Predictors of Distress in Cancer Patients Under Chemotherapy Treatment

Abstracts of the IPOS 15th World Congress ofPsycho-Oncology, 4–8 November 2013, Rotterdam,the NetherlandsPoster Abstracts

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Psychological States and Coping Strategies after

Bereavement Among Spouses of Cancer Patients:

A Quantitative Study in Japan

Mariko Asai1,2, Nobuya Akizuki3, Maiko

Fujimori1, Yutaka Matsui2, Hiroya Kinoshita4,

Yosuke Uchitomi1

1Psycho-Oncology Division, Research Center forInnovative Oncology, National Cancer CenterHospital East, Kashiwa, Chiba, Japan, 2GraduateSchool of Comprehensive Human Sciences,University of Tsukuba, Tsukuba, Ibaraki, Japan,3Psycho-Oncology Division, Chiba Cancer Center,Chiba, Chiba, Japan, 4National Cancer CenterHospital East, Kashiwa, Chiba, Japan

BACKGROUND: Comprehension and assess-ment of psychological states and coping strategiesduring spousal bereavement are necessary for hos-pital staff to provide psychological care in clinicalpractice. The purposes of this study were (1) tocharacterize psychological states and coping strate-gies after bereavement among spouses of cancerpatients in Japan and (2) to explore the factorsassociated with psychological states in oncologysettings. METHOD: In March 2009, questionnairesto assess spouses’ psychological states, coping strate-gies, and mental health states (GHQ-28) were sentafter patients died at the National Cancer Center ofJapan. To address the first purpose, exploratory fac-tor analysis, gender comparison, and calculation ofcorrelation with age, time since bereavement, andmental health states were conducted. Hierarchicalregression analysis was conducted to address the sec-ond purpose. RESULTS: A total of 821 spousesexperiencing bereavement for 7 months to 7 yearsparticipated in the study. Psychological statesrevealed three factor structures: “Anxiety/Depres-sion/Anger”, “Yearning”, and “Acceptance/Future-Oriented Feelings”. Coping strategies also revealed3 factor structures: “Distraction”, “ContinuingBonds”, and “Social Sharing/Reconstruction”. Cop-ing strategies represented 18% to 34% of each factorassociated with psychological states, whereas thecharacteristics of bereaved spouses and deceasedpatients represented 6% and <6%, respectively.More “Distraction and Social Sharing/Reconstruc-tion” and less “Continuing Bonds” were signifi-

cantly associated coping strategies for achieving“Acceptance/Future-Oriented Feelings” (p < 0.01).CONCLUSIONS: Both psychological states andcoping strategies after bereavement revealed 3 factorstructures. Coping strategies was the primary,bereaved spouses’ characteristics was the secondary,and deceased patients’ characteristics was the ter-tiary factor associated with psychological states.Enhancing “Distraction” and “Social Sharing/Reconstruction”, and reducing “Continuing Bonds”might be promising strategies for achieving positivepsychological states of the bereaved. RESEARCHIMPLICATIONS: Based on the Western theoreti-cal framework of “stress and coping theory”, copingstrategies were the primary associated factor of psy-chological states, beyond the characteristics ofbereaved spouses/deceased patients. The strategy forencouraging coping strategies would contribute topositive psychological states in the bereaved. CLIN-ICAL IMPLICATIONS: All 3 factors of copingstrategies (“Distraction”, “Continuing Bonds”,“Social Sharing/Reconstruction”) included adaptiveand maladaptive items. Each item characteristicswould be useful to comprehend and assess whethercoping strategies utilized by the bereaved areadaptive or not in clinical practice. ACKNOWL-EDGEMENT OF FUNDING: This research wassupported in part by Grants-in-Aid for CancerResearch and the Third-Term Comprehensive 10-Year Strategy for Cancer Control from the Ministryof Health, Labour and Welfare, Japan.

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Patterns of Coping Strategies after Bereavement

Among Spouses of Cancer Patients

Mariko Asai1, Yutaka Matsui2, Yosuke Uchitomi3

1Graduate School of Clinical Psychology, TeikyoHeisei University, Toshima, Tokyo, Japan,2Graduate School of Comprehensive HumanSciences, University of Tsukuba, Tsukuba, Ibaraki,Japan, 3Graduate School of Medicine, Dentistry andPharmaceutical Sciences, Okayama University,Okayama. Okayama, Japan

BACKGROUND: The purposes of this study were(1) to identify healthy and unhealthy patterns ofcoping strategies after bereavement among spousesof cancer patients and (2) to explore the characteris-

© 2013 The Authors. Psycho-Oncology © 2013 John Wiley & Sons, Ltd.

Psycho-OncologyPsycho-Oncology 22 (Suppl. 3): 124–362 (2013)

Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.10002/pon.3394

tics of patients and spouses associated with thesepatterns of coping strategies, so that we could sug-gest the strategies for improving the unhealthy cop-ing patterns after spousal bereavement and theindicators for early detection of high-risk spouses.METHOD: In March 2009, questionnaires toassess spouses’ coping strategies (“Distraction”,“Continuing Bonds”, and “Social Sharing/Recon-struction”), psychological states (“Anxiety/Depres-sion/Anger”, “Yearning”, and “Acceptance/Future-Oriented Feelings”), and mental healthstates (GHQ-28) were sent after patients died at theNational Cancer Center of Japan. Non-hierarchicalcluster analysis was used to identify patterns of cop-ing strategies. Analysis of variance or chi-Squaretest were used to identify healthy and unhealthypatterns by comparing their psychological states,mental health, and potential psychiatric disordersidentified by the cut-off score of the GHQ-28. Dis-criminant analysis was conducted to explore thecharacteristics associated with these patterns ofcoping strategies. RESULTS: A total of 821spouses returned the questionnaires. Three patternsof coping strategies were “Distraction Focused(n = 215)”, “Continuing Bonds Focused(n = 219)”, and “General Coping (n = 215)”. Men-tal health was unhealthier in “Continuing BondsFocused”. Prevalence of potential psychiatric disor-ders was higher in “Continuing Bonds Focused”and lower in “Distraction Focused” than expectedvalue. The patients’ characteristics associated with“Continuing Bonds Focused” were “history of psy-chiatric consultation”, “duration of last hospitaladmission was less than one week”, “time since can-cer diagnosis to death was less than one year”, and“under 65 years”. CONCLUSIONS: Two strate-gies for improving the unhealthy coping patterns of“Continuing Bonds Focused” were (1) enhancing“Distraction” and reducing “Continuing Bonds”for achieving “Distraction Focused (healthy)”and(2) enhancing both “Distraction” and “Social Shar-ing/Reconstruction” for achieving “General Cop-ing (almost healthy)”. RESEARCHIMPLICATIONS: Two strategies for improvingthe unhealthy coping patterns of “ContinuingBonds Focused” among bereaved spouses wereidentified. These strategies would be useful todevelop an original Japanese program of psycho-logical support for the bereaved who have lost theirspouses to cancer. CLINICAL IMPLICATIONS:Four patients’ characteristics whose spouse wouldutilize the unhealthy coping patterns after bereave-ment were identified. These indicators would beuseful for early detection of high-risk spouses dur-ing end-of life (EOL) care. ACKNOWLEDGE-MENT OF FUNDING: This research wassupported in part by Grants-in-Aid for CancerResearch and the Third-Term Comprehensive 10-

Year Strategy for Cancer Control from the Minis-try of Health, Labour and Welfare, Japan.

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OmSorg - Dealing With Bereavement Lessons

Learnt from the Implementation of Action Plans in

all Danish Schools and Kindergartens

Per Bøge1, Jes Dige2, Annemarie Dencker1

1Danish Cancer Society, Copenhagen, Denmark,2Danish Cancer Society, Aalborg, Denmark

BACKGROUND: Every year more than 2500Danish children under the age of 18 experience theloss of a parent by death. Another 42,000 childrenexperience that their mum or dad is acute hospital-ized with a severe illness. METHOD: For morethan 18 years the project OmSorg (Dealing withBereavement) has been a nationwide practicalfounded school and kindergarten based interven-tion towards children (age: 0–18) in loss and grief.The aim is to secure responsible adult help to griev-ing children - no matter the course of the grief. Themain effort has been to inspire and support teachersand kindergarten staff in attending these difficultmatters. This is done by offering educational mate-rials, giving lectures, consultation and courses,establishing training groups for bereaved children,working with the media and by political lobbyism.RESULTS: One of the basic conditions in workingwith children in loss and grief is that the teachersshare a common approach on what their basicresponsibilities are. One of the main tasks has beento encourage the teachers in establishing ActionPlans for their meeting with grieving children. Anannual randomised survey among all Danish PublicSchools (since 1997) and Kindergartens (since2003) shows the development on the followingissue:“Do you have a written down Action Plan on howto comply with children in loss and grief?”

Schools Kindergartens

1997: 4% 2003: 23%

2012: 96% 2012: 86%

CONCLUSIONS: In our opinion, the basic condi-tion when working with bereaved children is that theresponsible adult person involved in the child’sunbearable situation makes space for the child to beheard, seen and understood. The “Action Plans” isan effective tool towards achieving this goal. The keyto this work is to denounce the part of our upbring-ing that taught us that silence is golden. Grief is notan illness, but on the contrary a very tough conditionof life. If we realise that SPEECH is golden, we canhelp the child continue life in spite of the wounds in

Poster Abstracts of the IPOS 15th World Congress 125

© 2013 The Authors. Psycho-Oncology © 2013 John Wiley & Sons, Ltd. Psycho-Oncology 22 (Suppl. 3): 124–362 (2013)DOI: 10.1111/j.1099-1611.2013.3394

the soul. RESEARCH IMPLICATIONS: If wewant to really spread the good practice of helpinggrieving children, the caretakers are very much de-pendend of the researchers to proove the effective-ness of their effort with reliable data. CLINICALIMPLICATIONS: It is possible - over a period of10 years - to change a whole country’s attitudetoward issues concerning responsible adult help togrieving children and adolescents in Schools - andPreschool settings. ACKNOWLEDGEMENT OFFUNDING: None.

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OmSorg - Dealing With Bereavement Integrating

Training Groups for Bereaved Children in Public

School Settings in Denmark

Annemarie Dencker1, Per Bøge1, Jes Dige2

1Danish Cancer Society, Copenhagen, Denmark,2Danish Cancer Society, Aalborg, Denmark

BACKGROUND: In every Danish Public Schoolthere are 6–7 children suffering from the loss of aparent, 1 or 2 who have lost a sister or a brotherand some 12–20 kids carries the anxiety and insecu-rity knowing that their mum or dad is seriously illor dying. METHOD: From more than 20 years ofexperience in the field, we know that a very efficientway to help grieving children in coping with the sadfeelings of loss and despair, is to establish TrainingGroups lead by responsible adults. As a conse-quence of our work, today there are some 220 train-ing groups in Denmark. Unfortunately his is stillfar too few to meet all grieving children’s needs.RESULTS: To remedy this sad fact OmSorg haslaubched the project: “Training Groups inSchools”. It is a 4 years intervention in cooperationwith a vast number of public schools in 3 selectedmunicipalities. The present status of the project isthat up to 50 new groups have started within theschool system. They are led by 150 volunteer teach-ers, therapists and schoolnurses. We follow,describe, evaluate and report the process closelyover the next 3 years. The presentation will takeyou through the first qualitative evaluation on thebennefits of beeing part of a group reported by thechildren involved. CONCLUSIONS: The obvi-ously goal is that the government must take itsshare of responsibility for the training groups’ oper-ations. Thus, we expect that at least 50% of allDanish schools have established Training Groupsfor grieving children within the next 10 years. Theneed is very much present, as most existing groupsreport long waiting lists. In short - We work forthat in the future there will be no need to put chil-dren’s grief on the waiting list. RESEARCHIMPLICATIONS: In all - to us known - evalua-tions of programmes aimed towards bereaved chil-dren we have never come across an evaluation

where the children involved has been given theopportunity to speek for themselves. This is (per-haps for the first time) done in our evaluation.CLINICAL IMPLICATIONS: Training groupsimplemented in Public School settings is in manyways a very direct, cheap and helpfull efforttowards bereaved children. ACKNOWLEDGE-MENT OF FUNDING: None.

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OmSorg - Dealing With Bereavement Working With

Training Groups for Bereaved Children

Jes Dige1, Per Bøge2, Annemarie Dencker2

1Danish Cancer Society, Aalborg, Denmark,2Danish Cancer Society, Copenhagen, Denmark

BACKGROUND: Every year more than 2500Danish children under the age of 18 experience theloss of a parent by death. Another 42,000 childrenexperience that their mum or dad is acute hospital-ized with a severe illness. One of the basic condi-tions in working with children in loss and grief isthat the responsible adult person involved in thechild’s unbearable situation makes space for thechild to be heard, seen and understood.METHOD: A very efficient way of helping griev-ing children in coping with the sad feelings of lossand despair is to establish Training Groups lead byresponsible adults. In the group the children canmeet peers who are in a situation very similar totheir own. They listen to one another, discus simi-larities, differences and problems. For once theycan be in a context where everyone can look at oneanother and freely say: “I know exactly how youfeel”. RESULTS: Since the early start in 2000 Om-Sorg has managed to start or support others toestablish more than 220 training groups nation-wide. This is still far too few to meet the needs of allgrieving children, but it is a successful beginning.CONCLUSIONS: 220 groups is - as mentioned -far to few. One of the biggest obstacles is that thework in the groups is based on volunteering. Ittakes time to find the right place for the group set-ting, funding, advertsing etc, etc. Often up 2 yearsof practical work before the group is established.And then - sadly enough - many volunteers areburned out when at last beeing at the center of theirwork. Here we do a great effort for making thenumber of groups to increase. CLINICAL IMPLI-CATIONS: The presentation will present somedetails from the work, point out some of the bene-fits and outcomes for the child to be part of thegroup, and finally give a short presentation on ourfuture plans. In addition we will show a few sam-ples from a TV-documentary describing the workdone in one of the training groups. ACKNOWL-EDGEMENT OF FUNDING: None.

126 Poster Abstracts of the IPOS 15th World Congress


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“What Bothers Me? The Memory”:

An Interpretative Phenomenological Analysis

Leonor Fasse1,2, C�ecile Flahault1,2,Anne Br�edart1,2, Sylvie Dolbeault1, Serge Sultan3

1Institut Curie, Paris, France, 2Universit�e ParisDescartes, Paris, France, 3Universit�e de Montr�eal,Montr�eal, Canada

BACKGROUND: Whereas a grief-related disor-der tapping prolonged disabling reactions might beincluded in the DSM 5, the mechanisms underlyingit remain poorly described. Some studies high-lighted the risk for bereaved spouses after a cancerto develop this disorder, especially when reportingan insecure attachment. However no qualitativestudy explores associations between attachmentstyles and adjustment to grief in this population.This study aims at enhancing knowledge aboutthe delineation of this debilitating condition.METHOD: The interview of a male widower(57 years) of a cancer patient, presenting a disorga-nized attachment and meeting at 6 monthspost-death the criteria for PGD (Inventory of Com-plicated Grief, Prigerson et al., 1995) was subjectedto an Interpretative Phenomenological Analysis(IPA, Smith, Flowers & Larkin, 2009). This stan-dardized analysis targets the meaning makingprocesses with regards to attachment styles.RESULTS: Three inter-related master themes arepresented: (1) Forgetting, and continuing bonds;(2) Guilt; (3) Disorganization of the daily life.Within these, the analysis describes ruminative cop-ing as an avoidance mechanism, and its function inadaptation to loss, while associations betweenmeaning making and attachment are underlined.Furthermore this study provides an insight regard-ing “normal” versus complicated reactions after theloss of a loved one, including relocation of contin-uing bonds and reorganization of self-definingmemories. CONCLUSIONS: Our data indicatethat disorganized attachment is a major predictorof poor adjustment in bereavement. Whereas rumi-nation was sometimes viewed as a confrontationprocess, associated with recovery from the loss,accordingly to the grief work hypothesis, our studyunderlined its ambiguous function, as an avoidancemechanism. Disorganized attachment, that is highanxiety and high avoidance in attachment, wouldundermine the integration of loss, by focusing griefprocess on avoidance, rather than on a beneficialoscillation between confrontation and avoidance.RESEARCH IMPLICATIONS: Our data high-lighted the associations between intra-individualfactors such as attachment styles present upstreamfrom the death and adjustment to spousal loss. Thequalitative design of the study enables the research-ers to capture complex links between attachment,meaning making processes and grief reactions.

More studies are needed to explore cognitive, emo-tional and social mechanisms underlying these reac-tions, in an integrative perspective. CLINICALIMPLICATIONS: As the very nature of Pro-longed Grief Disorder remains unclear, our studyprovides indications of impaired grief processessuch as difficulties in finding meaning (or findingmeaning pervaded by intense guilt), chaotic attach-ment to the deceased, and frozen autobiographicalmemory. These impaired processes could becometherapeutic targets of individual grief support pro-grams based on the Dual Process Model of Copingwith Bereavement (Stroebe & Schut, 1999), whichintegrates the attachment theory. ACKNOWL-EDGEMENT OF FUNDING: Support for thisresearch came from the French National CancerInstitute SHS 2011 (INCa).

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Prolonged Grief Disorder (PGD) in The Cancer

Context: Results of A longitudinal Study Pre- and

Post-Death Among Spouses of Cancer Patients

Leonor Fasse1,2, C�ecile Flahault1,2,Anne Br�edart1,2, Sylvie Dolbeault2, Serge Sultan3

1Institut Curie, Paris, France, 2Universit�e ParisDescartes, Paris, France, 3Universit�e de Montr�eal,Montr�eal, Canada

BACKGROUND: Bereaved people are consideredby health professionals and by common sense asvulnerable persons. Recent research suggests thatcaregivers of cancer patients can meet the criteriafor PGD, which might be included in the DSM-5.However little is known regarding the display ofmaladaptive reactions in spouses of patients beforethe death, and how it spreads after death. Thisstudy aims at capturing the very nature of thesereactions and their predictors. METHOD: In aconsecutive cohort of spouses of palliative cancerpatients (N = 60), we studied at T1 (from 1 to6 months before death) specific predictors of emo-tional adjustment at T2 (6–9 months after death).Evolution of depression between T1 and T2 (BDI)and intensity of grief reactions and Prolonged GriefDisorder (ICG) are linked to: Attachment (Experi-ences in Close Relationship Scale); Burden (Mont-gomery & Borgatta Caregiver Burden Scale);Coping and orientation of grief (Inventory of DailyWidowed Life); coping styles (COPE). Regressionanalyses were conducted to predict adjustment atfollow-up controlling for baseline scores.RESULTS: In the sample of 60 participants(M = 62.9 years, 60% male), the vast majority ofthe spouses (66%) reported during the palliativephase a depressive symptomatology and feelings ofburden associated with the caregiving experience.After the death of the patient a minority (13.9%)meet the criteria for a Prolonged Grief Disorder.Above all, PGD is predicted by their levels of



depression assessed before the death and by theiranxious attachment. The factors linked with thedisease or with the death itself do not significantlypredict the condition of the bereaved spouses.CONCLUSIONS: Our data indicate that upstreamfrom the death, then in the first months of bereave-ment, the spouses of cancer patients report animportant psychological distress. Particularly, a sig-nificant minority of spouses experience dysfunc-tional grief, which is associated with later healthimpairments. Depression during the palliativephase and anxious attachment constitute warningsigns for grief-related disorder. RESEARCHIMPLICATIONS: Our data highlighted the asso-ciations between intra-individual factors such asattachment styles present before the death andadjustment to spousal loss. More longitudinal stud-ies are needed to capture the variability in griefreactions among caregivers of cancer patients. It isof critical importance to study the display of themaladaptive response to loss in long-term, asexperts have suggested a time criterion of12 months for the PGD diagnosis. CLINICALIMPLICATIONS: When the very nature of Pro-longed Grief Disorder remains ambiguous, ourstudy provides indications of factors associated withthis condition such as an insecure anxious attach-ment and depression during the pre-death period.These indications may allow us to identify the per-sons who could benefit from an early support frommental-health professionals. ACKNOWLEDGE-MENT OF FUNDING: Support for this researchcame from the French National Cancer InstituteSHS 2011 (INCa).

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Psychiatric Disorders and Background

Characteristics of The Bereaved Seeking Medical

Counseling at a Cancer Center

Mayumi Ishida1, Hideki Onishi1, Satoshi Kawada1,

Hiroaki Toyama1, Yosuke Uchitomi2

1Department of Psycho-Oncology, SaitamaInternational Medical Center, Saitama MedicalUniversity, Hidaka-city, Saitama, Japan,2Department of Neuropsychiatry, OkayamaUniversity Graduate School of Medicine, Dentistryand Pharmaceutical Sciences, Okayama-city,Okayama, Japan

BACKGROUND: The death of a person is a stress-ful event in life. This stress is related to the physicaland psychological well-being of the bereaved. Withthe aim of alleviating psychological distress in thebereaved, our hospital started an outpatient servicefor bereaved families. The purpose of this study wasto examine psychiatric disorders and backgroundcharacteristics among the bereaved who lost a lovedone with cancer and who sought medical counselingat a cancer center. METHOD: In this retrospective

study, all patients who consulted the outpatient ser-vice for bereaved families in our hospital betweenApril 2007 and March 2013 were reviewed. Thisstudy was approved by the Institutional ReviewBoard of Saitama International Medical Center,Saitama Medical University. RESULTS: Duringthe study period, 124 patients consulted the outpa-tient service for bereaved families. Their ages ran-ged from 17 to 84 years (mean: 53 � 15). The mostcommon psychiatric disorder among the bereavedwas bereavement reaction (n = 49, 40%), followedby major depression (n = 34, 27%). Eight patients(n = 8, 6%) experienced dissociative disorders inaddition to their psychiatric diagnosis. Females(n = 103, 83%) and the bereaved who lost theirspouse (n = 72, 58%) were the most common usersof the service. CONCLUSIONS: This retrospectivestudy demonstrated the characteristics of thebereaved seeking medical counseling at a cancercenter. Most of the patients who consult outpatientservices for bereaved families suffer from psychiat-ric symptoms related to the death of close familymembers, and need some help. Therefore, weshould avoid viewing symptoms of psychiatric dis-orders as only reactions to bereavement. Psychiatricinterventions including psychotherapy and medica-tions are required for these families. RESEARCHIMPLICATIONS: None. CLINICAL IMPLICA-TIONS: We should avoid viewing symptoms ofpsychiatric disorders as only reactions to bereave-ment. Psychiatric interventions including psycho-therapy and medications are required for thesefamilies. ACKNOWLEDGEMENT OF FUND-ING: This study was supported by the Third-TermComprehensive 10-Year Strategy for Cancer Con-trol and Research of the Japanese Ministry ofHealth, Labor and Welfare and Grant-in-Aid forScientific Research.

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Early Parental Death and Risk of Hospitalization

for Affective Disorder in Adulthood

Charlotte Weiling Appel1, Christoffer Johansen1,

Isabelle Deltour1, Susanne Oksbjerg Dalton1,

Annemarie Dencker1, Jes Dige1, Per Bøge1, Bo

Andreassen Rix1, Pernille Enevold Bistrup1, Atle

Dyregrov2, Preben Engelbrecht3, Henrik Hjalgrim4

1Danish Cancer Society, Copenhagen, Denmark,2Center for Crisis Psychology, Bergen, Norway,3Children, Adolescents and Grief, Copenhagen,Denmark, 4Children’s Welfare, Copenhagen,Denmark

BACKGROUND: Early parental death is one ofthe most stressful childhood life events and mayinfluence subsequent psychological health. Weinvestigated the association between early parentalloss and risk of hospitalization for an affective



disorder in adulthood. METHOD: Our nationwideregister-based cohort study comprises 1,225,660people born in Denmark in 1970–1990, of whom138,893 experienced the death of a parent beforethe age of 30 years. Followup for hospitalizationfor an affective disorder in the period 1990–2009yielded 15,261,058 person-years and 19,867 hospi-talizations for affective disorder (bereavedn = 2644; nonbereaved n = 17,223). A Cox propor-tional hazards model was used to assess hazardratios (HRs) for hospitalization with an affectivedisorder according to early parental death.RESULTS: People who experienced early parentaldeath had an increased risk of hospitalization for aunipolar disorder (men: HR = 1.33; 95% confi-dence interval [CI] = 1.23–1.44; women: 1.23; 1.17–1.30). Stronger associations were observed forparental death caused by suicide than for othercauses. For bipolar affective disorder, an increasedrisk of hospitalization was observed only after sui-cide. CONCLUSIONS: People who had lost a par-ent had an increased risk of hospitalization forunipolar affective disorder. Although this was par-ticularly true for bereavement due to parental sui-cide, it was also found for parental death fromother causes. In contrast, an increased risk of hospi-talization for bipolar affective disorder wasobserved only after parental suicide. RESEARCHIMPLICATIONS: There is a need for furtherresearch into the association between early parentaldeath and depression, e.g. risk of mild depression,use of antidepressants, and identification ofother vulnerable groups. CLINICAL IMPLICA-TIONS: Health personnel, dealing with people,who have lost a parent during childhood or youngadulthood, should be aware that this group has anincreased risk of severe depression that requireshospitalization. This is especially true for thosewho lost a parent to suicide. ACKNOWLEDGE-MENT OF FUNDING: None.

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Communication Skills Training Program for

Internship Year Nursing Students to Reduce

Oncology Patient Emotional Distress in Egypt

Somaya Abou Abdou

Suez Canal University, Ismailia, Egypt

BACKGROUND: Communication skills are thecornerstone of the patient provider relationship incancer care. Lack of these skills can diminish disclo-sure, increase patient anxiety. Nurses play animportant role in providing emotional care andsupport to patients and their families. Unfortu-nately, few nurses receive sufficient training toensure they are proficient in key communicationtasks. This study was carried out to determine theimpact of communication skills training programon reduce oncology patient emotional distress.

METHOD: A quasi experimental design with pre-post assessment was utilized in this study with sam-ple size of 86 participants from internship yearnursing students. The study was conducted inTraining Unite and Oncology Units at Suez CanalUniversity Hospitals. Internship year nursing stu-dents went through the problem-based learningprocess and role-playing exercises with regular feed-back on basic communication skills, breaking badnews, effectively providing information and how todeal with patient’s emotionsduring the training pro-gram. The nurse students were evaluated bothbefore and after the training using “Empathic Ten-dency”, “Empathic Skill” and “CommunicationSkills Evaluation Scales”. RESULTS: The trainingimproved internship year nursing students’empathic tendency, empathic and communicationskills. “Respect to patients, giving constructivefeedback, using effective body language, usingcontinuing and leading reactions” showed gradualimprovement during observations while self-disclo-sure and “ineffective communication techniques”were lower. CONCLUSIONS: Communicationskills training programs have effectively improvedthe empathic tendencies, empathic skills, and com-munication skills of the internship nurses student.Therefore, expanded training programs on commu-nication skills programs during in-service programscould improve nurses’ communication skillsACKNOWLEDGEMENT OF FUNDING: None.

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Prognostic Awareness and Communication of

Prognostic Information in Malignant Glioma: A

Systematic Review

Allison Applebaum, Eli Diamond, Geoffrey

Corner, Antonio DeRosa, William Breitbart

Memorial Sloan-Kettering Cancer Center, NewYork, NY, USA

BACKGROUND: Prognostic awareness (PA) is atopic of research and clinical interest in healthcarecommunication, palliative care, and psycho-oncol-ogy. Accurate PA has been linked to positive psy-chosocial outcomes for patients and caregivers, butlittle is known about PA among patients withmalignant glioma (MG), a devastating disease withuniformly poor prognosis. This systematic reviewsynthesized the literature on PA in MG, with anemphasis on patients’ understanding of prognosisand preferences regarding communication of prog-nostic information. METHOD: A systematic liter-ature review was conducted of N = 5 databases(Cochrane, Embase, PsycINFO, Pubmed, andWOS) with search terms related to brain neo-plasms, prognosis, awareness, and patient-physi-cian communication. Of the N = 7219 studiesretrieved, N = 14 studies met inclusion criteria andwere included in the systematic review.



RESULTS: Of the articles that met inclusioncriteria, 9 were empirical studies and 3 were reviewarticles or practice guidelines based on authors’clinical experience. Across studies, methods formeasuring PA and communication preferenceswere heterogeneous, as were rates of PA, whichranged from 25% to 100%. Studies of communica-tion preferences suggest dissatisfaction with com-munication regarding prognostic informationamong MG patients and their caregivers. CON-CLUSIONS: Despite the importance of PA inadvanced cancer and the uniformly poor prognosisin MG, there is a dearth of evidence regarding PAamong patients with MG. Our review highlighted awide range of PA among MG patients and inconsis-tent preferences for detailed prognostic informa-tion. While many patients prefer detailedprognostic information, evidence also suggests thatpreference for limited information may serve as amechanism to preserve hope. Additional studies areneeded to understand the most effective means ofmeasuring PA and communicating prognosticinformation to patients with MG and their caregiv-ers. RESEARCH IMPLICATIONS: There is anurgent need for rigorous, prospective, and stan-dardized assessment measures of PA amongpatients with MG and their caregivers that accountfor the unique clinical features of this disease,including certain poor prognosis from the time ofdiagnosis and progressive neurological decline.CLINICAL IMPLICATIONS: PA and prefer-ences for communication of prognostic informa-tion, as well as the factors that may influence them,are currently poorly understood in MG. Rigorousstudy of the needs of MG patients regarding prog-nostic information will provide an opportunity toimprove patient-physician communication andquality of care. ACKNOWLEDGEMENT OFFUNDING: This research was supported in partby grant NCI T32CA009461-28 from the NationalCancer Institute to AJA.

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Communication Skills of Nurses Caring for

Oncology Patients: A Multicentric Study

Nazmiye Kocaman Yildirim, G€us�len Terakye,

Azize Atli OzbaşOncology Nursing Association of Turkey, Ankara,Turkey

BACKGROUND: Nurses caring for oncologypatients need to use their communication skills effec-tively to help patients and those close to them copewith the adverse impact of their illness. Professionalknowledge and skills are required in order to com-municate with patients and families. The purpose ofthis study is to identify the areas of nurses’ self-per-ceived proficiency and inadequacy with regards tothe application of communication skills when inter-

acting with cancer patients and their families.METHOD: The study sample consisted of 108oncology nurses at 4 medical centers (Istanbul,Ankara, Erzurum, Gebze) and who volunteered toparticipate, who wanted to receive training on psy-chological care, and who fully completed the ques-tionnaires. Data were collected during face-to-faceinterviews where the “Communication Skills Confi-dence Questionnaire” was used. Developed by Fal-lowfield al. in 2001, this instrument comprises 14statements relevant to communicating with cancerpatients. It is designed for nurses to rate theirself-perceived proficiency in these skills between 1 (Ido very badly) and 10 (I do very well). The Cron-bach’s Alpha co-efficient was calculated as 0.94.RESULTS: The participants’ mean age was29.1 � 5.6 and average number of years in oncologywas 3.1 � 3.5. The mean “self-confidence” score forskills in communicating with cancer patients was6.46 � 1.65 (2.29–9.79). The 5 communicationissues nurses felt most inadequate in were: discussingsexuality (5.08 � 2.51) and the concept of death anddying (5.29 � 2.38) with patients, informing patientfamilies about impending death (5.87 � 2.29), dis-cussing prognosis with patients and supporting fam-ilies of recently deceased patients (6.13 � 2.50).Nurses perceived themselves as competent in com-municating with patients of their own age-groups(7.46 � 1.90), patients who are medical profession-als (7.37 � 1.90) and those with high levels ofeducation (7.08 � 1.69). CONCLUSIONS: Theresults of this study indicate that nurses view them-selves as particularly inadequate in communicatingwith patients about sexuality and death. They alsoexperience difficulty in supporting families of soon-to-die or recently deceased patients. Discussingprognosis with patients was another important areaof perceived inadequacy. Several studies addressthe challenges nurses face when confronting mortal-ity. While organizational procedures and collabora-tion between curative and palliative teams canfacilitate discussion of death and sexuality, culturalinfluences undeniably affect the ability to communi-cate about these subjects. Nurses clearly need todevelop their communication skills with regards totopics they have difficulty discussing. RESEARCHIMPLICATIONS: In order to support nurses inoncology units, it is necessary to identify factorswhich affect nurses’ communication skills withregards to sexuality and death. Furthermore, we rec-ommend that researchers in this area conduct cor-roborative studies to compare the results of Turkishstudies with results from differing cultural back-grounds. This study may serve as a guide in thedevelopment of training programs that address theneeds of nurses. CLINICAL IMPLICATIONS: Itis apparent that some of the needs of oncologypatients are not currently able to be met. We foundthat clinical nurses experience difficulties in develop-ing skills necessary for communicating with cancer



patients, especially in discussing sexuality, death andprognosis with patients and in providing support topatient families. We recommend the development ofpost-graduate training programs for nurses toenhance the skills necessary to address the issueshighlighted by this study. ACKNOWLEDGE-MENT OF FUNDING: This study was sponsoredby the Oncology Nursing Association of Turkey.

P1-13

Evaluating The Design and Effectiveness of Question

Prompt Lists in Oncology: A Systematic Literature

Review

Kim Brandes1, Annemiek Linn2, Julia van Weert2,

Phyllis Butow3

1School of Psychology, University of Sydney,Sydney, New South Wales, Australia, 2AmsterdamSchool of Communication Research, University ofAmsterdam, Amsterdam, The Netherlands, 3Centrefor Medical Psychology and Evidence-basedDecision-making, University of Sydney, Sydney,New South Wales, Australia

BACKGROUND: For the past 2 decades QuestionPrompt Lists (QPLs) have been used extensively inthe oncology setting to enhance patient participationand, consequently, to improve patients’ psychologi-cal outcomes such as anxiety. Across studies differ-ent designs of QPLs have been used. The objectiveof this systematic review is to give an overview ofhow QPLs have been designed and to examinewhether the effectiveness of a QPL is determined byits design. METHOD: A literature search was con-ducted in PsycINFO, Medline and CINAHL. Addi-tional studies were sought via the snowball method,where the reference lists of included articles werehand searched for eligible articles. Empirical studiesthat included a QPL in an oncology setting wereincluded. Further, the methodological quality ofstudies was assessed using a list with 11 criteria mea-suring internal validity designed by the CochraneCollaboration Back Review Group. Studies that met6 or more of the criteria were considered as highquality studies and studies that met less than six ofthe criteria were considered as low quality studies.RESULTS: Of the 51 articles that were found, 21articles met the inclusion criteria. It was found thata QPL was effective in enhancing question asking.The effectiveness of a QPL in improving psychologi-cal outcomes was limited. Further, the design of aQPL varied between studies. In sum, the majority ofQPLs were given to patients before consultation inhardcopy. QPLs mostly consisted of general ques-tions that can be applied to multiple types of cancer.In most studies a QPL was part of a larger interven-tion. Limited evidence was found that the design ofa QPL can influence its effectiveness. CONCLU-SIONS: A QPL was effective in improving patientparticipation during consultation. In the majority of

studies the number of questions asked by the patientduring consultation increased. The effectiveness of aQPL on psychological outcomes such as anxiety waslimited. In studies that were effective in reducingpatients’ levels of anxiety patients compiled theirown QPL, thus the QPLs were individually tailored.These individually tailored QPLs might have beenmore effective because patients included affectivequestions on them. Emphasizing affective communi-cation instead of instrumental communication couldbe a way of improving the effectiveness of a QPL onpsychological outcomes. RESEARCH IMPLICA-TIONS: To date, QPLs have been designed withinstrumental questions (e.g. questions regardingtreatment) and the results on psychological out-comes are limited. A possible reason is that patientshave both instrumental (the need to understandwhat is going on) and affective (the need to expressworries and to be understood) information needs. AQPL does not address this affective informationneed. Creating a QPL with affective questions orwith concerns could potentially improve patients’psychological outcomes. CLINICAL IMPLICA-TIONS: Improvement in psychological outcomessuch as anxiety has been associated with betterhealth outcomes for the patient. The clinician canprovide the patient with needed information toimprove psychological outcomes if the clinician isaware of the worries of the patient. Empoweringpatients with a QPL framed with affective questionscan create the opportunity for clinicians to tailortheir consultation to the worries of patients and pro-vide them with information that can improve psy-chological outcomes. ACKNOWLEDGEMENTOF FUNDING: None.

P1-14

The Therapeutic Stage Setting. Towards a Greater

Acceptance of Care and for Better Wellbeing of

Cancer Patients

Yannick Bressan, Marie-Fr�ed�erique Bacqu�e

(1INSERM, EA 3071, UDS), Strasbourg, France

BACKGROUND: An experiment has been donein 2008 in the Laboratory of Imagery and CognitiveNeurosciences (CNRS) of Strasbourg France. Wediscovered the important role of the stage directionfor the emergence of the theatrical reality via theprinciple of adhesion (e.g. the existence of the actoris substituted by the character he performs.) Theapplication of this study in clinical psychology fieldwas then a way of research in cancer patients com-pliance. METHOD: An experimental frameworkfor the management of medical interview was estab-lished based on a series of attitudes, voices and sce-nography. The observation protocol was built onrelationship and exchanges between patients andphysicians after numerous meetings about theirexpectations, fears and attempts (software: Alcest



interview analysis). In addition, a discussion oftheir experiences (via interviews proposed few daysafter the experiment) versus the neutral observationof these experiments was a strong indicator forbuilding up the best events of this therapeutic stagesetting. RESULTS: The rate of patients acceptanceto their cancer treatment when the choice is madein the context of a staged treatment is superior thanthe percentage of acceptance without the use oftherapeutic stage setting. According to the resultsobtained in the framework of neuro-aesthetic, agreater patients rate adhere to medical protocol inthe context of the therapeutic stage. CONCLU-SIONS: The special brain activities and cognitivestates of the viewers observed during the experi-ment allows us to consider the therapeutic stagesetting as a possible psychological tool in oncol-ogy. This experiment of therapeutic stage settingallows us to expect

• Greater acceptance rate of illness of patientsparticipating in a therapeutic stage setting.

• Greater acceptance of interpersonal and intra-subjective effects (relationship with family andfriends, self-esteem).

• Greater acceptance of treatment (compliance,care obligation).

RESEARCH IMPLICATIONS: The principle ofadhesion is related to the emergence of a fictionalreality replacing sometimes the own reality of thesubject who adheres. The adhesion phenomenonobserved in clinical psychology (e.g. the Compli-ance), is not the principle of adhesion but is relatedto it. The utilization of the principle of adhesion inthe therapeutic stage setting could improve the rela-tion doctors / patient’s comfort especially for deci-sion-making related to the choice of the medicalprotocol. CLINICAL IMPLICATIONS: Ourexperimental design could enhance physicians skillsto explain treatment modalities to their patients.But to have clinical implications it is necessary toanswer to primordial ethical questions. How toenable physicians to have a strategic approach thatis specially related to improve the exchange patient/doctor in a way to accept the treatment protocol?What are the ethical implications of this protocolthat works on social and unconscious influences?ACKNOWLEDGEMENT OF FUNDING: None.

P1-15

Cancer Disclosure: Account from a Pediatric

Oncology Ward in Egypt

Hanan EL Malla1, Ulrika Kreicbergs2,

Nathalie Helm Ylitalo1, Ulrica Wilder€ang1,Yasser El Sayed Elborai3,4, Gunnar Steineck1,2

1Sahlgrenska University Hospital, Gothenburg,Sweden, 2Karolinska Institutet, Stockholm, Sweden,3National Cancer Institute, Cairo, Egypt,4Children’s Cancer Hospital, Cairo, Egypt

BACKGROUND: Barriers to disease disclosureare many and vary across cultures and societies.Considering that truth telling about one’s diagnosisis the first step towards good patient-physiciancommunication and for treatment decision-makingin cancer patients it is unfortunate that commonpractice in the Arab world stands in the way of suchcommunication. As concerns disease disclosure inconnection with childhood cancers in Egypt, itappears that no studies have been made prior toour study. METHOD: We examined in some detailthe nature of disease disclosure at the time of thefirst chemotherapy treatment; among children whohas been diagnosed with cancer and were about tostart treatment. This was done by administering 2questionnaires to 304 parents of children diagnosedwith cancer at the Children’s Cancer Hospital inCairo (CCHE), Egypt, one before the first chemo-therapy treatment and the other before the third.RESULTS: We found that nearly three quarters(72%) of the parents had their child’s cancer diag-nosis communicated by the physician. Only thirty-nine percent of the children were present with theparents during the disease disclosure conversation.CONCLUSIONS: There is a need for greater rec-ognition of patient autonomy among physiciansand the need for developing better practice for thedisclosure of cancer diagnosis to the children andyoung adolescents and their parents. RESEARCHIMPLICATIONS: We hope that this study canform a base and provide important information thatcan be used to initiate interventions and future stud-ies exploring similar topics. CLINICAL IMPLICA-TIONS: Our aim is to gain a greater recognitionand better practice of disease disclosure for thechildren/young adolescent and their families.ACKNOWLEDGEMENT OF FUNDING: None.

P1-16

Short-Term Courses of Communication Skill

Training in General Hospitals

Chun-Kai Fang1,2, Woung-Ru Tang2,3,

Sheng-Hui Hsu2,4, Yeong-Yuh Juang2,5,

Shih-Che Chiu2,6, Kuan-Yu Chen2,7

1Department of Psychiatry & Suicide PreventionCenter, Mackay Memorial Hospital, Taipei,Taiwan, 2Taiwan Psycho-Oncology Society, Taipei,Taiwan, 3Graduate Institute of Nursing, Chang GungUniversity, Taoyuan, Taiwan, 4Department ofPsychiatry, Koo Foundation Sun Yat-Sen CancerCenter, Taipei, Taiwan, 5Department of Psychiatry,Chang Gung Memorial Hospital, Taoyuan, Taiwan,6Department of Radiation-Oncology, MackayMemorial Hospital, Hsinchu, Taiwan, 7Division ofPsychosomatic Medicine, Taipei City PsychiatricCenter, Taipei City Hospital, Taipei, Taiwan

BACKGROUND: Since 2010, Taiwan Psycho-Oncology Society (TPOS) began to promote the



communication skill training (CST) of bad news tell-ing for cancer care with the SHARE model, whichwas empowered by the Bureau of Health Promotionin Taiwan. For encouraging more and more medicalstaff to understand the importance of CST, theshort-term courses of communication skill trainingwere promoted in general hospitals nationwide. Thesurvey hoped to understand the efficiency of theshort-term CST courses. METHOD: Empoweredby Bureau of Health Promotion in Taiwan, fromJanuary to December in 2012, TPOS provide 2short-term courses of CST including the CST-miniSHARE (4 hours) and CST-1D-SHARE (6 hours).All courses were held in general hospital nationwide.The ratio of facilitators to participants was 2:4 asthe same as the CST-TTT (communication skilltraining- training the trainer). Participants’ opinionsof truth telling were assessed using the Japanesetruth-telling scale for evaluation. RESULTS: Therewere 35 hospitals and 454 medical staff attendingthe courses, including 367 in CST-mini SHAREand 87 in CST-1D-SHARE. Except the factor ofsetting, the other three factors were improved afterthe training courses, including method of disclosingbad news, providing emotional support, and pro-viding additional information (all p < 0.001). Manyparticipants considered to attend the CST-TTT infuture. CONCLUSIONS: Short-term courses ofcommunication skill training were also efficient tohelp medical staff for understanding the importanceof communication and improving their basic skills.Short-term courses can’t alter the CST-TTT butcan encourage more and more medical staff to learncommunication skill training. RESEARCHIMPLICATIONS: Many experts suspect the effi-ciency and outcome of the time-limited trainingcourses about the communication skill training. Wehope to evaluate and analyze data for the furthernational policy. CLINICAL IMPLICATIONS: Inoverload clinical work, it is possible to encouragemedical staff to learn communication skill.ACKNOWLEDGEMENT OF FUNDING: TheBureau of Health Promotion in Taiwan.

P1-17

Association Between Doctor-Patient Relationship

and Maladaptive Coping to Cancer in European

Countries

Elena Meggiolaro1, Maria Cristina Colistro2, Elena

Samor�ı2, Maria Giulia Nanni3, Agustina Sirgo

Ramirez4, Elisabeth Andritsch5, Marta Bell�e6,Eva Juan Linares7, Maria Alejandra Berardi1,

Laura Cavana2, Maura Muccini2,

Federica Ruffilli1, Elisa Ruggeri2, Ilaria Strada2,

Ilenia Pagliara2, Antonella Carbonara3,

Luigi Grassi3

1Istituto Scientifico Romagnolo per lo studio e laCura dei Tumori (IRST) S.r.l. IRCCS, Meldola

(FC), Italy, 2Istituto Oncologico Romagnolo IOR,Forl�ı, Italy, 3Division of Psychiatry, University ofFerrara, Ferrara, Italy, 4Psycho-oncology UnitOncology Department University Hospital SantJoan de Reus, Reus, Spain, 5University Clinic ofInternal Medicine, Division of Oncology, MedicalUniversity of Graz, Graz, Austria, 6Department ofOncology, C�a Foncello Hospital of Treviso, Treviso,Italy, 7Psycho-Oncology Unit, Hospital de la SantaCreu i Sant Pau, Barcelona, Spain

BACKGROUND: The role of doctor-patient rela-tionship in oncology has been the object of a num-ber of studies. Recent data regarding the use ofspecific instrument to examine some variables impli-cit in communication have shown the importance ofempathy, attention and emotional support by oncol-ogists towards their patients. As a part of a largerEuropean study, the aim of the present report wasto identify the association of doctor-patient relation-ship and maladaptive coping among cancer patients.METHOD: 284 cancer patients aged 18–65 years,with no cognitive deficits, Karnofsky Score >60 anda life expectancy >6 months, participated in a multi-center European study involving Italy, Austria,Spain. Each patient was administered a booklet forthe evaluation of several variables, including, for thepurpose of the present report, the 24-item PatientSatisfaction with Doctor Questionnaire (PSQ-MD)(Loblaw et al., 2004), to measure characteristics ofdoctor-patient relationship, 2 clinical subscales ofthe Mini-MAC (Watson et al., 1984), namely Anx-ious Preoccupation and Hopelessness, to measuremaladaptive coping; and the 0-10 NCCN DistressThermometer (NCCN, 2012), to measure patients’emotional distress. RESULTS: In agreement withthe original data, 2 factors were extrapolated fromthe PSQ-MD: Physician Disengagement (extent towhich patients appraise their physicians as interestedonly in the medical aspects of their problems), andPhysician Support (extent to which patients perceivetheir physicians as concerned, supportive, empathicand aligned with the patient’s best interests). Hope-lessness and anxious preoccupation were associatedwith scores of Physician Disengagement (r = 0.31,p < 0.01; and r = �0.28, p < 0.01, respectively). Incontrast, Physician Support was related to lowerscores on hopelessness (r = 0.25, p < 0.01) and, mar-ginally, distress (r = 0.15, p < 0.01). CONCLU-SIONS: The study indicated that cancer patients’perception of their relationship with their own doc-tor is associated with coping styles and symptomdistress. In particular, a tendency to be concernedabout their illness (Anxious Preoccupation) or tobe hopeless about it (Hopelessness), as well as emo-tional stress symptoms were related to a perceptionof their physicians as detached, objective and inter-ested more in the medical aspects rather than con-cerned, supportive, and empathic. RESEARCH



IMPLICATIONS: Given the vast research oncommunication skills in oncology, the use ofspecific tools, such as the PSD-MD can be of helpin examining both the impact of the bipolar factorphysician engagement/disengagement on patients’coping and the possible changes in physicians’ atti-tudes after communication skills workshops ortraining. CLINICAL IMPLICATIONS: Resultssuggest the importance of establishing specific sup-portive and educational programs aimed at improv-ing doctor-patient communication, in order toimplement the quality of that relationship and topositively influence patients’ coping with cancer.ACKNOWLEDGEMENT OF FUNDING: Isti-tuto Oncologico Romagnolo (IOR), Forl�ı, Italy;FAR Project, University of Ferrara, Italy.

P1-18

Communication of Health Practitioners With

Parents of Children With Malignant Diseases

Marina Grubic1, Ana Bogdanic1, Zoran Cipek2

1University Hospital Centre Zagreb, Zagreb,Croatia, 2Association for Helping Children andFamilies Facing Malignant Disease “Firefly”,Zagreb, Croatia

BACKGROUND: It has been found that goodcommunication and developing collaborative rela-tionships with parents facilitates their adjustmentand reduces stress. Besides its importance for psy-chological well being of parents and children, goodadaptation to illness can also affect the course ofthe child’s illness and improve patient outcomes.The aim of this research was to examine the experi-ences and needs of parents of children with malig-nant diseases, focusing on their communicationwith health practitioners. METHOD: Participantswere 32 parents of children diagnosed with malig-nant diseases that are currently in remission for per-iod between 6 months and 3 years. Parents werecontacted in premises of Association for helpingchildren and families facing malignant disease“Firefly” where they filled out questionnaires whichexamined their experiences in communication withhealth practitioners. The age of children wasbetween 2.5 and 13 years. RESULTS: The firstinterview usually lasts longer then ten minutes, in32% of cases parents answered it lasted 5 minutesor less. Only one third of the parents understood allgiven information, in 41% of the cases physiciandid not check their understanding of the giveninformation. Physicians’ behavior in first consulta-tion is mostly viewed as professional, kind andunderstanding, while nurses are described as profes-sional, kind and compassionate. In communicationwith physicians parents need an optimisticapproach with hope, support, more devoted timeand more detailed information. Around two thirdsof the parents are overall satisfied with physician-

parent communication. CONCLUSIONS: Ourresults showed that most of the parents view theirexperiences in communication with health practitio-ners in a positive light, but also gives some guidelinesfor further improvement of health practitioners’communication skills in order to provide better sup-port to parents and address their needs in communi-cation. RESEARCH IMPLICATIONS: Furtherresearch should be made to address more specificneeds in communication of both parents and chil-dren with malignant diseases. It would be evenmore valuable to examine the communicationbetween health practitioners and patients while stillin treatment, in order to obtain more reliable data.CLINICAL IMPLICATIONS: There is a need forfurther education of health professionals in order toimprove their communication skills. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-19

Enhancing Patient Participation in Oncology

Consultations: A Best Evidence Synthesis of

Patient-Targeted Interventions

Inge Henselmans, Hanneke de Haes,

Ellen MA Smets

Department of Medical Psychology, AcademicMedical Center, Amsterdam, The Netherlands

BACKGROUND: Due to the complexity of can-cer consultations, the contribution of patients isoften limited. This systematic review examined thecharacteristics and effectiveness of patient-targetedcommunication interventions to enhance cancerpatients’ participation in consultations. Threeresearch questions were formulated. (RQ1) Whatare the characteristics of patient-targeted interven-tions for enhancing patient participation in cancerconsultations? What effect do these interventionshave (RQ2) on immediate, intermediate and longterm patient outcomes and (RQ3) on care processand provider outcomes? METHOD: Relevantstudies were selected by a search of databases untilmid-2010 (Pubmed, PsycINFO and CINAHL),citations in relevant reviews as well as backward/forward citations. Studies were included if (1) theaim was to enhance patient participation within theupcoming consultation and (2) the intervention tar-geted adults diagnosed with cancer. For the evalua-tion of effectiveness (RQ2 and 3), only controlledtrials were included. Characteristics and outcomeswere extracted by 2 researchers. A “Best EvidenceSynthesis” was conducted to quantitatively qualifyeffectiveness according to a set of principles, takinginto account the quality of studies. RESULTS: Atotal of 52 publications were included, describing46 studies and 30 unique interventions. One thirdwas delivered through either written or multimediamaterial; two thirds face to face. Most originatedfrom English speaking countries. Half targeted



heterogeneous cancer populations; one third tar-geted women with breast cancer. Half focused oninitial, treatment planning consultations. Overall,there was evidence for an effect on observed patientparticipation. There was no evidence for an effecton patient or doctor satisfaction and insufficientevidence for an effect on psychological or physicalwell-being and consultation duration. The findingswere largely independent of study quality. CON-CLUSIONS: The number of patient-targeted inter-ventions to enhance patient participation was shownto increase over the past decennia, reflecting the shifttowards patient-centered medicine. The majoritywas delivered face to face, suggesting a willingnessto invest in patient communication support. Thissystematic review demonstrated evidence for aneffect of patient-targeted communication interven-tions on observed patient participation. Particularlyon the more difficult areas of communicationpatients seem to benefit from support. Evidence foran effect on intermediate and long-term patient out-comes as well as provider and health care processoutcomes was insufficient or absent. Potential expla-nations for this lack of effect will be discussed.RESEARCH IMPLICATIONS: Implications forfuture research are discussed, including attention forthe gaps that were found in the literature, the chal-lenge to find the right outcome measures, the qualityof reporting in communication intervention studiesand the importance of clarity about the theoreticalunderpinnings of communication interventionstrategies. CLINICAL IMPLICATIONS: Patient-targeted communication interventions seem effec-tive in enhancing patient participation in oncologyconsultations. Hence, they should remain on theresearch agenda and implementation of evidence-based interventions in clinical practice is warranted.Stimulating patient participation may improve theeffectiveness of communication and facilitate opti-mal patient centered-care. ACKNOWLEDGE-MENT OF FUNDING: The first author isfinancially supported by a personal grant of theDutch Cancer Society (UVA 2009–4439).

P1-20

Using Data to Guide Effective Cancer Advocacy

Group Leadership Training and Support Programs:

The Case of The Global Advocacy Leadership

Academy (GALA)

Gary Kreps, Paula Kim

George Mason University, Fairfax,VA, USA

BACKGROUND: Health advocacy groups canmake significant contributions to supporting theneeds of those confronting cancer by shaping healthpromotion programs that are responsive to theneeds of consumers. Yet effective health advocacygroups demand strategic leadership, including thedevelopment of skills for communicating effectively

with different stakeholders, media representatives,researchers, health care providers, health systemadministrators, and public policy makers. TheGALA program is designed to support the trainingneeds of health advocacy group leaders.METHOD: The development of effective trainingprograms, such as GALA depend on careful needsanalysis research to guide evidence-based programdesign, implementation, and refinement. A series ofin-depth, semi-structured, qualitative personalinterviews with a purposive sample of active healthadvocacy leaders and influential health promotionprofessionals were conducted across selected globalhealth communities to learn more about the con-cerns of health advocacy leaders and the uniqueissues they face. The data collected are being usedto expand our understanding about the uniquetraining needs of health advocacy leaders and thebest strategies we can develop for meeting thesetraining needs. RESULTS: Twenty-eight in-depthpersonal interviews were conducted with key cancercommunity representatives from 4 different conti-nents, and 5 different countries (USA, Taiwan, Es-tonia, Japan, and New Zealand). Respondents wereasked to react to the GALA Mission Statement, todescribe the issues faced by advocacy group leaders,and to identify advocacy group leader training andsupport needs. Overall, there was strong supportfor the GALA mission, and specific recommenda-tions were made for supporting health advocacygroup leaders. The responses from the survey arebeing used to guide evidence-based development ofGALA training programs to support effectivehealth advocacy group leadership. CONCLU-SIONS: The survey clearly validated the need fortraining programs, like GALA, to support the devel-opment of effective advocacy group leadership. Thelist of issues generated suggests that comprehensivehealth advocacy training programs should covermany topics. Health advocacy leaders must developa deep understanding of the health care delivery sys-tem, the legal and regulatory health care environ-ment, the corporate participants in the health caresystem, the health research enterprise, and the influ-ences of media on health advocacy goals. It is alsocritically important for leaders to develop importantcommunication, leadership, team-building, fund-raising, and financial management competenciesand skills. RESEARCH IMPLICATIONS: Needsanalysis surveys are instrumental for guiding devel-opment of health advocacy leadership support pro-grams. The GALA program will continuegathering data from health advocacy leaders to helprefine and expand training and support programs,especially as the health care system evolves and thedemands of effective health advocacy leaders andorganization change. In this way, the GALA pro-gram can grow, expand, and, continually beresponsive to the needs of health care advocacygroup leaders. CLINICAL IMPLICATIONS: This



study suggests strong demand for building collabo-rations across advocacy groups and with keypartners from the health care system. To be effec-tive, the GALA program must not only provide rel-evant training for health advocacy leaders, it mustalso facilitate partnership building, collaborativeproblem solving, and effective media relations. Itmust also provide ongoing consultation, advisoryservices, problem solving support, and disseminatekey information about new findings and best prac-tices for health advocacy. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-21

Communication of Genetic Test Results for a Breast

and Ovarian Cancer Susceptibility: Report of

a 2-Year Follow-Up Study and Comparison of Three

Scoring Systems

Julie Lapointe1,2, Michel Dorval1,2, Catherine

Nogu�es3,4, Genepso Cohort3,5, Claire Julian-

Reynier5,6

1Facult�e de pharmacie, Universit�e Laval, Qu�ebec,Qu�ebec, Canada, 2Centre de recherche du CHU deQu�ebec, Qu�ebec, Qu�ebec, Canada, 3Centre Ren�eHuguenin, Saint-Cloud, France, 4Institut Curie,Paris, France, 5Inserm U912, Marseille, France,6Institut Paoli-Calmettes, UMR 912, Marseille,France

BACKGROUND: Communicating about genetictest results serves several purposes and couldinvolve different types of relatives and friends. Tobetter support this communication clinicians needto have more information about its unfolding pro-cess. In their efforts to conduct innovative projectson communication, researchers need to be aware ofthe different scoring system options. This study is alongitudinal assessment of communication aboutgenetic test results for carriers and non-carrierswomen of a familial BRCA1/2 mutation.METHOD: For 522 women, the communicationto first-degree relatives, spouse, and friends wasassessed 15 days, 1 year, and 2 years after receivingthe test result. One point was counted when the rel-ative was told, 0 when the relative was deceased orwhen there were no relatives of this kind, and �1when the relative was not told. The 3 scoring sys-tems were: (i) a compilation of communication witheach type of relatives and friends, (ii) an index rang-ing between �7 to +7, and (iii) a dichotomous scorebased on whether or not women had told all typesof relatives. RESULTS: Fifteen days after thewomen had received their genetic test results, theproportions of communication ranged between98% for spouses and 54% for children. Carriershad shared their test results with fewer types of rel-atives and friends than non-carriers15 days afterreceiving their genetic test results (1.89 vs. 2.55,

respectively, p < 0.01) but this difference was nolonger present in the 1 year and 2 years follow-up.Overall, 29% of the participants told relatives of alltypes 15 days after receiving their test results; thisproportion amounted to 37% 1 year later and 39%two years later. CONCLUSIONS: In both groups,genetic test results were communicated with fewertypes of relationships shortly after receiving theirtest result as opposed to 1 and 2 years afterwards.Carriers seemed to communicate about their testresults less extensively than the non-carriers did, butsuch difference is no longer present in the longerterm after receiving their genetic test results.Although proportions of communication with eachtype of relatives were considerable, a wide majorityof women reported at least one type of relative withwhom they did not communicate about their genetictest results. RESEARCH IMPLICATIONS: Themeasurement of communication is complex. Com-munication measurement scale and scoring systemsshould be carefully chosen. In light of these results,the utility, limits and empirical background of thesedifferent scoring systems of communication will bediscussed. It might be a good practice to use andreport more than one scoring system as it will be ofgreater benefit to both the clinic and research prac-tice. CLINICAL IMPLICATIONS: The mutationstatus affects communication in the short term, butnot in the longer term. Carrier women can be reas-sured about the fact that they might need timebefore they are ready to communicate about theirtest results. Given that spouses were almost alwaysquickly informed and given that they are likely aprivileged source of psychosocial support, inquiringabout the nature, process and satisfaction with thiscommunication could be important. ACKNOWL-EDGEMENT OF FUNDING: Sources of sup-port: Julie Lapointe is a CIHR Fellow inPsychosocial Oncology Research and Training(PORT), was funded through a CIHR TrainingGrant (No. TGF- 63285), a Michael Smith ForeignStudy Supplements - Canada Graduate ScholarshipsA Tri-Agency (SSHRC, NSERC and CIHR) Pro-gram and the Fonds d’enseignement et de recherchede la Facult�e de pharmacie de l’Universit�e Laval.The study project was funded by the InstitutNational du Cancer (INCA - grant R11108AA).



P1-22

Characteristics of Cancer Outpatients and Their

Hesitation Types While Communicating With their

Doctors During Medical Consultations

Yuko Ogawa1, Yuko Takei2, Harumi Koga1,

Mai Shimada1, Ayami Nagao1, Miho Sasaki1,3,

Yoshihiko Kunisato4, Keishi Tanigawa5,

Shin-ichi Suzuki6

1Graduate School of Human Sciences, WasedaUniversity, Tokorozawa, Saitama, Japan, 2Facultyof Medicine, University of Miyazaki Hospital,Miyazaki, Miyazaki, Japan, 3Health Care Center,Kibi International University, Takahashi, Okayama,Japan, 4Department of Psychology, School ofHuman Sciences, Senshu University, Kawasaki,Kanagawa, Japan, 5Biothera Clinic, Shinjuku,Tokyo, Japan, 6Faculty of Human Sciences, WasedaUniversity, Tokorozawa, Saitama, Japan

BACKGROUND: Although effective communica-tion between cancer patients and their doctorsincreases compliance and better health outcomes(Rodin et al., 2009), cancer patients often hesitate tospeak with their doctors because of a conflictbetween deciding what to discuss and a feeling ofgiving up on their doctors (Ogawa, 2013). This studywas conducted to clarify the characteristics of suchpatients and their hesitation types, by examining therelationship between their hesitation types andsociodemographic characteristics. METHOD: Theparticipants were 38 individuals (15 male and 23female, mean age 61.42 � 11.42 years) undergoingeither outpatient immunotherapy or hyperthermiatreatment. Participants were asked to recall theconversation during their most recent consultationwith their primary doctor. They then completedquestionnaires measuring anxiety and depression(HADS: Zigmond et al., 1993), quality of life (EO-RTC-QLQ-C30: Aaronson et al., 1993) and thedegree of hesitation when speaking with their pri-mary doctor (Ogawa, 2013). A cluster analysis wasperformed on the hesitation factors. Fisher’s exacttests were used to examine the relationship betweenpatients’ sociodemographic characteristics and hesi-tation types. RESULTS: The cluster analysis foundthat cancer patients’ hesitation types can be catego-rized into Good, Conflicted, and Hesitant. Fisher’sexact tests and residual analyses revealed that“Good” patients showed significantly low anxiety(p = 0.036) and depression (p = 0.036) and highemotional functioning (p = 0.006). “Conflicted”patients were younger than 65 (p = 0.027) andshowed significantly high performance status(PS) (p = 0.010) and role functioning (p = 0.014).“Hesitant” patients showed significantly low PS(p = 0.029), global score (p = 0.002), role function-ing (p = 0.002), and emotional functioning (p =0.010), and high fatigue (p = 0.018) and insomnia(p = 0.012). CONCLUSIONS: Patients with better

psychological status are less likely to experience hesi-tation when speaking with their doctors. Patientswith younger age, high PS and role functioning arelikely to experience conflict in deciding topics of dis-cussion. Patients with low PS, global score, rolefunctioning, emotional functioning, and high fatigueand insomnia were likely to give up on their doctors.These findings suggest that even patients with fewsymptoms experience hesitation while communicat-ing with their doctors. Furthermore, becausepatients with poor physical and psychological condi-tions are likely to give up, doctors may need to adopta more active communication approach with them.ACKNOWLEDGEMENT OF FUNDING: None.

P1-23

Work-Related Stress and Helping Professionals: The

Experience of The Oncohematology Department of

Cosenza Hospital

Angela Piattelli1,2, Enzo Cordaro3, Filippo

Canino1, Deianira Di Nicola3, Armodio

Lombardo2, Luigi Marafioti1, Lucio Marrocco1,

Candida Mastroianni1, Salvatore Palazzo1,

Fortunato Morabito1

1Dipartimento di Oncoematologia AziendaOspedaliera, Cosenza, Italy, 2Ordine PsicologiCalabria, Catanzaro, Italy, 3APOLIS (Associazionedi Psicologia del Lavoro e delle Organizzazioni InSicurezza), Roma, Italy

BACKGROUND: First aim of the study was toevaluate quali/quantitatively stress experienced bythe oncohematological working group. Second aimwas to design shared actions and behaviors in linewith both:good practice on psychosocial risk in theworkplace, with the needs of both relational, emo-tional and organizational of the professionals,, toencourage personal and professional growth as avehicle for change and continuous improvement ofa working group. METHOD: We used the Apolis(Association of Psychology Organizations Work InSecurity) procedures which include the administra-tion of the ROAQ (Organization Risk AssessmentQuestionnaire) to the members of the working groupand the administration of a structured interview tothe leaders of the professional group for analysisquantitative. Instead, for the qualitative analysismethod involves the construction of four workshopsconducted by the method of focus groups. Three ofthese were focused on perception, motivation andinterpersonal relationships within the work group.The fourth workshop was made using the techniquesof problem solving. RESULTS: 65 subjects (32Oncology Unit, 20 Hematology Unit, 13 Units ofRadiation) participated. The development of theROAQ highlighted critical points in the emotionalvariables and action such as to prefigure a high levelof risk that the operators develop work stress-related



psychopathologies. The qualitative analysis of thecontent of the laboratory showed the most frequentresponses in terms of emotional charge given by therelationship with the young patient and between themembers of the working group. In the laboratory ofproblem solving the most frequent responses wereoriented towards the realization of dynamic groupsmeeting. CONCLUSIONS: All the participantsexpressed their motivations about stress workplaceexperienced. This result made it possible to imple-ment reductive measures of future risk of work-related stress as the realization of dynamic groupsmeeting: a monthly basis setting to plan togetherchange and improvement in the working group.ACKNOWLEDGEMENT OF FUNDING: None.

P1-24

Brain Tumors in Children: A Support Tool for

Parent-Child Communication About The Disease

Geraldina Poggi1, Maura Massimino2,

Carlo Alfredo Clerici2, Marta Tettamanti1,

Veronica Biassoni2, Annarita Adduci1

1IRCCS E. MEDEA, Bosisio Parini-Lecco, Italy,2Fondazione IRCCS Istituto Nazionale dei Tumori,Milano, Italy

BACKGROUND: Psychological disturbances inchildren with brain tumor are determined by manyfactors, including the quality of parent-child com-munication about the disease. Proper communica-tion about the disease is associated to a betteradjustment by the child. The aim of this researchwas to verify whether a communication supporttool for parents improves communication with theirchildren, favoring a more functional awareness ofthe disease as well as a better psychological out-come in children. METHOD: The parents of 31children with brain tumor were given a book –which had been created for the purpose – contain-ing indications and examples on how to explain thedisease to children. At the end of tumor treatments,children received a psychological assessment,including the Child Behavior Checklist (CBCL), toinvestigate the quality of parent-child communica-tion about the disease and the child’s awareness.The experimental group consisting of 12 childrenwas compared with a control group of 64 childrenwho received the same assessments prior to thebook creation. RESULTS: The 2 groups did notdiffer in clinical and demographic variables. Parent-child communication was found to be appropriatein 75% of the cases in the experimental group and31.2% of the cases in the control group. This differ-ence proved to be significant (p = 0.016). The experi-mental group obtained on average lower scores onall CBCL scales. The difference between the 2groups proved significant on the “Social Problems”scale (p = 0.005). On the “Internalizing Problems”scale, the control group scored in the pathological

range more frequently than the experimental group(p = 0.011). CONCLUSIONS: Our findings dem-onstrate the efficacy of the book, which helped par-ents enhance communication about the disease withtheir children. The experimental group received toa greater extent complete, truthful, consistent andindividualized information about the etiology ofthe disease, its evolution and outcome and thetreatment received (tumor treatment, drug therapy,rehabilitation). This information was always pro-vided in a language that was intelligible, age-appro-priate and at a level consistent with their cognitiveabilities. This favored a greater psychologicaladjustment. RESEARCH IMPLICATIONS: Ourfindings should translate into indications and guide-lines for clinical practice. This is why we deem ourfindings worthy of being further explored. We planto carry out an additional investigation in order toconfirm them in a larger sample of patients. CLINI-CAL IMPLICATIONS: Both avoidance and inef-fective communication are associated withpsychological problems. One of the priorities of clin-ical practice is to identify early the families with dif-ficulties in dealing with, and sharing, informationabout the disease with their child. Our study showsthat psychological difficulties can be prevented orminimized by raising the parents’ awareness of theimportance of proper communication and trainingthem. ACKNOWLEDGEMENT OF FUND-ING: We gratefully acknowledge the funding sup-port provided by Fondazione Guido Berlucchi.

P1-25

Patient-Centered Communication (PCC), Illness

Perceptions and Self-Management Behaviors in

Lung Cancer Patients: Ongoing Research Project

Julie G. Trudel1, Doris Howell2

1University Health Network, Behavioural Sciencesand Health Research Division, Toronto GeneralHospital and Lawrence S. Bloomberg, Faculty ofNursing, University of Toronto, Toronto, Ontario,Canada, 2University Health Network, BehaviouralSciences and Health Research Division, PrincessMargaret Hospital and Lawrence S. Bloomberg,Faculty of Nursing, University of Toronto, Toronto,Ontario, Canada

BACKGROUND: PCC requires partnership,mutual exchange of information and an empathicrelationship between patients and healthcare pro-viders (Erickson, Gerstle, & Feldstein, 2005). Posi-tive illness perceptions in cancer patients have beenassociated with improved quality of life and bettercoping strategies (Buick, 1997; Kaptein et al.,2011). Yet, there is still much unknown about therelationship between PCC, illness perceptions andself-management behaviors in cancer patients. Thisstudy will examine the association between thosethree variables. METHOD: In this cross-sectional



study, participants are recruited during treatmentand follow-up clinic appointments at the PrincessMargaret Hospital in Toronto, Ontario. They areasked to complete five self-administered question-naires at the clinic or complete the questionnaires athome and return them in a stamped envelope. Thequestionnaires consist of a demographic question-naire, the Patient Perception of Patient-Centerednessquestionnaire (PPPC) (Stewart, Meredith, Ryan, &Belle-Brown, 2004), the Revised Illness PerceptionQuestionnaire (Moss-Morris et al., 2002), the Can-cer Behavior Inventory-Brief version (Heitzmannet al., 2011), and the Hospital Anxiety and Depres-sion Scale (HADS) (Zigmond & Snaith, 1983).RESULTS: Statistical analyses: Multiple regres-sions will be performed to assess how much variancein illness perceptions and self-management behaviorsis explained by the following independent variables:patient-related variables (3 variables: age, education,social support) and PCC (3 scores: 2 subscores and atotal score). The steps used by Katz (2011) todevelop multivariate models will be followed.Mediation analyses using the steps of Baron andKenny’s (1986) model will verify if the associationbetween PCC and self-management behaviors ismediated by the illness perceptions. CONCLU-SIONS: Not applicable because study is in pro-gress. RESEARCH IMPLICATIONS: This is animportant study because it will help researchersunderstand if PCC is a type of communication thatall healthcare providers need to provide to theirpatients in order to help them perceive positivelytheir illness, and manage better their illness duringtreatment and at follow-up. Also, the results ofthis proposed study will be instrumental in identify-ing a key factor related to the healthcare deliveryservices that would be beneficial for managing can-cer. CLINICAL IMPLICATIONS: Interventionscould be put in place to improve the communica-tion skills of both healthcare providers and cancerpatients if the results demonstrate that PCCinfluences positively the way lung cancer patientsperceive and self-manage their illness. Also, moreemphasis could be put on training better futurephysicians about using the PCC. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-26

How are Verbal and Paraverbal Contents Associated

With the Use of Communication Skills in a Highly

Emotional Simulated Interview? A Pilot Study

L. Van Achte1,2, C. Reynaert3, A. Li�enard2,Y. Libert2, I. Merckaert2, A. Moucheux4, M. Cail-

lier4, F. Delevallez2, J.-F. Durieux4, D. Razavi2

1Universit�e Catholique de Louvain, Louvain-la-Neuve, Belgium, 2Universit�e Libre de Bruxelles,Bruxelles, Belgium, 3Universit�e Catholique deLouvain, Louvain-la-Neuve, Belgium, 4Centre dePsycho-oncologie, Bruxelles, Belgium

BACKGROUND: Highly emotional interviewsare frequent in oncology. These interviews requirespecific communication skills. Few studies haveinvestigated the relation between verbal and para-verbal content of communication skills. This studyexamines the relation between verbal content andparaverbal content - in terms of prosodic synchronyor desynchrony of voice intonation modulations -of communication skills used by an experienced cli-nician to facilitate a highly emotional simulatedinterview. METHOD: Voice intonation modula-tions have been assessed in a simulated interviewbetween an experienced clinician and an actressplaying the role of a young mother diagnosed with abreast cancer recurrence and expressing a fear ofdeath. The verbal content of communication skillsused by the clinician was assessed with the CRCWorkshop Evaluation Draft Manual. Twelvesequences of turns-of-speech alternances includingthese communication skills were identified. Theseturns-of-speech alternances were then assessed withthe Praat Software in order to examine prosodicsynchrony and desynchrony of turns-of-speech alter-nances. Fifty-eight prosodic desynchrony alternanc-es were identified and compared with fifty-eightprosodic synchrony alternances. RESULTS: “Inter-pretative hypotheses” were more associated withprosodic desynchrony (38% of alternances) thanwith prosodic synchrony (1% of alternances).CONCLUSIONS: Clinicians should be aware thatthe use of an “interpretative hypothesis”, in highlyemotional interviews, is associated with prosodicdesynchrony. In the context of these interviews,prosodic desynchrony clearly supports the verbalcontent of communication skills. RESEARCHIMPLICATIONS: Paraverbal content and espe-cially voice intonation modulations should be fur-ther studied to examine how they may - positivelyor negatively - be associated with the verbal contentof communication skills, not only in simulated butalso in actual interviews. CLINICAL IMPLICA-TIONS: Clinicians should be aware that the para-verbal content and especially voice intonationmodulations may be congruent or not with the ver-bal content of their communication skills.ACKNOWLEDGEMENT OF FUNDING: Thisresearch program was supported by the “FondsNational de la Recherche Scientifique - SectionT�el�evie” of Belgium and by the “Centre de Psycho-oncologie” of Brussels.



P1-27

Perceived Information Provision and Satisfaction

Among Patients With Ovarian Tumors: The Role of

Health Literacy

M.N. Verkissen1,2, N.P.M. Ezendam1,2,

M.P. Fransen3, M.J. Aarts2, O. Husson1,2

1CoRPS – Center of Research on Psychology inSomatic Diseases, Department of Medical andClinical Psychology, Tilburg, The Netherlands,2Eindhoven Cancer Registry, Comprehensive CancerCenter South CCCS, Eindhoven, The Netherlands,3Department of Public Health, Academic MedicalCenter, University of Amsterdam, Amsterdam, TheNetherlands

BACKGROUND: Appropriate information pro-vision is an essential aspect of patient-centered care,and can result in better patient reported outcomes.However, low health literacy (HL) can create a bar-rier to accessing and processing information pro-vided, leading to patient dissatisfaction. Thegeneral aim of this study was to investigate the roleof HL in perceived level of information provision,information satisfaction and the use of Internet tofind disease-related information in a sample ofpatients with ovarian tumors. METHOD: Women(N = 548) diagnosed with an ovarian or borderlineovarian tumor between 2000 and 2010, registered inthe Eindhoven Cancer Registry, received a ques-tionnaire including a subjective item to screen forlow HL (“How confident are you filling out medicalforms by yourself?”), the EORTC QLQ-INFO25 toevaluate the perceived level of and satisfaction withinformation provision about the disease, medicaltests, treatment and other services, and one itemabout Internet usage. Multiple linear and logisticregression analyses were conducted to investigatethe associations of subjective HL and educationallevel with perceived information provision, satisfac-tion with information received and Internet usage.RESULTS: About 50% responded (N = 275). Ofall women, 46% had high, 41% had medium and13% had low subjective HL. Lower HL was associ-ated with less perceived information provisionabout medical tests (medium compared to high HL:B = �15.8; low compared to high HL: B = �8.3,on a scale from 0–100) and lower information satis-faction (low compared to high HL: OR = 0.2). Wedid not find significant associations between HLand information provision about disease, treatmentand other services, and Internet usage. Educationallevel was positively related to HL, but not associ-ated with perceived information provision, infor-mation satisfaction and Internet usage.CONCLUSIONS: Low subjective HL was associ-ated with a lower level of perceived information pro-vision related to medical tests and lower informationsatisfaction among patients with ovarian tumors.RESEARCH IMPLICATIONS: Future research

may be improved by addressing objectively mea-sured HL and information provision. Our findingsmay also indicate a need for the development of amore sensitive cancer-specific measure of HL, whichmight be more related to cancer-specific communica-tion. CLINICAL IMPLICATIONS: Patients withlower HL perceived that they received less informa-tion about medical tests, which may have causedthem to be less satisfied with the informationreceived. As information provision is an importantinfluential factor in the support for patients, it isimportant to further investigate whether, and how,the provision of information to patients with lowHL should be enhanced. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-28

The Analysis of The Relationship Between Marital

Adjustment and Coping Strategies in Married

Women With Breast Cancer

Elcin Akdeniz

Maltepe University, Istanbul, Turkey

BACKGROUND: The breast cancer occur crisisby the women on physical, psychological and socialarea. It have been reported that social support isvery effective to cope with crises of women espe-cially support by spouses of women with breastcancer. The marital adjustment is important predic-tor to perceive social support and coping with stres-sors of women with breast cancer. This paperreports relationship between marital adjustmentand coping strategies in married women with breastcancer. METHOD: The aim of this study was toinvestigate the relationship between marital adjust-ment and coping strategies in married women withbreast cancer. The sample of study included 50women with breast cancer who have been treated inan Oncology Hospital in Turkey and 50 in the gen-eral surgical service of the same hospital treatednon- cancer. In the study three instruments wereused: Descriptive Knowledge Form, DyadicAdjustment Scale (Spainer, 1976), and Ways ofCoping Inventory (Folkman & Lazarus, 1984).Thedata were evaluated chi Square test, Mann Whit-ney-U and Correlation Analysis. RESULTS: Itwas found that there were not statistically signifi-cant differences between the socio demographiccharacteristics of the women with breast cancer andnon-breast cancer except the living city characteris-tic. A positive correlation was found between thescores of marital adjustment and effective copingway in the correlation analysis. (r = 0.32, p < 0.05).There is also a negative correlation between thescores of marital adjustment and ineffective copingway with the percentage 38%. (r = �0.38,p < 0.05). CONCLUSIONS: This study has identi-fied that women with breast cancer can cope moreeffectively and less ineffectively as the marital



adjustment of the couple increases. The maritaladjustment could be a predictor to assessment per-ceived social support of the women with breast can-cer which is necessary for coping with cancerrelated problems. Given the fact the cancer is a notpersonal but a family disease, the health care pro-viders can identify the easier the women’s problemsand origin of them. According to this identificationthey could give more effective psychological sup-port to women with breast cancer. RESEARCHIMPLICATIONS: Based on these conclusions, itsuggested to select the sample of control groupexcept the patients without any breast disease thatit could effect similar worrys and coping problemswith the cancer patients. It suggested too that nextresearch could structured about the relationshipbetween positive thinking, coping and maritaladjustment to identify better if the positive thinkingeffects both of them. CLINICAL IMPLICA-TIONS: Based on these conclusions, it suggestedthat to assessment the relationship between copingand marital adjustment and to provide family coun-seling if the marital adjustment has been perceivedless by the women with cancer. Family counselingcan be used in cancer care especially when thewomen with breast cancer have problems with cop-ing of cancer experiences. The health professionalin cancer care can use the results of study to preventthe possible coping problems. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-29

The Influence of Paediatric Cancer on Parents’

Marital Satisfaction: Differential Predictors for

Mothers and Fathers’ Marital Satisfaction When

Caring for a Child With Cancer

Willow Burns1,2, Serge Sultan1,2, Katherine

Peloquin1, Sophie Marcoux2, Philippe Robaey2

1Universite de Montreal, Montreal, Canada, 2CHUSainte-Justine, Montreal, Canada

BACKGROUND: Within the paediatric oncologycontext, the cancer experience can have a significantinfluence on the family system as a whole (Long &Marsland, 2011). Parents have several caregivingand support roles in the child’s rehabilitation(Hutchinson, Willard, Hardy, & Bonner, 2009),thus their well-being (including their marital well-being) is of fundamental importance. This researchexamines the impact of paediatric cancer on moth-ers and fathers’ marital satisfaction over time whileaccounting for interrelationships in partner’sadjustment. METHOD: Couples completed theFamily Well-Being Assessment to determine famil-ial stress and perceived well-being (Caldwell, 1988)and the Profile of Mood States-Bipolar Form todetermine mood states (Lorr, McNair & Heuchert,1980, 2003) at diagnosis and 3 months later. Mari-tal satisfaction was assessed at 1-year (n = 72) and

2-years post diagnosis (n = 61) with the Locke-Wallace Marital Adjustment Scale (Locke & Wal-lace, 1959). RESULTS: Analyses using the Actor-Partner Interdependence Model (APIM; Kenny etal., 2006) suggest differential marital satisfactionpredictors for mothers and fathers of paediatriccancer patients. Mothers’ marital satisfaction at 1and 2-years post diagnosis was predicted by familialvariables at diagnosis and 3 months (family well-being, family support, and parental role conflict)(actor effects). For fathers, marital satisfaction pre-dictors at 1 and 2-years post diagnosis includeddepressed mood (at 3 months) and fatigue (at diag-nosis) (actor effects). Fathers’ marital satisfactionat 2-years post diagnosis was also predicted by thepartner’s role conflict (at diagnosis) and fatigue (at3 months) (partner effects). CONCLUSIONS: Byusing a relatively new conceptual model, this studywas able to take past research on parental couplesof children with cancer one step farther; accountingfor both individual and interactional predictors ofmothers and fathers’ marital satisfaction over time.These findings demonstrate that marital satisfactionfor parents of children with leukemia differ, andindicate the importance of considering dyadic ele-ments, such as partner effects. Mothers’ marital sat-isfaction was solely related to her family well-beingin the early stages of the illness, whereas fathers’marital satisfaction was related to both his ownmood and his partner’s mood and family well-being. RESEARCH IMPLICATIONS: These find-ings have implications for theory and researchadvancement within the field of paediatric oncol-ogy. This research advocates for theoretical consid-erations to be made on the level of analysis used.Examining the parental couple at the dyadic level,as was done in this study, has inherent advantagessuch as accounting for interrelationships and test-ing gender effects. Hence, this research could be acatalyst for a more social-internationalist approachtowards understanding parents of children withcancer. CLINICAL IMPLICATIONS: Further-more, this research has significant clinical implica-tions for health professionals working with thesecouples. It suggests that although mothers andfathers encounter the same chronic stressor (paedi-atric cancer), their experiences vary according togender and to an extent time of assessment. Thus,clinical interventions aimed at helping these couplesneed to be tailored to their specific needs at thattime. In addition, these findings emphasize theimportance of early intervention and continuedsupport for parents. ACKNOWLEDGEMENTOF FUNDING: CRSH-UdM “small grants”,Fondation CHU Sainte-Justine; Le Centre derecherche interdisciplinaire sur les probl�emes con-jugaux et les agressions sexuelles (CRIPCAS).



P1-30

Paediatric Cancer Through The Lens of Attachment

Theory: A Systematic-Critical Review of The

Literature on Marital Adjustment in The Parental

Couple

Willow Burns1,2, Serge Sultan1,2, Katherine

Peloquin1

1Universite de Montreal, Montreal, Canada,2CHU Sainte-Justine, Montreal, Canada

BACKGROUND: Although the effects of paediat-ric cancer have been examined in parents individu-ally (Vrijmoet et al., 2008), the impact on theirmarital adjustment is a relatively novel researcharea, which has received little attention (cf. DaSilva, Jacob, & Nascimento, 2010; Long &Marsland, 2011). The aim of this research was toperform a systematic-critical literature reviewexploring the impact of paediatric cancer on mari-tal functioning of parents and explain these findingsaccording to attachment theory. METHOD: A sys-tematic literature review was conducted using bothkeywords and associated MeSH terms in the fol-lowing databases: PubMed, CINAHL, PSYCInfo,and Web of Science. The aim was to review paediat-ric oncology literature that focused on the parentalcouple, and put primary emphasis on relationalaspects and/or marital functioning of these parents.Only studies that met this aim, as well as the restric-tions for language (either English or French) anddate of publication (January 1993 to December2012) were retained. After synthesis of the results,key findings on these parental couples were paral-leled with attachment theory research. RESULTS:Review of the literature showed that paediatric can-cer was evidently a difficult experience for theseparents and effects of the illness on parental coupleswere quite varied. Some studies reported negativerepercussions, such as increased marital dissatisfac-tion and conflict (e.g., due to coping style differ-ences), and dissatisfaction with sexuality within theparental couple. However, other studies reportedthe positive impact on the couple, such as strength-ened trust, communication and spousal support.These discrepancies might be explained by differ-ences in attachment styles of these couples; wherebysecure couples would cope with this stressor in amore adaptive and mutually supportive manner.CONCLUSIONS: Overall, this review acknowl-edges that the stress of paediatric cancer does nothave a uniform impact on parental couples. Whilesome couples’ marital functioning deteriorates, oth-ers’ is reinforced as a result. This is consistent withcore tenets of attachment theory, which suggestthat one’s attachment representations (i.e., secureor insecure) influence both their perception of stressand how they cope with stressors. Presumablyreported differences in the impact of cancer on theparental couples in this review can be explained by

attachment differences; whereby secure coupleswere more likely to report positive effects on theirmarital relationship than insecure couples.RESEARCH IMPLICATIONS: The systematicapproach in this review provided a concise synthe-sis of research on parental couples, while the criticalaspect allowed findings to be grouped theoreticallyand then explained through a relevant theoreticalframework: attachment theory. This field ofresearch is generally atheoretial, and this the firsttime that attachment has been proposed as a con-ceptual framework for understanding the impact ofpaediatric cancer on the parental couple. Futureresearch needs to examine this proposed associa-tion. CLINICAL IMPLICATIONS: By establish-ing parallels from findings on parental couples ofpaediatric cancer patients with findings on attach-ment theory, we formed an argument that couldhave significant clinical implications. If futureresearch empirically tests the proposed associationand it is significant, clinicians would be able to pre-dict to some extent, which parental couples, basedon their attachment tendencies, might experiencedeteriorations in marital functioning as a result.This in turn could allow for early intervention andsupport. ACKNOWLEDGEMENT OF FUND-ING: CRSH-UdM “small grants”, FondationCHU Sainte-Justine; Le Centre de recherche inter-disciplinaire sur les probl�emes conjugaux et lesagressions sexuelles (CRIPCAS).

P1-31

Carers in Medical Consultations: How Can They

Support Patients and Be Supported?

Phyllis Butow1, Rebekah Laidsaar-Powell1,

Ilona Juraskova1, Cathy Charles2, Wendy Lam3,

Amiram Gafni2

1Centre for Medical Psychology and Evidence-basedDecision-making, School of Psychology, Universityof Sydney, Sydney, New South Wales, Australia,2Department of Clinical Epidemiology &Biostatistics, Centre for Health Economics & PolicyAnalysis McMaster University, Hamilton, Ontario,Canada, 3School of Public Health, University ofHong Kong, Hong Kong

BACKGROUND: Informal carers (e.g. familymembers/friends) often accompany patients intooncology consultations. They may provide emo-tional, informational, and logistical support forpatients, and participate in medical decision-mak-ing. Carers may also change the dynamics of theconsultation, influence the patient-physician rela-tionship, and increase the complexity of theencounter. In 3 studies we have explored patient,carer and physician views on the carer role, theroles they actually play and reviewed the evidenceon this topic. METHOD: 52 papers were identified



in a systematic review of quantitative andqualitative studies exploring physician-adultpatient-adult companion communication and/ordecision-making within medical encounters. Datawere extracted, quality reviewed and synthesised.Interviews were conducted, audiotaped, transcribedand coded with 30 patients, 34 carers, 10 oncologynurses and 11 oncologists, regarding their views ofthe carer’s role, and barriers and facilitators to theirappropriate involvement. Twenty audiotapedoncology consultations involving carers werereviewed and on the basis of all of the above, aninteraction analysis coding system for triadic con-sultations was developed and applied to 72 furtherconsultations involving carers. RESULTS: Resultsindicated carers regularly attend consultations, arefrequently perceived as helpful, and assume a vari-ety of roles. Some carer behaviors were felt to bemore helpful (e.g. informational support) and lesshelpful (e.g. dominating/demanding behaviors),and preferences for involvement varied widely.Interviews revealed perceived benefits (e.g. support,improved recall, reduced patient burden) and chal-lenges (e.g. dysfunctional family dynamics, conflict-ing treatment wishes) of family involvement.Facilitators (e.g. oncologists’ encouragement offamily involvement), barriers (e.g. blocking behav-iors of the oncologist) and health professional strat-egies (e.g. clarify patient and carer role preferences)were described. Such facilitation however, occursvery rarely in clinical practice. CONCLUSIONS:Triadic communication in medical encounters canbe helpful but challenging. A new theoretical frame-work is needed to guide ethical carer involvementin medical consultations. Strategies and training forhealth professionals are needed. Carers and patientsneed support to maximise their contribution andensure carers are adequately supported.RESEARCH IMPLICATIONS: Future researchcould usefully evaluate interventions targetingtraining for health professionals in ethical commu-nication with carers and patients, and support forcarers and patients to maximise communication.CLINICAL IMPLICATIONS: Carers require sup-port to maximise their involvement in medical con-sultations to better support patients, and involvecarers to the level the patient and carer desire.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by the Informed Medical Deci-sions Foundation (IMDF).

P1-32

Post-Traumatic Stress Symptoms in Parental Dyads

of Children Diagnosed With Cancer: A Longitudinal

Analysis

Nicola Silberleitner1, Louisevon Essen2,

Martin Cernvall2

1University of Konstanz, Konstanz, Germany,2Uppsala University, Uppsala, Sweden

BACKGROUND: Posttraumatic stress symptoms(PTSS) are a common reaction in parents to theirchild’s cancer diagnosis. However, little is knownabout how parents’ PTSS develop during the courseof the disease and about how fathers’ and mothers’symptom trajectories are related. The present studyhad two aims: (1) examine the change in parents’PTSS and (2) examine the dynamic longitudinalrelationship between fathers’ and mothers’ PTSS,exploring the phenomenon of interdependent emo-tional systems in this population. METHOD: Par-ticipants of this study were 91 parental dyadswhose children were diagnosed with cancer. Moth-ers and fathers completed the PTSD Checklist -Civilian Version (PCL-C; Weathers et al., 1993) viatelephone after the moment of diagnosis, duringtreatment and after the end of successful treatmentor transplantation. The latent difference score(LDS) modelling framework was applied to thedata collected at six assessments. The framework ofLDS modelling represents an alternative methodfor the structural modelling of longitudinal datacombining features of latent growth curve modelsand cross-lagged regression models. The modelswere fit using Mplus (Muth�en & Muth�en, 1998-2010). RESULTS: Results generally indicated thatfathers’ and mothers’ PTSS decreased proportion-ally to their previous symptom levels. Further, LDSanalyses revealed that change in fathers’ PTSS wasproportional to previous symptom levels in corre-sponding mothers after the end of successful treat-ment or transplantation, respectively. That is,mothers with high levels of PTSS put fathers at riskfor stagnating or even increased symptoms overtime. Reversely, when fathers suffered from highlevels of PTSS, mothers with low symptom levelshad a protective effect. For mothers, however,change in symptoms was not significantly associ-ated with fathers’ previous levels of PTSS. CON-CLUSIONS: In conclusion, crucial processes inparental dyads may be overlooked when mothersand fathers are examined as 2 separate units. Previ-ous studies are limited with regard to investigatinghow parents’ PTSS are dyamically related overtime. The findings of this study demonstrate thatone parent may act as a risk or, conversely, as aprotective factor in terms of the other parent’sdevelopment of PTSS. RESEARCH IMPLICA-TIONS: The present analyses of coupled change inPTSS were mainly exploratory, aiming at identify-ing the phenomenon of interdependent emotionalsystems. Since the results indicate that parents actu-ally react as an emotional system rather than as 2separate units, theoretical models of mechanismsby which parental dyads influence each other insymptom development are desirable. On that basis,refined research questions can be addressed infuture studies. CLINICAL IMPLICATIONS:Future psychosocial strategies may be based on theunique needs of the parental dyad. A more efficient



and rapid route to symptom reduction in one par-ent may involve considering the role of the otherparent. It may be important to buffer the endanger-ing effect of a highly affected other parent, or fosterthe protective potential of a less affected other par-ent, respectively. Psychosocial care addressing bothparents may strengthen the relationship betweenmothers and fathers. ACKNOWLEDGEMENTOF FUNDING: This work was supported bygrants from the Swedish Research Council (K2011-70X-20836-04-4), the Swedish Cancer Society(2010/276), and the Swedish Childhood CancerFoundation (PROJ08/010).

P1-33

In Sickness and in Health: Diurnal Salivary Cortisol

Patterns in People With Cancer and Their Spouses

Timothy H. Y. Chan1, Lai Ping Yuen2, Tammy

Lee3, Jessie S. M. Chan1, Jonathan S. T. Sham1,

Cecilia L. W. Chan1

1Centre on Behavioral Health, University of HongKong, Hong Kong, 2International Association andHealth and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong

BACKGROUND: Recent studies show evidenceof co-variation between healthy couples’ diurnalsalivary cortisol secretion, suggesting that they facesimilar stressors in their shared life. What if one inthe couple experiences a disproportionate stressor?The study examines the diurnal salivary cortisolpatterns in people with cancer and in their spouses,and investigates if there is any spousal influence oncortisol regulation. METHOD: The study analyzeddata collected at a baseline assessment prior to arandomized controlled trial examining the effects ofan exercise intervention on cancer-related quality oflife. Analysis was based on fifty-three persons withcancer and their spouses. Each couple collected sal-iva samples at home on the same day (waking,45 minutes after waking, noon, 5pm and 9pm). Cor-tisol values were natural log transformed beforeanalysis. They also completed questionnaires thatmeasures health-related quality of life, sleep quality,perceived stress, mood, and social support.RESULTS: Compared to their spouses, cancerpatients (mean years since diagnosis = 1.68 years;SD = 1.41) had poorer physical well-being and sleepquality, but perceived greater social support. Cou-ples did not have different salivary cortisol levelsand diurnal slopes. Only cortisol levels at wakingand 5pm were conjugally correlated. Linear regres-sions showed (a) patient’s diurnal slope associatedwith patient’s sleep quality, while spouse’s diurnalslope associated with patient’s, not spouse’s, sleepquality, and patient’s social support; and (b)patient’s and spouse’s morning cortisol level(45 minutes after waking) was associated with the

other partner’s perceived stress and social support.CONCLUSIONS: Findings showed that whilepatients reported poorer physical health, they didnot experience significantly different psychosocialand physiological responses from those of theirspouses. Similar to past findings, only cortisol levelsat morning and evening were correlated, when thecouples were more likely to spend time together. Forboth patients and spouses, diurnal salivary cortisolpatterns associated only with patient’s sleep quality.RESEARCH IMPLICATIONS: This is the firststudy of the possible co-regulation effect of cortisolrhythms between cancer patients and their spouses.Further prospective research is recommended in lightof the limitation of the current study being cross-sec-tional. CLINICAL IMPLICATIONS: Findingssuggest that although cancer is a health threat to anindividual, couples face the illness together both inpsychological and physiological terms. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-34

Couples’ Experiences 0f Undergoing Treatment for

Prostate Cancer Adjustment-Related Difficulties:

A Qualitative Study

Anna Collins1, Anthony Love2, Annette Street3,

Sidney Bloch4, Gillian Duchesne1, Jeremy

Couper1,4

1Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia, 2Victoria University, Melbourne,VIC, Australia, 3LaTrobe University, Melbourne,Victoria, Australia, 4St Vincent’s Hospital &University of Melbourne, Melbourne, Victoria,Australia

BACKGROUND: The diagnosis and treatment ofprostate cancer (PCa) can result in significantchanges to a man’s physical and emotional func-tioning, which may adversely affect intimate aspectsof his relationship with his partner. Survivorshipissues in this population therefore pose unique chal-lenges related to promoting the psychological well-being of couples. This qualitative study exploredcouples’ experiences of CECT, a manualised six-session couple therapy program delivered by clini-cal psychologists and psychiatrists via a rando-mised controlled trial. METHOD: Purposefullysampled couples (N = 10) who completed CECTwere interviewed about their experiences of under-taking a specialist mental-health intervention.Interviews were exploratory, but utilised semi-structured prompts to facilitate discussion relatingto: (1) Acceptability and perceptions of CECT; (2)Life after treatment for PCa; (3) Impact of PCa onthe relationship; (4) Methods of coping; (5) Hopesfor the future. Interviews were recorded, tran-scribed, and checked for accuracy. A thematicanalysis was undertaken by three investigators,



using a constant comparative method influencedby grounded theory. Analysis was undertakensimultaneously with data collection, and emergingthemes were explored until data saturation wasreached. RESULTS: The following themes wereprevalent in the data: (1) Returning to a “new” nor-mal - which encompassed life as it was before diag-nosis, but with changed perceptions of intimacy. (2)Talking about the unspoken - whereby CECTopened up communication of PCa-related con-cerns, which were previously unacknowledgedbetween partners. (3) Setting the scene for dealingwith future challenges - creating a mutual approachto face the uncertain future, and adapt to difficul-ties as they arise. (4) Cementing coping strategiesused at the couple level - positivity, humour, andaffirmation of each partners’ feelings, as importantcoping strategies recognised by couples. CONCLU-SIONS: The breakthrough in this CECT approachis the treatment of PCa adjustment-related difficul-ties systemically, at the couples level. We surmise:(1) Couples reported favourably the opportunityfor a mutual supportive forum in which to commu-nicate their fears and concerns. (2) Partners appre-ciated the opportunity to be involved andacknowledged in the PCa treatment and care pro-cess. (3) The couples approach provides a uniqueleverage point, which likely affords the greatestopportunity for change. RESEARCH IMPLICA-TIONS: Further research examining support formen with PCa related challenges should prioritise acouples approach. Adaptations to the CECT frame-work for structuring support may include reducingCECT to 4 face-to-face sessions � 2 bolster sessionsas required, with the option for these additional ses-sions to be provided via a telephone/internet format.CLINICAL IMPLICATIONS: Specialist mental-health professional’s providing CECT were avalued addition to patient care. CECT has clinicalrelevance for men and their partners requiring sup-port and the couple approach was endorsed by allparticipants. Alterations to the treatment dose, assuggested by couples, may be clinically appropriate.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by beyondblue.

P1-35

Impact of Partners Variables on Depression and

Quality of Life in Couples Facing Cancer

Natalie Drabe1, Richard Klaghofer1,

Diana Zwahlen2, Stefan B€uchi3, Josef Jenewein1

1Department of Psychiatry and Psychotherapy,University Hospital Zurich, Switzerland,2Department of Psychosomatics, University Hospitalof Basel, Switzerland, 3Clinic for Psychotherapy andPsychosomatics “Hohenegg”, Meilen, Switzerland

BACKGROUND: The purpose of this study wasto examine the impact of partners’ variables

(patients and partners anxiety, Sense of Coherence(SOC), posttraumatic growth (PTG), relationshipquality (RQ) and physical complaints) on depres-sion and quality of life (QOL) in couples facingcancer. METHOD: Questionnaires assessing anxi-ety and depression, SOC, PTG, RQ, QOL andphysical complaints were applied to 207 patientswith different cancer types and stages and theirpartners. Anxiety and depression was measured bythe Hamilton anxiety and depression scale, SOC bythe 13-item Sence of Coherence scale, PTG by thePosttraumatic Growth Inventory and QOL by theEUROHIS-QOL 8-item index. To determine RQpatients and partners were asked the followingquestion: How happy do you feel yourself in yourrelationship right now? Hierarchical regressionanalysis was done to calculate the impact of partnervariables on patients and partners depression andQOL. RESULTS: Partners depression and RQaccount for 23.7% of the variance of patients’depression. 29.2% of the variance was explained bypatients’ physical complaints, SOC and PTG. Inpartners patients’ depression and RQ account for24.7% of the variance of the partners’ depression.36.1% of the variance was explained by partners’physical complaints and SOC. Partners’ depressionand RQ accounted for 21.4% of the variance ofpatients QOL. 45.8% of the variance was explainedby patients’ variables. In partners patients’ depres-sion and RQ accounted for 13.4% of the varianceof partners QOL. 44.1% of the variance wasexplained by partners’ variables. CONCLU-SIONS: These findings demonstrate the needs forsurvey depression and relationship quality in bothcancer patients and their partners. If a depressionor worse relationship quality is detected, couplesshould be referred to a psychiatrist with experiencein couple therapy. It can be assumed that if thedepression of the partner or the relationship prob-lems is treated properly patient‘s depressive symp-toms can be reduced and his or her quality of lifeincreased. That applies to the partner as well. Butthis has to be scientifically proven in the future byfurther studies. ACKNOWLEDGEMENT OFFUNDING: This work was supported by the Zur-ich Cancer League (Krebsliga Z€urich, www.krebs-liga-zh.ch).

P1-36

Psychological Distress in Caregivers of Cancer

Patients

Savita Goswami, Jayita Deodhar,

Lekhika Sonkusare, Rohini Hawaldar

Tata Memorial Hospital, Mumbai, India

BACKGROUND: Caregivers of cancer patientsgo through a lot of psychological distress. As thesufferings and needs of the patients increase, sodoes physical, emotional and financial burden of



the caregivers, who often become “second-orderpatients”The aims of the study are–:1. To assess psychological distress of the caregivers

of cancer patients.2. To assess the impact of life events.3. To assess coping strategies used by the caregiv-

ers.METHOD: A retrospective observational crosssectional study was done in the setting of psycho-oncology service of a tertiary care cancer centre in adeveloping country. Caregivers of patients referredto the service and who are closely involved inpatient care were included. A retrospective analysisof caregivers’ assessments done over a period of3 months was conducted, noting the sociodemo-graphic details of the caregivers, patient’s diseasestatus, psychological distress of and coping strate-gies used by caregivers (identified on the basis ofinterview done with the help of semi- structuredproforma) and Life Event Scale score. Relevant sta-tistical analysis was done. RESULTS: 100 (59 menand 41 women) primary adult caregivers of cancerpatients between the age group of 18–75 years wereassessed. Psychological distress was present in 43%of caregivers, who were between the age group of21–40 years. High distress was noted in gastrointes-tinal (60%) and (53%) in haemato-lymphoid cancerpatients’ caregivers followed by head and neck(33%) and brain tumor (29%) patients’ caregivers.In 36% caregivers, Life event Scale score was high.Majority of caregiver (98%) expressed multipleproblems and concerns, main being emotional andpractical. Adaptive coping strategies were used by97 out of 100 caregivers assessed. CONCLU-SIONS: Psychological distress was seen in 33% ofcaregivers of cancer patients. Increased distress isassociated with diagnosis of high care givingdemands associated with some types of cancers likehemato-lymphoid, brain tumor, gastrointestinaland head and neck. The predicted degree of risk fordistress due to life events was seen at moderate levelin 36% of caregivers. Useful and adaptive copingstrategies were used by almost all the caregivers,indicating a high amount of resilience, despite theburden of caregiving. RESEARCH IMPLICA-TIONS: There is a need for research to assess theimpact of psychological interventions (individual orgroup based) on distress of cancer patients’ caregiv-ers at different stages of treatment. The influence ofpersonality and cultural variables on resilience ofcaregivers also needs to be studied. Socio-culturalinfluences on caregiver distress and coping strate-gies is another challenging area of research. CLINI-CAL IMPLICATIONS: Considering high levels ofdistress in cancer patients’ caregivers, specializedpsychological and social interventions for caregiv-ers are a priority service area. Clinical efforts areneeded to assist distressed caregivers in providingpractical support to the patient. Tailor made psy-

chological interventions for helping caregivers toattend to their own emotional needs and taking intoaccount their coping strategies, will be useful.ACKNOWLEDGEMENT OF FUNDING: None.

P1-37

When a Parent Has Cancer: Developing an

Educational Programme to Enhance Supportive

Care for Patients and Young Families

Lucy Grant, Sara Lister, Theresa Wiseman

Royal Marsden NHS Foundation Trust, Surrey, UK

BACKGROUND: There is an established need forfamily-centred care when a parent has cancer.Oncology professionals often avoid issues associ-ated with patients’ families and children becausethey lack confidence, feel inadequately preparedand unsupported.Targeted, evidence-based educa-tional initiatives are needed to improve the qualityof care. A pilot educational programme was devel-oped to enhance the supportive care for patientsand young families when a parent has cancer. Thedevelopment, implementation and evaluation of theprogramme are described. METHOD: The devel-opment of the programme followed examination oftheory and research and consultation with psycho-oncology and educational experts. Attachment, childdevelopment and systemic theory informed the con-tent; models of adult learning, problem-based andreflective practice the learning methods. It was run 3times with professionals from a specialist cancer treat-ment centre - 10 per programme. Evaluation pre-post programme: prior to participants were askedabout their hopes for the programme and concernsabout providing support. On completion they wereasked about their experience of programme, itsinfluence on clinical practice, their feelings aboutproviding support. Qualitative analysis was usedfor questionnaire data. RESULTS: Thirty-oneprofessionals from varying backgrounds took part.Before, they described fears and felt they lackedskills, knowledge, experience, and emotional capac-ity.Afterwards, they were enthusiastic about pro-viding support and meeting challenges morepragmatically. They reported increased confidence:initiating conversations; explore emotions; assessfamily coping; providing support; facilitate parent-child communication; had increased understandingof the impact of illness on children at different ages;open communication; and importance of self-care.Group reflection, support and clinical scenarioswere seen as essential to learning. All anticipated apositive change to their clinical practice. Some hadconcerns about forgetting skills, balancing familysupport with other roles, and time for self-care.CONCLUSIONS: The programme successfullyincreased oncology professionals’ confidence andenthusiasm; and perception of their skills, ability



and knowledge in offering supportive care when aparent has cancer. It was highly acceptable to pro-fessionals from a range of backgrounds, includingmedics, nurses and allied health. Findings suggestthat group-based reflection and clinically-basedproblem-solving exercises are important factors inbuilding confidence, mechanisms of support, andhelping participants connect learning to the clinicalcontext. Professionals experience a significant emo-tional burden providing support to young families.The programme helped to deepen professionals’appreciation of their emotional needs and encour-age self-care. RESEARCH IMPLICATIONS: Ini-tial findings suggest the programme is beneficial andsuitable for further evaluation.Further research fol-lowing-up participants at timed periods after com-pleting the program is needed to assess whetherlearning outcomes are transferred to the clinical set-ting, and what professional support mechanismssustain the provision of supportive care, and help tomanage the emotional burden on professionals.Fur-ther research would usefully also include patient andfamily perspectives’ on the quality of care provided.CLINICAL IMPLICATIONS: There is an unmetneed for family-centred care when a parent hascancer. The programme is a useful step towardenhancing professionals’ supportive care in thisunderrepresented area. Systematic provision of sup-port to patients and families that encourages opencommunication, assesses family coping, and consid-ers the needs’ of children is likely to help preventpsychological difficulties occurring in children andfamily members. It may also help to identify vulner-able families where specialist services are needed.ACKNOWLEDGEMENT OF FUNDING: TheRoyal Marsden Cancer Charity.

P1-38

Creative Therapy for Children of Cancer Patients

Emilie Hennus, Loekie Van der Burg, Adriaan

Visser

Psycho-Oncology Centre De Vruchtenburg,Rotterdam, The Netherlands

BACKGROUND: It is more recognized that can-cer and its treatment have impact on the emotional,cognitive and social life of children of cancerpatients. At the psycho-oncology foundation theVruchtenburg (Rotterdam, the Netherlands) theapplication of creative therapy for children of can-cer patients has been evaluated in terms of the per-ceptions by parents on the quality of the therapy(satisfaction, reaching the aims), and progress ofthe children in expressing their emotions and socialactivities. METHOD: The children (6–18 years)did participate in 6–8 sessions doing all kind of cre-ative expressions: painting, drawing and molding.A questionnaire was sent to the parents of childrenwho followed the therapy during 2009–2012. The

questionnaire contains standardized questionsabout the aims and effects of the therapy, theimpressions of the parents on changes in the chil-dren, and the satisfaction with the therapy. Forty-three parents received the questionnaire; 24 ques-tionnaires were sent back; the non response wasmainly due to the physical and psychological condi-tion of the parents. RESULTS: The parents didevaluate the therapy with a mean score of 8.4 (10point scale). Nearly all parents (91%) indicated thattheir aims were realized. They perceive that theirchildren did express more emotions, paid attentionto their feelings of mourning, and could easier totalk about the illness and their emotions. The par-ents indicate an improvement of the functioning ofthe children: less expression of anger, sadness andanxiety. The therapy gave the children a place totalk about their emotions and experiencing thatthey are not alone with their problems. CONCLU-SIONS: The creative therapy is evaluated very pos-itively by the parents. It leads to changes in theemotional life of children and their social function-ing. The therapy did fulfill their aims. RESEARCHIMPLICATIONS: The current positive evaluationis not measuring the objective effects of the therapy,but only the perception by the parents, which mayby biased in the perception of the emotional andcognitive problems of their children. There is a needfor further research applying follow- up measuresand comparing this therapy with other interven-tions. CLINICAL IMPLICATIONS: Creativetherapy is a fruitful approach to support childrenof cancer patients to cope with their emotionalproblems. It is advised to offer this therapeuticallyapproach in Dutch center for psycho-oncology forchildren of cancer patients. ACKNOWLEDGE-MENT OF FUNDING: No.

P1-39

Abstract withdrawn

P1-40

Valleys: A Webseries About Survivorship and

Caregiving for Young Adults With Metastatic

Cancer

Michael Lang

University of Calgary, Calgary, Canada

BACKGROUND: Film has quickly become a do-minante form of communication around the world.This is shown by the fact that one billion peoplewatch videos on YouTube every month. Psychoso-cial oncology professionals can use the medium offilm in thier practice. The purpose of this presenta-tion is to provide an example of a freely availablefilm tool, Valleys: The Webseries, that can be used inindividual and family counselling. METHOD: This



presentation will use Episode 3 – “This Guilty Feel-ing” from the newly released webseries, Valleys, toillustrate how film has the ability to teach impor-tant coping behaviours and open lines of communi-cation between cancer survivors and theirsupporters. Set in the majestic and wild Grand Can-yon of the southern USA, this webseries includesthe perspectives of one young adult woman withmetastatic cancer, Amy, her best friend Annie andher husband and daughter as they explore theirrelationship and grapple with the unique physicaland emotional challenges that cancer has broughtinto thier lives. RESULTS: The webisode showsthe emotional burden that is placed on the support-ers of someone with cancer as well as the cancerpatient themselves. The story emphasizes theimportance of open and honest communicationbetween cancer survivors and their supporters anddemonstrates that everyone touched by cancerexpereinces the same emotions, just for differentreasons. The universality of the difficult emotionsfaced in a cancer expereince often goes unoticedbecause each person involved does not feel like theyshould be “burdening” each other with their feel-ings. This webisode gives the opportunity to broachthis subject during family or individual counselling.CONCLUSIONS: Film is a universal languagethat can be used for many different purposes inclinical psychosocial oncology practice. CLINI-CAL IMPLICATIONS: Attendees will learn abouta freely available film tool that can be used in theirclinical practice with metastatic cancer patients aswell as gain a candid and engaging insight into thechallenges faced by both cancer surivors and theirsupporters. ACKNOWLEDGEMENT OFFUNDING: Lazarex Cancer Foundation, ChasingRainbows Young Adult Cancer Advocacy, Survive& Thrive Expeditions.

P1-41

Trajectories of Marital Satisfaction for Couples

Confronted to Husband’s Prostate Cancer

Olivier Lareyre1,2, St�ephanie de Chalvron1, Ana€ısLafaye1, Florence Cousson-G�elie1,2

1Laboratory Epsylon, Montpellier, France,2Epidaure, Montpellier, France

BACKGROUND: To be face to a prostate cancerand the radiotherapy’s effects, patients often needfor a caregiver on a daily basis: their wife. However,both spouses are confronted to an important dis-tress. In this deleterious context, marital satisfac-tion is not only an element of well-being, but couldalso be a determinant of disease’s adjustment. Thepurpose of this study was to define the maritaladequacies’ trajectories and psychosocial determi-nants associated. METHOD: Our sample wascomposed by 90French prostate cancer patients,who received radiotherapy (mean age: 67 years),

and their spouses (mean age: 62 years). A longitu-dinal approach was used with 4 times of evaluationsfrom the beginning of radiotherapy to 4 monthsafter treatment. Both husbands and wives com-pleted the following questionnaires. State anxiety(Spielberger’sSTAI adapted by Bruchon–Schweit-zer and Paulhan), social support (Segrestan et al.’sQSS) and coping strategies (Lazarus and Folk-man’sWCC adapted by Cousson et al.) were evalu-ated at T1. Marital satisfaction (Spanier’sDASadapted by Antoine et al.) was completed at T1,T2, T3 and T4. RESULTS: Patients’ and spouses’marital satisfaction whether in groups or withineach matched pair is stable between the 4 measure-ment times and reflects a good fit between spouses.Overall, adequacy also remained stable. However, 5trajectories of dyad adequacy could be distin-guished (aftershock, stable mismatch, stable matchrecovering, unstable). No significant effect wasfound between STAI, QSS or WCC at T1 and thosetrajectories, except thelow spouses’ perceived socialsupport at T1 increasing the probability of belong-ing to the “stable mismatch” group. CONCLU-SIONS: We aimed to make a first approach ofadequacy pathways for the marital satisfaction dur-ing a prostate cancer disease. In accordance withprevious researches, we have found overall a goodstable adequacy between patients’ and wives’ ade-quacy, hiding heterogeneity of reactions.The mostfrequent (“aftershock”), concerning 26.4% of thecouples, improve adequacy after the beginning oftreatments, but led to a later decrease. The presenceof a subgroup of wives perceiving low social sup-port in the “stable mismatch” groupconfirms theimportance for a following ofthe 2 spouses.RESEARCH IMPLICATIONS: This researchhighlight the importance for taking account the 2spouses’ point of view when investigating maritalsatisfaction.Moreover, in terms of methods, thisstudy aimed to compare patients with their wives,not only comparing 2 groups like most of the stud-ies, but preserving the unique relation of each cou-ple. Further studies are still necessary to developstatistical analyzes to determine developmentaltrajectories for paired samples. CLINICALIMPLICATIONS: This study support previousrecommendations for practitioners to keep anattention on both of the spouses when one of themis confronted with cancer. Illness affects not onlythe patient’s life and deleterious situations can pre-exist that should not be ignored. More generally,patients’ marital satisfaction should be considerednot just as an intimate question but as a part ofquality of life. ACKNOWLEDGEMENT OFFUNDING: INCA, French National CancerInstitute and French League against Cancer.



P1-42

Start the Talk: Supporting Children and Adolescents

When a Family Member has Cancer - A Guide for

Educators and Health Care Professionals

Jill Taylor-Brown1, Deborah McLeod2, Linda

Corsini3, Mary Jane Esplen4, Joan Hamilton5,

Laura Labelle6, Andrea Laizner7, GinaMacKenzie8,

Shane Sinclair6, Andrea Warnick9

1CancerCare Manitoba, Winnipeg, Manitoba,Canada, 2Dalhousie University, Halifax, NovaScotia, Canada, 3The Ottawa Hospital BreastHealth Centre, Ottawa, Ontario, Canada,4University Health Network, Toronto, Ontario,Canada, 5CDHA QEII Cancer Care Program,Halifax, Nova Scotia, Canada, 6Tom Baker CancerCentre, Calgary, Alberta, Canada, 7McGillUniversity Health Centre, Montreal, PQ, Canada,8BC Cancer Agency, Vancouver, BC, Canada,9Mount Sinai Hospital, Toronto, Ontario, Canada

BACKGROUND: Although most people withcancer are older, a significant number will developcancer during child rearing years. Studies on theimpact of parental cancer suggest children andteens experience distress when living with a parentwith cancer. Those whose parents have moreadvanced disease appear to be the most distressed.Few resources exist to guide educators and healthcare providers on how best to support children andadolescents when a family member has cancer.METHOD: The Canadian Association of Psycho-social Oncology (CAPO) Education Committee,supported by the de Souza Institute, developed anevidence-based online education resource for healthcare professionals and school based personnel tosupport children and adolescents when a familymember has cancer. A working group of Canadianexperts in psychosocial oncology guided the devel-opment of the resource, which included environ-mental scans of existing resources, and a review ofthe literature. Demographic data is being collectedfrom users before they can access the resource, andusers are invited to evaluate their experience withthe resource through an online survey.RESULTS: “Start the Talk” consists of 4 modules:What is Cancer; Children’s and Teen’s Responsesto Cancer in the Family; Preparing to Help; andCommunicating and Providing Ongoing Support.Available 24/7, it is intended to prepare educatorsand health care providers with a greater under-standing of the impact of cancer in the family onchildren and teens, and suggests ways to be helpful.The resource was launched in May, 2013. Evalua-tion data from the first 6 months will be presented,including a description of users, satisfaction andsuggestions for revisions. CONCLUSIONS: Themandate of CAPO is to provide psychosocialoncology related education to professionals andmembers of the public. Online resources extend the

reach of education resources to provide 24/7 help,to those in both urban and rural areas. Data col-lected from users will help inform whether the tar-get audiences are being reached as well as theeffectiveness of this approach to meeting identifiedneeds. RESEARCH IMPLICATIONS: Evalua-tion of online education resources is challenging.Our first step is to evaluate satisfaction and reach,the results of which will be discussed in this presen-tation. Possibilities for more rigorous evaluation ofthis, and similar resources that CAPO has devel-oped will be presented. CLINICAL IMPLICA-TIONS: The benefit of “just in time” web-basedresources to practitioners, whether in education,health or community based settings, is largelyunknown. We anticipate that evaluation will helpus to understanding how practitioners use suchresources, as well as opening the door to collabora-tions between CAPO, psychosocial oncology spe-cialists and practitioners in other settings.ACKNOWLEDGEMENT OF FUNDING:Funding was received from the de Souza Institutefor costs related to developing this online resource.

P1-43

Comparing Depression and Anxiety in Spousal

Relatives With Cancer Patients: Meta-Analysis of

Long Term Cancer Survivors

Alex J Mitchell1, John S Gill2

1University of Leicester, Leicester, UK, 2Universityof Leicester Medical School, Leicester, UK

BACKGROUND: There is considerable debateabout levels of depression and anxiety in spousalrelatives of cancer patients in the early stages andalso in the long-term. We aimed to discoverwhether depression/anxiety are more or less com-mon in spousal relatives compared with long-termsurvivors of cancer. METHOD: We defined longterm survivors as those 2 years or more since adiagnosis. We conducted a systematic review andmeta-analysis 12 comparative depression analyses(against spousal relatives) and 5 comparativeanxiety studies (against spousal relatives). In the 12analyses examining the prevalence of depressionstudies recruited 2722 individuals a mean of4.2 years after cancer. The anxiety studies recruited1230 individuals. RESULTS: The prevalence ofdepression was 26.7% in the pooled sample of 1437cancer survivors and 26.3% in 1285 spousal rela-tives, a pooled relative risk (rr) was 1.01 (95%CI = 0.86 to 1.20). The prevalence of anxiety was28.0% in the pooled sample of 631 cancer survivorsand 40.1% in 539 spousal relatives. The pooled rel-ative risk (rr) was 0.71 (patients vs relatives) sug-gesting 41% higher anxiety in relatives than LCS.Within this data there appeared to be one outlierand if removed the rr was 85% higher in spousalrelatives vs LCS. CONCLUSIONS: Results



suggest that risk of depression is equivalent in rela-tives of long-term cancer patients but risk of anxi-ety is actually higher. After 2 years of more post-diagnosis anxiety remains very high in spousal rela-tives. RESEARCH IMPLICATIONS: Resultsmay be mediated by time since cancer, type of case-ascertainment and burden of disease in cancerpatients. These moderating factors should be clari-fied in future research. CLINICAL IMPLICA-TIONS: From this study we suggest screening andsurveillance for mood disorders is extended torelatives of cancer patients, and extended to includerelatives of long-term survivors. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-44

Family Participation in the Adjustment of Children

and Adolescents who Survive Cancer

Geohanna Noel1,2, Marilda Arellano1, Dayana

Astorga1, Joseph Fernandez1, Daiviris Vielma1

1Universidad de Los Andes, M�erida, Venezuela,2Centro de Investigaciones Psicol�ogicas, M�erida,Venezuela

BACKGROUND: The aim of this non-experimen-tal study was to determine the active participationof the family in the adjustment of children and ado-lescents who survived cancer. METHOD: Thesample was represented by 21 children and adoles-cents of both sexes, between 2 and 21 years old,assisting to the Oncology department in the Univer-sity Hospital, and one parent for each child. Thequestionnaire applied to each parent was FamilyInvolvement in the Past (PIP) which assesses thebehavioral and emotional support given by familymembers as well as the level of patient adaptation.RESULTS: High parent involvement (M: 28) wasshown, with the mother having a 70% of interven-tion. The average emotional support (M: 24.3) andhigh behavioral support (M: 78) found showed thatparents have tools to deal with the nuisance of thechild. The negative emotions present in the parentsduring treatment were stress*, anxiety*, impotence*,fear*, depression* and sadness*, all decreasing sig-nificantly at the time of completing the treatment.Positive emotions such as joy* peace* and happi-ness* were also found. *(P > 0.05): CONCLU-SIONS: The mother had the greatest participationin terms of emotional and behavioral support,showing that parents have tools to deal with thediscomfort of the child. The negative emotions dur-ing treatment disappeared in the period of survival,showing a new period of adjustment appearing inthe opportunity of well being. Surviving cancerinvolves a series of trials that must be overcomefrom the physiological perspective as a “cure orremission” of disease, as well as the healing of“emotional” wounds that the situation involves.RESEARCH IMPLICATIONS: There are many

questions needing to be answered when workingwith oncology patients: adjustment to new life,family support, treatment of a serious illness. Thisresearch gives appropriate answers to these ques-tions. CLINICAL IMPLICATIONS: Integrated,multidisciplinary work between physician and psy-chologist should be strengthened each day to makeit function as a tool to accelerate steps towards ahappy and healthy survival. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-45

Abstract withdrawn

P1-46

Characteristics Associated with Posttraumatic Stress

Symptoms and Quality of Life in Children with

Parental Cancer in Japan

Miwa Ozawa1, Sachiko Kiyoto2, Hiroyuki Ohtani3,

Tomohiro Tamaki4, Shinichi Tsujimoto1

1St. Luke’s International hospital, Tokyo, Japan,2National Hospital Organization Shikoku CancerCenter, Ehime, Japan, 3National HospitalOrganization Kusyu Cancer Center, Fukuoka,Japan, 4Hokkaido University Hospital, Hokkaido,Japan

BACKGROUND: About a quarter of cancerpatient have dependent children. Cancer not onlyaffects the patients, but the experience alsoencroaches deeply on family life. Recently in Japan,there is a greater recognition for the need to under-stand the effects of parental cancer on children.However, there are few studies in Japan evaluatingthe relationship between characteristics of the parentswith cancer and the functioning of their children.METHOD: We conducted a multi-institutionalcross-sectional study comprising children of cancerpatients hospitalized or visiting on an outpatientbasis for treatment or follow-up at one of fourmajor clinical centers in Japan between October2011 and December 2012. Children were consideredeligible if they were between ages 6 and 18 years.Questionnaires were administered to the childrenand their affected parent with cancer to collectedinformation on sociodemographics, psychosocialfactors, quality of life (QOL), and illness-relatedcharacteristics. These included a scale of social-sup-port, emotional condition (HADS and IES-R),family functioning, posttraumatic stress disorder-reaction index (PTSD-RI), and PedQL for children.RESULTS: Eighty-two children and their parentaffected with cancer returned questionnaires. Themedian ages of the parents and children were45 years (range: 36–53 years) and 13 years (range:6–17 years), respectively. Forty-three percent ofchildren aged 6–14 years and 12% of children aged



15–17 years showed symptoms of posttraumaticstress. Daughters reported higher PTSD-RI scoresthan sons (p = 0.012). Single parent (p = 0.002)and no siblings (p = 0.003) were associated withlower QOL based on children’s self-reported data.Additionally, lower QOL of children was associatedwith anxiety (p < 0.001), depression (p < 0.001)and posttraumatic stress syndrome (PTSS)(p < 0.001) of parents. CONCLUSIONS: To ourknowledge, this is the first study to evaluate thecharacteristics of children affected by parental can-cer in Japan. Our data showed PTSS to be morefrequent in elementary and junior high school chil-dren than high school children and affected moregirls than boys. Low QOL of children was relatedto having a single parent and no siblings. Poormental health of parents affected physical, emo-tional and social functioning of children. Thesefindings suggest that total care for cancer patientsshould include their children. RESEARCH IMPLI-CATIONS: Our previous research showed that70% of clinicians believe it is better to support chil-dren with parental cancer, and 85% of them indi-cated there to be a lack of appropriate data aboutchildren affected by parental cancer in Japan. Wedemonstrated that considerable proportion of chil-dren with parental cancer suffer from psychosocialissues and suboptimal QOL suggesting a need forfurther studies to clarify the risk factors and evalu-ate the effectiveness of potential intervention strate-gies. CLINICAL IMPLICATIONS: The numberof individuals affected by cancer in their 30′s, 40′sand 50′s are increasing. Many have school agedchildren making it increasingly necessary for clini-cians to consider the children with parental cancerin an effort to provide total care. Our results sug-gested that lower QOL in children is related to theirparents’ emotional state and the composition offamily. Total care needs to have a field of visionthat includes the support of children. ACKNOWL-EDGEMENT OF FUNDING: This study wassupported by a grant from the Japanese Ministry ofHealth, Labour and Welfare.

P1-47

Is Primary Caregiving Stress Related to Secondary

Caregiving Stress? A Cross-Sectional Study of

Chinese Family Cancer Caregivers

Adrian H.Y. Wan1, Timothy H.Y. Chan1, Lai Ping

Yuen2, Tammy Lee3, Jessie S.M. Chan1, Jonathan

S.T Sham1, Cecilia L.W. Chan4

1Centre on Behavioral Health, the University ofHong Kong, Hong Kong, 2International Associationand Health and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong,4Department of Social Work & SocialAdministration, University of Hong Kong, HongKong

BACKGROUND: Caregivers stress is cited as afocus of intervention for effective informal cancercare in the field of psycho-oncology. Existing litera-ture on caregivers are plagued two major limita-tions: First, few studies examine how stress relatedto care provision (primary stress) spreads and influ-ences the other aspects of the caregivers’ life (sec-ondary stress). Second, few studies examinedcaregiver stress in a patient-caregiver dyad. Thisstudy contributes to our understanding of caregiverstress by addressing these limitations.METHOD: 235 pairs of Chinese cancer patientsand their family caregivers completed question-naires on their perceived social support (Multidi-mensional Scale of Perceived Social Support),perceived stress (Perceived Stress Scale), mood(Hospital Anxiety and Depression Scale), and self-reported mental health (Short Form 12). To mea-sure the impacts on cancer caregiving on caregivers’financial well-being, health status, and daily lifeschedule (secondary stress), caregivers also com-pleted the Caregiver Stress Assessment (CRA).RESULTS: Regression analyses with caregivers’demographics background, perceived stress relatedto primary cancer caregiving, as well as care recipi-ents’ demographics, cancer-related medical condi-tion, mood, and self-perceived social supports asreported by caregiver-patient dyads were entered aspossible predictors showed that: (a) caregivers’ per-ceived caregiving stress was associated with alldimensions of secondary stress (betas = 0.16, 0.10and 0.21; (b) impacts on daily schedule was alsoassociated with patient’s depression and physicalhealth (betas = �0.06 and 0.19), and; (c) impactson caregiver’s health was associated with caregiv-ers’ gender and perceived family support(betas = 1.0 and �0.9). CONCLUSIONS: Thepresent study found that primary caregiving stressproliferated into secondary stress in the context ofprimary family cancer giving. Caregivers’ perceivedcancer caregiving stress appeared to be a major fac-tor associated with all aspects of secondary stress.Impact on caregivers’ schedule was associated withcare recipients’ mood and physical functioning,whereas impacts on caregivers’ health was associ-ated with caregivers’ gender and the self-perceivedfamily support. RESEARCH IMPLICATIONS:The present study showed that primary stress isassociated with secondary stress in the context thecancer caregiving among Chinese patient-caregiverdyads. The present study leaned empirical supportto and extended the application of the stress processmodel (Pearlin, Mullan, Semple, and Skaff, 1990).CLINICAL IMPLICATIONS: The findings of thepresent study highlighted the multi-faceted needs ofcancer caregivers and the care recipients. The cul-tural obligation of taking care of one’s family mem-ber imposes considerable stress on the caregivers.The present study suggested that to improve qualityof informal caregiving, it is important to facilitate



expectation management of the caregivers, toenhance the family support of the caregivers, andto address the psychological and physical needs ofthe care recipients. ACKNOWLEDGEMENT OFFUNDING: None.

P1-48

Dyadic Coping of Patients With Hematologic

Malignancies – Preliminary Findings of a

Longitudinal Study

Gregor Weißflog1, Ulrike Ruppin2, Klaus H€onig3,Harald G€undel2, Anja Mehnert1, Jochen Ernst1

1University Leipzig, Department for MedicalPsychology and Medical Sociology, SectionPsychosocial Oncology, Leipzig, Germany,2University Medical Center Ulm, Department forPsychosomatic Medicine and Psychotherapy, Ulm,Germany, 3University Medical Center Ulm,Comprehensive Cancer Center, Ulm, Germany

BACKGROUND: Hematological cancer is relatedwith multidimensional burden for the patients andtheir partners. This is caused by the life threat itselfand by the prolonged and often exhausting treat-ment including transplantations for the patient.The concept of dyadic coping (Bodenmann 1995)acknowledges this fact. In this context, supportiveand not helpful ways of coping can be distin-guished. METHOD: Therefore, 320 patients andtheir partners (dyads) will be included in a Germanmulticenter study (Leipzig and Ulm). In a prospec-tive design with 2 time points (t1: < a half year afterdiagnosis; t2: 6 months later) patients, aged 18 to 75with ICD-10 diagnosis (C81–C96; D46) complete aquestionnaire assessing dyadic coping (instrument:Dyadic Coping Inventory) and further psychosocialparameters (e.g. distress with PHQ-4, quality of lifewith the SF-12, attachment with a German shortversion of the ECR). Further, 15 problem-centeredinterviews focusing on dyadic coping processes willbe conducted. RESULTS: We will present findingsconcerning (a) the course and changes in dyadiccoping over time, (b) dyad- related predictors ofdysfunctional coping, (c) associations of dyadiccoping and personal, pair- and illness related char-acteristics and (d) specific aspects of dyadic copingin dyads with one partner having hematologicalcancer. CONCLUSIONS: The results will providean enhanced understanding of dyadic coping inpartnerships of haematological cancer patients.Further, the results could have impact on the devel-opment and adaptation of psychosocial interven-tions for dyads that are faced with cancer.RESEARCH IMPLICATIONS: Common copingprocesses in a partnership have the potential toencourage or to hamper individual coping. There-fore, it is necessary to investigate interactions of ill-ness-related coping of the patient and the partner inorder to conduct patient-centered psychosocial

research for cancer patients. CLINICAL IMPLI-CATIONS: The systematic consideration of dyadiccoping could contribute to an early detection of dys-functional and maladaptive coping. Due to an earlyidentification of factors related to dysfunctional dya-dic coping appropriate and tailored psychosocialinterventions can be offered early. ACKNOWL-EDGEMENT OF FUNDING: This study isfunded by a grant from the German Jos�e CarrerasLeukaemia-Foundation (grant: DJCLS R 12/36).

P1-49

The socio-Economic Costs of Back Pain on Working

Children of Working Patients with Cancer of the

Cervix

John Weru

Aga Khan University Hospital, Nairobi, Kenya

BACKGROUND: Back pain is a common reasonof multiple doctor consults in patients with cervicalcancer. It affects all ages but worse at the age of>50 .The study explored the socio economic effectsof back pain on the working children of workingpatients. METHOD: Data consisted of workingchildren whose parents presented with back painwith a primary diagnosis of cervical cancer. A ques-tionnaire was sent to the children .Cross sectionalstudy. RESULTS: Over 30% of the participantsreported absence from work at least 10 days in anyear to assist their parents visit doctors, buy medica-tion, attend non pharmacological modalities and dochores for their parents. 40% reported that in1 year, >40 days were away from families, thelonger the duration of pain, the more the absencetime. Adjustments of work load factors, at home, atwork, and socio-economic standing showed thatpain was a relatively independent determinant ofcare burden.>75% reported missing an engagementin 1 year. The scenario was worse if there were otherunderlying conditions. CONCLUSIONS: The bur-den of back pain with cancer of the cervix affects thewhole family both socially and economically. It isimportant that excellent management coupled withcounseling is practiced. Supportive care for thepatient and family is an important aspect of qual-ity care. RESEARCH IMPLICATIONS: Physicalaspects of care are important when dealing withpatients with cancer. But social factors are usuallyignored with consequence more distress for patientsand families. A bigger research need to be under-taken to assess this situation. CLINICAL IMPLI-CATIONS: Though the parents were working,children had to chip in financially and assist theirparents to access better care which became evenmore frustrating when the pain was not controlled.As such paying attentiont to psychosocial settingsgreatly enhance the care patients receive.ACKNOWLEDGEMENT OF FUNDING: Noacknowledgement.



P1-50

Quality of Life in the Informal Carers of Cancer

Patients with Cachexia

Sally Wheelwright1, Anne-Sophie Darlington1,

Deborah Fitzsimmons2, Jane Hopkinson3, Colin

Johnson1

1University of Southampton, Southampton, UK,2Swansea University, Swansea, UK, 3CardiffUniversity, Cardiff, UK

BACKGROUND: Informal caregivers have animportant role in managing care and supportingpatients with cancer. The challenges associated withcaregiving may be increased if the patient also hascachexia, a multidimensional syndrome character-ised by involuntary weight loss, muscle atrophy andphysiological changes which cause progressivefunctional impairment. The aim of this study is toidentify the quality of life (QoL) issues which areimportant for carers of cancer patients withcachexia. METHOD: Relevant electronic databas-es were searched using free text and MESH-termsrelated to cancer, cachexia, QoL and carers. Fullpapers were retrieved for studies which describedqualitative interviews with the informal caregiversof cancer patients with cachexia or unintentionalweight/appetite loss. Studies of carers of patientswith paediatric cancers were excluded as were stud-ies in which the carer only acted as a proxy for thepatient. The reference lists of the retrieved articleswere checked for additional articles. Direct quotesfrom carers were extracted from the articles by 2judges, who carried out open content analysis.RESULTS: The search found 15 relevant studieswith 114 direct quotes. In about half the quotes,there was no information about how the carer’sown QoL was affected. QoL issues in the remainingquotes fell under the following general headings: -dissatisfaction with health care professionals; feel-ings of guilt, worry and anger over patient’s eating;change to own diet and eating habits; missing pastfood-related experiences; empathy and sympathyfor patient; not knowing what to do for the best;family conflict; putting a lot of time and energy intofood. CONCLUSIONS: The complexity of caringfor a cancer patient with cachexia translates into arange of problems and experiences for informal ca-rers. However, carers can sometimes be reluctant toreport on how their lives are affected and focussedresearch with carers is required to provide a com-plete list of the relevant QoL issues. RESEARCHIMPLICATIONS: Carers of cancer patients withcachexia may be too focussed on the patient toreport fully on their own experiences. Carefullydesigned interviews are therefore required to fullyexplore the impact on the QoL of carers. These inter-views will also inform the content of psychoeduca-tional interventions for families affected by cancercachexia. CLINICAL IMPLICATIONS: The liter-

ature shows the challenges of caring for a loved onewith cachexia. Clinicians should not ignore thepatient’s weight loss: carers want their acknowledge-ment and advice. It may help the patient, and theirrelationships, if professionals acknowledge andaddress carers’ feelings of guilt, worry and anger,and provide advice to carers as well as patients onhow best to address eating difficulties in cachexia.ACKNOWLEDGEMENT OF FUNDING: None.

P1-51

The Peculiarities of Perception of Cancer of the

Oncologikal Patients, People Related to Them and

Within the Society

Yeva Asribabayan

Yerevan State University, Yerevan, Armenia

BACKGROUND: Today in Armenia, despite thewide prevalence of the disease, public perceptionsof cancer remain mostly imaginary and are mainlybased on myths and fear rather than scientific facts.An important indicator of Armenian society’swrong attitude towards cancer is the fact that thetrue diagnosis is often concealed from the patient.This work was aimed at research of the peculiaritiesof attitude towards cancer with groups having vari-ous relations with the disease. METHOD: Toachieve maximal efficiency of the research, methodsof survey, association and testing were selected andthe following methodologies were utilized: a surveydeveloped specifically for this research and aimedat revelation of attitudes towards cancer was usedwith all research groups. The group of patientsdiagnosed with cancer was additionally tested withBehterev Institute personality test (LOBI) aimed atrevelation of types of attitudes towards diseasesand SF-36 health survey, which belongs to theunspecific questionnaires aimed at assessment ofquality of life. Microsoft Excel and SPSS (Statisti-cal Package for the Social Sciences) software wereused for data processing. RESULTS: Taking intoaccount the type of relation with cancer, the surveysample is divided into 5 main groups: (1) cancerpatients, (2) relatives and friends of cancer patients,(3) oncologists, (4) junior medical staff and (5) thegeneral public - group of individuals with no directrelation with cancer. First 20 participants areincluded in each of the first 4 groups while 60 areincluded in the fifth group. Summing up theresearch in this 5 pilot groups and combining theresults, the following conclusions were made. CON-CLUSIONS: Cancer patients’ attitude towardscancer is ambiguous and contradictory. The atti-tude of cancer patients’ relatives is extremely nega-tive: the fact of the disease itself is considered to beunfair and horrific. In the group of junior medicalstaff, it was found that the intensive, close interac-tion with cancer patients is mainly based on com-passion and emotional support. Oncologists



demonstrate rational, realistic approach towardscancer and are based on more “scientific” knowl-edge of the issue and the need of putting a meaningto their own work. The attitude towards canceramong the general public has 2 important features:fear and avoidance. RESEARCH IMPLICA-TIONS: This research brings out the real attitudeof the Armenian society towards cancer and thereasons for this attitude. It also provides an insightinto the ways attitude towards cancer is impactedby the type of one’s relation with the disease. Inter-national psycho-oncology specialists can refer tothis research for information on the peculiarities ofpatients’ attitude towards cancer in cases of con-cealment of the disease from the patient and lack ofrelevant psychological assistance. CLINICALIMPLICATIONS: The results of this work can beuseful for cancer patients, their relatives, as well asthe medical staff for organization of complex psy-chotherapeutic work, which will take into accountthe peculiarities of perception of cancer amongabove mentioned groups as well as their impact oneach other. This work can also have an educationalrole among cancer patients, their relatives and med-ical staff, thus contributing to mutual recognitionand creation of environment of comfort.ACKNOWLEDGEMENT OF FUNDING: None.

P1-52

A Plea for Total Care: An Examination of the

Doctor-Patient Relationship in the Context of Breast

Cancer Care in Egypt

Mai Kabbani

Dar El Fouad Hospital, Cairo, Egypt

BACKGROUND: The research is an empiricalstudy examining the doctor-patient relationship asan important foundation to the quality of healthcare with patients with breast cancer in Egypt. Theresearch focuses on four bioethical concerns thatemerge within the doctor-patient relationship: equalallocation of resources, disclosure of diagnosis, deci-sion-making and informed consent; for analyzingsuch relationship in the context of cancer care inEgypt. METHOD: This is a qualitative researchmainly relying on semi-structured in depth inter-views using open-ended questions to explorepatients and doctors’ perceptions and attitudes onthe various bioethical constructions and the doctor-patient relationship. Eleven patients with breastcancer and nine doctors were interviewed comingfrom both public and private medical institutions inCairo. RESULTS: The bioethical concerns are cul-turally constructed in Egypt unlike the alreadyinstitutionalized bioethical principles in the west. Inmany cases, doctors and patients’ perceptions differin relationship to the way and degree of disclosureof diagnosis. Doctors do not negotiate power withpatients as they feel and are expected to always

know what is right, while some patients demandparticipation in the treatment decision-making.Although informed consent is formally institution-alized it is not explained thoroughly to patients,leading to disappointments post breast surgery.Equal allocation of resources has been recognizedas a major public problem influencing the doctor-patient relationship. CONCLUSIONS: The cultur-ally constructed bioethical concerns are determinedby several factors affecting the doctor-patient rela-tionship with breast cancer in Egypt. These factorsinclude the nature, severity, and risk of the illness,the illness’ psychological impact on patients, familystructure, the socio-economic position of bothpatients and doctors, and the medical institution.The doctor-patient relationship is just another con-textualized social relationship. Adapting the bioeth-ical principles to fit the context within which theclinical encounter is taking place without compar-ing it to the western basis will improve the doctor-patient relationship enhancing patients’ satisfactionand compliance thus improving the quality ofhealth care. RESEARCH IMPLICATIONS: Thisresearch is an initial exploratory study to the doc-tor-patient relationship and bioethical principles inEgypt. This research should not be generalized butcan be used by other researchers and policy makersto explore new bioethical guidelines. Researcherscan also administer a larger scale to draw newguidelines and further improved quality of healthcare programs. CLINICAL IMPLICATIONS:The doctor-patient relationship is poorly describedand misunderstood within the clinical encounters ofbreast cancer in Egypt increasing patients’ dissatis-faction and non-compliance to treatment. Clini-cians should consider all the different aspects thatplay a role in shaping the doctor-patient relation-ship in order to institutionalize bioethics forimproving the relationship. A plea for total care iscalled for putting into consideration an integratedperspective: clinical, psychological, socio-economic,cultural, spiritual, political and educational.ACKNOWLEDGEMENT OF FUNDING: None.

P1-53

What are the Factors Associating With Caregiver

Identity in Cancer Care? A Cross-Sectional Study of

Chinese Family Cancer Caregivers


Yuen2, Tammy Lee3, Jonathan S.T. Sham1, Cecilia

L.W. Chan4

1Centre on Behavioral Health, the University ofHong Kong, Hong Kong, 2International Associationand Health and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong,4Department of Social Work & SocialAdministration, University of Hong Kong, HongKong



BACKGROUND: Numerous studies have identi-fied the positive role informal cancer care inenhancing quality of life of the care recipients.However, little is known about associating factorsof caregiver identity in primary cancer caregivingwithin a family; and that available studies focusedprimarily on Caucasian population. Thus, thisstudy aimed to bridge the gap in existing knowledgeby identifying factors within the patient-caregiverdyads that are associated with caregiver identity inthe Chinese community. METHOD: 235 pairs ofChinese cancer patients and their family caregiverswere surveyed. The caregivers completed a ques-tionnaire on their perceived stress (Perceived StressScale) and the “self-esteem” subscale of the Care-giver Stress Assessment (CRA), which is presum-ably a proxy measure for caregiver identity;whereas the care recipients completed questionnaireon their self-reported mental and physical health(Short Form 12). In addition, the patient-caregiverdyads also completed a measure on their perceivedsocial support (Multidimensional Scale of PerceivedSocial Support), as well as their demographics.RESULTS: Caregiver identity was significantlycorrelated to care recipients’ mental functioning(p = �0.35), and; caregivers’ social support fromfriends (p = 0.32) as well as perceived stress in care-giving (p = �0.35). Caregiver identity was not asso-ciated with family support as well as caregivers’physical functioning. Regression analyses with carerecipients’ mental health, caregiver’s social supportfrom friends and perceived stress entered as possi-ble predictors found that higher level of caregiveridentity was associated with: (a) higher level ofcaregivers’ perceived support from friends, (b)higher level of caregivers’ perceived stress, and; (c)poor care recipients’ self-reported mental healthstatus. CONCLUSIONS: Contrary to existing liter-ature on caregiving identity, the present study foundthat perceived stress in caregiving as well as the carerecipients’ impaired mental state appeared to be thebuilding blocks for Chinese caregivers’ identity.Nevertheless, it is consistent with existing literaturethat caregivers who received more supports fromfriends are more likely to report a lower level ofsense of caregiving burden. RESEARCH IMPLI-CATIONS: The present identified factors associ-ated with caregiver identity of Chinese primarycancer caregiver in the family. The paradoxical find-ings on the effect of perceived stress and care recipi-ents’ mental health status warranted additionalresearch efforts to further explore the phenomenonin the Chinese community. CLINICAL IMPLICA-TIONS: The results of the present study also high-lighted the importance of cultural sensitivity inunderstanding caregiver identity and burden, as wellas informal health practices in psycho-oncology.ACKNOWLEDGEMENT OF FUNDING: None.

P1-54

Does Caregiver Stress Mean Differently for Male

and Female Cancer Caregivers? A Cross-Sectional

Study of Chinese Family Primary Cancer Caregivers



S.T. Sham1, Cecilia L.W. Chan4

1Centre on Behavioral Health, the University ofHong Kong, Hong Kong, 2International Associationand Health and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong,4Department of Social Work & SocialAdminsitration, University of Hong Kong, HongKong

BACKGROUND: Informal cancer caregiving haslong been recognized as a stressful experience. Can-cer caregiving resulted in impairments to daily lifeschedule, financial arrangement, family relation-ships, and physical health of the caregivers. Little isknown about caregiving stress across the gender.This study attempts to explore whether caregiverstress means differently to Chinese male and femalecaregiving spouse, in the context of the patient-caregiver dyads. METHOD: 146 pairs of Chinesecancer patients and their caregiving spouse weresurveyed. The caregivers completed a questionnaireon their perceived stress (Perceived Stress Scale)and the Caregiver Stress Assessment (CRA);whereas the care recipients completed questionnaireon their self-reported mental and physical health(Short Form 12). In addition, the patient-caregiverdyads also completed a measure on their perceivedsocial support (Multidimensional Scale of PerceivedSocial Support), as well as their demographics. Forthis study, a total of 72 male caregiving spouses(49.3%) and 74 female caregiving spouses weresurveyed (50.3%). RESULTS: Regression analyseswith patient- and caregiver-perceived social sup-port, patients’ mental and physical health, andcaregivers’ perceived stress entered as possible pre-dictors of impairments on caregivers’ financialarrangement, daily schedule, and family relation-ship found that: (a) impacts on financial arrange-ment were associated only with support fromfamily for the females (beta = �0.29); (b) impactson schedule were associated with caregivers’ sup-port from friends for the females (beta = �0.41),but with the patients’ familial support for males(beta = 0.30), and; (c) impacts on family relation-ship were associated with caregivers-perceived sup-port from friends for both genders (beats = �0.17and �0.28). CONCLUSIONS: Caregivers’ supportfrom friends appeared to have the protective effectson family relationships for both gender. Neverthe-less, impairments on financial arrangements anddaily scheduling were associated with different setsof factors for caregiver of different gender. Caregiv-ers’ familial support appeared to have the protec-



tive effect on disruptions of financial arrangement,daily schedule and family relationships only for thefemale caregivers. Whereas for the male caregivers,self-perceived stress and supports from friendsappeared to have the protective against caregiverstress, whereas patients’ support from friendsseemed to mitigate disruptions of daily life sche-dule. RESEARCH IMPLICATIONS: At present,existing literature studied caregiver stress withouttaking adequate consideration to the possible gen-der effect. And thus, little was known about cancer-related caregiving stress across the genders. Thefindings of this research implied that caregivingstress might mean differently for Chinese male andfemale caregivers, and thus future research effortson Chinese caregiving stress have to take into con-sideration of the possible gender differences. CLIN-ICAL IMPLICATIONS: This study implied thatfamily-based psychosocial intervention would bene-fit female cancer caregivers, but not male caregiv-ers. The findings of this study called for a review ofexisting psychosocial support for male caregivingspouse in the Chinese context, who might needstrengthening their social support networks outsidethe family to help them cope. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-55

Carry That Weight: A Comparison of the Impacts of

Cancer Caregiving on Male and Female Chinese

Family Caregivers



S.T. Sham1, Cecilia L.W. Chan4

1Centre on Behavioral Health, The University ofHong Kong, Hong Kong, China, 2InternationalAssociation and Health and Yangsheng, Hong Kong,China, 3The Hong Kong Anti-Cancer Society, HongKong, China, 4Department of Social Work & SocialAdminsitration, University of Hong Kong, HongKong, China

BACKGROUND: Cancer not only impacted onthe patients, but also on their caregivers. Cancercaregiving resulted in impairments to daily life sche-dule, financial arrangement, family relationships,and physical health of the caregivers. Little isknown about caregiving stress across the gender.This is the purpose of this study to explore whetherimpact of caregiver stress means differently to Chi-nese male and female caregiving spouses in the con-text of the patient-caregiver dyads. METHOD: 146pairs of Chinese cancer patients and their caregiv-ing spouse were surveyed. The caregivers completeda questionnaire on their perceived stress (PerceivedStress Scale) and the Caregiver Stress Assessment(CRA); whereas the care recipients completed ques-tionnaire on their self-reported mental and physical

health (Short Form 12). In addition, the patient-caregiver dyads also completed a measure on theirperceived social support (Multidimensional Scale ofPerceived Social Support), as well as their demo-graphics. For this study, a total of 72 male caregivingspouses (49.3%) and 74 female caregiving spouseswere surveyed (50.3%). RESULTS: Regressionanalyses with patient- and caregiver-perceivedsocial support, patients’ mental and physical health,and caregivers’ perceived stress entered as possiblepredictors of impairments on caregivers’ financialarrangement, daily schedule, and family relation-ship found that: (a) impacts on financial arrange-ment were associated only with support fromfamily for the females (beta = �0.29); (b) impactson schedule were associated with caregivers’ sup-port from friends for the females (beta = �0.41),but with the patients’ familial support for males(beta = 0.30), and; (c) impacts on family relation-ship were associated with caregivers-perceived sup-port from friends for both genders (beats = �0.17and �0.28). CONCLUSIONS: Caregivers’ supportfrom friends appeared to have the protective effectson family relationships for both gender. Neverthe-less, impairments on financial arrangements anddaily scheduling were associated with different setsof factors for caregiver of different gender. Caregiv-ers’ familial support appeared to have the protec-tive effect on disruptions of financial arrangement,daily schedule and family relationships only for thefemale caregivers. Whereas for the male caregivers,self-perceived stress and supports from friendsappeared to have the protective against caregiverstress, whereas patients’ support from friendsseemed to mitigate disruptions of daily life sche-dule. RESEARCH IMPLICATIONS: At present,existing literature studied caregiver stress withouttaking adequate consideration to the possible gen-der effect. And thus, little was known about cancer-related caregiving stress across the genders. Thefindings of this research implied that caregivingstress might mean differently for Chinese male andfemale caregivers, and thus future research effortson Chinese caregiving stress have to take into con-sideration of the possible gender differences. CLIN-ICAL IMPLICATIONS: This study implied thatfamily-based psychosocial intervention would bene-fit female cancer caregivers, but not male caregiv-ers. The findings of this study called for a review ofexisting psychosocial support for male caregivingspouse in the Chinese context, who might needstrengthening their social support networks outsidethe family to help them cope. ACKNOWLEDGE-MENT OF FUNDING: None.



P1-56

Build it, but will They Come? Development and

patient use of an Online Information Tool Designed

to Reduce Psychosocial Distress

Jamie Bryant1,2, Robert Sanson-Fisher1,2, William

Stevenson4, Frans Henskens1, Rochelle Smits1,2

1University of Newcastle, Newcastle, New SouthWales, Australia, 2Hunter Medical ResearchInstitute, Newcastle, New South Wales, Australia,3Newcastle Cancer Control Collaborative,Newcastle, New South Wales, Australia, 4RoyalNorth Shore Hospital, Sydney, New South Wales,Australia

BACKGROUND: Communicating treatmentoptions and providing psychosocial support arecritical in assisting patients to cope with a cancerdiagnosis. The provision of information can takemany forms, from verbal information provided bya clinician to the use of written, video and webbased materials. The advantages and disadvantagesof each of these approaches will be described, aswell as the development and use of a web-basedinformation tool in the context of a randomisedcontrolled trial. METHOD: A randomised con-trolled trial is being conducted to examine the effec-tiveness of a web-based information tool inreducing depression, anxiety, and unmet informa-tion needs among haematological cancer patientsand their support persons. Patients and their sup-port persons are recruited by their clinician at thefirst consultation then randomly allocated as a dyadto receive the intervention or usual care. Interven-tion participants are provided with access to a web-based tool designed to provide tailored informationand decisional support around diagnosis, treatmentoptions, and self-management strategies. Partici-pants can access the web-based tool in hospitalusing iPads, and via home computer when dis-charged. RESULTS: The content of the web pro-gram was developed using existing resources fromcancer organisations. Two expert advisory commit-tees rated written and video content for accuracy,completeness, detail and communication style.Information was revised until consensus wasachieved. The program was then piloted with 33haematological cancer patients; 90% found theprogram easy to use and all reported that theywould share it with others. The web-based toolrecords at each log in the date, time, person access-ing the content, which sections and how long thecontent is accessed. Data about use of the webbased tool will be provided. CONCLUSIONS:Web-based information access has the potential toimprove critical outcomes for cancer patients. Thisinnovative intervention uses technology to supporttailoring, can be easily integrated into practice, anddraws on best practice recommendations at a criti-cal phase of the disease trajectory. This research

has a high potential for translation into clinicallysignificant benefits for haematological cancerpatients and their families. RESEARCH IMPLI-CATIONS: Empowering patients to self-manageoffers a mechanism for improving importantpatient centred outcomes. This trial will provideinformation about the acceptability, feasibility andeffectiveness of web-based information program inmeeting important needs of cancer patients. CLIN-ICAL IMPLICATIONS: Web-based technologiesoffer the potential of providing tailored informa-tion about treatment options, as well as preparingpatients for potentially threatening interventions.Access to information via tablet computers is nowfeasible for patients who are admitted to hospitalfor long periods of time. The ability to track patientuse of information provides useful clinical andresearch feedback necessary to improve the qualityinformation provided to patients. ACKNOWL-EDGEMENT OF FUNDING: This research isfunded by a Translational Research Grant from theCancer Institute New South Wales.

P1-57

‘Fitter na Kanker’: The Effectiveness and Working

Mechanisms of two Different e-Health Interventions

for People Suffering From Chronic Fatigue After

Cancer

FZ Everts1,3, ML Van de Lee1, MDJ Wolvers2,3,

MMR Vollenbroek-Hutten2,3

1Helen Dowling Institute, Bilthoven, TheNetherlands, 2Roessingh Research and Development,Enschede, The Netherlands, 3Telemedicine group,Faculty of Electrical Engineering, Mathematics andComputer Science, University of Twente, Enschede,The Netherlands

BACKGROUND: About a quarter of cancer sur-vivors suffer from chronic cancer-related fatigue(CCRF). Physical activity interventions and psy-chosocial interventions seem effective in reducingthese fatigue complaints. E-health makes interven-tions available for patients who do not have theenergy to travel. This study aims to investigate theeffectiveness of 2 e-health interventions in reducingfatigue. Also, working mechanisms and predictorsto the effectiveness of the interventions, are studied.Results are expected in the year 2016. METHOD:In the next 2 years, an RCT including 330 CCRFpatients will be performed using 3 conditions: 2nine-week e-health interventions (Ambulant Activ-ity Feedback and online Mindfulness Based Cogni-tive Therapy) and a 9 week minimal controlcondition (psycho-education). Participants in thecontrol condition are offered one of the interven-tions six months after baseline. Fatigue is measuredwith the fatigue severity subscale of the ChecklistIndividual Strength. Work ability and mentalhealth are studied as secondary outcome measures.



Working mechanisms (i.e. mindfulness, physicalactivity) are studied during treatment. Follow-up isassessed 6 and 12 months after baseline. Bayesianstatistics will be used. RESULTS: We expect thatboth interventions are effective in lowering fatigueseverity 6 months after baseline. We expect thatincreasing the level of mindfulness will reduce fati-gue in online MBCT and balancing and/or increas-ing physical activity as well as improving activityperception will reduce fatigue in AAF. Also, wehypothesize that general working mechanismsaccount for lowering fatigue severity, that isincreasing sleep quality, a good working relationwith the therapist, and high expectations of thepatient for the intervention. CONCLUSIONS:What Is Known:

• CCRF is a serious and growing problem, forwhich easy accessible interventions are needed.

• Both physical activity interventions and psy-chological interventions aimed specifically atreducing CCRF are effective. What This StudyAdds:

• Knowledge about the effectiveness of 2 differ-ent types of e-health interventions for CCRF.

• Knowledge about specific and general workingmechanisms of these interventions to optimizetreatment for CCRF.

• Knowledge about what type of treatmentworks best for whom.

RESEARCH IMPLICATIONS: By studying theworking mechanisms of 2 different e-health inter-ventions simultaneously, we are able to isolatetreatment specific working mechanisms from moregeneric working mechanisms. Bayesian statisticsallows us to evaluate a set of informative hypothesisby incorporating prior information into the analy-sis. Consequently, more power is generated withthe same sample size, therefore, making it possibleto do these complex analyses on relatively smallsample sizes. CLINICAL IMPLICATIONS: If wefind AAF and MBCT to be effective, a large groupof cancer survivors will have access to home-basedinterventions that reduce fatigue, increase well-being and promote work ability. In addition we willknow how to advice patients which type of inter-vention will most likely help them. By studying therelative importance of treatment specific workingmechanisms as increasing level of mindfulness anda good balance in activities we can optimizeinterventions for fatigue. ACKNOWLEDGE-MENT OF FUNDING: This project is sponsoredby Alpe d’Huzes/KWF foundation.

P1-58

An Innovative, Interactive Intervention for the

Internet: Helping Cancer Patients Find Solutions

and Cope With Negative Feelings

Patricia Fobair

Stanford University Hospital, Cancer Center,Supportive Care Program, Mountain View, CA,USA

BACKGROUND: Since the birth of Psycho-Oncology in the 1980′s, one focus concernedresearch on interventions that help patients copewith emotional distress. Returning from a Ful-bright-grant in Ho Chi Minh City, November 2012,the author re-framed a teaching tool (1990′s) thatimproved patients’ ability to overcome moments of,“Loss of Control,” and turned it into an interactive,self-directed website, https:www.copingengine.com/designed for users to identify negative feelings,thoughts and find solutions to the underlying prob-lem(s). METHOD: During her breast cancer treat-ment in 1987, Fobair was surprised to learn howmany emotional moments there were in the postdiagnosis experience. To better prepare otherpatients, she found a teaching tool used with drugaddicts. Fobair took Matano’s design and added 22active coping choices. “Coping with Loss of Con-trol” was important to patients at Stanford Univer-sity Hospital for 22 years. But, in Vietnam (2012),a cross cultural validation occurred as social workstudents and others found it the most compellingwork presented in the 9 lectures at the University ofSocial Sciences and Humanities, Vietnam NationalUniversity. RESULTS: A unique, user directedinteractive intervention was launched May, 2013 asan i Phone app/website for cancer patients. It isdesigned for the user to identify an emotionallycharged negative feeling or thought, then choose anactive coping solution. The copingengine.com canbe reused as many times as desired. Now live, https:www.copingengine.com/ is being disseminatedthrough lectures and internet distribution. As inter-est increases, and supporting funds develop, a vali-dation of it’s effectiveness is planned. StanfordUniversity Hospital, the American Cancer Societyand others have found the website useful forpatients. CONCLUSIONS: Since the 1990′s thedevelopment of interventions for cancer patientshas followed the medical guidance and self-helpmodels of each decade. As people throughout theworld make use of websites to learn about andsolve their problems, it is helpful to have a teachingtool on line which improves the ability to find solu-tions to problems that brings up emotionallycharged negative feelings. RESEARCH IMPLICA-TIONS: With additional funding, validationresearch is planned to learn the effectiveness thatcopingengine.com has for subgroups. What stepsare necessary to make an active coping choice



work? The copingengine.com can be expanded toaddress the needs of other chronic illness groups,the bereaved, or being in a “car accident.” Outcomeresearch is possible, how does 1 judge whether anactive coping choice was helpful or not. Work hasbeen started in these directions. CLINICALIMPLICATIONS: Cancer patients experience fre-quent moments of distress post-diagnosis, duringthe treatment period and beyond. Now, with accessto a computer, i Pad, and i Phone or Android, thepatient will have the opportunity to define his feel-ings, and thoughts and choose a solution to prob-lems that come up for them each day.ACKNOWLEDGEMENT OF FUNDING: Thewebsite, http:www.copingengine.com/ was fundedby the author. The teaching experience in Vietnam,November 2012 came from grant #5133, CIES Ful-bright Specialist program.

P1-59

Motivating (Former) Cancer Patients to Increase

Their Physical Activity: The Computer Tailored

Oncoactive + Project

RHJ Golsteijn1, C Bolman1, DA Peels1,

H de Vries2, L Lechner1

1Open University of the Netherlands, Heerlen, TheNetherlands, 2Maastricht University, Maastricht,The Netherlands

BACKGROUND: The increasing incidence ofcancer, increasing survival rates, and importantnegative physical, psychological and psychosocialeffects of cancer and its treatment emphasize theimportance to develop interventions that reducenegative effects and prevent recurrence of cancerand co-morbidities. Physical activity (PA) enhanc-ing interventions provide important efforts in thisrespect. Despite the beneficial effects of PA, most(former) cancer patients do not meet the recom-mended levels of PA, therefore easily accessible PAprograms should be developed. METHOD: Dur-ing this project an existing effective personalizedcomputer tailored intervention (based on behav-ioral change techniques) to increase and maintainPA in older adults (ActivePlus) will be adapted andextended for (former) colon and prostate cancerpatients. Adaptations will be based on preliminarystudies, literature and interviews with cancerpatients and experts. A randomized controlled trial(RCT) will be performed, comparing the interven-tion to a waiting list control group. In total 428(former) colon and prostate cancer patients will berecruited. Follow-up measurements will be per-formed 3, 6 and 12 months after baseline measure-ment. Concurrently a process evaluation will beperformed. RESULTS: The adaptations will resultin a unique new intervention for (former) colon andprostate cancer patients: OncoActive+. The inter-vention will be fine-tuned to specific needs and

experiences of (former) cancer patients such as cop-ing with fatigue, lack of energy, physical sideeffects, distress and a lack of self-efficacy in over-coming these barriers. A printed and a Web-basedversion of the intervention, and a website with addi-tional elements (e.g. discussion forum, expert con-sultation facility) will be developed. The RCT willprovide us with information on PA behavior,health outcomes (e.g. health related quality of life,fatigue) and appreciation of the intervention. CON-CLUSIONS: The developed OncoActive+ inter-vention will be an easily accessible PA interventionfor (former) colon and prostate cancer patients asthe user defines when and how to be physicallyactive. Since OncoActive+ is based on computertailoring, it has the potential to easily reach broadpatient populations with low (personnel) costs, andis therefore low in demand of health care providers.If proven effective, the feasibility of the interven-tion will be examined among relevant organizationsin order to come up with an end product that isusable in practice. In the future OncoActive+ mightalso be useful for other cancer types. RESEARCHIMPLICATIONS: The results of the RCT mayprovide information on the effects of PA on (for-mer) colon and prostate cancer patients. If the On-coActive+ interventions is effective in increasingPA, further research may be done to extend theintervention to other groups of cancer patients.Additionally, the research may also provide infor-mation on the feasibility of implementing PA pro-grams in practice. CLINICAL IMPLICATIONS:OncoActive+ has the potential to positively influ-ence several health outcomes, cancer recurrenceand co-morbidities by stimulating PA. As most cur-rent PA programs are based on face-to-face con-tacts, they are quite demanding for health careproviders in terms of time, money end quality ofimplementation. If proven effective, OncoActive+would be a less demanding alternative to most cur-rent PA programs. The end product of the projectought to be ready for large scale implementation.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was funded by KWF Kankerbestrijding(Dutch Cancer Society), project number NOU 2012-5585.



P1-60

Communicating Cancer Treatment Information

Through the Web - How can we use the Patient’s

Perspective in Developing Useful Information?

Wendy Hopmans, Olga Damman, Danielle

Timmermans, Cornelis Haasbeek, Ben Slotman,

Suresh Senan

VU University medical center, Amsterdam, TheNetherlands

BACKGROUND: As patients are increasinglyexpected to participate in healthcare decisions, ade-quate and useful information about cancer treat-ment is vital. It seems important to incorporate thepatients’ perspective in developing such informa-tion.The purpose of this study was to investigatehow patients understand, use and evaluate a newlydeveloped website providing information on a newtreatment option for stage I non-small cell lungcancer (NSCLC). METHOD: From patients whowere referred to undergo stereotactic ablative radio-therapy (SABR) for stage I NSCLC, as well as theirfamily members, a total of 24 were recruited. Aqualitative user evaluation of the developed proto-type website was followed by an additional user testafter a redesign of the website. Methods usedincluded semi-structured interviews and “thinkingaloud”. RESULTS: Participants appeared mostinterested in the pages about “which treatmentoptions are available” and “what is stereotacticradiotherapy”, and indicated a preference need formore detailed information. Furthermore, not allparticipants clearly understood the risks of side-effects and struggled with some specific definitionsmentioned on the website, especially concerningNSCLC and the difference between conventionalradiotherapy and SABR. CONCLUSIONS: Byusing several established user testing methods suchas thinking aloud, we gathered data before andafter design changes of the website. Pre- and postcomparisons of the website highlighted theimprovements made to the site, including a largedecline in number of problems and increased read-ability and lay-out. Had this qualitative approachnot been taken, some of these problems and subse-quent improvements to the website may have beenoverlooked, and the website would thus not havebeen patient-centred. RESEARCH IMPLICA-TIONS: The development of online informationabout cancer treatment should involve testing bypatients, as involving the targeted patient group inwebsite development will increase the likelihood ofa more patient-centred and comprehensive websitethat can support patient participation in treatmentdecision-making. CLINICAL IMPLICATIONS:By involving patients in the development of ade-quate and useful cancer treatment information, cli-nicians can understand the information needs andbarriers in information processing of their patients

when confronted with new treatment options. Thiscan lead to better available information, which cansupport the treatment decision making process.ACKNOWLEDGEMENT OF FUNDING: None.

P1-61

An Online Community for Oncology Professionals in

Flanders

Eva Jacobs1, Sabien Bauwens2, Wim Distelmans2,

Sofie Eelen1, Angelique Verzelen1

1C�edric H�ele Instituut vzw, Mechelen, Belgium,2Universitair Ziekenhuis, Brussel, Belgium

BACKGROUND: Within the Belgian NationalCancer Plan 320 extra psychologists, nurses andsocial workers were recruited. This increased theneed for exchange and sharing experiences in Bel-gium. In answer to these needs, the C�edric H�eleinstitute (CHi) wants to create a secure online com-munity, with access to up-to-date information,training materials and scientific research. The CHitrainings and workshops confirm the need forexchange of knowledge and good practices betweenhealth care providers, beyond the borders of hospi-tals and organizations. METHOD: CHi conducteda qualitative research with 100 onco-professionalsto discover the need for an online community. Wedeveloped a survey. Results show a large supportbase for the community, beyond the borders of dis-ciplines and institutions. There is little to no experi-ence in the use of communities. Many professionalsuse the internet on a regular basis to search forwork related information. Almost all professionalswere in favor of an accessible online platform inpsycho oncology. In addition CHi composed a coregroup with representatives from each discipline(oncologist, psychologist, social worker, nurse) inorder to specify and further develop functionalities.RESULTS: There is a large support base, bothamongst professionals working in the hospitals asin the home care for cancer patients. Major focus isease of use, the community shouldn’t require priorknowledge or experience with social media. It is asecure platform, with clearly visible profiles, andclose quality control. In terms of functionalities,there is a need to a clear who’s who, a news feed, aforum for the exchange of study materials and dis-cussions, calendar with useful events and trainingcourses, a research track in which the bridgebetween researchers and clinicians is simplified, e-learning possibilities. CONCLUSIONS: An onlinecommunity is a relatively new phenomenon withinthe healthcare industry. A search for similar initia-tives provided little to no sites. CHi would mainlyexpand the interactive part of the site and give peo-ple the chance to strengthen their working skills.The CHi community wants to cultivate better psy-chosocial care for cancer patients, in a secure envi-ronment. All relevant, up-to-date information in



our field will be there to consult. To this end, we setup cooperation initiatives with universities, key-players and experts in Psycho-Oncology.RESEARCH IMPLICATIONS: The communityaims to connect the clinical world with scientificresearchers. There will be more attention to imple-mentation of research results in the daily practice.The community will facilitate contacts betweenresearchers and clinicians making participation inresearch more accessible. Researchers will haveclearer view of research questions, relevant to thefield. The community will help to establish and real-ize multicentre studies. CLINICAL IMPLICA-TIONS: The clinical implications are 3-fold: toscientific research, offering access to relevant high-quality information, create a platform for continu-ous professional development. Researchers canannounce and publish their research results directlyto professionals, which will facilitate implementa-tion in the daily practice. In addition, access toquality information for onco-professionals will besimplified, bundled in one place. The meeting withcolleagues will respond to the need to exchange.ACKNOWLEDGEMENT OF FUNDING: TheC�edric H�ele instituut was founded thanks to thesupport of the national society “Vlaamse Liga tegenKanker” (the Flemish League against Cancer).

P1-62

Development and Feasibility of a Web-Based

Question Prompt Sheet Aimed to Increase the

Discussion of Health Related Quality of Life Topics

in the Initial Follow-Up Consultation After

Esophageal Cancer Surgery

Marc Jacobs, Inge Henselmans, Derk Arts,

Mark van Berge Henegouwen, Mirjam Sprangers,

Hanneke de Haes, Ellen Smets

Academid Medical Center / University ofAmsterdam, Amsterdam, The Netherlands

BACKGROUND: Given the poor prognosis ofesophageal cancer and the impact of surgery onhealth-related quality of life (HRQL), it is impor-tant to address patients’ postoperative informationneeds. Therefore, we have developed a web-basedlist of example questions (i.e., a question promptsheet, QPS) for the initial follow-up consultationafter surgery for esophageal cancer. The QPS aimsto increase patient participation (e.g., more ques-tions asked) and the discussion of HRQL topics.METHOD: We will conduct a total of three studiesto examine (1) patients’ usability of the QPS(n = 8), (2) patients’ evaluation of the usability andusefulness of the QPS (n = 40), and (3) the clinicalfeasibility of the QPS (20 patients and 2 surgeons).Each study will produce a modified QPS which willthen be tested in the subsequent study. In study 1,we asked purposefully selected patients who had

undergone surgery, to think aloud whilst using theQPS. Patients were surveyed afterwards. We thencategorized audio recorded comments, and changedthe QPS accordingly. RESULTS: Study 1: 8patients (6 male, age range 51–70) were interviewed(mean 1 h 45 m). We obtained 454 individual com-ments (187 positive, 214 negative, 27 neutral) and91 explicit suggestions for improvement. Most com-ments were related to: (1) the introduction of theQPS, (2) navigation, (3) the arrangement of exam-ple questions, (4) instructions, and (5) logging out.All patients perceived the QPS to be very useful,and many proposed to extend its use to other con-sultations. Most patients did not find the QPS bur-densome. CONCLUSIONS: Study 1 resulted inseveral changes to the QPS to enhance patient-friendliness. The results of study 2 and 3 will furtherdetermine the feasibility of a web-based QPSintended to increase the information provision ofHRQL. These studies are ongoing and (prelimin-ary) findings will be presented at the conference.RESEARCH IMPLICATIONS: This QPS isunique in that it is: (1) web-based and linked to thesurgeon, (2) focused on HRQL, (3) for use in a fol-low-up consultation, and (4) designed for patientswith esophageal cancer. In addition, this projectdemonstrates the iterative process of the develop-ment of a feasible communication support tool. Bymaking use of several methods (e.g., think-aloudinterviews, web-based surveys, pilot study in clini-cal practice), we aim to deliver a thoroughly devel-oped QPS. CLINICAL IMPLICATIONS: ThisQPS aims to provide both patients and clinicianswith a valuable tool to prepare the initial follow-upconsultation after surgery for esophageal cancer.As a result, we aim to increase the number ofHRQL questions asked by patients, and also thenumber of HRQL topics covered by clinicians. Inthe end, we aim to increase tailored informationprovision, and to help patients cope with the oftendetrimental and long-lasting side-effects of esopha-geal cancer surgery. ACKNOWLEDGEMENTOF FUNDING: None.

P1-63

The Effect of age on Perceptions of e-Health in Men

with Prostate Cancer (PCa)

Camella J. Rising1, Nadine Bol2, Samira Hosseini1,

Selamawit Tesfaya1, Gary L. Kreps1

1Department of Communication, George MasonUniversity, Fairfax, Virginia, USA, 2AmsterdamSchool of Communication Research/ASCOR,University of Amsterdam, Amsterdam, TheNetherlands

BACKGROUND: PCa patients confront physio-logical and psychological ramifications of diseaseand treatment that require ample informationaland emotional support. E-health may convey such



support through static Internet media as well asinteractive online communication. Currently, evi-dence about how age influences use and perceptionsof PCa e-health is lacking. We examined Internetbehavior and experiences to determine whetherthere are differences between patients under65 years old and patients 65 years old and older.METHOD: Permission for this study was grantedby the institutional review board of George MasonUniversity and the Inova Health System. PCapatients (n = 297, Mage = 64.99, SD = 8.32, range40–89) were recruited through the Inova HealthSystem and online PCa social networks. A ques-tionnaire was designed that included measuresrelated to personal and PCa characteristics; generalInternet use; PCa e-health seeking behavior andexperiences; reasons to use/not use PCa-relatedonline communication; and psychosocial dimen-sions of e-health (feeling informed, in control, con-nected with others, able to cope, confident intreatment decision, scared, depressed, lonely, anx-ious). RESULTS: Compared to older patients,patients under age 65 were more frequent and com-fortable Internet users. Younger patients used e-health more for concern about erectile dysfunction,whereas older patients used e-health more for con-cern about urinary incontinence (v² = 3.85,p = 0.050). Regarding online communication,younger patients reported using e-health more toreceive emotional support (v² = 12.50, p < 0.001).Finally, older patients experienced more negativepsychosocial dimensions of e-health (e.g., moreanxious, depressed) and less positive dimensions ofe-health (e.g., more informed, in control) as a resultof less Internet use (b = �0.10, 95% CI [�0.26,�0.01]). CONCLUSIONS: Our findings suggestthat greater use of the Internet leads to a more posi-tive psychosocial response to PCa-related Internetinformation and/or support. Furthermore, importantfindings include greater use of online PCa communi-cation for emotional support and encouragement byyounger patients. This is noteworthy because pastresearch without consideration for age has shown e-health to be used predominantly for informationalsupport over emotional support. Because PCa inci-dence is lower in men under 65 years old, it may bedifficult to find emotional support in their own socialcircles. Online social networks may generate newsocial circles to fulfill emotional support needs.RESEARCH IMPLICATIONS: Our findingsshow that use and perceptions of PCa e-health varyby age. Future studies should examine how use andperceptions vary not only by age but with greatertime since diagnosis. Furthermore, audience analy-sis of other segments of the PCa population is war-ranted, including evaluation of patients affected bythe “digital divide,” such as racial and ethnicminorities. Understanding of diverse audience seg-ments gleaned from research should be translatedfrom evidence to practice. CLINICAL IMPLICA-

TIONS: Clinicians should be cognizant of greateruse of e-health for emotional support among youn-ger PCa patients. Patients under 65 years old maybenefit from education about how to access onlinePCa social networks. Furthermore, for patients65 years old and older, clinicians should be awareof the relationship between increased Internet expe-rience and positive psychosocial effects of e-health.Helping advance the Internet skills of this agegroup may reduce feelings of loneliness, anxietyand depression. ACKNOWLEDGEMENT OFFUNDING: None.

P1-64

Digitally Empowered: Psychometric Validation of an

Instrument to Measure Patient Reports of

Informational and Decisional Empowerment

Gul Seckin, Ilkem Coskun

Isik University, Istanbul, Turkey

BACKGROUND: Nearly half of cancer web siteshave links to online health support communities.This suggests computer-connected patients’ desireto be proactive by networking with other patientsand developing their support resources. The aim ofthis presentation is to provide data on initial psy-chometrics of a newly developed the Cyber Info-Decisional Empowerment Scale (CIDES). Theinstrument is a seven-item self report questionaireand measures perceived informational and deci-sional support benefits of using cancer supportwebsites. METHOD: Data come from a sample of(N = 350) of cancer patients (M = 50, SD = 11)who participated in the Study of Virtual HealthNetworks for Cancer Patients of the 21st Century.Respondents completeted the survey in a web-basedformat. A subsample of women with breast cancer(N = 255) was selected from the total sample andfurther divided into age-based subsamples to assessfactor structure stability on an age-stratified sub-sample. Data were subjected to exploratory factoranalysis (EFA) using principle components withVARIMAX rotation on the full and subsamples. Aconformatory factor analysis (CFA) was conductedusing AMOS 19.0 to further validate the scale.RESULTS: The composite scale is unidimensionalwith excellent internal consistency reliability. Thehighest average scores were obtained for informa-tional empowerment items. The lowest average wasfound for the item that measured empowerment toseek second opinion from other health care profes-sionals. Comparison of the resulting factor matricesacross the subsamples and CFA goodness-of-fitindices provided an additional confirmation of therobustness of the scale. CONCLUSIONS: Thestudy provides initial empirical foundation of aninstrument specifically designed for measurementof digital empowerment. The study expanded themeasurement of patient empowerment to include



info-decisional support in cyberspace via peer-based health communities. This is the first step,albeit an important one, in understanding howcomputer-mediated health support communitieshelp those coping with cancer. RESEARCHIMPLICATIONS: The ability of this compositemeasure to provide information about the extent towhich computer-connected patients view digital peersupport as an empowerment tool makes it a valuableaddition to the literature on supportive care in can-cer and quality of life research. As there is a growingdiscussion in online information technology totransform personal health, the findings constitute astep forward in understanding how patients usetechnology to better manage their health carethrough provision of support. CLINICAL IMPLI-CATIONS: The information obtained from theadministration of this short scale will provide helpfulinformation for health care professionals andresearchers in understanding patient efforts to beproactive during the process of cancer management.Additionally, this instrument will help to unpack dig-ital influences on physician and patient encounters.ACKNOWLEDGEMENT OF FUNDING: None.

P1-65

The Use of Social Media to Recruit Participants in

Cancer Care Research: Challenges and

Opportunities

Carolina Casa~nas i Comabella, Marta Wanat

Oxford Brookes University, Oxford, UK

BACKGROUND: Ethical concerns about theinvolvement of seriously ill patients in research areoften raised by ethics committees and health careprofessionals. On the other hand, seriously illpatients are happy to take part in the studies as itoften gives them a sense of purpose and an oppor-tunity to give something back. As a result, recruit-ment in this field is often challenging. Social mediacan provide an alternative opportunity for recruit-ment. METHOD: Ethical concerns about theinvolvement of seriously ill patients in research areoften raised by ethics committees and health careprofessionals. On the other hand, seriously illpatients are happy to take part in the studies as itoften gives them a sense of purpose and an oppor-tunity to give something back. As a result, recruit-ment in this field is often challenging. Social mediacan provide an alternative opportunity for recruit-ment. RESULTS: The types of social media mostcommonly used for recruitment include, but are notlimited to, interactive social applications (e.g. Face-book) and blogs. Some studies have successfullyused social media to recruit the so called “hard toreach” participants, as they have the potential totarget a wider audience. However, this method mayattract patients who are already well informed andproactive in seeking support, creating a biased

picture. Screening of potential participants mayalso prove difficult as it relies on patients’ under-standing of their condition, which in a traditionalresearch set-up is usually done by the clinicians.CONCLUSIONS: Social media provide an oppor-tunity worth exploring in regards to the recruitmentof research participants in fields where recruitmenthas proven to be challenging. However, the scientificliterature on the use of social media to recruitresearch participants in cancer care is sparse andmore research needs to be done in this field. The casestudy presented here has shed some light into thepotential challenges and opportunities when usingsocial media for recruitment purposes. Guidelinesmust be kept up to date in the fast-moving, dynamiclandscape of social media. RESEARCH IMPLICA-TIONS: The opportunities provided by this methodof recruitment should not be overlooked. Equally,we must be mindful of the ethical challenges associ-ated with the use of social media. Methodologically,using social media may produce an inaccuratepicture of patients’ experiences and needs, aspatients who use social media might not be represen-tative of the population studied. Guidelines areessential if we are to incorporate this as a standardpractice. CLINICAL IMPLICATIONS: Holisticcare means responding to changing patients’ needs.e-Health is part of a paradigm shift, where patientshave become active consumers, as opposed to thetraditional, “doctor knows best”, passive receiverof health care. The use of social media by patientsin healthcare provides a very good example of thisnew paradigm. ACKNOWLEDGEMENT OFFUNDING: Oxford Brookes University.

P1-66

Kanker Nazorg Wijzer: Supporting Cancer Survivors

With Psychosocial and Lifestyle Problems Using an

Online Tailored Intervention

Roy Willems1, Catherine Bolman1, Ilse Mesters2,

Iris Kanera1, Audrey Beaulen1, Lilian Lechner1

1Open University of the Netherlands, Heerlen, TheNetherlands, 2Maastricht University, Maastricht,The Netherlands

BACKGROUND: Cancer is a life-threatening dis-ease which causes psychosocial and physical prob-lems that may continue after primary treatment hasbeen completed successfully. However, the currentaftercare available does not sufficiently meet cancersurvivors’ needs. Therefore, we developed an onlinetailored intervention, the “Kanker Nazorg Wijzer”(Cancer Aftercare Guide; KNW). The primary goalof the KNW is to encourage self-management incancer survivors, in order to help them to deal withpsychosocial and lifestyle problems they encounter.METHOD: The content of the KNW was deter-mined by the results of preliminary research, consist-ing of a literature study and focus group interviews



and a survey among former cancer patient. Aim ofthis research was to investigate the most prominentinformation and support needs of former cancerpatients and to gain insight in the psychosocial andlifestyle problems they experience. For the evalua-tion of the KNW, an RCT with follow-up measure-ments at 3, 6 and 12 months will be performedcomparing the KNW intervention to a waiting listcontrol group. In total, 750 adult cancer survivorswill participate in the study. RESULTS: The preli-minary research results led to the development ofeight modules in the KNW focussing on depressionand anxiety, fatigue, return to work, social contactsand intimacy, physical complaints, physical activ-ity, nutrition, and smoking. First, participants willbe advised which modules fit their specific needs.Within a module, participants get tailored adviceand practical assignments teaching them to copebetter with the specific theme. Additionally, partici-pants can get in contact with other cancer survivorsthrough online discussion forums. The RCT willprovide information on change of self-managementand coping skills, lifestyle behaviours, and experi-enced quality of life and psychological distress.CONCLUSIONS: The KNW will be an easilyaccessible self-management intervention for cancersurvivors. Since the KNW is based on computertailoring, it has the potential to easily reach broadpatient populations at low costs, while still provid-ing specific information tailored to the personalneeds of the user. Also, the KNW is consistent withthe current guidelines, stating that self-managementin cancer survivors should be stimulated. If theKNW cannot sufficiently meet the user’s needs, theuser will be advised on where to get (more inten-sive) professional help. In this way, the KNW canserve as a starting point in stepped care.RESEARCH IMPLICATIONS: The results of theRCT will provide information on the relationshipbetween secondary outcomes such as coping, per-ceived social support, experienced fatigue, return towork and lifestyle behaviour on the primary out-comes quality of life and psychological distress.Additionally the research will provide informationof the intervention elements, including tailoredinformation and self-management training on theprimary and secondary outcomes. CLINICALIMPLICATIONS: The development of the KNWintervention could lead to a theory- and evidence-based intervention aimed at improving QoL of can-cer survivors by assisting them in self-care. Thestudy results will demonstrate which people are atrisk of developing psychosocial and lifestyle prob-lems during their life after cancer. The KNW aimsto support these patients by encouraging self-carethrough offering tailored information and supportat an early stage. ACKNOWLEDGEMENT OFFUNDING: This research project is funded by theDutch Cancer Society (KWF Kankerbestrijding).

P1-67

Unmarried Women With Breast Cancer: Their

Psychological Distress and Quality of Life After

Treatment

Rainbow T. H. Ho1,2, Irene K. M. Cheung1,

M. Y. Luk3, Paul S. F. Yip2, Phyllis H. Y. Lo1,

Caitlin K. P. Chan1, Cecilia L. W. Chan2

1Centre On Behavioral Health, The University ofHong Kong, Hong Kong, 2Dept of Social Work andSocial Administration, The University of HongKong, Hong Kong, 3Dept of Clinical Oncology,Queen Mary Hospital, Hong Kong

BACKGROUND: According to the World HealthOrganization in 2008, there were around 7.6 mil-lion people died from cancer around the world.More and more women encountered the incidenceof breast cancer. Early detection and improvementin breast cancer treatments had contributed to thelow breast cancer death rates, however patientsgone through cancer treatments may usually experi-ence lots of physical discomfort and psychologicaldistress. The negative affect even lasts after thetreatment. METHOD: Pre-test and post-testdesign had been used in this study. 76 breast cancerpatients had been recruited from 2 local hospitalsand community cancer support organization. Par-ticipants were asked to fill in a set of self-reportedquestionnaires prior to the commencement ofradiotherapy treatment and right after the comple-tion of the treatment. Participant’s radiotherapy-related symptoms (fatigue, stress, anxiety, depres-sion, pain level and sleep disturbances) and qualityof life would be measured. RESULTS: At the base-line measurement, married women scored highermark in social well-being (FACTB-SWB), func-tional well-being (FACTB-FWB) and overall qual-ity of life (FACTB) than single women. There wassignificant difference at baseline (before randomiza-tion) in their quality of life between the marriedwomen and single women (all ps > 0.05). The post-test measurement (after receiving the radiotherapytreatment), married women still scored significanthigher quality of life score than single women.Moreover, single women had lower emotional well-being (FACT-EWB) and higher psychosocial dis-tress (PSS). CONCLUSIONS: This research find-ing is aimed at discussing the psychologicalcharacteristics and quality of life among marriedand unmarried breast cancer patients. Findingsshowed that unmarried had more negative psycho-logical reactions to the cancer treatment and itaffected their quality of life. More than that, singlewomen had higher psychological distress aftertreatment. It would be a negative influence ontheir survivorship care. RESEARCH IMPLICA-TIONS: The importance of spousal support afterbreast cancer treatment had been widely studied inthe field. However, limited research findings has



addressed on the psychological needs of singlewomen. This study may reveal the unique chal-lenges of unmarried women with breast cancer.And how did the cancer treatment affect their socialand functional well-being. CLINICAL IMPLICA-TIONS: It is very important to provide intensivepsychological care to breast cancer patients aftertreatment. This study may also imply that singlewomen with breast cancer may need more survivor-ship care after cancer treatment. ACKNOWL-EDGEMENT OF FUNDING: This study issupported by the Research Grants Council GeneralResearch Fund (HKU745110H), Hong Kong Can-cer Fund, Queen Mary Hospital and Pamela YoudeNethersole Eastern Hospital.

P1-68

A Unique Challenge: Sexuality in Young Women

After Breast Cancer Treatment From a

Developmental Perspective

Monika Jankowska

The Greater Poland Cancer Centre, Poznan, Poland

BACKGROUND: Earlier diagnosis and advancesin breast cancer treatment have significantlyimproved survival rates. Consequently, quality oflife has become a matter of great importance andmore attention has been focused on sexuality.Although sexuality is important at every stage oflife, it plays a crucial role for young women inachievement of developmental tasks: establishingintimate relationship and starting a family. Alteredsexuality after cancer treatment may create aunique challenge in their development.METHOD: Review of literature was made to pres-ent up-to date research findings on sexual life inyoung women with breast cancer. The PubMed,Elsevier, Medline browsers and the web weresearched for scientific articles published in Englishlanguage in the period of 1999–2013. Followingphrases were used: breast cancer, young women,premenopausal, sexual, sexual functioning, sexual-ity, development, developmental tasks. Literaturereview was supplemented by the author’s own clini-cal experience. RESULTS: Numerous studiesreport that many young women experience distur-bances in body image after breast cancer treatment.Invasive therapy raises concerns about fertility. Awide variety of sexual dysfunctions are reportedincluding low sexual desire, decreased arousal andlubrication, impaired orgasm, painful intercourse,diminished sexual satisfaction and frequency of sex-ual activity. What is more, treatment may inducepremature menopause. Altered sexuality challengefuture and present relationships. Single women faceconcerns about cancer disclosure and engaging innew intimate relationships whereas couples have toresume sexual activity after cancer and adjust to anew sexual situation. CONCLUSIONS: Breast

cancer treatment may affect sexuality of youngwomen in all its domains: biological, psychologicaland relational and sexual act in all its functions:procreation, pleasure and intimacy at the timewhen sexuality is essential in successful attainmentof specific developmental tasks: being in an intimateromantic relationship and starting a family. Alteredsexuality may threaten natural developmental tra-jectory. Consequently, young women after breastcancer treatment are at high risk of sexual dysfunc-tions and are more vulnerable to disruptions inbiopsychosocial development. Due to this uniquedevelopmental context young women requirespecial attention of researchers and clinicians.RESEARCH IMPLICATIONS: A precise defini-tion of young women must be provided. Moreresearch on the impact of breast cancer on sexualityand intimate relationships in young women isneeded both from women’s and partners’ perspec-tives. Risk and protective factors for sexual dys-functions must be recognized for single andpartnered women, in heterosexual and same-sexcouples, with more attention to cultural contextand methodological quality of studies. A uniqueexperience of young BRCA mutation carriersrequires further investigation. CLINICAL IMPLI-CATIONS: Due to developmental context changesin body image, sexual functioning and fertility inyoung women with breast cancer must be addressedin clinical settings throughout the process of diag-nosis, treatment and recovery. Intervention pro-grams should be couched in developmentalframework. Interventions that target body image,cancer disclosure and establishing new relationshipsseem beneficial for unpartnered women whereascoupled-based psychoeducational interventionswith elements of sexual therapy are recommendedfor partnered women. ACKNOWLEDGEMENTOF FUNDING: None.

P1-69

Sexuality and Cancer in the Elderly: What About

Moroccan Patients?

Sihame Lkhoyaali, Meryem Ait el haj, Reda

Khmamouche, Saoussane Kharmoum, Youssef

Bensouda, Hassan Errihani

National Institute of Oncology Moulay Abdellah,Rabat, Morocco

BACKGROUND: Understanding sexualityamong older adult cancer survivors is com-plex.Thorough assessment merits consideration ofnormal physical and emotional changes with age.In Morocco, the influence of cancer on sexualityrepresents a delicate and little investigated subjectwhere the taboo of sex adds to the mystical fear ofthe disease. This survey has shown that lack ofcommunication is one of the main problems in



recognizing and handling sexual problems.METHOD: We conducted a prospective studyconducted during 10 months, including 150patients aged over 70 years followed at theNational Institute of Oncology in Rabat assessingthe impact of cancer on sexuality in older subjectsafter informed consent. RESULTS: Median agewas 73 ans, the most commun cancer is lymphomaand breast cancer 82 (54.7%) patients were mar-ried, 43.3% widower, 72(48%) of patients have apreserved sexual activity. 65% of patients reporteddecrease in libido, 19.4% have erectile dysfonctionand only 9.7% of them were able to communicatewith their spouse partner about this taboo. Anxietywas found in 74% of cases and depression in 12.6%(DSM IV). 52 patients (34.7%) admitted takingplants and 30 (20%) patients used sprituel medicineCONCLUSIONS: In morocco the impact of can-cer in sexuality represents a delicate and little inves-tigated subject where the taboo of sex specially inthe elderly adds to the mystical fear of disease. thepatient partner’s spouses and healthcare teamunderestimate this impact witch affect the qualityof life.Efforts are necessary to improve sexual activ-ity of elderly cancer patients ACKNOWLEDGE-MENT OF FUNDING: None.

P1-70

Dealing With Cancer – Does Gender Matter?

Gender Differences as an Important Psychosocial

Aspect in Cancer Patients

Anahita Paula Rassoulian, Birgit Flechl, Olivera

Cenic, Andras Acel, Cathrin Skrabs, Heinz

Gisslinger, Christine Marosi, Gerald Prager,

Markus Raderer, Christoph Zielinski, Ulrich J€ager,Alexander Gaiger

Department of Medicine I, Division of Hematologyand Hemostaseology and Division of Oncology,Medical University of Vienna, Vienna, Austria

BACKGROUND: Cancer is a leading cause ofdeath worldwide and the total number of casesglobally is growing, influenced in part by anincreasing and aging world population. Genderaspects have been identified as relevant to ourhealth system, patient-doctor communication andthe outcome of cancer patients. So far, limited datais available analyzing the relationship between gen-der aspects, somatic and psychosocial parametersin cancer patients. METHOD: 4278 adult cancerpatients (51.8% women, 48.1% men) were includedin a cross-sectional single-center study. Fifteensomatic and psychosocial variables were includedin the analysis based on published data and feasibil-ity: somatic factors: sex, age, cancer site, metastaticdisease, anemia; social factors: income, education,unemployment, social support (children, maritalstatus), residency; psychological factors: depres-

sion, anxiety, distress and previous psychiatric dis-orders. Standardized questionnaires have been usedto assess anxiety and depression (the Hospital Anx-iety and Depression Scale –HADS- cut off >7 fordepression and >9 for anxiety), socio-demographiccharacteristics as well as the patients’ need for psy-cho-oncologic support. RESULTS: Our data dem-onstrated significant psychosocial differences basedon gender issues in patients dealing with cancer.Women showed significantly higher levels of anxi-ety (p < 0.001), requested more frequently psycho-social support by our psycho-oncology team(p < 0.005) and subsequently received more psy-chosocial support. Women affected with cancerwere more often divorced/widowed (social sup-port), had lower education and income than men.Moreover, a significantly higher number of womenused complementary medicine in addition to theirstandard treatment. CONCLUSIONS: The resultsof this study indicate that1. women and men have different perceptions of

anxiety when affected with cancer.2. higher levels of anxiety and lack of social sup-

port resulted in an active coping style (requestfor psychosocial support) in female cancerpatients.

3. psycho-oncological support strategies offeredin our study either do not reflect the needs ofmale patients or are not communicated in agender appropriate manner or are indeed notneeded by male patients.

RESEARCH IMPLICATIONS: Given the impactof gender aspects in cancer, these factors should beconsidered in the design of future therapeutic trials,screening and treatment approaches for individualpatients. Failure to acknowledge the impact of gen-der aspects in communication and study designmight account for a confounding bias in clinical tri-als. CLINICAL IMPLICATIONS: Gender spe-cific psycho-oncological approaches need to beestablished. Data presented here indicate that theinclusion of gender issues support the goal of per-sonalized medicine to use each patient′s uniquegenetic and environmental characteristics to designoptimal health care strategies. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-71

Breast Cancer: Identity, Intimacy, Sexuality After

Total Mastectomy

Carole Suzor

Butterfly-Projects, Qu�ebec, Canada

BACKGROUND: In Western Society, breasts areovervalued. How does react a woman after a totalmastectomy? There is a face to face with a loss ofthe physical integrity. In the real mirror, she sees animage of an asymmetric body. However, other



images arrive in the same time in the mirror. Theycome from the social and symbolic mirrors. Whatare the impacts of these images on identity, inti-macy and sexuality after total mastectomy?METHOD: I studied this issue by an exploratoryqualitative sociological research. Therefore I inter-viewed (n = 12) women in Quebec (Canada) whohad a total mastectomy (n = 6) with breast recon-struction (n = 9) with chemotherapy. Their age var-ied from 35 to 56 years old. Nine (n = 9) womenwere less than fifty. Eight (n = 8) women had a het-erosexual partner living with her (4 = singles). Theinterviews were intimate and varied from 45 min-utes up to two and a half hours. I analysed, therespondent’s comments that started with the dis-covery of breast anomaly until the sexual interac-tion post-mastectomy, by a content analysis (n = 5themes). RESULTS: After analysis, I developedthe concept of Mirrors. In these Mirrors, theimages interlaced: real, symbolic, social. If somewomen felt as complete women with a new body,others felt as incomplete women or half woman. Inmy study, (n = 9) women resumed sexual interac-tion after breast removal and before breast recon-struction (n = 5). Two women had a sexualexclusion from their regular partner. These 2women, without breast reconstruction, received aproposition from men who knew about their totalmastectomy. One of them refused and anotherwoman accepted. One woman with breast recon-struction refused propositions before and afterbreast reconstruction. CONCLUSIONS: The sex-ual life is possible after total mastectomy withoutbreast reconstruction. A sexual partner’s construc-tive look helps a woman’s perception (images) tore-find their identity as a complete woman. By theopposite, a destructive outlook from her partnerisn’t helpful. It destroys the sexual link. In mystudy, the women developed strategies to re-appro-priate their intimacy and sexuality: clothing, behav-iour, surgery (breast reconstruction). For some,breast reconstruction supports the re-building ofthe body image and/or the self-image. With breastreconstruction is easier to wear sexy lingerie, so tohave again a seductive approach with the sexualpartner. RESEARCH IMPLICATIONS: Myqualitative research was done in Canada in a Wes-tern Society. The perception and the interpretationof the images were come from of this socioculturalcontext. The social images from Mirrors depend onthe process of socialization. Where you were born,you growth up and you live influence the way howyou interpret the images after a total mastectomy.It would be interesting to study this issue by atranscultural research: African women, etc. CLINI-CAL IMPLICATIONS: The support groups andthe health professionals are significant for womenwho had a total mastectomy. They have an essen-tial role in helping women to regain their self-esteem, for some, consequently their feelings about

their completeness especially when a woman has apartner with a destructive outlook. To feel anincomplete woman interferes on intimacy and sexual-ity. It would be important to considerate this aspectand to integrate it in health care in onco-sexology.ACKNOWLEDGEMENT OF FUNDING: None.

P1-72

Abstract withdrawn

P1-73

Communication About Breast Cancer Genetic

Counseling Results With Daughters and Sisters in

the Long Term

Jessica Baars1,2, Margreet Ausems1, Elsvan Riel1,

Marijke Kars3, Eveline Bleiker2

1Department of Medical Genetics, Division ofBiomedical Genetics, University Medical CenterUtrecht, Utrecht, The Netherlands, 2Division ofPsychosocial Research and Epidemiology & FamilyCancer Clinic, The Netherlands Cancer Institute,Amsterdam, The Netherlands, 3Department ofMedical Humanities, Julius Center for HealthSciences and Primary Care, University MedicalCenter Utrecht, Utrecht, The Netherlands

BACKGROUND: Little is known about the com-munication to 1st degree relatives of genetic coun-seling results (e.g. DNA-test results, breast cancerrisks and/or screening recommendations) in thelong term. We investigated: (1) whether theseresults were a topic in conversations between moth-ers and daughters, and between sisters more thaneight years after receiving genetic counseling and,(2) how patients coped with the breast cancer riskand screening behavior of their first-degree rela-tives. METHOD: To date, 11 in-depth interviewshave been conducted by telephone with femalebreast cancer patients who had had genetic counsel-ing between 1997–2005, and received screening rec-ommendations for a daughter and/or sister. Weused QRS Nvivo 10 to assist with interview datamanagement and the thematic analysis. Interviewswere coded independently by 2 researchers and dis-crepancies were discussed and agreed within theresearch team. More participants will be recruiteduntil data saturation has been reached.RESULTS: Participants included BRCA 1/2 carri-ers (n = 2), and patients with an uninformative testresult (n = 9). Among the latter, DNA-test resultssuch as the meaning of the test and the increasedrisk for breast cancer, had usually not been dis-cussed during the past years. Mostly few wordswere devoted to recent results of periodic surveil-lance (e.g. mammography). One’s own alertnesswas seen as important for early diagnosis and sur-vival. However overall, patients wanted their 1st



degree relatives to continue their lives without wor-rying too much about breast cancer risk. CON-CLUSIONS: Preliminary results show that,though not frequently mentioned, screening prac-tices are a topic of communication between mothersand daughters, and between sisters in the long term.Among sisters, who were frequently given a copy ofthe counseling letter, patients felt they had donetheir duty to inform and it was now the responsibil-ity of their sister to undertake screening. Whendealing with their daughter’s increased breast can-cer risk, mothers tried not to pay much attention tothat, but to focus on the positive aspects of the par-ticipation to a breast cancer screening program andone’s own alertness. RESEARCH IMPLICA-TIONS: Genetic counseling advice is targeted tothe counselee, and usually to their female first-degree relatives. We gained insight into the contentof the communication between these family mem-bers and how they cope with their family members’elevated breast cancer risk in the long term. Inter-estingly, our qualitative analysis showed a differ-ence in the way of dealing with a daughter’s or asister’s elevated breast cancer risk. CLINICALIMPLICATIONS: Counselees have a central rolein the communication of genetic test results to rela-tives. We found that mostly sisters, but not all adultdaughters, were given a copy of the letter of thegenetic counselor. In the long term, these daughtersdepend on their mother for information about thegenetic counseling results. This raises questions asto whether this is an acceptable way of informingindividuals at elevated risk for breast cancer.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by the Dutch Pink RibbonFoundation (grant number 2010.WO14.C60).

P1-74

Supporting Counselees in Disclosing Hereditary

Cancer Information to At-Risk Relatives:

A Pilot Study

Eveline de Geus1, Cora Aalfs1, Fred Menko2,

Rolf Sijmons3, Hanneke de Haes1, Ellen Smets1

1Academic Medical Centre/University ofAmsterdam, Amsterdam, The Netherlands, 2VUUniversity Medical Centre, Amsterdam, TheNetherlands, 3University Medical Centre Groningen,Groningen, The Netherlands

BACKGROUND: Despite the use of genetic ser-vices, counselees do not always share hereditarycancer information with their at-risk relatives. Thisproject aimed to develop and assess the feasibilityof an intervention which supports counselees in dis-closing hereditary risk information to relatives.METHOD: Intervention: an additional telephoniccounseling session, delivered by psychosocial work-ers, after regular genetic counseling. An interven-tion protocol was developed by psychologists based

on Motivational Interviewing techniques, aiming toimprove counselees’ knowledge, motivation andself-efficacy with regard to informing relatives.Evaluation: Consecutive counselees visiting theClinical Genetic department for hereditary breast/ovarian or colon cancer received additional coun-seling and completed a pre- and post counselingquestionnaire. Feasibility of the intervention wasbased on (1) patients’ evaluation; (2) analysis ofaudio recorded counseling sessions; (3) pre- andpost counseling differences of the primary out-comes (knowledge, motivation and self-efficacy)and (4) recruitment potential. RESULTS: Of all358 counselees who were invited between Februaryand September 2012, 231 responded (65%); 21%declined participation and 43% gave their consentto participate. 144 counselees completed the pre-counseling questionnaire; 136 telephonic counselingsessions were recorded and 123 counselees com-pleted the post-counseling questionnaire (drop-out:15%). Preliminary results show that counseleesevaluated the intervention as positive. The psycho-social workers performed the counseling largelyaccording to the protocol. Pre- and post counselingdifferences were found for knowledge: M1 = 7.23,M2 = 9.10, p = 0.025; motivation: M1 = 50.61,M2 = 47.70, p = 0.01 and self-efficacy: M = 23.80,M2 = 25.01, p = 0.021. CONCLUSIONS: Theintervention, comprising an additional telephoniccounseling session to support counselees informingrelatives about hereditary cancer, was found to befeasible. The effectiveness of the additional counsel-ing will be investigated in a randomized clinicaltrial. RESEARCH IMPLICATIONS: This pilotstudies gives more insight in the feasibility of anintervention which supports counselees in disclos-ing hereditary cancer risk information to relatives.The effectiveness of this intervention must howeverbe investigated in a randomized clinical trial.CLINICAL IMPLICATIONS: Genetic counselorsrely on counselees to inform their relatives abouttheir hereditary cancer risk and possibilities toreduce this risk. It is therefore essential that theirability to be a good informant is maximized, whilerespecting their wish not to inform (some) relatives.The developed intervention will (1) support counse-lees in this difficult test and (2) hopefully allowmore at-risk relatives to make a well informed deci-sion taking up genetic services and preventivescreening. ACKNOWLEDGEMENT OF FUND-ING: This study was funded by the Dutch CancerSociety; Grant number: UVA 2010-4658.



P1-75

Awareness and Acceptability of Preimplantation

Genetic Diagnosis (PGD) as a Reproductive Option

Among BRCA Carrier Couples

Joyce Gietel-Habets1,2, Inge Derks-Smeets1,2,

Aad Tibben3, Vivianne Tjan-Heijnen2,4, Joep

Geraedts1,2, Ron van Golde5, Encarna

Gomez-Garcia1, Marleen Kets6, Christinede

Die-Smulders1,2, Liesbeth van Osch1,7

1Department of Clinical Genetics, MaastrichtUniversity Medical Centre, Maastricht, TheNetherlands, 2GROW - School for Oncology andDevelopmental Biology, Maastricht UniversityMedical Centre, Maastricht, The Netherlands,3Centre for Human and Clinical Genetics, LeidenUniversity Medical Centre, RC Leiden, TheNetherlands, 4Department of Internal Medicine,Division of Medical Oncology, MaastrichtUniversity Medical Centre, Maastricht, TheNetherlands, 5Department of Obstetrics andGynaecology, Maastricht University MedicalCentre, Maastricht, The Netherlands, 6Departmentof Human Genetics, Radboud University NijmegenMedical Centre, Nijmegen, The Netherlands,7Department of Health Promotion/CAPHRI,Maastricht University, Maastricht, The Netherlands

BACKGROUND: The awareness of PGD asreproductive option among BRCA carrier couplesis often reported to be low (20–30%). Althoughafter explanation the majority of carriers are sup-portive of offering PGD, most would not considerit personally. However, a majority indicates thedesire to be able to take this option into consider-ation. With this study we aim to increase insight inthe awareness and acceptability of PGD amongBRCA carrier couples in the Netherlands.METHOD: 186 BRCA mutation carriers and part-ners of carriers participated in a cross sectionalsurvey. Participants were recruited in cooperationwith two clinical genetic centres and via internet.Announcements about the study with a link to anonline questionnaire assessing awareness andacceptability of PGD, were made at digital commu-nities of patient organisations associated withhereditary breast and ovarian cancer (HBOC). Anonline questionnaire was filled in by 165 BRCA car-riers and 21 partners of a BRCA carrier. 38 partici-pants (20.4%) indicated that they (or their partner)had been diagnosed with breast cancer. 24.2% wasreligious and 62.9% was highly educated.RESULTS: 76.3% of BRCA carriers and partnerswere aware of PGD, of whom 88% were aware ofits possibility for HBOC. 80.3% found PGD forHBOC acceptable and 41% would personally con-sider this. Previous awareness, knowledge andhigher perceived seriousness of HBOC were posi-tively associated with acceptance and willingness toconsider PGD for HBOC. Willingness to consider

PGD was higher among non-religious participants.The majority of carriers (34.8%) first heard aboutPGD from a physician or other health workerwhich was also the preferred informational med-ium. Clinical geneticists and genetic counsellorswere the most appreciated health workers for PGDinformation provision. CONCLUSIONS: A largemajority of BRCA carrier couples is aware of PGDfor HBOC and considers it acceptable, whereas lessthan half would consider it personally. About halfprefers natural conception without diagnosis, and asmall minority prefers prenatal diagnosis (PND). Itappears that the reach of information on PGD as areproductive option among BRCA carrier couplesis good although room for improvement remains.These results show that PGD is a preferred repro-ductive option over PND among BRCA carriercouples. RESEARCH IMPLICATIONS: Neverbefore data suggested such high awareness of PGDfor HBOC. This might imply that BRCA carriercouples eligible for PGD are adequately reached.To enhance individual guidance during the deci-sion-making process regarding PGD it would beinteresting to get more insight into motives andconsiderations playing a role in this process, whichis currently being studied by our department.CLINICAL IMPLICATIONS: Although it seemsthat information about PGD as reproductiveoption adequately reaches a large majority ofBRCA carrier couples, information provisionshould still be improved for the remaining minority.The recruitment strategy via digital communities ofpatient organisations associated with HBOC mighthave led to selection bias and could have contrib-uted to the relatively high awareness of PGD forHBOC. Furthermore, initial information aboutPGD should be provided by a clinical geneticist orgenetic counsellor. ACKNOWLEDGEMENT OFFUNDING: This study was funded by the Dutchbreast cancer foundation Stichting Pink Ribbon.None of the authors have competing interests todeclare.

P1-76

Professional Psychosocial Care Offered to Breast

Cancer Patients Undergoing Rapid Genetic

Counseling and Testing in Breast Cancer Patients:

What is the Problem?

Daniela Hahn1,2, Eveline Bleiker2,3, Marijke

Wevers3,4, Titia Brouwer4, Senno Verhoef2,

Marianne Kuenen3, Elly Kaats1,2, Sanne

Stehouwer4, Margreet Ausems4, Neil Aaronson3

1Department of Psychosocial Counseling andFamily, The Netherlands Cancer Institute,Amsterdam, The Netherlands, 2Family CancerClinic, The Netherlands Cancer Institute,Amsterdam, The Netherlands, 3Division ofPsychosocial Research and Epidemiology, The



Netherlands Cancer Institute, Amsterdam, TheNetherlands, 4Division of Biomedical Genetics,University Medical Center Utrecht, Utrecht, TheNetherlands

BACKGROUND: Offering rapid genetic counsel-ing and testing (RGCT) directly after the diagnosisof breast cancer and before surgery has been con-sidered distressing. Therefore, professional psycho-social care is offered to breast cancer patientsundergoing RGCT. First results are reported hereon the use and nature of professional psychosocialservices in the RGCT setting. METHOD: Datawere collected as part of a multi-center randomizedcontrolled trial (“Time–trial”) comparing RGCTversus usual care in newly diagnosed breast cancerpatients with a suspected hereditary form of the dis-ease. The frequency of use of such services wasassessed via a checklist completed by professionalpsychosocial caregivers summarizing the frequencyand content of the psychosocial counseling sessions.RESULTS: 265 women were randomized at thetime of breast cancer diagnosis to either rapidgenetic counseling (n = 178) or usual care (n = 87).Fifty women (28%) in the RGCT interventiongroup received additional psychosocial care (face-to-face or telephone). Of these, 58% had only onesession, 20% two and 22% three or more. Mostcommon presenting problems were: “coping withbreast cancer” (49%), “genetic counseling and test-ing” (22%), “family communication and support”(16%), “personal functioning” (9%), “strengthen-ing social system” (4%). Women opting for “rapid”genetic testing (DNA test results within 4 weeks)more frequently discussed issues related directly togenetics. CONCLUSIONS: Approximately one-third of women who undergo RGCT seek addi-tional psychosocial support, the large majority ofwhom require only one session. In general, copingwith breast cancer was the most prominent topicdiscussed, although women who opted for the“rapid track” were more focused on issues sur-rounding genetics than the women who opted forthe semirapid-track testing (DNA test result within4 months) and “routine testing” (test results avail-able >4 months). RESEARCH IMPLICATIONS:Very few studies have presented data on the contentof psychosocial counseling sessions within the fieldof cancer genetics. More clinical psychosocial carestudies like ours are needed that focus on the spe-cific psychosocial problems encountered by individ-uals who are offered genetic counseling and testing.This may help us in an attempt to further open theblack box of need for and content of /satisfactionwith targeted evidence-based psychosocial care in(hereditary) cancer. CLINICAL IMPLICA-TIONS: A third of all women who were offeredRGCT may benefit from additional psychosocialhelp. In clinical practice, this professional support

should be available and offered to all counseleesundergoing rapid genetic testing. Our first resultsindicate that not genetics, but coping with (breast)cancer is the most frequently discussed topic duringthe procedure of genetic counseling and testing.This has clinical implications for the focus of psy-chosocial workers on predominantly coping with(hereditary) cancer. ACKNOWLEDGEMENT OFFUNDING: Funding for the RCT study was pro-vided by NutsOHRA Fund.

P1-77

Sense of Coherence and Self Concept Patterns in

Individuals at Risk of Hereditary Colorectal Cancer

(Lynch Syndrome)

Helle Vendel Petersen1,2, Steen Ladelund1,

Christina Carlsson2, Mef Nilbert1,2

1The Danish HNPCC-register, Clinical ResearchCenter, Copenhagen University Hospital, Hvidovre,Hvidovre, Denmark, 2Department of Oncology,Institute of Clinical Sciences, Lund University,Lund, Sweden

BACKGROUND: Lynch syndrome is a hereditarycancer syndrome predisposing to colorectal, endo-metrial and ovarian cancer. Most individuals wholearn about hereditary cancer manage well, butidentification of subgroups that find this knowledgeburdening would allow psychosocial intervention.The purpose was to asses sense of coherence (SOC)in individuals at risk of Hereditary Colorectal can-cer (Lynch syndrome) and correlate the data toresults from the general population and to self-con-cept in the Danish Lynch syndrome cohort.METHOD: A total of 345 individuals identifiedwith Lynch syndrome completed the 13-item SOCscale and the 20-item Lynch syndrome self-conceptscale. SOC scores were compared to a general popu-lation and were correlated to self-concept estimates.Characteristics of subgroups with adverse scoreswere described. RESULTS: Individuals with Lynchsyndrome report SOC scores similar to the generalpopulation. SOC and self-concept correlated wellwith a correlation coefficient of �0.51. Subsets withconvergent and divergent scores, which may reflectdifferent psychological effects from knowledgeabout hereditary cancer, were identified. CON-CLUSIONS: Individuals with Lynch syndromereport SOC scores similar to the general popula-tion. SOC and self-concept correlate well but allowidentification of subset that report adverse outcomeand may be relevant for targeted intervention.RESEARCH IMPLICATIONS: The possibility toapply self-concept and SOC in order to identify sub-groups with different needs shold be furtherexplored. Such data could be genrated through cor-relations between self-concept and registry data one.g. health care consumption. CLINICAL IMPLI-CATIONS: Identification of subgroups would be



valuable for inddividualized management of Lynchsyndrome from a psychological point of view.ACKNOWLEDGEMENT OF FUNDING: TheDanish Cancer society, Copenhagen UniversityHospital, Hvidovre, Denmark.

P1-78

Familial or Hereditary? Differences in Informational

Needs, Communication Behavior and Perceived

Quality of Care (QoC) Between Patients With

Lynch Syndrome and Familial Colorectal Cancer

L.A.D.M. van Osch1,2, B. Salden3, C. Hoving1,

M. Laven1, K. Holtkamp1, A.A. Masclee3,

S. Sanduleanu3

1Maastricht University, Department of HealthPromotion/CAPHRI, Maastricht, The Netherlands,2Maastricht University Medical Centre, Departmentof Health Promotion/CAPHRI, Maastricht, TheNetherlands, 3Maastricht University MedicalCentre, Department of Internal Medicine, Divisionof Gastroenterology and Hepatology, Maastricht,The Netherlands

BACKGROUND: Between 2% and 5% of coloncancers arise from well-defined inherited syn-dromes, including Lynch syndrome (LS), whereasup to one-third of colon cancers exhibit increasedfamilial risk (familial colorectal cancer; fCRC). InfCRC, susceptibility genes are unidentified, therebylimiting possibilities of genetic testing and targetedsurveillance strategies. The present study investi-gates differences in informational needs and com-munication behavior, quality of life (QoL) andperceived quality of care (QoC) between LS andfCRC patients. METHOD: A mixed methodapproach was applied to investigate impact of diag-nosis, satisfaction with provided care and informa-tion, and communication behavior amongindividuals with LS or fCRC who had accom-plished genetic testing. First, focus group interviewswere conducted (N = 16). Transcripts were ana-lyzed and provided input for the development of a58-item questionnaire, quantifying the main aspectsof QoL, informational needs and communicationbehavior, and QoC. Patients were recruited via themultidisciplinary outpatient clinic for counselingand surveillance of high-risk groups at MaastrichtUniversity Medical Center. 87 Patients (41 LS, 46fCRC patients) participated in the questionnairestudy. RESULTS: The 2 patient groups did notdiffer in QoL. fCRC patients expressed high con-cern regarding the long surveillance intervals, expe-rienced less disease control and had a higher desirefor information about medical examinations andrisk for CRC than LS patients. 91% of fCRC and98% of LS patients communicated about theirincreased risk with partners and relatives. The needfor emotional support and providing clarity to their

family were more important motivators for com-munication in LS patients than fCRC patients.Besides information on the disease and its inheri-tance, both patients groups preferred informationon follow-up, new developments and lifestyle fac-tors. CONCLUSIONS: Patients with familialCRC have a higher desire for information aboutCRC risk and experience more feelings of insecuritythan patients with Lynch syndrome, possibly as aresult of a perceived need for more intensive sur-veillance. Psychosocial profiling might form thebasis for shared decision making and finallyimprove the quality of counseling and patients’ sat-isfaction in high-risk groups. RESEARCH IMPLI-CATIONS: Although overall QoL did notsignificantly differ between the 2 patient groups,subtle differences in informational needs, and par-ticularly the expressed feelings of insecurity andlow perceived control among fCRC patients maywarrant further investigation to prevent longer-term psychological consequences. CLINICALIMPLICATIONS: Physicians and counselors needto be aware of differences in informational needsbetween patients with familial and hereditary can-cer. Potential insecurities that arise as a result ofunidentified genetic causes need to be addressed incounseling, as well as tailored information on life-style, risk and medical developments. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-79

Determinants and Changes in Psychological

Adaptation and Quality of Life During

Chemotherapy for Diffuse Large B Cell Non-

Hodgkin’s Lymphoma in the Vulnerable and Frail

Elderly (“Psy-frail” Study)

Florence Cousson-Gélie1,2, Priscilla Allart3,

St�ephanie de Chalvron1, Pierre Soubeyran4,3

1University of Montpellier 3, Epsylon Laboratorie,Montpellier, France, 2Institute Cancer Montpellier,ICM, Montpellier, France, 3University of Bordeaux,Bordeaux, France, 4Institute Bergoni�e, Bordeaux,France

BACKGROUND: The aim of the “Psy-Frail”study is to assess the impact of psychosocial factorson fatigue, quality of life and depression on olderpatients living with a non-Hodgkin’s lymphomaand treated by chemotherapy. We hypothesize thatelderly patients with low routines, high fightingspirit, low helplessness/hopelessness and high per-ceived social support report higher quality of life,lower fatigue and better outcome during treatment.METHOD: Sixty-seven patients treated by eightcycles of chemotherapy, aged 70 years old and morewere included of 2009 to 2011. Quality of life(QLQC-30), depression (MADRS, MINI, GDS-15),cognitive state (MMS), nutritional state (MNA),fatigue, (MFI-20), comorbidity (CIRS-G), quality



of relationships (QRI), routinization (EPR) andcoping (WCC-R) were assessed before (before thecycle 1), during (between the cycles 3 and 4) andafter chemotherapy (after the cycle 8). We study theimpact of psychosocial variables on quality of lifeand psychological adjustment during the period oftreatment. RESULTS: Analysis of the results con-cerned with the first three-time evaluation is cur-rently under way and will be communicatedthrough this communication and poster, at the con-gress of 4 to 8 November 2013. These results will beinterested in the evolution of the quality of life,mood and psychological adjustment of patientsthroughout their treatment by chemotherapy.CONCLUSIONS: The study represents a majoradvance which would allow understanding the rela-tionships between psychosocial factors and canceroutcome in older, frail and vulnerable patients. Thisresearch could allow a better comprehension ofpsychological predictors of a good quality of lifeand survival. RESEARCH IMPLICATIONS: Theresearch implications will be available from analysisof results. CLINICAL IMPLICATIONS: Thanksto the results, clinicians may refine the psychologi-cal care and work on therapeutic approaches toimprove counselling offered to patients, in order toreduce anxious and depressive symptoms, if fre-quent during the haematological cancer.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was supported by the French NationalCancer Institute (INCa).

P1-80

Transfer to an Acute Care Hospital for Nursing

Home Residents Without Cognitive Impairment with

a Diagnosis of Cancer

Jorunn Drageset1, Geir Egil Eide2, Charlene

Harrington3, Anette Hylen Ranhoff4

1Bergen University College & University of Bergen,Bergen, Norway, 2University of Bergen&WesternNorway Regional Health Authority, Bergen,Norway, 3University of California, San Francisco,USA, 4Haraldsplass Hospital and Department ofClinical Science, University of Bergen, Bergen,Norway

BACKGROUND: There are few studies of hospi-tal admission of cognitively intact nursing home(NH) residents with a diagnosis of cancer. Knowl-edge about the associations between demographicsand medical variables with hospital admissions canaid in preventing unnecessary admissions. Theobjective was to determine whether residents withcancer have more hospital admissions and whethersociodemographic and medical variables are associ-ated with hospital admission among cognitivelyintact NH residents with and without cancer.METHOD: A prospective study in 2004–2005 withfollow-up to 2010. Residents aged ≥65 years, 60

with cancer and 167 without, cognitively intact andhad at least 6 months’ residence. Medical recordsfrom the NHs provided sociodemographic andmedical variables. We identified 227 respondentsthrough the NHs records and linked them to thehospital record system to register all admissions.We examined whether demographic and medicalvariables were associated with the time from inclu-sion to first hospital admission. RESULTS: Resi-dents with cancer diagnoses had more hospitaladmissions (25 of 60) than those without (53 of167) (log-rank test, p = 0.04). Residents with cancerat inclusion had 1.7 times higher risk for hospitaladmission than residents without. The most com-mon main diagnoses among residents with cancerat discharge were cancer related and circulatory dis-eases. Infectious diseases, respiratory diseases andcirculatory diseases were most common among resi-dents without cancer. Independent of cancer, resi-dents with ≥3 years of education had a significantlyhigher risk of hospitalization than those with lesseducation. CONCLUSIONS: Residents with can-cer diagnoses had more hospital admissions thanthose without. Their main diagnoses in hospitalwere often related cancer. RESEARCH IMPLICA-TIONS: Further information is needed about thesymptoms and causes of hospital admission, andespecially whether the cancer-related admissionsare for palliative care. CLINICAL IMPLICA-TIONS: Preventing unnecessary admissions andsecuring the necessary care requires that nurses beaware of cancer-related symptoms and collaboratewith the nursing home physician and palliative carepersonnel to provide the best care. ACKNOWL-EDGEMENT OF FUNDING: Jorunn Dragesetreceived a postdoctoral fellowship from the Norwe-gian Cancer Society.

P1-81

Knowledge and Attitudes Towards Cancer in an Old

Sample: Final Report

Tania Estape, Jordi Estap�e, Sara Soria, Ariadna

Torres

FEFOC, Barcelona, Spain

BACKGROUND: In 2007 we began a study toascertain knowledge and attitudes in old peopletowards cancer in our culture. Our goal is to haveour own data to desing programmes that fit to theeldest to improve their knowledge, have a realisticattitude towards cancer and change their mindstowards prevention, early diagnosis and pessimismand misbelieves related to cancer. METHOD: Weapproached 874 people 65 years old or over. Theywere contacted by trained professionals in their lei-sure centres. They completed a semi-structuredinterview consisting of 72 questions covering differ-ent topics on cancer knowledge and attitudes, pre-vention, early diagnosis, research topics and



support. RESULTS: We have 814 valid question-naires.Mean age: 75 (SD = 6.90), 54% women,31% lives alone, 6% had cancer in the past.31%feels as a risk group, 2% think cancer is contagiousand 5% a punishment consequence.The moreknown prevention was no smoking (95%) andexcessive sunbathing (90%) and the less avoidingoverweight (33%). 68% believes in early diagnosis,but differences in procedures (88.4% mammo-grams, 44% PSA). Research terms are unknown(27% informed consent).32% feels treatment isworse than cancer, in case of having it 36% wouldprefer not undergoing therapy.79% would likeknowing diagnosis and prognosis and 71% wouldinform others.Gender, age and having had canceryielded few differences. CONCLUSIONS: This is afinal report of a work previously presented. Ourdata shows old people in our zone have a lowknowledgeabout cancer illness, being the main con-clusion that they do not feel themselves as a riskgroup. Pessimistic attitudes towards cancer andtowards cancer treatment are in the basis of theirunderuse of medical advice when ill. Also they seekmedical consultation in a delay since some symp-toms are underestimated or attribute to old age. Ahigh percentage prefer to know full diagnosis andprognosis in case of having cancer and wouldn’thide it to relatives and friends RESEARCHIMPLICATIONS: Having these conclusions ournext effort is to design a programme to improveknowledge and attitudes towards cancer in thisgrowing population. They may assume themselvesas a sample especially in risk and we must work topromote an active attitude in order to have a betterprognosis and when is possible a better quality oflife of old people. CLINICAL IMPLICATIONS:Our next step is being planned now and it is todesign an action to reach old people and to changetheir attitude towards cancer moving from a pessi-mistic view to a more realistic one. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-82

Impact of Surgery on Psychosocial Needs Among

Older Chinese Colorectal Cancer Patients: A

Longitudinal Analysis

Richard Fielding, Wendy W.T. Lam, Wylie W.Y.

Li, Jensen Poon, Wai Lun Law

The University of Hong Kong, Hong Kong

BACKGROUND: Colorectal cancer (CRC) is apredominant cancer in developed populations.Hong Kong has a rapidly ageing population. Eluci-dating the impact and issues older cancer patientsface is needed for effective care planning to meetthe needs of older cancer patients. Little informa-tion has been published on how supportive careneeds (SCNs) differ between younger and oldercancer patients. This presentation details some

preliminary findings on a cohort of Chinese CRCpatients. METHOD: Newly diagnosed CRCpatients attending surgical departments in a majorHong Kong regional hospital were approachedprior to admission for surgery. After informed con-sent, participants completed a face-to-face inter-view including assessments of unmet supportivecare needs using the Chinese-version of the Sup-portive Care Needs Survey (SCNS-34-Ch) prior to,and again one month after their surgery. Older(>64 yoa) and younger (<65 yoa) CRC patients’supportive care needs are compared and contrastedbefore and 1 month after surgery using repeatedmeasures ANOVA. RESULTS: Females comprised alarger proportion of younger (45%) than older(32%) patients, while more younger patientsreported higher educational achievement. Youngerpatients reported more SCNs and significantincreases in Health Information & Systems (HIS)needs over time, but low and declining Psychologi-cal SCNs. Care & Support (PCS) SCNs increasedslightly, moreso in the older group. Both groupsshowed significant increases in Physical SCNs. SexSCNs were low but increased in younger whiledeclining in older patients. CONCLUSIONS:Younger cancer patients reported higher HIS, PCSand less so Psy SCNs compared to their older coun-terparts at Baseline. Younger cancer patients showthe most obvious increases in SCNs over the monthfollowing surgery, with higher HIS, Physical andSex SCNs. Older patients demonstrated markedincreases only in Physical SCNs. Otherwise, SCNsremained mostly unchanged from low pre-surgerylevels. RESEARCH IMPLICATIONS: CRC andrelated surgery impact younger and older peopledifferently. Excepting HIS needs, in this cohort,SCNs remained generally low. Psychological needsdeclined over time, indicating that these were lar-gely anticipation-based. Most reported SCNs werelower that is reported elsewhere in the literature.Future research needs to consider cultural, serviceand age influences on SCN. CLINICAL IMPLI-CATIONS: Many CRC patients experience higherpsychological need prior to surgery. In this cohort,significant jumps in both HIS and Physical SCNsindicate clinical shortfalls in the provision of bothinformation and assistance in adjusting to theimpacts of treatment. Differences in service provi-sions are likely to be responsible for major differ-ences in SCNs. ACKNOWLEDGEMENT OFFUNDING: Health Care Promotion Fund grant7080651, Food & Health Bureau, Hong KongGovernment.



P1-83

Fatigue and Depression Among Younger and Older

Breast Cancer Patients: The Mediating Role of

Optimism

Inbar Levkovich1, Miri Cohen1, Shimom Pollack2,

Karen Drumea2, Ilanna Duvdevany1, Georgeta

Fried3

1University of Haifa, Haifa, Israel, 2Oncology Unit,Rambam Medical Center, Haifa, Israel, 3Institute ofClinical Immunology, Rambam Medical Center,Haifa, Israel

BACKGROUND: Several studies reported lowerlevels of distress in younger than older breastpatients cancer, but only a few studies assessed dif-ferences in cancer related fatigue (CRF) in thisregard and their results were not conclusive. Theaim was to assess levels of depression and CRF inolder and younger breast cancer patients, post-che-motherapy treatment, and to assess the mediatingrole of optimism between age, depression, andCRF. METHOD: Participants were 84 breast can-cer patients, 47 of whom were <60, and 37 ≥60,diagnosed with breast cancer stages I-III, 3 monthsafter the end of chemotherapy. Patients filled out aphysical symptoms list, Fatigue Symptom Inven-tory (FSI), Center of Epidemiological Studies –Depression Scale (CES-D), Life Orientation Test(LOT-R55) for optimism and socio-demographicand cancer-related questionnaires. RESULTS:Levels of depression and CRF were low to moder-ate in both groups, but the older cancer patientsreported lower levels of CRF, but no statisticallysignificant differences were found for levels ofdepression and optimism. CRF and depressionwere highly associated (r = 0.59). Multivariateregression analysis revealed that 49% of the vari-ance of depression and 54% of the variance ofCRF were explained by study variables. Physicalsymptoms and optimism were significant predictorsof depression and CRF. The association of physicalsymptoms and depression, but not CRF, was par-tially mediated by optimism (z = 2.16, p < 0.05).CONCLUSIONS: Although levels of CRF werehigher in the older breast cancer patient group, agewas not a predictor of either depression or fatigue,when background variables were controlled for. Inaddition, although CRF and depression were sig-nificantly correlated, distinct patterns of associationto physical symptoms was found; direct associationof physical symptoms with CRF was found, whilethe association of physical symptoms and depres-sion was mediated by level of optimism.RESEARCH IMPLICATIONS: This study con-tributes to the empirical knowledge about symp-toms of depression and CRF in older breast cancerpatients as compared to younger patients; althoughdepression and CRF were highly associated, oldercancer patients reported lower levels of CRF, but

similar levels of depression. The different pattern ofassociations of physical symptoms and optimismversus each of the symptoms is of importance andshould be further studied. CLINICAL IMPLICA-TIONS: In contrast to previous studies, wherestage of disease and treatment variables were con-trolled for, older patients exhibit levels of depres-sion similar to those of younger patients.Therefore, clinicians should be aware of the risk ofdepression in older as we well as younger patients.They should be also aware of the relation betweendepression and CRF, and also of their distinct char-acteristics. As suggested for depression, CRFshould be also screened for. ACKNOWLEDGE-MENT OF FUNDING: The study was partiallyfunded by The Israel Cancer Association.

P1-84

Between Two Worlds: Liminality and Late-Stage

Cancer-Directed Therapy

Gail Adorno

University of Texas, Arlington, Arlington, Texas,USA

BACKGROUND: Cancer-directed therapy neardeath is a growing trend among persons with late-stage cancer regardless of national healthcare deliv-ery system. Although rates of aggressive chemo-therapy (i.e. within 14 days of death) in developedcountries vary, this phenomenon continues unde-terred where access to biomedical technology exists.A theoretical framework is presented whichdescribes cancer-directed therapy (e.g. chemother-apy) given for very advanced disease as a socio-cul-tural phenomenon which offers questionablebenefits and portends suffering, but also potentialfor growth. METHOD: Theories and conceptsdrawn from cultural anthropology, sociology, andexistentialism illustrate how contextual factors con-tribute to the creation of a “liminal” space; the latterpart of the cancer trajectory where living and dyingcan overlap. Derived from clinical observations, thisconceptualization demonstrates that practice makesan important contribution to theoretical develop-ment in psychosocial oncology and end-of-life careresearch and practice. RESULTS: When liminalityis applied to clinical practice, cancer-directed ther-apy for terminal illness represents a temporal expe-rience stemming from the advanced cancer patient’suncertain position between 2 worlds as defined byacknowledged roles - neither sick role nor dyingrole. This tension suggests an existential crisis pre-cipitated by challenges to one‘s self where previ-ously valued roles and newer meaningful ones areunattainable. CONCLUSIONS: This tension sug-gests an existential crisis precipitated by challengesto one‘s self where previously valued roles andnewer meaningful ones are unattainable. Taboosabout cancer, terminal illness, dying, and death



serve as negative rites by masking authenticity dur-ing social interaction. An abrupt transition fromthis space to a dying role affords advanced cancerpatients and their families little time for the instru-mental or emotional tasks associated with dyingand death. RESEARCH IMPLICATIONS: Bio-medical explanatory models are inadequate to fullyunderstand the lived experience of cancer patientsand how they manage change over time. Moreover,the clinical significance of living/dying with para-doxical realities has received little attention in thepsychosocial oncology assessment or interventionliterature. This presentation will demonstrate how atheoretical framework can inform interventions forexistential despair when patients with advancedmetastatic disease express loss of meaning andinterconnectedness with others. CLINICALIMPLICATIONS: Applied to clinical practice, thisperspective gives the cancer patient, family, andhealth care provider a way of “unmasking” a per-iod of transition during terminal illness whenaggressive disease-directed care continues. Thisconceptualization contributes to new theories ondying from cancer in a hypermodern society. Exis-tential therapies, as part of whole person care, arediscussed as an approach to support people duringmedical decision making and transition from dis-ease-specific treatment to palliative care.ACKNOWLEDGEMENT OF FUNDING: Sup-ported in part by a Doctoral Training Grant inOncology Social Work from the American CancerSociety.

P1-85

Hope and Meaning in the Context of Different

Psychological Intervention Settings: When -

to Whom - How?

Elisabeth Andritsch

Division of Clinical Oncology, Medical University ofGraz, Graz, Austria

BACKGROUND: “To have hope then is toacquire a belief in your ability to have some controlover your circumstances.” (Jerome Groopman).Hope and meaning are the spiritual domains in thecare of cancer patients and are described as predic-tors for “good coping”. Hope as a never endingprocess is also a choice and involving will, which isinfluenced by different factors and different behav-iours. Some psychosocial interventions are focus-sing on those factors relating to hope and meaning.METHOD: Different psychosocial interventionsincluding the focus on hope and meaning will bedemonstrated based on the literature search.Thereby it will be analysed at which stage of the ill-ness to whom these interventions are carried outand which psychotherapeutic methods are used.The importance of hope and meaning integrated inthe basic communication between professionals,

patients and their families will be characterizedrelating on the literature and existing data.RESULTS: I will discuss which different aims aredescribed in the different used psychosocial inter-ventions relating to hope and meaning. CONCLU-SIONS: Hope and meaning are effective values fordifferent outcomes, e.g. relating coping and quality oflife the concept of hope and meaning should be inte-grated in the care of patients from the beginning ofthe diagnosis until the terminal phase of the disease.ACKNOWLEDGEMENT OF FUNDING: None.

P1-86

Hope and Optimism - The Additional Benefit for

Patients With Cancer in the Interdisciplinary

Treatment - From the Perspective of

Psychoneuroimmunology

Thomas Bauernhofer, Elisabeth Andritsch, Silke

Zloklikovits, Stefanie Stanzer

Division of Clinical Oncology, Medical UniversityGraz, Graz, Austria

BACKGROUND: “Face the worst while hopingfor the best - because wonder and tragedy arealways interwoven” (David Spiegel, Living BeyondLimits; 1993). Hope and its “little sister” optimismgive us meaning and perspective in our lives. Bothare important resources to power the will to live.Our patients define hope as “that you can still enjoya good quality of life even if live expectancy isuncertain.” METHOD: We undertook a random-ized study to evaluate a psycho-educational inter-vention program offered to an intervention group(IG) compared to a waiting group (WG) with thesame intervention 6 months later and healthy vol-untaries (NC). Fifty-one postmenopausal womenwith breast cancer stage I, II, III and comparablehealthy women used as a control group (HealthyControls, HC,), were evaluated in three differenttime points during a 6 months study period: Asemi-structured interview, standardized psychologi-cal questionnaires and blood draws were carriedout. RESULTS: We observed that even patientsafter curative treatment of early breast cancer andno evidence of disease experience a higher degree ofstate and trait anxiety as well as intrusion comparedto NC. The stress hormone levels cortisol and nor-adrenalin were significantly elevated compared toNC. Furthermore, immune cell numbers werealtered significantly in the patients group versus NC.Stress hormone levels and immune cell alterationswere significantly improved in the IG but not inWG. CONCLUSIONS: We conclude that psycho-logical variables are attributed to hormonal andimmunologic parameters and may be influenced bypsycho-educational interventions supporting the con-cept of the mind-body unity. ACKNOWLEDGE-MENT OF FUNDING: Supported by grants ofthe Oesterreichische Nationalbank (Anniversary



Fund, Grant No: OENB 11179) and of the “Vereinf€ur Krebskranke an der Med.Univ. Klinik Graz”.

P1-87

Measure of Hope & Spirituality in End Stage Renal

Disease

Abhijit Dam, Priya Khanna, Nikesh Kumar,

Anwesha Banerjee1

Kosish-the Hospice, Bokaro Steel City, Jharkhand,India

BACKGROUND: This study was undertaken todevelop an insight into the psychosocial and spiri-tual issues in patients with End Stage Renal Disease(ESRD) in the Indian subcontinent. The palliativecare needs of patients with ESRD are well docu-mented. This study attempts to explore the relation-ship if any between spirituality and hope in patientswith ESRD on maintenance haemodialysis. Thesecondary aim was to assess the symptom burden.METHOD: 40 patients with ESRD undergoinghaemodialysis in a unit in a semi-urban hospital set-ting in the Eastern part of India were randomlyselected over a period of 3 months. Patients in allage groups and both genders were included.Patients who consented were requested to self-administer 2 questionnaires -Spiritual Health andLife Orientation Measure (SHALOM) and HearthHope Index (HHI). Both questionnaires were trans-lated in Hindi, the local language. The symptomsexperienced by the patients and their severity werealso recorded to assess symptom burden.RESULTS: The age of patients ranged between 35and 80 with a mean of 54.8. There were 9 females.Most of the patients reported experiencing symp-toms of depression, fatigue and pain. There appearsto be a strong relationship between some indices ofSHALOM and HHI. Relationship between Spiri-tual Dissonance and hope appears weak. These willbe further discussed in detail at the conference.CONCLUSIONS: Professionals should be able torecognise and address spiritual health issues to beable to provide holistic care to patients in palliativemedicine. It is important for all health care profes-sionals to be able to pick up symptom burden, men-tal health issues and seek specialist advice.RESEARCH IMPLICATIONS: A larger rando-mised multicenter study to assess the relationshipbetween spiritual health and hope in ESRD shouldbe undertaken to validate these results. CLINICALIMPLICATIONS: Patients with ESRD have acomparable, if not greater, symptom burden topatients suffering from terminal malignancies.Addressing the spiritual concerns in such patients& helping them to foster a sense of hope is an inte-gral part in the holistic care of such patients.ACKNOWLEDGEMENT OF FUNDING: None.

P1-88

The Detection of Positive Responses After a Breast

Cancer Diagnosis: A Systematic Review

Anna Casellas, Antoni Font, Jaume Vives

Universitat Aut�onoma de Barcelona, Cerdanyola delVall�es, Barcelona, Spain

BACKGROUND: This systematic review aims tofind the best available evidence regarding positiveresponses in women diagnosed with breast cancerfrom their disease experience. METHOD: Relevantoutcomes were located in electronic databases (Med-line, PsycINFO, Web of Science, Scopus, Cochrane,CINAHL, Wiley Online Library, DIALNET andTDX) using subject headings, keywords, titles andabstracts until 2012. A selected list of descriptorswas used to identify studies including positive psy-chology related responses from breast cancer. Theinformation was extracted independently by 3reviewers and results were compared. Discrepancieswere resolved by consensus. There was no restrictionregarding the year of publication, study design,sample size or participants’ demographical andmedical characteristics. RESULTS: 59 studies wereincluded in the review. Posttraumatic growth, opti-mism and spiritual coping were the most commonresponses found among papers. Also an inverseassociation between developing positive responsesand age was found, as well as a direct associationbetween positive responses and having children orbeing partnered. Additionally, 5 groups of positivepsychology related therapies were found to beapplied on breast cancer patients: hope therapy,meaning-making therapies, spiritual therapies andwritten emotional-expression interventions. Thesetherapies were capable of enhancing QoL, well-being, PTG, hope, meaning, happiness, optimism,life satisfaction and benefit finding in women withbreast cancer. CONCLUSIONS: Positive psychol-ogy is beginning to be studied in relation to breastcancer. It has been found that these positiveresponses are given in 3 vital spheres: the personalsphere (e.g. well-being, personal growth), socialsphere (e.g. enhanced altruism, personal relation-ships) and disease-related sphere (e.g. hope, mean-ing-making). However, few interventions have beendeveloped in order to promote these positiveresponses. Only 5 groups of therapies have beenfound to be applied in breast cancer patients. Thisentails a need to engage more research in order todevelop ways of promoting positive responsesamong women with breast cancer. RESEARCHIMPLICATIONS: This review reveals that moreevidence is needed regarding positive psychology,especially among women with breast cancer. Thus,future research needs to examine those women whoare more likely to develop positive responses fromtheir experience of breast cancer. Identifying theprocesses through which these women develop



responses like hope, meaning or optimism, betweenothers, is also relevant for researchers in developingtherapies to promote these responses. CLINICALIMPLICATIONS: Psychologists may obtain bene-fit from the information obtained in this review in,at least, 2 ways. On the one hand, it provides rele-vant data regarding the demographical and medicalcharacteristics of those women who tend to developpositive response from breast cancer, what canresult in useful screening criteria. On the otherhand, it also provides psychologists with efficienttherapies in promoting positive responses amongwomen diagnosed with breast cancer ACKNOWL-EDGEMENT OF FUNDING: None.

P1-89

Effect of Group Meaning-Centered Hope Therapy

for Cancer Patient and Their Families on Their

Quality of Life

Negar Reisi-Dehkordi1, Mehran Farhadi2, Razieh

Ghorbani3, Ali Zargham-Boroujeni4

1Islamic Azad University of Hamedan, Hamedan,Iran, 2Department of Psychology, Boali University,Hamedan, Iran, 3Saied-al-Shohada Hospital,Isfahan University of Medical Sciences, Isfahan,Iran, 4Nursing and Midwifery Care ResearchCenter, Faculty of Nursing and Midwifery, IsfahanUniversity of Medical Sciences, Isfahan, Iran

BACKGROUND: Quality of life is a multidimen-sional concept which is considered as main purposeof supportive care in chronic diseases like cancer.Many interventions have been done for quality oflife improvement in cancer patient, however, effectof indirect intervention on patients’ quality of lifehas not been investigated yet. This work wasdesigned and carried out to determine effect ofgroup meaning centered hope therapy on cancerand their families’quality of life. METHOD: Thissurvey was a 3 group clinical trial with pre-test andpost- test design in wich effect of independent vari-able (meaning- centered hope therapy) on dependentvariable (quality of life) was investigated. The sam-ple was selected among cancer patient who wereaware of their diagnosis’were in the early stage ofdisease and had pass one course of chemotherapy.Statistical analysis of data was performed in tow sec-tion, descriptive and illative. RESULTS: Based onour finding, group meaning-centered hope therapyfor patients and their families were usefule com-pared to control group. The results show thatgroup sessions either for patient and their familesequally improved their quality of life. CONCLU-SIONS: Quality of life in cancer patients improvedby group meaning-centrred hope therapy either forpatients or their families. CLINICAL IMPLICA-TIONS: When patient can’t come to group therapyif one of the home caregivers (familes) come ingroup session we can increase pateint’s quality of

life. ACKNOWLEDGEMENT OF FUNDING:Thanks to Entekhab center of Supportive and Palli-ative Care for kind cooperation and support thatmade conducting this research possible.

P1-90

Meaning in the Life of Japanese Female Breast

Cancer Patients: Its Idiographic Aspects

Chiaki Ihara

Kyoto Gakuen University, Kameoka, Kyoto, Japan

BACKGROUND: Meaning in Life (MiL) is a coreconcept for psychological care of cancer patients.The author has already reported quantitativeaspects of MiL in Japanese female breast cancerpatients (IPOS, 2012). This study aims to assess itsidiographic nature using the “Schedule for Meaningin Life Evaluation” (SMiLE), an individualizedinstrument for the assessment of MiL, which wasdeveloped in Germany and validated in English,French, Japanese and Spanish. METHOD: In theSMiLE the respondents list 3–7 areas providingMiL to their lives in their current situation, and ratethe current level of satisfaction (�3, very unsatis-fied, to +3, very satisfied) and importance (0 to 7)with each area. 200 healthy Japanese females and119 female breast cancer patients (age 30–70) diag-nosed as Stage I-III, without recurrence and metas-tasis, were asked to answer the SMiLE and otherquestionnaires. The areas nominated were assignedto 15 categories identified in a representative studyconducted in Germany (Family, Partnership, Socialrelations, Occupation/Work, Leisure time/Relaxa-tion, Home/Garden, Finances, Spirituality/Reli-gion, Health, Satisfaction, Nature/Animals, Socialcommitment, Hedonism, Art/Culture and Growth).RESULTS: (a) 110 patients (P, age 54.6 � 10.4)and 192 healthy females (H, age 49.6 � 11.1) filledin the SMiLE. In P, “Family” was most often indi-cated, followed by “Leisure time/Relaxation” and“Social relations”, while “Spirituality/Religion”,“Finances” and “Home/Garden” were the least 3areas. In H, “Family” was also the most, but“Occupation/Work” was the 2nd, “Social rela-tions” was the 3rd. “Spirituality/Religion”, “Home/Garden” and “Art/Culture” were the least ones. (b)Mean values of satisfaction were 1.90 � 1.27 (P)and 1.75 � 1.32 (H) (P > H, p < 0.05) and those ofimportance were 5.47 � 1.60 (P) and 5.57 � 1.57(H) (n.s.). CONCLUSIONS: Patients showedhigher levels of satisfaction with MiL in total. Thatimplies that the patients are feeling more gratefulfor their lives. The percentages of the people whohave nominated the specific categories were not sig-nificantly different between 2 groups except for 2categories, “Occupation/Work” and “Leisure time/Relaxation”, the former H listed more, the latter Plisted more. The mean value of satisfaction of P forthe category “Social commitment” was significantly



higher (p < 0.05). These imply that in P the areasthat provide MiL might shift from the materialthings to psychological ones. RESEARCH IMPLI-CATIONS: The analysis of these qualitative datatogether with the quantitative data (presented lastyear) will provide multilateral findings about theMiL of the cancer patients. The tendency of thedata of the Japanese cancer patients is similar butnot the same when compared with the results ofGerman and French studies. The precise compari-son will open the possibilities for cross-culturalstudies on MiL of the cancer patients between theWest and the East. CLINICAL IMPLICA-TIONS: The overall analysis of the qualitative dataand quantitative data on MiL of the cancer patientswith SMiLE helps the Japanese clinicians to knowand assess the patients’ current situation and needfor MiL and to plan effective intervention pro-grams for them. The SMiLE also could be a usefultool to open communication between cancerpatients and clinicians about MiL. ACKNOWL-EDGEMENT OF FUNDING: This work wassupported by JSPS KAKENHI Grant Number22530771.

P1-91

Quality of Life, Spirituality and Hope in Elderly

Palliative Care Patients: An Italian Experience

Samantha Serpentini1,2, E. Pasquin1, P. Del

Bianco2, C. Berti1, F. Busa1, E. Capovilla2

1Az. ULSS 3 Bassano del Grappa, Vicenca, Italy,2Veneto Institute of Oncology IOV-IRCSS, Padua,Italy

BACKGROUND: Aging process and psychologi-cal distress related to the cancer experience mayadversely affect an older patient’s ability to copewith the illness. Particularly, the critical conditionof the advanced phase of cancer suggests the impor-tance of a global approach that consider not onlythe quality of life but also the spiritual needs. Theaim of the present study is to evaluate QoL and theSpirituality of elderly palliative care patients inItaly. METHOD: The evaluation was conductedthrough two structured questionnaires: the EORTC(European Organization for Research and Treat-ment of Cancer) QLQ-C15-PAL and the WHO-QOL-SRPB (World Health Organization Qualityof Life - Spirituality, Religiousness and PersonalBeliefs). RESULTS: The sample presents 80elderly patients (M = 46; F = 34; range age: 65–94;mean age: 79.5). The study is in progress, finalresults will be presented at the conference. The par-tial analysis show a tendency of our subjects tohave lower scores regarding QoL domain (Physicalfunctioning, Emotional functioning and Globalhealth status); instead is possible to observe higherscore in Fatigue, Dyspnoea, Insomnia, Appetiteloss and Constipation. Spirituality domain tend to

show lower results on: Awe, Whole, Strength,Peace, Hope, Faith. Physical scale negatively seemsto correlates with Whole, Emotive scale with Con-nect, Strength and Faith, Dyspnoea with Awe.CONCLUSIONS: The partial results indicate thatQoL, Spirituality and Hope are key variables in theelderly palliative cancer patients. Actually, we canobserve a critical QoL with a poor global statusand with more symptoms. Regarding Spirituality,our patients seems to demonstrate a less sense ofparticipation to these dimensions. Various aspectsof QoL tend to be associated with different spiritualissues. Our results, although observational, allowinteresting reflections on the Italian context andindicate the opportunity to continue further studiesto more accurately describe the relationshipbetween QoL, psychological well-being and spiri-tual needs. ACKNOWLEDGEMENT OF FUND-ING: None.

P1-92

Investigating the Role of Physical Symptoms on

Important Goal Pursuit in Early-Stage Breast

Cancer Patients

Natalie Stefanic1, Peter Caputi1, Don Iverson1,

Lisbeth Lane2

1University of Wollongong, New South Wales,Australia, 2Wollongong Hospital, New South Wales,Australia

BACKGROUND: The diagnosis and treatment ofearly-stage breast cancer can interrupt ongoinggoal-directed behaviour, and disrupt or completelyblock the pursuit of important personal goals.Symptoms of pain, fatigue, and insomnia are com-mon across different treatments. Patients whoreport this particular cluster of symptoms arehighly susceptible to functional impairment andpoor psychological outcomes. This prospectivestudy sought to better understand the relationshipbetween physical symptoms and personal goal pur-suit in breast cancer patients over time.METHOD: Forty-three women recently diagnosedwith early-stage breast cancer provided self-reportdata at 1, 2, 4 and 6 months post-surgery. Ques-tionnaires assessed physical symptoms, cancer-related goal interference, and psychological dis-tress. Non-parametric correlations, cluster analysisand one-way analysis of variance were conductedto test the study hypotheses. RESULTS: The 5most prevalent symptoms at each time-point werepain, difficulty sleeping, lack of energy, feelingdrowsy and difficulty concentrating. Goal interfer-ence was significantly correlated with pain at T1, dif-ficulty sleeping and feeling drowsy at T2, lack ofenergy at T2–T4, and difficulty concentrating at T1–T4. Women in the moderate-to-high symptom clus-ter had significantly higher average goal interference,depression, anxiety and stress than women in the



low-to-moderate cluster at each time-point. CON-CLUSIONS: These novel findings indicate thatcommon treatment-related physical symptoms dif-ferentially impact on the personal goal pursuit ofbreast cancer patients in the months following sur-gery. As expected, cancer-related goal interferencewas higher in women experiencing higher combinedlevels of these symptoms. Women in this subgroupalso reported higher levels of psychological distress.RESEARCH IMPLICATIONS: This study pro-vides important insight into the impact of cancerdiagnosis and treatment on important goal pursuit,an under-researched topic in oncology. Moreresearch is needed to further explore the role ofphysical symptoms on goal pursuit in the short-and long-term following a cancer diagnosis. CLIN-ICAL IMPLICATIONS: The findings suggest thatwomen who experience high levels of pain, insom-nia and fatigue at one or multiple times followingsurgery may require ongoing psychosocial supportto help them cope with goal interference, disengagefrom unattainable goals and continue pursuinggoals that remain attainable. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-93

Course and Predictors of Hopelessness and

Demoralization

Sigrun Vehling1, Anja Mehnert1,2

1University Medical Center Hamburg-Eppendorf,Hamburg, Germany, 2University Medical CenterLeipzig, Leipzig, Germany

BACKGROUND: The constructs of hopelessnessand demoralization represent 2 differentapproaches that are currently used to assess existen-tial distress in patients with cancer. The presentstudy aims to determine and compare the courseand predictors of these phenomena over 1 year.Given the high relatedness between hopelessnessand depression, we further aimed to analyze thecourse and potential difference of these constructsin 2 groups of cancer patients with different prog-nosis. METHOD: At T1, N = 307 patients withlung/gastrointestinal (46%) and breast/gynecologi-cal (54%) cancer were recruited during inpatienttreatment. The majority (79%) were diagnosed withadvanced cancer, 55% received palliative treat-ment. After 1 year (T2), 25% of the patients haddied and N = 150 (65% of remaining patients) par-ticipated again. Patients completed self-report mea-sures including Beck Hopelessness Scale,Demoralization Scale, Patient Health-Question-naire-9, and Memorial Symptom Assessment Scale- Short Form. In order to identify predictors ofeach dependent variable at T2, regression analyseswere conducted controlling for baselines values,age, gender, treatment phase (curative vs. palliative)and number of physical problems at T2.

RESULTS: At T1, moderate to severe scores werefound in 33% of the patients for hopelessness, 33%for demoralization, and 30% for depression. At T2,moderate to severe scores were found in 43% forhopelessness, 27% for demoralization, and 29% fordepression. The correlation between hopelessnessand demoralization was r = 0.75 (p < 0.001). AtT2, the mean hopelessness score was significantlyhigher (M = 7.6, SD = 2.8 vs. M = 8.1, SD = 3.0)(p = 0.003). Hopelessness at T2 was higher inpatients with lung/gastrointestinal cancer (b = 0.17,p = 0.04) and in those with more physical problems(b = 0.30, p < 0.001). Demoralization at T2 wasonly higher in those with more physical problems(b = 0.29, p < 0.001). CONCLUSIONS: The dif-ferences in changes of hopelessness and demoraliza-tion over 1 year point toward different conceptualemphases within these constructs, despite their highintercorrelation. This is further underscored bypatients with lung/gastrointestinal cancer beingmore hopeless at T2 compared to T1, but not moredemoralized, depressive or anxious. Importantly,this result was independent of gender and treatmentphase. RESEARCH IMPLICATIONS: Based onthe results it could be hypothesized that the con-structs of hopelessness and demoralization identifydifferent aspects of existential distress in cancerpatients. Hopelessness refers to negative cognitiveexpectations of the future, while demoralizationrefers to both emotional and cognitive symptoms ofloss of meaning and a sense of failure in addition tofeelings of hopelessness. Hopelessness might hencemore closely relate to changes in prognosis. CLINI-CAL IMPLICATIONS: Only patients with lung/gastrointestinal cancer showed an increase in hope-lessness after 1 year, independent of treatmentphase. An explanation might be that among thosereceiving palliative treatment, patients with lung/gastrointestinal cancer still face a faster disease pro-gression than patients with breast/gynecologicalcancer. Patients with lung cancer did however notshow an increase in depression, anxiety, anddemoralization in our sample, indicating that anincrease in hopelessness is not necessarily associ-ated with higher emotional distress. ACKNOWL-EDGEMENT OF FUNDING: This study wasfunded by the German Donor’s Association.

P1-94

Oncological Case Management and Care for

Concerns Regarding Meaning - A Case Study

Anja Visser1, Henry Wolterink2, Rineke Leys2

1Helen Dowling Institute, Bilthoven, TheNetherlands, 2Maasstad Hospital, Rotterdam, TheNetherlands

BACKGROUND: Several Dutch hospitals -among which the Maasstad Hospital - have recentlyintroduced casemanagement in their oncological



care chains. The casemanagers of the MaasstadHospital call their patients by telephone 2 to 5 daysafter they have received the diagnosis to monitortheir well-being (post-diagnosis telephone call). Inthe current exploratory mixed-methods study theexperiences of oncological patients and casemanag-ers of the Maasstad Hospital regarding caseman-agement and the post-diagnosis telephone call wereinvestigated. METHOD: Semi-structured, qualita-tive interviews were held with the 6 casemanagersof patients with ovarian, prostate, or breast cancerthat were treated with curative intent. In addition,seven post-diagnosis telephone calls were recordedby the urology and gynaecology casemanagers.Consecutive patients with prostate, ovarian orbreast cancer were asked to fill out a short ques-tionnaire on their satisfaction with the care fromtheir oncology nurse (N = 52) and 11 of these par-ticipants took part in a semi-structured qualitativeinterview. All interviews were verbally transcribed.The transcripts were then coded and the coded frag-ments were summarized in order to answer theresearch questions. RESULTS: In particular theinformation about the diagnosis, curative treatmentand prognosis that was provided by the casemanag-ers and the availability of the casemanagers for thepatient’s needs were appreciated by patients. Never-theless, several areas of improvement were observed(see Conclusion). The casemanagers seemed to beequipped to carry out the post-diagnosis telephonecalls. However, they did not always respond ade-quately to questions and concerns regarding mean-ing that were raised by the patients - such asfeelings of guilt, questions about performing one’sprofession, and fear of death - thereby overlookingsome of their needs. CONCLUSIONS: There isroom for improvement in casemanagement for can-cer patients in the Maasstad Hospital. The follow-ing recommendations are made, that may alsobenefit other hospitals:

• Ensure attention to a patient’s concerns regard-ing meaning through guidelines about the goaland structure of the post-diagnosis telephonecall

• Provide regular contact between patients andcasemanagers.

• Assign only one casemanager to a patient.

• Adjust the amount of information that is pro-vided to the needs of the patient.

Provide structure in the duration of consultationsso that waiting-time is reduced, but patients canvoice all of their questions and concerns.

RESEARCH IMPLICATIONS: The currentexploratory study raises a number of questionsregarding the presence and effects of spiritualneeds, and the need for and the effects of spiritualcare in the curative oncological setting. As of yetnot much is known about these issues, particularlywithin the Netherlands. Furthermore, informationis needed on the effects of the implementation of

oncological casemanagement on patient satisfac-tion and well-being within the Netherlands, to fur-ther increase the quality of oncological care.CLINICAL IMPLICATIONS: The present studyhas provided information on several issues thatshould be taken into account when implementingcasemanagement in a hospital’s oncological carechain. Especially the structuring of the consulta-tions with the casemanager and the provision ofinformation, need to be considered carefully inorder to fully meet the needs of the patient withoutincreasing the workload of the casemanager toomuch. Involving the patient in these matters is key.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by the Stichting GeestelijkeVerzorging Rijnmond and the Helen DowlingInstitute.

P1-95

A Case Report of Application of Existential

Approach in an Elder Cancer Patient With Suicide

Ideation

Shu-Ting Zhuang1,3, Chia-Ta Chan2,3

1Suicide and Substance Prevention Center, ShinKong Wu Ho-Su Memorial Hospital, Taipei,Taiwan, 2Department of Psychiatry, Shin Kong WuHo-Su Memorial Hospital, Taipei, Taiwan, 3TaiwanPsycho-Oncology Society, New Taipei, Taiwan

BACKGROUND: Cancer patients maybe thinksuicide as copying strategy in a sudden or for a longtime when they fell much distress or hopelessness.We can see the cancer as existential frustration(Frankl, 1959) or really anxiety about death topatients (Yalom, 2008), and the therapeutic rela-tionship, the patient-therapist encounter, will healpatients in terror of existential isolation (Yalom,1980).This case report illustrates the meaning of therelationship in a elder cancer patient with high sui-cide risk. METHOD: The patient is a 70-year-oldman who divorced 50 years ago and lives alone there-after. He was diagnosed with prostate cancer, stageIV, with spinal metastasis in January 2013. His sui-cide ideation resulted from his dysfunctional left legand the diagnosis. The psychiatrist referred him tothe psychologist. Till the end of April, he has under-gone 11 sessions bedside individual psychotherapyduring the period of inpatient, 5 sessions on the tele-phone after discharged from hospital, and 1 sessionin outpatient clinic. All sessions will be analyzedbased on the approach of logotherapy and existentialpsychotherapy. RESULTS: The patient hadstrongly suicide ideation at first but finally had thewill to living again. It was the relationship effectedhis attitude remarkably because he said he appreci-ated our team “remembered” him. He had no willto tell us why he lived alone all his life. But he knewhe deserved to be loved though this experience. He



practiced hard walking instead of jumping to deathalone at home. He found the meaning of suffering(Frankl, 1959), showed his potentialities in life(May, 1983) and took his responsibilities (Yalom,1980). And these changes were revealed in here andnow (Yalom, 1980) in psychotherapy. CONCLU-SIONS: Even we can use some screen tools toassess the problems cancer patients with suicide riskhave, it still has obstructions. Such as patients don’twant to talk or it’s not right time to use these tools.At this time, therapists are “the tool”. According toFrankl’s and Yalom’s concepts, if therapists see thesuicide ideation/attempts of cancer patients notmasks for other problems, if therapists can containpatients’ terror of death and bravely enter into theirexistential concerns, and these attitude can facilitatepatients finding the meaning of suffering autono-mously in a genuine and secure base. CLINICALIMPLICATIONS: If applying existential approachto cancer patients appropriately, the therapeuticalliance will get much more steady and secure. Withmuch more helpful relationship, any screen tool orintervention will get much effective. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-96

The Influence of Chemotherapy on Cognitive

Functioning in Patients With Breast Cancer

Paulina Andryszak1, Pawel Izdebski1, Monika

Wilkosc1,2, Bogdan Zurawski3, Jerzy Tujakowski3

1Institute of Psychology, Kazimierz WielkiUniversity in Bydgoszcz, Bydgoszcz, Poland,2Department of Psychiatry, Collegium Medicum wBydgoszczy, Nicolaus Copernicus University inTorun, Bydgoszcz, Poland, 3Franciszek LukaszczykOncology Center, Bydgoszcz, Poland

BACKGROUND: The effect of chemotherapy oncognitive functioning has not been adequatelydescribed yet, and results of previously publishedstudies provide equivocal results. The aim of thestudy is to assess the influence of chemotherapy oncognitive performance (memory and learning,information processing speed) and some aspects ofexecutive functions in patients with breast cancer.METHOD: 31 breast cancer female patients quali-fied to adjuvant chemotherapy with four doses ofAC (mean age = 52 � 8) participated in the pro-spective study before chemotherapy initiation (T1),after the 2nd cycle (T2) and up to 30 days after thelast dose of chemotherapy (T3). The evaluation ofcognitive functioning was carried out using theTrail Making Test A&B (TMT A&B), the StroopColor-Word Interference Test (SCWIT), the DigitSymbol Substitution Test (DSST), the Fluency Test(COWA) and the Rey Auditory Verbal LearningTest (RAVLT). RESULTS: The results obtainedshowed significant improvement in: TMTA in T3compared to T1 (z = 2.9; p = 0.004); TMTB in T2

compared to T1 (z = 4.14; p = 0.000); T3 comparedto T1 (z = 4.04; p = 0.000). Significant improve-ment was also found in the second part of SCWITin: T2 compared to T1 (z = 2.845; p = 0.004); T3compared to T1 (z = 3.989; p = 0.000); T3 com-pared to T2 (z = 2.02; p = 0.04). Moreover signifi-cant improvement was observed in DSST: T2compared to T1 (z = 3.55; p = 0.000); in T3 com-pared to T1 (z = 3.61, p = 0.000). Significant deteri-oration was found in the first part of SCWIT in T3compared to T1 (z = 2.34; p = 0.019). CONCLU-SIONS: Our results indicate that after adjuvantchemotherapy with four doses of AC for breastcancer only the time of accomplishment of the firstpart of the Stroop Color-Word Interference (read-ing colors written in black) worsened, whereas in allother tests no differences or even improvement wasfound. Further analyzes will be performed.RESEARCH IMPLICATIONS: The resultsobtained are inconclusive. Probably other factorswhich were not taken into consideration duringthese analyzes could have influenced these results.Further studies should include other factors (e.g.emotional and somatic functioning) which mightinfluence cognitive performance. Use of tests, whichhave psychometrically matched, alternate formscould help to minimize practice effect. Moreover,different types of chemotherapy should be com-pared. CLINICAL IMPLICATIONS: While ana-lyzing cognitive functioning of patients treated withchemotherapy various factors should be taken intoconsideration, e.g. emotional and somatic aspectsof functioning of patients. It is important to use, ifpossible, the tests with have alternate forms to min-imize practice effect. ACKNOWLEDGEMENTOF FUNDING: None.

P1-97

Self-Report Behavioral Measures Associate More

Strongly Than Psychosocial Measures With Diurnal

Salivary Cortisol Patterns in Persons With Cancer

Irene K.M. Cheung1, Timothy H.Y. Chan1, Lai

Ping Yuen2, Tammy Lee3, Jessie S.M. Chan1,

Jonathan S.T Sham1, Cecilia L.W. Chan1

1Centre on Behavioral Health, The University ofHong Kong, Hong Kong, 2International Associationand Health and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong

BACKGROUND: Diurnal salivary cortisolrhythms are associated with various psychosocialand behavioral factors (e.g. sleep quality andstress). Most psycho-oncological studies involvingcortisol were done with specific cancer groups, mostnotably breast and prostate cancer patients. Littleis known about patients with mixed cancer diagno-ses. At the same time, the relation between salivarycortisol and physical activity has not been explored



before. The current study aims to investigate whichmeasures are better predictors of cortisol response.METHOD: The study analyzed data collected at abaseline assessment prior to a randomized con-trolled trial examining the effects of an exerciseintervention on cancer-related quality of life.Ninety-four persons with mixed cancer diagnosescompleted an online questionnaire with behavioralmeasures (sleep quality, daily physical activity) andpsychosocial measures (perceived stress, mood,social support). They also collected five saliva sam-ples at home during 1 day (waking, 45 minutesafter waking, noon, 5pm and 9pm). Cortisol valueswere natural log transformed before analysis.RESULTS: We calculated the diurnal slope (by lin-ear regression on collection time) and area-under-the-curve (AUC). Poor sleep quality was correlatedwith flatter diurnal slope (r = 0.27, all ps < 0.05below), elevated evening cortisol (r = 0.30) andhigher AUC (r = 0.28). Low physical activity wasassociated with elevated evening cortisol (r = 0.21)and higher AUC (r = 0.25). On the other hand, psy-chosocial measures did not associate with salivarycortisol patterns, despite the fact that behavioraland psychosocial measures were correlated. Regres-sion on diurnal slope and AUC with behavioral andpsychosocial measures confirmed the same findings.CONCLUSIONS: Among persons with mixedcancer diagnoses, low physical activity and poorsleep quality salivary were found to be associatedwith higher cortisol levels and flatter patterns.Interestingly, while psychosocial measures werecorrelated with poor sleep quality, they did notappear to affect salivary cortisol secretion. Thefindings of the study suggest that behavioral mea-sures of physical activity and sleep may be superiorto psychosocial measures in predicting cortisolresponses, and by extension physiological outcome,in cancer patients. RESEARCH IMPLICA-TIONS: The study demonstrated for the first timein mixed cancer patients the relationship betweenphysical activity and diurnal cortisol secretoryactivity. CLINICAL IMPLICATIONS: The studyre-confirms the importance of sleep quality andphysical activity in maintaining the well-being ofcancer patients. The findings suggest that behav-ioral intervention, such as exercise, may producephysiological improvement in cancer patients.ACKNOWLEDGEMENT OF FUNDING: None.

P1-98

Looking at the Mirror: Different Approaches in

Assessing Body Image in Breast Cancer Patients

Simone Cheli1, Lucia Caligiani1, Francesca

Focardi1, Luisa Fioretto2

1Psycho-oncology Unit, Department of Oncology,Florence, Italy, 2Health Director, Department ofOncology, Florence, Italy

BACKGROUND: An effective psychologicalassessment is the one that promotes a standardizedand personalized information gathering. It ought toallow a quantitative comparison with normativedata and a qualitative analysis of the personal expe-rience. The more complex is the focus of such anassessment, the more important is the integrationof quantitative and qualitative data. In order todevelop a supportive-expressive group therapy onbody image in breast cancer patients, we integratedpsychometric and narrative methods. METHOD:During the phase I of the study we translated andvalidated the Body Image Scale (Hopwood et al.,2001) on an Italian sample (n = 217) of cancerpatients. We also developed and validated a proce-dure for eliciting (open questions) and analyzing(computer aided qualitative data analysis software)the personal narratives about Quality of Life, can-cer and body image. The 2 tools have been adminis-tered together with the Psychological DistressInventory (Morasso et al., 1996) and the DistressThermometer (Roth et al., 1998). In phase II weexplored costructions of breast cancer patients(n = 127) using Body Image Scale and narrativeprocedure. RESULTS: The Italian version of BodyImage Scale shows a high reliability (Cronbach’salpha = 0.919). As in the original English versionthe Factor Analysis (Principal Component Analy-sis) highlights one significant factor (% of explainedvariance = 58.281). The analysis of the written nar-ratives about Quality of Life, cancer and bodyimage shows some recurrent clusters: (I) QoL isusually described in terms of daily normality; (II)cancer narratives refer to psychological constructsof distress and anguish; (III) questions about bodyimage subsume a relational barrier, especially withpartners. CONCLUSIONS: The described proce-dure seems to be useful in assessing the patients dis-tress about body image and in developing a tailor-made intervention. On one side we were able toidentify high-level distress women, on the other sidewe clearly defined the personal experiences and therecurrent themes to be elaborated during the grouptherapy. It is interesting to note that the relationalthemes were the core issues of illness experienceand specifically of problems in coping with changesin body image. RESEARCH IMPLICATIONS:An integration of quantitative and qualitative pro-cedures in assessing cancer experience seems to be apreferential option. Narrative approaches enhanceand specify the psychometric results. Standardizedtools allow to compare personal narratives with anormative sample. Such an integration is particu-larly significant whenever we aim to develop a sup-portive-expressive intervention. CLINICALIMPLICATIONS: The body image changes inbreast cancer patients involve aesthetic and rela-tional issues. In our research recruited women high-lighted that the more stressful issue was therelational barrier they experienced. Dealing with



body image issues probably means to deal with arift in reciprocal constructions between patientsand their social networks’ members. In order topromote an elaboration of such issues, psycho-on-cologists ought to understand the personal experi-ences of significant relations, especially with thepartners. ACKNOWLEDGEMENT OF FUND-ING: The research was supported by CIPOMO(Italian Association of Hospital Oncology HeadPhysicians), through the grant of Manzione Award.

P1-99

The Recall of Information After First Oncological

Consultations in Female Patients With Breast

Cancer

Giuseppe Deledda1,2, Claudia Goss1, Alessandro

Bottacini1, Maria Angela Mazzi1, Lidia Del Pic-

colo1, Irene Bighelli1, Mario Ballarin1, Elena Fio-

rio2, Annamaria Molino2, Christa Zimmermann1

1Department of Medicine and Public Health,University of Verona, Verona, Italy, 2Oncology Unitof Oncology, Ospedale Civile Maggiore, HospitalTrust of Verona, Verona, Italy

BACKGROUND: After a consultation the recallof information is influenced by many contextualvariables. In oncology setting, to remember cor-rectly the information provided by the oncologistmay have important implications on treatmentadherence, and on the level of anxiety and depres-sion. The aim of this study is to propose a methodto study the degree of information recalled byfemale patients with breast cancer after their firstcontact with the oncologist. METHOD: 71 breastcancer patients at early stage, who attend theOncology Out-patient Services were asked to par-ticipate the study. After the consultation patientscompleted the Recall Questionnaire regardinginformation on treatment information (treatmentname, frequency, duration, posology) and sideeffects. These information are then coded adoptinga check-list which is also applied to the audio-recorded consultation, to code the informationgiven by the oncologist. The two coding check-listsare then matched in order to calculate their agree-ment. A regression analysis will be performed inorder to explore the association between the agree-ment index and the characteristics of patients andoncologists. RESULTS: The patients’ medium agewas 59 years (SD = 10.51; range 29–74). The Lin’scoefficient shows a low concordance (rho = 0.156;p < 0.01) between the number of recalled informa-tion by the patients (M = 4.4 [SD = 2.6]) and thenumber of information given by oncologists(M = 11.4 [SD = 4.75]). Analysis on patients’ recallby treatment name, duration, frequency and posol-ogy, shown that patients recall a mean of 1.9 infor-mation (SD = 1.5), in comparison with a mean of 6

information given by oncologist (SD = 2.4). More-over, patients recall a mean of 2.5 side effects infor-mation (SD = 1.8), in comparison with a mean of5.4 information given by oncologist (SD = 3.5).CONCLUSIONS: The method used in this studyto analyzes the patients’ recall appears feasible andeffective. The preliminary data show that the moreinformation (cut score of 4) is given, the less infor-mation patients recall. This result is consistent withthe literature. Future studies should consider addi-tional factors such as anxiety of the patients, the ill-ness stage, the doctors’ style, the context and whenthe memory is measured. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-100

Assessment of Cancer Outpatient Satisfaction With

Care: A Systematic Literature Review of Self-

Reported Instruments

Anne Bredart1,2, Juan Arraras3, Fabio Efficace4,5,

Jean-Luc Kop6, Sylvie Dolbeault1,7

1Institut Curie, Paris, France, 2University ParisDescartes, Boulogne Billancourt, France, 3Hospitalof Navarre, Pamplona, Spain, 4GIMENA DataCenter, Rome, Italy, 5University of Rome, Rome,Italy, 6University of Lorraine, Nancy, France,7University Paris-Sud, Paris, France

BACKGROUND: Cancer care is increasingly pro-vided in out-patient settings for treatment follow-up or cancer survivors’ surveillance. Patient satis-faction is now recognized as an important indicatorof care quality, related to adherence and health out-comes, and providing indications for care improve-ment. A literature review was performed tohighlight the population target, content, develop-mental process and psychometric performance ofpatient satisfaction assessment in the cancer outpa-tient setting, and to highlights needs for improvedcancer outpatient patient satisfaction instrument.METHOD: A systematic literature search from thepast 20 years using the Medline, PsycInfo, CI-NAHL and Cochrane databases to identify studiesthat described the development/validation of cancerpatient satisfaction questionnaires to be used in theoutpatient setting, or that applied patient satisfac-tion questionnaires in that specific setting (exclud-ing the cancer screening or advanced/EOL cancercare setting) was conducted. A combination of key-words including satisfaction with care OR patientsatisfaction, AND determinant OR factor OR pre-dictor AND psychomet* OR validation AND can-cer AND ambulatory OR outpatient were used.Reference lists of patient satisfaction reviews andrelevant organization websites were also consulted.RESULTS: A total of 146 citations were identified,mostly from the past 10 years. After removingduplicates, analysis of these citations indicated that13 studies described questionnaires/subscales



specifically designed for the cancer outpatient set-ting. Among these studies, the population targetmainly included any cancer diagnosis type.Domains of care assessed addressed access, avail-ability, choice, communication/interpersonal skills,convenience, continuity, coordination, effective-ness, health promotion, multidisciplinary team-work, waiting time. Whereas most questionnaireswere developed according to a multi-step approach,only 2 questionnaires underwent a (non-simulta-neous) cross-cultural validation. Twelve question-naires underwent at least basic psychometricanalyses including construct validity and internalconsistency analyses. CONCLUSIONS: The num-ber of studies addressing patients’ perception of thequality of care in the cancer outpatient setting isincreasing, reflecting the need to improve cancerpatients’ interactions and navigation through long-term, multidisciplinary and multi-setting care.However, there is paucity of studies using psycho-metrically solid cancer outpatient satisfaction ques-tionnaire. No such questionnaire developed in across-cultural setting, taking into the account thecharacteristics of different cultures, was identified.RESEARCH IMPLICATIONS: There is urgentneed to develop a cross-cultural and methodologi-cally sound cancer patient satisfaction question-naire that could be used in international studiesaimed at assessing and comparing results of initia-tives for care improvement in the oncology outpa-tient setting. CLINICAL IMPLICATIONS:During the initial diagnostic-treatment, the meta-static chronic treatment or the surveillance phase ofthe cancer trajectory, cancer patients or survivorsare regularly followed over long time periods inoutpatient settings, e.g.: to check for treatmenteffects, to monitor disease recurrence or evolution,to manage symptoms or adverse effects, or toaddress psychosocial issues. Assessing patient satis-faction in this context may provide indications forcare improvement in the clinical encounter or at theinstitutional level. ACKNOWLEDGEMENT OFFUNDING: None.

P1-101

Prevalence, Intensity, and Predictors of the

Supportive Care Needs of Women Diagnosed With

Breast Cancer

Chavie Fiszer1,2, Sylvie Dolbeault1,3, Serge

Sultan4,5, Br�edart Anne1,2

1Psycho-oncology Unit, Supportive CareDepartment, Institute Curie, Paris, France, 2InstitutCurie, LPPS Paris Descartes, Paris, France,3INSERM U 699, Paris, France, 4University ofMontreal, Montreal, Canada, 5Centre de Recherchedu CHU Ste Justine, Montreal, Canada

BACKGROUND: The assessment of supportivecare needs is a crucial step in the development of

appropriate interventions that may improve thequality of life of cancer patients. This reviewdescribes and analyzes the prevalence and predic-tors of the unmet supportive care needs of breastcancer (BC) patients and survivors and suggestspaths for further research. METHOD: Multipledatabases were searched (CINHAL, PubMed/Med-line, PsycInfo), considering only quantitative stud-ies using validated needs assessment instrumentsand focusing uniquely on women diagnosed withBC, returning 761 hits. After removing duplicates,titles and abstracts were inspected for relevance(439 papers). A remaining fifty-seven were read inentirety, of which thirty-three were rejected as theydid not employ validated measures or did notreport concrete data regarding frequencies or meanscores. RESULTS: Twenty-four studies answeredto all eligibility criteria. Twenty were cross-sec-tional and the remaining 4 were longitudinal. Mostincluded patients at different moments along theBC trajectory, from diagnosis to decades into survi-vorship, with the major proportion of patientsunder treatment. Results clustered around psycho-logical and information needs, with the top concernbeing “fear of the cancer returning.” Predictors ofhigher needs included advanced disease stage,greater symptom burden, shorter time since diagno-sis, higher levels of distress, and younger age. Prev-alence differed between cultures with Asian womenreporting greater information needs and lower psy-chological needs compared to Western women.CONCLUSIONS: To date, studies assessing BCneeds are primarily cross-sectional and includewomen who are at different moments along the BCtrajectory, employing different measures, or thesame measure scored in different ways, makingcomparison between studies problematic. The pau-city of psychosocial factors assessed in relation toneeds thwarts our ability to understand and predictwho is at risk for greater needs. RESEARCHIMPLICATIONS: In illustrating what is known sofar about the needs of women who have been diag-nosed with BC we can move forward and designresearch protocols to refine our understanding inorder to predict who is at risk for greater needs andhow needs are likely to change over time. Specifi-cally, future research should delve deeper into indi-vidual factors that may influence needs, employlongitudinal designs, and use unambiguous scoringand reporting of needs. CLINICAL IMPLICA-TIONS: This study is the first step in designingeffective care for those women who need it most atthe right time, thereby optimally allocating scareresources. Furthermore, meeting the needs of BCpatients may promote better health related qualityof life. ACKNOWLEDGEMENT OF FUND-ING: Institut Cure; Ligue contre le cancer.



P1-102

Validation of the Zarit Scale for Assessment of

Caregiver Burden in Mexican Primary Caregivers of

Cancer Patients

Oscar Galindo Vazquez1,2, Corina Benjet3, Mar�ıaHayde�e Cruz Nieto2, Edith Rojas Castillo2,

Ang�elica Riveros Rosas4, Francisco Ju�arez Garc�ıa3,Jos�e Luis Aguilar Ponce5, Miguel �Angel �Alvarez

Avitia6, Salvador Alvarado Aguilar2

1Facultad of Psychology, National AutonomousUniversity of Mexico, Mexico City, Mexico,2Department of Psycho-Oncology, National CancerInstitute, Mexico City, Mexico, 3Direcci�onEpidemiological and Psychosocial Research,National Institute of Psychiatry Ramon de la FuenteMu~niz, Mexico City, Mexico, 4Division of Research,School of Accounting and Administration, NationalAutonomous University of Mexico, Mexico City,Mexico, 5Subdirecci�on of Internal Medicine,National Cancer Institute, Mexico City, Mexico,6Department Medical Oncology, National CancerInstitute, Mexico City, Mexico

BACKGROUND: Being a caregiver of a personwith a disability or chronic illness has a diversity ofpsychosocial consequences. Caregivers oftenassume the role of assistance without notice and noknowledge in care tasks. Several studies reportexhaustion, fatigue, insomnia, weight loss and dete-rioration of health in caregivers of people with can-cer. To determine the psychometric properties ofthe Zarit Scale on Mexican primary caregivers ofpatients with cancer. METHOD PARTICI-PANTS: Participants were 261 women (72.7%)and 98 men (27.3%) with a mean age of43.4 � 13.0 years caregivers of cancer patients atMexico’s National Cancer Institute. INCLUSIONCRITERIA: Family, acquaintance or friend whocan read and write, that perform care activities forthe patient with cancer (with any diagnosis, stageand treatment), received no financial remuneration.Exclusion criteria Family, acquaintance or friendwho can’t read and write who reports receivingfinancial remuneration for their care activities andhas health care training. INSTRUMENTS: ZaritScale, Beck’s Depression Inventory (BDI), Beck’sAnxiety Inventory and The Goldberg’s GeneralHealth Questionnaire (GHQ). RESULTS: Usingprincipal component analysis with varimax rotationset to three factors was determined that the factorstructure was similar to the original version. Theinternal consistency of the overall scale was anappropriate index (a = 0.90). Cronbach’s alphasfor subscale had the following values: Impact ofcaregiver a = 0.90, a = 0.76 Interpersonal Rela-tionship Expectations of self-efficacy and a = 0.67explaining the 51.65% of the variance. The validitythrough correlations with concurrent measuresshowed significant (Pearson’s r): BDI.54, BAI 56

and GHQ .48, (p < 0.05). CONCLUSIONS: TheZarit Scale on Mexican primary caregivers ofpatients with cancer has adequate construct valid-ity, internal consistency and concurrent validity foruse in cancer patients from the Mexican popula-tion. The relevance of these results is a cost effectivetool to provide timely mental health care early incaregivers for those in need. RESEARCH IMPLI-CATIONS: In Mexico there was not an adaptedand standardized scale for the assessment of burdenin primary caregivers of patients with cancer. Theresults of the study propose The Zarit scale forMexican primary caregivers of patients with canceras an instrument with psychometric properties.CLINICAL IMPLICATIONS: Its use will enablean appropriate assessment of caregivers of cancerpatients as a first step in developing help manualsand interventions that promote self-care, with theaim of reduce care burnout and promote optimalcare of the cancer patient. ACKNOWLEDGE-MENT OF FUNDING: Detecting of deteriora-tion of health in caregivers of people with cancerthrough the Zarit Scale may benefit caregivers Mex-icans overwhelm in cancer patients, is relevantbecause it can achieve reliable assessment validity,and thus develop counseling programs in this groupof caregivers.

P1-103

Patient Competence in the Context of Cancer: A

Contribution to Construct Validation

Tina Zeiss, Juergen M. Giesler, Joachim Weis

Tumor Biology Center Freiburg, Freiburg, Germany

BACKGROUND: Patient competence (PC) is aconstruct that has gained some attention recently asit aims at describing skills and abilities required forpatients with cancer when confronting coping tasksarising from this life-threatening chronic diseaseand its treatment. This study attempts to compre-hensively validate a new self-rating measure of PC(published in 2008) in order to further clarify thisconstruct and provide a sound methodologicalbasis for further research on its determinants andoutcomes. METHOD: In a longitudinal multi-cen-tre study, a total of 512 patients with breast, colo-rectal, or prostate cancer will be surveyed at thebeginning and the end of their oncological rehabili-tation, and 9 months afterwards. In addition toself-rated PC, fear of progression, coping with ill-ness, self-efficacy for coping with cancer, and qual-ity of life will be assessed at all points ofmeasurement as validity criteria. Data analysis willemploy structural equation modeling and repeatedmeasures ANOVAs controlling for diagnosis, treat-ment type (curative vs. palliative), and gender. Thefactorial validity of the PC measure will be testedvia confirmatory factor analyses (CFA).RESULTS: At the time of preparing this abstract,



200 patients have already been recruited into thestudy. At the congress, we will report on the resultsof a CFA for the data of the first measurementpoint for which we expect to have available approx-imately 400 patients by then. It is assumed that itwill be possible to replicate the 8 dimensions of PC(5 problem- and 3 emotion-focused ones) that werefound in the original publication. In addition, wewill report on the relationships between the dimen-sions of PC and the validity criteria mentionedabove. CONCLUSIONS: The present study willprovide a comprehensive basis for determining thevalidity of the construct of PC as measured by theoriginal questionnaire. If necessary in the light ofempirical evidence, it will also help modify andimprove its subscales and refine the underlying con-ceptual model. RESEARCH IMPLICATIONS:Since it has been claimed that PC is crucial for avariety of outcomes in the context of cancer (andother chronic conditions), a thoroughly validatedinstrument for measuring PC in this field is a prere-quisite for testing hypotheses relating PC to, e.g.quality of life, well-being, fear of progression, oreven survival of cancer patients. Therefore, thisstudy will help build the methodological basis uponwhich future research on these hypotheses may pro-ceed. CLINICAL IMPLICATIONS: Having avail-able a reliable and valid measure of PC and itsdistinct facets will capture the whole range of inter-individual differences that exist with respect to thisset of patients’ coping skills and abilities. As such,it will also help develop and evaluate interventionsfor promoting PC that are sensitive to coping tasksthat may be specific for a given type of cancer.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is supported by the German Federal Ministryof Education and Research.

P1-104

Survivor Unmet Needs Survey (SUNS) for

Hematological Cancer Survivors: A Psychometric

Assessment

Alix Hall1, Catherine D’Este1,2, Flora Tzelepis1,

Marita Lynagh1, Robert Sanson-Fisher1

1Priority Research Centre for Health Behaviour,Faculty of Health, The University of Newcastle &Hunter Medical Research Institute, Callaghan, NewSouth Wales, Australia, 2Priority Research Centrefor Gender Health & Aging; and Centre for ClinicalEpidemiology and Biostatistics, Faculty of Health,The University of Newcastle & Hunter MedicalResearch Institute, Callaghan, New South Wales,Australia

BACKGROUND: Addressing the needs of cancersurvivors is central to providing optimal supportivecare. Relevant and psychometrically sound needsassessment tools are required to accurately assesssurvivor needs. There is an absence of valid and

reliable, multi-dimensional needs assessment toolsfor use within hematological cancer survivor popu-lations. This study aimed to rigorously assess therelevance, reliability and validity of the SurvivorUnmet Needs Survey (SUNS) for use in an adultsample of hematological cancer survivors.METHOD: The SUNS is an 89-item measure ofcancer survivor unmet needs across five domains,including, Emotional Health, Access and Continu-ity of Care, Relationships, Financial Concerns andInformation. The SUNS was developed and psy-chometrically evaluated in a heterogeneous sampleof Canadian cancer survivors. In this study, theSUNS was psychometrically evaluated for use withAustralian hematological cancer survivors usingdata collected from hematological cancer survivors,aged 18–80 years at time of study and recruitedfrom four Australian population-based cancerregistries. A second survey was completed by a sub-sample of survivors from 2 of the registries to assessinstrument test-retest reliability. RESULTS: Todate SUNS data from 492 hematological cancersurvivors from three registries have been enteredand analysed. Preliminary factor analysis usingdata from 368 survivors who completed all 89 itemsof the SUNS, illustrates initial support for use ofthe original five-factor structure of the SUNS in anAustralian hematological cancer survivor popula-tion. Preliminary analysis also suggests satisfactorylevels of internal consistency; and construct andconvergent validity. Floor effects were evident forall five domains. CONCLUSIONS: Needs basedassessment is a vital step in achieving optimal sup-portive care. However, no previous multi-dimen-sional needs assessment tool has beenpsychometrically evaluated for use in a population-based sample of hematological cancer survivors.Preliminary analysis demonstrates promising find-ings of the SUNS as a psychometrically sound mea-sure of unmet needs in population-based samples ofhematological cancer survivors. However, flooreffects may impact on the responsiveness of thescale. RESEARCH IMPLICATIONS: Establish-ing the SUNS as a valid and reliable unmet needsmeasure for hematological cancer survivors willallow future researchers to accurately assess theunmet needs of hematological cancer survivors; aswell as providing an opportunity to standardisefuture research practices in this area. Futureresearch should also strive to evaluate the psycho-metric properties of predictive validity and respon-siveness using longitudinal research designs.CLINICAL IMPLICATIONS: This study suggeststhat the SUNS could potentially be used by healthcare providers to routinely assess the unmet needsof hematological cancer survivors. Assessing theunmet needs of hematological cancer survivorsusing a psychometrically rigorous tool will ensurethe needs of survivors are accurately identified andappropriate supportive care is provided in a timely



manner. ACKNOWLEDGEMENT OF FUND-ING: This research was co-funded by beyondblueand Cancer Australia (Application ID: 569290).Alix Hall was previously supported by an Austra-lian Postgraduate Award and is currently sup-ported by a 2012 Prime Minister’s Australia AsiaEndeavour Postgraduate Award. Dr Flora Tzelepisis supported by a Leukaemia Foundation of Aus-tralia and Cure Cancer Australia Foundation Post-Doctoral Research Fellowship.

P1-105

Comparing Quality of Life Between Adult Survivors

of Childhood Cancer and Siblings: The Role of

Post-Traumatic Stress Symptoms

I-Chan Huang1, Tara Brinkman2, Gregory

Armstrong2, Leslie Robison2, Kevin Krull2

1University of Florida College of Medicine,Gainesville, Florida, USA, 2St. Jude Children’sResearch Hospital, Memphis, Tennessee, USA

BACKGROUND: Childhood cancer survivorsreport more post-traumatic stress symptoms(PTSS) and lower health-related quality of life(HRQOL) compared to siblings. Individuals withhigh PTSS might endorse response categories ofHRQOL items differently compared to those withlow PTSS given the same level of HRQOL (differ-ential item functioning; DIF). This study aims tocompare HRQOL between adult survivors of child-hood cancer and siblings by accounting for mediat-ing effects of PTSS and DIF related to PTSS.METHOD: 7103 cancer survivors and 390 siblingsin the Childhood Cancer Survivor Study (CCSS)completed the Medical Outcomes Study 36-ItemShort-Form Health Survey (SF-36) which measureseight domains of HRQOL. PTSS was measuredusing the Post-traumatic Stress Disorder SymptomScale. Items with DIF related to PTSS were identi-fied using a graded response model and HRQOLdomain scores were calibrated by accounting forDIF related to PTSS. The extent to which PTSSstatus mediated the discrepancies in HRQOLbetween survivors and siblings was tested and thedifferences in HRQOL domain scores between sur-vivors and siblings were estimated using regressionanalyses. RESULTS: 13 items of the SF-36 wereidentified with DIF related to PTSS: physical func-tioning (5 items), vitality (2 items), role limitationsdue to emotional problems (2 items), mental health(2 items), role limitations due to physical problems(1 item), and general health (1 item). Beforeaccounting for mediating effect of PTSS, survivorsreported lower DIF-calibrated HRQOL in alldomains compared to siblings (p < 0.01), exceptbodily pain, vitality, and role limitations due toemotional problems. However, PTSS significantlymediated the relation between survivorship andHRQOL where survivors reported lower DIF-cali-

brated HRQOL compared to siblings only in physi-cal functioning (effect size = 0.37; p < 0.01).CONCLUSIONS: More than one-third of the SF-36 items demonstrate DIF related to PTSS status inchildhood cancer survivors and siblings. Althoughchildhood cancer survivors often report impairedHRQOL compared to siblings, the observed differ-ences may be in part due to DIF related to PTSSthat influences perceptions and report of HRQOLitems, and the mediating role of PTSS on HRQOL.Without careful consideration of DIF effectsrelated to psychological state such as PTSS and themediating effects of PTSS on HRQOL, the compar-ison of HRQOL between cancer survivors andsiblings can be misleading. RESEARCH IMPLI-CATIONS: DIF findings provide insights for psy-cho-oncology research. If DIF reflects psychosocialadjustment for HRQOL items by cancer survivors,calibrating DIF item scores between survivors andsiblings would be a reasonable strategy. Calibrationallows item parameters to be separately estimatedfor the subgroups and these different parameterestimates can be used to estimate HRQOL scores.Further research also is encouraged to use cognitiveinterviewing techniques to investigate the psycho-logical mechanisms behind the DIF findings.CLINICAL IMPLICATIONS: The significantmediating effects of PTSS on the relation betweensurvivorship and HRQOL provide useful implica-tions for clinical practice. Given that impairedHRQOL between cancer survivors and siblings ischiefly explained by the presence of PTSS, evaluat-ing PTSS status alongside other psychosomaticsymptoms such as pain and fatigue in cancer survi-vors is an important component in survivorshipcare. Improving survivors’ HRQOL throughappropriate psychosocial interventions to treatPTSS is a reasonable strategy. ACKNOWLEDGE-MENT OF FUNDING: This work was supportedby the National Cancer Institute (NCI) CancerCenter Support (CORE) grant CA21765 (TMB,GTA, LLR, and KRK), by the National Instituteof Arthritis and Musculoskeletal and Skin Diseases(NIAMS) grant U01 AR052181 (ICH), and by AL-SAC (TMB, GTA, LLR, and KRK).

P1-106

Further Validation of the Symbolic Assessment of

Fatigue Extent (SAFE)

Subathra Jeyaram, Surendran Veeraiah, Vidhubala

Elangovan

Cancer Institute WIA, Chennai, Tamilnadu, India

BACKGROUND: Symbolic Assessment of Fati-gue Extent (SAFE), developed in 2012, is a 12 itempatient rated tool assessing both extent (4 items)and impact (8 items) of fatigue in adult cancerpatients. Responses are either symbolic visual rep-resentations on a 5 point likert scale (smileys, shape



gradients or body caricatures), with items assessingimpact represented pictorially. The objective of thestudy is to establish further validity of the SAFEspecifically discriminant, concurrent and conver-gent validity. METHOD: A mixed group of cancerpatients (n = 42) were administered the SAFEalong with the Multidimensional Fatigue Inventory(MFI-20), Distress Thermometer and Cancer Insti-tute Quality of Life (CI-QOL). Breast cancerpatients (n = 36) attending a follow-up clinic wereadministered the SAFE along with the PittsburghSleep Quality Index (PSQI) and the Hospital Anxi-ety and Depression Inventory (HADS). A separategroup of CML patients (n = 72) were administeredthe SAFE, and their hemoglobin readings were gath-ered from routine hemogram investigations con-ducted during their visit to the out-patient clinic. Agroup of healthy controls (n = 35) were also admin-istered the SAFE. RESULTS: SAFE had a signifi-cant negative correlation with QOL (r = �0.704,p < 0.01). Subscales physical (r = �0.69, p < 0.01)and psychological (r = �0.64, p < 0.01) wellbeinghad the highest correlation. Item to item correlation(on current level of fatigue) between SAFE andQOL was (r = 0.562, p < 0.01). SAFE correlatedsignificantly with anxiety (r = 0.55, p < 0.01) anddepression (r = 0.52, p < 0.01). SAFE also had asignificant positive correlation with the PittsburghSleep Quality Index (r = 0.536, p < 0.01). No signifi-cant correlations were found between hemoglobinvalues and fatigue. Cancer patients during treatmenthad significantly greater fatigue extent compared tocancer survivors (t (77) = �2.05, p < 0.05) andhealthy controls (t(64) = 3.74, p < 0.001). CON-CLUSIONS: SAFE was found to have good con-vergent validity (significantly correlated with QOL,Sleep, depression, anxiety and distress) and Con-current validity (correlated with another fatiguescale). Discriminant validity of the tool was alsoestablished as the tool was able to distinguishbetween cancer patients from survivors and healthycontrols. Thus, SAFE was found to be a valid toolto assess fatigue among cancer patients in a clinicalsetting. RESEARCH IMPLICATIONS: The toolcan be utilized widely by researchers for the assess-ment of fatigue in research studies, particularly inpopulations with variability in language as the toolsdependency on language proficiency is less. Thetool can be adopted by researchers around theworld and a pool of data can be gathered todevelop country and culture specific norms. CLINI-CAL IMPLICATIONS: The demonstration of thediscriminant validity makes it particularly ideal forclinical practice. The tool can be administered in>5 minutes making it suitable for both in-patientand out-patient use. The tool will help raise aware-ness among clinicians on the extent of fatigue expe-rienced by cancer patients and the impact of fatigueon different dimensions of life and will pave the

way for suitable interventions. ACKNOWLEDGE-MENT OF FUNDING: None.

P1-107

Outpatient Psychiatric Clinic in a Portuguese

Cancer Center, 2013

Andreia Ribeiro, Cristina Vale, Lucia Monteiro

Instituto Portugues de Oncologia, Lisboa, Portugal

BACKGROUND: Data concerning Psycho-Onco-logic issues and needs of Portuguese cancer patientsare scarce. IPOLFG is the main cancer centre inPortugal: total Outpatient Clinic = 216.500 andPsychiatry Outpatient Clinic = 2.700 pts (2012).For 7 years, Psychiatry Unit is implementing a Psy-cho-Oncology Program for multidisciplinary teamsto improve screening of distress and early interven-tion upon psychiatric symptoms. This study dis-closes IPOLFG Psychiatry Outpatient Clinic data:lag-time, rate and accuracy of reference, patients’medical and psychiatric profile and outcome.METHOD: Analysis of data from 2.5 months ofthe IPOLFG Psychiatry Outpatient Clinic (1 Feb-16 April 2013), where 3 senior psychiatrists are parttime working. From information system databaseand patients′ medical files, we obtained: Socio-demographic (gender, age) and scheduled Appoint-ment data (lag-time between request and 1stappointment, type of appointment (First/ Follow-up; Emergency/ General Psychiatry/ OncoSexolo-gy/ Tobacco/ Family/ Staff; follow-up period); On-cologic (site and stage of disease, present treatment)and Psychiatric data (diagnosis at 1st evaluation,type of intervention, outcome, referral). Psychiatricdiagnosis followed non-structured interviews,DSM-IV-TR and ICD-10 criteria. Statistical proce-dures included descriptive statistics, frequencyaccounts and correlations. RESULTS: Socio-demographic, appointment data 809 scheduledappointments, 604 attended (75%). 73% female;average age: 55 years old (3–96 yo). 1st appoint-ment = 27%, follow-up = 73%; General Psychia-try = 71.8%, Emergency = 16.7%. Mean follow-up time: 20 months. Oncological profile site: breast(29.6%), hematological (24.4%), head & neck(16.9%); no cancer (16.1%); stage: remission(61.5%), metastatic (14.2%), locally advanced(8%); not applied (16.6%); treatment: none(56.9%), chemotherapy (17.1%), hormonal therapy(13.3%). Psychiatric profile (cancer pts) initial diag-nosis: Adjustment Disorders (37%), Major Depres-sion (23%), multiple diagnosis (10%); none (3%);Psychiatric treatment: psychotropic drugs (49%),drugs plus psychotherapy (38%); none (2%). Refer-ral: IPOLFG Psychiatry Outpatient Clinic (89.3%),discharged (6.3%). CONCLUSIONS: The typicalprofile of the cancer patient at 1st appointment ofIPOLFG Psychiatry Outpatient Clinic is a female,57 years old, with breast or head & neck cancer,



actually under remission and free of anti canceractive treatment. Prevalent psychiatric diagnosis isAdjustment Disorders. Intervention bases on psy-chotropic drugs often conjugated with supportivepsychotherapy; psychiatric follow-up continues atIPOLFG. Further data will be launched: (1) lag-timebetween request and 1st appointment; (2) correla-tions between individual oncologic and psychiatricdata at 1st appointment; (3) evolution of psychiatricprofile throughout time. RESEARCH IMPLICA-TIONS: In a few years we would like to re-evaluateIPOLFG Psychiatry Outpatient Clinic data lookingfor positive trends that might validate the ongoingPsycho-Oncology Program. Main variables to con-trol would be: rate and accuracy of psychiatricreferral, evolution of diagnosis and patients’ out-come. CLINICAL IMPLICATIONS: The presentcharacterization is fundamental to understand thestandard of Psycho-Oncology care in IPOLFG andto improve its quality in the future, namely toadjust the Psychiatric intervention to the needs andprofile of our patients. Upgrading the quality ofpsychiatric care will eventually increase patients′coping skills and quality of life. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-108

Cancer and Non-Cancer Pain – Assessment and

Consequences

Valeri Nikolov, Maya Galabova, Miroslava

Petkova

Trakia University, Stara Zagora, Bulgaria

BACKGROUND: Lately, studying the psychoso-cial factors of pain has been a topic of interest fromresearchers. Many investigators suggesting thatregardless of its origin pain is perceived the sameway by everyone. Still others claim that pain is per-ceived differently depending on different factors.The purpose of this study is to compare pain inten-sity, frequency and its impact on daily functioningin two groups of pain patients - colorectal cancerpatients and non-cancer patients. METHOD:Thirty two (32) patients were examined (firstgroup). The mean age of patients was 64.1 years(SD = 10.6), 56% were male, 52% did not knowtheir cancer diagnosis which was related to colon(42%) and rectum (58%). The second researchgroup consisted of twenty eight (28) patients withchronic low back pain. All patients were assessedbased on clinical standards (physical examination,laboratory results, histological diagnosis and analy-sis of medical records). Semi structured interviewwas conducted with questions about coping strate-gies, frequency of pain episodes, emotional prob-lems and daily activities. Pain intensity wasassessed with VAS (Visual Analog Scale).RESULTS: There were no significant differences insubjective perception of pain between the two

groups. This result confirms the predominantresearchers’ idea that there is a similarity in subjec-tive experience of pain in patients with differentconditions including cancer. We found significantdifferences in the preferable coping strategiesbetween the two groups of patients. The cancerpatient group shows greater preference for usingpassive coping strategies, but non-cancer patientgroup displays mixed coping strategies – passiveand active. Coping strategies had been exploredconsidering coping to be a reflecting of motivationfor different goals (e.g., pain relief vs. improvedfunction). CONCLUSIONS: The data suggeststhat regardless of the similarity in experience ofpain in different groups of patients, cancer showsgrater negative effects on daily functioning thannon-cancer chronic pain conditions. Non-cancerpatients use variety of coping strategies includingactive but cancer patients prefer passive copingwith pain. In addition, our results suggest that theuse of active coping strategies may, through theirassociation with acceptance, result in a better physi-cal, psychological and emotional functioning. Theuse of passive coping strategies like avoidance,pain-contingent rest, and defensive behavior mayresult in an increased pain and disability over time.RESEARCH IMPLICATIONS: Future researchshould investigate a wider range of affective andbehavioral consequences of chronic cancer pain. Itis possible that arousing emotions are more effec-tive inhibitors of pain than calm states of relaxationbecause active coping strategies are adaptive never-theless intensity of pain. The differences in func-tional consequences of pain between cancer andnon-cancer patients support the view that a cancerdiagnosis is a uniquely traumatizing event, produc-ing broad negative impact on survivor’s psychoso-cial functioning. CLINICAL IMPLICATIONS:Clinically, the results of this study support the con-tinued use of interventions that encourage adaptivecoping (e.g., maintaining activity despite pain andacceptance) and that discourage maladaptive cop-ing (e.g., defensive behavior) should be provided topatients who have not yet learned to adequatelymanage pain. Pain intensity and its behavioral andemotional consequences should be consistentlyassessed, and, when there are significant findingsthey have to be clinically elevated and treatedappropriately. ACKNOWLEDGEMENT OFFUNDING: We thank the Trakia University, Fac-ulty of Medicine for the financial support of thisproject. This study was supported by a scientificgrant 7/2009.



P1-109

Depression as a Possible Risk Factor for Cancer:

A Systematic Review of Prospective Studies

Deepa Damodaran1, Varghese Paul2

1Department of Psychology, Bharathiar University,Coimbatore, Tamilnadu, India, 2Department ofPsychology, Prajyoti Niketan College, Thrissur,Kerala, India

BACKGROUND: Depression has been proposedas a predisposing factor for cancer as findings ofvarious studies reveal a tendency among patientswith depression toward a marginally significantassociation with the subsequent cancer risk. Butresults of prospective epidemiological studies havebeen inconsistent and inconclusive. Through thispaper authors evaluated the evidence of depressionas a possible factor influencing the development ofcancer by reviewing prospective cohort studies.METHOD: Studies were identified by computer-ized searches of Medline and Embase with a sensi-tive search strategy using the keywords as well asmanual searches of reference lists of selected publi-cations. As per the protocol and the PRISMA 2009recommendations articles were retrieved. After therelevance screen, further selection process was con-ducted based on inclusion criteria: prospectivecohort design, population-based sample, structuredmeasurement of depression, focus on depression asa potential risk factor for cancer and report ofempirical data. Methodological quality wasassessed with a validated checklist. Double-dataextraction ensured accuracy. Analysis was by nar-rative synthesis. RESULTS: Out of 9 articlesassessed for eligibility, 3 studies provided evidenceof a relationship between depression and cancerrisk. This overview of the evidence suggests a causalrelationship between depression and cancer risk.Although chronic and severe depression is found tobe associated with elevated cancer risk, results ofstudies investigating association between less severedepressive episodes and cancer risk were not con-clusive of causal association, but suggestive duepartly to methodological heterogeneity. CONCLU-SIONS: Having mood disorders been prevalentand disabling in nature, these studies provide sup-port to hypotheses about a common biologicalpathway between depression and cancer and high-light the need to identify the mechanisms to regu-late it. It also emphasizes the deleterious effect thatdepression can have on lifestyle factors which inturn may predispose the individual to develop can-cer. RESEARCH IMPLICATIONS: Depressionmay either have a long delayed effect on cancerrisk, or it may play a role in combination withknown risk factors to increase cancer risk. Futurestudies can focus on empirical studies to furtherexamine the mechanisms through which emotionsand psychological well-being affect our health.

CLINICAL IMPLICATIONS: As depressionaffects the immune and hormonal system cliniciansmust be aware about the psychobiological mecha-nisms under which it operates. Depression mayincrease the probability that the individual willengage in behaviors that indirectly increase the riskof developing cancer. This awareness shouldencourage better identification of those at risk andthe development of effective interventions to pro-tect them from developing cancer. ACKNOWL-EDGEMENT OF FUNDING: None.

P1-110

Pain and Social Activity in Colorectal Cancer

Patients

Miroslava Petkova, Valeri Nikolov, Maya

Galabova

Trakia University, Stara Zagora, Bulgaria

BACKGROUND: Colorectal cancer is among theleading causes of cancer related deaths in men andwomen across the world. This investigation was car-ried out to examine whether pain is positively corre-lated to decreased social activity, anxiety anddepression in colorectal cancer patients. The pur-pose of this study is to also compare pain intensity,anxiety, depression and social activity in two groupsof pain patients - colorectal cancer patients and non-cancer patients METHOD: Thirty two (32) patientswere examined. The mean age of patients was64.1 years (SD = 10.6), 56% were male, 52% didnot know their cancer diagnosis which was relatedto colon (42%) and rectum (58%). The secondresearch group consisted of twenty eight (28)patients with chronic low back pain. All patientswere assessed based on clinical standards (physicalexamination, laboratory results, histological diagno-sis and analysis of medical records). The methodsused were Visual Analogue Scales (VAS), standard-ized interviews and self-questionnaires – BackDepression Inventory and State-Trait AnxietyInventory for Adults. RESULTS: Twenty ninepatients experienced pronounced anxiety because oftheir pain and 23 patients expressed depressive pain-associated symptoms. Anxiety and depression showsignificant correlation with pain intensity. Therewere no significant differences in pain-anxiety andpain-depression correlations between the 2 groups.Most patients reported a decreased activity becauseof pain. The patients’ functioning was examined inthe following areas: physical functioning, socialfunctioning, emotional problems and their impacton accomplishments at work or other usual activitiesand mental functioning. We found significant differ-ences between cancer and non-cancer groups in levelof functional activity decreasing especially mentalfunctioning and social activities. CONCLU-SIONS: The results suggest that experience of painproduced marked levels of anxiety and depression in



both cancer and non-cancer groups. Nevertheless,these patients who had not been diagnosed with can-cer had statistically significant higher activity in mostareas of life. In the cancer group we found decreasedand impaired functioning in every social activitylisted in the structured interview (hobbies, seeingfriends) and in most cases the decrease correlatedsignificantly with the intensity of the pain. In non-cancer group functional impairment is significantonly in respect of physical functioning; nevertheless,there were similar levels of pain intensity in bothgroups. RESEARCH IMPLICATIONS: Futureresearch should investigate the correlation betweenchronic cancer pain, social support and copingmechanisms. Creation of reliable scales with goodpsychometric properties and involving more patientsin similar research will improve the accuracy anddependability of the obtained results. CLINICALIMPLICATIONS: Research on psychosocial fac-tors related to cancer pain would serve as improvedassessment of the subjective nature of pain. In addi-tion research on correlations between cancer, painand social functioning connected to cultural andeconomic factors as parts of quality of life will pro-vide new insights into the bigger socio- economicscope. ACKNOWLEDGEMENT OF FUND-ING: We thank the Trakia University, Faculty ofMedicine for the financial support of this project.This study was supported by a scientific grant 7/2009.

P1-111

Cognitive Control Dificit and Distress in Patients

With Lymphoma

Ekaterina Stepanchuk

Saint-Petersburg State University, Saint-Petersburg,Russia

BACKGROUND: It is known that effortful cogni-tive control is necessary for coping with emotionaldistress. It’s obvious that a new diagnosis of cancerand aggressive treatment contribute to the develop-ment of depressive and anxious feelings. The aim ofthis study was to identify the cognitive activitydisturbances in association with analysis of thedevelopment of affective disorders in lymphomapatients. METHOD: Participants were asked todetect grammatical errors in neutral and stressfultext fragments. Stressors fragments contained infor-mation on emerging lymphoma symptoms and sideeffects of chemotherapy, as well as related to cancerexperience feelings of helplessness and hopelessness.If patients heard a sound signal, they should havereacted to it by pressing a certain button. The aver-age time of the sensorimotor response to sound, theaverage time of errors searching time in the text wascalculated. 20 healthy controls and 32 newly diag-nosed patients with different forms of lymphomaparticipated in this study. RESULTS: Patient’ssearch time of errors in stressful fragments was sig-

nificantly longer than in neutral fragments. Thereaction time of patients with lymphoma to acousti-cal signal was also significantly longer then inhealthy controls. Correlation analyses revealed anassociation of lower patient’s distress and less fixa-tion time on the stressor fragments. The level ofmental rumination in patients and the number ofoccurred errors during the test “Signal” detected tobe positively linked. CONCLUSIONS: Patientswith lymphoma were found to experience the cogni-tive activity disturbances when had been exposedstressful information related to the disease. Thus,fixing the attention on the topic of disease is a pre-dictor of the development of affective disorders,including clinical level. These findings suggest thatthe psychophysiological methods can be used inpsychooncology as fast and reliable tools to identifypatients with the highest risk of distress after thediagnosis of cancer. More detailed studies of themechanisms of depression and anxiety in cancerpatients are required. ACKNOWLEDGEMENTOF FUNDING: None.

P1-112

Assessment of Psychiatric and Psychosocial

Problems Among Newly Diagnosed Cancer Patients

at the National Cancer Institute - Cairo University

Jafar Udwan, Nelly Mahgoub, Amal Sami

Cairo University, Cairo, Egypt

BACKGROUND: This study aimed to assess psy-chiatric and psychosocial problems secondary tonewly diagnosed cancer patients admitted to at theNational Cancer Institute, Cairo University, Egypt.A randomized sample of 280 patients newly diag-nosed of cancer in the Oncology Inpatient depart-ments was selected. METHOD: A descriptivecross-sectional design was used for this study as aresearch methodology. Quantitative methods wereused in this study through using three tools of datacollection. The researcher developed the first twotools, while the last one was a ready standardizedtool. These were: (1) the Patient Medical Psychoso-cial Demographic profile, (2) the Developed MentalStatus Examination Inventory, and (3) Anxiety/Depression Scale. RESULTS: This study revealedthat more than half of sample were males (58.7%),the highest percentage of the research sample aged(36–40) years and more than 55 years and the high-est percentage of them between illiterate and sec-ondary school graduated. Less than two thirds ofthe research sample were married (62.3%). Twofifths (41%) had psychiatric and psychosocial prob-lems in different levels. In subscale result, 28.9%had mild depression, 8.2% had moderate conditionof depression, 26.2% had mild anxiety, while for14.7% it was moderate, and for only 7.5 it wassever. CONCLUSIONS: This study concluded thatnearly two fifths of the study sample had psychiat-



ric and psychosocial problems related to their diag-nosis of cancer, the highest percentage of them hadmild anxiety/depressive disorder and a few hadsever anxiety/depressive disorder. This study rec-ommends integration and rationing psychiatric andpsychosocial assessment as an essential element forcare of cancer patients to identify their problemsand their response to diagnose in order to preventcomplications of psychiatric and psychosocialproblems. RESEARCH IMPLICATIONS: Thisstudy used comprehensive bio-psychosocial assess-ment tool to explore and emphasize the positiveand negative effect of every variables around cancerpatient; as culture, family component, work, life-style etc, on patient’s psychosocial status. Thisdirects to study each variables in-depth and itsimpact on psychosocial status of cancer patients.Also this study consider as the first in Middle East.CLINICAL IMPLICATIONS: The use of suchtools leads to prevention and early detection of psy-chosocial problems, emotional problems, andSocial Commission, Therefore, the conduct of thisstudy helps to identification and Evaluation ofpatients strength and need which helping cancerpatients to deal with, and prevention of Behavioralcomplication during the treatment process.ACKNOWLEDGEMENT OF FUNDING: None.

P1-113

Exploring the Emotional Impact of Research on the

Researcher

Marta Wanat

Oxford Brookes University, Oxford, UK

BACKGROUND: In recent years, qualitativemethodologies have become very popular and rep-resent a new research paradigm in health care.However, the unique set of demands on peopleinvolved in these studies such as building a rapportor witnessing emotional stories have been largelyneglected, especially in the context of self-care strat-egies. They pose a challenge for both practitionersas well as novice researchers who may find them-selves in a semi-therapeutic relationship withoutnecessary experience. METHOD: In this presenta-tion, I will reflect on the emotional impact of doingresearch in relation to my PhD study which focuseson the experiences of cancer patients and their part-ners when their bowel cancer recurs. First I willexplore the potential challenges of conductingresearch on sensitive topic. Then, drawing on thecurrent literature and ethical guidelines I will pro-vide a framework which allows thinking about thechallenges associated with conducting research onsensitive topics. RESULTS: Regardless of previousresearch experience in cancer care, conductingsemi-structured interviews over a period of timewith a vulnerable patient group and their partnerscan be an emotionally difficult task. Challenges

such as establishing a rapport with the participant,dealing with physical and emotional suffering whilemaintaining professional boundaries will beexplored. A number of self-care strategies forresearchers at individual, managerial and organisa-tional level will be considered such as a reflectivediary, peer support and supervision and how theycould be incorporated in the practice. CONCLU-SIONS: Emotional impact of research on theresearcher is an important issue, especially in quali-tative research, yet has been largely neglected andneeds further attention. Professional guidelines areimportant in ensuring that research is being con-ducted in ethical manner, however, they may not besufficient in dealing with the demands of the workon day to day basis. These are also important toconsider when applying for ethical approvals asthese issues are being picked up in the ethics com-mittees more and more. Planning and on-goingmonitoring of the impact on the researcher is vitalin ensuring researcher emotional safety.RESEARCH IMPLICATIONS: Reflecting on therole of the researcher and emotions is important asit may also have an impact on the quality of dataobtained. The presence of emotions in the interviewcontext whether coming from participants orresearcher can tell us a lot of the nature of the phe-nomena itself. Research training should includeaspects related to self-care and the ethical guidelinesrelated to managing difficult situations in the inter-view context. CLINICAL IMPLICATIONS:There is a need to acknowledge the potential emo-tional impact of research on researchers. The well-being of the participant and the researcher areinter-linked and one cannot be considered withoutthe other. Self-care might be a useful concept inthinking about the well-being of researchers in can-cer care yet relatively few studies addressed it. Self-care strategies are important to consider and can beeasily incorporated into practice. ACKNOWL-EDGEMENT OF FUNDING: Oxford BrookesUniversity.

P1-114

Health Literacy in Cancer Patients: State of the Art

and Future Directions

Nicole Ezendam1,2, Mariette Verkissen1,2, Olga

Husson1,2, Christian Von Wagner3, Marie-Louise

Essink-Bot4, Mirjam Fransen4

1CoRPS – Center of Research on Psychology inSomatic Diseases, Department of MedicalPsychology and Neuropsychology, TilburgUniversity, Tilburg, The Netherlands, 2EindhovenCancer Registry, Comprehensive Cancer CenterSouth, Eindhoven, The Netherlands, 3Department ofEpidemiology and Public Health - University CollegeLondon, London, UK, 4Department of PublicHealth, Academic Medical Center, Amsterdam, TheNetherlands



BACKGROUND: Adequate health literacy (HL)is important for cancer patients to actively partici-pate in their health care. However, little researchhas been conducted regarding HL among cancerpatients. The objectives of this study were to pro-vide a systematic literature review of instrumentsused to assess HL in cancer patients and an over-view of research questions studied. Furthermore,we propose a framework to measure functional,interactive, critical HL in cancer communication inthe process of cancer care. METHOD: A system-atic literature search using PubMed was indepen-dently performed by 2 authors on 8 April 2013. Thesearch string included literacy, specific HL instru-ments and cancer. The search resulted in 1869 hits.Studies were excluded if they focused on cancerscreening, used qualitative interviews instead of aHL instrument to evaluate HL, did not include can-cer patients or were only focused on knowledge.After screening of titles and abstract by twoauthors, 65 full-text papers were reviewed. Refer-ence lists of selected papers were screened for rele-vant studies. In total, 17 articles were included inthis review. RESULTS: 6 different instruments(REALM, REALM-R, S-TOFHLA, HeLMS,SBSQ, FCCHL) were used to assess HL, mainlyamong prostate and breast cancer patients. Threeinstruments measured objective HL and three mea-sured perceived HL. Four instruments could onlybe administered by a health care provider orresearcher, while two could be self-assessed. Ofthose 2 instruments, one assessed only functionalHL and one appeared to have too difficult items forpeople with low HL. A diverse set of topics in rela-tion to HL was studied, such as effects on diseasestage at diagnosis (2 studies) and differential effectsof educational interventions (3 studies). CONCLU-SIONS: A range of HL measures was used toassess HL among cancer patients. Among thesemeasures was no cancer-specific measure, whichmight be useful since along the cancer continuumpatients may need HL related skills that are specificfor cancer patients. Furthermore, no single instru-ment was currently available that can be used as aself-administered questionnaire assessing objec-tively all three aspects of HL (functional, interac-tive and critical). A broad range of researchquestions was studied, not allowing drawing con-clusions on any topic. RESEARCH IMPLICA-TIONS: A cancer-specific self-administered HLquestionnaire might be a valuable enhancement onexisting more generic HL instruments. To developsuch an instrument we have developed a conceptualframework with on one axis the communicationneeds along the cancer-continuum and on the otheraxis the functional, interactive and critical HLrequirements. For instance, communication needsmight include aspects of accessing care, skills tojudge treatment options and communicate aboutthe prognosis with the health care provider. CLINI-

CAL IMPLICATIONS: We showed that the studyof HL in cancer research is still in its infancy. Noone single instrument is used which decreases thepossibility to compare results. However, the HL ofpatients is likely to be of great importance in thecommunication between patients and health careproviders, which warrants the need for moreresearch. For this, we need a cancer-specific self-report instrument that is sensitive and valid.ACKNOWLEDGEMENT OF FUNDING: NEwas funded with grant no. UVT 2010-4743 fromthe Dutch Cancer Society, The Netherlands.

P1-115

Intellectual Disabilities and Cancer: A review of the

Current Literature

Samantha Flynn1, Nick Hulbert-Williams1, Ros

Bramwell1, Lee Hulbert-Williams2

1University of Chester, Chester, UK, 2University ofWolverhampton, Wolverhampton, UK

BACKGROUND: As the life expectancy of thosewith an intellectual disability increases, the likeli-hood of receiving a cancer diagnosis (or, indeed,that of other chronic illnesses) is raised. An evi-dence base on the psychosocial, informational andsupportive care needs of this specific patient groupis emerging, though it is still in its infancy. Thisreview aims to synthesise the literature published todate, and to make suggestions regarding the futuredirection of research in this area. METHOD: Anon-systematic, scoping review of the literatureexploring the psychosocial, informational and sup-portive care needs of people with an intellectual dis-ability and cancer was conducted with the view todetermining whether a full systematic review wasrequired. A predefined inclusion criteria aidedstudy selection. Databases were hand searched withthe view to identifying relevant literature, referencelists were also hand searched to ensure that all rele-vant literature was included. A total of 24 paperswere identified as being relevant to the review.RESULTS: This small literature reports some per-tinent findings. Pre-diagnosis, people with an intel-lectual disability may not report their cancersymptoms to their caregivers, thus potentiallydelaying diagnosis. Suggested causal reasons forthis in women later diagnosed with breast cancerinclude embarrassment at discussion of intimateand sexual topics. Pictorial aids can enable patientsto indicate the location and intensity of pain,though other communication deficits remain. Post-diagnosis, the lack of accessible cancer informationexplaining symptoms and treatment options forthose with an intellectual disability has been shownto increase anxiety and uncertainty. CONCLU-SIONS: This study raises important questionsabout how cancer care is provided to those with anintellectual disability, both prior to, and after



receiving a diagnosis. Although the results have sig-nificant implications, they are based on a small lit-erature base; much of the reported data has beengathered either using proxy reporting or by inter-viewing people with an intellectual disability whodo not have cancer. Psychosocial oncology placeshigh value on talking directly to cancer patientsand listening to their needs to inform service provi-sion and policy setting (Macmillan, 2007); similarstrategies should be adopted for patients with anintellectual disability. RESEARCH IMPLICA-TIONS: Studies identified in this review tend tofocus on a few single aspects of the cancer experi-ence, for instance communication with healthcareprofessionals, and there are a number of researchgaps relating to cancer experiences in those with anintellectual disability. Future research should collectdata directly from the person with an intellectualdisability. We would also recommend adopting amore multifaceted approach collecting data fromcaregivers, family members, and a broader range ofclinicians. CLINICAL IMPLICATIONS: As therehas been little research in this area, we have littleknowledge about how to best support people withan intellectual disability who have cancer symptoms,or later receive a diagnosis; it is a fair assumption,however, that their needs may not be the same asother cancer populations and need discussing withpatients in a sensitive manner. Effective communica-tion between oncology and intellectual disabilitycare teams is essential for best practice care.ACKNOWLEDGEMENT OF FUNDING: None.

P1-116

Psychosocial Screening Program: Decreased of

Distress and Increased Quality of Life

Cristiane Decat Bergerot1,2, Tereza Cristina

Cavalcanti Ferreira Araujo2, Alexandre Nonino1,

Marco Murilo Buso1

1Centro de Cancer de Bras�ılia (CETTRO), Bras�ılia,DF, Brazil, 2Universidade de Bras�ılia (UnB),Bras�ılia, DF, Brazil

BACKGROUND: Based on scientific evidence, itis undeniable the importance to recognize distressin cancer patients. The routine screening for distresscan orient the clinical care to provide adequate sup-port, providing feedback to oncologists on thequality of their psychosocial care, being helpful toidentify the need for improvement efforts. Weinvestigate the course and prevalence of distressover the treatment, verifying the correlation withquality of life (QoL), and examine the effectivenessof psychosocial program. METHOD: Two hun-dred patients answered: (1) Distress Thermometer(DT) and Problem-List (PL) and (2) FunctionalAssessment of Chronic Illness Therapy-General(FACT-G) at baseline (T1), halfway time point

(T2) and at completion of chemotherapy (T3).After each assessment, all results were discussedwith the patients’ physician, to establish the bestconduct. The conducts ranged from psycho-educa-tion, manage the side effects, to referrals. Descrip-tive analyses were calculated for socio-demographic, illness-related variables, DT, PL andFACT-G prevalence; chi-square and correlationwere conducted to explore the effect of the distresscourse on PL and QoL. RESULTS: Proportion ofpatients experiencing moderate to severe distress(MSD) decreased (T1. 41.5%; T2. 9.1%; T3. 4.4%),being emotional and physical the most problemsreported. The QoL mean scores slightly increased(T1. 85.6; T2. 90.4; T3. 92). There were a main effectof distress decreasing overtime (p = 0.000), of dropin problems reported (p < 0.05), and of QoL increase(p = 0.000). MSD were significant related (p = 0.000)to PL (T1. x2 = 77.5; T2. x2 = 79.1; T3. x2 = 158.5)and poor QoL (T1. x2 = 93.4; T2. x2 = 311.6; T3.x2 = 278.4). CONCLUSIONS: Routine screeningfor distress followed by personalized discussionbetween psychologist and oncologist (psychosocialprogram) resulted in reduction of MSD incidenceand of problems-related distress reported, as wellas, QoL increased, even under chemotherapy sideeffects. We observed that this kind of supportivefeedback helps not only in identifying problemscontributing to MSD, as offering appropriate prac-tical and psychological assistance. This routineoffers a viable strategy for ensuring that distress isidentified and managed in a timely way. Moreover,we could provide more opportunities for connect-ing patients to adequate support, resulting in moreappropriate referrals. RESEARCH IMPLICA-TIONS: Systematic screening for distress and mul-tidisciplinary discussion was a good way toimprove uptake of resources, rather than simplifyfocusing on screening alone. This routine maybe akey to reduce distress and to improve quality of life,providing equal access to psychological services.Future studies should be conducted to replicate andextend the current finding. As this study recruitedpatients just from a single cancer center, the study’sgeneralizability to other settings can be reduced.CLINICAL IMPLICATIONS: Understanding anindividual’s level of distress related to their symp-toms and illness-related concerns was fundamentalto screening, referral, assessment and treatment.Moreover, this routine helped to determine theseverity of distress and the appropriate interven-tion; let patients know more about the psychosocialservices and the program available to take care ofthem, and mainly to encouraged those distressedpatients without sufficient motivation for seek helpand adequate active treatment. ACKNOWL-EDGEMENT OF FUNDING: None.



P1-117

How is Psycho-Oncological Care Delivered in

France: A Nationwide Survey Part 1 - Institutional

Care

Sarah Dauchy1,2, Franc�oise Ellien1,3, B�en�edicteIsquin1, C�ecile Charles2

1French Society of Psycho-Oncology (SFPO),Paris, France, 2Gustave Roussy - Cancer Campus -Grand Paris, Villejuif, France, 3Reseau SPES,Champcueil, France

BACKGROUND: Despite an increasing attentionpaid to psycho-oncology, little is known in Franceabout the actual institutional or non-institutionalcare offering. The over 30 year-old French societyof Psycho-oncology (SFPO) has conducted anationwide survey to identify the psychologists andpsychiatrists working with cancer patients anddescribe their organisation and their missions,including training and research. We present herethe findings of this survey for the hospital psycho-oncological care offering, for in and outpatients.METHOD: The target population is the profes-sionals of psycho-oncology (POP), psychologistsand psychiatrists, of all the cancer care hospitalsand clinics accredited by the National Cancer CareOrganisation. In a two-stage approach, organisa-tions were asked to provide a list of the profession-als, who then have been sent the survey by post.The questionnaire includes 50 questions, exploringthe following fields: number of POP, experience,duration of work, workload, initial and continuoustraining, links between professionals, traceability,transmission procedures, care offering, training andresearch activities, funding. RESULTS: 783 carestructures answered. 21% had no POP and 41%less than a FTE. 320 of the 1118 identified POPreturned the questionnaire (29% response rate).68% of POP work part time for cancer patients.15% are initially trained in psycho-oncology butthe majority received continuous training. Averagetime devoted to patients is 80% (20% to families).66% of POP perform training activity. 21% areinvolved in research activity, mostly without dedi-cated time and funding. Links within POP, betweenPOP and supportive care or oncology teams, will bedescribed, as far as transmission of informationprocedures. CONCLUSIONS: Psycho-oncologyhas been developing in France for 40 years andappears in this survey well developed and integratedin comprehensive cancer care. Standards of organi-sation and transmission can be identified and willsupport national recommendations for the organisa-tion of psycho-oncological care. Significant progressremains to be done considering inequalities of accessbetween the different structures and the lack of ini-tial training in psycho-oncology. RESEARCHIMPLICATIONS: Time dedicated to research inpsycho-oncology could be better identified and

founded in order to allow psycho-oncologicalresearch to improve its ability to be published atnational or international levels. CLINICALIMPLICATIONS: This survey suggests 2 maindevelopment perspectives - inequalities of access topsychological care have to be reduced; the SFPOasks for the integration in the cancer care structuresaccreditation process of a mandatory psychologicalcare offering, with well defined quality criteria. - thenext SFPO congress (Paris, 11–13 december 2013)will be dedicated to psycho-oncology training.ACKNOWLEDGEMENT OF FUNDING: ThisSurvey has received funding from the FrenchNational Cancer Care Organisation (InCA).

P1-118

How is Psycho-Oncological Care Delivered in

France: A Nationwide Survey Part 2 - Non-

Institutional Care

Sarah Dauchy1,2, Franc�oise Ellien1,3, B�en�edicteIsquin1, C�ecile Charles2

1French Society of Psycho-Oncology (SFPO),Paris, France, 2Gustave Roussy - Cancer Campus -Grand Paris, Villejuif, France, 3R�eseau SPES,Champcueil, France

BACKGROUND: Despite an increasing attentionpaid to psycho-oncology, little is known in Franceabout the actual institutional or non-institutionalcare offering. The over 30 year-old French societyof Psycho-oncology (SFPO) has conducted anationwide survey to identify the psychologists andpsychiatrists working with cancer patients anddescribe their organisation and their missions,including training and research. We present herethe findings of this survey for the non-institutionalpsycho-oncological care offering, as organisedwithin cancer care networks. METHOD: The tar-get population is the psychologists of all the Frenchcancer care networks identified by the NationalCancer Care Organisation. In a two-stageapproach, networks were asked to provide a list ofthe professionals, who then have been sent the sur-vey by post. The questionnaire includes 28 ques-tions, exploring the following fields: nb of POP,experience, missions, initial and continuous train-ing, links with other professional, traceability,transmission, training and research activities, fund-ing. RESULTS: 57 of the 201 healthcare networksreturned the questionnaire (response rate 28%).First part of exploration is about employed psy-chologist. 21/54 networks employ none, 29/54 0.5to 1 FTE. Most of the time employed psychologistswork both as network coordinators and clinicians(for patient psychological assessment and follow-up). Second part describes private psychologistsnetwork that exists in 38/54 networks. Public fund-ing for cancer patient psychological care is avail-able for 29/38, mostly for a limited number of



psychological interventions. Links within psycholo-gists and with other non-institutional professionalsare explored, as well as training and clinical super-vision for private psychologists. CONCLU-SIONS: In France psycho-oncology is integratedin outpatients comprehensive cancer care and canbe public funded even for private professionals.However it remains unequally available, with heter-ogeneous organisation. Training of professionals,clinical supervision, and multidisciplinaryexchanges should be developed and financiallysupported. The SFPO had published in 2010 guide-lines for the organisation of non-institutional psy-cho-oncology. Significant progress remains to bedone for these guidelines to be implemented inorder to guarantee for patients and families anequal access to quality and integrated psycho-onco-logical care. RESEARCH IMPLICATIONS: Timededicated to research in psycho-oncology could bebetter identified and founded in order to allow psy-cho-oncological research to improve its ability tobe published at national or international levels.CLINICAL IMPLICATIONS: THIS SURVEYSUGGESTS 2 MAIN DEVELOPMENT PER-SPECTIVES: - inequalities of access to psychologi-cal care have to be reduced; the SFPO asks for theintegration in the cancer care structures accreditationprocess of a mandatory psychological care offering,with well defined quality criteria. - the next SFPOcongress (Paris, 11-13 december 2013) will be dedi-cated to psycho-oncology training. ACKNOWL-EDGEMENT OF FUNDING: This Survey hasreceived funding from the French National CancerCare Organisation (InCA).

P1-120

Comparison of Two Psychosocial Cancer Care

Models for Rural Areas: The P-O-LAND Study

Mechthild Hartmann, Markus Haun, Halina

Sklenarova, Andrea Hellmann, Brigitte Schlehofer,

Wolfgang Herzog

Department of General Internal Medicine andPsychosomatics; Division of Psycho-Oncology,Heidelberg, Germany

BACKGROUND: There is some evidence thatcancer survivors living in rural areas show greateremotional distress and lower utilization of psycho-social services than urban residents. Therefore,there is an urgent need to implement adequatemodels of care to remedy urban-rural disparities.Whereas in most states no distinct rural care modelexists, in the federal state Rhineland-Palatinate/Germany an area-wide psychosocial care conceptwas initiated more than ten years ago, but not yetevaluated against usual care. METHOD: Wedefined 2 comparable study regions (one in Rhine-land-Palatinate and one in the federal state Baden-

W€urttemberg) and assessed all institutions andpractices which participate in rural psychosocialcare of cancer survivors as well as in the care oftheir family members in both regions. The surveyincluded all psychotherapists, counselling offices,clinics, hospices and peer-support groups of thestudy regions. Participants filled in a questionnaireregarding their offers to cancer patients, qualifica-tion, number of patients/year, and waiting time. Allparticipants were contacted by mail and remindedup to 4 times. RESULTS: 208 questionnaires weresent to mental health specialists; the response ratewas 80% (n = 167). Fifty-nine questionnaires weresent to counselling services; the response rate was81% (n = 48). Sixty-five percent of the psychother-apists confirmed to be involved in the care of cancerpatients with a mean number of 6 cancer patients/year/practice. While the rates of involvement werecomparable between both rural areas, the numberof treated cancer patients was twice as high inRhineland-Palatinate (8 vs. 4; p = 0.0205). Thesame was true for counselling services (p = 0.0109).CONCLUSIONS: Access to comprehensive carefor cancer survivors in rural communities appears tobe facilitated by the community-based initiativedescribed and investigated in this study. Area-wideregional counselling offices and timely limited train-ings for health professionals may reduce barriers foradequate psychosocial care in terms of improvedtransition and coordination. RESEARCH IMPLI-CATIONS: The question of reducing disparities inpsychosocial cancer care regarding place of resi-dence has seldom reached scientific attention. Ourstudy shows that it is feasible to determine andcompare psychosocial care structures in rural areas.As a next step we will survey all doctors of thestudy regions regarding transition problems to psy-chosocial care. In addition, we will assess psychoso-cial distress and needs in a sample of cancersurvivors and their family members. CLINICALIMPLICATIONS: If results of the P-O-LANDstudy further confirm positive effects of the Rhine-land-Palatinate care model, efforts such as thesecould be replicated in other rural communities andmay impact the care and quality of life of survivorswith many types of cancers. Findings from thisstudy will inform clinicians as well as health careplanners how to succeed in providing better andmore comprehensive care to patients in rural areas.ACKNOWLEDGEMENT OF FUNDING: Thestudy is supported by the German Ministry ofHealth.

P1-121

Creating a New Public Psycho-Oncology Service in

a Private Hospital

Amit Laron, Lea Baider, Rafael Peper, Lili

Borochov

Assuta Hospital, Tel-Aviv, Israel



BACKGROUND: We will describe the develop-ment of psycho-oncology, as a public health servicein a private hospital. The work with the staff, theinitial relationship with the oncologists, nurses andpatients, will be described. METHOD: “Assuta”hospital is a private hospital, with a large clinicaland radiotherapy departments. Until 2012 no psy-cho-oncology service was available to meet thepatients and staff needs. With the growing awarenessfor such a service, a preliminary psychological workwas initiated. Focus groups were made available forthe staff members, patients and families.RESULTS: After the pilot got good commentsfrom staff and patients the service begun to workand expanded through the year to include groupsfor patients, group for staff, individual and familyintervention and seminars for the group of psychol-ogists. In a short time the psycho-oncology unitbecame an integral part of the oncology center.Other wards in the hospital are showing interest inthe service, and plans for the future are being made.CONCLUSIONS: Creating a public service of psy-cho-oncology within a private hospital is not obvi-ous and present many challenges. Describing theneedsand searching for the answers are the firststep. It follows by consultations, journal clubs andconstant feedback to the staff uncertain of rele-vance of our work. RESEARCH IMPLICA-TIONS: A psycho-oncology unit is necessary forcreating basis for research. One of the plans for thefuture is to develop a research team. it is pity thatno research was done before the entrance of theunit to assess the ccontribution of such a change.CLINICAL IMPLICATIONS: Relevance of com-munication and evident based research of the psy-cho-oncology unit to all the oncology staff.Relevance of the effectiveness of care and psycho-logical intervention for patients diagnosed withcancer and their families within the heterogeneousIsraeli culture. ACKNOWLEDGEMENT OFFUNDING: None.

P1-122

Psychiatric Intervention for Hospitalized Patients in

a Portuguese Cancer Center - Evaluation &

Evolution

Cristina Vale, Andreia Ribeiro, Lucia Monteiro

Instituto Portugues de Oncologia de Lisboa, Lisboa,Portugal

BACKGROUND: The prevalence of distress andpsychopathology in cancer patients is consistentlyestimated in 35–40%. International guidelines rec-ommend the implementation of Psycho-OncologyPrograms to achieve better screening and earliertreatment of patients′psychiatric symptoms. IP-OLFG is the main Portuguese Cancer Center (285beds). Last 7 years, Consultation-Liaison Psychia-try Service (CLP) has been working within multi-

disciplinary teams to achieve excellence in Psycho-Oncologic care. Authors analyzed CLP data from2006 to 2011 to evaluate IPOLFG Psycho-Oncol-ogy Program. METHOD: This study analyses datafrom CLP intervention in 2 periods of 12 monthswith a 4 years gap: 2006/2007 = 249 patients (pts)versus 2010/2011 = 446 pts. From the informationsystem database, CLP and pts′ medical files, we col-lected: Socio-demographic (gender, age, marital sta-tus, residence), Oncologic (admission ward, site andstage of disease) and Psychiatric data (lag-timebetween request and 1st psychiatric evaluation, diag-nosis, type of intervention, referral). Psychiatricdiagnosis followed non-structured interview, DSM-IV-TR and ICD-10 criteria. Statistical proceduresincluded descriptive statistics, frequency accountsand correlations. RESULTS: Epidemiology, lag-time answer, treatment and follow-up showed no sig-nificant variation. Psychiatric Referral Rate rose 2.5to 4%; no. of requests/year rose from 249 to 446.2006/07: CLP intervention was mainly within medi-cal wards (72%); 2010/11: medical versus surgicalratio got balanced (57% vs. 43%). IPO mediantime of hospitalization per patient: 8.8 (2006) versus6.6 days (2011). CLP patients’ hospitalization timeis consistently higher: rose from 2x, 2006 to 4x,2011 (16.2 vs. 26.6 days). Psychiatric Diagnosisvaried significantly (2006/07 vs. 2010/11): Adjust-ment Disorders: 32% versus 51%; Mood Disor-ders: 31% versus 13%, Delirium: 13% versus 17%.CONCLUSIONS: The Surgical Departments ofHead & Neck, General Surgery and Gynecologyhave significantly increased their psychiatric referralrate. Wherever the site of cancer and the Service ofadmission, CLP team has been assessing and treat-ing less severe psychiatric disorders. We acknowl-edge that we are achieving some of Psycho-Oncology Program main goals: rise of the psychiat-ric referral rate, accuracy in referral, earlier distressscreening whether in medical or surgical Depart-ments, CLP answer lag-time to request less than24 h. RESEARCH IMPLICATIONS: To betterevaluate the efficacy of the Psycho-Oncology Pro-gram in the future we will use instrumental screen-ing and diagnosis tools, control pain and comparewith a control group. CLINICAL IMPLICA-TIONS: Last 7 years, CLP has been implementing a

Psycho-Oncology Program based on international guide-

lines although tailored for Portuguese patients’ needs

and adapted to professionals knowledge and tradition.

The Psycho-Oncology Program bases on intensiveside by side CPL work, teaching of Psycho-Oncol-ogy key themes and training skills within multidisci-plinary teams. The following step will be theroutine usage of the Thermometer Distress in ourwards in order to assess distress as the 6th vitalsign. ACKNOWLEDGEMENT OF FUNDING:None.



P1-123

Quality Treatment for PCa: A Patients’ View

Hans Ransdorp

prostaatKankerStichting, Bussum, The Netherlands

BACKGROUND: Every year prostate cancer(PCa) is diagnosed to thousands of men around theworld. As it happens most often when cancer isdiagnosed, fear of death, anxiety, and uncertaintymay emerge; moreover, PCa offers several opportu-nities of treatment with the same level of estimatedefficacy, which represents both an opportunity anda burden. The aim of this work is to discuss howthe best care path can be defined for each individualand unique patient. METHOD: The challenge tobridge the gap between PCa patients’ needs andbiomedical research and clinical practices has beensustained by the advocacy activity of Europa Uomofor many years. The goals of Europa Uomoinclude: finding ways and means to promote qualityof life for PCa patients and their families; promot-ing the dissemination and exchange of evidence-based and up to date information on PCa; promot-ing multi-professional care and appropriate medicalinfrastructure. The arguments here presented arethe outcome of the continuous and widespreadadvocacy work carried on by Europa Uomo whichincludes discussion tables, expert panels andpatients’ feedback. RESULTS: The proposed per-spective is centred on the idea that patient careshould be redefined by considering the treatmentoptions not only through the doctor’s eyes, butmostly according to the profile of the patient,including: the role that partner or family want toplay on his behalf, the minimal quality of lifedesired, wishes regarding the end of life, culturalbackground, psychological and social condition.The best treatment option needs to be determinednot only based on clinical and physicians’ decisions,but also according to the patient’s profile and prior-ities in order for the patient to make an informedchoice. CONCLUSIONS: Following the proposedcare path, the patient dealing with a PCa will havea clear and easy-to-follow care path which startsfrom the availability of information about the clini-cal centre with high standards of care, and proceedswith an integrated, multidisciplinary patient man-agement, involving different professionals. Thefocus on the patient’s profile and priorities, alongwith good standard quality of treatments, is likelyto promote patients’ wellbeing in the short and longterm. RESEARCH IMPLICATIONS: The imple-mentation of a high quality treatment model forPCa care opens crucial questions to answer byresearchers of different disciplines, mainly concern-ing the clinical and organizational issues that sucha model brings. CLINICAL IMPLICATIONS:The proposed model will strongly impact on thewellbeing of patients with PCa, as it takes into

account the patient as a whole, including personaland social aspects, and not only as an individual totreat for cancer. Moreover, the care path describedfacilitates the patient’s management also from thephysicians’ perspective, since it proposes a collegialdiscussion of each clinical file and promotes a betterevaluation of pros and cons of the treatmentoptions. ACKNOWLEDGEMENT OF FUND-ING: None.

P1-124

The Patient Oriented Psychosomatic Model for

Oncohematology

Anatoly Zhirkov, Anastasija Yakovleva

St Petersburg State University, Saint Petersburg,Russia

BACKGROUND: In the present research weapplied stress theory to elaborate a patient-orientedmodel of disease for use in clinical practice. Specifi-cally, we addressed the case of leukemia which weunderstood as both psychological and somatic dis-order. We hypothesized that psychological andhematological signs in patients are correlated andthat for various forms of leukemia different indica-tors are interrelated. In the conclusion we describedour findings using the original concept of psychoso-matic harmonization. METHOD: We analyzeddata on 78 patients of specialized HematologicalUnits with chronic myeloid leukemia (CML) orlymphocytic leukemia (CLL) diagnosed within6 months prior to the study. Among the studiedpatients, no significant cognitive impairments orsymptoms suggesting major psychopathology werefound. They received standard chemotherapy andno other treatment during the study. Patients werepersonally invited to participate in the study, andeveryone signed an informed consent. The ques-tions battery for psychological survey consisted ofDC, HADS, BDI, SCT, and SFL. Then we con-ducted statistical analysis using psychological sur-vey data, standard hematological signs, and signsfrom the IPOS standard. RESULTS: Patients withCLL and CML showed different patterns of psy-chological symptoms. 51% of CLL patients andonly 37% of CML patients were found to be dis-tressed. 46% of CLL patients and only 24% ofCML patients were characterized by the increasedlevels of self-concept. The depression level washigher at CLL patients than at CML. Correlationanalysis revealed connections from 0.675 to 0.841between some psychological and hematologicalsigns. For CLL and CLM groups they were differ-ent in magnitude but remained significant. Thehighest correlation was fond between Internality tofamily and the number of lymphocytes for CLLpatients. CONCLUSIONS: Nowadays the conceptof psychological stress is often used for the evalua-tion of psychological status of oncology patients



whereas hematological parameters of physiologicalstress are used less often. This situation is partlycaused by the differences in approaches used bypsychologists and hematologists respectively. Ourresults, however, show high correlations of psycho-logical and somatic signs in oncohematologypatients. Such results lend substantial support forthe proposed theoretical model which combinespsychological and somatic parameters to describepatient’s condition. We argue that this model canhelp psychologists, hematologists, and nurses todesign more effective plans for patient-orientedtreatment. RESEARCH IMPLICATIONS: As aresult of our study, we found empirical support forthe hypothesized interrelationship between patients’psychological and somatic parameters. Therefore,we argue that psychological and somatic factorsshould be addressed simultaneously in order to getcomplex picture of the disease. For instance, stresstheory can be an adequate tool for the interdisci-plinary medico-psychological research in oncohe-matology. We also believe that found relationshipsbetween hematological and psychological signsneed further research. CLINICAL IMPLICA-TIONS: Gathering from our results, we suggestthat the interrelationship between psychologicaland somatic factors should be taken into account inclinical practice. We think that interdisciplinarymedico-psychological approach can help to betterunderstand patients’ conditions. Additionally, itcan lead to elaboration of patient-oriented planscombining pharmacological treatment and psycho-social support. ACKNOWLEDGEMENT OFFUNDING: None.

P1-125

Body Image Distress Among Breast Cancer Women

on Chemotherapy

Nor Zuraida Zainal1, Norley Shuib1, Zuraida

Ahmad Sabki1, Chong Guan Ng1, Anita Zarina

Bustam2

1Department of Psychological Medicine, Faculty ofMedicine, University of Malaya, Kuala Lumpur,Malaysia, 2Clinical Oncology Unit, UniversityMalaya Medical Centre, Kuala Lumpur, Malaysia

BACKGROUND: Body image distress is commonin breast cancer patients resultant from the breastcancer itself and/or the breast surgery. This studyaims to explore the level of body image distressamong breast cancer women on chemotherapy.METHOD: It is a cross-sectional study conductedin an out-patient Oncology Unit. Every consecutivepost-operative breast cancer came for chemother-apy was invited into the study. The socio-demo-graphic and clinical profiles were obtained. Each ofthem self-rated their level of body image distressusing the Breast-Impact of Treatment Scale (BITS)

with other questionnaires Hospital Anxiety andDepression Scale (HADS) and Rosenberg Self-esteem Scale (RES). RESULTS: A total of 70women with mean age of 49.5 + 8.8 years partici-pated in the study. 10% of the women had mastec-tomy with reconstruction, 60% had mastectomywithout reconstruction and 30% had lumpectomy.The mean duration of post-surgery was 22.0 +33.4 months. The mean score for BITS was22.4 + 17.1. Of all, 38.6% was categorized as “dis-tress case” where 27.1% had moderate and 11.5%had severe distress levels. BITS was significantlycorrelated with HADS but not with RES. CON-CLUSIONS: One-third of the post-operativebreast cancer women on chemotherapy had bodyimage distress. The distress was associated withanxiety and depression. RESEARCH IMPLICA-TIONS: This study can be expanded to a largernumber of subjects and prospectively to follow-upthe cohort for 1 to 5 years to see the trend ofchanges in the level of body image distress. CLINI-CAL IMPLICATIONS: The high level of bodyimage distress cannot be overlooked. The surgeonsand oncologists should be aware the risk of thispsychological problem and to work closely with themental health workers. ACKNOWLEDGEMENTOF FUNDING: \Funding from UniversityMalaya Research Grant (UMRG 296/2011).

P1-126

Health Related Quality of Life (HRQOL) and Side-

Effects in the Course of Low-Dose Interferon-Alpha

Therapy in Malignant Melanoma - in Comparison to

a Control Group Without Interferon-Alpha

Karoline Albrecht1,2, Frank Meiss1, Doroth�eeNashan3, Katrin Reuter2

1University Freiburg - Medical Center, Departmentof Dermatology, Freiburg, Germany, 2UniversityFreiburg - Medical Center, Department ofPsychiatry and Psychotherapy, Freiburg, Germany,3Klinikum Dortmund gGmbH, Department ofDermatology, Dortmund, Germany

BACKGROUND: In melanoma patients thereported Health Related Quality of Life (HRQOL)is generally high. A decrease in HRQOL is howeveroften found in association with adjuvant treatmentwith Interferon-alpha (IFN-a). Although severalstudies report on IFN-a side-effects and large ran-domized controlled trials often accompany theireffectiveness evaluation with the assessment ofHRQOL, the combined analysis of the course ofrelevant side-effects, i.e. fatigue and depression andHRQOL under low-dose IFN-a therapy is stillinsufficiently studied. METHOD: The purpose ofthis study is to investigate whether patients underlow-dose IFN-a therapy report an increase in side-effects accompanied with a lower HRQOL than acontrol group of patients with treatment indication



but without having received the treatment. For thatpurpose the course of HRQOL (EORTC QLQ-C30), fatigue (EORTC FA-13) and depression(HADS-D) are assessed over 6 months in consecu-tively recruited melanoma patients (treatment groupN = 48, control group N = 72). With a generalizedlinear model (GLM) approach the 2 groups arecompared over three assessment points with globalHRQOL, fatigue and depression as dependent vari-ables. RESULTS: Unexpectedly, the GLM modelsshowed no global HRQOL deterioration afterIFN-a initiation in the treatment group. A signifi-cant interaction effect between the groups over the3 assessment points was however found due to anincrease in HRQOL in the observation group.Physical fatigue increased significantly in the treat-ment group after IFN-a initiation and slightlydecreased in the observation group over the assess-ment period of 6 months. The course of depressionsymptoms was not significantly different betweenthe groups. CONCLUSIONS: Patients under low-dose IFN-a seem to primarily suffer from physicalside-effects including physical fatigue, rather thenpsychiatric side-effects. This suggests lower psychi-atric toxicity of low-dose therapy in comparison tothe high-dose regimen, with higher depression ratesreported in various studies. Furthermore thehypothesis of a global HRQOL deterioration in theIFN-a treatment group - as found in other studies –was not supported by our data. HRQOL differ-ences between the groups are caused by animprovement of HRQOL over time in the observa-tion group. RESEARCH IMPLICATIONS: Ourfindings underline the role of physical fatigue in theadjuvant treatment with IFN-a. In further researchon IFN-a fatigue should be carefully assessed indistinction to depressive symptoms, which seem tobe less prevalent than expected. The absence of aglobal HRQOL deterioration under IFN-a shouldbe confirmed by further randomized controlled tri-als. More detailed insight into the association ofspecific side-effects with HRQOL would be desir-able. CLINICAL IMPLICATIONS: Based on ourdata we believe fatigue to be the biggest challengefor patients’ HRQOL under low-dose IFN-a treat-ment. Thus patient information on side-effectsshould educate patients on fatigue and its manage-ment and clarify the difference between fatigue anddepression. The negative impact of IFN-a onpatients’ HRQOL reported in other trials is chal-lenged by our findings, which might indicate thatlow-dose IFN-a is better tolerated than expected.ACKNOWLEDGEMENT OF FUNDING: Wethank MSD Pharma for co-funding this researchproject.

P1-127

Anxiety Symptoms in Hospitalized Haematological

Patients

Ant�onio Barbosa1,2, Filipe Barbosa1, Catarina

Mota1, Daniel Sampaio1,2, Carlos Ferreira1,2

1Hospital de Santa Maria, Lisbon, Portugal,2Faculdade de Medicina de Lisboa, Lisbon, Portugal

BACKGROUND: Haematological malignanciesare life-threatening situations that could potentiatethe emotional deregulation, and psychological suf-fering. The patients undergo invasive treatments, aschemotherapy and bone marrow transplant, andface a real threat to their lives. Our Aim is to studythe prevalence of anxiety symptoms in haematolog-ical patients. We also will compare with two controlgroups (a healthy volunteer group and systemiclupus erythematosus patients). METHOD: 83sequential haematological patients were admittedin a general university hospital, with an average ageof 43.85, 51.8% were male, 55% had leukaemiadiagnosis and 26% had lymphoma diagnosis. SLEpatients (n = 89) were assessed in a specializedautoimmune consultation, and presented an aver-age age of 40.79. The Healthy volunteer controlgroup was constituted of 31 individuals with amean age of 39.48. Haematological patients wereobserved by a psycho-oncology team (NIPSO), andwere psychologically assessed by means of TAS-20,HADS and a socio-demographic and clinical ques-tionnaire. The same instruments assessed the othergroups. RESULTS: We found a significant preva-lence of anxiety symptoms (36.2%) in haematologi-cal patients. However, we did not found asignificant difference between the healthy controlgroup. SLE patients exhibit higher levels of anxietysymptoms. For depressive symptoms, we found sig-nificant statistical differences between haematologi-cal patients and the healthy control group, but wedid not find for the SLE group. Anxiety symptomswere positively correlated with alexithymia. We didnot find significant statistical differences betweenanxiety symptoms and stage of the disease, or clini-cal factors. CONCLUSIONS: We found a preva-lence of anxiety symptoms in hospitalizedhaematological patients that underline the feelingof threat these patients face. We did not find statis-tical differences with clinical factors. RESEARCHIMPLICATIONS: In future research we shoulddeepen our knowledge in these field, to betterunderstand the suffering and psychological traumalived by these individuals. CLINICAL IMPLICA-TIONS: This study underlines the importance ofspecific tailored size interventions for these patients,who present several challenging problems that needto be taking in consideration when helping to dealthe psychic and physical suffering. ACKNOWL-EDGEMENT OF FUNDING: None.



P1-128

The Evidence-Practice Gap in Oncology: Are We

Contributing to Implementation Science?

Jamie Bryant1,2, Robert Sanson-Fisher1,2, Allison

Boyes1,2, Kimberley Jones1,2, Mariko Carey1,2

1University of Newcastle, Newcastle, New SouthWales, Australia, 2Hunter Medical ResearchInstitute, Newcastle, New South Wales, Australia

BACKGROUND: The past decade has seen sig-nificant improvements in cancer survival. However,concern about disparities between best-evidenceand the care provided to cancer patients persists.Given increased focus on dissemination andimplementation research, it would be expected thatpublications focused on examining evidence prac-tice gaps in oncology would have increased overtime. Using bibliometric methods, this reviewexamined the number and type of publicationsexamining evidence-practice gaps in oncology in2000, 2005 and 2010. METHOD: Medline wassearched for the three time points of interest usingMeSH headings and keywords. Eligible papers werethose that examined evidence-practice gaps inoncology and were published in English. Papersmeeting eligibility criteria were coded as data-basedor non-data based, with all data based papers werefurther classified as: (i) descriptive studies docu-menting an evidence-practice gap or barriers toaddressing an evidence-practice gap; or (ii) inter-vention studies examining strategies to reduce anevidence practice gap. The cancer type examined inall data-based studies and the design used in inter-vention studies were also coded. RESULTS: 166relevant papers examining the evidence practice gapin oncology were identified. The number of publica-tions increased over time. The majority were databased publications, however less than 10% of thesewere intervention studies which examined the effec-tiveness of strategies to reduce discrepanciesbetween best evidence and clinical practice. Onlyone study was a randomised controlled trial. Themajority of studies examined evidence-practice gapsin breast cancer care. CONCLUSIONS: Effectiveimplementation of evidence into practice necessi-tates that methodologically rigorous research iden-tifies where evidence-practice gaps exist, thendevelops and tests interventions to identify optimalstrategies to close the gap. Despite significantinvestment in clinical research, little research efforthas gone to measuring and intervening to close evi-dence practice gaps in oncology over the last dec-ade. There is a clear need for furthermethodologically rigorous intervention studies, andstudies focusing on high burden or under-servedcancers. RESEARCH IMPLICATIONS: Develop-ing and implementing research to reduce evidencepractice gaps in oncology poses a number of meth-odological challenges. The involvement of health

behaviour scientists, healthcare providers and pol-icy makers is imperative if high quality and relevantresearch is to be produced. CLINICAL IMPLICA-TIONS: Bridging the evidence practice gap repre-sents a feasible, timely and effective method ofimproving important outcomes for cancer patients.Misuse, underuse and overuse of treatments willcontinue unless there is greater commitment toresearch which focuses on the translation andimplementation of advances in clinical oncologyscience. ACKNOWLEDGEMENT OF FUND-ING: This review was supported by a StrategicResearch Partnership grant between the CancerCouncil New South Wales and the Newcastle Can-cer Control Collaborative (New-3C).

P1-129

Irrationality and Response Expectancies: Impact on

Chemotherapy Induced Side Effects and Quality of

Life in Breast Cancer Patients

Ancuta-Mihaela David

Medisprof, Cluj-Napoca, Cluj, Romania

BACKGROUND: Postchemotherapy grade 2–3gastrointestinal and fatigue side effects continue tobe common and may affect compliance to cancertreatment in spite of antiemetics. The aim of thepresent study was to investigate the predictive valueof expectancies in above cited chemotherapy sideeffects, catastrophizing chemotherapy side effects,irrational beliefs regarding the intensity of chemo-therapy side effects, emotional distress, generalwellbeing and quality of life in breast cancerpatients. METHOD: The study was prospective,performed on 32 women receiving neoadjuvant che-motherapy for breast cancer hospitalized in MED-ISPROF Oncology Day-hospital- Cluj Napoca.Chemotherapy was anthracyclines and taxanebased and antiemetics used were according torecent ASCO/ESMO guidelines for these drugs.The patients completed questionnaires (QLQ-C30,QLQ-BR23, POMS, ABS II, VAS, CSSCS) foreach variable described above before / after eachcycle of chemotherapy and weekly home.RESULTS: Response expectancies about chemo-therapy side effects (grade 1–3 nausea, vomiting,fatigue, emotional distress) significantly predicttheir presence after chemotherapy (p < 0.05). Gen-eral irrational beliefs significantly predict the pres-ence of emotional distress before chemotherapy(p < 0.05). Catastrophizing secondary symptomssignificantly predict the presence of chemotherapyside effects (p < 0.05). CONCLUSIONS: Responseexpectancies in breast cancer patients undergoingneoadjuvant chemotherapy regarding chemother-apy grade 1–3 induced side effects (nausea, vomit-ing, fatigue and emotional distress) and generaldistress prior to chemotherapy predict levels offunctionality, symptomatology and side effects.



The results suggest that psychological interventionfocused on response expectation and irrationalbeliefs might be effective in reducing emotional dis-tress and chemotherapy induced side effects.ACKNOWLEDGEMENT OF FUNDING: None.

P1-130

International Variation in Breast Surgeons’

Attitudes Towards Prophylactic Surgeries and

Intensive Screening- Comparison Between France,

Germany, The Netherlands and The UK

Mariska Den Heijer1, Christi van Asperen2, Hilary

Harris3, Irma Nippert4, Joerg Schmidtke5,

Anne-Deborah Bouhnik6,7, Claire Julian-Reynier6,7,

D Gareth Evans8, Aad Tibben2,1

1Erasmus Medical Centre, Rotterdam, TheNetherlands, 2Leiden University Medical Centre,Leiden, The Netherlands, 3University of Manchester,Manchester, UK, 4Westfaelische Wilhelms-Universitaet, Muenster, Germany, 5HannoverMedical School, Hannover, Germany, 6Aix-Marseille Universit�e, Marseille, France, 7InstitutPaoli-Calmettes, Marseille, France, 8St. Mary’sHospital, Manchester, UK

BACKGROUND: Different options may be dis-cussed with a woman with a BRCA mutation tomanage her increased risk for breast/ovarian can-cer, consisting of either intensive surveillance orprophylactic mastectomy (PM) and/or prophylacticoophorectomy (PO). After they have learned abouttheir high risk, women are counseled on risk reduc-ing strategies by, amongst other professionals,breast surgeons (BS). In a study amongst BS inFrance, Germany, the Netherlands and the UK weinvestigated their attitudes towards prophylacticsurgeries. METHOD: In order to examine differ-ences in attitudes, we have analyzed data from aEuropean survey of cancer risk communication (In-CRisC-study). The InCRisC study was a postal sur-vey with a self-administered questionnaire carriedout in 2009–2010 amongst BS in 4 European coun-tries (UK, France, The Netherlands and Germany).In total, 1221 BS (37%) completed the question-naire. RESULTS: French and German BSreported less positive attitudes towards PM as com-pared to BS from the Netherlands and the UK.Similarly, approximately 47% of the German and79% of the French BS were of opinion that POshould be an option for an unaffected BRCA1/2mutation carrier from the age of 40 years, as com-pared to 98% and 92% of the BS in the Nether-lands and the UK, respectively. Furthermore,French and German BS were more likely to per-ceive access to increased surveillance and screeningand increase of life expectancy due to screening as abenefit of predictive testing. CONCLUSIONS:These results demonstrated international differ-ences in breast surgeons’ attitudes towards prophy-

lactic surgeries and screening in unaffected femaleBRCA1/2 mutation carriers from the age of40 years. This finding might reflect that differentpolicies are adopted regarding the counseling ofprophylactic surgeries and screening. As the clinicalevidence should be the guiding principle in care, itwould be interesting to know the survival ratesassociated with each combination of preventivestrategies. RESEARCH IMPLICATIONS: Al-though there may be cultural differences inprofessionals’ attitude towards prophylactic surger-ies, the clinical evidence should be the guiding prin-ciple. Consequently, it would be interesting toknow the survival rates associated with each combi-nation of preventive strategies, which would help togive women all the information required for theirdecision making to be autonomous and wellinformed. CLINICAL IMPLICATIONS: In thecontext of the uncertainty about the effectiveness ofintensive screening, non-directive counselling andinformed decision making about prophylactic sur-geries and screening is essential. ACKNOWL-EDGEMENT OF FUNDING: The internationalstudy was supported by the German Bundesminis-terium fuer Bildung und Forschung (BMBF, Fed-eral Ministry of Education and Research), contractnumber 01GP0617.

P1-131

Factors Influencing Functioning at Work After

Cancer: A Focus Group Study With Cancer

Survivors and Health Care Professionals

Heleen Dorland1, Femke Abma1, Corn�e Roelen1,2,

Ans Smink3, Adelita Ranchor3, Ute B€ultmann1

1Department of Health Sciences, Community &Occupational Medicine, University Medical CenterGroningen, University of Groningen, Groningen, TheNetherlands, 2365/ArboNed, Utrecht, TheNetherlands, 3Department of Health Sciences,Health Psychology, University Medical CenterGroningen, University of Groningen, Groningen, TheNetherlands

BACKGROUND: Due to earlier diagnosis andimproved treatment, an increasing number of adultcancer survivors (CSs) are living with cancer as achronic disease. Although 30% to 90% of thosediagnosed with cancer return-to-work (RTW) fol-lowing treatment, the risk of unemployment andearly retirement is increased in the years after can-cer treatment. To date, little is known about thefactors influencing health-related work functioning(WF) over time among CSs who returned to work.METHOD: Four focus groups were conducted toget more insight into WF in the post-RTW phase:three with CSs who resumed work after cancerdiagnosis (n = 22, in various stages of re-integra-tion) and one with (occupational) health careprofessionals (HCP, n = 7). Research questions



were (1) Which factors influence functioning atwork? and (2) Did the meaning of work changeafter cancer? RESULTS: Physical (e.g. fatigue),cognitive (e.g. concentration) and psychologicalaspects like coping style, acceptance, insecurityregarding work and health were mentioned by CSsand HCPs as factors affecting WF. Moreover,social support (from colleagues, employer, occupa-tional physician, partner) and work-related factors(e.g. job control and work accommodations) wereconsidered important for WF. CSs also mentionedthat feelings of guilt towards colleagues influencedtheir WF. Although work has a different meaningin terms of changed priorities after cancer diagno-sis, work still remains a very important factor formany CSs. CONCLUSIONS: This focus groupstudy identified factors related to WF in employeesafter cancer diagnosis, both from the CSs’ and theHCP perspective. Factors that were mentioned asmost impairing WF were work-related, psychoso-cial and/or medical. Having had a cancer diagnosisinfluenced WF, but work remains an importantaspect of life. The results provide direction foractions to improve WF and to maintain stay-at-work. RESEARCH IMPLICATIONS: The resultscan be used to elaborate a comprehensive model for“Work functioning among CSs”, based on the Can-cer & Work model by Feuerstein et al. 2010. Futureresearch should aim at examining the relativeimportance of these factors. It is also important toinvestigate whether and how these factors changewhen CSs have returned to work for an extendedperiod of time. CLINICAL IMPLICATIONS: Inthis study, we identified factors for clinical practice.These factors include fatigue and cognitive prob-lems, insecurity and maintaining contact with col-leagues and supervisor during treatment. Asindicated above, evidence for the importance ofthese factors for WF at a group level should beestablished in future research, as are effective strat-egies to address these factors. ACKNOWLEDGE-MENT OF FUNDING: This study was supportedby the Alpe d’HuZes Foundation, as part of theresearch program ‘Living (together) with cancer’.The study contributes to the mission of the DutchCancer Society ‘To enhance the quality of life inpeople with cancer’. The study is conducted in col-laboration with 365/ArboNed, a large Occupa-tional Health Service.

P1-132

Dispositional Optimism in Breast Cancer: Relations

with Disease-Related Quality of Life

Antoni Font, Silvia Pastells

Universitat Aut�onoma de Barcelona, Cerdanyola/Barcelona, Spain

BACKGROUND: Quality of life in cancer is influ-enced by many medical and psychosocial variables.

From the point of view of the positive psychology,optimism could be considered as a personality orreaction/coping variable. This study assesses thepossible relationship between optimism and qualityof life in breast cancer patients. Our purpose is toknow which aspects of quality of life are morerelated to dispositional optimism, to improve, whennecessary, the adaptation to the medical situations.METHOD: 50 women with breast cancer between30 and 67 years (mean age 50.6 years) answeredindividually about their current state in 27 differentquality of life aspects (with the QL-CA-Afex ques-tionnaire) and a dispositional optimism/pessimismtest (LOT-R of Craven et al.) in a non-profit cancerorganization setting. All participants signed a previ-ous agreement. Results show that 90% got chemo-therapy after a mastectomy (60%) or tumorectomy(30%) procedure. In free-disease interval were 44%and 56% in a treatment phase of the disease, pre-dominating the complementary treatment after sur-gery (14 patients). A trained psychologist appliedthe instruments. RESULTS: Findings revealed anegative relationship between optimism and all the27 aspects of quality of life. Mean comparisons ofquality of life and optimism taking into accountsocio-demographic and medical variables (T-tests),provided no significant differences between groups.Correlations (Pearson) between dispositional opti-mism and quality of life suggest that women with ahigher total score of dispositional optimism dis-played significantly (p < 0.05) less physical symp-toms and emotional difficulties. Furthermore,pessimism significantly correlated with loss of qual-ity of life in the family and social subscale(p < 0.05) and in emotional subscale (p < 0.01).CONCLUSIONS: In congruence with previousreports, optimism is significantly related to manyaspects of quality of life. Women with breast cancerwith high dispositional optimism feel less anger, lesspain, have less difficulties in their movements, feelless tired, sleep better, go on with their home tasks,feel more illusion and less fear. But in some aspects,like social function or fatigue, it seems more impor-tant not being pessimistic than being optimistic.Moreover, objective conditions, e.g., of being ornot in a certain active stage of illness and relatedtreatment do not alter the tendency of being opti-mistic or pessimistic. RESEARCH IMPLICA-TIONS: The results indicate that the relationshipbetween dispositional optimism and quality of lifeis complex. It appears that optimistic patients areless vulnerable to the consequences of the disease,but it is also possible that optimists perceive moreopportunities to receive support and to useresources and therefore recover before the loss ofquality of life associated with disease conditions.Future research needs to examine the relationshipbetween dispositional optimism and optimism ascoping strategy. CLINICAL IMPLICATIONS:Dispositional optimism appears to protect the



quality of life of women with breast cancer. Pessi-mism seems to facilitate the loss of quality of liferelated to health status. Since these are not alwaysmutually exclusive aspects, in the clinical practice isnecessary to evaluate both optimism and pessi-mism. A strategy based on evaluating both trendswould facilitate to identify preventively and helppatients at the different phases of the disease.ACKNOWLEDGEMENT OF FUNDING:None.

P1-133

Relation Between Perceived Threat and Depression

Among Cancer Patients: The Moderating Role of

Health Locus of Control

Gil Goldzweig1, Ilanit Hasson-Ohayon2, Shirly

Alon3, Efrat Shalit1

1The Academic College of Tel Aviv-Yaffo, Tel-Aviv,Israel, 2Department of Psychology, Bar-IlanUniversity, Ramat-Gan, Israel, 3PsychologicalServices “Meir” Medical Center, Kfar-Saba, Israel

BACKGROUND: Depression has been studied asa major psychological reaction to cancer. There isambiguity in the literature concerning the relationbetween levels of depression among cancer patientsand objective aspects of the illness (e.g. stage). Thegoal of the current study was to investigate the rela-tion between levels of depression and both objectiveand subjective aspects of the illness and to assessthe role of health locus of control and social sup-port in these relations. METHOD: 59 cancerpatients were recruited from a major cancer centerin Israel. Participants were evaluated on standard-ized instruments measuring: Depression, Perceivedthreat of the illness, health locus of control andsocial support. RESULTS: Levels of depressionwere found to have positive significant correlationto perceived threat of the illness and significant neg-ative correlation to both social support and internalhealth locus of control. There was no correlationbetween depression and objective aspects of the ill-ness. Internal locus of control was found to be asignificant moderator of the relation between per-ceived illness threat and depression: relationbetween depression and perceived threat wasweaker given higher levels of internal locus of con-trol. CONCLUSIONS: Subjective aspects of thedisease are highly relevant in understanding psy-chological distress among cancer patient. Theseaspects are not directly correlated to objectiveaspects of the illness but rather to subjective psy-chological factors. Internal health locus of controlmight have negative impact upon both depressionand perceived illness threat and the relationbetween these two variables. Patients with internallocus of control might be more able to utilize socialsupport then patients with external locus of controleven though social support might be considered as

an external resource. RESEARCH IMPLICA-TIONS: There is a need to understand the relationbetween personal and inter-personal aspects of thepatients and perceived illness threat. Based on fur-ther research the notion of perceived threat mightbe incorporate into a larger model of coping. Moreresearch is needed in order to understand the rela-tions between different aspects of health locus ofcontrol (internal, external, destiny/faith) and psy-chological distress. CLINICAL IMPLICA-TIONS: Both physicians and psycho-oncologyteams need to consider perceived illness threat andnot only objective factor of the illness while con-sulting patients. Encouraging patients to find socialsupport resources might have both direct impactupon depression and indirect impact throughchanges in the perceived threat of the illness.ACKNOWLEDGEMENT OF FUNDING: None.

P2-1

Depressive Disorder in Adult Cancer Patients

Referred to Psycho-Oncology Service in a Tertiary

Care Cancer Institute in a Developing Country:

Clinical Profile, Interventions Used and Outcome

Jayita Deodhar, Savita Goswami, Lekhika

Sonkusare, Rohini Hawaldar

Tata Memorial Hospital, Mumbai, India

BACKGROUND: Studies report prevalence ofmajor depressive disorder between 5–15% in cancerpatients. There are few reports of outcome studiesof depressive disorders in cancer patients in devel-oping countries. The purpose of this study is toidentify the demographic and clinical profile, sever-ity of depressive disorder, interventions used andoutcomes in those adult cancer patients diagnosedwith depressive episode/disorder following referralto psycho-oncology service in a tertiary care cancerinstitute in a developing country. METHOD: Aretrospective analysis of case records of all newpatients referred to the in-house psycho-oncologyservice of a tertiary care oncology hospital from 1January 2011 to 31 December 2012 and diagnosedwith Depressive Episode or Recurrent Depressivedisorder (by clinical interview for patient assess-ments using International Classification of DiseasesVersion 10 Chapter V) was undertaken. Patientcharacteristics, cancer diagnosis, past and familypsychiatric history, severity of depression, interven-tions used and outcome (using Clinical GlobalImpression scales, CGI) were recorded. Relevantstatistical analysis using Statistical Package forSocial Sciences version 18 was done. RESULTS: Of770 new adult cancer patients referred, 59 werediagnosed with Depressive Episode or RecurrentDepressive disorder (7.7%), including 37 femalesand 52 outpatients. The most frequent cancer siteswere breast (19), gastrointestinal (12) and head and



neck (10). Half the patients had a past history butonly 8 had a family history of psychiatric illness.Psychological interventions were used in allpatients. Psychopharmacology was required for 45patients of whom 37 were prescribed an antidepres-sant. Of 45 patients whose follow up data wereavailable, there was improvement on CGI in 31 ver-sus no change in 14 patients (p < 0.001). CON-CLUSIONS: Depressive episode/disorder was seenin 7.5% of adult new cancer patients referred to ourservice. Breast and head and neck cancers were thecommon sites of cancer diagnosis, as has been seenin other studies. There were more female patientsdiagnosed with depressive episode in our practice,which may be a referral bias. Psychopharmacologi-cal interventions were required in most patients.There was positive outcome noted in most of ourpatients on follow up and this was statistically sig-nificant. RESEARCH IMPLICATIONS: There isa need for research to evaluate efficacy of variousantidepressants used in cancer patients for positiveoutcome of depression. There is also need to evalu-ate specific psychotherapies in different groups ofcancer patients diagnosed with depressive disorder.CLINICAL IMPLICATIONS: Development andaudit of Clinical Practice Guidelines keeping in mindsocio-economic challenges faced in developing coun-tries need to be done. The burden of economicadversity adding to physical illness impacting ondevelopment, treatment and outcome of depressivedisorder in cancer patients should be evaluated.ACKNOWLEDGEMENT OF FUNDING: None.

P2-2

The Topic Complementary Medicine Within The

Doctor-Patient-Dialogue - A Qualitative Study

Kathrin Gschwendtner1, Jennifer W€agerle1,Gudrun Klein2, Corina Guethlin2, Claudia

Lampert3, Christine Holmberg4, Hans Helge

Bartsch1, Joachim Weis1

1Tumor Biology Center at the University ofFreiburg, Freiburg, Germany, 2Johann WolfgangGoethe University, Frankfurt am Main, Germany,3University of Hamburg, Hamburg, Germany,4Charit�e, Berlin, Germany

BACKGROUND: In German-speaking areasaround 40% of all cancer patients use complemen-tary medicine (CM) and the number of users isincreasing. Especially in the internet exists a multi-plicity of information about CM and yet patientshave only limited access to quality-controlledinformation about CM. The “Competence Net-work Complementary Medicine in Oncology” (CO-CON) aims to improve this lack of information.The evaluation of the patients’ information andconsultation needs and behaviour is one researchproject of COCON. METHOD: In a qualitativecross sectional design, 87 cancer patients (♀ = 51;

♂ = 36) in various therapy situations agreed to par-ticipate in a semi-standardized interview. Topics ofthe interview were the previous and current use ofCM, the information and consultation behaviouras well as the information and consultation needs.The doctor-patient-dialogue regarding CM is oneaspect of the previous consultation behaviour. Theinterview length varied between 9:10 and58:30 minutes. The code plan was developed induc-tively in exchange with 2 expert groups and was val-idated in 4 double coding sessions. RESULTS: Inour sample most patients regard their physician asthe main consultation partner for all medical issuesand this includes CM. The mistle therapy and die-tary supplements are even often recommended byphysicians. Only a few patients who mentionedtheir CM use experienced a dismissive attitude. Anadvice against CM is given especially during ongo-ing chemo- or radiotherapy. Patients interested inCM who did not mention their CM use or interestassume that their physicians have not enough timeto discuss CM, think that physicians from oncol-ogy-focused fields are not qualified in CM or expecta dismissive attitude. CONCLUSIONS: There isstill restraint by patients to approach their physi-cians about CM. However, the treating physiciansseem to be the desired consultation partner for CM.The advices given are somewhat various but notgenerally dismissive. RESEARCH IMPLICA-TIONS: In previous studies a predominant part ofthe patients state that they do not discuss their CMuse or their interest in CM with their treating physi-cians. Our results contradict these findings and willbe evaluated in a broader based questionnaire sur-vey in the context of COCON. CLINICAL IMPLI-CATIONS: The results show that there is a needfor information and consultation about CM.Therefore a quality-based standard of informationand consultation about CM should be developed.COCON aims to satisfy these needs by implement-ing a CM information platform, a medical consult-ing expert service and CM education programs forhealthcare professionals and self-help group leadersin Germany. ACKNOWLEDGEMENT OFFUNDING: This study was supported by the Ger-man Cancer Aid (Deutsche Krebshilfe e.V.).

P2-3

Social Support and Post Traumatic Growth Among

Women With Breast Cancer: Diversity of Agents

and Types of Support

Ilanit Hasson-Ohayon1, Rivka Tuval-Mashiach1,

Gil Goldzweig2, Rienat Levi1, Noam Pizem3, Bela

Kaufman3

1Department of Psychology, Ramat-Gan, Israel,2School of Behavioural Sciences, The AcademicCollege of Tel-Aviv Yaffo, Tel-Aviv, Israel, 3Divisionof Oncology, Chaim Sheba medical center TelHashomer, Ramat-Gan, Israel



BACKGROUND: In the psycho-oncology litera-ture, the interest in such classical negative psycho-logical outcome as depression and anxiety has beenbroaden to the assessment of positive outcomessuch as post traumatic growth (PTG), hope andmeaning. Consistent with this approach that stres-ses the importance of addressing possible positiveoutcomes for patients with cancer, the currentstudy reports a preliminary examination of the rela-tionships between agents and types of social sup-port and PTG among women with breast cancer.METHOD: 80 married women who were diagnosedwith breast cancer completed social support (CPASS;Goldzweig et al., 2010) and post traumatic growth(PTGI; Tedeschi & Calhoun, 1996) self-report mea-sures. Correlations and regressions analyses wereconducted in order to assess the relationshipsbetween various agents (spouse, family, friends, beliefbased) and types (emotional, cognitive, instrumental)of social support and PTG. RESULTS: All agent ofsupport (family, friends, belief based) excludingspouse support, were found to be related to posttraumatic growth various dimensions. Regressionanalysis revealed that support provided formfriends and believes base support contributed sig-nificantly to the prediction of PTG over the otheragents of support. With regard to types of support,all types of social support were found to be relatedto PTG sub-scales. Regression analysis revealedthat only cognitive support, and not emotional andinstrumental support, significantly predicted PTGtotal score over the other types of social support.CONCLUSIONS: Various agents of support playdifferent role in the process of PTG. It seems thatmarried women coping with breast cancer rely onother sources of social support than their spouse inorder to promote PTG. In addition, all three typesof support are related to these women’ PTG, withcognitive support having a unique contribution overemotional and instrumental support. RESEARCHIMPLICATIONS: The current research resultssupport the importance of addressing social sup-port as a construct that consist both different typesof support and various agents that provide thesetypes of support. Additional longitudinal studiesare needed in order to further validate the relationsbetween agents and types of social support andPTG. CLINICAL IMPLICATIONS: Althoughpreliminary, the current study findings demonstratethe importance of friends and belief system assources of growth for women coping with breastcancer. In addition, the importance of cognitivesupport should also be taken into account. Thesemay lead for tailoring interventions that aim toincrease the efficient use of these sources.ACKNOWLEDGEMENT OF FUNDING: None.

P2-4

Myth or Reality: Are Head and Neck Cancer

Patients at Increased Risk for Suicidal Thoughts and

Gestures? Preliminary Results

Melissa Henry1,2, Zeev Rosberger1,2, Christopher

Longo1,3, Saul Frenkiel1,2, Michael Hier1,2, Martin

Black1,2, Anthony Zeitouni1,4, Karen Kost1,4,

Alex Mlynarek1,2, Christina MacDonald1,

Juli Atherton5, Michael Meaney1,4

1McGill University, Montreal, Quebec, Canada,2Jewish General Hospital, Montreal, Quebec,Canada, 3McMaster University, Halmilton, Ontario,Canada, 4McGill University Health Centre,Montreal, Quebec, Canada, 5Universite du Quebec aMontreal, Montreal, Quebec, Canada

BACKGROUND: While head and neck cancerpatients (HNC-P) are reportedly at increased riskfor completed suicide (H&N-CP 50.5/100,000 vs.general cancer population 33.6/100,000 versus gen-eral population 13.8/100,000; JAMA, 2006), sui-cidal ideations and attempts have yet to beinvestigated in this population. Suicide risk factorsfound in a general oncologic population may notentirely correspond to those associated with HNC,since these patients face unique challenges (e.g., dis-figurement, difficulties speaking, eating, andbreathing). METHOD: This ongoing funded studyaims to identify psychological QoL trajectories inH&N-CP, including investigating suicidal ideationsand attempts measured pre-HNC diagnosis(life-time), at baseline(<2 weeks post diagnosis), and at3,6, and 12 months post diagnosis. Patients com-pleted the Beck Scale for Suicidal Ideation (BSSI)and questions covering suicidal ideations andattempts (lifetime and since last questionnaire).Patients also completed self-reported measures ofQoL (FACT-G & HN), depression (BDI-II), bodyimage (BIS), alcohol and drug misuse (RAPS4-QFand DAST-10), social supports (SSQ-6), sociode-mographics/illness/treatment information, and pastpsychiatric history. Our aim is to present prelimin-ary analyses of the frequencies and variables associ-ated with suicidal ideations in HNC-P recruitedthus far. RESULTS: Forty-six newly diagnosedHNC-P completed both baseline and 3 month fol-low-up measures. Lifetime pre-cancer and 3 monthssuicidal ideations were 10.8% and 8.5%, respec-tively; suicidal attempts were 2.4% and 0%; and2.2% committed suicide <3 months (during thecourse of treatment). Suicidal thoughts at 3 monthswere related to: lifetime pre-HNC suicidal ideations(p = 0.034) or past psychiatric diagnosis (p =0.001), higher levels of anxiety/depression (p =0.001) and body image concerns (p = 0.001), lowerquality of life functionally (p = 0.0009) and forH&N-specific issues (p = 0.01; especially difficultiesbreathing p = 0.001, alcohol p = 0.002, pain inmouth/throat/neck p = 0.01). Physical wellbeing



(p = 0.12) was not significant, possibly due to a lackof statistical power. CONCLUSIONS: Preliminaryrates of suicidal ideations found in our study weresignificantly higher than those found in the generalpopulation (1 year: men 1.8%; women 2%). How-ever, they seemed stable over time (from pre-cancerto 3 months post-diagnosis). Suicidal HNC-P seemto suffer globally from a holistic point of viewincluding physically (pain, difficulties breathing)and psychologically (anxiety, depression, bodyimage, alcohol use). RESEARCH IMPLICA-TIONS: Further studies are needed to investigaterisk and protective factors of suicidal ideations andgestures in HNC-P; distinguishing a pre-existingpsychological vulnerability to one acquired throughthe cancer experience and its treatment. It alsoremains unclear to what degree suicidal HNC-P’squality of life is objectively (i.e., medically) orsubjectively (i.e., negatively reporting on their expe-rience) more compromised. CLINICAL IMPLI-CATIONS: Suicidality may be important toconsider in light of the patient’s broader socio-emo-tional and historical context including past lifeexperiences and current HNC-related struggles.One may want to consider asking patients abouttheir past psychiatric history during initial medicalintake as a way of gauging vulnerability to upcom-ing HNC treatments. This can allow patients to bereferred to appropriate supportive resources early-on in their cancer trajectory. ACKNOWLEDGE-MENT OF FUNDING: This study is funded bythe Fonds de recherche en sant�e du Quebec (FRSQ).

P2-5

Which Health-Related Quality of Life Outcomes

Should be Discussed During the Initial Follow-Up

Consultation After Surgery for Esophageal Cancer?

Preliminary Findings of a Delphi Survey

Marc Jacobs1, Inge Henselmans1, Rhiannon

Macefield2, Natalie Blencowe2, Ellen Smets1,

Hanneke de Haes1, Mirjam Sprangers1,

Jane Blazeby2,3, Mark van Berge Henegouwen1

1Academic Medical Center / University ofAmsterdam, Amsterdam, The Netherlands, 2Schoolof Social and Community Medicine / University ofBristol, Bristol, UK, 3Division of Surgery Head andNeck / University Hospitals Bristol, Bristol, UK

BACKGROUND: Esophageal cancer surgery hasa detrimental and long-lasting effect on health-related quality of life (HRQL). Therefore, cliniciansneed to systematically inform patients about thecourse of important outcomes. The aim of thisstudy is to identify outcomes deemed important bypatients and health-care professionals (HCPs;surgeons, nurses, and dieticians) to address in theinitial follow-up consultation. METHOD: A two-round Delphi survey. The initial list for the first

round contained 49 outcomes (29 HRQL). Weinvited patients and HCPs to rate each outcome on ascale of 1 (not important) to 9 (absolutely important)by either a postal or web-based questionnaire. Rat-ings were categorized as low (1–3), moderate (4–6),and high importance (7–9). We considered an out-come to be of high importance if >70% of partici-pants rated the outcome as high AND if <15% ratedthe outcome as low. These outcomes will be includedin the second round for which the same patients andHCPs will be resurveyed. RESULTS: We reportthe preliminary findings of round one of the Delphisurvey, which was completed by 104 patients and56 HCPs (21 surgeons, 20 dieticians, 16 nurses). Atop 10 list of most important outcomes to be dis-cussed revealed that patients and HCPs only shared4 outcomes: removal of cancer, eating and drink-ing, recovery period, and swallowing problems dueto scar tissue. HCPs, and not patients, consideredthe discussion of global quality of life, physicalfunctioning, and weight loss to be a top 10 topic.Patients, and not HCPS, wanted to discuss survival,cancer recurrence, vitamin B12, and food supple-ments. CONCLUSIONS: Preliminary findingssuggest that patients and HCPs hold different viewson the topics that need to be discussed in the initialfollow-up consultation after esophageal cancer sur-gery. Whereas clinicians focus on broader conceptsof quality of life (e.g., global quality of life, physicalfunctioning, eating and drinking), patients focus onspecific issues related to prognosis (e.g., diseaserecurrence), and eating and drinking (e.g., supple-ments, vitamin B12). We expect to report the resultsof the completed Delphi survey at the conference.These findings will then provide the topics that needto be included in a (web-based) informationpackage for HCPs. RESEARCH IMPLICA-TIONS: The final list provides an overview of out-comes most patients and HCPs consider importantto discuss in the initial follow-up consultation.Hence, high-quality evidence-based informationneeds to be available to inform patients about theseoutcomes. As such, our list may guide the selectionof outcomes for future trials and observationalstudies. Inaddition, future research also needs tofocus on ‘translating’ the evidence-based informa-tion, derived from studies, in a manner that isunderstandable to patients. CLINICAL IMPLI-CATIONS: The outcomes identified in the final listneed to be addressed in the initial follow-up consul-tation after esophageal cancer surgery. However,since time is limited, and several outcomes do notbelong to the expertise of surgeons, multidisciplin-ary teams need to determine which HCP (surgeon,nurse, or dietician) addresses which outcome. As aresult, patients receive information by the HCPmost knowledgeable about the specific outcome.ACKNOWLEDGEMENT OF FUNDING: Rhian-non C Macefield, Natalie Blencowe, and JaneBlazeby are funded by the MRC ConDuCT Hub.



P2-6

Goal Adjustment Strategies Operationalized and

Empirically Examined in Patients With Cancer

Moniek Janse1, Esther Sulkers1, Wim J. E. Tissing1,

Robbert Sanderman1, Mirjam A.G. Sprangers2,

Adelita V. Ranchor1, Joke Fleer1

1University Medical Center Groningen, Groningen,The Netherlands, 2Academical Medical Center,Amsterdam, The Netherlands

BACKGROUND: Adolescents facing cancer arelikely to experience goal disturbance. Goal distur-bance is related to psychological distress, which canbe alleviated by goal adjustment. Relevant theorieshave identified several goal adjustment strategies(GAS), but their use has not been empiricallytested. Therefore, this study aims to operationalizeand empirically test the use of GAS in adolescentswith cancer using characteristics of goals.METHOD: Adolescent cancer patients listed theirgoals 3 and 12 months post-diagnosis. All goalswere scored on goal characteristics (importance,attainability and effort by patients; life domain andlevel of abstraction by authors). The following 6GAS were operationalized: (1) Continue to pursuedisturbed goals, (2) Give up effort to attain the goalbut remain committed, (3) Scale back goals in thesame life domain, (4) Reprioritize goals, (5) Formnew goals, (6) Give up goal commitment withoutturning to a new goal. The operationalization of allGAS was based on the scores of the goal character-istics using mathematical formulas. RESULTS: AllGAS could be feasibly operationalized using rele-vant goal characteristics. Cancer patients (N = 32,56.3% female) used all strategies, except for (6)Give up goal commitment without turning to a newgoal. The use of an additional strategy was foundfrom the data: (7) Scale up goals in the same lifedomain. CONCLUSIONS: Goal adjustment strat-egies can be feasibly determined using mathemati-cal formulas based on goal characteristics. Over thenext couple of months, we will investigate the useof these strategies in a larger sample of adults withcancer and compare their use over both samples.These results will be presented at the congress inaddition to the results stated in this abstract.RESEARCH IMPLICATIONS: Future researchcould investigate which strategies are most adaptivefor cancer patients. CLINICAL IMPLICA-TIONS: Once clinicians are aware which goaladjustment strategies are most adaptive for specificpatients, they should be able to help patients signalgoal disturbance and find appropriate ways fordistressed cancer patients to adjust and alleviate theirdistress. ACKNOWLEDGEMENT OF FUND-ING: Preparation of this abstract was funded bythe Dutch Cancer Society (RUG 2009-4461).

P2-7

The Generic and Stoma-Specific Quality of Life of

Cancer Patients With a Colostomy, Ileostomy or

Urostomy

Femke Jansen1, Nelly van Uden-Kraan1,2, Anne

Braakman3, Irma Verdonck-de Leeuw1,2

1VU University Medical Center, Amsterdam, TheNetherlands, 2VU Faculty of Psychology andEducation, Amsterdam, The Netherlands, 3DutchOstomy Association, Maarssen, The Netherlands

BACKGROUND: Studies in cancer and non-can-cer patients with a colostomy, ileostomy or urosto-my have repeatedly reported limitations in patient-reported quality of life (QoL). However, few studieshave focused on factors associated with impairedstoma-specific QoL in colorectal and bladder can-cer stoma patients. In addition, it is not knownwhether the generic and stoma-specific QoL differsbetween patients with a stoma due to cancer andpatients with a stoma due to other causes.METHOD: All patients with a colostomy, ileosto-my or urostomy participating in the Stomapanel ofthe Dutch Ostomy Association in August 2012 wereasked to complete a generic (RAND-36) andstoma-specific QoL (stoma-QoL) questionnaire.The association of different socio-demographic(gender, age, education level and employment sta-tus) and clinical variables (type of stoma and timeelapsed since stoma-operation) with the stoma-QoLof cancer stoma patients were assessed using back-ward linear regression analyses. In addition, thedomain scores of the RAND-36 and total stoma-QoL score of all cancer stoma patients were com-pared with all non-cancer stoma patients using lin-ear regression analyses. RESULTS: In total, 379cancer patients (81% colorectal, 18% bladder and1% other) and 289 non-cancer patients (37% Coli-tis Ulcerosa, 23% Crohn’s disease and 40% other)with a colostomy (55%), ileostomy (32%) and/orurostomy (16%) were included. The stoma-QoL ofcancer stoma patients was significantly associatedwith female gender (b = �3.04), age ≥65 years(b = 2.33), higher education (b = 2.99) and beingemployed (b = 2.26) (R2 = 0.07). Adjusted for gen-der, age, type of stoma and time elapsed sincestoma-operation, cancer stoma patients scoredhigher on stoma-QoL (b = 2.12) and all RAND-36domains (8.46 < b ≤ 19.06) except on mentalhealth, compared to non-cancer stoma patients.CONCLUSIONS: Gender, age, education leveland employment status were associated withstoma-specific quality of life in cancer stomapatients. Compared to patients with a stoma due tonon-cancer causes, cancer stoma patients reporteda better generic and stoma-specific QoL.RESEARCH IMPLICATIONS: Some socio-demographic factors were associated with the stoma-specific QoL in cancer stoma patients, however, this



accounted only for a small amount of variance inQoL. In order to improve health care and QoL instoma patients, further studies should investigatewhich other factors are associated with the genericand stoma-specific QoL in cancer stoma patients. Inaddition, further studies should analyze which fac-tors account for the difference in QoL between can-cer and non-cancer stoma patients. CLINICALIMPLICATIONS: Awareness of factors associatedwith QoL and of differences in QoL between cancerstoma patients and non-cancer stoma patients isimportant. Results of this study may help to iden-tify patients with low QoL and who may benefitfrom supportive care. ACKNOWLEDGEMENTOF FUNDING: This study was funded by theDutch Ostomy Association.

P2-8

Predicting Optimal Cancer RehabIlitation and

Supportive Care (POLARIS): Meta-Analyses of

Individual Patient Data of Randomized Controlled

Trials Evaluating the Effect of Physical Activity,

Exercise and Psychosocial Interventions on

Health-Related Quality of Life in Cancer Survivors

Laurien Buffart1,2, Joeri Kalter1,2, Mai Chin A

Paw1,2, Martijn Heymans1,2, Neil Aaronson3,

Kerry Courneya4, Paul Jacobsen5, Robert

Newton6, Irma Verdonck-de Leeuw1,7,

Johannes Brug1,2

1VU University Medical Center, Amsterdam, TheNetherlands, 2EMGO Institute for Health and CareResearch, Amsterdam, The Netherlands, 3TheNetherlands Cancer Institute, Amsterdam, TheNetherlands, 4University of Alberta, Edmonton,Canada, 5Moffitt Cancer Center and ResearchInstitute, Tampa, USA, 6Edith Cowan University,Joondalup, Australia, 7VU University, Amsterdam,The Netherlands

BACKGROUND: The primary aim of PredictingOptimaL cAncer RehabIlitation and Supportivecare (POLARIS) is to: (1) conduct meta-analysesbased on individual patient data (IPD) to evaluatethe effect of physical activity, exercise and psycho-social interventions on health-related quality of lifeof cancer survivors; (2) identify important sociode-mographic, clinical, personal, or intervention-related moderators of the effect; and (3) build andvalidate clinical prediction models identifying themost relevant predictors of intervention success.METHOD: We will invite principal investigatorsof randomized controlled trials evaluating theeffects of physical activity, exercise or psychosocialinterventions on health-related quality of life com-pared with a wait-list, usual care or attention con-trol group among adult cancer survivors to join thePOLARIS consortium and share their data forpooled analyses to address the proposed aims.

Eligible randomized controlled trials were identifiedthrough literature searches in four databases.RESULTS: To date, we have identified 132 eligibleand unique trials. At the moment, eighteen princi-pal investigators already agreed with sharing theirdata in the POLARIS database (n = 5223). CON-CLUSIONS: The POLARIS consortium will con-duct IPD meta-analyses, with the ultimate goal toeffectively target physical activity, exercise or psy-chosocial programs to cancer survivors. Insight intothe moderators of the effectiveness of physicalactivity, exercise or psychosocial intervention is anessential step towards personalized care for individ-ual cancer survivors. Further, this study allows usto build a clinical decision rule supporting evi-dence-based decision making about which interven-tion would be most effective for a given outcomeand a given patient group. RESEARCH IMPLI-CATIONS: We will ask study collaborators to sup-ply raw data. We will examine these data forcompleteness and consistency with the original pub-lications. To harmonize the data variables, data willbe imported into a data warehouse. Subsequently,the data will be prepared for transformation of ori-ginal studies, including variable checking. Finally,transformation of the data labels of the originalstudies into the POLARIS coding scheme and inte-gration into the data warehouse will be performed.CLINICAL IMPLICATIONS: The POLARISconsortium tries to generate evidence essential totarget physical activity, exercise and psychosocialinterventions to the individual survivor’s character-istics, capabilities, and preferences. ACKNOWL-EDGEMENT OF FUNDING: The POLARISstudy is supported by the ‘Bas Mulder Award’granted to L.M. Buffart by the Alpe d’HuZesFund, part of the Dutch Cancer Society.

P2-9

Quality of Life Trajectory and its Sub-Patterns in

Newly Diagnosed Advanced Lung Cancer Patients

During the First 12 months of Being Diagnosed

Yeur-Hur Lai1, Yun-Hsiang Lee1, Yu-Chien Liao2,

Shiow-Ching Shun1, Wei-Yu Liao1, Chong-Jen

Yu1, Pan-Chyr Yang1

1National Taiwan University, Taipei, Taiwan,2Yuanpei University, Hsinchu, Taiwan

BACKGROUND: Relatively few studies haveexamined the longitudinal QOL changes and poten-tial QOL-sub patterns on newly diagnosed non-operable advanced lung cancer patients (Stage IIIB& IV). Factors related to the changes are alsoimportant to be identified. The aims of this studywere to (1) explore the overall QOL and QOL sub-patterns in advanced lung cancer patients duringthe first 12 months of diagnosis, and (2) identifyfactors related to the changes. METHOD: A



prospective longitudinal study was conducted in amedical center in Taiwan. A total of 160 newlydiagnosed advanced lung cancer patients wererecruited and completed 5 assessments (before firsttreatment, and 1, 3, 6, 12 months from receivingfirst treatments) (T1–5, respectively). The QOL wasmeasured by the overall QOL item in the EORTCQLQ-C30 (0–100 scoring, higher is better). TheQOL sub-patterns and factors related to the pat-terns were analyzed by Latent Class Growth Analy-sis (LCGA). Factors the models (independentvariables) included the changes of physical func-tion, selected symptoms, emotion distress, and self-efficacy (on coping with cancer). RESULTS: Gen-erally, patients perceibved moderate levels of QOLacross the 12 months. Three QOL sub-patternswere identified. In the pattern I (more than 50%subjects), patients reported moderate to good levelsof QOL (scoring around 70–80) across the12 months. In the pattern II (around 45% of sub-jects), patients reported moderate levels of QOL(scoring around 50–70 QOL). In the pattern III(<10% subjects), patients reported poor levels ofQOL (scoring around 40 or less). Overall, factorssignificantly related to the changes of QOLincluded physical function, fatigue, emotion dis-tress, and self-efficacy. CONCLUSIONS: Thisstudy provideds a relatively more comprehensiveevidences about the overall and sub-patternschanges of QOL in newly diagnosed advanced lungcancer patients in first 12 months of cancer diagno-sis. Timing and tailoring interventions are neededto improve QOL in patients with different QOLsub-patterns. RESEARCH IMPLICATIONS:Brief, tailoring and clinically feasible tailoring inter-ventions should be further developed based on thefindings in sub-patterns. These interventions shouldbe examined of their effectiveness on QOLimprovements in advanced lung cancer patients.CLINICAL IMPLICATIONS: Clinically, system-atic QOL assessments would be suggested by usingbrief tools to reflect patients’ QOL related problemsor needs. Timing and appropriate interventions aresuggested to be delivered based on the assessments.For those with very poor QOL, health care profes-sionals should be particularly cared. ACKNOWL-EDGEMENT OF FUNDING: This study ismainly supported by National Health ResearchInstitute (NHRI) and partly by National HealthCouncil (NSC) in Taiwan.

P2-10

Launching a Career in Psychosocial Oncology

Research: The Powerful Combination of Strong

Mentorship and Timely Program of Research

Julie Lapointe1,2, Fay J. Strohschein1,3, Shannon

Groff4, Carmen G. Loiselle1,2

1Christine and Herschel Victor/Hope & Cope Chairin Psychosocial Oncology, Montreal, Qu�ebec,Canada, 2Department of Oncology and IngramSchool of Nursing, Faculty of Medicine, McGillUniversity, Montreal, Qu�ebec, Canada, 3JewishGeneral Hospital, Montreal, Qu�ebec, Canada,4University of Calgary, Community Health Sciences& Alberta Health Services Cancer Care, Holy Cross,Alberta, Canada

BACKGROUND: Starting a research career inpsychosocial oncology is both exciting and chal-lenging. Currently, there is a renewed interest inimproving health services for cancer survivors.However, challenges include highly competitivefunding with low success rates and predominantfocus on fundamental research. Programs such asthe Psychosocial Oncology Research Training(PORT) are conducive to propelling youngresearchers into productive career paths. In thispresentation, key elements of this research trainingprogram will be discussed. METHOD: A recentworkshop held on “Innovative Research in CancerSurvivorship” is a prime example of the synergythat takes place at PORT, a Strategic Training Ini-tiative in Health Research (STIHR) funded by theCanadian Institutes of Health Research (CIHR).This workshop, developed in collaboration between2 trainees and the program leader, aimed to raiseawareness on current trends in psychosocial oncol-ogy research and spark innovative research ideas,partnerships, and projects. Activities included shortinteractive lectures alternating with small group dis-cussions and a multi-step group exercise entitled“turning a bad research idea into an innovativeone”. RESULTS: Held in April 2013 in Ottawa,Canada, this one-day face-to-face PORT workshopprovided time and space for more than 20 master’s,doctoral and postdoctoral trainees to acquire theknowledge and frame of mind required to design“good” and innovative research projects. Traineesappreciated the opportunity to practice their skillsat refining “bad” research ideas into exciting, rele-vant and fundable ones. They also particularlyappreciated the small group discussions with theirrandomly paired mentor as it allowed them to dis-cuss with these experienced and successful research-ers about the up and down sides of conductinginnovative research project. CONCLUSIONS:Graduate research training and junior careerlaunching can be both rewarding and extremelychallenging. Research training programs such asPORT fill an important gap by offering an



academic community uniquely positioned to fosterlearning, networking, collaboration, “healthy”competition, social, and financial support. Throughthe reliance on information technology, face-to-faceexchanges, dedicated workshops and researchinternships, PORT’s program offers varied andinnovative research skills building activities whichhave been throughout the years instrumental inshaping the developing career of its trainees.RESEARCH IMPLICATIONS: In a field as com-petitive as research, an excellent training experienceis invaluable in building capacity. Research trainingprograms such as PORT enhance the developmentof skills and competencies to enable fellows todesign and carry-out innovative, high quality, per-son-centred, and feasible studies. CLINICALIMPLICATIONS: Supporting aspiring youngresearchers to think outside the box, design timelystudies, innovate in their field, and proactively dis-seminate their results can directly contribute toenhancing clinical practice. The knowledge gainedthrough such training programs set the conditionsand contexts that most favorably launch juniorresearchers into an exciting career. ACKNOWL-EDGEMENT OF FUNDING: Julie Lapointe iscurrently a postdoctorate CIHR Fellow in PORT aStrategic Training Initiative in Health Research(STIHR) funded by the Canadian Institutes ofHealth Research (CIHR). Fay Strohschein hasreceived funding from the FRQ-S; the Quebec Net-work for Research on Aging, the PORT Program;the McGill University Faculty of Medicine; and theJewish General Hospital Department of Nursing.Shannon Groff is funded through the Alberta Can-cer Foundation, the PORT Program, KnowledgeTranslation Canada and the CIHR.

P2-11

Coping Profiles of Patients With Different

Functional and Psychosocial Status:

A Person-Oriented Approach

Juliane Lessing1, Martine Hoffmann2, Dieter

Ferring1, Gilles Michaux3

1INSIDE, University of Luxembourg, Walferdange,Luxembourg, 2RBS - Center fir Altersfroen, Itzig,Luxembourg, 3Centre of Health Promotion, ZithaClinic, Luxembourg, Luxembourg

BACKGROUND: Due to medical-technical pro-gress, cancer became a treatable, even curable dis-ease and cancer patients have to deal with theirdisease and its consequences sometimes over manyyears. Hence, psychosocial support of cancerpatients becomes more and more essential. Tounderstand the growing need for psychosocial careof cancer patients, assessment of patients’ copingbehavior is necessary. The present study investi-gated coping profiles of cancer patients fromFrance with different functional and psychosocial

status. METHOD: The study followed a quantita-tive cross-sectional design. We assessed 99 non-hos-pitalized cancer patients attending ambulant radio-and/or chemotherapy with different health statusand age (15–82). The patients filled out a question-naire assessing sociodemographic and disease-related variables, illness perception (using theFrench version of the IPQ-R-Brief), subjective well-being (using the French version of the FACT-GP)and coping styles (using the French version of theBrief-COPE). Five persons had to be excluded fromthe analysis due to too many missing values oroutliers. Data of 94 persons was analyzed usinghierarchical and non-hierarchichal cluster analyses,ANOVAs and Chi-Squared tests. RESULTS: Wefound 4 groups with different functional and psy-chosocial status. The biggest group (39 persons)indicated overall well-being. One group (29 per-sons) showed only physical and functional burden,the third (19 persons) reported social burden andlack of support. The smallest group (7 persons)showed the highest ratings of physical, functionaland emotional burden. This last group used signifi-cantly more dysfunctional coping strategies such asself-blame and less “positive” strategies as accep-tance, positive reframing and humor. The groupswith highest ratings of physical and functionalimpairments reported significantly more pain. Nopronounced differences were found regardingdemographics and disease-related parameters.CONCLUSIONS: Our study identified four clus-ters with different profiles of functional, physical,social and emotional well-being that interestinglydid not differ with respect to disease progressionindicators. The groups differed however concerningtheir coping behavior. Especially, persons reportingthe highest emotional burden showed less “posi-tive” but more self-blaming coping behavior as theother groups without such emotional strain. Thesefindings thus indicate different coping profilesfor patients with specific disease burden thatmay require different psychosocial interventions.RESEARCH IMPLICATIONS: The studyemphasized a differential approach to well-beingand coping behavior in cancer patients. In order toprovide effective interdisciplinary care and treat-ment, it is evident to detect patients who are highlyaffected by their disease. Interventions shouldalways be tuned to the differential needs of patientsin a given life situation. One step in this directionclearly lies in the development and use of screeninginstruments in oncological settings. CLINICALIMPLICATIONS: Especially the cluster with thehighest burden used less so-called “positive” copingstrategies such as acceptance, positive reframingand humor. If one considers these strategies asthreat minimization strategies this finding may indi-cate that in case of heightened burden a positiveappraisal of one’s situation may be difficult toachieve. The concept of “depressive realism” may



be used here to describe this phenomenon and itsclinical-therapeutic implications. ACKNOWL-EDGEMENT OF FUNDING: The study pre-sented above took place within the framework ofthe Tempus (Trans-European Mobility Programfor University Studies) Program JEP-26029-2005with funding by the European Commission and theparticipating universities (Luxembourg, Stras-bourg, France, and Omsk, Russia). This projectemphasized the development of teaching in oncol-ogy in the oblast of Omsk and was carried out from2006 to 2009.

P2-12

Dance Movement Therapy for Patients Undergoing

Radiotherapy: A Qualitative Investigation of

Motivation, Needs and Benefits

Phyllis H.Y. Lo1, Rainbow T.H. Ho1,2, Irene K.M.

Cheung1, Caitlin K.P. Chan1, Cecilia L.W. Chan1,2,

Paul S.F. Yip2, Mai Yee Luk3

1Centre on Behavioral Health, The University ofHong Kong, Hong Kong, 2Department of SocialWork and Social Administration, The University ofHong Kong, Hong Kong, 3Department of ClinicalOncology, Queen Mary Hospital, Hong Kong

BACKGROUND: Radiotherapy often leads to amultitude of physical side effects leading to psycho-logical distress and impaired qualities of life. Focus-ing on mind-body connection, dance-movementtherapy (DMT) can potentially bring upon bothphysical and psychological healing through its crea-tive movement processes. This presentation willcomprehensively explore patient needs duringradiotherapy, motivation to participate in body-mind interventions, changes as a result of DMT,and attitudes after radiotherapy, which is littleknown for Chinese breast cancer survivors.METHOD: 105 Chinese breast cancer patientswho were undergoing or just completing radiother-apy were recruited from hospitals in Hong Kong.The qualitative study design complements a largerrandomized-controlled trial to provide in-depthunderstanding on the needs and experience ofpatients. Upon completing the 6-session DMT (9contact hours), participants commented (in writing)on how the intervention benefited them (or not),what helped them get through the 5 week radio-therapy and what was now most important tothem. Comments were coded using content analy-ses. Resultant themes were verified and detailed viafocus groups with 8 participants conducted oncebefore and once after DMT. RESULTS: Partici-pants agree that radiotherapy is time to resume par-ticipation in groups so as to resume normality.DMT was attractive compared with other psycho-social groups for its physical benefits. Patients weremotivated to resume exercise appropriate forthem and overcoming the side-effects of preceding

chemotherapy; despite painful arms and fear ofsweat affecting radiotherapy sites. Patients appreci-ated both physical and psychosocial benefits ofDMT. Physical improvements counteracted sideeffects of treatments, leading to better sleep andincreased wiliness to exercise at home. Psychosocialbenefits included released emotions through move-ment, enhanced cancer coping particularly throughradiotherapy, changed attitudes, feeling less alone,etc. CONCLUSIONS: For breast cancer patients,radiotherapy is typically a period when they battlewith residual side-effects from chemotherapy orsurgery compounded by fears of other side-effectsarising from radiotherapy. Yet, seeing an impend-ing end to frequent hospital visits, their buddingdesire to resume exercise renders body-mind inter-ventions particularly appealing to patients at thisstage. Understanding their needs and motivationsat unique treatment periods enable the design ofappropriate interventions. Nonetheless, patients’motivation is dampened by not knowing the inten-sity and type of exercise deemed appropriate. DMTis recommended for patients undergoing radiother-apy for its extensive mental, physical and socialtherapeutic elements. ACKNOWLEDGEMENTOF FUNDING: This study is part of a random-ized controlled trial funded by the Hong KongResearch Grants Council’s General Research Fund(HKU745110H). We would also like to thank theHong Kong Cancer Fund, Queen Mary Hospitaland Pamela Youde Nethersole Eastern Hospital,but most of all, participating survivors in thisstudy.

P2-13

In the Name of God the Compationate the Merciful

– Psychodynamic of Psychiatric Problems of Head

and Neck Cancers Comparing with other Cancers

Gholamhossein Mobaraky, Saeed Soheilipour

University of Medicine, Esfahan, Iran

BACKGROUND: Psychological problems of can-cer are affecting prognosis and therapuetic processof diseaes. Different psychiatric disorders cancom-plictate diagnosis and therapy, so to know thesedisorders can help the therapist and patients. Evenif diffrent types of cancers might have all types ofpsychiatric disorders, but some of psychiatric prob-lems see more in some types of cancers (e.g.,suicide and depression). METHOD: Objective:Compare psychiatric problems in cancer of headand neck and other parts of the body in psychody-namic view. Methods: Using 2 types of studies, ret-rospective (review 200 psychiatric consultations)and self filling questionnare by 20 pts. with headand neck cancers and 20 pts. with other types. Oneof questioner was Beck, and another was suicidalideation questionnaire. RESULTS: This study hasproven that suicide and depression are more



common in indiviuals with head and neck cancerrather than in other kind of cancer. Psychodynamicinterpratation of this phenomena is that because ofH&NCA affects apearance and beauty and causeslow self esteem, which ends in suicide, that discusedin main essay, with statics. CONCLUSIONS: Toknow having H&N cancer pt. therapist concernhigh risk of suicide, so consult with psychiatrist,and start psychotherapy and drug therapy assoon as possible. ACKNOWLEDGEMENT OFFUNDING: None.

P2-14

Patients’ Perspectives on Adherence to Treatment in

Chronic Myeloid Leukemia

Michelle Normen1, Surendran V2, Prasanth

Ganesan2, Rejiv Rajendranath2, T.G Sagar2

1Madras Cancer Care Foundation, Chennai, TamilNadu, India, 2Cancer Institute WIA, Chennai, TamilNadu, India

BACKGROUND: Medication adherence is a vitalissue when treating cancer patients requiring pro-longed therapy. Imatinib is an oral drug that pro-longs life in patients with chronic myeloid leukemia(CML). Evidence suggests that one-third patientsare non-adherent to treatment and this has adverseconsequences. Non-adherence is a complex issuewhen treating a potentially life-threatening illness,the reasons for which are poorly understood. Thepresent study explored psychosocial issues of adher-ence to treatment in CML patients prescribed I-matinib. METHOD: A qualitative method using asemi- structured in-depth interview was used for thestudy. Thirty CML- Chronic Phase (CP) patients(19 male and 11 female) receiving Imatinib (free ofcost under the Glivec International Patient Assis-tance Program) for a minimum period of 6 monthswere enrolled. Patients having cancer in anothersite, those who had undergone bone marrow trans-plant were excluded. After informed consent wasobtained the interview was conducted which wasaudio recorded. Level of distress and fatigue wereassessed using the Distress Thermometer (NCCN)and the Symbolic Assessment of Fatigue Extent(SAFE) scale (validation under progress).RESULTS: Content analysis revealed seven majorthemes: individual perception about illness, interac-tion with healthcare provider and system, issueswith side-effects of Imatinib, logistics issues, signifi-cance of social support, psychological issues andunderstanding of adherence to treatment. Psycho-logical issues, side-effects and logistics affectedadherence to an extent, yet individual perceptionabout illness was a major determinant of treatmentadherence. Significance of social support andinteraction with healthcare provider and systemwas good and could be factors that improvedadherence. Although majority (76.7%) reported

experiencing fatigue, 80% were found to have onlymild fatigue on assessment. Mild distress was foundin 50% patients. CONCLUSIONS: Individual per-ception about illness emerged as a prominent factorto understand treatment adherence in chronic mye-loid leukemia. The resultant sub-themes includedawareness about diagnosis and treatment, attitudetowards illness, significant changes in day to dayfunctioning and worry with regard to the future oftheir family. Hence, through an in-depth inquiry intothe patient’s perception of their illness keeping inmind their socio-economic and educational back-ground, further adherence interventions can be imple-mented. RESEARCH IMPLICATIONS: Futureresearch warrants for a prospective study to under-stand the level of adherence in this patient popula-tion using quantitative assessments. Thedevelopment of a theoretical model on treatmentadherence for this patient population. Psychosocialintervention studies can be undertaken to study theeffect of adherence to treatment with differentsocio-demographic groups. Finally, conductingspecific intervention studies to highlight the impor-tance of adherence using flip charts, educationalpamphlets and psychological counselling services.CLINICAL IMPLICATIONS: From this study,clinicians can be made aware of the specific psycho-social factors affecting adherence and thereby helpto identify and address issues at the commencementof treatment. A holistic psycho-educational inter-vention can be implemented into the system forimproving adherence. Regular documentation ofpatient’s progress with a tool to objectively measureadherence can aid to quantify levels of adherence.Further, patients need to be consistently followed upregarding difficulties faced in adhering to treatment.ACKNOWLEDGEMENT OF FUNDING: None.

P2-15

Pilot Study on Diagnosis Communication and

Patient’s Rights in an Eastern European Country

Anca Bojan, Andrada Parvu, Anca Farcas

“Iuliu Hatieganu” University of Medicine andPharmacy, Cluj-Napoca, Romania

BACKGROUND: Current Romanian medical leg-islation is centered on patient’s autonomy. In medi-cal practice persists a “traditional” care model,approaching the patient as part of a family whichfilters medical information that reaches the patient,interferes in decision-making process, producingethical dilemmas and diminuishing patient’s auton-omy. Many physicians let themselves involved into“silence conspiracy” by the families and some doc-tors are asking the psychologists for the characteris-tics of patients that want their autonomy to berespected. METHOD: Transversal study, 40 cancerpatients were administered a semi-structuredinterview based on: knowledge of the diagnosis,



knowledge of patient’s rights, the manner of diag-nosis communication, possible interference fromthe family in doctor-patient communication and inthe decision-making process. Inclusion criteria: ageof over 18, signing informed consent, malignantdiagnosis. Exclusion criteria: patients that refusedto participate. The subjects included were randomlychosen from the patients admitted and treated in anational cancer institute. The methodology of thestudy was approved by the Medical UniversityEthics Comitee. The data was processed both quali-tatively (phenomenological approach) and quanti-tatively using SPSS.16. RESULTS: 90% of thepatients wanted to know the diagnosis, this wishwasn’t statisticaly associated with patient’s gender,sex, age, environment, marital status, education(Fisher’s Exact Test, p > 0.05) or age (Mann-Whi-ney Test, p > 0.05). The patient’s wish to knowdetails about disease and treatment is associatedwith the environment the patient came (Fisher’sExact Test, p = 0.005) and the level of education(Fisher’s Exact Test, p = 0.027). Younger patientsconsider that the diagnosis should be disclosed, theolder patient believe that silence conspiracy shouldbe adopted (Mann-Whiney Test, p = 0.017). Thepaper presents also a phenomenologic analysis ofpatient’s opinions about disclosing the diagnosis.CONCLUSIONS: The majority of the patientswanted to know the truth about their disease con-sidering this fair. 10% didn’t want to learn the diag-nosis, but their doctors have told them withoutasking, infringing their rights. Some families foundout medical details about their ill relative from thedoctors before the patient and without patient’sconsent- a fact that breaks the law, but is accordingto the medical communication custom in our coun-try. The patients consider this humiliating and dim-inuishing their dignity. The patients’ approachand communication manner must be individualisedand adapted to patient’s specific preferences.RESEARCH IMPLICATIONS: There are fewstudies in Romania concerning doctor-patient com-munication and patient’s rights. We propose toextend the study, to interview more patients includ-ing ethnic minorities in order to search for theirpreferences in medical communication and protec-tion of patient’s rights. We also want to include inthe study families to study their preference of inter-ference in doctor-patient relationship and doctorsto study the causes of persisting the paternalisticattitude, contrary to current legislation. CLINI-CAL IMPLICATIONS: As in other ex-communistcountries, many doctors (especially older ones)don’t have communication and ethics knowledge,infringing patient’s rights. The majority of thepatients wanted to know the truth, but their opin-ion could differ. On the basis of this study, therecan be conceived seminars for physicians to furtherthe knowledge and application of patient rights inpractice and informational campaigns for patients

regarding their rights. ACKNOWLEDGEMENTOF FUNDING: None.

P2-16

Prevention Research in the Field of Psychosocial

Oncology: A Golden Opportunity?

Samara Perez1,2, Zeev Rosberger1,2

1McGill University, Montreal, Canada, 2LouiseGranofsky Psychosocial Oncology Program, SegalCancer Center, Jewish General Hospital, Montreal,Canada

BACKGROUND: Over the past 30 years, the fieldof psychosocial oncology has established itself as aspecialized discipline that examines the psychologi-cal, behavioural, and social aspects of cancer. Thefield addresses two dimensions: (1) the emotionalimpact of cancer and its treatment by patients, fam-ilies, and health care professionals, and (2) the psy-chological and behavioural factors that influencethe disease process. Overall, mainstream psychoso-cial oncology research has been limited in address-ing primary & secondary prevention issues.METHOD: The objective was to examine the placeof cancer prevention research in the field of psycho-social oncology. We conducted a content analysisof articles related to cancer prevention published inPsycho-Oncology, the major journal that reflectsthe development of science and practice in psycho-social oncology. We examined the prevalence ofprevention studies in Psycho-Oncology, and thendetermined the specific content areas of these arti-cles. The 20-year lifespan of the journal (1992–2012) permitted a reasonable overview to study thisissue. RESULTS: We identified numerous primaryand secondary prevention strategies related toreduction in cancer incidence or mortality relatedto (1) smoking; (2) Occupational exposures; (3) Airpollution (4) Sun exposure/UV light; (5) alcohol;(6) Exercise; (7) Vaccination against viruses andinfectious agents; (8) Oral contraception reduction;(9) Selective estrogen receptor modulators (SERM);(10) mastectomy/oophorectomy; and (11) screening(e.g., mammography). Using a predetermined selec-tion criteria, we identified if the articles primaryfocus was on interventions, attitudes, knowledgeand beliefs, theoretical analyses or factors associ-ated to any of the aforementioned primary and sec-ondary prevention strategies. CONCLUSIONS:Only 17/1775 (1.2%) articles focused on primaryprevention, while 72/1775 (4.1%) articles focusedon secondary prevention. Thirty-one articlesfocused on specific screening practices, 27 ongenetic testing/counseling and 14 were classified as“other”. The majority of primary prevention arti-cles examined psychosocial factors influencing pre-vention strategies such as decrease or avoidance ofsun exposure. (e.g., High-and average-risk individu-als’ beliefs about, and perceptions of, malignant



melanoma) RESEARCH IMPLICATIONS: Pre-vention does not occupy a predominant placewithin the journal Psycho-Oncology, and by impli-cation, perhaps within the field. At the beginning ofthe new millennium, Holland (2002) restated manyof the remaining questions in psycho-oncologyresearch. But there continued to be major gaps inprimary and secondary prevention, as they relatedto psychosocial issues. CLINICAL IMPLICA-TIONS: The burden of cancer mortality can bereduced through an increased focus on prevention,which offers the most logical/cost-effective long-term strategy for cancer control. Increased atten-tion should focus on other modifiable risk factorssuch as diet, physical activity, exposure to viral/bacterial infections. Greater psychosocial oncologyresearch needs to consider the factors affecting bothprimary/secondary prevention strategies, (e.g. theimportance of testing interventions aimed at alter-ing modifiable risk factors and lifestyle behaviorssuch as HPV vaccine uptake). ACKNOWLEDGE-MENT OF FUNDING: Supported by an operat-ing grant from the Canadian Institutes of HealthResearch to Zeev Rosberger and Fellowship sup-port from the Fonds du Recherches en Sant�e duQu�ebec to Samara Perez.

P2-17

Quality of Life in Indian Breast Cancer Patients

After Breast Conservation Surgery or Modified

Radical Mastectomy

Shehroo Pudumjee, Anupama Mane, Sanjay

Deshmukh, Kamlesh Bokil, Arunima Guha,

S P Sane1Ruby Hall Clinic - Kamalnayan Bajaj CancerCentre, Pune, India

BACKGROUND: The increase in incidence ofbreast cancer has spawned new trends in researchbut the parameter of Quality of Life (QOL) remainsrelatively unexplored in India. With patients con-sidering post treatment QOL as a decisive factorwhen opting for Breast Conservative Surgery (BCS)or Modified Radical Mastectomy (MRM), examin-ing differences between these groups became imper-ative. This study assesses the differences in QOLand its sub categories across Indian patients basedon BCS / MRM status. METHOD: These interimfindings are based on the data collected from 56breast cancer patients who have undergone eitherBCS (N = 26) or MRM (N = 30) with Chemother-apy and Radiation. Patients were assessed using theFunctional Assessment of Cancer Therapy – Breast(FACT - B) Version 4 QOL scale. The assessmentwas conducted 6 months post treatment on womenwho had been treated for Stage I, II or III breastcancer patients. RESULTS: The Mann Whitney –U test showed that the patients who underwent aBCS experienced a significantly better quality of life

overall with a p-value of 0.042 on the FACT – Bassessment. The Trial Outcome Index (TOI) wassignificantly better in the BCS group with a p-valueof 0.026. The Physical Well Being (PWB) and Func-tional Well Being (FWB) subscales showedimproved QOL for BCS patients with p-values of0.020 and 0.016 respectively. There was no differ-ence found across Social Well Being (SWB), Emo-tional Well Being (EWB), the Breast CancerSubscale and across age at diagnosis. CONCLU-SIONS: The study showed that overall QOL wassignificantly better in the case of patients whounderwent BCS as compared to those who under-went MRM. The areas of physical and functionalwell being were significantly better in the BCSgroup. QOL did not vary significantly in the areasof emotional and social well being and did not showany variation with age. RESEARCH IMPLICA-TIONS: This study has the potential to drive QOLresearch to investigate the impact of diagnosis atdifferent stages on QOL in the context of BCS andMRM. It could provide a basis for analysis of anytemporal variation of post treatment QOL lendinggreater insight into patient care. These findings willalso encourage intervention based studies andapproaches which can target the specific difficultiesfaced by patients of BCS and / or MRM. CLINI-CAL IMPLICATIONS: The study lends newground and evidence that has the potential to alterthe decision making process for patients beingoffered a BCS or MRM. Providing credence viaquantifiable proof that a BCS is favourable withregard to QOL will lend impetus to newer tech-niques and innovative methods focused on conser-vation. It would provide a basis for psycho-education and psychotherapy using a more patientcentric approach as opposed to a disease focusedapproach. ACKNOWLEDGEMENT OF FUND-ING: The Ruby Hall Clinic – Kamalnayan BajajCancer Centre, Pune provided the infrastructureand material resources required for the study.

P2-18

Biowave Assay for Distress Interaction Between

Advanced Cancer Patients

Hsu Qiwang1, Liu Junkang2, Xu Weiwei2, Feng

Qinghe3, Jiang Hailing1

1Hsu Qiwang (Beijing) International MedicalAcademy, XingCheng, LiaoNing, China, 2BiowaveResearch Center, the Third Military MedicalUniversity, ChongQing, China, 3The Third Hospitalof HeBei medical University, Shijiazhuang, HeBei,China

BACKGROUND: Psychologic stress affects treat-ment effect for advanced cancer patients. Kendallresearch showed worry and emotional concerns, themost common problems with the DT, BSI, check-list, questionnaires etc. These traditional methods



may be accompanied with the newly experimentaltechnique, Biowave Assay possessing some advan-tages as real-time surveillance for distress. In thispaper we repost experimental data about origin ofpatient distress in order to explore the represents ofworry and emotion variation as interaction betweenpatients. METHOD: We used the experimentalmethod called Biowave Assay can be referred toLDCC test. Determining two patients LDCC asfollow procedures:

1 To collect specimens of 50 microliter periph-eral blood.

2 To separate neutrophil with density gradientcentrifugation.

3 Laying up 51°C for 0, 5, 10, 12, 14, 16, 20,25 minutes respectively.

4 Added to staining solution in 37°C, the time ofstaining reaction based on Set Up a Criteriatest.

5 Microscopy determined and recorded positivecells.

6 Basis statistical analyze on positive rate,obtained the LDCC index as LDCCI.According to the reference range of distress itused to determine the degree.

RESULTS: The 2 advanced cancer patients, Yaoand Zhang received medical service of Biowave insame ward. Yao’s state of illness was more severitythan Zhang’s, even if their LDCCI were in therange of physiology as general condition. Clearlythis represent can be viewed Yao’s LDCCI was sta-ble as the Zhang’s consolation effect. Through theclinical experiment for the consolation, whenZhang left the ward for some days the Yao’sLDCCI would be ascending. Then Yao’s stateappeared exacerbation, when her symptom compa-nied by LDCCI raised the Zhang’s increased soon.Zhang’s LDCCI won’t descend until went backhome for remission. CONCLUSIONS: The newly-developed Biowave Assay test frequently appliedfor evaluation of distress as LDCCI variationreflects the degree. It is regarded as efficient forevaluation of distress, as well as suitable in experi-ment of the cause. The LDCC test we have builtseems appropriate for surveillance of the variationabout advanced cancer patient distress, as exclud-ing pain factors. This newly Biowave Assay testwould be used as experimental supplement for tra-ditions. It includes the Distress Thermometer, aself-administered scale from 0 to 10 to rate. Collect-ing sociodemographic characteristics from patients’clinical files completed the BSI and the PCL duringoutpatient registration. RESEARCH IMPLICA-TIONS: Using the Biowave Assay we made LDCCdebt constraint test. The biowave dominance origi-nated in CNS in brain makes the biowave networkformation throughout the body. Their dynamicstructure shows the ascendant of CNS that reflectsthe reactive sensitivity to environment stimulus invitro or in vivo. So that the higher of the ratio of

the positive the lower sensitivity of CNS. In thecondition the biological activity of CNS appearednot well, vice versa. CLINICAL IMPLICA-TIONS: In the LDCC test of biological abnormalvariation results in the neurobiological experimentbasis for a neuroses and psychoses. That is the diag-nostic standard for the diseases above. The differ-ence between all figures are smaller, it is always inphysiological range calling “tending equally” aspotential distress standards. The other is temporarydistress, as a standard called simple distress. Severeform the highest occurs closely to the maximumregularly and along with the tending equally.ACKNOWLEDGEMENT OF FUNDING: None.

P2-19

Abstract withdrawn

P2-20

Fatigue in Women Treated for Various Forms of

Gynecological Cancers

Ragnhild Johanne Tveit Sekse

Haukeland University Hospital, Department ofObstetrics and Gynecology, Bergen, Norway

BACKGROUND: Fatigue is one of the most com-mon symptoms following treatment for gynecologi-cal cancer. The aim of the study was to examinecancer-related fatigue in women treated for variousforms of gynecological cancer, and to explore possi-ble relationships in fatigued and non-fatiguedaccording to psychological distress (anxiety, depres-sion) and to quality of life. Analysis regarding (dis-ease- and) treatment-related factors was alsoincluded. METHOD: One hundred and thirtywomen treated for gynecological cancers and par-ticipating in a larger intervention study wereincluded. Fatigue, psychological distress, health-related quality of life and demographics wereassessed by self-report questionnaires. Disease- andtreatment characteristics were extracted from medi-cal records. RESULTS: Cancer-related fatigue wasreported in 44% of the women treated for gyneco-logical cancers, with a significant higher proportionin the group of cervix cancer compared to ovarianand uterine cancer. The participants with fatiguereported significant higher levels of anxiety anddepression as compared to the non-fatigued. Therewas no relationship between fatigue and QOLdomains, as measured by SF 36, except the domains“vitality” and “physical role-function.” There weresignificant differences related to age with a higherproportion of fatigued in the younger group. CON-CLUSIONS: The women treated for gynecologicalcancers reported higher cancer-related fatigue thanpreviously reported in this population. Women



reporting fatigue had significantly higher levels ofpsychological distress compared to the non-fati-gued and also according to role function, vitality,age and income. RESEARCH IMPLICATIONS:All women with a diagnosis of gynecological can-cer, should be screened for fatigue and symptommanagement from the time of diagnosis, through-out the treatment trajectories and during aftercare.Both somatic and psychological aspects, must befocused. These findings also reveal a need for goodinterventions related to symptom management andpatient education. CLINICAL IMPLICATIONS:Health personnel should pay more attention to can-cer-related fatigue in their dialogue with patients.Sufficient screening instruments exploring fatigueshould be used routinely in clinical settings. Fur-thermore, in caseness of fatigue, healthcare person-nel should provide education and self-caresuggestions that include the most appropriate inter-vention to alleviate fatigue. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-21

Music as a Therapy for Cancer Patients

Monika Malgorzata Stanczyk

Greater Poland Cancer Centre, Poznan, Poland

BACKGROUND: Music therapy in oncology hasnot a long clinical tradition in Poland. The purposeof this presentation is to show the music therapytechniques in the context of cancer care and to pres-ent the integration of music therapy program intocontinuum supportive cancer care for inpatients ata leading oncology hospital in Poland - the GreaterPoland Cancer Centre in Poznan. METHOD:Music therapy can be a part of the complementarymedicine program in cancer care - it can accom-pany medical treatment. There are many benefits ofmusic therapy for cancer patients. Interactive/active- as well as receptive/passive music therapy tech-niques can be easily introduced into clinical situa-tion. Techniques are selected from a variety ofoptions based on patients’ needs, preferences andmusic therapist’s assessement. They include listen-ing to the live and recorded music, playing theinstruments, relaxation techniques with music,movement with music. RESULTS: Music therapyis an effective form in supporting cancer patientsduring the treatment process. Music therapy can beused to promote relaxation, reduce anxiety andstress, relieve discomfort, reduce patients experi-ence of pain, and offset some of treatment relatedsymptoms. Music therapy offers opportunities forself-espression and brings positive experiences.CONCLUSIONS: Experience of cancer generatesa number of physical, emotional and social andexistential needs. The music therapy program is ap-pled to meet patients needs during diagnosis andtreatment proces, and it can be practiced with both

- individal and patients group. Music can addressmany of them by offering a wide range of benefits -promote wellness, improve physical and emotionalwell-being, to improve the quality of life.RESEARCH IMPLICATIONS: Many studiespresented in the literature indicate that music ther-apy is aplied to relieve symptoms such as anxietyand pain, difficulty in breathing, high level of stress,fear or lonelines. Music therapy in cancer should befocus on the needs of patients arising from theexperience of disease as well as from side effects oftreatment. CLINICAL IMPLICATIONS: Musictherapy may be an effective method of support forcancer patients at various stages of cancer disease.Music therapy interventions may be applied in con-junction with other standard medical treatmentsuch as surgery, chemotherapy and radiation. Awide variety of of music therapy activities can takea place in cancer care settings. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-22

Social Connotations of Prostate-Cancer:

Work in Progress

Johannes Temme1, Andrea Schumacher2

1University of M€unster, M€unster, Germany,2Department Med. A, University Hospital ofM€unster, M€unster, Germany

BACKGROUND: Prostate cancer is the mostcommon cancer of the man, with currently about60,000 new cases per year in Germany. Despite thisfact, little is known about the social connotationsof the disease and about patients’ subjective percep-tions of their illness. Patients’ concepts about aeti-ology, prevention, treatment and prognosis of theircancer as well as their notion of the controllabilityof the disease have decisive impact on the individ-ual’s health behaviour and disease management.METHOD: Patients’ subjective concepts aboutprostate cancer are assessed in this cross-sectionalstudy. 89 prostate-cancer patients of the UniversityHospital M€unster (primary disease or relapse) aged48–80 years (mean = 65, 35; median = 67) wereincluded. The following instruments were used forassessment: Brief Illness Perception Questionnaire(B-IPQ), Hospital Anxiety and Depression Scale(HADS), General Self-Efficacy Scale (SWE), Euro-pean Quality of Life Questionnaire (EQ-5D withEQ-VAS). The study was approved by the EthicsCommittee; all patients gave their informed consentprior to inclusion into the study. RESULTS: Dataof the study will be presented at the meeting. Thesample will be divided into subgroups, comparingthe outcome scores. Associations between thepatients’ subjective perception of disease, anxiety/depression, general self-efficacy and health-relatedquality of life will be assessed by correlation analy-sis (Spearman’s rho), univariate and multivariate



linear regression (see abstract of Anna KatharinaWulfert “Social connotations of breast cancer”).CONCLUSIONS: Medical advances in the treat-ment of prostate cancer have led to prolonged lifeexpectancy but survivors might have to face addi-tional medical and psychosocial problems. Socialconnotations connected with prostate cancer andsubjective theories about the illness affect patients’perception of their disease and can thus indirectlyaffect the coping process. Up till now, social conno-tations of prostate cancer have been insufficientlyresearched. A deeper understanding of the socialconnotations of prostate cancer will provide infor-mation on how to improve care and treatment forthis group of patients. RESEARCH IMPLICA-TIONS: Over the last years a lot of effort was putinto educating cancer patients about their disease.Despite all the efforts, many patients with prostatecancer feel stigmatized by their disease. A deeperunderstanding of the social connotations of pros-tate cancer will help to optimize health educationand preventive measures. This study might providean insight if health education concerning prostatecancer has been successful so far and how it couldbe modified more effectively. CLINICAL IMPLI-CATIONS: The diagnosis prostate cancer is asso-ciated with distinct emotional pressure for thepatient. A better understanding of his subjectiveillness perceptions and the emotional implicationsof the disease may help to improve patient’scompliance, coping strategies and the generaldoctor-patient-relationship in cancer treatment.ACKNOWLEDGEMENT OF FUNDING: None.

P2-23

Barriers to Help-Seeking Amongst Obese Women

With Symptoms of Gynaecological Cancers: A

Healthcare Professionals’ Perspective

Sara Tookey, Michael Larkin, Ruth Howard, Beth

Grunfeld

University of Birmingham, Birmingham, UK

BACKGROUND: Obese women are reported athigher risk of developing some gynaecological can-cers (i.e. endometrial and ovarian) than non-obesewomen. Weight-related barriers contribute to delayin general healthcare utilization; however, specificfactors that contribute to late presentation forgynaecological cancers have not been examined.The aim of this study was to explore healthcareprofessionals’ perspectives of the potential barriers,to prompt help-seeking amongst obese women pre-senting with symptoms of gynaecological cancers.METHOD: Qualitative interviews were under-taken with 15 UK based healthcare professionalsspecialising in gynaecological cancer services(gynaecologists, radiographers, oncologists, psy-chologists and specialist nurses). Semi-structuredinterviews explored healthcare professionals’

perceptions of obese women with symptoms ofgynaecological cancers, barriers to help-seekingamongst these women (including potential weightand ethnicity related barriers) and potential inter-ventions to improve help-seeking behaviouramongst obese women. Interviews were transcribedverbatim and data was analysed using the “frame-work” method. RESULTS: Three main themesemerged as barriers to help-seeking for obesewomen presenting with symptoms of gynaecologi-cal cancers: (a) embarrassment of the examinationprocess, (b) lack of awareness of gynaecologicalcancer symptoms, and (c) sociocultural barriers (i.e.accessibility, language, discomfort in discussingsex-related topics). Community education interven-tions were suggested to build public knowledge ofgynaecological cancer symptoms (e.g. throughmedia broadcast and dissemination of informationin primary care settings) and the importance ofeffective general practitioner patient communica-tion in addressing the increased risks associatedwith obesity and the possible emotional and socio-cultural barriers which may affect help-seeking forgynaecological cancers. CONCLUSIONS: Thisstudy utilized an innovative approach informed byhelp-seeking literature, to explore barriers forwomen who may be at higher risk of presentingwith more advanced stage gynaecological cancersdue to delays in help-seeking. The study highlighteda mix of individual and cultural factors (i.e. emo-tional barriers, symptoms and risk-factor knowl-edge, and sociocultural influences) that mayinfluence help-seeking for symptoms of gynaecolog-ical cancer. Future research should investigate bar-riers to help-seeking from the patient perspective todevelop an informed intervention aimed at improv-ing time to help-seeking for diverse populations.RESEARCH IMPLICATIONS: This research istimely given the current obesity public health con-cern and its association with increased risk, morbid-ity and mortality for some cancers. Althoughreducing levels of obesity is preferable, the currentsituation demands a focus on improving help-seek-ing behaviour amongst obese women to improvesurvival outcomes. This study builds foundationfor larger patient focused research to explore socio-cultural factors in more depth (i.e. across ethnici-ties/cultures) and develop predictors of delay in thispopulation. CLINICAL IMPLICATIONS:Find-ings from this study provide a first step in a plan ofwork to inform the development of a culturally sen-sitive intervention to improve help-seeking amongstobese women. Interventions have been suggestedby healthcare professionals to target communityand primary care settings and will be furtherexplored in future research investigation the patientperspective of help-seeking amongst obese andoverweight women with symptoms of gynaecologi-cal cancers. ACKNOWLEDGEMENT OFFUNDING: None.



P2-24

A Large Cohort Study Evaluating Quality of Life in

Patients With Head and Neck Cancer, is it Feasible?

A.J. van Nieuwenhuizen1, L.M. Buffart2,

R.H. Brakenhoff1, J.H. Smit3, R. Bree1,

C.R. Leemans1, I.M. Verdonck-de Leeuw1,4

1Department of Otolaryngology-Head and NeckSurgery, VU University Medical Center,Amsterdam, Noord-Holland, The Netherlands,2Department of Epidemiology and Biostatistics andthe EMGO Institute for Health and Care Research,VU University Medical Centre, Amsterdam, Noord-Holland, The Netherlands, 3Department ofPsychiatry, Neuroscience Campus Amsterdam andEMGO Institute for Health and Care Research, VUUniversity Medical Centre, Amsterdam, Noord-Holland, The Netherlands, 4Department of ClinicalPsychology, VU University Medical Center,Amsterdam, Noord-Holland, The Netherlands

BACKGROUND: To evaluate the feasibility of acomprehensive baseline assessment of a cohortstudy evaluating the course of quality of life (QoL)and its association with survival, taking intoaccount cancer-related, personal, biological, psy-chobehavioural, and lifestyle-related factors.METHOD: Newly diagnosed head and neck can-cer (HNC) patients were asked to participate.Assessments consisted of questionnaires (635items), home visit (interview, physical tests, bloodand saliva collection), and tissue collection. Feasi-bility was evaluated by representativeness of thestudy sample and achievability of the assessments.Representativeness of the study sample was evalu-ated by comparing demographics, clinical factors,depression, anxiety, and QoL between respondersand non-responders using independent t-tests orChi-Square tests. Achievability was evaluated using4-point Likert scales covering the number of ques-tions, time investment, intimacy and physical bur-den. RESULTS: During the inclusion period(4 months), 15 out of 26 (60%) patients agreed toparticipate. Less women participated, 13% in theresponders group versus 63% in the non-respond-ers group (p = 0.008). Furthermore, no differenceswere found in demographic and clinical characteris-tics, emotional distress and QoL between partici-pants and non-participants. Responders completedmore than 95% of the questionnaires items, andrated the number of questions, time investment andintimacy as feasible, and the physical and psycho-logical burden as low. It took on average 3 hoursto complete the questionnaires and 1.5 hours forthe home visit. CONCLUSIONS: The comprehen-sive baseline assessment in patients with HNC wasconsidered feasible and participation rates weresufficient. The study sample was representative andachievability was high. RESEARCH IMPLICA-TIONS: This study reveals that a comprehensive

assessment including various questionnaires, physi-cal measurements and biological assessments is fea-sible according to patients with newly diagnosedHNC. The research infrastructure as developed inthis feasibility study can be used as a framework forfuture large cohort studies targeting other cancerpopulations. A large prospective cohort study willstart in 2013 aiming to include 739 HNC patientsand their informal caregivers in the Netherlands.CLINICAL IMPLICATIONS: Results of theplanned large cohort study will guide futureresearch to improve treatment and supportive carefor cancer survivors. ACKNOWLEDGEMENTOF FUNDING: None.

P2-25

The Perceived Severity of Chemotherapy Side

Effects: A Comparative Study Between Cancer

Patients and Non-Patients

Sifra Bolle, Julia van Weert

University of Amsterdam/Amsterdam School ofCommunication Research (ASCoR), Amsterdam,The Netherlands

BACKGROUND: Chemotherapy treatment isoften associated with its side effects. As side effectsare seen not only just as physical experiences, butalso as psychological and perceptual experiences,this study aims to gain a better understanding ofthe perceived severity of the side effects and the dif-ferences in perceptions between chemotherapypatients and non-patients (i.e. potential newpatients). Also, based on the Common SenseModel, we tested if pre-existing knowledge is adeterminant of perceived severity. METHOD: Atotal of 2993 respondents completed our online sur-vey. Respondents were (1) (former) cancer patientsthat are or have been treated with chemotherapy(n = 999), (2) non-patients that are or have beenhighly involved with a significant other who hasbeen treated with chemotherapy (n = 823), or (3)non-patients that have never been highly involvedwith a significant other who has been treated withchemotherapy. RESULTS: For 9 out of the fifteenmeasured side effects we found that chemotherapypatients reported a significant lower perceivedseverity than both groups of non-patients wouldexpect. We found this result for the side effects“infection and fever”, “nausea and vomiting”,“constipation and diarrhea”, “hair loss”, “mouthand throat sores”, “nerve and muscle effects”,“bleeding”, “concentration and short term memorychanges”, and “anxiety and depression”. Chemo-therapy knowledge significantly predicted the per-ceived severity of chemotherapy side effects fornon-patients, but we did not find this effect for che-motherapy patients. CONCLUSIONS: The resultthat for most side effects non-patients have a higherperceived severity than chemotherapy patients can



be explained by the Social-Cognitive Transitions ofAdjustment theory, which holds that patients learnto adapt on the basis of changes that are associatedwith the illness and its treatment. Also, we foundevidence for the Common Sense Model: non-patients form their perception on the basis of theirpre-existing knowledge, where chemotherapypatients base their perceptions on their own experi-ence. RESEARCH IMPLICATIONS: Previousresearch shows that the perceived severity of che-motherapy side effects may change in the course ofdecades. This study builds upon these previousstudies by giving insight into the present percep-tions of the side effect of chemotherapy. Further-more, this study gives a theoretical foundation,which was still missing in this area of research.Future studies should consider other possible deter-minants of perceived severity and possible out-comes that can be predicted by perceived severity.CLINICAL IMPLICATIONS: The results of thisstudy can be used to improve provider-patient com-munication. By understanding how patients formperceptions of the side effects of chemotherapy, cli-nicians can give realistic expectations to new che-motherapy patients. Clinicians should tailor theircommunication differently to new and experiencedpatients. Especially for new patients, effective infor-mation provision is very important as new patientshave no previous experience to base their percep-tions on and rely on their knowledge. ACKNOWL-EDGEMENT OF FUNDING: This study iscommissioned by Public eyes and was supportedwith an unrestricted grant from AMGEN and theDutch Cancer Society (KWF).

P2-26

Current Status of Psycho-Oncology Services in

India: A Survey Study

Shameem Varikkodan, Surendran Veeraiah,

Vidhubala Elangovan

Cancer Institute (WIA), Chennai, Tamil Nadu,India

BACKGROUND: In India, every year 1 millionpeople are diagnosed with cancer and the trend isincreasing. There are 26 Regional Cancer Centers(RCC) and more than 300 tertiary cancer treatmentcenters in India. Though psycho-Oncology is anessential service in the oncology team, it remains anisolated field in India. This study aims to under-stand the current status of Psycho-oncological ser-vices in India. METHOD: Survey method wasadopted for the study. Through an online search,RCCs (26) in India were identified. All the RCCswere contacted over telephone and they werebriefed about the study. Among the twenty sixRCCs sixteen RCCs consented to provide informa-tion as requested by the researcher. A telephonicinterview was carried out by using a semi-struc-

tured interview schedule. The interview focused onthe availability and accessibility of psycho - oncol-ogy services, referral systems and support groups.The responses were documented and analyzed usingdescriptive statistics. RESULTS: Of the RCCsinterviewed 43% (7) reported having Psycho-oncol-ogy services whereas 56% (9) do not have such ser-vices. Psychiatrist (1), Psychologist (7), SocialWorkers (2) and volunteers (1) are offering Psycho-oncology services. While 18% of the RCCs referpatients to other hospitals, 54% refer them to psy-chiatric departments of the same hospital. Serviceproviders reported that more than half of the can-cer patients experience moderate to severe psycho-logical distress. Of the RCCs interviewed only 38%have support group and 50% do not have any sup-port group. CONCLUSIONS: More than half ofRCCs in India do not have any form of Psycho-oncology Services. Psychiatrist, Psychologist, andSocial Workers are providing such services to cancerpatients. The number of professionals available in theRCCs is not adequate to meet the psychosocial needsof cancer patients. The Psychological burden of can-cer is huge as reported by service providers. Half ofthe RCCs in India do not have any support groupsfor patients and family members. RESEARCHIMPLICATIONS: Further research can explorethe psychological or Psycho-oncological services inother tertiary level cancer treatment centers or hos-pitals. Research in the quality of psychological inter-ventions rendered in these RCCs and other tertiarycancer treatment centers also need to be undertaken.The oncologist perspective about the need for Psy-cho-oncological services can also be explored.CLINICAL IMPLICATIONS: There is a clearneed for more professionally trained Psycho-Oncolo-gists who can identify and address the Psycho-Socialproblems experienced by the Cancer Patients andtheir family members during their cancer journey.ACKNOWLEDGEMENT OF FUNDING: None.

P2-27

Living With Untreated Prostate Cancer: A

Longitudinal Study on the Impact of Active

Surveillance on Anxiety and Distress Levels

Lionne DF Venderbos1,2, Roderick CN van den

Bergh1, Monique J Roobol1, Fritz H. Schr€oder1,Marie-Louise Essink-Bot2,3, Chris H Bangma1,

Ewout W Steyerberg2, Ida J Korfage2

1Erasmus University Medical Center, Department ofUrology, Rotterdam, The Netherlands, 2ErasmusUniversity Medical Center, Department of PublicHealth, Rotterdam, The Netherlands, 3AcademicMedical Center, Department of Public Health,Amsterdam, The Netherlands

BACKGROUND: Patients with potentially indo-lent prostate cancer (PC) can be managed with



active surveillance (AS) in the Prostate cancerResearch International: Active Surveillance study(PRIAS). The goal of our study was to analyze anx-iety and distress in men living with “untreated” PCwhile being on AS. METHOD: Prospective, longi-tudinal cohort study including 129 Dutch patientson AS. Treatment was chosen in discussion bypatient and physician. Participants completed ques-tionnaires with validated measures on anxiety anddistress at inclusion (t = 0), 9 and 18 months afterdiagnosis (t = 9 and t = 18, respectively). Changesin scores on depression (CES-D), generic anxiety(STAI-6), PC specific anxiety (MAX-PC), self-esti-mated risk of progression and decisional conflict(DCS) about patients treatment choice wereassessed between t = 0, t = 9 and t = 18 usingrepeated measures analysis (SAS). Changes inphysical health (SF-12 PCS) between t = 0 andt = 18 were assessed using a paired t-test.RESULTS: Nine patients (9/129) between t = 0and t = 9, and 33 patients (33/108) between t = 9and t = 18 stopped AS; 86% on protocol basis.Response rates for patients still on AS at t = 0,t = 9 and t = 18 questionnaire were 86%, 90% and96%, respectively. CES-D, total MAX-PC, self esti-mated risk of progression and DCS scores did notchange significantly (p > 0.05) when comparingt = 18, t = 9 and t = 0 scores, but generic anxiety(STAI-6) (p = 0.033) and fear of disease progres-sion (sub-score of the MAX-PC) (p = 0.007) diddecrease significantly. Men who switched to activetreatment were not invited to fill-out quality-of-lifequestionnaires after they received treatment. CON-CLUSIONS: After 18 months on AS, average lev-els of anxiety and distress remained favourably lowfor men who remained on AS; generic anxiety andfear of disease progression decreased. RESEARCHIMPLICATIONS: Our study was one of the firstinitiatives to assess anxiety and distress among ASparticipants during a period with 18 months of fol-low-up. Our results need to be validated by futureresearch. Furthermore, we recommend the compar-ison of our outcomes on quality-of-life of AS par-ticipants to outcomes of alternative treatmentoptions for low risk PC. CLINICAL IMPLICA-TIONS: Urologists should take into account whendiscussing treatment options with patients thepotential psychological discomfort men may experi-ence from living with “untreated” prostate cancer.Our study has shown positive results, however, thatmay not be the case for all men choosing AS.ACKNOWLEDGEMENT OF FUNDING: Pros-tate Cancer Research Foundation (SWOP), Rotter-dam, The Netherlands.

P2-28

Understanding Health and Health Behaviors Among

People who are Confronted With Cancer

Ewa Wojtyna1, Agnieszka Wiszniewicz2,

Malgorzata Bereza3, Katarzyna Marek1, Anna

Syska-Bielak4, Jolanta Grabowska-Markowska2,

Agata Basek2

1University of Silesia, Katowice, Poland, 2HospicyCordis, Katowice, Poland, 3The IskierkaFoundation, Warszawa, Poland, 4MariaCurie-Sklodowska Memorial, Cancer Center andInstitute of Oncology, Gliwice, Poland

BACKGROUND: The mentality of modern man(mentality of the right thumb) is based on rational-ism, individualism and hedonism. It follows thatthe pursuit of clear purposes: fast, easy and oftenenjoyable. Meanwhile, the disease is not part of thisspecification. In addition, distress associated withthe situation of the cancer makes that the imple-mentation of health behavior becomes difficult andambiguous. METHOD: The aim of the study wasto determine the relationship between the under-standing of health, distress, and health behaviorsamong people confronting the cancer. The studyincluded 50 cancer survivors, 50 family members ofcancer patients and 50 of people who belong to thepersonnel working in oncology and palliative medi-cine wards. There used 4 questionnaires: Under-standing Health Questionnaire, The DistressThermometer, HADS and Health BehaviorsQuestionnaire. RESULTS: The study has shownsignificant relationships between subjective under-standing of health and distress, and the implemen-tation of health behaviors. People with a severetendency to select the purpose of easy, clear andquick exhibited higher levels of distress and anxiety,and less likely to take health behaviors. CONCLU-SIONS: The mentality of the right thumb (fast,clear, easily) in a situation of confrontation withcancer leads to making temporary behaviors aimedat reducing emergency stress. This means a greatertendency to engage in non-healthy behavior (forexample: smoking, overeating) and less frequentengagement in health behaviors. RESEARCHIMPLICATIONS: It is important to take furtherlongitudinal studies on different health behaviormodels with regard to the mentality. CLINICALIMPLICATIONS: During the clinical practicefocused on lifestyle changes, pay attention to thegoals that are associated with the satisfaction ofhedonistic needs and assimilation methods of deal-ing with distress. Also important is implementationof new health behaviors in a simple and unambigu-ous way (for example by action in different stages).ACKNOWLEDGEMENT OF FUNDING: None.



P2-29

Social Connotations of Breast Cancer-Work in

Progress

Anna Katharina Wulfert1, Andrea Schumacher2

1University of M€unster, M€unster, Germany, 2Dept.Med. A, Hematology/Oncology, University Hospitalof M€unster, M€unster, Germany

BACKGROUND: A high number of tumourpatients experience their disease as stigmatizing.Social connotations and subjective theories aboutthe illness affect patients’ perception of their diseaseand can thus indirectly affect the coping process.The study assessed in a sample of breast cancerpatients, social connotations about the disease aswell as anxiety, distress and self-perceived personalcontrol over the illness. METHOD: 94 breast can-cer (primary or secondary disease) patients tookpart in the cross-sectional study at the UniversityHospital M€unster, Germany. The age range was32–86 years (mean: 53; median: 52.5). The follow-ing instruments were used for assessment: BriefIllness Perception Questionnaire (B-IPQ), HospitalAnxiety and Depression Scale (HADS), generalself-efficacy scale (SWE), European Quality of LifeQuestionnaire (EQ-5D with EQ-VAS). The extentof disease control was measured by the item 3 ofthe Brief-IPQ. The study was approved by theEthics Committee; all patients gave their informedconsent prior to inclusion into the study.RESULTS: Patients’ perceived controllability oftheir disease has significant influence on the out-come-sores. Patients with perceived disease control(n = 23) scored lower in the B-IPQ (p = 0.001) andthe HADS-anxiety-scale (p = 0.043) compared topatients without disease control (n = 70). Partici-pants with perceived disease control scored higherin the EQ-5D (p = 0.010) and the EQ-VAS(p = 0.033) than participants without perceived dis-ease control. Univariate linear regression analysisconfirms the effect of perceived disease control onthe B-IPQ outcome-scores (B = 10.86, p = 0.001),EQ-5D (exp.B = 0.89, p = 0.016) and EQ-VAS(exp.B = 0.78, p = 0.025). CONCLUSIONS: Med-ical advances in cancer therapy lead to prolongedlife expectancy, but might also cause additionalmedical and psychosocial problems. Understandingsocial connotations of cancer may offer newapproaches to improve patient‘s quality of life andcoping. Until now, social connotations of breastcancer have been insufficiently researched. The firstanalysis of our data shows that self-perceived con-trol over the disease has high impact on patients’dis-ease–management and their subjective quality oflife. RESEARCH IMPLICATIONS: The resultsof our study show breast cancer patients with per-ceived personal control over their disease have abetter quality of life and a better state of health.These findings can help to optimize health

education and prevention for this group of patients.The study can also provide information about theeffectiveness of health education in breast cancerpatients in the past and how it could be modifiedmore effectively in the future. CLINICAL IMPLI-CATIONS: Patients with carcinoma are exposedto a lot of psychological strain during their illness.This psychological strain is often underestimated.A better understanding of the subjective illness per-ceptions and the emotional implications of the dis-ease may help to improve patients’ compliance,coping strategies and the general doctor-patient-relationship in cancer treatment. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-30

Oncologists’ Recognition of Depressive Symptoms in

Advanced Cancer Patients: What Symptoms do they

Accurately Detect and How?

Lucie Gouveia1, Sophie Lelorain2, Anne Br�edart3,Sylvie Dolbeault3, Serge Sultan1,4, Willow Burns1,4

1Universit�e de Montr�eal, Montr�eal, Qu�ebec,Canada, 2Universit�e Paris Descartes, Paris, France,3Insitut Curie, Paris, France, 4Centre HospitalierUniversitaire Sainte-Justine, Montr�eal, Qu�ebec,Canada

BACKGROUND: Research suggests that oncolo-gists may be inaccurate in their ability to recognizedistress in cancer patients and that depression oftengoes undetected. The aim of this study was toexamine oncologist-patient agreement on specificdepressive symptoms, and to identify potential pre-dictors of this accuracy. These included sadness,pessimism, sense of failure, dissatisfaction, guilt,self-dislike, suicidal ideation, and holding a nega-tive body image. METHOD: 201 adult advancedcancer patients self-reported depressive symptomswith an 8-item version of the BDI which has beenvalidated for use amongst the somatically ill. Theironcologists (n = 28) answered the same question-naire in a perspective-taking task. RESULTS:Intra-class correlations for individual BDI-8 itemsvaried around a median of 0.30 (Min–Max = 0.14–0.52). Sensitivity varied around a median of 41.6%(Min–Max = 20.6–73.5%) and was highest pessi-mism, negative body image, and sadness, whilespecificity varied around a median of 71.5% (Min–Max = 40.0–94.6%) and was highest for suicidalideation, self-dislike, and guilt. When controllingfor prevalence, detection was most accurate for sad-ness, pessimism, guilt and suicidal ideation. Linearregression analyses identified similarity in gender,physician compassion, and quality of the patient-physician relationship as predictors of accuracy onvarious symptoms. Additional analyses concerningthe recognition of symptoms are discussed. CON-CLUSIONS: The findings suggest that oncologistshave difficulty discriminating between patients who



experience depressive symptoms and those who donot. This is especially true for symptoms that areless visible. Moreover, relational variables may playan especially important role as facilitators ofpatient-physician agreement on less visible symp-toms. RESEARCH IMPLICATIONS: Future lon-gitudinal or experimental research is needed tobetter understand the skills that allow for accuratedetection. CLINICAL IMPLICATIONS: Consid-ering that oncologists are an important source ofreferral to psychosocial services, additional trainingis needed. This could focus on key depressive symp-toms in this population and on the development ofrapport with patients. ACKNOWLEDGEMENTOF FUNDING: Institut National du Cancer SHSSPE 2010 (France); Fondation du CHU Sainte-Jus-tine (Montreal, Canada).

P2-31

Medical End-of-Life Decisions at the University

Hospital of Brussels (UZ Brussel, Belgium)

Willem Distelmans, Sabien Bauwens, Catherine

Baillon, Eveline Clemmen, Vicky Van de Velde,

Annelien Tack

Vrije Universiteit Brussel, Brussels, Belgium

BACKGROUND: This descriptive researchexplored which medical end-of-life decisions weretaken in every event of death at UZ Brussel (Bel-gium). The incidence of medical end-of-life deci-sions, the characteristics of this decision process,the characteristics of the doctors involved in thisprocess and the patient demographics were pros-pected. This research was carried out in the specificcontext of a university hospital. The sample wasdrawn between 1 September 2011 and 30 November2011. METHOD: Using the death certificatemethod, the doctor (participant) whose patient wasdeceased was traced. Participants were asked tocooperate by reporting the end-of-life decisionsthey made, with their patient, through a standard-ized face-to-face post-mortem questionnaire. Inclu-sion criteria were that a patient had died at UZBrussel and that the doctor knew the patient beforedying. Exclusion criteria were that the doctor whosigned the death certificate simply took note of thedeath or the interview couldn’t take place within14 days after a patient’s death and cases of perina-tal death. The Ethical Review Boards of UZ Brusselgranted permission. RESULTS: Medical end-of-life decisions were common practice (92.3%) butmost of the time this was without explicit request/knowledge of the patient. In most of the cases onlyfamily of the patient was consulted. Penultimateend-of-life decisions were in 51.9% of the casesdecisions that concerned withholding or withdraw-ing potentially life-prolonging treatment. Last end-of-life decisions were rather decisions of adaptingor alleviating pain by using opioids (48.1%). Cases

of euthanasia were more frequent compared withgeneral numbers of the Belgium population. It wasalso more common to take medical end-of-life deci-sions in cancer patients. Doctor-doctor consulta-tion was the most common interdisciplinarycommunication. CONCLUSIONS: These findingsconclude that the process of medical end-of-lifedecisions is a difficult task that requires attention.Timely and realistic communication with patients,their family and a multidisciplinary team were acrucial element in end-of-life care. RESEARCHIMPLICATIONS: Follow-up studies are usefuland necessary to compare these results with otherhospital contexts (and hospital cultures). Furtherqualitative research can be important to explorepotential needs and perceptions of doctors, patientsand relatives in end-of-life situations. Howeverpractical, ethical, deontological and methodologicaldifficulties may complicate this research. CLINI-CAL IMPLICATIONS: Medical end-of-life deci-sions are common practice, but communicationwith patients, family and colleagues about thistopic is not so simple and can elevate emotionalpressure. In the future an increase in importance ofmedical end-of-life decisions due to different socialevolutions can be expected. Training in communi-cation with patients, family and other care takerswill be a point of interest for doctors who opt forqualitative end-of-life care. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-32

Psychological Distress and Quality of Life of Cancer

Patients and Their Caring Relatives

Heide Götze, Norbert K€ohler

University of Leipzig, Department of MedicalPsychology and Medical Sociology, Leipzig,Germany

BACKGROUND: While an increasing number ofpalliative cancer patients receives home care withfamily caregivers providing a high level of care andsupport, there is little psychological support forboth patients and family caregivers. One reason forthis shortcoming is the lack of knowledge about thelevel of psychological distress and quality of life inpalliative patients and their family caregivers.METHOD: In order to assess psychological dis-tress and quality of life, interviews were conductedwith palliative cancer patients and their family care-givers. Quality of life was assessed using the EO-RTC QLQ-C15-PAL (cancer patients) and the SF-8 questionnaire (family care givers). The level ofpsychological distress was evaluated using the Hos-pital Anxiety and Depression Scale (HADS) andthe extent of social support with the Oslo SocialSupport scale (OSS). RESULTS: 120 palliativepatients (42.5% female, age: M = 69 years) and106 family caregivers (67.9% female, age:



M = 64 years) answered the questionnaire. 75% ofcaregivers were the partner of the patient. One infour patients showed high level of anxiety and everysecond patient had high level of depression. Themain symptoms were fatigue, loss of appetite,shortness of breath and pain. 33% of family care-givers had high level of anxiety and 28% had highlevel of depression. Caring partners had higher psy-chological distress and poorer quality of life thanother caregivers, high financial burden and dissatis-faction with partnership had also a significantimpact. CONCLUSIONS: Family caregivers man-age multiple care giving demands while facing theemotional task of preparing for the loss of theirloved one. They are highly psychologically distressedand show a reduced quality of life. However, there isno professional outpatient psychological supportoffered to these people. RESEARCH IMPLICA-TIONS: Research findings about the level of anxi-ety and depression in palliative cancer patients andfamily care givers are rather inconsistent. Further-more, there is a lack of knowledge regarding poten-tially moderating effects of socio-demographicfactors on psychological distress and quality of life.Future research should, therefore, assess the impactof such factors (gender, age etc.) in order to adaptprofessional support to the needs of family caregiv-ers. CLINICAL IMPLICATIONS: Outpatientpalliative care should also provide professional psy-chotherapeutic and psychological support. Theneed for psychological support is highest in caringpartners and caregivers with problematic relation-ship with the patient. ACKNOWLEDGEMENTOF FUNDING: This study was supported by theGerman Cancer Aid (“Deutsche Krebshilfe e. V.”,grant number 109309).

P2-33

Early Palliative Care for Improving Quality of Life

and Survival Time in Adult Patients With Advanced

Cancer: Protocol of a Cochrane Review

Markus Haun1, Sabine Sommerfeldt1, Gerta

R€ucker2, Hans-Christoph Friederich3, Michael

Thomas4, Mechthild Hartmann1

1Department of General Internal Medicine &Psychsomatics, Heidelberg University Hospital,Heidelberg, Germany, 2German Cochrane Centre,Institute of Medical Biometry and MedicalInformatics, University Medical Center Freiburg,Freiburg, Germany, 3Division of Psycho-Oncology atthe National Center of Tumor Diseases, HeidelbergUniversity Hospital, Heidelberg, Germany,4Department of Thoracic Oncology, Thoraxklinik atHeidelberg University Hospital, Heidelberg,Germany

BACKGROUND: Early palliative care hasreached high international attention since the semi-nal work of Temel (2010). She showed in lung

cancer patients that starting with palliative care(PC) already at the time a person is diagnosed withmetastatic cancer, can be favourable to improvequality of life and survival. As a consequence, fur-ther trials on early PC in different cancer groupshave been initiated recently. However, currentlythere exists now systematic quantitative overviewof these trials. METHOD: We will conduct a sys-tematic review within the Cochrane Pain, Palliativeand Supportive Care (PaPaS) Review Group. Thegoal of the review is to assess and summarize allrandomized controlled trials and controlled trialson early PC. All types of PC will be included, ifinterventions were aiming at at least two compo-nents of quality of life (e. g. bodily symptoms anddepression). Interventions evaluating the impact ofonly one component of PC (e.g. medication on painor psychological interventions) will be excluded.Outcomes of interest are quality of life, symptomintensity, distress, and survival time. RESULTS:After title registration with the Cochrane Collabo-ration two reviewers independently drafted a highlysensitive search strategy in close cooperation withthe group’s Trial Search Coordinator. The consecu-tive search in MEDLINE yielded 5.244 potentiallyrelevant records. Our database search is still on-going with EMBASE, PsycINFO, Cochrane Cen-tral Register of Controlled Trials, CINAHL,LILACS, SIGLE, and clinical trial registries beingsearched for completion. So far, we have foundeight randomized controlled trials meeting inclu-sion criteria. Final results will be presented in theupcoming Cochrane Review. CONCLUSIONS:Early PC has been increasingly subject to efficacyresearch with quality of life being the most impor-tant primary outcome. Several primary studies nowallow for compilation and integration within ameta-analysis. The Cochrane Collaboration hasendorsed early PC to be an important clinical issueand will further support our work to prepare areview based on the highest levels of quality.RESEARCH IMPLICATIONS: Besides results onefficacy of early palliative care the systematicreview will also provide information on methodo-logical quality of trials (risk of bias) and researchdeficits. This can be used to set standards for fur-ther studies on this topic and to highlight areas inneed for future research. CLINICAL IMPLICA-TIONS: The aim of this Cochrane review is tosummarize all trials on early PC and help people tounderstand the evidence. The results will guide peo-ple (clinicians as well as patients) to make practicaldecisions about using early palliative care in cancer.As a Cochrane review the evidence will be regularlyupdated. ACKNOWLEDGEMENT OF FUND-ING: None.



P2-34

Using Ritalin & Ketamine in Depressed Cancer

Patients

Jamal Khatib

King Hussein Cancer Center-KHCC, Amman,Jordan

BACKGROUND: Advanced cancer is a depress-ing life limiting situation, depression in turn worsenor even destroys the quality of already limited life.Since almost all antidepressants take no <3 weeksto act, finding rapid acting antidepressants is of cru-cial importance. The aim of this review is to lookinto randomized controlled trials that used Keta-mine and Ritalin in treating depression to draw aconclusion/evidence. METHOD: Two separate ret-rospective pubMed searches using A-Ritalin-Keta-mine together with the words depression weredone. The retrieved publications were filtered by“Randomized Controlled Trials” for Ketamine andRitalin. Randomized clinical trials that looked intothe antidepressant effect of Ketamine and Ritalinwere identified and separated, then analyzed.RESULTS: Filtered by “clinical tails” search,retrieved 100 clinical trial for Ritalin, and 107 forKetamine. Most of the trial showed significant anti-depressant effet within 4 hours–1 day. CONCLU-SIONS: Both Ritalin and Ketamine are safe andeffective “Antidepressants” with rapid onset ofaction, however there are controversies about dura-tion of improvement. RESEARCH IMPLICA-TIONS: A randomized clinical trial comparingmethylphenidate and Ketamine for depression incancer inpatients King Hussein Cancer Center hasbeen processed. CLINICAL IMPLICATIONS:Using Ketamine and /or Ritalin as antidepressantis Justified in certain groups of patients especiallysuicidal, and patients with limited time and termi-nal cancer or other end of life situations, howeverlong term use needs further evaluation.ACKNOWLEDGEMENT OF FUNDING: None.

P2-35

Current-Situation Survey Regarding the Way of

Presenting Information for End-Of-Life Care in

Japan After Enactment of Basic Anticancer Law

Mika Kobayashi1, Kanako Ichikura2, Ayako

Matsuda3, Wataru Noguchi4, Toshiko Matsushita5,

Eisuke Matsushima2

1Toho University, Tokyo, Japan, 2Graduate Schoolof Tokyo Medical and Dental University, Tokyo,Japan, 3National Cancer Center, Tokyo, Japan,4Graduate School of Keio University, Kanagawa,Japan, 5Yokohama City University, Kanagawa,Japan

BACKGROUND: In Japan, a Basic AnticancerLaw was legislated in 2007, and The Ministry of

Health, Labor and Welfare then released the Anti-cancer Measure Promotion Plan based on this law.The plan advocates the improvement of physicians’communication skills, as they require special sensi-tivity for patients in disclosing unfavorable diagno-ses and prognoses to them. The aim of this studywas to survey the current situation of the way ofpresenting information for end-of-life care inJapan. METHOD: A mail survey was conductedin 5376 hospitals of 8843 hospitals throughoutJapan, where cancer patients at the end of life likelyto get inpatient or outpatient treatments. The ques-tionnaire consisted of 7 major categories. Theresults were compared with data from a previoussurvey conducted in 4911 hospitals in 2006, beforethe Basic Anticancer Law. In this report, questionswere focused on confirmations of treatment coursesamong patients in end-of-life care. The bioethicsresearch center at Tokyo Medical and Dental Uni-versity formally stated that the present study couldbe conducted without official approval of the ethicscommittee. RESULTS: The response rate was22.8% compared to 30.5% in the previous survey.The cancer diagnosis disclosure rate was73.5 � 29.0%, confirmation of changing therapeu-tic measures from curative to only palliative treat-ment was 68.6 � 32.3%, confirming requests oflife-prolonging treatment was 60.2 � 35.9%, anddisclosure of life expectancy was 32.5 � 28.0%.Regarding confirmation of treatment courses atend-of-life care, results of the two studies were com-pared. The rates of “confirming wills of patientsand their family members” increased from 48.6%to 60.9% (p < 0.0001). The rates of “discussing thesituation with patients’ families first, and confirm-ing the will of families” decreased from 45.0% to34.5% (p < 0.0001). CONCLUSIONS: Cancer isthe leading cause of death among Japanese, andmore than 300,000 people die from cancer everyyear. To improve the current situation, the BasicAnticancer Law was enacted in 2007. The resultsshowed that the rate of disclosing unfavorable diag-noses and prognoses to patients themselvesdecreased with the increasing seriousness of theclinical situation. However, with the enactment ofthe Basic Anticancer Law, autonomy of thepatients themselves has become more respected,although the will of family members still exerts agreat influence on clinical decision-making inJapan. RESEARCH IMPLICATIONS: The pres-ent nationwide study was significant for revealingthe current situation regarding the way of present-ing information for end-of-life care. More analysesand further studies are expected to increase ourunderstanding of the details of area differences.After the enactment of Basic Anticancer Law, theJapanese Psycho-Oncology Society has activelyorganized communication skill workshops for phy-sicians in cancer practice. More individualized stud-ies would be helpful for determining more specific



issues during daily clinical practice. CLINICALIMPLICATIONS: The autonomy of patients hadbecome more respected, as was entrusting the willof family members in the process of decision-mak-ing for end-of-life care. In the Japanese culturalcontext, families’ preferences are respected as wellas patients’ own thoughts. Then, there are highexpectations for physicians to have communicationskills with the actual Japanese circumstances. Fur-ther strengthening and deepening of educationalactivity are needed to support physicians’ clinicalpractice centered in designated cancer care hospi-tals. ACKNOWLEDGEMENT OF FUNDING:None for the study conducted in the present study.Regarding the previous survey in 2006 was sup-ported by Health Labour Sciences Research Grant.

P2-36

Cognitive-Behavioral Therapy for Depression and

Anxiety in Advanced Cancer: A Literature Review

Edgar Landa-Ram�ırez1, Ang�elica Rivero-Rosas1,

Georgina C�ardenas-L�opez1, Joseph Andrew

Greer2, Sof�ıa S�anchez-Roman3, Andy Field4

1Faculty of Psychology, National University ofMexico (UNAM), Mexico City, Mexico,2Department of Psychiatry Massachusetts GeneralHospital & Harvard Medical School, BostonMassachusetts, USA, 3National Institute ofNutrition and Medical Science “Salvador Zubir�an”,Mexico City, Mexico, 4School of Psychology,University of Sussex, Sussex, UK

BACKGROUND: Anxiety and depression are themost prevalent emotional problems in patients withadvanced cancer. Both have been associated withthe exacerbation of physical symptoms in this pop-ulation. It is still unclear the effect of cognitive-behavioral therapy on anxiety and depression inadvanced cancer. The aim of this work is conduct aliterature review for identifying and describing theeffectiveness of CBT on depressive and anxiouspatients with advanced cancer. METHOD: ThePICO system was used to identify the main ele-ments of the research question. The search was con-ducted using: Cochrane Central; Pubmed;PsycInfo, and Redalyc. Synonyms of CBT, anxiety,depression and advanced cancer were found bycrossing 3 terms together with the Boolean com-mand “AND”. The review was conducted both inEnglish and Spanish. This review included experi-mental studies (randomized controlled trials, pureexperiments; quasi-experimental studies; N = 1designs) and clinical case designs. Adults of18 years of age or older with a diagnosis ofadvanced cancer, and experiencing anxiety ordepression were included. All patients had toundergo a CBT. RESULTS: From 882 papers only12 studies met the inclusion criteria. Depression

was evaluated as the primary or secondary end-point in 10 out of 12 articles comprised in thisreview Of the 10 studies, 7 reported a decrease onthe depression scores between pre- and post-evalua-tion, but only 4 studies deemed those changes asstatistically significant. Anxiety was evaluated asthe primary or secondary endpoint in the 12 studiescomprised in this review. Of the 12 studies, 9reported that there was decrease on the anxietyscores between pre- and post-evaluation; six studieswere statistically significant. CONCLUSIONS: Itcan be assumed that the CBT has had positiveeffects for treating both problems when present in amild or moderate range. Anxiety reported bettereffects than depression; however, these effectsappear to remain only on the post assessment andnot in the follows-ups. It should be noted that in 2studies patients in the waist list control groupdecreased their depression or anxiety scores - with-out any intervention - which can indicate a possibleregression to the mean. Therefore, the decrease inthe scores should be carefully interpreted in thosestudies that have no comparison group.RESEARCH IMPLICATIONS: We need moreCBT research with Randomized Control Trials inorder to assess the overall effect of this therapy inanxiety and depression in patients with advancedcancer. Also we need to develop new techniques fortreating depression in this population. CLINICALIMPLICATIONS: Cognitive behavioral therapy isan option for treating anxiety in patients withadvanced cancer. Cognitive restructuring of realand unreal thoughts different kinds of relaxationand patient’s education are very useful techniques.ACKNOWLEDGEMENT OF FUNDING: None.

P2-37

Anxiety and Depression are Related to Physical

Symptoms Burden in Mexican Patients With

Terminal Cancer

Edgar Landa-Ramırez1, Ivonne Nalliely

P�erez-S�anchez1, Sof�ıa S�anchez-Rom�an2,Alfredo Covarrubias-G�omez2

1Faculty of Psychology-National University ofMexico (UNAM), Mexico City, Mexico, 2NationalInstitute of Nutrition and Medical Science “SalvadorZubir�an”, Mexico City, Mexico

BACKGROUND: Anxiety and depression are themost prevalent emotional problems in patients withterminal cancer. Both have been associated with thepresence and intensity of physical symptoms suchas fatigue, pain and anorexia. It is still unclear theassociation of anxiety/ depression mood and physi-cal symptoms burden in Mexican patients. The aimof this research was assess the relationship amonganxiety, depression and the presence and intensityof physical symptoms burden in patients with



terminal cancer. METHOD: We carried out across-sectional analysis in patients who came forthe first time to palliative care consultation. Weused the Mexican adaptation of Edmonton Symp-tom Assess System (ESAS) and Hospital Anxietyand Depression Scale (HADS). 96 patients with ter-minal cancer participated in this study. Chi Squarewas used to assess the relationship between the vari-ables anxiety, depression and physical symptoms.We also applied the Spearman’s rho correlationcoefficient for variables anxiety, depression andintensity of physical symptoms. We used a signifi-cance level of p < 0.05. RESULTS: We found alow but statistically significant relationship amongdepression and the presence of pain v² = 4.704,p < 0.03; anxiety v² = 4.144, p < 0.04; nauseav² = 6.748, p < 0.009; and anorexia v² = 10.210,p < 0.001. Depression and intensity of pain: rs=.331,p<0.01; weakness rs =.407, p<.001; anxiety rs =.375,p<0.003; nausea rs =.402, p<0.002; mouth problemsrs =.333, p<0.01; insomnia rs =.257, p<0.04; andanorexia rs =.388, p<0.002. Anxiety was statisticallysignificant related with anorexia v²=5.603, p<.01 andanxiety v²= 5.968, p<.01. Anxiety and intensity ofpain rs=.310, p<0.01; depression rs = 0.309,p < 0.01; anxiety rs = 0.487, p < 0.001: nausears = 0.282, p < 0.03; and anorexia rs = 0.318. CON-CLUSIONS: According to the data obtained it canbe assumed that anxiety and depression are relatedto presence and intensity of physical symptoms bur-den in Mexican patients with terminal cancer. Thephysical symptoms reported by Mexican patientswere similar than those reported in other interna-tional research: pain, insomnia and anorexia. Giventhe design used in this research we cannot talkabout causality in the information obtained.RESEARCH IMPLICATIONS: We can improvepsychological research for treating anxiety anddepression and assess the effect in the control ofsymptoms in patients with terminal cancer. CLINI-CAL IMPLICATIONS: For a successful controlof physical symptoms in palliative field it is neces-sary to assess whether the patient is anxious ordepressed. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-38

Change of Uncertainty and Related Factors in

Patients with Advanced Lung Cancer - A 12 Month

Longitudinal Follow-Up Study

Yu-Chien Liao1, Yeur-Hur Lai2, Yun-Hsiang Lee2,

Wei-Yu Liao2, Pan-Chyr Yang2, Chong-Jen Yu2

1Yuanpei University, Hsinchu, Taiwan, 2NationalTaiwan University, Taipei, Taiwan

BACKGROUND: Novel anticancer agents effec-tively prolong the length of survival for advancedlung cancer patients, but the 5-year survival rateremains at 13–16%. Thus, lung cancer patients live

with continual uncertainty that jeopardizes theirquality of life. The purpose of this study was toexamine changes in the level of uncertainty and itsrelated factors during the 12-month period follow-ing a new diagnosis of advanced lung cancer.METHOD: For this longitudinal study werecruited advanced lung cancer patients from aleading medical center in Northern Taiwan.Patients were assessed for their levels of uncer-tainty, symptoms, and depression before treatment,and at 1, 3, 6, and 12 months after treatment initia-tion by using the Mishel uncertainty in illness scale,the symptom scales of the EORTC QLQ C30, andthe depression scale of the hospital anxiety anddepression scale. We used generalized estimatingequations models to examine the change of uncer-tainty and its related factors. The inverse probabil-ity weighting method was employed to manage thenon-ignorable missing data. RESULTS: Of the 129patients who were recruited, 75 completed the 5assessments. The patients reported the highestuncertainty level before treatment and remained atsteady levels from treatment initiation to 6 monthssince treatment. The level of uncertainty significantlydecreased at 1 year. Patients who perceived moreuncertainty and a better Karnofsky performancescale score at the pretreatment stage had greateruncertainty during the follow-up period. Moreover,patients with high levels of depression and symp-toms including pain, dyspnea, and poor appetitehad significantly higher levels of uncertainty acrossthe 12 months. CONCLUSIONS: Advanced lungcancer patients experienced continual uncertaintyabout their disease and the effects of treatment dur-ing the 12 months after treatment began. Thesefindings show that uncertainty arises when patientsexperience symptom aggravation. Pain, dyspnea,and appetite loss were the most distressing symp-toms, which triggered unpredictable feelings forpatients. Higher levels of depression during the fol-low-up period led to greater reported levels ofuncertainty. Moreover, the pretreatment uncer-tainty level and performance status were significantsignals for the increase in uncertainty during the12 months following diagnosis. RESEARCHIMPLICATIONS: Structuralized interventions tai-lored to lung cancer subgroups must be developedfor uncertainty management. Based on our find-ings, we suggest that uncertainty reduction inter-ventions comprise symptom management training,symptom monitoring, individualized counselingservices, and cognitive process exchange training toaddress patient concerns. Further components ofthe interventions and their dose and interveningduration required for managing persistent uncer-tainty in lung cancer patients must be tested. CLIN-ICAL IMPLICATIONS: Health care professionalsshould conduct systematic assessments for lungcancer patients at the pretreatment phase to iden-tify patients with a high risk of uncertainty and pro-



vide timely interventions. Furthermore, it is imper-ative to continue symptom monitoring and man-agement, counseling services, and uncertaintyreduction interventions across the disease trajecto-ries of advanced lung cancer patients. ACKNOWL-EDGEMENT OF FUNDING: This study wassupported by a grant from the National HealthResearch Institutes (NHRI - EX98 - 9807PI).

P2-39

The Sights and Sounds of Palliative Care:

Caregivers’ Experiences at the Deathbed

Christine Sanderson1, Elizabeth Lobb1,2, Jane

Mowll1, Phyllis Butow3,4, Melanie Price3,4, Naomi

McGowan3

1Calvary Health Care Sydney, Sydney, New SouthWales, Australia, 2The Cunningham Centre forPalliative Care, Darlinghurst, New South Wales,Australia, 3Centre for Medical Psychology &Evidence-based Decision-making (CeMPED),Sydney, New South Wales, Australia, 4School ofPsychology, The University of Sydney, Sydney, NewSouth Wales, Australia, 5School of Medicine, TheUniversity of Notre Dame, Sydney, New SouthWales, Australia

BACKGROUND: Within the literature on pallia-tive care, the possible occurrence of PTSD as partof the spectrum of complications of grief seems tohave gone largely unrecognised. Nonetheless ourclinical experience suggests that trauma symptomsand possibly PTSD may contribute significantly tobereavement morbidity in this population. This isan exploratory paper examining responses to thedeath of a loved one who has had cancer, with afocus on possible trauma/PTSD responses.METHOD: Consecutive care-givers participatingin the Australian Ovarian Cancer Quality of LifeStudy and who were bereaved during this studywere invited to participate in a follow-up study.Approximately five months post-bereavement,caregivers were sent a letter of condolence invitingthem to participate in semi structured telephoneinterviews. Questions were developed for the fol-lowing domains: preparation for death, informa-tion and decision making, emotional andcommunication issues, the last weeks of life, end oflife care, and the death itself. Interviews were taperecorded and transcribed verbatim. Caregivers’recollections of their end of life experiences werecoded and analysed. RESULTS: The patientswhose death was the subject of these interviewswere in contact with palliative care services, yetthese interview transcripts describe trauma associ-ated with these expected deaths. Highlighting thesub-structural emotional tone within these inter-views reveals that the expressions of distress andshock identified, even though some phrases are in

common usage, are repetitively present in this set-ting. All interviewees used language consistent withsome degree of traumatisation. Whilst there wasevidence suggestive of resilience and resolution, anumber of interviewees describe intrusive memoriesassociated with the physical sights and sounds thatthey witnessed at the deathbed. CONCLUSIONS:These findings are not diagnostic, nor can preva-lence of PTSD be estimated from this material,nonetheless the language used is very suggestive ofthese interviewees having undergone a profoundlytraumatic experience. Palliative care practicefocuses on relief and prevention of suffering, andpreparation for death - for both patients and lovedones. The skillful care of caregivers requires anunderstanding of the nature of their experience,especially if we are to reduce traumatisation of vul-nerable individuals. Identifying the true significanceof PTSD in palliative care caregivers is therefore animportant future topic of research. RESEARCHIMPLICATIONS: Unlike deaths in ICU, or sud-den deaths, traumatic experiences have not previ-ously been considered as an important aspect of thebereavement experience for expected deaths in palli-ative care. As far as we are aware no information iscurrently available on the true prevalence or likelyoutcome of such problems. The extent of PTSD inthis population should be further investigated withlongitudinal studies using appropriate assessmenttools. CLINICAL IMPLICATIONS: Our initialhypothesis for these findings is that expected deathhas an inherent trauma within it, no matter howwell families are prepared, or symptoms managed.Our study demonstrates the phenomenon of the“shocked caregiver” with evidence suggestive ofPTSD symptoms. If trauma symptoms are presentin bereaved carers in palliative care it has implica-tions for the provision of palliative care includingpreparation for the death and for the provision ofbereavement counselling ACKNOWLEDGE-MENT OF FUNDING: The AOCS QoL studywas funded by the Cancer Councils of New SouthWales and Queensland (grant number RG 36/05New South Wales). Financial support for the par-ent study (AOCS) was provided by the US ArmyMedical Research and Materiel Command (grantnumber DAMD17-01-1-0729), the National Healthand Medical Research Council (NHMRC; grantnumbers 400413, 400281) and the Cancer Councilsof NSW, Queensland, South Australia, Tasmania,Victoria and Western Australia.



P2-40

Psychosocial Impact of Fungating Wounds on

Cancer Patienits

Joyce Marete1, Hellena Musau2

1Aga Khan University Hospital, Nairobi, Kenya,2Nairobi Hospice, Nairobi, Kenya

BACKGROUND: Fungating malignant woundsdevelop when tumour cell infiltrate and erodethrough the skin. The term “fungating” is used todescribe the development and progression of thewound which may be proliferating and / or ulcerat-ing. They have a major psychosocial impact andnegatively affect the patients quality of life (QOL)METHOD: Patients’ QOL was evaluated using theFunctional Scale, which assess the following QOLdomains: Physical wellbeing, Social/family wellbe-ing, Emotional wellbeing, Functional wellbeing andSpiritual wellbeing. RESULTS: Patients reportedmany significant needs across all QOL domains,others reported difficulties in securing financial sup-port for disease treatment and wound management.Low mean score in physical wellbeing meant thequality of symptom management for terminally illpatients remain poor. Although participantsreported finding comfort and strength in their faithand spiritual belief, they were at risk of spiritualdistress. The functional wellbeing was poor andsuggests that patients are particularly in need offinancial support because of expensive treatmentand their inability to continue working. CONCLU-SIONS: Good psychological support should beemphasized to help patients to accept their illness.The findings suggest that, once patients accept theirillness, their QOL can be greatly improved. Patientswho had good family support and acceptance tendto have good quality of life. RESEARCH IMPLI-CATIONS: This study included patients withwound only and also patients with different type ofcancer, so the results cannot be generalized to allterminally - ill patients in Kenya. Further studiesshould be conducted to explore wound care andQOL in other illnesses compared to cancer. CLINI-CAL IMPLICATIONS: Effective evidence basedmanagement for malignant fungating woundsshould be incorporated into existing wound careprotocol. Development of wound clinics in hospicesand palliative care units as well as in outreach/mobile palliative care units in order to reachpatients and families in the remote and ruralregions of the country. ACKNOWLEDGEMENTOF FUNDING: Research funding: The DianaPrincess of Wales Memorial Fund. KNH PCU,Nairobi Hospice and KEHPCA.

P2-41

Recognition of the Patient Before Medical

Treatment Affects the Reduction of Pain in Cancer

Patients (PartII)

Hiromichi Matsuoka1, Chihiro Makimura1,

Atsuko Koyama1, Masatomo Otsuka2, Kiyohiro

Sakai1, Ryo Sakamoto1, Kazuhiko Nakagawa3

1Department of Medical Oncology, Division ofPsychosomatic Medicine, Kinki University Facultyof Medicine, OsakaSayama/Osaka, Japan,2Department of Palliative Care Medicine, SakaiHospital, Kinki University Faculty of Medicine,Sakai/Osaka, Japan, 3Department of MedicalOncology, Kinki University Faculty of Medicine,OsakaSayama/Osaka, Japan

BACKGROUND: Pain is among the most com-mon symptoms of cancer. There is much researchabout the patient’s amount of pain using theNumerical rating scale (NRS), or in respect to emo-tions using the Hospital anxiety and depressionscale (HADS). However, little is known about theinfluence of individual cognition and individualview of pain. Therefore, the objective of this studyis to investigate the effect of cancer patient’s indi-vidual cognition and individual view to pain.METHOD: We prospectively analyzed 100patients (male 50) experiencing pain as a result ofcancer. The subjects of this study were cancerpatients who went to our hospital regularly or werehospitalized between 2009 and 2011. Morphinetreatment was performed according to the standardmethod including titration (NCCN Guidelines™,Adult Cancer Pain).We investigated if the recogni-tion of the patients before medical treatment affectsthe reduction of pain in cancer patients.RESULTS: Patients who thought their pain wouldlessen in the future on Day1 had a chance of painreduction on the NRS on Day 8 (p = 0.001). Wealso examined the relation between “the mentalcondition before medical treatment” and “a chanceof their pain lessening”. In the correlation matrixcreated in advance, there were mild correlationcoefficient (r = �0.335, p < 0.01) between “the rec-ognition of getting better on Day1” and “HADS-Dhigh score on Day 1”, and also mild correlationcoefficient (r = �0.285, p < 0.01) between “the rec-ognition of getting better on Day 1” and “theHADS-A high score on Day 1”. CONCLU-SIONS: Our results suggest that the patients whothink their pain would lessen in the future couldexperience a reduction of pain by Day 8.ACKNOWLEDGEMENT OF FUNDING: None.



P2-42

The Role of a Psychiatrist in a Mobile Palliative

Team

Tomislav Peharda, Ivica Sain, Dragan Trivanovic

General Hospital Pula, Pula, Croatia/Istria, Croatia

BACKGROUND: Palliative mobile team are spe-cialist consulting services in the field, out of hospi-tal, aimed to support GP in whole palliativetreatment. Its role is organizational, educationaland professional. The team participates in creationof a network that connects the primary and second-ary health care, educates patients, families andhealth professionals, but also takes part in the treat-ment itself. It has a major role in shaping a groupmatrix and in opening dialogues on specific issues.METHOD: The frame of group work was support-ive, from which some important issues to considerstemmed: “You know, doctor, it is increasinglydifficult for me to find gratification in a treatmentwhen I see that patient is dying anyway, where ismy medical boundary?” “I often find myself in a sit-uation that apart from medical treatment, I amasked some other questions, about life, aboutdeath, about the meaning of all, of heaven or aboutthe meaning of illness, so sometimes I am takenaback by such queries.” How to psychodinamicallyapproach to such emotional issues in team?RESULTS: Work with severely ill person opens acomplex dimension for which we are poorly pre-pared by our medical education. The group workraised awareness of some important points:

1. Concept of gratification in a palliativeapproach versus conventional treatment.

2. Awareness of counter-transference issues insomatic therapies.

3 Taking work home and realization of an infan-tile desire in dreams.

4. Situations in which a paramedical part playsan important role, which becomes part oftreatments.

CONCLUSIONS: A psychiatrist has the task ofopening questions that involve emotional sphere ofa doctor, which shows specificity compared to con-ventional treatment. Answers are not necessarilygiven, but opening of a group itself allows channel-ling the anxiety and finding more adequate formsof emotional response. RESEARCH IMPLICA-TIONS: The questions arise working on field onwhat somatic doctors could not detect as a problemon field and what limitated their work. This showshow emotional level of palliative doctor has a sig-nificant role play in tretment and personal satisfac-tion. CLINICAL IMPLICATIONS: To answerthe questions:

How to (medically) treat where the effect oftreatment is minimal and mutual expectationsare high?

How to find personal gratification in cases whenwe know that our role is limited?Where is the border line between empathiccapacity and our personal emotions?How far to go in talks with patients about topicsthat are not medical, but are part of the overallhealing process?

ACKNOWLEDGEMENT OF FUNDING: None.

P2-43

Psychiatrist in a Mobile Palliative Team

Tomislav Peharda, Ivica Sain, Dragan Trivanovic

General Hospital Pula, Pula,Croatia/Istria, Croatia

BACKGROUND: Palliative mobile team arespecialist consulting services in the field, out ofhospital, aimed to support GP in whole palliativetreatment. Its role is organizational, educationaland professional. The team participates in creationof a network that connects the primary and second-ary health care, educates patients, families andhealth professionals, but also takes part in the treat-ment itself. It has a major role in shaping a groupmatrix and in opening dialogues on specific issues.METHOD: The frame of group work was support-ive, from which some important issues to considerstemmed: “You know, doctor, it is increasingly dif-ficult for me to find gratification in a treatmentwhen I see that patient is dying anyway, where ismy medical boundary?” “I find myself in a situationthat apart from medical treatment, I am askedsome other questions, about life, about death,about the meaning of all, of heaven or aboutthe meaning of illness, so sometimes I am takenaback by such queries.” How psychodinamicallyapproach to such emotional issues in team?RESULTS: Work with severely ill person opens acomplex dimension for which we are poorly pre-pared by our medical education. The group workraised awareness of some important points:

1. Concept of gratification in a palliativeapproach versus conventional treatment.

2. Awareness of counter-transference issues insomatic therapies.

3. Taking work home and realization of aninfantile desire in dreams.

4. Situations in which a paramedical part playsan important role, which becomes part oftreatments.

CONCLUSIONS: A psychiatrist has the task ofopening questions that involve emotional sphere ofa doctor, which shows specificity compared to con-ventional treatment. Answers are not necessarilygiven, but opening of a group itself allows channel-ling the anxiety and finding more adequate formsof emotional response. RESEARCH IMPLICA-TIONS: The questions arise working on field onwhat somatic doctors could not detect as a problem



on field and what limitated their work. This showshow emotional level of palliative doctor has a sig-nificant role play in tretment and personal satisfac-tion. CLINICAL IMPLICATIONS: To answerthe questions: How to (medically) treat where theeffect of treatment is minimal and mutual expecta-tions are high? How to find personal gratification incases when we know that our role is limited? Whereis the border line between empathic capacity andour personal emotions? How far to go in talks withpatients about topics that are not medical, but arepart of the overall healing process? ACKNOWL-EDGEMENT OF FUNDING: None.

P2-44

The TIRED [Treatment of FatIgue During Palliative

Care for Advanced or Metastatic Disease] Study:

Two Interventions for Fatigued Advanced Cancer

Patients, a Randomised Controlled Trial

H Poort1, CA Verhagen2, ME Peters2, MM

Goedendorp1,3, WT van der Graaf2, H Knoop1

1Expert Centre for Chronic Fatigue, RadboudUniversity Nijmegen Medical Centre, Nijmegen, TheNetherlands, 2Department of Medical Oncology,Radboud University Nijmegen Medical Centre,Nijmegen, The Netherlands, 3Department of HealthSciences, University of Groningen, UniversityMedical Center Groningen, Groningen, TheNetherlands

BACKGROUND: Fatigue is an important symp-tom lowering the quality of life (QoL) in patientswith advanced cancer (AC). Graded exercise ther-apy (GET) and cognitive behaviour therapy (CBT)have shown to be effective in reducing fatigue incancer survivors, but the effectiveness for patientsreceiving systemic palliative treatment has not beendemonstrated. We started a study to test the effectsof both interventions in patients with AC. Media-tors of the expected reduction in fatigue will bedetermined. METHOD: TIRED is a prospectiverandomised, controlled, multicentre interventiontrial with 3 conditions (GET, CBT, and care asusual). GET consists of weekly sessions of 2 hoursresistance and aerobic training with a physical ther-apist during 12 weeks. CBT consists of 10 individ-ual 1 hour sessions with a cognitive behaviouraltherapist over a period of 12 weeks. A treatmentprotocol for CBT has been developed consisting of6 modules aimed at factors that are thought to per-petuate fatigue. Both interventions are designed toreduce fatigue in patients with advanced breast orcolorectal cancer. Secondary endpoints are func-tional impairment and QoL. RESULTS: Two-hun-dred-nineteen adult patients diagnosed withadvanced breast or colorectal cancer will berecruited and randomised between one of 3 groups.All patients who have been severely fatigued for at

least 2 weeks without known and treatable somaticcause (other than cancer related), and scheduled toreceive first line of palliative cancer treatment areeligible. Recruitment of participants began in Janu-ary 2013. At present, four hospitals are participat-ing. Post-treatment measures are expected to becompleted in December 2015. The results of thisstudy will provide insights in whether GET andCBT are effective in reducing severe fatigue inpatients with AC. CONCLUSIONS: This studywill evaluate the effects of two interventionsdesigned to reduce severe fatigue and functionalimpairment, and improve QoL compared to care asusual. To the best of our knowledge, this is the firstcontrolled intervention study specially designed forseverely fatigued patients with AC receiving thefirst line of palliative cancer treatment. In additionto effectiveness, mechanisms of the expected reduc-tion in fatigue are explored. More specifically, are(a) an increased level of physical activity and/orphysical fitness; or (b) a change in fatigue relatedcognitions, mediators for the reduction in fatiguebrought on by the 2 interventions? RESEARCHIMPLICATIONS: The TIRED study will provideinsight in the effectiveness of GET and CBT spe-cially designed to target severe fatigue in patientswith AC. Identifying the mediating factors for bothinterventions will enable us to improve future inter-ventions for fatigue in this patient group. CLINI-CAL IMPLICATIONS: Fatigue has proven to beone of the symptoms significantly lowering thequality of life. Until now there is no evidence-basedor generally accepted intervention to treat fatigueduring the palliative trajectory. When GET andCBT are effective, the best or if equally effectiveboth interventions can be implemented in the carefor patients with AC. ACKNOWLEDGEMENTOF FUNDING: The TIRED study is funded bythe Dutch Cancer Society, The Netherlands.

P2-45

Unbearable Suffering Cancer Patients Dying at

Home: A Dutch Study of the Relationship Between

Intensity of Symptoms and Bearability

Cees Ruijs1, Ad Kerkhof2, Gerrit Van der Wal1,

Bregje Onwuteaka-Philipsen0

1VU University Medical Center, Amsterdam, TheNetherlands, 2VU University, Amsterdam, TheNetherlands

BACKGROUND:- 45% of all cancer patients in the Netherlandsdie at home.

- Euthanasia in about 1 out of 7 cancer patientsdying at home in the Netherlands indicates sub-stantial unbearable suffering.

- Physicians are trained in interventions directedat symptom control.



- Mental health professionals generally are notpart of the palliative home care team.

- Research question: what is the relationshipbetween intensity of symptoms and unbearabil-ity.

METHOD:

- 44 general practitioners during 3 yearsrecruited cancer patients estimated to diewithin 6 months.

- Instrument: State-of-suffering-V (SOS-V):quantitative assessment of intensity and unbea-rability of 69 symptoms.

• comprehensive design: physical, psychological,social and existential aspects.

• 5 domains: medical signs and symptoms - lossof function - personal aspects - environment -nature and prognosis of disease.

• assessment of overall unbearable suffering.• five-point rating scale, range: 1 (not at all) - 5(hardly can be worse).

• additional quantitative questions addressingunbearability.

- Interviews: bimonthly, sooner if condition dete-riorated.

- Analysis: scores 4 and 5 indicate either highintensity or unbearability.

RESULTS:

- Participation: 76 out of 148 (51%) patients.- Follow up until death: 64 patients.- High intensity symptoms most frequentlyunbearable: pain (92%), loss of control overone’s life (92%), fear of future suffering (89%).

- Low intensity symptoms most frequentlyunbearable: loss of control over one’s life(80%), vomiting (73%), not being able to doimportant things (52%).

- For overall unbearably suffering patients themedian number of unbearable symptoms was16 (range 6–38), compared to 6 (range 0–24)for patients for whom the suffering overall wasbearable.

- The qualitative experience included physicalsuffering, processes of loss and existential suf-fering.

CONCLUSIONS:

- Unbearable suffering is characterized by vari-able relationships between intensity of symp-toms and unbearability, and variations innumbers of unbearable symptoms per personresulting in overall unbearable suffering.

- Symptoms may be unbearable without resultingin overall unbearable suffering.

- Overall unbearable suffering is related to highernumbers of unbearable symptoms, yet there islarge overlap with overall bearable suffering.

RESEARCH IMPLICATIONS:

- The demonstrated distinction between intensityof symptoms and bearability in cancer patientsdying at home indicates for research investigat-ing also in palliative cancer home care the addi-tional effects of psycho-oncologic interventionsto provide relief of suffering additionally tointerventions directed at symptom control.

- A multi-setting primary care study organizationmay provide patients numbers sufficiently largeto evaluate effect outcomes.

CLINICAL IMPLICATIONS:

- The intensity of symptoms is an important, butnot sufficient, indicator of unbearable suffer-ing.

- Patients should be asked directly about theintensity of their symptoms and about theirjudgment of unbearability.

- Health professionals responsible for the care ofpatients dying from cancer require to be trainedin assessment of the multiple dimensions of suf-fering.

- To understand the overall suffering of a patientrequires comprehensive assessment.

ACKNOWLEDGEMENT OF FUNDING: None.

P2-46

Evaluation of Advanced Cancer Patients’ Most

Important Concerns: The Italian Validation of the

Concerns Checklist and the Cancer Behaviour

Inventory-Brief Version

Samantha Serpentini1,2, Paola Del Bianco2, Gian

Carlo Odorico3, Irene Guglieri2, A. Chirico4,

Chiara Berti1, Francesca Busa1, Guido Biasco5,

Thomas V. Merluzzi6, Eleonora Capovilla2

1Az. ULSS 3, Bassano del Grappa (VI), Italy,2Veneto Institute of Oncology IOV-IRCSS, Padua,Italy, 3Fondazione Hospice M.T.C. Ser�agnoli,Bentivoglio (BO), Italy, 4Dipartimento di Senologia,Istituto Nazionale Tumori “Fondazione Pascale”-IRCCS, Napoli, Italy, 5Academy of the Sciences ofPalliative Medicine (ASMEPA), Bentivoglio (BO),Italy, 6Institute for Scolarship in the Liberal Arts(ISLA), University of Notre Dame, South Bend,Indiana, USA

BACKGROUND: Due to the lack of specificinstruments in Italian for the evaluation of con-cerns and the paucity of questionnaires on the cop-ing methods in advanced cancer patients, thepresent study intends to translate and validate inItalian the Concerns Check-list (CCL) and the Can-cer Behaviour Inventory brief version (CBI-b).METHOD: The research design is multicentric,observational and cross-sectional and patients will



be enrolled from December 2012 to December2014. For the purpose of validation, the followinginstruments will also be used: EORT Quality ofLife Questionnaire (C-30), Hospital Anxiety andDepression Scale and the Mini Mental Adjustmentto Cancer Scale. The questionnaires will be admin-istered to a minimum of 210 advanced stage cancerpatients who attend the symptom control and palli-ative care clinic. Participants are eligible for thisstudy if they are at least 18 years of age, diagnosedwith incurable cancer and able to speak and readItalian fluently. RESULTS: Currently the CCLand the CBI-b questionnaires have been translatedinto Italian and back translated, and a pilot studyhas been conducted involving 5 patients representa-tive of the target population. In the light of theinformation gathered from the pilot phase, we haveprepared the final version of the 2 instruments to bevalidated in the present study. The partial resultswill be presented at the conference. CONCLU-SIONS: The Italian version of the CCL and CBI-bmay be useful for research and the clinical practicein the field of palliative care in Italy. RESEARCHIMPLICATIONS: With regard to the experimen-tal context, it is crucial to have specific instrumentswith sound psychometric properties; in this way itis possible to have available appropriate measuresto conduct rigorous studies focused on patients inadvanced stage of cancer. CLINICAL IMPLICA-TIONS: In order to improve the clinical practice inthe end of life care, it would be useful to identifythe specific problems that affect patients receivingpalliative care. This could be an important resourceboth in the identification of patients needs and instructuring specific psychosocial interventions.ACKNOWLEDGEMENT OF FUNDING: None.

P2-47

Abstract withdrawn

P2-48

The Experience of a Son “Cancer”: Reflections of a

Study in Portugal

Maria Joao Cunha1, Joao Paulo Pereir1, Joao

Maria Pereira2

1ISMAI, Porto, Portugal, 2ISCTE, Lisbon,Portugal

BACKGROUND: The diagnosis of malignant dis-ease in childhood, assumes specifics relations to thecharacteristics of the stage of life (developmentaltasks, processes of socialization, education, etc.)interfering with personal and family life organiza-tion and causing intense pain and suffering in thefamily, redefining demands of the emotional stand-point carers / family. METHOD: It’s a cross-sec-tional study that was designed primarily to

characterize how the experience of malignant dis-ease of a child, may compromise the health andwell-being of parents inquiring how attachmentstyle interfered in this process. We used the follow-ing instruments: the WHOQOL-Bref, the EVA-Bonding Scale Adult, the 23 QVS -Vulnerability toStress Questionnaire, and finally, the BSI-Psycho-pathological Symptoms Inventory. RESULTS:The paranoid ideation, anxiety and interpersonalsensitivity were the more present psychopathologi-cal symptomatology in these parents. The perfec-tionism and intolerance to frustration, the drama ofexistence, inhibition and functional dependenceand subjugation factors contribute more to vulner-ability to stress, with 58% of parents met criteriafor emotional disturbance, and 47% of vulnerabil-ity to stress. Parents of children with cancer whohave secure attachment experience levels of per-ceived quality of life and higher levels of psycho-pathological symptoms below those of parents ofchildren with cancer who have insecure attachment.CONCLUSIONS: Parents of children with cancerwho have a secure attachment style seem to havemore resources to cope with all conditions of suffer-ing that pass along the illness of their children. Theway they manage emotions and stress seems to beso adjusted and then commit less your own health.RESEARCH IMPLICATIONS: The results sug-gest that secure attachment style may be a protec-tive factor for the health of these parents, theinterventions approaches with these families shouldhave this aspect as a reference providing the possi-bility of a secure attachment figure throughout thedisease process. ACKNOWLEDGEMENT OFFUNDING: We thank UNIDEP-ISMAI the sup-port given to the execution of this work.

P2-49

Psychological Reactions of Children and Adolescents

to Malignant Disease and Treatment and Their

Parents’ Reactions - Assessment and Support

Tamara Klikovac

Institut for Oncology, Belgrade, Serbia

BACKGROUND: Can psychological reactionssuch as: anxiety, depression and fatigue during thetreatment be properly estimated with existing in-strumentsand how they affect the quality of life andefficiency of the prevalence in children and adoles-cents aged 7 to 19 who are treated from differentmalignant diseases.Is it possible to construct amodel for providing adequate psychological andpsycho-social support. METHOD: Determine ifthere are any differences: (1) in the level of anxiety,depression, fatigue experience, perception of thequality of life and the way of prevalence dependingon age, sex, diagnosis and the degree of damage tothe primary illness (2) in the quality of life, fatigueand prevalence from the perspective of affected



children and adolescents and the perspective oftheir parents, who are present during treatment andgiving the assessment (3) if there is a connectionbetween the levels of anxiety, depression, fatigue,quality of life and prevalence on affected childrenand adolescents and levels of parental stress.RESULTS: Will be presented. Anxiety will betested by The Revised Children‘s Manifest AnxietyScale (RCMAS).Depression will be tested by TheChildren‘s Depression Inventory (CDI).Quality oflife will be tested by The Pediatric Cancer Qualityof Life Inventory (PCQOL - 32).Fatique will betested by The Pediatric Functional Assesment ofChronic Illnes Therapy Fatigue scale (FACIT - Fscale.Prevalance will be measured by KIDCOPEscale.Parental stress will be measured by PSI/SF -Parenting Stress Index shor form.Cohesion and sta-bility of the family (from the aspect of a parentpresent during the tratment of the child) will betested with FACES IV. CONCLUSIONS: TheSample of this research will include all children andadolescents aged 7 to 19 who are affected by vari-ous malignant diseases during the treatment atDepartment for Pedriatic Ooncology of the Insti-tute for Oncology and Radiology of Serbia.Sincethe instruments that will be used in this researchhave been adjusted to children and adolescents whoare tested, the children patients will be allocatedinto two groups:The first group -children aged 7 to12,The second group- adolescents aged 13 to 19.RESEARCH IMPLICATIONS: The main goalsof research are checking different instruments, pro-viding assesment of different psychological reac-tions and constructing the model of psycho-socialhelp for children, adolescents and their parents dur-ing oncological treatment at the pediatric oncologydepartment. CLINICAL IMPLICATIONS: Psy-cho-social model of help for children, adolescentsand their parents during oncological treatment atthe pediatric oncology department will be con-structing depends of results and cultural specific ofserbian population. ACKNOWLEDGEMENT OFFUNDING: None.

P2-50

Social Support of Childhood Cancer Survivors and

Healthy Children: Are There Any Differences?

Veronika Koutn�a1,2, Marek Blatn�y1,2, Tom�a�sKep�ak3, Martin Jel�ınek1,2, Tereza Bla�zkov�a2

1Institute of Psychology, Academy of Sciences of theCzech Republic, Brno, Czech Republic, CzechRepublic, 2Institute of Psychology, Faculty of Arts,Masaryk University, Brno, Czech Republic, CzechRepublic, 3Department of Paediatric Oncology,Children’s Medical Centre, University HospitalBrno, Brno, Czech Republic, Czech Republic

BACKGROUND: Increasing rates of survival inpaediatric cancer patients focused research on the

psychosocial adaptation to this highly demandingexperience, late effects of the treatment and subse-quent quality of life of the survivors. Social supportis assumed to be an important factor influencingoutcomes of coping with the serious illness. Thepurpose of this study is to describe the structure ofsocial support in childhood cancer patients in com-parison with social support of healthy children.METHOD: A total of 101 childhood cancer survi-vors (7–19 years, M = 13, SD = 3.7) in remissionfor 2–5 years, who have undergone various types oftreatment and 231 healthy children (8–19 years,M = 13.4, SD = 3.4) was included in the study.Childhood cancer survivors were recruited throughQOLOP (Quality of Life Longitudinal Study ofOncology Paediatric Patients) project. Perceivedsocial support was measured by the 18-item SocialSupport Questionnaire originally designed for theQOLOP project – based on the MOS Social sup-port survey and adapted by the clinicians to reflectpaediatric cancer conditions. Data were analysedusing descriptive statistics and analysis of variance.RESULTS: Mother was the most important sourceof social support for both research groups, whileperceived social support from mother was bigger inthe childhood cancer survivors. No differencesbetween research groups were found in social sup-port from father. Despite lower or equal number offriends, childhood cancer survivors reported higheramount of perceived social support obtained fromfriends. Further analyses revealed also some genderand age differences in the structure of social sup-port. Grandparents and siblings appear to be otherrelevant sources of social support for both researchgroups. CONCLUSIONS: This study identifiedimportant sources of social support for paediatriccancer survivors and healthy children. Althoughthe results do not establish any essential differencesin the structure (sources) of social support betweenthis 2 research groups, the types and amount ofsocial support provided by these sources may differdepending on the state of health, age and gender ofthe childhood support recipient. However, resultsof this study are based only on the subjective evalu-ation of perceived social support from the perspec-tive of children (support recipients) and theperspective of relevant sources of social supportwas not included. RESEARCH IMPLICA-TIONS: Further research is needed to confirm pos-sible explanations of identified differences. In thisrespect a qualitative methodology or study designcombining measuring of perceived social supportwith measures of actually received support could beuseful. CLINICAL IMPLICATIONS: The resultsof this study imply the importance of analyzingsocial network and social support of childhood can-cer survivors in order to be able to provide appro-priate care in case of atypical structure orunavailability of usual sources of support.ACKNOWLEDGEMENT OF FUNDING: This



study is supported by the Czech Science Founda-tion (GACR), grant no.406/07/1384 and grant no.P407/11/2421.

P2-51

Pathways Linking Childhood Cancer Late Effects to

Anxiety and Depression in Adult Survivors: A

Report From the St. Jude Lifetime Cohort Study

Tara M. Brinkman1, S. Cristina Oancea1, Kevin R.

Krull1, Leslie L. Robison1, Melissa M. Hudson1,

James G. Gurney1,2

1St. Jude Children’s Research Hospital, Memphis,Tenneesee, USA, 2School of Public Health,University of Memphis, Mempis, Tenneesee, USA

BACKGROUND: Subgroups of adult survivorsof childhood cancer are at-risk for emotional dis-tress. Sociodemographic variables, cancer diagno-sis, and cancer treatments have been associatedwith symptoms of anxiety and depression in survi-vors. Yet, the mechanisms underlying emotionaldistress many years after treatment completion arenot fully understood. We investigated the impact ofadverse late effects on long-term survivors’ emo-tional health. METHOD: Participants included1863 adult survivors of childhood cancer (median32 years of age at follow-up) who completed a com-prehensive medical evaluation at St. Jude Chil-dren’s Research Hospital. Symptoms of anxietyand depression were assessed using the Brief Symp-tom Inventory-18 (BSI-18) with elevated distressdefined as T-scores ≥63. Survivors self-reportedcancer-related pain and learning/memory problems.Odds ratios (OR) and 95% confidence intervals(CI) were calculated using multivariable logisticregression models to quantify risk factors for dis-tress. Path analysis was used to examine associa-tions among socioeconomic variables and reportedlate effects. RESULTS: Anxiety was reported by11.7% of survivors and 15% reported elevatedsymptoms of depression. Cancer-related pain wasassociated with elevated distress (anxiety: OR 5.8,95% CI, 3.5–9.8; depression: OR 4.5, 95% CI 2.8–7.4) as was moderate learning/memory problems(anxiety: OR 2.3, 95% CI, 1.5–3.5; depression: OR4.0, 95% CI 2.7–5.9). Path analysis suggested thatcancer-related pain has a direct effect on symptomsof distress (anxiety: b = �0.22; depression b =�0.15). Similarly, learning/ memory problems evi-denced a direct effect on emotional distress (anxiety:b = �0.09; depression b = �0.19). Cancer-relatedpain and learning/memory problems showed anindirect effect on distress through socioeconomicstatus. CONCLUSIONS: Consistent with previousreports, the majority of survivors in our sample didnot report elevated symptoms of anxiety or depres-sion, suggesting largely positive emotional adjust-ment several decades following diagnosis and

treatment for childhood cancer. Our study extendsprevious reports by demonstrating that perceptionsof cancer-related pain and learning/memory prob-lems were directly and indirectly associated withelevated symptoms of anxiety and depression inlong-term survivors. RESEARCH IMPLICA-TIONS: These data highlight the need to considerthe complex interplay between cancer-related lateeffects and socioeconomic factors when consideringsurvivors’ emotional health. Future studies mayconsider a more comprehensive assessment of emo-tional health in adult survivors of childhood canceras well as evaluation of interventions targeting dis-tress symptoms. CLINICAL IMPLICATIONS:Screening for emotional distress in adult survivorsis warranted, especially for survivors who presentwith pain and cognitive morbidities. Intervening onfactors that contribute to emotional distress mayhave the potential to reduce the burden of distresssymptoms in survivors, though future research willneed to explore such associations. ACKNOWL-EDGEMENT OF FUNDING: This work wassupported by the Cancer Center Support (CORE)grant CA21765 at St. Jude Children’s ResearchHospital and by ALSAC.

P2-52

Comparisons of Fatigue Reported by Children With

Brain Tumor Versus Other Forms of Childhood-

Onset Cancer

Jin-Shei Lai, Jennifer Beaumont

Northwestern University, Chicago, Illinois, USA

BACKGROUND: Fatigue is one of the most com-mon complaints for cancer patients and its impacton survivors could extend even years after comple-tion of cancer treatment. Yet, very few studies haveaddressed this issue in pediatric survivors of cancer,especially the differences between children withbrain tumors (BT) and those with other types ofcancer (non-BT). This study aims to compare fati-gue reported by BT and non-BT. METHOD: 515patients (53% BT; 47% non-BT) aged 7–21(mean = 14 years; 56% males) were recruited. 34%received radiation therapy, 72% chemotherapy,71% surgery. Years since last treatment(mean = 3.3) was divided into 3 categories: <1 year(n = 34.3%), 1–2 years (12%), and >2 years(53.4%). Health-related quality of life was mea-sured using PedsQL-generic. Fatigue was measuredusing PedsQL-Fatigue, which has three sub-scales:general, cognition, and sleep fatigue. T-tests andANOVA were used to compare fatigue between BTversus non-BT and years since last treatment.Regression analysis was used to compare fatiguebetween cancer types adjusted by years since lasttreatment. RESULTS: There were no differences(p > 0.01) between BT and non-BT in physical,emotional, and school functioning; BT reported



worse social functioning. BT reported more cogni-tion fatigue than non-BT (t = �4.11, p < 0.001)but not general (t = �0.68, p = 0.497) or sleep fati-gue (t = �0.38, p = 0.706). Patients treated within1 year reported more general (p < 0.01) and sleepfatigue (p < 0.01) than other 2 categories. No sig-nificant differences between groups were found incognition fatigue. In regression, BT remained a sig-nificant predictor of cognition fatigue (p < 0.001)after adjusting for years since last treatment. Yearssince last treatment was only significant predictor(p < 0.001) of general and sleep fatigue. CONCLU-SIONS: Using pedsQL, we found that childrenexperienced more severe general and sleep fatiguewithin one year of their last treatment, regardless oftype of cancer. However, the same conclusion couldnot be made for cognition fatigue, for which type ofcancer (BT vs. non-BT) was the primary predictorregardless of years since the last treatment. This maybe due to similarities between cognition fatigue andself-reported cognition and cognition is known to bea primary concern for children with brain tumor.General and sleep fatigue are non-specific to cancertype and their impacts seemed to diminish aftercompletion of treatment. RESEARCH IMPLICA-TIONS: Our analysis showed BT reported morecognitive related fatigue than non-BT group regard-less of years since last treatment. Yet general andsleep related fatigue seemed to lessen overtime. Lit-erature suggest childhood cancer survivors reportedfatigue and sleep disturbance even in their adult-hood. In the future a longitudinal study monitoringfatigue over time more comprehensively, such as byusing a fatigue item bank, is needed. CLINICALIMPLICATIONS: Results showed that BTreported more cognitive fatigue, which was not asurprise due to their cognitive decrements - a pri-mary concern for children with BT. However theyalso reported more problems in social functioningthan non-BT, which indicated appropriate andtimely intervention is needed for this group to helpthem adapt to their social environment better.ACKNOWLEDGEMENT OF FUNDING: Thisproject was supported by National Cancer Institute ofthe United States (R01CA125671, PI: Jin-Shei Lai).

P2-53

Mental Disabilities in Children With Head Brain

Tumors - Reality or Parents’ Predisposition

Yulia Malova1,2

1Faculty of Psychology Lomonosov Moscow StateUniversity, Moscow, Russia, 2Russian ScientificCenter of Radiology, Moscow, Russia

BACKGROUND: The complex psychologicalconsequences of the brain tumor - neuropsychologi-cal and affective disorders; retardation of mentaldevelopment, adjustment difficulties - need psycho-logical help. In clinical practice of pediatric neuro-

oncology there is lack of the verification of cogni-tive disotders. METHOD: 30 children in the age 5–14 with recurrent head brain tumors and theirmothers were tested For children we used Luria’smethod of complex psychological diagnostics, pro-jective drawings, Children Apperceptive Test. Formothers – partly formalized interview, question-naire of parental attitude, Spilberger anxiety scale.RESULTS: Parental attitude towards the chil-dren’s mental disorders, their education and otherdevelopmental sources depends rather more on thecancer induced somatic effects and prognosis thanon the reality of the neuropsychological status. Thepatient’s psychological well-being depends on thetype of the parental attitude and has negative corre-lation with the anxiety level of mother. CONCLU-SIONS: Patients’ mental development has gotmore impact of parent’s predisposition regardingchildren’s state than primary cognitive disorders.RESEARCH IMPLICATIONS: This approach letus to learn more about the psychological retarda-tion in mental development in children with thehead braintumors. ACKNOWLEDGEMENT OFFUNDING: The psychological diagnostics andcorrection is necessary in both – children with braintumors and their families.

P2-54

Corticosteroids–Induced Neuropsychiatric Episodes

in Acute Lymphoblastic Leukemia Adolescent

Patients

Marzena Samardakiewicz1, Magorzata Mitura-

Lesiuk2, Jerzy R. Kowalczyk1,2

1Medical University, Lublin, Poland, 2Dept. ofPediatric Hematology, Oncology andTransplantology, Lublin, Poland

BACKGROUND: Systemic corticosteroids, pred-nisone or dexamethasone (PRED or DEX), are animportant component of acute lymphoblastic leuce-mia (ALL) treatment protocols. Prolonged, andhigh dose admitting of corticosteroids can causesome neurotoxic effects, which can display somebehavioral changes, especially in young children.We evaluated an incidence of acute neuropsychiat-ric episodes in ALL adolescent patients receivingPRED (1–28 days: �60 mg/m2/day) and DEX (1–21 days: 10 mg/m2/day), according to ALL-IC2002 Protocol. METHOD: 37 consecutive adoles-cent patients (64.9% boys) with ALL diagnosisentered the study. Patients were diagnosed betweenJan, 2007 – March, 2012 in pediatric onco-/hema-tology ward in Lublin, Poland. Mean age at thediagnosis was 14.1 years and mediana 16.2 years.During intensive treatment patients were providedwith planned psychosocial support program. Addi-tionally, within first 2–3 weeks of treatment, evalu-ation of FIQ, VIQ and PIQ of patients wereperformed. Behavioral side-effects and neuropsy-



chiatric episodes were rated using clinical interviev.RESULTS: Mild intensity of behavioral sideeffects during corticosteroids therapy wereobserved in 29.7% of studied patients. The mostfrequently diagnosed symptoms were: anxiety, wee-piness, decreased mood and withdrawal. In thestudy, 5.7% of patients received antidepressanttreatment. Remaining patients with symptoms ofbehavior disorders received only hydroxyzine, thatwas adduced to individuals on the different level offrequency. 4/37 adolescent patients (10.8%)revealed acute neuropsychiatric episodes (with highanxiety, with seeing and hearing things, lack of con-sciousness) when corticosteroids were reduced. 2boys revealed acute neuropsychiatric symptomstwice: when both PRED and DEX were reduced.CONCLUSIONS: 1. Symptoms of mild intensitybehavioral corticosteroids side effects wereobserved in one third of adolescent cancer patients.2. ALL adolescent patients are at risk of neuropsy-chiatric episodes at the moment of corticosteroidsreduction. 3. Neuropsychiatric effects during activetreatment of ALL in adolescence needs furtherstudies. ACKNOWLEDGEMENT OF FUND-ING: Grant DS408/13. Sponsored by Ass. forChildren with Blood Disorders, Lublin, Poland.

P2-55

Abstract withdrawn

P2-56

Reliability and Utility of the Dutch Translation of

the Psychosocial Assessment Tool (PAT)

Simone M Sint Nicolaas1, Sasja A Schepers2,

Martha A Grootenhuis2, Chris M Verhaak1

1University Medical Center, Department of MedicalPsychology, Nijmegen, The Netherlands, 2AcademicMedical Center/Emma Children’s Hospital,Psychosocial Department, Amsterdam, TheNetherlands

BACKGROUND: Yearly, 550 children are diag-nosed with cancer in the Netherlands, which meansa confrontation with several stressors. Over timemost families adjust well to these stressors, but asubstantial part of the families lacks adequateadaptation, which can lead to severe psychosocialproblems. The use of the Psychosocial AssessmentTool (PAT) makes it possible to screen families fortheir risk of psychosocial problems. The currentstudy describes the reliability and utility of theDutch PAT. METHOD: Families of newly diag-nosed children with cancer (age 0–18) from fourDutch pediatric oncology centers (AMC/RUMCN/SKZ/VUmc) participated. During a one year per-iod 219 children were diagnosed with cancer ofwhich 128 were eligible (excluded: language prob-

lems, relapse, palliative treatment). Of the 128 eligi-ble families, 90 agreed to participate (response rate70%). At diagnosis one parent completed the PATand PAT utility scale among other questionnairesonline (www.hetklikt.nu). General utility of theDutch PAT was assessed on a 100 mm VAS-scaleafter completing the questionnaire. Data of 85 fam-ilies (59% female caregiver N = 50, 31% male care-giver N = 35) were available for pilot analyses.RESULTS: PAT total score (possible range 0.00–7.00) is the sum of seven subscales (possible range0.00–1.00). Total scores 0–1.0 are considered “uni-versal”, 1–1.9 “targeted”, and ≥2 “clinical”. Analy-ses showed that distribution of PAT riskcategorizations in the Netherlands was comparableto the United States (68.2% universal, 28.2% tar-geted, 3.5% clinical). Internal consistency of thetotal PAT score was satisfactory (a = 0.66) and ofmost subscales acceptable, however 3 scales needfurther consideration. Mean of the total PAT scorewas M = 0.77 (range = 0–2.63), mean scores of thesubscales ranged M = 0.06–0.22. Parents rated theutility positively: comprehensibility M = 78.25,clarity M = 79.68, unpleasantness M = 19.51,and appropriateness M = 62.82. CONCLU-SIONS: Reliability of the Dutch total PAT score issatisfactory, however on subscale and item levelthere is a need for closer examination. Parents ratedthe utility of the questionnaire positively. For theDutch situation, the best applicable item distribu-tion has to be investigated before it can be imple-mented in Dutch clinical pediatric oncologypractice. RESEARCH IMPLICATIONS: The dis-tribution of PAT risk scores in the Netherlands arecomparable to previous research in the United Sta-ted and Australia. However, internal consistency ofsome subscales need further examination on itemlevel to give more insight in the applicability of theDutch PAT. Results on this will be presented.CLINICAL IMPLICATIONS: The Dutch PAThas proven to be a feasible instrument to completeduring the beginning of treatment and was rated byparents as a comprehensible, clear, and appropriatequestionnaire. The distribution of the PAT riskscores in the Netherlands is comparable to the Uni-ted States, however on item level further examina-tion is needed. In the second period of our studythe feasibility of the clinical use of the Dutch PATwill be investigated. ACKNOWLEDGEMENT OFFUNDING: The IMPROVE study has beenfunded by the Dutch Cancer Society.



P2-57

A Longitudinal Case-Control Study on Goal

Adjustment in Adolescents With Cancer

Esther Sulkers1, Moniek Janse2, Aeltsje Brinksma1,

Petrie F. Roodbol1, Willem A. Kamps3, Wim J.E.

Tissing3, Robbert Sanderman2, Joke Fleer2

1University of Groningen, University Medical CenterGroningen, UMCG School of Nursing and Health,Groningen, The Netherlands, 2University ofGroningen, University Medical Center Groningen,Department of Health Sciences, Health PsychologySection, Groningen, The Netherlands, 3University ofGroningen, University Medical Center Groningen,Department of Pediatric Oncology/HematologyBeatrix Children’s Hospital, Groningen, TheNetherlands

BACKGROUND: Severe illnesses may disturb theattainment of personal meaningful goals. Beingable to adjust one’s goals to what is possible is anadaptive way to deal with goal disturbance. Thestudy examined whether: (1) the goals of adoles-cents with cancer (3 and 12 months post-diagnosis)differed from those of healthy controls with regardto value-orientation and abstraction level, (2) thevalue-orientation and abstraction level of the goalsof adolescents with cancer changed over time.METHOD: Thirty-three adolescents with cancer(age median = 14 years, 55.9% girls, all types ofcancer) and 66 matched controls completed the Per-sonal Project Analysis Inventory. Participants wereasked to generate their personal goals for theupcoming year and to rate them on goal-impor-tance. All goals were coded by two independent rat-ers on goal content and abstraction level.RESULTS: Significant between-group effects (atbaseline and follow-up) were found for value-orien-tation and goal abstraction. Compared to controls,adolescents with cancer showed an intrinsic ratherthan extrinsic value-orientation (i.e. reporting moreintrinsic than extrinsic goals, assigning higher rat-ings of goal-importance to intrinsic than extrinsicgoals). Furthermore, adolescents with cancerreported their goals on a lower level of abstractionthan controls. Despite small changes, there were nosignificant differences in patients’ goals over time.CONCLUSIONS: Group differences in value-ori-entation and goal abstraction indicate that adoles-cents with cancer use the flexible structure of thegoal system to deal with changing circumstances togoal pursuit. The lack of change over time suggeststhat goal adjustment begins early in the disease tra-jectory and continues over time. More researchwith a longer follow-up is needed to determinewhether these shifts in value-orientation and goalabstraction level are permanent or not.RESEARCH IMPLICATIONS: This study hasenhanced understanding of goal adjustment in ado-lescents with cancer. Not known however, is

whether the shifts in value-orientation and goalabstraction, are permanent or not. This might beaddressed in future research. Other venues forfuture studies with a longer follow-up periodinclude the influence of late effects of cancer treat-ment (which may become apparent at a later pointin time) on patients’ goal system, and the relation-ship between goal adjustment and well-being.CLINICAL IMPLICATIONS: Notwithstandingour results that on the average the adolescents withcancer adapt relatively well to goal disturbance,there might be individuals who are less able toadjust their goals appropriately. For those, targetedsupport (e.g. information about the timeline ofhealth related constraints to goal pursuit, advice onalternative routes to goal achievement,) should beavailable in order to facilitate adaptive disengage-ment and reengagement. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-58

Neuropsychological Follow-Up of Children With

Acute Lymphoblastic Leukemia

Jurgen Lemiere1, Trui Vercruysse1, Nathalie Nolf2,

Elke Van Gysel1, Ben Van Calster3,4, Nady Van

Broeck5, Marleen Renard1, Yves Benoit2, Anne

Uyttebroeck1

1Paediatric Haemato-Oncology, UniversityHospitals Leuven, Leuven, Belgium, 2PediatricHaemato-Oncology, Ghent University Hospital,Gent, Belgium, 3Department of Development andRegeneration, KU Leuven, Leuven, Belgium,4Biostatistics Unit, Leuvens Kankerinstituut,University Hospitals Leuven, Leuven, Belgium,5Clinical Psychology, KU Leuven, Leuven, Belgium

BACKGROUND: Acute lymphoblastic leukemia(ALL) is the most common malignancy in children.Decades ago childhood ALL was a largely fatal dis-ease. However, nowadays, thanks to improvedtreatments, children with ALL have a great chanceto survive. The purpose of this study is to evaluatethe impact of possible risk factors (gender, age atdiagnosis, risk stratification and parental educa-tional level) on the development of intellectualfunctioning in a group of Chemotherapy-Only-Treated children for ALL. METHOD: Between1990 and 1997, a group of 94 patients (median ageat first assessment: 6.4 years) treated with chemo-therapy were included in a multi-center prospec-tive-longitudinal study. All children were treatedaccording to the EORTC 58881 protocol. CNS pro-phylaxis consisted of HD-Methotrexate IV(4 9 5 g/m²/24 h) and IT-Methotrexate, withoutcranial irradiation. Inclusion criteria were: age atonset <12 years, primary disease, low or standardrisk, no CNS invasion. Intellectual functioning wasevaluated at 3 timepoints, with a 3-year interval,



using the Dutch adaptation of the Wechsler Intelli-gence Scale for Children Revised. RESULTS: Theresults of the multiple regression analysis showedthat IQ increased more strongly over time for PIQthan for VIQ (Increase per year is 1.2 points morefor PIQ, p = 0.0002). Age at diagnosis and parentaleducational level were significantly related to intel-lectual functioning. Children of which at least oneparent finished higher education (p < 0.0001).Additional, increasing age at diagnosis led to higherIQ scores (p = 0.04). Further, no significant differ-ences were found between boys and girls and low orstandard risk. CONCLUSIONS: Parental educa-tional level and age at diagnosis are significantprognostic factors for IQ. Despite potential neuro-toxic effects of chemotherapy in the treatment ofchildren with ALL, no negative late effects onintelligence were found in this prospective longitu-dinal study. RESEARCH IMPLICATIONS: Eval-uation of neuropsychological long-term effects oftreatment for ALL is extremely important. Themethodology of the present study encompassessome important strengths: multi-centric and longi-tudinal design using same cognitive assessmenttool. However, a more broaden neuropsychologicalbattery and ecological valid instruments are neededto fully understand potential risk factors on cogni-tive functioning in children treated for ALL. CLIN-ICAL IMPLICATIONS: Despite the absence ofintellectual decline in Chemotherapy-Only-Treatedchildren for ALL it cannot be concluded that a neu-ropsychological follow-up of this group is not nec-essary. In clinical practice it is recommended to bealert for signals of neuropsychological problems indaily life of this group. When signals of neuropsy-chological problems are present it is crucial to assessa neuropsychological battery that encompassesmore than a measure of intellectual functioning.ACKNOWLEDGEMENT OF FUNDING: None.

P2-59

The Use of Psychodrama in Teaching Oncology

Nurses Death Awareness Through Confronting Their

Own Death

Azize Atli OzbaşHacettepe €University Faculty of Nursing, Ankara,Turkey

BACKGROUND: Oncology Nurses work remindsthem of their own mortality, challenging their useof denial; and forces the awareness of death uponthem in a way that they may be unprepared for.This study describes the use of psychodrama as atechnique to help oncology nurses confront theirown mortality and develop a sense of death aware-ness in a protected environment, outside of the clin-ical setting, in order to reduce stress when workingwith dying patients. METHOD: This study wasconducted with a cohort of 36 oncology nurses.

Psychodrama techniques and methods were used tohelp nurses confront their own mortality and feel-ings around their own eventual deaths. The nurseswere asked to estimate their life expectancy andpredict their age and/or the dates of their antici-pated death. Participants organized anticipateddeaths in a room. The Psychodramatist madeapproached them step by step to anticipated deathages and asked a second life on the end day. Studyassessments consisted of qualitative data analyzedby the researchers from observations of the psycho-drama exercises transcriptions of nurses’ state-ments. RESULTS: The majority of nurses in thisstudy accepted their deaths, while the death of aloved-one was more likely to be denied or unaccept-able. More than half of the nurses were determinedto be accepting of death when the time comes (aver-age mean 70 years). A majority of the nurses deathstimated that they would live very long lives andthus death was in the very distant future. Most didnot want to consider living a second life suggestedby psychodramatist. This wanting was correlatedwith perceptions of locus of control, and percep-tions of death. CONCLUSIONS: Nurses’ attitudeof denial of death, ignorance and isolation areobserved. The majority of nurses acknowledge thatdeath is inevitable, they have death awarenessabout themselves; they see themselves living to 70–75 years of age. However, they rarely mention thepossible death of parents or spouse. Approachingdeath, the choice to consider living a second lifeafter this life ended was correlated with thinking,(a) there is no chance to change, (b) they want todo something different with their lives, (c) thosewho felt a sense of acceptance of the life they livedand peace of mind. RESEARCH IMPLICA-TIONS: Death is a very difficult issue to beaddressed. As Yalom says, “to look at the sun is toface death.” The psychodrama method can moreenable this confrontation. Unlike other methods oftherapy, psychodrama is here and now to solve theproblem and of the past as well as future concerns,including offers to work on a multi-dimensionalreality. CLINICAL IMPLICATIONS: Althoughsignificant advances in oncology, cancer continuesto evoke fears of impending death. When nursesworking with oncology patients don’t recognize thesituation of the patient, are not aware of their ownfeelings about death, they often feel helplessnessand aren’t able help patients and their families asprofessionals. Nurses need tobe aware of their emo-tions, thoughts, attitudes towards death. This studyof nurses’ attitudes towards death, offers a methodto help enhance death awareness. ACKNOWL-EDGEMENT OF FUNDING: This study is notsupported by any institute.



P2-60

Empowerment and Related Factors in Oncology

Nurses

Azize Atlı Ozbas1, Havva Tel2

1Hacettepe University Faculty of Nursing, Ankara,Turkey, 2Cumhuriyet €University Faculty of HealthScıences, Sivas, Turkey

BACKGROUND: Oncology nurses, when com-pared to other nurses, are confronted with uniquechallenges based on the kind of treatments theyapply and the group of patients they care for. Theconcept of power and empowerment are increas-ingly important in the field of oncology nursing.The purpose of this study is to determine the per-ception of empowerment and related factors inoncology nurses. METHOD: This is a descriptivestudy in a cohort of 135 oncology nurses from gov-ernment oncology hospitals in Ankara, Turkey.Structural empowerment was measured using theConditions of Work Effectiveness Questionnaire-II(CWEQ-II), and psychological empowerment wasmeasured using Spreitzer’s psychological empower-ment scale. In addition data was collected using apersonal information form, the Maslach BurnoutInventory and the Beck Depression Inventory.Pearson correlation analysis, k2 test, and t-test wereused in the statistical evaluation of the data.RESULTS: In this study, nurses average age was30.78 � 5.6, average number of years working inoncology = 8.6 � 6.6. Nurses work place empow-erment inventory average score = 3.16 � 0.5; psy-chological empowerment average score = 5.54 �0.96, effectiveness subscale of psychologicalempowerment ( = 4.39) was less than the workactivity subscale of work place empowerment per-ception Nurses’ ( = 2.8). There is a significant nega-tive relationship between nurses workplaceempowerment score and emotional burnout (r =�0.18; p < 0.05), psychological empowerment score,and depression (r = �0.23; p < 0.05). Among nurses,decrease in work place empowerment increases emo-tional burnout; and similarly a decrease in psycho-logical empowerment increases depression.CONCLUSIONS: Psychological empowermentperception and workplace empowerment perceptionof oncology nurses are higher than the middle level.Effectiveness dimension of psychological empower-ment and work activity dimension of workplaceempowerment scores were lower than the other sub-scales. These 2 subscales are concerned with the deci-sion and control over their activities. RESEARCHIMPLICATIONS: Empowerment perception ofnurses is not related to socio-demographic vari-ables. However, empowerment perception is relatedto emotional burnout their depression level. Forthis reason, an intervention focusing on empower-ment in oncology nurses may be effective in pre-venting depression and emotional burnout. Studies

are needed to focus on work activities and effective-ness in order to help nurses feel more empowered.CLINICAL IMPLICATIONS: Empowering pro-vide practitioners with access to information, sup-port, resources, and opportunities to learn andgrow. Empowerment is also a psychological pro-cess, which occurs when one has a sense of motiva-tion in relation to the workplace environment.Because of their working environment oncologynurses are commonly faced with emotional fatigueand psychological problems. For this reason; indi-vidual and institutional regulations should beplanned to provide awaking of nurses’ power.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is not supported any institute.

P2-61

The C�edric H�ele Institute: 10 years of Development

of Expertise in Psycho-Oncology In Flanders

Sofie Eelen1, Sabien Bauwens2, Wim Distelmans2,

Eva Jacobs1, Angelique Verzelen1

1C�edric H�ele Instituut vzw, Mechelen, Belgium,2Universitair Ziekenhuis Brussel - Oncology Centre,Brussel, Belgium

BACKGROUND: In Belgium there was a need tobundle, expand and improve psychosocial care inoncology. A lot of caregivers wished to enhanceand to improve the quality of their interventions. Inorder to respond to these needs, a group of expertcaregivers joined their strengths and knowledge byestablishing a multidisciplinary Flemish Institutefor psychosocial oncology, called the C�edric H�eleinstituut (CHi). All of this found place in collabora-tion with care providers and policy agents.METHOD: A focus of CHi is to organize andcoordinate training in psychosocial care and to cre-ate networks of caregivers. The CHi organizes sev-eral courses and workgroups for different targetgroups (doctors, psychologists, social workers, [spe-cialist] nurses). On the CHi-website, informationabout courses, symposia, literature and research ispublished. In contacts with the caregivers CHiobserves needs in psychosocial care. Another focusis to indicate these needs to policy agents. CHi wasinvolved in coordination platforms and work-groups of the National Cancerplan of the Belgiangovernment. CHi participates in research projectsin psycho-oncology in order to promote evidencebased practice. RESULTS: In 2012 106 profession-als in oncology participated in one of the CHicourses or workgroups. The workgroup of onco-psychologists grew from 5 to 160 members. CHi or-ganised in association with the universities, for thefourth time a two-year training in psycho-oncology.The Belgian government finances the subscriptionof 35 psychologists in the psycho-oncology pro-gram and of 150 professionals in the communica-tion trainings. CHi organized an event for 210



participants. 9 courses were organized in service ofother organisations. CHi-website has 2400 visitorsper month. Regularly a newsletter is composed,sent and read by 1500 professionals. CHi partici-pated in research projects. CONCLUSIONS: Sinceits foundation the CHi has become a reference formany professionals in oncology. It’s a place wherenetworking and continuing education in psychoso-cial oncology takes place and is encouraged. In2013 the CHi wants to create an internet commu-nity and forum to further improve networking andto centralize and gather knowledge and informa-tion. The government finances a project to use thiscommunity for research purposes, to further inves-tigate the needs of professionals in oncology. Overthe next few years the CHi hopes to become areference centre for scientific research in psychoso-cial oncology in Flanders. RESEARCH IMPLI-CATIONS: All CHi education programs andnetworking activities, are evidence-based and pro-mote the implementation of evidence based knowl-edge and interventions in the daily clinical practiceof oncology. CHi aspires to encourage and coordi-nate more innovating research in psychosocialoncology. This action will stimulate practice basedevidence. The close contact with onco professionalscan generate interesting research partnerships.CLINICAL IMPLICATIONS: The Chi is a refer-ence in psychosocial oncology in Flanders. The Chiprovides professionals a large network, access toinformation and scientific research in psycho-oncol-ogy and a range of training in the psychosocialaspects in oncology and important skills. Since10 years Chi promotes the importance of the psy-chosocial aspects in oncology and enhances exper-tise of onco-professionals. The facilitation andstimulation of scientific research and the distribu-tion of publications, promotes evidence basedpractice in psycho-oncology. ACKNOWLEDGE-MENT OF FUNDING: The C�edric H�ele instituutcould be founded thanks to the support of thenational society “Vlaamse Liga tegen Kanker” (theFlemish League against Cancer).

P2-62

To Prevent Burnout and To Promote Spiritual Well-

Being in Physicians Among Cancer Care

Chun-Kai Fang1, Yuh-Cheng Yang1, Pei-Yi Li2

1Mackay Memorial Hospital, Taipei, Taiwan,2National Taipei University of Nursing and HealthSciences, Taipei, Taiwan

BACKGROUND: Previous studies found physi-cians among cancer care often suffering from burn-out and poor well-being. The studies were to createand evaluate the continuing medical education forphysicians to prevent burnout and to promote spiri-tual well-being. METHOD: After surviving thephenomenon and factors of burnout, we design the

lecture including (1) awareness and exploration, (2)stress and burnout, and (3) response and adjust-ment. We designed Course A (60 minutes) andCourse B (180 minutes) both included all threethemes. Participants decided to attend one courseby themselves. We measured the satisfaction andthe efficiency 3 months later. The tools of evalua-tion included: Michigan Organization AssessmentQuestionnaire (MOAQ), Maslach Burnout Inven-tory-Human Service Survey (MBI-HSS), Demoral-ization Scale-Mandarin Version (DS-MV), andPhysician’s Spiritual Well-Being Scale (PSpWBS).RESULTS: There were 57 physicians (responserate = 54.8%) completing the questionnaires. Theseverity of demoralization among physicians agedover 45 was decreased after the intervention(p = 0.04, T-test). The physicians who had notexperienced their family died appeared the spiritualgrowth after the courses (p < 0.001, T-test). Theseverity of burnout among physicians who hadexperienced their family died was decreased afterthe intervention (p = 0.08, T-test). CONCLU-SIONS: It is possible through continuing medicaleducation to promote spiritual growth and to pre-vent depletion of the physicians occurred. However,according to our findings, it is necessary to designdifferent courses for different groups. To promotepsychological and spiritual health of physiciansamong cancer care is important. RESEARCHIMPLICATIONS: It needs much time to preventburnout and promote spiritual growth; however,we try to find some efficient ways under the busymedical work and provide the evidence-basedresearch. CLINICAL IMPLICATIONS: The psy-chological health and spiritual well-being is medicalethic for patients and family. ACKNOWLEDGE-MENT OF FUNDING: Taiwan National ScienceCouncil (NSC 100-2511-S-195-001-).

P2-63

Mental Health of Health Care Providers in a Cancer

Hospital, a Three Year Follow-Up

Chihtao Cheng1,2, Shenghui Hsu1, Yichen Hou1,

Pohsien Lin1, Ginglong Wang1, Shihming Shih1

1KFSYSCC, Taipei, Taiwan, 2Department ofpsychology and social work, National defenseuniversity, Taipei, Taiwan

BACKGROUND: Health care providers in cancerhospitals often suffer from great stress from work.Psychological disturbance and burn out are notrare in the population. Screening for psychologicaldisturbance among health care providers enablesearly detection and management of minor mentalillness, which leads to better employee mentalhealth and clinical care. The stress level and psy-chological disturbance encountered by health careproviders in cancer hospitals may vary with time.METHOD: This study aims to look into the varia-



tion of mental health screening results over a periodof 3 years. We used a 12-item Chinese Health Ques-tionnaire as a screening tool for psychological dis-turbance. A cut-off point of 3/4 was used foridentifying psychological disturbance. RESULTS:Nurses had a significantly higher prevalence of psy-chological disturbance then other health profes-sionals in the cancer hospital. Higher psychologicaldisturbance of health care providers was observedin specific months of each year. CONCLUSIONS:The mental health of health care providers in can-cer hospitals may differ from one professionalgroup to the other; it may also varies at differenttimes of the year. RESEARCH IMPLICA-TIONS: This study demonstrates a pattern ofvariation of psychological disturbance amonghealth care providers in a cancer hospital over time.Possible cause of this phenomenon needs furtherinvestigation. CLINICAL IMPLICATIONS: Thisstudy on the mental health of health care providersin a cancer hospital calls for our attention andintervention in particular groups and at particulartimes of the year. ACKNOWLEDGEMENT OFFUNDING: None.

P2-64

Health and Wellbeing in Portuguese Health Care

Providers in Women With Breast Cancer

Maria Joao Cunha1, Joao Paulo Pereira1, Santiago

Gascon2, Jo~ao Pereira3, Marisa Costa1

1ISMAI, Porto, Portugal, 2Universidad Zaragoza,Zaragoza, Spain, 3ISCTE, Lisbon, Portugal

BACKGROUND: Oncology health care profes-sionals are involved in the treatment and with thechallenge presented by the complexity of the tasksrelated to diagnosis and clinical care; they facepainful situations, perception of workload anddemands related to the process of communicatonwith patients and families. Literature reports highlevels of stress experienced by these professionals,risk of burnout (Maslach, 1982; Schaufeli & Enz-mann, 1988), emotional disorders, and poor percep-tion of quality of life. METHOD: Aims:Investigate the stress vulnerability, burnout, psy-chopathological symptoms and quality of life inthese professionals by examining whether there aredifferences by gender and length of service in thefunction. We aim to verify how vulnerability tostress, burnout, psychopathological symptoms andquality of life are intercorrelated. Instruments:23QVS; MBI; Areas Worhlife; BSI; WhoQoL(Bref); Bref Cope R. Participants: 103 breast oncol-ogy professionals, mean age = 34.83 years, 78%nurses, 48% work in shifts; 47% work more than12 years. RESULTS: 14% vulnerable to stress; 3%burnout; 12% emotional disorders; Perception ofreasonable quality of life. Health professionals whocare for women with breast cancer and that reveal

themselves vulnerable to stress have higher rates ofpsychopathological symptoms, emotional exhaus-tion, and a less positive perception of their qualityof life. The initial stage of development of the activ-ity in this context is associated with greater difficul-ties of personal fulfillment. Women doesn’t notshow higher levels of stress vulnerabildade andburnout when compared to men. CONCLU-SIONS: Participants, who are at an early stage ofthe development of professional activity have moredifficulties of personal fulfillment and expresshigher levels of psychopathological symptomswhich leads to rethink the support given to them atthis stage. The inexistence of diferences related togender, seems to suggest that these identification isnot crucial to the welfare of these professionals.However, males health professionals tend to havemore difficulties in managing emotions thanfemales. RESEARCH IMPLICATIONS: Theresults of this study appear to show the importanceof prevention plans, health promotion and inter-vention on psychosocial risks in oncology and par-ticularly in breast oncology. The levels of stress candirectly affect the health and well being of theseprofessionals, increasing the possibility of error inthe execution of their tasks, absenteeism increase,decrease how communication takes place, increas-ing incivility. CLINICAL IMPLICATIONS: Inmost cases the focus of interventions in psicooncol-ogy has been directed to patients and families. Hasbeen forgotten wellbeing and health professionalswho care for them all and who strive to providequality services. Thus, we think it is essential tolook for an assertive also for those who care. Con-tribute to their professional achievement and healthis also a way to gain an improvement in care tooncology patients. ACKNOWLEDGEMENT OFFUNDING: We thank UNIDEP-ISMAI the sup-port given to the execution of this work.

P2-65

The Impact of a Clown Intervention on the

Symptoms of Anxiety and Depression of Adult

Patients With Advanced Cancer

Guilherme Kenzzo Akamine, �Erika Neves de

Souza Moraes, Fl�avio Mitio Takahagui, Gabriel

Henrique Beraldi, Sandra Scivoletto

University of S~ao Paulo, S~ao Paulo, SP, Brazil

BACKGROUND: Patients with cancer frequentlysuffer from psychiatric disorders, namely anxietyand depression, which may result in increased costs,extended hospitalization period, reduced treatmentcompliance and impairment in quality of life.Recent studies show that the intervention withclowns may be an alternative to manage emotionaldistress in children. The main scope of this studywas to investigate the impact of a clown interven-



tion on anxiety and depression symptoms of adulthospitalized patients with advanced cancer.METHOD: Eighty-seven adult patients withadvanced cancer participated in the study: 44 ofthem belonged to the experimental group (EG), 43to the control group (CG). During hospitalization,patients of the EG interacted one or two times witha couple of clowns properly trained. All partici-pants of the EG were assessed through the HospitalAnxiety and Depression Scale (HADS) beforeclown intervention (baseline), and then after thefirst (T1) and the second (T2) intervention. Patientsof the CG were also assessed through HADS. Rele-vant clinical and demographic data were obtainedand repeated measures ANOVA was used for correla-tion with psychiatric morbidity. RESULTS: Theonly demographic variable that differed betweengroups was gender, with more women in the EG(p = 0.007). The HADS-A (anxiety) and HADS-D(depression) mean scores were similar between bothgroups at baseline (HADS-A: EG 7.68, CG 7.56;HADS-D: EG 6.86, CG 6.28; p > 0.05) andremained so until T2 (group 9 time interaction,p > 0.05, for both HADS-A and HADS-D).Patients in the EG presenting with more severesymptoms at baseline (i.e. HADS-A or HADS-Dscores ≥ 9) showed greater chances of decreasingHADS scores over time when compared to patientswith milder symptoms at baseline in the same group(p < 0.05). CONCLUSIONS: Although we did notobserve significant differences on the symptoms ofanxiety and depression between both groups, themean scores of both HADS-A and HADS-Dshowed a clear tendency to decrease in the EG. Thepatients who presented with more severe symptomswere those who have most benefited from the inter-vention. Due to some studies pointing out themedical benefits that clown interventions may bringto infants, we encourage more studies to be devel-oped considering adult patients as well. Finally, theintervention with clowns may be a low-cost,easy-to-use, non-pharmacological complementarytherapeutic modality, especially in the context ofpalliative care. RESEARCH IMPLICATIONS:We encourage new studies to be developed withbigger samples of adult patients with advanced can-cer, longer time of intervention and evaluation ofoutcomes in other dimensions of health, such as thePerformance Status, pain and quality of life scales.There is need to determine how long the positiveimpact of a clown intervention could last and, even-tually, if patients with milder symptoms of anxietyand depression would also benefit from a longerintervention span. CLINICAL IMPLICATIONS:Therapeutic clowning is being largely used world-wide and is thought to play an important comple-mentary role in healthcare, though there is ashortage of evidence in this field, especially when itcomes to adult patients. This study addresses thebenefits that adult patients with advanced cancer -

who demand special attention in mental health care-, could get from an intervention with clowns,mainly the ones presenting with more severe symp-toms of anxiety and depression. ACKNOWL-EDGEMENT OF FUNDING: None.

P2-66

The Role of Psychological Trauma and Traumatic

Situation in the Pathogenesis of Cancer

Eugenia Ananyeva

Chelyabinsk Regional Oncology Center,Chelyabinsk, Russia

BACKGROUND: Patients with psychotraumaalways require special handling in therapy. Cancerpatients may be in the process of psycho traumaticor simply to experience distress of varying intensity.Understanding the psychodynamics of injury helpsto build a competent plan interventions and pro-motes a differentiated and individualized approachto cancer patients on therapy. METHOD: Multi-level trauma psychotherapy proposed by ProfessorH. Fischer, is a recognized method of treatment oftraumatized people in Germany. During the trau-matic process is developing a variety of symptoms,including secondary symptoms of psychosomatic dis-eases. In the case of secondary cancer is, in fact, thesymptoms come to the fore, making itself less con-spicuous traumatic process of going deep in the psy-che. That less, the patient requires travmaterapiya,along with the conventional methods of care. Profes-sor Fisher’s method maximizes carefully and effec-tively help these patients cope with the effects ofpsychological trauma. RESULTS: Among patientsdiagnosed with cancer in the history of life there isthe presence of distress 1–3 years before diagnosis.However, symptoms of traumatic process atstudies revealed only in some patients. CONCLU-SIONS: We can assume that a lot of patients canbe classified into the category of psychologicaltrauma. That is, they have a history of not only atraumatic situation as such, but also develops a psy-cho traumatic process. Unlike traumatic situationfrom the process can be reduced to the subjectiveexperience of human feelings of helplessness andtotal collapse of the world that accompany living adifficult life situation (psychological trauma) orabsent (traumatic situation distress). CLINICALIMPLICATIONS: The ability to notice the signsof the presence or absence of patient psychologicaltrauma, further helps to build a customized plan ofintervention, taking into account the psychodynamics of the injured person. For these patientsis particularly important caring and respectful atti-tude to their experiences and suffering. Specificitytiered therapy helps restore peace injuries in andaround the patient, creating additional resources asneeded cancer patients. ACKNOWLEDGEMENTOF FUNDING: None.



P2-67

U-CARE: YoungCan - Development of an

Internet-Based Self-Help Program of Psychosocial

Support and Psychological Treatment

Malin Ander, Louise von Essen, Gustaf

Ljungman, Elisabet Mattsson, Teolinda Toft, Ann-

ika Lindahl Norberg

Uppsala University, Uppsala, Sweden

BACKGROUND: Although most persons struckby cancer during adolescence cope well with theexperience an important minority report clinicallyrelevant cancer-related emotional distress. Internet-based self-help (ISH) may represent an alternativeto provide access to evidence-based psychosocialsupport and psychological treatment. This paperdescribes the development including the theoreticaland empirical framework of an ISH program: U-CARE: YoungCan with the aim to reduce cancer-related emotional distress among adolescents andyoung adults (AYA) struck by cancer during ado-lescence. METHOD: The development of U-CARE: YoungCan was guided by previous researchand clinical observations of cancer-related emo-tional distress and how it can be understood andconceptualized from the perspective of cognitive andbehavior theory. Treatment components build uponevidence-based treatments for psychiatric conditionsrelated to issues described by AYA struck by cancerduring adolescence. RESULTS: U-CARE: Young-Can targets: worry and anxiety; depressive symp-toms; body dissatisfaction; and mild traumaticstress and includes cognitive behavioral therapy;information; and moderated interactive support.The program is accessible via an internet platform,the U-CARE-portal, during 12 weeks. The pro-gram’s feasibility e.g. it’s acceptability has beentested in a pilot study and in a lived experiencegroup. The program’s clinical efficacy and cost-effectiveness will be evaluated in a randomized con-trolled trial starting during 2013. CONCLU-SIONS: This paper describes the development andrationale of an ISH program for survivors of cancerduring adolescence. Such programs are likely thewave of the near future and may make psychosocialcare and psychological treatment accessible to thosewho need it. Development and tests of the effects ofthis venue are therefore essential. RESEARCHIMPLICATIONS: The description of U-CARE:YoungCan make an important contribution to thebody of knowledge regarding internet-based psycho-social support and psychological treatment forAYAs struck by cancer during adolescence. CLINI-CAL IMPLICATIONS: A significant minority ofthose struck by cancer during adolescence suffersfrom cancer-related emotional distress. There is alack of evidence-based interventions for this popula-tion. Development and tests of the effectiveness ofsuch interventions are therefore essential. U-CARE:

YoungCan may represent a promising approach toprovide psychosocial support and psychologicaltreatment to AYAs who suffer from cancer-relatedemotional distress. ACKNOWLEDGEMENT OFFUNDING: This work was supported by a strate-gic grant to Uppsala University Psychosocial CareProgram (U-CARE); The Swedish Cancer Society(grant number CAN 2010/726 Louise von Essen);and The Swedish Childhood Cancer Foundation(grant number PROJ10/086 to Louise von Essen).

P2-68

Pre-Operative Exercise Training in Advanced Rectal

Cancer Patients: Exploring Perceptions of Quality

of Life During Active Treatment

Shaunna Burke1, Jennifer Brunet2, Catherine

Sabiston3, Sandy Jack4, Michael Grocott5,

Malcolm West6

1University of Leeds, Leeds, UK, 2University ofOttawa, Ottawa, Canada, 3University of Toronto,Toronto, Canada, 4University HospitalSouthampton, Southampton, UK, 5University ofSouthampton, Southampton, UK, 6AintreeUniversity Hospital, Liverpool, UK

BACKGROUND: Improving quality of life (QoL)of advanced cancer patients is a foremost concernamong health care practitioners. Exercise canenhance QoL in patients undergoing active treat-ment for cancer. Little is known about the impactof exercise on experiences of QoL during the timeperiod after neoadjuvant therapy while awaitingsurgery. The purpose of this study was to exploreadvanced rectal cancer patients’ perceptions ofquality of life during participation in a pre-surgeryexercise program METHOD: A hermeneutic phe-nomenological approach was used to guide this lon-gitudinal study to allow for the co-construction of ameaningful understanding of how QoL might beshaped by advanced rectal cancer patients’ partici-pation in a pre-operative exercise program. Patients(n = 10) participated in repeated semi-structuredin-depth interviews which covered four broad QoLdomains (i.e. physical, psychological, social, spiri-tual well-being). Patients’ personal accounts ofQoL were explored prior to (0-weeks), midway (3-weeks), and at completion (6-weeks) of the pro-gram. We analyzed the data using strategiesgrounded in a phenomenological approach.RESULTS: Participation in the program facili-tated positive changes in QoL over time by: (1) fos-tering a greater sense of vitality; (2) cultivating apositive attitude; (3) enhancing social connections,and; (4) fostering a strong sense of purpose in lifefor these patients. CONCLUSIONS: Pre-operativeexercise programs can be effective in promotingQoL among patients diagnosed and treated forlocally advanced rectal cancer during a particularly



difficult time in the cancer trajectory. Additionalresearch is needed to develop and evaluate imple-mentation strategies to facilitate the delivery of pre-operative exercise programs as part of routine carein this population. RESEARCH IMPLICA-TIONS: This study led to a better understandingof advanced rectal cancer patients’ experiences ofQoL during participation in a 6-week structuredexercise program after neoadjuvant therapy andprior to surgery. Large-scale studies testing theeffectiveness of pre-operative exercise interventionsthat help advanced cancer patients positivelyappraise their QoL are needed. CLINICALIMPLICATIONS: This study suggests that healthcare providers might want to council their patientsto increase their pre-operative exercise levels as itmight prevent worsening of fatigue and promotevitality, a postive attitude, social wellbeing, and asense of purpose among advanced rectal cancerpatients. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-69

Effects of Qigong Practice on Salivary Cortisol in

Cancer Patients and Their Caregivers: A

Randomized Waitlist-Controlled Trial

Timothy H. Y. Chan1, Lai Ping Yuen2, Tammy

Lee3, Jessie S. M. Chan1, Jonathan S. T. Sham1,

Cecilia L. W. Chan1

1Centre on Behavioral Health, University of HongKong, Hong Kong, 2International Association andHealth and Yangsheng, Hong Kong, 3The HongKong Anti-Cancer Society, Hong Kong

BACKGROUND: Evidence on whether the prac-tice of qigong, a mind-body integrative exercise intraditional Chinese medicine, improves quality oflife remains inconclusive. Previous studies showedcortisol changes in healthy subjects after practicingqigong, while study of breast cancer patients foundno cortisol changes at the end of a qigong course.The objective of this study is to examine the effectsof qigong on salivary cortisol in mixed cancerpatients and their caregivers. METHOD: Ninety-six pairs of mixed cancer patients and their caregiv-ers (N = 192) participated in a randomized waitlist-controlled trial. Fifty pairs joined a 10-sessionqigong training practice while 46 pairs served ascontrols. Dropout rate was 11% (intervention: 5,control: 6) at the end of intervention, with addi-tional 8% at follow-up after 1 month (intervention:8, control: 0). Assessment was conducted at base-line, the end of intervention, and follow-up. Atassessment, each patient-caregiver pair collectedsaliva samples at home on the same day (waking,45 minutes after waking, noon, 5pm and 9pm) andcompleted measures of perceived stress and sleepquality. RESULTS: Cortisol values were natural

log transformed before analysis. The diurnal slopeand area-under-the-curve (AUC) were calculated.Among patients, cortisol levels increased signifi-cantly at noon and 5pm after intervention(F = 6.28 and 5.30, all ps < 0.05); mean cortisoland AUC were also elevated (F = 5.83 and 5.36).No significant changes were observed at follow up.Among caregivers, no significant changes of sali-vary cortisol were observed after intervention,although a flatter diurnal slope was observed inintervention group at follow up (F = 4.69). Bothpatients and caregivers reported no significantchanges in perceived stress and sleep quality. CON-CLUSIONS: Contrary to what has been reportedin the literature, the current findings showed thatqigong practice led to increased daytime cortisollevels in cancer patients, and flatter diurnal slope incaregivers. Both results were indicative of higherstress. Whether qigong practice increased stress lev-els was unclear, as no corresponding changes inperceived stress and sleep quality were observed.Further research is needed to understand the causeof cortisol changes after qigong practice.RESEARCH IMPLICATIONS: The current studyshows that qigong practice may result in heightenedcortisol secretion. Previous studies showed that sali-vary cortisol increases significantly immediatelyafter high intensity exercises. This study reveals apotential confounding problem when using salivarycortisol as a physiological marker of stress in anexercise intervention study. CLINICAL IMPLI-CATIONS: Qigong practice is increasingly inte-grated in supportive cancer care in Chinesecommunities. While it is generally safe with little sideeffects, more research is needed in order to under-stand its physiological effects on cancer patients.ACKNOWLEDGEMENT OF FUNDING: None.

P2-70

Abstract withdrawn

P2-71

Horticultural Therapy: The Use of Gardening in a

Support Group in Cancer Ward

Chung Ching Hui

Mackay Memorial Hospital, Taipei, Taiwan

BACKGROUND: Horticultural therapy has usedin the hospital from Ancient Egypt. Doctors letpatients touch natural landscape. It improvespatients mental and physical healthy (Paine &Francis, 1990; Paine, 1997). Horticultural therapyprovides a nonthreatening context for the develop-ment of a therapeutic alliance between patients andmedical team members. Horticultural therapy isn’tlimited to the form of actual gardening, includingimagining nature, viewing nature, visiting a healinggarden in the hospital. METHOD: Support groups



are a safe place for people to share the pain of grief,loss and offer emotional support. Combining thesupport of the group and horticultural therapyoffer patients what they need most: acceptance andnonjudgmental listening. This is a 12-week horticul-ture program and an open group. The authordesigned sensorial activities including vision, touch,smell, taste and hearing. RESULTS: Horticulturaltherapy was expected to influence healing, alleviatestress, increase well-being and promote the partici-pation in social life. It also improves patient’s socialskills, self-esteem. Although cancer and anti-cancertherapy menace their life, they learn “Life” fromthe plants. CONCLUSIONS: Horticultural ther-apy mediates emotional, cognitive and sensorymotor function improvement. It increases socialparticipation, healthy and well-being and life satis-faction. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-72

A Study of Cancer Survivors’ Wellbeing and

Volunteering Work

Florence Oi Yan Chung

Hong Kong Cancer Fund, Hong Kong

BACKGROUND: The purpose of this study wasto investigate the impact of volunteering on cancersurvivors’ wellbeing. Numerous studies have founda positive relationship between volunteering andwellbeing (Leventhal, 2009; Kroll, 2010; Mellor etal., 2008; Costanzo, Ryff, & Singer, 2009). How-ever, none of these previous studies examined theimpact of volunteerism on cancer survivors’ wellbe-ing in a Chinese population. METHOD: Partici-pants in this study consisted of 150 cancer patientsrecruited through Hong Kong Cancer Fund(HKCF), a Hong Kong psychosocial cancer serviceprovider. The sample was evenly divided into 3groups: 50 volunteers; 50 nonvolunteers; and 50new cases who had not used any services at HKCFprior to the study. The Body-Mind-Spirit WellbeingInventory (BMSWBI; Ng et al., 2005) was adoptedto assess the holistic health of participants.RESULTS: The results from a univarate ANOVA

showed that wellbeing levels among volunteers, non-volunteers and new cases groups were significantlydifferent, F (2, 147) = 36.547, p < 0.01. The resultfrom LSD post hoc test revealed that cancer survi-vors who engaged in volunteering work had a statisti-cally significantly higher overall wellbeing level thanthe other groups (p < 0.05). However, the frequencyof volunteering was not significantly correlated withwellbeing in this study, which is in contrast to find-ings of previous research (Morrow-Howell, 2003;Van Willigen, 2000). CONCLUSIONS: This is apioneer study to explore the relationship betweenvolunteering work and cancer survivors in HongKong. The results of the study indicated that there

was a positive relationship between volunteeringwork and wellbeing of cancer survivors. Due to thelimitation of the design of the study, the causal rela-tionship could not be drawn at this stage.RESEARCH IMPLICATIONS: This study hadlimitations in that the demographic variables werenot controlled for. Future research using randomselection and matched controls is needed to demon-strate a causal connection. Also a longitudinal studyto examine changes in wellbeing among cancer survi-vors across time among volunteers is recommended.CLINICAL IMPLICATIONS: Nonetheless, vol-unteering has the potential to be a useful additionto psycho-social care planning for adult cancer sur-vivors. Service providers and health professionalsmay want to improve the wellbeing of cancer survi-vors by encouraging and providing opportunities todo volunteering work. ACKNOWLEDGEMENTOF FUNDING: None.

P2-73

Risk Factors Linked to Distress in the Pre-Surgical

and Pre-Chemotherapy Phases. Do They Have the

Same Psychological Basis?

Cristina Civilotti1,2, Efrem Sabatti3, Claudia

Romano3, Francesca Facchi3, Gianluca Fogazzi3

1Department of Psychology, University of Turin,Turin, Italy, 2Edo ed Elvo Tempia Foundation,Biella, Italy, 3Sant’Anna Clinic Institute, SanDonato Group, Brescia, Italy

BACKGROUND: The main purpose of this studywas to describe the women’s experiences after hav-ing received a breast cancer diagnosis in terms ofanxiety, depression and distress in 2 phases alongthe cancer journey: the pre-surgery phase and thepre-chemotherapy phase. Moreover, we tried tomodel predictors of distress in the 2 phases, using across-sectional methodology of the following vari-ables: age, stage of the disease, education, employ-ment status, level of anxiety and level of depression.METHOD: The data were collected in the BreastUnit of the Istituto Clinico S. Anna, Brescia, Italy,via a routine psychological screening program. Of227 consecutive patients, 196 gave consent andcompleted responses for the administration of threequestionnaires: BDI-II (Beck et al., 1996), STAI(Spielberger et al. 1983) and PDI (Morasso et al.,1996). 106 patients were in Group-A (pre-surgeryphase) and 90 patients were in Group-B (pre-che-motherapy phase). Anxiety, depression and socio-demo variables (age, education, employment status,stage of the disease) were entered in a stepwise mul-tiple regression analysis to predict the perceived dis-tress level. RESULTS: In Group-A, 48.2% of thewomen reported a significant level of anxiety and38.5% reported at least a mild level of depression;in Group-B anxiety and depression were foundrespectively in 44.3% and 37.3% of the sample.



The mean of PDI score was 26.13 in Group-A(SD = 9.13) and 26.77 in Group-B (SD = 8.39). InGroup-A, the prediction model (F (2, 92) = 71.180,p < 0.001) showed anxiety and depression as signifi-cant predictors and accounted for approximately60% of the variance of PDI scores. In Group-B,depression and age emerged as predictors, and thismodel (F (2, 86) = 71,798, p < 0.001) explained62% of the variability in the PDI scores. CON-CLUSIONS: There were no differences betweenthe mean of Group-A and that of Group-B in termsof anxiety, depression and distress. In both A and Bgroups, correlations were identified between thepresence of distress and anxiety and depression, butnot with socio-demographic variables. However,differences were noticed in the predictors of distressin the 2 phases: in the group-A, anxiety and depres-sion were the components that emerged withgreater strength in determining the perception ofthe level of distress. In the group-B the level of anx-iety was excluded from the model and the predictivevariables were depression and younger age.RESEARCH IMPLICATIONS: Many progresseshighlight the differences that occur at various stepsof the disease, but many are still pursued in orderto understand the complexity of human experiencealong the cancer journey, from the beginning to thelater phase, such as survivorship or end of life. Forfuture research, we underline the importance of alongitudinal perspective, as psychological distresshas been shown to vary significantly during timeand stages of the disease. CLINICAL IMPLICA-TIONS: This study underlines how it is importantto properly understand the psychological sufferanceof a woman with breast cancer in order to providechanges in her care management during the cancertrajectory. In particular, this study demonstrateshow the level of anxiety plays a different role indetermining distress in the two phases studied: anx-iety is more impairing right before the surgery,while in later phases seems to be more integratedand accepted by patients. ACKNOWLEDGE-MENT OF FUNDING: Funding was providedthrough the Priamo Association (Brescia, Italy),Sant’Anna Clinic Institute - San Donato Groupand Fondazione Edo ed Elvo Tempia (Biella, Italy).We thank Dr. Diana Lucchini and to the entireOncology team of the Sant’Anna Clinic Institute.

P2-74

Abstract withdrawn

P2-75

Phase I Pilot of a Mindfulness-Based Stress

Reduction Intervention for Head and Neck Cancer

Patients Receiving Radiotherapy of Curative Intent

Jeremy Couper1, Annabel Pollard1, David Castle2,

Kate Neilson2, Jodie Burchell1, Maria Ftanou1,2,

June Corry1, Danny Rischin1, David Kissane3,

Meinir Krishnasamy1, Tom Trauer2,3, Linda

Carlson4

1Peter MacCallum Cancer Centre, Melbourne,Victoria, Australia, 2University of Melbourne,Melbourne, Victoria, Australia, 3Monash University,Melbourne, Victoria, Australia, 4University ofCalgary, Calgary, Alberta, Canada

BACKGROUND: Despite studies showing thatHead and Neck Cancer patients experience some ofthe highest distress of all cancer patients, few psy-chological interventions exist to help these patientscope with the challenges of diagnosis and treat-ment. This study examines the feasibility andacceptability of an adapted Mindfulness-BasedStress Reduction (MBSR) intervention tailored forHead and Neck Cancer patients undergoing radio-therapy with curative intent. This intervention usesa novel one-on-one administration to accommodatepatients’ radiotherapy schedules. METHOD: Theprimary aims are to assess the feasibility of admin-istering this intervention in a hospital setting andthe acceptability of this intervention to patients.The secondary aim is to assess changes in mindful-ness and how this relates to distress and quality oflife. Thirty participants will be recruited from thePeter MacCallum Cancer Centre. Patients complete7 sessions of the MBSR intervention concurrentlywith radiotherapy. During the intervention,patients’ attendance of sessions and their adherenceto mindfulness practice outside of sessions will berecorded. Patients complete questionnaires beforeand after the intervention that assess their distress,quality-of-life and mindfulness. RESULTS: Thefeasibility of the intervention will be assessed byrecording the number of patients who completed asufficient amount of sessions and mindfulness prac-tice outside of sessions. The acceptability of theintervention to Head and Neck Cancer patients willbe assessed by examining whether those patientswho completed the intervention differed significantlyfrom those who did not on a number of demo-graphic variables. The secondary aims of the studywill be assessed by examining the change over timein self-reported mindfulness, and the relationship ofpost-intervention distress and quality-of-life toself-reported mindfulness. CONCLUSIONS: Thisstudy will assess whether it is possible to address theneeds of Head and Neck Cancer patients undergo-ing radiotherapy of curative intent using a one-on-one MBSR intervention. The results of this pilot will



indicate whether an adapted MBSR intervention isof interest to this population, and whether it is possi-ble for these patients to adhere to the program dur-ing the course of radiotherapy treatment. This studywill also offer some preliminary evidence as to theefficacy of such an intervention in alleviating patientdistress and improving quality-of-life followingradiotherapy. RESEARCH IMPLICATIONS: Ifthis trial demonstrates that the adapted MBSRintervention is acceptable and feasible to Head andNeck Cancer patients, and that increasing levels ofmindfulness are connected to lower psychologicaldistress and higher quality-of-life, we intend to fur-ther assess the effectiveness of this intervention atreducing distress and increasing quality-of-lifeusing a randomised controlled trial. CLINICALIMPLICATIONS: The results of this study willprovide an indication of whether a tailored, one-on-one MBSR program is a viable option to helpHead and Neck Cancer patients cope with the chal-lenges of radiotherapy. Based on this information,the feasibility of using mindfulness-based treat-ments to support this population will be discussed.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was funded by beyondblue, an AustralianGovernment funded organization that aims to pro-vide a national focus and community leadership toincrease the capacity of the broader Australiancommunity to prevent depression and respondeffectively.

P2-76

Community-Based Exercise Intervention for

Oncology Patients Suffering From Fatigue: Effects

on Symptoms, Psychosocial Health, Aerobic Fitness

and Body Composition: A Pilot Study

Stefanie De Jesus1, Lyndsay Fitzgeorge2, David

Massel3, Harry Prapavessis1, Michael Sanatani3,

Neville Suskin3, Karen Unsworth1The University of Western Ontario, London,Ontario, Canada, 2Fanshawe College, London,Ontario, Canada, 3London Health Sciences Centre,London, Ontario, Canada

BACKGROUND: Exercise and functional rehabil-itation are thought to offer significant benefits tocancer patients. Fatigue is the most common anddistressing symptom experienced by cancer patients,both during and after treatment. Research hasreported that supervised structured exercise pro-grams improve quality of life and symptom manage-ment, including fatigue, as well as aerobic fitnessand body composition. This study examineswhether similar results could be achieved using acommunity-based intervention. METHOD: Twentywomen (Mage: 53.05 years; Mmass: 81.9 kg) wererecruited from the London Regional Cancer Pro-gram following curative therapy for resected breast

cancer. Patients underwent a thorough baselineassessment and were assigned a progressive aerobicexercise program (50–70% of their baseline maxi-mum heart rate) at a community facility. The PiperFatigue (PFS), Edmonton Symptom Assessment(ESAS), and Functional Assessment of CancerTherapy-General (FACT-G) scales evaluated psy-chological and symptom prevalence. Aerobic fit-ness, physical activity levels, and body compositionwere objectively assessed using a graded treadmillprotocol, accelerometers, and dual x-ray absorpti-ometry, respectively. Assessments were conductedat baseline and following the 16-week intervention.RESULTS: Significant (p < 0.05) improvementswere found in sensory fatigue (PFS; g2 = 0.277),patient-reported symptoms (ESAS; g2 = 0.325),and physical (g2 = 0.454), functional (g2 = 0.462),and overall (g2 = 0.373) quality of life (FACT-G).Aerobic fitness variables (heart rate, peak VO2,RER) did not significantly improve, except forduration (g2 = 0.460). Non-significant (p > 0.05)changes were found for objectively measured bodycomposition variables (percent fat, fat mass, fat freemass, lean mass, visceral adipose tissue volume)and physical activity levels (minutes engaged in sed-entary, light, and moderate-to-vigorous activity).CONCLUSIONS: There is mounting evidence thatexercise, in general, is beneficial for individualsalong the cancer continuum. However, what isurgently needed is a more specific refinement ofcommunity-based exercise interventions and recom-mendations to fit an individual cancer patient’sfunctional ability, disease status, and overall treat-ment goals. As a pilot study, this trial demonstratesthat a 16-week community-based exercise programis sufficient to enhance fatigue and psychosocialvariables, but not aerobic fitness, body composi-tion, and physical activity patterns. RESEARCHIMPLICATIONS: Feasibility, acceptability (i.e.compliance to exercise), and adherence issues mustbe addressed prior to building on this pilot studywith a series of randomized studies in specific can-cer patient populations, in order to help define theoptimal interventions for our patients. CLINICALIMPLICATIONS: A structured and supervisedcommunity-based aerobic exercise program is safeand effective to achieve symptom and psychologicalbenefits, but not effective at improving the afore-mentioned variables aerobic capacity, physicalactivity patterns, and body composition, possiblydue to exercise compliance. Nevertheless, this pilotstudy highlights the synergistic, coordinated, andintegrated approach between cardiac rehabilitationand secondary prevention programming to yield abeneficial impact on psycho-oncology care.ACKNOWLEDGEMENT OF FUNDING: Lon-don Regional Cancer Program Small Grants forCancer Research and Training.



P2-77

The Acceptance and Commitment Therapy for

Increase the Psychological Flexibility of Cancer

Patients

Giuseppe Deledda1, Magarotto Roberto2, StefaniaGori21Service Clinical Psycology, Hospital Sacro Cuore-Don Calabria, Negrar, Verona, Italy, 2U.O.Oncology, Hospital Sacro Cuore-Don Calabria,Negrar, Verona, Italy

BACKGROUND: The Acceptance and Commit-ment Therapy proposes the hypothesis that psycho-logical suffering is caused by the interactionbetween language, cognition and behavioural con-trol. Rather than focus on the reduction of symp-toms, the primary purpose is to help the person toaccept their thoughts and emotions, and live in thepresent consistently with their values. The aim ofthis introduction is to address the ACT Hexaflexprocesses in order to increase the psychological flex-ibility of cancer patients. METHOD: Will be pres-ent the ACT protocol used to oncological patientand in palliative care setting in the U.O. of Oncol-ogy, Hospital Sacro Cuore Don Calabria in Negrar(VR). ACT establishes psychological flexibility byfocusing on 6 core processes: acceptance of privateexperiences, cognitive defusion, being present, tohave a perspective-taking sense of self, identifica-tion of values that are personally important.RESULTS: The data showed significant improve-ments on outcome measures from pre to post.Regression analyses showed that changes in psy-chological flexibility predicted changes in distressand mood. CONCLUSIONS: The results obtainedusing the ACT approach in oncology, pose a moresolid basis to support the importance of a non-judg-mental attitude in order to employ the energiestoward what we consider most important in ourlives. Acceptance allows to move more freely with-out being stopped by distressing feelings.ACKNOWLEDGEMENT OF FUNDING: None.

P2-78

“Yes, I Have Cancer, But I am Going to Beat it!Only Then Will I Become a Mother”. A Case Report

From the Psychosocial Perspective: Embryo

Preservation in Breast Cancer

Ozcan Yildiz1, Sibel Dogan1, Seher Sen1, KadriyeSlocum2

1Istanbul Medipol University, Istanbul, Turkey,2Istanbul Sehir University, Istanbul, Turkey

BACKGROUND: Among health problems of ourcontemporary society, cancer is one of the mostimportant, and sadly, thousands of young ladiesare diagnosed with cancer annually, during theirreproductive period. The chemotherapy medica-tions and radiation therapy that are used for the

treatment of this condition harm the ovarian tissue,which in turn increases likelihood of early meno-pause. At present, the freezing of embryos isaccepted as the most grounded of all methods formaintaining reproductive ability. METHOD: Thisstudy is a case report, and the case involves a 26-year old young lady. She came to our oncology unit,upon being diagnosed with breast cancer (invasiveductal carcinoma of the breast). At the time, she hadjust been married for 9 months, and was attemptingto become pregnant, when she suddenly recognizeda lump in her breast. This case addresses, in detail,her journey from this point onward: the psychologi-cal periods she went through and the positivechanges that emerged in these periods, upon decid-ing to freeze her embryos, prior to the onset of hertreatment. RESULTS: The in-depth interviewmethod was used to gain a better understanding ofthe different psychological periods she experienced,A psychosocial support program was also pro-vided, on a regular basis. Through this program,patient showed a decrease in the difficulties she wasexperiencing psychologically. Being an individualwho had a great deal of desire and sensitivity tobecoming a mom, once the process of freezing herembryos was complete, it was observed that she notonly adapted to her radiotherapy and chemother-apy treatments with more ease and speed, but thatshe also continued her therapy with a great deal ofmotivation. CONCLUSIONS: We are of the opin-ion that, informing and as it is necessary guiding,ladies who have been diagnosed with breast cancerwithin reproductive age, specifically those who areyoung, with the options that are available in the areaof protecting their reproductive ability, in corre-spondence with psychosocial approaches, will havea positive impact, on their ability to cope with theirillness, their feelings of hope and their psychologicaldifficulties. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-79

Effect of Relaxation Exercise on Fatigue,

Depression and Level of Quality of Life in

Diagnosed with Breast and Colorectal Cancer

Within Patients Under Adjuvant Chemotherapy

Sibel Dogan1, Havva Tel2, Metin Ozkan31Istanbul Medipol University, Istanbul, Turkey,2Cumhuriyet University, Sivas, Turkey, 3ErciyesUniversity, Kayseri, Turkey

BACKGROUND: Cancer is a chronic phenome-non covering a lot of psychological and psychosocialproblems in addition to being a medicalphysical ill-ness. Cancer patients develop variable and differentemotional, psychological and behavioral reactionsin the diagnosis, treatment, relapse and palliativeperiods. As cancer diagnosis; cancer treatment, dis-ease progression causes increased psychological



distress in the individual and also decreased qualityof life of their. METHOD: Study was conductedat Oncology Hospital at Erciyes University. Studysample was composed of 70 patients diagnosed withbreast cancer and colorectal cancer, who were tak-ing adjuvant chemotherapy for the first time andwho were being planned to take ambulatory adju-vant chemotherapy lasting at least 3 cures. Studygroup was applied relaxation exercise. Effect ofexercise was evaluated by measurement instrumentsprior to every chemotherapy cure and on 7th day ofending cure being measured for 6 different timesduring 3 cures. Data were collected with question-naire form, Piper Fatigue Scale, Beck DepressionScale and EORTCQLQ C-30 Quality of Life Scale.RESULTS: Fatigue level of the study grouppatients was high compared with controls and bymeasurements and inter group comparisons it wasfound that fatigue scores in study group decreasedwhile increased in control group. Depression scoreswere found to be lower in study group and higherin control group. Quality of life increased in studygroup patients who were applied relaxation exer-cise. Depression, fatigue and scores of quality of lifewere positively correlated and while depressionincreased, fatigue increased and quality of lifedecreased. CONCLUSIONS: It was recommendedto regularly evaluate fatigue, depression and qualityof life levels of subjects diagnosed with cancerwithin general care, to conduct further clinical trialsto emerge the efficiency of relaxation exercises, touse devices like I-pod for applying relaxation exer-cises during chemotherapy, to integrate relaxationexercises into routines at chemotherapy units, toinclude information on recognition and handling ofdepression and fatigue in patient and family symp-tom management educations. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-80

Quality of Life, Vulnerability to Stress and Coping

Strategies in Patients With Oral Cavity Cancer:

Presentation of Preliminary Results of a Study

Conducted in Portugal

Sara Duarte, Maria Joao Cunha, Joao Paulo Pere-iraISMAI, Porto, Portugal

BACKGROUND: Oral Cavity Cancer (OCC) ispositioned in a clinical level of imposing challenges,regarding the social and psychological aspects com-ponents that arises when We look to the recent sci-entific production, that empirically validatedinnovative knowledge and effective techniques. It isnecessary to develop a persistent investigation inthis area, that at the moment is so little explored,and the goal of a better perception of the psycho-logical impacts arising in the treatment of thispatients. METHOD: The sample is constituted by

40 participants diagnosed with OCC. Measuringinstruments were used to assess the vulnerability tostress, coping strategies and quality of life. AIMS -(1) find which factors contribute the most to vulner-ability to stress in these patients, and We explorethe relationship between the presence of Vulnerabil-ity to stress and perceived quality of life; (2) evalu-ate the differences between Smoking and Non-Smoking patients regarding the perception of qual-ity of life and identify the Coping Strategies withhigher prevalence in this context. (3) explore therelationships between all the variables in study.RESULTS: The outcomes seem to be congruentwith some previous studies with cancer patients, sincepatients classified as Vulnerable to Stress showed amore negative perception of their Global Quality ofLife; cancer patients who are smokers, relates inferiorGlobal Quality of Life when compared with non-smokers, and Active Coping was one of the strategiesthat emerge in the relation with positive perceptionsof the Global Quality of Life is also evident the rela-tionship between coping strategy Religion and psy-chological well-being. CONCLUSIONS: Thisresearch shows how psychological variables caninfluence the lives of cancer patients and thereforeunderlines the importance of psychological supportto these individuals, which may attenuate their suf-fering, as well as implement some missing andadaptive resources. This type of research, inPortugal, is an innovative step for the scientificcommunity and in particular to the specific area ofPsycho-Oncology. RESEARCH IMPLICA-TIONS: We are aware that is necessary to improvethe responses and performance at the level of psy-cho-oncology. More studies that allow us to knowthe reality about OCC in order to develop efective-ness, and thereby stimulating the development ofquality health care. Portugal remains the onlycountry in Europe where the cause of death causedby cancer continues to rise 6% annually. CLINI-CAL IMPLICATIONS: The results suggest theimportance of creating intervention programs pro-moting quality of life and well-being that includetraining on coping strategies and the active con-struction of meaning of life in disease.ACKNOWLEDGEMENT OF FUNDING: Wethank UNIDEP-ISMAI the support given to theexecution of this work.

P2-81

Online Mindfulness-Based Cognitive Therapy for

Chronic Cancer-Related Fatigue - A Pilot Study

FZ Everts, ML Van der Lee, E De JagerMeezenbroekHelen Dowling Institute, Bilthoven, The Netherlands

BACKGROUND: Chronic cancer-related fatigue(CCRF) can persist for months or even years aftercompletion of successful cancer treatment and has



a major impact on the quality of life of cancer out-patients. Face-to-face Mindfulness-Based CognitiveTherapy (MBCT) has shown to be effective inreducing CCRF. An online MBCT has been devel-oped, as online interventions are easily accessible: amajor advantage for this group of patients. Theefficacy of online MBCT was investigated in thispilot study. METHOD: The main outcome mea-sure was fatigue severity assessed with the ChecklistIndividual Strength (CIS). Thirty-six CCRFpatients were exposed to a nine-week online MBCTintervention. Since the present study was set up in aclinical setting and there was no proper controlgroup, data about the waiting-list control group(n = 23) from the face-to-face MBCT study of Vander Lee and Garssen (2010) was used for compari-son of the outcome measurements over time.RESULTS: ANCOVA showed that fatigue at post-assessment was significantly lower in the interven-tion group, compared to the waiting-list compari-son group, controlling for pre-treatment level offatigue. The proportion of clinically improved par-ticipants in the intervention group (52%) was sig-nificantly larger than in the wait-list comparisongroup (4%). Compared to other online interven-tions, the dropout rate of the online MBCT wasacceptable, though higher than in face-to-faceMBCT (36% online and 6% face-to-face). CON-CLUSIONS: The findings of this pilot study sug-gest that individual online MBCT may be effectivein reducing fatigue CCRF in patients. The dropoutrate for online MBCT was higher than for face-to-face MBCT, though acceptable for an online inter-vention. RESEARCH IMPLICATIONS: In thispilot study, data was collected in a clinical setting.A randomized controlled study with a larger sam-ple and longer follow up is needed to demonstratethe efficacy of MBCT online. In addition, dropoutshave to be monitored carefully. CLINICALIMPLICATIONS: There is a considerable numberof CCRF patients who do not have access to inter-ventions, as they don’t have the energy to travel tothe treatment center. To provide a large group ofcancer survivors with access to an effective onlinetreatment, studying the efficacy of online interven-tions is necessary. The purpose of this pilot study isto investigate the efficacy of an online MBCT inreducing chronic fatigue in cancer survivors.ACKNOWLEDGEMENT OF FUNDING: None.

P2-82

Longitudinal Associations Between Illness

Perceptions, Coping and Distress Among Breast

Cancer Patients Attending a Psycho-Educational

Intervention

Maarten J. Fischer1, Marion E. Wiesenhaan-Breeuwer1, Aukje Does-Den Heijer2, Wim C.Kleijn1, Johan W.R. Nortier1, Adrian A. Kaptein11Leiden University Medical Center, Leiden, The

Netherlands, 2Diaconessenhuis, Leiden, TheNetherlands

BACKGROUND: Understanding factors thatcontribute to emotional distress in patients is essen-tial in the development of interventions to reducepatient distress. According to the Common SenseModel (CSM) (Leventhal et al., 1980), distress canbe regarded as one of the illness outcomes influ-enced by patients’ perceptions of their illness andcoping responses. This study aimed to investigatethe longitudinal associations between illness per-ceptions, coping and emotional distress in breastcancer patients who attended a psycho-educationalintervention. METHOD: A total of 74 womentook part in one of nine intervention groups offeredsince 2005 by our hospital. The standardized pro-gram consisted of 8 consecutive meetings and onefollow-up session 2 months after the 8th session.Sessions were supervised by a social worker and anurse practitioner. Study variables were assessed byquestionnaires before the start of the group inter-vention (T1), directly after the eighth session (T2),and 12 months after T1 (T3). All questionnairescontained the 25-item Hopkins Symptom CheckList (distress), the Illness Perception Questionnaire-Revised (illness representations) and the Dutch ver-sion of the COPE (coping). RESULTS: Cross-sec-tional analyses showed that distress at baseline waspositively related to the IPQ-R subscales Conse-quences, Timeline Chronic, Timeline Cyclical andEmotional Representations, whereas an inverseassociation was observed between distress and Ill-ness Coherence (all r > 0.40). Regarding coping,results show that greater use of Avoidance wasstrongly related to higher distress scores (r = 0.47),whereas Acceptance was inversely related to dis-tress (r = �0.28). Longitudinal analyses showedthat greater distress at T2 & T3 was related to anincrease over time in the IPQ-R subscales IllnessIdentity and Timeline Cyclical. An increase inAcceptance coping was related to greater distress atT3. CONCLUSIONS: This study is one of the fewlongitudinal investigations regarding the relation-ship between illness perceptions, coping and dis-tress in women with breast cancer. In accordancewith assumptions from the Common Sense Modelour results suggest that illness representations, cop-ing and distress vary over time as new informationand experiences are incorporated into patients’continuous process of self-regulation. The observa-tion that changes in illness perceptions and copingare related to future distress holds promise for thedesign of psychological interventions. RESEARCHIMPLICATIONS: No objective information aboutpatients medical characteristics and possible diseaseprogression had been available in this study. There-fore, studies are needed to investigate what medicalfactors influence patients’ perceptions of their ill-



ness and lead to changes in these perceptions. Sec-ondly, the role of Acceptance coping on distressshould be further clarified. Future research shouldunravel the mechanisms that cause some patients toincrease their level of Acceptance over time andexamine its relation to distress. CLINICALIMPLICATIONS: Results from this study suggestit would be interesting to design an intervention tar-geting at patients’ perceptions of breast cancer, ashas previously been done in patients with myocar-dial infarctions (Petrie et al., 2002; Broadbent et al.,2009). Our results in particular have demonstratedthe importance of patients’ perceived timeline per-ceptions, emphasizing the relevance of preparingpatients for possible long-term symptoms andteaching strategies to cope with symptoms whichmay appear at an irregular interval. ACKNOWL-EDGEMENT OF FUNDING: This project wassupported by a grant from Pink Ribbon, the Neth-erlands.

P2-83

The Use of Narrative Therapy to Manage Emotional

and Existential Distress in the Oncology Setting

Jeanelle Folbrecht1, Miguel Fernanez2, Liz Cooke11City of Hope National Medical Center, Duarte,California, USA, 2Psychological & EducationalConsultancy, Subiaco, West Australia, Australia

BACKGROUND: Best practice in psycho-oncol-ogy to treat adjustment difficulties is short-termtherapy using cognitive-behavioral or mindfulnesstechniques. Although research demonstrates thatthese techniques can be quite helpful in managingsymptoms of distress, there are some patients andsome situations in which the effectiveness is limited.Clinical techniques to guide the use of Narrativetherapy to reduce anxiety and depression, improveadjustment and coping, and reduce existential dis-tress will be discussed. METHOD: Narrative ther-apy is a postmodern approach defined within thesocial constructionist worldview that truth andreality are socially constructed or shared perspec-tives bound by history and context. Within a narra-tive therapy framework, meaning is generatedthrough stories in different contexts and problemsare manufactured within these contexts (Lambie &Milsom, 2010). Solutions, therefore, are focused onaltering the stories. This, in turn, changes meaningand redefines problems (Fernandez, 1999c; 2002b).The role of the narrative therapist is to retain a levelof curious optimism, always asking for clarity byusing co-exploration as a tool. RESULTS: Narra-tive therapy in oncology is not new although theconsistent application of its power to give meaningto life events is underutilized. Pecchioni (2012) dis-cusses and explores the interruption of cancer tothe “life script.” Ragin (2013) discussed a narrativeapproach to communication and the honor given to

patients as they rewrite and refocus their life narra-tive. Active listening techniques are used to elicitand exploring the life narrative. Narratives usuallyreveal themes including: Victim, Victorious, Unfor-tunate, Thankful, Persecuted, and Hero. Tech-niques that serve to prematurely comfort narratoror listener are discouraged as they serve to end nar-rative exploration. CONCLUSIONS: Techniquesof Cognitive-Behavioral and Mindfulness Therapyare important resources for reducing distress in thesetting of oncology, but the effectiveness is some-times limited. Use of Narrative Therapy is a tech-nique that can be used to get at core issuesunderlying symptoms of distress including interpre-tation and meaning in the cancer experience. Work-ing to refocus the life narrative on themessuggesting positive coping and meaning rather thanpowerlessness or victimization can result inimprovements in adjustment and coping, reduc-tions in anxiety and depression, and resolution ofexistential distress. RESEARCH IMPLICA-TIONS: Research into theories regarding themespresent in life narratives and their impact upon cop-ing and systems of distress in the oncology setting isneeded. CLINICAL IMPLICATIONS: Abstractprovides a theoretical framework for utilizing Nar-rative Therapy in psycho-oncology to reduce dis-tress and enhance coping and adjustment.ACKNOWLEDGEMENT OF FUNDING: None.

P2-84

An Evaluation of a Reflexology Service for Cancer

Patients and Their Relatives

Emma Lewis, Rachel FoxwellOncology Health Centre, Hull and East YorkshireNHS Trust, Hull, UK

BACKGROUND: Previous research demon-strated the effectiveness of reflexology and scalpmassage for improving the quality of life (QoL) ofearly breast cancer women (Sharp et al, 2010).Through the use of charitable funds the OncologyHealth Centre has continued to offer reflexologyand scalp massage sessions, but has widened thisavailability to all types of cancer patients and rela-tives. The centre has continued to evaluate the psy-chological effectiveness of these interventions andnow presents the results. METHOD: BetweenApril 2012 and March 2013, seventy cancer patientsand relatives were referred for 6 hourly sessions ofreflexology, scalp massage or a combination ofboth. Participants completed the FunctionalAssessment of Cancer Therapy (FACT-G), Hospi-tal Anxiety and Depression Scale (HADS) andMood Rating Scale (MRS) during the first and lastsessions. Participants also completed a satisfactionsurvey at the final session, which enabled commentson the service they had received. RESULTS: Fifty-eight participants completed pre and post measures.



Wilcoxon Signed Rank Tests were used to analysethe data. An improvement in scores between preand post treatment was found on all measures. Thisimprovement was significant for the FACT-G phys-ical, emotional and functional well-being, HADSanxiety and depression and MRS relaxation, happi-ness, clear-headedness, easy-goingness and confi-dence subscales. The FACT-G social/family well-being and MRS energy subscales were not signifi-cant. Qualitative comments highlighted variousbenefits of the sessions, including relaxation, dis-traction, a pleasant treatment to associate with hos-pital and providing something to look forward to.CONCLUSIONS: The current study demonstratesthat reflexology and scalp massage complementaryintervention sessions within an Oncology HealthCentre can lead to significant improvements in QoLand mood. This supports previous research in earlybreast cancer women (Sharp, 2010) and extends thebenefits to a wider range of cancer patients and rel-atives. RESEARCH IMPLICATIONS: The studyhighlights a need to further investigate the impactof complementary therapies on psychosocial out-comes, such as QoL and mood. This could be com-pleted through multi-centre studies, or extendingand comparing the options of complementary ther-apies, such as acupuncture and aromatherapy mas-sage in other specific cancer populations. The studyhas also highlighted the value of combining quanti-tative and qualitative data to produce rich data.CLINICAL IMPLICATIONS: Reflexology andscalp massage are complementary interventionsthat can lead to significant improvements in QoLand mood across a wide range of cancer patientsand relatives. These interventions could be incorpo-rated more frequently into cancer care services todevelop a ‘holistic’ approach to cancer care ser-vices, which has been emphasised by recent research(Ben-Arye et al, 2013). ACKNOWLEDGEMENTOF FUNDING: Charitable funds financed thereflexology service during this period of time.

P2-85

Psychosocial Interventions to Improve Quality of

Life and Emotional Wellbeing for Recently

Diagnosed Cancer Patients

Karen Galway1, Amanda Black2, Marie Cantwell1,Chris Cardwell1, Moyra Mills3, Michael Donnelly11Queen’s University Belfast, Northern Ireland, UK,2Division of Cancer Epidemiology and Genetics,National Cancer Institute, Bethesda, USA,3Northern Health and Social Care Trust, Antrim,Northern Ireland, UK

BACKGROUND: UK government policy andemerging international guidelines recommend thatall individuals who are diagnosed with cancershould be assessed for emotional problems andgiven access to appropriate psychological support

services. However, the ideal timing, nature, contentand method for delivery of services require substan-tiation. This review examines the effectiveness ofindividual psychosocial interventions to improveQuality of Life (QoL) and emotional wellbeingdelivered in the first 12 months after a diagnosis ofcancer. METHOD: We searched the CochraneLibrary (including CENTRAL), MEDLINE, EM-BASE, and PsycINFO up to January 2011. No lan-guage restrictions were imposed. Randomisedcontrolled trials of psychosocial interventionsinvolving interpersonal dialogue between a “trainedhelper” and individual newly diagnosed cancerpatients were selected. Only trials measuring QoLand general psychological distress were included.Where possible, outcome data were extracted forcombining in meta-analyses. Continuous outcomeswere compared using standardised mean differencesand 95% confidence intervals, using a random-effects model. The primary outcome, was examinedby outcome measurement, cancer site, theoreticalbasis for intervention, mode of delivery and disci-pline of trained helper. RESULTS: 3309 recordswere identified; 30 trials were included in thereview. No significant effects were observed forQoL at 6-month follow up (SMD0.11; 95%CI-0.00to 0.22); however, a small improvement in QoL wasobserved with cancer-specific measures (SMD0.16;95%CI 0.02 to 0.30). General psychological distressas assessed by “mood measures” improved (SMD-0.81; 95%CI�1.44 to �0.18), but no significanteffect was observed when measures of depression oranxiety were used (depression SMD0.12; 95%CI�0.07 to 0.31; anxiety SMD0.05; 95%CI�0.13to 0.22). Psycho-educational and nurse-deliveredinterventions administered face to face and by tele-phone produced small positive significant effects(SMD0.23; 95%CI 0.04 to 0.43). CONCLU-SIONS: The significant variation observed acrossparticipants, mode of delivery, discipline of ‘trainedhelper’ and intervention makes it difficult to arrive atfirm conclusions regarding the effectiveness ofpsychosocial interventions for cancer patients. It canbe tentatively concluded that nurse-delivered inter-ventions comprising information combined with sup-portive attention may have a beneficial impact in anundifferentiated population of newly diagnosed can-cer patients. The review revealed a lack of acknowl-edgement for assessing need in this population.RESEARCH IMPLICATIONS: Future researchshould address assessment of need, to identifypatients likely to benefit from psychosocial inter-ventions, such as those at risk of emotional prob-lems. Where patients are at psychological risk, thecorrect psychometrics must be employed to ensurethe measures are sensitive to the sub-clinicalchanges that might be expected. Accurate powercalculations should take this into account. It wouldalso be useful to examine the relationships betweenpatient characteristics and expectations of psycho-



social support. CLINICAL IMPLICATIONS: It isimportant to ascertain which type of “trained helper”is the most appropriate health or allied health profes-sional to deliver various types of psychosocial inter-ventions for cancer patients, ideally according toneed. For example, can a stepped care approachemploy a variety of multi-disciplinary professionals?Commissioning bodies would benefit from an effortto conduct economic appraisals of the cost-effective-ness of interventions. ACKNOWLEDGEMENTOF FUNDING: The authors would like to thankthe Research and Development Office, PublicHealth Agency, Department of Health, Social Ser-vices and Public Safety for support through aCochrane Collaboration Fellowship Award.

P2-86

Physical Activity Intervention for Cognitive &

Emotional Functioning in Breast Cancer Patients

Receiving Chemotherapy

Kajal Gokal1, Fehmidah Munir1, Deborah Wallis1,Samreen Ahmed2, Ion Boiangiu2, KiranKancherla21Loughborough University, Loughborough,Leicestershire, UK, 2Leicester Royal Infirmary,Leicester, UK

BACKGROUND: High levels of emotional dis-tress prior to chemotherapy are associated withpoorer cognitive performance post-chemotherapy.Current interventions fail to assess if cognitive func-tioning can be maintained through improvingpatients’ emotional well-being. Physical activity isknown to enhance emotional well-being in cancerpatients and improve cognitive functioning in thosewith dementia. This physical activity interventionaimed to reduce cognitive impairment in breastcancer patients and investigate if this is mediated byimprovements in emotional distress. METHOD:Forty-two breast cancer patients receiving chemo-therapy were recruited from Leicester RoyalInfirmary breast cancer clinic. Participants wererandomised into the intervention group (n = 13) orcontrol group (n = 16). The intervention consists of12 weeks of home-based, moderate intensity walk-ing. The intervention group were provided withguidance and motivation to incorporate moderatelevels of walking around their treatment schedules.All patients wore an accelerometer for seven daysto gain an insight into walking practices at baselineand post-chemotherapy. Cognitive and emotionalfunctioning was assessed by neuropsychologicalmeasures and questionnaires at 3 time points. Datacollection is on-going (target n = 62). RESULTS:To date there has been a good uptake of patientswho are adhering to the intervention. Thirteenladies have completed the study so far, 6 in theintervention group and 7 in the control group. Datawill be analysed towards the end of summer 2013,

complete results will be available at the time of theconference. CONCLUSIONS: Based upon trendsin data collected to date, it is expected that those inthe intervention group will show less cognitivedecline compared to the control group.RESEARCH IMPLICATIONS: The implementa-tion of the physical activity intervention will pro-vide an insight into the nature of cognitivedysfunctions experienced by breast cancer patientsand if they are mediated by emotional distress.CLINICAL IMPLICATIONS: The interventionwill provide consultants and other healthcare pro-fessionals with the ability to guide patients towardsself-help methods of improving their quality of lifeand cognitive functioning through chemotherapy.ACKNOWLEDGEMENT OF FUNDING: Theresearch is funded by Loughborough University aspart of a PhD project.

P2-87

Challenges of Implementing a Randomized

Controlled Trial of a Psychological Intervention in

Patients Newly Diagnosed With Advanced Cancer

Melissa Henry1,2, Shitong Wang2, S. RobinCohen1,2, Robert Platt1,3, Laurent Azoulay1,2,Walter Gotlieb1,2, Susie Lau1,2, Khalil Sultanem1,2,Gerald Batist1,2, Bernard Lapointe1,2, DarenHeyland4,51McGill University, Montreal, Quebec, Canada,2Jewish General Hospital, Montreal, Quebec,Canada, 3McGill University Health Centre,Montreal, Quebec, Canada, 4Queen’s University,Kingston, Ontario, Canada, 5Kingston GeneralHospital, Kingston, Ontario, Canada

BACKGROUND: This pilot study is testing thefeasibility and acceptability of a 3-arm RCT of theMeaning-Making Intervention (MMi;Lee,2006) in60 newly diagnosed advanced cancer patients(ACP), comparing the MMi to an attention-controland usual care alone. While there have beenpreviously published reports of challenges in RCTsof palliative care patients there has been no previ-ous study of RCT implementation barriers of a psy-chosocial intervention in newly diagnosed ACP.METHOD: Patients complete self-administeredmeasures at baseline, and at 2, 4, and 6 monthspost-randomization. Thus far, we have recruited 45participants over 6 months, meeting our recruit-ment goal of 7 patients/month. We kept a journalof implementation challenges and facilitators, con-ducted a content analysis, and have reached theo-retical saturation (i.e. no new theme emerged overpast 3–4 weeks of recruitment). RESULTS: Oncol-ogy team-based challenges were: patients not beinginformed of their advanced staging, suboptimalphysician cooperation (i.e., busy clinics, lack of per-ceived value of psychosocial research, emphasizingown or biomedical studies), a lack of internal com-



munication, and gaps in continuity of care. Patient-related challenges included: reluctance to partici-pate in a psychological intervention, refusal to talkabout their diagnosis for fear of being emotionallyre-traumatized, fluctuating health status, balancingbetween recruiting patients soon after diagnosisand respect for this sensitive period, geographicalbarriers, and family gatekeeping. We were able tofind ways around the barriers; these will be dis-cussed. CONCLUSIONS: Implementing a RCTwith ACP can be challenging in several ways, bothfrom an oncology team and patient/family view-point. The encountered barriers can particularlyinvolve stigma when the tested intervention is psy-chological in nature. Success requires sensitivity,good communication, and strong problem-solvingskills on the part of the RCT research staff.RESEARCH IMPLICATIONS: We present waysto navigate barriers and limitations as revealedthrough our experience of implementing a RCT inACP. These include frequent research staff meet-ings and close staff supervision on clinical issuessurrounding recruitment. The continuous monitor-ing and case by case analysis of challenges as theyarise coupled with a responsive, flexible approachhas been found to be effective. Establishing clearmeans of communication between all parties fur-ther facilitates the swift resolution of potentialissues. CLINICAL IMPLICATIONS: Our experi-ence implementing a RCT in ACP highlights howimportant it is to diligently select research staff ableto tolerate the delicate context of an oncology set-ting for staff, patients, and their families. It alsoemphasizes the importance of ongoing supervisionand training to address clinical concerns and mini-mize implementation barriers. More specifically, itunderlines the importance of helping patients ver-balize any concerns and correct any misconceptionsabout participating in a psychological interventionstudy. ACKNOWLEDGEMENT OF FUND-ING: Canadian Institutes of Health Research(CIHR) Cancer Institute.

P2-88

The Effects of Body-Mind-Spirit (BMS) Group

Therapy and Supportive-Expressive (SE) Group

Therapy on Perceived Stress and Emotional Control

in Breast Cancer Patients

Rainbow Tin Hung Ho, Ted Chun Tat Fong,Cecilia Lai Wan ChanThe University of Hong Kong, Hong Kong

BACKGROUND: Breast cancer patients are com-monly known to suffer from a variety of behavioralsymptoms following diagnosis and treatment. Thecurrent study aimed to investigate the protectiveeffects of Western and Eastern psychotherapies inimproving psychological stress response for breastcancer patients. METHOD: A total of 157 breast

cancer patients, aged between 18 and 65, wererecruited in Hong Kong and randomized into oneof the three group therapies, namely, the body-mind-spirit (BMS) group, supportive-expressive(SE) group, and control group. Outcome measures,which included the Perceived Stress Scale (PSS) andCourtauld Emotional Control Scale (CECS), wereassessed at baseline with 3 follow-up measurementsin a 1-year span. Latent growth modeling was usedto explore the growth trajectories of PSS and CECSand treatment effects of the two therapies.RESULTS: For the total sample, logarithmicdeclining trends were found for the repeated mea-surements of perceived stress (v2(4) = 4.6, p > 0.05,CFI = 1.00, TLI = 1.00, RMSEA = 0.03, SRMR =0.07) and emotional control (v2(5) = 4.5, p > 0.05,CFI = 1.00, TLI = 1.00, RMSEA = 0.00, SRMR =0.07). Decreases in perceived stress and emotionalcontrol were positively correlated (r = 0.35,p < 0.05). Significant reduction in both perceivedstress and emotional control was found for theBMS group therapy, while similar favorable out-comes found in the SE group were not statisticallysignificant. CONCLUSIONS: The study demon-strates significant reductions in perceived stress andemotional control and suggests potential long-termtherapeutic effects for the BMS group therapy forpatients with breast cancer. The effectiveness of theSE group therapy remains to be elucidated in furtherstudies. RESEARCH IMPLICATIONS: Futureresearch could attempt to elucidate the usefulness ofSE group therapy by identifying patients who aremore likely to benefit from the therapy with regardto the cultural adaptation. CLINICAL IMPLICA-TIONS: The beneficial effects as revealed in thisstudy provide supportive evidence of the effective-ness and feasibility of the BMS group therapy forbreast cancer patients. ACKNOWLEDGEMENTOF FUNDING: None.

P2-89

Illness Perceptions of Cancer Patients: Relationships

With Illness Characteristics and Coping

Petra Hopman, Mieke RijkenNetherlands Institute for Health Services ResearchNIVEL, Utrecht, The Netherlands

BACKGROUND: Illness perceptions have provento be predictive of coping and adjustment in manychronically ill patients. Insights into illness percep-tions of cancer patients are however scarce. Thepurpose of the present study was to explore howpeople with cancer perceive their illness. Moreover,we examined the relationship between cancerpatients’ illness perceptions, their illness character-istics (type of cancer, post diagnosis time-span, andtreatment) and coping strategies. METHOD: Par-ticipants were 325 cancer patients from a genericnationwide longitudinal panel-study among cancer



patients in the Netherlands. They completed therevised Illness Perception Questionnaire (winter2011/2012) and the Mental Adjustment to CancerScale (spring 2012). Patient and illness characteris-tics were derived from the National CancerRegistry (NCR) and through self-registration.Descriptive statistics were used to describe thestudy sample, and to compute means and distribu-tions of the IPQ-R scales. Analyses of variancewere conducted to examine whether illness percep-tions are related to illness characteristics. Linearregression analyses were conducted to determinethe relation between illness perceptions and coping.RESULTS: Cancer patients generally perceivetheir illness as a chronic condition and have astrong belief in the effectiveness of cancer treat-ment. People with skin cancer experience relativelylittle negative consequences (p < 0.01). Recentlytreated patients experience more negative conse-quences (p < 0.001) and perceive their illness asmore chronic (p < 0.01) than patients who weretreated in the (distant) past. Perceptions of morepersonal control (p < 0.01) and immunity attribu-tions (p < 0.05) are related to adaptive ways ofcoping, whereas beliefs about negative conse-quences (p < 0.05) and emotional representations(p < 0.001) are related to maladaptive ways of cop-ing. CONCLUSIONS: The perception of cancer asa chronic condition is hold by many cancer patientsthemselves. How cancer patients perceive their ill-ness is not strongly related to the type of cancer.Cancer patients’ illness perceptions are modestlyrelated to their way of coping: perceptions of per-sonal control and immunity attributions relate toadaptive ways of coping, whereas beliefs about neg-ative consequences and emotional representationsrelate to maladaptive ways of coping. RESEARCHIMPLICATIONS: The current research is one ofthe first to focus on illness perceptions of cancerpatients and to relate these to cancer patients’coping strategies. Where known research on cancerpatients’ focuses on relatively recently diagnosedpeople, the current study also covers cancerpatients in the chronic phase. Moreover, we wereable to demonstrate that illness characteristics maybe equally or even more important when it comesto the development of illness perceptions. CLINI-CAL IMPLICATIONS: The current study pro-vides further insight into the relationship betweencancer patients’ illness perceptions and their copingstyles. Since illness perceptions can be changed, itmay be possible for cancer patients to adopt (more)adaptive coping strategies by intervening on theway they perceive their illness. Our results mighttherefore contribute to the development of supportprogrammes that pay structural attention to theway cancer patients perceive their illness and helpthem cope with it. ACKNOWLEDGEMENT OFFUNDING: This study was financially supportedby the Dutch Cancer Society.

P2-90

FAMOCA: Family Online Counseling for Families

With Parental Cancer

Harriet Huggenberger1, Binia Roth2, Jens Gaab3,Brigitta W€ossmer4, Christoph Rochlitz5, JudithAlder11Gyn. Social Medicine and Psychosomatics,University Hospital Basel, Basel, Switzerland,2Child and Adolescent Psychiatry Services ofBruderholz, Bruderholz, Switzerland, 3ClinicalPsychology and Psychotherapy, Departement ofPsychology, University of Basel, Basel, Switzerland,4Psychosomatics, University Hospital Basel, Basel,Switzerland, 5Oncology, University Hospital Basel,Basel, Switzerland

BACKGROUND: A parental cancer diagnosispsychologically affects the whole family. As such, athird of patients, partners and children developclinically relevant levels of psychological distress.Several evaluated family based interventions showimprovements in psychological adjustment, but aface-to face contact was needed. FAMOCA is aweb-based counseling program for families affectedby parental cancer providing information and cop-ing strategies age-specifically. The aim of the studyis to evaluate the efficacy of this interactive inter-vention. METHOD: In this prospective, random-ized-controlled study, 90 families with childrenbetween three and 18 years will be referred either tothe intervention (IG) or the control group (CG)shortly after initial cancer diagnosis of a parent.The IG follows the online program during fourmonths, where age-specific information as well aspracticing of coping strategies are provided viamultimedia. Families of the CG receive an informa-tion booklet for parents and children. Familial andcouple adjustment, parental mental health andcoping, as well as child adjustment are assessed atthe beginning, at the end of the program and12 month after diagnosis. RESULTS: The websitegoes online and thus the study starts in July 2013.Results of a first pilot study on usability and feasi-bility aspects of the online program will be pre-sented. CONCLUSIONS: Research shows therelevance of psychooncological support for familieswith parental cancer. FAMOCA is an innovative,low-threshold internet program, which aims toimprove the adjustment to cancer of all familymembers. RESEARCH IMPLICATIONS: Web-based, interactive interventions are the new formsof therapy. In other fields of psychological research,they have been proven as efficacious as face-to-faceinteractions. So far, web-based interventions forcancer patients have been provided in single, coupleand group format while to our knowledge there areno studies evaluating its effectiveness for familiesaffected by parental cancer. FAMOCA aims toshow, if family counseling is effective by internet.



CLINICAL IMPLICATIONS: The online inter-vention can easily become part of standard psych-ooncologic care. For the provider, the internet is atime- and cost-effective method to deliver interven-tions to improve psychological adaptation. For thefamily, counseling in the internet overcomes someof the known barriers in attending to psychoonco-logic support, such as geographical distance. Theresults of the study will help to identify families,who benefit from a web-based counseling approachand who need further assistance. ACKNOWL-EDGEMENT OF FUNDING: This study is sup-ported by the Swiss Cancer Research andconducted by an interdisciplinary team of theDepartments of Psychosomatics and Oncology ofthe University Hospital of Basel, the Departmentof Psychology of the University of Basel, and theChild and Adolescent Psychiatry Service of Bruder-holz in Switzerland.

P2-91

Study Protocol: A Randomized Study of An

Internet-Based Cognitive Behavioural Therapy

Program for Sexuality and Intimacy Problems in

Women Treated for Breast Cancer

Susanna B. Hummel1, Jacques J.D.M. vanLankveld2, Hester S.A. Oldenburg1, Neil K.Aaronson11The Netherlands Cancer Institute, Amsterdam, TheNetherlands, 2Open University, Heerlen, TheNetherlands

BACKGROUND: Sexual dysfunction is a preva-lent, long term complication of breast cancer andits treatment. Many women consider face-to-facesexual counselling to be too confronting, and see in-ternet-based interventions as a less threatening andmore acceptable approach. Recent studies havedemonstrated the efficacy of internet-based pro-grams in improving sexual functioning in the gen-eral population. The current study will focus on aninternet-based treatment program for improvingsexual functioning in breast cancer survivors.METHOD: This multicenter, randomized con-trolled trial will investigate the efficacy of an inter-net-based cognitive behavioural therapy (CBT)program in alleviating sexuality and intimacy prob-lems in women treated for breast cancer. Secondaryoutcomes include body image, menopausal symp-toms, marital functioning, psychological distressand health-related quality of life. 160 breast cancersurvivors with sexuality/intimacy problems will berandomized to either an intervention or controlgroup. Questionnaires will be completed at base-line, mid-treatment, post treatment and at 3 monthfollow-up (or equivalent times for the controlgroup). RESULTS: This is a design paper. Noresults are yet available. CONCLUSIONS: Thereis a need for accessible and effective interventions

for the treatment of sexuality and intimacy prob-lems in breast cancer survivors. This study will pro-vide evidence about the efficacy of an internet-based approach to delivering a CBT interventiontargeted specifically at these sexual health issues.RESEARCH IMPLICATIONS: This study willprovide a rigorous test of the efficacy of an inter-net-based CBT program for the treatment of sexu-ality and intimacy problems among breast cancersurvivors. CLINICAL IMPLICATIONS: Whenproven to be effective, internet-based cognitivebehavioural therapy for problems with sexualityand intimacy will be a welcome addition to the careoffered to breast cancer survivors. Hopefully thistherapy will lower the barrier to seek help for theseproblems, resulting in an improved quality of lifeafter breast cancer. ACKNOWLEDGEMENT OFFUNDING: This study is funded by the DutchCancer Society and the Pink Ribbon Foundation.

P2-92

The Loneliness Predict the Function of Japanese

Head and Neck Cancer Patients

Kanako Ichikura1,2, Aya Yamashita1, TaroSugimoto3, Seiji Kishimoto4, Eisuke Matsushima11Section of Liaison Psychiatry and PalliativeMedicine, Graduate School of Tokyo Medical &Dental University, Bunkyo-ku, Tokyo, Japan,2Research Fellow of the Japan Society for thePromotion of Science, Bunkyo-ku, Tokyo, Japan,3Department of Oto-Rhino-Laryngology, MedicalHospital of Tokyo Medical & Dental University,Bunkyo-ku, Tokyo, Japan, 4Section of Head andNeck Surgery, Graduate school of Tokyo Medical &Dental University, Bunkyo-ku, Tokyo, Japan

BACKGROUND: In patients with head and neckcancer, medical treatments interfere with their func-tion of breathing, swallowing or vocalizing. It isimportant for patients to recover some function bythe time they leave the hospital. The perceivedsocial support might enhance their function, as therelationship between self-care behavior and theirfunction. The purpose of this study was toinvestigate the loneliness predict the function ofpatients with head and neck cancer in Japan.METHOD: The study was a cross-sectional designwith self-completed questionnaire. From our data-base of 191 patients participated in Head & NeckCancer Inventory Validation Study at MedicalHospital of Tokyo Medical & Dental Universitybetween September 2011 and March 2013, weselected 122 patients who were received hospitaltreatment. The questionnaire consisted of Func-tional Assessment of Cancer Therapy for Head &Neck Cancer (FACT-H&N) and the revised UCLAloneliness Scale. A multiple regression analysis wasperformed to estimate effect of loneliness on thefunctional loss of head and neck after controlling



disease-related variables as potential confounders.RESULTS: Of all 122 participants, 87 (75 malesand 12 females) completed all questions in thisstudy. Overall, there were patients with pharynxcancer (n = 60), larynx cancer (n = 5), and oral can-cer (n = 18). The most commonly treatment wassurgical operation (n = 50), followed by Chemo-therapy (n = 23) and combination of chemotherapyand radiation therapy (n = 14). In a multipleregression model, the loneliness predicted the func-tional loss of head and neck (B = �0.19, 95%CIs�0.31 to �0.07) in addition to the radiation ther-apy and the duration of hospitalization. CONCLU-SIONS: Our results support the hypothesis that theloneliness effects on the low function of swallowing,breathing or vocalizing at the time of hospital dis-charge. It is suggested that the function recovery inthe hospital treatment is not only influenced by bur-den of treatment such as radiation therapy or longhospitalization but also subjective perception aboutreceiving support. Their self-care behavior such asmouth cleaning or taking a shower might be moti-vated by the thought of being not alone andenhance their function. RESEARCH IMPLICA-TIONS: To maintain the function in patients withhead and neck cancer, it is not important to havestable source of support but to feel someone’s helpin their life. Unfortunately while many patients inhead and neck cancer live alone, there are manyhealth care support systems around them. In thefuture, we should develop programs for patientswith head and neck cancer to improve the skills ofself-care or getting someone’s help. CLINICALIMPLICATIONS: The final therapeutic goal is tomaintain patients’ Quality of Life (QOL), especiallyoral function. Our study suggests that pretreatmentpsychological care can be effective in function recov-ering of patients with head and neck cancer at thetime of hospital discharge. Therefore health careprovider should help them find and take advantageof the information about various support systems.ACKNOWLEDGEMENT OF FUNDING: Thiswork was supported by Grant-in-Aid for JSPSFellows (Grant Number: 241085-00).

P2-93

Evaluation of the Effectiveness of Telephone

Counseling Intervention on Early-Stage Breast

Cancer Patients

Isil IsikKoc University School of Nursing, _Istanbul, Turkey

BACKGROUND: This experimental study wasconducted to evaluate the impacts of telephonecounseling and advising with the booklet interven-tion compared to only advising with the bookletintervention on anxiety, depression, quality of life,psychosocial adjustment to illness situations ofpatients who have completed stage 0,I,II breast

cancer treatment. METHOD: The sample of thisstudy consisted of 120 patients recruited from anoncology clinic by using simple random samplingmethod. Subjects were randomly assigned intothree groups; telephone counseling and advisingwith a booklet group, advising with a bookletgroup and control group. The subjects in experi-ment-2 group were trained at the hospital about theusage of the booklet and the subjects in experi-ment-1 group received 8-session telephone counsel-ing besides advising with a booklet. Data werecollected before and 8 weeks after the interventionby using Personal Information Form, HospitalAnxiety Depression Scale, SF-36 and PsychosocialAdjustment to Illness Scale. RESULTS: Results ofthis study demonstrate that telephone counselingand advising with the booklet intervention has asignificant impact on depression and anxiety levelof patients, SF-36 mental domain and generalhealth perception domain and PAIS-SR psycholog-ical distress domain in comparing to just advisingwith the booklet and control group. In addition, itwas found that while 2 intervention methods hadan impact on quality of life total score, vitality/fati-gue, emotional role functions, physical role func-tions, health care orientation, sexual relationships,family environment, professional environment, theydidn’t have any impact on social functions, physicalfunctions and pain levels of patients. CONCLU-SIONS: In Turkey there is no study about early-stage breast cancer patients, comparing the effect oftelephone counseling and booklet. There areresearches about this topic which had used tele-phone counseling patients about depression, anxi-ety and psychological strain were found to be moreeffective than informing about the condition usinga booklet. This result shows that regular telephonecalls between a patient and a professional havepositive impact on mental status of patients.RESEARCH IMPLICATIONS: For the futureresearches, telephone counseling and informationbooklet can be used in same and different types andstages of cancer, same and different variables, inorder to determine the effect of interventions ondifferent groups of patients can be made. CLINI-CAL IMPLICATIONS: According to the resultsof study “Early Stage Breast Cancer Patient Book-let” is an effective choice enhancing the quality oflife, patients’psychosocial adaptation of patients totheir disease is recommended. Patients with early-stage breast cancer, when evaluating anxiety,depression and psychological strain, in additionintervention with the booklet telephone counselingis also recommended. ACKNOWLEDGEMENTOF FUNDING: None.

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P2-97

Support Group for Children Whose Parent has

Cancer - Implementation and Evaluation of the

CLIMB� Program in Japan

Mariko Kobayashi1, Kaori Osawa2, Miwa Ozawa31The Open University of Japan, Chiba-city, Japan,2Tokyo Kyosai Hospital, Tokyo, Japan, 3St. Luke’sInternational Hospital, Tokyo, Japan

BACKGROUND: With the increase of cancerpatients in Japan who are raising dependent chil-dren, a program to support them is critically impor-tant. We identified a need to provide support groupfor children whose parent has cancer. After takingthe CLIMB training in the U.S., we started a pro-gram in August 2010. The purpose of this presenta-tion is to discuss evaluation of the program inTokyo and report our success at dissemination ofthe program throughout Japan. METHOD: InTokyo, we provided 6 groups of CLIMB to chil-dren aged 6–12 from August 2010 to December2012. Each program is held over 6 consecutiveweeks for 2 hours. The program follows a standardtraining manual modified from the U.S. manual.We had concurrent parents’ groups. Thirty ninechildren have participated (11 boys, 28 girls). Thirtytwo parents (28 mothers, 4 fathers, within them 3well spouses) attended. We asked participants to fillout questionnaires before and after the group inter-vention and analyzed the effect. In July, 2012, weconducted a 2-day training for professionals fromacross Japan. RESULTS: Children noted high sat-isfaction (mean = 4.4–5.0, selected from 1–5) on29/30 items. Fewer children felt the parents’ cancerwas “not their fault”, more children felt “they feelstronger through the experience”. Overall QOL ofmothers significantly increased, e.g. “I am satisfiedwith family discussions regarding cancer”, and “Ifeel closer to my partner”. Spontaneous continuingreunions demonstrate strong bonding among par-ents and children. 37 participants (nurses, socialworkers, psychologists, child life specialists, andphysicians) from all over Japan attended the train-ing workshop. Due to our training, as of May,2013, 5 additional hospitals have implementedCLIMB. CONCLUSIONS: Parents’ QOL andchild’s self-esteem increased after CLIMB; satisfac-tion levels reported were very high. Our findingsindicate increased communication within the fam-ily. Parents bonded with other parents; children

with peers. This demonstrates positive effects ofCLIMB. To disseminate a program to support chil-dren of cancer patients and increase the number ofprograms offered, we built a system to train theleaders for CLIMB to benefit more children. Weidentified that oncology professionals in Japan hada high interest in implementing a CLIMB programin their institution. All the hospitals presentingCLIMB use a multidisciplinary program and fur-ther expansion is expected. RESEARCH IMPLI-CATIONS: Based on data from pre and posttestmeasurements on each attendee and evaluation, wefound that the child’s sense of guilt decreased andcoping skills regarding parent’s illness increased.Further, mother’s QOL and communication wereimproved. This indicates the importance and valueof the program and the need to continue. We havestarted multi institutional research from fall of2012, and will continue our research on effective-ness of CLIMB in multi institutions in Japan.CLINICAL IMPLICATIONS: There is increasedawareness on importance of support for children ofcancer patients within medical professionals inJapan. Many want to attend CLIMB training work-shop and this shows a need for structured supportprogram. Satisfaction level of families participatedare very high, and led to annual reunion gathering.We will continue our activity to increase hospitalspresenting CLIMB through training and supportingthem when launching program so that more childrenand patients can attend. ACKNOWLEDGEMENTOF FUNDING: This study was supported by agrant from the Japanese Ministry of Health,Labour and Welfare (2010–2012).

P2-98

The Characteristics of Female Patients in a Specific

Psycho-Oncology Outpatient Service

Atsuko Koyama, Hiromichi Matsuoka, ChihiroMakimura, Ryo Sakamoto, Kiyohiro SakaiKinki University, Faculty of Medicine,Osakasayama City, Osaka, Japan

BACKGROUND: The division of psychosomaticmedicine, Kinki University Faculty of Medicineand its branch hospitals opened an outpatient ser-vice for cancer patients and their families. Thefemale to male ratio of its patients is approximately2:1 and there are several gender-specific problemsrelated to bio-psycho-social factors with femalepatients. The primary aim of this study is to discussthe characteristics of female patients in this speci-fied outpatient service from the viewpoint of gen-der-based medicine. METHOD: The study periodwas from May 2010 to April 2013. The data of newpatients who had symptoms related to cancer andvisited the specific outpatient service for psycho-oncology were collected. All patients were at least16 years old. All the items assessed during routine



clinical practices were extracted from the patients’medical charts. Multiple factors such as age, sex,cancer site, family background, clinical symptoms,and psychiatric diagnosis were analyzed. Psychologi-cal tests of depression and anxiety were also exam-ined. RESULTS: The data of 210 new cancerpatients, including 16 family members of cancerpatients, were analyzed. The most common cancersite was breast cancer and the most common psychi-atric disorder was adjustment disorder. Femalepatients had more anxiety tendencies than depressivestates. Female patients were also more likely to besuffering from psycho-social issues such as cosmeticrelated problems, family care and/or financial issuesthan male patients. For example, the depressivemood of female patients was exacerbated by alope-cia due to chemotherapy. The anxiety tendency wasincreased by a lack of family support and financialfragility. CONCLUSIONS: Approximately twicethe number of female patients than male patientscame to our specified outpatient service for psycho-oncology since the majority of patients were sufferingfrom breast cancer. There were several characteristicsrelated to gender-specific issues with female patients.More intensive intervention is needed based on gen-der-based medicine. In addition, in order to deal withthese bio-psycho-social factors, a psycho-oncologicalapproach by a multidisciplinary team including der-matologists, plastic surgeons, aestheticians, psycholo-gists and medical social workers would be useful.RESEARCH IMPLICATIONS: This study showedthe characteristics of female cancer patients whocame to our specific outpatient service. From theresults of this study, further examination of breastcancer patients might be needed since they comprisenearly half of the cancer patient population. Thestudy showed the advantages of psychosomaticmedical doctors’ intervention from the viewpoint ofgender-based medicine. CLINICAL IMPLICA-TIONS: This study explained the reasons why can-cer patients visited our specified outpatient serviceand what kind of psycho-oncological interventionwe can provide that is useful for them. Dependingon these results, we can give more efficient support,including a multidisciplinary team approach, toboth cancer patients and their families in the future.ACKNOWLEDGEMENT OF FUNDING: None.

P2-99

The Efficacy of a 6-Week Group Psycho-

Educational Program on Mood Symptoms and

Quality of Life Among Philippine Breast Cancer

Patients: A Randomized, Controlled Trial

Dianne Ledesma1, Miyako Takahashi2, Ichiro Kai11University of Tokyo, Tokyo, Japan, 2NationalCancer Center, Tokyo, Japan

BACKGROUND: Breast cancer is the most com-mon form of cancer among Philippine women. The

diagnosis of cancer leads to various psychosocialstresses such as distress, fatigue, and poor qualityof life. Group psychotherapy is a widely used toolto address many psychosocial needs in cancer. Thisstudy set out to determine the efficacy of a 6-weekgroup psycho-educational program for Philippinebreast cancer patients in terms of improvement ofmood and quality of life. METHOD: This studywas conducted at the University of Santo TomasHospital Benavides Cancer Institute in Manila,Philippines, among Stage I-III breast cancer outpa-tients who had completed active chemotherapyand/or radiotherapy. Twenty (20) were randomizedinto an Intervention Group and twenty (20) into aWait-list Control Group. All patients were assessedat Baseline (T1), immediately post-therapy (T2),and at 3-month follow-up (T3) on the psychosocialscales of fatigue (BFI), distress (HADS), moodsymptoms (POMS), quality of life (EORTCQLQC30 and BR23), social support (MOS SocialSupport Scale), and coping skills (Brief COPE).Data was analyzed using two-way ANOVA withrepeated measures. RESULTS: Patients’ mean agewas 47 years old and 62.5% were married. 57.5%were in Stage 2. Thirty two patients (17 Interven-tion and 15 Control) completed the program. Com-pared with the control group, the interventiongroup showed significantly lower total mood distur-bance (p = 0.02), lesser fatigue/inertia on thePOMS subscale (p = 0.03), improved quality of life(p = 0.05), and also significantly used more activecoping skills like Planning (p = 0.03) and Use ofInstrumental Support (p = 0.01), and significantlyhad less negative coping skills like Self-blame(p = 0.05). Some variables immediately showedimprovement at T2, while other variables had mini-mal effects at T2 but increased at T3. CONCLU-SIONS: The 6-week group psycho-educationalprogram shows promise as an effective tool for pro-viding psychosocial support to Philippine breastcancer patients, as evidenced by its effects in lower-ing mood disturbance, increased use of positivecoping styles and a higher quality of life. Asidefrom the stress directly related to diagnosis andtreatment with cancer, Philippine breast cancerpatients have difficulty in access to health care,which for many remains expensive. This program isa relatively inexpensive and useful psychosocial toolto help alleviate stresses brought about by theuncertainties related to cancer. RESEARCHIMPLICATIONS: This research first of all impliesthat a psychological intervention program can beconducted in a challenging environment such as thePhilippines, where participation in interventionresearch is not very common and psychologicalsupport for cancer patients is not generally a partof overall cancer treatment regimens. Secondly, theresearch results further corroborate existingresearch on the efficacy of such a group psycho-educational program in a different country, point-



ing to its international appeal. CLINICAL IMPLI-CATIONS: Philippine institutions do not providestandard psychosocial support for cancer patients,usually because of untrained staff or low priority.Stressing the importance of the benefits gainedfrom providing such support is one of the chal-lenges now, as well as raising interest among cancertreatment centers in the country. This researchshows that with properly trained staff, an easy toreplicate psycho-educational program can be pro-vided in the hospital setting to improve psychoso-cial care for patients. ACKNOWLEDGEMENTOF FUNDING: This research received partialfunding from the University of Tokyo.

P2-100

Effect of Brief Psychoeducation Using Tablet PC on

Depression and Quality of Life in Distressed

Patients During Chemotherapy: A Pilot Study

Joo-Young Lee1,2, Dooyoung Jung1, MihyeMoon3, Bhumsuk Keam4, Hye Yoon Park1,5,Bong-Jin Hahm1,5

1Department of Neuropsychiatry, Seoul NationalUniversity Hospital, Seoul, Republic of Korea,2Advanced Education for Clinician-scientists, SeoulNational University, Seoul, Republic of Korea,3Department of Nursing, Seoul National UniversityHospital, Seoul, Republic of Korea, 4Department ofInternal Medicine, Seoul National UniversityHospital, Seoul, Republic of Korea, 5Department ofPsychiatry and Behavioral Science, Seoul NationalUniversity, College of Medicine, Seoul, Republic ofKorea

BACKGROUND: Distress management hasbecome an important consideration for cancerpatients regarding its strong association with qual-ity of life (QoL) and possibly survival. The effect ofdistress screening has been studied profoundly,whereas that of psychoeducation in cancer patientsstill warrants further investigation. We focused ontablet PC due to its potential capability to deliverpsychoeducation to cancer patients in the midst ofbusy clinical oncology setting. METHOD: Thirtysix cancer patients with anxiety or depression, deter-mined by Hospital Anxiety and Depression Scale(HADS), were enrolled among those who visiteddaytime chemotherapy unit in Seoul National Uni-versity Cancer Hospital between May 2013 and June2013. Participants were quasi-randomized either intopsychoeducation (n = 19) or control (n = 17) group.Psychoeducation for cancer-related distress and itsmanagement including relaxation technique wasprovided in a 20-minute-movie clip using tablet PCduring chemotherapy infusion. HADS, the SF-8,M.D. Anderson Symptom Inventory (MDASI),Insomnia Severity Index (ISI), and the Impact ofEvent Scale - Revised (IES-R) were administered atbaseline and in 3 weeks. RESULTS: Nineteen par-

ticipants (100%) in psychoeducation group and 16participants (94.1%) in control group completedthe study. Compared to controls, psychoeducationgroup showed significant improvement after3 weeks, in terms of depression subscale of HADS(p = 0.001), mental component summary score ofthe SF-8 (p = 0.009), avoidance subscale of theIES-R (p = 0.049), and ISI (p = 0.021). CONCLU-SIONS: Brief psychoeducation delivered by tabletPC during chemotherapy infusion could be bothtime- and cost-effective method in improvingdepression, insomnia, and QoL for the cancerpatients with distress. RESEARCH IMPLICA-TIONS: Further research must follow to validatethe long-term efficacy of psychoeducation usingtablet PC. Developing more effective psychoeduca-tional materials and determining the optimal timeperiod of application must be explored in the futureresearch. CLINICAL IMPLICATIONS: Ourstudy suggests that brief psychoeducation usingtablet PC can be applied in chemotherapy units,and perhaps can be extended to other areas, toimprove depression, insomnia, and QoL of cancerpatients with distress. ACKNOWLEDGEMENTOF FUNDING: None.

P2-101

Efficacy of a 3-Session Psychoeducational

Intervention for Cancer Patients and Their Families

at the Time of Diagnosis - Preliminary Data

Concha Leon1,2, Rosanna Mirapeix1,2, EstherJovell3, Tom�as Blasco4, �Angels Arcusa2, Miquel�Angel Segu�ı11IOV - Hospital Parc Tauli de Sabadell, Barcelona,Spain, 2IOV - Consorci Sanitari de Terrassa,Barcelona, Spain, 3Epidemiology - Consorci Sanitaride Terrassa, Barcelona, Spain, 4DepartamentoPsicologia B�asica UAB, Barcelona, Spain

BACKGROUND: Many patients had stated thatinformation received by the oncologist at the timeof diagnosis is not well understood since it is ham-pered by the emotional distress. Thus, additionalsessions to ask questions, and to receive informa-tion in a understandable way should be needed. Inorder to help patients and families to achieveunderstanding of their situation and to reducethe emotional distress at diagnosis, a brief psycho-educational intervention has been designed.METHOD: Ninety two ambulatory cancerpatients (55 female and 37 male), diagnosed andtreated at the Institute Oncologic del Vall�es (IOV),from august/2012 to february/2013, were contactedby phone and were invited to participate in 3 psi-coeducative sesions. Written informed consentswere signed by the participants. We evaluated soci-odemographic and emotional status (anxiety, stress,anger and depression) through an addapted ther-mometer, pre-post intervention. RESULTS: 38



patients and 18 relatives agreed to participate in thestudy, including 18 patients and 5 relatives com-pleted questionnaires pre-post intervention (18women, mean age 54 years and 5 men, mean age66 years). The most frequent diagnosis among par-ticipants was breast cancer. We found that levels ofAnxiety (pre = 5.4, post = 4.1), Stress (pre = 4.6,post = 3.6), Depression (pre = 4.6, post = 3.4) andAnger (pre = 6.3, post = 4.6) decreased. CON-CLUSIONS: The study involved more womenthan men. Being newly diagnosed prevents continu-ously attendance at meetings. The emotional dis-tress decreases over time, but we have no controlgroup to infer that it is due to the intervention.RESEARCH IMPLICATIONS: It is essential toexpand the sample of subjects in order to concludeon the effectiveness of the intervention. CLINICALIMPLICATIONS: If proven the efficiency of inter-vention raises the possibility of incorporating it intostandard clinical practice. ACKNOWLEDGE-MENT OF FUNDING: Study supported by Aso-ciaci�on Espa~nola Contra el C�ancer (AECC) - JuntaProvincial de Barcelona.

P2-102

Connecting Cancer Care Researchers and Graduate

Students Through an Innovative Research Training

Initiative: The Canadian PORT (Psychosocial

Oncology Research Training) Program Reaches to

International Partners

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

BACKGROUND: Cancer is a leading cause ofphysical and psychological suffering. Through itsfocus on key personal and contextual factors thataffect people’s experience with cancer, psychosocialoncology is increasingly attracting young research-ers seeking rigorous training in an emergent trans-disciplinary field. Established in Canada since 2003,the Psychosocial Oncology Research Training(PORT) program described herein seeks to buildresearch capacity in the field through enhancedmentoring, innovative research, and proactive dis-semination of findings. METHOD: PORT includessix Canadian universities and offers training andfinancial support to graduate students; pairingaccomplished researchers with fellows at the mas-ters, doctoral and post-doctoral levels. Partnershipwith the National Institute of Mental Health andNeurosciences (NIMHANS in Bangalore, India)adds richness and cross-cultural relevance.Advanced multi-media technology is utilised topromote information exchange and networkingopportunities. An annual 3-credit 13-week video-conference graduate seminar in psychosocial oncol-ogy research is a mandatory component of thecurriculum. The annual face-to-face scientific

meeting is linked to a national conference. Yearlyapplications for PORT are encouraged from quali-fied international and national candidates.RESULTS: For a decade now, PORT continues tobe highly regarded as a rigorous, cutting edge, andhighly attractive research training program (nation-ally and internationally). To date, the program hashosted 39 mentors and 63 fellows. Internationalgraduate students represent 6 countries. Fellows’output totals 336 peer-reviewed publications and460 scientific presentations. Research interests arediverse and include new areas such as patientexperiences interacting with the health care system,the effects of early physical exercise on cancerrecovery, and the role of tailored survivorship careplans and e-health cancer navigation platforms inenhancing health outcomes, patient empowermentand psychosocial adjustment. CONCLUSIONS:By training the next generation of psychosocialoncology researchers, PORT continues to build acritical mass of scholars in this field. The broad,trans-disciplinary model facilitates dissemination ofevidence-based knowledge stemming from multi-method approaches within and across more than adozen disciplines and settings. Additional interna-tional partners would add cross-cultural relevance,providing mutual opportunities for key contribu-tions to the field. To this end, PORT leaders areproactively engaged in identifying potential sourcesof international funding to expand the reach of thisimportant initiative. ACKNOWLEDGEMENTOF FUNDING: The Institute of Cancer Research(ICR) and the Institute of Health Services and Pol-icy Research (IHSPR) fund PORT through theCanadian Institutes of Health Research (CIHR).McGill University faculties and Graduate andPost-Doctoral Studies, Hope & Cope, and EL-LICSR also are providing matching funds.

P2-103

Changes in Social Relations as a Result of

Participation on Group Intervention in Cancer

Patients (2)

Tomoko Matsui1, Kei Hirai1, Masako Shikoji2,Madoka Tokuyama21Osaka University, Suita, Osaka, Japan, 2ToyonakaMunicipal Hospital, Toyonaka, Osaka, Japan

BACKGROUND: Studies on group interventionsthat deal with social relations in cancer patients haveshown that such interventions could increasepatients’ social support and help build social sup-port networks. Therefore, group interventions areexpected to have beneficial effects on cancerpatients’ social relations. This study extracted fac-tors concretely that contribute to changes in thesocial relations of Japanese cancer patients after tak-ing part in a group intervention. METHOD: Sevencancer patients (mean age = 63.0; SD = 10.3) who



participated in group therapy based in problemsolving therapy were interviewed. Participants wereasked about changes in their social relations afterbeing affected with cancer and taking part in grouptherapy. After making verbatim records from voicedata, we conducted contents analysis. (Kappa coef-ficients = 0.89 and 0.84). RESULTS: We identifiedseven elements related to changes in social relationsafter experiencing cancer (e.g. decreased social net-work, decreased social support, absence of socialsupport network, need of contact with patients withthe same disorder). Following that, 6 elements wereidentified about changes in social relations aftertaking part in group therapy (e.g. increased socialsupport network, receipt of social support, provi-sion of social support, raising companionship).Especially, patients received and provided emo-tional and informational social support each other,and received these 2 supports from stuff and satis-faction with support. CONCLUSIONS: The find-ings suggest that social support that participantsneed differ depending on residence form. Most par-ticipants felt decreased social networks with friends,so it suggests that companionship that patients feltdecreased because people tend to feel companion-ship from interaction with friends. The findingssuggest that participation in group therapy leads tothe perception that one’s social relations have chan-ged in several ways. Particularly, participants feltcompanionship that have not been referred. What’smore, we made it clear that patients received andprovided emotional and informational social sup-port each other, and received these two supportsfrom stuffs and satisfaction with support.RESEARCH IMPLICATIONS: When researchersexamine the effect of group intervention for changesof social support, they should consider residenceform of participants and kinds of social supportsmeasured. Additionally, the results of group inter-vention studies covering loneliness in cancer patientshave little consistency. The companionship andsocial support have effects that reduce loneliness, sowe could give the suggestion for understanding theconsistency. CLINICAL IMPLICATIONS: Medi-cal stuffs should understand not only psychologicalaspects but also social relations aspects of groupintervention’s effects, and curry out it consideringthese aspects. It’s difficult for patients to get instru-mental support in the intervention, so stuffs shouldconnect patients who need this support to anothersuitable stuff (e.g. social workers). ACKNOWL-EDGEMENT OF FUNDING: None.

P2-104

Psychosocial Support Needs of Adolescent and

Young Adult (AYA) Transplant Patients

Lina Mayorga1, Jonathan Espenschied1, LizCooke1, Marcia Grant1, Jennifer Gotto1, RachelLynn2, David Snyder11City of Hope National Medical Center, Duarte,California, USA, 2MD Anderson, Houston, Texas,USA

BACKGROUND: Existing evidence suggests thatAdolescent and Young Adult (AYA) patients usemore psychosocial support services and have greaterlevels of distress than do older cancer patients (Mor,Allen & Malin, 1994). Bleyer et al suggests, “thegreatest difference in management of adolescentsand young adult patients is psychosocial care thatthey require. These patients have special needs thatare broader in scope and more intense than those atany other time of life” (p.19). METHOD: The pur-pose of this study is to explore the psychosocialsupport needs of AYA patients before, during andafter transplant. We conducted a retrospectivechart review of all 2011 transplant patients referredfor psychiatric evaluation within 100 days of trans-plant, either pre-transplant for screening/evaluationor post-transplant through inpatient hospitaliza-tion. Of the twenty-two total patients, thirteen fellinto the AYA group and are described here. Dataon sociodemographic, disease, treatment, and per-sonal characteristics of transplant patients whoreceive psychiatric evaluations were collected usinga retrospective chart review tool. Analysis includedsimple frequencies and descriptive statistics.RESULTS: Thirteen young adult transplantpatients were seen for psychiatric consultation(53.8% female; 46.2% male). Primary reason forreferral was anxiety (23.1%), and depression(30.8%). Of those seen, 46.2% had a previous psy-chiatric history and 46.2% experienced pre trans-plant distress. High rates of substance abuse wereidentified with history of alcohol use 69.2%, andalcohol use within 6 months of transplant 23.1%.Prior history of marijuana use 38.5%, use within6 months of transplant 15.4%. Psychosocial issuesincluded: 15.4% current conflict with support sys-tems or family members; 23.1% had caregiverissues affecting continuity of care post-transplant.CONCLUSIONS: Higher rates of mortality, sub-stance abuse, pre-transplant distress and psychiatricconcerns prior to transplant were found in this can-cer population subset. Expected prevalence amongadults in the community with regard to anxiety andsubstance abuse were found in similar rates. Thesefindings further highlight the special needs of thispopulation of cancer patients and support Bleyer,et al and others requiring more attention andresearch for this young adult population.RESEARCH IMPLICATIONS: While a sizeable



body of literature exists for young adult survivorsof childhood cancer, we’re just beginning to see thefocus shift to issues concerning individuals that arediagnosed during stages of adolescence and youngadulthood (AYA) and psychosocial issues duringtreatment. Transplant is challenging for mostpatients. The AYA population comes to transplantwith exceptional and unique psychosocial needs.Further description of needs, as well as identifica-tion and testing of intervention approaches areneeded. CLINICAL IMPLICATIONS: An AYAdiagnosed with cancer must move through typicaldevelopmental processes with the burden of addi-tional stressors including the emotional impact of acancer diagnosis, trials and tribulations of therapy,and the emotional, social and physical late effectsof the disease and its treatment (Evan & Zeltzer,2003). Screening prior to transplant is essential inidentifing potential problems early. Increased orfocused psychosocial support before, during andafter transplant is needed. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-105

Identifying Information Gaps and Resources

Required to Support the Development of a Patient

Education Toolkit for the Adolescent Young Adult

(AYA) Oncology Patient Population

Lina Mayorga, Kayla Fulginiti, Marisol Trujillio,JoAnn Namm, Renee Ortiz, Jeanelle Folbrecht,Natalie KellyCity of Hope Cancer Center, Duarte, California,USA

BACKGROUND: Research indicates that AYAsin treatment have a desire for treatment decisionsthat honor their unique needs in areas of education,medical management, sexuality and survivorship. Achallenge in providing AYA’s with tools/resourcesis that little to no printed educational materialsexists specifically for the AYA population. The pur-pose of this study was to identify educational needsof AYA patients and health professionals at cancercenters and organizations to develop an educa-tional toolkit for AYA’s. METHOD: The follow-ing modalities were utilized in identifying theeducational needs of AYA’s (1) literature review,(2) query and telephone interviews of health careprofessional at various cancer centers or cancerorganizations; including the respondents’ role attheir organization, geographic location, and currentuse and needs of the AYA population in areas ofeducation and information gaps (n = 20), (3) AYAeducational needs assessment. A needs assessmentwas developed and included questions designed todetermine patient’s information needs to supportthe use an AYA toolkit. Responses were analyzedusing descriptive statistics and thematic analysis.RESULTS: Data acknowledged the need of educa-

tional specific resources and tools for the AYApopulation from both the patients and healthcareprovider’s perspective. However, many of the clini-cians acknowledged lack of the knowledge andskills required to use these tools, or awareness ofcredible sources of information. AYA informa-tional and educational gaps were identified in thefollowing areas: communication, medical manage-ment, symptom management, sexuality & relation-ships, body image, coping, managing emotions andstress, managing life, school and work andresources for support. CONCLUSIONS: An AYAspecific toolkit was developed by a multidisciplin-ary team to address all educational and informationgaps and needs identified. There is a small butgrowing body of evidence available to address mostof the specific topics mentioned, however this infor-mation needs to be available in print versus on theWorld Wide Web and needs to be tangible to bothhealth care providers and patients/families. Crea-tion of a tool, informed by the literature, couldaddress these needs. This tool could be furtherenhanced by incorporating additional informa-tional and psycho-social needs identified by cancerpatients. RESEARCH IMPLICATIONS: Under-standing individual patient preferences is critical toimprove health behaviors. Implications of the resultswill be discussed in terms of enhancing patient-cen-tered tailoring of health information and communi-cation for the AYA population. CLINICALIMPLICATIONS: Too little research has taken theAYA’s patient perspective into account, in terms ofeducational and psycho-social needs. Health behav-ior is impacted by the patient’s attitudes, emotionsand motivations that in turn are influenced by thesocial world, their thoughts about their disease andtreatments and their relationships with others.ACKNOWLEDGEMENT OF FUNDING: None.

P2-106

Innovative Uses of Health Education Technologies

can Reduce Distress and Empower Newly Diagnosed

Cancer Patients to Take an Active Role in Their

Care

Lina Mayorga, Ben Laroya, Laura SimmonsCity of Hope Cancer Center, Duarte, California,USA

BACKGROUND: A cancer diagnosis can causepatients to feel anxious, overwhelmed and unpre-pared to meet the challenges of treatment. An elec-tronic orientation class was piloted for newpatients/families to gain insight on innovative waysto use technology to help patients/families preparefor their cancer journey. The class provided anoverview of what to expect during the first appoint-ment, taking an active role in their care, communi-cation, advanced care planning, patient safety,navigation and psychosocial resources/ support.



METHOD: In order to reach more patients thephysical one hour orientation class was convertedto a thirty minute electronic program. It waspiloted amongst new patients and caregivers. Usingvarious technologies (1) computer based program(iPAD/ tablet) (2) online module (3) DVD/video.The various technologies allowed the ability to tai-lor education based on their preference. Partici-pants were scheduled into the program accordingto their convenience, by a scheduler. Data gatheredincluded Pre/post test data, patient satisfaction sur-vey. In addition twenty participants were selectedto participate in a post 30 day follow-up telephoneinterview and pilot an additional modality for com-parison. RESULTS: Of the 114 patients/caregiverswho participated in the pilot study, 82 completediPad/tablet version of patient orientation class, 15online education module and 17 video/DVD com-pletions. After completing the presentation, 95%believed it would improve communication withtheir medical team, 92% felt empowered to take amore active role in their care, and 94% reported abetter understanding of how to seek assistance forpsychosocial needs and had a better understandingof how to use hospital resources appropriately. Allparticipants expressed a preference for using thesealternate methods to participate in the programversus in person class or printed materials. CON-CLUSIONS: Research has shown that internetand web-based interventions can empower patientsto take more of an active role in their care. Usingdifferent information technologies may offer practi-cal alternatives to engage patients and families inhealth education, promotion and prevention. Thispilot study allowed us to gain insight on incorporat-ing meaningful and effective uses of technology forhealth education programs helps patients betterprepare for their cancer journey by addressing geo-graphic barriers that potentially restrict patientsand families from participating in educationalprograms. It may also provide real-time communi-cation opportunities that create supportive environ-ments. RESEARCH IMPLICATIONS: Thegeneral use of technology is widely popular, how-ever the use of technology in health education isstill in its early stages and the impact on health edu-cation and potential health outcomes is not fullyunderstood. Further research is needed to comparecurrent technologies and explore innovative waysto use them in health education. Moreover, as newtechnologies are developed, new opportunities foreffective delivery of health education and socialsupport strategies will be possible. CLINICALIMPLICATIONS: Findings from this study canguide future interventions to improve health com-

munications and patient engagement in the health-care process. Data will be used to guide thedevelopment of future educational programs forpatients and families and to explore innovative waysto use technology to deliver educational programsand interventions. Understanding gained from thisstudy provides an opportunity to enhance healthcommunication and health education strategiesmore effectively to benefit patients and families.ACKNOWLEDGEMENT OF FUNDING: None.

P2-107

Psychiatric Rehabilitation of Patients With

Oesophageal Cancer

Gholamhossein Mobaraky, Shohreh EMAMI,Mona Hadi Mohammadabadi, MahbobehMardanshahUniversity of Medical Sciences, Esfahan, Iran

BACKGROUND: Patients with cancer mostlyhave psychiatric problems before and after therapy,especially if they undergo surgery. These psychiatricproblems can be due to organic problems (assecondary symptoms), or functional problems (psy-chiatric disorders). METHOD: First to categorizedthese problems and then to have a definition foreach of them, then explain psychiatric modalitiesfor each of them and rehabilitation of patients sepa-rately. RESULTS: In cancer we have 2 types ofpsychiatric symptoms or syndromes. If patientdevelops psychiatric symptoms after cancer, we sayhe has secondary symptoms, for example, depres-sion. This is called mood disorder due to GMC.But if after knowing that he/she has cancer he/shedeveloped depression, it is adjustment disorder, buttherapy in both is the same: Drug therapy, psycho-therapy, vocational rehabilitation, family therapyare used for both types. CONCLUSIONS: Inoesophagostomy special problems are eating andspeech problems. These 2 problems could be due tophysical defects that are produced. Intensity ofpatient reaction to speech lost depends on thedefect, personality of patient, preceding stresses,coping of patient, social situation, occupation ofpatient. These factors should be considered in reha-bilitation of patient and therapy processes. Apho-ny, dysphony, mutism, are speech problems thateach of them and rehabilitation of them would bediscussed in essay. ACKNOWLEDGEMENT OFFUNDING: None.



P2-108

The Relationship Between Emotional Expression and

Resilience in a Long-Term Telephone Group for

Women With Secondary Breast Cancer

Mary O’Brien1, Leigh Yong Li2, Tom O’Brien3,Janine Giese-Davis41The Women’s Psychotherapy Service Inc.,Brisbane, Queensland, Australia, 2Department ofOncology, University of Calgary; Tom BakerCancer Centre, Department of PsychosocialResources, Calgary, Alberta, Canada, 3University ofQueensland, Brisbane, Queensland, Australia,4Department of Oncology, University of Calgary;Tom Baker Cancer Centre, Department ofPsychosocial Resources, Calgary, Alberta, Canada

BACKGROUND: Supportive-expressive grouptherapy SEGT has been shown to improve psycho-logical wellbeing and reduce distress in women withsecondary breast cancer, despite deteriorating phys-ical health over time. However mechanisms of ther-apeutic change are not fully understood. Fewstudies have examined the relationship betweenemotional expression, topic discussions and psy-chological wellbeing and distress, within the samecancer population. In this paper we examine this ina long term weekly telephone group for womenwith secondary breast cancer. METHOD: Audiotranscripts of 9 group sessions over a 9-month per-iod were coded for emotional expression and topicdiscussions using the Specific Affect Coding Sys-tem-Breast Cancer and Topic Coding Systems andthen correlated with changes in psychological well-being, QOL, and distress of participants (n = 8), onstandardised measures including the IES, ABS andEORTC over the recording period as well as for theduration of their time in the group. RESULTS: Agreater percentage of time spent talking about fam-ily and friend relationships during group sessionswas significantly correlated with improvement overtime (slope) on intrusion (IES) (r = �0.79, p =0.02) and global function (EORTC) (r = 0.79,p = 0.02). Preliminary results will also be presentedfor emotional expression. CONCLUSIONS: Fam-ily and friend relationships consistently rank asamong the highest concerns for people diagnosedwith cancer. We provide evidence that talking aboutthese concerns in SEGT helps to improve resilienceand decrease trauma symptoms. RESEARCHIMPLICATIONS: This research increases ourunderstanding of mechanisms of therapeuticchange within SEGT cancer support groups andhelps to inform the focus of more effective groupinterventions for this population. CLINICALIMPLICATIONS: Facilitation of discussion con-cerning family and friend relationships within SEGTgroups has meaningful benefits for participantsand therefore should be encouraged by therapists

for this population. ACKNOWLEDGEMENT OFFUNDING: None.

P2-109

Co-Morbidity of Depression Among Cancer Subjects

and its Implication to Treatment Options for

Improved Outcome: A Perspective from a

Developing Country

Andrew Toyin Olagunju1,2, Olatunji FrancisAina1,2, Babatunde Fadipe2, Foluke OladeleSarimiye3, Tinuke Oluwasefunmi Olagunju41Department of Psychiatry, College of Medicine,University of Lagos, Lagos, Nigeria, 2LagosUniversity Teaching Hospital, Lagos, Nigeria,3Department of Radiotherapy, University CollegeHospital, Ibadan, Oyo, Nigeria, 4Health ServiceCommission, Lagos, Nigeria

BACKGROUND: Co-morbidity of depressivesymptomatology is a common indication for use ofmental health services in oncology. At the end ofthis presentation the participants should have anunderstanding of the burden of depression amongcancer patients in this context and appreciates itsrelevance to cancer treatment. Specifically, thisstudy was set to evaluate the burden of depressionand describe the associated factors among cancerparticipants in a developing context. METHOD: Adesigned questionnaire, Centre for EpidemiologicalStudies Depression Scale Revised (CES-DR) and theSchedule for Clinical Assessment in Neuropsychiatry(SCAN) were administered by the researchers on200 participants made up of attendees of a Nigerianhospital with histological diagnoses of cancer. Thedata were analysed with statistical package of socialsciences version 15. RESULTS: Majority of partici-pants, 85.5% were females and the commonest typeof malignancy was breast cancer (51.0%). Ninety-eight (49.0%) participants had significant depres-sive symptomatology (CES-DR scores of ≥16) asagainst the diagnosis of depression in 55(27.5%)participants following SCAN interview. A substan-tial proportion of subjects 36(65.5%) had moderatedepression, 15(27.3%) were mildly depressed and7.2% had severe depression. In this study, diagnosisof depression among cancer patients was signifi-cantly associated cancer stage (p = 0.006), dura-tion of cancer (p =0.048), pain (p < 0.001),physical complication (p < 0.001) and past familyhistory of mental illness (p = 0.002). However,only pain and duration of cancer were predictive ofdepression. CONCLUSIONS: A significant bur-den of depression was observed in cancer patients,as more than one-quarter of those studied wereaffected, and moderate to severe levels of depres-sion were noted in majority of the depressed. Psy-chosomatic factors like advanced cancer stage aswell as duration, pain, physical complications andfamily history of mental illness were related to the



experience of depression. However, only pain andlonger duration of cancer seems to predict depres-sion among cancer patients. Thus, the findings inthis study seem to underscore the adoption of com-prehensive cancer care with full inclusion of psy-chosocial interventions for improved overalloutcome. RESEARCH IMPLICATIONS: Thereplication of similar research as well as researchfocusing on development and standardization ofscreening instrument(s) for early detection of psy-chosocial complications of cancer is warranted. Inaddition, there is need for collection of robust dataon the impacts of cancer treatment models on over-all outcome towards developing evidence basedcancer treatment policy(s) and programs. CLINI-CAL IMPLICATIONS: Comprehensive treatmentinitiatives that include prompt identification as wellas treatment of cancer and mental disorders likedepression, management of psychosocial problemsand care for pain should be integrated into cancercare in this part of the world. The development aswell as popularization of screening instrument(s)with good diagnostic and administration propertyto ensure prompt identification of mental disordersfor improved overall treatment outcome in cancercare are also implied. ACKNOWLEDGEMENTOF FUNDING: None.

P2-110

Psychological Factors Related to Cancer

Paul K VarghesePhrajyotiniketan College/University of Calicut,Calicut Kerala, Kerala, India

BACKGROUND: It was hypothesised that cancerpatients and non - cancer individuals differ in theirpersonality make up and the stress experienced dueto life change events. A sample of 240 cancerpatients with oral cancer, lung cancer and abdomi-nal cancer (both male and female) were comparedwith 100 non-cancer individuals (50 male 50female). METHOD: Malayalam versions of 16PFform C, Locus of control scale, Life - changeEvents Questionnaire and Interview schedule wereadministered to measure the personality and stressfactors. RESULTS: It was observed that all thethree cancer patient groups experienced a greaterdegree of stress than the non-cancer individuals.The study revealed that the stress was found to bepositively and significantly related to External locusof control. It was found that cancer patients andnon-cancer individuals significantly differ withrespect to the personality factors A, E, F, H, L, M,N, Q2 and Q3 on 16 PF. CONCLUSIONS: Thismeans that normal non-cancer individuals and the3 cancer patient groups significantly differ withrespect to the personality factors A (Cyclothymia v/s schzothymia) factor E (dominance vs. submission)factor F (Surgency vs. Desurgency) factor H (chari-

table, adventurous vs. shy and timid), factor L(Suspecting vs. trusting), factor M (unconcernedness vs. conventional) factor N (sophistication vs.rough simplicity), factor Q2 (Self sufficiency vs.group dependency) and factor Q3 (High self senti-ment vs. poor self sentiment) on 16 PF.RESEARCH IMPLICATIONS: This resultreveals that the non-cancer individuals showed thepersonality characteristics like warm hearted, outgoing, submissive, mild, cheerful, talkative, frank,expressive, adventurous, socially bold, impulsive,friendly etc. in general. CLINICAL IMPLICA-TIONS: But on the other hand cancer patientsshowed the personality characteristics like reserved,detached, critical, aggressive, stubborn type, silent,slow, shy., withdrawn, more prone to conventional,worried, emotionally detached, group dependingon social approval, sound follower type, law selfsentiments etc. in general. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-111

Adult Cancer Patients’ Representations of Cancer

and Social Support. Relations Between Perceived

Social Support and Social Norm. Qualitative

Psycho-Social Approach.

Laura Perlier, Marie-Fr�ed�erique Bacqu�eUniversity of Strasbourg, Strasbourg, France

BACKGROUND: Our first objective is to providedeeper comprehension of the perceived social sup-port and its relationship with patients’representa-tions of cancer. Our second purpose is to get awareof the social norm’s influence on patients’ represen-tations of Cancer. We analyse patients’ healthbeliefs concerning social support, to understandtheir internal contradiction between social norma-tive prescriptions of autonomy, and the regressionphenomena necessary to accept the healthcare sys-tem, and especially psychotherapeutic support.METHOD: Data collection: Field survey with reg-istered half-directive interviews are conducted upona 30 male and female cancer patients sample(belonging to a French Oncology Dept.). An inter-view guide is set down after preliminary analysisand applied to the participants. Data analysis: L.Bardin’s Thematic Content Analysis, is used as adescriptive presentation of qualitative data andopinion detection. Main themes are extracted fromeach interview transcription. A list of commonthemes is built in order to give expression to collec-tive voices across participants. Results are com-pared and confirmed by Alceste software.RESULTS: Some Thematic Content Analysis(TCA) outgoing issues:1. “To be there” is the most valuable perceived

social support for patients.2. Offering social support seems to be as impor-

tant for patients as receiving it.



3. Nurse’s support is the most appreciated onebecause the most emotional among caregivers.

4. Social support has a buffering effect betweensocial norm and patient’s deeper emotions (likeregression).

5. Social support creates a Self’s space and time,within Cancer.

CONCLUSIONS: This qualitative study aims tovalidate the mutual connection existing betweensocial support’s perception and the internal socialnorms lauding autonomy and performance –research field that seems to be unexplored yet. Weshow that social norm influences patient’s healthbeliefs, attitudes and behaviour, it can therefore act-ing sometimes as a barrier in accepting or demand-ing social support and care. Revealing to caregiversthat social norm has an impact on one’s representa-tions and behaviours towards social support couldhelp them to intervene more efficiently, forewarningsocial support refusal by patients. RESEARCHIMPLICATIONS: Outgoing research (based onsocial norm influence on health beliefs and behav-iour) could be conducted on the role of social sup-port in expressing affects; social support bufferingeffect on the social norm; or how to increase intra-pair groups communication. Additional research isalso needed to understand where are the limitsbetween social norms on self-sufficiency and patientsreal will of autonomy (understood as human dig-nity). CLINICAL IMPLICATIONS: Therapywith patients could change their representations onsocial support, their health beliefs and behaviours.Caregivers training program, providing knowledgeand skills, should overpass cognitive knowledgeand include social representations and emotions.Mutual help pair groups should be developed forpatients and caregivers. Psycho-oncologists shoulddiversify their approches and communication skills,in order to demythologize psychotherapy and makeit “accessible”. ACKNOWLEDGEMENT OFFUNDING: None.

P2-112

The Regional Counseling Cancer Center (CCOR):

Specifity and Role of Psychological Support by

Telephone Within the Network of Care Services

Francesca Maffei1,2, Ludovica Mazzei1,2, GiuliaSpalla1,2, Luca Pianigiani1,21Assessorato alla Salute, Regione Toscana, Italy,2Istituto Tumori Toscano, Regione Toscana, Italy

BACKGROUND: The CCOR is located in theTuscany Region and is part of the network of psy-cho-oncology and oncology services with the opera-tional model of the Contact Center. The Centerinvolves informative-counseling psychologists andpsychotherapists who provide psychological phonesupport to cancer patients and their relatives by a

free number available for 12 hours daily. Ourintervention aims to emphasize the specificity of thecenter and the potentiality of psychologicalphone support within the oncology services.METHOD: The contact is made with a psycholo-gist in the front line that performs the first analysisand counseling in order to assess the appropriate-ness of the care pathway and the need for explicitor implicit psychological support. If such a needarises, the user is offered a phone interview with apsychotherapist who co-constructs with the persona phone therapeutic intervention in the short-medium term. The personal data and those in thecourse of treatment and psychological con-tents are inserted for each call, in a managementsoftware and encoded to extrapolate the variablessuitable for reworking statistics using SPSS.RESULTS: The CCOR has received 3140requests,510 for psychological support,104 in2012.The data-analysis of 2012, shows that userscall the Center along all stages of the disease andtheir more frequent experiences are: difficulty toshare and communicate the disease at the stage ofdiagnosis(43%) and of treatment(32%);discomfortfor inadequate medical management(24%) at fol-low-up;contents related to the fear-of-death(38%)in terminal illness. Among those who have access topsychological-support,41% identify this need bymeans of the interview with the psychologist.Therequest for psychological help,88% of users sent tothe support, is exhausted within the Center(12% issent and taken over by local services). CONCLU-SIONS: The demand analysis carried out by psy-chologists through the informative counseling iseffective to help the user to recognize the need forpsychological support implicit and access to trailsin the immediate psychological support. This char-acteristic results in an action of secondary preven-tion, because in many cases allows to intercept, atan early stage, the risk factors for a developing psy-chopathology. The intervention of psychologicalsupport phone exhausts the request of applicationin most cases, thus confirming the data of thenational and international literature the effective-ness of this tool. RESEARCH IMPLICATIONS:The intervention ensure the continuity of care anddevelop the network in order to set up a centralnode and a reference for users and clinicians. Weconsider appropriate to carry out a controlled studyon the effectiveness of psychological support toimplement the type of phone services of psycho-oncology in order to offer a viable alternative to theindividual setting. Accordingly this approachwould fit a better appropriateness (effective inter-vention at the lowest cost). CLINICAL IMPLICA-TIONS: The data presented contribute to increasethe knowledge of the experiences related to the dis-ease, which is useful for clinicians in order to paymore attention to the needs of communication andlistening to the patient and his/her family. The



results of the study suggest the importance of anearly phone takeover to reduce the level of sufferingand distress in the different stages of the diseaseand to encourage a process of adaptation.ACKNOWLEDGEMENT OF FUNDING: None.

P2-113

A Group-Based Intervention to Facilitate

Posttraumatic Growth in Portuguese Women With

Non-Metastatic Breast Cancer - Preliminary Data

Catarina Ramos1, Isabel Leal1, Richard G.Tedeschi21UIPES – Psychology and Health Research Unit,I&D, ISPA – University Institute, Lisbon, Portugal,2University of North Carolina, Charlotte, Charlotte,North Carolina, USA

BACKGROUND: There is considerable evidenceof posttraumatic growth (PTG) in women withbreast cancer. Recent literature supports the effi-cacy of group-based interventions. Although, littleresearch has extended to the expressive writing par-adigm in the development of interventions towomen with breast cancer, and even less is knownwhen referring to a group intervention that inte-grates some strategies from different theoreticalframeworks, developed to increase breast cancerpatients’ perception of benefits, in the aftermath oftrauma. METHOD: This communication presentsa detailed protocol of a group intervention for Por-tuguese women with non-metastatic breast cancer,designed to facilitate PTG. The intervention wasmade on a weekly basis, during 8 weeks. It is basedon an integrative model of cognitive-behaviouralstrategies, expressive writing and mindfulness tech-niques, which aim to: promote emotional disclosureand interpersonal communication; manage emo-tional distress; balance between gains and losses;intentionally process emotional and cognitive reac-tions towards their illness; construction of a coher-ent personal narrative about what has occurred;revise beliefs and goals for the future; and, develop-ment of new values and priorities of life.RESULTS: The results and efficacy of this inter-vention will be reported for 5 different groups, eachcomposed by 6–8 women with breast cancer, beingfollowed at 5 different hospitals in 2 main cities.CONCLUSIONS: This group intervention proto-col has significant impact on the psychologicaladjustment to breast cancer and, specifically, in theindividual perception of benefits or growth in breastcancer women with the diagnosis until 5 years. Adetailed discussion based on the intervention proto-col and major outcomes will be presented.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by a Portuguese Foundation forScience and Technology (SFRH/BD/81515/2011).

P2-114

The Interview With Adult Cancer Patients: A

Qualitative Survey. Cancer as an Expression of the

Shadow

Christina SansonFreelancer, Aosta, Italy

BACKGROUND: “The interview with adult cancerpatients: a qualitative survey. Cancer as an expres-sion of the Shadow” is an MA dissertation aboutthe adult patient and diagnosis communication,which, through a qualitative research, aims to iden-tify the issues that most concern the person in deal-ing with the cancer psycho-social discomfort andwith the topics of his/her emotional story, that he/she carries out in his/her interviews with variousprofessional figures. METHOD: Seeking to maxi-mize heterogeneity, the characteristics of the samplecollected (10 interviews with patients and 21 withprofessionals, such as doctors, psychiatrists, psy-chologists and nurses) have involved from a genderpoint of view an equal number of interviewees, andpeople having suffered from various tumors, benignand malignant, in remission, follow-up, free ofrecurrence or with metastasis. A semi-structuredinterview has been chosen, as the qualitativemethod allows to collect data and subjectivedescriptions of the experience,which are useful toformulate a hypothesis on the correlation betweenthe psycho-dynamics organization and the onset ofcancer. RESULTS: Based on illness, conversationand relationship, data are giving a meaning to thesubjective living with cancer, both at an individualand social level, by focusing on the existing, andhighly distinctive, ‘gap’ between theoreticalassumptions and real-life experience.Besides famil-ial genetics, the work focuses on the transgenera-tional aspect and its possible influence on the onsetof cancer, through family history and secrets, coin-cidences in events, the ‘unspoken’, and psychologi-cal and physical symptoms, referring to an existingunconscious able to share and to be shared, as wellas to pass through time and generations. CON-CLUSIONS: Focusing on interpersonal relation-ship, this work traces the meaning people give totheir cancer experience and any related learningthat derived and resulted in a change in their wayof life and in their dealing with everyday life. Thedata has been read through the Jungian thought,finding a parallel in the Shadow and in the Individ-uation process with the cancer genesis from a psy-chological point of view. Although the resultscannot be generalized, due to the limitations in thesample considered, this research has led to an arti-cle, currently in press, which contributes to the fieldof psycho-oncology. RESEARCH IMPLICA-TIONS: This work deals with the clinical, socialand personal pathway of adult patients diagnosedwith cancer. Communication is the key to under-



stand this qualitative empirical research, whichaims to be a prevention project and highlight theincreasingly recognized relation between the PNEIand the state of mental and physical health of a per-son, focusing on a mind-body link and on a self-taught process that makes use of the everyday lifeexperience related to the illness so as to develop anew vision of life. CLINICAL IMPLICA-TIONS: ‘Cancer as an expression of the Shadow’ –by focusing on the individual and collective uncon-scious, the ‘unspoken’, transgenerational links andsynchronicity – is a further tool of reasoning on theonset of cancer, a simple hypothesis on the ‘evilobscure’ that presents itself, in the demographicincrease of the illness, as a social problem and apoint of inter- and multidisciplinary encounteramong oncology, genetics and psychology.ACKNOWLEDGEMENT OF FUNDING: None.

P2-115

Best Foot Forward: Designing a Pilot Intervention

and Feasibility Study of a Peer-Led Delivered

Walking Groups for Breast Cancer Survivors

Karen Scanlon1, Claire Knight1, LeanneTaylor-Sturdy1, Gill Hubbard2, Richard Kyle21Breast Cancer Care, London, UK, 2University ofStirling, Scotland, UK

BACKGROUND: Emerging evidence suggeststhat regular physical activity can reduce the risk ofbreast cancer recurrence, cancer-specific mortalityand all-cause mortality by up to 40% compared topeople who are not active (Holmes et al, 2005; Ho-lick et al, 2008). Physical activity can also have anumber of other biological, physical and social ben-efits; such as reducing cancer-related fatigue,improvements in aerobic fitness, reduction in bodyweight and body fat, and improved quality of life.METHOD: The BFF intervention commenced inApril 2013 and will run for three years. Its primaryaim is to improve the physical and emotional well-being and promote long-term adherence to physicalactivity. Our evaluation will consist of 2 elements(volunteer and client) that will be simultaneouslyconducted (using an action research methodology)alongside the delivery of the BFF intervention. Thiswill ensure that learning from our evaluation con-tinually shapes and strengthens service delivery. Amixed method study design is being employed andthe process and outcome evaluation measures beingused will be fully outlined. RESULTS: This pre-sentation will report on the learnings of the first9 months of delivering and developing the BFFwalking groups, in particular from the staff stake-holders and volunteer perspectives. We will alsodiscuss implications for involving services users inthe design and delivery of the intervention and itsevaluation, and the strategies being employed toensure learnings from this action research approach

are incorporated. CONCLUSIONS: The BFFintervention will be discussed and positioned withinthe broader context of other national and local“health walk” initiatives, as well as the theoreticaland behavioural frameworks that we have adoptedfor this study. In particular, addressing the value ofpeer support from someone with a personal experi-ence of breast cancer. ACKNOWLEDGEMENTOF FUNDING: Breast Cancer Care received a 3-year grant from the Health and Social Care Volun-teering Fund to develop and evaluate the BFFintervention. Breast Cancer Care has commissionedthe University of Stirling to undertake the volun-teer (walk leaders) evaluation.

P2-116

The Association Between Mental Adjustment to

Cancer and Social Support

Veena Shukla Mishra, Dhananjaya SaranathCancer Patients Aid Association, Mumbai,Maharashtra, India

BACKGROUND: Social support has been identi-fied as an important factor for alleviating cancerpatient’s psychological distress. The associationbetween emotional, informational and instrumentalsocial support with psychological adjustment tocancer has been addressed. The interpersonal rela-tionship that protects cancer patients from deleteri-ous effects of stress due to cancer is critical formental adjustment of patients. The aim of ourstudy was to examine the impact of social supportwith mental adjustment in cancer patients.METHOD: The study included 70 cases of cancerpatients with 37 males and 33 females, with an aver-age age of 51 years. The patients were equallydivided into test group and control group and eval-uated using the Mental Adjustment to Cancer(MAC) Scale and Multidimensional PerceivedSocial Support Scale (MPSS), at diagnosis and aftera period of 6 months. The test group patients(n = 35) were subject to three interventional modal-ities of psycho-educational, emotional and instru-mental support; whereas the control group patientsreceived instrumental support. RESULTS: At ini-tial diagnosis, MAC scale in the test group cancerpatients showed a score of 45.33 � 5.16 in Fightingspirit (FS). and a comparative score in controls. Wealso observed a similar score in the Helplessnes/hopelessness (H/H), mean = 14.18 � 3.0 in testgroup, and 14.69 � 2.9 in control group. TheMPSS scale results indicated a moderate score of12.25 � 2.96 in both groups. Thus, at initial diag-nosis a significant difference was not observed intest and controls. On follow-up, test group showedan increase in FS and decrease in H/H. However, incontrol group a difference in the FS or H/H wasnot observed. CONCLUSIONS: The 3 types ofsocial support provided to patients have shown a



positive effect on the adjustment of the patients totheir disease. The test group patients exhibitedincrease in the level of adjustment to cancer andthey faced their problems more easily in more com-fortable way than the control group. The assess-ment at 6 month after the 3 support showed that itled to a change in level of adjustment with the can-cer. Hence it may be concluded that all 3 supportare needed by the patients to adjust with the dis-ease. RESEARCH IMPLICATIONS: The 3 socialsupport characterized as emotional, psycho educa-tional and instrumental support, was demonstratedto cause positive changes in level of adjustment tocancer by the patients. This mandates that theseshould form part of the routine in for the patientsin the Indian context as well. The data showed thatemotional support will help break the barriersbetween patients and caregiver, thus advantageousto the patient treatment. CLINICAL IMPLICA-TIONS: To promote holistic treatment it is impor-tant to consider the psycho social aspects of anindividual patient. The patient is thus protectedfrom the deleterious effects of the additional stressof the disease. A good holistic support system willbe effective in boosting positivity in the patientsand better adjustment and acceptance of the dis-ease. The psychological intervention may not sub-stitute for painkillers but it may serve as anadjuvant therapy. ACKNOWLEDGEMENT OFFUNDING: The authors gratefully acknowledgeCancer Patients Aid Association for the supportont he project.

P2-117

The Counseling Cancer Centre of the Tuscany

Region: The Experience of a Contact Center Service

and Psychological Skills in Needs Assessment and in

the Supporting Care

Olivia Stanzani1,2, Francesca Grandi1,2, PaoloCortini1,2, Cecilia Dell’Olio1,2, Luca Pianigiani1,21Assessorato alla Salute, Regione Toscana, Italy,2Istituto Tumori Toscano, Regione Toscana, Italy

BACKGROUND: Since November 2009, the Tus-cany Region Department of Health has activatedthe Regional Counseling Cancer Centre (CCOR),with the scientific collaboration of the RegionalCancer Institute (ITT) and the Healthcare Manage-ment Laboratory (MeS) of Sant’ Anna University.The CCOR is made of 4 Psychologists-FrontLine(FL), 6 Psychologists-BackLine (BL, psychologicalsupports) and 1 Coordinator. The FL managesrequests through informative counseling and col-laborates with public health through the healthcarereferent, the Focal Point (FP). METHOD: THEFL: • promotes the identification of the problemand the possible solutions through demand analy-sis, counseling and problem-solving. • helps the per-son to identify the implicit needs supporting in the

resolution process. • provides valid information,updated, customized on care pathways. • provides aspace for listening in crisis times, focusing on usefulgoals to overcome the discomfort and facilitatingthe decision making of the patient, becoming apoint of reference for users. • activates FP to solvecritical path and gaps care at the Local HealthAuthority (LHA). • activates BL after evaluatingthe need for psychological support. RESULTS:Totally the CCORresponded to 2820 requests.Thedata analysis of 2012 (n = 705)reveals that is usedequally by family and friends (38.2%) and bypatients themselves (38%); people interested in pre-vention reach the 20% and professionals the2.5%.The 76% are women and 62% in range40–75 years.The psychosocial concerns: physician-patient relationship (63%); pathway interruptions(26.5%) and social issues and poor informationproviding (10.4%). 86% of assisted remains underthe care of their LHA.The resolution problemthrough the joint intervention FL-FP characterizesthe first-area, counseling provided by FL marks thethird-area, the BL linked to the second-area (Cra-mer’s V = 0.4;p = 0.000). CONCLUSIONS:CCOR helps the cancer patients and their familiesto follow the clinical pathways and obstaclesrelated to the psychological dimension of the illnessor to organizational breakdowns. According toother experiences like our, the CCOR also confirmsthe effectiveness of a listening activity and demandanalysis at different stages of the care pathway. TheCenter provides patients and their families supportand guidance throughout the course by creatingeasy access to the services offered by the health sys-tem, activating direct contact with medical facili-ties, focusing on the function of active listening andemotional restraint of the patient and his family.RESEARCH IMPLICATIONS: This experiencehighlights the role of the counselling for the pathimprovement: the process of patient involvement inthe care pathway, a clear communication with thedoctor and the sharing of objectives. Infact this kindof intervention facilitates the patient empowerment,so that the communication quality and the relation-ship with physicians are improved. Further studiesare needed to evaluate the impact of realized jointmanagement of cases in terms of organizationallearning within Health Authority. CLINICALIMPLICATIONS: Making a good counseling andresolve critical in agreement with the patient makesmore fluid the entire course of treatment. Thereforethis type of intervention helps to increase the per-ception of belonging and taking charge effective forthe patient and reduce the “leaks” from the LHAinvolved in the care pathways. The experiencesacquired from the Center are useful tools for LHAto improve the quality of care pathways.ACKNOWLEDGEMENT OF FUNDING: None.



P2-118

Struggling for a Sense of Control in Order to be

Prepared: Consequences of Chemotherapy-Related

Fear Among Breast Cancer Patients

Karin Stinesen-Kollberg1, Ulrica Wilder€ang1,Gunnar Steineck1,21University of Gothenburg, Gothenburg, Sweden,2Karolinska Institute, Stockholm, Sweden

BACKGROUND: Aim: To investigate howwomen assessed their psychosocial support needsconcerning chemotherapy-related side effects afterbreast cancer treatment. METHOD: We con-ducted an observational study and analyzedresponses from 313 women who had undergonesurgery for breast cancer at Sahlgrenska UniversityHospital breast cancer clinic 12 months priors.RESULTS: Concerning desire for support, therewas no statistically significant difference betweenthe group receiving chemotherapy compared withthe group not receiving chemotherapy (fear of hairloss: age adjusted p value 0.5120 and fear of nausea:age adjusted p value 0.7230). Both groups reporteda desire to receive psychosocial support immedi-ately following diagnosis. CONCLUSIONS: Oneyear after diagnosis, women treated for breast can-cer distinctly recall an immediate desire to receivepsychosocial support concerning chemotherapy-induced side effects, regardless of receiving chemo-therapy treatment or not. RESEARCH IMPLICA-TIONS: Data indicate that women associate breastcancer with chemotherapy and that they have adesire to know what chemotherapy treatmententails. This association appears so strong that itstill comes to mind even when responding to a ques-tionnaire one year after diagnosis. If we can learnhow to increase preparedness for treatment, wemay be able to decrease the risk for psychosocialmorbidity and thereby shorten breast cancer diag-nosed women’s rehabilitation needs. CLINICALIMPLICATIONS: Offering psychosocial supportand basic information about eventual chemother-apy treatment immediately following diagnosis mayincrease a sense of control and thus reduce thestress associated with the grim phase betweenbreast cancer diagnosis and surgery. ACKNOWL-EDGEMENT OF FUNDING: National SwedishBreast Cancer Foundation.

P2-119

The Theory of Planned Behavior Predicting Physical

Activity in French Children Aged Between 5 to

11 Years Old

Monica Takito1,2, Bruno Fr�egeac3, SimonDallifard4, Bertrand Porro5, Oliver Coste6,Florence Cousson-G�elie21USP, Sao Paulo, SP, Brazil, 2ICM InstitutR�egional du Cancer, Epidaure. Universit�e deMontpellier 3, Epsylon, Montpellier, France, 3ICM,

Institut R�egional du Cancer, Epidaure. Professeurdes �ecoles, Montpellier, France, 4Universit�e deMontpellier 1, Montpellier, France, 5Universit�e deMontpellier 3, Epsylon, Montpellier, France,6Direction G�en�erale de la Jeunesse et des Sports,Montpellier, France

BACKGROUND: Physical activity is highly rec-ommended for all people as a potential behavior toimprove health. In adults, physical activity couldprevent certain types of cancer, and others. Duringchildhood physical activity suffer a lot of influencefrom environmental factors. The objective of thisstudy was to test the ability of the Theory ofPlanned Behavior (TPB) for explaining physicalactivity behavior. METHOD: This observationalstudy included a sample of 734 children between 5and 11 years old, selected in 11 public schools inFrance. This is a baseline study before an interven-tional study to improve physical activity. All chil-dren answered an auto- questionnaire based onTPB including assessment of attitude, subjectivenorm, perceived behavioral control. We also evalu-ated socio-demographic factors (age, sexe) andenvironmental factors (ex: physical activity practiceby family, friends). An ordered logistical regressionwas model considering hierarchical analysis basedon TPB. Level of significance was 5% in each level.RESULTS: The fact that family (father, motherand siblings) and friends are physically active orsupport the practice of physical activity was posi-tively associated with higher weekly frequency ofphysical activity in univariate analysis. However,only the fact of his father playing sports remainedsignificantly associated with a higher frequency ofphysical activity in multivariate analysis. Despitepositive or negative attitude seems important,believe that physical activity all days improve phys-ical fitness keep in the final model as an adjustedvariable. By the other side, personal identity andperceived behavior control were important predic-tors related to activities during leisure time. CON-CLUSIONS: These results provide partial supportfor the utility of TPB in explaining physical activitybehavior in a sample of French children. Evenintention could be the most important predictor toimprove physical activity; these results showed thatis necessary to engage family, friends and teachers.Children perceived as selves with autonomy to con-trol their leisure time. RESEARCH IMPLICA-TIONS: The research implication is that if familyand friend were engaging it will be possible increasethe chance of improve physical activity of childrenand as consequence physical fitness and quality oflife. CLINICAL IMPLICATIONS: These findingshave implications for tailoring physical activity pro-grams in this population. ACKNOWLEDGE-MENT OF FUNDING: This research wassupported by the “Agence R�egionale de sant�e de



l’H�erault” and ICM (Institute Cancer of Montpel-lier). The first author is supported by CNPq (Cien-cias sem Fronteiras).

P2-120

Effect of Group Counseling for the Empowerment of

Mental Health on Resilience in Cancer Patients

Chaliya Wamaloon, Sopit Tubtimhin, MonlikaPuttichat, Pimwadee TreerojpornUbonratchathani Cancer Hospital, Department ofMedicine, Ubonratchathani, Thailand

BACKGROUND: The emotional impact of can-cer diagnosis that patients may feel shock, disbelief,fear, anxiety, guilt, sadness, grief, depression, andanger. Each person may have some or all of thesefeelings, and each will handle them in a differentway. Group counseling may help patients for emo-tional coping. The objective was to evaluate theeffect of group counseling for resilience in cancerpatients. METHOD: This study conducted thequasi experiment design of 20 cancer patientswhom were treated with radio therapy betweenMay to July 2011. The participants were dividedinto 2 groups, 10 for control and 10 interventiongroups. Participants in the intervention wereattended group counseling for twice a week in4 weeks, and each 60–90 minutes per time. Partici-pants in the control group were offered no interven-tions and received their usual medical care. Thequestionnaire used for data collection included per-sonal information, Resilience scale, and groupcounseling evaluation. The independent t-test andpair t-test were employed to analyze. RESULTS:The results of this study showed that statisticallysignificant difference the mean score of resiliencebetween the intervention group and control group(mean difference = 19.5; 95%CI: 17.61 to 21.38,p < 0.05) and there was a statistically significantdifference the mean score of resilience betweenbefore and after in the intervention group (meandifference = 14.9; 95%CI: 12.77 to 17.03, p < 0.05)CONCLUSIONS: The findings suggest that groupcounseling could resilience cancer patients foremotional coping that clinician may apply for help-ing cancer patients. RESEARCH IMPLICA-TIONS: The result of this study show the programcan be applied for empowerment of mental healthcrisis in patients with other chronic diseases. CLIN-ICAL IMPLICATIONS: Normal score standardof resilience from the Department of MentalHealth, Thailand is 55–69 points. The results of thisstudy showed that the experimental group was69.80 points, that higher than the standard. Whentesting the difference between the control groupand the experimental group was found to have amean score difference 19.5 points, which is statisti-cally significant (p-value <0.05). ACKNOWL-EDGEMENT OF FUNDING: Department of

Medicine and National Research Council of Thai-land.

P2-121

Motivation for Childhood Cancer Patients to

Participate in a Combined Physical and Psychosocial

Intervention Program: “Quality of Life in Motion”

E.M. van Dijk-Lokkart1, K.I. Braam2, G.J.L.Kaspers3, T. Takken4, I. Streng5, M.A.Grootenhuis6, J. Huisman71VU University Medical Center, Department ofMedical Psychology, Amsterdam, The Netherlands,2VU University Medical Center, Department ofPediatric Oncology/Hematology, Amsterdam, TheNetherlands, 3VU University Medical Center,Department of Pediatric Oncology/Hematology,Amsterdam, The Netherlands, 4Wilhelmina’sChildrens Hospital/UMC Utrecht, Department ofPediatric Physiotherapy and Exercise Physics,Utrecht, The Netherlands, 5Sophia’s ChildrensHospital/Erasmus Medical Center, Department ofPediatric Oncology, Rotterdam, The Netherlands,6Emma’s Childrens Hospital/Academic MedicalCenter, Psychosocial Department, Amsterdam, TheNetherlands, 7Wilhelmina’s Childrens Hospital/UMC Utrecht, Department of Medical Psychology,Utrecht, The Netherlands

BACKGROUND: Survival rates in childhoodcancer have increased dramatically in the past dec-ades. However, survivors can have late effects,including impaired physical fitness which can leadto other physical health problems and may impacthealth-related quality of life (HrQOL). In order toimprove physical fitness a 12-week physical andpsychosocial intervention program was developed.In a multi-centre RCT 38.3% of invited patientswere willing to participate. The question arises as toreasons of this limited participation. METHOD:All childhood cancer patients (8–18 years) duringtreatment with chemo- and/or radiotherapy or nolonger than 12 months off treatment, were eligible.Patients requiring bone marrow transplantationand/or growth hormone treatment, those depend-ing on a wheelchair or being unable to “ride abike”, and those with mental retardation wereexcluded. Eligible patients received written and ver-bal information about the study. Patients and par-ents not wishing to participate were asked to fill ina one-time survey regarding reasons for non-partic-ipation, physical activity, HrQOL and behaviourproblems. The baseline measurements of the partic-ipants included the same questionnaires (except fornon-participation). RESULTS: Of 162 eligiblepatients 100 (61.7%) non-participated, of which57% filled in the one-time survey. Parents reported“time-consuming participation” and “participationtoo heavy for child” as main reasons for non-par-ticipation, and children “time-consuming participa-



tion” and “already frequent sports participation”.No differences between participants and non-par-ticipants were found for mean age, HrQoL andparental-reported behaviour problems in the totalgroup. Participating older children (11–18 years)reported more behaviour problems (p = 0.03), inparticular more internalising problems (p = 0.02)and rated their quality of social functioning lowerthan non-participating peers. Parents of participat-ing children aged 11–18 also reported more behav-iour problems (p = 0.04). CONCLUSIONS:Participation of childhood cancer patients in aphysical and psychosocial intervention program isrelated to the burden of the intervention, as per-ceived by patients and parents. It appeared thatadolescents with more internalising behaviourproblems and a lower quality of social functioningwere more prone to participate in the study. Alsoparents of the participating adolescents reporthigher behaviour problem scores than parents ofthe non-participating adolescents. RESEARCHIMPLICATIONS: Physical activity and fitness aresupposed to be important determinants for physicalhealth and HrQoL in childhood cancer patients.Interventions to stimulate physical activity gainincreasing interest, but participation is hamperedby the burden of the intervention. Therefore insightin factors related to participation or non-participa-tion in intervention programs is crucial in optimiz-ing recruitment and motivation strategies, as wellas to develop tailor-made interventions. This studyis the first with information on this subject. CLINI-CAL IMPLICATIONS: Participation in a physicaland psychosocial intervention program is hamperedby the burden of the intervention. Especially ado-lescent patients with better psychosocial function-ing seem to have lower motivation to participate.This information can help to develop interventionsin which larger groups can be included.ACKNOWLEDGEMENT OF FUNDING: Thisstudy is financially supported by the Alpe d’HuZes/Dutch Cancer Society (ALPE-VU 2009-4305).

P2-122

Professionals’ and Patients’ Perspective on

Facilitators and Barriers for Return to Work in

Unemployed Cancer Patients: A Focus Group Study

M.P. van Egmond, S.F.A. Duijts, S.J. Vermeulen,A.J. van der Beek, J.R. AnemaVU University Medical Center, Department ofPublic and Occupational Health, EMGO+ Institute,Amsterdam, The Netherlands

BACKGROUND: It is estimated that 62% of can-cer patients return to work (RTW). Current RTWsupport programs have been designed for employ-ees, but are not suitable for unemployed workerswho receive a sickness benefit. In order to develop aRTW program specifically for this subgroup, we

studied the facilitators and barriers for RTW in thisgroup of patients, and in the physicians who assessunemployed cancer patients with regard to theirsickness benefit. METHOD: We conducted sepa-rate focus group interviews with (1) cancer patientswho receive a sickness benefit and (2) insurancephysicians (IPs) who assess cancer patients with asickness benefit (unrelated). Patients were invited tointerviews at the VU University Medical Center.For IPs, local peer review groups were used to hosttheir interview. The focus group interviews wereguided by an experienced moderator. Topics dis-cussed included: attitude towards RTW over time,barriers and facilitators regarding RTW, involve-ment of others (e.g. spouse) in decision-making,possible interventions. Data was collected using anaudio recording device and collection continueduntil saturation was reached. RESULTS: In total,6 focus groups were organized; 3 patient focusgroups, including seventeen participants and threephysician focus groups, including twenty-two par-ticipants. All data was transcribed verbatim and iscurrently subject to analysis. Results will be knownby October 2013. CONCLUSIONS: Data satura-tion was reached for both the patient and IP per-spective. Therefore, the researchers estimate thatthe results regarding RTW factors will be applica-ble to most of the cancer patients who receive asickness benefit. Further conclusions will be drawnwhen the results are known. RESEARCH IMPLI-CATIONS: This study is, to our knowledge, thefirst to assess RTW factors for cancer patients whoreceive a sickness benefit. Nowadays, research forcancer patients is usually diagnosis-based. If foundthat employment status may affect factors forRTW, this could support a new approach thattakes employment status into account. Also, thiscould be applied to other types of patients andfields in clinical research. CLINICAL IMPLICA-TIONS: If found that specific RTW factors arerelated to employment status, this could have impli-cations for the development of supportive interven-tion programs. Such programs should then betailored to the employment status of the patient,rather than solely to the diagnosis. ACKNOWL-EDGEMENT OF FUNDING: This study isfunded by the Dutch Institute for Employee BenefitSchemes (SMZ UWV).

P2-123

Determinants of Seeking Psychosocial Care in Dutch

Men With Prostate Cancer

Adriaan Visser, Laura DaeterThe Vruchtenburg, Rotterdam; University of AppliedSciences, Rotterdam, The Netherlands

BACKGROUND: Prostate cancer patients oftenexpress the need for supportive care, although theyare not frequently participating in supportive care



activities. To study the determinants of seeking psy-chosocial care, patients’ supportive care needs wereassessed (SCNS) and their attitude about support-ive care, perceived social support and self-efficacy(ASE model) on psychosocial care seeking. Further,as external factors the influence of distress, bio-graphical and medical factors, previous experiencewith and evaluation of supportive care was studied.METHOD: A cross-sectional study with a conve-nience sample of patients who completed a ques-tionnaire. The patients were recruited frominstitutes of in the Dutch South- West cancer area(hospitals, patient organization, social media andpsychosocial care facilities). Care needs were mea-sured with the SCNS; patient’s attitude towardscare seeking, perceived social support and self-effi-cacy were assessed by using former ASE measures.Distress was measured by the HADS. The measure-ment of biographical characteristics (age, SES, mar-ital status), medical factors (time since diagnosis,type of treatment, metastasis), previous experiencewith and evaluation of supportive care was usedfrom a former Dutch study. RESULTS: Weincluded 87 patients, who all returned the question-naire by email or post. Results indicated that 36%had some experience with social care facilities.About one third of all men look for expert informa-tion (urologist, urology nurse, patient organiza-tion). More than 20% of the participants valuetheir support from the hospital as unsatisfactory,marking the received support from the hospitalwith a mean score of 6.7 on a zero to ten scale.Results of a multiple regression analysis pointedout that only psychological, physical needs anddepression are the main determinants for futuresupportive care use. CONCLUSIONS: The resultsshow that psychological and physical needs besidedepression are more important determinants offuture supportive care use than the ASE driven fac-tor attitude towards care seeking, anxiety, previouspsychosocial care use, satisfaction with care andage. RESEARCH IMPLICATIONS: More studiesshould focus on multiple determinants of the use ofpsychosocial care facilities by prostate cancerpatients. CLINICAL IMPLICATIONS: TheVruchtenburg, on which behalve the study was per-formedis developing a policy to attrack more pros-tate cancer parients. Urologists, urology andoncology nurses and other health-care professionalsshould use this information for patient centeredreferrals to psychosocial care facilities as well as todevelop fitting interventions. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-124

The Effect of Group Psychological Intervention in

Chinese Gastric Cancer Patients’ Rehabilitation

Lili Tang, Ying Pang, Yapeng Wang, YeningZhangPeking University Cancer Hospital, Beijing, China

BACKGROUND: The purpose of this study is: 1.to examine the effectiveness of group psychologicalintervention on emotion and quality of life in con-valescent gastric cancer patients in China, andexplore the influence factors; 2. to examine theacceptability of group psychological interventionby the participants and explore the therapeutic fac-tors of intervention by semi-structured qualitativeinterview. METHOD: 1. Totally 60 patients diag-nosed with gastric cancer and finished active treat-ment participated in this controlled trial. 30patients joined the intervention group, which con-sisted of ten consecutive, weekly sessions of100 minutes each in length, whereas other 30patients served as controlled subjects. All partici-pants completed pre-test and post-test question-naires consisting of Cancer Quality-of-life CoreQuestionnaire (QLQ-C30), Self-Rating DepressionScale (SDS) and Self-Rating Anxiety Scale (SAS).Intervention group had 3-months follow-up 2. Bystratified random sampling, eight patients from theintervention group who had completed three assess-ments accepted interview according to a semi-struc-tured outline. RESULTS: Participants’ globalquality of life (QOL) was significantly improvedafter interventions [(65.00 � 21.25) vs. (75.00 �16.14)], especially nausea/vomiting, dyspnea, sleep,appetite, anxiety and depression. In the interven-tion group, global QOL improvement in patients oflow global health status was significantly greaterthan patients of high status [(�18.33 � 22.54) vs.(2.50 � 15.24)]. In the control group, fatigue andanxiety were aggravated in low health status groupand improved in high status group. Interviewshowed group psychological intervention has goodacceptability. The main therapeutic factorsincluded: hope adjustment, universality, impartinginformation, group cohesiveness, emotion ventingand altruism. CONCLUSIONS: 1. Group psycho-logical intervention could alleviate depression andanxiety mood and improve the quality of life ofgastric cancer patients and promote their rehabilita-tion. 2. The effect of group psychological interven-tion in quality of life and negative emotions ofgastric cancer patients with low global health statuswas more significant. 3. The group psychologicalintervention has good acceptability in gastric cancerpatients;The main effect factors include hopeadjustment, universality, imparting information,group cohesiveness, emotion venting and altruism.RESEARCH IMPLICATIONS: Verify the effectof group psychological therapy in Chinese gastric



cancer patients’ rehabilitation; research results andconclusions as theoretical support and limitationsand questions found during this research processwas showed for the future researchers in grouptherapy in cancer patients so that they could makemore improvement in future research protocols.CLINICAL IMPLICATIONS: Provide theoreticalsupport for application of group psychologicaltherapy in Chinese gastric cancer patients, as animportant adjunctive intervention in the holisticoncology clinical practice. ACKNOWLEDGE-MENT OF FUNDING: Capital medical scienceDevelopment Fund.

P2-125

A Preliminary Evaluation on the Effectiveness of a

Memory Enhancement Psycho-Educational Group

on Improving Mood and Short-Term Memory in

Hong Kong Cancer Patients

Elsa YuHong Kong Cancer Fund, CancerLink SupportCentre, Wong Tai Sin, Hong Kong

BACKGROUND: Fear, anxiety and depressionare the most common emotions experienced by can-cer patients (Reich, 2008). Previous research showsevidence of correlation between depression andmemory loss (Burt & Byrd, 1995). A memoryenhancement psycho-educational group was devel-oped and introduced as an intervention to addressthis concern, which involved teaching memoryenhancement skills and mood management strate-gies through experiential games and daily practice,in order to improve levels of depression and anxiety,and enhance memory functioning. METHOD: Atotal of 48 cancer patients participated in a total of 5memory enhancement psycho-educational groupsconducted between November 2011 and May 2013.Theories of Experiential Learning (Kolb, D, 1984)and the Chronic Disease Self-Management Program(Stanford Patient Education Research Center, 1993)formed the basis of the content of this program. Par-ticipants were invited to fill in the General HealthQuestionnaire (GHQ-12, Pan & Goldberg, 1990)before and after the group in order to measure theirpsychological distress level. A memory subjectivequestionnaire and objective test (Small, 2003) wereused to measure participant’s self-ratings of memorycapacity and memory functioning. RESULTS: Thefindings showed a significant decrease in psycholog-ical distress (M = �8.13, SD = 6.08, p = 0.000),while subjective memory and objective memoryalso showed significant increases (M = 23.38,SD = 26.49, p = 0.000 and M = 1.02, SD = 1.41,p = 0.000 respectively). CONCLUSIONS: Partici-pants showed a significant decrease on measures ofdistress and an enhancement of their self-reportedmemory functioning after joining this psycho-edu-cational group. Control group and development

with more evidence base information are suggestedas the next step of the research. RESEARCHIMPLICATIONS: A control group should beincluded in the future to facilitate a better under-standing of the effectiveness of the intervention. Itis further suggested that additional objective mem-ory measurement tools be used in the future to fur-ther explore nature of the memory enhancementobserved in this study. CLINICAL IMPLICA-TIONS: This memory enhancement group wouldbe continued to conduct for cancer patients as ithas a significant benefit for them. After developingwith more evidence based data, the content of thegroup can be refined in order to increase its effec-tiveness. ACKNOWLEDGEMENT OF FUND-ING: None.

P2-126

Impact of Chemotherapy-Induced Alopecia Distress

on Body Image, Psychosocial Well-Being, and

Depression In Breast Cancer Patients

Eun-Kyung Choi1, Im-Ryung Kim1, OliverChang2, Danbee Kang3, Seok-Jin Nam4, JeongEon Lee4, Se Kyung Lee4, Young-Hyuck Im5,Yeon Hee Park5, Jung-Hyun Yang6, Juhee Cho3,71Cancer Education Center, Samsung ComprehensiveCancer Center, Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul, Republic of Korea, 2Krieger School of Artsand Sciences, Johns Hopkins University, Baltimore,Maryland, USA, 3Department of Health Science andTechnology, School of Medicine and SAHIST,Sungkyunkwan University, Seoul, Republic ofKorea, 4Department of Surgery, Samsung MedicalCenter, Sungkyunkwan University School ofMedicine, Seoul, Republic of Korea, 5Department ofHematology and Oncology, Samsung MedicalCenter, Sungkyunkwan University School ofMedicine, Seoul, Republic of Korea, 6Department ofSurgery, Konkuk University Medical Center,Konkuk University School of Medicine, Seoul,Republic of Korea, 7Departments of Health,Behavior and Society and Epidemiology, JohnsHopkins Bloomberg School of Public Health,Baltimore, Maryland, USA

BACKGROUND: Chemotherapy-induced alopecia(CIA) is a traumatizing and distressing experience forwomen with breast cancer. But, few studies havebeen conducted about association between alopeciaand quality of life, but there most of them have beenlimited to studies with specify alopecia distress andits impact on body image and psychological disor-ders. This study evaluates the impact of chemother-apy-induced alopecia distress on body image,psychosocial well-being and depression among breastcancer patients. METHOD: A cross-sectional sur-vey was conducted with patients who participatedin a breast cancer advocacy events held at 16 hospi-



tals in Korea. Alopecia distress was assessed usingthe “Chemotherapy-Induced Alopecia DistressScale (CADS),” which evaluated the distress inphysical, emotional, daily activity, and relationshipdomains. The CADS indicated that higher score ishigher distress. Body image and psychosocial well-being were measured by the EORTC QLQ Core 30and BR-23, and depression was measured using theCES-D. Univariate and multivariate linear regres-sion analyses were used to evaluate the associationbetween CIA distress and body image, psychosocialwell-being, and depression. RESULTS: A total of168 patients participated in the study; the mean agewas 48.4 and 53% of the patients were receivingactive treatment such as chemotherapy and radio-therapy at the time of the survey. More than 50%of the patients experienced alopecia distress.Patients who had higher CIA distress experiencedabout 2 times poorer body image than patients withlower CIA distress after adjusting for all socioeco-nomic status and clinical characteristics. Distressedpatients were also more likely to report lower emo-tional and role functioning, and the CIA distresswas also negatively associated with depression aftercontrolling for all covariates (p < 0.01). CONCLU-SIONS: To the best of our knowledge this is thefirst quantitative study confirms that patients expe-rience moderate to severe distress due to CIA andits distress has a significantly negative impact onbody image, psychosocial well-being, and depres-sion in women with breast cancer. In future studies,it will be necessary to identify factors that associ-ated with onset and course of alopecia distress andto develop interventions for minimizing alopeciadistress in women with breast cancer. ACKNOWL-EDGEMENT OF FUNDING: The research wasaccomplished by support from the AMOREPA-CIFIC and Korea Breast Cancer Foundation.

P2-127

Multidisciplinary Support Needs in Cancer Patients

in a German Comprehensive Cancer Centre

Hans-Christoph Friederich1, Anette Brechtel1,Robert Schiel1, J€urgen Walther1, Joachim Wiske-mann2, Ingeborg R€otzer2, Dirk J€ager1,2, MechthildHartmann11Medical University Hospital, Heidelberg, Germany,2National Center for Tumor Diseases, Heidelberg,Germany

BACKGROUND: Supportive care plays anincreasingly important role in cancer patients.Modern therapies have significantly improved dis-ease control and prolonged survival. However, themajority of cancer patients is incurable and suffersfrom the disease itself and potential side-effects ofstressful treatments. The prevalence of supportneeds have mainly been addressed separately in thevarious disciplines in previous studies. The aim of

the present study was to investigate multidisciplin-ary support needs in cancer patients. METHOD:A total of 562 patients suffering from gynecologi-cal, gastrointestinal or dermatological cancers tookpart in the survey. Questionnaires were used toassess support needs for psychooncological inter-ventions, social work, nutritional counseling andexercise therapy. Additionally, psychic comorbiditywas assessed using the Patient-Health Question-naire (PHQ-D). The assessment was computer-assisted using tablet-PCs and the study took placeat a German Comprehensive Cancer Centre.RESULTS: From the 562 patients, 52% (n = 294)asked for psychooncological interventions or psy-chotherapy and family counseling. One third (34%)of this subgroup showed at least a moderate depres-sive episode. Besides psychooncology, the vastmajority (97%) of these patients had additionalsupport needs: 28% asked for all four services(psychooncology, social work, nutrition, exercise),40% asked for three services (psychooncology plustwo additional support services) and 29% for twoservices (psychooncology plus one additional sup-port service). CONCLUSIONS: The findings ofthe survey indicate that the vast majority of cancerpatients across different cancer entities and at dif-ferent stages of their disease have multidisciplinarysupport needs compromising psychooncology,social work, nutritional counselling and exercisetherapy. RESEARCH IMPLICATIONS: Giventhe multidisciplinary support needs in cancerpatients, more integrated and comprehensive sup-port services have to be developed for cancerpatients. The effectiveness of these multidisciplin-ary supportive care programs should be evaluatedin clinical trials. CLINICAL IMPLICATIONS:Multidisciplinary supportive care programs deliv-ered by a team of different healthcare professionals(e.g. psychotherapists, social workers, dieticiansand physiotherapists) is necessary to optimize qual-ity of life in cancer patients at all stages of their dis-ease. This requires a close collaboration betweenthe involved therapists to coordinate a multifacetedsupportive care tailored the patient’s needs.ACKNOWLEDGEMENT OF FUNDING: None.

P2-128

Oncological Patients’ Desire to Receive

Psychological Support - A Peruvian Representative

Sample

Samuel Gonzales-PuellUniversidad de San Martin- Psychology DepartmentResearch Institute, Lima, Peru

BACKGROUND: The objective of the study is toexplore the psychological needs of a patient in rela-tion to cancer and his/her desire to receive profes-sional or family oriented psychological support.The study targeted 340 Peruvian oncological



patients (men and women). METHOD: As part ofthe study both a socio-demographic data analysisand an analysis of psychological factors (anxiety,adaptation to the disease, depression and other fac-tors related to the disease and its treatment) wereconducted. Tools used as instruments of evaluationinclude a demographic survey, two psychologicalevaluation instruments (HADS and WAYS CopingScale), the Karnofsky Scale and the Cancer Reha-bilitation Evaluation System (CARES). Dataobtained through CARES was analyzed in relationto the desire expressed by patients to receive or notreceive psychological support from health profes-sionals or from their families. This data wasreviewed considering differences in sex.RESULTS: Results are currently being processedstatistically in coordination with the Free Univer-sity of Brussels (Professor Razavi, PsychosomaticUnit, Psychology Department). We expect these tobe finalized by September 2013. CONCLUSIONS:There are no conclusions at this time. They will becompleted once the data analysis is available.RESEARCH IMPLICATIONS: One of the objec-tives of the study is to compare these results with aprevious study conducted with a Belgian sample byMerckaert et al in 2009. CLINICAL IMPLICA-TIONS: This is the first study of its kind carriedout in Peru with a significant sample (340 patients).Results will hopefully influence the development ofpublic policies inside the oncological field in Peru.ACKNOWLEDGEMENT OF FUNDING: None.

P2-129

Emesis and Quality of Life Among European Cancer

Patients

Maria Alejandra Berardi1, Tatiana Bertelli1, MariaGiulia Nanni2, Elisabeth Andritsch3, AgustinaSirgo Ramirez4, Eva Juan Linares5, Marta Bell�e6,Laura Cavana7, Elena Meggiolaro1, MauraMuccini7, Federica Ruffilli1, Elena Samor�ı7, ElisaRuggeri7, Ilaria Strada7, Antonella Carbonara2,Luigi Grassi21Istituto Scientifico Romagnolo per lo studio e laCura dei Tumori IRST S.r.l. IRCCS, Meldola FC,Italy, 2Division of Psychiatry, Department ofBiomedical and Specialty Surgical Sciences,University of Ferrara, Ferrara, Italy, 3UniversityClinic of Internal Medicine, Division of Oncology,Medical University of Graz, Graz, Austria,4Psycho-oncology Unit Oncology DepartmentUniversity Hospital Sant Joan de Reus, Reus, Spain,5Psycho-Oncology Unit, Hospital de la Santa Creu iSant Pau, Barcelona, Spain, 6Department ofOncology, C�a Foncello Hospital of Treviso, Treviso,Italy, 7Istituto Oncologico Romagnolo, Forl�ı, Italy

BACKGROUND: The influence of chemother-apy-induced nausea and vomiting (CINV) has beenstudied as a factor influencing cancer patients’ qual-

ity of Life (QoL). The aim of the study, as a part ofa larger European research protocol, was to iden-tify the relationship of emesis (acute and delayed)and quality of life (QoL) with psychosocial (in par-ticular coping and psychological distress) and rela-tional (doctor-patient communication) variables.METHOD: 284 cancer patients aged 18–65 years,with no cognitive deficit, a Karnofsky Score >60and a life expectancy >6 months, participated in amulticenter European study (Italy, Austria, Spain).Each patient completed the Functional LivingIndex for Emesis (FLIE) (Martin et al., 2003)before chemotherapy (FLIE-1); the 24-item PatientSatisfaction with Doctor Questionnaire (PSQ-MD)(Loblaw et al., 2004), two subscales of the Mini-MAC (Watson et al., 1984), (i.e. Anxious Preoccu-pation and Hopelessness); and the 0-10 DistressThermometer (NCCN, 2012). Five days after che-motherapy the patients completed the FLIE (FLIE-2) again and a 0-10 VAS CINV diary to measurenausea and vomiting. RESULTS: DT moderatecaseness (score > 4) was shown in 48% of cancerpatients and a more severe distress (score ≥ 7) in27.2% patients. Intensity of nausea on days 3–5and score on FLIE-2 were associated with DTscores (r = 0.24, p = 0.01), Mini-MAC hopeless-ness (r = 0.23, p = 0.01). FLIE-2 was also associ-ated with low scores on Physician Support on thePSQ-MD. CONCLUSIONS: The study indicatedthat cancer patients’ emotional stress, coping strate-gies as well as low support form physician in doc-tor-patient relationship are associated with nauseapost-chemotherapy, irrespective of anti-emetictreatment. RESEARCH IMPLICATIONS:Results suggest the importance of psychosocialvariables, to be further explored, in post-chemo-therapy symptoms, especially CINV. CLINICALIMPLICATIONS: The study suggests that screen-ing of patients’ coping styles and distress are impor-tant to possible preventive intervention of CINV.Furthermore, doctor-patient relationship should bemonitored given the possible influence on influenc-ing patients’ QoL. ACKNOWLEDGEMENT OFFUNDING: Istituto Oncologico Romagnolo(IOR), Forl�ı, Italy; FAR Project, University ofFerrara, Italy.

P2-130

The First Analysis of Quality of Life of Patients

With Acute Leukemia in Republic of Armenia

Yervand Hakobyan, Smbat DaghbashyanHematology Center RA, Yerevan, Armenia

BACKGROUND: Since hematological cases canbe treated and prolongation of life is achieved,many different spirituals and psychological con-cerns must be addressed to maintain smooth func-tioning and optimize quality of life (QoL). Thisresearch study has been designed the first time to



place into hematological practice in Armenia amodified QoL questionnaire and find out correla-tions between efficiency of treatment of AL andQoL. METHOD: QoL questionnaire include com-mon and disease related specific problems: over 50questions about psychological and functional con-ditions of the patients their relationship with oth-ers, self-esteem issues, etc. The questionnaires werefirst filled out within the 7 days after admittanceand after two weeks. RESULTS: The study ofquestionnaires revealed that weakness impaired thepatients’ QoL in 80% (n = 64), the bone pain – in85% (n = 68), fever- in 75% (n = 60), dyspepsia –in 60% (n = 48), followed by the decreased abilityto work – in 60% (n = 48) and lower personal rela-tions – in 62.5% (n = 50) of cases. QoL indicatorswere dependant on the disease diversity and accom-panied risk factors. Patients with high-risk andAML have shown the poorer indicators of QoLthen the patients with low-risk and ALL. Reliableinformation and trustful communication is themost well validated instrument that measure theQoL outcomes. CONCLUSIONS: The first steptowards dealing with the routine chemotherapytreatment is communication. It’s important forpatients to communicate their thoughts and feelingswith their healthcare practitioners. The second stepis QoL information: perception that many of depres-sive feelings are predictable and not fatal, and manyof side effects are impermanent, may become mean-ingful. Low personal relations, depression and anxi-ety, financial burden problems play negative andsignificantly impair patients’ QoL. The modifiedQoL questionnaire for the patients with AL is oneof the well-validated instruments to place into every-day practice to obtain reliable scores and meaningfuldata on QoL. ACKNOWLEDGEMENT OFFUNDING: None.

P2-131

The Development of Prostate Cancer Patients’

Information Needs: Patients’, GPs’ and Significant

Others’ Perceptions Focusing on Diet

Angelos Kassianos, Monique Raats, John NicholsUniversity of Surrey, Guildford, UK

BACKGROUND: The literature provides evi-dence how doctor-patient communication mayimprove health outcomes (Stewart et al., 2000; Becket al., 2002; Flach et al., 2004) especially in cancercare (Mainous et al., 2004). Rees et al. (2003) foundthat prostate cancer patients are highly interested inseeking information. There hasn’t been a studyidentified evaluating the discrepancies betweenhealth professionals, patients and significant othersperceptions as to when patients develop needs inhealth care especially diet. METHOD: This is across sectional study using an online survey. Partic-ipants (N = 220) were recruited through the Pros-

tate Cancer Charity’s website, an advertisement onthe Prostate Care Cook Book (Rayman et al., 2008)and the Royal College of GPs (South West ThamesFaculty). The questionnaire used consisted of 3variables: time of information need development,food item awareness in reducing risk of prostatecancer, importance of diet in cancer aetiology. Anopen ended question on GP’s attitudes towards wasused to compliment the data. Kruskall Wallis andCochran’s Q tests in SPSS were used to analyse thedata. RESULTS: Results from this study indicatethat a) male GP’s believe patients develop an inter-est in some information needs sooner than femaleGP’s do, b) female GPs with less experience believepatients are in need for information regarding sexu-ality sooner than experienced female GPs, c) maleGPs believe patients need information regardingmental health sooner than experienced female GPs,d)GPs, patients and significant others differ ontheir perceptions in 7 out of 11 information needsand e) GPs show discrepancies on their awarenessof food items that are considered beneficial forprostate cancer. CONCLUSIONS: Gender andexperience of GPs was found to predict their per-ceptions on the time prostate cancer patientsdevelop a need regarding mental health, sexuality,interaction issues and more information. Regardingdifferences between GPs and patients this studyconfirms previous ones (Fallowfield et al., 1995;Zemmercuk et al., 1998) indicating that GPs under-estimate patients’ needs and fail to provide topatients the information they need (Schikel et al.,2013). However, this study also suggests that signif-icant others’ have highly prioritised need for infor-mation after their family members/friends’diagnosis as well. RESEARCH IMPLICA-TIONS: This study suggests that significant othersare a group that future interventions may want tofocus as well as their need for information is alsocloser to diagnosis than health care providers per-ceive. Findings can inform research aiming toimprove patient (and their family/friends) andhealth care providers communication. CLINICALIMPLICATIONS: Doctor-patient communicationcan be improved if we understand the different per-ceptions of health care providers and the peoplethat are primarily affected by cancer (patients andsignificant others). This will also improve patientoutcomes such as satisfaction with health care pro-vision and probably other psychological constructsthat can be identified for further research (i.e. qual-ity of life). ACKNOWLEDGEMENT OF FUND-ING: None.



P2-132

Benefits of Mindfulness Improving Emotional Status

and Quality of Life in Oncology Patients.

Comparison of Two Schedules of Treatment.

Concha Leon1,2, Rosanna Mirapeix1,2, EstherJovell3, Tom�as Blasco4, Esther Pousa5, �AngelsArcusa2, Miquel �Angel Segu�ı11IOV - Hospital Parc Tauli de Sabadell, Barcelona,Spain, 2IOV - Consorci Sanitari de Terrassa,Barcelona, Spain, 3Epidemiologia - ConsorciSanitari de Terrassa, Barcelona, Spain,4Departamento Psicologia B�asica UAB, Barcelona,Spain, 5Salut Mental - Hospital Parc Tauli deSabadell, Barcelona, Spain

BACKGROUND: The use of Mindfulness toreduce emotional distress and improve psychologi-cal adaptation in cancer patients has increased andhas proven to be highly effective. However it is notwell known which schedule of treatment sessionsallows to better results. This study aims to testwhether a 30 minutes/daily meditation (30M) ismore useful than 10 minutes/daily meditation(10M) to decrease anxiety and depression andimprove quality of life in ambulatory cancerpatients. METHOD: Ambulatory cancer patientsdiagnosed and treated at both centers in the Insti-tute Oncologic del Vall�es (IOV) who agreed to par-ticipate in the study were given written informedconsents and were included in the study. Patients inTerrassa-Center received instructions to develop athome the 30M schedule during 10 weeks, andpatients in Sabadell-Center, the 10M schedule athome during 8 weeks. Anxiety, depression andquality of life were assessed by STAI, BDI andQLQC-30 at pre-intervention and after patientshad completed 6 treatment sessions at least.RESULTS: 25 oncology patients completed thestudy (30M group n = 12; 10M group: n = 13). Nodifferences were found between groups at baselinemeasures. Anxiety and depression decreased at postintervention both in the 10M group (BDI,STAI-E,STAI-R p = 0.000) and in the 30M group (BDI:p = 0.027; STAI-E: p = 0.08; STAI-R: p = 0.01).Furthermore, the following quality of life dimen-sions improved at post-intervention in the 10Mgroup: Physical (p = 0.005), Emotional (p = 0.012),and Fatigue (p = 0.001). CONCLUSIONS: Resultssuggest that Mindfulness could improve quality oflife and reduce anxiety and depression in cancerpatients, and that a short daily time is required toachieve these results since a 10 minute/daily prac-tice schedule allows to better results than a 30 min-ute/daily practice schedule in improving somequality of life dimensions. RESEARCH IMPLI-CATIONS: Results suggest that, after 6 weeks ofdaily mindfulness sessions, both schedules were use-ful to reduce Anxiety and Depression, and thatsome dimensions of quality of life improved in the

10M group. However, more research with largersamples is needed to know whether a 10M scheduleallows to more improvements in anxiety, depressionand quality of life once the patients have completedthe whole schedule (10 weeks). CLINICALIMPLICATIONS: This study suggests that a 6-week10M schedule offers the same benefits than a30M schedule to reduce anxiety and depression lev-els, and has additional effects improving somedimensions of quality of life. Thus, the formershould be recommended in order to enhance adher-ence to treatment, since it is less time-cost and moreeasy to apply. ACKNOWLEDGEMENT OFFUNDING: Study supported by Fundaci�o ParcTaul�ı de Sabadell.

P2-133

Association Between Symptom Severity, Depression,

and Relevant Factors at Six Months After Surgery

in Head and Neck Cancer Patients

Wei-Lin Liu, Yeur-Hur Lai, Yen-Ju ChenNational Taiwan University, College of Medicine,Department of Nursing, Taipei, Taiwan

BACKGROUND: Depression is a common psy-chological problem in cancer patients. Head andneck cancer (HNC) patients experience physicalfunction changes after surgery treatment. Thesephysical symptoms affect patients’ quality of lifeand cause psychological distress. Therefore, thepurpose of this study are: (1) to explore the symp-tom severity in HNC patients received surgery for6 months (2) to examine the relationship betweenthe symptom severity and depression (3) to identifythe predictors of depression. METHOD: This is across-sectional research with purposive sampling.Patients were newly diagnosis of head and neckcancer and received surgery for 6 months in a medi-cal center in north Taiwan. We used SymptomSeverity Scale (SSS), Depression Subscale of Hospi-tal Anxiety and Depression Scale (HADS) to evalu-ate patients’ symptom severity and depression.Description analysis, Pearson correlation and linearregression were used. We put the meaningful demo-graphic variables and top ten severe symptoms intoregression model to predict the depression afterreceiving surgery for 6 months. RESULTS: Werecruited 156 patients’ responses. The averagedepression score is 3.4 (SD = 3.5). The most dis-tressed severe symptoms were difficult chewing(Mean = 3.1, SD = 3.8), dry mouth (Mean = 3.0,SD = 2.9) and difficult swallowing (Mean = 2.3,SD = 3.3). Patients’ depression was correlated tofatigue, dry mouth, poor appetite and insomnia(r = 0 .51, 0.41, 0.39, 0.38, respectively; p < 0.05).The significant predictors of depression were fati-gue, without occupation, dry mouth, insomnia anddifficult chewing (R2 = 0.40, p < 0.05). CONCLU-SIONS: The results found physical symptoms sig-



nificantly predicted patients’ depression. Patientshad occupation and income after surgery may havelower levels of depression than patients did not.Researchers and care providers should be aware ofpatients’ symptoms and psychological distress aftertreatment, and give patients appropriate supportsto improve their life after treatment. RESEARCHIMPLICATIONS: In the result, patients’ occupa-tion and income status associated with depression.Future study should make more effort on exploringthe family or environment context in this popula-tion to clarify the association between depressionand their life after treatment. CLINICAL IMPLI-CATIONS: The results indicated eating functiondecline after surgery significantly affect patients’ lifeand emotional status. Health care providers shouldregularly assess patients’ eating function and givethem rehabilitation early. ACKNOWLEDGE-MENT OF FUNDING: None.

P2-134

Abstract withdrawn

P3-1

Nurses’ Need of a Learning Program for Evidence-

Based Practice at Center Hospitals for Cancer Care

in Japan: A Content Analysis of Interviews

Reiko Makabe, Noriko NemotoFukushima Medical University, Fukushima-shi,Japan

BACKGROUND: Previous studies have reportedthat nurses at center hospitals for cancer care inJapan had inadequate knowledge of evidence-basedpractice (EBP), and a high number of experiencednurses were without education in EBP. However, lit-tle is known about nurses’ needs for EBP learningprograms. Therefore, the purpose of this study wasto describe their needs for EBP learning programs ascontinuing education at center hospitals for cancercare. METHOD: A qualitative inductive study wasconducted, and participants were a conveniencesample of 24 Japanese nurses who work at centerhospitals for cancer care (11 novice nurses and 13expert nurses). They were interviewed using semi-structured interview questions. Then, a content anal-ysis was performed to find out the reasons, contents,and strategies of the program. RESULTS: Eighteenparticipants (75%) stated that they needed an EBPlearning program. The commonly found reasonswere “importance of EBP for a cancer care practice”and “need of opportunities to learn EBP.” Theydesired to include “strategies to support cancerpatients and families” in the program. In addition,we also found that they preferred “group discussionwith other nurses,” and “a series of educational pro-grams rather than a single program at one time.”

CONCLUSIONS: These findings suggested that anEBP learning program needs to be developed to pro-vide higher quality care at center hospitals for cancercare in Japan. RESEARCH IMPLICATIONS:Further studies on EBP need to be performed inorder to evaluate an effective program at these hos-pitals. CLINICAL IMPLICATIONS: These find-ings provide us with a basis to develop an EBPlearning program, including strategies to supportcancer patients and their families, as continuing edu-cation at center hospitals for cancer care in Japan.ACKNOWLEDGEMENT OF FUNDING: None.

P3-2

Risk Factors and Prevention of Post-Traumatic

Stress Disorder in Breast Cancer Patients

Giedre Bulotiene1, Jurgita Matuiziene2, KestutisZagminas31Institute of Oncology, Vilnius University, Vilnius,Lithuania, 2Vilnius College, University of AppliedSciences, Vilnius, Lithuania, 3Vilnius University,Faculty of Medicine, Vilnius, Lithuania

BACKGROUND: A breast cancer diagnosis is apotential life-threatening event associated withsignificant distress. Even after successful treatment,cancer diagnosis may continue to be a source of dis-tress. The present study was aimed to identify theassociation of symptoms of posttraumatic stressdisorder (PTSD) with clinical and social factors innewly diagnosed breast cancer patients and to offerthe ways of managing negative psychosocial out-comes. It is the part of a larger prospectiveresearch. METHOD: The study included 180women with cT1-T3/N0-N1/M0 stages of breastcancer treated at the Institute of Oncology, VilniusUniversity. Before the surgery women completedfour questionnaires: Impact of Event Scale - revised(IES-R), Beck Depression Inventory II (BDI - II),Vrana-Lauterbach Traumatic Events Scale-Civilian(TEQ) and a form about patient’s socio-demo-graphic status. Data about their diagnosis weretaken from their hospital case-records. Frequencyof significance was presented as a percentage. Todetermine factors predisposing PTSD, multiplelogistic regression analysis was carried out. Valuesof p < 0.05 were considered statistically significant.For statistical data analysis SPSS software, version21 was used. RESULTS: 45% of patients had frommoderate to severe symptoms of PTSD (score ofIES-R ≥ 35). 37% of women were suffering fromdepression of different level. Logistic regressionanalysis showed that depression (adjusted OR 8.15;95% CI - 3.14–21.16; p < 0.0005), earlier and pres-ent psychological traumatic experience (adjustedOR 2.31; 95% CI - 1.12–4.78; p < 0.024) associatedto high scores of posttraumatic stress. Negative cor-relation was found between the manifestation ofPTSD and time, which passed from the moment



patients were informed that they are ill with thecancer (�0.33; p < 0.012). CONCLUSIONS: Sig-nificant numbers of newly diagnosed breast cancerpatients suffer PTSD symptoms. Depression andearlier traumatic experience are the predictors ofPTSD. The finding show that early evaluation ofpsycho emotional needs of breast cancer patients isnecessary and early interventions for the preventionof PTSD are meaningful especially if patient statesabout the earlier traumatic experience and badmood. Newly diagnosed cancer patients should beprovided regular care and assistance. RESEARCHIMPLICATIONS: It is necessary to develop usefulintervention for the prevention of PTSD in cancerpatients. Early prevention of PTSD minimizingPTSD symptoms could improve the quality ofwomen’s lives. CLINICAL IMPLICATIONS:Seeking to reduce influence of PTSD symptoms,medical staff has to assess cancer patients’ mood,its changes after the diagnosis of disease and earliertraumatic experience. A united and easily appliedsystem must be established for the evaluation ofemotional status in cancer patients. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-3

Innovative Efforts in a Romanian Oncological

Center: Dimensions of Patient-Centered Health Care

Anca Mirsu-Paun1, Coralia Mirsu-Paun2,11Association for Promoting and Developing Psycho-Social Oncology in Romania, Bucharest, Romania,2Institute of Oncology, Bucharest, Romania

BACKGROUND: Patient-centered care, as qual-ity health care, is associated with improvements inpatient satisfaction, health-related quality of life,and psychological wellbeing, health outcomes, andhigher survival rates. A group of Romanian oncol-ogy patients reported high levels of distress: 47.5%depression, 46.7% anxiety, and 28.1% criticallylow quality of life. Clearly, there is a need to under-stand how to improve the experience of thesepatients who are the “experts” regarding their ownhealth care needs. METHOD: An estimated 35patients from a large Romanian oncological hospi-tal will be recruited to anonymously participate inthis study. The study questionnaire will ask partici-pants to rate (a) the subjective importance and (b)the care they actually received, along the eight gen-eral dimensions identified by Ouwens et al. (2010)(e.g. access to care, communication and respect,etc.). Patients will be encouraged to provide anyadditional dimensions important to them (qualita-tive data). Data analysis: to determine whichdimensions of patient-centered care are mostimportant, which ones are lacking, and which addi-tional dimensions emerge from the qualitative data.RESULTS: It is expected that Romanian oncologypatients will identify significant needs regarding

their patient-centered care based on their healthcare experiences (i.e. aspects of their care whichthey rated low and thus are still lacking). It is alsoexpected that the results will indicate which dimen-sions are most important and thus warrant furtherimmediate attention and development. Addition-ally, the qualitative data will provide informationregarding the specific needs of Romanian patients(versus patients from other countries). CONCLU-SIONS: Using a specific set of patient-centered in-dictors is a much needed first step towarddeveloping innovative patient-centered interven-tions in Romania. Health care professionals’ opin-ions and guidelines are important and yet it ispatients themselves who can provide best informa-tion regarding their health care needs, which canfurther lead to their increased adherence to treat-ment and increased treatment satisfaction. Theresults from this study can be used to develop spe-cific and targeted ways to improve the health careexperience among Romanian oncology patients.RESEARCH IMPLICATIONS: Future researchcan examine the effectiveness of patient-centeredcare by comparing levels of distress and health out-comes among patient who experience versus thosewho do not experience such care. Also, replicatingresults from this study on a larger sample includingsubgroups (e.g. by diagnosis, illness stage, etc.) willallow a more accurate generalization of its findings.Comparing results with those from other Europeancountries can increase our understanding of cross-national differences in patient-centered care needs.CLINICAL IMPLICATIONS: Implications forclinical practice include: (a) tailoring psycho-socialprograms to the stated needs of the patients; and (b)attempts to sensitize health care providers to the spe-cific needs of patients (e.g. if need for communica-tion of health care information is rated highly thenproviders can be alerted regarding this fact or ifpatients rate family involvement as very importantto them, efforts can be made to increase opportuni-ties for such involvement). ACKNOWLEDGE-MENT OF FUNDING: None.

P3-4

Young People With Cancer and Hospital Care: ‘It’sa Whole Different World’ How can Hospital Care

Promote the Wellbeing of Young People With

Cancer?

Suzanne MooneyQueen’s University Belfast, Belfast, NorthernIreland, UK

BACKGROUND: Young people with cancer arerecognised as a vulnerable patient cohort whosewellbeing and resilience is compromised by the dualcrisis of unanticipated life-threatening illness at acritical transitional life stage. Although good out-comes include quality of life and successful matura-



tion, little is known about young people’s needs orthe constituents of age-appropriate healthcare.Applying the Sense of Coherence theoretical frame-work, this study examines how hospital care canpromote wellbeing enhancing strengths and copingresources. METHOD: This doctoral study appliesa qualitative narrative design to explore the per-spectives of two under-researched populations ofteenagers and young adults [TYAs: 16–19, 20–24 years], carers and multi-disciplinary profession-als. A series of three semi-structured interviews over6–9 months are conducted with 14 young peoplereceiving treatment in adult provision and their pri-mary carers. Young participant interviews utilisevisual diagramming including social network mapsand timelines to support engagement in the inter-view process while exploring identity, illness, rela-tionship and healthcare narratives. Supplementarysingle interviews are carried out with 15 multi-disci-plinary hospital professionals. RESULTS: Sup-portive relationships and inclusive communicationprocesses are identified as central components ofwellbeing-promoting hospital care enabling TYAsfind meaning from their experience, manage uncer-tainty, access resources and sustain engagementwith everyday life. Although parents are identifiedas key resources whose wellbeing has a reciprocalimpact on TYA coping, they are often marginalisedto the periphery of adult service provision. Multi-disciplinary professionals are confirmed as activeparticipants in the young person and family’s evolv-ing illness narratives with the potential to contrib-ute positively to their wellbeing. Findings alsohighlight the importance of psychosocial wellbeingto sustaining treatment and remaining involved inlife. CONCLUSIONS: An increased focus on rela-tionship-building, communication and strength-ori-entated support for young people and their primarycarers, both individually and as a family system, isrecommended as a prerequisite for optimal hospitalcare across the treatment trajectory. Greater inter-disciplinary collaboration is required with all pro-fessionals understanding their role in promotingTYA and carer wellbeing, and having the skills toenable the young person’s emerging adulthoodwhile welcoming carer involvement. Professionaltraining should include an inter-disciplinary com-ponent, recognise the importance of psychosocialwellbeing and develop communication skills andprocesses specifically targeted at this neglectedgroup of patients and their carers. RESEARCHIMPLICATIONS: Further research is required tounderstand the experience of TYAs receiving pallia-tive and end of life care, and their carers. Attentionshould also be directed at the needs of young peopleaged 14–15 years treated in either paediatric set-tings or admitted directly to adult services. Theimpact of qualitative research on sensitive topicswith vulnerable participants also requires furtherstudy to ensure interviews enhance rather than

diminish participant wellbeing at times of crisis.CLINICAL IMPLICATIONS: This study indi-cates that a whole system interdisciplinaryapproach with a focus on relationship-building andcommunication is required to enhance young peo-ple’s resources throughout the cancer trajectory.Recognition of the importance of psychosocialwellbeing and the reciprocal impact of young per-son and carer wellbeing is essential for optimalcare. Hospital care for this transitional age groupadmitted to adult services must move beyond per-son-centred care, to welcome and develop servicesfor carers and families. ACKNOWLEDGEMENTOF FUNDING: This doctoral study is sponsoredby Belfast Health and Social Care Trust andQueen’s University Belfast, and funded by theNorthern Ireland Public Health Agency’s Researchand Development Office (2009–2014).

P3-5

Evidence-Based Practice Related to Effects of

Peripheral Neuropathy Caused by Chemotherapy on

Quality of Life In Japan: A Literature Review

Noriko Nemoto, Reiko MakabeSchool of Nursing, Fukushima Medical University,Fukushima, Japan

BACKGROUND: To review and identify Japa-nese articles of evidence-based practice (EBP)related to effects of peripheral neuropathy causedby chemotherapy on patients quality of life.METHOD: At the end of March 2013, tworesearchers specializing in cancer nursing conducteda literature search on Igaku Chuo Zasshi, a Japa-nese medical literature database. They performedkeyword and “AND” searches for the terms“peripheral neuropathy”, “chemotherapy” and“quality of life (QOL)” used in literature publishedbetween 2003 and 2013. RESULTS: The keywordsearches resulted in 19014 articles for “peripheralneuropathy” 79082 articles for “chemotherapy”and 44695 articles for “QOL”.The 32 originalpapers using the 3 terms were then selected. Afterreading and reviewing the 32 articles, 9 were finallyselected as relevant articles for this study. The 9articles were reviewed and summarized for ourstudy with regards to methods, study results, andconclusions. Research designs of the 9 articles wereintervention studies (n = 3), descriptive studies(n = 5) and qualitative study (n = 1). The articlesinclude intervention studies on peripheral neuropa-thy, however, it is not possible to assert said studieseffectiveness. CONCLUSIONS: This literaturereview suggests that peripheral neuropathy causedby chemotherapy is an important issue which caninfluence patients’ quality of life. We need to vali-date the efficacy of intervention that patients withperipheral neuropathy caused by chemotherapy can



practice themselves, based on EBP. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-6

Auditing Psychological Interventions in Oncology

Patients With the Outcome Rating Scale and

Session Rating Scale in a Clinical Health

Psychology Setting

Bruce Pereira1,2, Monroope Phull1,3, InesOhlhausen1,4, Donna Court1, I~nigo Tolosa1,21University Hospital Birmingham NHS FT,Birmingham, UK, 2Birmingham and Solihull MentalHealth NHS FT, Birmingham, UK, 3AstonUniversity, Birmingham, UK, 4Albert-Ludwigs-Universitat Freiburg, Freiburg, Germany

BACKGROUND: Patient-directed and outcome-informed approaches improve therapeutic out-comes (Reese, Norsworthy & Hawkins; 2009).Therapeutic alliance improves outcomes, retentionand the course of therapy (Miller, Duncan, Brown,Sorrel & Chalk, 2006; Lambert et al., 2003). TheOutcome Rating Scale (ORS) and Session RatingScale (SRS) measures patient functioning and ther-apeutic alliance, respectively (Miller, Duncan, Sor-rell & Brown, 2005). This audit aims to measure theoutcome of psychological interventions with theORS and SRS in cancer patients. METHOD: Astandard audit cycle will be used to guide the auditprocess. The audit will take a stepped approach toreviewing current local service level agreements(SLA’s). The existing and current ORS/SRS datafor all patients accessing psychology services in anoutpatient setting will be collected and analysed.Results will be compared to local SLA’s and will beused to implement changes and to plan furtheraudits and research. This data pertains to cancerpsychology patients, but is part of a larger audit todetermine outcomes across physical health difficul-ties. RESULTS: Local SLA’s are based on stan-dards that 50% of patients accessing psychologyservices will report a 5-point increase on the ORS,while 80% of patients will report scores of 80% orhigher on the SRS. Results will show that the ORSand SRS help to improve the therapeutic outcomesand alliance with cancer patients; while serving tomeet outcomes agreed through SLA’s. Researchshows that change occurs early in the therapeuticprocess (Miller, Duncan, Brown, Sorrell & Chalk;2006). Similar results are expected, while expectingto find variations amongst session numbers andrate of change across different physical illnesses.CONCLUSIONS: Results of all ORS/SRS datafrom oncology patients accessing clinical psychol-ogy between January 2012 and October 2013, aswell as research and clinical implications will be dis-cussed. RESEARCH IMPLICATIONS: Data onthe rate of change across different physical healthpresentations within an acute physical health set-

ting will highlight the need for further research onpatient-directed and continuous outcome-informedapproaches in clinical health psychology, and psy-cho-oncology in particular. The results will alsopromote the clinical use of practice-based researchand audit to improve therapeutic process, allianceand outcomes in cancer psychology. Furtherresearch may have implications for cost effective-ness of therapy by minimising disengagement.CLINICAL IMPLICATIONS: Improvements inservice provision may include reviewing pathwaysof care, including referrals and signposting to com-munity psychological services for those not pro-gressing in therapy. Results will help inform futureSLA’s to provide a more targeted service based ondifferential outcomes and therapeutic change ratesacross different physical illnesses, including cancer.Improved patient rapport and targeted outcomesmay improve the service effectiveness and minimiseand predict therapeutic disengagement. Otherimprovements could include more targetedsupervision discussions. ACKNOWLEDGEMENTOF FUNDING: The project is being run andfunded by the Cancer Psychology Service at theQueen Elizabeth Hospital in the United Kingdom.

P3-7

Gender Differences in Cancer Caregiving: An Italian

Study on Strain and Coping

Annalisa Stablum1, Samantha Serpentini1,2, DoraCapozza3, Ines Testoni3, Eleonora Capovilla11Veneto Institute of Oncology, IOV - IRCCS,Padua, Italy, 2Azienda ULSS 3, Bassano del GrappaVI, Italy, 3Department Of Philosophy, Sociology,Education & Applied Psychology, University ofPadua, Padua, Italy

BACKGROUND: Several studies reported thatcaregivers of cancer patients are exposed to a con-siderable burden related to the caregiving responsi-bilities; however little is known on the relationshipsbetween demographic characteristic (gender, eth-nicity, etc.) and caregiving in oncology. The presentresearch aims to analyse the possible influence ofgender differences and coping strategies on thestrain experienced by the caregiver. METHOD:The study involves a group of caregivers attendingthe Day Hospital of the Veneto Institute of Oncol-ogy in Padua (Italy). All participants have agreedto voluntarily participate in the research. Theinstruments used are the following: 1) the FamilyStrain Questionnaire-Short Form (FSQ-SF), toevaluate the strain; 2) the Coping Orientation toProblem Experienced-New Italian Version (COPE-NVI), to assess the coping strategies. RESULTS:The sample consisted of 112 primary caregivers(range age: 20–76 years), 67% (N = 75) werewomen, while 33% (N = 37) were men; 51. 6% ofthe sample has a middle-high educational level. Par-



ticipants were mostly the patient’s spouse (53.6%)or an adult children (28.6%). Women feel a stron-ger emotional strain connected with assistance, inparticular when their educational level is low.Strain considered as the only factor correlates nega-tively to the problem-oriented coping strategy.Among the different dimensions evaluated by FSQ-SF, the only one unrelated to gender differences isthe need to know about the beloved’s illness. CON-CLUSIONS: This research help to define the Ital-ian caregiver’s profile. In most cases it concernswomen, spouses with a middle-high educationallevel. Women play the main role in the caregivingmanagement, experiencing a considerable strainrelated to the assistance, in particular when theyhave a low educational level. Coping strategieswhich people generally use to face stressful lifeevents influence strain; specifically, the caregiverswho adopt an active problem-oriented strategyexperience a lower level of strain. RESEARCHIMPLICATIONS: The results gained from thisresearch suggest the importance to focus furtherstudies in order to highlight the best strategies fight-ing the negative consequences related to caregiving;to observe the psychological and physical effects ofstrain on the cancer caregiver, in consideration ofgender differences and other demographic charac-teristic; to observe the effects of caregiving onpatient’s quality of life. CLINICAL IMPLICA-TIONS: Focusing specific clinical attention to themost fragile type of caregiver (women with a loweducational level); identifying the cancers with thehighest incidence in the male population (since gen-erally they have a female caregiver) and providingfrom the first visits a psychological screening forcaregivers to assess the coping strategies. Planningpsycho-educational interventions to enhance anddevelop active and useful coping methods to reducethe negative consequences connected with the man-agement of the care. ACKNOWLEDGEMENTOF FUNDING: None.

P3-8

Abstract withdrawn

P3-9

Patients’ Words Into Action: Occupational Therapy

Approaches in Rafik Hariri University Hospital

Lebanon

Sally Souraya1,31Hotel Dieu de France Hospital, Beirut, Lebanon,2Lebanese Association for Self Advocacy, Beirut,Lebanon, 3Lebanese Occupational TherapyAssociation, Beirut, Lebanon, 4Rafik HaririUniversity Hospital, Beirut, Lebanon

BACKGROUND: The first and unique occupa-tional therapy service in Oncology in Lebanon has

started in 2010 at the Rafic Harriri University Hos-pital as the only psycho-social support provided forcancer patients at this hospital. Thus, many chal-lenges were faced due to the novelty of this fieldand the lack of funding. The presentation will high-light the challenges faced and the approaches usedin order to put patients’ words into action in indi-vidualized therapeutic plans. METHOD: The pre-sentation will be addressing the main features ofthe service provided and highlighting how patients’words and advocacy were used to develop thera-peutic plans to help in improving the psychologicalstate of cancer patients. Practical examples and casestudies will be provided. RESULTS: The presenta-tion will show qualitative results of the impact ofoccupational therapy approaches used on the qual-ity of life of cancer patients and their families. Theresults will be discuss in term of the importance ofindividualized therapeutic plan which were basedon patients’ needs and expectations. Moreover theunique effect of these plans will be highlighteddue to the satisfaction attained by the patientsregarding the quality of care given. CONCLU-SIONS: The presentation will pose the followingquestion: if the care planning is based on the needsvoiced by patients’ words, how can we effectivelylisten to cancer patients? And, How can we useadvocacy techniques to make patients participate intheir care planning and how this particpation cancreate a difference and improve the quality of care.RESEARCH IMPLICATIONS: This presentationwill give directions into how to integrate advocacyinto health research and will highlight difficultiesthat could be faced at this level n a developpingcountry. CLINICAL IMPLICATIONS: Throughthe practical examples of case studies, clinicians willbenefit from tips related the therapeutic approachused with cancer patients and will learn how valu-able is to listen to their patients’ needs and to buildup their therapeutic plans based on them.ACKNOWLEDGEMENT OF FUNDING: None.

P3-10

A Systematic Review of Patient-Reported Outcome

Measures Assessing Quality of Patient-Centred

Cancer Care

Flora Tzelepis, Shiho Rose, Robert Sanson-Fisher,Tara Clinton-McHarg, Mariko Carey, ChristinePaulUniversity of Newcastle & Hunter Medical ResearchInstitute, Newcastle, New South Wales, Australia

BACKGROUND: The Institute of Medicine(IOM) has endorsed six dimensions of patient-centredness as vital to providing quality healthcare. However, whether patient-reported outcomemeasures (PROMs) comprehensively cover thesesix dimensions remains unexplored. This systematicreview explored: (1) whether PROMs that assess



the quality of patient-centred cancer care addressedthe six IOM dimensions of patient-centred care;and (2) the psychometric properties of these mea-sures. METHOD: Five electronic databases weresearched to retrieve published studies describing thedevelopment and psychometric properties ofPROMs assessing the quality of patient-centredcancer care. Two authors determined if eligiblePROMs covered the six IOM dimensions ofpatient-centred care of: (1) respectful to patients’values, preferences, and expressed needs; (2) coordi-nated and integrated; (3) provide information, com-munication, and education; (4) ensure physicalcomfort; (5) provide emotional support; and (6)involve family and friends. The adequacy of psy-chometric properties based on recommended crite-ria was also evaluated. RESULTS: Across all 21PROMs, the most commonly included IOM dimen-sion of patient-centred care was information, com-munication and education (19 measures). Twomeasures included one IOM-endorsed patient-cen-tred care dimension, 2 measures had two dimen-sions, seven measures had three dimensions, fivemeasures had four dimensions, and four measureshad five dimensions. One measure, the Indicators(Non-small Cell Lung Cancer), covered all 6 IOMdimensions of patient-centred care, but had ade-quate face/content validity only. None of the mea-sures met recommended criteria for test-retestreliability. CONCLUSIONS: There are no psycho-metrically rigorous PROMs developed with cancerpatients that capture all six IOM dimensions ofpatient-centred care. Further psychometric testingof the Indicators (Non-small Cell Lung Cancer) isneeded. Construction of comprehensive measuresthat can be used with the general cancer populationare required. RESEARCH IMPLICATIONS: Thissystematic review highlights that existing measuresof patient-centred cancer care fail to accurately cap-ture the whole-person orientation of cancer care.There is a need to develop new measures assessingthe quality of patient-centred care that cover all sixIOM-endorsed dimensions. Such measures need tobe psychometrically robust and suitable for usewith a range of cancer populations. CLINICALIMPLICATIONS: Quality improvements to thehealthcare system can be guided by measures thatassess the quality of patient-centred cancer care.Reliable and valid patient self-report measures thatidentify where improvements to care are neededmay facilitate advancements to health care servicesand health care professionals’ training.ACKNOWLEDGEMENT OF FUNDING: DrFlora Tzelepis is supported by a Leukaemia Foun-dation of Australia and Cure Cancer AustraliaFoundation Post-Doctoral Research Fellowship.Dr Tara Clinton-McHarg was supported by a Leu-kaemia Foundation Post-Doctoral Research Fel-lowship. Dr Tzelepis was supported by a Hunter

Medical Research Institute Leukaemia TravelAward to attend the IPOS conference.

P3-11

Abstract withdrawn

P3-12

Prostate Cancer Survivors’ Experiences of

Participation in Recreational Football - A

Qualitative Evaluation Of The “FC Prostate Trial”

Ditte Marie Bruun, Julie MidtgaardUniversity Hospitals Centre for Health CareResearch, Copenhagen University Hospital,Copenhagen, Denmark

BACKGROUND: Despite increasing awarenessof the relevance of gender-sensitive rehabilitation,male cancer survivors are underrepresented insurvivorship care and rehabilitation. To meet thedemand for studies encompassing the needs of malecancer patients, we initiated the “FC ProstateTrial” with the aim to examine effects of recrea-tional football in prostate cancer patients undergo-ing androgen deprivation therapy. The purpose ofthis study is to describe the results of the qualitativeevaluation of the participants’ experiences with par-ticipation. METHOD: Drawing on principles ofethnographic research, the study took advantage ofmethod triangulation in collection of data. Datawere collected through semi-structured focus groupinterviews (5 9 n = 5–7) and participant observa-tions (a total of 20 hours) in the period from June2011 to May 2013. Both methods were based on asemi-structured interview/observation guide includ-ing the following themes: “motivation for participa-tion”, “safety and tests”, “interpersonal relations”,“responses to the training”, “the role of coach”,“reactions from significant other”. RESULTS: Theparticipants were motivated by the opportunity ofself-managing the disease through participation ina well-known and high-valued sport. The inherentcharacteristics of football (i.e. the presence of acoach, the element of playing and being part of ateam) and the clinical monitoring and testing wereemphasized by the participants as essential for thesimultaneous concern for the disease and distrac-tion from the disease. Physical and mental well-being, space for solidarity and exchange of personalexperiences and positive feed-back from significantothers were described as positive responses fromparticipation and were experienced as fundamentalfor post-intervention maintenance. CONCLU-SIONS: This qualitative study suggests that recrea-tional football may be a unique and relevantalternative rehabilitation strategy that appeals toprostate cancer survivors receiving androgen depri-vation therapy, as it facilitates self-determination



and the development of a community of practiceenabling social support and solidarity. These find-ings support previous studies indicating that malecancer patients give priority to active, rational,action-orientated activities and that sport participa-tion may contribute to blurring the patient roleamong cancer survivors. RESEARCH IMPLICA-TIONS: Sustained provision of rehabilitation ini-tiatives that reflect the need of peer supportfacilitated through physical activity in male cancersurvivors calls for new approaches in the futurecancer rehabilitation research. Knowledge on theapplicability and effectiveness of exercise interven-tions in real life settings and deeper understandingof long-term adherence to behavior chance (i.e.physical activity) in male cancer patients andsurvivors are warranted. CLINICAL IMPLICA-TIONS: The present study indicates that recrea-tional football can promote recruitment andadherence to physical activity in prostate cancersurvivors. Furthermore, the findings reveal thatprostate cancer survivors appreciate and benefitfrom interactions with peers through sport partici-pation. Therefore, it is imperative that cancer reha-bilitation strategies incorporate gender sensitiveinitiatives and contexts that reflect male cancer sur-vivor’s need for independency and self-determina-tion on one hand and their need for patient careand support in the other. ACKNOWLEDGE-MENT OF FUNDING: The FC Prostate Trialhas received DKK 1.4 million from the Danishfoundation TrygFonden.

P3-13

Factors Influencing the Return-to-Work Experience

of Women Survivors of Gynecological Cancers: An

Exploratory Descriptive Study

Marie-Jose Durand, Maryse Caron, Am�elieBertrandUniversit�e de Sherbrooke, Sherbrooke, Canada

BACKGROUND: A large proportion of womenwith gynecological cancers are still active membersof the labour force when they are diagnosed. Oneof the challenges they face is returning to work(RTW) after treatment. Limited knowledge is avail-able on the RTW process of this category ofwoman in the Qu�ebec population. The aim of thisstudy was therefore to explore the factors influenc-ing the RTW experience of Qu�ebec women withcervical or endometrial cancer. METHOD:Exploratory descriptive study. Two focus groups,each two hours long, were run with women whohad cervical or endometrial cancer, held paidemployment at the time of diagnosis, and were liv-ing in an urban area. A total of 15 women betweenages 34 and 54 participated in this study. Clinicaland sociodemographic data were collected fromtheir computerized clinical files and through a ques-

tionnaire. Content analysis of the focus group tran-scripts was performed using pre-establishedcategories for initial coding. These categories werebased on the variables of the Feuerstein model for aRTW after cancer (2010). RESULTS: The mainRTW facilitators concerned the meaningfulness theparticipants perceived in their work (e.g. they saw itas a return to normal life or as a response to theirneed to reduce the cancer’s impact). The presenceof support services (e.g. psychological follow-up,support group) was also identified as an RTW facil-itator. The main obstacles involved three main fac-tors: (1) the individual (e.g. high personaldemands), (2) services received (e.g. absence orinadequacy of interventions and resources support-ing the RTW), and (3) the work environment (e.g.high employer expectations). Participants identifiedfinancial pressure as a major incentive for accelerat-ing RTW. CONCLUSIONS: This exploratorystudy revealed the multi-dimensional nature of thefactors related to the RTW of women following agynecological cancer. The current structure ofhealthcare services and poor knowledge of the dis-ease in the workplace constitute major obstacles toa healthy, sustainable RTW of this population.RESEARCH IMPLICATIONS: The results ofthis study help fill the gap left by the lack of dataon the RTW of women following a gynecologicalcancer. They also help generate hypotheses aboutways to promote sustainable RTW that will have tobe tested in future research. CLINICAL IMPLI-CATIONS: The results of this study will give prac-titioners who work with this clientele a betterunderstanding of the factors facilitating or hinderingtheir RTW. The results may also provide a basis fordeveloping interventions tailored to people livingwith cancer as they pursue their RTW trajectory.ACKNOWLEDGEMENT OF FUNDING: None.

P3-14

Nordic Walking for Patients With Early Stage

Breast Cancer

Maarten J. Fischer1, EllyM.M. Krol-Warmerdam1,GemmaM.C. Ranke1, Henricus M. Vermeulen1,Joke Van der Heijden2, JohanW.R. Nortier1,Adrian A. Kaptein11Leiden University Medical Center, Leiden, TheNetherlands, 2Action4vitality, Noordwijkerhout, TheNetherlands

BACKGROUND: Surgery and radiation to theaxilla as part of breast cancer treatment often resultin arm and shoulder morbidity. In addition to thegeneral benefits for cardiorespiratory fitness, Nor-dic Walking (NW) targets at the muscles of theupper extremities and shoulder. This may increaseshoulder mobility and reduce functional limita-tions. Our objective was to offer a NW interventionto women recovering from early stage breast cancer



treatment and to explore changes in well-being andshoulder function. METHOD: A NW programwas offered in three consecutive years from 2009–2011. The 1-hour sessions were supervised by a certi-fied NW-instructor. The program consisted of 10weekly training sessions. The program took placefrom April to June. Subjective outcomes wereassessed by questionnaire before and after the 10-week course, and at 6 months follow-up. Outcomesincluded shoulder morbidity (SPADI), vitality andmental well-being (SF-36), limitations in ADL andsocial activities (5-point Likert scales), and percep-tions about shoulder morbidity (Brief IPQ). A physi-cal therapist assessed participants’ shoulder range ofmotion before the first training session and at the10th training day. RESULTS: Twenty-eight womentook part in the NW groups, of which 82% com-pleted the course. Repeated measurements showed asignificant improvement in vitality and a reductionin perceived shoulder symptom severity and ADLlimitations, after 10 weeks of training. Results fromthe Shoulder Pain and Disability Index hadimproved, but this change was not significant untilsix months follow-up. Goniometric data indicatedthat active and passive range of motion (forwardflexion, abduction, external rotation) of the affectedshoulder had improved significantly in the 10-weekinterval. The NW intervention was well received bythe participants. All would recommend it to otherpatients. CONCLUSIONS: This study has investi-gated a new method of aftercare for patients withearly stage breast cancer who have undergone sur-gery or radiation to the axilla. Results from thispilot study suggest that a Nordic Walking programfor this patient group is a feasible and enjoyableintervention. Although our results call for furtherresearch, our data show that NW can have a benefi-cial effect on patients’ shoulder morbidity and ADLlimitations. RESEARCH IMPLICATIONS: Firstof all, adequately powered and controlled studiesare needed to determine whether improvements inRange of Motion and well-being are attributable tothe NW intervention or to natural recovery, and towhat degree the affected and contralateral arm willbenefit from training. It also remains to be deter-mined to what degree improvements in ROM areenduring and to what extent these improvements inROM relate to improvements in pain and disability.CLINICAL IMPLICATIONS: Evaluation of theintervention has demonstrated that accessibility ofthe training location should be optimized to facili-tate participation. Furthermore, supervising agroup of cancer patients requires that the instructorhas sufficient knowledge about the disease andtreatment modalities of the participants, and hasthe social skills to discuss emotional events thatmay occur during the program and to recognizeparticipants’ needs for additional care. Finally,participants may need support in distinguishingnormal from abnormal sensations. ACKNOWL-

EDGEMENT OF FUNDING: This project wassupported by a grant from Pink Ribbon, the Neth-erlands.

P3-15

Factors Associated With Physical Activity

Intervention Adherence and Maintenance in Cancer

Survivors During and After Treatment: A Systematic

Review

Caroline Kampshoff, Mai Chinapaw, FemkeJansen, Johannes Brug, Willem van Mechelen,Laurien BuffartVUMedical Center, Amsterdam, The Netherlands

BACKGROUND: Beneficial effects of physicalactivity (PA) and exercise among in cancer surviv-orsdepends on intervention adherence and mainte-nance. The associated factors need to be identifiedto further improve and personalize interventions.We aimed to systematically review factorsassociated with PA adherence and maintenance incancer survivors. METHOD: Studies were identi-fied by searching PubMed, Embase, PsycINFO andSPORTDiscus from inception to April 2012. Weincluded full-text articles that: (1) were performedin adult cancer survivors; (2) quantitatively assessed(a) PA intervention adherence and maintenance,and (b) potentially associated factors; (3) were pub-lished in English. The methodological quality of theselected studies was examined. A best evidence syn-thesis was applied providing summary scores forassociations evaluated in three or more studies.RESULTS: Nineteen studies were included andgenerally had high methodological quality (67–92% of maximum score). They investigated associ-ations of 73 personal and 6 environmental factorswith adherence, and 68 personal and 4 environmen-tal factors with maintenance. Only few summaryscores could be calculated. Socio-demographic(age, marital status, education and employment)and clinical factors (disease stage, time since diag-nosis, and treatment regime) were not associatedwith PA adherence. Patients in higher stage ofchange had higher PA adherence. Higher age,instrumental attitude and PA levels after diagnosiswere associated with higher PA maintenance.CONCLUSIONS: Evidence on factors influencingintervention adherence and maintenance in cancersurvivors is limited but indicate that personal andenvironmental factors may play a role. Additionalresearch is needed to understand and act on barri-ers to improve PA. ACKNOWLEDGEMENT OFFUNDING: This study is supported by the Alped’HuZes/KWF Fund. The research grant is pro-vided by the Dutch Cancer Society.



P3-16

Work it Out: The Six Steps of Intervention Mapping

Process for Designing a Self-Led Return-to-Work

Intervention Tool

Fehmidah Munir1, Deborah Wallis1, KatrynaKalawsky1, Emma Donaldson-Feilder21Loughborough Univeristy, Loughborough,Leicestershire, UK, 2Affinity Health at WorkConsultancies, London, UK

BACKGROUND: There are few UK-basedreturn-to-work (RTW) interventions for thoseaffected by and living beyond cancer, that bringstogether the expertise of healthcare professionalsand employers in supporting the individual toRTW. There is an essential and urgent need forinterventions for those affected by cancer that iden-tify work adjustments or ways to manage workwith regard to their cancer-related health. Wetherefore developed a work-related guidance tool(Work it Out) to address this issue. METHOD:The six steps of the intervention mapping process(Bartholomew et al., 2006) were used to guide thedevelopment of the Work it Out tool: (a) needsassessment, (b) the Identification of outcomes, per-formance objectives and change objectives; (c)selecting theory-based methods and practical strate-gies; (d) developing program components andmaterials; (e) planning for program adoption,implementation, and sustainability; and (f) plan-ning for evaluation. Each step leads to a productthat guides the next step. RESULTS: A needsassessment identified the “gaps” in information/advice received from healthcare professionals andother stakeholders. The intended outcomes andperformance objectives for the tool were then iden-tified followed by theory-based methods and animplementation plan. The tool was designed to be aself-led tool that can be used by any person with acancer diagnosis and working for most types ofemployers. CONCLUSIONS: The interventionmapping process to develop the tool took 9 monthsto complete. To our knowledge, no similar tech-nique has been used for developing RTW interven-tions for those affected by cancer. RESEARCHIMPLICATIONS: Intervention Mapping is a valu-able protocol for designing complex guidance tools.The process and design of this particular tool canlend itself to other situations both occupational andmore health-care based. CLINICAL IMPLICA-TIONS: The tool promotes consultation anddiscussion with a range of different healthcare pro-fessionals, employers, employment agencies andsupport services who are all involved in the RTW ofan individual diagnosed and treated for cancer.Healthcare professionals should promote the use ofthe tool to their patients as part of their clinical care.ACKNOWLEDGEMENT OF FUNDING: UK

National Cancer Survivorship Initiative (Depart-ment of Health and Macmillan Cancer Support).

P3-17

Effects of a Brief Outpatient Rehabilitation

Program for Cancer Patients on Physical Activity,

Return to Work and Quality of Life

Maren Hjelle Guddal1, Alv A. Dahl2,3, RoyNystad1, Lene Thorsen2, Sophie D. Foss�a2,3,Sigbjørn Smeland3,41Dept of Rehabilitation and ClinicalSservice,Division of Cancer Medicine, Surgery andTransplantation, Oslo University Hospital, Oslo,Norway, 2National Resource Center for Late Effectsafter Cancer Treatment, Division of CancerMedicine, Surgery and Transplantation, OsloUniversity Hospital, Oslo, Norway, 3University ofOslo, Oslo, Norway, 4Division of Cancer Medicine,Surgery and Transplantation, Oslo UniversityHospital, Oslo, Norway

BACKGROUND: Oslo University Hospital, Ra-diumhospitalet, is offering a multidisciplinary out-patient rehabilitation program (ORP) to cancerpatients who have recently completed their treat-ment for lymphomas, beast and gynecological can-cers. The program is funded by the NorwegianGovernment program “Fast return to work (Fast-RTW)”. The aim of this study was to assess theeffects of a brief OPR with attendance once a weekover seven weeks on physical activity, work statusand quality of life. METHOD: All participantswere within employment age and had to be on sick-leave or in need of sick-leave. Each day of the pro-gram consisted of a patient education session fortwo hours, followed by a one hour lunch break for“small talk”. Then followed two hours with physi-cal activity/relaxation. Data were collected at base-line (T0), at the end of the intervention (T1), and at6-months follow-up (T2) using items from theHealth Survey of Nord-Trøndelag County(HUNT), The Core Quality of Life Questionnaireof the European Organization for Research andTreatment of Cancer (EORTC QLQ-C30) andpatient’s report on work-status. RESULTS: 93%of 172 participants completed the program. Meanage was 52 years. The proportion on sick leavedecreased from 65% at T0 to 12% at T2. At T269% of the participants were in full or partial workcompared to 27% at T0. Increase in physical activ-ity from T0 to T2 was observed in terms ofincreased frequency, duration and intensity of exer-cise habits.Those who impoved their work statusduring the study period reported a higher level ofphysical activity, indicating a correlation betweenphysical activity and increased work abil-ity.HRQoL domain scores improved significantlyfrom T0 to T2. CONCLUSIONS: Our brief multi-disciplinary outpatient rehabilitation program for



patients after treatment for cancer was feasible. Thepatients reported increased physical activity andincreased work rate 6 months after termination ofthe program. There seems to be a positive correla-tion between returning to work and degree of physi-cal activity. RESEARCH IMPLICATIONS: Theresults of the program should encourage furtherresearch on the effects of this type of brief, low cost,outpatient multidisciplinary rehabilitation programfor other types of cancer patients. Future studiesshould also examine which patients will have thegreatest benefit from such a program. CLINICALIMPLICATIONS: This study highlights theimportance of structured group-based physicalactivity as an important ingredient of a multidisci-plinary rehabilitation program. ACKNOWL-EDGEMENT OF FUNDING: The program isfunded by the Norwegian Government program“Fast return to work (Fast-RTW)”.

P3-18

Physical and Mental Support in Young Patients

During Cancer Treatment, a Multidisciplinary Pilot

Intervention Study

Ase Sagen, Kjersti Tveten, Guro Hydle Kvalsvik,Gerd Guldbrandsen, Alexandra Østgaard, IngerThuneOslo Uiversity Hospital, Oslo, Norway

BACKGROUND: Cooping with cancer treatmentis reported to be challenging for young patients, inparticularly, but studies regarding this subject arelimited. The main aim of this study was to evaluatewhether an intervention with group based physicalexercise combined with oncology nurse counsellingand psychologist consultations given to young can-cer patients during treatment are associated withphysical function, level of anxiety and depression.METHOD: This multidisciplinary pilot interven-tion study included young adult cancer patientsdiagnosed with cancer of testis, breast, the lympha-tic system or gynecological cancer, and were carriedout during adjuvant cancer treatment. The inter-vention included a group based physical exerciseprogram lead by a physiotherapist for 90 minutes,twice a week in 12 weeks and in addition oncologynurse counselling and psychologist consultations.Physical function and Hospitial Anxiety andDepression Scale (HADS) were assessed at base-line, 12 weeks and at 6 months. The effect of theintervention on physical function and mental healthwere analysed by using parametric/non-parametrictests, including qualitative methods. RESULTS:We observed among these young (28 � 4 years)cancer patients (n = 19) an increase over time inphysical function (p < 0.05): Max Step Length testsand the Sit-to-Stand test increased by 9.2% to15.5%, and by 9.9% to 18.7% from baseline to12 weeks and 6 months, respectively. The Aastrand

fitness test improved suggestively with 25% at6 months follow-up (p = 0.071). Grip strength andHADS did not change from baseline to follow-up.Adherence to follow-up during 12 weeks cancertreatment was mean 8 � 5 weeks. Qualitativereports supported a multidisciplinary approachduring cancer treatment. CONCLUSIONS: Theseresults indicate that this multidisciplinary approachwith group based exercise and counselling duringtreatment may play a role for young adult cancerpatients in relation to physical function, anxietyand depression. However, the results must be inter-preted with caution due to small sample size, drop-outs and no reference group included. RESEARCHIMPLICATIONS: Our small pilot study should belooked upon as hypothesis generating, only. How-ever, our study support that the multidisciplinaryapproach including both physical and mentalsupport in young cancer patients during adjuvanttreatment should be assessed in larger RCT’s.Furthermore, additional measurements i.e of physi-cal function, fatigue and coping strategies, shouldbe included. CLINICAL IMPLICATIONS: Thismultidisciplinary pilot study in young adult patientsindicates that physical and mental support duringadjuvant cancer treatment is feasible in a vulnerableperiod of life and serious treatment, but needs to bereplicated. ACKNOWLEDGEMENT OF FUND-ING: The Norwegian Cancer Society and ActiveAgainst Cancer supported the study.

P3-19

Emotional and Psychological States of Patients

With Dyschezia Following Low Anterior Resection

for Rectal Cancer

Masami SatoUniversity of Tsukuba, Tsukuba, Ibaraki, Japan

BACKGROUND: The patients who received thelow anterior resection for rectal cancer show char-acteristic symptoms of dyschezia such as frequentdefecation, feeling of incomplete evacuation,urgency, difficulty in discerning stools and gas, andsoiling and have difficulties in their social lives. Thecurrent study attempts to investigate emotional andpsychological states of the patients with dyscheziafollowing the low anterior resection for rectal can-cer. METHOD: We conducted interviews with 13patients who received low anterior resection for rec-tal cancer (mean age 62.3; SD = 11.5; 4, 2, 6, and 1cases of stage I, II, III, and IV, respectively) 1–3times for each patient 2–13 months after the opera-tions. We evaluated defecation symptom using Defe-cation Dysfunction Assessment Scale (DDAS; range9–36), asked about lives, assessed psychologicalstates using POMS, and asked to grade defecationsymptom out of 100 points. POMS was calculatedusing standardized T score. Dyschezia was evaluatedby defecation frequency and DDAS. Six subjects



were interviewed more than once and their clinicalcourses were analyzed. RESULTS: Mean values ofPOMS items showed TA = 47.2 (SD8.78),D = 49.2 (SD8.36), AH = 46.2 (SD7.62), V = 50.6(SD8.27), F = 45.2(SD8.90), and C = 49.8(SD10.27). Ten cases showed greater values com-pared with standard scores. Their self-evaluationwas 50–95, and DDAS was 10–26. Emotions wereimproved during the time (6 cases). However, in thecase that showed high scores as 60–70 except for Veven 3 months after the resection, most itemsexcept for one showed high values around 60 even1 year after the operation. DDAS of this patientwas higher than that of other cases. The self-evalua-tion was low as 50 even 13 months after the opera-tion. CONCLUSIONS: Gradual improvement indefecation symptom tends to cause improvement ofpsychological state. However, many cases showedhigh POMS which is far higher than the standardscore as 50, suggesting the necessity of the care forpsychological stability. Especially, the item “con-fusing” showed high score, reflecting the non-pre-dictable and out-of-control defecation after theoperation. Besides, low self-evaluation score couldbe associated with emotional instability.RESEARCH IMPLICATIONS: Instable emotioncould be caused not only by the defecation dysfunc-tion but also by the low self-evaluation. Thus, theimprovement of self-evaluation could improveemotional stability despite of continuous defecationdysfunction. This would be addressed in futurestudies. CLINICAL IMPLICATIONS: In somecases, patients who received the low anterior resec-tion for rectal cancer feel confusion because of theout-of-control defecation symptom. Althoughgradual improvement in defecation dysfunctiontends to stabilize emotion, the patients with lowself-evaluation could still feel confusing and needpsychological care. ACKNOWLEDGEMENT OFFUNDING: The study was supported by Grant-in-Aid for Scientific Research (C) (No. 23593221).

P3-20

Patterns of Daily Physical Activity and Fatigue in

Cancer Survivors: A Pilot Study

Josien Timmerman1,2, Marit Dekker1,2, RoelKurvers2, Thijs T€onis1,2, Hermie Hermens1,2,Miriam Vollenbroek-Hutten1,21Roessingh Research and Development, TelemedicineGroup, Enschede, The Netherlands, 2TwenteUniversity, Biomedical Signals and Systems Group,Enschede, The Netherlands

BACKGROUND: Cancer-Related Fatigue (CRF)is a distressing and debilitating symptom whichaffects a third of all cancer survivors who finishedcurative treatment. Activity management is fre-quently included in the management of CRF. How-ever, the evidence of the beneficial effects of activity

management on CRF is scarce. The aim of ourstudy was to explore patterns of fatigue and physi-cal activity throughout the day to see how physicalactivity is related to self-reported fatigue in cancersurvivors. METHOD: Physical activity was mea-sured with a MTx inertial 3D-motion tracker, for 5consecutive days from 8 am to 8 pm in cancer sur-vivors (free from cancer, last treatment ≥ 3 monthsago). Simultaneously, fatigue was scored thricedaily (morning, afternoon, evening) by survivors ona mobile phone with a 0–10 VAS scale. Changes infatigue and physical activity throughout the daywere tested with Repeated Measures ANOVA. Possi-ble associations between fatigue and physical activ-ity on the different day parts were explored withnon-parametric correlations (Kendall’s Tau).RESULTS: 18 cancer survivors (6 male; mean age55.7 � 10.2 years) were included. Time since lasttreatment ranged from 3 to 204 months, and 83%of the survivors underwent combined treatment ofsurgery, radiotherapy and/or chemotherapy. Can-cer survivors reported a significant increase in fati-gue throughout the day (p = 0.001); fatigueincreased from an average of 3.7 in the morning to5.1 in the evening. At the same time, a significantdecrease in physical activity was observed frommorning to evening (p = 0.003). Self-reported fati-gue in the evening showed a significant relationshipwith activity in the afternoon (p = 0.009), and atrend with morning activity (p = 0.07). CONCLU-SIONS: Cancer survivors that finished curativetreatment reported increasing levels of fatiguethroughout the day. The increase in fatigue accom-panied a decrease in level of physical activity. Survi-vors that showed highest activity in the morning andafternoon also reported higher levels of fatigue in theevening. This suggest that adequate management ofdaily physical activity could aid in management ofCRF. RESEARCH IMPLICATIONS: Althoughthe present study suggest that daily physical activitypatterns are associated with self-reported levels offatigue in cancer survivors, no causal relationshipbetween physical activity and fatigue could beestablished. Furthermore, an indepth analysis ofphysical activity patterns in an adequate poweredstudy is necessary to clarify how and in which pop-ulation of cancer survivors activity managementcould aid in decreasing CRF following cancer treat-ment. CLINICAL IMPLICATIONS: Activitymanagement is an important aspect of current CRFtreatment protocols. Our study partly supports theassumption that levels of daily physical activity areindeed associated with self-reported fatigue. How-ever, due to the cross-sectional design, no conclu-sions can be drawn from the present study aboutthe effect of activity management in daily life onfatigue. More research is needed that determinesthe clinical evidence of activity management in themanagement of CRF following primary treatment.ACKNOWLEDGEMENT OF FUNDING: This



study is part of the A-Care2Move project. A-CaR-e2Move is sponsored by KWF - Alpe d’Huzes.

P3-21

Cognitive Functions Among Adult Lymphoma

Cancer Survivors

Sugumar Venkatesan1, Surendran Veeraiah1,Prasanth Ganesan1, Rejiv Rajendranath1, ArunTipandjan21Cancer Institute, Chennai, India, 2InternationalCentre for Psychological Counseling and SocialResearch, Puducherry, India

BACKGROUND: Cognition is a complex processwhich is needed intact to deal with the complexworld. Cognitive deficits associated with cancertreatment and the disease itself can have a dramaticeffect on patients’ quality of life. The primary pur-pose of the study was to find out the cognitivefunction among lymphoma cancer survivorsMETHOD: Adult Lymphoma survivors (N = 60)who reports to the medical oncology OPD in Can-cer Institute (WIA) for follow-up were included byusing purposive sampling technique. Long-termadult lymphoma cancer survivors (N-60:male = 38.30% & female = 61.70%) were taken atleast 2 years from the completion of last chemo-therapy cycle and presently not receiving cancertreatment, and disease-free of lymphoma who hadbeen treated with systemic chemotherapy. NIMH-ANS neuropsychological battery was administeredto the cancer survivors to understand the level ofmemory, attention, motor function & psycho-motor function. RESULTS: Dessriptive statisticswhich revealed the Mean, Standard deviation andpercentage of socio-demographic variables such asage (M = 36.83; SD=12.58), Survival rate(M = 6.1; SD = 7.8), Diagnosis (HD = 48.30%;NHL = 51.70%). Survivors who treated with sys-tematic chemotherapy shows deficit in long termmemory (26.7%), working memory (35%), selectiveattention (36.8%), and in psychomotor ability(21.8%). Mann U Whitney test and ANOVA, control-ling for age and education respectively, revealedthat adult lymphoma survivors scored significantlylower on the battery of neuropsychological tests,particularly in the domains of working memory(p < 0.004) and verbal memory (p < 0.023) respec-tively. CONCLUSIONS: From the above study itcan be concluded that the adult lymphoma survivorsdeficit in cognitive functions particularly selectiveattention, visual, verbal, and working memory, andPsycho-motor speed. This reveal that not onlypatient who are affected by CNS cancer are gettingcognitive impairment but also patients who are diag-nosed with local cancer like lymphoma also havingimpairment in cognition RESEARCH IMPLICA-TIONS: In India this is the first study were done incognitive functions among adult lymphoma cancer

survivors CLINICAL IMPLICATIONS: Inci-dence rate of adult lymphoma has been increasingin worldwide. The major problems facing by theclinicians are about the quality of life of the survi-vors. So, this study gives the insight about the neu-ropsychological problems facing by the survivorsbecause this might leads to poor quality of lifeACKNOWLEDGEMENT OF FUNDING: Forthis abstract we did not get any funding from theprivate sector and also from the government. Infuture if we get funding, we will compare the cogni-tive functions with CNS cancer survivors, Lym-phoma survivors and normal peoples to give a clearpicture about the detoriation of cognitive function.

P3-22

Work it Out: Development of a Self-Led Return-

to-Work Intervention Tool Using a Delphi

Consensus-Building Method

Deborah J Wallis1, Fehmidah Munir1, KatrynaKalawsky1, Emma Donaldson-Feilder21Loughborough University, Leicestershire, UK,2Affinity Health at Work, London, UK

BACKGROUND: Involving stakeholders in thedesign of interventions is an important aspect ofdeveloping patient-centred resources. For those liv-ing with and beyond cancer there are few UK-basedstakeholder-informed resources available to sup-port the individual in returning to work. The Del-phi technique provides a systematic method ofgaining consensus from a variety of stakeholderswithin their domain of expertise. This method wasused to develop a patient-centred work-relatedguidance tool to manage return-to-work issues.METHOD: The first draft of the tool consisted ofquestions divided into four chronological categoriesto represent the stages of the cancer journey in rela-tion to work. Within each of the categories thequestions were organised into three themes (health,finance, work). Consensus and validation of thetool were achieved in a two-round Delphi proce-dure. Respondents rated the relevance of each itemon a 9-point Likert scale, and indicated to whomeach question should be asked. To assess the extentof agreement between experts the interquartilerange (IQR) was calculated for each item. Perceivedrelevance was assessed using median ratings.RESULTS: In round one of the Delphi procedure172 respondents were provided with a 43-itemresource and given four weeks to respond. In addi-tion to their ratings they could suggest alternativesand provide qualitative feedback. All questions thatachieved good consensus were also perceived ashighly relevant. Questions that did not achieve con-sensus were re-evaluated in the second round (139respondents; 80.9%). Two new questions wereincluded based on feedback from round one. Basedon the same statistical procedures used in round



one, a final 40-item guidance tool was piloted with35 individuals living with and beyond cancer.CONCLUSIONS: This work-focused guidancetool provides people living with and beyond cancerwith a sense of empowerment by promoting a proac-tive approach when addressing work-related issuesand encouraging effective communication withhealthcare and other professionals. Novel aspects ofthe tool include its relevance for individuals withmost types of cancer and in a variety of work situa-tions. The results of the pilot study suggest that it iswelcome and needed by those living with andbeyond cancer and by other relevant stakeholders.RESEARCH IMPLICATIONS: This study used arigorous, systematic and evidence-based methodol-ogy to develop a practical guidance tool aimed atempowering those living with and beyond cancer tomanage work-related issues. The Delphi techniqueis a practical and cost-effective method that may beadapted for use in a variety of healthcare contexts.CLINICAL IMPLICATIONS: The guidance toolaims to promote exchange of information betweenpatients, healthcare professionals and other stake-holders, therefore has the potential to enhancecommunication between these groups.ACKNOWLEDGEMENT OF FUNDING:NATIONAL CANCER SURVIVORSHIP INI-TIATIVE (DEPARTMENT OF HEALTH ANDCANCERMACMILLAN SUPPORT):

P3-23

Predictors of Distress in Cancer Patients Under

Chemotherapy Treatment

Cristiane Decat Bergerot1,2, Tereza Cristina Caval-canti Ferreira Araujo2, Marco Murilo Buso11Centro de Cancer de Bras�ılia CETTRO, Bras�ılia, DF,Brazil, 2Universidade de Bras�ılia UnB, Bras�ılia, DF,Brazil

BACKGROUND: Cancer diagnosis and treatmentpromote a sense of vulnerability, sadness, and fearfor patients, often resulting in distress. When thishappen quality of life, satisfaction with care andtreatment adherence can be greatly affected. Manag-ing this situation may require to use a variety of cop-ing strategies for psychosocial adjustment. Thepresent purpose was to identify variables (sociode-mographic, problem list, quality of life and coping)that predict moderate to severe distress (MSD) andmild distress (MD). METHOD: Two hundredpatients from a brazilian cancer patients partici-pate, answering before start chemotherapy (T1),halfway time point (T2) and at completion of treat-ment (T3): Distress Thermometer (DT) and Prob-lem List (PL); Functional Assessment of ChronicIllness Therapy - General (FACT-G); Ways ofCoping (WAYS). They were between 18–89 yearsold (M = 56.8; SD = 15), being 69.5% women,63% married, and 55% had at least college degree.

The main diagnosis were breast (30%), hematology(22%) and gastrointestinal (17.5%), being 59.5%with advanced disease stage. Logistic regressionwere used to identify predictors of distress.RESULTS: At T1, predictors for MSD were mar-ried/divorced (x2 = 15.4; p = 0.05), housing (x2 =19.2; p = 0.002), family (x2 = 11.5; p = 0.003) andemotional problems (x2 = 99.9; p = 0.000; R2

N =53%); for MD: distancing/positive reappraisal(x2 = 42.1; p = 0.000). At T2, spiritual problems(x2 = 7.56; p = 0.006) and nausea (x2 = 52.9; p =0.000; R2

N = 54%) for MSD; distancing, problemsolving and positive reappraisal (x2 = 24.9; p =0.001) for MD. At T3, only family problem [x2 =5.5; p = 0.05] for MSD. CONCLUSIONS : Therewas a statistically significant reduction in distressand a increased on quality of life over assessments.Our observation linking MSD to marital status(T1) and some problems at PL, and MD predictscoping strategies. This findings have a impressiveprediction success, mainly for emotional (T1), andnausea (T2). Quality of life did not appear as a pre-dictor. The same occur for age, gender, education,diagnostic and staging. Moreover, patients withMSD at T1 have an increase probability to presentMSD at T2 and T3, which reinforces the literaturedata - the best predictors of later distress is earlydistress. RESEARCH IMPLICATIONS: Contin-ued research is needed to understand how distressrelates to quality of life, gender, age, cancer typeand severity, treatment and symptom burdenthroughout the continuum of care. CLINICALIMPLICATIONS: There is no doubt about theimportance of detecting distress in cancer patients asearly as possible, in order to facilitate rapid and tar-geted intervention for those who will need it most,as well as the importance of the follow-up. But,understand the predictors of distress during thetreatment could be a key to improve cancer care,given more indicators to direct psychosocial care.ACKNOWLEDGEMENT OF FUNDING: None.

P3-24

A Preliminary Perspective of Distress Prevalence by

Diagnosis and Disease Stage in a Sample of

Brazilian Cancer Patients

Cristiane Decat Bergerot, Paulo Gustavo BergerotCentro de Cancer de Bras�ılia CETTRO, Bras�ılia,DF, Brazil

BACKGROUND: In 2001, a study demonstratedthe prevalence of distress for 14 cancer sites in astudy of 4496 cancer patients. They reported thatthe prevalence ranged from 43.4% for lung cancerto 29.6% for gynecological cancers. The presentstudy aims to investigate the prevalence of distressby cancer sites in a brazilian cancer patients, duringthe chemotherapy treatment. METHOD: Partici-pants comprised 525 patients who treat at private



cancer center, located at Bras�ılia, DF, Brazil. Theyanswered the Distress Thermometer (DT) beforestart chemotherapy infusion (T1), halfway timepoint (T2) and at completion of treatment (T3).The mean age of the participants was 55.6 years(range 18–89; SD = 15.5); 66.1% were female;62.1% were married and 59.8% had at least collegedegree. The diagnosis were breast (26.1%), gastro-intestinal (24%), hematological (22.5%), gynecol-ogy (9.3%), lung (6.9%), genitourinary (4.2%) andothers types of cancer (7%). Descriptive analysisand linear regression of DT and diagnosis were car-ried out. RESULTS: The prevalence of distress atT1 range from 59.2% for gynecology cancer patientto 48.3% for hematological. At T2, this range from27.7% for gynecology to 17.1% hematological. AtT3, 17.4% for lung to 6.7% gynecology. The pre-dictor of distress at T1 and T2 was gynecological(p < 0.05). Cancer site had a significant effect onDT at T2 (F = 2.7; p = 0.03). The prevalence ofdistress by disease stage were highest for stage IVand lowest for stage I at T1 and T2, and stage III atT3. In this analysis, disease stage did not predictdistress. CONCLUSIONS: Unlike study publishedin 2001, gynecology cancer patients showed to bethe cancer site that report more frequently moder-ate to severe distress. In our study, lung cancer heldthe second position at T1, gastrointestinal at T2and breast at T3. Probably the results obtained atT2 and T3 suffered the impact of the chemotherapyside effects; and for patients with advanced diseasestage the perception of disease progress. Finally,the linear regression analysis determine gynecologycancer as a predictor of distress just for T1 and T2assessment, and any cancer site for T3; either, anydisease stage for all assessment. RESEARCHIMPLICATIONS: Future research should includedpatients from others cancer center, and others citiesin Brazil, in order to establish the Brazilian preva-lence. Moreover, to explore the relationship betweendistress and illness perception across time; andanalyze if there is any effects for gender, or othersdemographic data. CLINICAL IMPLICATIONS:Draws attention the high prevalence of distress forall cancer site at T1, which confirms that cancerdiagnosis is the time of greatest vulnerability to psy-chological morbidity; but, brings our attention tocreate strategy to minimize distress before patientsstart chemotherapy. The further reduction, bringsus the idea that this results is not only derived fromthe patient’s adaptation to cancer and treatment,but also from our routine of cancer care.ACKNOWLEDGEMENT OF FUNDING: None.

P3-25

Breast Cancer Patients: The Relationship of

Chemotherapy Regimen and Distress Levels on

Different Stages of Treatment

Cristiane Decat Bergerot1,2, Karen Lynn Clark3,Bartholomeu Torres Tr�occoli2, Marco MuriloBuso1, Matthew Loscalzo31Centro de Cancer de Bras�ılia CETTRO, Bras�ılia, DF,Brazil, 2Universidade de Bras�ılia UnB, Bras�ılia, DF,Brazil, 3City of Hope, Duarte, California, USA

BACKGROUND: Cancer patients face numerousstressors in physical, emotional, social and spirituallife domains, not only because of the stigma relatedto this disease, but mainly because the treatmenthas a substantial amount of acute and late symp-toms. The current literature emphasizes the effectof cancer, disease stage and treatment type on dis-tress levels. In this study we examined the chemo-therapy regimen (CR) relationship with distresslevels on different stages of treatment. METHOD:Ninety women with breast cancer completed theDistress Thermometer (DT) and Problem List (PL)before first chemotherapy infusion (T1), halfwaytime point (T2), and at completion of treatment(T3). Five types of CR were prescribed: 34.4% ofthe patients took AC-TX (doxorubicin/cyclophos-phamide/paclitaxel) regimen, 23.3% TC (docetaxel/cyclophosphamide), 14.4% TXT (doxorubicin/ci-clophosphamide/docetaxel), 14.4% TAC (docet-axel/doxorubicin/cyclophosphamide), and 13.3%FEC (fluorouracil/epirubicin/cyclophosphamide).The data was analyzed with three-regressions ofDT as dependent and CR as independent variables(controlling for age, marital status and diseasestage) followed by a repeated measures ANOVA withCR as independent and five problems as dependentvariables (practical, family, emotional, spiritual,physical). RESULTS: Severe to moderate distress(SMD) was reported by 48.9% of the patients atT1, 18.9% at T2 and 15.6% at T3. The mostreported emotional problems were for FEC (fears,worry, sadness) and TXT (worry, depression, ner-vousness). For physical problems were AC-TX(constipation, fatigue, pain, appearance), TXT(appearance, sleep, nausea, fatigue) and TAC (fati-gue, appearance, pain). Only TAC was a significantpredictor of distress at T1 (p = 0.004) and T2(p = 0.02) while TXT regimen was significant at T3(p = 0.04). The repeated measures ANOVA revealed asignificant interaction between CR and Physicalproblems (p = 0.02). CONCLUSIONS: The inci-dence of SMD and problems-related distressdecreased between T1 to T3, despite the increase ofpatients’ side effects. FEC and TXT causes moreemotional problems and AC-TX, TXT and TACmore physical problems. Considering the toxicity ofthe protocol, these results are consistent with theliterature. The highest problem-related distress



associated with CR was physical problems. More-over, TAC showed to be predictive of distress in T1and T2. RESEARCH IMPLICATIONS: Ourresults indicate that CR predicts distress in all treat-ments phases. Nonetheless, the effects of chemocan be persisted even after the end of treatment;and breast cancer survivors have increased risk fordistressful symptoms related to fear of recurrence,death and disability. More studies are thus neededto investigate those factors increasing the sample inorder to make the data more generalizable. CLINI-CAL IMPLICATIONS: The findings suggest avery positive benefit from the discussion betweenpsychologist and physician, in which side effectsand distress during treatment are addressed. It isimportant to create a strategy to help cancerpatients to deal with chemo, mainly for patientswho report problems related to TAC and TXT.This strategy could be related to tailored psychoso-cial education, preventive care for side effects, psy-chological management intervention, copingstrategies and should be reinforced regularly.ACKNOWLEDGEMENT OF FUNDING: None.

P3-26

Abstract withdrawn

P3-27

Screening and Treatment of Psychological Distress

in Colorectal Cancer (CRC) With Metastasized

Disease: The TES-Trial.

Hanna Bomhof-Roordink, Aartjan T.F. Beekman,Adriaan Honig, Adriaan Hoogendoorn, MechelineH.M. van der Linden, Bernovan Meijel, Chris J.J.Mulder, Maurits W. van Tulder, Elisabeth C.W.Neefjes, Maurice J.D.L. van der Vorst, HenkM.W. Verheul, Joost DekkerVUMedical Center, Amsterdam, The Netherlands

BACKGROUND: We have developed the TESprogram, which involves Targeted selection andEnhanced care, delivered on the basis of Steppedcare. Our goal is to present the design of the study.The primary study aim is to evaluate the effective-ness of the TES-program compared to usual care inreducing psychological distress in metastasized CRCpatients. Secondary aims include the evaluation ofthe impact of the TES-program on several other out-come measures and to evaluate the cost-effective-ness. METHOD: Study design The study isdesigned as a cluster randomized trial with 2 treat-ment arms in 10 hospitals. The treatment arms are:the TES program versus usual care. Outcomes areevaluated at the 1st cycle of chemotherapy, after3 weeks, 10 weeks, 24 weeks and 48 weeks. Studypopulation Patients with metastasized colorectal can-cer, 18–85 years old, at start of treatment with 1st

line chemotherapy. Interventions The TES program,which involves Targeted selection (screening at 0,10 and 18 weeks) and Enhanced care, deliveredon the basis of Stepped care (from watchfulwaiting to psychotherapy), and usual care.RESULTS: There are no results available yet.CONCLUSIONS: There is no conclusion availableyet. RESEARCH IMPLICATIONS: This is thefirst randomized controlled trial on this scale inwhich a combination of Targeted Screening,Enhanced Care and Stepped Care is compared tousual care in reducing psychological distress inmetastasized CRC patients. Furthermore the cost-effectiveness is determined. CLINICAL IMPLICA-TIONS: The results of this study will show whethertargeted screening, enhanced care and stepped carewill have an impact on the levels of psychologicaldistress in metastasized CRC patients. It will sup-port guidelines in which screening and treatment isadvocated or it will show that it cannot be assumedthat implementation of screening and treatmentleads to improvement in detection, management oroutcome of psychological distress. ACKNOWL-EDGEMENT OF FUNDING: The TES-trial wasfunded by KWF/Alpe d’HuZes. VU 2011-5279.

P3-28

The Construction of Cancer Cause: From

Identification to Psychosocial Dynamic

Patrice Cannone1, Lionel Dany2, Aude Templier1,Pascale Tomasini3, Marjorie Baciuchka-Palmaro3,Marie-Fr�ed�erique Bacqu�e41CHU Timone, Service Oncologie M�edicale etOncologie Digestive, Marseille, France, 2Universit�ede Provence, Marseille, France, 3CHU HopitalNord, Service Oncologie Multidisciplinaire etInnovations Th�erapeutiques, Marseille, France,4University of Strasbourg, Strasbourg, France

BACKGROUND: Causality is one of the mostimportant illness representations dimensions. Forpatients, the process that accompanies the identifi-cation of illness cause constitutes a key componentof the “search for meaning”. The study purpose is-(1) THE TYPOLOGY OF CAUSE PRODUCEDBY PATIENTS,: -(2) the potential role and impactof the construction of cancer cause by patients ondifferent dimensions of illness experience ofpatients (coping, psychological distress, quality oflife). METHOD: The survey was conducted usinga self-administered questionnaire amongst 110 can-cer patients (67.3% males; mean age 62.4) with che-motherapy treatment from the multidisciplinaryoncology and therapeutic innovations departmentof Marseille North University Hospital (France).Illness representations were assessed with the BriefIPQ (Broadbent et al., 2006). Responses to the cau-sal item (open-ended response item) were groupedinto categories (psychological, internal, external



and accident). The MAC (Watson et al., 1988) wasused to measure mental adjustment of patients; theHADS (Zigmond & Snaith, 1983) to assess psycho-logical distress, and the QLQ-C30 (Aaronson et al.,1993) to evaluate quality of life. RESULTS: Theprincipal cause cited by patients is the internalcause. Almost twenty percent of patients does notevoke any cause to their cancer. Women declaremore psychological cause and less external causethan men. Smokers or ancient smokers declaremore internal cause and less psychological causethan non-smokers. Patients who report psychologi-cal causal attribution present more anxious preoc-cupation adjustment. Patients who report internalcausal attribution have higher scores on anxiety,depressive and anxious preoccupation adjustment,and lower score on fighting spirit. Patients who donot report causal attribution have higher scores onanxiety and depression. CONCLUSIONS: Theresearch of aetiology of cancer is a major part ofcancer acceptation for cancer patients. Even if thisquestion is hidden behind defense mechanisms andcollective social influence it is at the origin of manymisunderstanding in doctors/patients relations.Psycho-oncology has now many tools to under-stand the unconscious cause of cancer in patients.This could be the way to have a better approach ofcancer cause meaning. RESEARCH IMPLICA-TIONS: Absence of cause as presence of multiplescauses or links between some causes and psycholog-ical components, constitute a heuristic way to ana-lyze illness experience. In other words, what is thefunction of causal attribution? Future work willaim to identify the processes involved into the “con-struction of the cause” (e.g. coping, identity issues,social norms, changes due to the experience of ill-ness, psychosocial constraints associated the evoca-tion of the cause). CLINICAL IMPLICATIONS:Because of its limitations, the process of identifica-tion of cancer cause needs to be questioned by thepsycho-oncologists in a psychosocial way. The psy-cho-oncologists could accompany patients concern-ing their construction of the cause, because thiselaboration may produce some suffering (e.g. anxi-ety, depression, guilt). This kind of study allows toidentify and to analyze the psychological needs ofpatients in a pragmatic and applied way in theperspective of supportive care in oncology.ACKNOWLEDGEMENT OF FUNDING: None.

P3-29

A Breast Cancer Specific Screening Questionnaire

for Psychosocial Problems: The PDQ-BC

Jolanda De Vries1,2, Mirjam Bogaarts3, JanRoukema1,4, Brenda Den Oudsten1,51Center of Research on Psychology in SomaticDiseases, Dept of Medical and Clinical Psychology,Tilburg University, Tilburg, The Netherlands, 2Deptof Medical Psychology, St Elisabeth Hospital,

Tilburg, The Netherlands, 3Dept of Oncology, StElisabeth Hospital, Tilburg, The Netherlands, 4Deptof Surgery, St Elisabeth Hospital, Tilburg, TheNetherlands, 5Dept of Education and Research, StElisabeth Hospital, Tilburg, The Netherlands

BACKGROUND: Although different psychoso-cial screening instruments exist, these instrumentsare all generic and not cancer type specific. Toassess psychosocial problems and risk factors spe-cifically relevant for patients with breast cancer, wedeveloped the Psychosocial Distress Questionnaire-Breast Cancer (PDQ-BC). The aim of this studywas to examine the psychometric properties of thePDQ-BC, a breast cancer specific screening list.METHOD: Before the start of adjuvant chemo-therapy, 164 (98.8%) women completed the PDQ-BC as routine care. The PDQ-BC consists of 35questions about psychological risk factors (traitanxiety, (lack of) social support), psychosocialproblems (state anxiety, depressive symptoms),social problems, physical problems, body image,financial problems, sexual problems, clinical factors(type of surgery, radiotherapy, hormone therapy,psychiatric morbidity), and demographic factors(marital status, age, age of children). Varying num-bers of patients also completed the WHOQOL-100,the CES-D, the DT, and the HADS. Fifty-fourpatients completed the PDQ-BC twice (one weekinterval). CFA, Pearson correlations, ICC, and chi-Square tests were used. RESULTS: CFA sup-ported the internal structure of the PDQ-BC (CFI= 0.95 NNFI = 0.91; RMSEA = 0.073). The PDQ-BC subscales’ Cronbach’s alphas ranged from 0.69to 0.88, except for Social problems (0.42). Moder-ate to high correlations (r ≥ 0.44) were foundbetween subscales of the PDQ-BC and the otherquestionnaires where expected. Low correlationswith other questionnaires were found whenexpected. The subscales Trait anxiety and Stateanxiety had a high correlation with the CES-D. Thesubscales State anxiety and Depressive symptoms(PDQ-BC) had a good sensitivity (87.5–78.6) andspecificity (81.1–73.0). Completion of the PDQ-BCtakes about 5 minutes. CONCLUSIONS: Thisstudy shows that the breast cancer specific screen-ing instrument PDQ-BC has good psychometricproperties and takes only a few minutes to com-plete. RESEARCH IMPLICATIONS: The PDQ-BC can be used in intervention studies in whichbreast cancer patients scoring high on psychosocialproblems are included in studies examining theeffectiveness of innovative psychosocial interven-tions. CLINICAL IMPLICATIONS: Consideringthe psychometric properties of the PDQ-BC, thisscreening instrument can be used to screen for psy-chosocial problems in patients with breast cancer aspart of routine care. ACKNOWLEDGEMENTOF FUNDING: None.



P3-30

Trends in Cancer Distress: Results of a

Representative Population-Based Investigation

Csaba Laszlo Degi1, �Eva K�allay1, M�aria Kopp21Babes-Bolyai University, Cluj Napoca, Romania,2Semmelweis University, Budapest, Hungary

BACKGROUND: Hungary has the highest rate ofcancer deaths in Europe, but trends in cancer dis-tress are still unknown. In the last decade depres-sion has increased in the general population, inboth genders with an ascending pattern throughage-categories. This study aims to inform aboutmajor tendencies in the modification of depressionand well-being among cancer patients, specific tothe Hungarian context. There are no previous lon-gitudinal investigations on psychosocial aspects ofcancer diseases in Hungary. METHOD: Our studyis based on data obtained from the HungarostudyEpidemiological Panel (HEP). HEP is a nationallyrepresentative follow-up survey assessing health-related functioning in the Hungarian adult popula-tion. Self-report data were collected in two waves:the first set of the data in 2002, and the second onein 2005/2006. Our results are based on the completeresults of 4524 participants. In the initial sample6.5% of respondents reported that they had beentreated for cancer, 214 were female and 64 weremale. The WHO Well-being Index and BeckDepression Inventory were completed. Non-para-metric tests were used in all statistical analyses.RESULTS: Half of cancer patients deceased from2002 to 2006, a third of them are in remission and17% experienced cancer recurrence in this period.Although cancer mortality during this time was26% higher for men compared to women, genderhad no or marginal impact on levels and trends ofcancer distress. Our results indicated decliningtrends in self-efficacy, sense of coherence and satis-faction with life, and ascending patterns for hostil-ity and subjective well-being. Effect sizes were smallto medium. Median depression scores were signifi-cantly higher in the recurrence group than that inremission, but overall they showed no relevantchanges. CONCLUSIONS: In this longitudinalstudy high cancer mortality rates were confirmed assignificant factors associated with psychosocial bur-den of cancer were highlighted. For depression aceiling effect was found, that contributes to invari-able adverse health effects over time though cancerpatients might counterbalance these influences with“response shift” adaptation processes, reflected infavorable changes of subjective well-being. Recur-rence in cancer and male gender negatively impacttrends in cancer distress and mortality, but lowerwell-being has significant effect only on women.There are no significant differences according togender and age in depression. Satisfaction with lifeshowed the strongest decrease in time.

RESEARCH IMPLICATIONS: A very importantquestion refers to the cultural specificity of ourresults. This longitudinal study from a large repre-sentative sample of the Hungarian population is amodel of best research for the Central EasternEuropean region, including Romania, where Hun-garians are one of the largest minority groups.Although we did not set forth to establish causalrelationships between investigated variables, futurestudies should address them between positive-nega-tive affects and trends in cancer morbidity. CLINI-CAL IMPLICATIONS: Practical value of ourresults consists in the delineation of tendencies, andthe identification of specific groups that may bemore vulnerable to changing trends in cancer dis-tress. Also, our results imply that unchangingdepression values observed in this sample might beattributed to the extent to which depressionremains uncontrolled among persons treated forcancer, making distress screening and treatment ofdepression clinical priorities. ACKNOWLEDGE-MENT OF FUNDING: This work was supportedby a grant of the Romanian National Authority forScientific Research, CNCS - UEFISCDI, projectnumber PN-II-RU-TE-2012-3-0011.

P3-31

Monitoring Quality of Life (QoL) and Distress in

Patients With Breast Cancer: The Care Notebook

Study

Maarten J. Fischer, Elly M.M. Krol-Warmerdam,Gemma M.C. Ranke, Mathieu H.W. Zegers,Roeland Aeijelts Averink, Astrid N. Scholten,Judith R. Kroep, Adrian A. Kaptein, Johan W.R.NortierLeiden University Medical Center, Leiden, TheNetherlands

BACKGROUND: Research has demonstratedthat problems and needs of patients with cancer arenot always adequately identified by health care pro-viders. Regular assessment and discussion of QoLhas shown to have beneficial effects on patient-pro-vider communication and Patient Reported Out-comes. A study was initiated at the ClinicalOncology Department of the Leiden UniversityMedical Center to incorporate repeated assessmentof QoL, distress and care needs into the routinecare for patients with early stage breast cancer.METHOD: A breast cancer specific QoL-monitorwas constructed containing two validated QoLquestionnaires (EORTC BR23 & Care Notebook),the Distress Thermometer, one free text dialog boxfor questions for the doctor, and one questionabout supportive care needs. A graphic summarywas designed that showed current and all previousresults from the QoL-monitor in the electronicpatient dossier (EPD). Semi-structured interviewswere conducted with 10 women with breast cancer.



Patients were asked to evaluate the content of themonitor on a 5-point Likert scale and to commenton their answers. Basic thematic analysis was usedfor the qualitative data. RESULTS: All patientsthought the questions were easy to understand andapplicable to their situation. All patients consideredthe questionnaire to be complete with no redundantitems. With regard to the expected benefits, patientsexpected the questionnaire results could serve as achecklist, reducing chances of missing importantinformation. In addition, patients expected that themonitor may facilitate the discussion of personal orintimate topics. Some patients were concerned thatthe introduction of the monitor would lead to aninformation overload for physicians. Two patientsdoubted whether the QoL monitor would improvethe already high quality of care. CONCLU-SIONS: Results from this study showed that ingeneral, patients held a positive attitude towardsthe QoL-monitor. The instrument proved easy tounderstand and was considered as a comprehensivechecklist for patients and physicians, possiblybroadening the agenda of the conversation. Formost patients the anticipated benefits of the assess-ment outweighed the burden of regularly complet-ing the questionnaires (before each new cycle ofchemotherapy). Nevertheless, patients occasionallywere unsure about how the QoL information wouldbe used in daily practice. RESEARCH IMPLICA-TIONS: This study has been followed by a multi-center randomized controlled trial in which theeffect of a breast and lung cancer specific QoL-monitor is investigated. Study outcomes are consultvariables (patient-provider interaction content,patient management, visit length) and PatientReported Outcomes such as QoL, distress, patientsatisfaction, illness perceptions and self-efficacywith regard to communication. CLINICALIMPLICATIONS: To increase the discussion ofQoL data during the visit, we now provide patientswith a copy of the graphical summary of their QoLdata just before the consultation. Furthermore,physicians receive a notification each time newQoL-data has been added to patients’ EPD.Finally, all physicians have received a pocket guide-line recently issued by the Dutch ComprehensiveCancer Centers with information about how infor-mation about QoL and distress can be used in dailypractice. ACKNOWLEDGEMENT OF FUND-ING: This project was supported by a grant fromPink Ribbon, the Netherlands.

P3-32

Psychometric Properties of the Hospital Anxiety and

Depression Scale for Cancer Patients in the Mexican

Population

Oscar Galindo Vazquez1, Corina Benjet2, FranciscoJu�arez Garc�ıa2, Edith Rojas Castillo3, Ang�elicaRiveros Rosas4, Jos�e Luis Aguilar Ponce5, Miguel�Angel �Alvarez Avitia5, Salvador Alvarado Aguilar31School of Psychology, National AutonomousUniversity of Mexico, National Institute of Cancerof Mexico, Mexico City, Mexico, 2Epidemiologicaland Psychosocial Research Division, NationalInstitute of Psychiatry ¨Ram�on de la Fuente Mu~niz¨,Mexico City, Mexico, 3Psycho-oncology Service,National Cancer Institute of Mexico, Mexico City,Mexico, 4Division of Research, School of Accountingand Administration, National AutonomousUniversity of Mexico, Mexico City, Mexico,5Division of Internal Medicine, National CancerInstitute of Mexico, Mexico City, Mexico

BACKGROUND: Symptoms of anxiety anddepression are among the major mental healthproblems in cancer patients affecting quality of life,treatment adherence and more symptoms Validand reliable screening instruments such as the Hos-pital Anxiety and Depression Scale (HADS) hasmade possible the detection of possible cases ofdepression and anxiety in medically ill patients. Thepsychometric properties of this instrument have notbeen documented in different types of cancer diag-noses in the Mexican population. METHOD:Determine the psychometric properties of theHADS in a sample of patients with cancer in theMexican population. 400 patients from theNational Cancer Institute participated, of which226 were women (56.5%) and 174 were men(43.6%), with a mean age of 47.4 � 14.1 years.Participants completed concurrently the HADS aswell as the following inventories: i) Beck Depres-sion ii) Beck Anxiety, iii) Stress Thermometer. Thesample of participants was obtained during consul-tations of Medical Oncology Services, Surgery,Radiotherapy and Psycho-oncology during the per-iod from June to December 2012. RESULTS: Afactor analysis adjusted to two factors explained44.29% of the variance with 13 of the 14 itemsloading on these two factors in a way similar to theoriginal version. The internal consistency of theoverall scale was satisfactory (a = 0.82). Cron-bach’s alphas for each subscale were .73 and .76.The concurrent validity assessed by way of correla-tions with concurrent measures showed significantassociations (Pearson r = 51–71, p < 0.05). CON-CLUSIONS: The HADS has adequate constructvalidity, internal consistency and concurrent valid-ity for use in cancer patients from the Mexican pop-ulation. The relevance of these results is a costeffective tool to provide timely mental health care



early in oncological treatment for those in need.Detecting anxiety and depression symptomsthrough the HADS may benefit cancer patients byensuring appropriate care that may increase qualityof life, treatment adherence and reduce hospitalstays. RESEARCH IMPLICATIONS: Being abrief instrument, easy to apply and reliable for theresearch in oncology population, it is relevant todetermine the magnitude of the problem, arrive atand implement prevention measures for the treat-ment of deserving cases. CLINICAL IMPLICA-TIONS: Additionally adequate systematicidentification of psychosocial damages is escrucialorder to identify the group of patients with morepsychological effects and use that information todirect psychological interventions have shown ben-eficial effects in this group of pacientes, con theobjective of maintaining acceptable parameters ofpsychological wellbeing in this population.ACKNOWLEDGEMENT OF FUNDING: None.

P3-33

How to Understand What Breast Cancer Patients

Say About Their Distress? When Suppression Talks

About of the Adaptation of Patients

V�eronique Gerat-Muller1,21CRLCC Institut Bergoni�e, BORDEAUX, France,2Laboratoire de Psychologie -Universit�e BordeauxSegalen, BORDEAUX, France

BACKGROUND: Results from Psycho-Oncologyresearch vary in terms of the prevalence, intensity,and nature of anxiety and depression issues forpatients evaluated by self-reported data. Clinicalpractice demonstrates large differences between theway distress is communicated and the way it isexperienced, which may explain the diagnostic diffi-culties. METHOD: Objectives: To determine theintrapsychological factors explaining the difficultiesin the evaluation of distress in Psycho-Oncology,using a scientific and clinical research approach.Prospective study. Sample: One hundred and onepatients with breast cancer (initial or recurrencetreatment). Instruments: Hospital Anxiety andDepression Scale (HADS), Rorschach-CS. Explor-atory clinical and inferential statistical analyses.RESULTS: Our results concern two groups ofanxiety-depressive patients: the Verbalise group,verbalizing psychological distress on HADS andidentified on Rorschach, and Silence group, whodid not express distress on HADS. Our approachcompares clinical and qualitative analysis with sta-tistical analysis of quantitative data. Our resultsreveal three intrapsychological variables that pre-dict the adjustment of the communication of emo-tional distress: emotional inhibition, relationalimmaturity, and impact of situational stress. Thesefactors allow us to establish, according to the inter-action that they have with each other, two psycho-

logical dynamics: a neurotic-type functioning forSilence adjustment and an operative functioningfor Verbalise adjustment. CONCLUSIONS: Ourapproach uses quantitative aspects of the nomo-thetic function of the HADS and the Rorschach-CS, and qualitative properties of the evaluation ofpsychological and subjective activity. As part of thestandardized clinical methodology, the precisionenabled us to isolate salient variables for the func-tioning of subjects in each of our analysis groups,and facilitated the comprehension of the particularunderlying psychological dynamics. The statisticalanalysis of the quantitative data obtained in thesecond step, enabled us to extend the results in theaim of developing more pertinent diagnostic meth-ods for appropriate follow-up. RESEARCHIMPLICATIONS: The research must integrateconscious and unconscious dimensions of the psy-che. This research allows us to envisage a richerinterpretation of the results obtained with the quan-titative scales of self-assessment CLINICALIMPLICATIONS: A better interpretation of scien-tific results evaluating distress will allow better careand appropriate support for cancer patients.ACKNOWLEDGEMENT OF FUNDING: GE-FLUC AQUITAINE (GROUPEMENT DES EN-TREPRISES FRANC�AISES DANS LA LUTTECONTRE LE CANCER):

P3-34

Examining the Sustainability of Screening for

Distress, the 6th Vital Sign, in 2 Outpatient

Oncology Clinics

Shannon Groff1,2, Jayna Holroyd-Leduc1,2,Deborah White1, Barry Bultz11University of Calgary, Calgary, Alberta, Canada,2Alberta Health Services, Calgary, Alberta, Canada

BACKGROUND: Research indicates that cancerpatients often experience significant distress duringtheir cancer journey. Attention has shifted from ifwe should screen for distress to implementation.Routine Screening for Distress was implemented intwo tumour groups at the Tom Baker Cancer Cen-tre, Calgary, Alberta Canada in May 2010. Theimplementation was supported by program staffand December 2011 marked the completion of theimplementation. This study examined the sustain-ability of Screening for Distress post-implementa-tion. METHOD: A mixed-method cross-sectionaldesign was utilized. To determine if screening rates,screening conversations and appropriate interven-tions occurred, the charts of 184 consecutivepatients attending the head and neck or neuro-oncology tumour clinics over a three week period inMay 2012 were reviewed. To examine the barriersand facilitators of sustainability 16 semi-structuredinterviews with administrators, physicians, andnurses were conducted from June-August 2012.



RESULTS: Of the 184 charts that were reviewed,163 (88.6%) had completed screening tools onthem. Of this 163, 130 (79.8%) of the charts indi-cated a conversation occurred with the patientabout the screening tool. Of the 89 (54.6%) chartswhere the need for an intervention was indicated,68 (76.4%) had an intervention documented. Sixoncologists, 7 nurses, and 3 administrators wereinterviewed and five themes which influenced thesustainability of the program emerged: 1) attitudes,knowledge and beliefs about the program, 2) imple-mentation approach, 3) outcome expectancy ofproviders, 4) integration with existing practices,and 5) macrosystem factors CONCLUSIONS:Patients continued to be screened 6 months afterthe completion of the implementation and nearly80% of the charts indicated a conversation tookplace and an intervention was provided when war-ranted. This data suggests that screening was beingsustained in the clinics but also highlight areas ofimprovement as they are slightly lower than the tar-get of 90%. Based on the feedback from partici-pants, sustainability may be enhanced and ratesimproved by ensuring that new staff are appropri-ately orientated to screening, by better integratingwith existing practices, and by rolling out to allgroups as a standard of care. RESEARCH IMPLI-CATIONS: Building on this work, future researchis needed to explore strategies, including barriersand facilitators, to effectively integrate Screeningfor Distress with existing practices. Additionallymore research is needed to explore what interven-tions are being provided and their alignment withbest practices. CLINICAL IMPLICATIONS: Thisresearch suggests that Screening for Distress can besustained as a clinical program beyond the comple-tion of funding. Clinicians who are interested inintegrating routine screening as part of their clinicalpractice are likely to find screening as a useful toolthat enhances patient-provider communication;however, when integrating screening they shouldensure the integration of screening with existingpractices to optimize sustainability. ACKNOWL-EDGEMENT OF FUNDING: Tom Baker Can-cer Centre, Alberta Cancer Foundation,Psychosocial Oncology Research Training Pro-gram, Knowledge Translation Canada, and theCanadian Institute for Health Research.

P3-35

The Development and Validation of the Paediatric

and Young Adult Distress Thermometer for Use

With Oncology Patients

Lesley Edwards, Gabriella HaeemsRoyal Marsden NHS Trust, Sutton, Surrey, UK

BACKGROUND: To develop and validate a newversion of the distress (worry and memory) ther-mometer for use in paediatric and TYA oncology

populations To pilot the developed tool for ease ofuse and content and design, and what was missingTo compare screening tool against recognised goldstandard measures. To assess the sensitivity andspecificity of the new tool To develop clinically rele-vant cut off points for referral purposesMETHOD: 1. cross sectional questionnairedesign 2. Patients will be assessed using consecutiveseries of paediatric and young adult oncologypatients 3. exclusion criteria:

• Estimated prognosis <3 months,

• Not able to speak or read English. The samplesize is N = 108–215 per age group = 540–1075 intotal. TOOL DEVELOPMENT: A. Focusgroups held with patients. Issues used to form theproblem/coping list. B. Field testing. Five paralleldevelopmentally sensitive versions with parentproxy thermometers were piloted (n = 45). C.Validation. Validated against gold standard mea-sures and cut off points established. RESULTS:Pilot results: The age and developmentally-appropriate psycho-social screening tools wereacceptable to patients and parents/carers, interms of ease of use, design, content and accuracyof problem identification. Validation results: 260participants recruited, 5 collaborating centres.CONCLUSIONS: Field testing of tool com-pleted. Validation to be completed and then fur-ther research to be carried out using the toolprospectively both in clinic and remotely. Pilot thetool in clinic settings with the accompanyingaction plan and audit use,referral rate and actionstaken. Drawing up of good practise guidelineswith regards to aplying this Health Needs Assess-ment (HNA)Tool in line with NICE and peerreview guidelines, and ensuing repeated use duringthe patient pathway. New development and use ofdistress thermometer in paediatric and TYA set-tings using developmentally appropriate versions(under 5, 5–7, 8–12, 13–15 and 16–24 versions).Research Implications. The devleopment of thistool will inform further research into screeningfor psycholgical and learning and memory prob-lems. Further research would usefully incorporatea family screening thermometer to ensure a moresystemic approach is adopted when dealing withfamilies where there is a diagnosis of cancer, andtherefore acknowledging the impact upon thewhole family and wider family system. The newtool could be used strategically throughout thepatient pathway and add to risk assessment strat-egies. CLINICAL IMPLICATIONS: This is animportant development to enable clinicians toscreen either face to face or remotely for psycho-logical, memory and learning problems and thentake action to ensure those who need or want helpcan access the support they need. This is an easilyadministered screening tool which can be used byany trained member of staff and ensure that



patients’ needs are being met. This can be used asa repeated outcome measure. ACKNOWL-EDGEMENT OF FUNDING: Funding fromNational Cancer Survivorship Initiative (NCSI).

P3-36

Phenomenology of Subsyndromal Delirium in

Postoperative Esophageal Cancer Patients

Akiko Hayashi, Noriatsu Tatematsu, ToshiyaMuraiKyoto University, Kyoto, Japan

BACKGROUND: Delirium is common complica-tion of cancer and it should be diagnosed as earlyas possible because it is a sign of underlining criticalphysiological disturbance. In recent studies the sig-nificance of subsyndromal delirium is pointed outas early sign of delirium. In this study, to elucidateearly, prodromal symptoms of delirium, we con-ducted a prospective observational study in postop-erative esophageal cancer patients withoutdementia. METHOD: 28 esophageal cancerpatients (Male27 Female 3) without dementia(MMSE>23) aged from 52 to 79 years scheduledfor esophageal transection (29: thoracoscopic andlapaloscopic esophagectomy1: lapaloscopic esoph-agectomy) in Kyoto University Hospital were suc-cessively enrolled in this study. We assessedsymptoms and severity of delirium using the Delir-ium-rating scale revised 98 (DRS-R98) (Trzepacz2001) on postoperative day 2 and 6 longitudinally.RESULTS: All the scores of DRS-R98on postop-erative day 2 were over 3 suggesting that they havesubsyndromal delirium to some degree. Frequenciesof each symptom on postoperative day 2 weresleep-wake disturbance 100%, Hallucination100%, Attention deficit 63%, Liability of affect59%, disorientation 44%. One subject died fromanastomotic leak on day 4. On postoperativeday 6, all the scores were reduced except for a scoreof a subject who died from anastomotic leak onday 8. CONCLUSIONS: According to DSM-4,the essential features of delirium are disturbance ofconciousness with reduced ability to focus, sustainor shift attention and a change in cognitionor thedevelopment of a perceptual disturbance. Thoughsubsyndromal delirium (SSD) dose not fully meetthe criteria of delirium, it is suggested that it hadhigher mortality and decline in activities of daily liv-ing. Our results were consistant with the previousstudis about SSD and the importance of early detec-tion of symptoms such as sleep-wake cycle distur-bance, hallucination, attention deficit, and liabilityof affect were suggested. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-37

Psychosocial Risk Factors for Depression in Patients

With Hematological Malignant Diseases Who Were

Going to Receive Hematopoietic Stem Cell

Transplantation

Takeshi Horie1, Kazuhiro Yoshiuchi1,Yoshiyuki Takimoto1, Yasuhito Nannya2,Mineo Kurokawa2,3, Akira Akabayashi11Department of Psychosomatic Medicine, TheUniversity of Tokyo, Tokyo, Japan, 2Department ofHematology/Oncology, The University of Tokyo,Tokyo, Japan, 3Department of cell Therapy andTransplantation Medicine, The University of Tokyo,Tokyo, Japan

BACKGROUND: Hematopoietic stem cell trans-plantation (HSCT) is an alternative to conventionaltreatment for adults with hematological malignantdiseases. Because HSCT is associated with life-threatening physical morbidity, lengthy convales-cence, and social isolation, the potential for signifi-cant psychosocial morbidity is high. The aim of thisstudy was to investigate psychosocial risk factorsfor depression in Japanese patients with hematolog-ical malignant diseases who were going to receiveHSCT. METHOD: Subjects consisted of 208 adultpatients with hematological malignancy receivingHSCT between September, 1996 and April, 2013 atthe University of Tokyo Hospital. Patients wereasked to complete Hospital Anxiety and Depres-sion Scale, Rosenberg Self-Esteem Scale, SocialSupport, State-Trait Anxiety Inventory (STAI) andStress Coping Inventory (SCI) before HSCT. Thesubjects were divided into groups with or withoutdepression using the Hospital Anxiety and Depres-sion Scale. RESULTS: Multiple logistic regressionanalysis showed a significant association betweendepression and trait anxiety. In addition, emotion-focused coping tended to have an association withdepression. CONCLUSIONS: Depression wasmost strongly linked with trait anxiety and copingstyle, and using screening instruments to identifythese factors may be useful for preventive interven-tions. RESEARCH IMPLICATIONS: The pres-ent study indicates that depression in patientsbefore HSCT might be associated with trait anxietyand coping style. However, the present study wascross-sectional. Therefore, prospective studies areneeded in the future. CLINICAL IMPLICA-TIONS: This study indicates that depression islinked with trait anxiety and coping style, and usingscreening instruments to identify these factors maybe useful for preventive interventions. ACKNOWL-EDGEMENT OF FUNDING: None.



P3-38

Distress Screening by Distress Thermometer in a

Community Psycho-Social Oncology Center -

Sharing of the Local Experience in Hong Kong

Wong Ka Yuk, Wong Kam FungCancerLink Support Centre of Hong Kong CancerFund, Hong Kong

BACKGROUND: Mood disturbance often occursamong cancer patients and their families. Earlydetection of distress with suitable interventionmight help the affected to cope better throughoutthe cancer trajectory. Systematic distress screeningis an important means to detect early distress. In2012, Hong Kong Cancer Fund began a trial pro-ject of distress screening among all new users of itsthree cancer care centres. The present study aims toshare some preliminary findings of this project.METHOD: All new service users from June toDecember 2012 including cancer patients, familymembers or friends were invited to complete theDistress Thermometer (DT) and the ProblemCheck List (PL) (NCCN, 2008) during their initialvisit to CancerLink. Clinical assessment by socialworkers were arranged if the users’ DT level wasequal to or above 4 (NCCN, 2008). An individual-ized intervention plan was designed for users inorder to reduce their distress level. The distresslevel of the users was periodically checked utilizingthe DT & PL to evaluate their progress.RESULTS: 455 sets of DT and PL data were col-lected from our new service users (342 patients, 108carers and 5 friends). 64% had DT levels ≥ 4. Carerdistress levels were significantly higher than that ofpatients (carers: mean = 5.61, patients: mean =4.60, p < 0.01). The distress level for users in thediagnostic phase was the highest compared withother phases (diagnostic phase: mean = 6.47,p < 0.01). With regards to PL, both patients andcarers had similar levels of physical problems(patients: mean = 15.46, carers: mean = 15.82).CONCLUSIONS: Over 60% of cancer patientsand carers had DT level over 4, indicating distresswas prevalent which is consistent with previousfindings. Our findings also demonstrated that thecarers had significantly more stress than patients,and that they also experienced physical distur-bances comparable to that of patients, even thoughthey did not undergo cancer treatment themselves.Patients at diagnostic phase experienced more dis-tress than in other phases. More data analysis willbe shown in the presentation. RESEARCHIMPLICATIONS: The carers experience higherstress when compared with the patients. Furtherresearch is required to investigate on factors con-tributing to the higher distress among carers.Besides, the high distress level of the service userswho were in diagnostic phase might be a transientdistress and requires further analysis. CLINICAL

IMPLICATIONS: As a cancer care service pro-vider, the physical health and high distress of carersshould also be addressed. Apart from our cancersupport centre, hospitals should also systematicallycarry out distress screening in order to identify andintervene in the lives of distressed patients and ca-rers at an earlier stage. ACKNOWLEDGEMENTOF FUNDING: None.

P3-39

Associations Between Psychological and Physical

After-Effects in Women Undergoing Colposcopy and

Related Procedures for Follow-Up for an Abnormal

Cervical Smear

Mairead O’Connor1, Judith Murphy1, ChristineWhite2,3, Carmel Ruttle3, Cara Martin2,3, GrainneFlannelly4, Gunthervon Bunau3, John O’Leary2,3,Loretto Pilkington3, Mary Anglim3, MichaelTurner3, Nadine Farah3, Sinead Cleary3, TomDarcy3, Walter Prendiville3, Linda Sharp11National Cancer Registry Ireland, Cork, Ireland,2Trinity College Dublin, Dublin, Ireland, 3CoombeWomen’s and Infants University Hospital, Dublin,Ireland, 4National Maternity Hospital, Dublin,Ireland

BACKGROUND: If cervical screening is to beeffective, women with abnormalities on smear testsrequire follow-up. One follow-up option is a col-poscopy examination. It is known that undergoingcolposcopy and related procedures, such as biopsy/treatment, can be distressing for women. Less isknown about the psychological and physical after-effects and whether there are associations betweenthe two. We investigated prevalence of women’spsychological and physical after-effects followingcolposcopy and related procedures and inter-rela-tionships between these. METHOD: Womenreferred for colposcopy following an abnormalsmear result completed questionnaires 4 monthsfollowing their initial colposcopy at two hospitalsin Ireland. Anxiety and depression was assessedusing the Hospital Anxiety and Depression Scale(HADS; significantly anxiety, HADS subscalescore ≥ 11; significant depression, HADS subscalescore ≥ 8). Specific worries (next smear beingabnormal, future fertility worries and concernsabout cervical cancer) were measured using theProcess Outcome Specific Measure. Details of phys-ical after-effects (pain, bleeding and discharge)experienced following colposcopy and related pro-cedures were collected. RESULTS: 425 of 584women completed questionnaires (responserate = 73%). Prevalence of clinically significantanxiety and depression was 21% and 8% respec-tively. 69% were worried about their next smearbeing abnormal, 56% had concerns about futurefertility and 36% had worries about cervical cancer.The reported prevalence of pain, bleeding and



discharge following colposcopy and related proce-dures was 56%, 65% and 38%, respectively. Over-all, 80% of women reported one or more physicalafter-effect. Women with significant anxiety weremore likely to report pain or have bleeding for>7 days. Women with significant depression weremore likely to report having experienced moderate/severe pain. CONCLUSIONS: High proportionsof women report anxiety and worries 4-months fol-lowing colposcopy and related procedures. Simi-larly, high proportions report physical after-effects.To our knowledge, this is the first study to showthat there are inter-relationships between theseafter-effects. RESEARCH IMPLICATIONS:These findings suggest that ensuring that womenare fully informed about the likelihood of physicalafter-effects may help to minimise anxiety: researchis required to determine whether this is the case.CLINICAL IMPLICATIONS: Clinicians andnurses need to be fully aware of the psychologicaland physical after-effects experienced by womenfollowing colposcopy and related procedures, sothat they can provide support, reassurance oradvice if required by women. ACKNOWLEDGE-MENT OF FUNDING: This research was fundedby the Health Research Board, Ireland.

P3-40

Prevalence and Predictors of Anxiety and Worry in

Women After Colposcopy: A Longitudinal Study

Mairead O’Connor1, Judith Murphy1, ChristineWhite2,3, Carmel Ruttle3, Cara Martin2,3, GrainneFlannelly4, Gunthervon Bunau3, John O’Leary2,3,Loretto Pilkington3, Mary Anglim3, MichaelTurner3, Nadine Farah3, Sinead Cleary3, TomDarcy3, Walter Prendiville3, Linda Sharp11National Cancer Registry Ireland, Cork, Ireland,2Trinity College Dublin, Dublin, Ireland, 3CoombeWomen’s and Infants University Hospital, Dublin,Ireland, 4National Maternity Hospital, Dublin,Ireland

BACKGROUND: Organised screening is effectivein reducing cervical cancer incidence. Women withabnormal cytology require follow-up and many arereferred for a colposcopy examination. Studies havereported raised anxiety levels prior to and duringthe examination. Less is known about the psycho-logical after-effects, and the issues that concernwomen. This study aimed to estimate prevalence ofanxiety and specific worries at 4, 8 and 12-monthspost-colposcopy and identify women most atrisk of suffering psychological after-effects.METHOD: Women referred for colposcopy fol-lowing an abnormal smear result completed ques-tionnaires 4-, 8- and 12-months following theirinitial colposcopy at two hospitals in Ireland. Anxi-ety was assessed by the Hospital Anxiety andDepression Scale (HADS). Worries about future

fertility and cervical cancer were assessed by theProcess Outcome Specific Measure (POSM). Preva-lence of significant anxiety (HADS anxiety subscalescore ≥11) and each worry was estimated at eachtime-point. Multiple logistic regression models weredeveloped to identify predictors of risk of anxietyand each worry. RESULTS: 584 women wererecruited (response rate=73%, 59%, 52% at 4, 8,and 12 months). Over 12 months, prevalence ofsignificant anxiety remained steady (21%, 23% and20% at 4, 8 and 12 months). Worry about futurefertility was the most common worry; 56% wereworried at 4 months, declining to 47% at 8 monthsand 39% at 12 months. Cervical cancer worries fellfrom 36% at 4 months to 23% at 12 months. Inmultivariate models, being younger and having everhad depression, a lower satisfaction with life/healthcare, no private health insurance, and lesssocial support were significantly associated withincreased risks of anxiety and worries post-colpos-copy. CONCLUSIONS: High proportions ofwomen attending colposcopy report anxiety orworries afterwards. While worries declined overtime, the proportions affected remain high at12 months.Various socio-demographic and otherfactors are associated with an increased risk of psy-chological distress post-colposcopy. RESEARCHIMPLICATIONS: This study highlights that col-poscopy and related procedures can place a signifi-cant psychological burden on women. Research intoappropriate interventions that target “vulnerable”women and reduce this burden is urgently required.Research is also needed into whether this burdenimpacts on compliance with follow-up or future cer-vical screening intentions. CLINICAL IMPLICA-TIONS: Clinicians and other medical professionalsinvolved in the follow-up of women with abnormalcytology should be aware of the psychological after-effects experienced by women following colposcopyand related procedures. They also need to be awarethat certain groups of women are at higher risk ofsuffering adverse psychological after-effects andmay benefit from support. ACKNOWLEDGE-MENT OF FUNDING: This research was fundedby the Health Research Board, Ireland.

P3-41

The Distress Thermometer and The PHQ-2 for

Ultra-Brief Screening Depression Of Cancer

Patients In Korea

Hye Yoon Park1,2, Jong-Heun Kim3, Bong-JinHahm1,2

1Seoul National University Hospital, Seoul, Republicof Korea, 2Seoul National University College ofMedicine, Seoul, Republic of Korea, 3NationalCancer Center, Gyeonggi-do, Republic of Korea

BACKGROUND: The development of ultra-briefscreening tools using in busy clinical settings is



important to help clinician recognize depressivepatients with cancer. This study aims to examinethe performance of the Distress Thermometer (DT)and the Patient Health Questionnare-2 (PHQ-2) asa one or two-item screening tool to identify depres-sion in Korean patients with mixed cancer.METHOD: Thirty hundred and fifty four patientswith mixed cancer were recruited in five hospitalscompleted the DT, the PHQ-2, and the HospitalAnxiety Depression Scale (HADS) from March toMay 2009. The performance of each tool was exam-ined against major depressive disorder based on theKorean version of the Mini International Neuro-psychiatric Interview’s (MINI) for their sensitivityand specificity. RESULTS: Receiver operatingcharacteristic (ROC) curve analyses identified a DTscore of 5 as the optimal cut-off with sensitivity andspecificity of 0.71 and 0.75. A PHQ-2 cutoff scoreof 2 was considered optimal with sensitivity andspecificity of 0.83 and 0.72. Discrimination levelswere comparable for the DT (area under the curve(AUC) 0.79) and the PHQ-2 (AUC 0.83). Overallperformances of these ultra-brief tools were alsocomparable with HADS, a 14-item scale (AUC0.82). CONCLUSIONS: One or two-item ques-tions as the DT and the PHQ-2 can be usefulscreening tools for depression in oncology clinicalpractice. Compared with the DT, the PHQ-2appears to show higher sensitivity detecting depres-sion in Korean patients. RESEARCH IMPLICA-TIONS: This is the first study to validatedepression screening tools against depressive disor-der based on structured interview in Koreanpatients with cancer. CLINICAL IMPLICA-TIONS: Compared to a long-item scale, ultra-briefscreening tools consisting of one item or two itemscan be efficacious for screening depressive disorderin cancer care. ACKNOWLEDGEMENT OFFUNDING: This study was supported by a grantfrom the National R&D Program for Cancer Con-trol, Ministry for Health and Welfare, Republic ofKorea (grant number: 0820340).

P3-42

Distress in Women Recently Diagnosed With Breast

Cancer

F.K. Ploos van Amstel, M.F.M. Gielissen, K.H.Sessink, W.T.A. van der Graaf, J.B. Prins, P.B.OttevangerRadboud University Nijmegen Medical Centre,Nijmegen, The Netherlands

BACKGROUND: The Distress Thermometer(DT) is a validated instrument, recommended byNational Comprehensive Cancer Network to screenfor distress in cancer patients. The uniqueness ofthis study is that it explored the level of distress, theproblems women experienced and the request forreferral to a professional shortly after the diagnosis

of breast cancer and before treatment started.METHOD: This study used cross-sectional datafrom the trial Nurse Intervention Project about theuse of the DT. Women newly diagnosed with breastcancer in a university hospital were asked to fill inself-reported questionnaires. Distress was assessedwith the DT and the Hospital Anxiety and Depres-sion Scale (HADS). Cut-off point of ≥ 5 on the DTwas used for distress and cut-off point of ≥ 7 wasused for severe distress. Scores ≥ 15 on the HADSwere used for clinically significant emotional dis-tress. RESULTS: Of 198 patients, 117 (59%) expe-rienced distress (DT ≥ 5) and 68 patients (34%)severe distress (DT ≥ 7). Mean (SD) DT score was5 (2,8). The most frequently reported problemswere nervousness (79%), anxiety (58%), sleep(54%), emotional control (49%) and fatigue (42%).Eighty-four patients (42%) of the total group and62 (53%) of the distressed patients requested orconsidered a referral to a professional to talk abouttheir problems. Mean (SD) HADS score was 11,4(7,8) and 63 patients (32%) scored ≥ 15. Patientswith distress measured by the DT scored also signif-icantly higher on the total score of the HADS.CONCLUSIONS: A recent breast cancer diagnosisresulted in distress in 59% of the patients. Problemsin the emotional domains of the DT were reportedmore than in the domains of physical, social or rela-tional problems. Half of the distressed patientsexpressed or considered a referral to a professionalshortly after diagnosis. The optimal cut-off point ofthe DT shortly after (breast) cancer diagnosis maybe discussed. RESEARCH IMPLICATIONS: Notunexpectedly, a high level of distress was measuredwith the DT in patients with a recent diagnosis ofbreast cancer. The used cut-off point of 5 may notbe specific enough in the screening for distress afterdiagnosis. We are currently investigating the opti-mal cut-off point of the DT shortly after the breastcancer diagnosis and in the course of the disease.Preliminary results will be presented. CLINICALIMPLICATIONS: Following the patient with theDT from diagnosis is important to signal, preventand decrease distress. Nurses and other profession-als should be aware of the impact of the breast can-cer diagnosis on the patient. They should pro-actively discuss with patients the opportunity forreferral to a professional if needed and/or wishedfor. ACKNOWLEDGEMENT OF FUNDING:This study is funded by Pink Ribbon, the Nether-lands.



P3-43

The Dynamics of Perceived Control on the Evolution

of Emotional Distress in Women With Breast

Cancer

Bertrand Porro1,2, St�ephanie de Chalvron1,2,Florence Cousson-G�elie3,21Paul Val�ery Montpellier 3 University, Montpellier,France, 2Epsylon Laboratory, Montpellier, France,3Epidaure, ICM, Montpellier, France

BACKGROUND: Emotional state is overallaffected the first year after breast cancer diagnosis.Perceived control of the disease and his changesseem to be crucial for the regulation of patients’emotional state. Our study focuses on the develop-ment of emotional distress up to a year after sur-gery, and the evolving in time of perception ofdisease control, and tries to show that this changerepresents a risk factor for the development of thepatients’ emotional distress. METHOD: 115patients (M = 56.56, SD = 10.07) with a first breastcancer were interviewed during their hospitaliza-tion. Women who had had cancer or chemotherapybefore surgery, not reading or not understandingFrench were excluded. Emotional distress wasassessed with the Hospital Anxiety DepressionScale (HADS) at the time of surgery (T0), then 1, 4,7, 10 and 13 months after surgery (T1 to T4). Con-trol was assessed by the Cancer Locus of ControlScale (CLCS) at T1, T2, T3 and T4. We attend tofound 4 trajectories of emotional distress.RESULTS: We confirm 4 groups: “resilient” groupwith low basal level, decreasing significantly (t =�3.45, p < 0.001); “stable” group with a basal levelslightly higher constant level over time; “deferred”group with a medium level at T0, which increasedsignificantly (t = 33.33, p < 0.001); “chronic” groupwith high emotional distress that remains constantover time. Low perceived control reduces the prob-ability of belonging to the resilient group (ORaj =0.227, IC95% = [0.062;0.836]) and to the stablegroup (ORaj = 0.175, IC95% = [0.045;0.688]) com-pared to the increasing risk of belonging to the dif-fered group (ORaj = 4.41, IC95% = [1.19;16,23]).Those whose scores disease control decreasedbetween T1 and T2 are less likely to belong to thestable group (ORaj = 0.86, IC95% = [0.16,0.46]).CONCLUSIONS: The study of changes in emo-tional distress highlights four profiles of trajecto-ries. We observed that most of the paths areequivalent to their basal level throughout the dis-ease values, with the exception of one which hasbeen increased during the first months after diagno-sis, before stabilize. It allows us to conclude theimportance in considering both perceived controlof the disease and his variations. Patients with highinternal causal attribution and/or low perceivedcontrol of the disease are more prone to emotionaldistress than others. RESEARCH IMPLICA-

TIONS: The first research interest is to introducedevelopmental trajectories of emotional distressand to find the factors who explain these develop-mental trajectories. We propose that futureresearch focuses on the evolution of the overallquality of life of patients and potentially mediatingrole of coping strategies. CLINICAL IMPLICA-TIONS: The clinical interest of this work is toshow that patients with low scores, or a decrease inthe perception of control up to 4 months after sur-gery, are those who should be monitored regularlyin order to prevent the risk of develop further dis-tress. ACKNOWLEDGEMENT OF FUNDING:Many thanks to Lilly’s Laboratories and theFrench National Cancer Institute (INCa).

P3-44

Screening Cancer Patients’ Distress and Care Needs:

Translation and Validation of the Cancer

Rehabilitation Evaluation System (CARES) for the

Flemish Population in Belgium

Bojoura Schouten1, Johan Hellings1,2, PatrickVankrunkelsven3,4, Kris Vanhaecht5,61Department of Medicine and Life Sciences,University of Hasselt, Diepenbeek, Belgium,2ICURO, Brussel, Belgium, 3Academic Centre forGeneral Practice ACHC, Department of Medicine,University of Leuven, Leuven, Belgium, 4BelgianCenter for Evidence-Based Medicine CEBAM, Leuven,Belgium, 5Center for Health Services and NursingResearch CZV, Department of Public Health andPrimary Care, University of Leuven, Leuven,Belgium, 6The European Pathway Association EPA,Leuven, Belgium

BACKGROUND: This study aims the translationand validation of the Cancer Rehabilitation Evalu-ation System (CARES) that could be used in Bel-gian research. Validation of this quality of life andneeds assessment tool to identify Flemish cancerpatients burden and care needs, following the con-frontation with cancer and its treatment, can giveinsights for patient-centered care directed on symp-tom-management, psychosocial wellbeing, informa-tion and further care needs. METHOD: Aheterogeneous sample cancer patients will berecruited in the clinic to complete the CARES in anelectronic format. The psychometric properties andfeasibility of the instrument will be tested on thebasis of statistical analysis. Also there will be a sup-plementary questionnaire to get insight in patientsexperiences with screening. RESULTS: This studyshould bring clarity about the validity, reliabilityand feasibility of the Dutch CARES-translation forthe Flemish population in Belgium. In additionqualitative questioning will give more insight in the“care consumers” experiences en preferences onscreening in the included group of cancer patients.CONCLUSIONS: After long existing copyright on



the CARES, the instrument is released for free use.A successful translation and validation in Dutchcan create the possibility in the Belgian-Flemishpopulation to scientifically document the number,type and severity of difficulties and care needs thatindividuals may be facing as a result of a cancerdiagnosis and associated treatment. RESEARCHIMPLICATIONS: Because of the broad coverageof domains in wellbeing -and in particular the psy-chosocial aspects- the use of the CARES in futurequantitative Belgian research can be of great valueto explore cancer patients burden and care needsthat go past the disease itself and its treatment. TheCARES-outcomes and other parameters can becombined to predict the risk of cancer patients todevelop psychosocial problems later in time aftertreatment aimed at physical recovery. CLINICALIMPLICATIONS: Better insight in patients overallwellbeing and care needs could confirm the appro-priateness of current multidisciplinary cancer carein Belgian practice, or result in recommendationsfor change in the future. Further research on theCARES itself could lead to a valuable screeningtool for clinical practice to detect distress and careneeds, what could stimulate communication aboutthe psychosocial topic and optimize the efficiencyin match between overall care needs and totalcross-boundary care. ACKNOWLEDGEMENTOF FUNDING: The subject of this abstract is partof a PhD-research project. Limburg Sterk Merk(LSM) gave funding to realise the research projecton UHasselt.

P3-45

Fear of Recurrence in Head and Neck Cancer

Patients

Brooke Swash1, Nicholas Hulbert-Williams1,Gozde Ozakinci2, Jason Fenemore1, GerryHumphries2, Simon Rogers31University of Chester, Chester, UK, 2University ofSt Andrews, St Andrews, UK, 3Aintree UniversityHospital, Aintree, UK

BACKGROUND: Fear of recurrence (FoR) iscommon in survivors of head and neck and is asso-ciated with increased distress. It is difficult to pre-dict which patients will experience FoR andwhether this will diminish over time. The PatientConcerns Inventory (PCI) is a means of identifyingFoR and can facilitate a discussion of real versusperceived risk with patients. This study aimed toqualitatively explore patients’ experiences of dis-cussing FoR with oncologists/surgeons in the clini-cal setting. METHOD: Head and neck cancersurvivors attending clinic for follow-up care wereasked to complete the PCI, as usual, prior to con-sultation. Those identifying FoR were invited totake part (n=11) and for this group, their consulta-tion with their clinician was recorded. A telephone

based, one-to-one follow-up interview was alsoarranged to further explore the issue of FoR andpatient’s experiences of how well this was managedin their consultation. All participants had com-pleted treatment over three months prior to takingpart, were over the age of 18 and were currently dis-ease free. RESULTS: A thematic analysis of boththe consultation and interview transcripts wasundertaken by two members of the research team.The analysis highlighted the following as relating toparticipant’s fears of recurrence: participant’s back-ground; coping style; personality; physical triggers;gender differences in how the fear presents; the nat-ure of the fear itself; and a sense of gratefulnesstowards the clinician. Of particular interest was thenovel finding that patients were reluctant to addresstheir FoR with their clinician for fear of appearingungrateful or of upsetting their valued relationshipwith their clinician. CONCLUSIONS: FoR is acommon issue for cancer survivors, but few studieshave explored this within a head and neck cancersample. Our findings indicate that whilst many fea-tures of FoR experience mirror those of other cancersurvivor groups, within head and neck cancer survi-vors particularly, prevalence might be higher thanpreviously appreciated. Patients report feeling reluc-tant to raise this issue with their clinician for fear ofappearing “ungrateful” and clinicians often don’tprioritise this issue within rushed consultations; thismay lead to under-reporting. RESEARCH IMPLI-CATIONS: This study is somewhat unique inexploring FoR within a clinical setting. Whilst someof the emergent themes (e.g. those relating to cop-ing style and personality) are concordant with pre-vious literature, novel themes also emerged. Futureresearch should address the issue of “patient grati-tude” further. We particularly need to know: howgeneralizable this finding is; to what extent it isassociated with FoR; and, whether it is a barrier toother types of patient-clinician communication.CLINICAL IMPLICATIONS: This work high-lights the difficulties that cancer survivors have inaddressing FoR with their clinicians; cliniciansmust instead be prepared to raise it with theirpatients as a standard part of follow-up care. Dueto the reluctance to raise the topic of FoR, it is pos-sible that current estimates are under-representa-tive; the PCI is a useful tool for screening FoR andmay present a more acceptable way for patients toraise this issue with clinicians. ACKNOWLEDGE-MENT OF FUNDING: This project receivedfunding from the British Association of Head andNeck Oncologists.



P3-46

In What Ways and Fields can the ORS/SRS

(PCOMS) be Useful in Clinical Practice? A

Literature Review

In�es Ohlhausen1, Ruchika Gajwani2,Inigo Tolosa3,41Albert-Ludwigs-Universit€at, Freiburg, Germany,2The University of Birmingham, Birmingham, UK,3Birmingham and Solihull Mental Health FNHST,Birmingham, UK, 4University Hospital BirminghamFNHST, Birmingham, UK

BACKGROUND: The PCOMS, consisting of theOutcome - and the Session Rating Scale, is a briefmeasure that has been developed by Miller, Duncanand Johnson (Miller, Duncan & Johnson, 2002) tomeasure outcome and therapeutic alliance. Is hasbeen validated (Bringhurst, Watson, Miller, &Duncan, 2006) and used throughout numerousstudies (e.g. Reese, Norsworthy, & Rowland, 2009).An overview article about research, use and imple-mentation has been published by one of the authors(Miller, 2012). METHOD: The aim of this reviewwas to thoroughly outline in which ways the ORS/SRS have been used and implemented in clinicalpractice and in which fields they were considereduseful. A systematic literature search was conductedin the following databases: Medline, PsychINFO,Psyndex, PsychARTICLES and Google Scholar.Keywords included Partners for Change OutcomeManagement System, PCOMS, Client Directed out-come informed, Client directed outcome therapy,Feedback Informed Treatment, FIT, ORS, SRS,Outcome Rating Scale and Session Rating Scale.Inclusion criteria for the review were english lan-guage and a mention of the (qualitative or quantita-tive) effect or impact of using the ORS/SRS.RESULTS: Of a total of 1690 hits, 20 articles wereextracted. These showed that the ORS/SRS havebeen successfully used in individual and couple ther-apy, in CAMHS settings and for counseling as wellas training purposes. From a research perspective,they have been used to investigate therapists’ andfamilies’ perspectives on their use from a qualitativepoint of view. CONCLUSIONS: Selected articleswill be presented in the poster and further fields ofimplementation can be discussed. RESEARCHIMPLICATIONS: Researchers might benefit froman overwiew of the different clinical settings, inwhich the ORS/SRS have been used in order todetermine new fields of interest or studies that areyet to be conducted. CLINICAL IMPLICA-TIONS: Outlining in which ways the ORS/SRShave been used and implemented in clinical practicemight be helpful in terms of an overview and alsogive ideas about possible studies or clicical imple-mentations in the future. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-47

The Impact of Physical Symptoms in the Course of

Distress, Anxiety and Depression in Lung Cancer

Patients During Chemotherapy

Claudia van Helden1, Anja van den Hout1, LilianLechner2, Nele Jacobs2, Jill Lobbestael31Atrium Medisch Centrum, Heerlen, TheNetherlands, 2Open Universteit Nederland, Heerlen,The Netherlands, 3RINO Zuid Nederland,Eindhoven, The Netherlands

BACKGROUND: The prevalence of mental dis-tress during chemotherapy is high. Some studiessuggest that certain points in time during the treat-ment process are the most appropriate for screen-ing. There are however few studies found where thecourse of mental distress was mapped. The purposeof this study is to investigate the course of distress,anxiety and depression (D.A.D.) before, during andafter treatment with chemotherapy in lung cancerpatients, and the influence thereon by physicalsymptoms. METHOD: In a longitudinal prospec-tive study 151 lung cancer patients undergoing che-motherapy were followed (mean age 64.5, range43–86; 61% men). Self-report questionnaires at 7time points were collected: before the start (T0), atthe first chemotherapy (T1), every 3 weeks (T2, T3,T4 and T5) and 3 months after completion of che-motherapy (T6). Measurements. Physical symp-toms: the somatic subscale of The ScreeningInventory for Psychosocial Problems (SIPP), Dis-tress: The Distress Thermometer (DT), Anxiety anddepression: The Hospital Anxiety and DepressionScale (HADS). Data were analyzed using paired t-tests, multilevel linear regression analysis and mul-tiple regression. RESULTS: Each time point anxi-ety levels were higher than depression levels. At T018.7% and 8.0% scored clinical levels of anxietyand depression. Between T0 and T6 there was nochange in levels of distress (t = �1.36, p = 0.18),anxiety (t = 0.27, p = 0.79) or depression (t = �.42,p = 0.16). Over the measurements there were signif-icant positive correlations between physical com-plaints and distress (B = 0.49, SE = 0.01), anxiety(B = 01.48, SE = 0.26) and depression (B = 0.04,SE = 0.01). D,A,D at T0 predicted average level ofdistress (ß = 0:38, p < 0.001), anxiety (ß = 0.73,p < 0.001), depression (ß=0.78, p<.001) from T1 toT5.T0 Anxiety and depression predicted T6 anxiety(ß = 0.42, p < 0.001) and depression (ß = 0.41,p = 0.01). T0 Distress was no significant predictorof T6 distress (b = �0.57, p = 0.74). CONCLU-SIONS: There is no significant change in the levelof D.A.D. before, during and after chemotherapy.These findings are consistent with earlier research.There are clear indications that there is a relation-ship between an increase in physical symptoms andan increase in D.A.D. This is in contrast with anearlier study identifying the relationship between



perceived control and psychological distress inbreast cancer patients as independent of changes inphysical state. It is possible that physical symptomsexperienced during treatment by breast cancerpatients differ from those in lung cancer patientswith resultant differences in effect on levels of dis-tress. RESEARCH IMPLICATIONS: A sugges-tion for future research is replicating this study inother populations of oncology patients in order toidentify the most appropriate screening moments.As physical symptoms proved clear predictors ofD.A.D. studies evaluating the impact of treatmentpackages that minimize psychological impact arehighly recommended. Developing and evaluatingeffective psychological treatments for lung cancerpatients at the start of medical treatment, aimed atreducing D.A.D. represents a challenge for thefuture. CLINICAL IMPLICATIONS: Screeningof lung cancer patients before treatment is recom-mended as a minimum. Baseline screening at thisstage can identify patients with high scores on D,A,Dlikely to require psychological support, and facilitateearly referral. Increased awareness of the correlationbetween physical symptoms and the degree ofD.A.D.could alert practitioners to early changes or increasesin physical symptoms and their likely impact. Thiswould enable referral for treatment of psychosocialneeds where appropriate during treatment.ACKNOWLEDGEMENT OF FUNDING: None.

P3-48

Trajectories of Psychosocial Distress and its

Correlation With Physical Problems, Social

Support, Coping Styles and Posttraumatic Growth

Among Breast Cancer Survivors

Ging-Long Wang1,2, Shih-Ming Shih1, Yi-ChenHou1, Sheng-Hui Hsu1, An-Chen Feng1, Chih-TaoCheng1,31Koo Foundation Sun Yat-Sen Cancer Center,Taipei, Taiwan, 2National Yang-Ming UniversitySchool of Medicine, Taipei, Taiwan, 3NationalDefense University, Taipei, Taiwan

BACKGROUND: Transition to survivorship forcancer patients can be distressful. At KF-SYSCC,the majority of our patients choose to return to thisinstitution for follow-up after completion of activecancer treatment. We studied the prevalence andthe trajectories of psychosocial distress in this pop-ulation and assessed its correlation with physicalproblems, social support, coping styles and post-traumatic growth (PTG) over 3 years. METHOD:Consecutive outpatients of early stage breast can-cer, who were about 9 months after active cancertreatment, were invited to participate in this pro-spective study at two time points. The patients,who participated in the study at time 1 in 2009,were further recruited for the follow-up study attime 2 in 2012. At both times, they were given mea-

surements to assess psychosocial distress, physicalproblems, social support, coping styles and PTG.Patients with the total score of the Hospital Anxietyand Depression Scale (HADS-t) >= 15 were con-sidered to be significantly distressed. RESULTS:At time 1, 248 patients completed all question-naires. From this group, 118 participated in thetime 2 study. Of the participants, 28.63% werescreened to be significantly distressed at time 1, and16.10% at time 2. Comparing with time 1, at time2, 6% of these patients remained distressed, 75%remained non-distressed, 8% changed from non-distressed to distressed and 11% changed from dis-tressed to non-distressed. The level of distress wascorrelated positively to physical symptoms, copingstyles of negative emotion and cognitive avoidance;and negatively to social support, coping style ofpositive attitude and PTG of interpersonal dimen-sion. CONCLUSIONS: Up to 29% of early stagebreast cancer patients transitioning to survivorshipexperiences psychosocial distress. The prevalence ofdistress appears to diminish over time. The level ofdistress is correlated to physical problems, socialsupport, coping styles and PTG. RESEARCHIMPLICATIONS: We will extend the assessmentof distress and its related factors to 5 post-treat-ment years and beyond to examine patients’ courseof distress and their response to psychosocial inter-ventions. CLINICAL IMPLICATIONS: Earlystage breast cancer patients transitioning to survi-vorship should be screened for psychosocial distress.Services to address issues of physical problems,social support, coping styles and PTG should be ini-tiated as soon as the treatment is completed.ACKNOWLEDGEMENT OF FUNDING: None.

P3-49

Psychosocial and Physical Problems Experienced by

Patients Visiting a Skin and Melanoma Center

Frank Weesie, Marianne Crijns, Marianne Kuenen,Germaine Relyveld, Sylvia ter Meulen, BiljanaZupan, Eveline BleikerThe Netherlands Cancer Institute, Amsterdam, TheNetherlands

BACKGROUND: According to the Dutch guide-lines, the Distress Thermometer (DT) and its prob-lem checklist should be completed by all oncologypatients to assess distress and problems. However,dermatologists have been using the Skindex-29 toassess quality of life. The aim of this study is toinvestigate which physical, psychosocial and func-tional problems are most prevalent in patients visit-ing a Skin and Melanoma Centre, and what(combination of) tools are best in identifying theseproblems. METHOD: During November 2012–April 2013, all new patients who visited the Skinand Melanoma Centre were invited to participatein the study, by completing a questionnaire at



home, one week after their visit. The questionnairesincluded the DT and its checklist, the Skindex-29(assessing skin related symptoms -such as itch, irri-tation and pain-; emotions -such as depression,worrying and embarrassment-; and functioning -such as interaction with others, sex life and sociallife-), and some additional questions about the needfor additional (psychosocial) care and the useful-ness of these questionnaires. RESULTS: 221patients (61% response) completed the question-naire (Mean age = 59, SD = 14 years; 43% men;62% with malignant skin disease). In total, 82patients (49%) scored 5 or higher on the DT. Mostprevalent complaints assessed by the problemchecklist were feeling tense (42%), fatigue (38%),and dry, itchy skin (37%). Scores of the total popu-lation on the DT correlated statistically signifi-cantly with the total score of the Skindex-29(Pearson Correlation = 0.68; p < 0.001). Most pre-valent complaints assessed by the Skindex-29 were:worries about the severity and progression of theskin problems (>53%), and symptoms like sensitive,irritated, itchy skin (>45%). CONCLUSIONS:According to the DT, approximately half of thegroup visitors of the Skin and Melanoma Centerexperiences levels of distress that warrant furtherattention. General problems such as tension andfatigue, as well as skin specific problems, are bothfrequently reported. High distress scores are notmore prevalent in patients currently diagnosed withskin cancer as compared to those with benign skinproblems. These results suggest that all patients vis-iting this Skin and Melanoma Center should bescreened for general aspects of distress (such as fati-gue), as well as skin-specific complaints (such asirritated skin). RESEARCH IMPLICATIONS:Analyses are ongoing to investigate which (combi-nation of) tools are most appropriate to use at theskin and melanoma centre, and which factors aresignificantly associated with the experienced prob-lems. CLINICAL IMPLICATIONS: At a skinand melanoma center, for each patient an assess-ment should be made of the experience of generalas well as skin specific psychosocial and physicalproblems. A combination of both the DT and theSkindex-29 questionnaires, as a tool to identify psy-chosocial and physical problems may be importantto improve communication and management ofthese issues. ACKNOWLEDGEMENT OFFUNDING: None.

P3-50

Feasibility of Distress Screening With the Distress

Thermometer (DT) and Patients’ Acceptance of

Referral to a Team Integrated Psycho-Oncologist: A

Pilot Study

Diana Zwahlen1,2, Christoph Rochlitz2, MichaelKoller3, Sacha Rothschild2, Alexander Kiss11Department of Psychosomatic Medicine, Basel,

Switzerland, 2Medical Oncology Department, Basel,Switzerland, 3Institute for Clinical Epidemiology andBiostatistics, Basel, Switzerland

BACKGROUND: Inspite of increasing efforts toidentify distressed patients and to increase the num-ber of referrals to psycho-oncological care, rela-tively few patients accept referral and the desire forpsycho-oncological support is broadly independentof the distress. Our presentation has two aims: 1) topresent our pilot data on distress and (acceptanceof) referral to psycho-oncological service and 2) todiscuss practical aspects of the screening procedurewith focus on communicating on the basis of theDT. METHOD: Screening for psychological dis-tress with the DT was implemented at the Univer-sity Oncology Outpatient Clinic Basel as part ofroutine clinical care. All oncologists received train-ing for communicating about psychosocial distresson the basis of the DT. Oncologist were instructedto inform all patients about the support service andto make explicit recommendation to see the psy-cho-oncologist if patients scored 5≤ on the DT.Over a nine-month period (July 2012-March 2013),we collected preliminary data on distress inpatients, referral to and acceptance of psycho-onco-logical support after the first consultation at theOutpatient Clinic. Oncologists were asked abouttheir experiences. RESULTS: Of the 236 includedpatients, 61.8% (n = 131) showed elevated levels ofDT scores 5 ≤ (DT 8–10: 15.6%; DT 5–7: 46.2%;DT 0–4: 38.2%). Overall, 18.2% of the patientsconsented to or wished for psycho-oncological sup-port. 42.4% of the high, 22.4% of the medium, and4.8% of the low distress group wished for oraccepted referral to the psycho-oncologist. Corre-spondingly, 72.5% of patients who were recom-mended to consult the psycho-oncologist (5≤) didnot make use of this service. Feasibility of theimplemented screening practice was demonstratedand all participating oncologists were positiveabout the practice change in daily routine. CON-CLUSIONS: ompared to international literaturethe rate of referral and acceptance of referral ishigher at our Clinic. Still, only a moderate propor-tion of the distressed patients also accepts referral toor utilizes psycho-oncological support. Communica-tion about psychosocial distress and psychooncolog-ical support on the basis of the DT seems to becrucial in the experience of oncologists. However,international guidelines describe recommendationsfor screening and referral procedures, but no recom-mendations are offered regarding the actual commu-nication with the patient on the basis of a screeningtool. This leads us to focus on patient-clinician inter-actions. RESEARCH IMPLICATIONS: Our dataserves as a pilot project for the following investiga-tion: a prospective study is planned (starting inOctober 2013) at the Outpatient Clinic in which we



first intend to explore why cancer patients accept orturn down psycho-oncological support service, andsecond, examine how patients and clinicians experi-ence talking about psychosocial distress onthe basis of the DT. CLINICAL IMPLICA-TIONS: We are convinced that attention nowneeds to shift from recognition of distress to diffi-culties associated with acceptance of referral. Inour experience communication on the basis of theDT not only is important to reveal needs and prob-lems of patients but also it is crucial for thepatients’ acceptance of referral to psychooncologi-cal services. One other important factor for accep-tance of psychooncological support might be theclose integration of a psychooncologist in the teamACKNOWLEDGEMENT OF FUNDING: None.

P3-51

Psycho-Sexual Problems in Vulval Malignancy

Biman Chakrabarti, Nidhu Ranjan Mondal,Tanmoy Chatterjee, Rahul RoychoudhuriSGCC&RI, Kolkata, West Bengal, India

BACKGROUND: Vulval malignancyis rare. Wehad 63 cases in a 10-year.period at S.G.C.C & R.I,THAKURPUKUR, Kolkata between 2000 and2009 (less than 1% of all gynecological malignan-cies). Purpose has been retrospective analysis of thepsychological problems as noted in case records.METHOD: Age, parity, occupation, menopausalstatus, co-morbidity (e.g. diabetes, co-existent cer-vical lesion, addictions, socio-economic status, edu-cation were all analysed. Investigations includedblood sugar estimation, Hb, renal function tests, vi-rological screening including H.P.V, H.I.V, PAPsmear and vulval biopsy. All patients had pretreat-ment councelling. Psychosexual status, sexual activ-ity, frequency, satisfaction were recorded. Therewas cultural barrier in enquring about orgasm.Councelling was also done during follow-up aftercompletion of treatment at regular intervals.RESULTS: 67% were over 50 years, 11% wereover 70 years. There was only 1 patient who was28 years old. Most were illiterate, multiparous, lowsocio-economic group (farm hands). Elderlypatients were not concerned about post treatmentsexual problems and would be happy to be diseasefree. Women over 70 years were not sexually activeand this was age related rather than disease related.All the patients were depressed, suffered frominsomnia, indigestion. More than a third sexuallyactive patients avoided sex after treatment. Thisavoidance is more psychological than diseaserelated. CONCLUSIONS: Radical vulvectomy waschosen for advanced cases in elderly women, whileconservaive surgery was selected for sexually activewomen (e.g. avoiding removal of clitoris if possibleand avoiding extremely mutilating operation). Posttreatment counselling involving both the patient and

her sexual partner played an important role in sex-ual rehabilitation. Use of vaginal dilator or lubricantjelly is discussed. Stable marital relationship as iscommon in India helps to cope the crisis in youngerwomen. Anxiety about desirability as a sexual part-ner has a very negative effect. RESEARCH IMPLI-CATIONS: It is important that patient ispsychologically prepared before undergoing treat-ment. CLINICAL IMPLICATIONS: SURGI-CAL TREATMENT: ACKNOWLEDGEMENTOF FUNDING: None.

P3-52

Psychological Stress of Raised CA125 in Post

Treatment Asymptomatic Ovarian Carcinoma

Follow Up

Biman Chakrabarti, Nidhuranjan Mondal,Tanmoy Chatterjee, Rahul RoychowdhuriSGCC&RI, Kolkata,West Bengal, India

BACKGROUND: Ovarian carcinoma is only 10–15% of gynecological malignancies but accountsfor a very high mortality. Most cases are dianosedlate stage iii/stage iv. Often there is spread to gen-eral peritoneum, liver & pleura.Though surgery isthe first line of treatment in advanced cases zeroresidual resection is not possible. In these casesNEO-ADJUVANTchemotherapy 3-6 cycles aregiven and complete surgical treatment is then possi-ble in most cases. Post op.adjuvent chemotherapy2–3 cycles are then prescribed. Follow-up is by clin-ical examination&estimation of marker CA125.METHOD: 88 cases of ovarian malignancies wererecorded during the year 2006 at our tertiary cancercentre. Of these 63 were epithelial carcinoma i.e71%. Patient age, parity, socio-economic educa-tional status were recorded. All the patients hadblood CA125 level recorded at the begining oftreatment and repeated after neo-adjuvant chemo-therapy, surgery & adjuvant chemotherapy. Followup was every 3 months for 2 years, then every6 months for 3 years and then yearly life long. Inmost cases raised CA125 comes down to normalrange of less than 36i.u. Recurrence which is notuncommon is often preceeded by rising CA125 byabout 3–6 months. The stress factor is assessed dur-ing this asymptomatic period of monitoring serum-CA125 level. RESULTS: The stress was wasdirectly proportional to educatinal status especiallywith computer education. Younger women weremore vulnerable than the elderly Urban womenmore psychologically affected than their rural coun-terparts. They dreaded the date of followup andwas afraid to ask the latest level of CA125. Thosewho survived 2 years without recurrence was grad-ually less stressful. Unfortunately most patientswere lost to follow up. Assessment of stress factorwas by degree of anxiety, insomnia, anorexia andirritability. Women of low socioeconomic group



and illiterates were very much less stressful andrelied more on destiny&religion. The young & tech-savy were the most vulnerable to anxiety disorder.CONCLUSIONS: CA125 level is useful in predict-ing the progress of the disease recurrence but earlytreatment of recurrence does not improve the finaloutcome,morbidity or mortality. Hence it seemsthat asymptomatic patients need not have CA125as follow up which might compromise her qualityof life. No symptom-no treatment, as treatment willnot cure recurrence. Earlier treatment of recurrencedoes not improve the morbidity or mortality.RESEARCH IMPLICATIONS: Repeated estima-tion of CA125 for follow up of asymptomaticpatient who already had full oncologic treatmentdoes not have any positive value but it drfinitelyincreases the patient’s anxiety when the CA125 levelstarts rising. At present it is perhaps wise not to givetoo much importance to rising level ofCA125.CLINICAL IMPLICATIONS: CLINICIANshould be alert about the stress of investigations ona symptom free cancer patient and proper councel-ling is mandatory at every stage of follow-up.ACKNOWLEDGEMENT OF FUNDING: None.

P3-53

Health-Related Stigma in Lung Cancer: Piloting an

Acceptance-Based Approach

Suzanne Chambers1, Samantha Clutton2, ElizabethFoley3, Bronwyn Morris1, Diane O’Connell4,Penelope Schofield5, Jeff Dunn21Griffith Health Institute, Griffith University,Brisbane, Australia, 2Cancer Council Queensland,Brisbane, Australia, 3Mind Potential. Centre forTraining and Research, Sydney, Australia, 4PeterMcCallum Cancer Centre, Melbourne, Australia,5Cancer Council New South Wales, Sydney,Australia

BACKGROUND: Lung cancer patients experi-ence higher levels of psychological distress thanother cancer patients. Health-related stigma inthese patients is a significant contributor to pooreroutcomes. Research to address health-relatedstigma in this group and promote better psycholog-ical outcomes for lung cancer patients is a priority.METHOD: Sixteen patients with lung cancer par-ticipated in a pilot of a multi-component cognitivebehavioural intervention with an acceptance-focus.Outcomes assessed included lung cancer stigma;anxiety and depression; cancer-specific distress;QOL; mediators included threat appraisal; socialconstraints; psychological flexibility. Post-test indepth interviews assessed intervention acceptability.RESULTS: Preliminary results will be presentedwith a focus on barriers to resolving health-relatedstigma in a highly distressed patient population.Therapeutic strategies to address distress andhealth-related stigma in this population will be dis-

cussed. CONCLUSIONS: Interventions to addressdistress that take into account health-related stigmain lung cancer patients are a priority. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-54

Quantifying Facial Expression of Head and Neck

Cancer Patients Undergoing Reconstructive Surgery:

How Does Smiling Intensity Relate to Psychosocial

Functioning?

Michelle Fingeret1, Juhun Lee2, Irene Teo1,Gregory Reece1, Mia Markey21The University of Texas MD Anderson CancerCenter, Houston, TX, USA, 2The University ofTexas at Austin, Austin, TX, USA

BACKGROUND: Head and neck cancer (HNC)and its treatment can result in significant changes tofacial morphology and have a critical impact on theformation of facial expressions. Head and neck can-cer patients are also at risk of experiencing psycho-social distress and impairment. The objectives of thisstudy are 1) to develop quantitative measures offacial expression (smiling) and 2) to investigate thepossible relationship between quantitative measuresof smiling intensity and self-reported psychosocialstatus. METHOD: Maximum smiling intensity of95 HNC patients (34 females, 65 males) prior toreconstructive surgery was evaluated using 48quantitative measures calculated from frontal facialphotographs with and without a smile. We com-puted a composite score (z-score) for each patient,which represents how much a patient’s maximumsmiling intensity deviated from the mean of healthycontrols. An array of self-report psychosocialinstruments evaluating body image and quality oflife outcomes were administered to patients. Nine-teen subscale scores were calculated from the psy-chosocial measures. Spearman rank correlation wasconducted to examine the relationships between thecomposite score and each psychosocial subscale.RESULTS: Increased deviation in smiling intensitywas significantly related to increased body image dis-satisfaction (Body Image Scale, r = 0.26, p = 0.02),increased discomfort in social situations (Satisfac-tion with Appearance - Perceived Social Impact,r = 0.33, p = 0.001), increased somatic complaints(Brief Symptom Inventory - Somatization subscale,r = 0.23, p = 0.03) decreased functional ability in thehead and neck (FACT-HN head and neck cancersubscale, r = �0.25, p = 0.02), and decreased gen-eral quality of life (FACT-HN total, r = �0.22,p = 0.03). CONCLUSIONS : We used quantitativemeasures of smiling intensity and psychosocial out-comes involving body image and quality of life toinvestigate the relationship between smiling intensityand psychosocial status of HNC patients prior toundergoing initial reconstructive surgery. We foundthat reduced smiling intensity was associated with



increased body image disturbance (i.e. appearancedissatisfaction and functional impairment) anddecreases in many aspects of quality of life.RESEARCH IMPLICATIONS: These resultshave implications for objectively measuring aes-thetic outcomes for HNC patients and gaining abetter understanding of how facial cancer and itstreatment can affect the formation of facial expres-sions over time. This is also the first study of itskind to report associations between image-basedquantification of facial expression and self-reportedpsychosocial well-being. Future studies are neededto examine these associations over time in cancerpatients undergoing facial reconstruction. CLINI-CAL IMPLICATIONS: Impairment in the abilityto smile is known to be a source of psychosocialdistress for HNC patients. This study shows prom-ise in developing methods to objectively evaluatethe manner in which formation of facial expressionsis affected during cancer treatment, and in develop-ing an understanding of the relationship betweenpsychosocial outcomes and expression formation.These data can inform the development of bodyimage interventions to maximize adjustment to dis-figuring aspects of cancer treatment. ACKNOWL-EDGEMENT OF FUNDING: This study wassupported in part by grant MRSG-10-010-01 fromthe American Cancer Society.

P3-55

Prostate Specific Antigen Utility and Anxiety in the

Management of Prostate Cancer by Active

Surveillance

Jake Anderson1,2, Jane Fletcher2,5, LinaRicciardelli1, Susan Burney2,5, Joanne Brooker2,5,Mark Frydenberg3,41School of Psychology, Deakin University,Melbourne, Australia, 2Cabrini Monash Psycho-Oncology, Cabrini Institute, Cabrini Health,,Melbourne, Australia, 3Department of SurgeryMonash University, Melbourne, Australia,4Department of Urology, Monash Medical Centre,Southern Health, Melbourne, Australia,5Department of Psychology and Psychiatry, MonashUniversity, Melbourne, Australia

BACKGROUND: Active surveillance (AS) is analternative treatment strategy for prostate cancer(PCa) and involves regular PSA blood testing andrepeat rectal biopsies, the aim of which is to moni-tor cancer progression and inform appropriatetreatment decision-making. Anecdotal evidencesuggests that some men experience anxiety whenundergoing AS.The primary aim of this study is toestablish if PSA test related anxiety exists in thispopulation. A range of secondary aims are alsoinvestigated. METHOD: Two hundred and sixty-five men with PCa on AS were invited to completeestablished psychological measures; 104 men (39%,

aged 51–90 years, M = 68; SD � 7) participatedand returned data. RESULTS: Overall, resultsindicated that men experienced low general and ill-ness specific anxieties and high HRQoL when com-pared to published clinical/non-clinical data. Ageand trait anxiety emerged as significant predictorsof PCa related HRQoL; trait, state anxiety and fearof recurrence were significant predictors of overallHRQoL. While there were significant bivariate rela-tionships between illness perceptions (disease conse-quences, illness coherence) and HRQoL, these didnot contribute significant variance in HRQoL out-comes when analysed in regression models. Finally,92% and 86% of the sample found the informationabout PCa and AS (respectively)to be either very orquite helpful and satisfied information needs. CON-CLUSIONS: Findings highlight the importance oftrait anxiety in relation to HRQoL and the benefitsof information provision to men with PCa on AS.ACKNOWLEDGEMENT OF FUNDING: Nofunding received in support of this abstract.

P3-56

Pain, Fatigue and Quality of Life in Hong Kong

Chinese Women With Early Stage Breast Cancer:

Before-Versus-After Adjuvant Radiotherapy

Tracy Kwan1, Rainbow Ho1,21Centre on Behavioral Health, The University ofHong Kong, Hong Kong, 2Department of SocialWork and Social Administration, The University ofHong Kong, Hong Kong

BACKGROUND: djuvant radiotherapy (RT) is acommon treatment for breast cancer for its benefitin reducing the risk of local recurrence. However,RT may induce substantial distress in patients andhave an adverse impact on their quality of life. Thepurpose of this abstract was to compare the experi-ences of pain and fatigue, and the quality of life ofHong Kong Chinese women who had completedRT with those who were awaiting RT. METHOD:This analysis comprised of 70 Chinese women diag-nosed with stage 0-III primary breast cancer whohad joined a larger trial investigating the effects ofa psychotherapy program. They were recruited con-secutively from two government hospitals and threecommunity centres in Hong Kong. The currentdata were collected before the program by self-administered questionnaires including the BriefPain Inventory (BPI), Brief Fatigue Inventory(BFI) and Functional Assessment of Cancer Ther-apy-Breast (FACT-B). Women were age-matchedand grouped by their RT status at enrollment:Pending (preRT, n = 36), within a month post-RT(1-postRT, n = 17), and over a month post-RT (>1-postRT, n = 17, median length = 91 days).RESULTS: The three groups were similar clini-cally and demographically (mean age = 50 years).All had breast surgery and 74% also had chemo-



therapy. In terms of severe pain and severe fatigue,respectively, 17% and 34% of preRT group versus18% and 41% of 1-postRT group versus 29% and29% of >1-postRT group had experienced thesesymptoms. The Kruskal-Wallis tests showed no sig-nificant overall group differences in the scores ofBPI, BFI, Total FACT-B and subscales except forthe FACT-B emotional well-being subscale(p = 0.04). In all FACT-B scales, the >1-postRtgroup scored the highest, the preRT group slightlylower and the 1m-postRT the lowest. CONCLU-SIONS: Before RT, a significant minority ofwomen were fatigued and had experienced severepain, suggesting the lingering effects of prior anti-cancer therapies. The occurrence of severe fatiguewas more common than severe pain both beforeRT and shortly after RT completion. About onethird of the women who had finished RT monthsago still experienced fatigue and/or pain. Patients’quality of life might be undermined in the firstmonth after treatment completion, but the longer-term quality of life after RT seemed comparablewith that before RT. RESEARCH IMPLICA-TIONS: The results suggested that the potentialimpact of RT on quality of life might be minor andtemporary. However, our small sample size implieda higher chance of a Type II error. Prospectiveresearch with a larger cohort is needed to betterunderstand the effects of RT across the period oftreatment and recovery. Research is also indicatedto explore the possible causes of severe fatigue orpain in patients who have long completed treat-ment. CLINICAL IMPLICATIONS: Assessmentof patients’ symptom status prior to RT commence-ment is important for early intervention, if neces-sary, to prevent further deterioration of patients’condition as RT progresses. Such an assessmentshould continue into the post treatment period.ACKNOWLEDGEMENT OF FUNDING: Thisproject is funded by the Hong Kong ResearchGrants Council’s General Research Fund (Refer-ence No. 745110).

P3-57

The Life Experience of Patients With Hepatocellular

Carcinoma

In-Fun Li1,21Doctoral Candidate, School of Nursing, NationalTaipei University of Nrsing and Health Sciences,Taipei, Taiwan, 2Supervisor, Department of Nursing,Mackay Memorial Hospital, Taipei, Taiwan

BACKGROUND: In Taiwan, HCC incidence wasranked third and which has been the second leadingcause of cancer-related death.Compared with othercommon cancers, hepatocellular carcinoma withpoor prognosis. It had the very huge impact ofpatient’s quality of life.The purpose of this studywas to explore hepatocellular carcinoma patients’

life experiences after diagnosis . METHOD: Thephenomenological study employed purposive sam-pling; six patients were recruited. Data were col-lected through semi-structured interview guidance,and analyzed according to Giorgi’s qualitativemethod. RESULTS: After data analysis, three cate-gories emerged: Learning how to face the uncomfort-able of the body and mood to survive (e.g. adjustingthe emotion when being informed of the conditions,following with the doctor’s suggestions of the treat-ments, and looking for the way to treat the pain),Fear of progression, to keep a healthy life for living(e.g. selecting the healthy food, adjusting the life styleand attitude, Cherishing the life to increase the valueof it (e.g. Sigh with emotions of regrets to the family,appreciate their supports and search for the meaningof life). CONCLUSIONS: This study results can beprovided as reference for nurses to pay attention tothe psychological issues, especially the fear of diseaseprogression which is on patients with hepatocellularcarcinoma in their life. RESEARCH IMPLICA-TIONS: Longitudinal research will design fortracking the fear of progression change in patients’slife, in order to provide proper care to patient atdifferent stages. CLINICAL IMPLICATIONS:This study results will help nurses to understandpatients’ illness and life experience, and accompanyhelp them face and adjust to their situation.ACKNOWLEDGEMENT OF FUNDING: None.

P3-58

Understanding Mediation Effect of Cancer-Related

Rumination Between Physical Symptom Distress and

Psychological Distress in Chinese Colorectal Cancer

Patients

Wai Yee Wylie W.Y. Li1, Wing Tak Wendy Lam1,Wai Lun Law2, Jensen Poon2, Richard Fielding11Centre for Psycho-oncological Research andTraining, School of Public Health, HKU, HongKong, 2Department of Surgery, HKU, Hong Kong

BACKGROUND: The age-adjusted incidence ofcolorectal cancer has increased over the past decadeboth globally and locally. Physical symptoms dis-tress is known to be an important contributor topsychological distress among cancer patients. Inaddition, intrusive thoughts are associated with theonset of depression and anxiety. This study aims toexamine the possible mediation role of cancer-related rumination between physical symptom dis-tress and depression and anxiety among ChineseColorectal cancer patients across the cancer jour-ney. METHOD: Newly diagnosed colorectal can-cer (CRC) patients recruited from a Hong Kongteaching hospital were interviewed three times:1 day before surgery (T1), 1 month (T2) and4 months post-surgery (T3) respectively. Patient’sanxiety and depression (psychological distress),physical symptom distress, cancer-related rumina-



tion and demographic information were recordedat each of three interviews. Linear Mixed Modellingwas adopted to investigate if there was any media-tion effect from rumination. RESULTS: Overall,205/219 (93.6%) patients participated in this study.Anxiety (b = �0.41, SE = 0.12, p = 0.001), but notdepression (b = �0.11, SE = 0.13, p = 0.395) levelsdeclined significantly from pre-surgery to 4 monthspost-surgery. Physical symptom distress was posi-tively related to both anxiety level (b = 2.35,SE = 0.37, p < 0.001) and depression level(b = 2.80, SE = 0.47, p < 0.001) respectively. Inaddition, higher physical symptom distress wasassociated with stronger rumination (b = 0.408,SE = 0.46, p < 0.001). Sobel test suggested a signifi-cant mediation effect from rumination betweenphysical symptom distress and anxiety (z = 7.19,p < 0.001) and depression (z = 5.84, p < 0.001).CONCLUSIONS: CRC patients had decreasinganxiety level but maintained fairly stable levels ofdepression over the time from pre-surgery to4 months post-surgery. Cancer-related ruminationseems to carry some of the impact associated withphysical symptom distress on cancer patients’ anxi-ety and depression level. There was a partiallymediation effect of cancer-related rumination onthe relationship between physical symptom distressand psychological morbidity. This points to themeanings and/or disruption attributed to physicalsymptoms as potential therapeutic targets.RESEARCH IMPLICATIONS: This studyrevealed the pattern change on psychological dis-tress (depression and anxiety) across the periodfrom pre-surgery to 4 months post-surgery amongCRC patients as well as rumination partiallyaffected the relationship between physical symptomdistress and depression and anxiety. Further inves-tigation may be needed to reveal if the relationshipbetween physical symptom distress and prolongedpsychological distress (e.g. 1 year post-surgery)would also be mediated by rumination. CLINICALIMPLICATIONS: Health care providers need topay more attention to patients’ physical symptoms.Distress arising from physical symptoms appears tobe in response to either the potential meaningsattributed to those symptoms, or to the disruptiveeffect of these symptoms on daily life, preventing“forgetting about” cancer that is necessary forreturn to near normal life. Interventions shouldaddress either physical symptoms themselves orruminative thinking about cancer prompted bythese to minimize psychological morbidities.ACKNOWLEDGEMENT OF FUNDING: Thisproject was funded by The Health and Health Ser-vice Research Fund of the Hong Kong Govern-ment, grant number 0708651.

P3-59

Psychiatric Rehabilitation of Patients With

Oesophageal Cancer

Gholam MobarakyIsfahan University of Medical Science, Isfahan, Iran

BACKGROUND: Patients with cancer mostlyhave psychiatric problems before and after therapy,especially if they undergo surgery. These psychiatricproblems can be due to organic problems (such assecondary symptoms), or functional problems (psy-chiatric disorders). METHOD: First to categorizethese problems and then have a definition for eachof them, then explain psychiatric modalities foreach of them and rehabilitation of patients sepa-rately. Results In cancer we have two types of psy-chiatric symptoms or syndromes. If patientdevelops psychiatric symptoms after cancer, we sayhe has secondary symptoms, e.g. depression. This iscalled mood disorder due to GMC. But if afterknowing that he/she has cancer he/she developeddepression, it is adjustment disorder. Therapy inboth is the same; drug therapy, psychotherapy,vocational rehabilitation, family therapy are usedfor both types. In oesophagostomy special prob-lems are eating and speech problems. These twoproblems could be due to physical defects that areproduced. Intensity of patient reaction to speechlost depends on the defect, personality of patient,preceding stresses, coping of patient, social situa-tion, occupation of patient. CONCLUSIONS:These factors should be considered in rehabilitationof patient and therapy processes. Aphony, dyspho-ny, mutism, are speech problems that each of themand rehabilitation of them would be discussed inessay. RESEARCH IMPLICATIONS: N/ACLINICAL IMPLICATIONS: N/A ACKNOWL-EDGEMENT OF FUNDING: None.

P3-60

Psychiatric Symptoms & Brain Tumors - Updating

Vania Viveiros1, L�ucia Monteiro21Centro Hospitalar Psiqui�atrico de Lisboa, Lisboa,Portugal, 2Instituto Portugues Oncologia de Lisboa,Lisboa, Portugal

BACKGROUND: More than 50% of BrainTumors (BT) present with psychiatric symptoms(PS). 80% are located in the frontal or limbic areas.PS are the BT inaugural manifestation in 18% ofpatients. Brain metastases (BM) are the most preva-lent BT and have the greatest incidence of PS,which is probably related to their scattered distribu-tion in the brain. The aim of this paper is to updateinformation between specific Psychiatric symptomsand brain tumor location. METHOD: A compre-hensive review of the literature focusing on reportsabout BT and their eventual PS, through PubMedbetween January 1970–October 2010. The search-



ing words were brain tumor, psychiatric symptoms,manifestation, and association. The authors portraya patient’s case report whose severe psychiatricsymptoms showed to be secondary to BM and wereactually the first clinical manifestation of a primarylung tumor. Patient’s medical files and computedtomography (CT) scans were reviewed in detail.RESULTS: Neither tumor location or histologyproved to be particularly associated with any spe-cific PS. Mood symptoms are the most commonlyrelated to an evolving BT. It seems to be statisti-cally significant the correlation between anorexiawithout disturbance of body image perception andtumors of hypothalamus. In the reported case, theclinical picture appointed to a sub-acute delirium ofunknown etiology. The scan conveyed several rightfronto-temporal e thalamo- diencephalic tumorssecondary to a disseminated yet so far silent, lungtumor (T1 N2 M1). CONCLUSIONS: Instead ofclassical neurological signs, BT may only presentpsychiatric symptoms. Both primary care and men-tal health teams should be alert to this frequentassociation. Early diagnosis and treatment of BTare determinant for the survival and quality of lifeof patients. Neuroimaging (CT and MRI scan)should be mandatory for all patients who present inthe psychiatry emergency room or psychiatry out-patient clinic with 1) new-onset psychosis, 2) recur-rence of previously well-controlled psychiatricsymptoms, 3) consistently atypical symptoms or 4)prolonged psychotropic refractory symptoms.RESEARCH IMPLICATIONS: Our present com-prehension of the neurophysiologic and neuroan-atomic correlates of behavior are far fromcomplete. The complex and still partially unknownnetwork linking different regions of the brain turnsunlikely any definitive correlation between neuro-psychiatric symptoms and site of lesions. Well-designed prospective studies, with large number ofpatients, matching psychiatric and neuro-oncologicfollowing-up series, are pivotal for a better compre-hension and useful diagnosis insight of the psychi-atric manifestations into Brain Tumors.CLINICAL IMPLICATIONS: The reported casehighlights the importance of being aware of a possi-ble oncologic etiology for the new onset, atypical orrefractory psychiatric symptoms; whether in pri-mary care or psychiatry clinic setting, the immedi-ate request of brain image exams is mandatory.This routine may be lifesaving for patients with dis-closed and possible curable neoplasm that wouldotherwise evolve undetected and eventually towardsa fatal stage. ACKNOWLEDGEMENT OFFUNDING: None.

P3-61

The Impact of Being Diagnosed With Lung Cancer:

A Qualitative Interview Study

Sijrike van der Mei1, Geke Dijkstra2, Ria Ziengs3,Marleen Stokroos4, Robbert Sanderman51Dept. of Health Sciences, University MedicalCenter Groningen UMCG, University of Groningen,Groningen, The Netherlands, 2Dept. of AppliedResearch in Care, UMCG, Groningen, TheNetherlands, 3Dept. of Pulmonary Diseases, UMCG,Groningen, The Netherlands, 4Dept. of PulmonaryDiseases, UMCG, Groningen, The Netherlands,5Dept. of Health Psychology, UMCG, Groningen,The Netherlands

BACKGROUND: Quality of life studies in lungcancer (LC) patients mostly have a quantitativeresearch design and focus on physical symptoms,emotional distress, and treatment effects, whereasthe social impact is under-researched. Little isknown of the personal experiences of patients stud-ied within a qualitative research design. This studyaims to explore patients’ personal experiencesregarding quality of daily life, with a focus on thepsychological and social domain, and patients’ sup-portive care needs. METHOD: This qualitativestudy concerns narrative interviews with 14 LCpatients (aged 48–77 years; 8 men and 6 women),diagnosed with non-small cell LC (n = 10) or smallcell LC (n = 4). Patients were recruited during rou-tine outpatient visits, applying a broad samplingstrategy regarding disease stage (i.e. palliative/cura-tive treatment, survivorship) and cancer treatment.Interviews were performed in-home using a topic-based interview guide. The audiotaped interviewswere transcribed and analyzed conform guidelinesfor qualitative analysis. To facilitate understandingof the results, the emerging themes and correspond-ing illustrative quotations were presented to psy-chosocial professionals involved in supportive carefor LC patients. RESULTS: Six major themesemerged: reality of LC, impact of LC, sharing thediagnosis with others, maintaining normality, themany faces of hope, and end of life. Communica-tion and information giving about diagnosis, treat-ment and prognosis was open and honest, but forsome not adequately tailored to individual needs.Spousal emotional and practical support was ofvital importance in coping with LC. A minoritywanted and received professional psychosocial sup-port. Patients had no experiences with organizedpeer support. Informal peer support, however, didlead to sharing valuable experiences for somepatients. For some survivors return-to-work andwork disability were important issues. CONCLU-SIONS: The range in experiences indicates themany faces of living with LC. Patients emphasizethe importance of maintaining normality and aretrying to live in a mindful manner. For survivors



normality may include vocational rehabilitationalthough barriers for return-to-work exist. Consid-ering supportive care, patients mobilized their ownsources of support. Unexpectedly, only a minorityneeded professional psychosocial care, despite thehigh prevalence of symptom and psychological dis-tress known from literature. The need for peer sup-port was also limited, fearing the experience ofnegative emotions and the notion that being in sim-ilar situations does not guarantee sharing the sameexperiences. RESEARCH IMPLICATIONS: Newinformation and communication technologies, suchas eHealth, should be explored to get insight intheir ability to tailor information to individualneeds of LC patients. In addition, research isneeded in the area of peer support; the pros andcons of peer-to-peer support in LC, as well as theeffects on quality of life. Lastly, the specific prob-lems and long-term difficulties of survivors of LCneed investigation. CLINICAL IMPLICA-TIONS: Recent changes in characteristics of theLC population, i.e. more female and youngerpatients, more never-smokers, increasing propor-tion of survivors, and the trend of extended time onpalliative treatment, impacts quality of daily lifeand consequently affects supportive needs. Survi-vors represent a subgroup with specific needs (e.g.return-to-work, long-term functional limitations).The knowledge generated by this exploratory studyindicates that communication, information, profes-sional psychosocial support en peer support shouldbe tailored to these needs. ACKNOWLEDGE-MENT OF FUNDING: This study was supportedby a grant from the Dutch Federation of Lung can-cer patients and the Dutch Cancer Society.

P3-62

“It is Not That Easy to Switch Off to it - The

Second Time Round”: Experiences of Patients With

a Recurrent Bowel Cancer and Their Partners

Marta Wanat1, Eila Watson1, Mary Boulton1, BeeWee21Oxford Brookes University, Oxford, UK, 2OxfordUniversity Hospitals NHS Trust, Oxford, UK

BACKGROUND: Cancer recurrence is a difficultstage of the cancer journey as it challenges patients’hopes that cancer can be cured and emphasises thelife threatening nature of illness. It is often associ-ated with physical and psychological difficulties.The impact on partners at this time is also signifi-cant. This study aims to explore the psycho-socialimpact of recurrence of colorectal cancer on thedaily lives of patients and their spouses/partnersand how they cope with it. METHOD: Twelvepatients with a diagnosis of bowel cancer recur-rence and their partners will be recruited from 4hospitals in the UK as well as online communities(recruitment in progress). Semi-structured inter-

views are being conducted separately with patientswho have had a recurrence and their partners/spouses, within 1–2 months after diagnosis. Dataare being analysed using IPA (Interpretative Phe-nomenological Analysis). RESULTS: Preliminaryfindings from the interviews suggest that patientsand partners experience a range of emotions includ-ing shock and despair when diagnosed with cancerrecurrence as they often thought that they managedto “beat the cancer”. The experience of initial diag-nosis provides a reference point for their experi-ences of recurrence as both patients and partnersoften compare the initial and the subsequent diag-nosis. Continuity in relationship with clinical teamwas found reassuring for patients especially whenbreaking bad news. Family members provide bothemotional and practical support for patients butthey often feel that they lack support from healthcare professionals. CONCLUSIONS: Recommen-dations on supportive care in colorectal cancerhighlight the need to provide care for patientsthroughout the cancer journey. However, we stillhave a limited understanding of the issues patientswith bowel cancer face when they experience arecurrence of the disease. Partners are importantsource of support for patients yet their supportiveneeds are often not attended to. This study contrib-utes to our understanding of the experiences ofpatients and their partners at this difficult time andwill help to inform the further development ofhealth care services to support them. RESEARCHIMPLICATIONS: This study provides an insightinto patients and partners experiences’ of bowelcancer recurrence as to date relatively little psycho-social research has focused on this period, espe-cially in comparison to the medical literature.However, more work is needed on the experiencesof patients’ with active and advanced disease acrossdifferent cancer sites. Future studies should alsoexplore what interventions are best suited toaddress the information and supportive needs ofpatients and their partners. CLINICAL IMPLICA-TIONS: While continuity of care may act as bufferin their experience of recurrence, receiving a diag-nosis of secondary cancer can still be a traumaticexperience for patients.The role of Clinical NurseSpecialist was especially highlighted in providingboth emotional and practical support. When pro-viding patients and families with information aboutprognosis, practitioners need to strike a balancebetween being realistic and maintaining hope, as itmay have an impact on their experiences through-out cancer journey. ACKNOWLEDGEMENT OFFUNDING: OXFORD BROOKES UNIVER-SITY:



P3-63

Quality of Life and Psychosocial Adjustment in

Colorectal Cancer Patients With Stoma and

Nonstoma

Isıl YıldızGayrettepe Florence Nightingale Hospital, Istanbul,Turkey

BACKGROUND: This study had been conductedwith the aim to determine quality of life and psy-chosocial adjustment of colorectal cancer patientswith stoma and nonstoma amd to evaluate the rela-tionships between these factors. Factors in thestudy were compared in terms of some sociodemo-graphic and illness factors. METHOD: 60 colorec-tal cancer patients contributed to the study.Participants were given a personal informationform, EORTC QLQ-C30 quality of life question-naire, EORTC QLQ-CR38 quality of life question-naire and Psychosocial Adjustment to Illness Scale.T-test and Mann Whitney-U tests were used in theevaluation of differences among these groups.Spearman correlation was used in the evaluation ofrelationships between factors. RESULTS: Accord-ing to the results, patients with stoma were foundto be different from the nonstoma group in termsof global health status, physical functioning, cogni-tive functioning, micturition problems, chemo side-effects, gastrointestinal problems and weight lossand in terms of psychosocial adjustment, domesticenvironment and psychologic distress. Other fac-tors were similar in the two groups. Althoughpsychosocial adjustment of the two group is moder-ate, patients with stoma is significantly worse thanpatients without stoma. Patients with stoma havemore problems with family and psychological adap-tation than nonstoma patients. In addition, thereare positive correlations between quality of life andpsychosocial adjustment CONCLUSIONS:Patients with stoma were found to be different fromthe nonstoma group in terms of some quality of lifeand psychosocial adjustment aspects. Patients withstoma have more problems in quality of life andpsychosocial adjustment than nonstoma patients.RESEARCH IMPLICATIONS: This study is thefirst comparing study about stoma and non stomapatients with colorectal cancer in Turkey. We needmore study in our country with this subject CLINI-CAL IMPLICATIONS: Oncology clinics in a mul-tidisciplinary approach to treatment arerecommended to include experienced psychologistsand psychiatrists about psycho-oncology and takinginto account problems during the treatment of can-cer patients with stoma, the planning of training andcounseling services should be continued by them.ACKNOWLEDGEMENT OF FUNDING: None.

P3-64

Spiritual Care by Nurses in Curative Cancer Care:

Experiences and Expectations of Patients

Marieke Groot1, Helen Koning1, Anja Visser1,Ren�e van Leeuwen2, Bert Garssen11Helen Dowling Institute, Bilthoven, TheNetherlands, 2Reformed University for AppliedSciences, Zwolle, The Netherlands

BACKGROUND: Each person is assumed to havespiritual needs; the need for love, others, God, theneed to find meaning and purpose etc. A life-threat-ening illness such as cancer can cause these needs tobecome unfulfilled. Nurses can play a role in fulfill-ing these needs. Spiritual care mainly takes placesin the palliative setting. It is not known if needs andexperiences from patients who are treated withcurative intent differ from those of palliativepatients. METHOD: Our study uses a mixed quali-tative and quantitative research design. About 80patients, coming from 9 hospitals spread over theNetherlands, will be approached at the end of cura-tively intended (adjuvant) treatment with chemo-therapy. In the second part of the study we will alsointerview about 80 nurses. Concerning the patientpart, we conduct semi-structured qualitative inter-views and ask patients to fill in questionnaires con-cerning quality of life and spiritual attitude andinvolvement. All interviews will be transcribed andcoded for analysis. Quantitative analysis will beused to investigate which characteristics influencethe quantity and quality of nurses’ spiritual care.RESULTS: At this moment we are transcribingthe first 20 patient interviews. On this rich materialwe are undertaking initial qualitative and quantita-tive analysis. At this moment (may 2013) it is tooearly in the process to explicitly mention results.However the first analysis cautiously shows thatspiritual care and the need for it in curative cancercare might be different from the spiritual careexpected and received by palliative patients. InNovember 2013 we will be able to give more andmore solid results on this interesting topic. CON-CLUSIONS: Just as with the results, at thismoment it’s too early in the research process to givevoice to conclusions. At the congress in November2013 we however can present more data that givesan insight in spiritual care to cancer patients treatedwith a curative intent. RESEARCH IMPLICA-TIONS: Substantial number of cancer patientsreport unfulfilled spiritual needs. Spiritual care isbelieved to improve quality of life and may help tocope with illness and treatment. Nurses in palliativecare seem to be naturally aware of the spiritualdimension of patients. Yet it is unknown if spiritualcare is provided in curative care. This study isintended to investigate the need for spiritual care incurative cancer care from patients’ and nurses’ per-spective. CLINICAL IMPLICATIONS: Nurses



are a category of caregivers who have shown aninterest in spiritual care training. Furthermore,because of the nature of their job, nurses under-stand the art of “diluted severity”, passingly talkingabout serious affairs; by diluting serious topics withtriviality, it is more easy to raise them in conversa-tion. If the study shows that spiritual care improve-ment in the curative sector is needed, our resultmight relatively easy be trained and implemented indaily care ACKNOWLEDGEMENT OF FUND-ING: None; we received no funding to support thisabstract. The study however is funded by the DutchCancer Society/Alpe D’HuZes.

P3-65

Writing a Spiritual Autobiography: Inner Dialogue,

Life Orientation and Resilience in Cancer Patients

Irma Verdonck1,2, Ruard Ganzevoort1, LennekePost2, Jannette Delver21VU University, Amsterdam, The Netherlands, 2VUmc, Amsterdam, The Netherlands

BACKGROUND: A cancer diagnosis often pro-vokes existential questioning concerning identity,meaning, and spirituality. Clinical practice atVUmc shows that writing a spiritual autobiography- a biography addressing existential and spiritualdevelopment - eases this questioning, and strength-ens personal life orientation and resilience. Draw-ing from various philosophical, psychological andtheological sources we explore the relationshipbetween writing a spiritual autobiography, personallife orientation, and resilience; especially concern-ing the role of emplotment and performative innerdialogue. METHOD: Effect study (N = 50); dura-tion 3,5 years. Cancer patients, diag-nosed > 0,5 year previous to study, treated withcurative intent, methodically write their spiritualautobiography during 8 group sessions in 4 monthsperiod. Quantitative research determines the effectof writing the spiritual autobiography (immedi-ately, 3 months and 9 months after the interven-tion) by means of validated questionnaires in termsof personal life orientation and resilience. Qualita-tive research studies the relationship between writ-ing, life orientation and resilience in two steps. Firsta conceptual framework on the relationship isdeveloped, secondly a content analyses of partici-pants spiritual autobiographies and interviewdatais conducted. RESULTS: This study is currentlybeing conducted. It will be completed in two yearstime and results are therefore forthcoming. How-ever, drawing from fields such as philosophy, psy-chology and theology, a conceptual framework onthe relationship between writing, life orientationand resilience can already be developed. Writing aspiritual autobiography can then be understood asfostering inner and outer performative dialogue,leading to an articulated and appropriated personal

life orientation and consequently to resilience. Spe-cific characteristics of the plot developed in theautobiography determine the manner in whichone’s inner dialogue, life orientation, and resilienceare affected. CONCLUSIONS: Gaining insight inthe relationship between writing a spiritual autobi-ography, life orientation and resilience by means ofemplotment and performative inner and outer dia-logue, allows for new insight and novel approachesin dealing with existential restlessness and discom-fort (e.g. as it relates to stress reduction, self man-agement etc). This is relevant and important to thefield of psycho oncology, as it allows for differentapproaches to improve and understand the (spiri-tual) quality of life and wellbeing of cancer patients.RESEARCH IMPLICATIONS: An increased(multi disciplinary) understanding of the relation-ship between writing a spiritual autobiography, lifeorientation and resilience - by studying the roleof emplotment and performative inner dialogue -can also lead to new insight and help understandthe relationship between e.g. writing, emplotment/inner dialogue and self management; or writing,emplotment/inner dialogue and coping; or writing,emplotment/inner dialogue and stress reduction.CLINICAL IMPLICATIONS: An increased(multi disciplinary) understanding of the relation-ship between writing a spiritual autobiography,emplotment/inner dialogue, life orientation andresilience, could eventually allow for the develop-ment of a variety of new clinical tools, instrumentsand interventions centering around writing andinner dialogue that allow cancer patients tostrengthen their resilience, increase their potentialfor self management and eventually get their lifeback on track. ACKNOWLEDGEMENT OFFUNDING: The research project is funded byAdessium, an indepentent foundation in the Neth-erlands.

P3-66

Spirituality/Religious Conviction in Cancer Patients

Anahita Paula Rassoulian1, Arndt B€ussing2,Alexander Gaiger11Department of Medicine I, Division of Hematologyand Hemostaseology, Medical University of Vienna,Vienna, Austria, 2Department of Medical Theoryand Complementary Medicine, University Witten/Herdecke, Witten/Herdecke, Germany

BACKGROUND: Numerous studies have shownthat spirituality/religious conviction might be aresource in coping with illness contributing to psy-chosocial adjustment, to patients attitude towardscancer treatments as well as to patients healthrelated quality of life. The aim of this study was toinvestigate whether 1) the “faith factor” demon-strates effects on anxiety and depression in cancerpatients, 2) is spirituality/religion a source of



strength and 3) sociodemographic factors impactspirituality/religious conviction? METHOD: 443patients (56% women, 44% men) diagnosed withcancer at the Clinic for Haematology/Haemaos-taseology and Oncology of the Medical Universityof Vienna were interviewed. Based on the bio-psy-cho-social-spiritual model we used standardizedquestionnaires like the anxiety and depression scale(HADS), spirituality and religiosity benefit(B€ussing) as well as sociodemographic characteris-tics. Furthermore, we obtained clinical data such ascancer site, presence of metastatic disease, haemo-globin, pain and fatigue; social factors includedincome, education, employment status, presence ofchildren in the household, marital status, residency(rural vs. urban); and psychological factors: depres-sion, anxiety, distress and previous psychiatric dis-orders. RESULTS: 231 (52%) of the 443 patientsstudied, referred themselves as spiritual and/or reli-gious (religious 24,4% spiritual 11,1% religious/spiritual 16,7%). We could not demonstrate anysignificant associations between spirituality/reli-gious conviction and biological or sociodemo-graphic factors. Study data demonstrated towardslower anxiety and depression levels in the spiritualand/or religious group. The highest levels of anxietyand depression were detected in the non-religious,non-spiritual group. CONCLUSIONS: Theseresults indicate that spiritual and religious convic-tion might play an important role in patients deal-ing with life threatening diseases. Nethertheless itshould be mentioned that familiy back up was themost important support for the patients sufferingfrom cancer. However these are only preliminarydata and further results will be presented.RESEARCH IMPLICATIONS: Our findings sug-gest, that spirituality should be included as a factorin quality of life evaluations. Further studies areneeded to validate this hypothesis. CLINICALIMPLICATIONS: The major implication of thisstudy is the need for the health care providers topay more attention to the question whether spiritu-ality/religious conviction serves as a resource toindividual cancer patients. Our data indicate thatthis is the case. ACKNOWLEDGEMENT OFFUNDING: None.

P3-67

Abstract withdrawn

P3-68

Meaning Making in Cancer Survivors: A Focus

Group Study

Nadia van der Spek1, Joel Vos2, Cornelia vanUden-Kraan1, William Breitbart4, Rob Tollenaar1,Pim Cuijpers1, Irma Verdonck-de Leeuw1,3

1VU University, Amsterdam, The Netherlands,2Leiden University Medical Center, Leiden, TheNetherlands, 3VU University Medical Center,Amsterdam, The Netherlands, 4Memorial Sloan-Kettering Cancer, New York, USA

BACKGROUND: Confrontation with a life-threatening disease like cancer can evoke existentialdistress, which can trigger a search for meaning incancer patients. The purpose of this study is to gainmore insight in the meaning making process amongcancer survivors. METHOD: We conducted fourfocus groups with 23 cancer survivors on this topic.Participants responded to questions about experi-enced meaning making, perceived changes in mean-ing making after cancer and the perceived need forhelp in this area. RESULTS: Most frequently men-tioned meaning making themes were relationshipsand experiences. We found that, in general, cancersurvivors experienced enhanced meaning after can-cer through relationships, experiences, resilience,goal-orientation and leaving a legacy. Some partici-pants, however, also said to have (also) experienceda loss of meaning in their lives through experiences,social roles, relationships and uncertainties about thefuture. CONCLUSIONS: The results indicatedthat there is a group of cancer survivors that hassucceeded in meaning making efforts, and experi-enced sometimes even more meaning in life thanbefore diagnosis, while there is also a considerablegroup of survivors that struggled with meaningmaking and has an unmet need for help with that.The results of this study contribute to develop ameaning centered intervention for cancer survivors.RESEARCH IMPLICATIONS: Meaning makingseems to be an important issue in cancer survivors,but much is still unknown about the meaning mak-ing process. The results of this study give insight inmeaning making processes in cancer survivors andtheir need for help with issues with meaning andoffer targets for future research. CLINICALIMPLICATIONS: Meaning making is importantin the adjustment to life after cancer. The results ofthis study offer more insight in the perceived mean-ing making issues of cancer survivors and their needfor psychological help with this. It also gives exam-ples of how cancer survivors experience meaning inlife after cancer. ACKNOWLEDGEMENT OFFUNDING: This study is funded by the DutchCancer Society / Alpe d’HuZes/KWF Fund.



P3-69

The CHANGE Study: Web-Based Cognitive

Behavioral Therapy for Fatigued Breast Cancer

Survivors

Harriet Abrahams1, Marieke Gielissen1, MartineGoedendorp2, Marlies Peters3, Stans Verhagen3,Hans Knoop11Expert Centre for Chronic Fatigue, RadboudUniversity Nijmegen Medical Centre, Nijmegen, TheNetherlands, 2Department of Health Sciences,University of Groningen, University Medical CenterGroningen, Groningen, The Netherlands,3Department of Medical Oncology, RadboudUniversity Nijmegen Medical Centre, Nijmegen, TheNetherlands

BACKGROUND: Approximately 40% of breastcancer survivors suffer from severe fatigue aftercompletion of cancer treatment with curativeintent. Individual cognitive behavioral therapy(CBT) especially designed for postcancer fatiguewas found to be effective. Unfortunately, treatmentcapacity is limited. A web-based version of theCBT with minimal therapist support is devel-oped to extend treatment options for postcancerfatigue. The effectiveness of the internet therapywill be determined in the CHANGE study.METHOD: The web-based CBT for fatiguedbreast cancer survivors will be compared to usualcare in a randomized controlled trial. Severely fati-gued women between 18 and 65 years old, whocompleted primary breast cancer treatment at leastthree months ago, can participate in the study. Thefollowing research questions will be assessed:

• What are the effects of internet therapy on fati-gue compared to usual care?

• What are the effects of internet therapy onfunctional impairments, psychological distressand quality of life compared to usual care?

• Does time since end of cancer treatment mod-erate the effects of internet therapy?

RESULTS: The internet therapy includes sixmodules that coincide with six factors assumedto perpetuate the symptoms of fatigue. Theseperpetuating factors are: (1) coping with breast can-cer and breast cancer treatment; (2) fear of diseaserecurrence; (3) dysfunctional fatigue-related cogni-tions; (4) sleep-wake rhythm; (5) activity pattern;and (6) social support. Several assessment tools areused to determine which key modules are applicableto each participant, which makes it possibly to pro-vide a tailored treatment. The internet therapy willbe demonstrated and the first experiences ofpatients with the internet therapy (test pilot) will bepresented. CONCLUSIONS: Web-based CBT isexpected to be less time-consuming for therapiststhan regular CBT, which would result in anincreased treatment capacity. Moreover, web-basedCBT could provide an additional, easy-accessible

treatment option for fatigued breast cancer survi-vors. Participants are able to follow the internettherapy at home, at any preferred time, and can gothrough the modules at their own pace.RESEARCH IMPLICATIONS: The CHANGEstudy will provide insight in the effectiveness ofweb-based CBT for fatigue in oncology care. Thestudy will demonstrate whether web-based CBT forpostcancer fatigue will be effective in reducing fati-gue, functional impairments, psychological distressand improving quality of life for breast cancersurvivors suffering from severe fatigue aftercompletion of cancer treatment. CLINICALIMPLICATIONS: Web-based CBT is expected toincrease the limited treatment capacity of postcan-cer fatigue. If web-based CBT would be effective, itcould provide an additional treatment option forpostcancer fatigue that can easily be implementedin regular care. ACKNOWLEDGEMENT OFFUNDING: The study is financed by a grant ofPink Ribbon, the Netherlands.

P3-70

Adventure Therapy: A Novel Approach to Increasing

Physical Activity and Physical Self-Concept in

Young Adult Cancer Survivors

Lisa J. Belanger1, Erin McGowan3, Michael Lang2,Lacy Bradley2, Kerry S. Courneya11University of Alberta, Edmonton, Alberta, Canada,2University of Calgary, Calgary, Alberta, Canada,3Memorial University, St. John’s, Newfoundland,Canada

BACKGROUND: Studies have demonstratedphysical activity (PA) is beneficial both physicallyand psychologically in cancer survivors includingyoung adult cancer survivors (YACS) but it hasbeen challenging to recruit YACS to conventionalPA programming. Adventure therapy (AT) usesmetaphors to enhance participant’s ability to trans-fer challenges during the expedition to daily life.The purpose of this pilot study is to determine ifAT can positively affect physical self-concept andPA in YACS. METHOD: YACS diagnosedbetween the ages of 15–39, who were participatingin an AT expedition were asked to complete a sur-vey before and after their expeditions. A group ofYACS not participating in AT were given the sur-veys at the same time points and served as a controlgroup. The survey included the Leisure-Time Exer-cise Questionnaire and the Physical Self Descrip-tion Questionnaire-Short From (PSDQ-S).RESULTS: Eight participants responded to boththe pre and post survey (4 AT, 4 control). The meanage of the sample was 29.7 � 4.8 years. Resultsindicated that there was a greater increase inPA minutes in the AT group (146 minutes/week)than the control group (34 minutes/week). At the



one-week follow-up, scores were higher for the ATgroup in PSDQ-S subscales of body fat and globalphysical compared to the control group. CON-CLUSIONS: To our knowledge, this is the firststudy exploring the possibility that AT couldincrease physical self-concept and physical activityin YACS. In this pilot study YACS participating inAT expeditions, had a greater improvement in self-reported PA minutes and improvements in percep-tion of their bodies, on measures of global physicaland body fat, than the control group. This indicatesthat YACS in the AT group were more comfortablewith their weight and how they felt about them-selves physically. RESEARCH IMPLICATIONS:Given the preliminary results that AT may improvehow YACS feel about themselves physically andincrease their PA minutes, additional research iswarranted. Larger studies of different types of ATsand longer follow-up are needed. CLINICALIMPLICATIONS: AT expeditions are becomingmore common for YACS and research on their pur-ported benefits are needed. Such research aroundAT will help oncologists and other health care pro-fessionals describe the potential benefits of AT toYACS and make recommendations to their patientsabout attending these expeditions. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-71

Predictors of Emotional Well-Being of Adolescent

Childhood Cancer Survivors

Marek Blatn�y1, Martin Jel�ınek1, IrenaKom�arkov�a2, Tom�a�s Kep�ak31Inst of Psychology, Academy of Sciences of theCzech Republic, Brno, Czech Republic, 2Dpt ofPsychiatry, University Hospital Brno, rno, CzechRepublic, 3Dpt of Paediatric Oncology, UniversityHospital Brno, Brno, Czech Republic

BACKGROUND: According to some studies,childhood cancer survivors suffer emotional prob-lems, externalized behavioral problems and socialwithdrawal during adolescence. On the other hand,there are studies on HRQL indicating that despitethe wide range of late effects there is no differencein quality of life between childhood cancer survi-vors and healthy adolescents. The presented studyexplores the influence of different sets of factorsidentified as significant predictors of emotionalwell-being of childhood cancer survivors in adoles-cence. METHOD: Participants were 100 adoles-cents (47 girls) aged 13–20 years. The PsychologicalFunctioning subscale of MMQL was used as a mea-sure of emotional well-being. Three sets of variableswere studied: demographic variables (gender, age),medical data (delay between the end of intensivetreatment and psychological assessment, diagnosis,severity of late effects), and information about par-ent-child interactions (parental involvement, con-

trol, warmth, and inconsistency of parenting). Toanalyze the influence of independentvariables, hier-archical regression analysis was used with demo-graphic variables in the first block of variables,parenting aspects in the second block of variablesand medical data in the third block of variables.RESULTS: The only predictors of emotional well-being are gender (boys report better emotionalwell-being) and consistency of parenting (consis-tency of parenting influences better emotional well-being). No influence of cancer treatment-relatedproblems was found. CONCLUSIONS: The studysupports findings implying that there are no differ-ences between well-being/quality of life of child-hood cancer survivors and healthy (general)population of children and adolescents. More pre-cisely: although there may be differences in thequality of life between cancer survivors and healthypopulation, the sources of the quality of life of can-cer survivors are the same as in the general popula-tion. CLINICAL IMPLICATIONS: The findingsdemonstrate the importance of taking into accountproblems that might be typical for the period ofadolescence in general within the psychosocial sup-port for childhood cancer survivors. ACKNOWL-EDGEMENT OF FUNDING: This work wassupported by the Czech Science Foundation (GrantNo. P407/11/2421) and the Czech Republic’s sup-port for long-term strategic development ofresearch organizations (RVO: 68081740).

P3-72

Distress, Problems, and Supportive Care Needs

After Hematopoietic Stem Cell Transplantation

Annemarie Braamse1,2, Bernovan Meijel2,4, OttoVisser3, Peter Huijgens3, Aartjan Beekman1, JoostDekker11Department of Psychiatry and EMGO Institute forHealth and Care Research, VU University MedicalCenter, Amsterdam, The Netherlands, 2InhollandUniversity of Applied Sciences, Department ofHealth, Sports & Welfare / Cluster Nursing,Research Group Mental Health Nursing,Amsterdam, The Netherlands, 3Department ofHematology, VU University Medical Center,Amsterdam, The Netherlands, 4ParnassiaPsychiatric Institute, The Hague, The Netherlands

BACKGROUND: It is known that hematologicalmalignancies as well as hematopoietic stem celltransplantations affect patients’ health-related qual-ity of life. The problem profile of this patient groupneeds clarification, however. Moreover, it is unclearfor which problems patients need help, and whethertheir needs are met or unmet. This study aimed toassess distress, problems and corresponding careneeds up to 5 years after autologous or allogeneicstem cell transplantation (auto-SCT, allo-SCT).METHOD: In this cross-sectional study, patients



treated with auto- or allo-SCT for hematologicalmalignancies completed the Distress Thermometerand corresponding Problem List, to which supple-mentary questions on supportive care needs wereadded. Auto-SCT and allo-SCT patients were ana-lyzed separately. To compare problems and needs atdifferent time points after transplantation, we cre-ated three groups: patients 0–1 year(s), 1–2.5 years,and 2.5–5.5 years after transplantation. RESULTS:In allo-SCT patients, distress and number of prob-lems tended to be lower with longer follow-up. Thepercentage of patients with distress after auto-SCTwas highest at 1–2.5 years after SCT. Overall,patients mainly reported physical problems, fol-lowed by cognitive-emotional and practical prob-lems. The physical problems being out of shape/condition, fatigue, muscle strength, and tingling inhands and feet were mentioned most, as were thecognitive-emotional problems concentration, mem-ory, and tension/nervousness. Despite the relativelyhigh number of reported problems, the minority ofpatients with problems reported (unmet) careneeds. CONCLUSIONS: With the current study,we reached a large number of hematopoietic SCTsurvivors willing to report on their problems andcare needs. Consequently, we were able to study thedifferences between patient groups at consecutivetime periods after transplantation. We pointed outthe specific problems patients face in the years afterauto- and allo-SCT, as well as their needs for addi-tional care. In addition to the usual care as offerednowadays, specific attention should go to problemsin the physical, cognitive-emotional, and (somewhatless) practical areas of functioning. RESEARCHIMPLICATIONS: Whereas previous studiesreported unmet needs to be mainly in the daily liv-ing, practical, and psychological domains, ourresults only partly confirmed these findings. Mostunmet needs seemed to be in the physical and cog-nitive-emotional domain. More research is neededto elucidate these findings. Also, future researchshould look further into explanations for the rela-tively small number of patients reporting unmetneeds. CLINICAL IMPLICATIONS: Judged byprevalence, physical problems are the first priority insupportive care, followed by cognitive-emotionaland practical problems. Our results suggest the needfor interventions targeting specific problems in theseareas of functioning. Physical problems might betargeted by exercise programs. For patients withconcentration and memory difficulties, patientscould be treated with cognitive rehabilitation, aim-ing at compensating cognitive impairments. Psycho-logical treatment could help in improving tension/nervousness or depression. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-73

Anxiety and Depression Severity in Colorectal

Cancer Survivors: A Comparison With the

NESDA-Cohort

Annemarie Braamse1, Sietzevan Turenhout1,Jochim Terhaar sive Droste1, Gerritde Groot2,Ren�e van der Hulst3, Michael Klemt-Kropp4,Sjoerd Kuiken5, Ruud Loffeld6, Tessa Uiterwaal7,Brenda Penninx1, Jan Smit1, Chris Mulder1, JoostDekker11VU University Medical Center, Amsterdam, TheNetherlands, 2Rode Kruis Hospital, Beverwijk, TheNetherlands, 3Kennemer Gasthuis, Haarlem, TheNetherlands, 4Medical Center Alkmaar, Alkmaar,The Netherlands, 5Sint Lucas Andreas Hospital,Amsterdam, The Netherlands, 6Zaans MedicalCenter, Amsterdam, The Netherlands, 7SpaarneHospital, Hoofddorp, The Netherlands

BACKGROUND: There are some indications thatcolorectal cancer (CRC) survivors suffer fromheightened levels of anxiety and depression symp-toms, independent of their quality of life (QOL).The present study aimed to (1) assess the prevalenceof anxiety and depression symptoms in CRC survi-vors, (2) compare CRC survivors’ anxiety anddepression severity to healthy controls and personswith a lifetime diagnosis of anxiety and/or depres-sion disorder, and (3) assess health-related QOL,particularly emotional functioning, in CRC survi-vors. METHOD: In this cross-sectional study, per-sons diagnosed with CRC 3,5 to 6 years ago wereasked to complete a questionnaire package, includ-ing the Inventory of Depressive Symptomatology,Beck Anxiety Inventory, and EORTC-QLQ-C30.Descriptive statistics were used to assess the preva-lence of anxiety and depression symptoms in CRCsurvivors. With multiple linear regression analyses,we compared anxiety and depression severity ofCRC survivors to data on healthy controls and per-sons with a lifetime anxiety and/or depression dis-order, available in the Netherlands Study ofDepression and Anxiety (NESDA). Descriptive sta-tistics were used for assessing health-related QOL.RESULTS: Of 132 eligible patients, 91 completedthe questionnaire package (response rate 69%).The majority of CRC survivors had no (80,6%) ormild (13,6%) anxiety symptoms; 5% reported mod-erate or severe symptoms. The majority had no(59,3%) or mild (33,0%) depression symptoms;7,7% reported moderate symptoms. Controllingfor several sociodemographic variables, CRC survi-vors had significantly lower anxiety and depressionseverity compared with persons with a lifetime anx-iety and/or depression diagnosis. CRC survivorsreported significantly higher depression severitythan healthy controls, but did not differ on anxietyseverity. CRC survivors reported relatively goodemotional functioning on the EORTC-QLQ-C30.



CONCLUSIONS: The present study is the first tocompare CRC survivors’ anxiety and depressionseverity with person with a lifetime diagnosis ofanxiety and/or depressive disorder, as well as withhealthy controls. Despite CRC survivors reportingbetter emotional function than the EORTC-QLQC30 general population reference group, theyreported significantly higher depression severitythan healthy controls. However, anxiety anddepression severity were significantly lower com-pared to persons with a lifetime anxiety and/or depressive diagnosis. RESEARCH IMPLICA-TIONS: In CRC survivors, measuring emotionalfunctioning in QOL measurements seems to lead toan underestimation of depression symptoms. Fur-ther research is needed to confirm these findings.CLINICAL IMPLICATIONS: Even in CRC sur-vivors with good emotional functioning on a QOLquestionnaire, clinicians should be aware of poten-tial depression symptoms. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-74

Unemployment Among Breast Cancer Survivors

Kathrine Carlsen1, Marianne Ewertz2, Susanne O.Dalton3, Merete Osler11Research Centre for Prevention and Health,Glostrup, Denmark, 2Department of Oncology,Odense University Hospital, Institute of ClinicalResearch, Odense, Denmark, 3Survivorship, DanishCancer Society Research Center, Copebhangen,Denmark

BACKGROUND: Even though nearly 80% ofbreast cancer survivors return to work in the yearsfollowing treatment, it may be a challenge for can-cer survivors to maintain an affiliation to the labormarket, as the risk for non-employment has beenshown to continue. The majority of studies have,however, been focusing on risk factors for non-working and not explicitly on unemployment.Breast cancer in combination with unemploymentmight be a substantial challenge to the affectedwomen. METHOD: This study is solely based oninformation from Danish administrative popula-tion-based registers. All women diagnosed withbreast cancer between 2001 and 2009 were identi-fied. As the outcome of the study was unemploy-ment, we restricted the analysis to women aged 18–63 years and being part of the workforce at thetime of diagnosis ending up with a population of14,749 breast cancer survivors. Using cox propor-tional hazard models the women were followedfrom the time of diagnosis until unemployment,death, early retirement, emigration, age 64 years orend of follow-up (last week of March 2011), what-ever came first. RESULTS: Two years after com-pletion of treatment, 10% of women wereunemployed. The risk of unemployment turned out

to depend mostly on history of unemployment withsignificantly different frequencies of unemploymentafter diagnosis among survivors with and without ahistory of unemployment. The risk for unemploy-ment after diagnosis were doubled, if the womanhad been unemployed 53–78 weeks before diagno-sis (OR: 2.04, 95%CI: 1.78–2.34). Independent ofemployment status before diagnosis, low socioeco-nomic position was significantly risk factors forunemployment in the fully adjusted model. Clinicalfactors and co-morbidity turned out to be of minorimportance for the future risk of unemployment.CONCLUSIONS: In this study of unemploymentamong women with breast cancer, we found thatunemployment before diagnosis was the single mostpredictive factor for unemployment in the years fol-lowing. Risk for unemployment was associatedwith low socioeconomic status, but not with comor-bidity or clinical factors. Depression before diagno-sis was a risk factor in the group of women notunemployed before diagnosis. This finding leads toidentification of a special vulnerable group ofwomen, who have to struggle with both a history ofunemployment and a severe disease. RESEARCHIMPLICATIONS: As the prevalence of breast can-cer survivors in working age is increasing it isbecoming more important to identify different path-ways from patient back to normal life. Non-workingcovers a range of possible states as retired, sicknessabsence, assisting spouse, leave or unemployed. Allthese states can be caused by different risk factors.Research in these different risk factors can improvethe rehabilitation of cancer survivors. CLINICALIMPLICATIONS: Identifying special vulnerablebreast cancer survivors is important in order to helpthis group of survivors to get back to a normalizedlife. Rehabilitation under and after treatment hasto be tailored to the special needs of the individual,and women with a history of unemployment mighthave special needs. ACKNOWLEDGEMENT OFFUNDING: This work is funded by The DanishCancer Society and The Novo Nordisk Foundationand is part of The Centre for Integrated Rehabilita-tion of Cancer Patients (CIRE).

P3-75

Breast Cancer Survivors and Innovative Return and

Stay at Work Intervention: A Research Protocol

Maryse Caron1, Dominique Tremblay1,2,Marie-Jos�e Durand1,31Universit�e de Sherbrooke, Sherbrooke, Qu�ebec,Canada, 2Centre de recherche de l’Hopital CharlesLeMoyne, Longueuil, Qu�ebec, Canada, 3Chaire derechercher en r�eadaptation au travail J.A.Bombardier et Pratt & Whitney Canada, Longueuil,Qu�ebec, Canada

BACKGROUND: To reduce the substantial gapsin our understanding of how to develop and



successfully implement survivors centred interven-tions, our research project aims: 1) To identify theinter related factors influencing the return to work(RTW) and staying at work (SAW), 2) To developa intervention for a healthy RTW, 3) To evaluatethe feasibility of the intervention. METHOD: Acomparative case study (n = 2) will be performed toidentify inter related factors influencing RTW andSAW for breast cancer survivors (Obj. 1). The unitof analysis will be the RTW and SAW trajectories.Data will be collected mainly throughout semi-struc-tured interview with breast cancer survivors(n = 24), 1 and 3 years after cancer diagnosis. Build-ing on the identified factors, complementary sourcesof information (literature review and expert panel)will be mobilised to develop a survivors and evi-dence-based intervention to support RTW and SAW(Obj. 2). The intervention prototype will then betested for the feasibility (Obj. 3). RESULTS: Withmore woman surviving breast cancer, it has becomemore likely that these cancer survivors can continueto work for many years following diagnosis andprimary treatment. The results of this project willjoin the specialised oncological rehabilitation pro-grams for cancer survivors to facilitate improve-ment of functional deficit related to cancer and itstreatment, and the health-related quality of life.CONCLUSIONS: In order to maximize effectiveintervention components of RTW and SAW, itmust be tailored accounting the complexity of fac-tors which can influence the success or failure of ahealthy cancer survivorship. Our study protocol setforth research methods to capture the breast cancersurvivors, their families, employers and colleaguesissues. RESEARCH IMPLICATIONS: The origi-nality of this project resides in the methods used forthe elaboration of the intervention. First, the use ofa logic modelling approach to conceive the interven-tion will permit to explain and describe the linksbetween the different components of it. Second, theparticipative approach will assure that the interven-tion designed in this study will be patient-centered.CLINICAL IMPLICATIONS: Again, the originalmethodology of this project will make the interven-tion developed of interest for clinical experts. Thelogic modelling approach will permit the experts tounderstand and evaluated the intervention potentialeffectiveness and the participative approach combinewith evidence-based data will assure the relevance ofthe intervention. ACKNOWLEDGEMENT OFFUNDING: Chaire de recherche en r�eadaptationau travail (J. A. Bombardier et Pratt & WhitneyCanada).

P3-76

Relationship of Fatigue, Exercise Intensity,

Depression, Physical Status and Fatigue Related

Factors in Head and Neck Cancer Survivors in

Taiwan

Yen-Ju Chen, Yeur-Hur Lai, Yun-Hsiang Lee,Yuan-Yuan FangNational Taiwan University, Taipei, Taiwan

BACKGROUND: Fatigue is a common symptomin cancer patients caused by active treatment. Someevidence supported exercise could improve cancerpatients’ fatigue. However, limited research hasexplored head and neck cancer survivors’ fatigueexperience related to exercise intensity and depres-sion. Therefore, the purposes of the study were: (1)to explore the relationship of fatigue, exercise inten-sity, depression and physical status; and (2) to iden-tify the predictors of fatigue in Taiwanese head andneck cancer survivors. METHOD: A cross-sec-tional study with purposive sampling was con-ducted in a medical center in northern Taiwan.Head and neck cancer patients completed treatmentfor 3 months to 5 years were included. We assessedpatients’ fatigue, exercise intensity, depression andphysical status by Fatigue Severity Inventory, Go-din Leisure-Time Exercise Questionnaire, Depres-sion Subscale of Hospital Anxiety and DepressionScale, and Karnofsky Performance Scale. Pearson’scorrelation, T-test, and ANOVA were used to exam-ine the association among fatigue and variables.The significant variables including age, monthssince diagnosis, surgery with or without reconstruc-tion, KPS, depression, and exercise intensity wereput into the linear regression model. RESULTS: Atotal of 144 eligible patients were recruited. Theresults showed that: (1) half of patients (52.6%) didmoderate leisure activity weekly, then strenuousactivity (27.7%) and light exercise (19.7%). (2)Patients had mild fatigue and it was correlated todepression and age (r = 0.24, �0.33, respectively;p < 0.01). Fatigue severity had significantly differ-ence by exercise intensity (F = 7.72; p < 0.01).Patients doing strenuous exercise had lower levelsof fatigue than patients doing moderate and lightexercise. (3) The predictors of fatigue were exerciseintensity, depression, age, and reconstruction(R2 = 0.26, p < 0.05). CONCLUSIONS: Theresults revealed that patients doing higher intensityexercise may improve their fatigue. Besides, depres-sion is also an important predictor of fatigue.Therefore, healthcare providers should also payattention to mental health while using exercise pro-gram to improve fatigue. Future study shoulddevelop effective intervention to manage the fatigueand enhance their quality of life. RESEARCHIMPLICATIONS: The finding indicated thatpatients’ fatigue was correlated to mental distressand activity. Also, the different age or complication



resulted from types of surgery lead to the levels offatigue variedly. It is necessary to understandpatients’ preference of exercise or activity and phys-ical function status for developing the various exer-cise guidance for fatigue management in the future.CLINICAL IMPLICATIONS: Our results foundfatigue still occur in head and neck cancer survi-vors. The impacts of mental distress and potentialphysical symptoms caused by treatment are neededto concern continuously in the survivorship. Thestudy suggests assessment of patients’ mental andphysical status simultaneously may promote fatiguemanagement effectively. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-77

“It Will Never be the Same:” Adjusting to Real Life

After Breast Cancer Treatment

Juhee Cho1,2, Im-Ryung Kim3, Soo Jung Park1,Danbee Kang1, Eun-Kyung Choi3, Jung HeeYoon31Sunkyunkwan University, Seoul, Republic of Korea,2Johns Hopkins Bloomberg School of Public Health,Baltimore, Maryland, USA, 3Samsung MedicalCenter, Seoul, Republic of Korea

BACKGROUND: Breast cancer patients feelrelieved when initial treatment is over and they arekeen to back to the life they had before cancer.However, the end of treatment would presentpatients with changes and new physical, psycholog-ical, and psychosocial challenges. This study aimedto explore the whole experience of adjusting to reallife after breast cancer treatment among Koreanbreast cancer patients. METHOD: This was asequential mixed methods study. In Phase I, indi-vidual in-depth interviews were conducted with 30disease free breast cancer survivors to identify diffi-culties, barriers, and concerns that they experiencewith adjusting to real life after cancer treatment. InPhase II, 280 breast cancer survivors were surveyusing 60 items in 5 domains that were identifiedfrom Phase I study: 1) fear of recurrence; 2) symp-toms related to physical and mental condition; 3)roles in family and community; 4) returning towork; and 5) life planning after cancer treatment.RESULTS: 87.1% of the study participants wor-ried about fear of recurrence. About one third ofthe survivors worried about that their childrenwould get cancer because of them (67.1%). Theyhad difficulties to implement or keep health behav-iors regardless of their knowledge. Women in 50’sexperience more challenges in daily life than otherage groups which might be due to multiple roles infamily and society. Low-income group have moreconcerns about their working ability than healthymanagement. Spouse’s supports and working andsocial environment was the key for them to over-come barriers to adjust to reality. CONCLU-

SIONS: Survivors experienced on-going problemsand challenges regarding daily activities, work-related life, personal relationship, and social activi-ties, and they were not well prepared for thechanges. They had both practical and emotionalissues with pain and fatigue and their daily activi-ties were disturbed by fear of recurrence and cancerstigma. Lack of information, negative perception,limited family and social support were the key bar-riers for them to adjust to reality. CLINICALIMPLICATIONS: Health professionals shouldassess needs of patients when the initial treatment isover and provide appropriate information and psy-chosocial support to the patients to help themadjust well to daily routine that they enjoyed beforethe cancer diagnosis. ACKNOWLEDGEMENTOF FUNDING: This study was a part of BRAVOprogram and we would like to thank GoldmanSachs for their support of the BRAVO program.

P3-78

Abstract withdrawn

P3-79

Fear of Cancer Recurrence in Patients With

Colorectal Cancer - A Retrospective Study

Jose Custers1, Marieke Gielissen1, StephanieJanssen2, Hans De Wilt2, Judith Prins11Radboud University Nijmegen Medical Centre,Department of Medical Psychology, Nijmegen, TheNetherlands, 2Radboud University NijmegenMedical Centre, Department of Surgery, Nijmegen,The Netherlands

BACKGROUND: Fear of cancer recurrence(FCR) is one of the most commonly reported prob-lems amongst colorectal cancer survivors and animportant unmet psychosocial need for help. It is anormal and common concern for cancer survivorswho have completed treatment and are in remis-sion. However, for some survivors this fearbecomes so high that they have difficulties in per-forming daily activities. This study focuses on theseverity and characteristics of FCR in colorectalcancer survivors. METHOD: Two hundred fiftyfour patients diagnosed with colorectal cancer inthe period 2003–2010 from the Radboud UniversityNijmegen Medical Centre in the Netherlands wereasked to participate. An information letter wasmailed to all colorectal cancer survivors togetherwith questionnaires on demographic variables andmedical data, the Cancer Worry Scale (lowfear: ≤ 13, high fear: ≥ 14) and the Fear of CancerRecurrence Inventory (subscales triggers, psycho-logical distress and functioning impairments).RESULTS: One hundred nine patients (43%)returned the questionnaires. Of these, 84 patients



(median age 67.1; range 42–89 years) were diseasefree and did not have a recurrence or metastasis(time since diagnosis M = 4.91 SD = 2.4). About athird of these patients (34.5%) experience high lev-els of FCR that coincide with psychological dis-tress, functioning impairments including work,daily and social activities, the ability to make futureplans and triggers that make one think about thepossibility of a recurrence. No relation was foundbetween high levels of fear and age, time since diag-nosis, gender, stage of disease or having a stoma.CONCLUSIONS: A long time after the diagnosisof colorectal cancer, FCR is a problem for a sub-stantial part of survivors. Survivors with high levelsof FCR experience significantly more psychologicaldistress, functioning impairments and triggers com-pared to survivors with low levels of FCR.RESEARCH IMPLICATIONS: This researchdemonstrates that severe FCR is still prevalent in asubstantial part of cancer survivors for a long per-iod after the end of primary treatment. Moreresearch into the underlying mechanisms of thedevelopment of severe FCR is needed to under-stand this phenomenon. CLINICAL IMPLICA-TIONS: The results implicate that fear of cancerrecurrence can have a large impact on survivors’lives. It is important to develop an intervention tai-lored to this specific fear to reduce the high levelstowards more normal levels of fear. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-80

Physical Exercise and Return to Work: Cancer

Survivors’ Experiences

Iris Groeneveld, Angela de Boer, MoniqueFrings-DresenCoronel Institute of Occupational Health, AcademicMedical Center, University of Amsterdam,Amsterdam, The Netherlands

BACKGROUND: Cancer survivors often experi-ence problems returning to work. Physical exercisemight influence return to work and vice versa. Togain insight into these influences, it is necessary toexplore cancer survivors’ personal experiences. Thegoals of this qualitative study are to explore cancersurvivors’ experiences with 1) return to work andwork performance; 2) a physical exercise programafter treatment; and 3) the perceived link betweenphysical exercise and work. METHOD: Semi-structured face-to-face interviews were held withcancer survivors of working age who had recentlybeen treated with chemotherapy and had after-wards completed a group-based supervised physicalexercise program. The interviewer asked openquestions and followed a phenomenologicalapproach. All interviews were audio-taped andtranscribed verbatim. The text was coded and cate-gorized using MaxQDA. A second assessor was

involved in coding two of the interviews.RESULTS: Ten cancer survivors participated, ofwhom nine were female and seven had breast cancer.Eight participants returned to work. Half of the sur-vivors had difficulties returning to work due toinsufficient occupational physician support. Six sta-ted they had suffered cognitive deficits whichimpaired work performance. Main perceived effectsof the exercise program were “improved fitness” and“renewed energy”. Most participants thought thatphysical exercise had likely contributed to return towork, primarily by increasing energy levels. Somebelieved that physical exercise had facilitated copingwith demanding work. A supportive work environ-ment was believed to stimulate the continuation ofphysical exercise. CONCLUSIONS: Cancer survi-vors experienced a positive influence of physicalexercise on return to work and work performance,and a positive influence of return to work on physi-cal exercise. RESEARCH IMPLICATIONS: Con-sidering our findings, and the fact that the numberof cancer survivors of working age is increasing andtheir 5-year survival is rising, it would be interestingto find out the implications of sustained physicalexercise on return to work and work performanceon the longer term. In further research, generaliz-ability should be optimized by including more malecancer survivors and a broader spectrum of cancertypes. CLINICAL IMPLICATIONS: Cliniciansshould incorporate supervised physical exercise as astandard component into the rehabilitation processof cancer survivors. Occupational physicians couldadvise cancer survivors to remain physically activebefore, during and after return to work. Also, theycan advise the employer to create an exercise-friendly environment to stimulate physical exerciseand thereby facilitate work performance.ACKNOWLEDGEMENT OF FUNDING: Weare grateful to the Alpe d’Huzes Foundation/Dutch Cancer Society for funding the study.

P3-81

Women’s Experiences of Social Support During the

First Year Following Primary Breast Cancer

Surgery

Sigrunn Drageset1, Torill Christine Lindstrøm2,Tove Giske31Bergen University College, Faculty of Healh andSocial Sciences, Bergen, Norway, 2University ofBergen, Faculty of Psychology, Bergen, Norway,3Haraldsplass Deaconess University College,Bergen, Norway

BACKGROUND: Social support is regarded asimportant in helping women adjust to breast can-cer, and varies during their disease and treatment.To be able to improve psychosocial care by usinginnovative approaches, it is important to under-stand social support and its significant role



throughout the breast cancer experience. The pur-pose of this qualitative follow-up study was todescribe women’s individual experiences of socialsupport during their first year after primary breastcancer surgery. METHOD: Individual semi-struc-tured interviews were conducted at a Norwegianuniversity hospital with 10 women (aged 51 to67 years) 1 year after primary breast cancer sur-gery. The interviews varied in length from 55 to100 minutes. The informants were asked andprobed about their experiences of social supportthroughout the first year following breast cancersurgery. The transcripts were analysed usingKvale’s method of qualitative meaning condensa-tion analysis. RESULTS: Analysis revealed fourthemes of social support: sharing experiences, con-tinuity, understanding, and information and expla-nation. Mutual sharing of experiences increased thewomen’s knowledge and experience of support, andminimised rumination. Continuity of care gave feel-ings of security and trust. To be met with under-standing and seen as a person, not just as “adiagnosis being treated”, was important in thewomen’s experiences of support. The women feltuncertainty and loss of support after treatment.Knowing that healthcare professionals had timeand would provide care if needed was important.Information and explanation about treatment andthe possible treatment-related problems were essen-tial. CONCLUSIONS: This study illuminateswomen’s experiences of social support during thefirst year following breast cancer surgery. Sharingmutual experiences appears to be an important cop-ing strategy in women’s experiences of social sup-port. The women’s psychosocial support needs areessential to include along with medical treatmentsand procedures. RESEARCH IMPLICATIONS:Further research could focus on the followingissues: (a) studying social support from healthcareprofessionals in the first year after breast cancersurgery among samples of women from differentcultures; (b) studying whether a nursing interven-tion (e.g. participation in a support group) duringthe first year after breast cancer surgery could havebeneficial effects on these women’s well-being andability to cope. CLINICAL IMPLICATIONS: Byunderstanding women’s individual experiences andsupport needs, healthcare professionals can be animportant resource in providing support and infor-mation to women. In order to provide holistichealthcare and support, it is essential to include thewomen’s psychosocial support needs along withmedical treatment. The results can be both usedclinically to understand the women’s support needsduring the first year following breast cancer sur-gery, and used in planning and implementing carefor these women. ACKNOWLEDGEMENT OFFUNDING: None.

P3-82

Physical and Psychosocial Problems in Cancer

Survivors Beyond Return to Work: A Systematic

Review

Saskia Duijts1, Martinevan Egmond1, EvelienSpelten2, Peter van Muijen1, Johannes Anema1,Allard van der Beek11VU University Medical Center, Amsterdam, TheNetherlands, 2Dutch Organisation of PsychosocialOncology, Amsterdam, The Netherlands

BACKGROUND: Attention for the expandinggroup of cancer survivors at work, and the lateeffects they are confronted with while working, hasbeen limited. The objective of this systematic reviewis to identify and summarize studies, exploringongoing physical and psychosocial problemsrelated to functioning of employees with a historyof cancer, beyond their return to work.METHOD: Publications were identified throughcomputerized Medline, Psychinfo, Embase and Ci-nahl searches (January 2000–March 2013). Studieshad to be directed at cancer survivors, who wereemployed during the study. Both qualitative andquantitative studies were included. Two reviewersindependently extracted data from each publica-tion, including design, study population, physicaland psychosocial problems (e.g. fatigue, cognitivelimitations), and outcome measures (e.g. work pro-ductivity). Qualitative and quantitative results wereextracted. RESULTS: The search identified 8979articles. After exclusion on title and abstract, 64were retrieved for full text screening, of which 30met the inclusion criteria. A total of 20 studiesreported quantitative and 10 studies reported quali-tative results. Regarding psychosocial problems,cognitive limitations were frequently reported toinfluence work ability; coping issues diverged fromdealing with insensitive management to over-pro-tectiveness of supervisors; fatigue was found to besignificantly more present in cancer survivors atwork than in the general working population.Regarding physical problems, treatment-inducedmenopausal symptoms were frequently described asbeing disruptive at work and affecting work perfor-mance. CONCLUSIONS: Ongoing physical andpsychosocial problems are present in occupation-ally active cancer survivors, which may cause seri-ous difficulties at work. The results of this studymay be used as input for developing supportiveinterventions for these survivors. RESEARCHIMPLICATIONS: This comprehensive overviewof most explored and reported problems in cancersurvivors impacting functioning at work may be apoint of departure for research on, for example,presenteeism and sickness absence in occupation-ally active cancer survivors. CLINICAL IMPLI-CATIONS: (Occupational) health careprofessionals, but also employers and colleagues,



should be included in the organisation of keepingcancer survivors occupationally active. Whenemployees with a history of cancer are given tai-lored support, and personal recommendations andwork-related adjustments are made, they may bemore likely to continue and manage their (former)illness at work. ACKNOWLEDGEMENT OFFUNDING: None.

P3-83

Early Stage Lung Cancer Survivors’ Characteristics

and Relevant Factors of Sleep Disturbance

Yow Shan Han, Yeur Hur Lai, Chia Tai Hung,Chia Ling ChangNational Taiwan University School of Nursign,Taipei, Taiwan

BACKGROUND: Sleeping disturbance was com-monly reported among cancer patients. Cancersymptoms such as pain, anxiety, and depressioncan interfere with sleeping quality. Advanced lungcancer patients’ emotional distress and symptomburden were typically emphasized. Two purposes ofthis study focused on early stage lung cancerpatients at one month after the operation (1) toexplore the association among pain severity, psy-chological burden, and sleeping disturbance, and(2) to identify relevant factors of patients’ sleep dis-turbance. METHOD: This was a cross-sectionalcorrelational study in a medical center in the north-ern Taiwan to recruit early stage lung cancerpatients whose tumor was just removed. The timepoint of Interview was at one month after surgery.The IRB approval was obtained. Pain severity, totalnumber of symptoms, physical exercise, perfor-mance, psychological status, and sleep quality wereself-reported in the instruments: a 10-point scale forpain, Godin physical activity questionnaire, Karnof-sky Performance Scale, Sleep Disturbance Question-naire, the Hospital Anxiety and Depression Scale-Anxiety, and Mishel’s Uncertainty of Illness-Com-munity version. Descriptive analysis, comparisonanalysis, and linear regression were proceeded forresearch purposes. RESULTS: This study recruited225 patients with the average of age 59.5(SD = 11.5). There were 132 female patients. Ninetypercent of patients had at least one symptom. Theworst pain and average pain were scored lower than3. Sixty percent of patient maintained physical exer-cise and that was correlated to less sleep disturbance.Patients reported a lower level of psychological dis-tress on anxiety (mean = 0.56, SD = 0.53), depres-sion, (mean = 0.54, SD = 0.57), and uncertainty(mean = 2.19, SD = 0.58). Regression shows thatsleeping distress was predicted by younger age, anincreasing number of symptoms and a higher levelof uncertainty and anxiety. CONCLUSIONS:Early stage lung cancer patients perceived a fewernumber of symptoms, less symptom burden, and a

low level of psychological distress that may bebecause the tumor was removed. Our findings sug-gest that (1) sufficient physical activity is necessaryfor sleep quality; (2) patients having more symp-toms and psychological problems were more likelyto have sleep disturbance. Therefore, strategiesabout symptom management and alleviating psy-chological distress are essential to prevent cancerpatients from sleep disturbance. CLINICALIMPLICATIONS: Clinical providers should stillbe aware of the fact that symptoms and psychologi-cal distress are still central issue in improvingpatients’ sleep quality, although early stage lungcancer patient did not report great symptom bur-den. Moreover, Patients in the survivorship areencouraged to maintain daily physical activities toimprove sleeping quality. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-84

Fear of Recurrence After Breast Cancer Treatment

Sarah Hauspie1, Geert Crombez21AZ Maria Middelares, Gent, Belgium, 2UniversiteitGent, Department of Experimental clinical andhealth psychology, Gent, Belgium

BACKGROUND: More women are faced withthe challenges of survival of cancer, such as dealingwith fear of recurrence. This study aimed to assessthe prevalence of fear of recurrence in curativebreast cancer patients. We investigated the relation-ship between fear of recurrence and distress as wellas a number of demographic and disease-relatedvariables. We also examined the statistical qualitiesof the Concerns About Recurrence Scale - EnglishLanguage Version for a Flemish audience.METHOD: Questionnaires were sent to 159patients who underwent curative breast cancertreatment in AZ Maria Middelares, a general hos-pital in Belgium, during the past 9 years. Thepatients completed the CARS-DLV and theDistress Barometer. We questioned these patientson a number of personal and disease-related data,and linked this to the data available through theregistration of the Multidisciplinary Oncology Con-sultations. RESULTS: The results show that14.5% of participants report high fear of recur-rence, and 61.8% moderate fear of recurrence. Weobserve a moderate to high correlation betweenfear of recurrence and distress. Except a negativecorrelation with age, we find no significant relation-ship between fear of recurrence and demographicand disease-related variables. The internal consis-tency of the CARS-DLV is high. CONCLU-SIONS: We conclude that fear of recurrence afterbreast cancer treatment is a topic that deserves clin-ical attention, given the high prevalence and associ-ation with distress. There is a need for a broaderplan of care for patient follow-up after cancer treat-



ment both, medical (including information aboutside effects anti-hormonal therapy) and psychoso-cial. Detection of high levels of fear of recurrencemay be an important first step. RESEARCHIMPLICATIONS: Most psychosocial interven-tions are tested and analyzed to help patients dur-ing cancer treatment. More research about how todeal with fear of cancer recurrence is needed so thatinterventions can be developed to further supportthese patients. CLINICAL IMPLICATIONS:Given the high prevalence of fear of cancer recur-rence, even years after treatment, and given theassociation of fear of cancer recurrence with dis-tress, detection of high levels of fear of recurrence isan important first step in psychosocial care aftercancer treatment. ACKNOWLEDGEMENT OFFUNDING: None.

P3-85

A Longitudinal Perspective on Post-Traumatic

Growthfollowing the Diagnosis of Breast Cancer:

The Mediating Role of Mindfulness and Attachment

Security

Naama Hirschberger1, Mario Mikulincer2,Tamar Peretz31Assuta Medical Center, Tel-Aviv, Israel,2Interdisciplinary Center IDC Herzliya, Herzliya,Israel, 3Hadassa Medical Center, Jerusalem, Israel

BACKGROUND: Research has focused attentionon positive change that takes place following a cri-sis and has examined both immediate responses aswell as the long-term effects of severe life stressorson positive growth. However, the scope of thesestudies is still limited as most studies are descriptiveand do not attempt to explain the dynamics thatinstigate change. Moreover, studies of post-trau-matic growth following diagnosis with cancer usu-ally do not examine growth over time. METHOD:The current prospective longitudinal study willexamine the role of psychological resources onpost-traumatic growth. In this study two groups ofwomen will be followed over time: The study groupconsisting of 30 women between the ages of 40–65who have been diagnosed with stage I or II breastcancer in the past 12 months and a matched controlgroup of 30 women. Both samples will be studiedthree times over a period of 2 years and will com-plete self-report questionnaires and will be inter-viewed. In addition, medical and demographicinformation will be obtained from patient hospitalrecords. RESULTS: The results of this research arebased on two stages of analysis. At the first stage,we conducted a qualitative analysis of the 180 inter-views of both the study group and the control groupat three times of measurement. In this stage wecontent-coded responses and extracted 15 uniquecodes that reveal the effects of a diagnosis of breastcancer on women’s self-concept and relational striv-

ings. We are currently conducting a longitudinalquantative analysis of the data and these findingswill be ready for presentation at the time of the con-ference. CONCLUSIONS: This research revealsthe profound impact of being diagnosed with breastcancer on the self-concept of survivors. This res-each is unique in the sense that it represents a pro-spective longitudinal study of women disgnosedwith breast cancer from the time of diagnosis upuntil 2 years later. Specifically, both the qualititiveand quantitative aspects of this research are exam-ined longitudinally and provide us with a uniqueperspective on the possibility of personal growthover time. CLINICAL IMPLICATIONS: Thisresearch will provide the basis for the developmentof clinical interventions designed to help womencope over time with the diagnosis of breast cancer,and will inform clinicians on how to promotegrowth and an existential sense of meaning in theface of severe adversity. ACKNOWLEDGEMENTOF FUNDING: This research was funded by agrant from the Israel Cancer Society.

P3-86

Interventions to Improve the Well-Being of Breast

Cancer Survivors at the End of Active Treatment: A

Systematic Review of the Literature

Nick Hulbert-Williams1, Samantha Flynn1, LisaHeaton-Brown1, Karen Scanlon21University of Chester, Chester, UK, 2Breast CancerCare, London, UK

BACKGROUND: Breast cancer is the most com-monly diagnosed cancer in the UK. Due to recentdiagnostic and treatment improvements, large num-bers are now living far beyond the end of activetreatment into long-term survivorship. Both physi-ological and psychological effects of cancer diagno-sis and treatment, however, can continue intolonger-term survivorship, reducing wellbeing andquality of life. This review aimed to reviewliterature on interventions delivered at the time oftransition from active treatment to follow-up.METHOD: Standard systematic reviewing proce-dures were used. Literature searching included elec-tronic databases of published literature, databasesof ongoing research in the UK, and hand-searchingof relevant conference proceedings. Inclusionscreening of search outputs, and all data extraction,were conducted by two reviewers independently. Atotal of 20 studies were included in this review. Dueto heterogeneity of methods and measures used ineach study, meta-analysis was not possible and so anarrative synthesis was used. Study methodologicalquality was assessed according to the CONSORTstatement. RESULTS: Methodological quality wasvaried, though none of the included studies was sopoor in quality that we felt it important to excludethe findings. Included studies grouped into four



design categories: psychotherapeutic interventions(4 studies), psychoeducational interventions (4studies), health-related behaviour change interven-tions (4 studies), and, combination interventions (8studies). A range of theoretical frameworks wasemployed including cognitive-behavioural, transac-tional, trans-theoretical, and mindfulness-basedapproaches. Some beneficial impact on psychologi-cal wellbeing was reported, though different modesof intervention seem more suited to particular out-comes than others. Overall, this evidence is smalland somewhat inconsistent with regard to statisticaland clinical effectiveness. CONCLUSIONS: Awide range of outcome variables were assessed ascomponents of well-being and this review raises thequestion as to what outcomes are most appropriatefor these interventions; some qualitative work withbreast cancer survivors at transition from treatmentwould be helpful to establish what outcomes theythink are most important. General trends suggestthat psychotherapeutic interventions are moreeffective for depression; psychoeducational inter-ventions for anxiety; and combination interventionsfor health behaviour change. All types of interven-tion seem to have some effectiveness for quality oflife and perceived health status, though few studiesreported statistically or clinically large effect sizes.RESEARCH IMPLICATIONS: One of the diffi-culties in conducting this review was fully under-standing the content of the interventions delivered;reporting was often brief and vague, presumablydue to journal word-limits. It is important thatadditional information is made available throughother means. We excluded a large number of poten-tially relevant studies simply because the mean timebetween end of treatment and intervention was toolarge; researchers should strive to reduce this poten-tially confounding variable in future studies. CLIN-ICAL IMPLICATIONS: There is a clear need tobe offering interventions to breast cancer survivorsat this important transition in their care. However,the evidence to date is unclear about which specificmode of intervention is most suitable. Interventionsare unlikely to be able to improve all aspects ofwell-being and so it is important that any interven-tion used is matched to individual patient need anddesired outcome. ACKNOWLEDGEMENT OFFUNDING: This work was supported by a projectgrant from the UK Big Lottery Fund.

P3-87

The Variance of Physical Activity and Psychological

Distress of Patient With Early Stage Lung Cancer

Through Three Months After Tumor Removal

Chia Tai Hung1, Yeur Hur Lai1, Yun Hsiang Lee1,Chia Ling Chang1, Jin Shing Chen21National Taiwan University School of Nursing,Taipei, Taiwan, 2National Taiwan UniversityCollege of Medicine, Taipei, Taiwan

BACKGROUND: Cancer patients are encouragedto maintain their physical activities to improve sta-mina and strengthen bone and muscles to preventfall. Early stage lung cancer is removable and thatmay change patients’ daily activities. Prior studieson physical activities addressed alleviation of fati-gue and energy conservation for advanced cancerpatients. The purpose of this study was to explorethe changes of physical activities and psychologicaldistress of early-stage lung cancer patients in threemonths after surgeries. METHOD: This was anlongitudinal observational study. The patients whowere diagnosed with lung cancer at stage I, II, andIIIA, and received tumor removal were recruited.Three interviews were at (1) before operation, (2)1 month and (3) 3 months after operation. Vari-ables included patients’ leisure-time physical activi-ties, quality to life, sleeping problems,psychological problems, and patients’ symptoms.Instruments measured these variables were the Go-din leisure-time physical activity questionnaire, EO-RTC-L13, sleep distress questionnaire. The IRBapproval was obtained. Descriptive analysis, inde-pendent t test, Pearson’s correlation, and linearregression were proceeded in the SPSS software.RESULTS: A total of 188 cancer patients com-pleted three interviews. The mean of age are 59.53(SD11.50). Half of patients (N = 97) had sufficientphysical activities (Godin ≥ 24) before diagnosis.Ten percent of all patients were increased into thesame activity category after surgery. The scores ofdepression, anxiety, and depression were lowalthough the scores of three psychological problemsbefore surgery were the highest. Regression showedthat physical functional was significantly restrictedby patients who were old, had more symptoms andmore depression, and decreased physical exercise.Emotional function limitation was mainly predictedby anxiety. CONCLUSIONS: Early stage lungcancer patients after tumor removal had less symp-tom burden, psychological distress, and sleepingdisturbance. Most of these cancer survivors con-stantly performed sufficient physical activities evenafter surgery. Maintaining physical activity is sig-nificantly correlated to improve patients’ physicalfunction. Anxiety influences patients’ emotionalfunction, while depression may limit physical activ-ity and then influences physical function. Our find-ing also suggests that patients having a lowernumber of symptoms can have less restriction onperforming physical function. RESEARCHIMPLICATIONS: Because early stage lung cancerpatients seems to have a low level of anxiety anddepression, it is important to develop a qualitativeresearch on understand psychological needs forearly stage lung cancer survivors. Current studyalso shows that physical activity improves patients’physical function. Further research on developingappropriate exercise mode for cancer patients, andusing objective measures or equipments to confirm



efficient of patient activities will be encouraged.CLINICAL IMPLICATIONS: Clinical providersshould still provide symptoms management and psy-chological support as the core of patient care to pre-vent cancer survivors from symptom burden andpsychological distress. Furthermore, it is importantto help these cancer survivors maintain sufficientphysical activity to enhance physical function.ACKNOWLEDGEMENT OF FUNDING: None.

P3-88

Relationship Between Sleep Problem and Anxiety in

the Head-And-Neck Cancer Survivors

Yu-Ju Hung, Yeur Hur Lai, Yun Hsiang Lee,Yen-Ju Chen, Chia Tai HungNational Taiwan University, Taipei, Taiwan

BACKGROUND: Head and neck cancer (HNC)patients have highly potency of insomnia. Theirsleeping problems may be caused by their psycho-logical distress, cancer-related symptoms, and lessflexible movement of their neck result from opera-tion and radiotherapy. Those problems can inter-fere with patients’ sleep quality and furthermoreimpact their quality of life. The aim of this studywas to evaluate the relationship between anxietyand sleep problems in the HNC patients.METHOD: A cross-sectional correlation studywas conducted in a medical center in northern Tai-wan. A total of 159 patients who were diagnosedwith head-and-neck cancer and completed treat-ment for 3 months to 5 years were recruited in thisstudy. Patients’ sleep problem and anxiety weremeasured by the (average sleep time) Medical Out-comes Study-Sleep Scale (MOS-SS), Sleep Distur-bance Questionnaire (SDQ), and the AnxietySubscale of Hospital Anxiety and Depression Scale(HADS). Description analysis was used to describepatients’ background information, sleep problemstatus and anxiety status. Pearson’s correlation wasconducted to examine the relationship betweensleep problem and anxiety. RESULTS: The majorfindings were: (1) patients’ mean age was 57(SD = 11.67) and majority of them were male(69%); (2) Most of patients were nasopharyngealcarcinoma (42.1%) and then oral cancer (30.1%);(3) Even though patients’ reported relatively lowlevels of sleep disturbance. Patients who werereported higher levels of anxiety had worse sleepproblems including concerning restlessness/agita-tion(r = 0.44), mental over-activit (r = 0.46), andsleep disturbance(r = 0.31). The total sleepinghours in average was 6.8 (SD = 1.92) and a lowscore were reported in each sleeping domain.Unemployed patients (n = 55) reported a higherlevel of sleeping problems and anxiety but that didnot reach statistical significance. CONCLU-SIONS: The age of these HNC patients were attheir middle age, which may imply a potential stress

of losing working capability. These patientsreported a moderate level of anxiety and sleepingproblems. The significant positive correlationbetween anxiety and sleeping problems may indi-cate that even a low level of anxiety can influencepatients’ sleeping quality. RESEARCH IMPLICA-TIONS: The HNC patients in Taiwan reportedanxiety at a less than moderate level, that mayresulted from a majority of male patients. Investi-gators should be award of male cancer patientsexpressing psychological distress regarding the gen-der difference. Meanwhile, other psychologicalproblems of head and neck patients should beexamined to find the association with anxiety andsleep problems, in efficiently improving patient’ssleeping quality. CLINICAL IMPLICATIONS:Our finding suggest that an integrate psychologicalassessment for head-and-neck cancer patients’ isessential. The positive relationship between anxietyand sleeping problems suggests that clinical provid-ers should help patients to learn self-managementabout anxiety in improving sleep problems for thesepatients. ACKNOWLEDGEMENT OF FUND-ING: None.

P3-89

Impact of a Bilingual Education Intervention on the

Quality of Life of Latina Breast Cancer Survivors

Gloria Juarez, Arti Hurria, Gwen Uman, BettyFerrellCity of Hope, Duarte, CA, USA

BACKGROUND: Breast cancer is the most fre-quently cancer diagnosed among Latina women.However, research on survivorship outcomesamong Latina breast cancer survivorship is lacking.Survivors face a host of physical, emotional, socialand spiritual challenges ranging from fear of recur-rence to the long term effects of cancer treatment,questions about sexuality issues, uncertainty andsocial support. Based on culture and contextual fac-tors, the needs of Latina breast cancer survivors areunique. METHOD: A two-group, prospective lon-gitudinal randomized controlled trial was used orthis pilot study. A cohort of 52 Latina BCSs wasrecruited. Women were randomly assigned to theexperimental or attention control group. Subjectsin both groups completed measures of quality oflife (QOL), uncertainty, distress and acculturationat baseline, at three and six month’s follow-up. Theattention control condition involved usual care pro-vided to patients. The experimental group consistedof four one hour face-to-face sessions, either inEnglish or Spanish, delivered by a bilingual nurseresearcher. Length of the intervention was tailoredto the patient’s needs. RESULTS: After control-ling for acculturation, the four dimensions of QOLincreased slightly in both groups or remainedunchanged, without significant group by time inter-



action. The social and psychological well-being sub-scales had the lowest scores for both groups, fol-lowed by physical well-being and spiritual well-being. For total QOL, although the group by timeinteraction was not statistically significant, the posthoc difference between time 2 and time 3 in theexperimental group approached significance(p = 0.052), with a slight increase in total QOL.CONCLUSIONS: The findings suggested that La-tina BCSs have multiple QOL and survivorshipissues and concerns that may put them at risk forpoorer QOL and adjustment to survivorship, par-ticularly when compared to Caucasian BCSs. Thefindings also provided preliminary insight to theimpact of a tailored, bilingual education interven-tion on the QOL of Latina BCSs. The study addsto the limited body of literature about that popula-tion and offers some key directions for guiding thedevelopment of culturally and linguistically tailoredQOL interventions. Information, support, andresources can assist Latina BCSs in managing theirsymptoms and QOL issues throughout survivor-ship. RESEARCH IMPLICATIONS: More cul-turally congruent intervention research is needed tohelp improve health outcomes of Latina BCSs.Additional studies should aim to test the interven-tion among larger samples with the statisticalpower to test for interaction among key variables.More inquiry with the teaching materials wouldhelp to revise the intervention to make it stronger.CLINICAL IMPLICATIONS: Latina BCSs arelikely to benefit from bilingual and culturally con-gruent interventions that may improve QOL. Non-English-speaking and low-acculturated Latinas aremore vulnerable to poor QOL and increased dis-tress and may benefit from bilingual educationinterventions that consider core cultural values andbeliefs. Tremendous cultural differences existamong ethnic groups regarding communicationstyles, decision-making preferences, adherence totreatment, use of rituals, and willingness to adoptsurveillance and health maintenance behaviorspost-cancer treatment. ACKNOWLEDGEMENTOF FUNDING: Acknowledgement of Funding:This research was supported by a grant from theNational Institutes of Health (NIH), National Can-cer Institute (K07CA106551-01A2).

P3-90

Post-Cancer Pain in Long-Term Cancer Survivor

Diocles KaimukilwaMakerere, Kampala, Uganda

BACKGROUND: Chronic pain has been largelystudied in advanced cancer but less is known on theextent to which long term cancer survivors experi-ence pain many years after treatment completion. It

still is a poorly understood issue and data on itsincidence and prevalence are lacking. This study isaims to evaluate patterns of pain in long-term can-cer survivors METHOD: 178 disease free long-term survivors were enrolled during routine followup visits at the outpatient unit of the National can-cer center “Dar es salaam Tanzania. Through oralinterviews, data were collected on pain using thebrief pain Inventory. Clinical and socio-demo-graphic variables were collected RESULTS: Meanage of the sample was 58 years, mean of years sincediagnosis was 10.5. Most of the samples werewomen [85%] with a diagnosis of breast cancer[73%]. Pain was present in 50% of the sample,mean severity of pain was 5.4 [0–10 scale], meaninterference on daily life was 5 [0–10 scale]. Painlocation was mainly in the forearm and shoulderjoint [39%]. 63% did not use any medication forpain relief. Female patients and those with comor-bidities had higher pain severity and patient with ahistory of lymphomas suffer from higher impair-ment in daily life. CONCLUSIONS: Pain is still amajor concern in long-term cancer survivors, bothbecause it can be severe and e it interferes with dailylife, moreover few survivors had their pain treated.Female survivors those with some comorbid condi-tion and with a history of lymphomas should beroutinely asked for the occurrence of painRESEARCH IMPLICATIONS: The reasons whyonly a minority of survivors receives pain relievingtreatments should be investigated in future studies.Moreover it could be longitudinally investigatedthe onset and the duration pattern of pain in survi-vors. It should be investigated the efficacy of nonmedical interventions to prevent the occurrence ofpain, such as physical activity or physiotherapyinterventions. CLINICAL IMPLICATIONS:Given the occurrence of pain, it is necessary toinvestigate the presence of this symptom also inlong-term cancer survivors, especially if they arebreast cancer survivors, or have had lymphomas orpresent multiple comorbidities. ACKNOWL-EDGEMENT OF FUNDING: Tanzania ministryof health, integrated program in Oncology n. 7:“Medical and psycho-social rehabilitation programfor long-term cancer survivors in ocean roadhospital.



P3-91

Long Term Effects of Altered Appearance due to

Breast Cancer Treatment

Danbee Kang1, Im-Ryung Kim2, Eun-KyungChoi2, Soo Jung Park1, Juhee Cho1,31Department of Health Science and Technology,School of Medicine and SAHISTSungkyunkwanUniversity, Seoul, Republic of Korea, 2EducationCenter, Samsung Comprehensive Cancer Center,Samsung Medical Center, Sungkyunkwan UniversitySchool of Medicine, Seoul, Republic of Korea,3Department of Health, Behavior and Society andEpidemiologyJohns Hopkins Bloomberg School ofPublic Health, Baltimore, USA

BACKGROUND: Breast cancer survivors reportpoor body image even several years after treatment.While poor body image is highly correlated withthe altered appearance, previous studies were lim-ited to evaluate short-term effect of altered appear-ance. This study aims to evaluate long term effectof altered appearance due to cancer treatment suchas psychosocial distress and body image. We alsocompared survivors’ distress and body image asso-ciated with altered appearance with those of generalpopulation. METHOD: A cross-sectional surveywas done with 275 of disease free breast cancer sur-vivors and age matched 315 of women withoutbreast cancer. Survivors were recruited at the com-munity events which held at 23 different areas inKorea and general population were recruited in thecommunity. We asked participants about currentstatus of skin, hair, and body shape and distress,and body image due to those changes at the time ofthe survey. Distress was assessed using 10 pointvisual analogue scale and body image was evalu-ated using selected questions from EORTC-BR23.Exploratory, ANOVA, and multivariate linear regres-sion analyses were performed. RESULTS: Survi-vors report more breast change (p < 0.01), hair loss(p < 0.01) and skin change (p < 0.01) than those ofgeneral population. The long term survivors(≥5 year) still experienced altered appearance dueto treatment. They also had higher distress andpoorer body image compared to the general womeneven they had the same level of altered appearance.Regardless of survivor length, women with breastcancer had similar distress and poor body imagedue to treatment. Clearly, severer altered appear-ance was associated with higher distress and lowerbody image in both patients and general populationgroup controlling all other socio-demographic andclinical characteristics. CONCLUSIONS: Ourquantitative study confirms that breast cancer sur-vivors experience altered appearance and its distresseven several years after treatment. Treatment-induced altered appearances seem not only affectpatients’ psychological distress and body image butalso psychosocial functions. Health professional

should bear in mind that treatment-inducedappearance changes could last long and provideappropriate information and education to patients.ACKNOWLEDGEMENT OF FUNDING: Theresearch was accomplished by the support fromKorea Breast Cancer Foundation.

P3-92

Body Image in Cancer Survivors: A Systematic

Review

Vicky Lehmann, Marrit A. Tuinman, Mari€etHagedornUniversity of Groningen, University Medical CenterGroningen UMCG, Health Psychology Section,Groningen, The Netherlands

BACKGROUND: The fact that cancer treatmentcan alter the body has stimulated research on bodyimage after cancer. However, studies vary in theirconceptualization and measurement of body imageand usually focus on sexual-organ related cancers,thereby providing cancer site-specific results only.We review the possible impact of any cancer typeon body image and in order to draw conclusions asto whether body image is altered due to cancer, weinclude case-control studies only. METHOD: Wesearched Medline, Cinahl, Embase, and Psychinfofor studies meeting our search terms: body image(also including physical appearance, body satisfac-tion, attractiveness, etc.) and cancer (including neo-plasms, etc.). The initial search, after duplicateextraction, yielded 1989 hits and their abstracts arecurrently screened for eligibility by the first twoauthors. Eligible studies are published in peer-reviewed journals, include disease-free cancer survi-vors, measure body image, and are written in Eng-lish. Full-text screening will further be restrained tostudies that include a (healthy) control group.RESULTS: The screening is still in progress, butresults will be available for presentation at theIPOS conference 2013. We will present studies thatcompared cancer survivors to (healthy) controlsand report effects sizes of differences betweengroups, as an estimate to whether (significant) dif-ferences in body image between survivors andhealthy controls are clinically relevant. We will alsoreport the used measures and rate the quality of theincluded studies. Based on a cursory review of theliterature, we estimate to be able to include about30–40 studies. CONCLUSIONS: This will be thefirst systematic review aggregating knowledgeabout the possible impact of (any type of) canceron body image in survivors. RESEARCH IMPLI-CATIONS: Future research should carefullyconsider which measurement to use when investi-gating body image while also clearly stating theirconceptualization of body image. Controls shouldbe carefully considered and matched to the investi-gated group of survivors in order to draw valid con-



clusions about differences and their meaningsbetween survivors and controls. CLINICALIMPLICATIONS: Our review can guide futureclinical practice as to whether it is important tooffer additional information and care to currentpatients and survivors when body image appears tobe impaired. Interventions or additional modulesfor existing programs might be designed.ACKNOWLEDGEMENT OF FUNDING: M.Tuinman works on the basis of a grant from theDutch Cancer Society, no RUG 2009-4442.

P3-93

Breast Cancer Experience Through the Body – A

Consecutive, Six-Year Longitudinal Study of 24

Women

Sara Lilliehorn, Anneli Kero, Katarina Hamberg,P€ar SalanderUme�a University, Ume�a, Sweden

BACKGROUND: Breast cancer is a disruptiveexperience, perceived through women’s bodies intheir everyday life context. However, patients’ bodyexperiences in a life context are not sufficientlyacknowledged in breast cancer research. Due to theincreasing number of breast cancer survivors, longi-tudinal studies that pay attention to long-termexperiences of the body are of vital importance inorder to gain knowledge valuable for rehabilitationinitiatives. This study is a contribution.METHOD: Twenty-four women were consecu-tively included in a prospective project and repeat-edly interviewed during 6 years from endinghospitalised treatment. The qualitative analysis wasmade by means of thematic narrative analysis. Outof the interviews individual narratives were con-structed that reflected each woman’s body experi-ence over time. The narratives were repeatedly readto identify possible common thematic elementsacross participants of how the body appeared tothe women and to discern processes of how thisdeveloped over time. Three main processes werefound in the analysis. RESULTS: Common to allwomen was to initially experience the body as sur-viving. Survival was key target and bodily com-plaints were thus measured and valued in favour ofthat. When back to a new everyday life after treat-ment five women quickly experienced their bodiesas comprehensible. They had undergone a minimumof treatments. 19 women reported more complaintsand experienced the body as broken, fragile andunreliable – as incomprehensible. With time andregained function most came to experience theirbodies as comprehensible. Three women, however,met with more bodily decline than they could rec-oncile, they eventually disassociated from theirbodies. CONCLUSIONS: This study makes aunique contribution by mapping out how breastcancer patients experience and value their bodies

over 6 years from ending hospitalised treatment.The findings are considered from a phenomenologi-cal perspective and reflect how the women “discov-ered” and handled their bodies as something theyhad, the bodies were seen as separated from them-selves while altering and changing due to sideeffects. The processes of establishing liveable bodyrelations differed depending on treatment impactand ability to incorporate body changes as part ofthemselves. The findings are discussed in relation totheories of bodynormativity and biographical con-tinuity. RESEARCH IMPLICATIONS: The studyclarifies that experiences and valuations of bodyalterations and side effects shifts over time. It indi-cates the importance of further studies to carefullyconsider this transition over time and interpret self-assessments of body experience in relation to treat-ment (on-going/completed) and overall life context(on sick-leave/working). CLINICAL IMPLICA-TIONS: This study highlights the impact of sideeffects, especially from endocrine treatment, onbreast cancer patients’ everyday life. We find it rea-sonable to suggest that physicians take a quitehumble stand when discussing the treatmentoptions. In cases of massive side effects, it must bepossible to end treatment without this causingexcessive worries for disease progression.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was supported by grants from the SwedishAssociation for Cancer and Traffic Victims (CTRF).

P3-94

Impact of Active Surveillance, Chlorambucil and

Chemo-Immunotherapy on Health-Related Quality

of Life in Patients With Chronic Lymphocytic

Leukemia in the Netherlands. Results of the

Population-Based PHAROS-Registry

Simone Oerlemans1,2, Esther Van den Broek1,Ward Posthuma3, Marten Nijziel4, Jan WillemCoebergh1,5, Lonneke Van de Poll-Franse1,21Comprehensive Cancer Center South/EindhovenCancer Registry, Eindhoven, The Netherlands,2Tilburg University, Tilburg, The Netherlands,3Leiden University Medical Center, Leiden, TheNetherlands, 4Maxima Medical Center, Eindhoven,The Netherlands, 5Erasmus University, Rotterdam,The Netherlands

BACKGROUND: The number of Chronic Lym-phocytic Leukemia (CLL) patients that live longafter their diagnosis is rising. This underpinshealth-related quality of life (HRQoL) as a relevantendpoint. Few studies have investigated HRQoL inCLL patients, and most were randomized clinicaltrials. As a consequence, patients with early-stageCLL, elderly patients and patients with comorbidi-ties were underrepresented. The aim of this studywas therefore to assess HRQoL in a population-based setting that includes these underrepresented



patients. METHOD: 175 patients diagnosed withCLL between 2004 and 2011 and registered in theEindhoven Cancer Registry received the EuropeanOrganization for Research and Treatment of Can-cer Quality of Life Questionnaire Core-30 (EORTCQLQ-C30), 136 patients responded (78%). We eval-uated HRQoL after different treatment modalities(active surveillance, Chlorambucil and intensechemo/immunotherapy) and among patients onand off treatment and subsequently compared thiswith an age-and sex-matched normative populationto assess the severity of the concerns. Detailed dataon stage and treatment were collected within thescope of the Population-based HAematologicalRegistry for Observational Studies (PHAROS); anextension of the Netherlands Cancer Registry.RESULTS: Patients treated for CLL reported sig-nificantly worse HRQoL than the norm population(p < 0.01 and clinically important differences(CID)), while no difference was observed betweenthe normative population and patients under activesurveillance. We observed more and larger differ-ences between patients treated with Chlorambuciland patients under active surveillance than betweenpatients treated with other chemo- and/or immuno-therapy and those under active surveillance. Bothpatients on and off treatment scored worse on allfunctional scales (except cognitive functioning),fatigue and sleeping problems compared to the nor-mative population (p < 0.01 and CID). CONCLU-SIONS: HRQoL of CLL patients was significantlyand clinically relevant lower compared to the age-and sex-matched normative population. CLLpatients treated with Chlorambucil reported thelowest HRQol scores. Both patients on and offtreatment showed an impared HRQoL comparedto the normative population. Since starting treat-ment in CLL patients has a drastic and long-lastingeffect on HRQoL, it seems be wise to be restrainedin starting treatment, especially in asymptomaticpatients, despite the recent success in prolongingsurvival. CLINICAL IMPLICATIONS: Sincestarting treatment in CLL patients has a drasticand long-lasting effect on HRQoL, it seems be wiseto be restrained in starting treatment, especially inasymptomatic patients, despite the recent success inprolonging survival. ACKNOWLEDGEMENTOF FUNDING: This study was financially sup-ported by the Jonker-Driessen Foundation andZonMW: the Netherlands organization for healthresearch and development, and through PHAROS:Population-based HAematological Registry forObservational Studies (#80-82500-98-01007).

P3-95

Development of a Self-Management Psychosocial

Intervention for Men With Prostate Cancer and

Their Partners: Lessons Learnt From the “Real

World”

Eilis McCaughan1, Gillian Prue2, OonaghMcSorley1, Kader Parahoo11Institute of Nursing and Health Research,University of Ulster, Jordanstown, UK, 2School ofNursing and Midwifery, Queens University Belfast,Belfast, UK

BACKGROUND: The purpose of this feasibilitystudy was to investigate the acceptability of a psy-chosocial intervention to men with prostate cancerand their partners, and to gain feedback from thefacilitators, participants and non-participants tomake changes to and enhance the intervention.METHOD: The Medical Research Council (MRC)framework for Randomised Controlled Trials ofcomplex interventions guided intervention develop-ment. The intervention was assessed in terms ofstructure, process and outcome. Recruitment strate-gies, randomisation procedures and acceptability ofquestionnaires were also tested. The nine weekgroup and telephone intervention commenced fol-lowing treatment. The intervention focused onsymptoms, sexual dysfunction, uncertainty, positivethinking and couple communication. Participantswere assessed at baseline, immediately post-interven-tion and at one and six months post-intervention.Outcome measures included self-efficacy and qualityof life. Process evaluation was conducted through afeedback questionnaire and qualitative interviews.RESULTS: Over the course of 12 months, 18 cou-ples agreed to participate. There was no significantdifference between the age of intervention group(Mean = 64.2, SD = 7.6) and the control group(Mean = 62.3, SD = 5.9; t = 0.585, p = 0.564). Oneof the main reasons for declining participation wasthe group format. The small numbers prevented thedetermination of the effect of the programme onpatient reported outcomes. CONCLUSIONS: Par-ticipants were satisfied with the information pro-vided, the structure of the programme and the levelof support received. They stated it provided a focusand time for reflection, helped them prioritise issuesas couples and made them more aware of theirbehaviour, needs and wants within their relation-ship. They valued the group format and peerencouragement attained through this. The partnersappeared to have particularly gained from the inter-vention. Further research is needed to enhancerecruitment and target “hard to reach” men.RESEARCH IMPLICATIONS: Many lessonswere learnt during the implimentation of the inter-vention. Despite the adoption of “male friendly”recruitment strategies, getting potential participantsto agree to take part in a group was challenging.



The practicalities of organising the groups was diffi-cult given the geographical location of participants(there was no convenient group for some of themen who had agreed to take part) and administra-tive logistics of getting the facilitators/participantsto agree dates. CLINICAL IMPLICATIONS: Inresponse to the findings, and in an attempt toaddress some of the problems highlighted, a Brief-CONNECT intervention is currently being devel-oped, which would involve a tailored one-to-oneone off intervention for men on completion ofcancer treatment. ACKNOWLEDGEMENT OFFUNDING: The study was funded by CancerFocus Northern Ireland.

P3-96

“Moving Forward”: Developing a New Evidence-

Based Information Resource for Breast Cancer

Survivors

Karen Scanlon1, Liz Reed2, Emma Blows3, JulieWray4, Debbie Fenlon51Breast Cancer Care, London, UK, 2Princess AliceHospice, London, UK, 3Kings College LondonUniversity, London, UK, 4Service Research UserPartnership, Breast Cancer Care, London, UK,5University of Southampton, London, UK

BACKGROUND: There are approximately500,000 breast cancer survivors in the UK (KCL,2008). For many, becoming a “survivor” followingtreatment is a time of crisis, abandonment and iso-lation (Allen, 2009; Smyth et al, 1995), yet fewresources are available. The Cancer Reform Strat-egy (Allberry, 2008) highlights the need to commis-sion services to support patients dealing with long-term consequences of cancer and treatment. Thisstudy aimed to design and develop a new resourcepack for breast cancer survivors post-treatment.METHOD: This qualitative mixed method studyconsisted of two phases: 1) two focus groups with12 breast cancer survivors and telephone interviewswith 12 healthcare professionals were conducted toidentify unmet need and inform resource develop-ment; 2) reconvened focus groups and writtenreviews from healthcare professionals to feedbackon the prototype resource. RESULTS: Partici-pants described a process of “reconciling a newidentity” over time and the need for self-manage-ment strategies, peer support and signposting toresources. Participants wanted a personalisedresource with practical help for regaining controlover their lives. They needed information at the endof treatment on what is normal, signs and symp-toms of recurrence, sources of support, writtenresources and an individual care plan. Format andcontent of the resource and feedback on the proto-type will be fully discussed. CONCLUSIONS: Peo-ple want resources to ease the transition betweenhospital-based treatment and survivorship. To

move forward, they need information and supportaround recurrence and coping with social pressuresto return to life as it was before. They should alsoknow where to access resources in the absence ofhospital support. These resources would help facili-tate a “new normal” life after treatment. We believethis resource will play an important role in futurebreast cancer follow-up care and will assist health-care professionals in tailoring information and sup-port provision. Results will be discussed within thecontext of current policy initiatives and NHS infor-mation provision. ACKNOWLEDGEMENT OFFUNDING: This study was funded by UK charityBreast Cancer Care. It was a collaboration withSouthampton University.

P3-97

Dispositional Optimism and Fatigue in Breast

Cancer Survivors

Inger Schou BredalOslo University Hospital and the University in Oslo,Oslo, Norway

BACKGROUND: A substantial proportion ofbreast cancer survivors experience fatigue. In viewof the large body of research demonstrating thatoptimism (generalized positive expectation) hasbeneficial effects on people’s well-being and health,one could assume that optimism might also have aprotective function in regard to fatigue. The study’saim was to investigate the association between dis-positional optimism and fatigue, when adjustingfor known factors associated with fatigue such as:age, psychological distress, and chronic pain.METHOD: A nationwide survey of 834 womentreated for early-stage breast cancer in Norway upto 6 years before the onset of this study. Thewomen completed the Fatigue Questionnaire, BriefPain Inventory Questionnaire, the Hospital Anxietyand Depression scale and the Life Orientation Test-Revised. Pearson’s correlation (r), t tests and logis-tic regression analysis were utilized. RESULTS: Ofthe 834 women 49% had reported fatigue. Womenwith fatigue scored significantly lower on optimismthan women without fatigue, (15.5 vs. 18.2,p < 0.0001). Fatigue and optimism were inverselycorrelated (r = �0.34, p < 0.001). Logistic regres-sion analysis with fatigue as the dependent variableshowed that lower degree of optimism was signifi-cantly associated with fatigue (OR 0.96; 95%C.I.0.92–0.99; p = 0.04), together with younger age,psychological distress and chronic pain. The modelaccounted for 35% of the variance in fatigue. Opti-mism alone explained 10% of the variance. CON-CLUSIONS: The study confirms that there is anassociation between fatigue and degree of opti-mism. It appears that breast cancer survivors with alow degree of optimism have a higher risk for expe-riencing fatigue than those with a high degree of



optimism. RESEARCH IMPLICATIONS: Thecurrent study examined fatigue cross-sectionally.Thus we cannot conclude that low optimism is apredictor for fatigue. A longitudinal study shouldbe conducted to investigate if dispositional opti-mism is a predictor for fatigue, when controllingfor age, psychological distress, and chronic pain.CLINICAL IMPLICATIONS: For breast cancersurvivors, healthcare professionals should pay moreattention to the possibility of fatigue in women withlow optimism (pessimism), who have chronic painand psychological distress. If pessimism has a cau-sal impact on fatigue measures, then helping highlypessimistic women become less pessimistic coulddecrease their experience of fatigue. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-98

“You Shouldn’t be too Suspicious of Your

Wellbeing” - Hope and Courage to Face Life in

Women Undergoing Ovarian Cancer Surgery

Lene Seibaek1, Niels Christian Hvidt2, LiseHounsgaard21Aarhus University Hospital, Aarhus, Denmark,2University of Southern Denmark, Odense, Denmark

BACKGROUND: This abstract is dealing withinner resources during severe illness. To involvepatient resources has become a mantra in healthcare, also within the context of cancer care. How-ever, implementing this approach in daily clinicalpractise has proved to be rather complex, regardlessthe immense importance that personal resourcesplay for sufferers, and that they may in fact oftencontribute to a good or bad outcome seen evenfrom a “classical” biomedical success barometer.METHOD: Aiming to provide personal perspec-tives on being newly diagnosed and starting treat-ment for a serious cancer disease, the livedexperiences of women undergoing ovarian cancersurgery were explored. The study period ran fromthe first visit in the out-patient clinic, till eightweeks later, when the women had either begun theirchemotherapy or completed their recovery. Tenwomen participated in two qualitative researchinterviews each, before and after their surgery. Theinterviews were digitally recorded and transcribedverbatim. By applying a phenomenological-herme-neutic text interpretation methodology, the findingswere systematically identified, put into meaning-structures, interpreted and critically discussed.RESULTS: The results offered insight into thecomplexity of challenges and personal developmentover time being a woman with ovarian cancer duringher perioperative period: Imminent death was per-ceived to be a plausible consequence of the treat-ment being non-effective. Besides constituting asevere strain, this created a strong focus on stayingalive. Feelings of hope were initiated by experiencing

physical comfort and mental wellbeing. This wasachieved via the fulfilment of basic needs and bybeing met with a positive attitude from health careprofessionals. Creating disease-free zones and main-taining everyday life were complementary, signifi-cant hope promoting strategies. CONCLUSIONS:Hope and courage to face life represent significantpersonal resources that are created not only in theinterplay between body and mind, but also betweenpatients and their health care professionals. Theoverall finding that it was not simply the women’sphysical bodies but rather their whole lives thatbecame impacted by the disease and treatmentpoints towards the importance of maintaining aholistic approach in cancer care, right from thecommencement of treatment and in particular dur-ing highly specialised fast track regimes.RESEARCH IMPLICATIONS: The physicaldimension of hope needs to be further studiedwithin a humanistic health research paradigm. Thecorrelation of this phenomenon with the fulfilmentof fundamental human needs, and the potentialimpact of basic care and psychosocial support onthis, are suggested as subjects for further investiga-tion. CLINICAL IMPLICATIONS: Clinical prac-tise can activate and integrate personal resources byproviding adjusted information, psychosocial sup-port and physical optimisation right from the com-mencement of treatment. The individual level ofpersonal resources seems deeply influenced by per-sonal lifestyle, social conditions, coping strategiesand personal experiences. However, by offering tar-geted family counselling and caring for the generalhealth and wellbeing, hope can be sustained andearly cancer rehabilitation initiated. ACKNOWL-EDGEMENT OF FUNDING: None.

P3-99

Predictors of Psychological Well-Being Among

Prostate Cancer Survivors

Frances Drummond1, Heather Kinnear2, EamonnO’Leary1, Anna Gavin2, Linda Sharp11National Cancer Registry Ireland, Cork, Ireland,2Northern Ireland Cancer Registry, Belfast, Ireland

BACKGROUND: Rising incidence and survivalmeans prostate cancer (PCa) is the most prevalentcancer in men in developed countries. In contrast to20 years ago, many men with PCa are asymptom-atic, diagnosed in primary care through “screening”prostate specific antigen tests. The growing burdenand changing routes to diagnosis makes it impor-tant to understand how PCa impacts on survivors’wellbeing. However, information on long-term psy-chological wellbeing is lacking. We investigatedpredictors of psychological well-being among PCasurvivors. METHOD: A postal questionnaire wasdeveloped and administered in 2012 to 6,937 PCa(ICD10 C61) survivors 1.5–15 years post-diagnosis,



identified through population-based cancer regis-tries in the Republic of Ireland (RoI) and NorthernIreland (NI). Based on self-reported data, “screen-detected” men were defined as those who wereasymptomatic and diagnosed via PSA testing,“symptomatic” men had urinary symptoms at diag-nosis. Psychological well-being was assessed usingthe Depression Anxiety Stress Scales-21. Logisticregression was used to identify associations betweenmethod of diagnosis, clinical and socio-demo-graphic factors and depression, anxiety and stressof any severity. This preliminary analysis includesthe first 1,402 respondents. RESULTS: Responsewas 58%. Depression, anxiety and stress (any sever-ity) were present in 19%, 14%, 25% of survivors,respectively. 56% were screen-detected. Method ofdetection was associated with increased risk of neg-ative emotional states in univariate analyses. Inadjusted analysis, depression risk was increased inunmarried men (OR = 1.85, 95%CI 1.16–2.96) andthose with co-morbidities (OR = 1.57, 95%CI1.07–2.29); and reduced in survivors without cur-rent incontinence (OR = 0.56, 95%CI 0.33–0.97) orfatigue (OR = 0.58, 95%CI 0.36–0.91). Men under-going watchful waiting/active surveillance had 5-times higher risk of depression than men treated inother ways (OR = 5.01, 95%CI 2.32–11.21). Riskdid not vary by time-since-diagnosis. Similar associ-ations were found for anxiety and stress. CON-CLUSIONS: Prevalence of anxiety and depressionwas high among PCa survivors. Although methodof detection was not associated with psychologicalwellbeing, risks of depression, anxiety and stresswere increased in men with particular persistenttreatment after-effects i.e. incontinence and fatigue,and in men who were being managed by watchfulwaiting/active surveillance. RESEARCH IMPLI-CATIONS: This study shows evidence of poor psy-chological health in groups of PCa survivors. Giventhat men are living longer with PCa, furtherresearch into factors affecting the psychologicalwell-being of long-term PCa survivors is warranted,and development of interventions to support survi-vors’ psychological wellbeing should be developedand rigorously evaluated before implementation.CLINICAL IMPLICATIONS: Healthcare profes-sionals need to be aware of the prevalence of nega-tive emotional states in PSA survivors. Thesefindings suggest that screening for depression, anxi-ety and stress should form part of routine follow-up of PCa survivors. ACKNOWLEDGEMENTOF FUNDING: This work was funded by theHealth Research Board Ireland and the ProstateCancer Charity UK.

P3-100

Abstract withdrawn

P3-101

A Web-Based Needs Survey of Young Adult Cancer

Service Users in Hong Kong

Lee Siu MeiUniversity of Hong Kong, Hong Kong, Hong Kong

BACKGROUND: Until 2011, there have been 700registered users aged 20 to 40 accessing CancerLinkServices. And newly registered young adult usersoccupied 13.2% of the total new users in 2011.With the increasing numbers of young cancer survi-vors, the need for appropriate information and ser-vices tailored to their life stage and needs areimportant. Hence, we carried out a survey to betterunderstand this population and facilitate the devel-opment of more life stage appropriate psychosocialcare. METHOD: 336 Young adult cancer survi-vors who had previous engagement with HKCFservices were invited via email to complete anonline survey, “Young Adult Need Assessment2012” in July 2012, launched through the HKCFOnline Survey System. We felt that the delivery ofthis survey through a web-based application wouldbe in line with the technology-literate nature of thispopulation. Survey questions included asking theparticipants to provide information on supportivecare needs, distress levels and service preferences.Participants were also asked whether they had uti-lized the various support services provided by Can-cerLink and their need for future services.RESULTS: 65 young adults responded the survey(approximately 20% response rate). 64% were inrehabilitation stage but 36% had suffered frommetastasis. Notable mood and adjustment issueswere that 70% of the patients scored 4 or above ona distress thermometer, 54% reported difficultieswith work/study, 74% reported problems withworry, 54% reported problems with lethargy and45% reported problems with memory/concentra-tion. Overall, the top 4 service needs were: psycho-logical groups, exercise classes, nutrition classesand qigong/taichi classes. 50% of young adult can-cer survivors indicated that they were interestedand wanted to participate in an activity programwith therapeutic elements. CONCLUSIONS: Thissurvey highlights the need for services with thera-peutic elements and which address mood issues,aspects of physical adjustment and work/studyissues. However, it can also be seen that youngadult survivors were also interested in other health-related, non-therapeutic classes, suggesting a needfor a variety of services differing in their levels oftherapeutic intensity. The finding that family-based support was the least preferred mode of



intervention is worthy of further investigation.ACKNOWLEDGEMENT OF FUNDING: None.

P3-102

A Systematic Review of Fertility and Parenthood

Issues in Female Cancer Survivors

Aleksandra Sobota, Gozde OzakinciUniversity of St Andrews, St Andrews, UK

BACKGROUND: Progress in cancer treatmentled to the significant increase in survival rates.Younger cancer survivors are faced with manyissues such as potential impact of diagnosis andtreatment on childbearing. Parenthood is importantfor social identity, especially for women and theinability to fulfill the desire of having a child canhave detrimental effects on psychological well-being. The purpose of this systematic review was toevaluate fertility and parenthood issues encoun-tered by female cancer survivors. METHOD: Thir-teen medical and social science databases weresearched for relevant articles using specific key-words related to cancer, fertility, and psychologicaloutcomes. The established inclusion criteria for thepapers were based on three factors: the targetedpopulation (reproductive age women diagnosedwith any type of cancer and not pregnant at diagno-sis), the reported outcomes (short- and long-termpsychological outcomes) and the study design(experimental and observational studies). Of a totalnumber of 8040 identified articles, 36 met all the eli-gibility criteria and were included in the review.RESULTS: Cancer-related infertility was found toprovoke stress reactions as well as affect survivors’quality of life and sexual functioning. Both fertilitycounseling by specialists and written or online edu-cational materials aimed at increasing knowledgeabout cancer-related effects on fertility shown toimprove psychological outcomes in female cancersurvivors. Reproductive decisions in those patientswho did not lose their fertility subsequently to can-cer were influenced by multiple fears related to dis-ease course and offspring’s health. However, despitethose fears, having a child was a desired goal formany women, giving them a sense of normalcy andhope for recovery. CONCLUSIONS: The existingevidence suggests that in addition to cancer itself,fertility issues can affect psychological outcomes infemale cancer survivors, particularly if having chil-dren was an important life goal and cancer inter-rupted those plans. Counseling and education seemto be beneficial in terms of psychological adjust-ment to the situation. Nonetheless, psychologicalimpact of cancer-related infertility is yet an under-studied area and several limitations to the researchexist including small patient samples, retrospectivedesign and predominance of breast cancer survivorsacross the studies which limit the generalizability ofthe findings to other cancer sites. RESEARCH

IMPLICATIONS: There is a gap in our under-standing of the complex associations among cancer,childbearing, and psychological well-being incancer survivors. We need to identify factors con-tributing to adverse psychological functioning.Longitudinal studies examining the trajectory ofadjustment to infertility and cancer as well as thedevelopment of effective interventions are stronglyrecommended. CLINICAL IMPLICATIONS:Cancer-related infertility can be prevented usingfertility sparing treatment methods or artificialreproductive technologies. In cases where fertilityimpairment is unavoidable, provision of reliableinformation and counseling should be offered topatients. The identification of risk factors leadingto worse psychological functioning could guide cli-nicians through the process of selecting patientsmost in need for support. ACKNOWLEDGE-MENT OF FUNDING: None.

P3-103

Sexual Function Among Young Breast Cancer

Survivors in Japan Correlates With Sexual

Communication With Partners

Miyako Takahashi1, Akira Oshima2, NorikazuMasuda3, Ayako Shikata3, Atsuko Kitano4, ErikoTokunaga5, Atsushi Fukuuchi6, Shinji Ohno21National Cancer Center, Tokyo, Japan, 2NationalKyushu Cancer Center, Fukuoka, Japan, 3NHOOsaka National Hospital, Osaka, Japan, 4St Luke’sInternational Hospital, Tokyo, Japan, 5KyushuUniversity, Fukuoka, Japan, 6Mitsui MemorialHospita, Tokyo, Japan

BACKGROUND: Sexuality is an important com-ponent in the quality of life of people with cancer.Since previous research with non-cancer patientsamples suggested that better communication aboutsexual issues in a couple results in better sexual sat-isfaction, we conducted a survey to reveal the corre-lation between sexual function among young breastcancer survivors in Japan and their sexual commu-nication with partners. METHOD: We conductedan anonymous, cross-sectional survey of out-patients (age 20-45) attending breast oncology clin-ics of five teaching hospitals in Japan. The ques-tionnaire contained questions regarding: socio-demographic and medical characteristics, FemaleSexual Function Index Japanese version (FSFI-J),and The Dyadic Sexual Communication Scale(DSC scale). RESULTS: Of the 477 patients whowere handed a questionnaire, we received 358responses (a response rate 75.1%). In this study, weused the data from 110 respondents who wereunder 40 y.o. at the time of diagnosis, who had anactive sexual relationship with their partner beforediagnosis, and who had the same partner beforeand after diagnosis. Mean age of the respondentswas 34.2�3.8 y.o.. The FSFI-J total score as well as



all 6 subdomain scores (desire, arousal, lubrication,orgasm, satisfaction, pain) showed statistically sig-nificant correlations with the DSC scale score (totalscore p = 0.003). CONCLUSIONS: This studyrevealed that better sexual functions (total and sixsubdomain scores) measured by FSFI-J were corre-lated with better verbal communication of sexualissues with a partner measured by DSC scale.RESEARCH IMPLICATIONS: This study addsto the literature that, among couples affected bycancer, too, better communication about sexualissues in a couple results in better sexual function.CLINICAL IMPLICATIONS: It is important forhealthcare professionals to provide survivors andpartners with support that facilitates their verbalcommunication about sexual issues. ACKNOWL-EDGEMENT OF FUNDING: Health LabourSciences Research Grant 2009, The Ministry ofHealth Labour and Welfare, Japan.

P3-104

Variation in Fatigue Among 6011 Cancer Survivors

and the Normative Population: A Study From the

Population-Based PROFILES Registry

Olga Husson1, Floortje Mols1,2, Lonneke van dePoll-Franse1,2, Jolandade Vries1,3, Goof Schep4,Melissa Thong1,21Tilburg University, Tilburg, The Netherlands,2Comprehensive Cancer Center South, Eindhoven,The Netherlands, 3St. Elisabeth Hospital, Tilburg,The Netherlands, 4Maxima Medical Center,Veldhoven, The Netherlands

BACKGROUND: Studies have shown that cancersurvivors commonly experience fatigue, probablydue to the disease and its treatment. However, fewstudies have compared the severity of fatigueamong patients with different types of cancer orcompared fatigue levels with a normative popula-tion. METHOD: We pooled data from six largecancer survivorship studies conducted through thepopulation-based PROFILES registry. All individ-uals diagnosed with endometrial (EC, n = 741) orcolorectal cancer (CRC, n = 3878) (1998–2007),thyroid cancer (TC, n = 306) (1990–2008), Hodgkin(HL, n = 150) or non-Hodgkin lymphoma (NHL,n = 716) or multiple myeloma (MM, n = 120)(1999–2008) sampled from the Eindhoven CancerRegistry were eligible for participation. Participa-tion rates for the studies ranged from 74–86%. Anormative population (n = 2040), representative ofthe Dutch population, was also assessed. All partic-ipants completed questionnaires on fatigue (FatigueAssessment Scale), health status (EORTC QLQ-C30 or SF36) and psychological distress (HospitalAnxiety and Depression Scale). RESULTS: Cancersurvivors were more often classified as fatigued orvery fatigued (EC/CRC:39%; HL:40%; HL:43%;MM:51%; TC:44%) compared with the normative

population (21%; p < 0.001). MM survivorsreported the highest levels of fatigue and differed sig-nificantly from EC and CRC survivors (p = 0.02).Small differences were seen between short-term(<5 years post-diagnosis; 41% fatigued) and long-term survivors (≥5 years; 39% fatigued; p = 0.06)and between younger (≤65 years; 42% fatigued) andolder survivors (>65 years; 39% fatigued; p < 0.01).Chemotherapy treatment was associated with morefatigue (43% vs. 39%, p < 0.01), as was comorbidity(no vs. 1 vs. ≥ 2: 26%, 35%, 53%, respectively,p < 0.01). CONCLUSIONS: As expected, cancersurvivors were more often fatigued or severely fati-gued compared to a normative population. Resultssuggest that fatigue varies by cancer type. MM sur-vivors were more likely to be fatigued when com-pared with other cancer groups. Survivors treatedwith chemotherapy or with more comorbid condi-tions were also more likely to feel tired.RESEARCH IMPLICATIONS: Variation in fati-gue per cancer and treatment type suggests that themechanisms underlying cancer-related fatigue couldbe different for different cancers. This underlinesthe need for more detailed research into the under-lying pathophysiological mechanisms of fatigue.CLINICAL IMPLICATIONS: Since significantlymore cancer survivors feel fatigued in comparisonwith the normal population, it underlines the needfor appropriate assessment and interventions likephysical training and/or psychological interventionduring or after oncologic treatment. More attentionshould be paid to fatigue in survivors of MM. Aschemotherapy is associated with fatigue, patientscould benefit from appropriate information ontreatment side effects. Furthermore, focus on bettercontrol or management of comorbid conditions ofcancer survivors is recommended. ACKNOWL-EDGEMENT OF FUNDING: Part supported bya Veni grant (#451-10-041) from the NetherlandsOrganization for Scientific Research (NWO) toFloortje Mols, a Cancer Research Award from theDutch Cancer Society (#UVT-2009-4349) to Lon-neke van de Poll-Franse and a Social PsychologyFellowship from the Dutch Cancer Society toMelissa Thong (#UVT2011-4960). Data collectionfunded by the Comprehensive Cancer CentreSouth, Eindhoven, The Netherlands; CoRPS, Til-burg University, The Netherlands; and an invest-ment subsidy (#480-08-009) from NWO.

P3-105

Lay Perceptions of Cancer and Attitudes Towards

Cancer Survivors in Community: Lay People and

Cancer Survivors’ Perspectives in Japan

Miyako TsuchiyaChiba University, Chiba, Japan

BACKGROUND: Lay perceptions of cancer mayaffect attitudes towards cancer survivors. Fatalism



among lay people leads to negative attitudes and tostigmatisation of cancer survivors. These attitudespresent a barrier to the development and promo-tion of home-based palliative care. This preliminarystudy explores the relationship between lay percep-tions and attitudes towards cancer survivors.METHOD: Japanese lay adults and cancer survi-vors were consecutively recruited from communitygroups or cancer self-help groups. Questionnaireswere mailed to 116 lay people and to 145 cancersurvivors; 68 lay people (58.6%) and 56 cancer sur-vivors (38.6%) returned completed questionnaires.The questionnaires asked respondents to read vign-ettes describing recovery from cancer treatment andtold it to a person in community, and then torespond to open-ended questions. For lay people,one additional open-ended question was includedasking about their perceptions of cancer. Theresponses were separately analysed across the sam-ple, using a thematic analysis. RESULTS: Theanalysis revealed that lay people perceived cancer asa threatening illness, a curable illness by early detec-tion, or a illness that I may develop. Seven themeswere extracted regarding lay people’s attitudestowards cancer survivors: understanding and con-sideration of the condition, a general sympathy forthe survivor, watching over them, encouragement,helping the cancer survivor to adjust their role in thecommunity, offering support in daily activities, andunchanged relationships as community members.The analysis extracted the same themes, with oneexception – “consideration of my feelings”, in cancersurvivor. “Offering support in daily activities” wasnot reported. CONCLUSIONS: Although partici-pants have negative and positive perceptions ofcancer, the negative perception may not be associ-ated with attitudes towards cancer survivors.Theme comparisons between lay people and cancersurvivors revealed that lay people intend to offerproblem-solving type support, whereas cancersurvivors wanted emotion-focused support.RESEARCH IMPLICATIONS: These resultssuggest that further quantitative epidemiologicalcommunity study is required to investigate the asso-ciation between lay perceptions and attitudestowards cancer survivors. CLINICAL IMPLICA-TIONS: There are discrepancies between the sup-port that lay people offer and the support thatcancer survivors need. To help develop and pro-mote home-based palliative care, these discrepan-cies need to be addressed. A community-basededucational program may help lay people under-stand cancer survivors’ perspectives and encouragevoluntary home-based palliative care in Japan.ACKNOWLEDGEMENT OF FUNDING: Thisresearch was supported by the Yuumi MemorialFoundation for Home Health Care.

P3-106

The Impact of an Automatically Generated

Survivorship Care Plan on Patient Reported

Outcomes (ROGY Care): Results of a Pragmatic

Cluster Randomized Controlled Trial Among

Endometrial Cancer Patients

Lonneke van de Poll-Franse1,2, Kim Nicolaije1,2,Nicole Ezendam1,2, Caroline Vos3, Dorry Boll4,Johanna Pijnenborg4, Anne Roukema1,3, RoyKruitwagen51Tilburg University, Tilburg, The Netherlands,2Comprehensive Cancer Centre South, Eindhoven,The Netherlands, 3Elisabeth Hospital, Tilburg, TheNetherlands, 4Tweesteden Hospital, Tilburg, TheNetherlands, 5Maastricht University MedicalCenter, Maastricht, The Netherlands

BACKGROUND: More patient tailored informa-tion for cancer survivors is needed. Evidence oneffects of implementing Survivorship Care Plans(SCPs), recommended by the IOM, is limited. Aimof this pragmatic cluster randomized trial is toassess the impact of SCPs in routine clinical prac-tice. An SCP-application was therefore built in theexisting regional web-based Registration systemOncological GYnecology (ROGY). Primary end-point is patient satisfaction with information. Sec-ondary endpoints are QoL and health care use.METHOD: Twelve hospitals were randomized tousual care or SCP-care. SCPs were automaticallygenerated by clicking the SCP-icon in ROGY andpersonally handed to and discussed with the patient.In usual care, gynecologists did not have access tothe SCP-application (icon). All newly diagnosedendometrial cancer patients were asked to completea questionnaire after surgery, 6, 12 and 24 monthsafter diagnosis. The questionnaire included the EO-RTC-INFO25 and asked whether patients actuallyreceived an SCP. We expected 150 endometrial can-cer patients: 75 per arm. We hypothesized thatpatients receiving SCP-care were more satisfied withthe information. RESULTS: 201 patients (74%)returned a questionnaire after surgery: 109 SCParm, 92 usual care arm. Of the patients in the SCParm, 69% reported receiving an SCP. Patients inboth arms reported similar scores on all scales ofthe EORTC-INFO25, including satisfaction withcare (87% vs. 82%, SCP vs. usual care, p = 0.20).Analyses according to actual care received showedthat patients who received SCP-care reported sig-nificantly higher scores (4–18 points) on all scalesof the INFO25, including satisfaction with care(91% vs. 78%, SCP vs usual care, p = 0.046) com-pared to those who did not receive SCP-care. CON-CLUSIONS: Even in a situation where SCPs canbe automatically generated, still one third does notreceive an SCP. But, those who do receive SCP-carereport better information provision and satisfac-tion. Follow-up measures will show whether this



ultimately results in better QoL and decreasedhealth care use. ACKNOWLEDGEMENT OFFUNDING: This trial is supported with a studygrant from the Dutch Cancer Society (#UVT-2010-4743). Prof. Dr. Lonneke van de Poll-Franse is sup-ported by a Cancer Research Award from theDutch Cancer Society (#UVT-2009-4349).

P3-107

Managing Fear of Cancer Recurrence With the

SWORD Study (Survivors’ Worries Of Recurrent

Disease)

M.A. van de Wal1, M.F.M. Gielissen1,A.S. Speckens2, J.B. Prins11Radboud University Nijmegen Medical Centre,Department of Medical Psychology, Nijmegen, TheNetherlands, 2Radboud University NijmegenMedical Centre, Department of Psychiatry,Nijmegen, The Netherlands

BACKGROUND: Fear of Cancer Recurrence(FCR) is a normal and common concern for mostcancer survivors. For 9–34% fear becomes achronic problem. Few studies investigated interven-tions specifically designed for clinical levels ofFCR. We developed and assessed an interventionbased on the theoretical model by Lee-Jones (1997),which hypothesizes that an emotional reaction(FCR) can be the result of interpretations of thethreat of cancer, triggered by perceptions of inter-nal and/or external cues. METHOD: In a two-armrandomized controlled trial, among breast, prostateand colorectal cancer survivors, the efficacy andcost-effectiveness of blended care will be comparedto treatment as usual in managing FCR andthereby reducing related functional and psychologi-cal consequences. The intervention is based on prin-ciples of cognitive behavior therapy (CBT) and isdirected at change of the cognitions and behaviorsmanaging FCR. It is designed as blended care,combining face-to-face CBT with online activities.Primary and secondary outcome measures areseverity of FCR, quality of life and cost-effective-ness. Moderators and mediators of treatmenteffects will be determined as well. RESULTS: Theintervention will consist of six to eight CBT sessionsover a three-month period. Key factors of FCR willbe determined for each patient and the interventionwill be tailored to a patient’s needs. The first fivesessions will be face-to-face communication with atherapist, in the last sessions (six–eight) shared deci-sion-making will take place on how to continuetherapy: face-to-face or via the interactive website(web-based CBT with psycho-education, assign-ments and email contact). The development of theintervention was secured by patient participation, amultidisciplinary reading committee and a smallpilot study. CONCLUSIONS: The SWORD studytackles FCR with one of the most frequently used

psychotherapeutic interventions nowadays (CBT)and complements this with the latest developmentsin the field of E-health. At this moment, the (cost-)effectiveness of the intervention is evaluated in arandomized controlled trial carried out in the Neth-erlands. RESEARCH IMPLICATIONS: To guidethe next generation of studies (and to inform clini-cal applications) the proposed study also includesinformation on moderators and mediators of treat-ment effects. This will help to increase our under-standing of the nature of FCR. CLINICALIMPLICATIONS: With the current study anappropriate evidence-based and cost-effective inter-vention to treat FCR can become available.Hereby, the SWORD study will improve quality oflife and quality of care in breast, colorectal andprostate cancer survivors and contributes to anoptimal adjustment to a severe disease like cancer.In the future, evidence-based results of the pro-posed study can be used to manage high levels ofFCR in patients with other cancer diagnoses.ACKNOWLEDGEMENT OF FUNDING: TheSWORD study was supported with a grant of theDutch Cancer Society (KWF Kankerbestrijding),the Netherlands.

P3-108

Work Status and Work Disability in Colorectal

Cancer Survivors: A Population-Based Study

Sijrike van der Mei1, Melissa Thong2,3, Angela deBoer4, Lonneke Van de Poll-Franse2,3, FloorMols2,31Dept. of Health Sciences, University MedicalCenter Groningen, University of Groningen,Groningen, The Netherlands, 2CoRPS - Center ofResearch on Psychology in Somatic Diseases,Tilburg University, Tilburg, The Netherlands,3Comprehensive Cancer Centre South, EindhovenCancer Registry, Eindhoven, The Netherlands,4Coronel Institute of Occupational Health, AcademicMedical Center, University of Amsterdam,Amsterdam, The Netherlands

BACKGROUND: Colorectal (CRC) cancer is oneof the most common cancers and the prevalence oflong-term survivorship increases because of steadilysurvival improvement. After treatment, patients areexpected to re-establish structure of daily life. How-ever, a substantial number does not return-to-work.Previous studies did not examine if a differenceexists between colon cancer (CC) and rectal cancer(RC). Aim of this study was to explore work statusand work disability in CC and RC survivors sepa-rately. METHOD: This population-based cross-sectional survey included 212 CC and 137 RC sur-vivors of working age (<65 years), diagnosedbetween 1998–2007, as registered in the EindhovenCancer Registry (response 82%). Questionnairesassessed work status (paid job vs. non-working, i.e.



unemployed, early retired, work disabled, home-maker). Forty-six percent of CC survivors weremale (RC 59%), 55% received surgery only (RC17%), 58% had a comorbid condition (RC 66%),6% had a stoma (RC 37%), and time since diagno-sis was 3.7 years (RC 3.9 years). Logistic regressionanalysis investigated the effect of type of cancer onwork status, adjusted for demographic and clinicalcharacteristics. RESULTS: 55% of CC survivorshad a paid job (60% fulltime) and 42% of RC sur-vivors (64% fulltime). Of the non-working CC sur-vivors, 48% reported early retirement, 7%unemployed, 25% work disabled, and 21% home-maker; for RC survivors, respectively 45%, 4%,26%, and 25%. The difference in work statusbetween CC and RC was significant (p = 0.01).Theunadjusted odds ratio (OR) of type of cancer was1.73 (95% CI: 1.12–2.67; p < 0.05). However, thiswas not significant in multivariate analysis (OR1.03, 95% CI: 0.50–2.67; p = 0.95) due to con-founding by primary treatment. Age, gender andcomorbidity significantly affected work status(p values < 0.001). CONCLUSIONS: Half of theCC survivors and about four out of ten RC survi-vors of working age are employed at long-term fol-low-up. The main reason for not working is earlyretirement and work disability. Compared to CC,RC survivors are less often employed. Investigationof factors associated with work status indicates thecomplex associations between demographic andclinical characteristics in their impact on work sta-tus. RESEARCH IMPLICATIONS: The limitedstudies on work status mostly merged CC and RCpatients into one study population. Our findingsindicate that work status among RC is less favor-able compared to CC. This may be related to treat-ment differences between CC and RC, which maynegatively impact work ability and in turn affectthe opportunity of return-to-work. Factors of workstatus need to be investigated within each groupseparately to elucidate if CC and RC are similar.CLINICAL IMPLICATIONS: The relative nega-tive outcome for RC survivors indicates that thisgroup is more vulnerable to drop-out of work.From the societal perspective, this is an indirectcost of cancer in terms of productivity loss. Healthcare professionals can play a role in assessing work-related problems. Special attention should be paidto negative effects of treatment and comorbidity onwork ability. Cooperation with vocational rehabili-tation specialists may lead to reduction of drop-outof work. ACKNOWLEDGEMENT OF FUND-ING: The first author received a Fellowship fromthe Dutch Cancer Society (DCS). Furthermore, thisstudy was partly supported by a Veni grant (Neth-erlands Organization for Scientific Research,NWO; #451-10-041) to Floortje Mols, a CancerResearch Award (DCS; #UVT-2009-4349) to Lon-neke van de Poll-Franse, and a Social PsychologyFellowship (DCS; #UVT2011-4960) to Melissa

Thong. Data collection funded by the Comprehen-sive Cancer Centre South, Eindhoven; CoRPS, Til-burg University; and an investment subsidy (NWO;#480-08-009).

P3-109

Breast Cancer Survivors’ Physical and Psychosocial

Profiles and Their Relationship to the Need for

Information and Support After Primary Medical

Treatment: A Cluster-Analytic Approach

Elke Van Hoof1, Evelyn Pauwels1,2,Caroline Charlier2, Ilse De Bourdeaudhuij21Vrije Universiteit Brussel, Brussels, Belgium,2UGent, Ghent, Belgium

BACKGROUND: Like the period of diagnosisand treatment, cancer survivorship is a time inwhich needs for information and support are preva-lent. Survivors’ needs must be adequately picked upby clinicians. Physicians and nurses, however, tendto underestimate cancer patients’ distress. By defin-ing the characteristics of survivors in need for infor-mation and support after completion of treatment,the identification of subgroups of survivors, vulner-able to a struggling reintegration after treatment,can be enhanced. METHOD: The goal of thisstudy was to determine whether physical and psy-chosocial profiles of breast cancer survivors differin post-treatment needs for information and sup-port. Breast cancer survivors (n = 440) were clus-tered on the basis of 19 variablesassessingsurvivors’ physical and psychological functioning,illness representations, social support and copingstrategies. RESULTS: The four emerging clusterswere characterized by means of survivors’ level ofdistress and way of dealing with the current situa-tion: (1) “low distress - active approach” (21.2%),(2) “low distress - resigned approach” (32.3%), (3)“high distress - active approach” (24.2%), and (4)“high distress - emotional approach” (22.2%). Survi-vors in both “high distress”clusters reported signifi-cantly higher needs for information and support.CONCLUSIONS: With respect to care needs, sur-vivors’ levels of distress are paramount to theirapproach of the situation. Therefore, screening fordistress could allow for the identification of survi-vors in need. RESEARCH IMPLICATIONS: Sur-vivors can be classified into four profiles based on awide range of physical and psychosocial features.Taking into account the connections between thesefeatures within each profile, the four profiles arecharacterized by means of survivors’ level of dis-tress and their way of dealing with the situation.The elaborate characterization of the profiles ofsurvivors in need for information and support aftertreatment allows to gain a clear insight into thissubgroup’s distinctive features. CLINICALIMPLICATIONS: The results emphasize thevarying patterns of adjustment of breast cancer



survivors. Moreover, elaborate characterization ofthe profiles of survivors in need for informationand support after treatment allows to gain a clearinsight into thissubgroup’s distinctive features.ACKNOWLEDGEMENT OF FUNDING: Thisstudy was funded by The Flamish League againstCancer (Vlaamse Liga tegen Kanker).

P3-110

Evaluation of Group Medical Consultations in The

Follow-Up of Breast Cancer: A Randomized

Controlled Pilot Study

Annemiek Visser1, Hanneke Van Laarhoven1,2,Margrethe Schlooz1, Thijs Van Dalen3, JudithPrins11Radboud University Medical Centre, Nijmegen, TheNetherlands, 2Academic Medical Center, Universityof Amsterdam, Amsterdam, The Netherlands,3Diakonessenhuis, Utrecht, The Netherlands

BACKGROUND: During follow-up of breastcancer survivors (BCS) there is a high need for psy-chosocial support and information. A group medi-cal consultation (GMC) provides individualmedical visits conducted within a group of 4–8patients. Expected advantages for patients are addi-tional time with the clinician as well as extra infor-mation or support from peer-patients. The aim ofthis pilot study was to evaluate the effectivenessand acceptability of GMCs compared to standardindividual consultations. METHOD: In this ran-domized controlled pilot trial 69 BCS, maximally5 years after treatment, are included. The interven-tion group (n = 38) participated in a GMC once,while the control group (n = 31) received usualcare. Besides a medical professional, a behavioralhealth professional was present as discussion lea-der. Primary outcomes, measured at baseline (T0)and one week post GMC (T1), were distress (SCL-90) and empowerment (CEQ). Additional second-ary outcomes were cancer worry, quality of life,patient satisfaction, information needs and receivedinformation. Intention-to-treat analyses withANCOVAs (n = 64) were used to compare differ-ences in SCL-90 and CEQ of T0 and T1 betweenboth groups. RESULTS: Differences in distress (F(1,58) = 2.83, p = 0.10) and empowerment (F(1,59) = 1.018, p = 0.32), did not significantly differbetween both groups, nor did quality of life andcancer worry levels. In both groups patients wereequally satisfied and positive about the content ofthe consultations, concerning the professional’sapproach, communication and personal symptoms.Patients in the control group were more satisfiedabout the available time from the medical profes-sional. At T1 patients reported more discussedthemes in GMCs than in individual consultations,while information needs prior to the consultationwere the same for both groups. Sixty-nine percent

experienced support from other participants in theGMC. CONCLUSIONS: GMCs did not improvepatients’ distress or empowerment. Patient satisfac-tion was equal in both groups. Although in GMCsmore total time with the medical professional isavailable, patients were more satisfied about theamount of time in an individual visit. However,since information provision was higher in GMCscompared to individual care, GMCs may be a goodalternative for follow-up care of BCS. RESEARCHIMPLICATIONS: This study has shown theacceptability of GMCs in the follow-up of BCS.The power of the pilot study was probably toosmall to find any significant differences. Moreover,a onetime GMC is a minimal intervention, whichmakes it difficult to show an effect. Therefore, acurrent RCT is focusing on the effectiveness ofGMCs combined with online GMCs via dedicatediPads. CLINICAL IMPLICATIONS: GMCs arebeing implemented in several outpatient clinics forBCS in The Netherlands. This study indicated nopsychological benefits of GMCs. However, infor-mation provision and support from peer patientsdid improve compared to standard individual care.Therefore, implementation of GMCs as part ofstandard care may be an alternative for BCS.ACKNOWLEDGEMENT OF FUNDING: None.

P3-111

Neuropathic Symptoms Among Colorectal Cancer

Patients With Diabetes: Results From the

Population-Based PROFILES Registry

P.A.J. Vissers1,2, F.M. Mols1,2, M.S.Y. Thong1,2,F. Pouwer1, L.V. van de Poll-Franse1,21CoRPS - Center of Research on Psychology inSomatic diseases, Department of MedicalPsychology and Clinical Psychology, TilburgUniversity, Tilburg, The Netherlands,2Comprehensive Cancer Centre South, EindhovenCancer Registry, Eindhoven, The Netherlands

BACKGROUND: It has been previously foundthat chemotherapy induced-neuropathy is commonamong cancer patients. In addition, neuropathicsymptoms are frequently reported among diabetespatients, due to high blood glucose levels whichaffect the nerve cells. As today up to one in fiveCRC patients also has diabetes we aimed to assessthe prevalence and severity of neuropathic symp-toms among patients with both cancer and diabetesand compare this with patients without diabetes.METHOD: Data from a population-based surveyconducted in 2011 among CRC patients, 2–11 yearsafter cancer diagnosis, was used. The prevalence ofdiabetes was based on self-report using the Self-Administered Comorbidity Questionnaire. CRCpatients with diabetes where matched on age andgender to CRC patients without diabetes. Neuropa-thy was measured using the EORTC-QLQ-CIPN20.



The differences on individual items from the EO-RTC-QLQ-CIPN20 between CRC patients with andwithout diabetes were assessed. RESULTS: 218(13%) from the 1643 responders reported havingdiabetes and were matched to 982 CRC patientswithout diabetes. A few differences in neuropathicsymptoms were detected with more CRC patientswith diabetes reporting tingling fingers or hands(12% vs. 8%, p-value = 0.05), troubles with han-dling small objects (9% vs. 6%, p-value = 0.05),troubles with walking stairs or standing up (13%vs. 9%, p-value = 0.03) and erection problemsamong males (67% vs. 52%, p-value = 0.0007)compared with CRC patients without diabetes. Nodifferences in clinical characteristics including che-motherapy treatment were observed. Due to thelow number of neuropathic symptoms no multivari-ate analyses were conducted. CONCLUSIONS: Ingeneral the prevalence of neuropathic symptomswas low and only a few marginally significant dif-ferences were observed between CRC patients withand without diabetes. Interestingly, chemotherapytreatment among CRC patients with diabetes wascomparable with CRC patients without diabetes.RESEARCH IMPLICATIONS: Since this study isthe first in addressing neuropathic symptomsamong patients with both cancer and diabetes,more research is needed. Future research shouldalso focus on chemotherapy type and dosageadministered and their effects on neuropathicsymptoms. CLINICAL IMPLICATIONS: Basedon current results patients with both colorectal can-cer and diabetes seem to tolerate chemotherapy wellbecause there is not a higher prevalence of neuro-pathic symptoms compared to the colorectal cancerpatients without diabetes. ACKNOWLEDGE-MENT OF FUNDING: Part of the research wassupported by a Veni grant (#451-10-041) from theNetherlands Organization for Scientific Research(NWO) to Floortje Mols, a Cancer ResearchAward from the Dutch Cancer Society (#UVT-2009-4349) to Lonneke van de Poll-Franse and aSocial Psychology Fellowship from the Dutch Can-cer Society to Melissa Thong (#UVT2011-4960).Data collection was funded by the ComprehensiveCancer Centre South, Eindhoven, CoRPS, TilburgUniversity, The Netherlands; and an investmentsubsidy (#480-08-009) of the NWO.

P3-112

The Individual and Combined Effects of Colorectal

Cancer and Diabetes on Health-Related Quality of

Life and Sexual Functioning: 1+1=3?P.A.J. Vissers1,2, M.S.Y. Thong1,2, F. Pouwer1,B.L. den Oudsten1,3, G.A.P. Nieuwenhuijzen4, L.V.van de Poll-Franse1,21CoRPS - Center of Research on Psychology inSomatic diseases, Department of MedicalPsychology and Clinical Psychology, TilburgUniversity, Tilburg, The Netherlands,2Comprehensive Cancer Centre South, EindhovenCancer Registry, Eindhoven, The Netherlands,3Department of Education and Research, St.Elisabeth Hospital, Tilburg, The Netherlands,4Department of Surgery, Catharina Hospital,Eindhoven, The Netherlands

BACKGROUND: This study compares personswithout colorectal cancer and diabetes mellitus(CRC-DM-), persons with only diabetes (CRC-DM+), persons with only colorectal cancer(CRC+DM-), and persons with both colorectalcancer and diabetes (CRC+DM+) on Health-Related Quality of Life (HRQoL) and sexual func-tioning. To study whether 1 + 1 = 3, the additiveinteraction effect of cancer and diabetes was tested.METHOD: Persons older than 60 years who par-ticipated in a survey in 2010 among patients withcolorectal cancer or among a normative Dutchpopulation, were included. Having diabetes wasself-reported. Both samples completed the EO-RTC-QLQ-C30 and four scales of the EORTC-QLQ-C38 to assess HRQoL and sexual function-ing, respectively. Associations were analyzed usingmultivariate linear and logistic regression models.Standardized beta’s and odds ratios (OR) werereported. RESULTS: 624 CRC-DM-, 78 CRC-DM+, 1726 CRC+DM-, and 328 CRC+DM+ per-sons were included in the analysis. No additiveinteraction effect of cancer and diabetes wasobserved on any of the HRQoL subscales, exceptfor pain (CRC-DM- 18; CRC-DM+ 13; CRC+DM-16; CRC+DM+ 18). CRC patients reported lowerscores on all HRQoL subscales, except globalhealth and pain, while DM patients reported lessfavorable scores on global health, physical func-tioning, fatigue and dyspnoea. More erection prob-lems were reported among CRC+DM+ perosns(OR=6.5) and CRC+DM- persons (OR=4.7) com-pared with CRC-DM- persons. Moreover, moremale CRC+DM+ persons reported ejaculationproblems compared with CRC+DM- persons(OR=1.6). CONCLUSIONS: CRC or its treatmentbut not DM seems to contribute to a decreasedHRQoL and sexual functioning compared with thenormative population. No additive interactionbetween cancer and diabetes was found, except forpain. Thus having cancer and diabetes does not



result in a worse HRQoL and sexual functioningthan the sum of both individual effects.RESEARCH IMPLICATIONS: Recently, muchattention has been paid to the association betweencancer and diabetes on incidence and survival rates.However, limited attention is being paid to theHRQoL of the increasing number of patients withboth diseases, whereas today up to one in five colo-rectal cancer patients also has diabetes. More stud-ies are needed to disentangle the complexinteraction between both cancer and diabetes onHRQoL and sexual functioning. CLINICALIMPLICATIONS: To improve quality of care, cli-nicians should become more aware of the long termHRQoL and sexual functioning problems amongpatients with cancer and comorbid diabetes.ACKNOWLEDGEMENT OF FUNDING: Partof the research was supported by a CancerResearch Award from the Dutch Cancer Society(#UVT-2009-4349) to Lonneke van de Poll-Franseand a Social Psychology Fellowship from theDutch Cancer Society to Melissa Thong(#UVT2011-4960). Data collection was funded bythe Comprehensive Cancer Centre South, Eindho-ven, CoRPS, Tilburg University, The Netherlands;and an investment subsidy (#480-08-009) from theDutch Organization for Scientific Research.

P3-113

Information and Support Needs Among a Diverse

Sample of Adult Cancer Survivors in the First Year

After Completion of Their Primary Treatment

Roy Willems1, Ilse Mesters2, Catherine Bolman1,Iris Kanera1, Audrey Beaulen1, Lilian Lechner11Open University of the Netherlands, Heerlen, TheNetherlands, 2Maastricht University, Maastricht,The Netherlands

BACKGROUND: Cancer is a life-threatening dis-ease which causes psychosocial and physical prob-lems that may continue after the primary treatmenthas been completed successfully. However, the cur-rent aftercare available does not sufficiently meetcancer survivors’ needs. In order to develop anonline tailored intervention to support cancer survi-vors on their primary needs, we conducted a surveyresearch to assess the most prominent informationand support needs among cancer survivors.METHOD: Cancer survivors were recruitedthrough eight hospitals in the Netherlands. Hospi-tal staff handed out the survey, which participantscould fill in and send to the Open University. After4-6 weeks, participants were invited by the OpenUniversity to participate in a second survey. Vali-dated measures were used to assess unmet needsand psychosocial and lifestyle concepts, such asquality of life, coping and self-management skills,social support, fatigue, returning to work, and life-style behaviours (physical activity, smoking, and

nutrition). The purpose of the second survey was totest the reliability of the translated Cancer Survi-vors Unmet Needs (CaSUN) measurement.RESULTS: In total, 278 cancer survivors partici-pated in the study. Mean age of the participantswas 60.2 years (SD = 10.46); 30.9% was male.Most important unmet needs reported were needsin the psychosocial (need for emotional support,dealing with fear of recurrence, contact with fellowsurvivors) and medical domain (dealing with com-plications, need for up to date information, needfor the best medical care). The reliability of theDutch version of the CaSUN and the relationshipsof information needs with concepts such as coping,self-management and quality of life were studiedand will be presented at the conference. CONCLU-SIONS: After primary treatment has finished, can-cer survivors experience a wide range of needs, ofwhich an important part consist of unmet needs.Since the number of cancer survivors will increaseover the upcoming decade, cancer survivors shouldacquire the skills to fulfil their most importantneeds. Current guidelines state that it is importantto improve self-management in cancer survivors.The results of the study were used to develop anonline tailored intervention, the “Kanker NazorgWijzer” (Cancer Aftercare Guide), to improve theseskills and teach cancer survivors to manage issueson the psychosocial, physical and lifestyle domain.RESEARCH IMPLICATIONS: The results of thesurvey research provide information on the mostprominent information and support needs of cancersurvivors, and on the degree that these needs arebeing met. Information on the relationship betweenthese needs on the secondary outcomes coping, self-management, illness perception, perceived socialsupport and lifestyle behaviour, and on the primaryoutcomes quality of life and psychological distresswill give insight in future directions for researchand interventions for former cancer patient. CLIN-ICAL IMPLICATIONS: The results of the studygive an indication of the most prominent met andunmet needs of cancer survivors and give sugges-tions for future directions in the patients’ aftercare.The results of the study are used in the developmentof an online tailored intervention aimed at encour-aging self-management in cancer survivors, in orderto help them to deal with psychosocial and lifestyleproblems they encounter in their recovery fromcancer ACKNOWLEDGEMENT OF FUND-ING: This research project is funded by the DutchCancer Society (KWF Kankerbestrijding).



P3-114

Yoga on Psychological Recovery From “Object

Loss” for Breast Cancer Survivors – Results From a

Pilot Study

Yayoi Yamauchi1, Yoshio Nakamura21Graduate school of Waseda University,Tokorozawa, Saitama, Japan, 2Faculty of SportSciences, Waseda University, Tokorozawa, Saitama,Japan

BACKGROUND: There are an increasing numberof breast cancer survivors in Japan. Many studiesabout yoga for cancer survivors have shown theireffectiveness on physical and psychosocial QOLquantitatively. It is gradually accepted that applica-tions of yoga to be helpful for grieving process. Weconsider breast cancer diagnosis as “object loss”directly impact on their QOL. This preliminarystudy focused on psychological defense mecha-nisms, aimed to figure out how they recover fromtheir diagnosis and treatment. METHOD: 20 Japa-nese breast cancer survivors aged over 20 wererecruited as participants for 12 weeks yoga inter-vention program. A 75 minutes yoga session con-sists of warm up, basic yoga postures, breath workand resting posture. All participants were encour-aged to practice at home as well as weekly groupsession. Group interviews and QOL assessments(FACT-B) were conducted at baseline and after12 weeks intervention. All interviews were audio-taped with consent, and transcribed to analyze. Therecovery stages were assessed and identified by acertified psychotherapist, a psychoanalyst and thefirst author individually, then made it into a con-sensus. RESULTS: 18 participants aged 36 to 53(mean: 46.6) completed 12 weeks program. Meanattendance was 11.3 of 12 classes. No seriousadverse events were reported through intervention.We found that psychoanalytic defense mechanism“denial” was used commonly in participants andthe appearance of “denial” related words wasdecreased after intervention. We also found theQOL score and appearance of “denial” relatedwords had significant correlations. Participantswho tended to make denial related words beforeintervention more likely to decrease QOL scoreafter intervention; 5 cases out of 7 (71%), and itappeared only 10% in participants who improved.CONCLUSIONS: Our results indicated that yogais a safe, feasible intervention for breast cancer sur-vivors particularly in psychological recovery pro-cess to help them progress the recovery stages.Consequently yoga could lead to improve theirlong-term QOL. ACKNOWLEDGEMENT OFFUNDING: None.

P3-115

The Contribution of Attachment to Psychological

Adjustment in Women Facing Breast Cancer

Sarah Cairo Notari1, Nicolas Favez1, LindaCharvoz1, Luca Notari1, B�en�edicte Panes-Ruedin1,Jean-Franc�ois Delaloye21NCCR Lives & FPSE, University of Geneva,Geneva, Switzerland, 2CHUV, University ofLausanne, Lausanne, Switzerland

BACKGROUND: Attachment theory provides ageneral model for understanding the way individu-als emotionally react when stressed. Two maindimensions of attachment have been identified: anx-iety (to exacerbate the emotional needs and depen-dence to others) and avoidance (to downplay threatand distress).This study examines the associationbetween treatment-related physical symptoms ofbreast cancer, anxious or avoidant attachment, andpsychological distress in women. METHOD: Thisstudy is part of a larger project on the role of socialsupport in women facing cancer. Women wererecruited during hospitalisation at the Breast Cen-tre of the University Hospital of Lausanne. For thisstudy, we used data from 72 women. Their meanage is 53.73 (SD = 12.17). After surgery, womencompleted the following self-reported question-naires: the European Organization for Researchand Treatment of Cancer (EORTC-QLQ BR23)for physical symptoms; the Experiences in CloseRelationships-revised (ECR-R) for adult attach-ment; and the Brief Symptoms Inventory (BSI-18)for psychological distress. Several socio-demo-graphic and medical data were used as control vari-ables. RESULTS: Different multiple regressionmodels have been tested to examine the link betweenphysical symptoms, attachment styles and psycho-logical distress. Contrarily to our hypothesis, anxietydoes not moderate but instead directly predicts dis-tress. On the contrary, avoidant attachment has amoderating effect on the link between physicalsymptoms and distress. Nevertheless, the best-fitmodel includes physical symptoms, anxious attach-ment and neoadjuvant treatment (control variable)as predictors; this model accounts for 50.7% of thevariance in distress. In this model no direct nor mod-erating effect for avoidant attachment was found.CONCLUSIONS: Our study shows that attach-ment plays a role in adjustment to breast cancer.This result demonstrates that women’s response tostress is not only determined by disease-specificvariables but also by their general way of regulatingemotions which is a trait of their personality. Inter-ventions aiming at helping women to cope withbreast cancer should take into account individualvariability in emotion regulation to be more effi-cient. ACKNOWLEDGEMENT OF FUND-ING: This study benefited from the support of theSwiss National Centre of Competence in Research



LIVES – Overcoming vulnerability: life course per-spectives, which is financed by the Swiss NationalScience Foundation. The authors are grateful to theSwiss National Science Foundation for its financialassistance.

P3-116

A 1-Year Follow-Up of Post-Traumatic Stress

Disorder (PTSD) Symptoms and Social Support

Perceived in Cancer

Gema Costa-Requena1,2, Rafael Ballester Arnal2,Francisco Gil31Department of Psychiatry, Hospital UniversitariVall d’Hebron.CIBERSAM. Universitat Aut�onomade Barcelona., Barcelona, Spain, 2Department ofBasic Psychology, Clinical Psychology andPsychobiology. Universitat Jaume I., Castellon,Spain, 3Psycho-oncology Unit. Hospital Duran iReynals, L’Hospitalet. Barcelona, Spain

BACKGROUND: Prevalence rates of cancer’sPTSD symptoms varied from 3% to 19%, depend-ing on the timing of the assessment of the PTSDsymptoms done during these studies. Social supportis considered a buffering variable in the cancertreatmnet. The purpose of this study was to explorethe relation between PTSD symptoms with the per-ceived social support at specific times between thediagnosis and the treatment of the cancer.METHOD: These studies consider three diagnosesof cancer, breast, head and neck, and colorectalcancer. The point times of the assessment consid-ered in the study were, preliminary time of oncol-ogy treatment (T1), at the end of the treatment(T2), at 6 months post-treatment (T3) and 1 yearfollowing post-treatment in each type of tumour(T4). The presence of PTSD symptoms wasassessed with the PTSD Checklist - Civilian version(PCL-C). Social support was evaluated with theMedical Outcomes Study Social Support Survey(MOS-SSS). Multivariate analyses were used toassess the associations of social support perceivedwith PTSD symptoms at the four time points con-sidered. RESULTS: 67 patients participated in thisstudy. The sample consisted of breast cancer(53.7%), head and neck (25.4%) and colorectalcancer (20.9%). At T1, 9% of the sample was iden-tified as suggestive of PTSD. The patients with clin-ical PTSD are increased at T2 to 12.7%, and theseare reduced to 10% of patients at T3 and T4. At T1and T2 time, social support perceived was relatedwith re-experiencing (p < 0.00) and numbing(p < 0.00) symptoms. At T3, social support wasrelated with all symptoms of PTSD (p < 0.00). AtT4, social support was related only with numbingsymptoms (p < 0.00) of PTSD. CONCLUSIONS:No evidence of significant differences with regardsto suggestive PTSD at follow-up times in cancertreatment could be found. The association of social

support perceived with different PTSD symptomsvaried across follow-up time. Numbing and re-experiencing symptoms of PTSD was found to berelated with social support perceived through diag-nosis and cancer treatment. RESEARCH IMPLI-CATIONS: Longitudinal research examiningtemporal changes of PTSD symptoms in cancer islimited. Changes of suggestive PTSD were evalu-ated across 1-year post-treatment. Moreover, it wasevaluated how specifically PTSD symptoms wereassociated with social support at follow-up. How-ever, these findings included a small sample size,and it was possible to examine only some of the keyvariables used to assess changes in psychologicaldistress across cancer treatment. Therefore, moreinvestigation is required to confirm these results.CLINICAL IMPLICATIONS: This study hasimportant clinical implications for assessment andtreatment of psychological distress in cancer. Spe-cifically, the findings highlights that social supportperceived was linked differently with symptoms ofPTSD in follow-up times of cancer treatment. Assuch, the patients may need different psychosocialsupport by follow-up time of post-treatment can-cer. ACKNOWLEDGEMENT OF FUNDING:This research was supported by the Catalan Agencyfor Health Technology Assessment and Research(Nº. 102/19/2004).

P3-117

Personality Factors in Adhesion to Tobacco

Cessation After Lung Cancer Diagnosis

Jonathan Graffi1, Elisabeth Quoix2, AnitaMolard2, Marie-Fr�ed�erique Bacqu�e31Hopitaux Universitaires de Strasbourg, EA 3071University of Strasbourg, Strasbourg, France,2Hopitaux Universitaires de Strasbourg, Strasbourg,France, 3EA 3071, University of Strasbourg,Strasbourg, France

BACKGROUND: Persistent smoking after lungcancer has been the subject of medical, therapeuticand epidemiological publications for 20 years ofresearch. Continued persistent smoking is all themore a problem for oncologists as there is evidencethat smoking cessation, with lung cancer, givestherapeutic benefit. Quitting smoking can improvethe response to treatments (chemotherapy, radio-therapy, surgery), quality of life and overall sur-vival. However many patients refuse adhesion totobacco cessation. A qualitative study has beenlaunched. METHOD: A comparative and prospec-tive single-center study is being conducted in theDepartment of thoracic oncology of StrasbourgUniversity Hospital. 50 patients are included, menand women, 18 years or+, with active smoking atdisclosure of lung cancer. A week after receivingthe diagnosis and having signed an informed con-sent, a research interview is conducted, then 2 to



4 months later, tests (Fagerstr€om, Q-MAT,H.A.D.S, SCL 90-R), another research interviewand projective methods (T.A.T, Rorschach) com-plete the data. Two groups are therefore compared,one with patients who maintain an active smokingand the other with those who stopped. RESULTS:Initial results indicate that adhesion differencesaren’t related to the denial of medical information,nor to resignation or to nicotine dependence.Patients who continue smoking seem to face a formof impossibility to wean. Cigarette is felt as part oftheir body in their narration and description oftheir body image (cigarette-identity). Cigarette isinvested as a companion of daily life (cigarette-rela-tionship). But smoking also gives the impressionthat it’s the last pleasure that remains and helpsthem not to collapse (cigarette-drug). Cigarette jus-tifies an unconventional choice, in opposition to themedical standard. CONCLUSIONS: Lung canceris the biggest cause of death by cancer and all themore so as there’s a continuation of smoking. Nev-ertheless many patients maintain active smokingafter cancer diagnosis. Our results suggest the exis-tence of a psychological functioning in which smok-ing takes part in the smoker’s identity, his way offunctioning and his self-therapy attempts. It alsoappears that smoking persistence reveals a choicethat confirms the smoker’s personality against soci-ety, medicine and doctors. RESEARCH IMPLI-CATIONS: Persistent smoking despite medicalrecommendations questions the concept of adhe-sion. Evading the doctor’s recommendations alsoraises the question of the effects of therapeutic alli-ance and prescription ethics. Despite medical evi-dence, could medicine decide for the unconsciousdesire of the subject? This questioning of persistentsmoking could be generalized to non-cancerpatients (myocardial stroke, COPD, asthma).CLINICAL IMPLICATIONS: Persistent smokinghas long been unexplored and patients have beenstuck by guilt-speech in their therapeutic manage-ment or in the words of their caregivers. A betterknowledge of the psychopathology of smoking can-cer patients could improve physicians’ relation totheir patients. Having in mind the unconsciousaspects of continued smoking will help to maintainthe link between doctors and patients, and help thepatients to change their attitude towards smoking.ACKNOWLEDGEMENT OF FUNDING: None.

P3-118

Psycho-Social Correlates of Fatigue in Chronic

Myeloid Leukemia

Subathra Jeyaram, Vidhubala Elangovan, RejivRajendranathCancer Institute WIA, Chennai, Tamilnadu, India

BACKGROUND: Fatigue is the most commonunder recognized symptom in cancer and ranked

greater than pain, nausea and depression in termsof its effect on the quality of life. Fatigue is com-monly reported at diagnosis in Chronic MyeloidLeukemia (CML). Fatigue is also a well docu-mented side effect of CML patients receiving longterm Imatinib treatment. The objective of this studyis to understand fatigue and its psycho-social corre-lates in CML patients treated with Imatinib.METHOD: CML patients (n = 71, age(M = 40.38, SD = 12.15)) reporting for their fol-low-up visit to the out-patient clinic were assessedfor fatigue and their hemoglobin readings weregathered from routine hemogram investigations. Asmaller group of CML patients (n = 44, age(M = 40.1 SD = 12.9)) were also administered theCancer Institute Quality of Life (QOL), HospitalAnxiety and Depression Scale (HADS) and theMemorial Symptom Assessment Scale (MSAS).Information on Imatinib Dosage and Disease sta-tus (achievement of complete cytogenetic response)was also collected. RESULTS: Fatigue correlatedsignificantly with QOL (r = �0.62, p < 0.01), Anxi-ety (r = 0.41, p < 0.01), Depression (r = 0.69,p < 0.01), MSAS (r = 0.7, p < 0.01) but not withHb (r = �.1, p > 0.05) and dosage (r = 0.09,p > 0.05). Fatigued patients had significantlygreater distressing symptoms (t(42) = �4.23,p < 0.01), anxiety (t(42) = �2.53, p < 005),depressed (t(42) = �5.35, p < 0.001) and hadpoorer quality of life (t(42) = 3.944, p < 0.001).Fatigued and non-fatigued patients did not differon disease status (t(31) = �1.85, p > 0.05), Hb (t(27) = 0.84, p > 0.05) and Imatinib dosage (t(31) = 0.042, p > 0.05). A multiple regression anal-ysis indicated depression (B = 0.58, SE = 0.2,p = 0.006) and MSAS (B = 11.214, SE = 3.4,p = 0.003) as variables significantly predicting fati-gue (F(2,41) = 28.63, p < 0.001, R2 = 0.58). CON-CLUSIONS: Fatigue was reported by CMLpatients treated with Imatinib. Fatigued cancerpatients are more anxious, depressed and experi-ence greater symptom distress. Fatigue is a signifi-cant contributor to poor quality of life. Depressionand Symptom distress were found to be significantpredictors of fatigue. RESEARCH IMPLICA-TIONS: Fatigue in CML does not seem to berelated to disease and dosage status. Cognitive andother psycho-social variables that may influencefatigue needs to be explored. The complex relation-ship between depression and fatigue needs to beexplored further. CLINICAL IMPLICATIONS:Fatigue is a significant and distressing symptomexperienced by CML patients treated with Imati-nib. This study demonstrates this in a populationwhere no previous data of this nature exists. Sincefatigue has the capacity to significantly lower qual-ity of life clinicians should focus on identifying andimplementing interventions to reduce fatigue.ACKNOWLEDGEMENT OF FUNDING: None.



P3-119

Personality Traits and Coping Styles Explain

Anxiety in Lung Cancer Patients to a Greater

Extent Than Other Factors

Ken ShimizuNational Cancer Center Hospital, Tokyo, Japan

BACKGROUND: Although various factorsthought to be associated with anxiety in cancerpatients, relative importance of each factors wereunknown. We tested our hypothesis that personal-ity traits and coping styles explain anxiety in lungcancer patients to a greater extent than other fac-tors. METHOD: A total of 1334 consecutivelyrecruited lung cancer patients were selected, anddata on cancer-related variables, demographiccharacteristics, health behaviors, physical symp-toms, and psychological factors consisting of per-sonality traits and coping styles were obtained. Theparticipants were divided into groups with or with-out a significant anxiety using the Hospital Anxietyand Depression Scale-Anxiety, and a binary logisticregression analysis was used to identify factorsassociated with significant anxiety using a multivar-iate model. RESULTS: Among the recruitedpatients, 440 (33.0%) had significant anxiety. Thebinary logistic regression analysis revealed a coeffi-cient of determination (overall R2) of 39.0%, andthe explanation for psychological factors was muchhigher (30.7%) than those for cancer-related vari-ables (1.1%), demographic characteristics (2.1%),health behaviors (0.8%), and physical symptoms(4.3%). Four specific factors remained significantin a multivariate model. A neurotic personalitytrait, a coping style of helplessness/hopelessness,and a female sex were positively associated with sig-nificant anxiety, while a coping style of fatalismwas negatively associated. CONCLUSIONS: Ourhypothesis was supported, and anxiety was stronglylinked with personality trait and coping style.RESEARCH IMPLICATIONS: Although traitanxiety is stable and invariable from a conceptualpoint of view, our previous report suggests thatanxious patients tend to be more likely to respondnegatively on other self-reported questionnaires,such as the EPQ-R or MACS. Consequently, a lon-gitudinal study in which trait anxiety is assessedbefore the onset of cancer and that analyzes to whatextent the trait of anxiety predicts the state of anxi-ety after cancer diagnosis is needed. CLINICALIMPLICATIONS: The use of screening instru-ments to identify these factors and the implementa-tion of cognitive behavioral interventions focusingon coping styles could be effective for reducing anx-iety. ACKNOWLEDGEMENT OF FUNDING:This work was supported in part by a Grant-in-aidfor Cancer Research, Clinical Cancer Research(H22-033) to KS and Third Term Comprehensive10-year Strategy for Cancer Control (H22-036) to

YU, from the Japanese Ministry of Health, Laborand Welfare.

P3-120

Comparison Between Patients With Hepatocellular

Carcinoma and Hepatitis C in Fatigue and

Psychological Distress Before Receiving Treatment

Shiow-Ching Shun1, Yeur-Hur Lai1, Chen-HuaLiu21College of Medicine, National Taiwan University,Taipei, Taiwan, 2Department of Internal Medicine,National Taiwan University Hospital, Taipei,Taiwan

BACKGROUND: Hepatocellular carcinoma(HCC) and Hepatitis C virus (HCV) infection aretwo major health problems in Taiwan. Fatigue anddepression were the most distress experienced bythese two groups. However, there is no study tocompare the status of fatigue and depressionamong these two groups. Therefore, the aim of thisstudy was to compare the differences in fatigue anddepression between patients with HCV and HCCbefore receiving treatments in the past week.METHOD: A cross-sectional design was used torecruit the participants. Eligible participants werehospitalized patients with HCC before receivingnon-surgical treatments; meanwhile, patients withHCV infection were outpatients scheduled toreceive interferon combined ribavirin therapy. Dis-ease information was collected from chart and a setof structured questionnaires was used to assesspatients’ fatigue, symptom distress, anxiety, anddepression. The t test was used to examine the dif-ferences between the two groups. RESULTS: Theparticipants with HCC (n = 114) and HCV infection(n = 96) all reported fatigue was the most distressedsymptom in the past week of treatment. Comparedto the patients with HCC, those with HCV infectionhad higher level of fatigue intensity and its interfer-ence with functioning and anxiety. However, thesame level of depression between the two groups.CONCLUSIONS: Before treatments, fatigue wasthe most distre ss problem in the two populations.The patients with HCV had the higher level of fati-gue, and anxiety but the same level of depressioncompared to the patients with HCC. RESEARCHIMPLICATIONS: Conducting fatigue manage-ment before treatment for two groups is needed. Theintervention of anxiety reduction for patients withHCV before receiving interferon therapy is sug-gested. CLINICAL IMPLICATIONS: Health careproviders should offer fatigue management pro-gram for both of them before receiving treatment.However, more anxiety reduction intervention forHCV patients before treatment and psychologicalmanagement for dealing with depression for thetwo groups are needed. ACKNOWLEDGEMENTOF FUNDING: Thank you for the grant support



from National Health Research Institute (NHRI-EX101-10121PC) and National Science Council(NSC98-2314-B002-103-MY3).

P3-121

Shared Decision Making in Dermato-Oncology –Preference for Involvement of Melanoma Patients

Karoline Albrecht1,2, Frank Meiss1, Doroth�eeNashan3, Katrin Reuter21University Freiburg - Medical Center, Departmentof Dermatology, Freiburg, Germany, 2UniversityFreiburg - Medical Center, Department ofPsychiatry and Psychotherapy, Freiburg, Germany,3Klinikum Dortmund gGmbH, Department ofDermatology, Dortmund, Germany

BACKGROUND: Involving patients in treatmentdecisions is frequently requested in oncology formedical, ethical and sociological reasons. For thatpurpose the implementation of Shared DecisionMaking (SDM) as a clinical decision-makingmodel, in which doctors and patients are seen aspartners who reach a mutually accepted decision, ispromoted. In dermato-oncology, however, it hasnot been investigated how patients want to beinvolved in treatment decisions or to what extentSDM is realized in clinical practice. METHOD:The aim of this study is to assess melanomapatients’ preference for involvement in treatmentdecisions and to test if this preference changes overtime. This was investigated in consecutivelyrecruited melanoma patients (stages I-III) in twoGerman Skin Cancer Centers, as part of a longitu-dinal questionnaire study. The Control PreferenceScale (CPS) assessed patients’ preferences at base-line (n = 405) and was re-administered 1 year later(n = 314) to detect potential changes. Additionally,the perceived realization of SDM in the adjuvantinterferon-alpha treatment decision was investi-gated in a subgroup of patients (n=108), using the9-item Shared Decision Making Questionnaire(SDM-Q-9). RESULTS: Almost half of the 405melanoma patients prefer shared decision making(49%), 34% want to decide autonomously and only17% want to delegate their decision to the doctor.We found a significant preference shift within the 1-year assessment period predominantly towardsmore active involvement. The mean SDM-Q-9score suggests that the patients in general felt mod-erately involved by their physicians in the SkinCancer Centers in Freiburg and Cologne. The sin-gle item analysis revealed that the individual SDMprocess steps vary in their degree of realization per-ceived by patients. CONCLUSIONS: The majorityof melanoma patients want to play an active role(autonomous or shared) in treatment decisions andonly a small percentage wants the doctor to decideon the treatment. Over time this preference for anactive involvement even increases. Our findings

indicate that the implementation of SDM in theadjuvant treatment situation is improvable. Thisunderlines the importance to enhance the imple-mentation of SDM in dermato-oncology.RESEARCH IMPLICATIONS: To our knowl-edge this study is the first to investigate patients’preferences for involvement of melanoma patientsand their perceived participation in the adjuvanttreatment situation in routine clinical practice sofar. It would be desirable to support the observedresults with further research on SDM in dermato-oncology since melanoma patients show a highpreference for SDM. CLINICAL IMPLICA-TIONS: Our data show that over 80% of mela-noma patients want to play an active role in theirtreatment decisions and that their preference for anactive involvement even increases over time. Thus, itis vital that physicians enable patients to play anactive role in treatment decision-making. The imple-mentation of SDM could be further enhanced forexample via SDM physician training programs orthe implementation of a decision aid. ACKNOWL-EDGEMENT OF FUNDING: We thank MSDPharma for co-funding this research project.

P3-122

The Involvement Of Breast Cancer Patients During

Oncological Consultations. A Multi-Centre

Randomized Controlled Trial. The INCA Study

Protocol.

Claudia Goss1, Alberto Ghilardi3, GiuseppeDeledda1,2, Chiara Buizza3, Alessandro Bottacini1,Irene Bighelli1, Maria Angela Mazzi1, Lidia DelPiccolo1, Michela Rimondini1, Federica Chiodera1,Mario Ballarin1, Maria Grazia Strepparava4,Annamaria Molino2, Elena Fiorio2, RolandoNortilli5, Chiara Caliolo5, Alessandra Auriemma5,Edda Lucia Simoncini6, Richard Brown7, ChristaZimmermann11Department of Public Health and CommunityMedicine, University of Verona, Verona, Italy,2O.U. of Oncology d.O., Ospedale Civile Maggiore,Hospital Trust of Verona, Verona, Italy, Verona,Italy, 3Department of Childcare and BiomedicalTechnologies, Section of Clinical Psychology,Faculty of Medicine and Surgery, University ofBrescia, Brescia, Italy, 4Department ofExperimental Medicine, Section of ClinicalPsychology, Faculty of Medicine and Surgery,University of Milano-Bicocca, Milano, Italy,5Oncology Unit of Oncology, Policlinico G. Rossi,Hospital Trust of Verona, Verona, Italy, 6MedicalOncology, Spedali Civili, Brescia, Italy,7Department of Social and Behavioral Health,School of Medicine, Virginia CommonwealthUniversity, Richmond, Virginia, USA

BACKGROUND: Studies on patient involvementshow that physicians make few attempts to involve



their patients who ask few questions if not facili-tated. Patients who participate in the decision mak-ing process show greater treatment adherence andhave better health outcomes. The aims of the pres-ent study are to 1) assess the effects of a pre-consul-tation intervention to increase involvement ofbreast cancer patients during the consultation, 2)explore the role of attending companions in theinformation exchange. METHOD: All firstpatients with breast cancer at an early stage, aged18–75 years who attend the Oncology Out-patientServices are asked to participate the study. Theintervention consists in the presentation of a list ofrelevant illness-related questions. The main out-come measures are: (a) the number of questionsasked by patients during the consultation, (b) theinvolvement of the patient, (c) patient’s perceivedachievement of her informative needs. The inter-vention study was preceded by an observationalphase to explore the information exchange betweenpatient and oncologist. RESULTS: The observa-tional phase has been completed. We recruited 77patients (mean age of 57). The majority (66%)attended with relative. Patients asked a mean of 17questions. The intervention is considered effica-cious if it increases the number of questions by30%. The sample size required in order to demon-strate such difference would therefore require atleast 45 control and 45 experimental patients (Po-cock 1983). CONCLUSIONS: It is expected thatthe use of a list of printed questions facilitates theparticipation of the Italian patients with breast can-cer in the information exchange and in the deci-sional processes. Considering the informative needsof the family members may open new and interest-ing perspectives. ACKNOWLEDGEMENT OFFUNDING: None.

P3-123

Are They Crazy to Refuse Chemotherapy?

Treatment Refusal: Does it Result From

Autonomism Movement in Western Societies or

Does it Reveal Problems in the Physician-Patient

Relationship?

Livia Edery, Marie-Fr�ed�erique Bacqu�eLouis Pasteur University, Strasbourg, Alsace,France

BACKGROUND: International literature is rarelyinterested into treatment refusal. We exploredadaptation and unconscious defense mechanisms infemale patients when adjuvant chemotherapy wasproposed after surgery of their breast cancer.METHOD: This is a comparative and longitudinalclinical research of the medical consultation. Ourresearch includes 50 patients affected from breastcancer and 3 oncologists. Following the curative sur-gery adjuvant chemotherapy is proposed to allpatients. Their decision-making allowed distributing

the patients in two groups: refusal and acceptance.Patient’s psychological factors of the refusal hasbeen registered and analyzed. Furthermore, thephysician-patient communication (verbal and non-verbal) and Risk-Benefit ratio of adjuvant chemo-therapy have been studied. RESULTS: 82% ofpatients have accepted adjuvant chemotherapy while18% refused it. In front of this anxiogenic medicalproposal, Adhesive patients suppressed their emo-tions. On the contrary, Refusal patients expressedtheir feelings. The psychicological elaboration torefuse the therapeutic protocol is determined bystructure of personality and strategies of adaptationof patient, acquired during her psychicological devel-opment (The social influence was not studied here).The verbal communication also led to the Refusalpatient. Conversely, the physician’s unconsciousnon-verbal communication as well as risk of dyingfrom breast cancer in coming 10 years for patientsdid not influence the choice of patients. CONCLU-SIONS: The main conclusion is to consider struc-ture of personality, coping and defense mechanismsof the patients in their therapeutic decision. Ourresults highlight the subjectivity of person and itsexperiences in the most extreme situation. This the-sis brings clinical and research perspectives in frontof the physician-patient relationship which oftenreduced to their social roles. In this context, physi-cian-patient relationship is a meeting between twopersons with different social status with peculiarstructure of personality, in a stressful situation.RESEARCH IMPLICATIONS: This model ofresearch features the lack of studies about the refu-sal of treatment. To adhere to the treatment is notsynonymous of active participation of patient. Toparticipate during the care does not mean partici-pating in the therapeutic decision. Likewise, thenon-verbal communication of oncologist needsmore investigation. CLINICAL IMPLICA-TIONS: In the oncology care a better knowledgeabout psychopathology of patients could facilitatetheir level of participation to their therapeutic pro-tocol. We propose a pre-disclosure consultationwith a clinical psychologist. This psychologicalinterview would allow a multidisciplinary reflectionto take into account the psychopathology of patientin medical consultation. ACKNOWLEDGE-MENT OF FUNDING: None.



P3-124

Dutch Oncologists’ Views On and Self-Reported Use

of Risk Prediction Models in the Breast Cancer

Setting

Ellen Engelhardt1, Arwen Pieterse1, Nanny vanDuijn-Bakker1, Ellen Smets2, Hanneke de Haes2,Anne Stiggelbout11Leiden University Medical Center, Leiden, TheNetherlands, 2Academic Medical Center,Amsterdam, The Netherlands

BACKGROUND: Deciding whether or not toundergo hormonal and/or chemotherapy is a diffi-cult balancing act of benefits versus side-effects.Risk prediction models (RPM) that quantify sur-vival gains of treatment options, e.g. Adjuvant!,appear to be increasingly used during consultationswith breast cancer patients. However, most RPMwere not originally designed for such use. Studieshave shown that patients have difficulty under-standing information from RPM. We investigatedwhy and how oncologists use RPM during consul-tations with patients. METHOD: There is limitedliterature on this subject, therefore, we first con-ducted structured interviews and online-focus-groups with medical oncologists from academicand general hospitals in the Netherlands. This datawas independently coded by two researchers. Weused the findings from the interviews and the focus-groups to develop an online-questionnaire thatcould be filled in anonymously. All medical oncolo-gists, surgeons, nurse practitioners and nursesmember of the breast cancer workgroups of theComprehensive Cancer Centers the Netherlandswere approached via e-mail and asked to completethe questionnaire. A reminder was sent after onemonth. The data was analyzed using SPSS 20 soft-ware. RESULTS: 87 respondents (partially) com-pleted the questionnaire (30% medical oncologists,29% surgeons and 41% specialized nurses). Adju-vant! is the best known (95%) and most frequentlyused RPM. Surgeons mainly use Adjuvant! duringthe consultation to explain why referral to the med-ical oncologist is necessary. Medical oncologistsmost often use Adjuvant! during consultations toinform and help patients decide about treatment orpersuade them to follow the proposed course oftreatment. Specialized nurses have a supportiverole, checking whether patients correctly under-stood the information. The majority of respondents(>75%) believe that using Adjuvant! helps patientsto better understand their prognosis. CONCLU-SIONS: RPM have found a place in daily practice,especially Adjuvant!. Moreover, oncologists believethat using RPM, such as Adjuvant!, helps patientsunderstand their prognosis better. However, somesmall studies have found that this is not always thecase. Communicating risks is not straightforward,and if not done properly it could backfire and cause

patients unnecessary anxiety for example. Thus it isbecoming increasingly important to explorewhether patients understand the information pro-vided by RPM, how they evaluate their use duringconsultations and whether this affects decision-making. RESEARCH IMPLICATIONS: BeforeRPM should undergo widespread implementation,insight is needed in the process and outcomes ofrisk communication using RPM, to ensure thatRPM and associated risk communication will bene-fit patients rather than provide a source ofunwanted cognitive burden or anxiety. The currentstudy is a first step in exploring these issues. Nextwe will explore patient understanding of estimatesprovided by Adjuvant! and their evaluation of itsuse during consultations. CLINICAL IMPLICA-TIONS: RPM could be valuable tools in clinicalpractice, promoting more open discussion betweenpatients and oncologists on prognosis and potentialtreatment benefits. However, it is important thatthis is done appropriately. More insights are neededon how best to communicate estimates from RPMto patients. We will use the data we obtain in thesecond phase to provide recommendations to on-cologists. ACKNOWLEDGEMENT OF FUND-ING: This project is funded by a grant from theDutch Cancer Society. We would like to thank allthe participants that generously donated their time,Cora Bakker-van der Zon and her colleagues fromthe Comprehensive Cancer Centers The Nether-lands for their help distributing our questionnaire.

P3-125

Pilot Study of a Decision Aid About Fertility

Preservation for Breast Cancer Patients

Mirjam Garvelink1, Moniek ter Kuile1, LeoniLouw�e1, Carina Hilders2, Anne Stiggelbout31Department of Gynecology, Leiden UniversityMedical Center, Leiden, South Holland, TheNetherlands, 2Department of Gynecology, Reinier deGraaf Hospital, Delft, South Holland, TheNetherlands, 3Department of Medical DecisionMaking, Leiden University Medical Center, Leiden,South Holland, The Netherlands

BACKGROUND: In order to improve the infor-mation provision about fertility preservation (FP)and to support informed decision making for youngwomen with breast cancer, a web-based decisionaid (DA) with explicit values clarification exercise(VCE) was developed. The aim of this study is tocompare the effectiveness of this DA with treat-ment as usual (a brochure) with regard to the deci-sion making processes and outcomes in a patientpopulation. METHOD: A multicenter (26 centers)RCT is conducted in the Netherlands. Eligibleparticipants are female breast cancer patients(18–40 years old) with an unfulfilled child wish.Participants are randomized between the DA and



brochures about FP. Measurements are done byonline self-report questionnaires at diagnosis (T0),after 6 weeks (T1) and after 6 months (T2). We willreport on results from the baseline and T1 measure-ment. Primary outcome is decisional conflict.Secondary outcomes are knowledge of FP, abilityto decide, DA-use (webstats). RESULTS: At timeof abstract submission for T0 26 (13 controls, 13intervention), and for T1 24 (12 controls, 12 inter-vention) questionnaires were available. Of the inter-vention group, 8 women logged into the DA (62%),7 (88%) used the VCE. Mean time spent on thewebsite was 27.4 minutes (0.5–73.6 minutes). Therewere no differences in knowledge, decisional con-flict, or ability to decide between arms, but a mar-ginal difference in effective decision making(p = 0.051). Mean absolute knowledge increase was20–25% between baseline and T1 (F(1,19) = 8.09p < 0.01). There was a positive correlation betweenVCE-use and knowledge at T1 (R = 0.660,p < 0.05). CONCLUSIONS: Both informationalsources lead to improved knowledge about FP, andenabled patients to make a decision. We did notfind differences with regard to decision processesand outcomes between the groups except for effec-tive decision making; women in the DA-arm scoredsomewhat better on effective decision making com-pared to the control group. So far no specific bene-ficial effects of the DA-arm compared to thecontrol arm were found, but an update with moreparticipants should provide more insight in theeffectiveness of this DA. RESEARCH IMPLICA-TIONS: This study offers a starting point forfuture research with more participants, after theeffectiveness of this DA specifically, and the effec-tiveness of DAs and VCEs in general on decisionmaking outcomes and processes. CLINICALIMPLICATIONS: The effectiveness of this DAabout FP compared to brochures has not yet beenrecognized in this study, but there are indicationsthat its use might be beneficiary for knowledgeincrease and effective decision making. We shouldenable future patients to decide for themselveswhich source they prefer to use (brochures or awebbased DA) by offering both. ACKNOWL-EDGEMENT OF FUNDING: DSW HealthInsurance, Schiedam, The Netherlands.

P3-126

Use of a Values Clarification Exercise About

Fertility Preservation Leads to More Clarity About

Values and More Knowledge in Healthy Participants

Mirjam Garvelink1, Moniek ter Kuile1, AnneStiggelbout2, Mariekede Vries31Department of Gynecolog, Leiden UniversityMedical Center, Leiden, South Holland, TheNetherlands, 2Department of Medical DecisionMaking, Leiden University Medical Center, Leiden,South Holland, The Netherlands, 3Department ofSocial Psychology, Tilburg University, Tilburg,North Brabant, The Netherlands

BACKGROUND: To improve information provi-sion about fertility preservation (FP) and supportinformed decision making for young breast cancerpatients, a decision aid (DA) with explicit valuesclarification exercise (VCE) was developed. Wefound that healthy respondents who used the VCEreported less decisional conflict compared to thosewho did not, but few respondents had used theVCE. The current experiment studies the relationbetween personality, DA-use and decisional conflictwith or without referral to the VCE. METHOD:Healthy participants (n = 193) were randomizedbetween information only(VCE-), informa-tion+VCE without referral to the VCE (VCE+), orinformation+VCE with referral to the VCE(VCE++) and were asked to make a hypotheticaldecision regarding FP. Measures were personalitytraits (neuroticism, conscientiousness, monitoring,blunting), DA-use (time spent, pages viewed, VCE-use), decisional conflict (including subscales), andknowledge. RESULTS: More women in VCE++used the VCE (85%) compared to VCE+ (57%;OR = 4.47, p < 0.001). There were no differencesin decisional conflict or knowledge between condi-tions (�/++), mean absolute knowledge betweenbaseline and post-DA was 40%. Secondary analy-ses revealed that blunting was univariately associ-ated with fewer pages viewed (B = �0.734SE = 0.23, p < 0.01), monitoring with more timespent on the DA (B = 21.01 SE = 9.75 p < 0.05).Within VCE+/++, VCE-use was related to morevalues clarity (M = 37.1(SD = 14.3); M = 31.1(SD = 14.7) p < 0.05). There was an interactionbetween group x conscientiousness and VCE-use(OR = 4.3 p = 0.038); conscientiousness was posi-tively related to VCE-use in VCE++, and notrelated to VCE-use in VCE+. CONCLUSIONS:Our DA leads to increased knowledge in a healthypopulation making a hypothetical decision. Therewere no differences with regard to knowledge ordecisional conflict. Secondary analyses suggest arelation between VCE-use and values clarity, andbetween conscientiousness and VCE-use in thereferred group. The extent of use of the total DAwas related to monitoring and blunting information



seeking styles. Therefore, personality (with regardto information seeking) might be an important fac-tor explaining the extent to which a DA is used,and the effectiveness of DAs . ACKNOWLEDGE-MENT OF FUNDING: DSW Health Insurance,Schiedam, The Netherlands.

P3-127

Beliefs About Medicines Among Cancer Patients: An

International Study

Federica Ruffilli1, Alessandra Montesi2, MariaGiulia Nanni3, Elisabeth Andritsch4, Eva Juan Lin-ares5, Marta Bell�e6, Agustina Sirgo Rodriguez7,Maria Alejandra Berardi1, Laura Cavana2, ElenaMeggiolaro1, Maura Muccini2, Elena Samor�ı2, Ilar-ia Strada2, Elisa Ruggeri2, Ilenia Pagliara2, Anto-nella Carbonara3, Luigi Grassi31Istituto Scientifico Romagnolo per lo studio e laCura dei Tumori IRST S.r.l. IRCCS, Meldola FC,Italy, 2Istituto Oncologico Romagnolo – IOR, Forl�ı,Italy, 3Division of Psychiatry, University of Ferrara,Ferrara, Italy, 4University Clinic of InternalMedicine, Division of Oncology, Medical Universityof Graz, Graz, Austria, 5Psycho-Oncology Unit,Hospital de la Santa Creu i Sant Pau, Barcelona,Barcelona, Spain, 6Department of Oncology, C�aFoncello Hospital of Treviso, Treviso, Italy,7Psycho-oncology Unit Oncology Department,University Hospital Sant Joan de Reus, Reus, Spain

BACKGROUND: A few data are availableregarding cancer patients’ compliance on treatmentin psycho-oncology literature. As a part of a largerEuropean study, the aim of the present report wasto identify the association of between patients’orientation/convictions towards medical treatmentand cognitive representation about medicineswith psychosocial and relational variablesMETHOD: 284 cancer patients aged 18–65 years,with no cognitive deficits, Karnofsky Score >60 anda life expectancy > 6 months, participated in a mul-ticenter European study involving Italy, Austria,Spain. Each patient was administered a booklet forthe evaluation of several variables, including, forthe purpose of the present report, the Beliefs aboutMedicines Questionnaire (BMQ) to assess patients’beliefs about medicines (General-GEN and Spe-cific-SPEC beliefs); the Patient Satisfaction withDoctor Questionnaire (PSQ-MD), the Anxious Pre-occupation and Hopelessness subscales of the Mini-MAC; and the 0-10 NCCN Emotional DistressThermometer. RESULTS: The study confirmedthe existence of two sub-factors on the BMQ-SPEC(Necessity-NEC, i.e. beliefs about the necessity ofprescribed medication for controlling illness; Con-cerns-CON) (i.e. concerns about the potentialadverse consequences of taking medicines); and twosub-factors on the BMQ-GEN, General Overuse(GO) (i.e. the tendency to perceive an overuse of

drugs by doctors) and General Harm (GH) (i.e. thetendency to consider drugs dangerous and poison-ing). BMQ-GO and BMQ-GH were related to highscores on PSQ-MD Physician Disengagement(r = 0.29,p = 0.01; r = 0.19,p = 0.01, respectively),and low scores on Physician Support. Anxious Pre-occupation (r = 0.24, p = 0.01), Hopelessness(r = 0.27, p = 0.01) and DT (r = 0.22, p = 0.01)were related to BMQ-CON. CONCLUSIONS:The study indicated that cancer patients’ beliefsabout medicines and cognitive representationsabout treatment are both related to maladaptivecoping styles, such as a tendency to be concernedabout their illness (Anxious Preoccupation) or tobe hopeless about it (Hopelessness) and emotionalstress symptoms. Furthermore characteristics ofdoctor-patients relationship, especially physiciandisengagement and low empathy and support wererelated to distorted convictions about medicines,including sense of harm and danger in followingdoctors’ prescriptions. RESEARCH IMPLICA-TIONS: Results suggest the importance of fur-ther exploring doctor-patient communication andrelationship as an area influencing cognitive repre-sentations about medicines and possibly adherenceto treatment. CLINICAL IMPLICATIONS: Thedata collected suggest the necessity and the impor-tance of specific and institutional programs for phy-sician to increase their communication skills inorder to create supportive and more engaged rela-tionships with their patients. ACKNOWLEDGE-MENT OF FUNDING: Istituto OncologicoRomagnolo (IOR), Forl�ı, Italy; FAR Project, Uni-versity of Ferrara, Italy.

P3-128

Patients’ Views on Shared Decision Making

Concerning a New Treatment Approach for Early

Stage Lung Cancer - A Mixed Methods Study

Wendy Hopmans, Olga Damman, Suresh Senan,Egbert Smit, Danielle TimmermansVU University medical center, Amsterdam, TheNetherlands

BACKGROUND: An important new choice prob-lem in oncology is the treatment of stage I non-small cell lung cancer (NSCLC). For patients withstage I NSCLC there are currently two curativetreatment options available, namely surgical resec-tion and stereotactic ablative radiotherapy (SABR).The purpose of this study is to retrospectively inves-tigate the views of patients with stage I NSCLC inthe treatment decision making process, in order toexplore possibilities for supporting shared decisionmaking. METHOD: A two-phased mixed methodsapproach was used. First, qualitative interviewswith patients who had made an earlier decisionbetween SABR and curative surgery (N=11) wereundertaken. We used both an open and semi-struc-



tured phase, whereby in the open interviews, avisual timeline was used to facilitate the process oftelling stories. We assessed main themes describingpatients’ experiences and their views of the decisionprocess. Second, postal questionnaires aboutshared decision making and their understanding ofthis concept were sent to patients who had made anearlier decision between SABR and surgery.RESULTS: Most patients wanted to be involved inthe decision making process to some extent. How-ever, although most patients wanted to be activelyinvolved, some patients explained participationexclusively in terms of being informed and agreeingwith the physician. They searched for informationand had their own preferences about treatmentoptions. Although physicians appeared to respectpatients’ preferences (if expressed by patients),patients did not always experience having a choiceas their physicians provided firm recommendationsregarding treatment. Data collection of the postalquestionnaire is currently ongoing and findings willbe available at the time of the meeting. CONCLU-SIONS: Although patients wanted to be involvedin the decision process, their actual experiencesindicated that physicians were actively directing thedecision making process from an early stage. Inorder to improve shared decision making for stageI NSCLC, physicians could provide more detailedinformation on both treatment options and explic-itly provide a choice. Furthermore, good qualitywebsites and patient decision aids could supportboth patients and physicians in making shared deci-sions. RESEARCH IMPLICATIONS: This typeof mixed-methods approach could be used morefrequently in the future to explain and verify aquantitatively developed model with qualitativedata. CLINICAL IMPLICATIONS: For clini-cians it is important to know whether lung cancerpatients want to participate in treatment decisionmaking and to what extent. Furthermore, it isimperative to know what definition patients have ofshared decision making, to make sure that both cli-nicians and patients speak the same language inorder to make a good treatment decision.ACKNOWLEDGEMENT OF FUNDING: None.

P3-129

Human-Centred Research and its Application to the

Rapid and Iterative Design of Digital Treatment

-Decision-Making Support Tools

Julie Man2, Nicholas Woolridge1, Jodie Jenkinson1,Shelley Wall1, Susan Bartlett2, Michelle McCune21University of Toronto, Toronto, ON, Canada,2Bridgeable, Toronto, ON, Canada

BACKGROUND: Individuals diagnosed withearly stage breast or prostate cancer have multipletreatment options but a lack of decision support.They are often left overwhelmed and confused or

have already consented to treatment before explor-ing their options. We present a human-centreddesign approach to create a decision support tooland its subsequent evaluation by prostate andbreast cancer patients. We evaluated: wording ofcontent, data visualization, amount of content dis-played, overall look, and user interface.METHOD: In-home ethnographies with 2 mendiagnosed with prostate cancer and 3 women diag-nosed with breast cancer (USA), focused on pastexperiences and current perceptions of treatmentdecision making. We conducted a series of informalinterviews with physicians and subject matterexperts (Canada) to understand the clinical point ofview of decision making and the clinician’s rolewithin this. Leveraging our research insights anddesign principles, we prototyped tool concepts anddesigns through collaborative iterations with Uni-versity of Toronto Biomedical Communicationsdepartment. From this we created a functional,web-based, educational treatment decision toolwhich we evaluated with users in their homes.RESULTS: Wording: no consensus betweenconversational versus clinical tone, some liked nar-ratives, others did not. Data visualization (usingsame dataset): no one preferred the randomizedicon array display, and there was a split preferencefor a survival curve and non-randomized icon arraydisplay. Amount of content displayed: most likedthe “click more” function, and having images andtext together to support learning. User interface: nopreference for a graphically enhanced version ver-sus a standard web-form version. Men and womenwere equally engaged in the information, however,women were more likely to respond to the look andfeel of the tool. CONCLUSIONS: Ingoingthoughts about crafting a single presentation for-mat were refocused when our research showed thatno cookie-cutter solution could meet the way vari-ous people feel, internalize, use, and acquire infor-mation. Our tools had to be flexible toaccommodate individual needs through preferredformats. Collaboration with other disciplines (soft-ware designers, health communicators) helped con-sider the impact of information interactivity andpresentation. As patients become more familiarwith digital tools, and HCPs shift from paternalisticto shared models of decision making, we must pre-pare for how people attain knowledge through digi-tal formats to engage with their HCPs and supportnetwork. RESEARCH IMPLICATIONS: Infor-mation sharing should not be limited by the staticapplication of text to digital formats as these maycause passive reading and less engagement, therebyfailing to meet users’ multiple needs. Technologymust improve communication by creating systemsthat are more dynamic and personalized. To getdigital tools closer to real-person interactions andinto user’s hands more quickly, iterative and partic-ipatory rapid prototyping is essential. CLINICAL



IMPLICATIONS: Digital tools are not intendedto replace the interactions between patients andHCPs but rather to complement the growing poolof experience-focused solutions that ultimatelyimprove patient outcomes. To arm patients withthe most relevant and valid information, cliniciansshould contribute to tool development, and vet anddistribute these tools. ACKNOWLEDGEMENTOF FUNDING: The Oncology Experience/Thera-Choice work was self-funded by Bridgeable, withthe assistance of financial grants from the AppliedResearch Commercialization Program from theFederal Development Agency for Southern Ontario(FedDev ARC), the Mitacs Enterprise Program,and the National Research Council IndustryResearch Assistance Program (NRC-IRAP)

P3-130

Advance Directives in Romania - Accepted or Not?

Andrada Parvu1,2, Silvia Dumitras2, RodicaGramma2, Angela Enache2, Stefana Moisa2,Gabriel Roman2, Beatrice Ioan21”Iuliu Hatieganu” University of Medicine andPharmacy, Cluj-Napoca, Romania, 2Center ofEthics and Health Policies,”Gr T Popa” Universityof Medicine and Pharmacy, Iasi, Romania

BACKGROUND: The advance directive (AD)represents an extension of patient’s authonomywhen losing decision-making capacity, a way torespect patient’s dignity. In Romania, during com-munism, doctor-patient relationship was paternalis-tic, a tendency that persists, even the Patient’s Lawis now centered on patient’s autonomy. EuropeanUnion recommends all member coutries to legislateend-of-life decision-making. We present a studyanalising the attitude of the Romanian peopletoward AD, identifying the utility of implementingAD, considering social-cultural specifics.METHOD: Transversal descriptive study, usingthe questionnaire that included 16 questions andwas pretested on 10% of the total amount of sub-jects and then validated. The target group: the pop-ulation over 18 years old from Romania, withoutpsychological affections. The randomised represen-tative sample included 828 persons. The error mar-gin was �3.4%, for a 95% level of confidence. Thesubjects participated in the study voluntarily andsigned an informed consent before filling the ques-tionnaire. The data was processed by classification,codification, tabulation and statistical analisis usingSPSS 16.0. The study had the approval of aNational University Ethical Comitee.RESULTS: 51.4% of the subjects consider ADuseful. The perception is not statistically differentfrom the age point of view (v2 test = 4.229,p = 0.376) or the gender point of view (v2

test = 1.792, p = 0.408). The trend to see the useful-ness of AD is higher for educated subjects (Spear-

man Coefficient=�0.108, p = 0.002). Health statedidn’t influence the opinion about AD (v2

test = 6.105, p = 0.806), neither the degree of satis-faction with respect to medical services (v2

test = 10.374, p = 0.240) or religious factor (v2

test = 2.604, p = 0.626). The paper will presentother factors influencing the opinion about AD andthe subjects’ motivations considering AD as neces-sary or not. CONCLUSIONS: Higher levels edu-cation persons have a higher interest in the AD andconsider that it must be regulated. The main advan-tages of such a document evidentiated by the sub-jects that agree with it are respecting the patient’sright to decide and improve the treatment, whilethe ones who do not agree with implementing ADsee as main risk the premature death of the patient.Furthermore, most persons that had a cancerpatient in their family consider AD useful inrespecting the patient’s dignity and autonomy.RESEARCH IMPLICATIONS: Considering theethical dilemmas of end-of-life decision making, thefinancial implications of the medical care at theend-of-life, the reccomandation of European Unionto introduce AD, future studies are recommendedto identify the attitude of the Health System deci-dents and providers of medical services in Romaniaabout AD, in comparison with the attitude of thepatients. CLINICAL IMPLICATIONS: In Roma-nia (and in other ex-communist countries) is neces-sary to encourage the active involvement of adultsin advance care planning and to start educationalprogrammes regarding the usefulness of the AD.There is also a need to improve and adapt to thesocial and cultural specifics the communicationbetween patients and the medical staff concerningthe medical decisions. ACKNOWLEDGEMENTOF FUNDING: This paper is a part of POSDRU/89/1.5/61879 Project (“Postdoctoral Studies inHealth Policy Ethics”) cofinanced from EuropeanSocial Funds through Human Resources Develop-ment Sectorial Operational Program 2007-2013.

P3-131

College Males HPV Vaccine Decision-Making in

The Post-Recommendation Era

Samara Perez1,2, Leonora King4,1, Zeev JewishGeneral Hospital1,31McGill University, Montreal, Quebec, Canada,2Jewish General Hospital, Montreal, Quebec,Canada, 3Louise Granofsky Psychosocial OncologyProgram, Segal Cancer Center, Jewish GeneralHospital, Montreal, Quebec, Canada, 4Lady DavisInstitute for Medical Research, Montreal, Quebec,Canada

BACKGROUND: HPV is the most common sexu-ally transmitted infection, accounting for 90% ofgenital warts and 5.2% of the worldwide cancerburden due to its association with cervical, anal,



penile, vaginal and oropharyngeal cancers. Recom-mended for females since 2006,the HPV vaccine hasonly recently been approved and recommended formales (January 2012). Given this change in policy,we examined knowledge, attitudes and beliefs aboutthe HPV and the HPV vaccine among a sample ofCanadian males. METHOD: We conducted a pilotstudy (February-April, 2013) in which 82 maleswere recruited from Montreal universities to com-plete an anonymous, on-line questionnaire. Usingthe Precaution Adoption Process Model (a six stagemodel of health behavior change), participants wereclassified according to their stage of adoption withrespect to the HPV vaccine. These stages are: Stage1 = unaware, Stage 2 = unengaged, Stage 3 = unde-cided, Stage 4 = decided not to act, Stage5 = decided to act, Stage 6 = acting/vaccinated.Depending on participants’ level of awareness, rele-vant knowledge questions were completed. All par-ticipants answered questions regarding their sexualhealth, attitudes and beliefs. RESULTS: Our sam-ple consisted of 61 males (Mean age = 20.7). 47males were aware of HPV, 35 were of the HPV vac-cine, and 18 were unaware of the male recommen-dation (Stage 1). Ten males were aware of thevaccine recommendation for males, but had notconsidered vaccination (Stage 2), 2 intended toreceive (Stage 5) and 5 had already received theHPV vaccine (Stage 6). Average HPV knowledgeand HPV vaccine knowledge scores were 14.5/26(55.8%) and 5.7/10 (57%) respectively. Eighty-three percent of those who had heard about theHPV vaccine reported that their HCP had neverdiscussed the vaccine. CONCLUSIONS: Aware-ness and knowledge about HPV and the HPV vac-cine was rather low in this sample of college males,which is consistent with the literature pre-male vac-cine recommendation. Furthermore, subjects instages 2, 5 or 6 did not necessarily have higher lev-els of knowledge than those who were unaware thatthey were eligible for the vaccine, suggesting thatknowledge is not the sole determining factor whenconsidering to get vaccinated. Further, althoughthe opinion of HCPs seems important to these men,most HCPs had not discussed HPV vaccinationwith them. RESEARCH IMPLICATIONS: Inorder to increase uptake of the HPV vaccine inmales, basic awareness of the vaccine is essential.The findings show that even among an educatedsample of university males, only one third wereaware that there was an HPV vaccine available forthem. Subsequent research efforts should imple-ment strategies to increase awareness about HPVwhile aiming to understand what additional factorsdrive vaccine decisions among this specific popula-tion. CLINICAL IMPLICATIONS: HPV is anincreasing public health issue that can be preventedthrough vaccination. Although national guidelinesare in place that recommend vaccine uptake formales, barriers continue to exist. More large-scale

research focusing on effective knowledge transla-tion and factors that guide HPV vaccine decision-making (especially the importance of the HCP rec-ommendation) is needed. The results from this ini-tial study indicate that these efforts areencouraging. ACKNOWLEDGEMENT OFFUNDING: Supported by an operating grantfrom the Canadian Institutes of Health Research toZeev Rosberger and Fellowship support from theFonds du Recherches en Sant�e du Qu�ebec toSamara Perez

P3-132

Information to Design a Surgical Decision Aid for

Young Breast Cancer Patients

Alejandra Recio-Saucedo, Claire Foster, SueGerty, Ramsey Cutress, Diana EcclesUniversity of Southampton, Southampton, UK

BACKGROUND: Breast cancer is the most com-monly diagnosed cancer in young women. Treat-ment at a young age can have significant impact onfertility and child-rearing, prompting the onset ofearly menopause and ovarian decline. It is notknown if young patients diagnosed with breast can-cer have specific information needs associated witheffects of treatment. Results of an on-going qualita-tive study to design a decision aid tailored to breastcancer patients diagnosed under 40 years isreported. METHOD: In order to explore youngwomen’s information needs, twenty in-depth semi-structured interviews with patients who had a diag-nosis of breast cancer at 40 years old or youngerwere conducted. Findings from the interviews werefurther explored in two focus groups with fivepatients each. Audio-recorded interviews and focusgroups were transcribed verbatim and analysedunder a thematic framework approach.RESULTS: Information that young women identi-fied was required to support treatment decision-making was categorized in five themes: types ofbreast cancer, surgical treatments, non-surgicaltreatments, fertility, and preparing for surgery:before and after. Themes including side effects oftreatment, fertility preservation and options forreconstructive surgery were identified as areas thatneed improvement, emphasising that more infor-mation on types of reconstruction and impact ofearly menopause would have been useful to have.The most important advantage for an online deci-sion aid was access to reliable information that sup-ports understanding of complex facts and risks.CONCLUSIONS: Women identified informationrelevant to them at the time of treatment decision-making as well as information that might have beenuseful. An online decision aid tailored for youngwomen is relevant considering age-related needsthat influence surgical treatment for breast cancer.RESEARCH IMPLICATIONS: This study has



identified ambiguity in the definition of young agefor breast cancer patients, ranging between 40 up to50 years old. This variation may be a factor in theways that other aspects of treatment are presentedto patients, including fertility preservation andoptions of immediate or delayed reconstruction.There is a need to determine an age threshold foryoung patients, which may be applicable at interna-tional level. CLINICAL IMPLICATIONS:Patients with access to the most relevant informa-tion to them at the time of making a treatment deci-sion may choose to play a role in their treatment,supporting a shared-decision making model. Clini-cians may face potential changes in the patient-pro-vider relationship from the paternalistic model toone where patients will feel more prepared to voicetheir concerns, values and preferences on the treat-ment path chosen. ACKNOWLEDGEMENT OFFUNDING: This study has been funded by theNational Institute for Health Research under theResearch for Patients Benefit Programme.

P3-133

Parental Decision-Making About the Human

Papillomavirus (HPV) Vaccine For Their Daughters

Andrea Krawczyk2,1, B€arbel Kn€auper2, VladimirGilca4,5, Eve Dub�e4,5, Zeev Rosberger1,31Louise Granofsky Psychosocial Oncology Program,Segal Cancer Center, Jewish General Hospital,,Montreal,Qu�ebec, Canada, 2McGill University,Montreal, Qu�ebec, Canada, 3Lady Davis Institutefor Medical Research and McGill University,Montreal,Qu�ebec, Canada, 4Institut national desant�e publique du Qu�ebec, Qu�ebec, Qu�ebec, Canada,5Laval University, Qu�ebec, Qu�ebec, Canada

BACKGROUND: The human papillomavirus(HPV) vaccine is an effective prevention measurefor HPV-causing cancers and genital warts. Forchildren and adolescents, the uptake of the vaccineis contingent on parental vaccination consent. Thisstudy aimed to identify key differences betweenparents who accept and parents who refuse theHPV vaccine for their daughters. This study alsoexamined if the health belief model (HBM), a theo-retical framework,is an adequate framework forguiding understanding of parental vaccination deci-sion-making. METHOD: In the context of a free,universal, school-based HPV vaccination program,a random sample of 2,500 Qu�ebec parents of 9–10 year-old girls were invited to participate in thestudy by mail. Participants completed a mail-inquestionnaire based on the theoretical constructs ofthe HBM. Additional factors previously identifiedin the literature were also examined. Of the 834 par-ents who completed the questionnaire (33%response rate), 88.2% reported accepting the HPVvaccine for their daughter. The outcome measure ofthe study, HPV vaccine uptake, was assessed with

the question:”Has your daughter received the HPVvaccine?” using a dichotomous yes/no response.RESULTS: The HBM constructs (perceived sus-ceptibility of daughters to HPV infection, perceivedbenefits of the vaccine, perceived barriers, and cuesto action) distinguished between parents whoaccepted and parents who refused the HPV vaccine.In particular, parental perception of vaccine safetywas the strongest factor associated with acceptanceand was a significant independent contributorbeyond all other HBM constructs. Other significantfactors associated with parental vaccinationacceptance were general vaccination attitudes,anticipated regret, adherence to other routinely rec-ommended vaccines, social norms, and positivemedia influence. CONCLUSIONS: The results ofthis study provide further support for the relation-ship between individual cognitive variables pro-posed by the HBM and uptake of the HPV vaccine.In particular, parental perception of vaccine safetyappears to be a pre-requisite for vaccine accep-tance. While most parents in this study had theirdaughters vaccinated, safety concerns were signifi-cantly related to vaccination refusal. This suggeststhat some parents may be reluctant to vaccinatetheir children when they perceive that a vaccinemay cause negative outcomes, even though thedisease that would be prevented is worse.RESEARCH IMPLICATIONS: The results ofthis study show that other factors not included inthe HBM (such as anticipated regret) were alsoassociated with vaccination uptake. The HBM is alinear, static model that does not specify how differ-ent beliefs influence one another. These results sug-gest that the HBM may be useful but not sufficientto fully explain parental vaccination decision-mak-ing. Researchers should consider conceptual frame-works that are dynamic and longitudinal (e.g. stagemodels). CLINICAL IMPLICATIONS: ParentalHPV vaccination decision-making is a multifacto-rial process and vaccination safety appears to be acritical factor in the process. In Quebec, most par-ents have chosen to vaccinate their daughters, butthis must be considered in the context of a free,school-based, government-supported program,whereas some provinces experienced poorer uptake.Targeted educational interventions focusing on themultivariate factors influencing parents’ decision-making can help dispel myths, improve the successof future vaccination programs and ultimatelyreduce cancer incidence. ACKNOWLEDGE-MENT OF FUNDING: This study was funded bygrant # 94479 from the Canadian Institute forHealth Research (CIHR).



P3-134

Exploring the Association of Patient Age and

Symptom Presentation on Physician Diagnostic

Decisions for Colorectal Cancer

Maria D. Thomson, Laura A. SiminoffVirginia Commonwealth University, Richmond,Virginia, USA

BACKGROUND: Colorectal cancer (CRC) is thethird leading cause of cancer death in the U.S. and2nd in the EU, despite treatment success with earlydiagnosis. Although primarily a concern for adults>50 years, incidence is increasing among youngeradults. US screening guidelines discourage routinescreening among individuals <50 years, relying ondiagnosis via symptom investigation. We examinedhow patient age and symptom presentation influ-enced diagnostic testing approaches in patients whopresented with symptoms of CRC. METHOD: Weused a 2x2 factorial experimental design that pre-sented clinical vignettes to a sample of 128 primarycare physicians in Virginia, USA. Physicians readand evaluated two patient vignette scenarios. Thevignettes were identical except for two factors,patient age (40 vs. 60 years) and symptom type(diarrhea/constipation [DC] vs. rectal bleeding[RB]). Each vignette closed with a series of ques-tions designed to elicit the physician’s differentialdiagnosis and tests they would order. RESULTS:The most common tests reported were blood work(91%), colonoscopy (58%), and ultrasound (67%).Colonoscopy was ordered more often for vignetteswith older patients [67% X2(1) = 7.9; =0.005] andRB [69%; X2(1) = 47.4; p < 0.000] as compared toyounger patients [49%] or DC [32%]. Ultrasoundswere reported more often for DC [64%;X2(1) = 37.8; p < 0.000] as compared to RB [36%].FOBT was ordered for 38% of vignettes, but nosignificant differences were found. A differentialdiagnosis of CRC was provided for 42% of vign-ettes, with significantly more occurring among theRB vignette as compared to DC [51.6%;X2(1) = 9.4; p = 0.002]; no age differences werefound. CONCLUSIONS: This study provides evi-dence that patient age may be influencing physiciandecision-making among patients presenting withCRC symptoms. Colonoscopies were ordered moreoften for the vignettes describing older patients andthe patients experiencing rectal bleeding as com-pared to the younger patients or those experiencingdiarrhea/constipation. FOBT was not reported veryoften despite being a less costly and less risky alter-native to colonoscopy. RESEARCH IMPLICA-TIONS: Given the ambiguity of many ofsymptoms associated with CRC, greater healtheducation emphasis on the signs and symptoms ofCRC is needed to empower patients to better iden-tify and report the onset and progression of theirsymptoms. This may be particularly important

among younger adults. CLINICAL IMPLICA-TIONS: The current emphasis on age (>50 years)for CRC screening may inadvertently influencephysicians’ diagnostic test selection resulting inunequal distribution of cancer diagnostic services(i.e. less referrals) among younger patients.This may have implications for the timelydiagnosis of colorectal cancer among youngeradults. ACKNOWLEDGEMENT OF FUND-ING: National Institutes of Health/NationalCancer Institute Grant # 5R01CA124607-05; Cana-dian Institute of Health Research.

P3-135

Patients’ Decision-Making in a Multidisciplinary

Approach: Met and Unmet Needs

Lara Bellardita1, Silvia Villa1, Tiziana Magnani1,Davide Biasoni2, Silvia Stagni2, Sergio Villa3,Riccardo Valdagni1,31Prostate Cancer Program, Fondazione IRCCSIstituto Nazionale dei Tumori, Milan, Italy, 2Dept.of Urology, Fondazione IRCCS Istituto Nazionaledei Tumori, Milan, Italy, 3Radiation Oncology 1,Fondazione IRCCS Istituto Nazionale dei Tumori,Milan, Italy

BACKGROUND: Patients diagnosed with pros-tate cancer (PCa) may experience uncertainty dueto the opportunity to choose among the multiplebut equally effective therapeutic/observationaloptions. Multidisciplinary (MD) approach repre-sents a suitable trail to help patients make the deci-sion. However, what are their met and unmet needsin the MD setting? The aim of our study was toexplore PCa-related decisional process when usinga decision aid (DA) tool after a MD visit.METHOD: A qualitative study was conductedbetween February and May 2012. Ten patients withlow/intermediate risk PCa accessing a MD visit atthe Prostate Cancer Program of Milan NationalCancer Institute were recruited. The Ottawa Per-sonal Decision Guide, a structured DA grid, wasadministered by a psycho-oncologist after the MDvisit in the form a semi-structured interview. TheDA structure focused on (a) clarifying the decision;(b) identifying patients’ decisional needs and (c)exploring those needs. Interviews were audio-recorded and verbatim transcriptions were made.Content analysis was performed by using a textanalysis software (T-LAB). RESULTS: Patients’mean age was 65 years (SD = 5.6, range 54–72).Four were external referrals, three were internal andthree requested the MD visit based on personalchoice. The text analysis showed the following: (a)despite patients reported to be well informed aboutthe medical options, most of them felt the need forfurther specifics; (b) most relevant decisional needswere to understand risks and benefits of each optionand more involvement from physicians’ side; (c) the



patients explained to consider physician’s recom-mendations as a crucial factor for the choice andemphasized the importance of higher engagementfrom the physicians’ side. CONCLUSIONS: PCapatients perceived the treatment decision making asa challenging complex experience involving theevaluation of medical information as well as psy-cho-social factors. Patients reported to have ade-quate information after the MD visit in order tomake an informed choice. Nonetheless, they alsohighlighted their need for higher participation fromthe physicians’ side and a more engaging interper-sonal approach. Patients and their families enter inthe territory of cancer without a psychosocial map.Hence, clinicians are called to inform patients andalso to guide them in developing a subjective repre-sentation of their needs and values related to thechoice. RESEARCH IMPLICATIONS: Thisstudy highlighted the main areas that need to beexplored to facilitate the decision-making processfrom the patients’ perspective. The research ondecision-making processes in a MD setting needs tobe further explored as it entails clinical, organiza-tional and interpersonal factors that interact andthat contribute to the effectiveness of MD visits interms of patients’ acquisition of information,decisional conflict and disease-related anxiety.CLINICAL IMPLICATIONS: Our results con-firmed that the MD approach represents a suitableand effective care management model: it allowspatients to collect adequate and reliable informa-tion they can base their choice on. Differently,patients attend several consultations with differentspecialists, which entails dealing with ambivalentand sometimes confusing information. The use of aDA tool may support patients in wrapping up thedata gathered during the MD visit and developinga representation of their preferences and values.ACKNOWLEDGEMENT OF FUNDING:Foundation I. Monzino and Foundation ProA-DAMO Onlus for support to the project Per unsentire condiviso: l’uomo e il tumore alla prostate.

P3-136

Children’s and Adolescents’ Experiences in Pediatric

Oncology Treatment Decision Making

Katharina Ruhe1, Domnita O. Badarau1, BerniceElger1, Felix Niggli2, Thomas K€uhne3,Tenzin Wangmo11University of Basel, Institute for Biomedical Ethics,Basel, Switzerland, 2Kinderspital Z€urich, Z€urich,Switzerland, 3Universit€ats-Kinderspital beider Basel,Basel, Switzerland

BACKGROUND: Several pediatric organisationsand the UN Convention on Children’s Rightsadvocate for inclusion of children and adolescentsin decisions that concern them. The importance ofactive participation of minors that are capable to

be involved in treatment decision making has beenwidely acknowledged. However, competent chil-dren and adolescents often face obstacles that keepthem from participating and voicing their views.Especially in oncology, clinicians and parents mayrefrain from inclusion for various reasons.METHOD: Semi-structured interviews are con-ducted with children and adolescents from 9 to17 years old that were diagnosed with cancer. Par-ticipant recruitment takes place in eight centers ofthe Swiss Pediatric Oncology Group (SPOG) inSwitzerland. Questions concern their experienceswith involvement in decision making at severalpoints in time during the course of their illness.Interviews are analysed using content analysis tocode for children’s and adolescents’ experienceswith inclusion or exclusion during decision makingand their attitudes and feelings towards these expe-riences. RESULTS: The on-going analysis revealedseveral themes related to participation of the minorpatients: extent of participation, delegation of deci-sion making powers, satisfaction with participation,conflict situations in decision making. CONCLU-SIONS: Participation of children and adolescentsin treatment decision making in pediatric oncologyseems to have been achieved to some degree. How-ever, sometimes conflicts arise and have to be dis-solved. It seems important to learn more aboutthese situations of conflict in order to be able tooptimally help patients, parents, and physicians tofind solutions and move on with the care.RESEARCH IMPLICATIONS: These prelimin-ary findings point researchers towards an importantarea where more information is needed. Decisionmaking is a challenging process and the involve-ment of three parties adds an additional layer ofcomplexity. More research is needed to explorehow treatment decisions including minor cancerpatients are made, identify potential pitfalls of theprocess and suggest validated solutions to optimiseinclusion of children and adolescents. CLINICALIMPLICATIONS: Clinicians need to be aware ofthe communication needs of minor patients in pedi-atric oncology and the extent to which they wish tobe included. There may be situations where youngpatients feel overwhelmed and wish to be includedto a lesser extent and delegate decision makingpower to parents and physicians. Some potential ofconflict is associated with inclusion of minorpatients that needs to be identified and carefullytaken into consideration. ACKNOWLEDGE-MENT OF FUNDING: The study is funded bythe Swiss National Science Foundation (SNF).



P3-138

Effectiveness of Dutch Psycho-social Interventions

for Oncology Patients: Balancing Between Research

Facts and Health Care Policy

Marieke Wildenbeest1,2, Adriaan Visser3,41Psychosocial Oncology Centre De Vruchtenburg,Rotterdam, the Netherlands, 2Department of HealthEconomics Policy and Law, Institute of HealthPolicy and Management, Rotterdam, TheNetherlands, 3Psychosocial oncology centre DeVruchtenburg, Rotterdam, the Netherlands,4Rotterdam University of Applied Sciences,Knowledge Centre Innovations in Care, Rotterdam,The Netherlands

BACKGROUND: : An increasing number of peo-ple with cancer and their proxies use psychosocialcare facilities e.g. (self) reference to psychologists,psychiatrist and psychosocial oncology centres. Thegovernment intendeds to reduce the costs of theoften still free of charge therapies and asked anadvice Dutch Board of Health Insurance (CVZ). Ina literature study we reviewed the reimbursement ofpsychosocial support for people with canceraccording to the effectiveness principles of theCVZ. METHOD: : This study is a literatureresearch in the Cochrane Library, PubMed andsEURch for (systematic) reviews and meta-analyseson existing evidence regarding the effectiveness ofthe following therapies which are often applied inthe Dutch psychosocial cancer care: individual psy-chotherapy, group counseling, haptotherapy, arttherapy and mindfulness- based stress reductioncourses. This included too a comparison of the psy-cho oncology literature with the offered psychoso-cial care at the Dutch Institutes of Psycho-oncology. RESULTS: : The literature review found11 studies of EBM level A1 and 2 studies of EBMlevel B. Almost all reviews show positive improve-ments in different outcome measures: anxiety,

depression, quality of life, fatigue and social well-being. The reviews indicated that there were onlyfew RCTs and recommend additional RCTresearch in the field of psychosocial cancer toimprove the strength of the outcomes of studies.Only the mindfulness-based stress reductioncourses as offered at that particular institutes showaccepted effectiveness. Effectiveness research doneby the institutions itself does not meet the require-ments of the CVZ. CONCLUSIONS: : The psy-chosocial therapies offered at the Dutch institutesof psychosocial cancer care mostly do not complywith the effectiveness requirements for reimburse-ment of the CVZ. If there is evidence for the effec-tiveness of psychosocial cancer care, the institutesshould adapt their current protocols for psychoso-cial cancer care. Alternatively the Dutch psychoso-cial cancer care institutes need to perform their owneffectiveness studies, meeting the criteria of RCTs.RESEARCH IMPLICATIONS: : The psychoso-cial therapies offered at the Dutch institutes of psy-chosocial cancer care mostly do not comply withthe effectiveness requirements for reimbursement ofthe CVZ. If there is evidence for the effectiveness ofpsychosocial cancer care, the institutes shouldadapt their current protocols for psychosocial can-cer care. Alternatively the Dutch psychosocial can-cer care institutes need to perform their owneffectiveness studies, meeting the criteria of RCTs.CLINICAL IMPLICATIONS: : Health care costshave increased enormously in the Netherlands overthe past decades. To make the health care costsmore manageable, the CVZ will introduce a morestringent package management, also for the psy-chosocial oncology. Because effectiveness of care ispart of the criteria of insured care, it is importantto prove the effectiveness of psychosocial supportfor people with cancer. ACKNOWLEDGEMENTOF FUNDING: : None.



Predictors of Distress in Cancer Patients Under Chemotherapy Treatment

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