Sydney,NSW, Australia

BACKGROUND: Returning to school after thecompletion of childhood cancer treatment is asignificant and celebrated milestone for manyfamilies. However, this period of transition mayalso present new challenges and continue beyondthe immediate re-entry term. This study aimed toevaluate primary and secondary school students’re-entry to school after completing cancer treat-ment. METHOD: Families of children and adoles-cents who began or returned to school aftercompleting cancer treatment 1–5 years prior, wereinvited to participate in individual, semi-struc-tured, telephone interviews. In cases where thesurvivor was under 12 years, only the parents wereinterviewed. In total, 112 members of 45 families(44 mothers, 34 fathers, 19 adolescents, 15 siblings)completed the study interview, which exploredtheir perspective of the school re-entry period.Interviews were transcribed verbatim and analysedusing the framework of Miles and Huberman.Emergent themes were cross-tabulated by samplecharacteristics using QSR NVivo8 and counts wereused to minimise researcher bias. RESULTS:Adolescents reported peer support as fundamentalin creating a positive school re-entry experience;however parents described child survivors asdisplaying limited understanding of social rules(e.g. turn taking, friendship formation). Survivorsappeared to relate more to older children orteachers relative to peers. For adolescents, symp-toms of fatigue and anxiety exacerbated theacademic challenge of revising lessons missed whileabsent. Tutoring was valued, though not alwaysutilised due to cost/unavailability. Changing



DOI: 10.1002/pon

school/grade often extinguished existing supportnetworks and was a period of unmet need. Theoutreach nurse was unanimously praised, whereasschool-counsellors appeared less involved withchildren’s school re-entry. CONCLUSIONS: Fac-tors affecting successful school re-entry differedsubstantially between primary and high school.The most commonly reported difficulty for youngersurvivors related to aspects of peer socialisation, incontrast to older students’ reports that the oppor-tunity to rejoin their social group and receive socialsupport from their peers was one of the mostpositive aspects of returning to school. Additionalsupport, potentially by the school counsellor, isneeded to help families meet their child’s ongoingand changing educational needs. Engenderingsupport from the school became progressivelymore difficult with time and the loss of networksformed when the child was ill. RESEARCHIMPLICATIONS: The findings of thisqualitative study provide grounds for a largerquantitative study investigating the unmet scholas-tic needs of children and adolescents after thecompletion of cancer treatment. Attention shouldbe given to students’ needs at various ages,milestones, and times after returning to school.The development of an intervention for schoolcounsellors, often unfamiliar with the special needsof paediatric oncology patients, may support theacademic trajectory of survivors. CLINICALIMPLICATIONS: Parents’ ability to navigate theeducation system, and advocate effectively onbehalf of their child, was often limited. Greaterinvolvement from the school-counsellor, in both apsychologically supportive and teacher-parent liai-son role, would be beneficial for many families whostruggle to receive needed services (such as tutor-ing). This is particularly so when a child enters anew classroom, and their physical appearance is nolonger suggestive of ongoing illness or need.ACKNOWLEDGEMENT OF FUNDING:Claire Wakefield was supported by a NationalHealth and Medical Council of Australia Post-doctoral fellowship (510421), this research was alsosupported by the Leukaemia Foundation ofAustralia.

P1-150

Psycho-Social Factors Related to the Abandonment

of the Treatment in Pediatric Patients to Acute

Leukemia

B. Gabriela Isaac-Otero, Martha Flores-Rojo, JoseMendez-Venegas, Ignacio Mora-MaganaNational Istitute of Pediatrics, Mexico City,Mexico

BACKGROUND: The Acute leukemia is the mostfrequent childhood cancer. The development oftreatments has allowed save the life of the children

who has suffered it. However, the necessity hasbeen identifying the factors that have contributedto the therapeutic failure. The abandonment to thetreatment supposes one of the main obstacles. Thepsycho-social factors and disease characteristicscould increase the incidence of abandonment;that’s for the aim of this research was describesuch factors. METHOD: A non experimental,retrospective and cross-sectional study was carriedout to the aim. The clinical files from patientattended between 2000 and 2005 year werereviewed, obtaining the data base from 134 filesas total. RESULTS: The results showed anabandonment index of 23% (n5 31/134). Thesocioeconomic level was the only variable signifi-cant for the abandonment. However it wasobserved that 77% of the patients that was in asituation of extreme poverty received economicsupport from associations. There aren’t registers ofthe situation of the patients who abandonment and45% the patients who followed the treatment,death in the processes. No other variable weresignificant for the abandonment. CONCLU-SIONS: The results suggest the development ofabandonment behavior could result from cognitiveand emotional processes by the patients and theirfamilies. The socioeconomic aspect is only thealleged reason to abandonment. RESEARCHIMPLICATIONS: These results are relevant be-cause the focus to help is the socioeconomic statusbut, 45% of the children die and 23 % abandon-ment the treatment showing 68% of therapeuticfailure. That’s why is necessary change the focusand give an integral service. CLINICAL IMPLI-CATIONS: The research has showed the impor-tance of the psychological intervention in the illnessprocesses. The methodological limitations makenecessary explore the cognitive and emotionalaspects in order to approach the patient. AC-KNOWLEDGEMENT OF FUNDING: None.

P1-151

Psychosocial Support for Pediatric Oncology &

Hematology Patients

Aslihan Ozcan, Halil Ibrahim Yildiz, FulyaZaltasHope Foundation for Children with Cancer,Istanbul, Turkey

BACKGROUND: Cancer is one of the mostprevalent diseases around the world. The treatmentis not only physically, but also emotionallyburdensome. Especially, children dealing withcancer may display psychosocial difficulties as aresult of their diagnosis the treatment process.Today, many hospitals provide psychosocial sup-port alongside conventional cancer treatments toimprove quality of life for their patients. Thepsychosocial support affects the length and the



DOI: 10.1002/pon

quality of hospital stay, and the cooperation withtreatment. METHOD: Exploratory methods areused to investigate the effects of psychosocialsupport on pediatric oncology patients. The sampleincludes 40 children diagnosed with cancer, andtreated in Hematology and Oncology unit ofCerrahpasa Hospital. The social support is pro-vided through various services, including artactivities, volunteer work, patients’ exhibitionsand mother support groups. Therapists thatvolunteer on the unit provide psychological sup-port for patients, mothers and staff members.These services to improve the quality of thehospital stay are offered by volunteers everydayon the unit. RESULTS: The results demonstratethat the quality of the hospital stay increases,through social support, positive treatment andpsychological help. The professionals help childrento focus on healing and healthy state. As anoutcome of social services, patients feel moresupported and connected. They find different waysto express themselves. In turn, their cooperationwith treatment increases. As a result of thepsychological help focused on grief process, loss,self-esteem, self-image, depression, social support,and coping skills, patients construct a healthy self-image. These services enhance their patients’ andmothers’ perceptions on hospital stay and decreasehospital stay. CONCLUSIONS: In conclusion, thisposter demonstrates that psychosocial supportpositively affects the length and the quality ofhospital stay, and the cooperation with treatment.Pediatric cancer patients have a need for self-expression and socialization. The psychosocialsupport gives them an opportunity to construct ahealthy self-image and have better quality oflife during their hospital stay. RESEARCHIMPLICATIONS: There is an increasing trend inthe world to include psychosocial support totreatment process. In Turkey, these services arestill new to the medical setting. There is a lack ofliterature on their effects on pediatric cancerpatients. As a result, this poster, presenting usefulinformation on how psychosocial support affectsthe quality and timing of hospital stay and theperceptions and cooperation of the patients, servesas ground to discuss the new possibilities. CLIN-ICAL IMPLICATIONS: This poster presents howpsychosocial support is provided in a PediatricHematology and Oncology unit. It provides usefulinformation on application of the services to themedical settings. It presents practical goals andoutcomes. Furthermore, it constitutes a precedentfor other future programs to offer psychosocialhelp to their patients. ACKNOWLEDGEMENTOF FUNDING: KACUV (Hope Foundation forChildren with Cancer) has funds these services.The families of children and the treatment inHematology and Oncology unit of CerrahpasaHospital have established the Foundation in

2000. The aim of KACUV is to support thetreatment of children whose families do nothave the means to afford the treatment. Further-more, the Foundation provides the psychosocialsupport to improve the quality of the treatmentprocess for children.

P1-152

Acute Psychiatric Episodes during Intensive Treat-

ment Course in Pediatric Cancer Patients Aged 8–12

and 12–18 years

Marzena Samardakiewicz, MalgorzataMitura-Lesiuk, Jerzy R. KowalczykMedical University, Dept. of Pediatric Oncology,Hematology, and Transplantology, Lublin, Poland

BACKGROUND: High dose of chemotherapymay lead to acute somatic complications. Somepatient may encounter intensification of fear anddisadaptative reactions as well as acute psychiatricepisodes. The purpose of the study was to assessthe incidence of acute psychiatric episodes duringtreatment course in pediatric cancer patients aged8–18 yrs. METHOD: This study covered history of207 consecutive pediatric cancer patients (YoungerGroup: 82 pts aged 8–12 yrs, and Older Group: 125pts aged 12–18 yrs), diagnosed between Jan,2007–March, 2011 in single pediatric onco-/hema-tology ward. The mean age was 9.7, and 14.9 yrsconsecutively in Younger and Older Group.Planned psychosocial support program was desig-nated to all patients. The frequency of acutepsychiatric episodes occurrence was rated withuse of clinical interview. RESULTS: Duringobservation period 32.8% patients had showndisadaptive reactions with various level of inten-sity. The most often notified behaviors wereregressive one that were manifested with depressedmood, stubbornness and withdrawal from theactivity. In 6.2% patients had noticed 18 acutepsychiatric episodes. Six of those episodes run withconsciousness disorder, delusions, anxiety andtouchiness. In all cases Pancreatitis was diagnosed.Other episodes occurred in patients who tookdexamethasone and during antifungal treatment.Duration of disorders was from 3 to 17 days.Psychiatric episodes in younger pts had CNSorganic etiology. Patients required several psychia-tric consultations and intensive pharmacologicaltreatment. CONCLUSIONS:

1. Symptoms of disadaptative reactionsoccurs in high percentage of pediatric cancerpatients.

2. In adolescent cancer patients acute psychiatricepisodes co-occurred with acute somatic com-plications.

3. In younger cancer patients acute psychiatricepisodes have mostly CNS organic etiology.



DOI: 10.1002/pon

ACKNOWLEDGEMENT OF FUNDING:Grant DS 408/11. Assoc. For Children with BloodDisorders, Lublin, Poland.

P1-153

The Effect of ‘Encounter Group Application’ On

Mothers’ Psychological Symptom Levels at the

Pediatric Oncology Clinic

Murat Sarisoy, Mehmet Kantar, Serap Aksoylar,Savas Kansoy, Nazan C- etingulEge University School of Medicine Department ofPediatrics Division of Pediatric Oncology, Ismir,Turkey

BACKGROUND: Accompanying a child who hasa fatal disease and his/her primary care, along withwitnessing various problems due to the treatmentcreates an immense psychological burden uponmothers. The aim of this research is to determinethe effect of ‘‘Encounter Group Application’’ -might be one of the attempts to provide support forboth patients and their relatives - upon mothers’psychological symptom levels. METHOD: Theresearch is done among the mothers of the patientstreated at Ege University Hospital, PaediatricOncology Department, Encounter Group Applica-tion is made with 30 mothers for 4–6 weeks. Beforeand after the research, SCL-90-R, SymptomChecklist is applied to the participants. The scaleis structured upon making evaluations according to90 items involving psychiatric symptoms andcomplaints in ten different symptom dimensions:somatisation, obsessive compulsive attributes, sen-sitivity in interpersonal relations, depression, anxi-ety, rage and hostility, phobic anxiety, paranoidsentiments (suspiciousness), psychoticism and ad-ditional scala. Consequently, the data obtainedwere analysed via the t test method for thesamplings matched in the SPSS 13.0 software.RESULTS: It is confirmed that statistically thatthere was a significant decrease in the ‘‘Psycholo-gical Symptom Average’’ of the mothers whoattended the 4–6 - week Encounter Group Appli-cation (p5 0.02). Moreover, when the psychologi-cal symptom details on the subscale wereexamined, a significant decrease in the ‘‘Interper-sonal Sensitivity’’ averages of the mothers werestatistically detected after the application(p5 0.00). When their level of paranoia wasexamined, again a significant decrease was identi-fied statistically (p5 0.00). There was neither aconsiderable decrease in their depression levelsstatistically, nor in their level of rage (p5 0.05 andp5 0.06, respectively). CONCLUSIONS: It isevident that more applications aiming at psycho-logical support and precaution should be made inthe field of paediatric oncology. In addition, it isproved essential that the permanent employment ofpsychological support professionals is important in

the sense that it is vital in regulating andpreserving the psychological lives of theparents who are indispensable constituentsof the treatment process. In conclusion, theevidences of the research will be defined as ashort-term basis of four-six weeks and demonstratethat the Encounter Group Application hasdecreased the psychological symptom burdens ofthe mothers. ACKNOWLEDGEMENT OFFUNDING: None.

P1-154

Bridging the Gap: Parent vs. Self-Reports of Health

Related Quality of Life Among Survivors of Child-

hood Cancer

Fiona Schulte1, Stephanie Garies1, DouglasStrother1,2, Kathy Reynolds1, Terri Shykula1,Deborah Dewey1,21Alberta Children’s Hospital, Calgary, AB, Canada,2University of Calgary, Calgary, AB, Canada

BACKGROUND: Children who survive cancerface a variety of problems including compromisedquality of life. Survivors, however, have beenfound to report more favourable outcomes com-pared to parent proxy reports. The objective of thisstudy was to explore discrepancies between parentand child cancer survivors’ subjective reports ofHealth-Related Quality of Life (HRQOL) com-pared to parents and siblings. It was hypothesizedthat a greater discrepancy between parent andsurvivors would exist compared to parents andsiblings. METHOD: The Pediatric Quality of LifeInventoryTM (PedsQLTM 4.0) was administered to41 survivors of childhood cancer and 23 siblings,ages 8-18 years (mean5 13.5 years, SD5 2.97years), and their parents (n5 41). Mean time offtreatment for survivors was 8.30 years (SD5 3.02).Participants were recruited from the PediatricOncology Long-Term Survivors Clinic at theAlberta Children’s Hospital. Total PedsQL scores,as well as Physical and Psychosocial subscalescores, were evaluated. Difference scores werecomputed to examine the discrepancy between: 1)parent and survivor and 2) parent and siblingHRQL scores. RESULTS: Significant mean differ-ences were found between: 1) parent and survivorratings and 2) parent and sibling ratings of TotalHRQOL (F(1,62)5 10.71, po0.01). Examinationof scores revealed a greater discrepancy betweenparent and sibling reports compared to parent andsurvivor reports. The same pattern of differenceswas found between the two groups for thePsychosocial (F(1, 62)5 7.19, po0.01) and Physi-cal (F(1,62)5 9.74, po0.01) subscale scores. Par-ent-proxy reports for survivors were significantlylower than norms for a healthy population(t5 4.65, po0.01). CONCLUSIONS: The findingsindicated that there was a greater discrepancy



DOI: 10.1002/pon

between parent and sibling reports of HRQOLcompared to parent and survivor reports. Thisfinding did not support our hypothesis and isinconsistent with existing literature describingdiffering HRQOL reports among parents andchildren with a chronic disease. Yet, there is apaucity of research that has explored siblings’HRQOL beyond the phases of diagnosis andthrough treatment. This research has shed lighton an important population, namely, siblings ofcancer survivors, who may require more frequentmonitoring of their psychosocial well-being aftercompletion of their sibling’s cancer treatment.RESEARCH IMPLICATIONS: This study chal-lenges previous research regarding the responsepatterns between parent proxy reports and childrenwith chronic disease. Specifically, previous researchhas suggested that parents tend to over-reportdifficulties with their children, whereas the survi-vors tend to underreport difficulties. The currentstudy suggests that there is no difference betweenparent proxy and survivor reports and thuslends validity to the use of parent proxy orself-report responses in this population.CLINICAL IMPLICATIONS: This research hassignificant clinical implications for the long-termcare of survivors and their siblings. Specifically,this research highlights the extra attention thatmust be paid to siblings, especially beyond thecancer treatment. Future research should seek todevelop effective interventions for these siblings.ACKNOWLEDGEMENT OF FUNDING:Funding provided by the Alberta Children’sHospital Foundation.

P1-155

Psychosocial Dimensions of Cancer in Adolescents

with Childhood Cancer

Yuko Takei1,2, Akiko Ogata3, Miwa Ozawa4,Hiroshi Moritake5, Atsushi Manabe4, Kei Hirai6,Shin-ichi Suzuki71Graduate School of Human Sciences, WasedaUniversity, Saitama, Japan, 2Japan Society for thePromotion of Science, Tokyo, Japan, 3Facultyof Education and Culture, Miyazaki University,Miyazaki, Japan, 4St. Luke’s InternationalHospital, Tokyo, Japan, 5Faculty of Medicine,Miyazaki University, Miyazaki, Japan, 6GraduateSchool of Human Sciences, Osaka University,Osaka, Japan, 7Faculty of Human Sciences, WasedaUniversity, Saitama, Japan

BACKGROUND: Adolescents with childhoodcancer have to go through the normal develop-mental process while coping with the emotionalimpact of cancer diagnosis and treatment as well aswith the emotional, social, and physical late effects.However, only few studies have investigated theeffects of cancer on an adolescent’s life after

discharge and their perception of these experiences.The purpose of this study was to explore thepsychosocial dimensions of ca ncer in adolescentswith childhood cancer. METHOD: The subjectswere 21 patients with childhood cancer, who hadvisited the pediatric outpatient clinics (7 males and14 females, mean age at survey5 15.872.1 years).Of the 21 subjects, 15 had leukemia, 4 hadmalignant lymphoma, and 2 suffered from bonetumor. After parental consent was obtained, theyparticipated in a semi-structured interview regard-ing the difficulties they faced in their life afterdischarge, and completed the Pediatric Quality ofLife Inventory (Peds-QL). The qualitative datawere analyzed with content analysis, chi-squaretest, and correspondence analysis, whereas thequantitative data were analyzed with t-test.RESULTS: The patients’ mean scores onPeds-QL were significantly lower than those ofhealthy children (po.05). Regarding the difficultiesthey faced in their post-discharge life, manypatients showed behavioral difficulties like ‘‘beingphysically active’’ (76%), ‘‘being academicallyslow’’ (52%), and ‘‘participating in school events’’(52%), and physical difficulties like ‘‘feeling un-well’’ (62%) and ‘‘painful treatment’’ (52%).Despite the hardships, many patients also gavepositive emotional responses like ‘‘the experiencebrought my family closer’’ (57%) and ‘‘I met manypeople’’ (52%). Statistically significant differenceswith respect to sex, age at diagnosis, and time sincediagnosis were also noted. CONCLUSIONS: Thisstudy identified the impact of cancer on the dailylife of adolescents with childhood cancer afterdischarge, and their perception of cancer. Theoverall psychological adjustment of patients wasconsidered slightly poor compared to their healthypeers. Most patients suffered from behavioral andphysical difficulties, because of cancer treatmentand its side effects. However, through this experi-ence, many patients also experienced positivechanges in human relationships. Some studiesshowed that perception of positive and negativeaspects functions as an independent construct.Future research should examine the associationbetween this independent construct and psychoso-cial adjustment in adolescents with childhoodcancer. RESEARCH IMPLICATIONS: Thisstudy showed that many adolescent patients haveexperienced burden of cancer in their post-dis-charge life. This experience can be considered thepredictors of their poor psychosocial adjustment.At the same time, they have also experiencedcancer-related growth. Both benefit finding andperceived burden may have a unique influence onadaptation to cancer. Future research shouldattempt to identify factors related to psychosocialadjustment in adolescents with childhood cancer.CLINICAL IMPLICATIONS: The primary ob-stacles faced by the cancer patients after returning



DOI: 10.1002/pon

to their daily lives are physical and behavioralproblems due to cancer treatment and its sideeffects. Unlike their stay at the hospital, thepatients now have to be involved in quotidianactivities such as attending school, studying, andplaying. Therefore, it is important to providesupport to them to ensure that their daily routineis not hindered by cancer treatment and itsside effects. ACKNOWLEDGEMENT OFFUNDING: This work was supported by aGrant-in-Aid for Cancer Research from theMinistry of Health, Labour and Welfare of Japan(H20-001).

P1-156

The Behavioral and Psychological Changes in

Adolescents Coping with Cancer

Andreea VidanPavel Association - Oncological Institute ofBucharest – Pediatric Oncology section, Bucharest,Romania

BACKGROUND: Psycho-oncology is a new fieldin Romania that is starting to expand since wenoticed a great need in this area. A chronic illness,such as cancer, causes great changes in a teenager’slife. These changes can have positive and negativeeffects upon their behavior and their relationshipswith their family, friends, health care team etc.Adolescents with cancer face many challenges thatmay have an impact upon their behavior andpsychological well-being. METHOD: Data collec-tion methods included individual and focus groupsemi-structured interviews, questionnaire and par-ticipant observation. The data were collected from2 groups of adolescents, aged between 14–18 years,25 subjects in each group (10 males and 15females), one group of adolescents, the experimen-tal group is undergoing cancer therapy and ishospitalized in the Oncological Institute ofBucharest - Pediatric Oncology and the other group(10 males and 15 females), the control group, hasthe same characteristics as the first group (the sameeducation, the same religion, ethnicity and comefrom similar backgrounds) without having to copewith this disease. RESULTS: Results revealed thatadolescents coping with cancer, experiencedchanges in their self-esteem, aggressiveness, beliefin God, responsibility, sociability, independence,empathy and motivation in comparison with thecontrol group. The changes that were revealedhave both positive and negative effects upon thebehavior and psychological well-being of the teen-agers coping with cancer. CONCLUSIONS: Whena teenager’s life is complicated by a long-term fightagainst cancer, a sensitive and understandingcare can be an important ally. The demands ofcancer treatment are particularly challenging fordiagnosed adolescents, taking into consideration

the well-known fact that the adolescence age is adevelopment stage that involves a great effort ofsocial adjustment. If attempts to cope with thecancer treatment demands are unsuccessful, adoles-cents may not comply with or may refuse treatment.One of the most important coping strategy is theadolescent’s social support system. RESEARCHIMPLICATIONS: The outgrowth of newperspectives in psycho-oncology based upon thespecific needs of the adolescents coping with cancer.CLINICAL IMPLICATIONS: Knowing thebehavioral and psychological changes thatinterfere in the adolescent’s life can havepositive implications upon the medical treat-ment compliance and the support and under-standing of family, friends and health careteam. ACKNOWLEDGEMENT OF FUNDING:None.

P1-157

Predictors of Posttraumatic Stress Symptoms in

Korean Mothers of Pediatric Cancer Survivors

H Kim1, K. M. Chung1, M. A. Rhee1, S. K. Yang1,S. H. Shin1, S. C. Won2, Y. J. Shin2, C. J. Lyu21Yonsei University, Seoul, Republic of Korea,2Yonsei University Health System, Seoul, Republicof Korea

BACKGROUND: Pediatric cancer is an intenselystressful reality for caregivers that can manifest asposttraumatic stress symptoms (PTSS). Motherswere targeted given the strong link betweenmaternal mental health and pediatric adjustmentto disease. This study aimed to determine 1)predictors of PTSS in Korean mothers of pediatricsurvivors and 2) differences in PTSS scores bycancer-related demographic factors. METHOD:Mothers were recruited from the Long-TermFollow-Up Clinic at Severance Hospital, Seoul,Korea. This multidisciplinary clinic offers biannualfollow-up services for cancer survivors. Onlymothers of survivors who had been off-treatmentfor X1 month were included in the analyses. Fiftyfive mothers were assessed on coping style (Ways ofCoping Checklist), perception of their child’squality of life (PedsQLTM, parent-proxy version),and PTSS (Impact of Events Scale). Total scoreswere used for analyses with the exception of copingstyle, which was divided into 2 subscale scores:passive and active coping. Cancer-related demo-graphic data were gathered from medical records.RESULTS: Of the 55 mothers, 45 reported theirage (M5 40.51, SD5 4.87). The overall modelexplained 35.6% of the variance in IES scores(po.0005). Passive coping made the largest uniquecontribution [b5 .65, t(51)5 4.38, po.0005] fol-lowed by mother’s perception of their child’squality-of-life [b5 -.41, t(51)5�3.61, p5 .001].Active coping was not a significant predictor.



DOI: 10.1002/pon

There were no IES differences by survivor genderor time since treatment completion. Approximately14% of mothers scored 1 SD above the IES meanscore (M5 13.22, SD5 9.41). CONCLUSIONS:Mothers who engage in a passive coping style orperceive their child as having poorer quality-of-lifeappeared to experience greater PTS symptoms.Conversely, maternal PTSS did not vary as afunction of cancer-related demographic factorssuch as patient gender and time since treatmentcompletion. Findings are consistent with studiesthat show that more subjective (i.e., self-report)factors are good predictors of PTSS. Although IESnorms have not been established for Koreanpediatric cancer populations, our findings indicatethat a subset of mothers scored within a rangeconsidered clinically significant as found in othertrauma samples. RESEARCH IMPLICATIONS:Results provide the basis for inclusion of keyfactors such as coping style and parent proxyreports as predictors of PTSS. Future studiesshould consider 1) a longitudinal design to examinePTSS over time and 2) examining rates of PTSS incaregivers of Korean pediatric cancer survivors.Additional methodological suggestions are toincrease the sample size (e.g., inclusion offathers), use multiple-site sampling, and includeother subjective parental measures. CLINICALIMPLICATIONS: Our findings support the needfor PTSS screening in clinical settings as childcarequality is dependent upon maternal mental health.Timely screening would allow for clinicians toidentify mothers at high risk for PTSD and toprovide appropriate mental health referrals. Fol-low-up care is also necessary as PTSS has beenshown to linger years after treatment completion.Psychoeducation to help mothers build moreactive coping skills may also be helpful in mana-ging stress. ACKNOWLEDGEMENT OFFUNDING: This study was funded by BrainKorea 21.

P1-158

The Belgian Government Funds the Post Academic

Training Program in Psycho-Oncology, Organised

by the Cedric Hele Institute

Sofie Eelen1, Sabien Bauwens2, Wim Distelmans2,Bernard Hensmans3, Eva Jacobs1, Wim Schrau-wen4, Lieve Vanderlinden5, Angelique Verzelen61Cedric Hele Instituut, Mechelen, Belgium,2Universitair Ziekenhuis Brussel, Brussels, Belgium,3Monster.be, Vilvoorde, Belgium, 4UniversitairZiekenhuis Gent, Ghent, Belgium, 5UniversitairZiekenhuis Leuven, Louvain, Belgium, 6The HumanLink, Antwerp, Belgium

BACKGROUND: The Cedric Hele Institute,Flemish Institute For Psychosocial Oncology(CHi), was founded in 2004. One of the main

objectives of the institute is to organise andcoordinate education and training programs inpsycho-oncology. In 2006 CHi founded a postacademic training program in psycho-oncology, inclose cooperation with the Flemish universities.After the second cycle of the course the Belgiangovernment decided to nationalize and to fund theeducation program. This cycle started in 2010.METHOD: The CHi founded a steering committeewhich had the mission to develop a trainingprogram in psycho-oncology. This committeedeveloped a two year training program. Thiscommittee exists of professors from the differentFlemish Universities and clinical experts in psycho-oncology. This training program is evidence-basedand has an interactive set up. To complete theprogram the students have to make a scientificpaper and to fulfill a series of supervision. Thedidactic skills of the trainers and the content of thecourses are monitored. The program is evaluatedthoroughly and evaluations are taken into account.RESULTS: In 2006, the first two-year trainingprogram in psycho-oncology in Belgium, formasters in psychology and medical doctors, waslaunched. 22 clinical psychologists registered. InJanuary 2008 14 trainees graduated. In 2008 asecond program started, with 25 psychologists. 16graduated in 2010. The overall evaluation of thetraining program and the evaluation of the specifictraining aspects, by the trainees were excellent. TheBelgian government decided in 2010 to startfunding the subscription of psychologists in oncol-ogy in the training program ‘psycho-oncology’. 50psychologists submitted their candidacy. 34 psy-chologists in oncology and one doctor started inthe current program. CONCLUSIONS: The rea-lisation of this post academic training, in closecooperation with the Flemish universities, means abreakthrough in the field of psycho-oncology inBelgium. This innovating training program is anacademic specialisation in psycho-oncology, whichoffers psychologists an evidence based academictraining in psycho-oncology. It also helps them toimprove their clinical skills in working with cancerpatients. The program promotes evidence basedpractice, but also creates contacts between theacademics and the clinical practitioners, whichstimulates clinical based evidence. RESEARCHIMPLICATIONS: With the training program theCHi and the Flemish universities want to enforcethe link between the academic and the clinicalworld in psycho-oncology. During the programmany academics teach their recent results inscientific research to the students. The psycholo-gists in the program write a scientific paper on arelevant subject in psycho-oncology, which ispublished on the website of the institute. Thesecan be a lead for scientists, in search of interestingresearch projects. CLINICAL IMPLICATIONS:The psychologists who followed the program



DOI: 10.1002/pon

increased their knowledge and skills in psycho-oncology. They optimized their communicationand clinical skills which will lead to a better care ofthe cancer patient and his relatives. The trainingprogram also stimulates the exchange of knowl-edge and experiences between the students andbetween the students and their teachers. Experienceshows this is a very interesting synergy, with astrong intradisciplinary network and qualitativework as result. ACKNOWLEDGEMENT OFFUNDING: The Cedric Hele instituut could befounded thanks to the support of the nationalsociety ‘Vlaamse Liga tegen Kanker’ (the FlemishLeague against Cancer).

P1-159

Demoralization Among Nurses Among Oncology,

Palliative Care, and Intensive Care Units

Chun-Kai Fang1, Pei-Yi Li2, Xing-Ru Lee3,Li-Yun Tsai4, Ming-Liang Lai51Department of Psychiatry & Suicide PreventionCenter, Mackay Memorial Hospital, Taipei,Taiwan, 2Department of Educational Psychologyand Counseling of National Taiwan NormalUniversity, Taipei, Taiwan, 3Institute of Life andDeath Education and Counseling, National TaipeiUniversity of Nursing and Health Sciences,Taipei, Taiwan, 4Department of Nursing, MackayMemorial Hospital, Taipei, Taiwan, 5Department ofNeurology, Medical College, National Cheng KungUniversity, Tainan, Taiwan

BACKGROUND: Demoralization indicates onephenomenon about existential distress and loss ofmeaning in life when the people suffering fromcancer or advanced diseases. However, demorali-zation occurs not only in patients, but also inmedical staff who are under huge pressure. Manystudies reported that burnout syndrome was oftenhappened on the nurses working among oncology,palliative care, and intensive care units. Thepurpose of the study was to understand demor-alization among nurses. METHOD: The study waspracticed in Mackay Memorial Hospital, Tamsuibranch. The Mandarin Version of the Demoraliza-tion Scale (DS-MV) and the job burnout-MaslachBurnout Inventory-Human Service Survey (MBI-HSS) were used by self-report for all nursesworking at medical intensive care units (MICU),surgical intensive care units (SICU), neural inten-sive care units (NICU), oncologic units andpalliative care units. The study used SPSS18.0 toset up files and perform the analysis. RESULTS:All 221 nurses were invited to take part, of whom160 (72.3%) accepted did so. The final number was154 (69.7%) after excluding incomplete responses.The mean of the DS-MV and MBI-HSS were35.73713.61 and 62.70710.35. In DS-MV, themeans were 39.14712.92 among nurses(n5 42) at

two palliative care units, 38.69711.35 amongnurses (n5 36) at two oncology units, and32.43714.32 among nurses (n5 76) at all ICU(po0.05). The seniority between 25 to 60 monthshad the highest scores of demoralization.CONCLUSIONS: The nurses who cared cancerpatients with all different stages were suffered fromdemoralization. The phenomenon of high demor-alization was dangerous for nurses and increasedthe possibility to reduce the nursing quality. Howto increase aspiration of nurses is very important.RESEARCH IMPLICATIONS: Demoralizationscale is not only used for cancer patients, but alsofor nurses. CLINICAL IMPLICATIONS: Demor-alization syndrome is not only important to carecancer patients, but also to care nurses themselves.ACKNOWLEDGEMENT OF FUNDING: Weappreciate to Taiwan National Science Council tosupport the study (NSC98-2511-S-003-064-).

P1-160

Giving Psychosocial Care to the Cancer Patients has

a Dual Effect: Patient Wise and Professional Wise

Didem Kafadar1, H.Omer Kasikci1, MustafaUnsal2, Zeynep Karakas3, Cagatay Karsidag4,Yildiz Yildirmak5, Demet Aydin2, A. Ihsan Dokucu11Istanbul Health Directorate, Istanbul, Turkey,2Okmeydani Training and Research HospitalDepartment of Radiation Oncology, Istanbul,Turkey, 3Istanbul University School of MedicineDepartment of Pediatrics Divison of Oncology-Hematology, Istanbul, Turkey, 4Bakirkoy Trainingand Research Hospital for Psychiatric and Neuro-logical Diseases Department of Psychiatry, Istanbul,Turkey, 5Sisli Etfal Training and Research HospitalDepartment of Pediatric Oncology, Istanbul, Turkey

BACKGROUND: The purpose of this presentationis to provide an insight into psychosocial problems ofthe oncology patients and to discuss the role of theprofessionals in psychosocial support. Psychooncol-ogy-Psychosocial Support Subcommittee is one ofthe committees formed under Provincial CancerControl Advisory Board which is composed ofprofessionals from health institutions that operateat the province and prepares an advisory report toreduce the cancer burden of the society at theprovincial level. METHOD: Subcommittee Meetinghas taken place in 2010 and was held like aworkshop. The subcommittee consisted of profes-sionals from departments of radiation oncology,oncology, hematology, psychiatry and family medi-cine who shared their observations and experiencesthey had throughout their work life and discussedtheir points of view and advices. Some of themembers also had administrative duties in healthcare.This meeting provided a coherent environmentbetween professionals. The output of the meetingreflected the general outline and how this can be



DOI: 10.1002/pon

implicated into research and clinical practice, thusmay be utilized for the arrangements of the admin-istrative practices. RESULTS: Patient’s reactiondepends on his knowledge, his life experience andhis social environment. Acute stress disorder isexperienced by the patient and followed by anxietyand depression. Side effects of the cancer treatmentlike hair loss and nausea may also cause psycholo-gical problems. All doctors dealing with cancerpatients should not leave all the responsibility andburden to the oncologists.Professionals may notknow the appropriate methods and limits ofpsychosocial care because of their intense work andlimited time, they may even develop burnoutsyndrome and may not even notice it.This in turncauses them to estrange themselves from the patients.CONCLUSIONS: In conclusion, teamwork isneeded in oncology treatment as patients’ needsand expectations are different. Psychiatrists andpsychologists must be part of this team as well asoncologists. There should be a coordination betweenproviders of psychosocial support for cancer patients.Voluntary groups who would like to attend theoncology clinics to give social support to the patientsshould also be considered. There has to be anarrangement in which voluntary groups together withthe social service workers and pscyhologists serve forthe oncology patients. There is a need for thepsychosocial support to be institutional for theessential process of cancer care. RESEARCHIMPLICATIONS: Research is needed to find themost appropriate way considering the educationaland cultural differences. Educational programs con-cerning the appropriate methods and limits of givingpsychosocial care in limited time should be preparedfor the care givers working in the intense oncologydepartments to improve their communication skills.-Various attempts should be made in order to handlethe burn-out syndrome in health professionals and anevaluation of burnout syndrome in care givers isneeded initially. CLINICAL IMPLICATIONS: Pro-fessionals should know how to inform the patientabout the facts while preserving the hope. Differentattitudes of patients are present like acceptance orrefusal of illness. Some patients may delay thetreatment. Psychologist should also work with thepatients’ doctor and family. A model of psychosocialsupport center by the hospital may havepositive effects on patients. To improve the atmo-sphere of the oncology clinics may also reflect a bettersurrounding both for professionals and patients.ACKNOWLEDGEMENT OF FUNDING: None.

P1-162

Turkish Nurses’ Experiences with Cancer

Patients in a Public Hospital: A Phenomenological

Study

Perihan Kucukkaya, Isil IsikKoc University, Istanbul, Turkey

BACKGROUND: It is reported that nurses findworking with cancer patients stressful and emo-tionally draining. However, current theoreticaldevelopments show that working with thesepatients have positive impacts as well. Whileworking with cancer patients and their familiesmay cause stress and sadness, it can also beexperienced as rewarding and satisfactory. Theaim of this study is to present the nurses’perspective of how they experience working withoncology patients. METHOD: A descriptive Phe-nomenological research design was used in thisstudy to analyze the experiences of nurses caringfor cancer patients. Data were collected from eightnurses working for a minimum of 3 years in the in-patient oncology service of a government hospitalin Ystanbul. In depth- interviews were conductedby using a semi-structured interview form. Allinterviews were tape-recorded and transcribedverbatim. Content analysis of the data was donethrough coding of the transcriptions, finding theemerging themes, organizing and defining thethemes for the final interpretation of the content.RESULTS: In this qualitative study of positive andnegative experiences of oncology nurses, dataanalysis revealed five emerging themes and 27sub-themes regarding the negative impacts of theirwork in nurses: knowing the outcome and processof cancer as an ailment, having to cope withnegative impacts,the comparative hardships work-ing in the field of oncology, not being able to meetthe patients’ information and emotional needs,having to care for the patient and the family. Therewere three main themes and 10 sub-themes in thepositive impacts realm: personal empowerment,enhanced joy of life, change in inter-personalrelationships. CONCLUSIONS: In this study,nurses are found to be perceiving work with cancerpatient more negatively than positively. We foundthat especially knowing cancer and the process alltoo well has major emotional impacts on thenurses, while they have difficulty meeting theinformation and emotional needs of the patients,and the perception of cancer. Factors such as nothaving psychological counselling, and lacking inteam work /institutonal support also creates hard-ships in caring for the patient and family. It istherefore crucial to enable nurses with the skill,knowledge and institutional support to workcomfortably with cancer patients. CLINICALIMPLICATIONS: hen nurses’ experiences inworking with cancer patients are examined indetail, negative aspects of the work can beminimized, thus enhancing quality of patientcare as well as patients’ and nurses’ satisfactionlevels. Also, stressing the positive aspects ofthis type of work which have not been exploredwidely, may alter the nurses’ perception ofworking in oncology, resulting in more nurseschoosing this field and reducing the turnover of



DOI: 10.1002/pon

oncology nurses. ACKNOWLEDGEMENT OFFUNDING: None.

P1-163

A Qualitative Evaluation of Burn-Out in Profes-

sionals Working on a Paediatric Oncology Unit in

Senegal (West Africa)

Sokhna Ndiaye1,2, Amadou Cambel Dieng2,Claude Moreira11Hospital and University Center Aristide LeDantec,Dakar, Senegal, 2Army Program for PsychologicalSupport (PSPA), Dakar, Senegal

BACKGROUND: This study was conducted onthe only paediatric oncology unit in Senegal.Nearly 100 children with cancer are treated yearly;more than 50% are cured. Protocols appliedrequire rigor in their administration due to thelethal side effects. The staff works intensively withmoderate means and no psychological support wasoffered. The purpose of this study is to evaluateburn-out in this population, assess the areas ofintervention and identify the need for individua-lised psychotherapy. METHOD: This is an analy-tical transversal qualitative study. The studyincluded the 17 medical and non-medical regularstaff members of the unit. The Maslach Burn-outInventory (MBI) was handed out at the beginningof a monthly staff therapeutic group in whichparticipation was voluntary and private. Within amonth, the interviewer/therapist held individualsessions with each participant to debrief them ontheir MBI scores and elaborate on unlistedstressors. The sources of data on this study werethe MBI questionnaires, the individual sessions andthe focus groups held monthly on the unit.RESULTS: No participant presented withburn-out syndrome. The mean scores for emotionalexhaustion, depersonalization and reducedpersonal accomplishment were 19.4, 6.9, and 37respectively; scores varied from 1 to 36, 0 to 15,and 28 to 47 respectively. During the individualdebriefing sessions and focus groups, participantsbrought up difficulties such as a heavy workload,dealing with issues beyond their area of expertise,dealing with patients at a terminal stage, atendency to trivialize happenings in their personallives, a feeling of restlessness and physical fatigue, afeeling of powerlessness, issues linked to culturalbarriers amongst many others. CONCLUSIONS:Although no participant was clinically burnt-out,the overall average scores were not low butmoderate. This population is followed up for apotential shift in their psychological state. Thestudy took place on a unit with high demands andno psychological support. Yet, many participantshad found ways to manage exhaustion, remainmotivated and be pleased with their workperformances. A follow-up longitudinal study is

planned to re-evaluate burn-out in the samepopulation, identify its determinants, and distin-guish efficient techniques applied to prevent it.In the prospective analysis, we will consider therecent accessibility to psychotherapeutic supporton the unit. RESEARCH IMPLICATIONS:Firstly, this study authorized for an appraisal ofthe repercussions of working in paediatric oncol-ogy on the human resources. Secondly, exploringthis subject was an opportunity to assess burn-outin a country of sub-Saharan Africa where nothinghad been investigated in the past. This can allowfor a comparison with populations investigated inother countries. Thirdly, we’ve concluded thatresearchers should follow the MBI with interviews,for the questionnaires unaccompanied are tooimpersonal and restrictive. CLINICAL IMPLICA-TIONS: As clinicians, this study is a mean toidentify employees requiring to be looked atclosely. Following the MBI questionnaires withinterviews may also be a method to establish arelationship with the client and if needed offertherapeutic support from that point on. Finally,from a therapeutic viewpoint this study allowed forpreventive assessment, which consequently beginstherapy quite early. Therefore, the populationsurveyed is predisposed to a better prognosis.ACKNOWLEDGEMENT OF FUNDING:None.

P1-164

To Think, to Feel, to Talk and to Realize: A

Construction of a Psychoanalytical Work Developed

with Health Professionals Dealing with Cancer

Patients

Sonia Novaes de Rezende, Silvia Maria Santiago,Maria da Grac-a Garcia AndradeState University of Campinas, Campinas, SaoPaulo, Brazil

BACKGROUND: To reflect about the psycho-analytical setting placed to analyze difficulties ofthe health team dealing with cancer patients, andits role as a device to take care of the carrier. It wasalso a goal to point out to the specialized healthservices managers the therapeutic possibilities fortaking care of health professionals to preventsickness in the process of the oncologycal care.METHOD: It was organized an interdisciplinarywork group in the oncologycal service, coordinatedby a psychoanalyst and developed from 2006 to2007 in the referral service for a region of 4 millioninhabitants. The participants of the group wereoncologists, public health doctors, nurses, psychol-ogists, psychoncologists, nutritionists, physiothera-pists, social workers and managers. The groupcontent produced in biweekly meetings was ana-lyzed under the psychoanalytical vertex.RESULTS: It was observed, at the beginning,



DOI: 10.1002/pon

a high level of stress in the group, with intensepain and psychological suffering; emotionaloscillations when dealing with the oppositionbetween life and death; worries with the nonadhesion to the treatment; identification processwith patients; difficulties in recognize and nominatetheir own demands and from the patients;communication difficulties and inside team con-flicts. The group worked in the oscillation omni-potence-impotence, changing what was causingsuffering to a thoughtful emotional experience,inside learning, extending and enriching thethinking. CONCLUSIONS: The therapeuticgroup with psychoanalytical orientation showedefficacy in the health professionals psychologicalsuffering relief and a tool of understandingabout the nature of their work, helping in thesearch for more powerful actions. This listeningprocess and the psychoanalytical intervention,allowed the relief of an extraordinary load ofpain and, consequently, the possibility of amajor integration with patients, families andother the health professionals. RESEARCHIMPLICATIONS: The psychoanalysis is an im-portant tool to build capacity and enhance thecommunication between patients and health pro-fessionals. The psychoanalytical groups with healthprofessionals had the purpose to improve thecapability to hear and give voice to patients andtheir families as a way for better understanding anda comprehensive care. ACKNOWLEDGEMENTOF FUNDING: None.

P1-165

Occupational Stress in Health Professionals

Maria Konstantina Theodoropoulou, VassilikiPanteliGeneral Oncology Hospital ‘‘Agii Anargyri’’,Department of Psychology, Kifisia, Athens, Greece

BACKGROUND: Occupational stress has drawnthe attention of many researchers in the last yearsbecause of its frequency and the problems thatoften cause to the employees. It occurs when thejob demands don’t match the capabilities, re-sources or needs of the individual. Health profes-sionals in particular are really vulnerable to stressbecause of the nature of their work. The purpose ofthis study was to evaluate the stress levels of ahospital staff. METHOD: The sample of our studyconsisted of doctors and nurses working at theGeneral Oncology Hospital ‘‘Agii Anargyri’’ inAthens, Greece. The age of the respondents rangedfrom 25 to 64 years and they have served theinstitution for a period ranging from 1 to 33 years.All participants had to fill in 4 questionnaires;Perceived Stress Scale (PSS), Job Content Ques-tionnaire (JCQ), Health Locus of Control (HLC)and Way of Life and Health. These instruments

measured perceived stressful experience or re-sponses, job satisfaction and aspects of health.RESULTS: 79,3% of the staff ranked very high atthe PSS and 44,8% considered their work as verystressful. 58,6% felt reduced life satisfaction and53,4% reported low job satisfaction. As bizarre asit may seem, although it is obvious that the score atjob or life satisfaction was very low, this result wasnot connected with occupational stress. Moreover,the burden of their duties was an importantstressor for 55,2% of the staff, while having controlover their job was a protective factor. On thecontrary, being exposed to hostility from thesupervisor or the colleagues caused stress to them.CONCLUSIONS: All the above findings show thatoccupational stress is very common among healthprofessionals. Heavy workload seems to be themain stressful aspect of their job. Although this isthe case, individuals face many stressful factors intheir personal life and they usually carry thisburden at work. All this pressure affects theiroverall job satisfaction and has a great impact attheir lives. Most health professionals realize theconsequences that stress has into their work andlife in general but hesitate to take action in order toprotect themselves and become less vulnerable to it.RESEARCH IMPLICATIONS: Interventions inthe setting of the hospital could be the object ofnew studies. It would be really interesting to applystress management programs in health profes-sionals and encourage them to engage in healthpromoting habits which could help them prevent orreduce their stress. CLINICAL IMPLICATIONS:Clinical psychologists specialized in staff supportshould be able to trace, evaluate and deal withstress among staff as soon as possible. As stressoccurs both from the workplace and the personallife, a combination of organizational changes inwork and individualized interventions could bevery effective in reducing stress at work. AC-KNOWLEDGEMENT OF FUNDING: None.

P2-1

When Students Weep: The Psychosocial Needs

of Students Conducting Research with Advanced

Cancer and Palliative Care Patients

Moire Stevenson1, Jamie Penner2, EmmaBelanger2, Christopher MacKinnon21Universite de Montreal, Montreal, QC, Canada,2McGill University, Montreal, QC, Canada

BACKGROUND: An increasing number of stu-dents are conducting research with patients andfamilies receiving advanced cancer and palliativecare. Students at the 18th International Congresson Palliative Care testified to the challenges andemotional impacts of this type of work andexpressed a desire for more support to cope withthese difficulties. A systematic review of the



DOI: 10.1002/pon

literature was conducted to better understand thepsychosocial needs of students undertakingresearch in advanced cancer and palliative care.METHOD: A systematic review of literaturerelated to the needs of student researchers inpalliative and advanced cancer was conducted onMEDLINE, PsycInfo and CINAHL databases.Key terms included: student�, trainee, fellow, orresearcher� and psychosocial need�, emotion�

support, moral support, challenge, or barrier andadvanced cancer, palliative care, hospice�, or end-of-life. After the initial search retrieved fewpertinent articles, a snowballing search of otheraspects of conducting sensitive research wasperformed. RESULTS: Research related to thepsychosocial needs of clinical students working inadvanced cancer or palliative care was identified,however, there was little research looking at theneeds of student researchers specifically. Whenresearch was discussed, authors spoke to ethics andmethods but not the psychosocial impact thisresearch has on the researchers themselves. Despitethe lack of research speaking to advancedcancer and palliative care student researchers,parallels can be drawn with the impact ofresearch involving sensitive topics in general.The review highlights that this research can beparticularly emotionally draining and difficult,and that student-researchers often lack support.CONCLUSIONS: The systematic review of theliterature revealed significant gaps in knowledge ofthe psychosocial needs of students who are doingresearch with patients and families receivingadvanced cancer and palliative care. Students’needs for psychosocial support may be gleanedfrom the needs of researchers in other sensitiveareas of research. However, creating a researchagenda to understand the experiences and needs ofstudents doing research with advanced cancer andpalliative care populations in particular is impera-tive. Such knowledge will inform the developmentof appropriate interventions to effectively supportthese students and contribute to sustaining theresearch community in the field. RESEARCHIMPLICATIONS: More research is needed to gaina better understanding of the psychosocial needs ofstudent researchers in advanced cancer and pallia-tive care. Studies exploring the psychosocial impactof training in this particular field, consideringdifferences in various research environments andtypes of research (quantitative, qualitative,field work etc.), will contribute to this under-standing and help guide future intervention workaimed at providing support for student researchersto meet their psychosocial needs. CLINICALIMPLICATIONS: Research in advanced cancerand palliative care is imperative as an evidence basefor clinical practice. However, the challenges andemotional impacts of this type of research coupledwith lack of psychosocial support tests the sustain-

ability of student researchers in this area. A betterunderstanding of the psychosocial needs of studentresearchers in this field will help to developnecessary interventions to support them thuspromoting the sustainability of research to informbest clinical practices. ACKNOWLEDGEMENTOF FUNDING: None.

P2-2

The First Step Towards Creating an Anxiety Scale

in Patients with Breast Cancer by Means of a

Qualitative Interview Method

Enil Afs-aroglu, Umut Dis-el, Ozlem GurkutHelp Those with Cancer Association, TRNC,Nicosia, Cyprus

BACKGROUND: In patients with breast cancer,the woman’s character,her way of perceiving herown sex,her beliefs, her age and her partner’sattitude and behaviour are all significant psycho-social factors that affect adaptation to the dis-ease.The aim of this study is to define anxiety inpatients with breast cancer and to determine thefactors that create the anxiety and to collect datawith a view to eventually develop an anxietyscale by means of qualitative interview method.METHOD: 34 patients with breast cancer, whowere evaluated between April 2008 and March2009, were included in the study. As data collectiontools, socio-demographic data forms and problemoriented qualitative interviews were utilized (TheProblem-Oriented Interview, Witzel, 1985; 2000).In this study it was aimed to understand howdifferent patients perceive the same disease (breastcancer) and what causes concern in these patients.RESULTS: In the qualitative interviews all of thepatients mentioned womanly image, 32 of themmentioned sexual attractiveness and desirability.15of the patients who thought that they are norsexually attractive anymore are afraid to havesexual intercourse/concerned about having sexualintercourse. It was observed in 14 patients, whoexperienced communication issues with their hus-bands and who have children, that they feeldeficient and insufficient. It was observed in all 34patients that they fear the possibility of metastasis.Again, connected to this, women with children fearthat their children will be left ‘motherless’. 22 of thepatients mentioned that they are afraid of future.CONCLUSIONS: The table created after thequalitative interviews. The majority of the state-ments in the table are referred to as the internal lifeof patients with breast cancer in various literature.The table that consists of 21 statements coversubjects such as feminine image, fear of death andthe future, sexuality, family and motherhood,guilt and self esteem. It is necessary that, thetable obtained at the end of the study is filled outby at least 200 patients, a factor analysis is carried



DOI: 10.1002/pon

out and a scale is developed. RESEARCHIMPLICATIONS: This study is not sufficient forgeneralisation but it constitutes a basis for a furtherstudy. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-3

Sleep Quality and Related Factors in Cancer

Patients

Azize Atli Ozbas, Nermin Gurhan, Esra KabatasGazi University, Ankara, Turkey

BACKGROUND: Emotional distress is highlyprevalent among patients with cancer (NCCN2006; Bultz & Carlson 2005; Ozalp et al., 2007).The outcomes of the present study are thought toserve beneficial contribution in determining psy-chosocial problems in sleep disorders etiology. Theaim of the present descriptive study was todetermine the psychosocial problems relatedwith sleep quality and investigate the relationbetween sleep quality and distress in cancerpatients. METHOD: The sample of the study wascomposed of 98 inpatients from Ankara OncologyHospital. Patient Information Form, PittsburgSleep Quality Index (PUKI) and Distress Thermo-meter (DT) assessment tools were conducted.RESULTS: PUKI scores of distressed patientswere significantly higher than undistressed patients(po0.05; t5 2.30). There was no difference regard-ing DT scores between patients who have good orbad sleep quality (p40.05; t5 0.52). Furthermore,patients who stated emotional distress experiencehave significantly higher PUKI scores than patientswho didn’t experience such distress (po0.05;t5 2,44). CONCLUSIONS: Albeit, sleep qualityof distressed cancer patients was worse than otherpatients, patients with bad sleep quality did nothave higher distress scores compared to others. Anexplanation for this finding may be that ‘‘Distresshave negative effect on sleep quality, howeverthere might be some other factors affectingsleep quality’’. ACKNOWLEDGEMENT OFFUNDING: The finding that showed the patientswith emotional distress had worse sleep quality thanothers refers to the importance of emotional problems.

P2-4

Unmet Supportive Care Needs in Hong Kong

Chinese Women Confronting Advanced Breast

Cancer

A Au1, WWT Lam1, O Cheung1, J Tsang1,2, TKYau1,3, I Soong1,3, W Yeo1,4, J Suen1,4, WM Ho1,4,KY Wong1,5, A Kwong1,6, D Suen1,6, WK Sze1,7,A Ng1,7, A Girgis1, 8, R Fielding11Centre for Psycho-oncology Research & Training,Departmetn of community Medicine & Unit forBehavioral Sciences, School of Public Health, Hong

Kong, China, 2Department of Clinical Oncology,The University of Hong Kong, Hong Kong, China,3Department of Clinical Oncology, Pamela YoudeNethersole Eastern Hospital, Hong Kong, China,4Department of Clinical Oncology, The ChineseUniversity of Hong Kong, Hong Kong, China,5Department of Clinical Oncology, Princess Mar-garet Hospital, Hong Kong, China, 6Department ofSurgery, The University of Hong Kong, Hong Kong,China, 7Department of Clinical Oncology, TuenMun Hospital, Hong Kong, China, 8University ofNewcastle & Hunter Medical Research Institute,Newcastle, Australia

BACKGROUND: Background: Breast cancer is amajor health burden worldwide. Improved treat-ment for advanced breast cancer (ABC) hasincreased survival duration for affected women.ABC’s now-chronic nature places significantdemands on women’s coping. Understanding howbest to support such women begins with document-ing their needs. We assessed unmet supportive careneeds among Hong Kong Chinese womenwith ABC. METHOD: Methods: Hong KongChinese women from six public hospital outpatientoncology clinics, newly diagnosed with ABC(locally advanced, metastatic or recurrent BC),mostly awaiting chemotherapy (76%) completedface-to-face interviews. Women completed theChinese version of Supportive Care Needs Survey-SF 33, Hospital Anxiety and Depression Scales,Memorial Symptom Assessment Scale-Chinese andPatient Health Questionnaire-9. Unmet needs wereranked by descending frequency variations in typeand extent of unmet needs in relation to demographicand medical factors, PHQ-9, HADS, and MSAS-Cwere then examined using multiple regression. RE-SULTS: Results: 27%–72% of 198/220 (90%) ofwomen (mean age 53.2 years (SD 9.74)) identifiedHealth system, information, and patient support(HSIPS) domain items as the 15 most prevalentunmet needs. ‘‘Having one member of hospital staffwith whom you can talk to about all aspect of yourcondition, treatment and follow up’’, was the mostprevalent item, reported by 72% of women. Symptomdistress (MSAS-C) was positively associated with allSCNS-33 domains except Sexuality, whereas lowsatisfaction with care (PHQ-9) was associated withboth the HSIPS and Physical & Daily living domains.Metastatic disease was associated with greater needstrength. CONCLUSIONS: Conclusion: Continuityof care, prompt, clear and sufficient informationabout medical and treatment issues and emotionalsupport from clinicians were the most prevalentreported needs, indicating shortcomings in currentcare. Distress and satisfaction were inversely relatedto unmet needs. These findings differ from reports onWestern populations that identified unmet psycholo-gical needs as most prevalent. RESEARCH IMPLI-CATIONS: Research Implications: Our data



DOI: 10.1002/pon

demonstrate needs prevalence in Chinese women withABC differ from their Western peers, suggestingAsian patients may prioritize needs differently. Thismay reflect both cultural and service influences. Sincecross-sectional data cannot clarify causality, we arenow following this group of women to explore theirchanging needs over time. CLINICAL IMPLICA-TIONS: Clinical Implications: Women with ABCdesire continuity of care and may care better under anamed doctor clinic system. This should improvepatient satisfaction with care and possibly simplifysymptom and patient management for clinicians.Clinic organizations that benefit clinic efficiency areapparently detrimental for ABC patients’ wellbeing. ACKNOWLEDGEMENT OF FUNDING:Acknowledgement of Funding: This study wasfunded and supported by The Hong Kong CancerFund and a grant from the Seed Funding Programmefor Basic Research by The University of Hong Kong.

P2-5

Reporting on the Clinical Utility of a Coping Skills

Intervention Program for AYAC: What Have We

Learned Thus Far

Sylvie Aubin, Zeev Rosberger, Kavan Petr, BatistGeraldMcGill University/Jewish General Hospital,Montreal, Quebec, Canada

BACKGROUND: Adolescent and young adultoncology has gained momentum in recognizing theunique medical and psychosocial needs of adoles-cents and young adults with cancer (AYAC).However, over 50% of their psychosocial needsremain unmet and we have yet to identify howclinical or research programs can be tailored tomeet their needs. We present preliminary resultsshowing the clinical usefulness and satisfaction of acoping skills intervention program aimed at en-hancing AYAC’s management of cancer-relatedchallenges. METHOD: The intervention programconsisted of three one-on-one thematic sessionsdelivered face-to-face or via webcam (i.e., Skype).Session 1, ‘‘Boxing the cancer’’ focused on resi-lience and the management of cancer-related issues;Session 2, ‘‘Hey, it’s still the same me’’ focused onpost-cancer relationship shifts and the managementof others’ emotional responses and; Session 3, ‘‘Sex,fertility, relationships and everything in between’’focused on the psychosexual repercussions of cancerand the management of impairments for the singleand coupled AYAC. Satisfaction with the interven-tion content and modalities was assessed using amixed method approach including self-report ques-tionnaires and semi-structured interviews withAYAC. RESULTS: A total of 48 young adults aged30.96 (4.93) currently enrolled in the study wererandomized to either the intervention (n526) orwait-list group (n522). Results from the interven-

tion group that have completed the 3 sessions(n5 24) showed that they participated in all 3 andconsidered the sessions as covering issues that wereeither important (86%) or relevant and useful (90%).Moreover, most were satisfied with the interventionmodalities (74%) and would highly recommend theintervention program to other AYAC (90%).CONCLUSIONS: Results showed that the inter-vention content (e.g., selected themes, strategiesprovided) and modalities (e.g., mode of delivery,duration, number of sessions) were positively ratedby AYAC and thus clinically relevant to thispopulation. Moreover, the use of a flexible approachwithin the confines of treatment standardizationeither in the content and mode of delivery maypartly explain high satisfaction ratings and lowattrition to the intervention program (n51). RE-SEARCH IMPLICATIONS: Preliminary resultsstress the importance of designing future clinicaloutcome studies assessing the comparative effective-ness of tailored intervention programs for AYACusing varying modalities and integrating technology(e.g., one-on-one, group, actual, online). CLINICALIMPLICATIONS: Preliminary results first con-firmed that the selected themes were relevant to theAYAC population and thus important to addressclinically. Secondly, the results demonstrated thatinterventions adapted to meet the clinical realities ofthis population was not only associated with hightreatment adherence but also satisfaction. AC-KNOWLEDGEMENT OF FUNDING: This studywas funded by the Fonds de la Recherche en Santedu Quebec (FRSQ) for 3 years.

P2-7

The Impact of Psycho-Oncologists’ Therapeutic

Attitudes: From Crisis Coping to Personal Develop-

ment in Breast Cancer Patients

Celine Brison1, David Ogez2,1, FredericMaddalena2, Ilios Kotsou1, Nady Van Broeck1,Emmanuelle Zech11Universite Catholique de Louvain, Louvain-la Neuve, Belgium, 2Cliniques Universitaires Saint-Luc, Bruxelles, Belgium

BACKGROUND: In 1957, Rogers postulated thatwarmth, empathy and genuineness were therapeu-tic attitudes necessary and sufficient for therapeuticchange. These attitudes are now considered as anessential component of the therapeutic efficacy(e.g., APA Task Force 29). In the present study, theaim was to investigate whether such attitudesexperienced in an oncology team were also effectivein helping cancer patients to deal with the surgery(‘‘crisis’’ moment) and to adapt to life aftertreatment. METHOD: The aim was to understandthe processes at hand and not to evaluate a specifichealthcare team. Three hospitals (Saint-Pierre inOttignies; Saint-Luc in Woluwe; Saint-Pierre in



DOI: 10.1002/pon

Brussels) were thus included to address commonfactors. Assessments were made three times: 1)during hospitalization, after the surgery; 2) threemonths after, during the chemotherapy and 3) afterall treatments, nine months after the surgery. Eachtime, the same symptomatic (Depression; Anxiety)and intrapsychic (Psychological Flexibility, Cop-ing, Needs, Values Self coherence) changes aremeasured. Finally, the perception of therapeuticattitudes by patients and its relationships with theother variables was evaluated. RESULTS: InOctober 2011, the second assessment will beavailable and results will be presented. We postu-late that therapeutic attitudes present at time 1 willonly help patients finding a listener to commu-nicate their suffering. We postulate that the realtherapeutic effects will begin at time 2. A moreempathic, warm and genuine psychologist shouldhelp the patient in coping better with his/her newlife: develop new coping’s strategies, more psycho-logical flexibility, better listening of his/her needsand more coherence in personal values. CONCLU-SIONS: This study will show the size and depth ofchanges people face in confronting breast cancerand HOW specific attitudes involved in thetherapeutic work can accompany and facilitatethese changes among breast cancer patients. Thedevelopment and training in the development ofsuch attitudes will be discussed. RESEARCHIMPLICATIONS: This study helps to understandWHY and HOW therapeutic attitudes are effica-cious. In a recent review, Watson (2010) concludedon the importance to propose more fine-grainedhypotheses. Here, with this study, two processesare pointed and analyzed: crisis’s coping andpersonal development. It should also be noted thatthis study is included in a bigger researchprogramme (David Ogez) which also comparesthese processes to the ones of patients who do notreceive psychological intervention. CLINICALIMPLICATIONS: The results will allow a betterunderstanding of how psychologists can helppatients recovering from cancer treatments. Thestudy addresses the complex work of the psychol-ogist’s active listening and will help to understandthe value of empathic, warm and genuine listeningin the hospital setting. ACKNOWLEDGEMENTOF FUNDING: None.

P2-8

heART - An Art Making Support Group for Cancer

Survivors

Chih Huei Choo, Jintana Tang, Li Lian Ong, JemieWang, Julia OngKK Women’s and Children’s Hospital, Singapore

BACKGROUND: There are barriers to cancersurvivors seeking psychological support. Sharing insupport group or formal therapy sessions can be

uncomfortable and threatening for some patients.In activity based support group, participants canfocus on an activity instead of ‘‘therapy’’. They canhave some ‘‘respite’’ as patients and the activitybrings out the wellness in them. Although the‘‘therapy’’ aspects are not emphasized, such activ-ity based support group can be therapeutic.METHOD: heART, an art making support groupopened to all cancer patients seen at the hospital,was started in October 2009. The group isconducted by a psychiatrist with an interest inart. The sessions are held twice a month and at nocost to patients. The participants are free to paintwhat they want. The paintings are sold andproceeds are used to fund the program. Some ofthe activities involving patients’ art work includeholding exhibitions, putting up the paintings inwards, raising fund for the hospital, printing ofcalendars and setting up a web page. RESULTS:As of March 2011, 37 sessions have been con-ducted. Average attendance increased from 7.1(first six months) to 12.3 participants per session(last six months). The number of participantsincreased from the initial 4 to 28. The age rangeis from 33 to 80 (mean 52.3). All are suffering frombreast or gynaecological cancers. Preliminary ex-amination of a focus group conducted shows thatthe participants have found the group beneficial,helping them in self discovery and improving theirself-esteem. Support, both from fellow participantsand staff, was helpful. Some view the hospital as aless threatening place. CONCLUSIONS: Theprocess of art making itself can be therapeutic forcancer survivors, even without the psychoanalyticcomponent of formal art therapy. Providing asupportive environment can improve patients’hospital experience. Ways to ensure continuousfunding are important to sustain such program. Aswith other creative art forms, some ways ofshowcasing the art works are important in sustain-ing the interest and passion. However, the finalproducts should not be the main focus of theprocess. Activities with a sense of contribution tocommunity can add value and meaning to the artmaking. RESEARCH IMPLICATIONS: Re-search into the elements that are therapeutic insuch activity based support group can help togenerate models and means to help cancer survi-vors. Other art forms such as music, photography,writing, dance and movement will probably havesimilar benefits. Different creative outlets willcater to individual interests. Qualitative researchwill be useful to identify the patterns andconcepts of patients’ experiences. CLINICALIMPLICATIONS: Recovery from cancer is ajourney rather than an end destination. Activitybased support group like heART, provides asupportive and non-threatening environment thatfacilitates active coping. By focusing on artmaking, the participants can discover aspects of



DOI: 10.1002/pon

themselves outside their illness. Art making,especially when it contributes to helping others,can add meaning to the creator’s life. Activitygroup can help in patients’ psychological adjust-ment, as they may otherwise not seek formalpsychological help. ACKNOWLEDGEMENT OFFUNDING: None.

P2-9

Elaboration of a Psychological Intervention for

Young Gynaecologic Cancer Women with Fertility

Impairment: A Preliminary Qualitative Study

Catherine Cavarec1,2, Nicolas Bendrihen1, SilkeShauder2, Philippe Morice1, Sarah Dauchy11Gustave Roussy Cancer Institute, Villejuif, France,2University of Paris VIII, Paris, France

BACKGROUND: Impaired fertility is often aconsequence of gynaecological cancer treatments.Fertility preservation is developing, raising newchallenges for patients who are given complexinformation on reproduction issues in a short andstressful period. Both distress and informationneeds are reported in previous studies (TschudinS, 2009). In order to elaborate a specific psycho-logical intervention for gynaecological cancerwomen with potential fertility impairment, a betterunderstanding of their needs and expectations isneeded. METHOD: For this qualitative mono-centric preliminary research women were eligible ifaged from 18 to 40, treated for gynaecologicalcancer at the Gustave Roussy Institute, with afertility impairment due to cancer treatments.Between January and March 2011 the participantoncologists solicited all eligible consecutive women.Evaluation used a semi-structured questionnaire,exploring recall of counselling, potential sources ofpsychological difficulties or conflicts, and helpexpectations. Interviews were audio-taped andanalysed using the inductive method (Blais 2006).Emotional distress was also evaluated with HADS.RESULTS: Eighteen women were interviewed, sixbefore and twelve after their treatments (mediantime after fertility impairment is 3 years, 0–11). Sixwomen benefited of ovarian cryopreservation.Mean age is 29. Only 4 women have no partner.4 have already at least one child. Complete analysisis ongoing and will be presented during thecongress. First analysis allows to stressthe importance of three different dimensions: theability to procreate (physical integrity), the desireto have children (in the future), the decision toconceive. The relative importance of each dimen-sion depends on women and may evolve withtime. CONCLUSIONS: The data collected in thissmall qualitative systematic study will help us tobuild a specific psychological support intervention,in order to help young gynaecologicalcancer women with fertility impairment to cope.

Alongside the three dimensions listed above, thetime needed by psychological adjustmentappears important. Psychological evolution maylast a long time after the treatmentdecision making. The relevance of discussions withfamily, caregivers, patients is also stressed by thewomen. RESEARCH IMPLICATIONS:A further research will be needed to evaluate thebenefit of such a psychological intervention.CLINICAL IMPLICATIONS: This psychologicalsupport intervention is planned to be proposedsystematically to young gynaecologicalcancer women with potential fertilityimpairment, to complete the information andcounselling given by the oncological and fertilitypreservation teams. ACKNOWLEDGEMENTOF FUNDING: None.

P2-10

Problem-Focussed Interactive Telephone Therapy

[ProFITTrr]: Results of a Feasibility Study

Magge Watson1,2, Penny Hopwood2, WhiteCharlotte1, Sue Davolls2, Sue Ashley1, Andrea Lynch11The Royal Marsden NHS Foundation Trust,Sutton, Surrey, UK, 2The Institute of CancerResearch, Sutton, Surrey, UK

BACKGROUND: To clarify the processes andresources required to set up and deliver a telephonepsychological therapy service and to assess accept-ability and efficacy of a telephone therapyprogramme for cancer patients. METHOD:A non-randomised, with-in group prospective de-sign was used. ProFITTr is based on principles ofcognitive-behavioural and problem-focussed ther-apy adapted to the needs of cancer patients.Patients considered were either (1) those initiallyscreened using the Hospital Anxiety and Depres-sion Scale [HADS] and the Mental Adjustment toCancer Scale [MAC-Helpless/hopelessness sub-scale only] scoring above the ‘‘caseness’’ cut-offsor (2) those referred to the Psychological MedicineService [Grand Total N5 802]. Therapy outcomeswere assessed pre and post, using additionally theCancer Concerns Checklist, the Cancer CopingQuestionnaire and the EQ-5D. Service evaluationdata was collected post-therapy using study specificmeasures. RESULTS: Of the screened sample 53%completed a HADS/MAC; 47% met eligibilitycriteria. Together with clinical referrals, this gave acombined recruitment cohort of N5 307 of which67 [22%] opted for telephone counselling. 42participants completed the trial and were assessed.HADS depression and anxiety scores were sig-nificantly decreased p5 .003 & p5 .002 respec-tively. Cancer Concerns improved p5 .005 as didCoping with Cancer p5 .001. 100% of participantswould recommend the service and 87% were ‘verysatisfied’. CONCLUSIONS: The results indicate



DOI: 10.1002/pon

that a meaningful minority of patients are willingto take up therapy delivered in a telephone formatand derive benefit. HADS anxiety and depressionscores significantly decreased, demonstrating theefficacy of the approach. Participants scores on theCancer Concerns Checklist and Coping withCancer Questionnaire both significantly improvedand showed patient were coping better withtheir cancer after the intervention. Finally fromthe service evaluation we can conclude that themajority of participants were satisfied with theservice. RESEARCH IMPLICATIONS: Feasibil-ity of telephone therapy with cancer patients hasbeen tested in only a few studies, mainly in NorthAmerica, and most focused on breast cancerpatients. The need for large randomised controlledtrials involving patients across diagnostic groups isessential. The current feasibility study will ascertaintherapy format and delivery methods prior toembarking on a multi-centre RCT. CLINICALIMPLICATIONS: There is a shortage of therapyprogrammes offered for hard to reach patientsincluding those; too ill to attend hospital, who livegeographically distant, with poor mobility or whoprefer the anonymity of non face-to-face consulta-tions. ProFITTr represents a pragmatic approachwhich allows highly trained professionals to delivertherapy regardless of patient’s location. This mayprovide a solution to the development of cost-effective and accessible psychological interventionsparticularly for centres with limited psycho-logical resources. ACKNOWLEDGEMENT OFFUNDING: Funded by Cancer Research UK andsponsored by The Royal Marsden NHS Founda-tion Trust in collaboration with The Institute ofCancer Research.

P2-11

Art Therapies as Complementary Therapies for

Cancer Patients

Sennur Kula Sahin, Sibel DoganErciyes University, Faculty of Health Sciences,Kayseri, Turkey

BACKGROUND: A diagnosis of cancer is usuallyaccompanied by change in one or more areas:emotional, physical, familial and social life andlifestyle. Complementary therapies are used inconjunction with medical treatment to improvethe quality of life of those suffering from cancer.Art therapies which are component of complemen-tary therapies include music, dance, humor andbibliotherapy. This review was made for takingattention to effects of art therapies as complemen-tary therapies. METHOD: This review provides ageneral introduction to application of arts intherapy as complementary therapies and detailedreview of kinds of art therapies in cancer.RESULTS: The studies that were releated to art

therapies for cancer patients have been examined.Dance, music, humor and bibliotherapy were themost used art therapy methods in studies. It hasbeen emphasised that these therapies had positivephysical and mental effects on the patients. Espe-cially in these studies, it was stated that vitalparameters such as blood pressure, the number ofbreath and heart rate improved and pain, nausea,vomitting and mental symptoms such as stress,anxiety, depression decreased. CONCLUSIONS: Asa conclusion, the reviewed literature was limitedabout art therapies used in different kinds of cancer,however art therapies were mostly used in patientswith breast cancer, despite being limited.Studies showing the effects of arttherapies in different kinds of cancer are required.ACKNOWLEDGEMENT OF FUNDING: None.

P2-12

‘‘Feelings are Chemicals which Can Kill or Cure’’.

Humor Therapy: The Way of Benefiting from Power

of Feeling for Cancer Patients

Sibel Dogan, Sennur Kula SahinErciyes University, Faculty of Health Sciences,Kayseri, Turkey

BACKGROUND: People with cancer commonlyexperience a range of symptoms, including painand various types of physical and emotionaldistress. Conventional treatments do not alwayssatisfactorily relieve these symptoms, and somepatients may not be able to tolerate their side effects.Complementary therapies such as humor therapiescan help relieve symptoms and improve physical andmental well-being. This review was made for takingattention to effects of humor therapy as complemen-tary therapies. METHOD: The review was carriedout by following search combinations terms of invarious databases: complementary therapy, inte-grated care, laughter therapy, humor therapy, humorand oncology. This review provides a generalintroduction to application of humor therapy ascomplementary therapies. RESULTS: The studiesthat were releated to humor therapies for cancerpatients have been examined. Humor was defined asone of the most used complementary therapymethods. It has been emphasised that these therapieshave many clinical benefits, promoting beneficialphysiological changes and an overall sense of well-being. Humor even had long-term effects thatstrengthened the effectiveness of immune system. Itserved a therapeutic tool for disorders such asdepression, and a coping mechanism. It also was anatural healing component for caregivers trying tocope with the stress and personal demands of theiroccupations. CONCLUSIONS: As a conclusion;despite being limited, there were studies onhumor therapy in patients with cancer, however thereviewed literature was extremely limited about



DOI: 10.1002/pon

humor therapy used based on different kinds ofcancer. Studies showing the effects of humor therapyin different kinds of cancer are required.ACKNOWLEDGEMENT OF FUNDING: None.

P2-13

Development of a Measure of Self-Concept in Youth

Diagnosed with Familial Adenomatous Polyposis

(FAP), a Heritable Condition

Mary Jane Esplen1,2, Terri Berk3, NoreenStuckless4, Arlette Lefebvre5, Jiahui Wong21Toronto General Hospital, Toronto, ON, Canada,2de Souza Institute, Toronto, ON, Canada, 3MountSinai Hospital, Toronto, ON, Canada, 4YorkUniversity, Toronto, ON, Canada, 5SickKids,Toronto, ON, Canada

BACKGROUND: The diagnosis of FAP at a youngage may alter a person’s self- concept, or sense of self,which may impact on an individual’s wellbeing andscreening behaviors. The purpose of this study is todevelop and validate an instrument for measuring theimpact of being diagnosed with Familial Adenoma-tous Polyposis (FAP) on an adolescent’s self-concept. METHOD: The study is being conductedin two phases: Phase I - Item Generation andRefinement and Phase II - Scale Selection and InitialValidation. RESULTS: We have completed Phase Iinvolving focus groups and interviews with adoles-cents between 12 years and 18 years who have beendiagnosed with FAP. Phase II is currently ongoing.To date 77 adolescents have completed the candidateself-concept scale and validating measures. Thecandidate scale items reflect the following themes:Self in relation to other, Body image, Vulnerability,Resilience, Social stigma, Sexuality and Intimacy andfuture sense of self. The presentation will focus on thescale construction, statistical results of subscalesand present the final scale. CONCLUSIONS:There are unique issues related to self conceptthat are relevant in considering the impact ofyouth onset genetic disorder. RESEARCHIMPLICATIONS: This is the first scale designedfor youth with FAP and will contribute to theempirical literature to assist further research ongenetic conditions. The scale could be used to informfuture studies on the psychosocial impact of FAP andassist with planning clinical interventions toimproved adjustment and quality of life.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was funded by the National Cancer Instituteof Canada (NCIC).

P2-14

The Comprehensive Development of a Psychosocial

and Educational Program for Caregivers: Integrat-

ing Empirical Findings, Clinical Expertise, and

Participant Reports

Andrea Feldstain1,2, Julie Martin-MacKay1,Sophie Lebel2, Martin Chasen1,3, Debbie Gravelle11Elisabeth-Bruyere Hospital, Ottawa, ON, Canada,2University of Ottawa, Ottawa, ON, Canada,3Ottawa Hospital, Ottawa, ON, Canada

BACKGROUND: Care for patients with canceris increasingly the work of loved-ones whooften feel unprepared to provide the requiredsupport. Few interventions have been developedand evaluated for caregivers of patients withadvanced cancer who are not yet terminal. TheElisabeth-Bruyere Palliative Rehabilitation Pro-gram is a cancer outpatient program for thosewho are experiencing symptoms and/or functionaldisabilities from disease or treatment. We willpresent the rehabilitation team’s support programoffered to their patients’ caregivers. METHOD:The format and content for the caregiver’sprogram has been developed using empiricalevidence, survey data, and discussions with healthcare professionals in oncology and in palliativecare. Upon completion of the program, caregiverscomplete a satisfaction questionnaire, which willinfluence ongoing refinements of the intervention.RESULTS: Preliminary qualitative data whichincludes feedback of program satisfaction andcomments from the caregivers and demographicinformation of the caregivers who attend will bepresented. CONCLUSIONS: The presentation willinclude issues that arose in the development of theprogram, barriers, and successes. We willdiscuss program feasibility and acceptability forcaregivers and present preliminary data to evaluatethis type of program in this specificpopulation. RESEARCH IMPLICATIONS: Theinterventions that do exist were developed forcaregivers of patients with early stage breast canceror who are closer to the end of their life.The development and investigation of thecurrent caregivers program will inform the litera-ture in terms of providing support forthis under examined population. CLINICALIMPLICATIONS: Other professionals whoseek to provide service for caregivers topatients living with advanced cancer, butwho are not terminal, can benefit from theincorporative work done by our team.ACKNOWLEDGEMENT OF FUNDING: TheCaregiver’s Psychosocial Education Programwas generously funded by The Ottawa RegionalCancer Foundation.

P2-15

Predictors for Patients’ Perceived Needs for Psy-

chosocial and Psychotherapeutic Support after

Breast Cancer Rehabilitation

Juliane Fink1, Holger Schulz1, Kai Kossow1, HansKordy2, Uwe Koch1, Birgit Watzke1



DOI: 10.1002/pon

1Department of Medical Psychology, UniversityMedical Center Hamburg- Eppendorf, Hamburg,Germany, 2Center for Psychotherapy Research,University Hospital Heidelberg, Heidelberg,Germany

BACKGROUND: Although many studies haveshown that the diagnosis of breast cancer isassociated with a wide range of potentiallypersistent psychosocial problems and needs, onlya small percentage of women do participatein professional psychooncological and psychother-apeutic treatment (Mehnert & Koch, 2008).Given these assumptions, the aim of thisstudy is to identify patients’ perceived needsfor psychosocial support. A special focuswill be set on investigating predictors of patient’ssubjective desires for professional support.METHOD: In a prospective multicenter studydata at admission (N5 700) and discharge ofcancer rehabilitation are assessed throughstandardized self-report questionnaires. Statisticalanalyses focus on linear regression prediction ofpatients’ perceived need for psychosocial andpsychotherapeutic treatment from sociodemo-graphic characteristics, anxiety and depressionsymptoms, functional health and self-efficacyexpectations. RESULTS: Data assessment will becompleted in May 2011. Results of theassessment will be presented with regard to theimprovement of acceptance of and access topsychosocial and psychotherapeutic treatment of-fered after cancer rehabilitation. CONCLUSIONS:Findings may lead to implications for patienteducation and information in terms of reducingthe gap between perceived need for andactual use of psychosocial and psychotherape-utic support. ACKNOWLEDGEMENT OFFUNDING: This study is funded by the FederalMinistry of Education and Research.

P2-16

Enhancing Psychiatric Triage by Developing and

Implementing Interactive Innovative Education

Modules for Social Workers Via the Web

Jennifer Gotto, Lina MayorgaCity of Hope National Medical Center, Duarte, CA,USA

BACKGROUND: Webinars has become an in-novative and popular media for clinicians toobtain information/education at their fingertipsPsychiatry constitutes only one part of a cancercenter’s mental health team as the highest trainedand least available resource. Social workers aremore plentiful and could be used to improveutilization of psychiatric services. We developedan interactive educational program for SocialWorkers to enhance their skills in identifying,

interviewing, documenting and triaging patientsfor depression. (face-to-face & webminars).METHOD: A 6 week, (face-to-face & webinarversions) interactive SW Depression educationalmodule was developed. A template was developedto ensure inclusion of clinically relevant materialappropriate for SW: safety, symptoms and severity.Modalities of face-to-face teaching includedPowerPoint, ARS (audience response system),videotaped case with MSE writing assignmentand live feedback, model patient interviewwith case discussion, and observed live patientinterviews with feedback. We used a mixedmethod approach to develop and evaluate theprogram that included a needs assessment, pre andpost SW self efficacy measures, and class/instructorevaluations. The Webinar version of the series wasdelivered via Blackboard. RESULTS: The inter-active educational series was piloted in fall2010. Feedback identified a need for on-goingcontinuing education of new SW a webinar versionof the series was developed via HOPEBOARD(Blackboard). Thus allowing, continued and stan-dardized education of SW’s. Evaluation data wascollected to ensure the program is beingimplemented as intended, identify areas for curri-culum improvement and to gain feedbackon each sub-topic. Multi-variate analysis are beingused to evaluate and cross compare perceivedefficacy of curriculum between those that com-pleted face to face module versus online module.And to bring forth additional insights for devel-opment of future programs centered arounddelirium and suicide. CONCLUSIONS: This cur-riculum integrates learning with the fundamentalsof psychosocial care in depressed cancer patients;by improving the participants skill capacity andenhancing their self efficacy to identify, assess,document and triage depressed cancer cases. Thecurriculum was implemented and formativelyevaluated amongst 25 social workers in the fall2010 and summer 2011. The results of theevaluated guided revisions to the curriculum andinitiated a quick response to the development of anonline educational series for new social work staffthat can also be adapted for nursing staff.RESEARCH IMPLICATIONS: The purpose ofthis study was to develop, implement and forma-tively evaluate innovative approaches to continuedenhancement of depression curriculum for socialworkers in a cancer setting through the develop-ment of face to face and online educationalmodules. CLINICAL IMPLICATIONS: It is notclear if the Depression education module improvedSW psychiatric triage. It did increase SW aware-ness and identification of patients with depressivesymptoms, reflected in increased email/verbalcommunication between SW/psychiatry aroundclinical issues. And increased clinical collaborationbetween SW/psychiatry around assessment and



DOI: 10.1002/pon

triage of patients. Thus, a larger percentage ofpatients could be reached with appropriate level ofintervention. This positive benefit provides afoundation for building and expanding a solidclinical programs. ACKNOWLEDGEMENT OFFUNDING: None.

P2-17

Early Detection of Depression and Anxiety Disorder

within Patients with Breast Cancer and a Comple-

mentary Group Program

Vanessa Gryspeerdt, Kristien Paridaens, LoreDedeyneAZ Sint Lucas, Bruges, Belgium

BACKGROUND: The months following a diag-nosis of breast cancer are a stressful period in apatients life. Coping and possible anxiety disordermight play an important role. Distress, anxiety anddepression are the most common psychologicalcomplaints within breast cancer patients. Theprevalence of emotional distress is about 39%.This means that the detection of adaptationaldisorder and follow up with individual support anda psycho-educative group program can be impor-tant. METHOD: A standard procedure has beenworked out by the breast clinic of the hospital SaintLucas in Bruges. A questionnaire is offered to allpatients with breast cancer who undergo a surgicalintervention. This questionnaire contains openquestions to screen for riskfactors to developdepression and also the HADS and PSSS. Basedon results of this screening a psycho-educationalprogram is proposed to a select group of patients.The most important elements of this program are:peer review and information sessions. During theprogram a breast care nurse, a breast psychologistand a specialist are present for support if needed.RESULTS: Evaluation of the program was madeby a qualitative and quantitative analyses. Thequalitative analyses by semi-structured interviewsshow us that the participants were very satisfiedwith the offer, the continence of the program andthe support. The motivation for participation wasmost of all due to the offer of information and thecontact with peers. The group program offeredthem a structure in their daily life. The quantitativeanalyses by ‘‘paired sample test’’ shows thatthe group program has no significant effect ondepression score. The anxiety score is significantlower after the group program (p5 .002).CONCLUSIONS: The evaluation of the groupprogram shows us that anxiety is an importantindicator for participation or absence in the groupprogram. Following aan group program candecrease the anxiety by the patient. We think thatthe link to the theory of ‘‘monitoring and blunting’’is important and can explain the decision of takingpart to a group program with information sessions

and peer review. In the future we would like to paymore attention to anxiety problems and theconsequences of distress in order to work evenmore preventive and to build out the groupprogram. RESEARCH IMPLICATIONS: We arelooking for opportunities to organise this investi-gation on a larger scale; a multicenter study.Several breast clinics in Flanders could beasked for their participation in this study in orderto have a better view on the situation inFlanders. CLINICAL IMPLICATIONS: Thestandard procedure has been experienced aspositive for a first screening, but there shouldalways be thought of the consequences of anxietydisorder. The importance of monitoring andblunting should be considered in the future.ACKNOWLEDGEMENT OF FUNDING:None.

P2-18

Information Needs of Cancer Patients: A Compar-

ison of Nurses’ and Patients’ Perspectives

Ancel GulsumAnkara University, Ankara, Turkey

BACKGROUND: Information is crucial for can-cer patients in coping with the disease, under-standing events through the course of cancertreatment and any side effects and participating inthe decision making process (Squiers et al., 2005;Florin et al., 2006).: Both patients and healthprofessionals perspectives are stressed as an essen-tial part of information provision to cancerpatients, and no study has yet been performed inTurkey, this study aimed to compare nurses’ andpatients’ perspectives. METHOD: This descriptive,comparative study was conducted at three publichospitals in Ankara, the capital of Turkey. Thepopulation consisted of 305 patients receivingtreatment for cancer and 130 nurses providing carefor them at the oncology units.of three hospitals.Data was collected with a study-specific question-naire. Based on previous clinical and theoreticalliterature and developed for the purposes of thestudy. Data analyse was conducted using theStatistical Package for the Social Sciences (SPSS)version 10.0. Descriptive statistics, Pearson Chi-square and Ridit Analyses were used to analyse thedata. RESULTS: First results was that, patientsand nurses do not have the same perception of theinformation provided to patients (po0.05). Sec-ondly, there was both congruence in eight out of 16information items between nurses and patients’preferences in terms of how much information wasneeded for patients but also significant incongru-ence on the remaining items(po0.05). A higher rateof nurses and patients reported the patients’information needs in the much needed category.Generally, demographic and situational variables



DOI: 10.1002/pon

had no impact on information needs of patientsThe patients who live out of Ankara reported moreinformation regarding post-discharging period(-po0.05). CONCLUSIONS: The decision on howmuch information is needed depends on practice,legal requirements, severity of illness, the patient’swishesThis study clearly shows that there is muchto do in terms of understanding the perceptionsand preferences of nurses and patients ininformation provision in Turkey. Nursesand all health professionals should be specificallyeducated on information provision and commu-nication skills in order to assess patients’ needs andprovide accessible information appropriate toindividual patient needs and wishes. RESEARCHIMPLICATIONS: If there is a difference inperceived information needs by health profes-sionals and patients, this suggests potential forcontradictory or even lacking information on thepatient’s side. Therefore this mismatch should beexamined and the reason for the varying informa-tion needs of patients perceived by patients and allhealth professionnals. In addition to this, theincongruence highlighted in this study also under-lines the need to identify what information meansto health professionnals and patients. CLINICALIMPLICATIONS: This study emphasises thatbefore information provision, health professionalsmust first assess the needs and preferences of thepatients properly since they will have more insightinto patient-centered information provision. In thisstudy, patients and nurses have reported as the firstitem on which patients needed information as post-discharge requirements. Therefore, it may beadvised to take into consideration duringeducation planning and post-discharge servicesshould be organised. ACKNOWLEDGEMENTOF FUNDING: None.

P2-20

MifoHuK: A Danish Milieu for Humanistic

Psychosocial Cancer Research

Helle Ploug HansenUniversity of Southern Denmark, Institute of PublicHealt, Reseach Unit: Health, Man & Society,Odense C, Denmark

BACKGROUND: The Milieu for HumanisticCancer research is an interdisciplinary researchnetwork established in 2007. It is based onhumanistic research, which uses qualitative meth-ods such as qualitative interviews, participant-observation and ethnographic fieldwork. Themilieu focuses on cancer patients’ existentialconcerns. The aim is to strengthen and develophumanistic psychosocial cancer research in Den-mark, initiate influential research, support re-searchers and the humanistic branch of cancerresearch and develop and initiate descriptive as well

as intervening projects. METHOD: Themembers of the milieu include senior researchesand doctors, post docs as well as PhD studentsall coming from a broad field of disciplines;anthropology, theology, sociology, psychology,gynecology, lung cancer, epidemiology as well aspublic health research. The milieu conducts work-shops several times during the year, PhD-coursesand working conferences on topics such aspatients’ existential concerns, qualitative researchstrategies, ethics and aesthetics. RESULTS:After three years the milieu has a solidscientific milieu for humanistic cancer research inDenmark. Mifohuk has been able to recruitsand maintains researchers in the field and toestablish a scientific cooperation with keypsychosocial cancer research milieus in Denmark.CONCLUSIONS: The vision of Mifohuk is toestablish and develop a solid scientific cooperationwith key psychosocial cancer research milieusinternationally. Especially it is the vision toestablish a dialogue with IPOS about integratinghumanistic cancer research in the society as akey field similar to epidemiological and psycho-oncological psychosocial cancer research.RESEARCH IMPLICATIONS: The vision ofMifohuk is in the near future to have at least onemulti-professional and interdisciplinary researchproject spanning different sciences and institutionsto ensure that a patient, from first symptom toeither cure, rehabilitation, palliation or death, ismet at the highest international standard. CLIN-ICAL IMPLICATIONS: The vision of Mifohuk isthat the health care professionals continue to takepart in Mifohuk making the necessary connectionsbetween psycho-social cancer research andclinical practice. ACKNOWLEDGEMENT OFFUNDING: We would like to thank The DanishCancer Society for funding the establishement ofMifohuk and its members for all the support theyhave given the milieu.

P2-21

Does Psychological Acceptance Correlate with

Positive Adjustment in Cancer Patients? Findings

from a Cross-Sectional Pilot Study

Nick Hulbert-Williams1, Lesley Storey2, LyndaAppleton31University of Chester, Chester, UK, 2Queen’sUniversity, Belfast, UK, 3Clatterbridge Centre forOncology, The Wirral, UK

BACKGROUND: High numbers of cancerpatients experience psychological distress followingtheir diagnosis and treatment. Empirically testedtraditional psychological interventions to reducedistress have demonstrated inconsistent results.Following the success of mindfulness-based inter-ventions, it is suggested that other third-wave



DOI: 10.1002/pon

therapies that build upon these (e.g. acceptance-based approaches) may offer potentially improvedintervention formats. This study aimed to test thebasis for this hypothesis by exploring correlationbetween psychological acceptance and a range ofcancer outcomes. METHOD: This pilot study usesa cross-sectional survey design. 500 patientsdiagnosed with colorectal, breast, prostate, or lungcancer in the previous twelve months were identi-fied by random sampling from medical recorddatabases. Questionnaire packs were sent forpatients to complete. Questionnaires assessed arange of measures including: variables related toacceptance-based intervention therapies (accep-tance, mindfulness); traditionally used indicatorsof adjustment (appraisal, coping, the Mini-MAC);and, a range of outcome measures (anxiety,depression, stress, benefit finding, quality of life).Data collection is underway and so far 56questionnaires have been returned. RESULTS:Our cut-off for questionnaire return is mid-September 2011; by this time we predict in excessof 200 participants to ensure sufficiently poweredanalyses. Data will be analysed using bothcomparative analysis between participantsub-groups, correlation analysis, and regressionanalysis to explore potential moderating andmediating relationships between variables assessed.CONCLUSIONS: If our hypotheses are con-firmed, and psychological acceptance is found tocorrelate highly with patient reported outcomemeasures in cancer, this supports the largertheoretical hypothesis that interventions toimprove psychological acceptance may be bene-ficial for helping cancer patients to adjust to theirillness. Development of such interventions isthe next stage in our programme of research.RESEARCH IMPLICATIONS: Acceptance andmindfulness form the cornerstones ofAcceptance and Commitment Therapy (ACT), athird-wave cognitive behavioural therapy.ACT has a rapidly growing evidence basesupporting its use for a variety of symptoms andpatient groups. To date, its empirical testing withincancer has been limited to just three publishedstudies. Further evidence is needed at the pilotstage to inform the feasibility and likelyeffectiveness of an ACT based RCT for cancerpatients. CLINICAL IMPLICATIONS: The psy-chology workforce in cancer care is large and thereis a growing need for efficient and effective (timeand cost) interventions for patients and theirfamilies. Evidence suggests that a range of inter-ventions are needed so that support can be tailoredto individual needs. ACT potentially offers such analternative approach, and if demonstrated to beeffective within this population, may provideanother useful therapeutic tool for clinicians touse. ACKNOWLEDGEMENT OF FUNDING:This research was supported by an internal

capacity building research grant from the PIsinstitution.

P2-22

To Understand Mental Health Related Issues

and the Importance of Regular Counselling in

Medical Management of Pediatric and Geriatric

Patients Undergoing Cancer Treatment: Experience

from a Super Speciality Private Hospital in

North India

Dipika Kaur, Harit Chaturvedi, Anil KumarAnand, Anupama Hooda, Samir Parikh, AmishVora, Nandini Hazarika, Kamna ChhibberMax Super Speciality Hospital, New Delhi, India

BACKGROUND: A number of psychosocialissues occur in a patient’s mind when diagnosedwith Cancer. Limited work has been done toidentify and address these issues. Our main purposeis to identify and provide a comprehensive reviewof these issues and address the research issuesobjectively and empirically. METHOD: A retro-spective chart review over 6 months was conductedto identify psychosocial concerns of children andelderly patients diagnosed with cancer. Depart-ments of Oncology and Mental Health worked inconjunction to identify counselling and psychoso-cial needs of cancer patients admitted in day-careand wards. Built around the consultation liaisonmodel, each patient was counselled by a Counsel-ling Psychologist working full-time for the Depart-ment of Oncology. Special needs and issues werediscussed with the treating physician, which wereaddressed in subsequent counselling sessions. Allfindings recorded in the worksheet of MentalHealth department were retrospectively analyzedto generate themes. RESULTS: Both populationsexperienced high levels of distress. Denial of illnessand depressive and anxious symptomotology werecommon significant areas of concern. Body imagedisturbances and self-blame were prominent inyounger sample. In contrast, elderly had difficultiesadjusting to the illness and environment, whichwere major areas of concern, as were sleepdisturbances and reminiscences of past andexistential concerns. Geriatric patients engaged inspirituality soon after diagnosis. The resultsrevealed that regular counselling helped: a) adapta-tion to illness and treatment procedures; b)compliance with the treatment; c) enhanced copingabilities; and e) acceptance of the disease and itssequelae. CONCLUSIONS: These findings weresuggestive of the key role that a mental healthprofessional plays in the medical management andpost-procedure routine care of cancer patients bothfor children and old age patients. Based on thesefindings, it is recommended that a structured,controlled research study be designed utilizingstandardized and validate questionnaires, which



DOI: 10.1002/pon

would provide further affirmation for the resultsobtained in the current research. RESEARCHIMPLICATIONS: Building on the above findings,a comprehensive prospective study could beplanned to address the mental health concernsand individual needs of cancer patients that couldimprove their of quality of life. And/or to developtraining programmes for the support staff workingfor oncology patients to enhance their skills inpatient care and communication. CLINICALIMPLICATIONS: In day to day practice closeassociation between Oncologists and MentalHealth professionals may help resolve ongoingconflicts occuring in the patients’ mind duringtreatment. though through research the scales usedshould be validated. ACKNOWLEDGEMENTOF FUNDING: None.

P2-23

Suicide Ideation Intent and Behaviour in Cancer

Patients

Ceyhan Balci Sengul1, Vildan Kaya2, Cenk AhmetSen1, Kemal Kaya31Denizli State Hospital, Denizli, Turkey, 2SuleymanDemirel University, Isparta, Turkey, 3Andeva Hos-pital, Antalya, Turkey

BACKGROUND: The suicide rate in cancerpatients are twice that observed in the generalpopulation. The psychological and physical stres-sors found to be associated with suicide in cancerpatients. Higher suicide rates among patients withcancer were associated with being male, white, orunmarried. Among men, higher suicide rates werenoted with increasing age at diagnosis. Suiciderates were also higher among patients withadvanced disease at diagnosis. METHOD: Weinvestigated the factors associated with suicidalityin cancer patients by Suicide ideation, behavior andintent scales at Denizli State Hospital Oncologyclinic in Turkey. Suicide ideation and behaviorscales were assessed to evaluate suicide risk incancer patients and suicide intent scale wasperformed for measuring suicide risk in cancerpatients with a history of suicide attempt. SPSS17.0 was used for statistical analysis. RESULTS:73 patients with cancer diagnosis were admitted toour study. 43 of the patients were female and 30 aremale. The mean age of the study group is51.2374.43 years. 37 of the patients had a priorpsychiatric history and 11 of them had a history ofsuicide attempt. Patients with previous suicideattempt had taken a higher average score fromsuicide ideation and behavior scales. We also foundthat patents with new cancer diagnosis and poorsocial support had taken higher points from suicideideation and behavior scales. CONCLUSIONS:Suicidality was associated with general medicalillnesses and specifically with cancer in many studies.

Every patient with cancer diagnosis should beevaluated for suicide risk. Patients with poor socialsupport, new cancer diagnosis and prior suicideattempt history might have an increased risk forsuicide and psychiatric support for this patientsmight be life preventing. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-24

Cognitive - Existential Group Therapy: An Effective

Way to Improve Depression in Women with Breast

Cancer

Bahman Bahmani1, Tahereh Kermany Ranjbar2,Said Kermany Ranjbar3, Ali Motlagh41University of Social Welfare and Rehabilitation,Tehran, Iran, 2Behavioral Sciences Research Center,Tehran, Iran, 3Shahid Beheshti University, Tehran,Iran, 4Cancer Study Center of Shahid BeheshtiUniversity, Tehran, Iran

BACKGROUND: The current study investigatedthe effect of the cognitive-existential group therapyon the level of depression, quality of life, selfesteem and hopefulness in women suffered fromdepression following the diagnosis of breast cancer.METHOD: 24 women with breast cancer werechosen sequentially from visitors of a cancer clinicin Shahid Beheshti University. All patients werebetween 20–65 years old and randomly assigned tocase and control groups. Exclusion criteria werehistory of depression, and metastasis to otherregions. All subjects were tested using Beck’sDepression Inventory-II, Miller Hope Scale andPope & McHale Self-Esteem scale and AaransonQuality of Life questionnaires before and afterweekly 90 minutes Cognitive - existential grouptherapy sessions. Level of depression in all parti-cipants was higher than average. After 12 sessionsfor cases, both groups re-tested using the above-mentioned questionnaires. RESULTS: The scoreswere significantly different between the two groupsfor all tests (po0.05) after cognitive-existentialsessions, but not before it. The average of the beckdepression inventory 2 was significantly lower andQuality of Life, self esteem and hopefulness washigher in the case group respectively. CONCLU-SIONS: The current study supports the previousclaims that cognitive-existential group therapy isan effective method to improve quality of life indepressed patients diagnosed with cancer. Inaddition, there is a reverse relation between thelevel of the depression and self esteem. Thecognitive-existential group therapy could be re-commended for all breast cancer patients. AC-KNOWLEDGEMENT OF FUNDING: None.

P2-25

The Psychosocial Impact of Cancer inMoroccan Families



DOI: 10.1002/pon

Saoussane Kharmoum1, Yassir Sbitti1, JinaneKharmoum2, Hind Mrabti1, Hassan Errihani11National Institute of Oncology, Rabat, Morocco,2Departement of pathology CHU IBN SINA,Rabat, Morocco

BACKGROUND: Cancer is an uncommon dis-ease. It attains deeply and painfully the person withcancer and also his family. Cancer impact in theNorth African families was not described exten-sively. The goal of our work is to describe thedifferent aspects of the impact of cancer in theMoroccan families. METHOD: During the periodfrom September to December 2009, 150 families ofpatients followed at the national institute ofoncology in Rabat, were interviewed by a ques-tionnaire covering socio-epidemiological character-istics, repercussions of disease to their psychic,sexual and religious practices. RESULTS: Therewere 378 members: children (51%), spouses (26%),and other members of the family(MF): mother,father, sister, brother. median age was 45 in adultand 16 in children. Traumatism and initial denial :97% of the wives(W), 19% of the husbands(H),100% of the children(C) and 60% (MF). Theobsession of having a cancer : 62% w, 37%H, 25%C. Culpability : 94% W, 15% H, 90% C. Toxichabits increased within 78% of the males’ adultfamily members. The recourse to popular medici in40% of the cases. We noted a increase in religiouspractices in 97% of families. CONCLUSIONS: Theresults of this work shows that all the members ofthe Moroccan family are likely to test an importantdistress, specially wives and children. Toxic habits,traditional medicine and religion are the dominantrefuge which incite us to be vigilant, in order to beable to treat any potential psycho-pathologicdemonstrations, and to enable the family tolive as normal as possible. RESEARCHIMPLICATIONS: Find solutions to improve thequality of life for families. CLINICAL IMPLICA-TIONS: To be able to detect, prevent and treat anypotential psycho-pathologic demonstrations forfamilies. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-26

National Telephone for the Psychological Support to

Oncological Patients and their Family Members

Tamara KlikovacInstitut for Oncology and Radiology, Belgrade, Serbia

BACKGROUND: Serbia, made a big step forwardin the field of psycho-oncology. In October 2010Serbian Association for Psycho-Oncology, in col-laboration with the Ministry of Health of Serbiaand the Republic Health Insurance has launchedthe first national telephone for free psychologicalcounseling and support to oncology patients and

their families (the number is 0800-202-303). Sincethe beginning of project up to april 2011(21.10.2010 -21.04.2011) we received a total of2.748 calls from across Serbia. METHOD: Thetelephone line for the psychological help andsupport was available from 10 am to 10 pm, 7days a week and on holidays. Two counsellingpsychologists were appointed in the morning andtwo in the afternoon. On group meetings held oncea week, we discussed what happened during theweek (who called, why they called, which problemswere the most complex ones and how we couldsolve them). The basic principle of work of the Lineis anonymity for users (if they wished), a freeservice available to patients all around Serbia,careful listening, emphatic reflection. RESULTS:Statistical analysis of the data from the databasewe made for this project, showed the followingresults. The total number of calls was 2.748. 1137of these calls were repeated calls becausepatients needed a continuous psychological coun-selling and 1611 were documented as the first call.A larger percent of women called, i.e. 1755 women(63.9%) compared to men 35.4% (973). Theyoungest Line user was a six-year old child (thechild’s grandmother called because the child’sfather was in the terminal stage of the disease)and the oldest one was an 88-year old patient.CONCLUSIONS: Patients, i.e. Line users mostlycalled due to following psychological problems:Feeling sad, desperate, helpless, hopeless, mean-inglessness;Depressive reaction and demoralisationabout the positive outcome of the disease;Suicidalthoughts;Fears (of being ruined, of pain, diseasedeterioration, loneliness and being left to themsel-ves);Anxiety (feeling worried, uneasy, tense, ner-vous;Mood swings and irritability;Familyproblems (lack of understanding, conflicts, poorcommunication and relations);Feeling rejected inthe social and work environment;The need to bebetter and more qualitatively informed on thedisease, treatment, adverse side effects of acombined oncological treatment, disease prognosisand treatment outcome. RESEARCH IMPLICA-TIONS: Most calls were made by patientsfrom Belgrade (692), from Vojvodina (538), South-ern Serbia (489) and Central Serbia (321).Compared to previous data, there were fewercallers from Eastern Serbia and WesternSerbia (171, and 192 respectfully). Majority ofcallers were women with breast cancer andtheir families (541), followed by patients withmalignant urologic diseases (453). A large percentof calls were made by patients with gynaeco-logical malignancies (194) and haemato-logical malignant diseases (187). CLINICALIMPLICATIONS: Majority of callers were onco-logical patients (who the line was primarilyintended for),followed by spouses of oncologicalpatients as the so-called ‘‘first-line support’’



DOI: 10.1002/pon

(212),their children (200 in total).There werealso calls we categorised as non-oncologicalpatients (168):drug addiction, alcohol, suicidalpersons, persons with different serious somaticdiseases: hepatitis,AIDS, multiple sclerosis,psychiatric patients, disabled persons);. We alsodocumented various complaints made bypatients (insufficient information, unfriendly staff)and we furnished them to the Ministry of Health.ACKNOWLEDGEMENT OF FUNDING: None.

P2-27

Media Promotion of the Project: National Tele-

phone for the Psychological Support to Oncological

Patients and their Family Members

Tamara Klikovac1, Ivana Stavric2, SvetlanaBlagojevic31Institut for Oncology and Radiology, Belgrade,Serbia, 2Cross Communications, Belgrade, Serbia,3Cross Communications, Belgrade, Serbia

BACKGROUND: The National project ‘‘TheLine for the Psychological Help and Support toOncological Patients’’ is carried out as co-opera-tion between the Republic of Serbia Ministry ofHealth and the Serbian Association for Psycho-Oncology within the National Strategy’’Serbiaagainst Cancer’’.Bearing in mind that the freetelephone line for the psychological support tooncological patients is the first national project inSerbia in the field of psycho-oncology. METHOD:Before starting the project we were aware of thefact that both the academic and broader commu-nity in Serbia needed to become informed onstarting the project.Organisation of the mediapromotion of this project had two basic aims.1.inform oncology patients from all around Serbiaand from all oncological centres and their familiesthat there was a new service available 7 days a weekand on holidays and that psychological supportwas provided by trained counselling psychologist-s.2.inform the academic community on starting theproject and to sensitise the broader communityabout the psychological needs of oncologicalpatients. RESULTS: We organised press confer-ences, guest appearances on popular shows on theNational television (morning programme, dailynews), guest appearances on specialised shows, aTV advertisement, articles in daily newspapers andweekly magazines. As promotion material, posters,flyers and brochures were printed.Monitoring andanalysing the calls showed that there was anincreased number of calls on a daily and weeklybasis proportional to guest appearances in themedia. Following prime-time guest appearances onthe National television, the number of calls wasincreasing by almost 40% on a daily basis.CONCLUSIONS: Media promotion of our pro-jects is very important in our society,because of

both the users and the broader community.Bearing in mind that our public health system isbeing reformed and that new practice models arebeing introduced (especially the ones relatingto the adequate communication with patients,kindness, caring about patients in a humane andempathic way, adequate psychological approach topatients, the media promotion serving to callattention to human values and the quality of thegeneral care about all patients, especially oncolo-gical patients, is of great significance. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-28

The Effect of a 6-week Group Psycho-Educational

Program on Philippine Breast Cancer Patients: A

Pilot Study

Dianne Ledesma1, Miyako Takahashi2, Ichiro Kai11University of Tokyo, Tokyo, Japan, 2DokkyoMedical University, Tochigi, Japan

BACKGROUND: Breast cancer is the mostcommon cancer among Philippine women. Forthose affected, there is an unmet need in dealingwith the consequent psychosocial issues. Grouppsychotherapy programs are known to be effectivein addressing such issues, but their effectiveness stillremains to be seen in Asian populations. This pilotstudy was conducted to determine the effectivenessof a structured, 6-week group psycho-educationalprogram among Philippine patients in improvingmood, distress, and quality of life. METHOD: Theprogram was conducted at the University ofSanto Tomas Hospital Benavides Cancer Institute(BCI) in Manila, Philippines. Seven patients withprimary breast cancer between Stage I-III whowere 4–24 months post-surgery and not underactive chemotherapy or radiotherapy, participated.The 6-week group psycho-educational programoriginated by Fawzy and Fawzy etal. (1993) wasused as the program model. Psychosocialassessments for mood (Profile of Mood States[POMS]), distress (Hospital Anxiety and Depres-sion Scale[HADS]), fatigue (Brief FatigueIndex[BFI]), and quality of life (EORTC-QLQC30and BR23) were given at baseline (prior tothe start of therapy), immediately post-therapy,and at 4-month follow-up. RESULTS: Ten pa-tients consented to participate, however, only sixpatients completed the program. The patients’ totalmood scores showed a decreasing trend frombaseline to the 4-month follow-up, highlightedby a decline in the negative subscales and anincrease in the Vigor/Activity subscale of thePOMS. The Depression component of the HADSalso decreased in the same period, althoughAnxiety component remained largely unchanged.The fatigue scores (BFI) showed a decreasingtrend from baseline to the 4-month follow-up.



DOI: 10.1002/pon

The function scores on both the QLQC30 andBR23 showed improving trends while thesymptom scores declined from baseline to the4-month follow-up. CONCLUSIONS: The6-week group psycho-educational program ofFawzy etal. shows promise as an effective tool toaddress the unmet psychosocial needs of Filipinobreast cancer patients. Although developed in theWest, this program may be acceptable to andappreciated by Asian patients whose culturalvalues and BACKGROUND: may differ signifi-cantly from western patients. The decline indepression, fatigue, and symptomatology, alongwith the increase in functioning and vigor, mayimply that the different components of the program(health education, coping skills training, stressmanagement and relaxation training) and thelength of the program may be effective for Filipinopatients. RESEARCH IMPLICATIONS: Mostgroup psychotherapy program models originatefrom the west and cater to western patients. Theapplicability of such a program towards Asianpatients is of interest because of the apparentdifferences in cultural norms and historical back-grounds. This pilot study allows us to plan arandomized, wait-list controlled trial that coulddetermine whether this group psycho-educationalprogram is really beneficial to cancer patients in thePhilippines. CLINICAL IMPLICATIONS: ManyPhilippine breast cancer patients have access toregular medical care but have an unmet need forpsychosocial care in dealing with cancer issues.That a 6-week group psycho-educational programmay be effective for Philippine patients implies anew window of access open to them in helping themcope with the long-term effects of experiencingbreast cancer and serves as a cost-effective means toprovide holistic care in a third world country.ACKNOWLEDGEMENT OF FUNDING: None.

P2-29

Comparison of Two Group Intervention Methods in

Reducing Emotional Distress: An Exploratory Study

Concha Leon-Pizarro1, Rosanna Mirapeix2, EstherJovell3, Tomas Blasco4, Angels Arcusa11Institut Oncologic del Valles, Hospital de Terrassa,Terrasa, Barcelona, Spain, 2AECC, Junta deSabadell, Sabadell, Barcelona, Spain, 3Recerca,Hospital de Terrassa, Terrassa, Barcelona,Spain, 4Psicologia Basica. Universitat Autonomade Barcelona, Barcelona, Spain

BACKGROUND: There has been an increased useof meditation techniques to reduce emotionaldistress and enhance psychological adaptation inpatients with cancer. Interventions which follow theprocedures stated by John Kabat-Zinn in hisMindfulness-Based-Stress-Reduction (MBSR) seemto be efficacious in helping cancer patients. The aim

of this study is to explore whether a MBSR groupintervention is more useful than a standardpsychoeducational intervention group to decreaseanxiety and depression in ambulatory cancerpatients. METHOD: Patients who received cancerdiagnosis and were treated at the Institut Oncologicdel Valles (Barcelona, SPAIN), and who wereinterested in receiving group psychological assis-tance were assigned to a MBSR intervention group(n5 20) or to a standard psychoeducational inter-vention group (n5 17). Patients answered the STAIand BDI questionnaires, as well as the QLQ-C30,before and after the intervention. The interventionprogram was developed across 10 weeks. RE-SULTS: 26 patients completed the interventionprogram (MBSR-group: 16, standard-group: 11).There were more patients with breast cancer at thestandard-group and more patients with colon cancerat the MBSR group. Patients at the MBSR groupdecreased their levels of state anxiety (p5 .001) andtrait anxiety (p5 .004), and increased their qualityof life in three subscales (Rol, Emotional andCognitive), as well as in the Global Scale (po.05in all cases). MBSR patients also reduced (po.05)their rates in four additional items of QLQ-C30:Fatigue, Diarrhea, Insomnia, and Financial Diffi-culties. Patients at the standard-group showeddecreasing levels only in state anxiety (p5 .015).CONCLUSIONS: These preliminary results suggestthat an MBSR group intervention is more effectivethan a standard psychoeducational interventiongroup in decreasing anxiety states and enhancingquality of life. RESEARCH IMPLICATIONS: Itcannot be concluded that MBSR group interventionreduces distress and enhances quality of lifebecause of methodological limitations in thepresent study. Thus, further studies with largersamples and accurately balanced groups are needed.CLINICAL IMPLICATIONS: It is suggested thatMBSR interventions can give larger effects thanpsychoeducational treatment in enhancing qualityof life and reducing emotional distress in cancerpatients. ACKNOWLEDGEMENT OF FUND-ING: This study was supported in part by theFundacio Joan Costa Roma from Consorci Sanitaride Terrassa.

P2-30

Elderly Cancer Inpatients’ Desire for Psychological

Support During the Diagnostic Phase or Before a

New Treatment Line: Prevalence and Implications

for Screening Psychological Needs

Yves Libert1,2, Isabelle Merckaert1,2, StephanieDubruille2, Sandrine Vandenbossche1,2, DominiqueBron1, Myriam Roos1, Darius Razavi1,21Faculte des Sciences Psychologiques et de l’Educa-tion, Universite Libre de Bruxelles, Brussels,Belgium, 2Institut Jules Bordet, Universite Libre deBruxelles, Brussels, Belgium



DOI: 10.1002/pon

BACKGROUND: Although professional psycho-logical support could be effective in helping elderlycancer patients to better cope with cancer and itstreatments, little is known about their desire forpsychological support. The aim of this study was toinvestigate elderly cancer inpatients’ desire forpsychological support during the diagnostic phaseor before a new treatment line and to identifypatients’ sociodemographic, geriatric, disease-re-lated characteristic and psychological factors asso-ciated with this desire. METHOD: This cross-sectional study assessed consecutive elderly cancerinpatients aged 65 years during the diagnosticphase or before a new treatment line. Patientscompleted a Comprehensive Geriatric Assessment(CGA), the Hospital Anxiety and Depression Scale(HADS), an Adaptation of the Cancer Rehabilita-tion Evaluation System (CARES) and reportedtheir desire for psychological support. RESULTS:Among the 330 included patients, 16% desiredpsychological support. Elderly patients’ desire forpsychological support was associated with beingyounger (OR5 3.009; p5 0.011), with havingdifficulties in achieving daily living activities(ADL) (OR5 1.230; p5 0.044) and with psycho-logical distress (HADS) (OR5 1.078; p5 0.003).CONCLUSIONS: Sixteen elderly cancer patientsout of hundred desire psychological support.RESEARCH IMPLICATIONS: This studyemphasizes that loss of autonomy underlinesfrequently a desire for psychological supportamong elderly patients with cancer. CLINICALIMPLICATIONS: Psycho-oncology services shouldbe aware that loss of autonomy is a core difficultyexperienced by elderly patients with cancer.ACKNOWLEDGEMENT OF FUNDING: None.

P2-31

‘‘But it Must be the Chemo that makes Me Sick....’’

Does Integrating Psychological Care into the Adult

Medical Model for those under 30 Decrease

Psychological Symptoms?

Toni Lindsay, Angela Cotroneo, Nicole FerrarSydney Cancer Centre/Royal Prince Alfred Hospi-tal, Sydney, NSW, Australia

BACKGROUND: The Sydney Cancer Centre/Royal Prince Alfred Hospital is a tertiary referralhospital with a specialised Sarcoma and Haema-tology service. Until April 2009, patients under theage of 30 were not routinely seen, however in orderto bring the hospital into alignment with the bestpractice, most of these patients are now beingreferred to a psychologist/counsellor and seenthroughout their treatment. METHOD: The cur-rent data is a reflection of 53 patients under the ageof 30 (Average5 21.9, range 16–30) who have beenengaged in the Psycho-Oncology Service sinceApril 2009. Data was collected by therapists

throughout the course of treatment with patients,with most patients having a session with thetherapist each treatment cycle. The data reportedis representative of clinician identified symptomsthroughout the ongoing review of each patient.Comparisons between those provided with psycho-logical support prior to treatment (N5 18) to thosewho had already been engaged in treatment priorto referral (N5 35). RESULTS: The results in-dicate a significant psychological burden of diag-nosis, with 61.5% of the sample experiencinganticipatory nausea, 67% showing clinical levelsof anxiety and over 85% showing behaviouralchanges, including sleep disturbance. Over 70% ofthe sample who had a solid tumour indicated adelay in diagnosis, and often felt that theirsymptoms were not heard, or dismissed by theirGP when presenting. Psychological interventionprior to treatment starting decreases the rates ofanticipatory nausea (�16%), depression (�35%),and the use of anxiolytics (�7%), however therewas negligible difference in the groups for the ratesof anxiety (�1%). CONCLUSIONS: The psycho-logical burden on this population whilst under-going treatment is significant, showing much higherrates of psychological symptoms then their adultcounterparts. This data provides rationale toproviding routine referral to psycho-oncology priorto beginning treatment, as this appears to decreasethe incidence of anticipatory nausea and the otherpsychological impacts of diagnosis and treatment.This intervention appears to have a strong correla-tion with lower rates of depression to those in thispopulation who had intervention once symptomshad been identified. However early interventiondoes not appear to help manage behaviouralconcerns such as sleep difficulties or problems withfamily. RESEARCH IMPLICATIONS: The AYApopulation has often been discussed in the litera-ture for their poorer medical and psychologicaloutcomes compared to adult and paediatricgroups. The current study has provided a ‘snap-shot’ of a clinical population of these youngpeople and their mental health and ongoingsupport needs. A strong case can be built forfurther structured research into the effective inter-ventions for this group which at this stage have notbeen strongly utilised or identified. CLINICALIMPLICATIONS: The difficulties of workingwith this population are often identified, particu-larly in their reluctance to engage in psychologicaltherapies. The current model has demonstratedsome improvement in the clinical symptoms of thepatients when engaged in regular psychologicalsupport. The clinical implications of such are quitesignificant, suggesting that there is value in a modelwhich favours early intervention over reactivework particularly in troublesome clinical areassuch as anticipatory nausea. ACKNOWLEDGE-MENT OF FUNDING: None.



DOI: 10.1002/pon

P2-32

Interdisciplinary in Oncology: Role of Care Co-

ordinator in Oncology in Setting up the Procedure

for Delivering Negative News in Terms of Coordina-

tion Between Different Stakeholders and Improving

Adaptation Process of Cancer Patients

Frederic Maddalena1, David Ogez1,2, Celine Brison2,Laurence Canon1, Charlotte Devalkeneer1, JamilaBousata1, Christine Sempoux11Cliniques Universitaires Saint-Luc, Brussels,Belgium, 2Universite Catholique de Louvain,Louvain-la neuve, Belgium

BACKGROUND: Technical advances in oncologyrequire Interdisciplinary work to improve treat-ment. For the patient, these progresses and themultitude of stakeholders are an additional sourceof difficulty. To adapt to these changes, the carecoordinator in oncology has developed a procedurefor delivering negative news. Our study aims toassess the satisfaction of the priority needs ofpatients at diagnostic announcement, as well as thecommunication tools that accompany it. METHOD:The procedure introduced in 2009 divided theshock of the diagnosis in 4 periods: (1) medicaltime, (2) interview with the care coordinator inoncology, (3) interventions of paramedicals, (4)information for general practicers. Communicationtools have been created at each stage to identifygeneral and specific needs of patients, but alsoto improve interdisciplinary communication.Evaluation questionnaires will be given to patientsto assess their satisfaction with the procedure ingeneral, as well as the tools we created. We alsoaim to clarify the specificity of each professional inthis process in terms of support. RESULTS: Theresult of the establishment of the procedure isawareness of all members of the interdisciplinaryteam to the difficulty of the diagnosis for thepatient. Then the specific tools at each step neededto be recognized. This process has energized theteam, allowed a clearer definition of roles, a betterinternal coordination, time savings, and ameliora-tion of care quality for the patient. It will also helpto understand the feelings of the patient, whichwere only empirical until now. The results will alsoshow the benefit of a coordinated interdisciplinarywork to improve the coping assistance for cancerpatients. CONCLUSIONS: This study will show usthe elements of satisfaction and dissatisfactiontowards the patient’s procedure and the tools thatcompose it. It will also indicate to what type ofperson (professional or not) the patient asks forsupport, to satisfy their priority needs. These twoelements would allow members of the interdisci-plinary team to identify areas to be improved inorder to optimize communication tools and en-courage a holistic approach to the patient whilerespecting his autonomy. It will also allow each

professional to better position themselves in relationto expectations that the patient has for his function.RESEARCH IMPLICATIONS: This study enablesthe interdisciplinary team to have general tools forspecific and personalized care. It helps to betterunderstand and respect the patient’s priorities. More-over, we can further study the evolution of theseneeds during the different stages of the disease. Thisstudy also suggests that if we can establish commu-nication tools validated at national level, it will notonly improve the quality of care, but also allowbenchmarking between hospitals for the patients’benefit. CLINICAL IMPLICATIONS: The clinicalimplication is to optimize the communication tools toimprove the patient’s satisfaction and to definespecificity of each professional. The cancer carecoordinator can arrange the best interdisciplinarywork by optimizing the screening interviews with eachnew patient. The study will also improve interdisci-plinary communication by identifying the elementsrequired by each stakeholder to ensure his role in thedifferent steps of the procedure for delivering negativenews. ACKNOWLEDGEMENT OF FUNDING:None.

P2-33

Benefits of Psycho-Oncology Care on Breast Cancer

Patients

Geeta Mathur, Kavita Hazare, Suchitra MehtaSadhana Charitable Trust, Nagur, Maharashtra,India

BACKGROUND: Diagnosis of breast cancer canbe castrophic for a women. She is completelydevastated and her whole world falls apart. Fear ofdeath, side effects of treatment like loss of hair or theorgan itself, social stigmas associated with cancergain mammoth proportions. Studies have provedthat psychological support extended to the breastcancer patients not only improves the quality of lifebut also reduce the risk of recurrence. The patientbecomes positive towards treatment. METHOD:Studies were done on breast cancer patients (women)in different age groups between 20 and 70 years.They were further divided in the category likeworking women and housewives, high and lowconfidence level, good and bad family support, highand low income groups, patients from the medicalfield like Doctors and nurses etc. These patients wereprovided with psychological support in coordinationwith doctors and the care providers especially in thearea of motivation, exercise, complimentary thera-pies and diet etc. Their fatigue levels, quality of lifeand recurrence was observed. RESULTS: Patientswith high confidence levels especially the workingwomen of all age groups have responded well topsychotherapy, and have coped with cancer indignified manner. Nearly 90% subjects are leading ahealthy and normal life despite bad family support



DOI: 10.1002/pon

and low finances. Women with low confidence levelsdo not enjoy the quality of life. Women in the highsocio- income group accept the psychological sup-port but it is difficult to remove the social stigmaassociated with cancer. Doctors do not acceptpsychological support. Psychological supports haveresulted in reduced fatigue and quality life in nearly80% of patients. CONCLUSIONS: Psychologicalintervention in breast cancer patients have increasedthe acceptance towards the treatment not only of thepatients but also of family. Lower fatigue levels,improved quality of life and positive attitude havedeveloped in patients leading to non-recurrence ofcancer. Motivational programme, workshops havehelped the patients to adjust in society. RESEARCHIMPLICATIONS: Detailed research is required inthe field of psycho-oncology along with the regulartreatment to enhance the lives of cancer patients.CLINICAL IMPLICATIONS: Psycho-oncologycan extend higher support in the clinical treatment ofcancer patients. ACKNOWLEDGEMENT OFFUNDING: None.

P2-34

Moderate but Consistent Team-Support is Useful for

Mental Care in Disaster Area

Tokuzo Matsui, Kazuhisa Hayashida, KenseiMaebayashi, Yukio Iwamoto, Hitomi Seino, RieNishii, Noriko Uwa, Hironori Mito, HisatoMatsunagaDept of Psychiatry, Hyogo Medical College,Nishinomiya, Hyogo, Japan

BACKGROUND: The East Japan Earthquakehas led disastrous damage on psychological andphysical aspects on disaster victims includingcancer patients. In terms of mental support onthose people, lots of mental support teams such asKobe-Hyogo team were sent to that area. Know-how of such support activities should be intro-duced to worldwide. METHOD: Based on therequest from disaster Sendai City, Kobe-Hyogomental support team was quickly organized andsent to disaster area 7 days after earthquake.Before the arrival of Kobe-Hyogo team, survivorsof local healthcare center made maps of evacuationarea and selected cases who need mental support.Each support team consists of two psychiatrists,one nurse, one psychologist, one welfare workerand clerk. General psychiatrists took care ofmental support for victims including cancerpatients who complained insomnia, anxiety anddepressive mood. Each team stayed Sendai areafor one week by rotation and visited severalevacuation areas everyday. RESULTS: With thesupport and cooperation of local healthcare center,Kobe-Hyogo team was able to conduct consistentmental support to disaster victims. One weekrotation system prevented particular member from

being overloaded which was enabled by theregistration of many backup members from Kobearea who were willing to return favors in Kobeearthquake. Team members were always ready torespond when victims desired to speak to, howeverteam members were cautious not to force victims totalk about their hard experience. Through thisvisit, general psychiatrists are involved in takingcare of mental support for cancer patients as well.CONCLUSIONS: Modification of previous men-tal support system at Kobe earthquake time madeit possible for team members to avoid burnout andunnecessary excessive intrusion to the disastervictims. Prior to the actual support activity, bothlocal governments adjusted the schedule and areawhich was a useful system in Kobe earthquake.Collaboration of support team and local staff isimportant in increasing the effect of this activity.Limited number of psycho-oncologists in disasterarea brought general psychiatrists into mental carefor cancer patients. In this way, ‘‘moderate butconsistent’’ approach will be important in mentalsupport after natural disaster. RESEARCHIMPLICATIONS: Long-term follow-up for vic-tims is necessary under the mutual cooperationbetween Sendai and Kobe health care center.Objective comparison between the East JapanEarthquake with Kobe Earthquake in 1995 frompsycho-oncological viewpoints will reveal morebeneficial support against disaster. CLINICALIMPLICATIONS: This mental support project isa milestone case for general psychiatrist to realizethe importance of psycho-oncology at naturaldisaster as well as during peace time. Applicationof medical cooperative care system in palliativecare team will be useful in the collaborativemental support activities at devastated area.ACKNOWLEDGEMENT OF FUNDING:None.

P2-35

A Systematic Review of Psychological and Psycho-

Educational Interventions Developed for Individuals

Affected by Melanoma

Jordana McLoone1, Nadine Kasparian1, ScottMenzies2, Bettina Meiser3,4, Graham Mann51School of Women’s and Children’s Health, Uni-versity of New South Wales, Kensington, Australia,2Sydney Melanoma Diagnostic Centre, Royal PrinceAlfred Hospital, and Discipline of Dermatology,Faculty of Medicine, University of Sydney, Sydney,NSW, Australia, 3Medical Oncology, Prince ofWales Hospital, Randwick, Australia, 4Prince ofWales Clinical School, University of New SouthWales, Kensington, Australia, 5WestmeadInstitute for Cancer Research, University ofSydney at Westmead Millennium Institute andMelanoma Institute Australia, Westmead, NSW,Australia



DOI: 10.1002/pon

BACKGROUND: Clinical practice guidelinesrecommend that structured psychological andpsycho-educational interventions be made avail-able to all melanoma patients. However, thecurrent availability of interventions and whatentails a ‘good’ intervention remains somewhatless clear. Past interventions differ fundamentally,targeting psychological well-being, screening beha-viours, and disease outcomes such as survival andmelanoma recurrence. The aim of this systematicreview was to provide a comprehensive overview ofpsychological and psycho-educational interven-tions developed for people affected by melanoma.METHOD: A systematic search of the electronicdatabases Medline, PsycInfo, Embase, andCINAHL was undertaken using predeterminedsearch terms and mesh headings to identifypsycho-educational and psycho-therapeutic inter-ventions designed for, and administered to, peoplewith a personal history of melanoma. Sixteenunique interventions, generating 27 articles, weredeemed eligible for inclusion in the review. Themajority of studies employed a quantitative meth-odology; however, qualitative methods were usedin two studies. RESULTS: The identified benefitsof psycho-educational intervention includedincreased patient satisfaction with clinical care andinformation provision, as well as adherence to skinself-examination (SSE) recommendations. Thebenefits of psychotherapeutic intervention includeddecreased anxiety and emotional distress, as well asincreased coping with illness. Improvementsbeyond the realm of psychological health werealso found, with improved survival rates found upto five years psychotherapeutic post-intervention.Psychotherapeutic interventions were also found tobe cost-effective when implemented as part ofroutine care. To the detriment of manystudies, sufficient information to support thereplication of the intervention was rarely provided.CONCLUSIONS: Psychotherapeutic and psycho-educational interventions delivered and evaluatedwithin the melanoma context have been shown toelicit not only positive changes in mental healthand health-related behaviours, but also inpatient survival. This review draws attention topsychological interventions as both cost-effectiveand flexible in delivery. Given the wide rangeof interventions reviewed, hospitals and clini-cians have ample choice in the tools they mayuse to tailor interventions to suit both clinicaland patient needs and budgets. RESEARCHIMPLICATIONS: Future intervention studiesshould not only report program outcomes, butalso include detailed descriptions of the interven-tion development and implementation stages, sothat the ‘active ingredients’ of such interventionsmay be identified and incorporated into futureinterventions and clinical practice guidelines. Inter-ventions should be described in enough detail that

they may be replicated, either for the purposes offuture research or for the translation of researchinto practice. CLINICAL IMPLICATIONS:Clinical practice guidelines recommend that struc-tured psychological and psycho-educational inter-ventions be made available to all melanomapatients. Encouragingly, interventions weredeemed cost-effective when implemented as partof usual care; however, what entails a ‘good’intervention remains somewhat less clear. Clini-cians should look for intervention programsthat not only increase patients’ awareness ofhealth behaviours, but which also demonstratethat key behaviours are being performed withgreater accuracy or thoroughness as a resultof the intervention. ACKNOWLEDGEMENTOF FUNDING: Nadine Kasparian is supportedby a Post-Doctoral Clinical Research Fellowshipfrom the National Health & Medical ResearchCouncil (NHMRC) of Australia (ID 510399).Bettina Meiser is supported by a Cancer InstituteNSW Career Development Fellowship (ID350989). This project was also supported by aProject Grant from beyondblue: the nationaldepression initiative.

P2-36

Volunteer Management: An Important Role for

Psychosocial Cancer Educators Providing Global

Cancer Support

Carolyn Messner1,21CancerCare, New York, NY, USA, 2HunterCollege SSW, New York, NY, USA

BACKGROUND: Effective management of vo-lunteers is essential to the efficacy of psychosocialcancer education for global populations. Volun-teerism has an extensive history in all continentsand cultures. Our current health care systemscreate many human resource hardships for psy-chosocial cancer educators. METHOD: Althoughpatient education programs are essential to cancertreatment, palliative and psychosocial care andadherence, many programs have been downsizedand restructured. The survival of these programshas depended upon the creativity of cancereducators in their deployment of staff, access tofunds from grants and use of volunteers.RESULTS: This presentation will describe TheVolunteer Program developed by the EducationDepartment of CancerCare.This program, which isadministered by an oncology social worker, reliesheavily upon lay, student and professional volun-teers for selected tasks of its daily operation,dissemination and expansion. The use of volunteersis cost effective, does not replace current jobs andcontributes to the viability of patient educationprograms. CONCLUSIONS: The author willidentify specific volunteer management techniques,



DOI: 10.1002/pon

which include: recruitment, diversity, selection,orientation, training, supervision, retention strate-gies, volunteer job descriptions, contracting, creat-ing a motivating environment, limit and boundarysetting, pitfalls and rewards, and evaluation andfeedback. CLINICAL IMPLICATIONS: Empha-sis will be placed on the importance of creating aglobal vision for volunteer management whichmeets the needs of global patients and theircaregivers, psychosocial education programs, theoncology patient population, the staff, theorganization and the volunteers. The author’sexperience in utilizing volunteers, lessonslearned, impact on staff morale, creative use ofglobal communication technologies, findingsfrom qualitative and quantitative researchand future implications will be included.ACKNOWLEDGEMENT OF FUNDING:None.

P2-37

Innovative Integration of Communication Technolo-

gies for Global Support of the Oncology Community

Carolyn Messner1,21CancerCare, New York, NY, USA, 2HunterCollege SSW, New York, NY, USA

BACKGROUND: The need for psychosocialpatient education programs is increasing with theadvent of personalized medicine, evolving biomar-kers, methods to predict response to treatment,advances in psychosocial services, palliative andend-of-life care. The multidisciplinary health careteam is overwhelmed by the volume of patients inaddition to workforce shortages and staffing cut-backs due to the worldwide recession. These teamsoften have limited time and resources to addressimportant psychosocial and oncology-related ques-tions posed by patients. METHOD: This oralpresentation will describe the impact of technologyin disseminating cancer patient education via one-hour, multi-disciplinary teleconferences/web caststo patients, their caregivers and healthcare profes-sionals globally. The author will present data fromtheir long-standing, pioneering, teleconferenceworkshop series, reaching over 45,000 patientsand caregivers annually in the live programs. Anumber of technological advances in the commu-nication industry have revolutionized patient edu-cation, enabling easy access for many to high techlearning about their treatment options. The tele-phone coupled with the internet enables easy accessfor most patients to high tech learning abouttreatment options. RESULTS: They offer newopportunities to cancer patient educators, thepsychosocial practitioner and NGOs to developcomprehensive cancer patient psychosocial supportand education services to bring expert-led informa-tional programs to patients, filling gaps in the

health care delivery system. This innovative use oftechnology allows successful outreach to previouslydifficult to reach global regions of the world.The author will describe innovative ways tointegrate novel communication systems, whichcontinue to proliferate, with traditional telephoneworkshops and telephone counseling and support.CONCLUSIONS: This innovative partnership withthe communication industry enables patients toaccess dynamic, interactive, mobile, voice-activatedinformation, compassionate support, anytime andanywhere. Quantitative and qualitative data eluci-dating these programs and the meaning they havefor patients, their caregivers and healthcare profes-sionals will be explicated. Exemplar literature,clinical examples and a replication model will beprovided. CLINICAL IMPLICATIONS: Theauthor will describe innovative ways to integratenovel communication systems, which continue toproliferate, with traditional, clinical psychosocialface-to-face and telephone support services. Theefficacy of adopting the most current communica-tion advances in reaching out to larger populationsof patients creates new opportunities to educate theoncology community about novel research, clinicaltrial outcomes, palliative care and psychosocialsupport and care, including online support groupsand web casts. ACKNOWLEDGEMENT OFFUNDING: None.

P2-38

Psychiatric Rehabilitation of Patients with Esopha-

geal Cancer

Gholamhossein MobarakyAlzahra Hospital, Esfahan, Iran

BACKGROUND: Patients with cancer mostlyhave psychiatric problems before and after ther-apy, especially if they undergo surgery. Thesepsychiatric problems can be due to organicproblems (as a secondary symptoms), or functionalproblems (psychiatric disorders). METHOD: Firstto categorized these problems and then have adefinition for each of them, then explain psychiatricmodalities for each of them and rehabilitation ofpatients separately. If patient develops psychiatricsymptoms after cancer, we say he has secondarysymptoms, e.g., depression. This is called mooddisorder due to GMC. RESULTS: In cancer wehave two types of psychiatric symptoms or syn-dromes. But if after knowing that he/she has cancerhe/she developed depression, it is adjustmentdisorder. Therapy in both is the same;drug therapy, psychotherapy, vocational rehabilita-tion, and family therapy are used for bothtypes. In esophagostomy special problems are eatingand speech problems, these two problems could bedue to physical defects that are produced. Intensityof patient reaction to speech lost depends on thedefect, personality of patient, preceding stresses,



DOI: 10.1002/pon

coping of patient, social situation, occupation ofpatient. CONCLUSIONS: These factors should beconsidered in rehabilitation of patient and therapyprocesses. Aphonic, dysphonic, mutes are speechproblems that each of them and rehabilitation ofthem would be discussed in essay. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-39

Evaluation of Kia Ora E Te Iwi: An Innovative

Psychosocial Cancer Education Programme for

Indigenous Maori peoples of New Zealand

Hazel NeserUniversity of Otago, Wellington, New Zealand

BACKGROUND: Maori Peoples of New Zealandexperience a disproportionate burden of cancer aswell as ongoing inequalities gaining timely access tooncology services. The distress associated with thisburden has been poorly addressed. Kia Ora E TeIwi is an innovative 6-week cancer educationprogramme designed to meet the psychosocialneeds of Maori in a culturally appropriate manner.This is the first time such a programme has beendelivered by Maori for Maori within New Zealand.METHOD: Four Maori health providers fromthroughout New Zealand were chosen via aselection panel, that met set criteria, to pilot KiaOra E Te Iwi with their clients. 37 Maori cancerpatients and their family/whanau, and eight Maorifacilitators participated in the study. Quantitativedata on the programme was obtained via evalua-tion forms completed at the end of each session (sixin total) and qualitative data was obtained viafocus groups held with participants and facilita-tors. RESULTS: Overall, participants werehighly satisfied with the programme. The mostsignificant finding was that participants wouldrecommend this programme to other Maoripatients and their family/whanau becauseit improved their knowledge and awarenessabout cancer, treatments and self-help strategies.They appreciated sessions being delivered in aculturally appropriate way, embedded in Maoritikanga (cultural practices), by Maori facilitatorswithin a traditional Maori setting called amarae (meeting house). This supportive settingenabled participants to share their cancerstories more easily which they found uplifting.Further design work to increase its appeal toMaori is needed. CONCLUSIONS: Kia Ora E TeIwi shows significant promise in meeting thepsychosocial needs of Maori cancer patients andtheir family/whanau in a culturally appropriateway. Ongoing design work is required to ensure itsappeal to Maori. Promotion of the programmeneeds to occur through trusted Maori healthnetworks as well as through oncology services.RESEARCH IMPLICATIONS: Further research

is required to enhance the content and delivery ofthe programme in a way that is appropriatefor Maori and by Maori. Partnership with Maoriresearchers is necessary because of theircultural knowledge, acceptance and expertise.CLINICAL IMPLICATIONS: Psychosocialneeds of Maori cancer patients and theirfamily/whanau are not met effectively withincurrent NZ oncology services as they tend to havea NZ European worldview on how to address theseneeds. However, referral of Maori patients to thisprogramme via Maori health providers would helpto reduce their cancer burden and associateddistress that is experienced by many Maori.ACKNOWLEDGEMENT OF FUNDING: Well-ington Division and National Office of the CancerSociety of New Zealand.

P2-40

How Much Do African Men Share in the Burden of

Breast Cancer in their Wives in Northwestern

Nigeria

Vincent Odigie, Lazarus M.D. Yusufu, DavidDawotola, Edith Odigie, Peter Abur, Peter Enesi,John KaseAhmadu Bello University Teaching Hospital, Zaria,Kaduna State, Nigeria

BACKGROUND: To highlight how involved areAfrican spouses in the psychosocial support oftheir wives with breast cancer. METHOD: Inter-active sessions were undertaken with consecutivebreast cancer women and their spouse during theperiod of admission/investigation/treatment andfollowup in the surgery and oncology/radiotherapyclinics by the authors using a proforma questio-naire with open and closed ended questionsover a thirty- eight month period at AhmaduBello University Teaching Hospital Zaria Nigeria.RESULTS: 302 consecutive patients. Two out ofevery three were young parturient womeno40years old. 76.2% had locally advanceddiseased, 40 spouses (13.2%) accompanied theirwives at first hospital visit. Most were ignorantof the disease. 28.5% visited/stayed with theirwives on the day of surgery. 98.7% of womenwould have loved the presence of their spouse onthis day. 69.7% phoned or sent emissaries toinquire about the health of their wives while onadmission. 11 of 18 patients that died didnot see their spouse before demise. 61.9% ofmedical bills financed wholly or partly byspouse. CONCLUSIONS: Husbands knowledgeand involvement psychosocial support for breastcancer patients is low. There is reluctance toaccompany wife to hospital or stay aroundwife in the operative/immediate post operativeperiod or during the terminal care. Financialburden of treatment is sometimes borne



DOI: 10.1002/pon

by the patient or her relatives. RESEARCHIMPLICATIONS: Oncologist, researchers inlow resource countries should endeavour to in-corporate the services of a psychooncologist andalso study the sociocultural pattern of cancerpatients in the sub region to be able tomeet the psychosocial needs of breastcancer patients in the sub region. CLINICALIMPLICATIONS: Oncologist in low resourcecountries should endeavour to educatespouses of breast cancer patients on the aware-ness/knowledge of breast cancer; the need forpsychosocial support and terminal care forbreast cancer and the various forms of supportspouses could be give. ACKNOWLEDGEMENTOF FUNDING: No funding was received tosupport this research.

P2-41

The Systematic Consultation in Psycho-Oncology

and its Objective to Refer Patients to an Appropriate

Care: The Experience in Belgium with French-

Speaking Patients

David Ogez1,2, Frederic Maddalena1, CelineBrison2, Ilios Kotsou2, Martine Berliere1, AlexKartheuser1, Philippe deTimary1, EmmanuelleZech21Cliniques universitaires Saint-Luc, Brussels,Belgium, 2Universite Catholique de Louvain, Lou-vain-la-neuve, Belgium

BACKGROUND: The Belgian State financespsychological interventions to patients sufferingcancer. This has incited us to elaborate anew conceptualization of the organization ofthe psycho-oncology. Interdisciplinary work isorganized around the Care Coordinator. Hisrole is to assess the psychosocial needs of thepatients. In addition to this evaluation, we haveconceived a semi-structured consultation whichwill be proposed systematically and willallow a referral of the patient to an appropriatepsychosocial care. METHOD: The systematicconsultation should allow the psychologist toidentify the psychological needs, the psychopatho-logical problems and the resources of thecancer patient. Our study aimed at assessing theeffectiveness of the offered support duringcancer treatments. Three studies were conducted.In the first, a survey was conducted to identify thepsychological needs of patients with breastcancer. The conclusions of this study were usedto develop a structured intervention. Once thesemi-structured interview was developed, we con-ducted two studies to assess the appropriateness ofpsychological intervention with patients hospita-lized with cancer. Questionnaires evaluated pa-tient’s needs, psychological symptoms, and copingstrategies. RESULTS: In the first study, nearly

90% of the patients reported being satisfiedwith the first contact. It allowed them to expresstheir distress at the time of surgery. Furthermore,30% of these patients consulted a psychologistafter the systematic consultation in order toshare their emotions and talk about chemotherapy.Moreover, profiles of patients (consult vs notconsult) were identified. The second andthe third study shows that one year afterthe intervention, patients who had received theintervention had lower depression and anxietylevels. The third study also showed thatthese patients will more easily consult later.CONCLUSIONS: The interest of a systematicpsychological consultation during cancertreatment is to orient the patient towardsappropriate support. Patients who received thepsychological consultation show less anxietyand depression one year after the treatmentstarted. A part of that population had started apsychological care. We hope that this supportwill allow a psychological social rehabilitation(Third study). RESEARCH IMPLICATIONS:It is always interesting to study the psycho-social needs of cancer patients. In a changingsociety and with the constant evolution ofmedical techniques, these needs are constantlyevolving. Moreover, it is also important tounderstand the effects of our clinical interventionson patients. By studying the coping and thepatient’s perception of the therapist, we willbetter understand the processes that are athand in the psycho-oncological intervention.CLINICAL IMPLICATIONS: The use of asystematic psychological consultation at cancerpatient’s treatment entrance should facilitate thepsycho-oncologist’s organization in a universityhospital. Furthermore, by using this systematicconsultation involving the assessment of thepatients’ psychosocial needs we allow the develop-ment of a relationship that will promote psycho-logical therapeutic work. We suggest that thismight be more so than when psychologists usetesting such as anxiety or depression scales.ACKNOWLEDGEMENT OF FUNDING:None.

P2-42

The Prevalence of Anxiety, Depression and Adjust-

ment Disorder in Cancer and the Association with

Psycho-Social Status

Sedat Ozkan, Abdulvahap Hıdır TuranIstanbul University, Istanbul, Turkey

BACKGROUND: It is reported that in %30–%40of cancer patients, psychiatric and psycho-socialmorbidity appears. Among them anxiety,depression and adjustment problems happen tobe of primary importance. These psychiatric



DOI: 10.1002/pon

problems affect life quality, care, cooperation and,in time, the response to treatment of the cancerpatients. METHOD: In this research, we haveaimed to investigate the prevalence ofanxiety, depression and adjustment disorders inthese cancer patients who do not define majorPsychiatric disorders and whose physicalstatus is stable. Special scales and psychometrictests were performed in each subject. RESULTS:As a result, it was seen that more than %20of the patients defined severe anxiety(%20), depression (%23) and adjustmentdisorder (%26). Those patients whose psycho-social situations are problematic, conflictual,or deprived are especially at risk to developpsychiatric morbidity. CONCLUSIONS: As aconclusion, psychiatric evaluation should bedone with these patients on their applicationand psychological care and treatment shouldbe on integral part of their total treatment.ACKNOWLEDGEMENT OF FUNDING:None.

P2-43

The Importance of Multidisciplinary Approach to

Cancer Patients: A Pilot Study

Tomislav Peharda, Dragan Trivanovic, KrizoKatinic, Dragutin BreskiGeneral Hospital Pula, Pula, Croatia/Istria, Croatia

BACKGROUND: Oncology patients show a highdegree of psychological disorders (intimidation,anxiety, depression, panic disorders, and phobia) atthe moment of diagnosis as well in the course of thetreatment. The primary goals of the study weredecreasing anxiety, depression problems and in-somnia, and increasing functionality in the fields ofmental, emotional and behavioral activities. Thesecondary goals were the decrease of somaticproblems and side effects of treatment (pain,nausea, vomiting and diarrhea). METHOD: TheBDI and the BAI were used in the research at startand after 6 months. The oncologist led indepen-dently records of the somatic status and thetreatment’s side effects by the NCI CTCAE v.3.0.criteria. The patient’s criteria: newly diagnosedoncology patients in Hospital, disease stadium II-IV, ECOG performance status 0-3, absence of amore serious psychiatric disorder prior to theoncology illness. The intervention study includedpatients by which psychooncological help wasparticularly indicated as well as those who volun-tarily accepted such a treatment. The control groupincluded patients who received no psychooncolo-gical treatment. RESULTS: A total of 62 subjectswere included in the research, 49 female and 13male. The age ranged from 31 to 78 years of age.The T-test for large dependent samples showed astatistically significant difference in anxiety and

depression of subjects before and after the therapy(t5 3.88, SS5 57, po0.01). The subjects had asignificantly lower anxiety level and a significantlylower depression level after 6 months of therapy. Inother patients a significant decrease of nausea andvomiting incidence has been achieved, as well as adecrease in pain intensity. CONCLUSIONS: An-xiety and somewhat less depression are presentwith different intensities in all cancer patients,signalizing the need of every patient for a applica-tion psycho-pharmaco therapy. Psychotherapy’seffect can be explained by a more direct connectionand interaction of psychological content and thesomatic part, but there is no change in neutropoe-nia since the connection is insignificant here andthe processes more independent from one another.RESEARCH IMPLICATIONS: Cancer effects notonly a somatic, body level but had influence onemotional and thought dimensions, too. This net ofmeaning must be considered much wider in orderto make our treatment better. The results show thata combined approach of psychiatrists and oncolo-gists brings significant results both on the physicaland the psychological level of cancer patients.CLINICAL IMPLICATIONS: For further activ-ities the multidisciplinary approach offers to us theguidelines of the psychooncological approach inGeneral Hospital Pula in two directions: a) trainingof the oncology team so that they could be able torecognize the role of the psychological content andmental mechanisms b) raising the awareness inpatients on the effect of inadequate thoughts andnegative emotions on the outcome of the treat-ment. ACKNOWLEDGEMENT OF FUNDING:None.

P2-44

Power of the Past: A Randomized Controlled Trial

Testing the Efficacy of a Life Review Therapy in

Depressed Palliative Cancer Patients

Irene Riepma1, Bas Steunenberg1,6, Remco deBree2, Rene Leemans2, Annemarie Becker2, EgbertSmit2, Pim Cuijpers1, Michiel van den Brekel3,Ernst Bohlmeijer4, Vincent Willemsen5, IrmaVerdonck-de Leeuw1,2

1VU University, Amsterdam, The Netherlands, 2VUMedical Center, Amsterdam, The Netherlands,3Netherlands Cancer Institute/Antoni van Leeuwen-hoek Hospital, Amsterdam, The Netherlands,4Twente University, Enschede, The Netherlands,5Ingeborg Douwes Center, Amsterdam, The Nether-lands, 6Julius Center/University Medical Center,Utrecht, The Netherlands

BACKGROUND: Incurable ill cancer patientsoften experience feelings of depression and emo-tional distress. In clinical practice there is an urgentneed for evidence based interventions. The goal ofthis study is to assess effectiveness of a structured



DOI: 10.1002/pon

life review protocol in palliative cancer patients andtheir partners. METHOD: 150 cancer patients withdepressive symptoms receiving palliative care, willbe randomized into an intervention group, receiv-ing the Life Review Therapy (4 sessions at thepatient’s residence) and a control group (waitinglist). The Life Review therapy focuses on retrievingpositive memories from the past and generating acoherent and meaningful autobiography. Thisenables re-evaluation of life events and reconstruc-tion of the story of life, including the diagnosis ofincurable cancer. Outcome measures include spe-cificity of autobiographical memory, depressionand quality of life. Partners are measured onemotional distress, caregivers’ burden and spiritualgrowth. RESULTS: A pilot study is completed.Findings indicate that structured screening ofquality of life in clinical practice and promptreferral is needed to include patients timely.Despite the latent depressive mood patients areable to retrieve positive memories and a trainingeffect occurs. Patients and also their partnersappreciate the intervention. The results from thepilot indicate that patients as well as their partnersmay benefit. CONCLUSIONS: Based on the pilotstudy, the intervention protocol is optimalized.OncoQuest (a touch screen computer system) isused to screen for depressive symptoms in clinicalpractice enabling rapid inclusion in the RCT.The randomized controlled trial is ongoing.RESEARCH IMPLICATIONS: This study is thefirst randomized controlled trial testing the efficacyof a life review intervention in palliative cancercare. CLINICAL IMPLICATIONS: There is anurgent need for evidence based psychosocial inter-ventions in the clinical practice of palliative cancercare. Depending on the results of this RCT, this lifereview therapy may become a regular interventionin palliative care. ACKNOWLEDGEMENT OFFUNDING: This project was funded by ZonMW.A Dutch foundation that stimulates healthresearch and the innovation of health care.

P2-45

Psycho-Oncology: A Pilot Study to Integrate

Psychiatric Services into Cancer Care at a Regional

Cancer Centre in Hamilton, Ontario, Canada

Simone Soares, Andreia Scalco, Allyson Ion,Richard Tozer, Adriana CarvalhalMcMaster University, Hamilton, ON, Canada

BACKGROUND: Up to 30% of patients who havecancer develop depression as a result of diagnosis ortreatment (Hopko et al, 2008). The purpose of thisstudy was to develop an integrated psychosocialmodel of health care delivery and to evaluate itsfeasibility and impact on patient and staff satisfac-tion. METHOD: Thirty breast cancer and 30prostate cancer patients were assessed using the

Edmonton Symptom Assessment System (ESAS)and INTERMED at their initial oncology visit.INTERMED is an interview-based instrument toefficiently assess case complexity, biopsychosocialhealth risks and treatment planning (Stiefel et al,1999). Patients with INTERMED scores of 20 orabove were referred to Supportive Care. Patient andstaff satisfaction with the model was assessed; aconvenience sample of 2 patients and 7 serviceproviders participated in qualitative interviews.Interviews were digitally recorded and underwentcontent analysis, whereby themes were systematicallyderived from the data. RESULTS: Eleven patientsscored 20 or higher on INTERMED and werereferred to supportive care (mean: 15.1, sd: 6.1).Mean scores for ESAS were 17.8 (sd: 19.7). Someconcerns were common to breast and prostate cancerpatients, but there were aspects unique to each typeof disease. While body image is a concern to femalepatients, for prostate cancer patients sexual functionand incontinence after treatment are main issues.Service providers discussed why psychosocial issuesmay be missed in cancer care and the best moment toassess these individuals. CONCLUSIONS:INTERMED may not be appropriate as an initialassessment in outpatient cancer patients but may beuseful on assessing changes in patient outcomes overtime. ESAS and INTERMED were not effective atassessing some relevant aspects to cancer patients.The moment when the assessment was performed,at the beggining of the treatment, was not appro-priate for some subjects. Ensuring ongoingeducation and support to front-line serviceproviders completing the Initial Health Assessmentmay increase understanding of psychosocial andpsychiatric issues in cancer patients. RESEARCHIMPLICATIONS: Evaluation of INTERMED andESAS as tools to evaluate case complexity inoncology. CLINICAL IMPLICATIONS: We dis-cuss methods to better integrate Oncology andSupportive Care teams and highlight the needsand expectations of cancer patients and staff.ACKNOWLEDGEMENT OF FUNDING:McMaster University Innovative Funding Grant.

P2-46

Social Support and Depression Among the Cancer

Patients

Havva Tel, Ayse Sari, Hatice TelCumhuriyet University, Faculty of Health Sciences,Sivas, Turkey

BACKGROUND: The present research was con-ducted in order to determine the state of social supportand depression among the cancer patients. METHOD:The research was conducted with 90 cancer patientswho received treatment at the oncology unit of auniversity hospital between the 1st of October and 31stof December, 2010. The data of the research were



DOI: 10.1002/pon

collected using Personal Information Form, BeckDepression Inventory and Multidimensional Scale ofPerceived Social Support. RESULTS: The age of thepatients ranged from 20 to 78 and mean age was54.26711.12. It was found out that there wassignificantly positive correlation between age and socialsupport (r5 .270, p5 .010) and age and depression(r5 .313, p5 .003). As the age of the patients increasedso did depression. Family support and special supportof the single patients were low. Those who thoughtthat their disease would be healed had lower depres-sion. Those who obtained assistance only from healthcare team experienced higher depression and lowerfamily support. CONCLUSIONS: As age increased sodid total social support and depression among thecancer patients. Therefore, initiatives that enable thecancer patients to benefit social support sources and touse them effectively and that prevent depression shouldbe planned. RESEARCH IMPLICATIONS: Re-searches that will investigate the effect of the initiativesenabling the cancer patients to use social supportseffectively should be conducted. CLINICAL IMPLI-CATIONS: The effective use of social supports shouldbe encouraged in preventing and treating depression,since it is an important coping method in the care ofcancer patients. ACKNOWLEDGEMENT OFFUNDING: The research was not supported by anyorganization.

P2-47

Depression and Self Care Agency Among the Cancer

Patients

Hatice Tel, Havva TelCumhuriyet University, Faculty of Health Sciences,Sivas, Turkey

BACKGROUND: The present research wasconducted in order to determine depression andself care agency among the cancer patients.METHOD: The research was conducted withcancer patients who received treatment at theoncology unit of a university hospital between the1st of October and 31st of March, 2011. 192patients participated in the study. The data of theresearch were collected using Personal InformationForm, Beck Depression Inventory, Self CareAgency Scale. RESULTS: There was significantlynegative correlation between depression scores andself care agency scores (r5�790, p5 .000). As thepatients’ depression increased self care agencydecreased. There was significantly positively corre-lation between length of disease and depressionscores of the patients (r5 .161, p5 .026) and as thelength of disease prolonged so did depressionscores. There was significantly negative correlationbetween length of disease and scores of self careagency and as the length of disease prolonged selfcare agency decreased. It was found out that thoseliving in a nuclear family had higher depression

scores. CONCLUSIONS: Cancer patients experi-enced depression and it affected self care agency ofthe patients negatively. As the length of diseaseprolonged so did depression but self care agencydecreased. RESEARCH IMPLICATIONS: Re-searches that will investigate the effect of theinitiatives preventing depression among the cancerpatients on self care agency should be conducted.CLINICAL IMPLICATIONS: Since depressionaffects self care agency of the cancer patients, it isnecessary to regularly assess depression and tosustain self care agency by providing the patientswith effective assistance. ACKNOWLEDGE-MENT OF FUNDING: The research was notsupported by any organization.

P2-48

Passive Coping Strategies as a Mediator between

Perfectionism and Psychological Symptoms

Claudia Trudel-Fitzgerald1,2, Renee-ClaudeRoy1,2, Lisa-Maria Slim1,2, Hans Ivers1,2, JoseeSavard1,21School of Psychology, Universite Laval, QuebecCity, QC, Canada, 2Laval University CancerResearch Center, Quebec City, QC, Canada

BACKGROUND: Anxiety, depression andinsomnia symptoms are frequently reported bycancer patients. Studies conducted in thegeneral population have shown that perfectionismand avoidant coping strategies are independentlyassociated with anxiety, depression andinsomnia symptoms. Moreover, avoidance hasbeen found to have a mediating role betweenperfectionism and these psychological symptomsin recent studies. However, these associationshave yet to be investigated in the context ofcancer. METHOD: As part of a larger epidemio-logical research, this study investigated associa-tions between perfectionism, coping strategiesand psychological symptoms (i.e., anxiety, depres-sion and insomnia) in patients scheduled toundergo surgery for cancer (N5 962). Thepatients completed the Multidimensional Perfec-tionism Scale, the Coping with Health Injuries andProblems,the Hospital Anxiety and DepressionScale and the Insomnia Severity Index a fewdays before or after surgery (T1) and six monthslater, during adjuvant treatments (T2). RESULTS:At T1, the association between perfectionism andpsychological symptoms was partially mediated bypassive coping strategies (partial mediation;b5 .11, p.0001). A similar pattern was foundat T2 (partial mediation; a5 .10, p.0001).Moreover, the direct association betweenperfectionism and psychological symptoms wassignificant at both time assessments (b5 .14,p.0001 and b5 .09, p.01, respectively).CONCLUSIONS: To our knowledge, this



DOI: 10.1002/pon

is the first study investigating relationshipsbetween perfectionism, coping strategies andpsychological symptoms in the context ofcancer. These findings suggest that perfectionismmay increase the risk of anxiety, depressionand insomnia symptoms, in part, througha greater utilization of passive coping strategies.There is also a direct association betweenperfectionism and psychological symptoms,a few days before or after surgery andduring adjuvant treatments. RESEARCHIMPLICATIONS: In order to better understandthe associations between perfectionism and anxi-ety, depression and insomnia symptoms,other potential mechanisms than copingstrategies should also be investigated (e.g.,cognitive distortions, social support). Moreover,it would be interesting to examine whetherthese relationships vary as a function of socio-demographic and medical characteristicssuch as gender, age and cancer site. CLINICALIMPLICATIONS: Psychological treatmentsintegrating specific interventions to reduce avoid-ance behaviors have already been found to bebeneficial for decreasing psychological symptomsin cancer patients. This study suggests that it couldalso be useful to help cancer patients lower theirhigh standards about personal achievements inorder to decrease their psychological symptoms.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is supported by a training award held by thefirst author and by a grant held by the fifth authorfrom the Canadian Institutes of Health Research(MOP - 69073).

P2-49

Cognitive and Emotional Regulation Styles in

Cancer Patients

Kaasim Fatih Yavuz1, Sevinc- Ulusoy1, OzlemYilmaz2, Pinar Saip31Bakirkoy Research and Training Hospital forPsychiatry and Neurology, Istanbul, Turkey,2Istanbul University, Istanbul Medical Faculty,Internal Medicine Department, Istanbul, Turkey,3Istanbul University Institute of Oncology, MedicalOncology Department, Istanbul, Turkey

BACKGROUND: Cancer, is a group of disease thatthreats the life, too often causes negative emotionalreactions and psychiatric disorders. According tocognitive-behavioral approaches,individual’s interpre-tation of unwanted experiences and copingstyles elicitdysfunctional emotional and behavioral conse-quences. The aim of this study is to researchthecognitive, emotional and behavioral coping styles ofpatients with cancer and their correlation with anxietyand depression. METHOD: The study consists of 39literate voluntary cancer patients who received treat-ment in Istanbul Universiity, Institute of Oncology

between April 2011 and May 2011. Participants havenomedical or mental disorder that inhibitsfromattendingthe research. Socio-demographic data form,Ruminative Response Style Questionnaire, LeahyEmotional Schemas Scale, Young-Rygh AvoidanceInventory, Hospital Anxiety and Depression Scale,and Beck Hopelessness Scale were administered toparticipants. RESULTS: Correlation between genderand anxiety and depression levels were evaluated byIndependent Samples Test and no significant statis-tical difference wasfound (for depression 0.66, foranxiety 0.91). With logistic regression analysis, thefindings showed that there were positive associationsbetween risk of anxiety and age (0.03). A positivecorrelation was found between risk of depression andthe cognitive-emotional subscale of the Young-RyghAvoidance Inventory (0.19). And also there was apositive correlation between depression and anxietylevels and the two subscales of Beck HopelessnessScale; hope subscale and feelings and expectationsabout future subscale (po0.01). CONCLUSIONS:We found that there is a positive correlation betweenage and risk of anxiety disorders in cancer patients.This result pointing out that there may be morecomorbid anxiety disorders especially with eldercancer patients. Another finding of our study isthe interrelation of cognitive-emotional avoidanceand depression. We found that patients withcognitive and emotional avoidance, experiencemore depression than non-avoidants. These findingsare consistent with literature about cognitive andbehavioral approach to depression. RESEARCHIMPLICATIONS: Cognitive and behavioral pro-cesses that cause anxiety and depression in cancerpatients have not been explored entirely yet. Whiledesigning instruments for investigating comorbidpsychiatric disorders in cancer patients, consideringdysfunctional avoidance coping styles andhopelessness can be helpful. CLINICALIMPLICATIONS: Our study indicates that cancerpatients often have hopelessness thoughts, cognitiveand emotional avoidance as coping styles which causedifficulties in diagnosing comorbid psychiatric dis-orders in these patients by clinicians. More detailedinterviews should be done with cancer patients.Especially with patients who have cognitive andemotional avoidance coping styles should be assistedwith more experiential techniques throughpsychotherapy process. ACKNOWLEDGEMENTOF FUNDING: None.

P2-51

The Unmet Needs of Individuals Who Have an Ill

Parent: A Comparative Literature Review of

Research in Cancer and Other Chronic Illnesses

Samantha Williams1, Nicholas Hulbert-Williams2,Wendy Nicholls11University of Wolverhampton, Wolverhampton,UK, 2University of Chester, Chester, UK



DOI: 10.1002/pon

BACKGROUND: Being ill has stress and distressimplications for not only the patient, but also fortheir family and support network. In the case of thediagnosis of an illness in a younger adult who mayalso have dependent children living at home,widespread disruption is likely. Their children willhave to manage their own anxieties for theirparent’s condition and as a result have unmetneeds which may impact upon their own quality oflife. METHOD: We systematically reviewed pub-lished literature exploring unmet needs in thechildren of parents with a chronic illness or cancer.Search terms included ‘cancer’, ‘chronic illness’,‘unmet needs’, ‘children’, ‘young adults’ and arange of their related synonyms. Our searchstrategy included a range of electronic databasesand indexes of key journals. We included onlyarticles published in English. Reference lists of allincluded papers were screened for additionalpapers to be potentially included. Secondaryscreening was conducted by a co-author to reduceinclusion bias. Results were synthesised using acomparative approach between literature on cancerversus other chronic illnesses. RESULTS: Twelvepapers were included, of which 7 related to childrenof cancer patients, and 5 related to children ofparents with a chronic illness. Results suggest thatthe psychosocial needs of individuals who have aparent with a cancer are similar to those with aparent with another chronic illness. The datasuggests that these children often have insufficientaccess to information and emotional support, andeven though they want to help care for their illparent, maintaining regular contact with their ownsocial support network is important, owing to areliance of their friend’s care and understanding.CONCLUSIONS: Young adults who have aparent with cancer or chronic illness have a varietyof unmet needs which impact upon their ownquality of life. The literature suggests informationaland support needs that are comparable with thoseof the patient. Access to information is generallythrough the ill parent who may find it difficult totalk about; emotional support is also seeminglyhard to access. The children of these ill individualshave a good knowledge of their role, yet this can beunderplayed by other family members. Retaining‘normality’, especially regarding their own socialactivities and support networks is important.RESEARCH IMPLICATIONS: There is littleempirical research which investigates the unmetneeds of children who have a parent with cancer orother chronic illnesses. What little there is suggestsa range of difficulties and psychosocial needs whichare rarely being adequately met. Further research isrequired, particularly that using quantitative mea-sures of unmet need; this information will be usefulin charting changes in need across a longitudinalcohort, and in the development of support services.CLINICAL IMPLICATIONS: Children of ill

individuals are often assumed to providephysical and supportive care to their ill parent,and yet their own wellbeing can often be over-looked. Research into the unmet needs ofthese individuals, and their longer-term conse-quences could help to inform clinicians of thepotential changes in a family’s dynamics and theirassociated effects. This review suggests that clinicalinterventions could be beneficial, especially thosewhich provide information and emotional support.ACKNOWLEDGEMENT OF FUNDING:None.

P2-53

Who Participates in a Randomized Trial of MBSR

after Breast Cancer? Analysis of Registry Based

Clinical Information from Eligible Danish Women

Supplemented by Analysis of Psychometric Self-

Report Data from Participants and a Sub-Group of

Decliners

Hanne Wurtzen1, Susanne Oksbjerg Dalton1,Klaus Kaae Andersen1, Peter Elsass2, Henrik L.Flyger3, Anne E. Pedersen4, Antonia Sumbundu2,Christoffer Johansen11Institute of Cancer Epidemiology, The DanishCancer Society, Copenhagen, Denmark, 2Universityof Copenhagen, Copenhagen, Denmark, 3Depart-ment of Breast Surgery, University Hospital Herlev,Copenhagen, Denmark, 4Department of BreastSurgery, Ringsted Hospital, Ringsted, Denmark

BACKGROUND: Women diagnosed withbreast cancer uses alternative treatments andpsychosocial services in order to maximizequality of life, reduce level of negative somaticand psychological effects, and increase existentialwell being. Smaller studies have providedinitial support for positive effects of mindfulnessbased stress reduction (MBSR) in treatment andpost-treatment phases of BC. Participant anddecliner characteristics must be systemati-cally explored in order to evaluate trials andimprove implementation of MBSR-interventions.METHOD: From all eligible women (N5 1208)clinical data on breast cancer, comorbidity anddemography were obtained from administrativeregistries. Eligible patients received invitation andquestionnaire containing demographic and lifestylemeasures and psychometric scales (SCL-90r,FACIT-Sp, BCPT, FFMQ, NEoPIR). Responseto invitation divided patients into groups: Decli-ners with no response, no interest, and noquestionnaire data (N5 872), decliners filling inquestionnaire without enrolling (N5 169), andparticipants (N5 336) filling in the questionnaireprior to randomization and as follow-up. Standardstatistical analysis controlling for the effect of ageand time since diagnosis and multivariate analysis(OR) will be conducted. RESULTS: Results of



DOI: 10.1002/pon

comparisons between the three groups of patientswith regard to comorbidity, breast cancer char-acteristics, treatment modality and use of govern-ment subsidized psychologist sessions will bepresented. Also the differences and similaritiesbetween participants and non-participants withregard to self-repot data on 1) diet, alcoholconsumption, physical activity and smoking,2)education, affiliation to work marked andnumber of children under 18 yrs. and 3) psychiatricsymptoms, existential wellbeing, burden of somaticsymptoms, mindfulness factors and personality willbe presented. The hypothetical effect of MBSRamong potential participants declining participa-tion will be presented. CONCLUSIONS: Conclu-sions regarding breast cancer, comorbidity anddemographic characteristics of participants anddecliners will be presentented. Conclusions regard-ing lifestyle and psyhometric characteristics ofparticipants compared to those of the sub-goupof decliners filling in study questionnaire will alsobe presented. Finally conclusions with regard topotential improvements of enrolment proceduresapllied by MBSR programs will be presented.RESEARCH IMPLICATIONS: The study willpoint out potential improvements of evaluations ofexternal validity of clinical trials by including self-report data also from patients not willing to enrollin trials. Further the findings will provide informa-tion relevant to decisions regarding the applicationof screening as part of the enrollment into clinicaltrials of psychosocial interventions. CLINICALIMPLICATIONS: Our study will point out sharedbreast cancer-, psychological-, existential-, lifestyle-, demographic- and lifestyle characteristics ofparticipants and of the group of patients not bythemselves inclined to participate in MBSR. Suchknowledge will allow for the introduction of moretailored enrollment procedures among differentgroups of patients in order to ensure equal accessand maximum benefit to be derived from introduc-tion of MBSR in standard clinical care.ACKNOWLEDGEMENT OF FUNDING: TheDanish Cancer Society and University of Copen-hagen provided funding for this study.

P2-54

Development of the 6-Item Screening Tool for the

Childhood Cancer Survivors: Comparison with the

CBCL

Sul Ki Yang1, Kyong Mee Chung1, Myung AhRhee1, Hana Kim1, Sung Chul Won2, Hyo SunKim2, Yoon Jung Shin2, Chuhl Joo Lyu21Yonsei University, Seoul, Republic of Korea,2Yonsei University Health System, Seoul, Republicof Korea

BACKGROUND: Many studies show that mostchildhood cancer survivors adjust well; however, a

subset of this population have reported adjustmentdifficulties. Further, their psychological difficultiesoften go undetected, highlighting the need forpsychological screenings that can be incorporatedinto routine medical care. Thus, the purpose of thisstudy was to develop and examine the utility of abrief 6-item screening tool for identifying survivorsat risk for psychological distress and in need offurther evaluation and intervention. METHOD:Participants were mothers of childhood cancersurvivors from the Long-Term Follow-Up (LTFU)Clinic at Severance Hospital, Seoul, Korea. Onlymothers of survivors who had been off-treatmentfor 12 months were included in the analyses. Thirtytwo mothers were given the Childhood BehaviorCheck List (CBCL) and a 6-item screening measurewith 5 point Likert-like scale created by the presentauthors. The latter measure consists of 2 mood-related items and 4 items in relation to survivors’overall quality of life. Using receiver operatingcharacteristics (ROC) analysis, the CBCL totalscore determined diagnostic utility and cut-offscore of the screening measure. RESULTS: A totalof 32 mothers completed the CBCL and screeningmeasure. The screening measure scores rangedfrom 6 to 18 (M5 11.81, SD5 4.39). The ROCanalysis showed that the AUC was .955, indicatingthat the screening tool had good diagnostic utilityrelative to the CBCL. Using a CBCL T score of 60as criteria, sensitivity and specificity were 100%and 75%, respectively, when the cut-off score wasset to 14.5. This cut-off score met the recommendedcriteria of sensitivity (0.90) and specificity (0.75)(Recklitis et al., 2007). CONCLUSIONS: Resultsshowed that a mother’s screening score of 15 pointsor higher indicated that her child was in need offurther psychological evaluation and possibleintervention. Thus, this measure appeared toincrease the likelihood of a childhood cancersurvivor receiving timely and appropriate mentalhealth referrals as well as decrease the chance of asurvivor undergoing unnecessary psychologicalevaluations. In sum, our findings illuminate theutility of this screening measure for use withinKorean pediatric cancer populations. Further,results provide the basis for future studies evaluat-ing the psychometric properties of screeningmeasures for use in this important medicalpopulation. RESEARCH IMPLICATIONS: Find-ings provide the basis for further psychometricevaluation of this brief screening tool and its utilityin Korean pediatric cancer survivor populations.Because this study focused specifically on thedevelopment of a parent-proxy screening measure,future studies should consider examining theutility of a self-report version. Additionalmethodological considerations include increasingthe sample size and multiple-site sampling.CLINICAL IMPLICATIONS: The brevity of ascreening measure allows for identification of



DOI: 10.1002/pon

survivors at risk for psychological distresswithout certain limitations such as testing fatigueoften caused by full assessment batteries. Initialscreening may also reduce the likelihood ofunnecessary testing, thereby avoiding excessivemonetary and time costs. In sum, this studysupports prior clinical research that shows theutility of brief screening tools in differentiatingsubsets of patients in need of further psychologicalassessment and intervention. ACKNOWLEDGE-MENT OF FUNDING: This study is funded byBK 21(Brain Korea 21).

P2-55

Trends in Breast Cancer Patients’ Satisfaction with

Psychosocial and Psychooncological Care in Breast

Centers in North-Rhine Westphalia, Germany

Lena Ansmann, Christoph Kowalski, StefanieSauter, Holger PfaffInstitute for Medical Sociology, Health ServicesResearch and Rehabilitation Science (IMVR),Faculty of Human Science and Faculty of Medicine,University of Cologne, Cologne, Germany

BACKGROUND: In 2003, breast centers wereimplemented in the German state of North-RhineWestphalia (NRW, 17 million inhabitants) with theaim of quality improvement in breast cancer care.To date, 52 breast centers consisting of 97 hospitalshave been certified. This study’s aim is (1) toidentify trends in patients’ satisfaction with psy-chosocial and psychooncological care along theprogress of the breast center implementation and(2) to analyze differences between breast centerhospitals concerning these aspects. METHOD:Breast centers in NRW participate in annualpatient surveys. After surgery, newly-diagnosedbreast cancer patients were surveyed on theirperception of several aspects of hospital care. Thisposter presents trends in patient satisfaction withpsychosocial and psychooncological care between2006 and 2010 by displaying mean scores overall hospitals. To investigate whether differencesbetween breast center hospitals in patient satisfac-tion have been decreasing over time, intraclass-correlation coefficients (ICCs) were calculatedusing multilevel modeling. RESULTS: The meanvalues of the patients’ overall satisfaction as well astheir satisfaction with psychosocial and psychoon-cological care were gradually increasing over time.Compared to the overall satisfaction rating, how-ever, patients’ satisfaction with psychosocial andpsychooncological care was substantially lower.The ICCs show that patients’ satisfaction withpsychosocial and psychooncological care variesbetween hospitals more than the overall satisfac-tion with care does. No linear trends could beidentified over time, i. e. the ICCs were decreasingfrom 2006 to 2007, then increasing until 2008

and decreasing again until 2010. Overall, theICCs were decreasing between 2006 and 2010.CONCLUSIONS: The results imply that, in NRW,patients are very satisfied with the care of breastcenter hospitals. Regarding psychosocial and psy-chooncological care, patients are, however, slightlyless satisfied. The slightly increasing satisfactionbetween 2006 and 2010 might be a result of thebreast center concept, even though causalitycannot be assumed. Moreover, the ICCs indicatethat, over time, there are fewer differences betweenhospitals in patients’ perception, particularly re-garding their satisfaction with psychosocial andpsychooncological care. Thus, the progressingfulfillment of the certification criteria may bereflected in consistently high levels of patients’perceived quality of psychosocial and psychoonco-logical care. RESEARCH IMPLICATIONS: Theidea to investigate variations between health carefacilities in patient’s perceptions could be a usefulapproach for evaluating the implementation of newconcepts in health care. Moreover, the analysis ofvariation between facilities can also be applied toother aspects of hospital care, such as performanceindicators. Thus, this work demonstrates theadvantages of using multilevel modeling in healthcare research. CLINICAL IMPLICATIONS:Although causal inferences cannot be made, wecan convey from our results that with a progressingimplementation of breast centers in NRW, thesatisfaction with overall, psychooncological andpsychosocial care for breast cancer patientsseems to be increasing. More detailed requirementsfor psychooncological and psychosocial care inbreast centers in NRW, however, may be needed,since the availability of at least one psychotherapistper breast center is the only specifying obligatorycriterion for certification. ACKNOWLEDGE-MENT OF FUNDING: We are grateful to theMinistry of Work, Health and Social Affairs of thestate of NRW which commissioned us to conductthe patient surveys as part of a continuousevaluation of the breast center concept in NRW.In addition, we would like to thank all hospitalsand patients who participated in the survey. Theauthors indicate no potential conflict of interest.

P2-56

Quality of Life and Coping Strategies of Cancer

Patients in a Private Cancer Center

Cristiane Decat Bergerot1,2, Tereza CristinaCavalcanti Ferreira Araujo2, Alexandre Nonino1,Marco Murilo Buso11CETTRO - Centro de Cancer de Brasılia, Brasılia,DF, Brazil, 2UnB - Universidade de Brasılia,Brasılia, DF, Brazil

BACKGROUND: Coping and Quality of life(QoL) are a central concern of clinicians working



DOI: 10.1002/pon

with cancer patients. Coping is a key concept fortheory and research on adaptation and health. QoLis a term used to denote outcomes as experiencedby the patient, that encompasses multiple domains,including, at least, physical, psychological, andsocial functioning. This study was conducted toexplore the coping strategies used by cancerpatients and assess their quality of life. METHOD:A total of 44 patients participated. They werebetween 29 and 83 years of age (M5 56), of bothgenders (27.3% male and 72.7% female), most ofthem married (70.5%), 45.5% had college degree,several types of cancer (gastrointestinal, breastcancer and lymphoma were the main diagnosis).They answered one sociodemographic question-naire on the first day of evaluation and, theFunctional Assessment of Cancer Therapy-General(FACT-G) and the Ways of Coping Checklist(WCC) in three distinct stages of the chemotherapyprotocol: beginning, middle and last day of thetreatment. RESULTS: In the beginning the aver-age QoL was 89.3 and the three most frequentcoping strategy were seeking social-support(61.4%), planful problem-solving (22.7%) andpositive reappraisal (6.8%). At the middle theaverage QoL was 94.1, and the three most frequentcoping strategies were seeking social-support(56%), distancing (24%) and positive reappraisal(12%). On the last day the average QoL was 98.7and the incidence of coping strategies were seekingsocial-support (64.3%), distancing (14.3%) andconfrontive coping, self control and positivereappraisal (7.1% each one). CONCLUSIONS:The patients quality of life has increased overassessments. Patients reported significantly moreuse of seeking social-support as a coping strategy inall evaluation. It is interesting to note the otherspatients: Beginning, planful problem-solving andpositive reappraisal illustrates the point at whichpatient is trying to solve the ‘‘problem’’ and tocreate a positive meaning for this moment; Middle,some patients are refusing to think about or tryingto create a positive outlook; Last day, patients aredivided into forget something, aggressive efforts toalter the situation, regulate one’s own feeling andcreate a positive meaning. RESEARCH IMPLI-CATIONS: These findings raise the possibility toinvestigate the patients trajectory during che-motherapy, however other studies are necessaryto evaluate the effectiveness of QoL and thosecoping strategies. However, effects of using parti-cular strategies to cope with cancer on mood andQoL have been well-documented. However, find-ings have been somewhat inconsistent, possible dueto the heterogeneous assessment techniques used tomeasure coping. CLINICAL IMPLICATIONS:Coping strategies are thought to play animportant role with respect to managing thephysical and psychological sequelae associatedwith a cancer diagnosis and treatment. QoL

data can also be used to guide the care of individualpatients. The routine evaluation of copingand QoL helps to identify individual who are atrisk for or have mood problems, improvespatient-clinician decision making, and guides thedevelopment of more effective therapy orsupportive care. ACKNOWLEDGEMENT OFFUNDING: None.

P2-57

Psychosocial Aspects of Cancer Patients: Correla-

tion between Distress, Mood Disorder, Quality of

Life and Coping

Cristiane Decat Bergerot1,2, Tereza CristinaCavalcanti Ferreira Araujo2, Marco Murilo Buso11CETTRO - Centro de Cancer de Brasılia, Brasılia,DF, Brazil, 2UnB - Universidade de Brasılia,Brasılia, DF, Brazil

BACKGROUND: Distress, anxiety and depres-sion are common emotional complications ofcancer that deserve clinicians attention, as well as,the ways patients choose to cope with this difficultmoment and the implications associated withdisease and treatment in their quality of life(QoL). We examined the correlation betweensymptoms of distress, anxiety and depression,coping and quality of life among cancer patientsfrom a Brazilian Cancer Center. METHOD: 44patients participated in this pilot study, 27.3%were male and 72.7% female, average age was 57(SD5 13.8), most of patients were married(70.5%), and 45.5% had college degree. TheDistress Thermometer, the Hospital Anxiety andDepression Scale, the Functional Assessment ofCancer Therapy-General and the Ways of CopingChecklist were used to evaluate the psychosocialaspects, followed by a multidisciplinary discussionto define the best intervention for each case. Thisresearch was authorized by the ethics committeeand the data were analyzed according to criteriadefined in literature and with help of the softwareSPSS 17.0. RESULTS: In the beginning of treat-ment, 40.9% of patients had a clinically significantlevel of distress, 29.5% had anxiety and 25%depression, the average QoL was 89.3. At the mid-cycle assessment, 14% presented with distress, 4%anxiety and depression, the average QoL was 94.1.On the last day of chemotherapy 7.1% still scoredabove 4 on the DT, 4% showed anxiety anddepression, and the average QoL was 98.7. Themost common forms of coping used in all stages ofevaluation was seeking social support; thesecond one was planful problem-solving in thebeginning and distancing at middle and last day.CONCLUSIONS: This study shows that patientswith high distress have worse QoL (74.8% withQoL o85) than patients without it (30% with QoLo85). Considering that coping is a major factor in



DOI: 10.1002/pon

the relation between distress (depression andanxiety) and cancer adaptation, patients tend toemotional support (seeking for social support)and to make efforts to seek informational. Theprogressive decrease of distress, anxiety anddepression was attributed to screening andmonitoring routine for identifying the level andnature of distress as well as the multidisciplinaryintervention tailored to each case. RESEARCHIMPLICATIONS: This result supports theimportance of these analyses, and the multidisci-plinary discussion as a method of understandingthe relations between distress, mood disorder,coping and QoL, as well as of understandingcoping process and the mechanisms throughwhich they come to affect patient’s well-beingover the treatment. Furthermore, it is importantto identify intersection points between patient’spsychological adjustment to cancer to knowmore about our patients and to offer a qualitycancer care. CLINICAL IMPLICATIONS:In this journey patients have to appraisal andreappraisal to revise the meaning of events in waysthat were more consistent with their new situationin an attempt to find a tolerable meaning to theevent. It is important to know how is this patientsprocess to propose the appropriate interventionstrategies. Such knowledge, can favor the adequateassistance to patients because of the understandingof suffering and doubts present in the phases ofdisease. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-58

A Place for Otherness in Psycho-Oncology:

Psychodynamic Perspective

David Marie1,2, Marie-Frederique Bacque2,Camille Reichling1, Eric Dudoit11Unite de Psycho-oncologie. Service OncologieMedicale et soins palliatifs. CHU TimoneAP-HM. Marseille. France, Marseille, France,2Universite Louis Pasteur, Strasbourg, France

BACKGROUND: Identity is constructed in rela-tion to others and encounters in psycho-oncologyare not exempt from this dimension. Patientssuffering from cancer highlight this attempt torestore identity after the shock of the disease.Potentialy lethal, cancer is a symptom of psychicspace in an existentialist version, potentially scal-able and dynamic. Patients never economize theirmotivation and query relational ties that wereformed and dissolved at the very location of theirbodies. METHOD: As a psycho-oncologist in amedical oncology and palliative care, we postulatethe hypothesis that the outcome of ties with hislove objects allows the individual to achieve abetter understanding of himself. For this, weconducted 90 follow-up meetings with 5 meetings

minimum for each patient. These interviews werefirst practice support and guidance. Our presenta-tion is therefore in the process of action researchwhose data were analyzed on the basis of patientdiscourse with Freudian psychoanalysis nosology.RESULTS: Our analysis has shown theimportance of psychic binding and unbinding workto love objects of cancer patients in terms of socialdimensions jostled by the events of the disease. Wealso found that the the link to these persons, firstinvested with affect and desire, is internaly nego-tiated to lead to a new place in the psychic reality.This place is first a reference place then it istransformed in important components of thesubject, and finally becomes its own reference.These queries are built by questions on theexistence of relations between human beings.CONCLUSIONS: Care in psycho-oncology em-phasizes the obvious stakes of separation fromloved ones and usual environment. It also high-lights the extent of relational sphere at the heart ofexistential questions. The speech of patients in alistening-based psycho-dynamic practice suggeststhe importance of relationships of love-objects inthe psychological development of each. Theseelaborations lead the subject towards the path ofself-knowledge and maintain him on the side ofLife. RESEARCH IMPLICATIONS: We offer aperspective that differs from a uniform psychicapprehension of cancer. To the psycho-dynamicanalysis, importance of intersubjectivity and fan-tasmatic life has often little to do with reality.Attention to relations with love-objects in binocu-lar vision (W.R. Bion) in psycho-oncology mayhelp to embrace all the challenges of bio-psycho-social life endangered by cancer. Provided also tohear the emotional turbulence as a structuring toolfor patients. CLINICAL IMPLICATIONS: Ad-dressing Psycho-Oncology under the seal of objectrelations may be understood as an ethical dimen-sion. Patients invite themselves to be thinked assubjects that would take the event of illness to tryto resolve psychic conflicts which slumbered hereand there. Cancer is also an opportunity to jointogether the ‘‘continents’’, which sometimesseem disjointed, of the psyche and body. It canthus be seen as a call for lovers of life!ACKNOWLEDGEMENT OF FUNDING:None.

P2-59

The Psychosocial Impact of Haematopoietic Stem

Cell Transplantation on Relative Donors

Brindha Pillay1, Stuart Lee2, Lynda Katona2, SueDe Bono2, Sue Burney1,3, Narelle Warren1, JaneFletcher31Monash University, Clayton, VIC, Australia,2Alfred Health, Melbourne, VIC, Australia,3Cabrini Health, Malvern, VIC, Australia



DOI: 10.1002/pon

BACKGROUND: This study investigated thepsychosocial impact of peripheral blood stem celldonation before, during and after donation forsibling donors of adults undergoing Haematopoie-tic Stem Cell Transplant. Sibling donors have thedual role of family member as well as donor,making them psychologically vulnerable in amanner that is different from other family mem-ber/caregivers. Much research focuses on thephysical rather than the psychosocial experiencesof donors, this research aims to rectify thisimbalance. METHOD: A mixed methods researchdesign was used to explore the ways in whichpeople perceived or gave meaning to their experi-ences of donation. Participants included 13 menand nine women, who underwent peripheral bloodstem cell or bone marrow donation between2007–2010 at The Alfred hospital, Australia. Datawere collected using a question schedule designedby the research team, using a combination of open-ended, Likert-type and check list format items.Using this format information was sought aboutpersonal details, preparation for donation, emo-tional experiences at key donation time points,perceived adequacy of emotional support. RE-SULTS: Positive and negative emotions wereexperienced. Positive emotions included: pre-dona-tion excitement, relief and gratitude at being amatch; satisfaction during donation that they couldhelp; and post-donation relief that the recipient’ssuffering would be reduced. Negative emotionsincluded: pre-donation anxiety related to risk toself (e.g,. from injections) and recipient; distressduring donation over the potential for the trans-plant to be unsuccessful; and post-donation anxietyover unexpected fluctuations in the recipient’shealth and guilt and responsibility for their out-come. Family dynamics, perceived adequacy ofpreparation and emotional support, and recipientoutcomes also influenced the psychological impact.CONCLUSIONS: This study highlighted themultifaceted psychological and social impact ofdonation for siblings and the extent to which theact of donation is embedded within a network offamilial ties that has positive and negative con-sequences. While extensive preparation for donorsmay not reduce anxiety, inadequate preparationcan increase negative emotional experiencesfor the donor. With the ongoing relationshipbetween recipient outcome and donor anxiety anddistress also demonstrated, this highlighted theneed for psychosocial support for donors before,during and following donation. RESEARCHIMPLICATIONS: This study provides directionsfor further research as the psychologicalimpact may persist long beyond the actual dona-tion. A larger sample size may be more representa-tive of the boarder national or internationalexperiences of the donor population. The majorityof the participants were donors whose recipient

had survived the transplant, the experiences fordonors whose recipient had died was notadequately documented. A comparison of thetwo donor groups was therefore not possible.CLINICAL IMPLICATIONS: To ensure thatinformation is provided well in advance anddelivered in a way that is tailored to the informa-tion needs of the donors. Post donation follow upshould be part of routine care regardless of thedonation outcome. Forming donor support groupsfor sibling donors to facilitate improved contactbetween donors and reduce feelings of isolationand helplessness that can be experienced by donorscould be facilitated. ACKNOWLEDGEMENTOF FUNDING: None.

P2-60

Parental Cancer: Are the Needs of Affected Families

and Children Met in Psychosocial Cancer Counsel-

ling Services?

Johanna Christine Ernst1, Volker Beierlein1, GeorgRomer2, Birgit Moller2, Uwe Koch1, CorinnaBergelt11Institute of Medical Psychology, University Med-ical Centre Hamburg-Eppendorf, Hamburg,Germany, 2Department of Child and AdolescentPsychiatry and Psychotherapy, University MedicalCentre Hamburg-Eppendorf, Hamburg, Germany

BACKGROUND: About 20% of cancer cases inGermany occur during parenting age (20–54 years).Many of those patients may have minor childrenand may experience additional emotional stressorsrelated to concerns about their children’s needsduring the course of the disease. While psychoso-cial cancer counselling services are available allover the country, specific offers for families arerare. Many authors state the need for appropriatetraining for health care providers who deal withthose families. METHOD: The study analysespsychosocial outpatient cancer counselling servicesin Germany with regard to their offers to familieswith parental cancer and their expert opinion onthe needs of those families.128 out of 216 out-patient cancer counselling services in Germanyfilled in a questionnaire on structural aspects ofcounselling offers as well as psychosocial needs offamilies with parental cancer (response rate 59%,questionnaires mainly answered by heads of theservices). The questionnaire also explored thecounselling centers’ experience with parental cancerand affected children in counselling routine,specific approaches to meet families’ needs andbarriers to provide psychosocial support. RE-SULTS: Providers estimate that 55% of theirclients are between 18 and 55 years. They furtherestimate that 15% of their clients have minorchildren, however, nearly 50% do not regularly asktheir clients whether they have minor children.



DOI: 10.1002/pon

Family and children counselling sessions are notprovided regularly at most counselling services.17% of the clients seek advice on issues related toparental cancer and 10% specifically expresspsychosocial needs of their minor children. Over60% of providers would welcome special courseson dealing with children and families facingparental cancer and over 50% require supportfrom experts like child psychologists. CONCLU-SIONS: Results indicate that cancer patients withminor children are represented with a considerablequantity in outpatient psychosocial cancer counsel-ling services. Although previous research suggestssignificant distress of cancer patients caring forminor children and increased risk for children ofcancer patients for developing emotional problems,most parents do not receive systematic guidance onparental issues in cancer counselling services. Fewparents and providers address parenting issuesactively. Given that half of the providers requiresupport for this sort of psychosocial counselling,appropriate training is needed to meet families’ andchildren’s needs. RESEARCH IMPLICATIONS:This study is a step in systematically assessing thepsychosocial care situation of parents and childrendealing with parental cancer. By documenting theestimated percentage of affected parents in cancercounselling services increased awareness may leadto future studies that examine psychosocial serviceplanning. CLINICAL IMPLICATIONS: Provi-ders must be aware of the great distress cancerpatients and their families and children experiencefacing parental cancer. Routine assessment ofchildren and parenting concerns may help toidentify psychosocial needs of parents and childrenand facilitate the provision of appropriatesupport during crucial disease times. Clinicalcooperation with child psychologists and specificcare programs for families with a parent withcancer should be established wherever available.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was part of the German multi-site researchproject ‘‘Psychosocial Services for Children ofParents with Cancer’’ supported by the GermanCancer Aid (Deutsche Krebshilfe, grant 108303).

P2-61

Pain, Fatigue, Sleep and Quality of Life in Elderly

Hospitalized Cancer Patients

Sibel Eyigor, Can Eyigor, Ruchan UsluEge University Faculty of Medicine, Izmir, Turkey

BACKGROUND: As the proportion of olderadults in the population continues to grow, thenumber of patients with cancer is expected toincrease proportionally. Data on elderly cancerpatients were generally compared with thequality of life scores of elderly patient group andwith the data of non-cancer individuals. The

purpose of this study was to examine differencesin reported pain, fatigue, sleep problems andquality of life between middle-aged and elderlyhospitalized patients with cancer. METHOD:This study has been designed to be a descriptivestudy and included 85 patients between 18–50years of age and 75 patients above 60 years of agewho were admitted to Tulay Aktas OncologyHospital for treatment and followed by theSupportive Care Unit. 53 middle-age (between18–50 years old) hospitalized cancer patients and47 elderly (460 years old) hospitalized cancerpatients were eligible for this study. Pain (visualanalog scale-VAS, verbal pain rating), fatigue(Brief Fatigue Inventory-BFI), sleep problems,quality of life (Short Form 36 [SF36], and EORTCQLQ-C30) were gathered using standardizedmeasures. RESULTS: In the elderly group, nosignificant difference was detected in terms of VAS,verbal pain rating, fatigue, fatigue type, sleepproblems and quality of life scores (p40.05). Whenthe two age groups were compared, BFI scoreswere found to be significantly high among theelderly patients (po0.05). A significant relationshipwas observed in both age groups between thescores of pain, fatigue and sleep problems, andquality of life (po0.05). CONCLUSIONS: Elderlyhospitalized cancer patients did not demonstrate adistinctive difference in terms of pain, sleep andQOL compared to the younger group. Therelationship between pain, fatigue, sleep and QOLshould be definitely kept in mind in clinicalpractice. RESEARCH IMPLICATIONS: Wethink that our study results sand hypothesis shouldbe supported also with other studies. CLINICALIMPLICATIONS: By all means, special attentionshould be paid to elderly patients in terms ofassessment and treatment. Yet, if the results ofcancer patients are not different from those ofyounger population and show similarities with theresults of patients with other medical problems, thedifferences in QOL and associated factors may bedue to cancer diagnosis rather than old age.ACKNOWLEDGEMENT OF FUNDING:None.

P2-62

Information Needs and Information-Seeking beha-

viour Related to Prostate Cancer

Angelos Kassianos1, Monique Raats2, HeatherGage31University of Surrey, Guildford, UK, 2University ofSurrey, Guildford, UK, 3University of Surrey,Guildford, UK

BACKGROUND: Information-seeking behaviouris thought to be beneficial for cancer patients. Itprovides increased certainty, assistance on findingmeaning to their experiences while at the same time



DOI: 10.1002/pon

health professionals ought to tailor information-provision according to patients’ needs (Rees et al.,2003). Related to this, Rees et al. (2003) introducethe idea that information-needs are increased asinformation-seeking behaviour increases. Thusinformation needs and information-seeking beha-viour are considered to be associated (Fallowfield,1997; Rees et al., 2003). METHOD: A cross-sectional survey design is developed using an on-line questionnaire aiming at prostate cancer pa-tients and their important others. Data areanalyzed using independent sample t-tests andmultiple regressions to examine the differencesbetween the groups on their behaviour, their needsand their perceptions and determine the factorsthat affect respondents’ behavioural change andtheir information-seeking behaviour. RESULTS:Results are expected to point out towards thedifferent perception of information and differentneeds among the study’s different groups and toindicate the improtance of their beilefs andattitudes towards the fact that they changetheir behaviour after diagnosis. Finally, it willhighlight the importance of information regardingdiet among prostate cancer patients and theirimportant others. CONCLUSIONS: This studylooks at

� Information needs and information-seekingbehaviour of people who have prostatecancer. More specifically it will investigate:their lifestyle changes after diagnosis; theirinformation needs; the time after diagnosisthey developed; the role of their beliefs aboutwhat caused their condition as a predictor oftheir information needs.

� It compares prostate cancer patients’ re-sponses in relation to their information needswith GP’s responses in order to identify thesetwo groups priorities and awareness.

RESEARCH IMPLICATIONS: Results of thisstudy throw a light into an understudied area andprovide useful information on what, when and whyprostate cancer patients seek specificinformation after being diagnosed. CLINICALIMPLICATIONS: Information seeking behaviouris important when assessing a cancer patient andalso their needs must be evalued so that therapyand consultation can be tailo-based and up-to date.ACKNOWLEDGEMENT OF FUNDING:None.

P2-63

Interpreting Patterns in Supportive Care Needs

between Breast and Colorectal Cancers

Wylie WY Li, Wendy WT Lam, Wai Lun Law,Jensen TC Poon, Ava Kwong, Dacita Suen,Richard Fielding

The University of Hong Kong, Hong Kong,Hong Kong

BACKGROUND: Breast cancer (BRCA) andcolorectal cancer (CRC) are the most prevalentcancers in Hong Kong. Though early detection andtreatment improves survival, the functional andemotional impacts remain substantial, and ifunaddressed can lead to avoidable decrements inquality of life. Hence, identifying and addressingpsychosocial needs among these patients is im-portant. This study reported the extent of psycho-social unmet needs and their associated factorsamong Chinese patients with BRCA or CRC.METHOD: Hong Kong Chinese patients withearly-stage BRCA (100% female, meanage5 52710.1 years) or CRC (44% female, meanage5 66.479.6 years), were consecutively re-cruited to complete a face-to-face questionnairewhile waiting for follow-up consultations at eithersurgical-oncology or clinical oncology units. Pa-tients’ psychosocial unmet needs (Supportive CareNeeds Survey Short Form (SCNS-SF34)), psycho-logical distress (Hospital Anxiety and Depressionscale (HADS)), and physical symptom distress(Memorial Symptom Assessment Scale Short-Form (MSAS-SF)) were assessed. Unmet needsprevalence was determined then fully-adjustedmultivariate models regressed on demographicand medical characteristics, psychological morbid-ity and physical and psychological symptomdistress. RESULTS: Amongst 201 participatingpatients (97 BRCA; 104 CRC patients) unmetneeds were more prevalent among BRCA (90%)than CRC patients (79%,). Unmet Health Systemand Information (HIS) needs dominated in bothpatient groups. HADS-depression was positivelyassociated with HIS and Physical and daily living(PDL) needs domains; HADS-Anxiety was posi-tively associated with Psychological needs; age wasnegatively associated with HIS, Patient care andsupport (PCS), and Sexuality needs; total symptomdistress was positively associated with PDL andSexuality needs, psychological symptom distresscorrelated positively with PCS, but negatively withSexuality needs. Cancer type was only associatedwith PCS. CONCLUSIONS: While the samplecharacteristics differed by diagnosis, patterns ofsupportive care needs in BRCA and CRC sampleswere quite similar, except for PCS unmet needsdomain. Both BRCA and CRC patients wantedmore informational support regarding disease andtreatment. Younger patients had greater unmetneeds in HSI, PCS, and Sexuality domains. Greaterphysical and psychological distress was signifi-cantly related to unmet supportive care needs.These unmet needs reflect current services short-comings in continuity of care and informationprovision. RESEARCH IMPLICATIONS: Thisstudy offers insights into the patterns of supportive



DOI: 10.1002/pon

care needs among Chinese patients diagnosed withCRC and BRCA. A longitudinal study is currentlyunderway to explore the changes of unmet needsover time. There are implications for the trainingneeds of oncologists and surgeons in handling theinformation needs of Hong Kong Chinese cancerpatients. CLINICAL IMPLICATIONS: The ex-tent and nature of psychosocial unmet needs inthese populations suggested the unmet needs are toa large extent independent of cancer type andpatient background, but more likely reflect featuresof the health care system. Furthermore, BRCApatients needed more patient care and support thanCRC patients; this can provide better insightabout targeting of medical support services andminimise the cost of patient care overestimation.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded and supported by The HongKong Cancer Fund and Health and HealthServices Research Fund 08090921.

P2-64

Breast Cancer Patient Support: Need Versus

Resources Studied at CICRI Nagpur, India

Suchitra Mehta1,2, Arjun Mehta1, Ajinkya Mehta11Sadhana Charitable Trust, Nagpur, Maharashtra,440010, India, 2Central India Cancer ResearchInstitute, Nagpur, Maharashtra, 440010, India

BACKGROUND: Breast cancer being mostcommonly occurring cancer in women in India,500 Breast Cancer patients of all age groupsfrom Central India Cancer Research Institute,Nagpur,India were studied for 10 years toevaluate need for modified intensive supportsystem comparing present resources. METHOD:Various psychometric scales used to measurefollowing factors:

� Underlying major stress

� Awareness regarding Cancer and itstreatment

� Family support

� Financial help

� Psychological support

RESULTS: Results showed considerable causalityof these factors to demand for proper and intensiveresources. CONCLUSIONS: Existing resourcesavailable at CICRI studied. Need for remodelingand planning new strategies for effective supportsystem proposed. RESEARCH IMPLICATIONS:Pilot Support system implementation programrun at CICRI since 1 year evaluated forfurther analysis. CLINICAL IMPLICATIONS:More effective treatment possible if propersupport systems are implemented along withmedical treatment. ACKNOWLEDGEMENT

OF FUNDING: Entire funding sponsored bySadhana Charitable Trust.

P2-65

The Regional Cancer Counselling Center: Telecon-

ferencing for Terminal Patients and Family

Luca Pianigiani1,2, Federica Bartolozzi1,2, FedericaBonini1,2, Silvia Bonini1,2, Gianni Amunni11Tumor Institute of Tuscany, Firenze, Toscana,Italy, 2Regional Cancer Center Counseling, Firenze,Toscana, Italy

BACKGROUND: The range of intense emotionsmanifest when patients and families are facing theterminal phases of disease in a loved one can beagonizing, divisive and exhausting. In the face ofsaddness, anger, despair and helplessnes, one of theprimary objectives of psychological support is tohelp individuals address the issues of loss anddeath, and provide a venue for them to expresstheir feelings and encourage new processes ofresilience. METHOD: Staffed by competent listen-ers and sympathetic professionals, the RegionalCancer Counseling Center (RCCC) helps patientand family in the process of grieving and itsassociated range of emotions. Commonly, at theend stage of disease, family, rather than patients;the patient often being unaware of the severity oftheir disease. Promoting open dialogue of emotionsand thoughts around the theme of loss providesindividuals the opportunity to recognize their mostprofound needs and to make proactive choicesregarding the support of each other and their lovedone during his/her remaining time without experi-encing feelings of exclusion and loneliness.RESULTS: The RCCC has provided counselingto over 200 families beginning in September 2009.More than 25% of families turned to the serviceduring the terminal phase of illness. In despair,families begin to question their decisions regardingpatient care and disease management and areovercome with the feelings of guilt, frustrationand helplessness attendant during this time. Help-ing families to recognize and assign a name to thesuffering can help transform an otherwise painfulexperience filled with fear and loss into one thatcelebrates ‘‘the presence of life’’, sharing memories,myths, values that create a sense of belonging andconnection. CONCLUSIONS: By listening, vali-dating and reassuring family members, the RCCCpsycologists enables the family to receive supportwithout leaving the side of their loved one. Supportis always available by telephone without the needfor appointments, thus allowing the family tomaintain its presence and care during this crucialtime. The large number and continuing demand bycallers supports the conclusion that the RCCCtelephone service is an effective and appropriatesolution, offering family and patient an opportu-



DOI: 10.1002/pon

nity to think and talk about death and detachment,not only as an unmanageable and devastatingmoment, but as a life stage. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-66

Opinion and Importance of Adequateness of Spiri-

tual Pain Assessment between End-of-Life Patients

Receiving the Palliative Care (Home and Inpatient

Care)

Tamari Rukhadze, Nino Menteshashvili, DimitriKordzaiaNational Cancer Centre of Georgia, Tbilisi, Georgia

BACKGROUND: The opinions of health careprofessionals, cancer-patients and their familymembers on adequate assessment, interpretationand management were studied. METHOD: Usingthe subjective questionnaires the following pointshave been studied:1. The quality of Pain and Symptom Control;2. Spiritual pain assessment;3. Clarification what the patient knows and what

are willing to know;4. If the patients are scared for bed prognosis and

dying.5. Where do the cancer-patients and their family

members prefer to receive palliative care - orwilling to die at hospice or at home?

In the survey 237 patients took part; 135 of themwere questioned at home, 102 - at the inpatient unit.The survey consisted of also 87 health care profes-sionals worked with cancer patients. RESULTS:Physical pain and symptom control was consideredas satisfactory by 62% of in-patients. Only in 43%were assessed spiritual pain by health care profes-sionals and evaluated adequately. In 68% patientswere familiar with their diagnosis, but only 39% hadan understanding about their prognosis. In spite ofthe fact, 87% of cancer-patients and their familymembers find it desirable to receive Palliative Care athome. In 89% patients and their family memberswished to carry their patients at home and patientspreferred to die at home. CONCLUSIONS: Despitethe implementation of palliative care services, insome cases spiritual pain is not adequately recog-nized and assessed. The conditions and quality forreceiving Palliative Care in inpatients are reliablyhigher than the level of equal procedures carried outat home, vast majority of cancer-patients and theirfamily members support the idea of spending lastdays of the life in traditional family atmosphere. Thefact deals with lifestyle developed for many centuriesand traditional culture of support and sympathyfrom the family members and close relatives. Forsuccessful pain management it is essential to evaluatethe pain (physical and spiritual). RESEARCHIMPLICATIONS: Search for an optimal instrumentto objectify and monitor the implementation of a

satisfactory pain (physical and spiritual) relief andpalliative care through home care will be done.CLINICAL IMPLICATIONS: For patients’ wholeassessment and realization of quality palliative care,it is too important to assess the spiritual and physicalpain and document them. It is also important thatpatients, who are not familiar with their diagnosisand prognosis are suffering spiritual pain and mostlynot recognized it. ACKNOWLEDGEMENT OFFUNDING: Georgian National Association forPalliative Care and National Cancer Centre ofGeorgia to make the study evaluable.

P2-67

Perceived Emotional Intelligence, Job Commitment,

Perception and Attitude of Oncology Health Work-

ers Towards Oncology Patients in the University

College Hospital Ibadan

Mcivir Tondo, Chioma AsuzuUniversity of Ibadan, Nigeria, Ibadan, Oyo State,Nigeria

BACKGROUND:

� To identify the relationship between per-ceived emotional intelligence, job commit-ment, perception and attitude of oncologyhealth workers toward oncology patients.

� To determine if some demographic variableshave significant influence on oncology healthworkers attitude towards oncology patients.

� To find out if there is a significant difference inthe perceived emotional intelligence of theoncology health workers towards their patients.

METHOD: This is a purposive study aimed atfinding out how oncology health workers perceiveoncology patients, their attitude towards thepatients and their level of job commitment. Thesurvey instrument was a 52 item, self-developedand validated questionnaire which was self- admi-nistered by literate oncology workers comprisingdoctors, nurses, technicians and technologists.Data was done by the SPSS statistical software.RESULTS:

� The study found mean age of participants tobe 38.5.

� Oncology health workers were sampledacross some departments: surgery 7.1%,Radiotherapy 71.4%, Nuclear Medicine14.3%, and (missing) 7.1% arriving at atotal of 100%.

� The study found that educational qualifica-tion has a significant influence on theoncology health workers’ attitude towardsoncology patients (po0.05).

� Significant correlation coefficient was foundbetween perceived emotional intelligence andjob commitment at (Po0.01).



DOI: 10.1002/pon

� Significant correlation coefficient was foundbetween perceived emotional intelligence andattitude at (Po0.05).

� There was a significant difference in theoncology health workers’ perceived emo-tional intelligence at (Po0.05).

CONCLUSIONS: This study revealed that canceris a complex disease that requires management/treatment across various professionals in differentdepartments. It confirms that a good understand-ing is required to handle patients with this type ofdisease, especially in some parts of Africa wherepatients turn up late for treatment, therebycomplicating treatment. So, oncology health work-ers with a higher educational qualification have apositive attitude towards the oncology patients.The survey revealed that emotional intelligencewhich is the ability to understand emotions, whenit’s high, there’s a corresponding high job commit-ment. Likewise, high emotional intelligence corre-sponds positively with attitude to patients.CLINICAL IMPLICATIONS: First, the findingsof the research will enable clinicians to have abetter understanding in handling oncology pa-tients, and be able to understand the emotions thepatients are passing through, to be able to attendbetter to their individual needs. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-68

Are Testicular Cancer Patients Cognitively Impaired

after Treatment? Comparing Patient Test Scores to

Norms

Ali Amidi1,2, Anders Degn Pedersen3, MimiMehlsen1,2, Robert Zachariae1,21Psychooncology Research Unit, Aarhus UniversityHospital, Aarhus, Denmark, 2Department ofPsychology, Aarhus University, Aarhus, Denmark,3Hammel Neurorehabilitation and Research Center,Aarhus University Hospital, Hammel, Denmark

BACKGROUND: Previous studies have suggestedthat cancer and cancer treatment may be associatedwith impaired cognitive function. However, onlyfew studies have investigated testicular cancerpatients. The aim of the present study was toinvestigate whether testicular cancer patients trea-ted with either surgery or surgery and chemother-apy differed in cognitive functioning compared totest norms. In a previous study of the presentsample, no differences were found between surgeryand chemotherapy and surgery only. METHOD:Participants were 72 men (age 24–70) treated fortesticular cancer 2–7 years earlier. Thirty-sevenparticipants had been treated with surgery (orch-iectomy), while 36 had been treated with surger-yfollowed by chemotherapy. All participants weregiven a comprehensive battery of standardizedneuropsychological tests measuring different cog-

nitive domains. Scores from the two groups werepooled and tests were compared to availableDanish test norms or international standard testnorms. For tests with age-differentiated normsavailable, z-scores were calculated. The scores ofthe two groups were also compared separately totest norms. RESULTS: The former testicularcancer patients scored significantly lower comparedto test norms on 13 out of 17 neuropsychologicalsubtests (p: 0.02–0.001). Significant impairmentwas found for the following domains: Processingspeed, verbal, visual and working memory, visuo-spatial ability and response inhibition. Furtheranalysis of treatment-related group differencescompared to test norms revealed dissimilarities ontwo cognitive domains. Processing speed wassignificantly impaired in the chemotherapy group(t(36)5�2.551; p5 0.015), while no such impair-ment was detectable in the surgery-only group. Asfor verbal memory function, statistical differencewas only found for the chemotherapy group(t(36)5�4.334, po0.01). CONCLUSIONS: Cog-nitive impairment may be caused by chemotherapy.However, our results also indicate that men treatedfor testicular cancer, irrespective of treatment type,show poorer performance on a majority of testscompared to norm populations. One explanationcould be that the surgical treatment is causingimpairment, either through psychological (e.g.distress) or biological mechanisms (e.g. changes inandrogen levels). An increased risk of cognitiveimpairment may also be present before treatment,i.e. caused by cancer itself or by initial psycholo-gical distress. Our results thus question the role ofchemotherapy as the only cause of treatment-related cognitive impairments. RESEARCH IM-PLICATIONS: Cognitive impairment related totesticular cancer treatment may not necessarily becaused by chemotherapy alone. Research investi-gating the cognitive side effects of cancer and itstreatment may want to include assessments ofdepression, post-traumatic stress, and other anxi-ety-related factors to more fully grasp the constella-tion of active mechanisms causing impairment.Biological variables such as changes in androgenlevels due to orchiectomy may also be of potentialinterest in future research. CLINICAL IMPLICA-TIONS: The current high success rate for treatmentof testicular cancer is mainly due to the introduc-tion of cisplatin-based chemotherapy. Given thehigh percentage of survivors (approx. 95%), it is ofclinical importance to retain focus on possible long-term consequences of the cancer and its treatment.Post-treatment support may include cognitiverehabilitation, while improved possibilities forpsychological support before, during, and aftertreatment could turn out to provide valuablebuffers against cognitive disadvantages.ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P2-69

Specific Characteristics of Value Orientations and

Needs of Oncopathologic Adolescents

Marina P. AralovaSouthern Federal University, OncogematologicalCenter of Rostov Regional Children Hospital,Rostov-on-Don, Russia

BACKGROUND: The attention is focused onpsychological rehabilitation of oncopathologic ado-lescents - on encouragement the development ofnovel adaptive relationship while preserving theirresponsibility and freedom of choice. The goal of theresearch is to detect value orientations and funda-mental needs of oncopathologic adolescents. Thefollowing adolescents 15–17 years old were observed:group A - 22 people (with acute lymphoblasticleukemia, lymphogranulomatosis and lymphosarco-ma; average remission duration - 3 years); controlgroup B - 44 people. METHOD: 1. Rokeach’smethods were used to study specific characteristics oftwo types of value orientations: terminal, defininggoals and meanings of life; instrumental, reflectingthe chosen means to achieve life goals. It consists of16 values of each type, which an observed individualevaluates according to their relevance. 2. Dadonov’stest-questionnaire was used to study prevalent needsand the emotional direction of such needs, eviden-cing towards the system of adolescent’s fundamentalmotives. It consists of the list with 10 emotionalexperiences, sorted by a tested person according tohis preferences. The indicators below have significantone-sample test Student’s t-statistics. RESULTS:Terminal values: Groups A&B - health, interestingjob and self-reliance; group A - material welfare,love, friends and family life; group B - knowledge,self-dependence, freedom and enjoyment - in thegroup B. Instrumental values: Groups A&B -cheerfulness and self-control, which are explainedby their age-specific traits; group A - mannerliness,honesty and tolerance; group B - efficiency inactivities, intolerance to flaws of others, strong will,education. Predominant needs, emotional direction: Inboth groups communicative emotions are prevalent;group A - emotions, associated with striving for self-affirmation are expressed in a much lesser extentthan in group B. CONCLUSIONS: Living throughcrisis life period oncologically sick adolescents haveearly perceived the value of human support,collaboration and propinquity of another person.These tendencies are not observed within the groupB. Terminal values in group A are typical for grown-ups; group B - reflect age-specific needs. In group Ainstrumental values are associated with the ability tolive among people, which is indispensible duringlong-term hospitalization, emaciating treatment andincreased intimacy within a family, caused by achild’s disease; in group B - associated with age-specific needs for self-affirmation of adolescents

and searching for their own niche among peers.RESEARCH IMPLICATIONS: The scientific no-velty of empirical investigation is the following: forthe first time using Russian sample of adolescentswith oncopathology we provide a description ofspecific traits of their values and needs, make preciseage-specific characteristics of adolescents with onco-pathology. Presented characteristics broaden thecomprehension boundaries of general and specificregularities of oncopathologic adolescents’ age-spe-cific development. We scientifically substantiate thedirections of their psychological tracking andempowerment. CLINICAL IMPLICATIONS: Weexposed a flaw in striving for self-affirmation forgroup A adolescents and relating healthy aggressive-ness. They don’t entirely live through the age-specificcrisis of finding a place among peers. It results fromthe compelled convergence of oncologically sickadolescents and grown-ups. Stirring up adolescents’own resources, creating facilities for recovery of self-development potential will contribute to theiradaptation in life. It should become the essence ofpsychological rehabilitation of oncopathologic ado-lescents in long-term remission. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-70

The Influence of Occupational Stress Reported by

Cancer Patients on the Subjective Need for Occupa-

tion-Related Rehabilitation and the Risk of Early

Retirement

Hilke M. Bottcher1, Monika Steimann2, MartinRotsch3, Karl-Heinz Zurborn4, Uwe Koch1,Corinna Bergelt11Hamburg-Eppendorf University Medical Center,Center of Psychosocial Medicine, Institute ofMedical Psychology, Hamburg, Germany, 2Rehabi-litation Clinic Lehmrade, Lehmrade, Germany,3Rehabilitation Clinic Schloss Schonhagen,Brodersby, Germany, 4Rehabilitation ClinicAhrenshoop, Ostseebad Ahrenshoop, Germany

BACKGROUND: Almost half of the cancersurvivors are younger than 65 years and returningto work is an important step for many patients intheir return to normalcy after cancer and itstreatment. Since occupational stress may hampera successful return work, we investigated theassociation of work-related stress, the subjectiveneed for occupation-related rehabilitation treat-ment and the risk for early retirement in cancerpatient attending inpatient rehabilitation. METH-OD: 477 patients answered two questionnaires ontheir working situation at the beginning ofinpatient cancer rehabilitation. Occupationalstress, the risk of early retirement and thesubjective need for occupation-related treatmentwere measured with the ‘Screening instrumentwork and occupation (SIBAR)’ and the ‘Effort-



DOI: 10.1002/pon

reward imbalance at work questionnaire (ERI)’.We conducted descriptive analyses as well asmultivariate logistic regression models to analysethe influence of occupational stress on the risk ofearly retirement and the wish to be supported whenpreparing to return to work. RESULTS: 19% ofthe study sample reported occupational stress and26% of the sample expressed the subjective need toreceive professional support with regard to theirreturn to work, due to their working situation. For46% of the patients participation in work-relatedrehabilitation offers should be recommended. Forpatients who reported to suffer from occupationalstress both the probability of being at risk to applyfor early retirement (OR5 5.67) and the prob-ability to feel the need of help were increased(OR5 2.15). CONCLUSIONS: Almost one out offive patients felt stressed at work. Patients whoreported work-related stress were more likely torate support as important, but were also at anincreased risk of applying for early retirement. Thisemphasises the need of implementing vocationalrehabilitation programs within aftercare. A sub-stantial part of the patients might not admit work-related problems as a reason to drop out of thelabour force rather than planning their return towork. Therefore patients at risk must be activelyidentified and offered professional support toimprove their working motivation. RESEARCHIMPLICATIONS: Occupational stress can becaused by different reasons. Therefore it is im-portant to differentiate what kind of professionalhelp is necessary, e.g. psychological assistance toaddress fears or physical assistance to improve theworking performance. The development of efficientscreening tools could support practitioners todetect patients at risk for delayed return to workor early retirement. Furthermore they could help todistinguish quickly between specific needs sothat appropriate support can be recommended.CLINICAL IMPLICATIONS: As some patientsmay have to overcome inhibitions to admit fearswith regard to their return to work, practitionersshould assure patients that experiencing occupa-tional stress is not uncommon and that discussingthe topic with professionals or other patientscould help to develop new strategies to cope withexisting problems and to reduce fears.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by the ‘‘Society for the promotionof rehabilitation research in Hamburg, Mecklen-burg-Western Pomerania and Schleswig-Holstein,e.V.’’ (German: Verein zur Forderung der Rehabi-litationsforschung in Hamburg, Mecklenburg-Vor-pommern und Schleswig-Holstein e. V, vffr).

P2-72

Feasibility and Acceptability of a Randomized Trial

of Tai Chi Chih in Senior Female Cancer Survivors

Anita Kinney1,2, Rebecca Campo2, KathleenO’Connor2, Kenneth Boucher2, Lisa Pappas2, PaulLaStayo3, Yoshio Nakamura4, Michael Irwin5,Neeraj Agarwal1, Kathleen Light61University of Utah, Department of Internal Med-icine, Huntsman Cancer Institute, Salt Lake City,UT, USA, 2University of Utah, Huntsman CancerInstitute, Salt Lake City, UT, USA, 3University ofUtah, Department of Physical Therapy, Salt LakeCity, UT, USA, 4University of Utah, Pain ResearchCenter, Salt Lake City, UT, USA, 5University ofCalifornia Los Angeles (UCLA), Los Angeles,California, USA, 6University of Utah, Departmentof Anethesiology School of Medicine, Salt LakeCity, UT, USA

BACKGROUND: Senior cancer survivors face aunique challenge of coping with treatment sideeffects, coupled with age-related declines andcomorbidities. Tai Chi Chih (TCC) may beparticularly suited for senior cancer survivorswho suffer from poor QOL and physical limita-tions. However, despite its increasing popularity indiseased populations, its benefits have not beenscientifically evaluated in this population. Thisrandomized two-group trial assessed the feasibilityand acceptability of TCC in senior, sedentaryfemale cancer survivors. METHOD: Using anexperimental design, after baseline assessments,64 female cancer survivors, ages 55 years and older,were randomized to TCC or health educationcontrol (HEC) classes. Individuals were consideredeligible if they reported being sedentary and self-reported at least one physical limitation (SF-12subscales). The TCC and HCC classes were 60minutes in duration, held three times a week, over12 weeks. Survey measures, physical assessmentsand biomarkers were collected at baseline and post-intervention. Community-based and clinic-basedrecruitment strategies were employed. Feasibilityand acceptability were determined by the enroll-ment and retention rates, as well as the survey data.RESULTS: Of the 334 women we contacted, 149(45%) expressed interest in participating; 64 (43%)of interested women met the eligibility criteria and64 (43%) of eligible women enrolled. The medianage was 65 years (range5 55–89) and the majority(84%) had breast cancer. Although costly($17,538), the most effective and efficient recruit-ment source was newspaper advertisements. Inter-im analysis revealed that the 13-week retention ratewas very good (85%); 88% and 81% in the TCCand HEC groups (p5 0.65), respectively. Satisfac-tion was not significantly different for the TCC(mean5 9.2; sd5 4.1) vs. HEC (mean5 11.5;sd5 7.4) groups (p5 0.35). CONCLUSIONS: Thisstudy is the first to scientifically evaluate thefeasibility, acceptability, and health benefits of amind-body exercise intervention, TCC, in seden-tary senior female cancer survivors. Reaching our



DOI: 10.1002/pon

accrual goal and achieving high retention ratesdemonstrates the feasibility of a trial of TCC in thisunderstudied and underserved population. Overall,satisfaction with the TCC and HEC interventionswas high, demonstrating acceptability of thestudy design among our study participants.RESEARCH IMPLICATIONS: Our findingsprovide important preliminary data in preparationfor implementation of a larger, definitiverandomized clinical trial of TCC in senior andsedentary female cancer survivors. Application ofCONSORT guidelines will improve the quality ofresearch and strengthen the evidence base forTai Chi as a supportive care modality in cancersurvivors. CLINICAL IMPLICATIONS: Com-pared to elderly individuals who have never hadcancer, elderly cancer survivors are more likelyto report worse quality of life and functionallimitations. Although TCC has been studiedextensively as a mind-body intervention in youngercancer populations and other elderly populations,there is a lack of rigorous clinical trials to assesswhether TCC is an acceptable, feasible, andpossibly effective intervention to improve healthfunctioning in older sedentary cancer survivors.ACKNOWLEDGEMENT OF FUNDING:Financial support was provided by NIH grantR21 CA135250-02 and the Huntsman CancerFoundation. We are grateful for NIH grant P30CA24014 to the Huntsman Cancer Institute forsupport of core facilities.

P2-73

A National Strategy for Cancer Rehabilitation and

Palliative Care in Denmark

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

BACKGROUND: The need for rehabilitation andtreatment of late effects in cancer will increase inthe coming years due to an increased survival andan increased cancer incidence in an ageing popula-tion. In Denmark, cancer rehabilitation andpalliative care are the keystones in the thirdnational cancer plan endorsed by the DanishParliament late 2010. This presentation will high-light the key issues in the national strategy andplans for implementation. METHOD: The politi-cal process leading to at national plan forrehabilitation and palliative care as well as centraldocuments and guidelines will be analyzed andpresented. The planning process in the NationalBoard of Health for implementation in the publicDanish health care sector will be presented.RESULTS: The national strategy for cancerrehabilitation and palliative care in the thirdDanish cancer plan tries to integrate rehabilitationand palliative care in the same clinical pathway.

This new approach will change the focus ofpalliative care in order to include rehabilitationmeasures. The national strategy will point outassessment tools and specify the elements in anintegrated generic clinical pathway for cancerrehabilitation and palliative care. Based on thegeneric pathway more than 20 diagnosis specificpathways will be implemented. CONCLUSIONS:After 10 years of strategic planning in cancer carein Denmark, the health authorities will now focuson a national strategy for cancer rehabilitation andpalliative care. In the development of nationalclinical pathways, the health authorities willinvolve the medical society and other relevantprofessionals at hospital as well as municipalitylevel. The results of this large effort remain to beseen. RESEARCH IMPLICATIONS: The newfocus will foster a number of changes in the healthcare sector, and health care outcomes research ishighly needed. CLINICAL IMPLICATIONS: Theintegration of rehabilitation and palliative care in acommon pathway will be in accordance withpatients’ needs, as cancer in many cases is achronic disease. ACKNOWLEDGEMENT OFFUNDING: None.

P2-74

Rehabilitation of Women following Treatment for

Gynaecological Cancer: A Randomized, Controlled

Study- A Description of a Multicenter Study and

Experiences So Far

Ragnhild Johanne Tveit Sekse1, Frøydis Haus-mann2, Vegard Iversen2, Gro Ncsheim-Bjørkvik3,Ellen Tengesdal4, Andre Bjerke5, Kari Bjorvand-Bøhn6, Margrethe Vika11Haukeland University Hospital, Bergen, Norway,2Bergen University College, Bergen, Norway, 3Uni-versity of Stavanger, Stavanger, Norway, 4Stavan-ger University Hospital, Stavanger, Norway,5University of Agder, Kristiansand, Norway,6Sørlandet Hospital, Kristiansand, Norway

BACKGROUND: Previous studies have shownthat participation in educational-, counselling- andphysical training groups may have positive effectson the quality of life for women treated forgynaecological cancer. The purpose of this studyis to evaluate and compare the effect of educa-tional- and counselling in groups versus physicaltraining in groups on women’s self reported qualityof life and coping. METHOD: Subjects: Womenwho have finished curative treatment for gynaeco-logical cancer at Haukeland University HospitalHF, Sørlandet Hospital HF and Stavanger Uni-versity Hospital HF from January 2007 until June2011. This intervention study has a randomizedcontrolled design with: 1) Educational and coun-selling groups, 2) Physical training in groups, 3)Control group, with three repeated measures at



DOI: 10.1002/pon

pre- intervention, post-intervention and at 1-yearfollow-up. The educational and counselling groupshave one session a week over a period of sevenweeks. The physical training groups have twosessions a week for 16 weeks, focusing on strengthand endurance training. RESULTS: So far, 90women have been included in the study and postassessments of these women will be completed inJune 2011.Outcome variables: Quality of life(global- and health related), coping, fatigue,sexuality, anxiety and depression. Physicaltests: Physical strength test and VO2 maximumtest. Preliminary data will be presented.CONCLUSIONS: To date, a total of 450 womenhave been invited to participate in the study,and 90 of these have been enrolled in the study.The study has just been extended to become amulticenter study to include sufficient participantsas estimated in power analysis. So far, it nowincludes two health regions in Norway.RESEARCH IMPLICATIONS: Experiences so farwill be presented. CLINICAL IMPLICATIONS:Discussion of clinical implication will be presented.ACKNOWLEDGEMENT OF FUNDING:Norwegian Cancer Society.

P2-75

Differences in (Psychosocial) Referral Behavior of

Oncologists in a ‘Practice as Usual’ Condition

Versus a ‘Systematic Screening of Distress’ Condi-

tion in Ambulant Cancer Care

Sabien Bauwens1, Catherine Baillon1, WillemDistelmans1, Peter Theuns21UZ Brussel, Brussels, Belgium,2Vrije UniversiteitBrussel, Brussels, Belgium

BACKGROUND: After development and valida-tion of the ‘Distress Barometer’ (DB), (a shortscreening instrument for distress), and a positiveevaluation of the feasibility and acceptability of theinstrument by doctors and patients, this implemen-tation study aims to examine whether a systematicscreening with the DB tool influences psychosocialreferral behavior of oncologists in every daypractice. METHOD: Ambulant cancer patientscoming for a consultation or a day treatment havebeen allocated to ‘the clinic as usual condition’ or‘the systematic screening by Distress Barometercondition’. In the ‘practice as usual condition’,oncologists themselves estimated the distress rateof their patients, in the experimental conditionpatients indicated their own distress rate on theDistress Barometer. In the two conditions, allconcrete (psychosocial) referrals, linked with thedistress level and the compliance with this referralwere noted. RESULTS: Detection rates of distressin the two conditions as well as differences inreferral behavior to psychosocial and other sup-portive care are compared. Facilitators and pitfalls

in the systematically use of a screening instrumentwill be analyzed. CONCLUSIONS: This study willgive further indications not only about how toimprove the detection rates of distress but also howto facilitate referrals and psychosocial care. Thestudy will try to put together a picture of thethresholds of effective referrals: what is theinfluence of the discrepancy between patients’distress rate and the estimation of distress by theironcologists? Which other thresholds are playing arole in referrals?. RESEARCH IMPLICATIONS:This study relativizes the importance of ‘the’optimal screening instrument, and indicates theimportance of clear understandings and indicationsabout referral strategies between first line oncologystaff and supportive staff in function of optimalpsychosocial care for cancer patients. CLINICALIMPLICATIONS: This study underlines the ne-cessity not only to help oncology staff on detectionof distress but also to help to develop communica-tion guidelines in order to counter referral difficul-ties and compliance of cancer patients in distress.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is granted by the ‘Nationaal Kankerplan’ ofthe Federal Government.

P2-76

Gastrointestinal Cancer: Distress and Emotional

Disorder Among Patients in Chemotherapy

Cristiane Decat Bergerot, Paulo Gustavo Bergerot,Alexandre Nonino, Joao Nunes MatosNeto,Marco Murilo BusoCETTRO - Centro de Cancer de Brasılia, Brasılia,DF, Brazil

BACKGROUND: Patients with gastrointestinal (GI)cancer are often diagnosed with locally advanceddisease or distant metastases. Accordingly, thispatient have to cope with limited on the possibilityof curative treatment and the impact on quality of lifedue to the severe physical symptoms, which results inemotional distress. Special problems in psychosocialadjustment are posed when tumors develop in GItract. The current study aimed to evaluate distress,anxiety and depression in patients with GI cancer.METHOD: This study was developed in an oncologycenter, located in Brasilia, Brazil. 93 patients, wereassessed with the Distress Thermometer (DT) andHospital Anxiety and Depression Scale (HADS)during three different stages of the chemotherapyprotocol: beginning, middle and last day. Thisresearch was authorized by the ethics committee.The data were analyzed according to criteria definedin literature and with help of the software SPSS 17.0.RESULTS: At the beginning of chemotherapy,patients mean scores were distress (53.8%), anxiety(39.8%) and depression (42%). In the middle oftreatment, the percentages of distress, anxiety, anddepression decreased to 33.8%, 24.3%, and 27%,



DOI: 10.1002/pon

respectively. On the last day, the levels were 11.3%for distress, and 14.5% for anxiety and 13% fordepression. CONCLUSIONS: A significant pro-portion of these patients shows symptoms ofdistress, anxiety and depression. In the beginningof therapy, the high incidence demonstrates theimportance of screening and effective managementof emotional disturbance related to the diagnosisand cancer treatment. Sometimes, we note, that theproblem of physical and psychological dysfunctionare so intertwined that they are difficult to separate.Because of that, we introduce a multidisciplinarydiscussion to facilitate the management of emo-tional disturbs related to patients’ experience inorder to improve quality of life and to offer a betteradaptation to this reality. RESEARCH IMPLI-CATIONS: There is great amount of distressassociated with GI cancer. It is important toestablish a routine of distress and emotionaldisturbance assessment as well as a multidisciplin-ary discussion, to open up the opportunity towork before the symptoms appear and tochoose the best intervention tailored to eachcase. The multidisciplinary efforts to implementgoals of psycho-oncology, palliative care andquality of life into routine care should also bethe perspective for further research. CLINICALIMPLICATIONS: Considering the generallypoor prognosis in advanced GI tumors, supportivecare intervention should be included in patients’treatment. A consequent integration of psychoso-cial concerns into clinical practice and research isof particular importance in those cases with poorsurvival prognosis. ACKNOWLEDGEMENT OFFUNDING: None.

P2-77

Impact of the Diagnosis and Treatment:

Incidence of Distress and Problem-Related in

Cancer Patients

Cristiane Decat Bergerot, Paulo Gustavo Bergerot,Alexandre Nonino, Patrıcia Werlang Schorn,Marco Murilo BusoCETTRO - Centro de Cancer de Brasıli, Brasılia,DF, Brazil

BACKGROUND: Cancer and its treatment havemore than physical impact. There are emotional,social, psychological, functional, spiritual, andpractical consequences as well. The cancer journeybegins when a person first learns something mightbe wrong, and it can continue long after treatment,in some cases, until death. Throughout thisjourney, patients will feel some degree of distress.The aims of this study were to measure distress andto identify problems-related during the course ofchemotherapy. METHOD: This study was con-ducted at ‘CETTRO - Centro de Cancer deBrasilia’, a private multidisciplinary cancer center

in Brazil’s Federal District, with the ethics com-mittee authorization. 328 patients participatedanswering to the Distress Thermometer (DT) andthe Problem List (PL) at three points during thecourse of chemotherapy: beginning, middle andlast day. Ages ranged from 18 to 86 years (M5 51),being 36% male and 64% female, most of patientswere married (61.9%) and had a college degree(43.6%). In this sample we had 26 different types ofcancer. RESULTS: The incidence of distress at thebeginning was 55.8%, 27% in the middle and13.4% on the last day of chemotherapy. Thefrequency of endorsed items progressively decrease,the most problems checked were: 1) Practical:insurance/financial (34.5%; 26.1%; 23.8%), work(20.4%; 13.4%; 11.5%); 2) Family: dealing withchildren (37.2%; 25%; 23%) and with partner(21.6%-14.4%; 12.3%); 3) Emotional: worry(76.5%; 54.6%; 53.3%), sadness (70.4%; 48.6%;43.7%), nervousness (63.7%; 44.7%; 36.4%); 4)Spiritual (7.9%; 4.6%; 2.7%); 5) Physical: sleep(57%; 48.9%; 46.4%), appearance (44.2%; 46.5%;45.6%), memory/concentration (41.8%; 37%;34.5% ), pain (40.5%; 27.5%; 22.6%), fatigue(40.2%; 38.7%; 36%). CONCLUSIONS: Despitethe fact that patients evaluated at the beginning arenot under the side effects of chemotherapy, thephysical problem were most frequently cited at thebeginning, and were the same, except for nausea(24.1%; 30.6%; 23%), that increased in themiddle and decreased on the last assessment.In conclusion, the progressive decrease in theincidence of distress and frequency of problemschecked can be understood as a result ofmultidisciplinary action, of the medical andpsychological intervention tailored to each case,and of screening and monitoring routine foridentifying the level and nature of distress.RESEARCH IMPLICATIONS: These resultshighlight the importance of an early screening.For future research, it is interesting to investigatethe difference in level of distress between patientswho need additional assistance and those whomobilized their own resource and managed thesituation on their own. CLINICAL IMPLICA-TIONS: We could find useful information in thisresearch both to improve the quality of care and toidentify those patients who would benefit with thepsychological support and intervention. AC-KNOWLEDGEMENT OF FUNDING: None.

P2-78

Can Distress Thermometer Predict Mood Disorders?

Cristiane Decat Bergerot1,2, Paulo GustavoBergerot1, Tereza Cristina Cavalcanti FerreiraAraujo2, Alexandre Nonino1, Marco Murilo Buso11CETTRO - Centro de Cancer de Brasılia, Brasılia,DF, Brazil, 2UnB - Universidade de Brasılia,Brasılia, DF, Brazil



DOI: 10.1002/pon

BACKGROUND: The literature points out thatdistress is about more than anxiety and depression.It arises from difficulties in domains such as pain,fatigue, nutritional concerns, and other physicalsymptoms, as well as common concerns such asfinances and drug coverage. In view of the scope ofthe term distress, the aim of the present study is toevaluate if the Distress Thermometer (DT) can beused to predict mood disorders. METHOD: Thepresent study evaluated the incidence of distressduring three stages of chemotherapy (beginning,middle and last day), among 328 patients of bothgenders (36% male and 64% female), with agesbetween 18 and 86 years (mean5 51), with 26different types cancer, from a private cancer centerin Brazil. This research was authorized by theethics committee. The procedures of gathering dataincluded the acceptance of the patients, applicationof the DT and the Hospital Anxiety and Depres-sion Scale (HADS). The data were analyzedaccording to criteria defined in literature and withhelp of the software SPSS 17.0. RESULTS: Weverified that most patients (55.8%) showed aconsiderably level of distress at the beginning ofthe treatment. There was a fall in the middle (27%)and on the last day of chemotherapy (13.4%).There was the same course on the depression andanxiety evaluation: at the beginning 61% showedwith anxiety (of 48.8% with distress) and 38.7%depression (of 36.9% with distress); in the middle21.8% (of 16.5% with distress) had anxiety and25.3% depression (of 20% with distress); on thelast day the rates were 16.5% anxiety (of 9.6% withdistress) and 13.8% depression (of 9.9% withdistress). CONCLUSIONS: Distress Thermometernot only quickly identifies patient’s keys concernsfor the health-care providers, helping them toidentify the need to conduct further assessmentand pursue appropriate referrals, but also guide thehealth-care providers conduct after the screeningand involve a more comprehensive and focusedexamination of the patient’s situation. This mea-sure allowed an in-depth look at the patient’spsychosocial health care needs. RESEARCHIMPLICATIONS: Furthermore, screening for dis-tress attempts to identify the concerns of patients ina timely manner, so those concerns can beaddressed at the earliest point in time. Thisscreening offers the opportunity for health careproviders to better understand the concerns of theirpatients. It is pertinent to conduct more studies toexamine the importance of integrating psychosocialaspects in the health team communication inreducing the incidence of distress. CLINICALIMPLICATIONS: If after applying the DT, weconsidered only patients with high distress todeeply look for diagnosis of anxiety, depressionand distress to propose intervention and treatment,we would have contemplated almost all patients.So, the DT is a good instrument to predict

psychiatric disorder. ACKNOWLEDGEMENTOF FUNDING: None.

P2-79

Screening for Distress, the 6th Vital Sign: A

Canadian Strategy for Influencing the Agenda for

Person-Centered Cancer Care

Barry Bultz1,2, Shannon Groff1, Andrea Williams3,Marg Fitch41Tom Baker Cancer Centre, Calgary, AB, Canada,2University of Calgary, Calgary, AB, Canada,3Alberta Health Services, Calgary, AB, Canada,4Sunnbrook Health Sciences Center, Toronto, ON,Canada

BACKGROUND: It is well documented thatdistress is common throughout the cancer journeywith prevalence ranging from 35%–45%. Theprevalence of distress has led to the emergence ofScreening for Distress programs which aim toidentify and address the distress experienced bypatients. In 2008 the Canadian Partnership AgainstCancer deemed Screening for Distress a priorityinitiative to move towards a vision of person-centred care and efforts began to coordinate theimplementation of screening across Canada.METHOD: This presentation will review thecurrent status of Distress as the 6th Vital Signand discuss activities to assure further uptake ofthis concept in Cancer Care. Additionally, aninitiative to implement Screening for Distressacross Canada will be highlighted. Progress todate and directions moving forward will bediscussed. RESULTS: Branding Distress as the6th Vital Sign has resulted in significant changes inconceptualizing cancer care service delivery withincreased opportunity to address person-centredcare within an interdisciplinary care model. Theimplementation of Screening for Distress inCanada involves the establishment of nationalrecommendations and extensive collaboration with7 jurisdictions currently implementing screening.To date over 10000 patients have been screenedand over 900 health care providers trained. Theprograms are being evaluated and attention isbeing paid to the implications of the implementa-tion strategy on successful program development.CONCLUSIONS: Endorsements of distress as the6th Vital Sign were possible through a multifacetedapproach of highlighting research supporting itsprevalence and implications of not addressing, andbranding distress in a language relatable to healthprofessionals. As the concept of distress, as the 6thVital Sign, continues to gain momentum, attentionhas shifted to how to best identify and addressdistress in cancer patients. The Canadian approachto implementing screening has resulted in theestablishment of a minimum data set and standar-dization of implementation strategies. RE-



DOI: 10.1002/pon

SEARCH IMPLICATIONS: The pan-Canadiancollaboration around Screening for Distress willallow for the comparison of screening data fromacross the country. Future research could comparedata from the jurisdictions and examine the impactof demographic characteristics on levels of distress.CLINICAL IMPLICATIONS: The goal for thepresentation is to raise awareness about theimportance of Screening for Distress and highlightthe collaborative strategy being employed inCanada that may be useful in other countries.ACKNOWLEDGEMENT OF FUNDING:Canadian Partnership Against Cancer.

P2-80

Relationship of Distress with Resilience and

Psychological Trauma in the Thyroid Cancer

Patients

Won-Jung Choi1, Jeong-Ho Seok1, Hang-SeokChang2, Young-Ja Oh2, Jee-Hee Oh1, Jong-SunKim1, Cheong Soo Park2, Jae-Jin Kim1

1Department of Psychiatry, Yonsei University Gang-nam Severance Hospital, Seoul, Republic of Korea,2Department of General Surgery, Yonsei UniversityGangnam Severance Hospital, Seoul, Republic ofKorea

BACKGROUND: It is important to managepsychological distress in cancer patients for mentalhealth and quality of life. Resilience is personalcharacteristic to cope with distress and to preventfrom developing psychopathology. Because thyroidcancer is known to have a favorable prognosis,patient’s psychological characteristics may havegreater impact on distress level than disease itself.We investigated if psychological distress may haverelationship with resilience and psychologicaltrauma in the thyroid cancer patients after mainsurgical treatment. METHOD: Forty-four thyroidcancer patients were recruited for this study. Aftertotal thyroidectomy patients’ global distress levelswere evaluated with distress thermometer. We alsoevaluated resilience, and psychological trauma withthe Connor-Davidson Resilience Scale (CD-RISC)and the Impact of Event Scale-Revised (IES-R),respectively. Spearman correlation analyses wereperformed to identify psychological factors asso-ciated with distress. RESULTS: In this study,significant negative correlations between globaldistress and Self-efficacy/Self-control factors ofCD-RISC were found. Global distress level werealso positively correlated with Arousal and Intru-sion factor scores of IES-R. CONCLUSIONS:Resilience may have a protective effect againstpsychological distress in the thyroid cancer pa-tients. Meanwhile, patients’ traumatic responseswhen diagnosed as cancer may increase psycholo-gical distress. RESEARCH IMPLICATIONS:Psychological characteristics which can modulate

patient’s psychological distress need to be evalu-ated during the initial diagnostic workup of cancer.CLINICAL IMPLICATIONS: Psychological dis-tress is associated with traumatic experience incancer patients and resilience may be protectiverole against it. ACKNOWLEDGEMENT OFFUNDING: This study was supported by a facultyresearch grant of Yonsei University College ofMedicine for 2010(6-2010-0140).

P2-81

Screening for Distress and Supportive Care Needs

during the Initial Phase of the Care Process:

Qualitative Experiment in France

Sylvie Dolbeault1,2, Laure Copel1, Anne Bredart1,31Institut Curie, Paris, France, 2UMR-S0669, UnivParis-Sud and Univ Paris Descartes, Paris, France,3Laboratoire de Psychopathologie et Processus deSante, Universite Paris V, Paris, France

BACKGROUND: To provide a qualitative de-scription of a clinical pilot experiment in a Frenchcancer center, conducted by a nurse after thetreatment decision consultation attended by newcancer patients during the initial phase of the careprocess. METHOD: The Psychological DistressThermometer (PDS) and a problem checklist wereadministered to 255 patients before nurse consulta-tion, helping her to manage the clinical interview,explore patient’s distress and supportive careneeds, and finally refer the patients in need to therequired Supportive Care units. RESULTS: Pa-tients were primarily referred to the social serviceunit (35 % patients), followed by the physiotherapyunit (23.9 %) and the psycho-oncology unit (19.6%of patients). In cases of significant distress (43 %patients with PDS 4 3), the percentage of patientsreferred to the psychosocial units increased (44 %referred to the Social Unit, 35 % to the Psycho-Oncology Unit). However, the main interest of ourscreening procedure resides in its qualitative anddidactic dimension, based on clinical training andcooperation with health care professionals duringthe process of investigating patients ´ distress andtheir supportive care needs. CONCLUSIONS: Thisfirst clinical experiment conducted among dedicatednurses involved in a Therapeutic Decision Con-sultation in a French cancer center has providedevidence in support of the idea that non-specialistprofessionals are able to identify patients ´ distressand their Supportive Care needs (particularly in thepsychosocial field) provided that they have receivedappropriate training. RESEARCH IMPLICA-TIONS: NA. CLINICAL IMPLICATIONS: Allour hospital dedicated nurses will now have to betrained to such a procedure, allowing a betterscreening of distress and patient’s problems, inorder to answer to all supportive care needs of ourpatients, in an appropriate way and at the right



DOI: 10.1002/pon

moment. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-82

Targeted Screening for Distress: Identifying Who Is

At Risk

Wendy Lam1, Miranda Chan2, Amy Or2, RichardFielding11University of Hong Kong, Hong Kong, China,2Department of Surgery, Kwong Wah Hospital,Hong Kong, China

BACKGROUND: Screening for distress is widelyadvocated to minimize distress in cancer. Fewinstitutions screen all cancer patients for distressbut this is a growing trend. However, mostdistressed cancer patients recover uneventfullyand absence of distress is common. Identifyingand targeting high-risk cases is more cost-effective.This paper describes distress in Chinese womenfollowing breast cancer surgery and argues for thedifferentiation of high-risk distress from ‘‘adap-tive’’ distress. METHOD: 405 Hong Kong Chinesewomen with early Stage Breast Cancer (BC) wererecruited within one week following breast cancersurgery. Women completed face-to-face interviewsat 1 week, one-month, 4-months and 8 months, and6-years post-surgery on measures of psychologicaldistress, social functioning, optimism, treatmentdecision-making difficulties (TDMD) and physicalsymptom distress (PSD). Trajectories of psychoso-cial distress were identified using Latent GrowthMixture Modeling (LGMM). Four distress trajec-tory groups provided the best model fit andrespective predictors were identified. Distress tra-jectories categories were used to predict psychoso-cial distress outcomes at 8 months and 6 yearsusing fully-adjusted multinominal regression mod-eling. RESULTS: Complete data were available for285/405 (70%) women at all time points. Thelargest category comprised 66% of women andshowed continuously low distress (Resilience), 12%had initially high distress that resolved over the8-month period (Recovered), 7% showed low-then-high-then low distress (Delayed-Recovered) and15% demonstrated persistently high levels ofdistress (Chronic). TDMD, PSD pessimism andconsultation dissatisfaction levels differentiallypredicted trajectory-group membership. 6 yearslater, of 186/285 women, those with Chronicdistress trajectories at Baseline-8-months had thepoorest psychosocial and social outcomes.CONCLUSIONS: Most women experience lowlevels of distress, while others have initiallylow but later high levels, whereas more than halfof these women had initially high, but declininglevels of distress. A subgroup comprising15%evidenced persistent distress. This latter group isthe high-risk group and need to be identified so

that where resources are limited, screeningcan be efficiently targeted. However, simplyscreening for distress will not differentiateRecovered (whose distress resolves spontane-ously) and Chronic trajectories, who wouldbenefit most from interventions. Further work isneeded to characterize this Chronic distresssubgroup so that they can be identified andtargeted. RESEARCH IMPLICATIONS: Despitethe focus on distress, in this sample of breastcancer patients and probably others, factorsapart from distress differentiated the chronicallydistressed from other distress groups. Theseincluded greater pessimism, PSD and TDMD.Work is now needed to clarify the underlyingissue that might make women vulnerable tochronic distress. CLINICAL IMPLICATIONS:Screening all women with breast cancer for distressmay be unnecessary and inefficient. Only 22% ofChinese women experienced distress levels warrant-ing intervention, one third of whom experienceddistress only around 3-months post-operatively butnot before or after. Physical symptoms appearimportant in determining distress and good symp-tom management may be critical in the preventionof psychosocial distress. Identifying further indica-tors and determinants of high risk for chronicdistress is needed. ACKNOWLEDGEMENT OFFUNDING: Hong Kong Cancer Fund supportedWWT Lam as a HKCF research scholar, and theHong Kong Government Health and HealthServices Research Fund provided funding forseveral aspects of this study.

P2-83

Screening for Distress: It Must be More Than

Simply Completing a Standardized Instrument

Margaret I. Fitch, Jeff MyersSunnybrook Odette Cancer Centre, Toronto, ON,Canada

BACKGROUND: The notion of screening fordistress as a standard of practice has been gainingsupport in the Canadian environment. However,in our cancer centre, we have learned thatscreening for distress has to be more thanjust having patients complete a standardizedinstrument to measure or quantify distress. Theremust be appropriate follow through with patientsbased on the scores they have provided to ensurethe full benefit of the screening program. METHOD:In our ambulatory cancer clinics, we implementeda programmatic approach to screening for symp-tom and psychosocial distress. Patients completethe Edmonton Symptom Assessment System(ESAS) and the Canadian Problem Checklist inthe reception area prior to seeing the physician ornurse. The scores are provided to clinicians whoreview them with the patient, acknowledging the



DOI: 10.1002/pon

results and responding to the identified concerns.Their response is aided by practice-based algo-rithms, guidelines, and protocols for interventionand/or referral. We have implemented the ap-proach in our lung, palliative care, gynecologic,and breast clinics. RESULTS: Over a three monthperiod, 815 patients were screened at the desig-nated computer kiosk using a touch screenapproach. This reflects approximately 30 % ofpatients coming to each of the clinics. Of thesepatients, for the depression rating, 8% are scoringin the severe range and 19% are scoring in themoderate range. For the anxiety rating, 10% arescoring in the severe range and 22% in themoderate range. For the well-being rating, 17%are scoring in the severe range and 36% are scoringin the moderate range. CONCLUSIONS: Integrat-ing the use of a standardized instrument forscreening cancer patients for distress in a busyclinical setting requires considerable and consistenteffort. Barriers to uptake and use of the toolinclude: patients struggle with computer based dataentry, staff perspectives that the tool results inadditional work and there may be a lack ofavailable service to support referrals, staff discom-fort in talking about emotional distress, and thebusy nature of the ambulatory clinic environment.RESEARCH IMPLICATIONS: Understandinghow best to integrate the use of a standardizeddistress screening tool in a busy clinical settingremains challenging. Yet it is crucial to have theimplementation correct and complete in order tomeasure the outcomes of the programmaticapproach. CLINICAL IMPLICATIONS: In abusy clinical setting it is helpful to have the patientperspective presented as a starting point forconversations. Using a standardized tool providesthe opportunity to have a consistent standard ofpractice in identifying emotional distress and avoidthe possibility of overlooking an issue that isconcerning the patient. The standardized tool alsoprovides an easy reference point to monitor theeffect of psychosocial interventions. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-84

Longitudinal Trends Relating to Fear of Recurrence

Amongst Head and Neck Cancer Survivors

Naseem Ghazali1, Hazel Swann2, GeraldHumphris3, Gozde Ozakinci3, Derek Lowe4,Simon Rogers1,41University Hospital Aintree, Liverpool, Merseyside,UK, 2University of Liverpool, Liverpool,Merseyside, UK, 3University of St Andrews, StAndrews, Scotland, UK, 4Edge Hill University,Ormskirk, Merseyside, UK

BACKGROUND: Fear of recurrence (FOR)following head and neck cancer (HNC) treatment

is one of the most significant patient concerns andis associated with psychological distress but thisconcern/need is infrequently met in the outpatientsetting. There is limited evidence suggesting FORdoes not diminish with time and clinical character-istics are ineffectual as predictors of FOR. The aimof this study was to evaluate long-term FORtrends by routine screening in outpatient clinics.METHOD: Prospective data collection from 197HNC patients attending 81 routine follow-upclinics occurred from October 2008 to January2011. All patients completed the Patient’s ConcernsInventory (PCI), a holistic, self-reported screeningtool for unmet needs/concerns and University ofWashington Quality of Life Questionnaire, version4. Those who indicated FOR on PCI alsocompleted the FOR questionnaire, where scoring‘a lot’ or ‘all the time’ for questions 1–6 and aresponse of 7–10 (10-point scale) for question 7were deemed as having ‘significant’ FOR. Statis-tical analysis was performed to determine correla-tions and individual agreement. Interventions forFOR were obtained from case-notes. RESULTS:462 sets of questionnaires were obtained from 197patients. FOR was inconsistently highlighted inthose with sequential PCI data of up to 5 visits.Significant FOR was reported by 11-27% (ques-tions 1-6) and by 18% (question 7). LongitudinalFOR data was obtained in 65% (123/197) and 35%who had two and three sequential visits, respec-tively. Significant FOR reported in 22%, 27% and24% of cases over sequential visits. There was lessstability of agreement at individual level. Youngerpatients were more likely to report significantFOR. Onward referrals for psychological supportwere made in those with significant FOR. CON-CLUSIONS: Significant FOR is prevalent in HNCsurvivors attending routine follow-up clinics.Longitudinal data suggests that FOR is stable withtime in this cohort although the individual FORexperience may fluctuate. Younger age is a risk forsignificant FOR. The PCI is a useful tool to broachFOR in the outpatient clinic as addressing this itemof concern, allowing clinicians to initiate theprocess of identifying those with significant FORso that appropriate and timely supportive careand psychological intervention can be provided.RESEARCH IMPLICATIONS: Previous studieshave established the value of PCI in screening forFOR in routine HNC clinics and that a highproportion of patients experience significant FOR.Our study suggests significant FOR is stable withtime. Utilization of PCI-FOR combination cantrigger need for intervention in those at risk.Further work is required to establish the supposi-tion that addressing FOR in clinic has resulted inmeeting the patients and their carers need on thisissue. CLINICAL IMPLICATIONS: The need toaddress FOR has gained expression through PCI.Multidisciplinary team approach in HNC is the



DOI: 10.1002/pon

current standard of care. However, psychologicalsupport is not always party to this set-up in somecentres. The PCI also allows patients to identifyprofessionals they would like to talk to, and the listincludes the psychologist and emotional supporttherapist. Therefore, PCI empowers patients totake charge of their cancer care, including thesupportive care needs. ACKNOWLEDGEMENTOF FUNDING: None.

P2-85

Previous History of Emotional Disorder and not

Actual Distress, Predicts which Patients Would ask

for Psychological Assistance

Concha Leon-Pizarro1, Esther Jovell2, TomasBlasco3, Antonio Sanchez-Hidalgo2, Gloria Arenas1,Jordi Alfaro1, Remei Blanco1, Luis Fernandez1,Aleydis Pisa1, Emma Dotor1, Angels Arcusa11IOV, Hospital de Terrassa, Terrassa,Barcelona, Spain, 2Recerca, Hospital de Terrassa,Terrassa, Barcelona, Spain, 3Psicologia Basica,Universitat Autonoma de Barcelona, Barcelona,Spain

BACKGROUND: Some studies have suggestedthat women are more interested than men, andyounger patients are also more interested inreceiving psychological help. However, these re-sults have not always found, and it is not wellknown whether other factors should be more usefulto identify which patients should be more prone toreceive psychological assistance. The main objec-tive of this research is to identify factors whichallow to identify patients who would benefit frompsychological assistance. METHOD: A sample of254 patients (132 women and 122 men) receivingtheir first visit in the Oncology Service wereassessed using a structured questionnaire. Emo-tional distress (mood, tension, fear, anger), Desireto receive psychological help, Effort to cope withcancer, and Perceived self-confidence, were evalu-ated with a Likert-scale with 4 levels of response.Sociodemographic and medical data were alsocollected. RESULTS: In the group of patientswho would ask for psychological assistance therewas a higher proportion of persons who hadreceived antidepressive or ansiolitic treatment(42.4%; p5 .002), who had been diagnosed ofdepression (35.6%; p5 .007), or who had receivedpsychological assistance for emotional disease(28.8%; p5 .005). There were not differences ingender, age, kind of tumor, stage, or prognosis.However, women had higher levels of fear thanmen. CONCLUSIONS: Although women hadmore fear than men because of their cancerdiagnoses, these differences did not predict desireof receiving psychological assistance. Cancer pa-tients with previous history of emotional disorderare more prone to receive help from psychoonology

services. Asking for previous emotional disorderswould help Oncology services to identify patientswhich would receive more benefit from psycholo-gical assistance. RESEARCH IMPLICATIONS:Previous studies have not stated that previousemotional disturbances would be a main prognos-tic factor of demands of psychological assistance.More studies are needed to confirm the presentresults. CLINICAL IMPLICATIONS: Askingfor previous emotional disorders would helpOncology services to identify patients whichwould ask for psychological assistance an whowould probably receive more benefit from it.ACKNOWLEDGEMENT OF FUNDING:None.

P2-86

Distress among Patients during Cancer Rehabilita-

tion: A Prospective Study Using the German Version

of the NCCN Distress Thermometer

Anja Mehnert, Uwe KochDepartment of Medical Psychology, UniversityMedical Center Hamburg-Eppendorf, Hamburg,Germany

BACKGROUND: A substantial percentage ofcancer patients suffer from psychosocial distressand psychosocial crisis during the course of theillness and cancer treatment. Purpose of this studywas to investigate the prevalence and change ofdistress among a sample of patients with mixedtumor entities during and after cancer rehabilita-tion taking into account relevant demographic andmedical characteristics. METHOD: Consecutivepatients were recruited from cancer rehabilitationfacilities in Germany and assessed at the beginning(t0), at the end (t1) and 12 months after the threemonths rehabilitation program (t2) and completedstandardized self-report questionnaires. N5 1,281patients were enrolled at t0 (78% participationrate), n5 1,193 completed the study questionnairesat t1. 12 months after rehabilitation, questionnaireswere mailed to n5 1,193 patients. However, 36patients (3%) had moved to an unknown addressand 30 (2.5%) had recently died. Of the remainingeligible 1127 patients, questionnaires were returnedby n5 883 cancer survivors (78%). RESULTS:Participants were M5 48.5 years old; 85% werefemale; 58% had breast cancer. Mean distressscores were 6.1 (SD5 2.3) at (t0), 4.3 (SD5 2.3) at(t1), and 5.5 (SD5 2.3) at (t2). Repeated MANO-VA (t0-t2) showed a decrease of distress over time(Po.001) (c-2 5 .04); however, interaction effectsindicated that women improved whereas distress inmen deteriorated over time (P5 0.004, c-2 5 0.008).Also, patients with breast cancer and hematologi-cal malignancies improved in distress in contrast toparticipants with other tumor entities (P5 0.01,c-2 5 0.02). The most frequent problems were



DOI: 10.1002/pon

physical (M5 3.6, SD5 3.6) and emotional pro-blems (M5 1.6, SD5 1.7). Distress correlated withanxiety (r5 .48) and depression (r5 .44)(Po0.001). CONCLUSIONS: Findings show thata large proportion of patients (61%) suffer fromcancer and treatment related distress. Despite acomprehensive cancer rehabilitation program, thelevel of distress did not change significantly overtime in contrast to anxiety and depression(Po0.001). Results indicate that overall distress iscaused by different psychological and cancerrelated stressors during the course of cancercompared to anxiety and depression andmight have a different impact on quality of life.RESEARCH IMPLICATIONS: Although muchresearch has focused on mental disordersamong cancer populations, relatively few studieshave investigates the nature and impact ofoverall distress. Despite the fact that distress isrelated to anxiety and depression, research shouldfocus on demographic and illness related factorsthat likely impact distress and overall quality of lifein detail. CLINICAL IMPLICATIONS: Cancerrehabilitation programs have gained muchattention during recent years, because they aretailored to the specific needs among cancersurvivors. However, research indicates that thelong term outcome of rehabilitation programsneeds to be improved probably by theimplementation of better after care and survivor-ship programs. ACKNOWLEDGEMENT OFFUNDING: This research was funded by theArbeitsgemeinschaft fur Krebsbekampfung imLande Nordrhein-Westfalen (ARGE) and Para-celsus-Kliniken Deutschland GmbH, Germany.

P2-87

Longitudinal Changes in HADS Defined Anxiety

and Depression following Cancer: A UK Study in an

Ethnically Diverse Sample

Karen Lord, Alex J Mitchell, Paul SymondsUniversity of Leicester, Leicestershire, UKBACKGROUND: There are few prospectivestudies that track depression and fewer still onanxiety following a new cancer diagnosis. Weaimed to examine the longitudinal trajectory ofclinical significant anxiety and depression for 9months after a diagnosis. METHOD: We analyseddata collected from Leicester Cancer Centre from2008–2010 involving approximately 1000 peopleapproached by a research nurse and two therapeu-tic radiographers. Of those approached we col-lected data on 738 presentations, that is people seenup to three times over 9 months during treatmentfor cancer. We have complete data on 71 BritishSouth Asian and 163 British White patientsfollowed up. RESULTS: The scores on the HADSA and HADS D consistently improved from 0 to 9months. For BSA, clinical depression was present

in 30.8% at baseline and 18.3% at 9 months.Clinical anxiety was present in 54% at baselineand 18.3% at 9 months. For BW, clinicaldepression was present in 16.7% at baseline and11.6% at 9 months. Clinical anxiety was presentin 36% at baseline and 21.5% at 9 months.CONCLUSIONS: In line with most other studieswe find an improvement in both anxiety anddepression in the first year following cancer. Thisapplies equally to BSA and BW patients. RE-SEARCH IMPLICATIONS: The extent andduration of improvement is known and requiresfurther study. CLINICAL IMPLICATIONS:Most patients’ emotional symptoms improve inthe first year. ACKNOWLEDGEMENT OFFUNDING: Hope Against Cancer.

P2-88

Perceived Value of Rapid Screening for Distress in

Routine Care: Opinion of Cancer Clinicians during

the Implementation Phase

Alex J Mitchell, Paul SymondsUniversity of Leicester, Leicester, UK

BACKGROUND: It is generally accepted thatcancer clinicians frequently overlook unmet needsand tend not rely upon their own clinical skills. Weaimed to examine the feasibility of a rapid screen-ing programme for distress based on the EmotionThermometer (DT) delivered by chemotherapynurses and treatment radiographers. METHOD:We asked chemotherapy nurses and treatmentradiographers (radiotherapists) to implement ascreening programme for distress (incorporatinganxiety and depression) using the Emotion Ther-mometers. We asked nurses to record their opinionon whether screening was valuable for each clinicalencounter. We report data on 240 nurse-patientinteractions and 135 radiotherapist-patient inter-actions. RESULTS: Nurses found the tool usefulin 52.9% (127/240) of screening applications.Radiotherapists found the screening programmeuseful in 54.0% (56/103) interactions. Across allclinicians they felt that the screening programmehelped with communication in 115/237 assessments(58.5%). They felt that the screening programmehelped with recognition in 89/234 (38.0%). Finallythey perceived that the screening programmewas impractical in 87/246 interactions (35.3%).CONCLUSIONS: Staff feedback suggests thatscreening is perceived as useful by front-line staffin about half of applications. Brief screening isusually seen as practical. More clinicians feelscreening helps with communication rather thanrecognition. RESEARCH IMPLICATIONS:Qualitative and quantitative evaluation of clini-cians opinions may be useful. CLINICALIMPLICATIONS: Screening can be implementedroutinely but staff perceive barriers to its success.



DOI: 10.1002/pon

ACKNOWLEDGEMENT OF FUNDING:None.

P2-89

Evidence based Screening for Distress and Depres-

sion in Cancer Settings: An Expert Consensus

Survey for 2011

Alex J Mitchell1, Kerrie Clover2, Gregory Carter21University of Leicester, Leicestershire, UK,2University of Newcastle, Newcastle, Australia

BACKGROUND: There is considerable uncer-tainty about how best to screen for depression incancer settings. There is currently no consensus onscreening, and although the NCCN offers guide-lines in the US and NICE offers guidelines in theUK explicit methods for screening are not clear. Asa result most centres adopt their own local practiceand there is much debate about which is theoptimal tool. METHOD: We therefore formed anexpert panel comprising 11 experienced and re-spected clinicians and academics from the US, UKand Australia. We ask each expert 34 questionsregarding depression screening and rated theanswers from full agree, to full disagree. Weanalyzed the majority opinion and degree ofagreement (by standard deviation method). Allexperts gave their opinion entirely independently ofother views. RESULTS:

1. The following items had full agreement(SD5 0): depression is an important clinicalendpoint; screening should be followed byappropriate aftercare; screening should beaccompanied by training and support.

2. The following items had high agreement (SDo0.75): clinicians do not often use validatedtools; future depression screening researchshould incorporate distress.

3. The following items had low agreement(SD41.5): cancer clinicians are not generallywilling to use brief screening tools; nationalguidelines for screening (for depression incancer settings) are not mostly in place;depression as part of adjustment disorder isnot well defined in cancer settings.

CONCLUSIONS: An expert panel reached goodconsensus regarding 12 screening issues andreasonable agreement about a further 19 issuesbut could not reach agreement about 4 issues.RESEARCH IMPLICATIONS: A consensus re-view paper regarding screening for depression,focussing on the accuracy and acceptability oftools would benefit from results of this expertsurvey concerning the latest screening practices.CLINICAL IMPLICATIONS: Experts agree onmany but not all issues pertaining to screening fordistress and depression. A larger survey of all IPOS

members is warranted. ACKNOWLEDGEMENTOF FUNDING: None.

P2-90

Could Emotional Functioning Subscale of the

EORTC QLQ-C30 be Indicative of Anxiety and

Depression in Cancer Patients?

Ali Montazeri1, Azadeh Tavoli2, Rasool Roshan31Department of Mental Health, Iranian Institute forHealth Sciences Research, ACECR, Tehran, Iran,2Tarbiat Modares University, Tehran, Iran, 3ShahedUniversity, Tehran, Iran

BACKGROUND: In order to decease burdens incancer patients in responding to relatively longinstruments, this study aimed to explore whetherthe emotional functioning (a subscale of theEORTC QLQ-C30) could measure anxiety anddepression in cancer patients. METHOD: Asample of gastrointestinal cancer attending toTehran Cancer Institute were entered into thestudy. Patients were asked to respond to twoquestionnaires: the emotional functioning subscaleof the European Organization for Research andTreatment of Cancer (EORTC) QLQ-C30 and theHospital Anxiety and Depression Scale (HADS).The Pearson’s correlation (r) and liner regressionanalysis were carried out to assess the extent towhich anxiety and depression scores are correlatedwith patients’ emotional functioning (EF). RE-SULTS: In all 142 patients were studied. The meanage of patients was 54.1 (SD5 14.8) years, 56%were male, and their diagnosis was related toesophagus (29%), stomach (30%), small intestine(3%), colon (22%) and rectum (16%). The meanemotional functioning was 64.9 (SD5 22.3). Themean anxiety score (HADS-A) was 7.6 (SD5 4.5)and for the depression (HADS-D) it was 8.4(SD5 3.8). There were statistically significantnegative correlation between EF and both anxietyand depression. In general, the correlationcoefficient for the HADS-A were higher thanthose for HADS-D (-0.63 and -.054 respectively).CONCLUSIONS: The findings demonstrated thatEF from the EORTC QLQ-C30 questionnairecovers both anxiety and depression. However, thecorrelation between HADS-D and the EF wasrather weak. RESEARCH IMPLICATIONS: Ingeneral it is safe to use emotional functioning tomeasure psychological distress in cancer patients. Itmight be better in addition to the EORTC QLQ-C30 we also use a depression specific questionnaireif we intend to measure depression specifically.CLINICAL IMPLICATIONS: The findings sug-gest that understanding psychological distressamong cancer patients is a complex issue and notbe captured unless careful examinations are carriedout. ACKNOWLEDGEMENT OF FUNDING:None.



DOI: 10.1002/pon

P2-91

The Risk of Cancer Among Children of Mothers

Who Experienced Distressful Events During Preg-

nancy

Fariba Nabavi Aleagha, Amir Askari, Ali Mada-dianpakIranian psychological Association, Tehran, Iran

BACKGROUND: The purpose of present study isto investigate the risk of cancer among children ofmothers who experienced distressful events duringpregnancy. METHOD: Statistical sample involvesmothers of male and female Iranian children withcancer (4–12 years) who are the member ofMAHAK. Total samples of 210 mothers ofchildren with cancer were selected by numericalsimple random sampling. The measurement toolsinclude Personal History Questionnaire and theSocial Readjustment Rating Scale (SRRS). Theinventories were carried out among the motherswho came to MAHAK hospital for cancer treatmentof their children. RESULTS: Statistical analysesthrough ‘‘t’’ student test for two independent groupsand Chi-Squared (w2) test showed that there is nosignificant difference between experiencing and notexperiencing the distressful events during pregnancyand the risk of cancer among children. CONCLU-SIONS: Results indicated that there is no significantrelationship between experiencing the stress (distressor eustress) by mothers during pregnancy and therisk of cancer among children. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-92

Effect of Anxiety and Depression on Illness

Perception of Patients with Gynecological Cancer

Mine Ozkan, Dilek Anuk, Serap Oflaz, NazmiyeKocaman Yildirim, Omer Yaci, Murat GuveliIstanbul University, Istanbul, Turkey

BACKGROUND: The purpose of this studywas to examine the reltionship between illnessperception and depression in patient with gyneco-logic cancer. METHOD: The sample of the studywas 28 outpatients. The data were collected withsemi-structured interview form, The Illness Percep-tion Questionnaire-Revised (IPQ-r) and Beckdepression Inventory(BDI). In the analysis of data,the frequency and Mann-Whitmey U test wereused. RESULTS: Patients with risk for anxiety hadan increase in illness identity, perceived seriousconsequences, emotional presentations and cyclicaltime score, and decrease in perceived personal andtreatment control scores (P40.05). Illness identity,perceived serious consequences, emotional repre-sentations, cyclical time score and decrease inperceived personal and treatment control scoreswere higher in patients who the risk of depression

(po0.05). Illness identity (p5 0.001) and seriousconsequences (p5 0.009) scores were higher inpatients with severe depressive symptoms accordingto BDI. CONCLUSIONS: The women with gyne-cologic cancer have risk for anxiety and depression.Six dimensions of IPQ-r was shown its efficiency onanxiety risk and two different scales for depressionwere shown the same result that the number ofillness perception symptoms were increasing withdepression score. There are limited studies on thissubject and patients. ACKNOWLEDGEMENTOF FUNDING: None.

P2-93

The Relationship between the Illness Perception and

Depression in Patients with Breast Cancer

Serap Oflaz, Dilek Anuk, Nazmiye KocamanYildirim, Omer Yaci, Fatma Sen, Murat Guveli,Sedat OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: The purpose of this study was toevaluate effects of illness perception on depression inpatients with breast cancer. METHOD: Ninety-seven breast cancer patients were enrolled into study.The data were collected with semi-structured inter-view form, The Illness Perception Questionnaire-Revised (IPQ-r) and Beck Depression Inventory(BDI). yn analysis of data, frequency and Mann-Whitney U tests were used. RESULTS: The mainage of patients was 48.2 (1/� 10.8) months andmean follow-up time was 42.3(1/� 45.7)months,mean score of BDI was 12.9(1/� 9.9). BDI scoreswere positively associated with scores of identity(po0.001), perceived serious consequences(po0.001) and negatively associated with scores ofillness coherence (p:0.04) and treatment control(p:0.03). CONCLUSIONS: The most frequentlyseen psychiatric disorders are depression and anxietyin cancer patients. In our study, 4 of sub dimensionsof IPQ-r were found to be effective in scoring ofdepression. In breast cancer patients, recognition ofrelationship between illness perception and psychia-tric factors may provide better recognition ofmaladaptive reactions of patients to illness andtreatment according to patients’ vision. AC-KNOWLEDGEMENT OF FUNDING: None.

P2-94

Self Esteem in Adolescents with Cancer

Dilek Demir, Sedat OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: Having a life-threatening dis-ease like cancer during adolescence poses a numberof problems. Such as self- esteem problem, anxiety,depression. purpose of this study was to identifythe adolescent’s own experience of areas of the life



DOI: 10.1002/pon

situation affected by the disease and problemsrelated to it. METHOD: There were 2 groups inwhich one of them is consist of 35 adolescentswhose childhood cancer treatment continues andthe other one consist of 36 adolescents whosetreatment is finished. Patient Information Formand Rosenberg Self-Esteem Inventory are used fordata collection. it was searched that, whether theself esteem changes in the adolescents whosediagnosed as cancer before and after the treatmentand if it is changed. RESULTS: According towhich variables that is to say diagnosis, sex, age,education, duration after the diagnosis and dura-tion after the treatment the self esteem is affected.‘‘Self-Esteem’’ points of the adolescents whosecancer treatment continues are lower than theadolescents whose cancer treatment is finished.‘‘Self-Continuity’’ points of the adolescents whosetreatment continues are lower than the adolescentswhose treatment is finished. It is seen that theadolescents whose treatment continues feel More‘‘psychic isolation’’ and ‘‘depressive affection’’than the adolescents whose treatment is finished.CONCLUSIONS: Through the awareness of thespecific factors affecting adolescents and youngadults with cancer, oncology teams can assist increating an atmosphere for the growth of positiveself-esteem in their adolescent patients.ACKNOWLEDGEMENT OF FUNDING: None.

P2-95

The Study on Level of Anxiety, Depression and

Expression of Emotions in Mother that has a Child

with Cancer

Birsen Sipahi, Sedat OzkanIstanbul Univercity, Istanbul, Turkey

BACKGROUND: It is well known that theparents of the children who have chronic or fataldisease also need psychological supports as thepatients must have. Especially the mother takes ona burden of long and intensive struggling with achild who is diagnosed with cerebral palsy orcancer. In this process the mother becomes face toface be unbalanced physically, psychologically andsocially. METHOD: In the present study weassessed the levels of anxiety and depression andexpressive emotions of the mothers whose childrenhave diagnosis of cancer and cerebral palsy whichare considered to be fatal or chronic diseasesorderly. We used Beck Depression Inventory,State-Trait Anxiety Inventory, Symptom CheckList, Toronto Alexitymia inventory and MultiplePerceptive Social Support Inventory and dataassessed by SPSS computerized program and t testwas used in matched series for constitutingpercentage. RESULTS: Anxiety and depressionlevel of the mothers of the children who havecancer are found to be higher than the levels of the

mothers of the children who have cerebral palsy. Ineach group it is found that the mothers have lackof expressing emotions sufficiently althoughthey have perception of more social supports.Levels of positive symptoms in the mothers of thechildren who have cancer were more specific thanthe levels of mother of the children who havecerebral palsy among to the Symptoms Check List.CONCLUSIONS: Besides these result havinghigher scores of parameters about depression,anxiety and somatisation which are the subscalesof Symptoms Scanning List were well adjustedwith our first result. Levels of anxiety anddepression are higher in mother of children withcancer and there are some somatic symptoms andthere exist lack of expression of emotionseven though they are provided with sufficientsocial support. ACKNOWLEDGEMENT OFFUNDING: None.

P2-96

Comparing Anxiety, Depression and Quality of Life

in Women with Breast Conserving Therapy and

Patients with Total Mastectomy

Selma Isguzar, Sedat OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: It’s reported that psychiatricand psychosocial morbidity appears in %30–40of cancer patients. Mostly reported psychopathol-ogies are, anxiety, depression and adaptationproblems which in turn affect the quality life ofpatients. Breast cancer may considerably affectpsychological states of patients. METHOD:Taking this fact in to consideration, in thisresearch two groups of patients, 20 patients ofTotal Mastectomy and Breast ConservingTherapy in each respectively were comparedwith each other in terms of differences in anxiety,depression and quality life scores. In research,patients were given Patient Assessment Form,Karnofsky Physical Performance MeasurementScale, Psychosocial State Evaluation Form,Beck Depression Inventory, Functional LivingIndex, STAI Anxiety Forms, Patient DistressInventory test to fill in. RESULTS: As a treat-ment Total Mastectomy causes an increase inanxiety of the breast cancer patients. In bothgroups, anxiety about spread or repetition ofbreast cancer is low, and there couldn’t befound a significant difference between the groups.There is no negative finding about a negativetendency in social relations and activitiesof both groups. In respect of psychologicalproblems, there was no significant differencebetween two groups. CONCLUSIONS: Thebest approach to patients with breast cancerwould be to consider psychosocial aspects and thequality life concerns when deciding on the



DOI: 10.1002/pon

type of the surgery and postoperative treatmentmodalities. ACKNOWLEDGEMENT OFFUNDING: None.

P2-97

Malignant Melanoma Patients’ Anxiety-Depression

Levels and Quality of Life

Pinar Ceylan, Sedat OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: Melanoma is the fastest grow-ing solid tumor among men and women andaccounts for 79% of skin cancer–related deaths.Research has identified that distress is frequentlyassociated with a diagnosis of cancer and may slowtreatment-seeking and recovery, increasing mor-bidity and even mortality through faster diseasecourse. The purpose of this study is to determinethe relationship between malignant melanomapatients’ depression-ayyxiety leyels and the qualityof life. METHOD: Forty malignant melanomapatients who are admitted to Istanbul University,Faculty of Medicine, Institute ofuncology consti-tutes the sample of this research. In thesample group, an Interview Form, Beck depressionscale, hospital-anxiety scale,a scale for copingwith stress,and SF-36 quality of life scale havebeen respectively applied. While evaluating thedata, ki-square test has been used when comparingthe qualitative data and the independent t-testhas been used when comparing the groupsof two and complementary statistical methods(average, standard deviation) have been used aswelL. RESULTS: According to the data obtaine-d,a significant statistical relationship has beenfound among the patients’ history of psychiatriciyynesses, psychiatric treatment variables, theiranxiety subscale at the hospital, malignant melon-ama patient’s hospital anxiety depression scale, theduration of the disease, patients’ gender, andmetastasis. it has been detcrmined that those withanxiety and depression use both problem andemotional-oricnted coping styles. on the otherhand others with no anxiety and depressiongenerally use problem oriented coping styles. Asignificant relationship has beenfound amonganxiety, depression and the quality of life as well.CONCLUSIONS: it is determined that the higherthe rate of anxiety and depression is, the lower thequality of life becomes. As a result of the research,the limitations and recommendations are et and theoutcomes of the studies are discussed in theframework of the relevant literature. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-98

The Investigation of Posttraumatic Growth and

Effecting Factors in Cancer Patients

Seda Bayraktar, Mine OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: 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 interview form and3 scales (Posttraumatic Growth Inventory, Ways ofCoping Inventory and Illness Perception Scale-R)to 78 cancer outpatients in Ystanbul UniversityOncology Institute. Datums were evaluated withusing one way anova, independent sample t-testand regression analysis. RESULTS: Resultsshowed that cancer patients in this sample hashigher posttraumatic growth levels to the mean.T. Results from independent sample t- test forposttraumatic growth and coping showed that therelation between posttraumatic growth andconfrontive coping, self-controlling, accepting re-sponsibility, escape-avodiance, planful problemsolving, positive reapprasial, seeking socialsupport. . As a result of stepwise regressionanalysis, it was found that self-controlling, accept-ing responsibility, escape-avodiance, positive re-apprasial, seeking social support, distancing andillness coherence were significant predictos ofposttraumatic growth. CONCLUSIONS:Results showed that ways of coping and illnessperceptions were important variables on posttrau-matic growth. The results of the study disscussedwithin the literature, shortcomings of the study andproposals for future research were suggested.ACKNOWLEDGEMENT OF FUNDING: None.

P2-99

Comparison of the Psychological Factors

(Depression, Anxiety, Coping) of Cancer Pain and

Non-Malignant Chronic Pain Patients

Aslyhan Kurt, Mine OzkanIstanbul University, Istanbul, Turkey

BACKGROUND: The aim of the present studywas to compare non-malignant chronic painpatients and cancer patients; in terms of painseverity, depression, anxiety and coping levels.METHOD: This study was conducted on a sampleof 30 non-malignant chronic pain patients whoapplied to Ystanbul Medicine Faculty AlgologyDepartment and 30 cancer patients who applied toYstanbul Oncology Institude Medical OncologyDepartment. The patients completed these tests inodrer: Patient Infomation Form (Demographicfacts), McGill Melzack Pain Questionnaire(MPQ), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory and Ways of Coping



DOI: 10.1002/pon

Inventory (WCI). In the evaluation of the data,t test (between group) and hierarchic regression(within group) analysis have been used.RESULTS: The result of this study suggest that,both cancer patients who has life threat during theillness and non-malignant chronic pain patientswho doesn’t have life threating situation, don’tshow any differences according to pain severity,depression, anxiety and coping levels. CONCLU-SIONS: In general, within pain group, the resultsindicate that there is a statistically meanful relationbetween pain severity and affective factors (depres-sion and anxiety). Overall, the results of the presentstudy support the belief that cancer pain is not aunique pain. ACKNOWLEDGEMENT OFFUNDING: None.

P2-100

Distress in Breast Cancer Survivors Measured with

the Distress Thermometer

F.K. Ploos van Amstel, S.W. van den Berg,H.W.M. van Laarhoven, M.F.M. Gielissen, J.B.Prins, P.B. OttevangerRadboud University Nijmegen Medical Centre,Nijmegen, The Netherlands

BACKGROUND: The use of the Distress Ther-mometer is recommended by the National Com-prehensive Cancer Network to monitor and detectdistress among patients of various cancer types inorder to improve psychosocial care. Whether theDT is a valuable instrument to assess distress inbreast cancer survivors (BCS) without recurrentdisease is unknown. METHOD: The objectiveswere to assess the value of the DT to detect distressamong BCS, and to investigate to what extent thisdistress is associated with treatment, demographicand psychosocial variables. In a cross-sectionalstudy, BCS of the outpatient clinic of a universityhospital were asked to fill in self-report question-naires: the Distress Thermometer, the EORTCQLQ C30 and BR23, the HADS and the IllnessCognition Questionnaire. RESULTS: Of the 258BCS to whom the questionnaire was sent, 129(50%) completed all questionnaires. Prevalence ofdistress (DT5) was 36%. Recently treated survivorsand women treated with both adjuvant radio-therapy and chemotherapy experienced most dis-tress (52% and 45%, respectively). The problemsfatigue(57%), muscle strength(47%) and physicalfitness(42%) were mentioned most often. Of thedistressed survivors 69% wished or considered areferral to a professional. Regression analysisshowed that reduced quality of life, reducedcognitive function and fatigue were predictors ofdistress (Po.05). CONCLUSIONS: Usingthe DT in BCS, distress is detected in 36% of thepatients. Distress is associated with extent oftreatment, time elapsed since surgery, quality of

life, cognitive function and fatigue. RESEARCHIMPLICATIONS: This study showed that pro-blems and increased distress are still present longtime after primary breast cancer treatment.Research in methods to decrease distressafter breast cancer treatment is urgently needed.CLINICAL IMPLICATIONS: Screening andmonitoring of distress with the DT in BCS isdesirable and forms an important part of psycho-social care. The professional, like the oncologistand/or nurse, should be aware of the problems anddistress and refer the patient to the right profes-sional when needed in order to give the patientproper care. This could prevent or lower distressand thereby improve the quality of life.ACKNOWLEDGEMENT OF FUNDING: Thestudy was supported with a grant of Pink Ribbon,the Netherlands.

P2-101

Patterns of Practice of Medical Oncologist with

Regard to Assessment and Management of Depres-

sion

Wadih Rhondali1,2, Elise Perceau2, Pierre Saltel3,Veronique Lafumas1, Marilene Filbet11U.T. M.D. Anderson, Houston, TX, USA,2Hospices Civils de Lyon, Lyon, France, 3CentreLeon Berard, Lyon, France

BACKGROUND: Depression is a frequent pro-blem in cancer patients that is known to reducequality of life; however, many cancer patients withdepression are not treated because of the difficultiesin assessing depression in this population. The aimof this study was to evaluate and improve thedepression assessment strategies of palliative carephysicians and oncologists. METHOD: We invitedall oncologists from three cancer centers toparticipate in this multicenter prospective study.Oncologists were asked to classify 22 symptoms(related and specific to depression in cancerpatients, related but not specific, and unrelated)as ‘‘important,’’ or ‘‘less important’’ for thediagnosis of depression in cancer patients. Weadministered these tests at three different timepoints (at baseline, after a video educationprogram, and after 4 weeks). They were also askedto complete a questionnaire exploring physicians’perceptions of depression and of their role in itssystematic screening. RESULTS: All 34 eligiblephysicians participated. Baseline performance wasgood, with over 70% of participants correctlyclassifying at least 7 of 9 related and specificsymptoms. We found no significant improvementsin scores in the immediate and 4-week follow uptests. Additionally, 24 (83%) and 23 (79%)participants expressed support for systematicdepression screening and a role for oncologists in



DOI: 10.1002/pon

screening, respectively. CONCLUSIONS: Oncolo-gists had good baseline knowledge about depres-sion’s main symptoms in cancer patients and apositive attitude toward being involved in screen-ing. Thus, underdiagnosis of depression is probablyrelated to problems associated with the oncologyworking environment rather than the physicians’knowledge. Further research is needed to pinpointthe causes of underdiagnosis and develop effectiveinterventions to improve depression’s diagnosisand treatment in the palliative care and oncologypatient populations. ACKNOWLEDGEMENTOF FUNDING: For this study, we received agrant from the APICIL foundation and Eli Lillyand Company Foundation.

P2-102

Prevalence of Depression in Outpatient Oncology

Clinic and Association with Others Symptoms

Wadih Rhondali1,2, Veronique Lafumas3, ElisePerceau3, Pierre Saltel2,3, Marilene Filbet11U.T. M.D. Anderson, Houston, TX, USA, 2CentreLeon Berard, Lyon, France, 3Hospices Civils deLyon, Lyon, France

BACKGROUND: Depression is a frequent incancer patients, with an estimated prevalence of15%. Recent studies have shown depression to bean independent predictive factor of cancer-relatedmortality. We explored the prevalence of depres-sion in the outpatient oncology clinic and theassociation with several symptoms assessed by theEdmonton Symptom Assessment System (ESAS).METHOD: In this multicentre prospective studyconducted from April 2009 to July 2009, wecollected the results from ESAS (10 symptoms:pain, nausea, fatigue, drowsiness, appetite, short-ness of breath, sleep, depression, anxiety, feeling ofwell being rated from 0 to 10) and we used the BriefEdinburgh Depression Scale (BEDS). We defined acut-off score of 6 for ‘probable depression’ and of10 for ‘highly probable depression’. RESULTS:146 patients completed the study. The prevalenceof probable depression was 54/146 (37%) andprevalence of highly probable depression was 20/146 (14%). We found a significant associationbetween probable depression and ESAS: pain(r5 0.169, p5 0.045), fatigue (r5 0.184,p5 0.030), depression (r5 0.544, po0.001), anxi-ety (r5 0.490, po0.001), feeling of well being(r5 0.323, po0.001). For patients with probableand highly probable depression, 85% werenot on antidepressants (respectively 46 and 17patients). CONCLUSIONS: We found a signifi-cant association between depression and multiplessymptoms as detected by the ESAS. The vastmajority of patients with the diagnosis of depres-sion were not receiving antidepressant treatment.Depression should be suspected in patients

with higher symptom distress at the ESAS.ACKNOWLEDGEMENT OF FUNDING: Forthis study, we received a grant from the APICILfoundation.

P2-103

Prevalence of Depression and Depressive Symptoms

in Palliative Cancer Patients: A Meta-Analysis

Irene Riepma1,2, Laurien Buffart2,1, Anne-MarieKrebber3, Remco de Bree3, Rene Leemans3,Annemarie Becker3, Johannes Brug2, Annemiekevan Straten1,2, Pim Cuijpers1,2, Irma Verdonck-deLeeuw1,3

1VU University, Amsterdam, The Netherlands,2EMGO Institute for Health and Care Research,Amsterdam, The Netherlands, 3VU Medical Center,Amsterdam, The Netherlands

BACKGROUND: Depression is an under-diag-nosed and highly impairing disease in advancedcancer patients. It deteriorates quality of life, mayhamper compliance with treatment and increasesmedical care consumption. Previous studies havereported prevalence rates between 5 – 39%. Withthis meta-analysis we aim to make an inventory ofall the studies that measured the prevalence ofdepression in cancer patients in the palliative phaseof the disease. METHOD: We conducted asystematic literature search in four bibliographicaldatabases (PubMed Embase, PsycINFO and CI-NAHL) up to April 2010. We included studies thatused clinical interviews and a screener to assess theprevalence of depression. Studies that measured theprevalence of depression in retrospect, by proxyand post-mortem as well as intervention studieswere excluded. We used a list of quality criteria tocompare the quality of the studies, focusing onpatient population, sampling method and validityof measurement instruments. Pooled prevalence ofdepression was computed using ComprehensiveMeta-Analysis. RESULTS: Of 1643 recordsfound in the literature search, 37 were eligible forthis meta-analysis. Another 9 were found byreferences. 31 studies used screeners, 11 studiesused clinical interviews and 4 studies usedboth. Quality assessment revealed a high numberof low quality studies. A pooled prevalence ofdepression as measured with screeners was 27.8%(95% CI 23.8–32.2). Pooled prevalence of 14studies using the Hospital Anxiety and DepressionScale with a cut-off score of 11 was 23.5%(95% CI 17.3–31.2) The pooled prevalence of 10studies that measured major depression withclinical interviews was 9.8% (95% CI 5.9–15.9).CONCLUSIONS: Prevalence of a major depres-sion among patients in palliative cancer care is10%, while prevalence of subclinical depressionvaries between 24 and 28%. Populations in the



DOI: 10.1002/pon

studies varied regarding cancer site and primarytreatment, in- or outpatient setting, andample size. There is no consensus regardinga gold standard in assessing prevalence ofdepression in patients in palliative cancer care. Inthe 46 studies included in the meta-analysis,10 different clinical interviews and 16 differentscreening instruments were identified. Furthermorea high level of heterogeneity between studieswas found. Therefore, pooled prevalence mustbe interpreted with caution. RESEARCHIMPLICATIONS: This meta-analysis emphasizesthe need for (international) consensus regardingassessment of depression in palliative cancer careand regarding reporting specific characteristics ofthe target population, such as socio-demography, ahistory of depression, cancer location, stage andtreatment and time of measurement. CLINICALIMPLICATIONS: This meta-analysis providesinsight into the prevalence of depression inpalliative cancer care. Treatment of depressionin this setting may improve quality of lifein a substantial number of patients.ACKNOWLEDGEMENT OF FUNDING:None.

P2-104

Is Genetic Counseling for Hereditary Cancer a

Stressful Event?

Afsaneh Roshanai1, Karin Nordin1,2, CathrineBjorvatn2, Katharina Wollf3, Ellen M. Mikkelsen4,Ingvar Bjelland2, Gerd Kvale51Department of Public Health and Caring Sciences,Uppsala, Sweden, 2Department of Public Healthand Primary Health Care, Bergen, Norway,3Department of Psychosocial Science, Bergen,Norway, 4Department of Clinical Epidemiology,Aarhus, Denmark, 5Department of ClinicalPsychology, Bergen, NorwayBACKGROUND: Today have genetic counselingbecome an integral part of specialized health caresystem. However, an assumption has been thatreceiving information about a potentially life-threatening event (e.g. cancer) may cause psycho-logical and emotional difficulties, and that geneticcounseling may facilitate adjustment to this in-formation. The present study investigated whetherindividuals who attend cancer genetic counselingsuffer more anxiety and/or depression compared toother groups facing a potentially stressful eventand the general population. METHOD: A total of4911 individuals from three Scandinavian countrieswere included in the study. Data was collected fromindividuals who were subjected to a potentialstressful event for instance had attended eithercancer genetic counseling (self-referred and physi-cian-referred) or routine mammography screening,were recalled for further control due to a suspiciousmammogram, had received a cancer diagnosis or

had received medical follow-up after a breastcancer-surgery. Data from the genetic counselinggroup was also compared to normative data.Participants filled in the Hospital Anxiety andDepression Scale twice: prior to the potentiallystressful event and 14 days after the event.RESULTS: Pre-counseling cancer genetic counse-lees reported significant lower level of anxietycompared to the cancer-related group but higherlevels of anxiety compared to the general popula-tion. The level of depression observed within thegenetic counseling group was lower compared toother participants. Post-event there was no sig-nificant difference in anxiety between the counse-lees and all other groups. The level of depressionreported in the self-referred group was significantlylower than all other groups. The level of anxietyand depression had decreased significantly withinthe genetic counseling group. In the cancer-relatedgroup only the level of anxiety had decreasedsignificantly post-event. CONCLUSIONS: Geneticcounseling does not seem to be a stressful eventcompared to other events within the health careservice. Individuals who attend cancer geneticcounseling reported lower levels of anxiety anddepression compared to all other study groups,with the exception of a higher level of anxietypre counseling compared to the generalpopulation. The result may of importance forplanning future genetic counseling services.RESEARCH IMPLICATIONS: In the near fu-ture, extensive information regarding the genetictransmission of a number of diseases will beavailable. Consequently genetic counseling willhave an impact on both the structure and the costsof health services. Thus, information is requiredregarding the psychosocial impact of geneticservices upon the individuals. Nevertheless, itseems necessary that in planning future researchregarding genetic counseling, focus on finding morevulnerable individuals who are in need of addi-tional support. CLINICAL IMPLICATIONS:Our data did not support the notion that theemotional challenge associated with genetic coun-seling calls for psychological interventions aimed atexploring feelings and emotions in depth. On thecontrary, genetic counseling may be associatedwith some transient elevations of anxiety thatfor most individuals will be handled without therequirements for any specific intervention.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was supported by a grant from the Norwe-gian Research Council. Norm data within thisstudy was used by permission of theHUNT committee (Helseundersøkelsen I NordTrøndelag). We also thank Claudia Lampic forthe permission to use data from her project‘‘Women’s experiences of participating in furtherinvestigation following breast cancer screening’’ inUppsala.



DOI: 10.1002/pon

P2-105

Correlations between Pain and Distress Detected by

Brief Screening Tools

Shelagh Wright, Dermot Ryan, Pamela GallagherSchool of Nursing Dublin City University, Dublin,Ireland

BACKGROUND: Prevalence of pain and distressis high in patients with cancer who may, as aconsequence, suffer reduced quality of life, complexpsychological and psychiatric morbidities andpotential mortality. Therefore early recognitionand treatment of pain and distress are vital in thispopulation group. Validated brief screening toolsfacilitate early detection of pain and distress. Thissection of a larger study looks at correlationsbetween pain and distress detected by brief screen-ing tools. METHOD: The study received approvalfrom the Cork University Hospital Ethics Com-mittee. A consecutive sample of 205 patients withadvanced cancer were recruited through (a) themedical oncology, haematology and palliative careservices at Cork University Hospital, and (b)inpatient lists at Marymount Hospice Cork fromMay 2009 to April 2010. Participants completedthe DT, the PHQ-2 and ‘help’ question, theHospital Anxiety and Depression Scale (HADS),the PCL (PTSD checklist) and PG12, numberrating scales from the Brief Pain Inventory andNCCN, and a verbal rating scale and wereinterviewed using the Structured Clinical Interviewfor DSM-IV (SCID). RESULTS: Study findings ofthe validation of the DT against the SCID andother tools for detecting distress are publishedelsewhere. Study findings showed prevalence of thecoexistence of pain and distress in patients withadvanced cancer. Of the two hundred and fivestudy patient participants, eighty five patientsexperienced moderate to severe pain. Patients’ scoreson the verbal and number pain rating scalescorrelated strongly with their scores on the DistressThermometer, HADS Anxiety, HADS Depressionand HADS Total scales. CONCLUSIONS: Findingsfurther support longstanding evidence of coexistenceof pain and distress in patients with cancer andespecially in patients with advanced cancer andcorroborate the need for use of brief screening toolsfor early identification of pain and distress in thispatient population. The literature shows stronglythat pain is a primary cause of distress in thispopulation group. Therefore the use of combinedbrief screening tools for pain and distress is essentialand can facilitate clinicians to optimise the earlydetection of either or both pain and distress for earlyand effective referral and intervention. CLINICALIMPLICATIONS: This study especially highlightsthe vital need for early screening and detection ofpain and distress together in patients with cancer andshows that brief rapid screening tools have the

potential to effectively facilitate busy clinicians toprovide integrated care in the clinical setting. Thisstudy highlights the benefits of research in palliativecare for essential contribution to the knowledge baseof patients’ experience of their cancer illness in orderto improve patient care. ACKNOWLEDGEMENTOF FUNDING: Acknowledgement of funding IrishCancer Society Grant number: CRPO8GAL.

P2-106

Mental Adjustment and Emotional Symptoms of the

Thyroid Cancer Patients with Psychological Distress

Jeong-Ho Seok1, Hang-Seok Chang2, Won-JungChoi1, Young-Ja Oh2, Jee-Hee Oh1, Yong SangLee2, Jong-Sun Kim1, Cheong Soo Park2,Jae-Jin Kim1

1Department of Psychiatry, Yonsei UniversityGangnam Severance Hospital, Seoul, Republic ofKorea, 2Department of General Surgery, YonseiUniversity Gangnam Severance Hospital, Seoul,Republic of Korea

BACKGROUND: Previous studies have reportedthat over a third of cancer patients have asignificant psychological distress. Even thoughthyroid cancer is known to have a favorabletreatment outcome and prognosis, patients mayexperience distress when they know their cancerdiagnosis. Mental adjustment to cancer and coex-isting emotional symptoms may have associatedwith their psychological distress. We investigatedwhich mental adjustment factor and emotionalsymptoms may be associated distress in patientsdiagnosed with thyroid cancer. METHOD: Onehundred and fifty-three thyroid cancer patientsparticipated in this study. After patients’global distress levels were screened with distressthermometer, patients were evaluated concerningmental adjustment to cancer diagnosis, anxiety anddepressive symptoms, global quality of life levelbefore the main surgical treatment. Depending onthe existence of significant psychological distress,patients were divided into two groups and inde-pendent sample t-test was performed to comparethe mental adjustment and symptom characteristicsbetween distress and no-distress groups.RESULTS: In this study, 44 patients (28.8%)who reported more than 4 points in the distressthermometer were included into the distress group.Helplessness-hopelessness and anxious-preoccupa-tion factor scores of the Korean version of theMini-Mental Adjustment to Cancer scale weresignificantly higher in the distress group than theno-distress group. The distress group reportedincreased anxiety and depressive symptoms anddecreased quality-of-life scores compared withthose of the no-distress group. CONCLUSIONS:Negative mental adjustment, increased emotionalsymptoms and decreased quality of life were found



DOI: 10.1002/pon

in the thyroid cancer patients with significantdistress. Distress screening may foster psychologi-cal adaption and sufferings and their quality of lifein the patients with thyroid cancer. Psychologicaland emotional support may be needed for thesedistressed patients to adapt to various problemsassociated with following cancer treatment.RESEARCH IMPLICATIONS: Psychologicaldistress can be associated with increased psycho-pathology and maladaptation, and decreasedquality of life in the patients with thyroidcancer. CLINICAL IMPLICATIONS: Distressscreening and psychiatric collaboration shouldbe accompanied at the initial phase of thyroidcancer treatment. ACKNOWLEDGEMENT OFFUNDING: This study was supported by a facultyresearch grant of Yonsei University College ofMedicine for 2010(6-2010-0140).

P2-107

Screening Diagnosis of Anxiety-Depressive Distur-

bances in Patients with Head and Neck Cancer

Nataliya Shakhurova1, Lidia Balatskaya2, EugenyChoynzonov2, Eugeny Schastnyy11Mental Health Research Institute SB RAMSci,Tomsk, Russia, 2Oncology Research Institute SBRAMSci, Tomsk, Russia

BACKGROUND: Making diagnosis of cancer is apsychotraumatic factor causing a number of psy-chopathologic manifestations which influence maynegatively affect results of anticancer treatment.Psychoemotional state of patients receiving variouskinds of specialized treatment for arisen relapse orprogressing tumor requires doctor’s attention inassociation with larger depth and persistence offormed mental disturbances. Objective: to carry outscreening assessment of mental state of patients withhead and neck cancers being at various stages oftreatment. METHOD: 34 patients (24 men, meanage 5276,7 and 10 women, mean age 5276,7) witha head and neck cancer were investigated. Stage I – 6persons (17,4 %), stage II - 8 (23,6 %), stage III – 13(38,3 %) and stage IV – 7 (20,7 %). 15 patients(44,1%) sought for specialized assistance for the firsttime, had newly made diagnosis and were at theinitial stage of combined therapy, whereas 19patients (55,9%) received therapy repeatedly inassociation with relapse of cancer. Screening ofdepressive disorders was conducted with BriefSymptom Inventory-18 (BSI-18); Derogatis, 2000).Results. According to data of conducted investiga-tion in 12 persons (35,3%) out of investigated groupwe have documented high general index of psycho-pathological symptoms (GSI 0,63), testifying tonecessity of clinical examination by a psychiatrist.In addition, we observed simultaneous increase ofclinically significant indices of anxiety and depres-sion (mean score according to scale of depression

0,63, mean score according to scale of anxiety 0,63)in 19 persons (55, 9%) in the entire studied groupwhat required a consultation of a psychiatrist as well.CONCLUSIONS: We have conducted comparisonof obtained indices among groups of newly admittedpatients (group 1, n515) and patients receivingcombined treatment associated with relapse of theprocess (group 2, n5 19). Incidence rate of clinicallysignificant symptoms of depression and anxiety hasconstituted 23,08 % (n53), in group 2 - 76,92%(n5 10) and was reliably higher (p5 0,04730).RESEARCH IMPLICATIONS: Obtained resultstestify to high incidence rate of psychopathologicanxiety-depressive symptoms in patients having headand neck cancers. Methodological use of valid andspecific diagnostic tools gives a possibility ofcomparison of obtained data in various investigatedcohorts, promotes effective dynamic observation ofclinical manifestations. CLINICAL IMPLICA-TIONS: Screening assessment of mental state ofpatients at various stages of treatment allowsplanning of further therapeutic and rehabilitativetactic with use of psychopharmacotherapy at stagesof combined treatment and combination of psycho-pharmacotherapeutic and psychotherapeutic impactsat the recovery stage associated with necessity offormation of speech function, presence of cosmeticdefect, change of social functions of the patient.ACKNOWLEDGEMENT OF FUNDING: None.

P2-108

Studying the Difference in Coping Styles among

Cancer Patients, Undergone Surgery Patients and

Healthy Persons

Hadi Bahrami Ehsan, Nasim TavassoliUniversity of Tehran, Department of Psychology,Tehran, Iran

BACKGROUND: This research compares themechanisms of coping with stress betweencancer patients and undergone surgery patients.METHOD: A 180-person sample consists of 60cancer patients, 60 undergone surgery patients and60 healthy persons all chosen randomly. Lazarosand Folkman coping styles’ measure was con-ducted. It was attempted that the groups beanalogous regarding age and gender. RESULTS:Analyzing the variance of the results in sub-measures of coping styles show that in some caseslike reassessment and escape-avoidance there aredifferent significant differences. In the rest of thesub-measures the difference was not significant.Also emotional coping style is significantlydifferent within the groups which are higher incancer and surgery patients than healthy persons.CONCLUSIONS: The results indicate that copingwith refractory diseases and having experiencedsurgery are devastating events to lead to a new



DOI: 10.1002/pon

organization of coping styles. Based on the resultsemotional coping approaches in patients areexposed to more serious changes. RESEARCHIMPLICATIONS: Based on the findings anddifferences in sub-measures, more research maybe done regarding changes in coping styles duringtreatment in order to find the best treatmentaccording to its compliance with the person’scoping style. CLINICAL IMPLICATIONS: Wesuggest necessary instructions be used to trainbest coping style methods to cancer andsurgery patients. ACKNOWLEDGEMENT OFFUNDING: None.

P2-109

Resource Loss, Resource Gain, Coping Styles, and

Distress Trajectories FOLLOWING a Breast

Cancer Diagnosis: A Mixture Group-Based

Trajectory Modeling Approach

Pei-Chiung Tu1, Wen-Yau Hsu1, Dah-Cherng Yeh21National Chengchi University, Taipei, Taiwan,2Taichung Veterans General Hospital, Taipei, Taiwan

BACKGROUND: There have been fewer studiesto investigate the distinct trajectories of psycholo-gical distress after a breast cancer diagnosis and itsdeterminants. Therefore, the goal of this studywas (1) to identify trajectories of psychologicaldistress and (2) to explore their relationships withchange in psychological resources and copingstyles. METHOD: Taiwan breast cancer patients(n5 107) were assessed within 2 weeks after cancerdiagnosis and before a breast surgery (T1), again at1-month (T2), 3-month (T3) and 6-months follow-ups (T4). The group-based trajectory modeling(GBTM) was use to analyze the longitudinal data.Psychological distress and quality of life weremeasure at the four time-points using HospitalAnxiety and Depression Scale (HADS). Theresource change scale and the Chinese-versionMental Adjustment to Cancer (Mini-MAC) wereassessed at T2, T3, and T4. RESULTS: TheGBTM identified two classes in psychologicaldistress: chronic distress (35%) and resilient(65%. Gaining resources during 7 months afterdiagnosis would significantly reduce psychologicaldistress, but losing resources would significantlyincrease psychological distress. In addition, peoplein chronic distress would likely to adopt morenegative-affect coping style than those in resilientat T2, T3, and T4; and less positive-affect copingstyle than those in resilient at T2. CONCLU-SIONS: Most patients were not distressed inresponse to breast cancer or only temporarily so.Yet, a minority of patients remained distress after abreast cancer diagnosis. Neither demographicalnor clinical variables did successfully distinguishdifferent trajectories of psychological distress.Indices of stress (resource loss, resource gain) and

coping styles (negative-affective coping and posi-tive-affect coping) following cancer could distin-guish distress trajectories. RESEARCHIMPLICATIONS: This study adopted individual-difference perspectives, and used the stress andcoping framework to account for the heterogeneityof risk and protective factors for distinct distresstrajectories of breast cancer patients. CLINICALIMPLICATIONS: Understanding differential tra-jectories of psychological distress and its associatedchange in resources and coping styles haveimplications for developing psychosocial interven-tion for breast cancer patients after diagnosis.ACKNOWLEDGEMENT OF FUNDING: None.

P2-111

Psychosocial Screening of Patients with Mamma

Carcinoma

Isabel van Schie, Marijke Zielstra, Epie Boven,Joost Dekker, Petroesjka van den Tol, Mechelinevan der LindenVU University Medical Center, Amsterdam, TheNetherlands

BACKGROUND: In the Netherlands, one inevery eight women is diagnosed with breast cancer.One third of these patients experience high distress.The National Cancer Control Program recom-mends the Distress Thermometer (DT) as a screen-ing instrument for quality of life problems forpatients with cancer. This study improves the well-being of women with mamma carcinoma byexamining the distress and to anticipate on theproblems and needs of breast cancer patientswithin a stepped care program. METHOD: Newlydiagnosed breast cancer patients in VU medicalcenter (VUMC) are screened for problems inquality of life with the DT and the HospitalAnxiety and Depression Scale (HADS) from April2009 until September 2011. Screening is performedby the mamma care nurse directly after diagnosisand continues three, six and nine months afterdiagnosis. Patients with high distress, DT 5 and/orHADS 15, are offered additional care. Psychologi-cal treatment is offered in a stepped care model,starting with Problem Solving Therapy (PST) andfollowed by specialised psychological treatment ifindicated. RESULTS: Preliminary results(N5 113) on the DT indicate that 76 (68%)patients experience high distress after diagnosis.On the HADS, 33 (30%) patients experience highdistress after diagnosis. Seventeen women (15%)indicated a wish for psychosocial support directlyafter diagnosis and received psychological treat-ment. Over a period of nine months, a decrease ofdistress is seen on the DT scores. At diagnosis thedistress levels are highest, with a significantdecrease after three months (p5 0.007). Patientsexpress their satisfaction in the follow-up inter-



DOI: 10.1002/pon

views and report effects of the stepped careprogram. CONCLUSIONS: Clinically high dis-tress is common in patients with mamma carcino-ma. It seems effective to screen for distress overtime and to offer additional care in a stepped careprogram. Communication between patient andcaregiver about quality of life might improve thedetection and recognition of problems. The womenin the study mentioned positive effects of thescreening and the psycho-oncological treatment.RESEARCH IMPLICATIONS: It is important tostudy the distress, anxiety and depression of breastcancer patients over a period of time and objectifypatient characteristics that increase the risk ofdevelopment of psychosocial problems during thetreatment period. The effect of different types ofpsychological treatment on distress, anxiety anddepression in breast cancer patients is a research arealittle is known about. CLINICAL IMPLICATIONS:The results in this study show the importance ofcommunication with breast cancer patients abouttheir quality of life and the offer of psychosocialtreatment in a stepped care program when necessary.The screening does not increase referrals or triggertime-consuming psychosocial treatments, it has apreventive function in the early detection of distress.The screening procedure identified patients with highdistress who could be missed when the DT was notused. ACKNOWLEDGEMENT OF FUNDING:Stichting Pink Ribbon.

P2-112

Physical Problems and Psychosocial Distress in

Breast Cancer Survivors

Ging-Long Wang1,2, Shih-Ming Shih1, Sheng-HuiHsu1, Yi-ChenHou1, An-Chen Feng1, Chi-Tao Cheng11Koo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan, 2National Yang-Ming University,College of Medicine, Taipei, Taiwan

BACKGROUND: It has been reported that thepost-cancer-treatment physical ‘‘side effects’’ aresignificantly linked to the level of psychosocialdistress in breast cancer survivors. This studyaimed to examine how often the physical problemsof the Problem List (PL) of the Distress Thermo-meter (DT) were endorsed by these patients, and totest whether these physical problems were asso-ciated with significant distress. METHOD: The DTis a one-item screening tool recommended by theNational Comprehensive Cancer Network(NCCN) for cancer patients. Compared to theHospital Anxiety and Depression Scale (HADS),the DT has been reported to be a valid screeningtool for breast cancer survivors. It consists of a 35-item Problem List (PL), which is grouped into 5categories: practical, family, emotional, spiritual/religious, and physical. 217 consecutive outpatientbreast cancer survivors at a cancer center in Taipei,

Taiwan, completed packets of questionnaires. Thequestionnaires included the HADS, the DT and thePL, among others. RESULTS: Practical problemswere checked by 5–20% of breast cancer survivors,family problems by 14–17%, emotional problems11–53%, spiritual/religious concerns 9%, andphysical problems up to 44%. 18 of the 21 physicalproblems correlated significantly with HADS45 15, and 16 with DT 45 4. The mostendorsed items, in descending order of frequency,were problems of fatigue, sleep, memory/concen-tration, skin dry/itchy, tingling in hands/feet,appearance, pain, feeling swollen, bathing/dres-sing, constipation, sexual, getting around, breath-ing, and eating. CONCLUSIONS: The PL of theDT is an efficient instrument for detecting somaticconcerns in breast cancer survivors. For thispopulation, most of the physical problems corre-late with significant psychosocial distress.RESEARCH IMPLICATIONS: Further researchis needed to assess whether physical problems alsocorrelate with distress in cancer survivors of othercancer types. CLINICAL IMPLICATIONS:Clinicians should be alert to possible psychosocialdistress when breast cancer survivors presentwith multiple somatic complaints. Conversely,in addressing high level of distress of thispatient population, the psychosocial interventionteam should take steps to enlist symptoms ofphysical problems. Patients can then be followedwith proper referrals and management.ACKNOWLEDGEMENT OF FUNDING: None.

P2-113

Cervical Cancer Screening for Community-Based

Screening Area

Elif Akar1, Sevda Gursel11Cancer Early Diagnosis, Screning and EducationCenter, Sakarya, Turkey, 2Health Authority,Sakarya, Turkey

BACKGROUND: Pap smear remains the mostsuccessful cancer screening method developed sofar. The cervical cancer-related mortality decreasedby 99% in communities that screening is appliedregularly. It is to emphasize that Pap Smear testhas an important place in early diagnosis of thecervical cancer by working with health centerswhich were selected as pilot area; to raise awarenessabout Pap smear, to increase awareness of im-portance of saving lives in cancer with earlydiagnosis. METHOD: Women whose ages rangein between 35–65 at Kazympa�a, Kemalp�a,Kurtulu�, Erenler were determined from heathcenter from household detection receipts; they wereinvited for screening for cervical cancer withinvitation to people method. The training forpeople to be done screening took place with visualpresentations - projection equipment, computers,



DOI: 10.1002/pon

and power point presentations at KETEM. Smearwas taken from women. RESULTS: 3890 smearswere taken from total 3890 women.2894 Benigncellular changes were found in the pathologyresults of smear tests; diagnosis of atrophy wasfound in 368 of them, of inflammation was foundin 457 of them, and of candida infection was foundin 135 of them.ASCUS finding was found in 28women; they were referred to gynaecologist andthen it was found that they were back to normal intheir smears taken after drug therapy. CIN1finding was found in 6 women; their referral torequired places was made. CIN2-3 was found in 2woman and her referral to gynaecologist wasprovided. CONCLUSIONS: At the end of Smeartests, it was found once again that smear test canhave normal values in line with complaints ofwomen, and smear test of those who has nocomplaint can have doubtful results. Our target isto emphasize once again that Smear test has animportant place for cervical cancer and to increaseawareness. ACKNOWLEDGEMENT OFFUNDING: None.

P2-114

Pattern of Depressive Symptoms among Breast

Cancer Patients

Elizabeth Oluwatoyin Akin-Odanye1, ChiomaChristy Asuzu1, Abiodun Olaniyi Popoola21Department of Guidance and Counselling, Univer-sity of Ibadan, Ibadan, Oyo State, Nigeria, 2Con-sultant Radiation Oncologist, Lagos StateUniversity Teaching Hospital, Ikeja, Lagos State,Nigeria

BACKGROUND: Given the enormity of cancerburden in developing countries and limited re-sources, most oncologists tend to neglect thepsychosocial aspect of cancer concentrating moreon the physical symptoms. This study sought toestablish the presence of depression in breastcancer patients and to determine the level andpattern of depressive symptoms in this group ofpatients. METHOD: Permission for this study wasgranted after submission of a research proposal tothe head of the Cancer Screening Centre atLASUTH. The research data was collected usingthe 21-item Becks Depression Inventory II (BDI-II) administered on 33 purposively selected parti-cipants. The purpose of the study was explained tothe patients. They were assured of high level ofconfidentiality and informed that participating inthe study was voluntary and would not affect theirtreatment in anyway. Those who chose to partici-pate in the study were given an informed consentform and the BDI-II to fill after which they werecollected. RESULTS: Participants in the study hadan age range of 33–96 years and an average age of51. Analysis of data showed that the 33 partici-

pants indicated varying degree of depressivesymptoms: 13 (39.4%) of the respondents hadminimal depression, 12 (36.4%) of them had milddepression, 3 (9.1%) had moderate depression and5 (15.2%) had severe depression. The average BDI-II score yielded 16.09 indicating mild depression.The mean score on the somatic and affectivecomponents yielded 12.24 and 3.85 respectively.This indicates that the depressive symptoms weremore related to the somatic rather than theaffective components of cancer among this sample.CONCLUSIONS: In most developing countrieslike mine emphasis is placed on treating thephysical aspects of an ailment while ignoring thepsychosocial impact of a life threatening disease.Few studies have attempted investigating thepresence of depressive symptoms in cancer patientshere. The findings of this study, confirms thepresence of depressive symptoms in breast cancerpatients which could be extended to other cancerpatients. This underscores the need for the devel-opment of intervention programs that wouldintegrate the psychosocial domain of patients intoroutine cancer care so that cancer patients are notleft to suffer psychologically without due attention.RESEARCH IMPLICATIONS: Since depressivesymptoms have been found to be present in cancerpatients, researchers may seek to investigate thepresence of other forms of psychosocial challengessuch as anxiety, stigmatization, family and inter-personal communication problems and the likethat could be experienced in this population.Identifying the different type of psychosocialproblems in cancer patients will further aidresearch into the development of appropriatepsychological intervention programs thatcould help remedy these psychosocial problems.CLINICAL IMPLICATIONS: In clinical settings,it is important that a multidisciplinary approach beadopted in the treatment of cancer patientsthroughout the cancer care continuum from screen-ing all through to survivorship. This is because thefindings of this study have shown that cancer is notonly a disease of the body but one that affects themind and invariably affects the way the patientthinks and acts towards himself, significant othersand the future. ACKNOWLEDGEMENT OFFUNDING: None.

P2-115

Fatigue, Depression, Sexual Problems and Quality

of Life in Breast Cancer Patients

Sibel Eyigor, Hale Karapolat, Hilal Yesil, YaseminKuzeyli, Ruchan Uslu, Berrin DurmazEge University Faculty of Medicine, Izmir, Turkey

BACKGROUND: Most of the cancer patients wereimproved functional capacity and quality of life(QoL) in time. Consequently, there has been an



DOI: 10.1002/pon

increase in studies on QoL and factors influencing it.However, data pertaining to our country on qualityof life in cancer patients and factors contributing toit is very limited. The purpose of this study was toevaluate fatigue, depression, sexual problems andeffectiveness of these variables on QoL in womenwith breast cancer. METHOD: A total 34 breastcancer patients and 20 age-matched healthy womensubjects were included in the study. The patients andcontrol groups were evaluated through the BriefFatigue Inventory (BFI), Center for EpidemiologicStudies Depression Scale (CESD), Female SexualFunction Index (FSFI), and The European Organi-sation for Research and Treatment of Cancer(EQRTC QoL -C30). RESULTS: When the patientand control groups were compared statisticallysignificant differences were found in the EQRTCQoL -C30 functional scale and CESD (po0.05). Nodifference was found in the other variables betweenthe groups (p40.05). We found significant positivecorrelations between BFI and CSED (r: 0,497)(po0.05). And also EQRTC QoL -C30 symptomscale correlated positively with BFI (r: 0,618) andCESD (r: 0,574) (po0.05). CONCLUSIONS: Ourresults indicate that, functional and psychologicalsituation were affected in breast cancer patients tocompare with healthy groups. The relationship ofquality of life, fatigue, depression and sexualfunctions were found in breast cancer patients. Webelieve that the data presented in this study wouldbe helpful in future studies and rehabilitativeapproaches in our country. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-116

Uncovering Data on the Psychosocial Needs of

Cervical Cancer Patients

Alison Hocking1, Lynette Joubert21Peter MacCallum Cancer Centre, Melbourne,VIC, Australia, 2The University of Melbourne,Melbourne, VIC, Australia

BACKGROUND: There is increasing recognitionof the role social workers play in assisting patientsto identify and address psychosocial needs inoncology settings but there are no evidenceinformed practice guidelines for delivering socialwork interventions with women receiving treat-ment for locally advanced cervical cancer. Wewould like to report on a study being undertaken atthe Peter MacCallum Cancer Centre, Melbourne,which is exploring the needs of women receivingthese targeted treatments. METHOD: A literaturereview was undertaken to identify any key themesand issues. A retrospective audit of 30 consecutivepatient records of women who had undergonecurative intent chemo-radiotherapy was completedutilising a clinical data-mining tool. This tool wasdeveloped using the literature review and identified

demographical data, documented psychosocialneeds and outcomes. The data was thematicallyanalysed and subjected to quantitative descriptiveand inferential analysis. RESULTS: The data-mining study found that the average age of patientswas 56, with almost half living in a rural area.Patients expressed a high level of complex psycho-social need around the domains of accommoda-tion/housing (40%), family/relationship issues(40%) and socio-economic issues; 50% of patientswere in receipt of a pension at the time of diagnosisand 37% required intensive financial assistance. Inthe majority of cases, patients relied heavily on allallied health and supportive care services, with alarge emphasis placed on high level social workinterventions (over 70%). CONCLUSIONS: Pa-tients expressed a high level of complex psychoso-cial need around the domains of housing, sexuality,relationships and socio-economic issues. It isunidentified as to whether or not these psychoso-cial issues are pre-exisiting to diagnosis or treat-ment, however it can be inferred that they have animpact upon patient’s coping abilities, and clin-icians need to be mindful of the burden ofother psychosocial concerns that patients aremanaging. RESEARCH IMPLICATIONS:Further qualitative research is being undertakenwhich is both consumer and carer inclusive,to help determine future service developments.CLINICAL IMPLICATIONS: Outcomes of thisand further research will inform the the develop-ment of targeted social work interventions for thispatient population. ACKNOWLEDGEMENT OFFUNDING: None.

P2-117

How Common is PTSD following a Diagnosis of

Breast Cancer? Pooled Estimate Through Meta-

Analysis

Vijay Delafon2, Alex J Mitchell11University of Leicester, Leicestershire, UK,2Leicestershire Partnership Trust, Leicestershire, UK

BACKGROUND: There is uncertainty about thefrequency of anxiety disorders, and in particularPTSD following a diagnosis of breast cancer.PTSD can be defined by self-report but the goldstandard is a clinical or semi-structured interview.METHOD: We conducted a systematic search andreview for PTSD following breast cancer. Weextracted the primary data and pooled this into ameta-analysis producing a weighted estimate. Weincluded only studies that used an interview basedgold standard; and only those that focussed onbreast cancer. RESULTS: e identified six indepen-dent studies of PTSD in breast cancer involving489 patients. Overall, PTSD occurred in 8.5%(95% CI5 3.1% to 16.1%) of patients. There washigh I2 (inconsistency)5 83.1% (95% CI5 58.8%



DOI: 10.1002/pon

to 90.5%) and possibly publication bias, necessi-tating random effects meta-analysis. The samplesize was also modest. The main limitation of thisstudy however, was the difficulty allowing for timesince diagnosis. CONCLUSIONS: This is the firstsummary estimate of PTSD following breastcancer. From six studies we find that PTSD occursin about 1 in 11 randomly selected breast cancerpatients. Rates may be lower in long-term survi-vors but this has not been examined to date.RESEARCH IMPLICATIONS: PTSD has beeninfrequently examined following breast cancer.Further research is needed, recruiting large repre-sentative samples. The current estimate should beinterpreted with caution. To our knowledge, noresearch in long-term cancer survivors has beenconducted. CLINICAL IMPLICATIONS: PTSDis an important complication of cancer, occurringin approximately 1 in 11 patients when examinedcross-sectionally early after a breast cancer diag-nosis. ACKNOWLEDGEMENT OF FUNDING:None.

P2-118

Developing an Online Psychological Support Inter-

vention for Men with Prostate Cancer

Addie Wootten1,2, Jo Abbott3, David Austin3,Britt Klein3, Anthony Costello1,2, DeclanMurphy1,2, Marita McCabe4, Katherine Chisholm4

1Royal Melbourne Hospital, Parkville, VIC,Australia, 2Australian Prostate Cancer ResearchCentre, Richmond, VIC, Australia, 3National eTher-apy Centre; Swinburne University of Technology,Hawthorn, VIC, Australia, 4Department of Psycho-logym; Deakin University, Burwood, VIC, Australia

BACKGROUND: In order to improve psycholo-gical outcomes for prostate cancer (CaP) patientsaccessible and timely support is required. Thispaper describes the development of a uniqueonline psychological intervention that is accessible,user friendly and engaging to men with CaP andthat reduces the stigma of psychologicaldistress in the context of prostate cancer.Thispaper outlines the process of development, thechallenges of internet based psychological inter-ventions and preliminary data from our rando-mised controlled trial. METHOD: Men withlocalised prostate cancer are being recruitedinto a randomised controlled trial to assess theefficacy of the online psychological intervention.The intervention is a 6 module self-directedCBT-based therapeutic intervention exploringtopics including; emotional responses and psycho-logical distress, coping with incontinence, mascu-linity, intimacy and sexual functioning,relationships, communication, stress management,living with uncertainty and mortality. Participantsare randomly allocated to one of three groups.

Group 1: online intervention. Group 2: onlineintervention plus moderated bulletin board.Group 3: moderated bulletin board only. Fiftyparticipants will be accrued to each arm of thestudy; total expected N5 150. RESULTS:This paper will outline the process of developingthe online intervention including the materialsdeveloped, the challenges of producing a self-directed program for use over the internet andthe creative challenges of developing an appealingand engaging platform for men to process theirexperiences of prostate cancer. Preliminary resultswill be presented and were not available at thetime of abstract submission. CONCLUSIONS:Engaging men in accessing and utilising psy-chotherapeutic support is a challenge for manyreasons. Often men diagnosed with prostate cancerare not routinely offered psychological support andmany men turn to the internet to access informa-tion and support from peers. Furthermore, there isstill an element of stigma associated with accessingpsycho-social support services for many men. Thisstudy provides an evaluation not only of theefficacy of the developed psychological interventionbut also whether men might be willing to accesssupport in this environment. RESEARCHIMPLICATIONS: We hope that this programnormalises the emotional and psychological re-sponses men with prostate cancer routinelyexperience and facilitates improved willingness toaccess support. This study has the potential toprovide an evidenced-based self-directedpsychological intervention over the internet thatenhances the emotional and psychologicalwell-being of men with prostate cancer in an easyto access, engaging and innovative medium.CLINICAL IMPLICATIONS: This study pro-vides a first-step in breaking down the barriers toaccessing support for men with prostate cancer. Itis anticipated that this program will allow men tounderstand the psychological processes that maybe influencing their mood state and may alsoencourage men to access more individualisedpsycho-therapeutic interventions in the future.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was generously funded through jointfunding from beyondblue: The National DepressionInitiativeand The Prostate Cancer Foundation ofAustralia (PCFA).

P2-119

The Effectiveness of Spirituality Intervention by

Group Method on the Increase of Hope, Happiness

and Life Satisfaction in Women Surviving from

Breast Cancer

Rahele Fallah1, Mahmoud Golzari2, MahboobehDastani2, Seyed Mahdi Mousavi1, Ali RezaZahiroddin3, Farah Lotfi Kashani1, MohammadEsmaeel Akbari1



DOI: 10.1002/pon

1Cancer Research Center/Shahid Beheshti MedicalSciences University, Tehran, Iran, 2Faculty ofPsychology and Educational Sciences of AllameTabatabaei University, Tehran, Iran, 3BehavioralSciences Research Center/Shahid Beheshti Univer-sity, Tehran, Iran

BACKGROUND: Existence of a positive andsignificant relation between spirituality andhope, happiness and life satisfaction is confirmedin many researches, but the effectiveness ofspiritual interventions in improving mentalstrengths or decrease the mental disorders has beenless dealt with . The present study is conducted inorder to determine the effectiveness of spiritualitygroup intervention on the increase of hope, lifesatisfaction and happiness in women survivingfrom breast cancer. METHOD: This research is thesemi-experimental study including 60 patients incase and control voluntary selected groups. Thesubjects participated in eight psycho educationalgroup sessions based on Islamic perspective spiri-tuality. In this research, spiritual experience ques-tionnaire of Ghobari et al. (2005, Iran), hopeSnyder (Lopez et al., 2000), Oxford HappinessQuestionnaire (Argyle et al., 1989), Dinner lifesatisfaction questionnaire (Dinner et al., 1985), andGHQ28 were used as measurement tools. Statis-tical analysis of data was performed usingdescriptive and inferential statistics through Cov-ariance and SPSS software. RESULTS: Theextracted data showed that the difference betweencase and control groups in hope, life satisfactionand happiness variables was significant (Po0.05).CONCLUSIONS: Spirituality intervention canincrease hope, happiness and life satisfaction inwomen surviving from breast cancer. Therefore, itis necessary to consider spirituality and its integra-tion in psychotherapy as an important issuetowards comprehensive plans in treatment, pallia-tive and supporting care in breast cancer patients.ACKNOWLEDGEMENT OF FUNDING:Cancer Research Center Shahid Beheshti Univer-sity of Medical Sciences.

P2-120

Spirituality, Hope and Mental Health in Breast

Cancer Patients

Rahele Fallah1, Mahmoud Golzari2, MahboobehDastani2, Farah Lotfi Kashani1, Ali RezaZahiroddin3, Nahid Nafici1, Seyed MahdiMousavi1, Mohammad Esmaeel Akbari11Cancer Research Center/Shahid Beheshti MedicalSciences University, Tehran, Iran, 2Faculty ofPsychology and Educational Sciences, AllameTabatabai University, Tehran, Iran, 3BehavioralSciences Research Center, Shahid BeheshtiUniversity of Medical Sciences, Tehran, Iran

BACKGROUND: Breast Cancer as the firstprevalent malignant disease in Iranian womanaffected the mental health and psychosocial beha-viors. In the other hand the Hope and Spiritualitywill improve Quality and may even Quantity of lifein Breast Cancer (BC) Patients. In this study therelation of mental health, hope and spirituality inBC cases are investigated. METHOD: This is across sectional, correlated study which is done in 91BC patient with at least 8 months after diagnosisand age between 30-60 years old, the pathologicalstages were I-II-III and stage IV cases wereexcluded. The questionnaires were GHQ-28, formantel health; Schneider for Hope and Spiritualexperience of Mr Ghobari and coworkers forevaluating the Spiritual effect. Questionnaires werecompleted for all cases. The data were analyzed bySPSS sops software. RESULTS: Mental healthsignificantly was correlated with hope, anxiety andsleep disorders. also had negative relation withhope (Po0.05); spirituality was significantly corre-lated with hope and mental health. The patientswith acceptable meaning of life had negativerelation with mental health disorders. CONCLU-SIONS: Hope and mental health improvement willaffect the quality and even quantity of life in BCpatients and should be in more Consideration intheir management. ACKNOWLEDGEMENT OFFUNDING: Cancer Research Center/ShahidBeheshti Medical Sciences University.

P2-121

Islamic Perspective of Spiritual Aspects in Cancer

Care

Mohammad Al-ShahriKFSHRC, Riyadh, Saudi Arabia

The physical, psychosocial, and spiritual aspectsof human life interact to result in the modelingof a person’s wellbeing. Delivery of qualitycare to cancer patients and their families calls forobserving their cultural BACKGROUND: andaddressing their spiritual concerns and preferences.For Muslim patients, religion is considered theexpression of spirituality. Islam is a belief systemand a way of living. It is the reference throughwhich Muslims commonly see, interpret and valuethings, including health, sickness, and death.This paper discusses the spiritual aspects thathealthcare professionals need to be aware of whencaring for Muslim patients with cancer.ACKNOWLEDGEMENT OF FUNDING:None.

P2-122

Faith among Patients with Metastatic Renal Cell

Carcinoma in a Secular Society



DOI: 10.1002/pon

Yoon Frederiksen1,2, Sidsel Bekke-Hansen2,Christina Gundgaard Pedersen1,2, IngeborgFarver1, Heidi Frølund Pedersen1,2, Kirsten Fode3,Frede Donskov3, Robert Zachariae1,21Psychooncology and Health Psyhology ResearchUnit, Dept. of Oncology, Aarhus UniversityHospital, Aarhus, Denmark, 2Department ofPsychology, Aarhus University, Aarhus, Denmark,3Department of Oncology, Aarhus UniversityHospital, Aarhus, Denmark

BACKGROUND: Little is known about differ-ences between religious, spiritual, and existentialconcerns in secular societies, and about cancerpatients’ perceptions of the influence of their faithon their Quality-of-Life (QoL) and the course ofthe disease. The present study examined theprevalence of religious and spiritual faith, theperceived influence of faith on QoL and cancer,and existential, spiritual, and religious concernsafter diagnosis in a sample of Danish metastaticrenal cancer patients. METHOD: Seventy patientswith stage IV metastatic renal cell carcinomatreated with tyrosine kinase inhibitors at a Danishuniversity hospital oncology unit (response rate61%, 72.9% male, age 43–85) completed baselinequestions regarding: Denomination, faith in God,faith in a higher spiritual power, religious, spiritual,and existential concerns since the time of diagnosis,and the perceived influence of their faith on QoL inrelation to the disease and the cancer itself. Patientsanswering ‘yes’ to having faith in God or a higherspiritual power were considered unambiguousbelievers, whereas patients answering ‘a little’ wereconsidered ambiguous believers. RESULTS: Themajority (85.7%) were Christians with 37.7%reporting unambiguous faith in God, 20.8%ambiguous faith, and 37.7% no faith (3.9%missing). Unambiguous faith in a higher spiritualpower was reported by 13%, 16.9% reportedambiguous faith, and 64.9% no faith (5.2%missing). Altogether 26% reported more religious,7% more spiritual, and 13% more existentialconcerns since diagnosis. Of believers in God,42.9% experienced some degree of positive influenceof their faith on their QoL, whereas the number was33.8% for the influence on the disease itself. Forbelievers in a spiritual power, the numbers were23.4% and 18.2%, respectively. CONCLUSIONS:The preliminary results of this study indicate thatsome degree of religious faith is prevalent amongpatients with metastatic renal cancer in a secularsociety. The patients reported more religious con-cerns following the diagnosis, and the perceivedinfluence of faith on QoL and cancer was found tobe higher among believers in God compared tobelievers in a higher spiritual power. RESEARCHIMPLICATIONS: It may be important in futurestudies to distinguish between faith in God and faithin a higher spiritual power when exploring the role

of faith for QoL and the course of disease.CLINICAL IMPLICATIONS: Faith and religiousconcerns may become more important to patientswhen the aim of cancer treatment is no longercurative but palliative. The convictions and con-cerns associated with faith could have implicationsfor physician-patient communication and treatmentadherence. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-123

The Effect of Spiritual Therapy for Improving the

Quality of Life of Women with Breast Cancer: A

Randomized Controlled Trial

Najmeh Jafari1, Ziba Farajzadegan1, AhmadrezaZamani1, Fatemeh Bahrami2, Hamid Emami3,Amir Loghmani11Community Medicine Department, IsfahanUniversity of Medical Sciences, Isfahan, Iran,2Consultation Department, Psychology School,Isfahan, Iran, 3Radiotherapy Department, IsfahanUniversity of Medical Sciences, Isfahan, Iran

BACKGROUND: Diagnosis of breast cancer is adevastating experience for a woman. Also treat-ment such as radiation therapy may cause psycho-social distress in these patients and threatened theirquality of life. Among several approaches, spiri-tuality has been shown to be significantly asso-ciated with improving the quality of life. The aimof this study was to assess the role of spiritualtherapy intervention in improving the quality oflife of patients with breast cancer undergoingradiation therapy. METHOD: This was a rando-mized controlled trial study that was undertaken ina radiotherapy clinic, Isfahan, Iran. BetweenOctober 2010 and February 2011, 68 patients withbreast cancer were randomized to either spiritualtherapy in addition of and control group whoreceived routine management and educationalprograms. Before and after 6 weeks spiritualtherapy sessions, the quality of life was evaluatedusing Cancer quality-of-life questionnaire (QLQ)-C30 and breast cancer specific questionnaire (BR-23). MANCOVA, T-test and Paired T-test wasused for analysis using Predictive Analytic SoftWare (PASW) version 18. RESULTS: In all sixtyfive patients actually completed the week 6 assess-ments and were evaluated for the outcome. Aftersix spirituality sessions, the mean Global healthstatus score/QOL reached from 44.37(SD5 13.03)to 68.63(SD5 10.86). (p5 0.00). There was astatistically significant difference in all functionalscales of EORTC QLQ-C30 after intervention.(po0.05). CONCLUSIONS: The results of thistrial showed that the spiritual therapy programcan improve the overall QOL of women withbreast cancer, indicated that this programshould be adopted in comprehensive care programs



DOI: 10.1002/pon

for women with breast cancer. RESEARCHIMPLICATIONS: To provide some theoreticalimplications of spiritual therapy in imroving thequality of life of patients with breast cancer.CLINICAL IMPLICATIONS: The results of thisstudy showed that this program should be adoptedin comprehensive care programs for women withbreast cancer. ACKNOWLEDGEMENT OFFUNDING: This study was founded by researchchancellor of Isfahan University of MedicalSciences as a research project numbered 389319.

P2-124

Reliability and Validity of the Arabic Translation

of the Functional Assessment of Chronic Illness

Therapy - Spiritual Well-Being

Mark Lazenby1, Jamal Khatib21Yale University School of Nursing, New Haven,CT, USA, 2King Hussein Cancer Center, Amman,Jordan

BACKGROUND: The Functional Assessment ofChronic Illness Therapy - Spiritual Well-being(FACIT-Sp) was developed in the United Statesto assess quality of life in relation to spirituality.We translated the FACIT-Sp into Arabic andassessed its reliability and validity among a diversesample of Arab cancer patients. We present thedata on the psychometric properties of thattranslation. METHOD: Three native Arabicspeakers translated the FACIT-Sp into Arabic;their translations were merged. The merged trans-lation was back-translated and checked against theEnglish version. After consulting an Arabic-fluentlinguist, we arrived at a penultimate translation.We cognitively debriefed 30 cancer patients at theKing Hussein Cancer Center, Amman, Jordan, onthe penultimate translation. Based on these results,we arrived at a final translation. Using the finaltranslation, 205 cancer patients (73% Muslim, 7%Christian, 20% unknown religion) with variouscancers at various stages of disease in treatment atthe King Hussein Cancer Center, Amman, Jordan,completed the FACIT-Sp. RESULTS: The mean(SD) for the FACIT-Sp was 89.89 (11.3); Cron-bach’s alpha reliability coefficient, an evaluation ofinternal consistency, was .83. Means (SD) andCronbach’s alpha for subscales were: Physicalwell-being (PWB) 17.3 (5.8) and .80; Social/family well-being (SWB) 18.5 (4.2) and .80;Emotional well-being (EWB) 16.8 (5.2) and .80;Functional well-being (FWB) 17.4 (5.3) and.83; Spiritual well-being (SpWB) 37.4 (6.7) and.83. Factor loading confirmed PWB, SWB, EWB,and FWB as subscales and showed that the 12questions of the SpWB subscale could be brokendown into three additional subscales: Peace, Mean-ing, and Faith. CONCLUSIONS: Consistent withpsychometric testing of the FACIT-Sp in English

and other languages, the Arabic version of theFACIT-Sp is a psychometrically sound measure ofspiritual well-being for Arabic-speaking cancerpatients. Factor analysis confirms the 5 majorsubscales of the FACIT-Sp (PWB, SWB, EWB,FWB, and SpWB), and the three subscalesof the 12-question SpWB subscale. RESEARCHIMPLICATIONS: The FACIT-Sp is a useful toolfor further research on the role of spiritual well-being in the quality of life of Arabic-speakingcancer patients. To further explicate the role ofreligion in spiritual well-being, future research mayassess spiritual well-being with the FACIT-Sp inthe context of patients’ religion-specific behaviors.CLINICAL IMPLICATIONS: The Arabic versionof the FACIT-Sp is a valid and sound tool forpsycho-oncology clinicians to use to assess thespiritual well-being of patients, thus makingpossible the assessment of spiritual well-being aspart of the routine cancer care of patients whospeak Arabic. ACKNOWLEDGEMENT OFFUNDING: Lazenby received a FulbrightResearch Scholarship to complete this work.

P2-125

Studying the Difference in Religious Orientation

among Cancer Patients, Undergone Surgery

Patients and Healthy Persons

Nasim Tavassoli, Hadi Bahrami EhsanUniversity of Tehran, Department of Psychology,Tehran, Iran

BACKGROUND: This research has been aimed toassess the dimensions of religious tendencies inconfronting refractory diseases like cancer andtraumatic events like surgeries. METHOD: 60cancer patients, 60 undergone surgery patients aswell as 60 healthy people were sampled randomlyin this research. It was attempted to have homo-geneous groups. To assess religious tendencies,Bahrami Ehsan religious tendency scale was usedwhich has been validated in Iran and includes 64questions. RESULTS: Variance analysis and posthock evaluation indicate that there is a significantdifference in religious orientation within thegroups. It was revealed that religious tendenciestend to be higher in cancer patients than undergonesurgery ones. Also the average religious disorgani-zation score in the surgery group is found to behigher than both patient and control groups.However the average religious valuation score issignificantly higher than surgery and controlgroups. Regarding gratification cancer patients arescored higher than the two other groups. CON-CLUSIONS: Based on the findings it seems somepsychological believes are formed to confrontrefractory diseases like cancer. At the same timemore serious questions arise when it comes tothinking about religion and death. RESEARCH



DOI: 10.1002/pon

IMPLICATIONS: Based on these findings theaverage score of the religious orientation sub-measures like religious disorganization, religiousevaluation and religious gratification are differentwithin the groups and calls for more researchstudying various religious orientation dimensions.CLINICAL IMPLICATIONS: According toreligious instructions it seems praying during thesurgery and orthodox treatments of cancerpatients prove helpful in alleviating thepatients. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-126

The Long-Term Health-Related Quality of Life of

Glioma Patients: An Observational Study

Neil Aaronson1, Martin Taphoorn2, Jan Heimans2,Tjeerd Postma2, Chad Gundy1, Guus Beute3, BenSlotman2, Martin Klein21The Netherlands Cancer Institute, Amsterdam, TheNetherlands, 2The VU University Medical Center,Amsterdam, The Netherlands, 3St. ElizabethHospital, Tilburg, The Netherlands

BACKGROUND: To investigate the generic andcondition-specific health-related quality of life(HRQL) of low-grade glioma patients (LGG) inthe period after completion of primary treatment.METHOD: 195 LGG patients, diagnosed, onaverage, 5.6 years earlier, were comparedwith 100 hematological (non-Hodgkin lymphomaand chronic lymphatic leukemia) cancer patients(NHL/CLL) and 205 general populationcontrols, matched on age, sex and educationallevel (healthy controls). Generic HRQL wasassessed with the SF-36 Health Survey, andcondition-specific HRQL with the Medical Out-comes Study Cognitive Function Questionnaireand the EORTC Brain Cancer Module. Objectiveneurocognitive functioning was assessed with astandardized battery of neuropsychological tests.RESULTS: No statistically significant differenceswere observed between the LGG and NHL/CLLpatients in SF-36 scores. The LGG patients scoredsignificantly lower than the healthy controls on 7 ofthe 8 scales and on the mental health componentscore of the SF-36. Approximately one-quarter ofthe LGG patients reported serious neurocognitivesymptoms. Female gender, epilepsy burden, andnumber of objectively assessed neurocognitivedeficits were associated significantly with bothgeneric and condition-specific HRQL. Clinicalvariables, including time since diagnosis, tumorlateralization, extent of surgery, and radiotherapydid not show a consistent relationship with HRQL.CONCLUSIONS: LGG patients experience sig-nificant problems across a broad range of HRQLdomains, many of which are not condition-specific.

However, the neurocognitive deficits and epilepsythat are relatively prevalent among LGG patientsare associated with negative HRQL outcomes, andthus contribute additionally to the vulnerability ofthis population of cancer patients. RESEARCHIMPLICATIONS: Our results indicate that LGGpatients, on average, experience significant HRQLdeficits, even years after the initial diagnosis andtreatment. Future research is needed to identify themost vulnerable subgroups of patients, as well asthose who appear to be particularly resilient.CLINICAL IMPLICATIONS: These results sug-gest the need for tailored survivorship care andrehabilitation services for LGG patients. Suchservices should be multidisciplinary in nature, andshould be subjected to rigorous evaluation todetermine their efficacy in ameliorating relevantHRQL problems. ACKNOWLEDGEMENT OFFUNDING: This study was supported financiallyby the Dutch Cancer Society.

P2-127

Examining Health-Related Quality of Life and

Access to Health Care Outcomes among Chinese,

Korean, and Filipino-American Breast Cancer

Survivors

Kimlin Ashing-Giwa1, Jung-won Lim2, LucyYoung3, Sophia Yeung41City of Hope National Medical Center, Duarte,CA, USA, 2Mandel School of Applied SocialSciences Case Western Reserve University, Cleve-land, OH, USA, 3Herald Cancer Association, SanGabriel, CA, USA, 4City of Hope National MedicalCenter, Duarte, CA, USA

BACKGROUND: Breast cancer incidence isincreasing among all Asian-American subgroups.Yet, few studies report on their survivorshipoutcomes. This study intends to examine health-related quality of life (HRQOL) and access tohealth care outcomes among Asian-Americanethnic subgroups. METHOD: Chinese- (n5 107),Korean- (n5 40), and Filipino- (n5 30) Americanbreast cancer survivors (BCS) were recruited fromthe hospitals and community health clinics. Eligibleparticipants included women within 6 month to 5years of being diagnosed with breast cancer. Thestandardized HRQOL outcome measures wereused to assess HRQOL and survivorship outcomes.Access to health care outcomes were measured byitems assessing diagnostic and therapeutic caredelays and satisfaction with health care. RE-SULTS: Of all FACT-G subscales, emotionalwell-being (M5 63.3; SD5 20.5) were the highest,followed by functional and physical well-being.Filipino-Americans (M5 64.4; SD5 13.3) showedthe best HRQOL while Koreans (M5 53.8;SD5 9.2) showed the poorest scores. SF-36and BSI-18 scores showed similar results as the



DOI: 10.1002/pon

FACT-G, with Koreans exhibiting poorestphysical and mental health status. In terms ofaccess to health care, Korean-Americans were lesslikely to delay to obtain a medical diagnosis afterfinding the lump/abnormality; yet they reportedthe longest days in therapeutic care delay. Diag-nostic care delay days showed significant differ-ences by length in living in the U.S. (F5 3.318;po0.05). CONCLUSIONS: Overall, Asian-Amer-ican BCS showed significant differences in demo-graphic information, indicating that Filipinos aremore likely to be educated, wealthy, and employedin a professional job compared to Chinese orKorean women. In HRQOL, findings indicatemoderate to favorable outcomes. HRQOL andaccess to health care outcomes for Asian-Amer-icans are probably influenced by socioeconomicstatus and cultural contexts. Therefore, in order tofurther understand the role of ethnic, cultural andsociologic influences diverse Asian groups must beincluded to detail a comprehensive and accuratereport on survivorship outcomes of Asian-Amer-icans. RESEARCH IMPLICATIONS: These re-sults indicate moderate to unfavorable HRQOLoutcomes for Asian-American BCS. Specifically,ethnic differences were noted with Korean-Amer-icans reporting the least favorable outcomesamong all other Asian subgroups. HRQOL andaccess to health care outcomes seem to besignificantly influenced by socioeconomic statusand cultural contexts. CLINICAL IMPLICA-TIONS: Regarding diagnostic care delay, Chinese-Americans were less likely to wait for theirdoctors to begin cancer treatments, followed byFilipino-Americans. Filipino-Americans reportedthe best score in satisfaction with care. In order tounderstand the role of ethnic, cultural and socio-logic influences, diverse Asian ethnic subgroupsmust be included to detail a comprehensive andaccurate report on survivorship outcomes ofAsian-Americans. ACKNOWLEDGEMENT OFFUNDING: A Grant from the Susan G. Komen(POP0601091).P2-128

Examining Demographic and Socio-Ecological

Influences on Depressive Outcomes among Latina

American Breast Cancer Survivors

Kimlin Ashing-GiwaCity of Hope National Medical Center, Duarte, CA,USA

BACKGROUND: The incidence and prevalenceof breast cancer among Latina-Americans areincreasing. Further, recent studies documentpoorer survivorship and health related quality oflife (HRQOL) outcomes among Latina-Americanbreast cancer survivors (BCS). This study examinespredictors of depressive symptomatology from asocio-ecological and patient-centered paradigm

based on the Contextual Model of HRQOL, anddetails the contributions of demographic variables,cancer-related medical factors, physical function-ing, socio-ecological burden, and socio-culturaldisplacement on depressive symptoms. METHOD:This study included 232 Latina-American BCS: 95were English language proficient and 137 werelimited English language proficient. Survivors wererecruited via mixed methods sampling that in-cluded cases ascertained from the CaliforniaCancer Registry, City of Hope and other hospitalregistries. Chi square and t-test analyses were usedto compare differences on predictor and outcomevariables by English language proficiency andCES-D scores. Hierarchical multiple regressionanalyses assessed the effects of demographic vari-ables, cancer-related medical factors, physicalfunctioning, socio-ecological burden, and socio-cultural displacement on depressive symptoms asmeasured by the CES-D. RESULTS: 53% of thesample exhibited elevated depression (CES-D16).Limited English proficient BCS had lower educa-tion level, lower household income, were less likelyto receive breast conserving surgery, and hadelevated depression. Depressive symptoms werepredicted by education, physical functioning, socialsupport, family stress, functional stress, socialfunctioning, and English language proficiency.The final predictive model examining explained66% of the variance. CONCLUSIONS: Findingssuggest that Latina-American BCS experienceunfavorable psychological outcomes, ethnic varia-bility in depressive symptoms based on languagedifferences exist, and that broader ecological andsocial components influence depressive symptoma-tology. Given the unequal burden of cancer and theneed to better address cancer care for the wholeperson, psychological and supportive care researchand practices should consider both clinical andsocio-ecological contexts to equalize and improvecancer outcomes. This study can inform futureresearch and clinical practice aiming to decreasedisparities in psychosocial outcomes, symptommanagement, and improve supportive care.RESEARCH IMPLICATIONS: Given the un-equal burden of cancer and the need to betteraddress cancer care for the whole person, clinicaland HRQOL research should examine the medical,psychological and socio-ecological contexts tomore comprehensively investigate the contributorsand predictors of HRQOL and survivorship out-comes. CLINICAL IMPLICATIONS: This studycan inform future research and clinical practiceaiming to decrease disparities in psychosocialoutcomes and symptom management, and improvesupportive care. Our findings suggest that medical,psychological and supportive care practices mustconsider both medical characteristics and thepatient lived experiences to equalize and improvecancer outcomes for all. ACKNOWLEDGE-



DOI: 10.1002/pon

MENT OF FUNDING: Department of Defense(DOD).

P2-129

Change in Exercise Activity and Quality of Life in

Breast Cancer Survivors (BCS): A Longitudinal

Evaluation

Yasmin Asvat1,2, Michael Andrykowski3, PaulJacobsen1,21University of South Florida, Tampa, FL, USA,2H. Lee Moffitt Cancer Center, Tampa, FL, USA,3University of Kentucky College of Medicine,Lexington, KY, USA

BACKGROUND: Cross-sectional data suggestexercise is associated with enhanced quality of lifein BCS. However, little is known about the impactof longitudinal change in exercise activity onquality of life in the survivorship phase. This studyhypothesized that BCS who increase exerciseactivity from post-treatment to three years laterwould report better quality of life relative to thosewho decrease exercise activity. Treatment status(chemotherapy or radiotherapy) was explored as amoderator of this effect. METHOD: Participantswere 180 BCS (age M5 49.8; SD5 8.3) treatedwith radiotherapy only (RT) or chemotherapy,with or without radiation (CT). Self-report mea-sures were completed six months and three yearspost-treatment. Quality of life was assessed withthe Medical Outcomes Study SF-36; compositescores for Physical (PCS) and Mental (MCS)health were computed. Exercise was assessed withthe Godin Leisure-Time Exercise Questionnaire;data were converted to weekly metabolic equiva-lents (METS). To perform planned analyses, BCSwere categorized into those who increased METS(n5 90; M increase5 62.29, SD5 64.44) and thosewho decreased METS (n5 90; M decrease5 54.17,SD5 65.94) from six months to three years post-treatment. RESULTS: On average, METS at sixmonths (M5 63.62; SD5 71.60) and three years(M5 67.68; SD5 74.39) post-treatment were com-parable (p5 .47). ANCOVAs controlling for qual-ity of life at six months post-treatment indicated astatistically significant main effect for change inMETS on both Physical (p5 .03) and Mental(p5 .01) health three years later. The hypothesiswas supported: BCS who increased their METSover time reported better Physical and Mentalhealth three years later (PCS M5 48.51,SD5 9.04; MCS M5 55.33, SD5 8.66) relativeto BCS who decreased their METS over time(PCS M5 45.66, SD5 11.57; MCS M5 52.35,SD5 9.43). There was no main effect of treatmentstatus for either Physical or Mental health(ps 4.05). CONCLUSIONS: The findingssupport past research on the benefits of exercisefor quality of life in BCS and extend our

understanding of how longitudinal change inexercise activity impacts quality of life in theearly survivorship phase. For BCS, increases inexercise activity during the survivorship phasecontribute to enhancements in long-termquality of life. This effect did not differ based onthe type of treatment received (chemotherapy vs.radiotherapy). RESEARCH IMPLICATIONS:Future research should examine patterns ofchange in exercise activity and its impact onquality of life in the late survivorship phase (i.e.,5, 10, and 15 years post-treatment). Also,future research should investigate factors thataccount for changes in exercise activity overtime (e.g., symptom burden, motivationalvariables). CLINICAL IMPLICATIONS: Thesefindings suggest that encouraging BCS toincrease their exercise activity during the earlysurvivorship phase may be an importantcomponent of cancer survivorship care. Specifi-cally, increasing exercise activity should bea component of interventions designed tohelp BCS optimize their long-term quality of lifeoutcomes. ACKNOWLEDGEMENT OFFUNDING: This research was funded by agrant from the National Cancer Institute(R01 CA82822).

P2-130

Patients Perception of Bodily Transformations after

Cancer Treatment is a Predictor of Future Well-

Being

Mikkel Auning-Hansen1, Mimi Mehlsen1, AndersB. Jensen2, Robert Zachariae11Psychooncology Research Unit, Aarhus, Denmark,2Dept. of Oncology, Aarhus University Hospital,Aarhus, Denmark

BACKGROUND: Any cancer diagnosis andtreatment causes psychological and physical strainsthat permanently change the patient’s perceptionand relationship to their own body. Whenundergoing cancer treatment, cancer patients maybegin to feel unattractive, dissociated or evenalienated from their own body leading to feelingsof distress and decreased well-being. The aim of thestudy was to examine cancer patients’ perceptionsof their body as a predictor of their well-being.METHOD: As part of a larger study, 515 patientswith various cancers and disease stages (mean age:59 years; 34% men) were recruited from a Danishoncological department (response rate: 71%).Baseline measures included demographic variables,cancer type, the WHO Well-being Scale (well-being), and four body image items: (BI1) ‘‘Mybody is not as strong or beautiful as before’’; (BI2)‘‘I experience my body in a different way’’; (BI3)‘‘My self-image as a person has changed’’; (BI4) ‘‘Iexperience my body as an alien or an enemy’’.



DOI: 10.1002/pon

Measures at an 8-month follow-up included: typeof cancer treatment, and well-being. RESULTS: Atotal of 374 patients (73%) completed the follow-up questionnaire. The most common cancers werehead and neck cancer among men (19.2%) andbreast cancer among women (55.2%). Poor body-image correlated inversely with well-being atfollow-up in both men and women (r:�0.19 and0.32, po0.01). Multiple regression showed thatamong women, but not men, items BI1(Beta5 0.154, po0.05) and BI2 (Beta5 -0.232,po0.01) predicted significant lower well-being aftercontrolling for age, treatment, and baseline well-being. Female skin-, bladder-, thymus-, and uteruscancer patients and male prostate-, colon andtesticular cancer patients had more negative body-image than other cancer patients. CONCLU-SIONS: Patients who reported a higher degree ofnegative feelings towards their body after cancertreatment displayed greater reductions in well-being 8 months later. The feeling of not feeling‘‘strong and/or beautiful’’ does not only reflectpoor integration of the bodily transformation thepatients have undergone during cancer treatment,but also predicts future well-being. Patients treatedfor gender specific cancers were especially suscep-tible to feeling alien or dissociated from their body.RESEARCH IMPLICATIONS: This study showsthat well-being may be significantly affected by thecancer patients’ perception and integration of theirbodily transformation after cancer treatment.Further research into factors influencing theintegration of patient’s perception of theirbodily transformation after treatment is needed.CLINICAL IMPLICATIONS: Overall well-beingis a protective factor against distress and animportant aspect of patients’ Quality-of-Life.Helping cancer patients undergoing treatmentfeel more comfortable and adapt to the bodilychanges experienced after disease and treatmentmay improve their long-term well-being.ACKNOWLEDGEMENT OF FUNDING: None.

P2-131

Weight Gain among Breast Cancer Survivors and its

Association to Emotions of Shame and Guilt

Jennifer Brunet, Catherine SabistonMcGill University, Montreal, QC, Canada

BACKGROUND: Examination of the antecedentsand protective factors of body- and weight-relatedshame and guilt is needed to prevent maladaptivehealth outcomes. Considering the stigma asso-ciated with being overweight/obese, weight gainin breast cancer survivors (BCS) may heightenshame and guilt. However, engaging in healthybehaviors may protect BCS from experiencingthese emotions. The relationships between post-treatment weight change and shame and guilt, and

the moderating role of physical activity and healthyeating were examined in BCS. METHOD: BCS(N5 125; Mage5 55.37 years, SD5 10.79) com-pleted self-report surveys shortly after the comple-tion of treatment (5 months) and six months later.Weight and height were recorded to the nearesthalf-kilogram (kg) and centimeter. Body massindex (BMI) was computed as weight(kg)/height(m)2 and weight change as weight at studyentry minus weight six months later. Analysesinvolved descriptive statistics and multiple hier-archical regression analyses, controlling for ageand weight status (i.e., BMI) at study entry.RESULTS: Participants reported lower levels ofshame (M5 2.19, SD5 .89) than guilt (M5 2.69,SD5 .97). The average BMI at study entry was25.94 (SD5 5.55) kg/m2. Of the participants whogained weight, the average gain was 2.23(SD5 1.68) kg.Weight status was significantlyassociated with shame (b5 .38) and guilt (b5 .22)in separate models. However, weight change wasnot significantly associated with shame or guilt,and physical activity and healthy eating (i.e., fruit/vegetable consumption) were not significant mod-erators. CONCLUSIONS: Findings provide evi-dence that weight status is predictive of negativeself-conscious emotions; however, weight changeafter treatment does not appear to further heightenexperiences of shame and guilt over six months.Women may partly attribute their initial weightstatus to long-term poor lifestyle habits and afailure to manage their weight (i.e., internalattribution), whereas they may attribute theirweight change to treatment side effects (i.e.,external attribution). Holding oneself responsiblefor one’s weight status may serve as a stimulus forself-conscious emotions. Furthermore, it appearsthat engaging in healthy behaviors is not protectiveagainst experiencing shame and guilt. RESEARCHIMPLICATIONS: Although a weight gain of2.23 kg may have health consequences, it could bereasoned that changes of this magnitude are notconsiderable enough to elicit shame and guilt in theimmediate period after treatment. Further researchshould focus on understanding the mechanismsexplaining the positive associations between weightstatus (i.e., BMI) and negative self-consciousemotions. CLINICAL IMPLICATIONS: Thesefindings are important because they provide abetter understanding of the psychological conse-quences of being overweight and/or obese as aBCS. An important step in the care of BCS wouldbe to develop interventions aimed at improvingbody image, particularly in overweight and obeseBCS, to reduce feelings of shame and guilt.ACKNOWLEDGEMENT OF FUNDING: Thefirst author is supported by a Social Sciences andHumanities Research Council doctoral fellowshipand a Psychosocial Oncology Research Trainingfellowship; the study was supported by a Canadian



DOI: 10.1002/pon

Institutes of Health Research grant awarded to thesecond author.

P2-132

Examining the Relationship between Pain and

Mental Health among Breast Cancer Survivors and

the Mediating Role of Physical Activity

Shaunna Burke1, Jennifer Brunet2, CatherineSabiston21University of Leeds, Leeds, West Yorkshire, UK,2McGill University, Montreal, QC, Canada

BACKGROUND: Surgical procedures and adju-vant therapies for breast cancer are often related toexperiences of pain symptoms that adverselyimpact quality of survivorship. There is limitedevidence examining the mental health outcomes ofpain among breast cancer survivors, and possiblemediators of the associations. This study examinedthe relationships between pain and mental healthoutcomes of depression and affect in this popula-tion. The mediating role of physical activity wasalso tested. METHOD: Recently treated breastcancer survivors (N5 145) completed self-reportmeasures of pain symptoms at baseline, wore anaccelerometer for 7 days, and reported levels ofdepression symptoms and negative and positiveaffect three months later. Hierarchical linearregression analyses, controlling for personal andcancer-related characteristics, were used to test theassociations between pain and each mental healthoutcome, as well as the mediation effect of physicalactivity. RESULTS: Pain positively predicteddepression symptoms [F(6,139)5 4.31, po0.01,R2 5 0.15] and negative affect[F(5,140)5 4.17,po0.01, R2 5 0.13], and negatively predicted posi-tive affect [F(6,139)5 2.12, p5 0.03, R2 5 0.08].Physical activity was a significant (po0.01) partialmediator of the relationships between pain anddepression and between pain and positive affect.CONCLUSIONS: Results highlight the adverseimpact that pain symptoms have on breast cancersurvivors’ mental health over time. Pain wasinversely related to positive affect and positivelyrelated to negative affect and depression. Further-more, physical activity partially mediated therelationships between pain and depressive symp-toms and positive affect. While existing interven-tion strategies may involve the use of supportgroups, individual therapies, pharmacotherapy,and/or proprioceptive enhancement, physicalactivity may also be an effective strategy to helpalleviate the negative mental health outcomesassociated with pain among breast cancer survi-vors. RESEARCH IMPLICATIONS: The resultsof the present study underscore the importance ofexamining the impact of physical pain on breastcancer survivors’ mental health. They also high-light the need to further investigate the hypothesis

that decreased physical activity is one of thepathways through which pain influences mentalhealth. Future research should consider potentialmoderators of the pain-mental health relationshipto further our understanding of the role of pain inthe lives of women post-treatment. CLINICALIMPLICATIONS: Efforts are needed to helpbreast cancer survivors manage pain and increasetheir level of physical activity to help improvemental health. Educating breast cancer survivors ofthe safety and benefits of physical activity needs tobe a top priority in order to ensure that they arenot reacting to their pain symptoms throughreduced physical activity. This study highlightsthe importance of designing and implementing painmanagement health care strategies among breastcancer survivors. ACKNOWLEDGEMENT OFFUNDING: This study was funded by theCanadian Institutes of Health Research and theCanadian Breast Cancer Research Allianceawarded to the last author.

P2-133

Articulating Chronicity in the Ovarian Cancer

Experience: Women’s Views of the on Going

Implications of Ovarian Cancer for Everyday Life

Meridith Burles, Lorraine HoltslanderUniversity of Saskatchewan, Saskatoon, SK,Canada

BACKGROUND: Although often perceived as alife-threatening or terminal illness because of poorsurvival rates, some recent academic literature hassuggested that ovarian cancer can be characterizedas a chronic illness that requires ongoing manage-ment. However, it has not been substantiated thatwomen experience ovarian cancer in this way. Toaddress this discrepancy in knowledge, we con-ducted a study to better understand the chronicaspects of ovarian cancer from the perspective ofaffected women. METHOD: The study adopted aqualitative approach that engaged women fromSaskatchewan, Canada who had experienced orwere experiencing ovarian cancer in in-depth face-to-face interviews and follow-up email interviews.Participants were asked to share their stories ofdiagnosis and treatment in the face-to-face inter-views, while the email interviews explored howovarian cancer affects daily life on an ongoingbasis. The sample included women from bothurban and rural locations who were at diversepoints in the illness experience, ranging from 10months to 13 years past initial diagnosis.RESULTS: During the interviews, participantsidentified lasting physical effects of surgery andtreatment, as well as significant psychological andsocial disruptions that required ongoing negotia-tion. Additionally, chronicity was evident for thoseparticipants who had experienced a recurrence or



DOI: 10.1002/pon

were currently in treatment, in that ovarian cancerwas viewed as episodic or as needing daily manage-ment similar to other chronic illnesses. Althoughlong-term survivors were less likely to perceiveovarian cancer as chronic and some women weredispleased at such an idea, analysis of the interviewdata demonstrates the chronic nature of theovarian cancer experience for many of the partici-pants. CONCLUSIONS: Conceptualizing ovariancancer as chronic recognizes that women oftenexperience lasting side effects and psychosocialdistress following the treatment period. Such acharacterization can also minimize the fear sur-rounding this illness because of its association withdeath, which can be beneficial to coping. Addi-tionally, women must be made aware of thechronic risk they face because of the likelihood ofrecurrence, and be offered the necessary health careand support services required to manage theirchronic risk, among other ongoing implications.RESEARCH IMPLICATIONS: This researchcontributes to the emerging literature on ovariancancer survivorship and cancer as a chronic illness.The research is innovative in its focus on howovarian cancer and survivorship are characterizedby affected women. In addition, this research offersinsight into the benefit of e-mail interviews forresearching experiences of illness at different pointsin time, and the potential use of e-mail forpsychosocial support in cancer care. CLINICALIMPLICATIONS: The findings of this researchhighlight aspects of ovarian cancer that affectedwomen experience as chronic or ongoing. Aware-ness of such issues is crucial to the successfuldelivery of health care and support services to thispopulation. Additionally, the findings highlight theimportance of ongoing care and support forwomen affected by ovarian cancer, particularlyduring transitions in care, such as after thecompletion of chemotherapy or at the 5-year‘survivor’ mark. ACKNOWLEDGEMENT OFFUNDING: This research was funded by theSaskatchewan Health Research Foundation.

P2-134

Benefit Finding in Disease Free Long-Term Cancer

Survivors

Claudia Cormio, Francesca Romito, FrancescoGiotta, Vittorio Mattioli, Giuseppe ColucciCancer Institute ‘‘Giovanni Paolo II’’, Bari, Italy

BACKGROUND: There is growing evidence inthe literature that people can experience posttrau-matic growth (PTG) following cancer diagnosis, aswell as distress. Recent studies have shown highlevels of post traumatic growth in cancer survivors.The aims of this study were to measure theprevalence of posttraumatic growth in long-termdisease-free cancer survivors; to examine the

relationship between social support, coping andpost-traumatic growth; to identify predictors ofpost-traumatic growth. METHOD: Cancer survi-vors were enrolled in the study during their routineannual follow up. Lifestyle was evaluated withsingle yes/no questions regarding tobacco andalcohol use, physical activity and dietary style.Data were collected on illness related variables(cancer site, years from diagnosis, treatments) andcomorbidities. Patients were assessed with Post-traumatic Growth Inventory (PTGI), Brief Copeand Multidimensional Scale of Perceived SocialSupport (MSPSS). RESULTS: 292 persons enteredthe study. Mean age was 58.4 years, mean survival11 years. Ptgi average total score was 35.46 (SD25.53), it was higher in younger survivors(p5 0.000) in those without comorbidities(p5 0.037) and in survivors engaged in physicalactivity (p5 0.007). A positive correlation betweenPtgi and Brief Cope (p5 0.000) and between Ptgiand Mspss (p5 0.000) was found. The predictors ofPTG were age, comorbidity, physical activity, andtwo coping subscales (Positive Reframing andReligion). CONCLUSIONS: In our sample theprevalence of posttraumatic growth is not as highas in previous studies, probably due to the longertime since cancer diagnosis and by the end oftreatments. After such a long time, cancer-relatedchanges may have been integrated into theindividual personality. The positive correlationsthat were found suggest that social support isassociated with many benefits in term of health andwellness. Moreover, having less comorbidities, theability to adaptively cope (positive reframing andreligion), and engage in physical activity werefound strong determinants in PTG. RESEARCHIMPLICATIONS: This study showed a decrease inlevels of posttraumatic growth in long termdisease-free cancer survivors. Goal of futureresearch could be assessing the state ofPTG over time, through a longitudinal study.CLINICAL IMPLICATIONS: The findings ofpresent study suggest the usefulness ofassessing patients social support and their copingabilities, in clinical practice. It would also be usefulto promote activities that implement the possibilityto have an adequate social support, and strengthenadaptive coping strategies, especially in elderlypatients. ACKNOWLEDGEMENT OF FUND-ING: The Italian Ministry of Health IntegratedProgram in Oncology n.7: ‘‘Medical and psycho-social rehabilitation program for long-term cancersurvivors’’.

P2-135

Predictors of Long-Term Cognitive Outcomes Due

to Oxaliplatin Chemotherapy: The Role of Dose and

Peripheral Neuropathies

Joanna Fardell1, Janette Vardy2,3, Ian Johnston1



DOI: 10.1002/pon

1School of Psychology, The University of Sydney,Sydney, NSW, Australia, 2Sydney Medical School,The University of Sydney, Sydney, NSW, Australia,3Sydney Cancer Centre, The University of Sydney,Sydney, NSW, Australia

BACKGROUND: A proportion of cancer survi-vors experience long-term cognitive impairmentsdue to chemotherapy treatment. These impair-ments significantly impact quality of life long aftertreatment completion, however the causes remainlargely unknown. Understanding the predictors ofcognitive difficulties due to chemotherapy is para-mount to providing adequate treatments. To thisend, we examined the impact of oxaliplatinchemotherapy dose on long-term cognitive out-comes and the relationship with peripheral neuro-pathy using a rodent model of cognition.METHOD: Healthy male Sprague-Dawley ratswere treated with oxaliplatin (0.6, 2, or 6mg/kg)or physiological saline (control) once a week for 3weeks. This dosing regimen was chosen to mimicthat used in the clinic. At 1 week, and 1,4 and 6months post-treatment completion cognitive func-tion was assessed using object location recognition(OLR), a measure of spatial memory, and novelobject recognition (NOR), a measure of objectmemory. These measures of cognition assess bothhippocampal and non-hippocampal brain function,respectively. In addition, mechanical sensitivitywas assessed during and after treatment usingvon Frey filaments, a measure of peripheralneuropathy. RESULTS: Rats treated with highdose oxaliplatin (6mg/kg) displayed lasting im-pairments in NOR compared to controls at 6months post-treatment. In contrast, rats treatedwith lower doses of oxaliplatin were not signifi-cantly different from controls on NOR. Shortlyafter treatment completion, rats treated withoxaliplatin had poor OLR regardless of dose,however, these impairments appeared to improvewith time. Level of peripheral neuropathy duringtreatment was dose dependent and resolved aftertreatment completion. Interestingly, the level ofperipheral neuropathy predicted OLR performanceat 4 months post-treatment and NOR performanceat both 4 and 6 months post-treatment.CONCLUSIONS: Animal models provide a usefulway of assessing the impact of chemotherapy oncognition in the absence of other variables thatconfound interpretation of human clinical data.This study demonstrates that, in the absence ofcancer and other anti-cancer treatments, oxalipla-tin chemotherapy impairs both object and locationmemory in healthy rodents long after treatment.Furthermore, the type and severity of cognitiveimpairment was determined by oxaliplatin dose,level of peripheral neuropathy experienced duringtreatment and time since treatment. RESEARCHIMPLICATIONS: The results presented here

demonstrate that oxaliplatin induces both cognitiveimpairments and peripheral neuropathies in ro-dents similar to those experienced by patients. Thisresearch identifies peripheral neuropathy as auseful predictor of cognitive impairment. Futureresearch should be directed towards evaluatingwhether the occurrence of peripheral neuropathy ispredictive of later cognitive decline in a clinicalsample of patients receiving oxaliplatin chemother-apy. CLINICAL IMPLICATIONS: Little researchhas investigated possible predictors of cognitivedecline due to chemotherapy. This study suggestsclinicians may be able to monitor the severity ofperipheral neuropathy during oxaliplatin che-motherapy as an indicator of later cognitivedifficulties. Early detection of patients likely toexperience cognitive deficits due to chemotherapywould enable clinicians to identify whichpatients would benefit from later cognitive rehabi-litation and treatment, thus reducing the impactof these deficits on long-term quality of life.ACKNOWLEDGEMENT OF FUNDING: RSAfunding from the Cancer Institute, NSW, Australiasupported this research.

P2-136

Docetaxel Chemotherapy Affects Cognitive Function

Shortly after Treatment in Laboratory Rodents

Joanna Fardell1, Janette Vardy2,3, Ian Johnston11School of Psychology, The University of Sydney,Sydney, NSW, Australia, 2Sydney Medical School,The University of Sydney, Sydney, NSW, Australia,3Sydney Cancer Centre, The University of Sydney,Sydney, NSW, Australia

BACKGROUND: A proportion of cancer patientsexperience cognitive deficits after treatment. It isdifficult it determine which chemotherapy agentscause cognitive impairment as patients typicallyreceive regimens containing several cytostatics aswell as other treatments. Previous animal studiesshow chemotherapy agents commonly used to treatbreast cancer (e.g. cyclophosphamide, 5-fluorour-acil) cause cognitive deficits. The study reportedhere is the first study to explore the effects ofdocetaxel dose on short-term cognitive outcomes inlaboratory rodents. METHOD: Healthy maleSprague-Dawley rats were treated with docetaxel(6, 10mg/kg) or physiological saline (control),once a week for 3-weeks. Dosing was chosen toapproximate what is used in the clinic. Cognitivefunction was assessed using the novel objectrecognition (NOR) task, spatial Morris watermaze (MWM), and contextual fear conditioning(FC) at 1,2, and 4-weeks post treatment. Thesetests of cognition assess object recognitionmemory, spatial learning and memory, andcontextual/configural memory respectively.RESULTS: Rats treated with docetaxel (both



DOI: 10.1002/pon

6mg/kg and 10mg/kg) performed worse thancontrols on object recognition memory (NOR) at1-week post treatment completion. At 2-weeks posttreatment there was no difference in spatiallearning or memory during MWM testing betweenchemotherapy-treated rats and controls. At 4-weeks post treatment rats treated with high dose(10mg/kg) docetaxel demonstrated poor initialrecall of contextual memory relative to rats treatedwith a lower dose (6mg/kg) of docetaxel andcontrols. CONCLUSIONS: The results showthat docetaxel treatment impairs particulardomains of cognitive function in healthylaboratory rats. Rats treated with docetaxeldemonstrate impairments in object recognitionand contextual memory shortly after treatmentcompletion. In contrast, spatial learning andmemory appeared to be unaffected by docetaxeltreatment. Finally, there was some evidence tosuggest a dose-response, with higher doses ofdocetaxel leading to impairments on contextualmemory, whereas those treated with a lower doseperformed similarly to control rats. RESEARCHIMPLICATIONS: The results presented here areconsistent with previous research demonstratingchemotherapeutic agents commonly used in thetreatment of breast cancer cause cognitiveimpairments in healthy laboratory rodents. Con-tinued research is required to identify whichdomains of cognition are affected by particularchemotherapeutic agents. CLINICAL IMPLICA-TIONS: Clinical studies have been unable toconclude whether certain treatment regimes aremore likely to lead to cognitive impairmentthan others due to small sample sizes andparticipants receiving a variety of anti-cancertreatments. Here we show that docetaxelchemotherapy in the absence of cancer and otheranti-cancer treatments causes impairmentsin cognition in healthy rodents. Clinicians shouldmonitor patients treated with docetaxel for suchimpairments in order to provide appropriateadvice and support. ACKNOWLEDGEMENTOF FUNDING: RSA funding from theCancer Institute, NSW, Australia supported thisresearch.

P2-137

Implementing Survivorship Care Plans: A Canadian

Experience

Margaret I. Fitch1, Jill Taylor-Browne2, JeffSisler2, Janine Giese-Davis3, Geoff Eaton4, HollyBradley51Sunnybrook Odette Cancer Centre, Toronto, ON,Canada, 2Cancer Care Manitoba, Winnipeg,Manitoba, Canada, 3Alberta Health Services,Cancer Care, Calgary, AB, Canada, 4Young AdultCancer Association, St. John’s, NL, Canada,5Wellspring, Toronto, ON, Canada

BACKGROUND: Individuals treated for cancerfind the end of treatment is stressful. They feeluncertain about the future, how to proceed, andwhat they should be doing to regain their healthand well-being. Survivorship Care Plans are citedas a useful approach to reduce uncertainty andprovide guidance for individuals as they move onwith their lives following cancer treatment. Ourinterest is in understanding the barriers to the useof survivorship care plans in Canada. METHOD:Four demonstrations projects were implemented totest approaches to using survivorship care plans ina Canadian environment. Each project was led by adifferent type of organization: a community basedagency, a formal cancer program, a consortium ofcancer agencies, and a national web-based agency.Each project was given the same survivorshiptemplate with seven specific sections to be filledin: treatment summary, surveillance, coping, stressmanagement, healthy living, community resources,and care team members. Each project was expectedto design an approach suited to their survivorpopulation and setting, implement the program,and evaluate its effectiveness. RESULTS: At theend of one year, all four programs had beenlaunched. Each serve different populations: headand neck, breast, colorectal, young adults. Despitethe variation in the agencies and the actualprogram designs, common challenges emerged inimplementing these programs. The major chal-lenges included lack of access to electronic doc-umentation that crosses care settings, and drawingthe treatment related information into a summarydocument in a timely manner. Critical successfactors included committed leadership in theagencies and locally involved champions. Thestructure and processes of the programs need tomatch the patient population and setting. CON-CLUSIONS: Survivorship care plans are feasible ina Canadian setting. Cancer survivors report theyare helpful in understanding the next steps in theircare and what they can do themselves. Health careprofessions see survivorship care plans as useful,but struggle with how to incorporate the prepara-tion of the necessary documents. Further work isneeded to understand the best practices forintroducing these tools in the cancer care path-ways. RESEARCH IMPLICATIONS: Futurework needs to be undertaken with other diseasepopulations and in other settings to determine thebest models for introducing the use of survivorshipcare plans. The best format for plans also needsto be studied. CLINICAL IMPLICATIONS:Patients facing the end of cancer treatment feeluncertain about what they should be doing tomove forward with their lives. Providing a survi-vorship care plan can be a useful approach tohelp the patients reflect upon what they mightdo in the future. In our current cancer environ-ment of constraint, innovative approaches are



DOI: 10.1002/pon

needed to introduce survivorship careplans into clinical settings. ACKNOWLEDGE-MENT OF FUNDING: These demonstrationprojects were supported through the CanadianPartnership Against Cancer - Cancer JourneyPortfolio.

P2-138

Understanding Recovery and Supporting Self Man-

agement of Cancer Related Problems following

Primary Cancer Treatment

Claire Foster, Deborah Fenlon, Phil Cotterell,Ikumi Okamoto, Matthew BreckonsUniversity of Southampton, Southampton, UK

BACKGROUND: The number of people livingwith or beyond cancer in the UK is rising by morethan 3% per year. The experiences and needs ofthose who have completed their primary cancertreatment are relatively neglected. Health profes-sionals may be unaware of who is struggling withproblems. How to best assess problems faced orwhich interventions are effective in helping relieveor prevent problems following primary treatmentare largely unknown. METHOD: Our researchprogramme will inform the development of moreefficient and effective services to support survivorsand enhance their return to productive and ful-filling lives through: a. A UK wide prospectivecohort of colorectal cancer patients to maprestoration of health and well-being b. An onlinesurvey to assess self efficacy to self managetreatment related problems following primarytreatment with radiotherapy/chemotherapy. c.Development and testing of an online interventionto increase self efficacy to self manage cancerrelated fatigue in the year following primary cancertreatment. RESULTS: Through our researchprogramme we will gain better understanding ofthe recovery process following treatment, identifywho is most likely to experience problems andwhen, and factors associated with resolution ofproblems. Our research programme will identifywho is most likely to need self managementsupport following primary treatment andwhat forms this should take. CONCLUSIONS:We are working closely with research partners(people affected by cancer) in the development anddelivery of our research. We particularly aim toinclude people typically under-represented in re-search - older people, people living in remote areas,people from black and minority ethnic groups,people with low literacy and low socio-economicstatus. CLINICAL IMPLICATIONS: With risingnumbers of survivors the need to understandproblems faced following treatment, how they areresolved, and how to support self management isbecoming increasingly important for service plan-ners and health policy makers. ACKNOWL-

EDGEMENT OF FUNDING: MacmillanCancer Support.

P2-139

Cancer Behind the Shoulders: Health Status and

Post-Traumatic Growth in Long-Term Cancer

Survivorship

Barbara Muzzatti1, Lorena Giovannini1, DanielaNarciso1, Luigi Grassi2, Maria Antonietta Annun-ziata11Centro di Riferimento Oncologico - NationalCancer Institute, Aviano (PN), Italy, 2Universityof Ferrara, Ferrara, Italy

BACKGROUND: The steady advances in medi-cine make long-term cancer-survivorship a realityfor a growing number of persons. It is a new‘‘clinical’’ condition in which long-term and lateeffects of the disease and treatments play a role inthe bio-psycho-social health of survivors. The mainpurpose of this study consists in investigating theself-perceived health status of a sample of long-term cancer-survivors. Furthermore, the presenceof features consist with the post-traumatic growthconstruct has been verified. METHOD: Onehundred and five Italian long-term cancer survi-vors, priory diagnosed with lymphoma or breast,gastrointestinal, and genito-urinary cancer, free ofevidence of disease at least five years post thecompletion of treatment, were individually admi-nistered the Short Form 36 (SF36) and thePost-traumatic Growth Inventory (PTGI). Tooladministration took place during a deeper psycho-social and medical assessment provided to users ofthe first rehabilitative clinic for long-term cancersurvivors started in Italy in 2008. RESULTS: Incomparison with Italian normative data fromgeneral populations, our sample showed: worsephysical functioning (p5 .0.2), general health(p5 .01), vitality (p5 .001), social functioning(p5 .003); more role-physical limitation(p5 .001), bodily pain (p5 .001), role-emotionallimitation (p5 .012); differences appeared inneither mental health nor post-traumatic growth(comparison with subjects with a previous trau-matic experience). Females reported worse physicalfunctioning, less bodily pain and vitality. Whoexperienced cancer for less years from treatmentcompletion (5–10) reported a worse social func-tioning and more role-emotional limitation. Noassociations between the tested dimensions andcancer diagnosis (lymphoma vs. solid tumor) andeducational status were found. CONCLUSIONS:Despite the completion of treatment from at leastfive years, long-term cancer survivors seem to showa worse health status than general populationsamples; in particular who experience this condi-tion for few years (5–10 vs. 101) show a worse



DOI: 10.1002/pon

socio-emotional functioning. Furthermore cancerdoes not seem to induce a different growth thanother threatening events in life. RESEARCHIMPLICATIONS: Present data suggest furthercomparisons in both health status and post-traumatic growth according to other socio-demo-graphic (e.g., age, marital status, occupationalstatus) and clinical (e.g., co-morbidities, presenceof relevant late or long-term effects) variables. Inaddition, comparisons with cancer patients atdifferent disease stages as well as with patientsaffected by other pathologic conditions couldbe informative. CLINICAL IMPLICATIONS:Our data suggest to plan multidimensionalfollow-ups also for long-term cancer survivors aswell as to design bio-psycho-social interventionsspecifically tailored for this kind of users.ACKNOWLEDGEMENT OF FUNDING: Theresearch Program is supported by the ItalianMinistry of Health.

P2-140

Sexuality and Intimacy in Long-Term Cancer

Survivors: Explorative Results from the First Italian

Cancer Survivor Clinic

Maria Antonietta Annunziata1, Lorena Giovanni-ni1, Barbara Muzzatti1, Luigi Grassi21Centro di Riferimento Oncologico - NationalCancer Institute, Aviano (PN), Italy, 2Universityof Ferrara, Ferrara, Italy

BACKGROUND: As more people achieve long-term survival after cancer, different aspects ofquality of life (QOL) need more attention. Sexu-ality is an important aspect in people’s life andcover both the physical sphere and the psycholo-gical one. Following cancer and its treatments,people could experience concerns about sexualityand/or real sexual difficulties as a result of physical/functional damage or psychological distress. There-fore, sexual dysfunctions have increasingly beenrecognized as negative consequences that impactQOL. METHOD: A brief questionnaire aboutdamage to the genitals and sexual preferences aftercancer was administered to adult participants tothe ‘‘Medical and psychosocial rehabilitation pro-gram for long-term cancer survivors’’. All patientsreceived a cancer diagnosis and, as inclusioncriteria, at the moment of the assessment all ofthem had been out of illness and treatment since atleast five years. The questionnaire consisted of onequestion about the presence/absence of damage tothe genitals (which could be answered yes/no) and8 questions about sexuality with Likert responsescale anchored 1 (none) - 5 (very much).RESULTS: 130 long-term cancer survivors werecontacted for the survey. 97 patients returned avalid questionnaire. The mean age of the samplewas 51 years (SD5 10,4). 65% of them were

female. Their diagnosis were 55% lymphoma,27% breast cancer, 18% other tumours. 70% ofthe sample did not have genital damage. In 53% ofthe group, interest towards sexuality and intimacyis the same as before cancer, both in patients withand without genital damage. Nevertheless, survi-vors seem to have decreased the frequency ofsexual intercourse (74%), giving more importanceto tenderness (72%). But they feel less satisfied(59%). CONCLUSIONS: Sexuality and intimacyare fundamental aspects in human wellbeing.Long-term cancer survivors appear to feel worseafter cancer and treatments in this peculiar sphereof their life, also when they do not have a specificgenital damage. Modesty about this theme couldeasily be surmounted in order to prevent complica-tion on mood, relationships, social and emotionallimits linked to disease, and help survivor to findagain a pleased sexuality.RESEARCH IMPLICA-TIONS: In order to obtain complete informationon long-term survivorship, researchers need toexplore all aspects of quality of life. Sexuality andintimacy are as important as delicate aspects forpatients wellbeing. As more patients achievesurvivorship, having more and more informationabout these spheres may help to better describeexpectation, impairment and interests on this topic.CLINICAL IMPLICATIONS: In order to guar-antee long-term cancer survivors the highestpossible quality of life, sexuality and intimacywellbeing have to be investigated. Knowingsurvivors’ real expectation and impairment letclinicians help him/her to fell better and to preventimportant complications on psychosocial life.ACKNOWLEDGEMENT OF FUNDING: Thisoriginal survey was support by found of ItalianHealth Minister.

P2-141

Using the Commonsense and Transtheoretical mod-

els to Understand Health Behaviours after Diagnosis

with Prostate or Breast Cancer

Heather J. Green, Gabriella Steinnagel, ColletteMorrisGriffith University, Gold Coast, QLD, Australia

BACKGROUND: After a cancer diagnosis,physical activity and healthy eating can help cancersurvivors to maintain better physical and mentalhealth. This study compared two models to helpunderstand factors that predict physical activityand nutrition in survivors of breast or prostatecancer. The transtheoretical model (TTM)focuses on stage of readiness to engage in abehaviour, and the commonsense illness represen-tations (CM) model looks at individualcognitive and emotional perceptions of the illness.METHOD: Participants were 92 men who hadbeen diagnosed with prostate cancer and 154



DOI: 10.1002/pon

women who had been diagnosed with breastcancer. Participants completed a written or onlinequestionnaire which assessed demographic andhealth information, illness representations, dietand exercise stage of change, self efficacy andpreferences regarding health behaviour interven-tions. Health behaviours in the past 7 days weremeasured via the International Physical ActivityQuestionnaire and concordance with national age-and gender-specific dietary guidelines. RESULTS:The TTM model was related to physical activity inboth male prostate cancer survivors and femalebreast cancer survivors. Exercise stage of changeand exercise self-efficacy were significant indepen-dent predictors of activity in multiple regressionsfor both survivor groups. This model was alsosupported for women’s nutrition scores but not formen’s. The CM model was not supported in thisstudy. Cancer survivors more frequently reportedincreasing physical activity and healthy eating sincediagnosis than maintaining or decreasing thesebehaviours and many expressed interest in inter-ventions that would assist with activity and healthyeating. CONCLUSIONS: Health behavioursamong survivors of breast cancer or prostatecancer can be partially explained by the TTMmodel of behaviour change. Further investigationof the commonsense illness representations modelin cancer survivors may require refinement ofmethods, as items referring to ‘‘your illness’’appeared to be viewed as having limited relevancefor many survivors. RESEARCH IMPLICA-TIONS: The applicability of the TTM model tohealth behaviours of cancer survivors could befurther investigated through longitudinal research,intervention research, and studies with moretargeted groups of survivors. CLINICAL IMPLI-CATIONS: Based on these results, it is likely thatinterventions based on the TTM model of beha-viour change would be helpful for cancer survivorswho want assistance with increasing their physicalactivity and/or healthy eating. This study showedthat many survivors take their own steps toimprove these health behaviours, and thus astepped-care approach may be appropriate, withhigher intensity health behaviour support availableto those who require this type of support.ACKNOWLEDGEMENT OF FUNDING:None.

P2-142

The Unmet Needs of Haematological Cancer

Survivors: An International Comparison between

Australian and Canadian Survivors

Alix Hall1, Sharon Campbell2, Rob Sanson-Fisher1, Marita Lynagh11School of Medicine and Public Health & PriorityResearch Centre in Health Behaviour, University ofNewcastle, Newcastle, NSW, Australia, 2Propel

Centre for Population Health Impact, University ofWaterloo, Waterloo, ON, Canada

BACKGROUND: Haematological malignanciesdiffer to solid tumours. Yet little research hasexamined the unmet needs of haematologicalcancer survivors utilising large, diverse, popula-tion-based samples. Furthermore, there have beenno international comparisons performed on theunmet needs of haematological cancer survivors.Such information is of interest given the dissimilarsocial environments and health care systems indifferent countries. The aim of this study is tocompare the unmet needs of Australian andCanadian haematological cancer survivors.METHOD: Two data-sets were used to comparethe unmet needs of Australian and Canadianhaematological cancer survivors. Survivors wererecruited from one Australian and three Canadianpopulation-based Cancer Registries and sent theSurvivors Unmet Needs Survey (SUNS). TheSUNS is a valid and reliable measure assessingunmet needs in the last month, across five domains.RESULTS: Two hundred and sixty eight Austra-lian and 115 Canadian haematological cancersurvivors returned a completed survey. A similarpercentage of Australian and Canadian survivorsreported experiencing at least one ‘high/very high’unmet need in the last month. A higher percentageof Canadian survivors reported no unmet needscompared to Australian survivors. Compared toCanadians, Australians reported higher levels offinancial, relationship and emotional needs. Inter-pretation and the possible implications of thesedifferences will be presented. CONCLUSIONS:Analysis indicated there are differences between thelevel and type of unmet needs experienced byCanadian and Australian haematological cancersurvivors. A greater percentage of Canadians hadno unmet needs while Australian survivors re-ported higher financial, relationship and emotionalunmet needs. The cultural and service differencesbetween these two countries may impact on thelevel and type of unmet needs experienced byhaematological cancer survivors. RESEARCHIMPLICATIONS: This study highlights the limita-tions and strengths of conducting internationalcomparison studies in psycho-oncology research.The data suggests that it may not be appropriate togeneralise findings from one country to a similarpopulation in another country. The lessons learntfrom this study and the implications of the findingson future research will be discussed. CLINICALIMPLICATIONS: These findings provide anindication of what areas could be addressed inorder to meet the specific unmet needs of haema-tological cancer survivors in Australia and Canada.Areas that potentially could be improved throughappropriate resource and service allocation are alsosuggested. Furthermore, the data indicates that it



DOI: 10.1002/pon

may be necessary to use country specific findings toinform service provision that are aimed to addressthe concerns of haematological cancer survivors.ACKNOWLEDGEMENT OF FUNDING: Thisresearch is supported by the Canadian CancerSociety Research Institute (grant 018777),the Canadian Institutes of Health Research(Grant KAL82607) and the Australian projectwas co-funded by beyondblue and Cancer Australia(Application ID: 569290).

P2-143

The Influence of Clinical, Socio-Demographic and

Work-Related Factors on Return to work 16 months

following a Breast Cancer Diagnosis: A Population-

Based Cohort Study

Marie Hoyer1,2, Birgitta Johansson3, KarinNordin2,4, Claudia Lampic51Regional Oncologic Centre, Uppsala UniversityHospital, Uppsala, Sweden, 2Department of PublicHealth and Caring Sciences, Uppsala University,Uppsala, Sweden, 3Department of Oncology,Uppsala University Hospital, Uppsala, Sweden,4Department of Public Health and Primary HealthCare, University of Bergen, Bergen, Norway,5Department of Neurobiology, Care Sciences andSociety, Karolinska Institute, Stockholm, Sweden

BACKGROUND: The aim was to examine theoccupational status and factors associated with notreturning to work following a breast cancerdiagnosis. METHOD: A population-based cohortstudy based on a Breast Cancer Quality Register inSweden. The study sample consisted of 551 women(age o64 at diagnosis), who completed question-naires at baseline (1–8 months post-diagnosis) andat follow-up (13–23 months post-diagnosis).Clinical register data and questionnaire data onsocio-demographics, fatigue and comorbiditywere obtained at baseline. Self-reported data onoccupational status and work-related factorswere obtained at follow-up. RESULTS: Seventy-one percent (n5 392) of the study samplewere employed at follow-up. Among breastcancer survivors, 14% (n5 55) had not returnedto 75% of their pre-diagnosis grade of work.Age 60, chemotherapy and cancer-related worklimitations were associated with no return to work.Including work-related factors in the equationreduced the effect of clinical factors onreturn to work. No interaction effects wererevealed. CONCLUSIONS: A majority of thebreast cancer survivors had returned to work16 months post-diagnosis. Corroboratingprevious research, the present study identifiedimportant clinical and work-related factorsassociated with not returning to work.RESEARCH IMPLICATIONS: More longitudi-nal and prospective studies are needed to verify the

present results. Also future studies should seek toincrease power for a thorough examination ofconfounding and interaction effects. CLINICALIMPLICATIONS: A sub-group of breastcancer patients appear to be particularly vulnerablein the process of returning to work. The resultsidentified important factors to take intoaccount in the clinical setting (i.e., old age andchemotherapy), and room for improvement re-garding adaptation of the work environment forbreast cancer survivors. Being able to identifyvulnerable subgroups of breast cancer patients isan important pre-requisite to offer optimal careand rehabilitation. ACKNOWLEDGEMENT OFFUNDING: The study was funded by theSwedish Society of Oncology via funds from theSwedish Breast Cancer Association; the Uppsala-Orebro Regional Research Council; theSwedish Council for Working Life and SocialResearch; and the foundation of Erik, Karin andGosta Selander.

P2-144

Evaluation of an Intervention to Promote Breast

Cancer Awareness and Early Presentation: The

Train the Trainers Breast Health Promotion Course

Lindsay Forbes1, Louise Atkins1, Diana Jupp2,Davinia Green2, Karen Scanlon2, Amanda Ramirez11Kings College, London, UK, 2Breast Cancer Care,London, UK

BACKGROUND: In 2008 Breast Cancer Caredeveloped and implemented the Train the TrainerBreast Health Promotion Programme to trainhealth professionals, community workers andvolunteers to deliver breast cancer awarenessmessages (aiming to promote early presentationof breast cancer and encourage breast screeningattendance) within their communities across Brit-ain. We aimed to measure the extent to which theprogramme increased knowledge and confidenceamong the trainees to deliver breast cancer aware-ness messages to others. METHOD: We asked alltrainees to complete a written questionnaire beforeattending the course and one month later. Thequestionnaire asked about breast cancer awareness,using a validated measure (Linsell L et al, 2010,Eur J Cancer), which included questions onknowledge of breast cancer symptoms, age-relatedrisk of breast cancer, and the NHS Breast Screen-ing Programme, frequency of breast checking, andconfidence to detect breast changes. The question-naire also measured confidence to explain risk andsymptoms of breast cancer, promote breast check-ing and early presentation and discuss advantagesof early diagnosis and barriers to early presenta-tion. RESULTS: 126 trainees took part in ninecourses over six months. 60 (48%) responded atone month. At one month, trainees had signifi-



DOI: 10.1002/pon

cantly increased knowledge of breast cancersymptoms and of the NHS Breast ScreeningProgramme, confidence to detect breast changesand frequency of breast checking, but did notincrease their knowledge of age-related risk ofbreast cancer. Trainees also had significantlyincreased confidence to deliver all elements of thebreast cancer awareness messages. CONCLU-SIONS: At one month, the Train the Trainerprogramme successfully increases breast cancerawareness and confidence to deliver breast cancerawareness health promotion messages. However,the programme does not increase knowledge thatthe risk of breast cancer increases with age.RESEARCH IMPLICATIONS: We plan to con-tinue follow up to examine whether the increase inbreast cancer awareness is sustained over time andto measure the extent to which trainees havedelivered of the breast cancer awareness messagesand to whom. CLINICAL IMPLICATIONS:We plan to examine how we might improve theTrain the Trainer programme to ensure thattrainees are equipped with the appropriate knowl-edge, confidence and skills. In particular, we willfocus on ensuring that they gain knowledge of thestrongest risk factor for breast cancer: age.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by Breast Cancer Care.

P2-145

An Intervention to Help Women ‘OVERcome’

Dyspareunia and Sexual Problems after Breast

Cancer Treatment

Ilona Juraskova1, Sherin Jarvis2,3, Kelly Mok4,5,Michelle Peate4,5, Bettina Meiser4,5, BenjaminCheah6, Shab Mireskandari3, Michael Friedlander4,51Centre for Medical Psychology & Evidence-basedDecision-making (CeMPED), The University ofSydney, Sydney, NSW, Australia, 2The BarbaraGross Research Unit, Department of Endo-Gynae-cology, Royal Hospital for Women, Sydney, NSW,Australia, 3School of Women’s and Children’sHealth, University of New South Wales, Sydney,NSW, Australia, 4Department of Medical Oncology,Prince of Wales Hospital, Sydney, NSW, Australia,5Prince of Wales Medical School, University of NewSouth Wales, Sydney, NSW, Australia, 6Neu-roscience Research Australia, Sydney, NSW,Australia

BACKGROUND: Up to 50% of breast cancer(BC) survivors report sexual problems, yet very fewintervention studies have addressed these issues.The OVERcome (Olive oil, Vaginal Exercise,Replenss) pilot study prospectively evaluated anovel intervention, involving: i) pelvic floor muscle(PFM) relaxation exercises to prevent/managePFM over-activity, ii) a vaginal moisturizer (Re-plenss) to alleviate vaginal dryness, and iii) olive

oil as a lubricant during intercourse, to addressdyspareunia, vaginal dryness and sexual problemsfollowing BC treatment. METHOD: 37 women(84% response rate) with dyspareunia were in-structed to perform PFM relaxation exercisestwice/day, apply a specific vaginal moisturizer 3times/week, use olive oil during intercourse, andcomplete a weekly compliance diary. PFM trainingwas administered by a pelvic floor physiotherapistat weeks 0 and 4, with follow-up at weeks 12 and26. At each time point, women completed validatedmeasures of dyspareunia, sexual functioning, qual-ity of life and distress; whilst the physiotherapistrecorded objective measures of PFM functioning.RESULTS: PFM training was effective (po0.001)and the OVERcome intervention resulted insignificant improvements in dyspareunia, sexualfunction, and quality of life over time (allpo0.001). Maximal benefits of the interventionwere observed at week 12. Most women rated PFMrelaxation exercises (94%), the vaginal moisturizer(88%) and olive oil (78%) as helpful, indicatingintervention acceptability. Six cases of vaginalstenosis were noted during initial screening/inter-vention, which has not previously been reported inthis population. CONCLUSIONS: This studydemonstrated the effectiveness of a novel, non-hormonal intervention to improve dyspareunia,overall sexual functioning and quality of life in thebreast cancer setting. The combination of PFMrelaxation exercises, olive oil as lubricant and apolycarbophil-based vaginal moisturizer (Re-plenss) was found to be an acceptable and feasibleintervention, and was associated with improve-ments in dyspareunia and sexual function inwomen following adjuvant breast cancer treatment.The OVERcome intervention can be taught easilywithin 2-3 visits to a pelvic floor physiotherapistand addresses a major unmet need for women withsexual problems after breast cancer. RESEARCHIMPLICATIONS: The study group is planning arandomized controlled trial involving multipleurban and regional centers within Australia, toassess whether the intervention is effective acrossdifferent centres. Further research is also warrantedto investigate mechanisms of vaginal stenosis andeffective preventative/rehabilitation strategies forwomen with a history of breast cancer, and this iscurrently being investigated in a separate study.CLINICAL IMPLICATIONS: The OVERcomefindings have the potential to significantly alter theway in which dyspareunia and sexual problems aremanaged in this population, as there are fewproven treatment options available to these womenin clinical practice. Oncologists may be more likelyto enquire about sexual problems in this popula-tion if an effective intervention can be recom-mended. Furthermore, this straightforward andrelatively accessible intervention may prove usefulto other women experiencing vaginal dryness and



DOI: 10.1002/pon

dyspareunia. ACKNOWLEDGEMENT OFFUNDING: The study was funded by a ProjectGrant from the Susan G. Komen BreastCancer Foundation, United States, which sup-ported Sherin Jarvis and Dr Kelly Mok. Dr IlonaJuraskova was supported by a Cancer InstituteNSW Early Career Development Fellowship. A/Prof Bettina Meiser was supported by a CareerDevelopment Award from the National Health andMedical Research Council of Australia and aCancer Institute NSW Career Development Fel-lowship.

P2-146

Comparison Study on Distress from Cancer Survi-

vors and General Population in Korea Focusing on

Depression and Suicide Ideation

Sujin Lee1, Hyekyung Woo1, Soyoung Kim1, IlhakLee2, Jonghyock Park1, Myongsei Sohn21National Cancer Center, Ilsan, Goyang City,Republic of Korea, 2Yonsei University, Seoul,Republic of Korea

BACKGROUND: With the increasing survivalrate from cancer, cancer survivors are living with apainful and distressful life. This study aims atidentifying high risk suicide attempt groups byinvestigate the status of distress, especially depres-sion and suicide ideation in Cancer survivorscompared with the general public in Korea.METHOD: We analyzed data from 2,661 cancersurvivors in National Cancer Center and 9 regionalCancer Center in Korea and Frequency matcheddata with age and gender 2,445 general populationwho completed the National Health and NutritionExamination Survey in 2008. Multivariate regres-sion analysis was used to identify factors affectingdepression and suicidal ideation. RESULTS: Can-cer survivors more likely to suffer distress than thegeneral population. Especially, Male cancer survi-vors who have more risk of suicide attempt thanothers as follows. high school or university educa-tion level, 1,000 to 2,990 thousand won incomelevel, high stress, recurrence of cancer, currentlysmoking, and low quality of life, low health status,and chemotherapy. Female cancer survivors whohave more risk of suicide attempt than others asfollows. more than 3,000 thousand won incomelevel, suffering comorbid symptoms, and highstress, recurrence of cancer, and low quality oflife, and low health status. CONCLUSIONS: Inthis study, cancer survivors in Korea who areclassified as high risk suicide attempt groups needto take the distress management and socialand economic support by screening fromearly treatment after diagnosis. RESEARCHIMPLICATIONS: Now it is time to pay attentionto cancer survivors and their distress and it is timeto establish the plan for policies, laws and resources

to cancer survivors as the social and economicsupport are needed. I hope this study to contributeto the preparation of plan for support of cancersurvivors in Korea. ACKNOWLEDGEMENT OFFUNDING: This study was supported by a grantof National Cancer center in korea (0710170-3).

P2-147

Supportive Care Needs of Gynaecological Cancer

Patients and Survivors

Anna-Lena Lopez1, Phyllis Butow1, ShannonPhilp2, Emily Phillips3, Kim Hobbs3, RosalindRobertson4, Kathryn Nattress2, Ilona Juraskova11Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School ofPsychology, The University of Sydney, Sydney,NSW, Australia, 2Sydney Gynaecological OncologyGroup, Sydney Cancer Centre, Royal PrinceAlfred Hospital, Camperdown, NSW, Australia,3Department of Gynaecological Oncology,Westmead Hospital, Westmead, NSW, Australia,4Gynaecological Cancer Centre, Royal Hospital forWomen, Randwick, NSW, Australia

BACKGROUND: While all cancers evoke psy-chosocial issues, gynaecological cancers can have aunique additional impact on women’s sexuality,fertility, body image and identity. Unmet needs inthis group are likely to be high, and if leftunaddressed may result in long–term psychologicaldistress and reduced quality of life. Therefore, thisstudy aimed to qualitatively explore and identifythe shared and unique supportive care needs ofyounger and older gynaecological cancer patientsand survivors. METHOD: A cross section of 30women aged 18 and older, affected by gynaecolo-gical cancers, participated in semi-structured inter-views to share their experiences at diagnosis, duringtreatment and the survivorship phase. Samplingcontinued until theoretical saturation wasachieved. A qualitative approach of InterpretativePhenomenological Analysis was used to code andinterpret the content of the interviews and establishcategories of (un)met needs. RESULTS: Prelimin-ary analyses have identified several shared cate-gories of needs relevant to gynaecological cancerpatients and survivors: i) support needs, ii)information needs (e.g. understanding femaleanatomy, treatment decision-making), iii) self-concept, iv) sexual functioning concerns and v)relationship concerns. Age-related differences wereevident within these shared areas of needs, withyounger women or those pre-menopausal atdiagnosis reporting additional unique needs: i)isolation (e.g. lack of support networks of aged-related peers with similar diagnoses; perceptions ofstigma); and ii) fertility concerns. In expressingtheir overall needs, women emphasised theimportance of appropriately timed support.



DOI: 10.1002/pon

CONCLUSIONS: This is one of the first studies toidentify areas of shared and unique (un)met needsof young and older women affected by gynaecolo-gical cancer. The findings have informed thedevelopment of a new supportive care needsmeasure within the gynaecological cancer setting,which is currently being psychometrically tested.This measure will be valuable for serviceprovision and evaluation of future age-specificinterventions. RESEARCH IMPLICATIONS:The identification of unmet needs within thispopulation has the potential to guide the develop-ment of needs-specific supportive care interventionresearch and clinical practice initiatives. CLINI-CAL IMPLICATIONS: Cancer care that ad-dresses patients’ supportive care needs is regardedas the gold standard. The identification of sharedand unique needs of younger and older women inthis population will allow health professionals toprovide relevant, effective and timely informationand support services specific to their needs. Theprovision of appropriate interventions can optimisethe outcomes for these women by improving theirpsychosocial adjustment to their diagnosis andtreatment, thereby improving their quality of life.ACKNOWLEDGEMENT OF FUNDING:None.

P2-148

Risk, Psychosocial Need and Clinical Satisfaction:

The Experiences of Australians at High and

Moderate Risk of Developing Primary Melanoma

Jordana McLoone1, Nadine Kasparian1, BettinaMeiser2,3, Phyllis Butow4, Kristine Barlow-Stewart5, Graham Mann6, Scott Menzies71School of Women’s and Children’s Health, Universityof New South Wales, Kensington, NSW, Australia,2Medical Oncology, Prince of Wales Hospital, Rand-wick, NSW, Australia, 3Prince of Wales ClinicalSchool, University of New South Wales, Kensington,NSW, Australia, 4Centre for Medical Psychology andEvidence-Based Decision-Making, School of Psychol-ogy, University of Sydney, Sydney, NSW, Australia,5Centre for Genetics Education, Royal North ShoreHospital, St Leonards, NSW, Australia, 6WestmeadInstitute for Cancer Research, University of Sydney atWestmead Millennium Institute and MelanomaInstitute Australia, Westmead, NSW, Australia,7Sydney Melanoma Diagnostic Centre, Royal PrinceAlfred Hospital, and Discipline of Dermatology,Faculty of Medicine, University of Sydney, Sydney,NSW, Australia

BACKGROUND: If detected early, the prognosisfor patients with thin, localized primary melanomais good, with five year survival rates estimated at98%. However, despite excellent survival rates,patients continue to live with an increased risk ofdeveloping new primary disease. This study aims to

examine risk perceptions, fear of cancer recurrence,melanoma-related behaviours, and clinical satisfac-tion among melanoma survivors at moderate orhigh risk of developing new primary disease.METHOD: Participants were recruited via eitherthe High Risk Clinic at the Sydney MelanomaDiagnostic Centre (high-risk group) or the Mela-noma Institute Australia (moderate-risk group).Individuals at high risk (i.e. multiple melanomadiagnoses, or one primary melanoma in thepresence of multiple atypical moles or dysplasticnaevus syndrome, DNS), or moderate risk (onemelanoma diagnosis and no DNS) completed aself-report questionnaire assessing psychologicalfactors (fear of melanoma recurrence, risk percep-tions, anxiety, depression); skin cancer screeningbehaviours (clinical and self-examination); sunprotection behaviours; satisfaction with clinicalcare; and demographic and clinical characteristics.RESULTS: Recruitment is ongoing. As of May2011, 286 participants (56% high risk) hadcompleted the survey (56% male, mean age: 60years). Clinically-relevant levels of anxiety anddepression were reported by 22% and 10% ofparticipants, respectively. Fear of cancer recur-rence was relatively low and did not differsignificantly between groups (t5�1.180,p5 0.24). However, 27% of participants reportedongoing fears of developing melanoma ‘a lot’ or ‘agreat deal of the time’, and for half the sample thisfear had been present for years. Overall, partici-pants reported high satisfaction with clinical care.Regression analysis will be undertaken uponrecruitment completion. CONCLUSIONS:Despite low overall scores for fear of cancerrecurrence, individual items assessing both theduration and frequency of concerning thoughtswere strongly endorsed by a substantial subset ofthe sample. Although preliminary, these initialfindings suggest that particular dimensions of fearof cancer recurrence may be important. A morecancer-specific tool may be necessary to capture themelanoma-related anxiety consistently reported inthe literature by melanoma survivors. Thoughparticipants reported high clinical satisfaction,based on the provision of expert medical care, theneed for comparable psychological care for thoseat increased risk of developing melanoma is yet tobe addressed. RESEARCH IMPLICATIONS:This study is unique in its focus on melanomasurvivors’ objective risk status and how this mayinfluence subjective perceptions of risk, clinicalcare, as well as emotional health and well-being.This research supports the development of futureinterventions, which, by tailoring aspects ofclinical care according to patient perceptions of risk,may benefit melanoma survivors at highor moderate risk of developing melanoma.CLINICAL IMPLICATIONS: Patients regularlyattended clinical skin examinations, providing clin-



DOI: 10.1002/pon

icians the opportunity to monitor patients’ psychoso-cial needs long term. As many patients remainedconcerned for years after initial diagnosis, psycholo-gical referral may still be relevant among long-termfollow-up patients. Though the provision of psycho-logical care to all patients is unfeasible, the need todevelop a broadly distributable melanoma-specificresource, to address potential issues among those atincreased risk of developing primary melanoma,is warranted. ACKNOWLEDGEMENT OFFUNDING: Nadine Kasparian is supported by aPost-Doctoral Clinical Research Fellowship from theNational Health & Medical Research Council(NHMRC) of Australia (ID 510399). Bettina Meiseris supported by a Cancer Institute NSW CareerDevelopment Fellowship (ID 350989). Phyllis Butowis supported by a Research Fellowship from theNHMRC (ID 211199). This project is also supportedby a Project Grant from beyondblue: the nationaldepression initiative.

P2-149

Is there an Increased Risk of Depression in Long-

Term Cancer Survivors? A Meta-Analysis of 15

Comparative Studies

Alex J Mitchell, David FergusonUniversity of Leicester, Leicester, UK

BACKGROUND: There is still considerable un-certainty about the prevalence of depressionfollowing a diagnosis of cancer. One significantfactor is the duration since diagnosis. A recentmeta-analysis found high rates early after a cancerdiagnosis (Lancet Oncology 2011: 12(2): 160–174).In the short term considerable distress is commonbut with improvements in treatment, survival hasimproved, and the psychological outlook for long-term survivors may be better than expected.METHOD: We conducted a systematic search,critical appraisal and meta-analysis of valid data.In order to clarify whether depression is morecommon in those with cancer we only collectedcomparative studies that also measured depressionin a control group. However we faced severalmethodological issues. Depression can be definedby self-report but the gold standard is a clinical orsemi-structured interview. The control group maybe physically well (eg general population controls)or physically unwell. Further a definition of ‘‘long-term survivor’’ is not universally agreed.RESULTS: We identified 128 candidate studiesbut only 20 with comparative data entered theanalysis (sample size of 259,448). 15 examinedLTCS. 11 compared this group against healthycontrols and 4 compared depression in LTCS withdepression in a physically unwell group. Theprevalence of depression in LTCS was 10.1%against 8.2% in comparators (uRR 1.236). Afterweighting there was no difference (aRR 0.97; 95%

CI5 0.86 to 1.1). Against healthy controls the RRwas 1.2 (aRR 0.97 95% CI5 0.85 to 1.1) andagainst physically unwell controls 0.583 (aRR 0.8695% CI5 0.65 to 1.14). CONCLUSIONS: Afteradjustments, depression is no more common inLTCS than in healthy controls. Depression inLTCS may in fact be less common than in amiscellaneous physically unwell group. This can beconsidered a positive finding for long-term survi-vors who, as a group, appear to do well psycho-logically after navigating the acute treatmentperiod. RESEARCH IMPLICATIONS: Com-parative studies must consider carefully the controlgroup which can be heterogeneous. Further studiesagainst other physically unwell ‘‘survivors’’ areneeded. CLINICAL IMPLICATIONS: Patientsand clinicians should not assume the prevalenceof depression is high indefinitely after cancer. Inthose people who enter remission with few com-plications and minimal disability the prevalence ofdepression is no worse than in the generalpopulation. ACKNOWLEDGEMENT OFFUNDING: None.P2-150

Type D Personality is Associated with Increased

Comorbidity Burden and Health Care Utilization

among 3080 Cancer Survivors

Floortje Mols1,2, Simone Oerlemans1,2, JohanDenollet1, Lonneke V. van de Poll-Franse1,21Department of Medical Psychology, Tilburg Uni-versity, Tilburg, The Netherlands, 2ComprehensiveCancer Centre South, Eindhoven Cancer Registry,Eindhoven, The Netherlands

BACKGROUND: Cancer survivors often reportcomorbid diseases, but there are individual differ-ences in risk. Type D personality is a generalpropensity to psychological distress that is relatedto poor cardiovascular outcomes. In this study, weexamined whether Type D was also related tocomorbidity burden and health care utilizationamong cancer survivors. METHOD: Individualsdiagnosed with endometrial cancer or colorectalcancer between 1998–2007, or lymphoma or multiplemyeloma between 1999–2008 as registered in theEindhoven Cancer Registry received the Self-admi-nistered Comorbidity Questionnaire, questions onhealth care utilization, and the Type D personalityscale; 69% (n53080) responded and 19% ofsurvivors had a Type D personality. RESULTS: Incomparison with non-Type D survivors, Type Dsurvivors significantly more often reported highblood pressure, osteoarthritis, back pain, depression,thyroid disease, and stroke in the past 12 months.Also, survivors with a Type D personality moreoften reported to feel bothered by the followingconditions during activities; high blood pressure,osteoarthritis, heart disease, depression, diabetesmellitus, lung disease, anemia, stroke, liver disease,



DOI: 10.1002/pon

and kidney disease. Finally, those with a Type Dpersonality more often indicated that they receivedtreatment for osteoarthritis. Type D’s visited theirgeneral practitioner and specialist more often in thepast 12 months (all p’so0.001). CONCLUSIONS:Cancer survivors with a Type D personality reportedmore comorbid diseases, felt more bothered by thesediseases and were more often treated for osteoar-thritis. Also, those with a Type D personality visitedtheir general practitioner and medical specialist moreoften compared to non-Type D’s. RESEARCHIMPLICATIONS: This study provides insight intothe association of Type D personality with thepresence and amount of bother experienced bycomorbid diseases and its associated health careutilization in cancer survivors. Further longitudinalresearch on Type D personality among cancersurvivors is necessary since this study showed theimportance of individual differences in personality asa potential determinant of the presence and theamount of bother experienced by comorbiddiseases among cancer survivors. CLINICALIMPLICATIONS: Type D personality may be avulnerability factor to screen for in clinicalpractice in order to identify subgroups of cancersurvivors who are at an increased risk for comor-bidity burden and health care utilization.ACKNOWLEDGEMENT OF FUNDING: Thepresent research was supported by a VENI grant(451-10-041) from the Netherlands Organization forScientific Research, awarded to Floortje Mols, and aCancer Research Award from the Dutch CancerSociety (UVT-2009-4349) to Lonneke van de Poll-Franse. Data collection of this study was funded bythe Comprehensive Cancer Centre South, theNetherlands; the Center of Research on Psychologyin Somatic Diseases (CoRPS), Tilburg University,the Netherlands; and an Investment Subsidy (480-08-009) from the Netherlands Organization forScientific Research.

P2-151

Type D (Distressed) Personality is Associated with

Poor Physical and Mental Health Status among

3080 Cancer Survivors

Floortje Mols1,2, Melissa S.Y. Thong1,2, LonnekeV. van de Poll-Franse1,2, Jan Anne Roukema3,Johan Denollet11Department of Medical Psychology, Tilburg Univer-sity, Tilburg, The Netherlands, 2Comprehensive CancerCentre South (CCCS), Eindhoven Cancer Registry,Eindhoven, The Netherlands, 3Department of Surgery,St. Elisabeth Hospital, Tilburg, The Netherlands

BACKGROUND: Most survivorship studies focusof clinical variables to explain differences inphysical and mental health status between patients.However, there is still a significant gap in ourunderstanding of the determinants of health status

outcomes; the role of individual differences is underexposed. The goal of this study was to determinethe association between Type D personality (theconjoint effect of negative affectivity and socialinhibition) and physical and mental health status ofcancer survivors. METHOD: In this study, datafrom four large population-based longitudinalsurveys on patient reported outcomes amongcancer survivors was used. All currently aliveindividuals diagnosed with endometrial or color-ectal cancer between 1998–2007, or with lymphomaor multiple myeloma between 1999–2008 as regis-tered in the Eindhoven Cancer Registry received aquestionnaire. Type D personality was assessedwith the DS14, and physical and mental healthstatus with the SF-36, EORTC-QLQ-C30 andHADS. Sixty-nine percent of survivors responded(n5 3080), 19% of them (n5 572) had a Type Dpersonality. Survivors with a Type D personalitywere younger and reported more comorbid diseasesthan non-Type D survivors. RESULTS: Type D’shad lower levels of general health, social function-ing, role-function emotional, mental health andvitality compared to non-Type D’s (SF-36; all P’so0.001). They also reported worse emotional andsocial functioning, global health status/quality oflife, and more fatigue (EORTC-QLQ-C30; all P’so0.001). Type D’s were more likely to experience adecreased health status on all SF-36 and EORTC-QLQ-C30 scales (ORs between 1.88-5.56). Theproportion of survivors reporting an impairedhealth status was higher among Type D (35-64%)than non-Type D’s (20-36%). Finally, Type D’swere more likely to be depressed (44% vs. 13%;po0.0001) and anxious (51% vs. 14%; po0.0001).CONCLUSIONS: In conclusion, Type D person-ality was associated with a poor physical andmental health status among survivors of endome-trial cancer, colorectal cancer, lymphoma andmultiple myeloma, even after adjustment forcomorbid depressive symptoms. RESEARCHIMPLICATIONS: These results call for furtherresearch on Type D personality among cancersurvivors followed over a longer period of time. Inaddition, potential underlying mechanisms (e.g.,poor adherence to treatment) that may explainthese Type-D related disparities in health statusshould also be investigated among cancer survi-vors. CLINICAL IMPLICATIONS: Type Dpersonality might be a vulnerability factor toscreen for in clinical practice in order to identifysubgroups at risk for impaired health status.Giving special attention to cancer survivors witha Type D personality is important as they are morelikely to experience a strong negative impact ofcancer on their physical and mental health statuswhich cannot be explained by socio-demographicor clinical characteristics. ACKNOWLEDGE-MENT OF FUNDING: This study was supportedby a VENI grant (451-10-041) from the Nether-



DOI: 10.1002/pon

lands Organization for Scientific Research awardedto Floortje Mols, and a Cancer Research Awardfrom the Dutch Cancer Society (UVT-2009-4349)to Lonneke van de Poll-Franse. Data collection ofthis study was funded by the ComprehensiveCancer Centre South, the Netherlands; the Centerof Research on Psychology in Somatic Diseases(CoRPS), Tilburg University, the Netherlands; andan Investment Subsidy (480-08-009) from theNetherlands Organization for Scientific Research.

P2-152

Quality of Life, Fatigue and Depression in Italian

Long-Term Breast Cancer Survivors

Francesca Romito, Claudia Cormio, FrancescoGiotta, Giuseppe Colucci, Vittorio MattioliNational Cancer Center ‘‘Giovanni Paolo II’’, Bari,Italy

BACKGROUND: Surviving breast cancer hasincreased in the last decades but, even in thelong-term period, patients experience late effectsthan can negatively impact their life. A differingdefinition of survival across countries may preventthe possibility both to compare and to use abroaddata to understand survival in specific geographicalareas, such as Southern Europe. The present studyaims to investigate fatigue, depression and qualityof life of long-term breast cancer survivors in Italy.METHOD: 255 long-term breast cancer survivorswere enrolled in the study during routine follow upvisits. Survivors were eligible to participate if theywere: a) 25–85 years old, b) disease and treatmentfree for 5 years, and, c) able to speak andunderstand Italian. Fatigue was measured withBrief Fatigue Inventory, Quality of life with SF-12and Depression with the Zung Depression Scale.Lifestyle was evaluated with yes/no questionsregarding tobacco use and physical activity. Sleeppattern was recorded on a dichotomic scale(regular sleep vs disrupted sleep). Data werecollected on illness-related variables (years fromdiagnosis, treatments) and comorbidities.RESULTS: The mean age of the sample was 58.4(range 35–80), mean survival time was 10.5 years(range 5–32). Most survivors did not smoke (91%)and did not engage in any physical activity (80%).46% had disturbed sleep pattern. 44% of survivorsscored one standard deviation below the norm forthe physical component of quality of life, and 35%for the mental component, thus reporting moderateor severe impairment in QoL. Moderate or severefatigue was present in respectively 22% and 11% ofthe sample. 37% of the sample showed mild (17%),moderate (12%) or severe (4.8%) levels of depres-sion. CONCLUSIONS: This study provides in-formation about the experience of surviving cancerin Southern Europe. The results suggest thatQuality of life, both the physical and the psycho-

logical aspects, is worse than in healthy subjectseven a decade after the cancer experience and this isparticularly true for younger survivors. Depressivesymptoms and fatigue have been found in roughly30% of the sample. None of the illness-relatedvariables, such as time from diagnosis, or type oftreatment received, nor life style behaviours havebeen found to impact any of the study outcomes.RESEARCH IMPLICATIONS: For future re-searches it could be useful to compare survivors’data with those deriving from the general popula-tion. Moreover, it could be suggested to investigatesleep more accurately and specifically in futurestudies on long-term survivors given the presenceof sleep problems in almost half of the sample.CLINICAL IMPLICATIONS: A multidimen-sional evaluation of cancer survivors is recom-mended during routine follow-up visits also manyyears after the end of the illness, because manynegative effects persist over time. It is also worthscreening sleep problems, a neglected aspect thatmay interfere with survivors’ physical and mentalwell-being. ACKNOWLEDGEMENT OFFUNDING: Italian Ministry of Health, IntegratedProgram in Oncology n. 7:’’Medical and psycho-social rehabilitation program for long-term cancersurvivors’’.

P2-153

Post-Cancer Pain in Long-Term Cancer Survivors

Francesca Romito, Claudia Cormio, CaterinaStolfa, Francesco Giotta, Giuseppe Colucci,Vittorio MattioliNational Cancer Center ‘‘Giovanni Paolo II’’, Bari,Italy

BACKGROUND: Chronic pain has been largelystudied in advanced cancer but less is known on theextent to which long term cancer survivorsexperience pain many years after treatment com-pletion. It still is a poorly understood issue anddata on its incidence and prevalence are lacking.This study aims to evaluate patterns of pain inlong-term cancer survivors. METHOD: 178 diseasefree long term survivors were enrolled duringroutine follow up visits at the outpatient unit ofthe National Cancer Center ‘‘Giovanni Paolo II’’in Bari, Italy. Trough oral interviews, data werecollected on Pain using the Brief Pain Inventory.Clinical and socio-demographic variables werecollected. RESULTS: Mean age of the samplewas 58 yo, mean of years since diagnosis was 10.5.Most of the sample were women (85%) with adiagnosis of breast cancer (73%). Pain was presentin 50% of the sample, mean severity of pain was5.4 (0–10 scale), mean interference on daily life was5 (0–10 scale). Pain location was mainly in theforearm and shoulder joint (39%). 63% did not useany medication for pain relief. Female patients and



DOI: 10.1002/pon

those with comorbidities had higher pain severityand patients with a history of lymphomassuffer from higher impairment in daily life.CONCLUSIONS: Pain is still a major concern inlong-term cancer survivors, both because it can besevere and because it interferes with daily life,moreover few survivors had their pain treated.Female survivors, those with some comorbidcondition, and with a history of lymphomas,should be routinely asked for the occurrence ofpain. RESEARCH IMPLICATIONS: The reasonswhy only a minority of survivors receive pain-relieving treatments should be investigatedin future studies. Moreover it could be long-itudinally investigated the onset and theduration pattern of pain in survivors. It shouldbe investigated the efficacy of non medical inter-ventions to prevent the occurrence of pain, such asphysical activity or physiotherapy interventions.CLINICAL IMPLICATIONS: Given the occur-rence of pain, it is necessary to investigate thepresence of this symptom also in long-term cancersurvivors, especially if they are breast cancersurvivors, or have had lymphomas or presentmultiple comorbidities. ACKNOWLEDGEMENTOF FUNDING: Italian Ministry of Health,Integrated Program in Oncology n. 7:’’Medicaland psycho-social rehabilitation program for long-term cancer survivors’’.

P2-154

Reproductive and Psychosocial Health Profile of

Young Men Diagnosed with Testicular Cancer,

Hodgkin’s and Non-Hodgkin’s Lymphoma Awaiting

Chemotherapy: A Comparison with Community and

Infertility Groups

Zeev Rosberger1, Marie Achille2, Barry Bultz3,Bejoy Thomas3, Raghu Rajan4, Ada Payne5, PeterChan61Louise Granofsky-Psychosocial Oncology Pro-gram, Segal Cancer Centre, Jewish GeneralHospital; Department of Psychology & Psychiatry,McGill University; Psychosocial OncologyProgram, Department of Onc, Montreal, QC,Canada, 2Department of Psychology, Universitede Montreal, Montreal, QC, Canada, 3Departmentof Psychosocial Resources, Tom Baker CancerCentre, University of Calgary, Calgary, AB,Canada, 4Department of Oncology, McGillUniversity, Montreal, QC, Canada, 5University ofToronto, Toronto, ON, Canada, 6Department ofUrology, McGill University Health Center; Depart-ment of Surgery, McGill University, Montreal, QC,Canada

BACKGROUND: Some chemotherapy regimensare gonadotoxic and may greatly impact youngmales. This study investigated first, the psychoso-cial and reproductive sequellae of young males

diagnosed with Testicular cancer (TC), Hodgkin’s(HL) or Non-Hodgkin’s Lymphoma (NHL) priorto chemotherapy. Second, these cancer patients’profiles were compared to a sample of males withidiopathic infertility and a sample of communitymales in an attempt to identify psychosocial issuesthat may be unique to male cancer patients.METHOD: 104 male patients with TC, HL orNHL were recruited from 4 hospitals in Montrealand Calgary, Canada. Additionally, 28 males withidiopathic infertility (Infertile controls5 IC) and63 males from the Montreal community (Commu-nity controls5CC) were recruited for comparison.Participants completed psychosocial questionnairesconsisting of validated scales (Profile of MoodStates (POMS-LASA), Symptoms Checklist 90-R(SCL 90-R), Functional Assessment of CancerTherapy - General (FACT-G), Infertility DistressScale (IDS)) along with biomedical assessments(semen and blood samples) to assess correlates offertility (e.g., sperm concentration and motility,Follicle Stimulating Hormone (FSH)). RESULTS:IC, TC, and NHL patients had lower than clinicalcut-offs (using WHO criteria) of 20 million/mLsperm concentration compared to the other groupspo.001, and o50% sperm motility po.001. Thegroups differed in mood disturbance p5 .01,energy po.001, depression p5 .03, anxietypo.001, and distress p5 .02. TC patients havesignificantly less mood disturbance and energy,more depressive symptoms and distress than CC,and were more anxious than CC and IC. CC andIC reported greater quality of life (physical, social/family, emotional, and functional well-being) thancancer groups. Cancer patients and IC did notdiffer significantly in infertility-related distress.CONCLUSIONS: Young males diagnosed withcancer exhibit significant reproductive decrementsand psychosocial distress prior to chemotherapy.TC patients have lower semen profiles (motilesperm index) than other cancer groups, but areequivalent to IC. Additionally, all participants hadcomparable FSH status. Psychosocial measuresindicated no differences across cancer groups indistress; however, TC patients had more psycholo-gical symptomatology than CC. Interestingly,cancer groups and IC did not differ in psychosocialmeasures, indicating that although the source ofdistress differed, all patients faced comparablelevels of psychosocial challenge. Both cancerpatients and IC appear equally concerned aboutinfertility risks. RESEARCH IMPLICATIONS:Future research can illuminate the specific fertilityissues (both psychological and biological) thatconcern cancer patients. Additional investigationis necessary to clarify the differences in fertilityneeds that may exist across various cancer groupsdue to diagnosis, as well as age and otherdemographic factors. Longitudinal designs canexplore the benefits of fertility counselling for



DOI: 10.1002/pon

patients at relevant points across theircancer treatment trajectory, and futureinterventions can be formulated accordingly.CLINICAL IMPLICATIONS: Health care profes-sionals can tailor fertility related counselling to theneeds of specific cancer patients in order to preventinfertility-associated distress. Health care profes-sionals can assist cancer patients who are at risk forfertility issues by discussing the side effects ofcancer treatment and providing fertility-preservingoptions before, during, and/or after cancer treat-ment when possible. Multidisciplinary treatmentteams that bring together oncologists and fertilityspecialists will provide patients with comprehensivecancer care. ACKNOWLEDGEMENT OFFUNDING: This research was part of a larger,multidisciplinary research program funded byCanadian Institutes of Health Research (CIHR).

P2-155

Goal Adjustment Capacities, Physical Activity and

Sedentary Behavior, and Emotional and Physical

Health among Breast Cancer Survivors

Catherine Sabiston1, Carsten Wrosch11McGill University, Montreal, Quebec, Canada,2Concordia University, Montreal, Quebec, Canada

BACKGROUND: In an effort to highlight a novelpsychosocial oncology framework of wellbeing,this prospective longitudinal study of breast cancersurvivors examined (i) the associations betweengoal adjustment capacities (i.e., goal disengage-ment and goal reengagement), and acute andchronic affect and physical health symptoms; and(ii) whether high physical activity and low seden-tary activity would mediate the effects of goaladjustment capacities on women’s acute andchronic emotional well-being and physical health.METHOD: Female breast cancer survivors(N5 176) were recruited through advertisementsand oncologist referrals from various local medicalclinics and hospitals in Montreal. Participantscompleted a questionnaire to assess goal disen-gagement and reengagement, physical activity, andsedentary behavior at baseline, and responded todaily questionnaires on three non-consecutive daysin the week following the baseline assessment toassess affect and physical symptoms. Three monthslater, 145 women (82%) completed a second datacollection. RESULTS: Goal reengagement pre-dicted high levels of positive affect and low levelsof physical symptoms over one week, and increasesin positive affect over 3 months. The combinationof high goal disengagement and high goal reen-gagement was associated with large 3-monthincreases in positive affect. The effects of goalreengagement on weekly positive affect and physi-cal health were mediated by high physical activity,and the interaction effect on 3-month changes in

positive affect was mediated by low sedentaryactivity. CONCLUSIONS: These findings suggestthat goal adjustment capacities are beneficial tobreast cancer survivors’ health and well-being byfacilitating adaptive lifestyle activity. RESEARCHIMPLICATIONS: Goal adjustment is associatedwith adaptive lifestyle activity among breast cancersurvivors. Women who are able to reengage in newgoals were more active than women with poor goalreengagement capacities. Also, the lowest levels ofsedentary activity were observed among womenwho disengaged from unattainable goals andreengaged in new goals. These relationships con-firm self-regulatory frameworks, advance ourunderstanding of predictors of lifestyle activity,and advance theory and research in this area.CLINICAL IMPLICATIONS: Goal adjustmentstrategies could be targeted in psychosocial oncol-ogy efforts directed at improving quality of lifefollowing breast cancer diagnosis and treatments.These findings, combined with existing workfocused on aging populations, suggest that teach-ing appropriate goal-setting plans that incorporategoal disengagement and reengagement capacitieshas implications for health and well-beingboth directly and through increasing physicalactivity and decreasing sedentary behavior.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by a Canadian Institutes ofHealth Research operating grant.

P2-156

Psychological Distress, Unmet Needs, Symptom

Prevalence, Benefit Finding and Social Support in

Cancer Survivors Completing Potentially Curative

Primary Treatment

Kerryann Lotfi-Jam1, Penelope Schofield1,2,Sanchia Aranda1,3, Michael Jefford1,21Peter MacCallum Cancer Centre, Melbourne, VIC,Australia, 2The University of Melbourne,Melbourne, VIC, Australia, 3Cancer InstituteNSW, Eveleigh, NSW, Australia

BACKGROUND: Many cancer survivorsexperience significant distress at treatment comple-tion due to the physical and psychosocial con-sequences of treatment. Identifying thoseexperiencing high levels of distress at end oftreatment will aid targeted intervention. Theaims of this study were 1) to examine levels ofdistress and other modifiable factors that contri-bute to distress and 2) to explore the impactof demographic and clinical variables on psycho-logical distress amongst Australian cancer survi-vors completing potentially curative treatment.METHOD: A consecutive sample of 125 survivors(response rate 85%) were recruited from twosites. Eligible participants were completingpotentially curative primary treatment for breast,



DOI: 10.1002/pon

prostate, colorectal or haematological cancers(Hodgkins or Diffuse Large B-Cell Lymphoma).Within 3 weeks of finishing treatment, participantscompleted reliable and valid self-report measuresto assess psychological distress (Brief SymptomInventory- BSI-18), general distress (DistressThermometer), unmet needs (Cancer SurvivorsUnmet Needs Survey - CASUN), social support(ENRICHD Social Support Instrument - ESSI),symptom prevalence (Memorial SymptomAssessment Scale - MSAS-SF) and benefit finding(Post Traumatic Growth Inventory - PTGI).RESULTS: Haematological survivors reportedsignificantly higher levels of clinical distress(30%), compared to colorectal (26%), breast(18%) and prostate (10%). Survivors experi-enced lack of energy (77%), difficulty sleeping(67%) and feeling drowsy (61%), but weremost distressed by sexual difficulties. 66%reported at least one unmet need (mean5 5 ofpossible 35 needs), with 25% needing helpmanaging concerns about cancer returning.Those who reported highest distress were younger,had young children, received chemotherapy orhormonal therapy, had more physical symptomsor had longer duration treatment (all po0.01).Higher distress correlated with higher symptomprevalence (r5 0.659), benefit finding (r5 0.587)and unmet needs (r5 0.379) and lower socialsupport (r5�0.193). CONCLUSIONS: Despitecompleting treatment and being ‘disease free,’many cancer survivors experience considerablepsychological distress, unmet needs and ongoingsymptom burden. These findings demonstrate anurgent need for improved information provisionand continued care after completing treatment.Tailored interventions should incorporate poten-tially modifiable factors such as increasing socialsupport, managing treatment side-effects andincreasing active coping skills to reduce distress inthis group. A longitudinal study is underway toinvestigate the predictive value of these relation-ships with ongoing distress, to test whether findingsremain stable over time. RESEARCH IMPLICA-TIONS: When examining risk factors for distress,it is essential to focus on both identification andpotential for intervention. Directing resources tothose who most require it is likely to be a morecost-effective strategy for managing psychosocialissues and requires evaluation. Development oftargeted interventions to reduce distress based onrelevant, modifiable factors is required. Surpris-ingly, benefit finding, or experiencing positivechange after cancer treatment was associated withhigher distress. This finding warrants furtherinvestigation. CLINICAL IMPLICATIONS:There is a demonstrated need for distress screeningin this population. Subgroups of survivors are athigh risk of poor psychosocial outcomes, includingthose who are younger and who have had more

intense treatment regimes. Sleeping difficulties,sexual dysfunction and other ongoing burdensomesymptoms were most strongly related to ongoingdistress and require increased support. AC-KNOWLEDGEMENT OF FUNDING: Ker-ryann Lotfi-Jam currently holds a NationalHealth and Medical Research Council PublicHealth Postgraduate Scholarship, ID 567146.Associate Professor Penelope Schofieldcurrently holds a National Health and MedicalResearch Council Career Development Award, ID628563.

P2-157

Results from a Pilot Study to Examine Perseverative

Cognitions and Personality and their Effect on

Subjective Cognitive Functioning

W. Schrauwen1, R. Belsack1, L. Dillen1,H. Denys1, R. Van den Broecke2, V. Cocquyt11University Hospital Ghent, Medical Oncology,Ghent, Belgium, 2University Hospital Ghent,Department of Gyneacology, Ghent, Belgium

BACKGROUND: The primary purpose of thisstudy is to focus on perseverative cognitionsand their influence on cognitive performance.Persistent cognitive changes after diagnosisand treatment in breast cancer patients can havea vast impact on survivors’ ability to regainfunctioning in society. Cognitive difficultieshave also been reported in other groups ofpatients, for example in patients with majordepression or PTSD. Williams (1996) suggeststhat a ruminative self-focus effects attention andconcentration. METHOD: A total of 198 breastcancer patients between 1.5 and 5 years afterchemotherapy were invited to participate in across-sectional descriptive study. Participants arewomen with stage I-III breast carcinoma treatedwith chemotherapy followed by radiotherapy/hormone therapy at the Breast Clinic of theUniversity Hospital Ghent, Belgium. Ninety com-pleted self-report questionnaires on cognitivecomplaints, perseverative cognitions, negativeemotions and personality. Personality traits likeopenness and neuroticism are considered to beimportant determinants of repetitive thought.RESULTS: Subjective cognitive complaints arestrongly correlated with anxiety, depression, wor-rying and rumination, and with the neurotic andconscientious scale of NEO. Participants hadhigh scores on anxiety, depression and worrying,even years after treatment. CONCLUSIONS:Results of this study suggest that worrying remainsvery high and the strongest predictor of cognitivecomplaints. Conscientiousness appeared as a pro-tective personality trait. ACKNOWLEDGE-MENT OF FUNDING: The financial support ofAstra-Zeneca is gratefully acknowledged.



DOI: 10.1002/pon

P2-158

Cognitive Impairment and Affect Regulation

during and after Curative Treatment for Breast

Cancer

W. Schrauwen1, L. Dillen1, H. Denys1, R. Van denBroecke2, V. Cocquyt11University Hospital Ghent, Medical Oncology,Ghent, Belgium, 2University Hospital Ghent, depart-ment of Gynaecology, Ghent, Belgium

BACKGROUND: Stressful life events are nor-mally followed by cognitive intrusions and workingthrough, in search for adaptation. Worry andrumination are characteristic of repetitive thoughtthat increases negative affect and interfere withcognitive functioning and problem-solving. Person-ality is likely to be an important determinant of thetype of repetitive thought in which individualstypically engage. More worrying/ruminationshould predict higher self-reported cognitive pro-blems, more maladaptive repetitive thought shouldalso predict performance on general neuropsycho-logical performance. METHOD: Women withstage I–III breast carcinoma scheduled to betreated with chemotherapy followed by radio-therapy or radiotherapy only, recruted followingsurgery but before the start of chemotherapy/radiotherapy. A control group of healthy womenperformed the same tests. Participants completedself-report measures for cognitive complaints,perseverative cognitions and negative emotions,along with a short neuropsychological battery ofneuropsychological tests for cognitive dysfunction.Changes in cognitive performance of chemother-apy recipients are compared with changes in agroup of women only receiving radiotherapy and ahealthy control group at baseline, after the end ofadjuvant therapy and 1 year later. RESULTS:Preceding the start of adjuvant therapy, breastcancer patient performed significantly less than ahealthy control group, especially on mental flex-ibility and verbal fluency. In an analysis ofcognitive performance after treatment, not a singlemeasure of our neuropsychological battery re-vealed deterioration. There was a tendencyof improvement on some cognitive measures.CONCLUSIONS: Subjective cognitive complaintsare strongly correlated with anxiety, depression,worrying and rumination, and with the neuroticand conscientious personality traits, but notwith neuropsychological test performance.ACKNOWLEDGEMENT OF FUNDING: Thefinancial support of Astra-Zeneca is gratefullyacknowledged.

P2-159

Quality of Life and Psychological Well-Being in

Melanoma Survivors

Eleonora D. Capovilla1, Samantha Serpentini1,Romina Spina1, Vanna Chiarion-Sileni2, MarcoRastrelli3, Luca G. Campana3, Maria Giacobbo41U.O.S. Psiconcologia - Istituto Oncologico Veneto(IOV) I.R.C.S.S., Padova, Italy, 2U.O.C.Oncologia - Istituto Oncologico Veneto (IOV)I.R.C.S.S., Padova, Italy, 3U.O. Melanomi e Sarcomi -Istituto Oncologico Veneto (IOV) I.R.C.S.S., Padova,Italy, 4U.O.C. Direzione Sanitaria - Istituto OncologicoVeneto (IOV) I.R.C.S.S., Padova, Italy

BACKGROUND: It is generally accepted thatcancer has an important impact on the life of anindividual also in long term. Little is known aboutthe effects of melanoma experience on generalcondition, physical, psychological and social, of thesurvivors. Therefore the aim of the present study isto evaluate Quality of Life (QoL) and Psychologi-cal Well-Being outcomes in disease-free melanomasurvivors. METHOD: At the beginning of 2010 weevaluated 100 patients (m: 47; f: 53; mean-age:53.94; range-age: 27–88) in follow-up, now disease-free, who received a diagnosis of cutaneousmelanoma from 2000 to 2007 (Stages I-II-III) andfollowed by I.O.V. (Istituto Oncologico Veneto -IRCCS) in Padova (Italy). Instruments used were:1) Short Form (SF-36) questionnaire, 2) Psycholo-gical General Well-Being Index (PGWBI). Meanscores were compared with normative data of thegeneral population. RESULTS: Compared withSF-36 general population, study patients had asignificant difference only for the ‘‘Mental Health’’scale (p5 0.009). Only patients between 55 and 64years obtained significant differences in ‘‘PhysicalActivity’’ (p5 0.003), ‘‘General Health’’ (p5 0.009)and ‘‘Vitality’’ (p5 0.038) scales. RegardingPGWBI, study patients present statistically signifi-cant better scores in all scales: ‘‘Anxiety’’(p5 0.017), ‘‘Depression’’(p5 0.000), ‘‘Psychologi-cal Well-Being’’ (p5 0.000), ‘‘Self-con-trol’’(p5 0.039), ‘‘General Health’’(p5 0.012),‘‘Vitality’’(p5 0,039), Global Index Score(p5 0.005). Female population show significantbetter outcomes in ‘‘Anxiety’’ (p5 0.002), ‘‘De-pression’’(p5 0.000), ‘‘Psychological Well-Being’’(p5 0.001), ‘‘General Health’’(p5 0.005),‘‘Vitality’’(p5 0.002), Global Index Score(p5 0.001). CONCLUSIONS: Patients who havesurvived melanoma have a better QoL in compar-ison with the general population. This could berelated to the recovery of the future perspective andthe resumption of the forward life trajectory.Cancer survivors are likely to re-evaluate theimportance of everyday events and this mayexplain why they had better psychological well-being scores. RESEARCH IMPLICATIONS: Fewstudies investigate the long-term consequences ofthe melanoma experience in the specific populationof disease-free survivors. The results suggest theopportunity of further analyses in order to explore



DOI: 10.1002/pon

the correlation between QoL and psychologicalfactors in a longitudinal perspective. CLINICALIMPLICATIONS: Our data show a good level oflong-term QoL and psychological well-being inmelanoma survivors but do not allow us to analyzethe psychological adjustment process to illness.Anyway, these findings highlight the importantrole of psychological dimension in the QoLconcept, especially in disease-free survivorspopulation. ACKNOWLEDGEMENT OFFUNDING: None.

P2-160

Losing Your Marbles: Understanding the Psychoso-

cial Issues Faced by Testicular Cancer Survivors

Allan B. Smith1, Madeleine King1, Phyllis Butow1,Ian Olver2, Tim Luckett1, Peter Grimison3, GuyToner4, Martin R. Stockler3, Elizabeth Hovey5,John Stubbs61PoCoG, University of Sydney, Sydney, NSW,Australia, 2Cancer Council Australia, Sydney,NSW, Australia, 3Sydney Cancer Centre, Sydney,NSW, Australia, 4Peter MacCallum Cancer Centre,Melbourne, VIC, Australia, 5Prince of WalesHospital, Sydney, NSW, Australia, 6Cancer VoicesAustralia, Sydney, NSW, Australia

BACKGROUND: Testicular cancer (TC) is themost common form of cancer (excluding skin) inmen aged 20–34 years and its incidence is rising.Although more than 95% of men with TC arecured, ongoing physical and psychological effectsrelated to the diagnosis and treatment of TC maynegatively affect men’s long-term psychosocialwellbeing. Few studies have comprehensively ex-amined long-term psychosocial outcomes in TCsurvivors. This study aimed to explore TC survi-vors’ experiences in depth. METHOD: This workis part of a cross-sectional study investigating theprevalence and correlates of psychological distressand impaired quality of life in 250 Australian TCsurvivors 6 months to 5 years from treatment.Survivors recruited from hospitals around Austra-lia who reported either: a) normal or b) severe/extremely severe levels of depression or anxiety onthe Depression Anxiety Stress Scale were invited toparticipate in a qualitative interview. These semi-structured telephone interviews explored difficultiesfaced by TC survivors and views on factors thatcontributed to or alleviated those difficulties.Interviews were audio-taped, transcribed, andcoded for themes using interpretive phenomenolo-gical analysis. RESULTS: Thematic saturation wasreached after 24 interviews. Difficulties experiencedby TC survivors related to four overarchingthemes: loss of confidence in self and others, lossof normal identity, loss of functional capacity, andconflicting expectations. Most TC survivorsfelt ill-prepared to deal with a cancer diagnosis so

early in their lives, which exacerbated difficulties.Establishing a new sense of normality, socialcomparison and social support alleviated difficul-ties. A comparison of the characteristics, experi-ences, and coping methods of TC survivors whoreported severe (n5 12) versus normal (n5 12)levels of depression or anxiety will be presented.CONCLUSIONS: These results provide an in-depth understanding of the challenges faced by TCsurvivors and factors that facilitated or impededcoping. Many of the difficulties experienced by TCsurvivors were associated with a sense of loss.Social contact with friends, family and other cancersurvivors aided coping. These findings will comple-ment the results of an ongoing cross-sectionalstudy by elucidating some of the issues underlyingpoor psychosocial outcomes in TC survivors.RESEARCH IMPLICATIONS: Further prospec-tive research is needed to determine which of thefactors identified in this study are most predictiveof poor psychosocial outcomes and whether theirinfluence changes over time. Well-timed interven-tions targeting the issues shown to be mostpredictive should be developed and evaluated toimprove long-term psychosocial outcomes in thispopulation. CLINICAL IMPLICATIONS: Menshould be informed of difficulties they mayexperience after treatment for TC to reduceconflicting expectations. Clinicians should alsomonitor survivors for loss of confidence in selfand others, loss of normal identity and loss offunctional capacity so appropriate support orreferral can be offered. Talking with a psychologist,social worker or support group may help TCsurvivors re-establish a new sense of normalityand facilitate social comparison and support.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was conducted by the Psycho-OncologyCo-operative Research Group in collaborationwith the Australian and New Zealand Urogenitaland Prostate Cancer Trials Group with fundingfrom Cancer Australia and beyondblue(grant num-ber 507961). Allan Smith is supported by anAustralian Rotary Health Ian Scott Mental HealthScholarship.

P2-161

Impact of the Earthquake in Japan on Cancer

Survivors and the Healthcare System

Miyako TakahashiDokkyo Medical University, Tochigi, Japan

BACKGROUND: The earthquake and tsunamithat devastated Japan on March 11,2011 has hadan enormous impact on cancer survivors and thehealthcare system. This presentation details thedisaster’s impact, ongoing support activities forcancer survivors, and lessons learned on providingeffective support based on local needs. The



DOI: 10.1002/pon

presenter, whose hometown was damaged by thetsunami, describes her personal experience as afamily member of the residents affected by thedisaster. METHOD: Information on cancer-related issues and support activities with regardto the earthquake were collected from newspaperarticles, online sites (blogs and homepages), andcancer survivors and healthcare providers in theaffected areas (by phone, e-mail, and social net-work services) from March to May 2011. Indivi-dual/group interviews with survivors andhealthcare providers will be conducted by October2011 in order to present their experiences andopinions regarding unresolved issues. RESULTS:A preliminary analysis revealed that cancer survi-vors residing in the areas directly hit by the tsunamiexperienced profound psychological distress causedby damage to their living environment, loss offamily members, and interruptions to cancertreatment. Many hospitals were destroyed andmedical records lost. Although Tokyo was notdirectly hit by the tsunami, the first-ever ‘‘plannedblackout’’ was implemented to prevent large-scalepower outages, forcing many hospitals to postponemedical examinations and cancer treatments. Forthyroid cancer survivors, there is a shortage oflevothyroxine because the factory that produces98% of the domestic share was damaged by theearthquake. CONCLUSIONS: The impact of thedisaster has been multifaceted. The psychologicaldistress of cancer survivors is strongly associatedwith their physical and social environments, whichchange with time. In fact, the impact of the disasteris not limited to regions directly hit by theearthquake and tsunami. Compared with the Kobeearthquake in 1995, academic- and survivor-ledcancer support organizations have been quick toprovide cancer-related information and supportactivities. The task remains, however, to determinewhether these activities have been effective.RESEARCH IMPLICATIONS: 1) The currentsituation surrounding cancer survivors needs to beclarified in different contexts in order to understandthe full impact the disaster. For instance, theexperience of a tsunami survivor would be differentfrom that of a nuclear plant evacuee. 2) Thepsychological impact of the disaster on cancersurvivors will need to be followed for years.CLINICAL IMPLICATIONS: 1) Effective meth-ods to reach out to people without access to theInternet and mobile phones should be developedduring the early stages of such disasters. 2) Multi-disciplinary collaboration is indispensable foraddressing patients’ psychosocial problems andmotivating them to continue treatment. 3) Securingthe physical and psychological health of healthcareproviders is also important, as many are disastervictims themselves. ACKNOWLEDGEMENT OFFUNDING: This research was funded by a JapanSociety for the Promotion of Science Grant-in-Aid

for Scientific Research (B) (KAKENHINo.21390158) and Health Labour Sciences Re-search Grant (H22-Ganrinsho-Ippan-008).

P2-162

Psychosocial Predictors of Breast Cancer Survivors’

Intimate Partners’ Needs for Information and

Support after Primary Breast Cancer Treatment

Evelyn Pauwels1, Caroline Charlier1, LilianLechner2, Ilse De Bourdeadhuij1, Elke Van Hoof3,41University Ghent, Ghent, Belgium, 2OPne univer-sity The Netherlands, Heerlen, The Netherlands,3Vrije Universiteit Brussel, Brussel, Belgium,4Belgian Cancer Center, Brussels, Belgium

BACKGROUND: Being breast cancer patients’and survivors’ key sources of support, intimatepartners go through the breast cancer trajectory atfirst hand. Although some partners appear tomanage the confrontation with cancer rathersuccessfully or even find benefit from the caregiving experience, several studies indicate thatintimate partners experience difficulties in dealingwith cancer. This study examines which psychoso-cial characteristics predict breast cancer survivors’partners’ post-treatment needs for information andsupport. METHOD: Partners eligible for this studyhad to be in an intimate relationship with a breastcancer survivor before the onset of breast cancer.Inclusion criteria (patients) were: (a) aged 18 to 65,(b) survivors of breast cancer, (c) 3 weeks to 6months after primary treatment and (d) Dutchspeaking. The recruitment of intimate partnersoccurred indirectly by contacting the survivors.Breast cancer survivors were recruited either duringfollow-up consultation or by consultation of thehospitals’ electronic patient files. Eighty-four in-timate partners completed measures of copingstrategies, social support, illness representations,perceived stress, self-efficacy, anxiety, depressionand marital malfunctioning. RESULTS: Partnerswere male and mainly middle-aged. The majorityof partners completed higher education and werecurrently employed. Partners reported a mean totallevel of care needs of 12.46. Partners in needreported higher anxiety and depression, emotionalillness representations and emotion-oriented cop-ing than partners without care needs and took amore negative view on the timeline and conse-quences of their spouse’s post-treatment condition.Partners’ emotional responses to the condition ofthe spouse and more negative perceptions regard-ing its duration were predictive of partners’ post-treatment needs for information and support.CONCLUSIONS: Post-treatment care needs arenot only reported but remain unmet. The psycho-social characteristics of partners in need forinformation and support after primary breastcancer treatment are not all that different from



DOI: 10.1002/pon

those of partners without needs. The fact thatpartners in need for information and supporttended to perceive the current post-treatmentcondition of the survivor as more chronic andexpected more severe consequences resulting fromit, adds to research indicating that taking on amore negative view of the illness of one’s partnerand its impact on life enhances partners’ vulner-ability to poor psychological adjustment.RESEARCH IMPLICATIONS: Despite the evi-dence regarding shortcomings in post-treatmentpartner care, literature on partners’ informationneeds after treatment is scarce. This study examinesthe partner’s needs after medical treatment of theirpatient-partner. CLINICAL IMPLICATIONS:Our research by the authors indicated thatpartners’ post-treatment needs for informationand support did not differ according to theirsociodemographic characteristics, nor accordingto the treatment received by the survivor. Bypaying attention to the key psychosocial character-istics indicated in the present study, clinicianssupporting couples confronted with breast cancercan optimize the division of the available man-power and means. ACKNOWLEDGEMENT OFFUNDING: This study was founded by theFlemisch League against Cancer (Belgium).

P2-163

Anxiety and Depression as a Predictor of Disease-

Specific and All-Cause Mortality in Patients with

Gastrointestinal Cancer: A Prospective Cohort

Study

Andrea Vodermaier1,2, Wolfgang Linden11University of British Columbia. Department ofPsychology, Vancouver, BC, Canada, 2Universityof Munich, Department of Obstetrics and Gynecology-Campus Grosshadern, Munich, Germany, 3BC CancerAgency, Vancouver, BC, Canada

BACKGROUND: Accumulating evidence sug-gests that psychological variables influence thecourse of cancer. The present study examinedeffects of anxiety and depression at the time ofcancer diagnosis on disease-specific and all-causemortality in a large population-based cohort ofpatients with gastro-intestinal cancers. METHOD:From 2004 to 2009 all newly diagnosed cancerpatients entering two large urban cancer carecenters in British Columbia have been routinelyscreened for anxiety and depressive symptoms withthe PSSCAN questionnaire. Survival analysis wasconducted to predict disease-specific and all-causemortality by presence or absence of clinical anxietyand depression with a mean follow-up of 51.2months. Analyzes were adjusted for age, gender,and disease stage. RESULTS: N5 903 patientswith gastrointestinal cancer were included in theanalyses. Of which, 24.9% had deceased until

October, 2010. 41.3% were female. Mean age atdiagnosis was 63.3 years. After diagnosis, 15.5%reported levels of anxiety and 9.4% reportedlevels of depression suggestive of a mentaldisorder. Clinical anxiety significantly predicteddisease specific (HR5 1.57(CI5 1.16–2.13)) andoverall mortality (HR5 1.54(CI5 1.15–2.06)).Clinical depression was even more closely asso-ciated with heightened disease specific(HR5 1.91(CI5 1.36–2.69)) and overall mortality(HR5 1.95(CI5 1.40–2.70)). CONCLUSIONS:Patients who experienced elevated levels ofanxiety or depression had a 1.5 to 2-fold risk ofpre-term death compared with patients withoutclinical levels of anxiety or depression.ACKNOWLEDGEMENT OF FUNDING:Canadian Institute of Health Research(CIHR) Team for Supportive Care in Cancer(AQC83559).

P2-164

Anticipatory Nausea among Ambulatory Cancer

Patients Undergoing Chemotherapy: Prevalence

Associated Factors and Impact on Quality of Life

Tatsuo Akechi, Toru Okuyama, Chiharu Endo,Ryuichi Sagawa, Megumi Uchida, TomohiroNakaguchi, Masaki Sakamoto, HirokazuKomatsu, Ryuzo Ueda, Makoto Wada, ToshiakiFurukawaNagoya City University Graduate School of MedicalSciences, Nagoya, Japan

BACKGROUND: Despite of recent improvementsin anti-emetic therapy, chemotherapy-induced nau-sea and vomiting still remains a significantproblem. The nausea and vomiting that oftenaccompany later treatments commences even priorto the administration of the chemotherapeuticagent, and this phenomenon has been defined asanticipatory nausea and vomiting. The purposes ofthe study were to investigate the prevalence ofanticipatory nausea, its associated factors, and itsimpact on quality of life among cancer patientsreceiving chemotherapy. METHOD: Randomlyselected ambulatory cancer patients who werereceiving chemotherapy participated in this study.The patients were asked to complete the MorrowAssessment of Nausea and Emesis scale, theHospital Anxiety and Depression Scale, theShort-form Supportive Care Needs Survey ques-tionnaire, and the European Organization forResearch and Treatment of Cancer QLQ-C 30.RESULTS: Complete data were available for 214patients. A total of 10.3% of the patients experi-enced very mild to severe anticipatory nausea. Thepresence of anticipatory nausea was significantlyassociated with most domains of the investigatedpatients’ outcome including psychological distressand perceived needs, with the exception of the



DOI: 10.1002/pon

health system and information domain of patients’needs and the physical functioning domain ofquality of life. Anticipatory nausea was alsoassociated with quality of life even after adjust-ments for age, sex, performance status, andpsychological distress. CONCLUSIONS: The pre-valence of anticipatory nausea in ambulatorycancer patients who receive chemotherapymay not be as high as previously reported.However, given its potentially significant impacton relevant outcome, including quality of life,anticipatory nausea should not be neglected incurrent clinical oncology practice. RESEARCHIMPLICATIONS: Since very few studies haveinvestigated the impact of anticipatory nausea onquality of life, more studies, especially longitudinalprospective studies, are needed. CLINICALIMPLICATIONS: Considering that once antici-patory nausea occurs it usually does not sponta-neously diminish and in view of the potentialimpact of anticipatory nausea on patientoutcomes, anticipatory nausea should not beneglected in current clinical oncology practice.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was supported in part by a Grant-in-Aid forScientific Research from the Japanese Ministry ofEducation, Culture, Science, and Technology and aGrant-in-Aid for Cancer Research from theJapanese Ministry of Labor, Health and Welfare.

P2-165

Long-Term Use of Sleeping Medications among

Cancer Patients

Marie Solange Bernatchez1,2, Josee Savard1,2,Hans Ivers1,21Laval University School of Psychology, Quebec,QC, Canada, 2Laval University Cancer ResearchCenter, Quebec, QC, Canada

BACKGROUND: Hypnotic are by far the mostcommonly used treatment for insomnia. A Cana-dian study showed that the use of sleeping pills andtranquillizers was approximately three times higheramong cancer patients than in the general popula-tion. However, little is known about the chronicuse of hypnotics in the cancer population and thefactors that are associated with it. The aim of thisstudy was to identify predictors of chronic use ofhypnotic among cancer patients. METHOD: In thecontext of a larger epidemiological research, 962cancer patients scheduled to undergo surgery wererecruited and 921 completed all relevant informa-tion for the present study. During theperi-operative period, the patients completed ademographic and medical questionnaire, theInsomnia Interview Schedule, the Insomnia SeverityIndex, the Physical Symptoms Questionnaire, theHospital Anxiety and Depression Scale, the List ofLife Events,andthe EORTC Quality of Life Ques-

tionnaire-C30. The patients also gave informationabout their hypnotic consumption on 6 occasions:at the peri-operative period, as well as 2, 6, 10, 14,and 18 months later. RESULTS: The patients werecategorized into the following four groups: nohypnotic use during the course of the study,hypnotic users at 1 to 2 time points, hypnotic usersat 3 to 5 time points, and hypnotic users at all timepoints. The patients who used a hypnotic at 3 timepoints or more were considered chronic users.Multiple regressions identified the following pre-dictors: older age (b5 .123, p5 .0002), prostatecancer (b5 -.137, p5 .01), difficulties falling asleep(b5 .123, p5 .002), early awakenings (b5 .089,p5 .02), anxiety (b5 .098, p5 .02), and pastpsychological difficulties, b5 .093, p5 .003. Thesespredictors explained 14.8% of the variance,F(12, 908)5 13.15, po.01. CONCLUSIONS:Patients who are older, who have difficulties fallingasleep or waking up too early, who are moreanxious, and who had psychological difficultieshave a higher risk to use hypnotic medications on achronic basis, while prostate cancer patients have alower risk than other cancer patients. An earlyidentification of high-risk cancer patientswill make it possible to propose to themalternative treatments for sleep disturbances suchas cognitive-behavioral therapy for insomniawhose efficacy is well demonstrated. ACKNOWL-EDGEMENT OF FUNDING: This study wassupported by training awards held by the firstauthor from the Canadian Institutes of HealthResearch (CIHR) and the Psychosocial OncologyResearch Training program and by a researchgrant held by the second author from the CIHR(MOP - 69073).

P2-166

Chemotherapy Induced Pain: Impact on Daily Life,

Thoughts and Feelings among Women with Breast

Cancer

Susanne BorjessonCaring Science, Uppsala, Sweden

BACKGROUND: The aim of the study was toexplore women’s perceptions of chemotherapy-induced pain, effects on thoughts, feelings anddaily life during adjuvant treatment of breastcancer. Modern treatments - high doses of che-motherapy - may induce painful neuropathies andsevere muscle, bone, and joint pain. Pain connectedwith chemotherapy are in studies more frequentlymeasured with instruments, however self-describedperception of pain occurs less frequently in studiesand in the literature. METHOD: Phenomeno-graphic approach was used in the interviewsand data analysis to explore the description ofthe individual woman’s perception/behavior andexperiences of pain during chemotherapy. After



DOI: 10.1002/pon

ethical approval of the study in September 2010,women newly diagnosed with breast cancer(n5 10) were consecutively included through oral/written request. Inclusion criteria were chemother-apy (antracycline/taxane) in doses of 75mg/m2/d,and pain during treatment of 4 cm on the visualanalogue scale. Exclusion criteria were inability tounderstand and communicate in Swedish or mentalillness. Pain measurements were done three times:before the treatment, on day 10 after treatment,and during the interview. RESULTS: The resultconsisted of five categories of description, theobvious pain, the manageable pain, the lonelypain, the shame-filled pain and ultimately thecrippling pain. The existence was open when thepain felt describable and manageable, while it wasconcluded when the pain seemed inexplicable andlife drastically changed. The study showed asignificant painful impact of chemotherapy. Thewoman had difficulties to refer to earlier giveninformation, when the pain went beyond previousexperiences. There was a tendency that the womanwaited before she contacted the medical services,this waiting made room for difficult thoughts andfeelings. CONCLUSIONS: Women whom experi-enced severe pain was initially left alone in theirexperience by the health care service. The pain wasbeyond their expectation but instead of seekingemergency help the women retreated. The painbrought fear and despair. For women where thepain were at more reasonable levels there wereroom for more positive interpretations of whathappened in the body. The pain was manageableand accepted. The pain was generally mostpronounced at the first course and in the contextof taxan even though the anthracycline sequencewas described to provide some pain but a muchmilder one. RESEARCH IMPLICATIONS: Forresearch, this study highlights the understanding ofchemotherapy induced pain and its impact on lifein women diagnosed with breast cancer, receivingchemotherapy.This raises further questions, are wedoing our very best in supporting these women andpreventing pain in those whom receiving che-motherapy, in a medical, social and caring context?Which methods are most appropriate in order todevelop an elementary model that systematicallyhelps and supports each patient with optimal paincontrol? CLINICAL IMPLICATIONS: The inter-views in this project highlight the impact of paincreated by chemotherapy in women’s daily life,thoughts and feelings during treatment. This isimportant knowledge for carers and clinicians inorder to meet, support and care for womenreceiving chemotherapy for breast cancer. It alsodemonstrates the need of careers and clinicians tobe responsive to signs of pain of these women.ACKNOWLEDGEMENT OF FUNDING: Thisstudy has obtained funding from the SwedishCancer Society, the Swedish Research Council

and the Regional Research Council in the Regionof Uppsala and Orebro.

P2-167

The Role of Dysfunctional Beliefs and Attitudes

about Sleep: Do they Predispose or Maintain

Insomnia in Cancer?

Caroline Desautels1,2, Sophie Ruel1,2, HansIvers1,2, Josee Savard1,21School of Psychology, Universite Laval, Quebec,QC, Canada, 2Laval University Cancer ResearchCenter, Quebec, QC, Canada

BACKGROUND: Insomnia affects up to 60% ofcancer patients. Dysfunctional beliefs and attitudesabout sleep have been found to be associated withinsomnia in the general population and in thecontext of cancer. The goal of this study was toassess to what extent dysfunctional beliefs andattitudes about sleep contribute to predisposingrather than perpetuating insomnia over time incancer patients. METHOD: Patients scheduled toundergo surgery for cancer (N5 962) completedthe Dysfunctional Beliefs and Attitudes aboutSleep scale (DBAS-16) at baseline (T1) and theInsomnia Interview Schedule (IIS) at six timepoints: at T1 and 2 (T2), 6 (T3), 10 (T4), 14 (T5)and 18 (T6) months later. At T1, participants werecategorized in one of these three groups based onthe IIS: good sleepers, insomnia symptoms orinsomnia syndrome. The natural course of insom-nia was studied by allocating participants into thefollowing four sleep trajectories at each time point:incidence, persistence, remission or relapse ofinsomnia. RESULTS: Chi-square analyses showedthat, in good sleepers, higher DBAS scores at T1were significantly associated with an increasedincidence of insomnia throughout the cancer caretrajectory, w2 (2)5 8.33, p5 .02. In participantswith insomnia symptoms, w2 (2)5 8.93, p5 .01,and insomnia syndrome, w2 (2)5 6.68, p5 .04, atT1, greater baseline DBAS scores were significantlyassociated with a higher persistence of insomniathroughout the 18-month follow-up. Conversely, inparticipants with insomnia symptoms at T1, lowerbaseline DBAS scores were significantly associatedwith higher remission rates, w2 (2)5 5.91, p5 .05.CONCLUSIONS: These findings suggest a pre-dictive role of baseline dysfunctional beliefs andattitudes about sleep in determining sleep trajec-tories in cancer patients. Higher levels of dysfunc-tional beliefs and attitudes about sleep appear to beinvolved both in the development and maintenanceof insomnia in the context of cancer, while lowerlevels of dysfunctional beliefs and attitudes aboutsleep appear to facilitate insomnia remission.RESEARCH IMPLICATIONS: Results found inthis longitudinal study are consistent with those ofprevious studies in showing significant associations



DOI: 10.1002/pon

between dysfunctional beliefs and attitudes aboutsleep and insomnia in cancer patients. In additionto showing, as previous studies have, that dysfunc-tional beliefs about sleep are associated withinsomnia persistence, these results suggest thatdysfunctional beliefs may also contribute toinsomnia incidence in cancer patients. CLINICALIMPLICATIONS: These results highlight therelevance of integrating cognitive therapy in thetreatment of insomnia in cancer patients. They alsosuggest that prevention of sleep difficulties could berelevant in good sleepers presenting high levels ofdysfunctional beliefs and attitudes about sleep.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was supported by a training award held byboth the first and the second authors from thePORT program (TGF-63285) and by a researchgrant held by the fourth author from the CanadianInstitutes of Health Research(MOP - 69073).

P2-168

Cancer Pain: Prevalence of Cancer Pain in Out-

patients Who Are Registered to a Cancer Therapy

Center

Fatma Eti Aslan1, Aysin Kayis1,2, Ilknur Inanir1,2,Zehra Kan Onturk1, Nermin Olgun1, UkkeKarabacak11Acibadem Universitesi, Hemsirelik Bolumu,Istanbul, Turkey, 2Acibadem Kozyatagi Hospital,Istanbul, Turkey

BACKGROUND: The study was carried out witha descriptive point of view aiming at determiningthe pain prevalence with patients registered in acancer treatment center or treated standing. In thestudy, the cancer patients’ pain prevalence,severity, painful areas, and their frequencies wereanalysed. METHOD: The study comprised 256cancer patients treated on stood in a cancertreatment center in Ystanbul in 2010, and 99cancer patients, the only ones that could be reachedto, who agreed to participate were used asexamples in the study. The data was collectedusing pain evaluation and individual characteristicsforms. For %50.5 of the reached patients did notsuffer from pain, the study was completed usingonly %49.5 of them. RESULTS: %30.6 of thepatients with pain suffered from colon/rectumcancer, %24.5 from lung cancer, and %51 frommetastasis. Besides, %20.4 among 49 patients withpain did not get pain treatment. Generally, Opioid,Nonsteroid Antinflematuar medicines (NSAM)and Adjuvan Analgesics in a combined way wereused as pain treatment. It was found out that%49of the 99 cancer patients treated standingsuffered from pain, and that %34.3 of them hadlow, %7.1 had ‘‘moderate’’, %24.5 had ‘‘extreme’’pain, and it was stated that the pain was constant

in %28.6 of the patients. CONCLUSIONS:The fact that %20.4 of the 49 patients with paindid not have pain treatment, and that half of thecancer patients under control suffered frompain was rather tragic and thought-provoking.ACKNOWLEDGEMENT OF FUNDING:None.

P2-169

The Effects of Chemotherapy and Spouse’s Ex-

istence on the Appearance of Delirium in Cancer

Patients

Hiromichi Matsuoka, Kiyohiro Sakai, RyoSakamoto, Minoru Niki, Rikako Jinnai, KanaeYasuda, Atsuko KoyamaSakai Hospital, Kinki University Faculty ofMedicine, Sakai City, Osaka, Japan

BACKGROUND: Delirium is frequently diag-nosed and sometimes difficult to be treated inhospitalized patients with cancer. However, themechanism of the delirium has not been clarifiedenough. There has been growing evidence inthe medical literature to support an increasedincidence of cognitive decline in cancer survivors,resulting from chemotherapy. But there are fewpatient reported data regarding delirium afterchemotherapy. We aimed to establish theeffects of chemotherapy and other risk factors onthe appearance of delirium in cancer patients.METHOD: We retrospectively analyzed 160patients (male 104) with cancer. The subjects ofthis study were cancer patients who were hospita-lized and died in our hospital between September2007 and January 2010. We investigated the effectsof anticipated multiple risk factors on the appear-ance of delirium in cancer patients by thediagnostic criteria of the delirium outlined by theDSM-IV-TR. who got married might have less riskof appearance of delirium. RESULTS: Patientstreated chemotherapy had two and half times asmuch as patients who didn’t have chemother-apy.(OR5 2.502; 95% CI5 1.160–5.397) andpatients who got married had about 50% reductionin the risk of appearance of delirium comparedwith patients who were not married (OR5 0.468;95% CI5 0.232–0.945). CONCLUSIONS: Ourresults suggest that chemotherapy can be the riskfactor of developing delirium, and patients whogot married might have less risk of appearanceof delirium. RESEARCH IMPLICATIONS:Delirium is regarded by family and caregivers asa difficult experience to witness. Effect of deliriumon family and care-givers is reported. On theother hand, little is known about the effect ofspouse’s existence to the delirium. This is thefirst study mentioning the effects of spouse’sexistence on the appearance of delirium in cancerpatients. CLINICAL IMPLICATIONS: Oncology



DOI: 10.1002/pon

professionals’ awareness of the relationship be-tween delirium and chemotherapy and beingmarried is important, because delirium in cancerpatients frequently is not recognized; and evenwhen it is recognized, it may be undertreated. Ourfindings suggest that chemotherapy can be the riskfactor of developing delirium, and patients who gotmarried might have less risk of appearance ofdelirium. In the future, we may predict thepossibility which patients may develop delirium.ACKNOWLEDGEMENT OF FUNDING:None.

P2-170

How Many People with Cancer Related Distress or

Depression have Suicidal Thoughts and How Many

Want Help for These?


BACKGROUND: Recently there has been moreattention towards people with suicidal thoughtswho suffer distress or depression in the context ofcancer. We aimed to study the frequency of suicidalthoughts in an ethnically diverse UK samplefocussing on who is willing to accept psychologicalhelp. METHOD: We analysed data collected fromLeicester Cancer Centre from 2008–2010 involvingapproximately 1000 people approached by aresearch nurse and two therapeutic radiographers.We collected data on 738 presentations, that ispeople seen up to three times over 9 months duringtreatment for cancer. We had complete dataregarding suicidality on 554 contacts. We measuredsuicidal thoughts using the question ‘‘thoughts thatyou would be better of dead or hurting yourself insome way’’ and scored as follows: not at all5 0;several days5 1; more than half the days5 2;nearly every day5 3. RESULTS: Of 554 patients44 had some suicidal thoughts (8%), 12 had regularsuicidal thoughts (2%). Of 69 people with majordepression, 24 had suicidal thoughts (36.2%). Of95 people with minor depression 7 had suicidalthoughts (7.4%). Of 205 people with distress on theDT, 37 had suicidal thoughts (18.0%). Of 44 withsome suicidal thoughts 30 would consider accept-ing help (68%). Of 12 with regular suicidalthoughts only 8 wanted help (67%). Of 7 withsuicidal thoughts nearly every day 5 wanted help(71%). CONCLUSIONS: In our clinically repre-sentative diverse sample, suicidal thoughts wereuncommon, present in only 8% (although theywere common in major depression in about 1/3).Of those with suicidal thoughts about a quarter didnot want help for these. This was not particularlyinfluenced by the presence or absence ofdepression. RESEARCH IMPLICATIONS:Further work is needed to replicate our findingson the question of who wants help with their

suicidal thoughts. CLINICAL IMPLICATIONS:Clinicians must help us understand why somepatients decline help for occassional or regularsuicidal thoughts. For those that do decline,automatic follow-up is probably indicated.ACKNOWLEDGEMENT OF FUNDING:None.

P2-171

The Pain and Anxiety Trajectory for Rectal Cancer

Patients during Brachytherapy

Sylvain Neron1,2, Samara Perez1,3, Renata Benc4,Zeev Rosberger1,3, Te Vuong41Louise-Granofsky Psychosocial Oncology Pro-gram, Jewish General Hospital, Montreal, Quebec,Canada, 2Department of Oncology, McGill Univer-sity, Montreal, Quebec, Canada, 3Department ofPsychology, McGill University, Montreal, Quebec,Canada, 4Department of Radiation Oncology,Jewish General Hospital, Montreal, Quebec, Canada

BACKGROUND: Colorectal cancer is the thirdmost prevalent cancer. Recent innovative bra-chytherapy treatment is: 1) More invasive;2) Involves placing a radioactive material in therectum and 3) Uses higher total radiation dose,over shorter time. Limited research exists regardingthe physical and emotional experience of thesepatients. The study objectives were to determinethe trajectory of the patients’ pain and anxietyexperience: (a) during, and (b) over the course offour days of treatment. METHOD: Rectal cancerpatients (N5 25; Mage560.5,SD5 11.0) who re-ceived brachytherapy at the radiation oncologydepartment of the Jewish General Hospital. Anapplicator is placed inside the rectum, for approxi-mately 90 minutes and withdrawn. The totaltreatment length is about 2 hours/day over 4 days.Patients completed self-report measures of anxietyand distress (State-Trait Anxiety Inventory) priorand posteach day of treatment. Verbal analogmeasures (VAS)of pain and anxiety were alsorecorded during treatment (before and after inser-tion of applicator, before and after high doseradiotherapy) on each day of treatment. RE-SULTS: Matched paired t-tests were conductedto examine changes in anxiety and pain. On thefirst day of treatment, anxiety is heightened butdecreases over the course of the four days. Duringthe procedure, there was no significant change inanxiety across treatments or days. There was asignificant difference between levels of pain beforeand after insertion of the applicator. Followinginsertion, the pain decreased but this is notstatistically significant. This trend is seen acrossall the days of treatment. CONCLUSIONS:Results indicate that for most patients that painwas associated with insertion of the applicator.Qualitative data for patients describing high levels



DOI: 10.1002/pon

of pain was not supported by the low mean painscore (3.0/10). However, there is a large distribu-tion of pain, with around 25% of the samplereporting moderate to high levels of pain (5-8 outof 10). Interestingly, no attenuation or habituationin anxiety was reported across treatment or days oftreatment. Additionally, the mean score for anxietywas low (3.2/10), but there was great variationacross patients. RESEARCH IMPLICATIONS:Pain and anxiety ratings were provided verballyand on a sequential basis, which may haveimpacted results. Future research should employindependent pain and anxiety measures, which canbe recorded using a pictorial thermometer ratherthan verbally, in order to accurately illustrateelevated pain levels. Future analysis should controlfor pain medication (time and dosage) and tumorlocation. CLINICAL IMPLICATIONS: Althoughthe mean score of pain can be classified as low,there is great variation in pain across thesample. Similarly, the mean anxiety score may beclassified as low, but here too there are highlevels of anxiety among some patients. Addressingeach patient’s unique set of needs including hisor her tumor location is important. Patient-tailoredpsychosocial interventions (e.g. hypnotic interven-tions) could be used to decrease pain and anxiety.ACKNOWLEDGEMENT OF FUNDING:None.

P2-173

Effect of Escitalopram on Depression and Quality of

Life in Ambulatory Female Patients with Breast

Cancer

Hye Yoon Park1, Byoung-Jo Lee1, Jong-HoonKim2, Jae-Nam Bae3, Bong-Jin Hahm1

1Department of Psychiatry, Seoul National Univer-sity College of Medicine, Seoul, Republic of Korea,2Department of Psychiatry, Gil Medical Center,Gachon University of Medicine & Science, Incheon,Republic of Korea, 3Department of Psychiatry, InhaUniversity College of Medicine, Incheon, Republic ofKorea

BACKGROUND: Among the patients with can-cer, management of depression is very important toimprove quality of life as well as distress. However,the efficacy of escitalopram, a potent serotoninreuptake inhibitor, has not been well evaluated inthose patients. We investigated the effect ofescitalopram on depression and quality of life inbreast cancer patients. METHOD: A 12-week,open-label, prospective study with escitalopramwas performed in 79 ambulatory breast cancerpatients with depression. Primary outcome mea-sure was Hamilton Depression Rating Scale(HAM-D) which was assessed at 1,2, 4, 8 and12 weeks after treatment. Clinical Global Impres-sion-Severity of Illness (CGI-S), the Distress

Thermometer (DT) and the Functional Assessmentof Cancer Therapy- Breast cancer (FACT-B) werealso evaluated to measure the improvement ofsymptoms, distress and quality of life. RESULTS:HAM-D, DT and CGI-S scores were significantlydecreased from week 1 (po0.01), and FACT-Bimproved from week 2 (p5 0.011). At week 12, allFACT-B subscales including the Physical, Emo-tional, Social/family, Functional well-being and theBreast cancer subscale statistically improved. Im-provement in distress and quality of life wasassociated with reduction of depressive symptoms.43.3% of participants met response criteriaand 33.3% did remission criteria at week 12.CONCLUSIONS: In the present study, escitalo-pram improved quality of life as well as depressionin breast cancer patients. Symptom improvementappeared to begin rapidly in a week and impact onquality of life. Escitalopram may be an effectivetreatment in breast cancer patients with depression.RESEARCH IMPLICATIONS: This is the firststudy of escitalopram treatment in cancer patientswith depression using serial structured assessmentsof distress and quality of life as well as depressivesymptoms from the very early period through 12weeks. CLINICAL IMPLICATIONS: Our studysuggests that escitalopram can be used for treat-ment option for depression in breast cancerpatients, especially who need rapid symptomaticimprovement. ACKNOWLEDGEMENT OFFUNDING: This study was supported by Lund-beck Korea LTD.

P2-174

The Anger and its Underlying Factors in Patients

with Cancer

Ryuichi Sagawa1,2, Kazuko Koga2, TakayukiNimura2, Toru Okuyama2, Megumi Uchida2,Tatsuo Akechi21Bisai Hospital, Inazawa, Japan, 2Nagoya CityUniversity, Nagoya, Japan

BACKGROUND: Cancer patients often confrontvarious physical and mental distresses during his/her illness trajectory and they sometimes expressanger. On the other hand, a patient’s anger oftenannoys medical staff and it can even disturboptimal cancer treatment. However, there havebeen few findings regarding cancer patients’ angerand its underlying factors. We conducted retro-spective chart review in order to examine frequencyof caner patients’ anger and their associatedfactors. METHOD: This study is a retrospectiveinvestigation using the chart review. The subjectsare cancer patients referred to palliative care teamin the Nagoya City University Hospital, Japanduring the period from April, 2008 to March, 2010.We defined the patients’ anger when the patientsexpressed hostility or the aggressiveness toward



DOI: 10.1002/pon

nurses and/or doctors. Two independent research-ers evaluated presence or absence of descriptionsabout anger expression using the medical records.We also explored the association between presenseof anger and patient’s demographic data, physicalstate, psychiatric diagnosis, cancer treatment situa-tion. RESULTS: Among 281 patients who wereindependently surveyed, 59 (21%) patients ex-pressed their anger (kappa5 0.88). Male patientsare more likely to express anger than femalepatients (27% and 14%, respectively; OR5 2.0,95% CI5 1.1–3.6), and the patients who werediagnosed as delirium express anger frequentlycompare to the patients without delirium (32% and16%, respectively; OR5 2.4, 95% CI5 1.3–4.3).The association between the other demographicbackground, the physical symptom such aspain and nausea, the stage of cancer andanger expression were not statistically significant.CONCLUSIONS: Approximately one-fifthreferred cancer patients expressed anger towardmedical staff, and male sex and diagnosis ofdelirium was suggested as their predictive factor.RESEARCH IMPLICATIONS: A larger samplesize and prospective study are necessary to confirmthe results. Further studies are required to deter-mine the factors associated with the anger expres-sion of patients with cancer, and t to develop theappropriate evaluation strategies of these patients.CLINICAL IMPLICATIONS: Anger expressionis not rare in cancer patients. Psychiatric assess-ment is important to deal with the anger expressionof the patients with cancer. Particularly, it wassuggested that differential diagnosis of delirium asthe organic psychic disturbance was important.ACKNOWLEDGEMENT OF FUNDING:None.

P2-175

Cortisol Levels Predict Insomnia in Patients Treated

for Prostate Cancer

Josee Savard1,2, Severine Hervouet1,2, Hans Ivers1,21Laval University Cancer Research Center, Quebec,QC, Canada, 2School of Psychology, UniversiteLaval, Quebec, QC, Canada

BACKGROUND: In the general population,studies have found a relationship between insomniaand hyperactivity of the hypothalamo-pituitary-adrenocortical (HPA) system, but it is not clearwhether hypercortisolemia is a risk factor or aconsequence of insomnia. As part of a largerlongitudinal study, this investigation aimed toassess whether increased cortisol levels are a betterpredictor of insomnia at a subsequent time pointthan the reverse path (insomnia predictinghigher cortisol) in patients with prostate cancer.METHOD: Sixty men scheduled to receiveradiation therapy for prostate cancer, with or without

androgen deprivation therapy (ADT), were as-sessed prior to receiving any treatment (baseline)and at seven additional times over a periodof 16 months (1,2, 4, 6, 8, 12, and 16 months)using the Insomnia Severity Index and plasmalevels of cortisol. Data were analyzed usingmixed modeling regressions controlling fortemporal dependency and treatments received(with vs. without ADT). RESULTS: Greaterinsomnia symptoms at one time point weresignificantly predicted (beta5 0.94) by insomniasymptoms, t(308)5 46.91, po.001, and cortisollevels (beta5 0.07), t(308)5 3.36, p5 .001, at theprevious assessment. Conversely, higher cortisollevels at one assessment were significantlypredicted by cortisol levels at the previoustime point (beta5 0.25), t(293)5 4.79, p5 .001,marginally predicted by insomnia symptoms as-sessed at the same time (beta5 0.11), t(293)5 1.90,p5 .06, but not significantly predicted byinsomnia symptoms at the preceding timepoint, t(293)5 0.38, p5 .70. CONCLUSIONS:Longitudinally, cortisol levels better predictedinsomnia severity than insomnia severitypredicted cortisol levels in patients treated forprostate cancer. RESEARCH IMPLICATIONS:Further studies are needed in order toestablish the causal role of HPA axisalterations and the risk for insomnia. CLINICALIMPLICATIONS: Although replicationof these findings is warranted, it wouldappear that interventions aiming at reducing thestress levels which are associatedwith HPA hyperactivity could contribute topreventing the development of insomnia inprostate cancer patients. ACKNOWLEDGE-MENT OF FUNDING: NARSAD and theCanadian Institutes of Health Research.

P2-176

Androgen-Deprivation Therapy is Associated with

Increased Insomnia in Patients with Prostate Cancer

Josee Savard1,2, Severine Hervouet1,2, Hans Ivers1,21Laval University Cancer Research Center, Quebec,QC, Canada, 2School of Psychology, UniversiteLaval, Quebec, QC, Canada

BACKGROUND: Androgen-deprivation therapyleads to nocturnal hot flashes and nocturia whichmay both disturb sleep. As part of a largerlongitudinal study, this investigation aimed to: (1)compare the evolution of rates of insomnia inpatients receiving ADT 1 radiotherapy (ADT-RTH) to patients receiving RTH only; and (2)assess the mediating role of hot flashes and urinarysymptoms in the relationship between ADT andinsomnia. METHOD: Sixty men scheduled toreceive RTH for prostate cancer, with (n5 28) orwithout (n5 32) ADT, were assessed prior to



DOI: 10.1002/pon

receiving any treatment (baseline) and at sevenadditional times over a period of 16 months (1,2, 4,6, 8, 12, and 16 months) using the InsomniaSeverity Index and a measure of physical symp-toms assessing the frequency of hot flashes andnight sweats (2 items) and urinary symptoms(3 items). Linear mixed models using a factorial(2 groups x 8 times) design tested main andsimple effects. Physical symptoms were added ascovariates to test mediation. RESULTS: Aftercontrolling for age and physical activity frequency,a significant time effect was found in ADT-RTHpatients, F(7,354)5 2.16, p5 .04, but not inRTH only patients, F(7,354)5 0.89, p5 .51. InADT-RTH patients, significant differences betweenthe baseline assessment (M5 4.4) and evaluationsat 2 months (M5 6.0; t(354)5 2.13, p5 .03), 4months (M5 6.0; t(354)5 2.17, p5 .03), and 6months (M5 6.9; t(354)5 3.25, p5 .001) werefound. A significant mediating role of night sweats(p5 .006) was found in the relationship betweenADT and insomnia symptoms, while the mediatingrole of hot flashes frequency (p5 .07) and excessiveurinary frequency (p5 .07) was marginally signifi-cant. CONCLUSIONS: ADT appears to beassociated with an increased risk for insomniathrough the influence of nocturnal hot flashes andto a lesser extent of urinary symptoms. RE-SEARCH IMPLICATIONS: Studies using objec-tive measures (sternal skin conductance andpolysomnography) are warranted in order to betterunderstand the role of hot flashes in the occurrenceof sleep disturbances in prostate cancer patients.CLINICAL IMPLICATIONS: These study find-ings suggest that reducing somatic symptoms, inparticular hot flashes, associated with cancertreatments may contribute to improving sleep inpatients with prostate cancer. ACKNOWLEDGE-MENT OF FUNDING: NARSAD and theCanadian Institutes of Health Research.

P2-177

Treatment Response to Psychiatric Intervention and

Predictors of Response among Cancer Patients with

Adjustment Disorders

Ken ShimizuNational Cancer Center Hospital, Japan, Tokyo,Japan

BACKGROUND: Although adjustment disordersare common among patients with cancer and suchpatients are frequently referred to consultation-liaison psychiatrists, little is known about theclinical courses of these patients. The present studyinvestigated treatment response to psychiatricintervention and predictors of response in arelatively large sampling of cancer patients withadjustment disorders. METHOD: We created adatabase of all referral cases with adjustment

disorders that included data on the patients’demographic and medical factors and thephysician-rated Clinical Global Impression (CGI)scale to assess treatment response and clinicalcourse. A CGI-Improvement scale score of betterthan ‘‘much improved’’ was regarded as indicatinga response to treatment; the number of patientswho responded to treatment during a four-weekfollow-up period was assessed. Also, predictors oftreatment response were explored by examiningdemographic and medical factors using a multi-variate analysis. RESULTS: Among the 238eligible patients, 136 (57.1%) responded to psy-chiatric treatment; most of these respondersimproved to a sub-threshold level of illness. Onthe other hand, 56 patients (23.5%) did notrespond to psychiatric treatment, 7 patients(2.9%) developed major depressive disorders,and 39 patients (16.4%) discontinued treatmentbefore achieving a response. Among the predictivefactors that were explored, suffering from painsignificantly predicted a good treatment response,while a worse performance status predicted apoor treatment response. CONCLUSIONS:Cancer patients with adjustment disorders canrespond to psychiatric treatment, but a few casesdevelop major depressive disorders. Severalpredictors of treatment response were identified.ACKNOWLEDGEMENT OF FUNDING: None.

P2-178

Curcumin for Depression in Cancer Patients

Seema ThekdiM.D. Anderson Cancer Center, Houston, TX, USA

BACKGROUND: Curcumin is a nutraceuticalextracted from the spice turmeric, which has beenused for years in Ayurvedic and traditional Chinesemedicine for its anti-inflammatory properties. Theproduction of proinflammatory cytokines,mediated by NF-kB, is hypothesized to be acommon physiological pathway underlying thedevelopment of depression, as well as fatigue,anorexia, and insomnia in cancer patients. Thepurpose of this presentation is to review thepotential of curcumin to ameliorate depressionand related cancer symptoms. METHOD: Anextensive literature review was used to understandthe physiological etiology of depression, fatigue,anorexia, and insomnia in cancer as it relates to theinnate immune response and inflammation. Theliterature was then reviewed to elucidate thephysiological properties of curcumin and linkthese properties with potential therapeuticapplications for depression and related cancersymptoms. Published preclinical and clinical trialswere reviewed in this area, and ongoing studieswere identified. RESULTS: Cancer, cancer treat-ment, and stress activate inflammatory pathways,



DOI: 10.1002/pon

initiated by DNA-binding of NF-kB. This cascadeis associated with the development of depressionand related cancer symptoms. Curcumin hasnumerous physiological actions pointing to poten-tial antidepressant efficacy. It has anti-inflamma-tory (due to potent NK-kB inhibition),neuroprotective, monoamine oxidase inhibitory,and antioxidant properties. To date, no clinicalstudies have been published examining the poten-tial efficacy of curcumin for depression and othercancer symptoms, but studies are ongoing. Follow-ing promising preclinical studies, recent clinical trialsinvestigating curcumin as an antineoplastic agentreveal tolerability and favorable effects on proin-flammatory cytokines in cancer patients. CONCLU-SIONS: Curcumin is a natural product with thepotential to be an efficacious, well-tolerated inter-vention for depression and other related cancersymptoms. The anti-inflammatory and other phy-siological actions of curcumin, convenience, andtolerability make it a strong candidate for furtherstudy and future clinical use. The additionalantineoplastic benefit of curcumin makes it particu-larly well-suited for the cancer patient and thecancer survivor. RESEARCH IMPLICATIONS:Although curcumin has been evaluated in clinicaltrials for numerous therapeutic applications, nostudies have been completed thus far examiningthis agent as an intervention for depression,fatigue, anorexia, and insomnia in cancer patients.In animal studies, curcumin reduced depressive-likesymptoms, increased monoamine levels, and de-creased expression of proinflammatory cytokines.Clinical studies to determine dose, formulation, andefficacy of oral curcumin for the treatment ofdepression and related symptoms in cancer patientsare needed. CLINICAL IMPLICATIONS: Depres-sion is prevalent in the cancer population withestimates ranging from 20-50%. Conventional anti-depressants have limited utility in some cancerpatients due to side effects, drug interactions,expense, and stigma. Additionally, patients aroundthe globe express interest in using medicinal naturalproducts. Providers who encounter these issues intheir practice will be interested to learn aboutcurcumin as a potential nutraceutical antidepressantagent due to its tolerability, convenience, andantineoplastic properties. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-179

Cancer Patient Decision Making and Autonomy

Related to Clinical Trial Participation

Jennifer Bell, Lynda G. BalneavesUniversity of British Columbia, Vancouver, BC,Canada

BACKGROUND: Oncology clinical trials(CTs) are necessary for the improvement of

patient care as they have the ability to confirmthe efficacy and safety of novel cancer treatments,and in so doing, contribute to a solid evidencebase on which practitioners and patientscan make informed treatment decisions.However, only 3–5% of cancer patients enroll inCTs. This literature review summarizes thefactors and contexts that influence cancer patientdecision making related to CT participation.METHOD: A systematic review was undertakenwithin PubMed, CINAHL, and EMBASEdatabases for articles written between 1995–2010and archived under the keywords ‘‘cancer’’,‘‘patient participation’’, ‘‘decision making’’, and‘‘randomized clinical trial’’. Articles selectedwere data-based, written in English andlimited to adult cancer patients. RESULTS: Inthe 45 articles reviewed, three main typesof factors were identified that influence cancerpatients’ decision making about participation inCTs: personal, social, and system factors. Sub-themes included patients’ trust in their physicianand the research process, coercion within thepatient-physician relationship, and systemic socialinequalities. How these factors interact and influ-ence patients’ decision-making process, however, isinsufficiently understood. CONCLUSIONS:Future research is needed to further elucidate thesociopolitical barriers and facilitators of CTparticipation and to enhance ethical practiceswithin CT enrolment. This research wouldinform targeted education and support interven-tions to foster patients’ autonomy in the decision-making process and potentially improve CTparticipation. RESEARCH IMPLICATIONS:This beginning body of research highlights theimportant role of physicians, family members,and support persons on cancer patients’ CTdecision making. More targeted and theoreticallyinformed psychosocial oncology research is re-quired that examines to what extent cancerpatients are able to exercise their autonomy,particularly when embedded in hierarchical socialrelationships and faced with subtle pressuresstemming from both moral and socialobligations. CLINICAL IMPLICATIONS: CTpersonnel are an integral part of the oncology CTrecruitment process as they are responsible forcoordinating and managing CTs andsupporting patients in their CT decision making.This specialty, therefore, offers a significantplatform to apply the review findings byproviding enhanced decisional support andassisting cancer patients in overcomingsociopolitical barriers that may undermine theirparticipation in CTs through education,advocacy, and linking with the multidisci-plinary team and patients’ social network.ACKNOWLEDGEMENT OF FUNDING: J.Bell’s doctoral work is supported by a Canadian



DOI: 10.1002/pon

Institutes of Health Research (CIHR) graduatescholarship and CIHR-funded PsychosocialOncology Research Training (PORT) program.

P2-180

Psychosocial Issues and Decision Making in Clinical

Trials: Associations between Symptom Burdens and

Expectations of Benefit for Advanced Cancer

Patients and Spousal Caregivers Participating in

Phase I Trials

Fay Hlubocky1, Tamara Sher2, Kristen Wroblewski1,Mark Ratain1, Christopher Daugherty11The University of Chicago Medical Center, ChicagoIllinois, USA, 2Illinois Institute of Technology, Instituteof Psychology, Chicago Illinois, USA

BACKGROUND: Prior research indicates thatACP hope to receive significant therapeutic benefitfrom phase I trial participation even in the face ofadvanced disease and presumed significant symp-tom burdens (SB). The influence of disease severityand psychological factors, as measured by SB, onsuch EB is unknown for both ACP and SC. Thepurpose of this study is to describe and identifypossible associations between SB and EB of ACPand SC regarding Phase I enrollment. METHOD:A convenience sample of ACP enrolling in phase Itrials and SC were evaluated at baseline (T1) andone month later (T2) using a battery of standar-dized and/or validated assessments of SB including:cognition (MMSE); depression (CES-D); state-traitanxiety (STAI-S/T); posttraumatic growth (PTGI);quality of life/qol (FACIT-Pal); global health (SF-36); and martial adjustment (DAS). Data regardingparticipants’ EB were obtained utilizing Likertscores (1–10) measuring the likelihood of che-motherapy in: ‘‘stabilizing’’ (ST), ‘‘halting/shrink-ing’’ (HL), producing ‘‘remission’’(PR), and‘‘curing’’ (C) ACP’s cancer. RESULTS: 104participants (52 Phase I ACPs and 52 SC) wereseparately interviewed at T1 and T2. For totalpopulation, median age: 61 (28–78y); 50% male;100% married; 87% Ca; 67% 4HS; 51% GI dx.Regression analyses revealed negative associationsbetween ACP STAI-S and EB: ST p5 .01 and HLpo.01 at T2. For SC, negative associations werefound between STAI-S and EB for: ST p5 .01; andHL po.01 at T2. SC STAI-T was negativelyassociated with ST cancer p5 .02. Associationswere found between SC SF36 and HL p5 .03.Further associations were revealed between SCDAS and EB: ST p5 .04; HL p5 .04. CONCLU-SIONS: This is the first research study to formallyassess SB and identify potential associationsregarding expectations of benefit for ACPs andtheir SC in Phase I clinical trials. Our data indicatethat several significant associations exist betweenACP and SC SB and EB from Phase I trialparticipation. Specifically, ACP psychological

SB(state anxiety) may be negatively associatedwith ACP EB. Also, several negative and positiveassociations exist between SC psychological andphysical well-being SB (state or trait anxiety;martial satisfaction; quality of life) and SC EB.RESEARCH IMPLICATIONS: This is the firstresearch study to formally assess SB and associa-tions regarding expectations of benefit for ACPsand their SC in Phase I clinical trials. Furtherresearch is needed to explore what SB mayinfluence ACP and SC expectations of benefit overthe course of trial and beyond through the use oflongitudinal studies in order to fully examine if andhow ACPs and SC SB and perceptions change onceACPs enroll in hospice. CLINICAL IMPLICA-TIONS: From a clinical perspective, there may begreat evidence for clinicans indicating that ACPsdecisions about participating in a Phase I clinicaltrial may be influenced by psychological andphysical SB which may contribute to ACP’s andSC’s beliefs regarding the likelihood of a therapeu-tic benefit. Therefore, the primary focus of theoncology community should concentrate on ACPand SC preferences for psychological support toaid in decision making and coping utilizingindividual or couples therapy during trial partici-pation. ACKNOWLEDGEMENT OF FUND-ING: The funding source to support this workwas provided by the National Institutes of Health(CKD; NIH-RO1 CA 087605-01A1).

P2-181

What Do They Know and What Do They Think

They Know? The Influence of Knowledge and

Perceived Knowledge on Human Papillomavirus

(HPV) Vaccination Decision-Making

Andrea Krawczyk1,2, Elsa Lau2, Samara Perez1,2,Zeev Rosberger1,21Department of Psychology, McGill University,Montreal, QC, Canada, 2Louise-Granofsky Pyscho-social Oncology Program, Segal Cancer Center,Jewish General Hospital, Montreal, QC, Canada

BACKGROUND: Many women are uninformedabout the Human Papillomavirus (HPV), which isa common sexually transmitted infection causingcervical cancer. The HPV vaccine has beenapproved for females age 9–26, who are particu-larly at risk of HPV infection. The study’s objectivewas to investigate young females’ levels of HPVvaccine knowledge and perceived knowledge, andhow these factors may influence vaccine decision-making. METHOD: 447 female college students(Mage 5 20.59, SD5 2.69) completed a self-reportquestionnaire, which included questions on actualand perceived levels of HPV knowledge. HPVknowledge (e.g., ‘HPV is the main cause ofcervical cancer’) was assessed using 22 items.Participants responded true, false or I don’t



DOI: 10.1002/pon

know (Range 0–22). Perceived HPV knowledgewas assessed using 3 items (e.g. ‘I feel knowledge-able about HPV’) on a 7-point likert scale (Range3–21; a5 .80). Participants indicated whether theyhad received the HPV vaccine. Non-vaccinatedparticipants indicated whether they intended toreceive the HPV vaccine. RESULTS: Overall, thelevel of knowledge was relatively low (M5 12.7/22)(e.g., a large majority of the subjects (83.4%)falsely believed that condoms prevented HPVtransmission), and most participants answeredover 50% of the questions incorrectly.Additionally, subjects reported modestperceived knowledge (M5 4.15/7). Examinationof the sample divided by vaccination status(vaccinated, intend, and do not intend)indicated that levels of perceived knowledgewere significantly higher in vaccinated subjects(M5 4.62/7) in comparison to thosewho intended (M5 4.15/7, po.001) and didnot intend (M5 3.90/7, po.001) to vaccinate.CONCLUSIONS: Young females have low knowl-edge as well as modest perceived knowledgeregarding HPV and the vaccine. Additionally,vaccinated females perceive themselves asmore knowledgeable than subjects who only intendor do not intend to vaccinate. Young women’sperception that they have enough knowledge tomake a vaccination decision is an importantfactor in addition to actual knowledge, and mayinfluence vaccine decision-making. RESEARCHIMPLICATIONS: In addition to investigating therole of factual HPV knowledge, perceived knowl-edge should be taken into consideration in futureresearch on vaccination uptake. The findings thatemerged from our cross-sectional sample suggestthat it is important to study changes in knowledgeand perceived knowledge in young women long-itudinally as they contemplate vaccine uptake. Thiscan be done using observational formats orrandomized intervention designs that aim toincrease knowledge and/or confidence in extantknowledge. CLINICAL IMPLICATIONS: Publichealth efforts to increase HPV vaccination uptakein this population need to continue educatingfemales on specific HPV and vaccine facts, andalso address young female’s perceptions andconfidence regarding their own knowledge andability to make an educated vaccination decision.ACKNOWLEDGEMENT OF FUNDING:CIHR Clinical Research Network on HPV andAssociated Diseases, PORT (Psychosocial Oncol-ogy Research Training Program, and CIHRFellowships.

P2-182

Competency to Consent to Initial Chemotherapy

among Elderly Patients with Hematological Malig-

nancies

Toru Okuyama1,2, Tatsuo Akechi1,2, ShinsukeIida3, Hirokazu Komatsu3,4, Takashi Ishida3,Shigeru Kusumoto3, Atsushi Inagaki3, MasakiLee3, Ryuichi Sagawa1, Megumi Uchida1,Yoshinori Ito1, Tomohiro Nakaguchi11Division of Psycho-oncology and Palliative Care,Nagoya City University Hospital, Nagoya, Aichi,Japan, 2Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Grad-uate School of Medical Sciences, Nagoya, Aichi,Japan, 3Department of Medical Oncology andImmunology, Nagoya City University GraduateSchool of Medical Sciences, Nagoya, Aichi, Japan,4Division of Chemotherapy, Nagoya City UniversityHospital, Nagoya, Aichi, Japan

BACKGROUND: Patients are required to havecompetency to consent to medical treatments forvalid informed consent. The purpose of this studywas to investigate the prevalence of patients whowere incompetent to consent to initial chemother-apy among elderly patients with first onsetmalignant lymphoma or multiple myeloma. Wealso aimed to know how well attending physiciansrecognized their patients’ ability to consent to thetreatments. METHOD: Patients aged 65 or olderwith hematological malignancies were continu-ously sampled when admitted to the hospital. Thevalidated Structured Interview for CompetencyIncompetency Assessment Testing and RankingInventory was used to assess their competency toconsent to chemotherapy. Their physicians wereasked about whether their patients were competent,just after they obtained the informed consent forthe treatment. This study was approved by theInstitutional Review Board and written informedconsent was obtained from each patient. If patientswere incompetent to consent to the study partici-pation, we obtained written consent from theirproxies in addition to a patient’s oral consent.RESULTS: Twenty-one patients were assessed foreligibility. Two patients were ineligible because oftheir severe physical condition. Both of them werejudged to be incompetent because they hadconsciousness disturbance. Among 19 patientsinterviewed, five (26%, 95% CI: 7–46%) werejudged to be incompetent. For total 21 patients,seven (33%, 95% CI: 13–53%) were judged to beso. None of the patients undergoing interviews wasrecognized to be incompetent by their attendingphysicians. CONCLUSIONS: Although the sam-ple size is too small to draw a conclusion, theresults indicated that a substantial proportion ofelderly patients with malignant lymphoma ormultiple myeloma may be incompetent to consentto the medical treatment. Furthermore physiciansmay have difficulty to recognize thisproblem among their patients. RESEARCHIMPLICATIONS: A larger sample size is neces-sary to confirm the results. Further studies are



DOI: 10.1002/pon

required to clarify the factors associated withincompetency to consent to medical treatments,and to develop screening strategies forpatients with such difficulty. CLINICALIMPLICATIONS: Physicians should keep in mindthat there are not a few patients who areincompetent to consent to treatments. They haveto learn the concept and assessment methods ofthis problem, and are encouraged to estimate thecompetency when they take informed consent fromelderly cancer patients. ACKNOWLEDGEMENTOF FUNDING: None.

P2-183

Tumor Gene Expression Analysis to Target Che-

motherapy: Attitudes of Breast Cancer Patients

Isabelle Pellegrini1, Myrto Rapti1, Jean-MarcExtra2, Anouk Petri-Cal1, Themis Apostolidis4,Patrice Viens2, Franc-ois Bertucci2,3, Claire Julian-Reynier11INSERM UMR912, Marseille, France, 2InstitutPaoli-Calmettes, Marseille, France, 3INSERMUMR891, Marseille, France, 4Universite Aix-Marseille, Marseille, France

BACKGROUND: To document how breast can-cer patients perceive their prognosis and a tailoredtreatment based on tumor gene expression analysis,and to identify the features of this approach thatmay impact its clinical application. METHOD: In-depth interviews were conducted at three Frenchcancer centres with 37 women (35–69 years) withnode-positive breast cancer undergoing an adju-vant chemotherapy regimen defined on the basis ofthe genomic signature predicting the outcome afterchemotherapy. Interviews were carried out afterthe end of the whole therapeutic sequence, at least9 months after initial diagnosis. Grounded theorywas used to guide sampling, data collection anddata analysis. RESULTS: Several concerns wereidentified. First, misconceptions about these meth-ods were identified due to semantic confusionsbetween the terms ‘‘genomic’’ and ‘‘genetic’’, whichled women to be afraid of transmitting cancer riskto their offspring. Second, the ‘‘not done’’ and ‘‘notinterpretable’’ signatures were re-interpreted by thewomen and associated with highly negative con-notations and generated anxiety and uncertaintyabout the future. However, the use of tumorgenomic analysis to adapt the treatment to eachpatient was perceived by patients as an approachfacilitating personalized medicine and had consid-erable support. CONCLUSIONS: Patients inter-viewed here had a consistently positive attitudetowards tumor gene expression analysis andpersonalized medicine. Nevertheless two specificpoints need to be improved in clinical practice:first, the difference between genomic signatures andgenetic testing should be explained to patients, and

secondly, the disclosure of ‘‘not done’’ and ‘‘notinterpretable’’ results should be handled with carebecause of the potentially negative implications ofthese terms. CLINICAL IMPLICATIONS: Im-proving the quality of provider-patient commu-nication will enable patients to play an active partin decision-making regarding their treatment; thiswill ensure that those who agree to their tumorgene analysis have realistic expectations and sounddeductions of the final result disclosure process.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was funded by a grant from the InstitutNational du Cancer (INCa) and Conseil RegionalPaca.

P2-184

Quality of Life of Older Rectal Cancer Patients is

not Impaired by a Permanent Stoma

Melissa Thong1,2, Ricardo Orsini3, Lonneke van dePoll-Franse1,2, Gerrit Slooter4, Ignace de Hingh3,Harm Rutten31Tilburg University, Tilburg, The Netherlands,2Comprehensive Cancer Centre South, Eindhoven,The Netherlands, 3Catharina Hospital, Eindhoven,The Netherlands, 4Maxima Medical Center,Veldhoven, The Netherlands

BACKGROUND: Rectal cancer affects mainly theelderly who have more comorbidities and poorerphysical function. The association between age attreatment and health-related quality of life(HRQL) is poorly understood. The aim of thisstudy was to investigate whether HRQL of olderrectal cancer (70 years) patients treated for a tumorin the lower two-third of the rectum differs fromyounger patients (o70 years). Furthermore theinfluence of a permanent stoma was taken intoaccount. METHOD: Patients with rectal cancerfrom 4 hospitals diagnosed in 1998-2007 wereidentified from the Eindhoven Cancer Registry. Allpatients were treated with either abdominoperineal(APR) or low anterior (LAR) resections. Survivorscompleted the Short-Form-36 (SF-36) health sur-vey and the EORTC Quality of Life Questionnaire-Colorectal 38 (QLQ-CR38). HRQL scores werecompared after dividing the patients in fourgroups, stratified by stoma status and age at timeof operation (o70 and 70). The SF-36 and theQLQ-CR38 sexuality subscale scores of thesurvivors were compared with a normal age- andsex-matched Dutch population. RESULTS: 143patients were included. Median follow-up:3.4 years. Older patients had comparable SF-36scores, except for poorer physical functioning(p5 0.0003), to younger patients. On the QLQ-CR38, older patients (p5 0.005) and patientswithout a stoma (p5 0.009) had worse sexualfunctioning than younger patients and patientswith a stoma, respectively. Older males had more



DOI: 10.1002/pon

sexual dysfunction (p5 0.01) compared to youngermales. Older patients with a stoma had worsephysical function (po0.01), but slightly bettermental health (po0.05) compared to the Dutchnormative population. However younger patientshad poorer sexual functioning and enjoymentcompared to the norm population (bothpo0.0001). CONCLUSIONS: This study showsthat older patients with a stoma have comparableHRQL to older patients without a stoma or thenormative population. Patients who are sexuallyactive after treatment could benefit from receivingpsychosocial and clinical support in the manage-ment of potential sexual dysfunction followingtreatment. RESEARCH IMPLICATIONS: Stu-dies which focus primarily on HRQL and treat-ment for elderly with rectal cancer is scarce despiterectal cancer affecting mainly the elderly. Further-more we make a comparison with a Dutchnormative population in general HRQL andsexuality. CLINICAL IMPLICATIONS: Antici-pating possible complications following colo-analanastomosis, patients and surgeons have a difficultchoice of treatment between an LAR and APR/Hartmann procedure for an older patient with adistal rectal tumor. Our findings indicate that apermanent stoma for elderly patients with a lowsituated rectal carcinoma could be feasible. Pa-tients who remain sexually active after treatmentcould benefit from receiving clinical and psycholo-gical support in the management of potentialsexual dysfunction following treatment. AC-KNOWLEDGEMENT OF FUNDING: Datacollection for this study was funded by theComprehensive Cancer Center South, the Nether-lands; the Center of Research on Psychology inSomatic Diseases (CoRPS), Tilburg University, theNetherlands; and an Investment Subsidy (480-08-009) from the Netherlands Organization forScientific Research.

P2-185

Fertility Preservation in Young Female Cancer

Patients: A Study to Assess Knowledge, Attitudes

and Intentions to Use Fertility Preservation

Corinne Urech, Judith Alder, Rosanna Zanetti,Christoph Rochlitz, Sibil TschudinUniversity Hospital Basel, Basel, Switzerland

BACKGROUND: Advances in cancer therapyhave resulted in an increased number of long termcancer survivors. The present study concernsfertility preservation (FP) for women who areexperiencing or have experienced cancers prior toor during their reproductive lifespan. The objec-tives are to (1) assess attitudes and knowledgeabout FP techniques, (2) evaluate anxiety anddecisional conflicts associated with fertility issuesand consideration of FP techniques and (3) assess

the helpfulness of various sources of support.METHOD: The study is part of a larger Swissproject comprising of two parts, each with adifferent methodological approach: On the onehand focus groups are accomplished and on theother hand an online survey is conducted. Only thelatter will be presented: The online-survey is basedon a pilot-study conducted in the UK with aspecifically developed questionnaire. It assessesparticipant’s knowledge about FP techniques,sources of knowledge, perceived risks/benefits andwillingness to use FP techniques, as well as anxietyand decisional conflicts and is accessible via cancerspecific websites. Quantitative analyses are com-puted using SPSS 17. RESULTS: Preliminaryresults from the pilot-study show that participants(n5 80) had good knowledge of embryo and eggfreezing, but little knowledge of more advancedtechniques and low confidence levels about theirknowledge about FP techniques. Strength ofpositive attitudes about FP techniques was sig-nificantly greater than negative attitudes (po.001).However, willingness to take any risks was low.Furthermore, the availability of information wasperceived as being difficult). Most often sources ofsupport were partner, family and physician. Theresults from the still ongoing online-survey of theSwiss study will be additionally presented at thecongress and intercultural differences will bediscussed. CONCLUSIONS: The so far achieveddata reveal that knowledge about FP was limitedand level of confidence about this knowledge waslow. Besides partner and family support, thephysician plays an important role as source ofinformation and support. To reduce decisionalconflict in this ethically complex context thedevelopment of decision and counselling aidsadapted for this context would be crucial.RESEARCH IMPLICATIONS: Considering thelimited knowledge on these psychological aspectsin the relatively new topic of cancer and FP, ouraim is to gain a deeper insight into this researchfield. Within the scope of our study, we intend touse the gained information to integrate theseelements into a decision-aid tool, which in turnhas to be evaluated in a future study. CLINICALIMPLICATIONS: Information transfer ischallenging in the given situation, in whichvarious meaningful issues have to be addressed inthe short time period between diagnosis andcommencement of treatment. With regard toadequate support in decision-making, it is ofutmost importance to be aware of thepatients’ conflicts and to know about individualsat risk for difficulties in decision-making. Thereforea structured guidance through the decision-makingprocess is greatly in demand. ACKNOWLEDGE-MENT OF FUNDING: The study is funded bythe Swiss Cancer League (Project Nr. KLS 02577-02-2010).0).



DOI: 10.1002/pon

P2-186

Between Breast Cancer Diagnosis and Surgery:

Women’s Experiences of Social Support

Sigrunn Drageset1, Torill Christine Lindstrøm2,Tove Giske31Bergen University College, Faculty of Health andSocial Sciences, Bergen, Norway, 2Faculty ofPsychology,University of Bergen, Bergen, Norway,3Haraldsplass Deaconess University College,Bergen, Norway

BACKGROUND: Receiving a breast cancer diag-nosis is a stressful life event. Social support plays akey role in women’s adjust to the stressful demandsof diagnosis and treatment.From a psychosocialand caring perspective it is important to increasethe understanding of these women’s experiencesregarding social support in the stressful periodfollowing diagnosis. The purpose of this qualitativestudy was to describe how women with newlydiagnosed breast cancer experienced social supportbetween diagnosis and surgery. METHOD: Indi-vidual semi-structured interviews were conductedwith a convenience sample of 21 women (aged41–73 years)with newly diagnosed breast cancerduring 2006–2007 at a Norwegian UniversityHospital. The interviews were conducted the daybefore surgery, before the preoperative informa-tion. The interviews varied in length from 50 to 120minutes. The informants were asked specificallyabout: experiences of social support betweendiagnosis and surgery. Transcripts were analysedusing Kvale’s method of qualitative meaningcondensation analysis. RESULTS: Analysisshowed these three aspects of social support:available support, emotional support, and socialstrain. To know that their family and friends wereavailable and loving was important. Most of thewomen needed a balance between distance andcloseness to their support network. Care, con-fidence, and encouragement were essential andgave strength. But both too much and too littlesupport from others was experienced as difficultand frightening. Some gave priority to their familymembers’ needs for social support instead of beingsupported themselves when communicating theirdiagnosis to their close family members. CON-CLUSIONS: Our findings give insight into bothsimilarities and variations in women’s reactions toreceiving a cancer diagnosis, and how theyexperience social support in the period betweendiagnosis and surgery. The social network, which isgenerally presumed to offer social support, couldactually also sometimes be experienced as aburden. RESEARCH IMPLICATIONS: Furtherresearch could focus on these issues a) Studywhether a nursing intervention (e.g. a telephonecall from the hospital) a few days after thediagnosis could have beneficial effects on these

women’s coping and well-being b) Study socialsupport in the period between diagnosis andsurgery among women from different cultures.CLINICAL IMPLICATIONS: Understanding ofwomen’s individual experiences and challenges intheir social networks, healthcare professionals canbe an important resource providing social support,and advice to women in their stressful situation.Healthcare professionals could encourage womento obtain appropriate support from their socialnetwork. The results can be used clinically both tounderstand what processes women with newlydiagnosed breast cancer, awaiting surgery, goesthrough, and used in planning and implementingcare to these women. ACKNOWLEDGEMENTOF FUNDING: None.

P2-187

Cancer Patients Care in the Country: Supporting

Families for the Cancer Patients’ Caregiving Tasks

Elcin BabaogluMaltepe University, School of Nursing, Istanbul,Turkey

BACKGROUND: The cancer experience forpatients and families occurs within the culturalcontext. Most of the time health providers areaware of the cultural milieu in which they live, forit is their world. Social support in cancer has beenfound to be of major importance in supporting anindividual’s coping ability. In this abstract will bediscussed the family members burden as aninformal care system in the country. METHOD:Family involvement in cancer care includes directassistance for self-care and activities such asshopping, transportation, money managementand arranging for treatments and services. Symp-tom management and control become a majorfocus for both the patient and the family as theystruggle to manage the symptoms of disease andside effects from ongoing treatment. Symptomdistress influences social and physical function ofthe family member, curtails caregiver-patient inter-action, and affect role interactions with others.Patients’ symptom distress also may lead to suchemotional responses as anger, frustration, ordepression, which then affect the demands on thefamily caregiver. RESULTS: The four main com-ponents of the oncology nursing role are: clinicalpractice, education, administration, and research.Educational activities are central to the role of theoncology nurse. Educating patientsand families about self-care behaviors relatedto treatment modalities, developing structurededucational programs, and implementing supportgroups have been identified as the most frequentactivities. Activities for family caregivers will besuccessful if they tailored to patient and caregivercharacteristics, family background, informal



DOI: 10.1002/pon

and formal care, support, care situations anddemands, knowledge, and beliefs about expectedoutcome and their ability to carry out needed care.CONCLUSIONS: Meeting the needs of the familycaregiver may prevent or minimize caregiver burdenand distresses. Nurses need to gain an under-standing of the role and demands of the multiplefactors that influence the family cancer care system.The goal of care is to restore or promote meetingthe needs of the patient with cancer and the familycaregiver, thereby enhancing the quality of life forfamilies living with cancer and limiting the caregiverburden experienced. ACKNOWLEDGEMENTOF FUNDING: None.

P2-188

Correlation of Distress and Perceived Social Support

of Breast Cancer Patients in a Turkish Sample

Azizi Atli, Derya Iren Akbiyik, Nermin Gurhan,Haldun SoygurGazi Eniversitesi, Ankara, Turkey

BACKGROUND: The aim of this study is toevaluate the level of distress and perceivedsocial support of breast cancer patients and theassociation between these. METHOD: This re-search had been conducted in Ankara OncologyHospital, and sampling was done from 206 patientsapplied to the surgery clinics for the diagnosis and

treatment of breast cancer. Data were collected byusing the distress thermometer and measure ofMultidimensional Scale of Perceived SocialSupport, the patient information form which isdeveloped by the researcher and analyzedby the SPSS 11.0 programme. RESULTS: Thelevel of stress in the sample group was found to be70.4%. Influence of their budget by the cost oftreatment (p5 0.00; X2 5 11.21), living alone(p5 0.04; X2 5 3.91), having another chronicdisease other than breast cancer (p5 0.00;X2 5 7.69) were effecting the distress level ofpatients. The average score of multidimensionalperceived social support of the sample group is66.3. The relationship between the total score ofmultidimensionally perceived social support anddistress thermometer was found statistically sig-nificant and negatively correlated (r5�0.307;po0.05). CONCLUSIONS: A great number ofbreast cancer patients had been found toexperience distress to some extent. A negativecorrelation was obtained between the social sup-port and the distress which may decrease copingskills and may affect the compliance rateswith the treatment. It was concluded that diagnos-ing this distress, interventions against it andincreasing social support may cause a decrease indistress of the patients. ACKNOWLEDGEMENTOF FUNDING: This abstract did not receivesupport.



DOI: 10.1002/pon

Gastrointestinal Cancer: Distress and Emotional Disorder Among Patients in Chemotherapy

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