Psychosocial factors influence the adaptation of cancer diagnosis/treatment: Association between...

POSTER ABSTRACTS

COSA 39TH ANNUAL SCIENTIFIC MEETING AND IPOS 14TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

220 COSA–IPOS 2012 Joint Meeting

© 2012 Wiley Publishing Asia Pty Ltd Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 220–358

POSTER ABSTRACTS

401

GOOD DEATH AMONG ELDERLY CANCER PATIENTS IN JAPAN

BASED ON PERSPECTIVES OF THE GENERAL POPULATION

Tatsuo Akechi1, Mitsunori Miyashita2, Tatsuya Morita3, Toru Okuyama1, Masaki Sakamoto1, Ryuichi Sagawa1, Yosuke Uchitomi4

1. Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan2. Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan3. Department of Palliative and Supportive Care Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan4. Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Okayama, Japan

Background: Very few fi ndings regarding the concept of good death among elderly cancer patients have been reported. This study investigated concepts relevant to a good death among elderly subjects.

Design: A cross-sectional survey.

Setting: National general population in Japan.

Participants: A national sample of 2595 adults including 466 subjects who were 70–79 years of age.

Measurements: An anonymous questionnaire containing 18 domains (phys-ical and psychological comfort, dying in a favorite place, good relationship with medical staff, maintaining hope and pleasure, not being a burden to others, good relationship with family, physical and cognitive control, envi-ronmental comfort, being respected as an individual, life completion, natural death, preparation for death, role accomplishment and contribution to others, unawareness of death, fi ghting against cancer, pride and beauty, control over the future, and religious and spiritual comfort) and two addi-tional concepts (‘pokkuri [sudden death]’, and ‘omakase [leaving the deci-sions to a medical expert]’) was completed. The relative importance of the concept among two age groups (40–69 years vs. 70–79 years) was investi-gated using an effect size (ES).

Results: Clinically signifi cant differences in the concept of good death were observed only for two domains and one component: ‘not being a burden to others (ES = −0.24)’, ‘role accomplishment and contribution to others (ES = 0.29)’, and ‘omakase (leaving the decisions to a medical expert)’ (ES = 0.60).

Conclusion: Only a few differences in the concept of good death existed between the elderly and younger subjects. When caring for terminally ill Japanese elderly patients, medical staff should acknowledge that some elderly patients value the traditional paternalistic attitude of physicians and that not all patients want to be actively involved in decision-making.

402

SMOKING BEHAVIOUR OF STUDENTS IN THE UNIVERSITY OF

IBADAN, NIGERIA

Chioma Asuzu, Patience OgunmusereUniversity of Ibadan, Ibadan, Oyo, Nigeria

Background: Tobacco smoking is a growing public health problem in the developing world. The health hazards of smoking are well documented and prevention of smoking has been described as the single greatest opportunity for preventing non-communicable disease in the world today.

Method: A cross-sectional survey was carried out to determine the cigarette smoking Knowledge, attitude and smoking behaviour among University of Ibadan students in western Nigeria. One hundred and ninety fi ve (195) university students were selected from seven faculties of the University of

Ibadan, Nigeria, through multistage sampling method. Data collected was analyzed using descriptive statistics, t-test and Pearson Product Moment correlation.

Result: Participants responded to a tobacco, knowledge, attitude and behaviour scale, with a reliability coeffi cient of 0.78. Their age ranged between 18 to 35 years; 135 male (69.2%), and 60 females (30.8%) par-ticipated in the study, with 71 (36.4%) married and 124 (63.6%) single. The largest group of smokers was infl uenced to start smoking by the infl u-ence of one or both parents, siblings, or friends, and only 1% of this group was infl uenced by their mothers, when buying cigarette for teachers and others. Most respondents continued to smoke even when they were aware of the health hazards of smoking. There were signifi cant differences between smokers and non-smokers knowledge, attitude and smoking behaviour (P < 0.05). Furthermore, there was signifi cant linear relationship between knowledge of negative consequences and negative attitude to tobacco smoking (P < 0.05).

Conclusion: This study recommends that anti-tobacco education and awareness should be adopted in the curriculum of schools and colleges. All forms of tobacco advertising and promotional activities should be banned in Nigeria, and parents should be encouraged to adopt more responsible attitudes toward smoking in their homes.

403

DISTRESS IN PATIENTS AND THEIR NATURAL CAREGIVERS

EARLY AFTER THE DIAGNOSIS OF INOPERABLE LUNG CANCER

Michele Aubin, Lucie Vezina1, Rene Verreault, Lise Fillion, Eveline Hudon2, Yves Lacasse, Sebastien Simard3, Andre Tourigny, Serge Dumont, Serge Daneault2

1. Laval Family Medicine Centre, Quebec, Canada2. University of Montreal, Montreal, Quebec, Canada3. Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada

Aim: This study aims to report distress experienced by patients and their natural caregivers early after the diagnosis of inoperable lung cancer.

Methods: A survey on patients recently diagnosed with inoperable lung cancer and their natural caregivers is being conducted in Quebec City (Quebec, Canada). They completed validated questionnaires regarding their sociodemographics and psychosocial characteristics (HADS, IDPESQ). Uni-variate, bivariate analyses and multiple regression were conducted.

Results: A total of 154 patients and 95 natural caregivers have participated to this survey so far. Surprisingly, patients’ distress scored low with the IDPESQ instrument (12.4 ± 11.3 on a scale of 0 to 100), and only 9.1% of them reported signifi cant distress with the HADS (total score ≥ 15 on a scale of 0 to 42). In contrast, natural caregivers reported signifi cantly higher distress (IDPESQ score: 22.9 ± 16.2; p < 0.0001) and 34.7% of them pre-sented signifi cant distress according to HADS scores (p < 0.0001). For patients, age < 65 (p = 0.02), female gender (p = 0.001) and smaller social network (p = 0.02) were associated with signifi cant distress, but delay since diagnosis, functional status, recurrence of cancer, metastasis and cancer treatment had no infl uence on distress. For natural caregivers, perception of higher burden of care (p < 0.0001) and shorter delay since diagnosis (p = 0.0037) were signifi cant predictors of distress, while age and gender were not associated with it.

Conclusion: The diagnosis of cancer seems to initially impact more on natural caregivers than on patients. These fi ndings reinforce the importance, in the patients’ initial global need assessment, of early assessing and manag-ing natural caregivers’ distress, as they are key partners in patient support and care throughout the cancer journey. Funding: This study is funded by the Canadian Cancer Society-Ontario Division.

Poster Abstracts 221

Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 220–358 © 2012 Wiley Publishing Asia Pty Ltd

404

PSYCHOSEXUAL EFFECTS OF GYNAECOLOGICAL CANCER

SURVIVORS IN INDIA

Indrani BasuMallikCancer Centre Welfare Home &Research Institute, Kolkata, W.B, India

Background: Scientifi c observations led to the fact that gynecological cancer patients suffer from intense stress featuring anxiety, depression, fear of treat-ment procedures, and fear of recurrence not only during the diseased state, but also at a disease free state after treatment. Stress resulting from the disease and treatment procedures affect the psychosexuality of the patients. The survivors reported sexual dysfunction and changed relationship with their partners.

Objective: Psychological stress and sexual dysfunction caused due to gyne-cological cancer and various oncological treatments, need to be identifi ed and quantifi ed for support and rehabilitation. Attempt was taken to quan-tify the stress levels at various stages of the disease and also at a disease free state. The sexual relationship before and after the disease and treatment were also studied.

Method: 200 women cancer survivors in the age group of 35 to 45, who had undergone various oncological treatments were studied.

(a) The psychological stress factors were quantifi ed by standard psychologi-cal tools and questionnaire.

(b) The site of cancer and the treatment modalities were obtained from the hospital records of the patients.

(c) The sexual factors were quantifi ed by the average frequency of intimacy with partners after treatment and this frequency was compared with their self reported average frequency of intimacy at their pre-diagnosed state (considered as the control group).

Results: 1. Stress level was acute for 92% of the patients at diagnosis, 85% showed sub acute anxiety during treatment and 68% showed moderate to mild anxiety in 3–8 years of disease free state.2. Fear of recurrence came down in the passage of time or increased dura-

tion of disease free state.3. Analysis of the occurrence of cancer sites showed 65% cancer cervix,

28% cancer ovary, 4% Gestational Trophoblastic Tumor and 3% endo-metrical cancer.

4. Analysis of treatment modality.treatment cervix ovary GTT endometriumSurgery 17% 10% – 2%Radiation therapy (RT) 32% – – –Chemotherapy (CT) – 10% 3% –Surgery +RT 10% – – 1%Surgery +CT – 8% 1% –Surgery +CT+RT 6% – – –

5. Change in relationship with partner after diagnosis and treatment were indicated in the results:

Treatment Modality Results of statistical hypothesis tests

1. Surgery Not signifi cantly different2. RT Signifi cantly different3. CT Not signifi cantly different4. Surgery & CT Signifi cantly different5. Surgery & RT Signifi cantly different6. surgery, CT & RT Signifi cantly different

Primary curative surgery caused minimum psychosexual problem, GTT patients with chemotherapy treatment also showed less problem, radiated patients were signifi cantly affected. The worst affected were those who had undergone surgery, radiation and chemotherapy combined. 14% of the patients suffered from sexual morbidity.

Conclusion: Anxiety and fear of recurrence diminished with duration of disease free state. Treatment modality seemed to have infl uence on psycho-sexuality. Research with a larger sample group is suggested. The cancer survivors with sexual dysfunctions needed medical and psychological inter-vention and support to regain normal relationship with partners.

1. Schover L R: Sexuality and cancer: For the Women Who Has cancer, and Her Partner (order#4657). New York, American Cancer Society, 1995.

405

PROSTATE CANCER – MEN AREN’T THE ONLY ONES

Margaret Bennett, Angela PearceProstate Cancer Foundation of Australia, St Leonards, NSW, Australia

Aim: Previous research indicates that partners of men diagnosed with pros-tate cancer exhibit higher levels of distress and have more unmet needs than men with prostate cancer themselves. The main aim of this study was to record the experiences of partners and assess methods for addressing their needs.

Method: A pilot community survey was conducted to assess women’s atti-tudes to prostate cancer and document their experiences since their partners diagnosis (n = 61). In addition, two women presented written biographical accounts of their experience and n = 8 participated in a focus group.

Results: From the survey data, 66% of partners reported feeling a deep sense of shock at the diagnosis and 41% indicated that they were currently receiving no support. From the biographical data, women indicated a lack of support in coping with the challenges involved in caring for their partner while dealing with the effects of the diagnosis themselves. Forty seven per cent of women also reported that their partners were reluctant to commu-nicate about cancer. Most women sought information from health profes-sionals (69%), online (64%) and from family and friends (54%). Women in the support group indicated their lack of involvement in treatment deci-sion making even when the outcomes affected them, their inability to fully share their concerns with their partners, and the diffi culties they had in accessing suitable information.

Conclusion: It is important for health professionals to recognise this lived experience of partners and the fundamental relationship changes that ensue as a result of diagnosis and treatment. Information and support needs to be addressed effectively and multisectorally to ameliorate the distress of partners.

References

1. Echlin EN & Rees CE. (2002). Information Needs and Information-seeking Behaviours of Men With Prostate Cancer and Their Partners: A Review of the Literature. Cancer Nursing, 25(1), 35–41.

2. Cliff AM & Macdonagh RP. (2000). Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners. BJU International, 86(7), 834–839.

406

INTEGRATION OF THE HEALTH TEAM TO ADDRESS THE

PATIENTS’ EMOTIONAL ASPECTS: CARING FOR THE WHOLE

PATIENT

Cristiane D Bergerot, Marco M BusoCETTRO – Centro de Cancer de Brasilia, Brasilia, DF, Brazil

Cancer care still fails to address psychosocial problems, which can compro-mise the effectiveness of health care and thereby adversely affect cancer patients. The present retrospective study explore a routine of distress screen-ing, which is followed by a multidisciplinary discussion, with the aim of establishing personalized strategies for intervention and treatment. Over two years, 328 patients from a Brazilian private cancer center, participated in a longitudinal study, answering the Distress Thermometer and the Hos-pital Anxiety and Depression Scale, three times over a 6-month period using. The data of each evaluation were discussed between oncologist assistant and psychologist, to establish appropriate intervention. Descriptive statistics, Pearson’s correlation and a logistic regression were employed to analyze the data. There was a prevalence of female patients (64%), with an average of 54.7 years of age (SD = 15.8, range 18–86 years). Gastrointestinal (28%), breast (23.8%) and hematological (22.6%) were the main diagnosis. The distress level progressively decreased along the assessment: fi rst day (55.8%), middle (27%) and last day of chemotherapy (13.4%), as well as the anxiety and depression score. There was a signifi cant association (p < 0.001)



between distress vs. anxiety and distress vs. depression: fi rst day [r = 0.8, t(328) = 21.6; r = 0.8, t(328) = 16.2; R2 = 0.85], middle [r = 0.8, t(285) = 18.4; r = 0.8, t(285) = 20.9; R2 = 0.86] and last day of chemo-therapy [r = 0.8, t(261) = 14.7; r = 0.8, t(261) = 20.8; R2 = 0.82]. Moreo-ver, additional comparisons of the items were analyzed and will be presented at the meeting. Preliminary results suggest that distress, anxiety and depres-sion scores tends to reduce during the 6-months period of evaluation, mainly because was supported by the multidisciplinary intervention and treatment tailored to each case.

407

REPORTS FROM PATIENTS WITH ADVANCED CANCER AND THEIR

CAREGIVERS OF THEIR HEALTH RELATED QUALITY OF LIFE

(HRQOL)

Charlotte Bradley-Peni1, Eleanora DalGrande2, Catherine M Burns1, Jane Whelan3, Bryan Burmeister3

1. Newcastle University, Newcastle, NSW, Australia2. School of Medicine, Adelaide University, Adelaide, South Australia, Australia3. Princess Alexandra Hospital, Woolloongabba, Qld, Australia

Recent studies have found pre-treatment scores of health related quality of life (HRQoL) independently predict length of survival in diverse populations of advanced cancer1. How long will I live? is a question frequently asked in the cancer setting. A recent cancer editorial suggested physicians not only rely on their biomedical data, but place greater emphasis on patient judg-ment on their own underlying health conditions, as measured by multidi-mensional measures of HRQoL2. Patients (n = 142) with advanced cancer were identifi ed consecutively as they presented to Radiation Oncology at Princess Alexandra, Brisbane, Australia over a seven-week period in late 2008. Caregivers (n = 110) identifi ed by patients were also included in the study. Socio-demographic and clinical data was collected together with measures of health status using the SF36 instrument. Patients observed over time, censored in late 2011 using the National Death Index, confi rmed half remained alive. Almost one third of patients reported their global health was excellent/very good, a third that it was good, and 36% it was poor/very poor. Almost a fi fth of caregivers reported poor health, 37% that it was good and 44% that it was excellent/very good. Compared to a year ago, 56% of patients and 20% of caregivers reported worsening health, although 19% of patients reported improved health. While patient gender reports did not differ in the composite physical and mental health scores, females reported markedly lower scores on role emotional scores (52.2) compared to males (61.9). No marked gender differences were identifi ed for caregivers. Analysis of composite scores by age confi rmed normative trends of younger people (<44 years) having worse mental health for both patients (39.1) and caregivers (37.2) when compared with those over 75 yrs (46.0/46.3). Factors predicting patient length of survival will be examined and implications for care at the end of life will be specifi cally addressed.

References

1. Chantal Quinten, Corneel Coens, Murielle Mauer, Sylvie Comte, Mirjam A G Sprangers, Charles Cleeland, David Osoba, Kristin Bjordal, Andrew Bottomley, on behalf of the EORTC Clinical Groups. Baseline quality of life as a prognostic indicator of survival.

2. A Bottomley & F Effi cace. Predicting survival in advanced cancer patients: is it possible with patient reported health status data? Annals of Oncology. 2006. 17: 1037–1038.

408

POSTTRAUMATIC GROWTH IN ADULT CANCER SURVIVORS: A

CRITICAL REVIEW OF EMPIRICAL RESEARCH USING THE

ORGANISMIC VALUING THEORY OF GROWTH

Julie St-Laurent1,2, Anne Brédart3, Serge Sultan1,4, Stéphane Guay1,2

1. Université de Montréal, Montréal, Québec, Canada2. Centre d’tude sur le Trauma, Montréal, Québec, Canada3. Institut Curie, Paris, France4. Centre de recherche du Centre Hospitalier Universitaire de Sainte-Justine, Montréal, Québec, Canada

Context: The past decade has seen an increase in empirical research focused on post traumatic growth (PTG) among cancer survivors. Although many studies intend to identify factors that may explain this growth process, the majority do not adhere to any specifi c theoretical model. Consequently, results obtained remain descriptive and scattered. The Organismic Valuing Theory (OVT)1 offers a good theoretical framework to study factors associated with PTG in this population. This model states that experiencing growth involves the accommodation of traumatic information regarding the illness into modi-fi ed schemas about self, others and the world. According to OVT, factors linked to accommodation are a signifi cant impact of diagnosis on personal goals, active cognitive and emotional processing of information, adaptive coping strategies, fl exible personality, and a supportive social environment.

Objectives: The primary objective of this review is to verify to what extent the empirical data on PTG in oncology offers support for OVT.

Methods: We systematically searched the literature on PTG in cancer patients in Medline, Embase and PsychINFO (earliest date available – 2012). Relevant papers were selected when the used the Posttraumatic Growth Inventory as a quantitative measure of growth. A hand-searched of reference lists and consultation with experts were conducted to ensure all relevant articles were included.

Results: Following screening of abstracts, 53 studies were included in this review. Results suggest that empirical data partially supports OVT, with many studies showing that adaptive coping strategies, and active processing of information were linked to PTG. Results were mixed concerning person-ality, supportive social environment and impact of diagnosis.

Discussion: OVT may be a good framework to understand the process of PTG along the cancer trajectory. It is crucial that future research in oncology focus on the testing and refi nement of theory such as OVT in order for study results to be synthesized and implemented into practice.

Reference

1. Joseph, S. & Linley, P.A. (2005). Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth Through Adversity. Review of General Psychology, 9 (3), 262–280.

409

MENTAL DISORDERS IN PEOPLE DIAGNOSED WITH CANCER:

FINDINGS FROM THE 2007 AUSTRALIAN NATIONAL SURVEY OF

MENTAL HEALTH AND WELLBEING

Joanne Brooker1,2, Annette Graham2, Sue Burney1,3, Jane Fletcher1,3, Graham Meadows2

1. Cabrini Health, Malvern, VIC, Australia2. Southern Synergy, School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia3. School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia

Aims: To investigate differences between Australians who had and had not been diagnosed with cancer with regard to total number and types of mental disorders reported across their lifetime and in the past 12 months.

Methods: Analyses were conducted using data from the 2007 Australian National Survey of Mental Health and Wellbeing. There were 8,841



participants, aged 16–85 years. Questions were drawn from the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview, Version 3.0.

Data was analysed using probability weighting providing estimates for the Australian population. The proportion of Australians matching diagnostic criteria for each ICD-10 anxiety, affective and substance abuse disorder category and sub-class was calculated. In statistical testing, differences in these rates and differences in the overall numbers of disorders between the two groups (cancer diagnosis and no cancer diagnosis) were examined.

Results: Survey respondents who had received a diagnosis of cancer had experienced signifi cantly more mental health disorders (M = 1.49) during their lifetime than those with no diagnosis of cancer (M = 0.97; t = 2.65, p = 0.01). There was no signifi cant difference in number of mental disorders reported by participants in the previous 12 months between those who had been diagnosed with cancer (M = 0.62), and respondents who had never been diagnosed with cancer (M = 0.37; t = 1.30, p = 0.199). Compared to the general population, those participants who had received a cancer diag-nosis had a signifi cantly higher lifetime prevalence of anxiety disorders (F(1,59) = 8.08, p = 0.006), post traumatic stress disorder (F(1,59) = 4.36, p = 0.04), affective disorders (F(1,59) = 8.91, p = 0.004), and bipolar affec-tive disorder (F(1,59) = 5.52, p = 0.02), and a signifi cantly higher 12 month prevalence of post-traumatic stress disorder (F(1,59) = 5.33, p < 0.05).

Conclusions: Compared to the general Australian population, cancer patients are at increased risk of mental illness. Screening in cancer patients should include assessment of anxiety and affective disorders, particularly post-traumatic stress disorder and bipolar affective disorder.

410

STRESSFUL EVENTS AND COPING STRATEGIES AMONG

POSTMENOPAUSAL WOMEN DURING ACTIVE TREATMENT FOR

PRIMARY OR RECURRENT BREAST CANCER

Maria Brovall1,2,3, Elisabeth Kenne Sarenmalm3,4,5, Lars-Olof Persson4, Jane Fall-Dickson6, Fannie Gaston-Johansson7

1. School of Life Sciences, University of Skovde, Skovde, Sweden2. Department of Oncology, Sahlgrenska University hospital, Gothenburg, Sweden3. Johns Hopkins University, Post Doctoral student, Baltimore, USA4. Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden5. Research and Development Centre, Skaraborg Hospital, Skovde, Sweden6. Georgetown University School of Nursing and Health Studies St. Mary’s Hall, Washington, DC, USA7. Johns Hopkins School of Nursing, Baltimore, USA

The purpose of this study was to identify common stressful events, how bothersome these events are experienced and which coping strategies post-menopausal women with newly diagnosed primary or recurrent breast cancer used during active treatment to manage these stressful events.

Design: Descriptive.

Setting: Two university hospitals and one county hospital in Sweden.

Sample: 131 women who were diagnosed with primary (n = 75) or recur-rent (n = 56) breast cancer.

Methods: The Daily Coping Assessment (DCA) was used to record what coping strategies the women used to handle everyday stressful events. Data were analyzed both qualitative and quantitative.

Main research variables: Stressful events, the level of bother and coping strategies to handle these stressful events.

Findings: Ten categories of stressful events were identifi ed. There were some signifi cant differences between the groups, and the most frequently experi-enced events for women with primary cancer were ‘nausea and vomiting’, ‘fatigue’, and ‘other symptoms’. Women with recurrent cancer most frequently experienced ‘other symptoms’, ‘pain’, and ‘distress’. ‘No

problem’were recorded by approximately 30% of all diaries. Signifi cant differences in perceived bother between the groups were found for ‘distress’, ‘other concerns’ and’ pain’. Women choose between varieties of (pre-defi ned) coping strategies for each event, and ‘acceptance’, ‘relaxation’ and ‘distraction’ were the most used in all stages.

Conclusions: Women with recurrent cancer experience more distress and are more troubled by this then woman with primary cancer. All women use various different coping strategies and the women with primary cancer use most numbers of strategies. It is important to routinely assess and recognize not only the frequency of stressful events but also the experience of how bothersome the event is experienced by the patient and what coping strate-gies the patient uses to manage the stressful event.

411

EMPLOYEE TO EMPLOYER COMMUNICATION SKILLS: BALANCING

CANCER TREATMENT AND EMPLOYMENT

Richard F Brown1, Myra Owens2, Cathy Bradley1

1. Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, United States2. Center for Clinical and Translational Research, Virginia Commonwealth University Offi ce of Research, Richmond, VA, United States

Background: Continuing to work during cancer treatments provides cancer patients with a sense of normalcy, positive self-esteem, better quality of life and protects against potential loss of income or insurance. Cancer patients face diffi culties accessing legally mandated benefi ts and accommodations when they return to the workplace during treatment. Poor employer – employee communication, infl ates these diffi culties. Although proven methods to facilitate physician – patient communication exist these have not been applied to the workplace. Thus, we aimed to assess the feasibility and utility of applying these methods to educate patients about their work-place rights, and provide them with communication skills training to aid conversations with their employers.

Methods: A DVD was produced to educate patients about patients’ legal rights in the workplace and facilitate workplace communication. The DVD depicted an employee working through a variety of workplace communica-tion challenges. Participants consisted of 28 solid tumor cancer patients (14 female and 14 male) who completed primary cancer treatment in the past 12 months and were employed at the time of diagnosis. Participants watched the communication skills training DVD, and completed a telephone inter-view. The interview elicited information about workplace experiences and evaluation of the DVD training program.

Results: The physician-patient communication skills training model utilized was successfully translated to the employer-employee setting. All but one participant found the DVD useful and easy to understand and indicated a high degree of confi dence using the communication skills to help them ask for workplace accommodations. All agreed that it would help newly diag-nosed patients in discussions with their employers.

Conclusion: Our data provides promising preliminary evidence that patient communication skills training can be applied to the workplace setting and is a welcomed aid to newly diagnosed cancer patients in their discussions with employers regarding the impact of treatment on their work perform-ance and needs for accommodations.



412

AFRICAN AMERICAN CANCER PATIENTS’ PERCEPTIONS OF

PARTICIPATION IN A PHASE I, II, OR III CLINICAL TRIAL:

WHAT DO REFUSERS SAY?

Richard F Brown1, Debbie L Cadet2, Robert H Houlihan2, Maria D Thomson1, Emily C Pratt1, Amy Sullivan3, Laura A Siminoff1

1. Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, United States2. Massey Cancer Centre, Virginia Commonwealth University, Richmond, VA, USA3. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, United States

Background: Less than 5% of all adult cancer patients enter clinical trials. In the United States these rates are lower in African American populations, negatively affecting the generalizability and validity of trial results. Many studies have identifi ed barriers to minority enrolment yet few studies have used rigorous qualitative methods to gain a comprehensive understanding of AA cancer patients’ trial refusal reasons. We aimed to a) explore trial refusal reasons in a sample of African American (AA) cancer patients who declined trial participation and b) gather patients’ perceptions of the poten-tial benefi t of an array of decision support tools.

Methods: Participants were 22 consecutively recruited AA cancer patients who had declined participation in a therapeutic clinical trial. Within three months of the trial refusal decision, participants completed an audio-recorded semi structured interview that asked about demographic/disease information, psychosocial factors and patients’ experience with clinical trials. Two months later participants completed a questionnaire that asked about their trial decision. Interview audio-recordings were transcribed in full. Transcriptions were analyzed using rigorous qualitative methods.

Results: Few patients received positive recommendations about joining a trial. Patients gave multiple refusal reasons. Only two participants refused to join a clinical trial due to issues of mistrust. Most participants refused due to fears of additional burdens and side effects. Many patients and family members misunderstood trial information. Family members mostly recom-mended against trial participation. Most patients felt that Question Prompt Lists or Decision Aids would assist information seeking and decision-making.

Conclusions: Low rates of physician recommendations warrant further investigation. It may be that these 22 patients were trial eligible but unin-sured or on Medicaid. Thus, the treating institutions receive no reimburse-ment to cover trial treatments. Interventions to reduce misunderstandings and aid decision-making, both within and external to the clinical interac-tion, need to target both patients and family members.

413

COGNITIVE PERFORMANCE AND PSYCHOSOCIAL WELL-BEING OF

CANCER PATIENTS: A PRELIMINARY STUDY

Timothy HY Chan, Adrian HY Wan, Pamela PY Leung, Cecilia LW ChanThe University of Hong Kong, Hong Kong, China

Aim: Cognitive impairment, either subjectively or objectively reported, is often associated with cancer and cancer therapies. Causes are attributed to side effects of therapy, fatigue, and mood disturbance. Although subjectively reported cognitive impairment is reported to be related to a patient’s quality of life, past studies have shown self-reported and objective cognitive meas-ures are either weakly or not correlated. Little research is done on how objective cognitive performance correlate with quality of life. This study aimed to answer this question, and explore possible behavioral or psycho-social factors that may affect cognitive performance among cancer patients.

Method: 94 mixed-type cancer patients completed a computer-based assess-ment battery based on presentation of playing cards. Two measures of cogni-tive performance, response time and accuracy of short-term memory recall,

were used. The patients also completed questionnaires on quality of life, mood, stress, sleep quality, social support, and physical activity.

Results: Cognitive performance, in terms of both response time and recall accuracy, declined with age (r = 0.26 and −0.40 respectively, both ps < 0.01) but did not differ on sex, cancer types, and types of therapies received. After controlling for age, response time was signifi cantly correlated with self-reported quality of life, perceived stress, and depression and anxiety levels (r = −0.23, 0.33, and 0.26 respectively, all ps < 0.01), while no relation was found for recall accuracy. Age-controlled regression analysis of response time showed perceived stress was the only signifi cant association (beta = 0.323, p < 0.01).

Conclusion: This study is a preliminary attempt to investigate possible linkage between cognitive performance and psychosocial well-being of cancer patients. Despite its limitations as a cross-sectional study, the current fi ndings offer evidence that psychosocial factors may infl uence cognitive performance in cancer patients, which in turn affects their quality of life.

414

CHINESE BREAST CANCER PATIENTS UNDERGOING

RADIOTHERAPY: ROLE OF FATIGUE AND ITS INFLUENCES ON

THEIR QUALITY OF LIFE

Rainbow TH Ho1, Irene KM Cheung1, Cecilia LW Chan1, Paul SF Yip1, MY Luk2, Phyllis HY Lo1

1. The University of Hong Kong, Hong Kong, HK2. The Queen Mary Hospital, Hong Kong, HK

Aims: Breast cancer is one of the most common cancers around the world. Chinese breast cancer patients usually experience a cluster of overlapping physical and psychological symptoms such as anxiety, depression, stress and pain. Cancer-related fatigue feeling is often confused with tiredness, and always being underestimated its severity. The present study aimed at explor-ing the level of fatigue among Chinese breast cancer patients undergoing radiotherapy treatment.

Methods: 78 Chinese breast cancer participants who are going to start the radiotherapy treatment had been recruited from two Hong Kong local hospitals and three cancer support organizations. Participants also invited to complete a set of questionnaire on their fatigue level, perceived stress, pain, anxious and depressive mood and quality of life before undergoing the radiotherapy treatment.

Results: Participants reported high severity of fatigue level were positively associated with pain severity (p < 0.01), pain interference (p < 0.01), higher anxiety level (p < 0.05), higher depressive mood (p < 0.01) and higher per-ceived stress (p < 0.05) than those experienced low fatigue severity level. In participants who experienced low severity level were more likely to experi-ence the positive physical well-being (p < 0.01), emotional well-being and functional well-being than high fatigue level participants. Regression analy-sis showed that age of participants is a possible predictor to their fatigue level (r = 0.237). Younger participants (aged below 50) were experiencing higher fatigue severity level than participants age beyond 50 (p < 0.05).

Conclusions: Research fi nding suggests that cancer-related fatigue relates to different physical and psychological dimensions of patients. Better manage-ment of fatigue would be helpful on reducing other distressing symptoms among Chinese breast cancer patients.

Acknowledgement: This study is supported by the Research Grants Council General Research Fund (HKU745110H), Hong Kong Cancer Fund, Queen Mary Hospital and Pamela Youde Nethersole Eastern Hospital.



415

PREDICTORS OF ENGAGEMENT IN AN ONLINE PSYCHOLOGICAL

SUPPORT PROGRAM FOR MEN TREATED FOR PROSTATE CANCER

Katherine Chisholm1, Marita McCabe1, Addie Wootten2, Joanne Abbott3, David Austin3, Britt Klein3, Anthony Costello2, Declan Murphy2

1. Deakin University, Burwood, VIC, Australia2. Australian Prostate Cancer Research Centre Epworth, Melbourne, Australia3. National eTherapy Centre, Swinburne University, Melbourne, VIC, Australia

The use of internet interventions has grown in both the mental health and general health setting, and has demonstrated recent growth in the cancer setting. These programs are thought to fi ll an important gap in service for cancer survivors requiring psychosocial support. Men with prostate cancer are not routinely offered psychosocial support despite strong evidence that being diagnosed and treated for prostate cancer poses signifi cant quality of life concerns for men and their partners. Lack of psychosocial support is in part due to lack of available resources and this project aims to develop and evaluate a structured, self-directed psychological support intervention that is accessible and appealing over the internet. The program, called My Road Ahead, is targeted to men who have been treated for localised prostate cancer and covers several areas which have frequently been raised as issues of concern, including psychological distress, sexual dysfunction, urinary dysfunction, relationship issues, and uncertainty about the future. To date, this is the fi rst online psychological intervention program targeting a broad range of needs in men treated for prostate cancer. This presentation will report on baseline data of those participants who have enrolled into a RCT investigating the effi cacy of My Road Ahead. Criterion for entry into the RCT was undergoing treatment for prostate cancer within 6 months to 5 years previously. Results signify the types of men likely to engage in an online psychological treatment program across demographic variables (including rural versus urban location), cancer treatment type, level of prior psychosocial support accessed, and baseline mood scores. These results are likely to inform future designs of online intervention programs and recruit-ment strategies for participants.

416

USING THE DISTRESS THERMOMETER AND THE HOSPITAL

ANXIETY AND DEPRESSION SCALE IN ITALIAN WOMEN NEWLY

DIAGNOSED WITH BREAST CANCER

Maria Rosa Stanizzo, Cristina Civilotti, Elisa Garrone, Riccardo TortaPsycho-oncology Unit, Department of Neuroscience and Oncology, University of Turin, Turin, Italy

Receiving a diagnosis of cancer is often a traumatic experience, and can cause severe distress. There is a need for screening tools that optimize cost-benefi t while preventing the risk of underestimating levels of distress in cancer patients.

The aim of this study was to compare the Distress Thermometer (DT) to the Hospital Anxiety and Depression Scale (HADS), defi ning an optimal cut-off score of the DT in this population.

477 consecutive women newly diagnosed with breast cancer in the Breast Unit of the San Giovanni Battista Hospital in Turin, Italy, were screened through a routine pre-surgery program. The inclusion criteria were: 1. histologically or cytologically confi rmed breast cancer (Stages I–III) 2. age > 18 years. The exclusion criteria were: 1. presence of psychotic disor-ders and 2. previous diagnosis of cancer. Participants completed the DT and the HADS, in the period between the diagnosis and surgery.

DT correlates slightly more signifi cantly with the anxiety dimension (HADS-A) (r = 0.69, p < 0.001) than depression (HADS-D) (r = 0.61, p < 0.001). The Receiver Operating Characteristic (ROC) curve analyses of DT scores generated an estimated Area Under the Curve (AUC) of 0.84 (95% CI 0.80–0.87) when compared to the HADS-A cut-off score, and an AUC of

0.81 95% CI 0.77–0.85) related to HADS-D. The DT cut-off score of >4 showed an optimal combination of sensitivity and specifi city for anxiety (sensitivity = 85%, specifi city = 67%) while for depression, a cut-off of >5 maximized sensitivity (70%) and specifi city (75%). Regarding the HADS – Total score, a score of DT > 4 indicated acceptable sensitivity (89%) and specifi city (64%), with a Positive Predictive Value of 87,9% and a Negative Predictive Value of 66,8%.

The single-item DT, followed by a comprehensive assessment, appeared to be an adequate routine screening tool in detecting distress as compared to the HADS. Limits of the research and future direction will be discussed.

417

THE IMPLEMENTATION OF A MINDFULNESS GROUP

PROGRAMME THROUGHOUT THE STATE OF QUEENSLAND

Samantha CluttonCancer Council Queensland, Spring Hill, Qld, Australia

Mindfulness Based Cognitive Therapy (MBCT) was initially devised as a cost effective way to prevent relapse in depression. This 8 week group programme has subsequently been adapted for cancer populations and has been found to be effective in reducing distress and improving well-being in people coping with the aftermath of diagnosis (Foley et al, 2010). The Cancer Council Queensland’s – Cancer Counselling Service – was imple-mented in 2004 in order to provide psychological support to people dis-tressed by cancer who would otherwise be unable to access a specialist intervention. MBCT was added to the suite of psychological interventions provided by the service in recognition of the need for a low intensity inter-vention that could provide people with strategies to stay in touch with the present moment and recognize and respond to triggers for depression and anxiety. What commenced with a small feasibility study in 2009 has emerged as a comprehensive statewide program – with more than 10 groups conducted in Brisbane and regional Queensland in 2012 – including a tel-ephone group for those unable to access a face-to-face service. This paper details the steps involved in establishing the feasibility and then rolling out the program – including training and maintaining skills of the facilitators and promotion and recruitment of participants statewide.

418

INTENTIONS TO USE TELEPHONE AND FACE-TO-FACE SUPPORT

SERVICES: ATTITUDES OF AUSTRALIAN MEN FOLLOWING

PROSTATECTOMY

Denise Corboy, Suzanne McLaren, John McDonald, Megan JenkinsUniversity of Ballarat, Mt. Helen, Vic, Australia

Aims: Prostatectomy, although offering the best prognosis for localised prostate cancer, can lead to distressing side effects such as incontinence and changes in sexual functioning. Services offering support for men experienc-ing cancer-related distress are under-utilised. Support services offered via telephone are thought to have the potential to reach men who are geographi-cally isolated, or uncomfortable with seeking support face-to-face. The aim of this study was to investigate the infl uence of perceived control, social pressure, attitudes, level of distress, level of self-reliance and stoicism on men’s intentions to use telephone-based and face-to-face support services.

Methods: A mixed methodology was used, in which data were collected through surveys and telephone interviews. A community sample of 447 men (response rate 30.9%) aged 42 to 77 years (M = 63.03, SD = 6.82) was surveyed after recruitment via Medicare Australia. All men had undergone a radical prostatectomy in the last quarter (October to December) of 2010. Semi-structured interviews with 29 men were analysed using a grounded theory framework.

Results: Signifi cant predictors of both telephone and face-to-face support were lower levels of stoicism, a more positive attitude towards support, and higher levels of perceived control and social pressure to use such a service.



In addition older age and being married/partnered predicted intention to use telephone support, whereas lower levels of physical well-being predicted intention to use face-to-face support. Sixty-six percent of men surveyed expressed a preference for face-to-face support over telephone support. The main reasons for this preference related to building genuine relationships and the desire to monitor body language.

Conclusions: The infl uence of positive attitudes, signifi cant others in men’s lives, and the importance of building rapport need to be considered in any interventions delivered via telephone. Technologies like Skype have the potential to deliver telephone interventions with all the benefi ts of face-to-face interactions.

419

PATIENT PREFERENCES FOR ADJUVANT RADIOTHERAPY IN

EARLY BREAST CANCER – AN AUSTRALIAN SUB-STUDY OF THE

INTERNATIONAL TARGIT TRIAL

Tammy Corica1,2, Anna K Nowak1, Christobel M Saunders3, Max K Bulsara4, David J Joseph2,5

1. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia2. Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia3. School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia4. Institute of Health and Rehabilitation Research, University of Notre Dame, Perth, Western Australia, Australia5. School of Surgery and Pathology, University of Western Australia, Perth, Australia

Background: The TARGIT trial compares single dose intra-operative radio-therapy (IORT) with 6–7 week external-beam radiotherapy (EBRT) in women with early breast cancer (EBC) at low risk of local recurrence (LR). We hypothesize that IORT will give a non-inferior risk of LR compared with EBRT. In order to guide women and doctors making choices about radiotherapy, a Patient Preference study was performed to determine what increased risk of LR, without detriment to survival, women with EBC would accept, in return for the increased convenience of IORT.

Methods: A cross-sectional study of patient preferences and their determi-nants in 209 women who had radiotherapy on the TARGIT trial (108 had IORT and 101 had EBRT). Preferences were determined by a self-rated questionnaire using validated trade-off methodology. Disease, treatment, and demographic details were collected and quality of life during radiotherapy.

Results: While 36% of patients were prepared to accept a 4%–6% increase in LR risk for the increased convenience of IORT, 22% would not accept IORT at all. Multivariate Poisson regression identifi ed treatment received as the only signifi cant determinant of preferences (p < 0.0001). This is despite signifi cant differences found in two-sample Kolmogorov-Smirnov tests of quality of life scores during treatment all favouring IORT. Compari-son of the treatment groups found that 60% of IORT patients would accept IORT at an increased risk of 4%–6% in contrast to 12% of patients in the EBRT group. Only 2% of IORT patients indicated they would not have IORT at all, in contrast to 43% of EBRT patients.

Conclusion: The EBRT group were risk-averse, whilst patients who had IORT valued the convenience of IORT highly. Participants of this study have justifi ed the treatment they were randomly allocated to, which questions the validity of post-treatment patient preference studies. Further research target-ing patients who have not yet received radiotherapy will now follow.

420

INFORMATIONAL NEEDS AND DEFICITS OF LATINAS DIAGNOSED

WITH BREAST CANCER

Rosario Costas-Muniz, Francesca Gany, Julia Ramirez, Thelma McNish, Jennifer Leng, Abraham AragonesMemorial Sloan Kettering Cancer Center, New York, NY, United States

Background: There is limited research on the informational needs and defi -cits of Latino cancer patients. Patients’ knowledge levels infl uences their ability to participate actively in decision-making processes for medical care and their ability to manage their condition to improve medical outcomes (Polacek, et al., 2007; Rust & Davis, 2011).

Purpose: This cross-sectional study explores the awareness of cancer staging of Latina breast cancer patients and examines what acculturative variables are associated with being unaware of cancer stage.

Methods: A cross-sectional needs assessment was conducted with Latino patients in cancer centers of New York. The survey was provided in the patient’s preferred language. Descriptive statistics and logistic regression were conducted for the analysis.

Results: One hundred and fourteen Latina breast cancer patients were recruited (age mean 55 years). Seventy-six per cent of the sample were monolingual in Spanish. Half of the patients were aware of their stage and 25% knew if their tumor had metastasized. After controlling for sociode-mographic characteristics, being an immigrant with limited English profi -ciency (LEP) and monolingual in Spanish, were independently associated with both not knowing their stage and not knowing if they had metastatic cancer. Being unaware of the state of the tumor was also predicted by uninsured status, more recent immigration, needing interpretation for health care and having at least two comorbidities. Patients who were receiving chemotherapy were more likely to know whether their tumor had metastasized.

Implications: This study show considerably low levels of stage awareness among Latinas diagnosed with breast cancer. This lack of knowledge might adversely impact their treatment decisions and disease management. Further studies should focus on identifying why these patients lack this information and what other type of information they are missing. Patients may benefi t from educational interventions aiming to empower patients to take a more active role and request more information about their disease.

References

1. Polacek-Johnston, G. N. L., Ramos, M. C., & Ferrer, R. L. (2007). Breast cancer disparities and decision-making among U.S. women. Patient Edu-cation & Counseling, 65(2), 158–165.

2. Rust, C., & Davis, C. (2011). Health literacy and medication adherence in underserved African-American breast cancer survivors: a qualitative study. Social Work in Health Care, 50(9), 739–761.

3. Chen, Y. P., Tsang, N. M., Tseng, C. K., & Lin, S. Y. (2000). Causes of interruption of radiotherapy in nasopharyngeal carcinoma patients in Taiwan. Japanese Journal of Clinical Oncology, 30(5), 230–234.

421

USE OF GRAPHIC DESIGN TO FACILITATE READING AND

UNDERSTANDING OF WRITTEN PATIENT INFORMATION IN

CLINICAL CANCER TRIALS

Pia Dellson, Mef Nilbert, Christina CarlssonDepartment of Oncology, Institute of Clinicial Sciences, Lund University, Lund, Sweden

Patient inclusion in clinical trials is a key issue for the advancement of cancer treatments. The increasing complexity of cancer treatments translate into increasingly complex information that should be understood by the patient in order to provide an informed consent for participation. We studied written information from four clinical trials for medical treatment of color-ectal cancer and collected data related to understanding and perception of



the information from focus group interviews with 14 patient advocates. Content analysis verifi ed four major themes: Comprehensibility, Emotions and associations, Readability, and Individual preferences. Informants who were older or had lower education found understanding of the written information particularly diffi cult. Twenty out of 44 suggestions from the informants were related to format, layout and illustrations, but the authors of the information did not address these issues. We therefore studied these aspects in detail and found four main themes related to how the use of graphic design facilitated reading and understanding of the information: Motivating reading and assimilation of the information, Facilitating fl uency of reading, Facilitating fi nding key messages and Conveying information graphically. Written clinical trial information has generally focused consider-ably more on content than on layout. The increasing complexity of the information and the shortcomings identifi ed related to graphic design, suggest that optimized layout, including e.g. logical structure, headings, fonts, illustrations and time lines, should be considered. Understanding seem particularly challenging for older individuals and those with lower educa-tion and refi ned layout may thus be relevant to consider also in relation to disparities in health care and equal rights to access clinical trials.

422

DEMOGRAPHIC FACTORS, REFERRAL PATTERNS AND CLINICAL

CORRELATES IN ADJUSTMENT DISORDER IN CANCER PATIENT

REFERRALS TO AN IN-HOUSE LIAISON PSYCHIATRY SERVICE IN A

TERTIARY CARE ONCOLOGY HOSPITAL IN INDIA

Jayita Deodhar, Savita Goswami, Lekhika Sonkusare, Rohini HavaldarTata Memorial Hospital, Mumbai, Mah, India

Literature on Adjustment Disorder, the most common psychiatric diagnosis in cancer patients, is scarce in the context of developing countries. Our study aims to examine the demographic, referral and clinical correlates in Adjust-ment Disorder in cancer patient referrals to an in-house liaison psychiatry service in a tertiary care oncology hospital in India. From an original data-base of demographic and clinical details of all new cancer patient referrals to the liaison psychiatry service of an oncology hospital over a 58 month period, the details of those diagnosed with Adjustment Disorder were exam-ined to record the demographic variables, cancer diagnosis, referral patterns, psychiatric interventions used and group differences (gender and patient setting). Relevant statistical analysis using Statistical Package for Social Sciences version 18 was done for descriptive statistics and group compari-sons. 451 of 2068 new patient referrals (21.8%) were diagnosed with Adjustment Disorder, in 59% inpatients and 53% males. The average age was 40.1 years. Haematolymphoid (21.1%) and head and neck cancers (18.6%) were most frequent cancer diagnoses, with referral reasons mainly for depression, sleep disturbances and anxiety. 92% of patients required psychological interventions only. Anxiolytics were the main psychopharma-cological agents used. Adjustment Disorder was more common in men than women with haematolymphoid (66% vs 34%) and head and neck cancers (70% vs 30%), and more common in outpatients with head and neck and inpatients with haematolymphoid malignancies. These differences was sta-tistically signifi cant (p < 0.000). Adjustment Disorder was the psychiatric diagnosis in more than one-fi fth of cancer patients referred to an in-house liaison psychiatry service in a tertiary care cancer centre in India, seen almost equally in men and women, with a difference noted in the cancer diagnosis of male and female patients. The role of cultural infl uences in development of Adjustment Disorder in different groups of cancer patients needs further studies in developing countries.

424

EVALUATION OF A TRAINING MODULE ON CLIENT CENTERED

COUNSELING IN CANCER CONDUCTED FOR VOLUNTEERS

WORKING IN ONCOLOGY IN A TERTIARY CARE CANCER

HOSPITAL IN INDIA

Jayita Deodhar, Savita Goswami, Lekhika SonkusareTata Memorial Hospital, Mumbai, Mah, India

Previous studies have emphasized the importance of a well structured curricu-lum for training of volunteers working in oncology, addressing knowledge, skills and attitude. Client centered counseling is useful in cancer patients. There are few reports of in service training programmes on client centered counseling in cancer in developing countries, conducted for volunteers working with cancer patients. In this paper, we aim to evaluate a half day training module on client centered counseling in cancer conducted for volun-teers working in a tertiary care cancer hospital in India. Volunteers belonging to an organization based in this setting were invited to attend a 3 hour training module on client centered counseling in cancer conducted by the in-house liaison psychiatry service of this same hospital. Questionnaires were com-pleted by the volunteers prior to and following the workshop to test knowl-edge regarding counseling in general and client centered counseling in particular and were given marks out of 20. After the workshop, participants were also given a questionnaire for evaluating the usefulness of the training module, rated 1 (not useful) to 5 (very useful). Relevant statistical analysis using Statistical Package for Social Sciences version 18 was done for descrip-tive statistics and group comparisons. Out of 15 volunteers who participated, 9 completed all questionnaires, which was used for the analysis. 5 respondents had more than 10 years of volunteering experience and 4 had semiformal training in counseling. The range of marks, the mean score and standard deviation prior to the module were 4–11.5, 7.8 and 2.82, and post module were 6–19, 12.5 and 4.25 respectively, this difference being statistically sig-nifi cant (p = 0.001). The module was rated 4 and above by all participants, the most useful components being role plays, theory and importance of active listening. All expressed an interest in similar workshops in future. There is, thus, a need for in service training programmes on client centered counseling for volunteers working in oncology.

425

ADDRESSING THE EDUCATIONAL AND PSYCHO-SOCIAL NEEDS

OF CHILDREN AND ADOLESCENTS DIAGNOSED AND TREATED

FOR CANCER IN AUSTRALIA

Barb Donnan1, Frank Alvaro2, Malcolm Coutts1, Luce Dalla Pozza3, Jenny Lavoipierre1, Donna Lawther1, Glenn Marshall4, Tracey Webster1

1. Educational Pathways Project, Ronald McDonald House Charities, Newcastle, NSW, Australia2. Paediatric Oncology, John Hunter Children’s Hospital, Newcastle, NSW, Australia3. Oncology Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia4. Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Sydney, NSW, Australia

The Educational Pathways Project operates across Sydney Children’s Hos-pital, The Children’s Hospital at Westmead, The John Hunter Children’s Hospital in Newcastle and Ronald McDonald House Charities. Research conducted with parents of children and adolescents with cancer has driven the Educational Pathways outcomes to date. One of the needs requested by parents was for educational liaison support in order to address the educa-tional gaps, needs and challenges associated with a cancer diagnosis in childhood or adolescence. This refl ects best practice international research and models of recognised educational and psycho-social needs for the chil-dren and adolescents.

A pilot of an Education Liaison Coordinator commenced at Sydney Chil-dren’s Hospital in January 2012. This professional educator liaises between the multidisciplinary oncology professionals, hospital school staff, home school staff and the student and his/her family. The goal is to establish and



maximise educational continuity and peer contact for the student from the time of diagnosis. After 3 months, this service has received referrals for 33 students and the uptake of the service has exceeded expectation.

This presentation will overview evaluative pilot data including stakeholder involvement, pilot challenges and sample student case studies. The data will be presented in the context of the need for legislative change in Australia in order to better meet the comprehensive needs of this cohort of students. Complimentary Educational Pathways research based initiatives will also be overviewed. This will include expansion of liaison services and evaluative data of the 2011 publication of the parent book titled What about school? A resource support book for parents of children and adolescents with cancer. This book is the fi rst of its kind in Australia and has received extremely positive feedback to date from parents, students and teachers.

426

DOES IT DO WHAT IT SAYS ON THE TIN? AN EVALUATION OF

USING A LICENSED COMMUNICATION SKILLS TRAINING

PRODUCT WITHIN A REGIONAL EDUCATION STRATEGY TO

INCREASE CAPABILITY AND CAPACITY IN END OF LIFE CARE

Sue Duke1, Susi Lund2

1. University of Southampton, Southampton, Hants, United Kingdom2. Hospital Palliative Care Team, Royal Berkshire Hospital, Reading, Berkshire, UK

Introduction: Developing communication skills in end of life care requires a strategic approach1. We use a licensed communication skills training product2 to train staff across a health authority. 45 trainers were trained in the product and they have provided the training to over 2000 people.

Aim: To access the impact of the training on individual practitioners, the conditions needed to achieve this impact and to build capability and capac-ity across the workforce.

Method: The impact on individuals was assessed in a cross sectional sample of 67 participants using a questionnaire to rate their confi dence and willing-ness to respond to emotional concerns and to comment on their experience of the training. The conditions needed to build capability and capacity was assessed via focus groups with the trainers and training co-ordinators.

Results: Individually the training has impact: 53 (79%) participants strongly agreed that the training increased their confi dence to respond to emotional concerns and 49 (73%) strongly agreed that it had increased their confi dence to address emotional concerns. In the free text they reported being more likely to enable individuals to fi nd their own solution rather than trying to solve the problem for them. Collectively the training provides a model for discussing patient and family end of life care concerns. From the trainers perspective the product is well crafted. The prescriptive format was evaluated by some as constraining and by others as helpful. From the co-ordinators perspective considerable time has been needed for negotiation of the license, co-ordination of sessions, communication with trainers and for governance of the training.

Conclusion: Using a licensed product for end of life care communications skills training has ensured a consistent quality of provision over a large workforce and built capability and capacity but these results have depended on skilful facilitation and meticulous co-ordination, communication and governance.

References

1. Duke S (2010) Communication skills training in end of life care – short of the mark? Invited editorial for European Journal of Oncology, 14(4), 261–262.

2. Sage and Thyme ™. A communication skills model to help people respond to people in distress http://www.uhsm.nhs.uk/academy/sagean-dthyme/Pages/home.aspx.

427

‘IT’S A VERY DIFFICULT BALANCE’: A QUALITATIVE STUDY OF

CANCER SPECIALISTS’ PERCEPTIONS OF DISCUSSING

COMPLEMENTARY AND ALTERNATIVE MEDICINE WITH THEIR

PATIENTS

Jaklin A Eliott1, Jessica Mignone2

1. Cancer Council Australia, Sydney, NSW, Australia2. School of Psychology, University of Adelaide, Adelaide, SA, Australia

Aims: The use of Complementary and Alternative Medicine (CAM) among patients with cancer has prompted debates within the healthcare setting regarding integration of CAM into conventional cancer care. Few studies have elicited the views of physicians regarding integrating CAM into cancer care. This study explores how cancer specialists experience and reportedly manage discussions about, and issues related to, CAM with cancer patients.

Methods: Semi-structured interviews with 12 physicians from three cancer clinics (oncology, haematology, and palliative care) within a tertiary teaching hospital were transcribed verbatim and thematically analysed. Sample size was determined by response rate (50% of identifi ed potential participants), and standards for data saturation.

Results: The dominant theme in physicians’ accounts centred on a potential confl ict between respect for patient choice (autonomy) and concern for patient welfare (benefi cence). Particularly in the context of the latter, physi-cians reported a tension between managing patient disclosure about CAM use in order to evaluate the quality of patient choice, whilst maintaining a good doctor-patient relationship. Physicians’ concerns about the potential of harm from CAM use reportedly caused some diffi culties for them during clinical interactions, requiring them to develop particular strategies to estab-lish or maintain a relationship conducive to patient disclosure of CAM use. This sometimes involved concealment of a negative evaluation of CAM or CAM use, a practice some identifi ed as problematic.

Conclusions: Integration of CAM into conventional cancer care may pose particular ethical dilemmas for physicians, requiring some change in their practice. There is a need to consider the perspectives of cancer specialists in debates regarding a process of integration, and to develop ethically informed communication strategies to guide clinical discussion of CAM use in patients diagnosed with cancer.

428

ASSOCIATION AMONG DEPRESSION, DEMORALIZATION, AND

POSTTRAUMATIC GROWTH IN CANCER PATIENT: PRELIMINARY

STUDY

Chun-Kai Fang1,2, Yu-Jing Chiu3, Pei-Chen Yeh3, Shih-Hsuan Pi2, Yu-Chan Li3

1. Department of medicine, Mackay Medical College, New Taipei, Taiwan2. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan3. Institute of Life and Death Education and Counseling, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan

Background: With the viewpoint of positive psychology, posttraumatic growth in cancer patients is valued for cancer patients. In the other hand, with the viewpoint of psychopathology, both depression and demoralization are two common psychiatric diagnoses in cancer patients. However, there are not enough survey to understand the association among depression, demoralization, and posttraumatic growth. The preliminary study is to understand their association.

Methods: After the approval of the Institutional Review Board, we invited inpatients and outpatients with lung cancer, lymphoma, or leukemia in Mackay Memorial Hospital to attend the study. Under the guidance of research assistants, all participants completed all questionnaires, including Distress Thermometer (DT), Patient Health Questionnaire (PHQ-9), Demoralization Scale (DS), and Posttraumatic Growth Inventory (PTGI). Data were analyzed with SPSS statistical software 18.0.



Results: A total of 86 participants (female: n = 49, 57%) completed the study. The means of DT, PHQ-9, DS, and PTGI scores were 4.10 (SD = 2.28), 6.64 (SD = 4.46), 28.76 (SD = 12.63), and 57.41 (SD = 23.84). By using the Pearson product–moment correlation coeffi cient to explore the relation-ship between the different scales, DT correlated with PHQ-9 (r = 0.49, p < 0.001) and DS (r = 0.48, p < 0.001), but not with PTGI (r = −0.04, p = 0.73); PTGI did not correlate with PHQ-9 (r = 0.12, p = 0.20) or DS (r = −0.11, p = 0.30). In the subscales, loss of meaning in DS was negative association with new possibilities (r = −0.25, p < 0.05) and personal strength (r = −0.27. p < 0.05) in PTGI; and sense of failure in SD was nega-tive association with relating to others (r = −0.22, p < 0.05), new possibili-ties (r = −0.33, p < 0.01) and personal strength (r = −0.33. p < 0.01) in PTGI.

Conclusion: Although PTGI was not associated with PHQ-9 or DS, some subscales of PTGI were negative associated with loss of meaning and sense of failure. We need more participants to understand their association to fi nd how to promote posttraumatic growth, and to prevent depression and demoralization.

Reference

1. Cheng-Yang Lee, Chun-Kai Fang, Yuh-Cheng Yang, Chien-Liang Liu, Yi-Shing Leu, Tsang-En Wang, Yi-Fang Chang, Ruey-Kuen Hsieh, Yu-Jen Chen, Li-Yun Tsai, Shen-Ing Liu, Hong-Wen Chen. Demoralization syn-drome among cancer outpatients in Taiwan. Supportive Care.

429

THE PHYSICIAN–PATIENT RELATIONSHIP AND THE EXPERIENCE

OF PAIN: A STUDY OF WOMEN UNDERGOING DIAGNOSTIC

MAMMOGRAPHY

Ingeborg Farver1, Christina Gundgaard Pedersen1, Berit Lassesen2, Anders Bonde Jensen3, Søren Christensen1, Robert Zachariae1,3

1. Unit for Psychooncology and Health Psychology, Aarhus University, Aarhus, Denmark2. Aarhus University, Centre for Teaching and Learning, Aarhus, Denmark3. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

Background: Although non-invasive, women often report pain during mammography. However, the variability of pain reports is high, making it relevant to explore potential factors infl uencing the experience of mam-mography pain. Several studies have investigated biological and psychologi-cal predictors, but fewer have explored the infl uence of situational circumstances on mammography-related pain.

Aim: To explore the possible infl uence of the physician-patient relationship on perceived mammography pain.

Method: As part of a larger study, 804 women referred by their GP to a mammography at the Department of Radiology, Aarhus University Hospi-tal, Denmark, completed questionnaires approximately seven days before the mammography including measures of sociodemographic factors and immediately after the mammography including a visual-analogue pain rating scale (VAS), the Physician-Patient Relationship Inventory (PPRI), and two single items concerning their general satisfaction with the personal contact with the physician (satPER) and the physician’s ability to handle the medical aspects of the consultation (satMED).

Results: The 549 women (mean age: 47.9) who had rated their pain experi-ence (pain: 230, no pain: 319) were included in the analysis. When entering PPRI total score or satPER and satMED, together with age, BMI, educa-tional level, and cancer risk group as independent variables in two multiple logistic regressions with pain vs. no pain as the dependent outcome, only PPRI (OR = 0.97; p = 0.001; CI: 0.96–0.99) and satPER (OR = 0.75; p = 0.024; CI: 0.59–0.96) reached statistical signifi cance.

Conclusion: In the present study, a more positive perception of the physician-patient relationship, especially of the personal contact with the physician, was signifi cantly associated with less perceived mammography-related pain.

Implications: The present fi ndings suggest that physicians performing mam-mography should be aware of the possible infl uence of their communication on the women’s pain experience. Future studies examining possible mediat-ing factors, e.g. anxiety and coping strategies, are needed, as are prospective studies examining directions of causality.

430

WHAT SHOULD BE TAUGHT TO FUTURE CLINICIANS AND

HEALTH-CARE PROFESSIONALS REGARDING GRIEF REACTIONS

IN THE CANCER FIELD?

Léonor Fasse1, Cécile Flahault2, Anne Brédart1, Sylvie Dolbeault, Serge Sultan3

1. Institut Curie, Paris, France2. Université Paris Descartes, Boulogne Billancourt, France3. Psychologie, Université de Montréal, Montréal, Québec, Canada

Aims: While Prolonged Grief Disorder (PGD) is proposed for inclusion in the DSM V, current literature suggests that health professionals often report some gap of knowledge regarding this condition and more widely concern-ing grief reactions emerging during the end-of-life and after death. This study aims at measuring this gap and at gathering accurate data to provide refi ned training to professionals facing bereavement after cancer.

Three complementary studies were conducted: (1): a systematic review of the literature concerning professional training in grief and coping with bereavement, in Medline and PsycInfo. (2) One hundred French psychology graduate students were asked to formulate a diagnosis and recommend a follow-up on the basis of a case study including a cancer history (a bereaved spouse after a loss to cancer, meeting symptoms of PGD). (3) Ten nurses were asked about their needs and expectations regarding training in end-of-life and bereavement issues.

Results: the fi rst study yielded 10 results, which reveals the paucity of empirical investigation of these topics. Responses of the 110 participants of studies 2 & 3 (82 women, mean age = 27.2) indicate: 1/Critical needs of communication routine skills with grieving families, especially with chil-dren; 2/Diffi culties in distinguishing what pertains to adaptive grief reac-tions, and what is a matter of mental-health professionals attention; 3/Questions regarding what a ‘good death’ is. Finally the review of literature underlines the necessity of early and regular training in the nursing and psychology curricula, based on integrative and specifi c techniques.

Conclusions: the fi ndings suggested that future psychologists and nurses described themselves as resourceless when they need to screen for particu-larly distressed relatives during the end-of-life and after the death of the patient. Diffi culties in identifying accurate criteria to offer relevant psycho-logical support may hinder a coherent intervention. Key-elements of relevant training are discussed, as well as clinical implications.

431

CURRENT DEFINITIONS AND MEASURES OF QUALITY OF LIFE IN

PEDIATRIC PALLIATIVE CARE: A SYSTEMATIC REVIEW

Magali Lahaye1,2, Olivier Luminet1,3, Léonor Fasse4, Nago Humbert2,5, Michel Duval2,5, Serge Sultan2,5

1. Université catholique de Louvain, Louvain-la-Neuve, Belgium2. Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada3. Belgian National Fund for Scientifi c Research (FNRS-FRS), Brussels, Belgium4. Institut Curie, Paris, France5. Université de Montréal, Montréal, Québec, Canada

Aims: Despite the important medical improvements in pediatric oncology, cancer remains the second most common cause of death among children between 5 and 14 years old in North America. Pediatric palliative care is focused on maintaining the best possible quality of life (QoL) in children with cancer. However, defi ning and assessing the QoL in pediatric palliative



care is complex, because of the various dimensions included in QoL and the specifi cities of end-of-life issues. Moreover, developmental and medical con-straints such as age and health status increase the complexity of assessment’s strategies. Recently, some authors have challenged the defi nition and the assessment of QoL in pediatric palliative care. But, to date, this topic has never been summarized in a systematic review. In the present study, we propose a conceptual and methodological review of QoL in pediatric pallia-tive care.

Methods: Online bibliographic databases (PsycINFO, MEDLINE, and Cinahl) were used to identify relevant studies that address the defi nition and the measurement of children’s QoL in pediatric palliative care.

Results: Preliminary results show that there are less than 10 studies that specifi cally investigate the QoL of children in pediatric palliative care. Moreover, fi ndings highlight that there is a need to adapt the defi nition and the instruments of QoL for children hospitalized in pediatric palliative care to be as close as possible to their subjective experiences and their specifi c needs.

Conclusions: Current clinical and research literatures suggest that there are specifi c dimensions to defi ne the QoL in pediatric palliative care. Future research should focus on developing new strategies for assessing QoL that address new topics, such as positive aspects of QoL (playing, smiling, etc.). An optimal defi nition and a valid and reliable measurement of QoL in pediatric palliative care are crucial to improve medical and psychological interventions and support.

432

A SYSTEMATIC REVIEW COMPARING QUALITY OF LIFE

DEFINITIONS AND MEASUREMENT STRATEGIES BETWEEN

ADULT PALLIATIVE CARE AND PEDIATRIC PALLIATIVE CARE

Josianne Avoine-Blondin1,2, Véronique Parent1,2, Léonor Fasse3, Michel Duval1,4, Nago Humbert1,4, Serge Sultan1,4

1. CHU Ste-Justine, Montréal, Qc, Canada2. Université de Sherbrooke, Longueuil, Qc, Canada3. l’Institut Curie, Paris, France4. Université de Montréal, Montréal, Qc, Canada

Purpose: Each year, about 1300 children suffering from cancer are treated in pediatric palliative care units in Canada. Recent clinical and ethical lit-erature has raised the question of the appropriate defi nition of quality of life (QoL) of children in palliative care. The ability of professionals to defi ne and evaluate QoL is key to core decisions in the trajectory of children and end-of-life issues. It is also linked with ethical questions such as futility of treatment. Although the concept behind adult QoL in palliative care has been clarifi ed and is now subjected to measure, this is not the case in pedi-atric palliative care. The objective of this review is to identify the degree of similarity of defi nitions of QoL in pediatric palliative care with adult pallia-tive care.

Methods: We led an extensive systematic search of Medline, PsycInfo, CINAHL databases to identify empirical studies including an assessment of QoL in palliative settings during the last twenty years. We recorded domains present in adult and child assessment strategies and compared the similarity between the two age groups.

Results: There are very few strategies to assess QoL in pediatric palliative care. The domains of QoL in the two age groups are largely similar which suggest that end-of-life issues are viewed as non age-specifi c. Almost no positive behaviors, activities or positive emotions were included in assess-ment strategies of ped QoL (smiles, playing, meaning-fi nding, connecting with people, etc.) which contradicts the traditional defi nition of QoL.

Conclusion: New assessment strategies should be develop to approach QoL in children, more in line with real life issues and including positive activities which constitute the core of QoL in children. Assessment of QoL should address specifi c domains of children life in end-of-life settings as they have been identifi ed by clinicians.

433

DAILY BAD NEWS IN STAGE IV CANCER INPATIENTS

Laura E Guerrero Gutierrez, Roberta Fenili, Fabiola Cortés-Funes Urquijo, Ignacio García Escobar, Almudena Narvaez Arrospide, Anhara García Valverde, Natalia Piñas GonzalezHospital U 12 de Octubre, Madrid, Madri, Spain

Bad news has been widely studied. There is also another type of negative information that is linked with illness trajectory and treatment which can lead to distress. This sort of message is known as Micro-Bad News (MBN) and has been studied in hematological patients, demonstrating that daily events are paramount to increasing distress in such patients. The aim of this survey is to detect MBN within daily communication between oncologist and inpatients with phase IV-cancer diagnosis, and to infer the patient’s perception of what negative information is and which type they fi nd more distressful. Based on a previous research, the following categories of MBN have been used: information about Physical Harm, threatening patient´s Private Sphere, generating or not solving Uncontrollability and Promoting Ambiguity.

Methods: During morning wards, we assessed daily communication, which affects patients adversely, and registered its frequency, content, predictabil-ity, newness and degree of distress.

Results: The survey comprises 914 doctor-to-patient interactions, of which 41 MBN (4,4%) were observed. Out of the 191-patient sample, 18% had received a piece of MBN at some point, and 2,1% had received more than one. The average value for the moment a piece of MBN was given, was day No. 8 (range: day#1-day#21), and SD 5,71. The reported distress mean value was 6,59% (1–10 range), and SD 2,69. No signifi cant differences between MBN regarding gender, diagnosis, hospitalization length, age, nor regarding their contents, were observed.

Conclusion: The fi ndings indicate that, in this study, patients presented less amount of MBN compared with previous studies. Nevertheless, the average distress reported by them is rather high, proving how relevant MBN are in the increase of perceived distress. From all the MBN referred to by the patients, none belonged to the Promoting Ambiguity category.

434

LESSONS LEARNT FROM SETTING UP A MULTI-CENTRE COHORT

STUDY IN THE UK: A COHORT STUDY TO EXPLORE RECOVERY OF

HEALTH AND WELL-BEING FOLLOWING PRIMARY TREATMENT OF

COLO-RECTAL CANCER (CREW (COLORECTAL WELLBEING)

COHORT)

Debbie Fenlon1, Kim Chivers-Seymour1, Alison Richardson1,2, Peter Smith1, Jessica Corner1, Jane Winter2, Claire Foster1

1. University of Southampton, Southampton, United Kingdom2. Southampton General Hospital, Southampton, United Kingdom

Background: Recruitment of participants with cancer from clinical settings into studies is commonly reported as slow. The introduction of national support systems and infrastructure in the United Kingdom, such as the National Cancer Research Network (NCRN), aims to increase the number of patients participating in high quality clinical research studies. This includes funding for clinical research nurses to support recruitment into such studies. Since the NCRN was established in 2001 the recruitment rate to high quality clinical research cancer trials on their portfolio has doubled. However, there is limited published data to inform researchers planning new studies as to the actual recruitment that they might expect and what may be done to enhance recruitment.

Methods: We have established a prospective, longitudinal cohort study of 1053 people with colorectal cancer, by recruiting from 30 centres across the United Kingdom.

Aim: This work will report details of how this study was set up and how the large cohort were recruited; including the process of selection of



participating sites, time to research governance approvals, time to fi rst recruit, rate of recruitment and time to completion of study. The processes to enhance recruitment will be discussed as well as diffi culties encountered and recommendations made for future studies.

Findings: The average time taken for each centre to gain all the necessary approvals and be able to start recruiting was 86 working days (range 38–207). Centres originally agreed to recruit 2–3 patients per week however in reality the average recruitment rate per site was only 0.67 per week. The recruitment of 1000 participants was completed by 30 recruiting centres in 17 month.

Conclusions: This was highly successful recruitment strategy but with a number of challenges that had to be overcome by working in collaboration with the NCRN, research nurses, fund and service users.

435

WHY DON’T PEOPLE GET SCREENED FOR CANCER? PRELIMINARY

RESULTS FROM AN ONLINE SURVEY REACHING UNDER AND

NEVER SCREENED POPULATIONS

Brooke Filsinger1, Dionne Gesink2, Alanna Mihic2, Nancy Kreiger1

1. Cancer Care Ontario, Toronto, ON, Canada2. University of Toronto, Toronto, Canada

Aims: Participation rates for breast, cervical, and colon cancer screening in Ontario are below targeted levels. Our aim was to develop targeted programs and interventions at the community and provincial level by engaging popu-lations that do not typically participate in cancer screening and identifying the barriers, facilitators, and stage of behaviour change associated with screening behaviours.

Methods: Data is being collected from a volunteer sample of the Ontario population (women over 18 years of age, men over 50 years) using a cross-sectional study design. Participants complete a short, self-administered online survey exploring cancer screening habits. Social media has been used to promote the survey through partnerships with community and govern-ment organizations (the YMCA, Ontario Public Libraries, etc.), in addition to traditional methods.

Results: The survey began in February 2012. Of the fi rst 1500 individuals to complete the on-going survey, 83.7% are female (n = 1256, median 49 years) and 16.3% are male (n = 244, median 61 years). The sample is 88.9% Caucasian. Preliminary results indicate the need for different or easier screening tests (29.5% of respondents). Doctors are not suggesting cancer screening (17.9%) and individuals cannot schedule time to take the tests (15.2%). In addition, 15.9% would start screening with the appearance of symptoms. There is no statistical difference in the screening behaviours of males and females. However, females were more confi dent than males that they could actually get screened for colon cancer (p < 0.05).

Conclusions: The online nature of the survey allows instant results and tailoring of participation strategies. This information has been used to form new partnerships and interest in cancer screening in minority groups and underrepresented areas. Based on the preliminary results, intervention strat-egies that address the nature of the screening tests and confi dence levels in ability to get screened have been initiated.

436

IMPLEMENTING A NATIONAL STRATEGY FOR ACHIEVING

PERSON-CENTERED CARE: THE NEED FOR MULTIPLE STRATEGIES

Margaret I FitchCancer Journey Action Group, Canadian Partnership Against Cancer, Toronto, Ontario, Canada

Background: Across Canada, evidence from various patient satisfaction surveys, needs assessments, and stakeholder forums provide a clear picture that cancer patients are not receiving the full range of supportive care

services that could be of benefi t to them. The cancer system needs to undergo a shift toward person-centered or whole person care. Such a shift requires cultural change, demanding concerted effort and multiple strategies in order to be successful.

Objectives: In 2007, the Cancer Journey Action Group within the Canadian Partnership Against Cancer, was established to provide leadership to achieve person-centered care in the Canadian cancer care system.

Methods: The Cancer Journey Action Group has developed and imple-mented several initiatives to demonstrate how person-centered care can be achieved. The initiatives include programs in Screening for Distress (6th vital sign), patient navigation, on-line support groups, survivorship care plans projects, cancer transition education, and palliative care/end-of-life educa-tion. Tools to support this work have been designed including evidence-based practice guidelines, algorithms, and on-line education modules. Evaluation has focused on program uptake, educational effectiveness, inter-professional teamwork and patient satisfaction.

Results: All initiatives have been evaluated by patients/survivors as helpful. Issues of importance to patients/survivors are the focus of conversations with, and assessments by, health care professionals. Critical success factors across the respective programs for achieving person-centered care include clarity of a shared vision, leadership, persistent and intentional effort, use of multiple strategies, and consistent messaging in communications.

Conclusions: Demonstration projects undertaken for each topic area have provided an excellent opportunity to learn about best practices to implement the respective approaches. Guiding principles for implementation and rel-evant tools/resources have been developed as a result. Progress toward person-centered care is evident, but concerted efforts are required to sustain momentum of these efforts in routine clinical practice.

437

EFFECTS OF FAMILY THERAPY ON THE COMMUNICATION OF

PATIENT SUFFERING FROM CANCER AND ITS FAMILY

Cécile Flahault1, Juliette Desdouits2

1. Université Paris Descartes, Boulogne Billancourt, France2. Institut Curie, Paris, France

Aims: Current literature suggests that family interventions should be pro-posed to patients with somatic illness and their family to promote better communication and adaptation of patient and its relatives. Concerning patients with cancer, studies show a better adaptation when patient and its family can communicate more easily about disease and their emotional reactions. This study aims at describing the effect of family intervention on the communication about cancer and emotion in cancer patient families.

Methods: We have done a systematic review of the literature concerning family interventions in somatic disease and cancer, to describe the recom-mendations that are given in recent research.

Then we have analysed, with qualitative method (IPA), fi rst and fourth fi lmed family therapy sessions (6 couples and 5 families). We intend to describe the talking evolution in the family to underline the changing in communication during the fi rst four sessions of therapy.

Results: Analysis of family sessions indicate: (1) Patient and spouse use more the ‘We’ after four sessions (19% to 45%), and less the ‘you’ and the ‘he/she’ (57% versus 30%) (2) Number of therapist interventions is decreas-ing of 32% from the fi rst to the fourth session and there are much more silences (10% more) (3) Cancer theme is decreasing from 71% of the talk themes to 54% (4) Expression of fears and sadness are increasing from 6% to 18% (5) At fi rst session parents want to speak about cancer in 80% of the families, and children want to speak about family life in 60% and about cancer in 30% of the families (6) At the fourth session, cancer theme is replaced by family issues.

Conclusion: This study suggest than family interventions have an effect on the communication en emotional expression. Clinical implications are dis-cussed and long term studies should be developed.



438

AN EXPLORATORY STUDY ON FACTORS ASSOCIATED WITH

PATIENT PREFERENCES FOR COMMUNICATION

Maiko Fujimori1, Tatsuo Akechi2, Yosuke Uchitomi1. National Cancer Center Hospital, Tsukiji, Tokyo, Japan2. Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan

Purpose: This study explored the impact of demographic, medical and psychological characteristics on patient preferences for communication on bad news.

Participants and methods: Five hundreds and eighteen patients with a variety of cancers were participated. Participants completed a measure assessing their preferences regarding the disclosure of bad news, consists of 70 items in 4 factors: how to deliver the bad news, reassurance and emo-tional support, additional information, and setting. They rated several psy-chosocial and medical characteristics, including the Mental Adjustment to Cancer Scale (MAC) and the Hospital Anxiety and Depression Scale (HADS).

Results: Regression analyses indicated that younger patients and those with higher education, the fi ghting spirit and anxious preoccupation dimensions of the MAC had signifi cantly higher scores on the ‘how to deliver the bad news’ scale; women and patients with the fi ghting spirit and anxious preoc-cupation dimensions of the MAC had signifi cantly higher scores on the ‘reassurance and emotional support’ scale; young patients and those with low satisfaction in own experience of the breaking bad news, higher educa-tion, the fi ghting spirit, the helplessness/hopelessness and anxious preoc-cupation dimensions of the MAC had signifi cantly higher scores on the ‘additional information’ scale; older, male, and patients with the fatalism dimension of the MAC had signifi cantly higher scores on the ‘setting’ scale.

Conclusion: Japanese physicians should consider the demographic (e.g. age, gender) and psychosocial characteristics (fi ghting spirit and anxious preoc-cupation) of patients when delivering bad news.

439

HOPE & HURDLES: AN INFORMATION RESOURCE FOR WOMEN

WITH SECONDARY BREAST CANCER

Kathy Wells, Julie Thompson, Michelle Marven, Candice Charles, Annie GayedBreast Cancer Network Australia, Camberwell, VIC, Australia

Background: In 2007, Breast Cancer Network Australia (BCNA) launched its Hope & Hurdles Pack for women with secondary breast cancer. To date, more than 4,500 copies have been distributed free of charge to women. In 2011–12, BCNA reviewed Hope & Hurdles to ensure it continues to provide up-to-date, appropriate information for women with secondary breast cancer.

Methodology

Surveys on women’s information needs and the current Hope & Hurdles resource were conducted with women with secondary breast cancer. Focus groups were held with women and health professionals. A reference group comprising health professionals, representatives of key professional bodies and consumer representatives was established to guide the review. Women with secondary breast cancer reviewed the design and content of the new resource, as did health professionals including the reference group members.

Results: Based on the results of our surveys and focus groups, and feedback from the reference group, BCNA is redeveloping Hope & Hurdles to include new and updated information. A suite of optional booklets is being developed on the main metastases sites (bone, lung, liver, brain) and end of life issues, providing women with additional in-depth information on these topics. Women can access these booklets if/when they want them. This makes the resource more fl exible and tailored to women’s individual needs. The new edition of Hope & Hurdles will be available in early September 2012.

Conclusions: There is a pressing need for tailored information for women with secondary breast cancer. Following our review, Hope & Hurdles will provide more tailored information to assist women with their diagnosis and support needs. With only around 40% of women with secondaries currently receiving the Hope & Hurdles resource, BCNA needs the vital support of health profes-sionals to help us reach women with this important updated resource.

440

APPLYING AN EVIDENCE-BASED APPROACH TO DEVELOPMENT

AND EVALUATION OF RESOURCES FOR FAMILIES FACING

ADVANCED CANCER: LESSONS LEARNED FROM THE ‘CONSUMER

TOOLKIT’

Afaf Girgis1, Sylvie D Lambert1, Claire Johnson2, David Currow3

1. The University of New South Wales, Liverpool, NSW, Australia2. Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia3. School of Psychology, Flinders University, Adelaide, South Australia, Australia

The aim of this study was to develop a Consumer Toolkit for families facing advanced cancer, which includes up-to-date literature on managing cancer challenges and assessment tools to enhance self-identifi cation and commu-nication of health care needs; and evaluate its appropriateness and useful-ness. The Consumer Toolkit was evaluated by 51 patients and/or caregivers and 14 health professionals, through surveys, focus groups and/or inter-views. Focus groups and semi-structured interviews were audio-recorded, transcribed verbatim and analysed in relation to the study aims. Frequencies were produced from the surveys. The Toolkit was a welcomed ‘road map’ to living with advanced cancer and addressed issues of critical importance to participants. Participants particularly valued the practical ‘top tips’ to self-manage concerns and web links to additional resources, but felt it lacked testimonials. Many found the assessment tools to be very or extremely useful to identify needs and indicated they would use them to discuss their need with health providers. Many health providers identifi ed inclusion of these tools as one of the Toolkit’s main novelties. Perceived benefi ts of using the Toolkit were: increased knowledge, normalising challenges faced, encourag-ing active involvement in care, facilitating discussion about needs, and connecting consumers to other resources. Health providers thought that this resource could easily be integrated in practice, with their evaluation mirror-ing consumers’ fi ndings. Readable and suitable patient education resources can be effective teaching aids. However, many resources are produced with inadequate attention to their suitability for the intended audience. This evaluation provided valuable insights into what families facing advanced cancer and health professionals valued most from the Toolkit. Findings can inform development of patient and caregiver resources.

441

‘I KNOW YOU THINK THERE IS THIS SYSTEM: BUT THIS IS WHAT

ACTUALLY HAPPENED TO ME?’ TRANSLATING CANCER

RESEARCH INTO A RESPONSIVE SUPPORTIVE CARE SYSTEM OF

SERVICES, PROGRAMS AND POLICIES

Ainslie HannanCancer Council Victoria, Carlton, Vic, Australia

Addressing the supportive care needs of those impacted by cancer requires an ability to be able to respond in dynamic, fl uid ways to a range of people with a range of experiences. Critical to responsiveness is the need to under-stand how the service system in the context of policy can coordinate an effective response that goes beyond the acute setting so that individual care needs no matter who you are, where you live or what your diagnosis, can be met.

Information and Support Services at the Cancer Council Victoria has just completed qualitative research across Victoria to increase its understanding



of what are the effective services, programs and policies that can respond to a diverse range of supportive care needs. The research although Victorian based has National implications. It included focus groups metropolitan and regional, supported by targeted group and individual interviews with patients, health professionals and cancer services ensuring cross tumour stream and stage of disease coverage.

This paper draws together the narratives of the individuals and the service system experience. It explores the possible impact of translating the fi ndings from this research into effective responsive services, policies and programs. It concludes that if supportive care needs are to be meet we must re-examine our understanding of cancer and our often pragmatic resource conscious delivery of supportive care. As professionals who have responsibility in supportive care we must be conscious of the policies and legislation inform-ing its delivery. It is proposed that there are opportunities for policy and law reform and that this can be achieved through effective relationships and partnerships.

442

CANCER PATIENTS’ OPINIONS OF PSYCHOSOCIAL SCREENING

Josette JEHM Hoekstra-Weebers1,2, James JC Coyne2,3, Harry HBM van de Wiel2

1. Comprehensive Cancer Center Netherlands, Groningen, the Netherlands2. Wenckebach Institute, University Medical Center Groningen, Groningen, the Netherlands3. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Aims: The current study investigates cancer patients’ opinions on psycho-social screening using the Distress Thermometer (DT) and Dutch Problem List (PL).

Methods: all cancer patients consecutively visiting out-patient oncology clinics in 6 hospitals in North-East the Netherlands were asked to complete questions on the DT/PL, communication about the response pattern, and referral. Descriptive and correlational analyses were computed.

Results: Of the 550 cancer patients approached, 302 participated (55%). Four-fi fths replied they completed a DT/PL; 33% once, 31% twice, 36% between 3–8 times. Percentages of respondents (totally) agreeing that the DT/PL were: useful for my medical specialist/nurse = 91%; suitable for its purpose = 88%; easy to complete = 81%; useful for myself = 79%; pleas-ant = 76%; diffi cult to encircle a number on the DT = 66%; burden-some = 31%; diffi cult = 30%; time-consuming = 29%. Of the respondents, 67% (totally) agreed that DT/PL completion gave them insight into prob-lems they experienced and 56% into severity of these problems; 59% that it helped in the communication with the health care provider and 43% in the communication with relevant others. Seventy-eight percent would rec-ommend others to complete the DT/PL. No signifi cant relationships were found between DT score or the number of times the instrument was com-pleted and any of these opinions. Seventy-two percent replied that the response pattern on the DT/PL had been discussed with them. Ninety-fi ve percent answered that communication was with a nurse and 93% of patients was (very) satisfi ed. Of the respondents, 60% responded that psychosocial or allied health professional care was offered but not needed, 24% that care was not offered and not needed, 15% that care was offered and needed, and 1% that care was needed but not offered.

Conclusion: cancer patients were mainly positive in evaluating the DT/PL, indicated that communication with staff took place in almost three-quarter of the cases, and that referral was in accordance with patients’ needs.

443

‘WHERE NOW?’ – PILOT STUDY OF A COURSE FOR PEOPLE

LIVING BEYOND CANCER

Lesley Howells, Mandy MacMahan, Ann-Louise Ward, Malcolm CookMaggie’s Centres, London, UK, United Kingdom

Aim: ‘Where now?’ is a seven-week survivorship course devised by Maggie’s (www.maggiescentres.org) for people making the challenging transition between active treatments and building the life they want beyond cancer. Aims to provide the support needed to:

• Make lifestyle changes in exercise, nutrition and managing stress• Adjust to living with uncertainty and fears of cancer recurrence• Make effective post-treatment partnerships with medical teams• Take a fresh look at priorities in work and relationships.

Study aim is to evaluate the course’s effectiveness and feasibility of delivery.

Methods: Pilot courses held in 3 Maggie’s Centres. Thirty-two participants had a mean age of 52 yrs (33 yrs: 72 yrs); were predominantly female (84%); educated to technical college level (74%); and within 24 months post treatment. Cancer diagnosis included breast (41%); colorectal (25%); ovarian (22%); cervical (3%); prostate (3%); NHL (3%); lung (3%). Stand-ardised measures administered pre and post included: Impact of Cancer Scale, Distress Thermometer.

Results: Signifi cant reduction was observed on two Impact of Cancer sub-scales: Health Worries (including fears of recurrence) (f = 24.642; n = 31; p < 0.000) and Negative Outlook (f = 4.514; n = 31; p = 0.042); and the overall Negativity Scale (f = 4.701; n = 16; p = 0.048) including worries about cancer’s long-term life interference. Distress reduced signifi cantly (f = 15.988; n = 23; p = 0.001). The fi ve most important aspects of the course experience: ‘Getting Support and Encouragement’, ‘Learning my problems are not unique’, ‘Getting direct advice, suggestions or education’, Learning that I am responsible for how I cope with my life’ and ‘Confront-ing diffi cult problems and fears’.

Conclusion: ‘Where Now?’ is feasible to deliver, universally well received and pilot results suggest it enables important changes in a person’s psycho-logical adaption to the challenges of survivorship. A controlled longitudinal trial is required to fully establish whether observed changes can be attributed to the course and are maintained over time.

444

ARE THERE DIFFERENCES BETWEEN THE WRITTEN AND THE

ORAL MEANS OF SCREENING PSYCHOSOCIAL DISTRESS WITH

THE DISTRESS THERMOMETER IN CANCER PATIENTS?

Sheng Hui Hsu, Ging-Long Wang, An-Chen Feng, Yi-Chen Hou, Chih-Tao ChengSun Yet Sen cancer center, Pei-Tou District, Taipe, Taiwan

Purpose: The Hospital Anxiety and Depression Scale (HADS) is a well accepted tool for screening the emotional problems for cancer patients.(1) To effi ciently screen psychosocial distress, NCCN has recommended the Distress Thermometer (DT) which is internationally accepted and used. (2) The DT is an one-item questionnaire, designed to be completed in writing by the patients. However, due to concerns over patients’ literacy or clinical expediency, many DT scores have been obtained through oral means by the nursing staff. The goal of this study is to assess the reliability of the DT scores collected through different means, by comparing with the HADS scores. The optimal cutoffs have been set at DT ≥ 4, HADS-total ≥ 15. (3)

Method: The DT was administered to three groups of patients by the fol-lowing different means:

Group 1: the nursing staff orally describing the DT without any visual aides;Group 2: the nursing staff describing the DT with a picture of the distress

thermometer;



Group 3: the patients completing the DT questionnaire by themselves.All patients were also requested to complete the HADS subsequently.

Results: One hundred and fi ve cancer patients recruited on their fi rst visit to KF-SYSCC were randomly assigned into three groups between Nov. 1, 2011 and Dec. 31, 2011. Eighty nine patients (85%) of them completed both the DT and the HADS.

There was no signifi cant difference in the demographic data among the three groups. The concordance rates between the DT ≥ 4 and the HADS-total ≥ 15 were 60% in group 1 (P = 0.44 by Fisher’s Exact Test), 77.8% in group 2 (P = 0.003 by Chi square test), and 71.8% in group 3 (P = 0.008 by Fisher’s Exact Test) respectively.

Conclusion: Screening psychosocial distress with the DT by oral means is as reliable as the written one if a picture of the distress thermometer has been shown to the patients.

Acknowledgement: None.

References

(1) Herrmann C. International experiences with the Hospital and Anxiety and Depression Scale – a review of validation data and clinical results. J Psychosom Res 1997; 42(1):17–41.

(2) Hoffman BM, Zevon MA, D’Arrigo MC, Cecchini TB. Screening for distress in cancer patients: the NCCN rapid screening measure. Psycho-Oncology 2004; 13:792–799.

(3) Wang GL, et al. The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan. Psych-Oncology 20: 639–646 (2011).

445

THE BIDIRECTIONAL RELATIONSHIPS OF COPING STRATEGIES

AND DISTRESS: A STUDY AMONG TAIWANESE NEWLY-

DIAGNOSED BREAST CANCER PATIENTS

Wen-Yau Hsu1, Wei-Ting Wang1, Cheng-Shyong Chang2, Dar-Ren Chen2, Shou-Tung Chen2

1. National Chengchi University, Taipei City, Taiwan2. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan

Aims: Literature regarding cancer adaptation has stressed the central role of coping strategies in reducing psychological symptoms. On the other hand, recent studies have indicated that distress and emotions might infl uence the use of coping strategies (Khosla & Hangal, 2004; Classen et al., 1996). However, little research has explored the latter possibility. The current study aims to explore whether coping strategies used among newly-diagnosed cancer patients predict latter distress or early distress predicts the use of coping strategies. This issue provides important information on whether we should focus on teaching coping strategies or reducing distress in the early intervention for cancer patients.

Methods: A longitudinal study was conducted with 113 breast cancer patients at the third month after the cancer surgery (T1) and the sixth month after the surgery (T2). The Chinese version of the brief COPE (Carver, 1997) and the Chinese version of the Hospital Anxiety and Depression scale (HADS) were assessed at both T1 and T2.

Hierarchical regression analyses were performed to examine the relative contribution of coping strategies to distress (anxiety and depression), con-trolling for age, marital status, income, cancer stage and the distress level at T1. For the reverse direction of predictions, the same steps were adopted.

Results: Approach coping at T1 signifi cantly predicted level of anxiety at T2 (β = −0.22, p = 0.019). On the other hand, the level of anxiety and depression at T1 signifi cantly predicted the use of approach coping at T2 (β = 0.22, −0.49; p = 0.011, p < 0.001), and T1 depression predicted the use of disengagement coping at T2 (β = 0.26, p = 0.016).

Conclusions: Our fi ndings emphasized the signifi cance of early distress level. While depression at early stage seems to be a sign for less use of adap-tive coping, anxiety has bidirectional meanings – a suffering sign that

predicts disengaged coping and a warning to motive the use of adaptive coping.

References

1. Khosla, M., & Hangal, E. (2004). Role of optimism and pessimism in coping with stress. Journal of Personality and Clinical Studies, 20, 71–78.

2. Classen, C., Koopman, C., Angell, K., & Spiegel, D. (1996). Coping styles associated with psychological adjustment to advanced breast cancer. Health Psychology, 15, 434–437.

3. Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4 (1), 92–100.

446

DEVELOPING A NATIONALLY COLLABORATIVE FRAMEWORK FOR

PSYCHOSOCIAL ONCOLOGY RESEARCH: A REVIEW OF THE UK

NCRI PSYCHOSOCIAL ONCOLOGY CLINICAL STUDIES GROUP

Nick Hulbert-Williams1, Julia Brown2, Lynn Calman3, Gill Hubbard4, Jennifer Levandowski5, Annmarie Nelson6, Penny Wright2

1. University of Chester, Chester, United Kingdom2. University of Leeds, Leeds, UK3. University of Manchester, Manchester, UK4. University of Stirling, Stirling, UK5. National Cancer Research Institute, London, UK6. Cardiff University, Cardiff, UK

Aims: The National Cancer Research Institute (NCRI) is part of a UK-wide cancer research network funded by the NHS and a number of UK Cancer Charities. There are 22 NCRI Clinical Studies Groups (CGSs), including a Psychosocial Oncology CSG. The aim of this paper was to review the con-tribution and success of this group since its inception in 2004.

Method: The CSG has developed a number of roles to support UK-based psychosocial oncology research. We reviewed: (a) the number of studies registered on the CSG Trials Portfolio, (b) the number of UK cancer patients who have been recruited into registered studies, and (c) the research-gener-ating activities of the CSG.

Results: There are 32 studies currently registered on the CSG Trials port-folio; 27 of which are actively recruiting patients. Including those studies which have been registered and are now closed to recruitment, this equates to recruitment of 24,780 patients into registered psychosocial oncology studies since 2004. Three sub-groups (Transition from Active Therapy; Living with Cancer; Symptoms and Side-Effects) meet twice yearly to gener-ate new ideas for psychosocial oncology research, many of which have received external funding. We also provide pre-submission peer-review for UK psychosocial oncology researchers seeking funding for new studies.

Conclusion: The NCRI Psychosocial CSG has a crucial role in UK cancer research. By ongoing registration of studies we can track what research is being conducted, ensure that no unnecessary replication is occurring, and monitor the total number of patients recruited. The sub-groups provide an essential funded mechanism by which multicenter collaboration can be fostered as they allow expert researchers, clinicians, methodologists and health professionals from around the UK to regularly meet to discuss and develop new research. These sub-groups also fulfi ll a capacity building role and are being successfully used to mentor junior psychosocial oncology researchers in the UK.

447

SPIRITUALITY AND MEANING IN LIFE OF THE JAPANESE FEMALE

BREAST CANCER PATIENTS

Chiaki IharaKyotoGakuen University, Kameoka, Kyoto, Japan

Aims: Spirituality and the Meaning in Life (MiL) are important for the mental supports for the cancer patients. This study aims to assess the psy-



chological and existential problems of the Japanese female breast cancer patients, compared with the normal women.

Methods: Patients (age 30–70) diagnosed as Stage I-III, without recurrence and metastasis, with no mental illness were asked to answer the question-naires. 66 patients fi lled-in the Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), General Health Questionnaire (GHQ30), the Subjective Well-being Inventory (SUBI), the Schedule for Meaning in Life Evaluation (SMiLE) and the subscale of Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp12). 200 normal females fi lled-in the same questionnaires. Individual interviews were performed to assess the psychological conditions of the patients.

Results: (A) Mean age were 54.6 ± 10.4 for the patients (P) and 49.6 ± 11.1 for the normal (N). There were no signifi cant differences between P and N as for the scores of SDS, STAI, GHQ30, the positive items of SUBI, SMiLE and FACIT-Sp12. The differences of the faith subscale of FACIT-Sp12 (p < 0.01) and the negative items of SUBI (p < 0.05) were signifi cant, where P showed the higher score. In P the correlation coeffi cients between FACIT-Sp12 and SDS, STAI-State, STAI-Trait, GHQ30 were −0.42, −0.56, −0.59 and −0.40 (p < 0.01) respectively, while those between FACIT-Sp12 and the SUBI were 0.68 (positive) and 0.55 (negative) respectively (p < 0.01). The tendency was the same for the correlation between SMiLE and other scores.

(B) Many experienced the cancer positively as the opportunity to confi rm the relationship with others and to accept the weakness of their own.

Conclusion: The cancer patients were not more depressive, anxious, nervous, or negative. Spirituality and MiL are considered as indices of the well-being of the patients. Further analysis with more data would be pre-sented at the congress.

Acknowledgment: This work was supported by JSPS.

448

DEPRESSION PREDICTS LOWER USE OF SERVICES IN

GYNAECOLOGICAL CANCER SURVIVORS

Iris Kusters1, Merran Williams1, Andreas Obermair1, Monika Janda2

1. Queensland Centre for Gynaecological Cancer, Brisbane, QLD, Australia2. Queensland University of Technology, Kelvin Grove, QLD, Australia

Objective: To assess the psychological wellbeing, unmet supportive care needs, quality of life and service needs of gynaecological cancer survivors with depression and/or anxiety and determine factors associated with their use of services.

Methods: In 2010, a population-based cross-sectional mail survey (49% response rate) was completed by 160 gynaecological cancer survivors, who were 5 to 30 month post diagnosis. Descriptive statistics summarized preva-lence of outcomes. Chi-Square tests were used to ascertain factors associated with depression and anxiety and assess whether patients with psychological distress had higher supportive care needs and used services to alleviate those ailments.

Results: The prevalence of depression/anxiety was 21% and 24% respec-tively. Factors associated with higher levels of depression included living alone, and being unemployed or retired.

Women with high levels of depression/anxiety had higher unmet supportive care needs in all domains including psychological (p ≤ 0.01), physical and daily living (p ≤ 0.01), health system and information needs (p ≤ 0.01), patient care and support needs (p ≤ 0.01) and sexuality needs (p ≤ 0.01), and also reported signifi cantly lower quality of life. Women with depression/anxiety were less likely to use services. Services needed but not used by women with high levels of depression or anxiety were psychiatrists, psy-chologists and pain specialists.

Conclusions: Still not enough women with physical and psychological sequela after treatment for gynaecological cancers are using services. Inad-equate use of services may lead to lower quality of life and more unmet supportive care needs in a number of domains. To improve utilization of

services and supportive care, well-defi ned survivorship care plans, and tar-geted survivorship interventions need to be developed, tested in randomised trials, and those successful need to be integrated into standard care.

449

A RANDOMIZED, CONTROLLED TRIAL OF MEDITATION FOR

WOMEN WITH BREAST CANCER

SunJoo Jang1, Bong-Jin Hahm1. Seoul National university hospital, Seoul, South Korea

From the moment of being diagnosed with breast cancer, patients must endure the psychological problems that come with the treatment process. Thus, these patients are at risk of low level of Quality of Life (QoL) espe-cially, after completing the treatment process when the breast cancer patients have to readapt to their daily life without medical help. Therefore, it is necessary to investigate the available modalities of assisting the patients in forming health patterns, such as meditation.

50 subjects were recruited and allocated via random allocation software. The experimental group (n = 20) received the 8-week meditation program based on Kuksundo. The control group (n = 21) received the same medita-tion program as the experimental group after completion of the fi rst- and eighth-week questionnaire.

All subjects performed HADS-A, HADS-D, FACT-B to evaluate anxiety, depression, and QoL, respectively.

The collected data were analyzed using SPSS for Windows. Chi-square tests, Fisher’s exact tests, and t-tests were performed to test homogeneity of characteristics and dependent variables between the experimental and the control groups. To test hypothesis t-test was used.

The results are as follows:

1) The results of homogeneity verifi cation of preliminary investigation data showed that there was no signifi cant difference between the experimental and control group except power scores.

2) 2) Compared with the control group, patients on meditation treatment showed signifi cant reduction in scores of anxiety (t = 2.74, p = 0.009).

3) 3) Compared with the control group, patients on meditation treatment showed signifi cant reduction in scores of depression (t = 2.20, p = 0.033).

4) 4) Compared with the control group, patients on meditation treatment showed signifi cant improvement in scores of QoL (t = −3.45, p = 0.001).

The present trial results demonstrate that the 8-week meditation program signifi cantly reduced anxiety and depression, and improved QoL in subjects with breast cancer. These results suggest that meditation has positive effects on emotion and QoL.1

Reference

1. Alexander, S., Palmer, C., & Stone, P.C. (2009, Dec 4). Evaluation of screening instruments for depression and anxiety in breast cancer survi-vors. Breast Cancer Research and Treatment. Retrieved April 24, 2010, from http://www.springerlink.com/content AS.



450

‘LIVING BENEATH THE SWORD OF DAMOCLES’: PERCEPTIONS OF

RISK AND FEARS OF CANCER RECURRENCE AMONGST

AUSTRALIAN MELANOMA SURVIVORS AT HIGH OR MODERATE

RISK OF DEVELOPING NEW PRIMARY DISEASE

Nadine A Kasparian1,2, Jordana K McLoone2, Bettina Meiser2,3, Phyllis N Butow4, Margaret Charles4, Kristine Barlow-Stewart5, Graham J Mann6,7, Scott Menzies4,8

1. The Children’s Hospital at Westmead, Westmead, NSW, Australia2. Prince of Wales Clinical School, University of NSW, Kensington, NSW, Australia3. Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia4. Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia5. Centre for Genetics Education, Royal North Shore Hospital, St Leonards, NSW, Australia6. Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead, NSW, Australia7. Melanoma Institute Australia, North Sydney, NSW, Australia8. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Background: Despite continued progress in the clinical management of melanoma, patients continue to live at increased risk of developing new primary disease. This study examined risk perceptions, fears of cancer recur-rence, melanoma-related behaviours, and satisfaction with clinical care amongst melanoma survivors at high or moderate risk of new primary disease.

Methods: Participants were recruited via the High Risk Clinic at the Sydney Melanoma Diagnostic Centre (high risk group) or the Melanoma Institute Australia (moderate risk group). Individuals at high risk (i.e. multiple melanoma diagnoses, or one primary melanoma and dysplastic naevus syndrome, DNS), or moderate risk (one melanoma and no DNS) completed a questionnaire assessing: psychological factors (e.g. fear of melanoma recurrence, risk perceptions, anxiety, depression); sun protection and skin cancer screening behaviours; satisfaction with clinical care; and demo-graphic and clinical characteristics.

Results: 310 participants completed the survey (high risk n = 165; moder-ate risk n = 145; response rate: 79%; 56% male; mean age: 59.5 years; SD = 12.8). Clinically-relevant levels of anxiety and depression, as measured by the HADS, were reported by 25% and 9% of participants, respectively. Seventy-three percent of participants reported clinically-relevant levels of fear of cancer recurrence, with mean scores similar between groups (t = −1.2, p = 0.2). Participants reported high levels of satisfaction with melanoma care. Path analysis is currently underway and will be presented at the meeting.

Conclusion: Melanoma patients experience a range of practical, emotional, physical, and social challenges as a result of their diagnosis and treatment. For some people, these challenges may continue to have an impact long after initial diagnosis. Although many patients exhibit healthy psychological adjustment, this study found that 73% of moderate- to high-risk patients report levels of fear of cancer recurrence indicative of the need for clinical intervention. To be effi cacious, psychological support must be offered to patients in a timely manner, and should be tailored to the individual’s needs and resources.

451

‘THE CRITICAL INGREDIENTS OF SUCCESS’: EVALUATION

FINDINGS OF A SUPERVISED EXERCISE PROGRAMME FOR MEN

WHO HAVE HAD A DIAGNOSIS OF CANCER

Colleen W Kendrick1, Katherine Nelson2

1. Cancer Society of New Zealand, Tauranga, Tga, New Zealand2. Victoria University of Wellington, Wellington, New Zealand

Evidence demonstrates the benefi ts of exercise for those with a cancer diagnosis and there is an increasing recognition of the need to tailor exercise opportunities for specifi c patient groups. In May 2011, the Waikato/BOP division of the Cancer Society of New Zealand introduced a supervised, circuit-based group exercise programme specifi cally for men. Given this was the fi rst known such programme in New Zealand, this study involved a process evaluation of the programme’s development and implementation. The aims of the study were to explore the experiences of the men who participated, to investigate their preferences for exercise, and identify factors essential to the ongoing design and delivery of acceptable, accessible and appropriate exercise programmes for men. The 10 male participants and the physiotherapist who delivered the programme were interviewed about their experiences of the 6 week programme. The men were aged 62–80 years with a median age of 69, had diverse professional and personal back-grounds, varied types and stages of cancer and a wide range of physical fi tness. This presentation discusses how well the programme met the men’s needs and what could be improved in delivering the exercise programme. It identifi es some of the barriers and enablers for men participating in exercise programmes. The fi ndings are framed within four major themes: 1) pro-gramme and purpose, 2) the importance of a safe, accessible, appropriate and inclusive programme, 3) camaraderie and the impact of competition and humour, and 4) achieving in the face of challenge. This research builds on existing knowledge and contributes to a deeper understanding of the utility and feasibility of a group based exercise programme for men and the factors that need to be considered in designing further programmes. Practi-calities, possibilities and implications for practice and future research are discussed.

452

PSYCHOSOCIAL IMPACT OF A CANCER DIAGNOSIS ON PATIENTS

AND FAMILIES IN SUBSAHARAN AFRICA

David M Kinyanjui1,2, Lawrence I Gichini1

1. Cancer Program, The Aga Khan University Hospital, Nairobi, Nairobi, Kenya2. Patient Support and Advocacy, Kenya Cancer Association, Nairobi, Kenya

Background: Caring for patients and families facing a diagnosis of cancer in Africa presents unique challenges. Economic and physical, access to specialist healthcare for cancer patients compounded by cultural and politi-cal barriers present major threat to patient’s sense of security and ability to cope with a cancer diagnosis.

Methods: A desk review, practice observations and interviews with key frontline caregivers on the psychosocial impact of cancer on patients and families as seen in African in the context of social, economic and political upheavals.

Findings: A diagnosis of cancer has a devastating effect on family dynamics. In Africa where the incidence is predicted to triple in the next 15 years, the cancer epidemic is happening in the context of wars, poverty and other social economic challenges. Poor people with cancer suffer disproportionate physical, emotional psychological, and social distress.

Conclusions: Formal and informal carers must take cognizance of the fact that cancer patients in Africa maybe facing double tragedy of being refugees, slum dwellers or an internally displaced. These factors have a major infl u-ence on the patients ability to cope and must be considered in designing psychosocial interventions. The impact of a cancer diagnosis on individuals



and families cannot be looked at from a psychological or emotional perspec-tives alone. It should be seen in the context of how the patient interacts with his social, economic and political environment.

References

Aura B, Zhong J, Hightower A, Brieman R, Feikin D, Audi A. (2007) Use of Personal Digital Assistants (PDA) for collecting household-level data in the Western Kenya Health and Demographic Surveillance System (DSS), 2005–2006. Seventh Indepth Network Annual General and Sci-entifi c Meeting, Nairobi, Kenya; Sep 3–7.

Barrett RE, Cho YI, Weaver KE, et al. (2008) Neighborhood change and distant metastasis at diagnosis of breast cancer. Ann Epidemiol 18: 43–47.

Byass P, Hounton S, Ouédraogo M, Somé H, Diallo I, Fottrell E, et al. (2008) Direct data capture using hand-held computers in rural Burkina Faso: experiences, benefi ts and lessons learnt. Trop Med Int Health 13: 25–30.

Coleman MP, Quaresma M, Berrino F, et al. (2008) Cancer survival in fi ve continents: a worldwide population-based study (CONCORD). Lancet Oncol 9: 730–756

Costanzo, Erin S, Ryff, Carol D, Singer, Burton H. (2009) Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being. Health Psychol 28(2): 147–156.

Do DP, Finch BK. (2008) The link between neighborhood poverty and health: context or composition? Am J Epidemiol 168: 611–619.

Fottrell E. (2008) Dying to count: mortality surveillance methods in resource-poor settings. Thesis, University of Umeå.

Fottrell E, Byass P. (2008) Population survey sampling methods in a rural African setting: measuring mortality. Popul Health Metrics 6.

INDEPTH: International Network of Field Sites With Continuous Demo-graphic Evaluation of Populations and Their Health in Developing Coun-tries [Homepage on the Internet] Available from: www.indepth-network.org.

K’Opiyo J, Mushinzimana E, Karama M, Agollaa R, Kaneko S. (2007) Development of Personal Digital Assistant (PDA) application on a demo-graphic surveillance system in Suba district, Western Kenya. Seventh Indepth Annual General and Scientifi c Meeting, Nairobi, Kenya; Sep 3–7.

MacKinnon JA, Duncan RC, Huang Y, et al. (2007) Detecting an associa-tion between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures. Cancer Epidemiol Biomarkers Prev 16: 756–762.

Oluwole SF, Ali AO, Adu A, et al. (2003) Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. J Am Coll Surg 196: 180–188

Parkin DM, et al (2008) Cancer in Indigenous Africans–burden, distribu-tion, and trends. Lancet Oncol 9(7).

Parkin DM, Nambooze S, Wabwire-Mangen F, Wabinga HR. (2010) Chang-ing cancer incidence in Kampala, Uganda, 1991–2006. Int J Cancer 126: 1187–1195.

World Health Organization Databank. WHO Statistical Information System. Geneva: World Health Organization; Year. Available at: http://www.who.int/whosis.

Sankaranarayanan R, Swaminathan R, Brenner H, et al. (2010) Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 11: 165–173.

Seitz DCM, Besier T and Goldbeck L. (2009) Psychosocial interventions for adolescent cancer patients: a systematic review of the literature. Psycho-Oncology 18: 683–690.

453

MEN WITH CANCER USING COMPLEMENTARY AND ALTERNATIVE

MEDICINE (CAM): VARIATIONS IN SIGNIFICANT OTHERS’

INVOLVEMENT

Nadja Klafke1, Jaklin Eliott2, Ian Olver3,4, Gary Wittert4

1. School of Psychology, The University of Adelaide, Adelaide, Australia2. Discipline of General Practice, School of Population Health & General Practice, The University of Adelaide, Adelaide, Australia3. Cancer Council Australia, Sydney, NSW, Australia4. Discipline and School of Medicine, The University of Adelaide, Adelaide, SA, Australia

Aims: Almost two-thirds of male cancer patients have experience with Complementary and Alternative Medicine (CAM) alongside conventional cancer treatment, often with the support or involvement of family or friends. This study examines how (1) men with cancer and their signifi cant others (SOs) perceive decisions about CAM use (2) SOs contribute to men’s CAM use.

Methods: Twenty-six men and twenty-four SOs were purposefully selected to include men varying in stage and type of cancer, CAM use, and perceived levels of intrapersonal and interpersonal confl ict regarding CAM use. Semi-structured interviews with men and their SOs were transcribed verbatim. The resultant text was categorised into themes, according to how individu-als, events, or actions were discussed in the context of the cancer diagnosis and CAM decision-making.

Results: Thematic saturation was reached after 43 interviews. Four distinct patterns of involvement of SOs with regard to different CAM categories and CAM therapies were identifi ed: 1) SOs are always actively involved, though to different degrees, in patients’ use of natural products (e.g., diet, dietary supplements, herbs and botanicals) 2) SOs are only actively involved in patients’ use of mind-body medicine (e.g., meditation/relaxation, Yoga, prayer, psychology/counselling) when the SO practices it as well 3) SOs are not involved when patients practice mind-body medicine as a private activity 4) use of CAM is sometimes associated with intrapersonal and interpersonal confl icts in men and their SOs.

Conclusions: CAM use has both individual and interpersonal consequences for men diagnosed with cancer. This is the fi rst study to elicit and analyse the talk of men with a variety of cancer types, and their SOs about CAM decisions. The results provide novel insights into the variations of family involvement in male cancer patients’ use of CAM, indicating how and when CAM use is benefi cial for men with cancer and their SOs.

454

ATTITUDE TO PSYCHO-ONCOLOGY AND PALLIATIVE CARE IN

SERBIA TODAY (DESCRIPTIVE PRESENTATION)

Tamara KlikovacNational Institut for Oncology and Radiology of Serbia, Paediatric Oncology Ward, Faculty of Philosophy, Department of Psychology, University of Belgrade

In Serbia there are about 7.5 million people (last census).

Malignant disease affect about 33,000 people annually, and about 400 children. Approximately 22,000 people and about 250 children die every year from malignant diseases. Unfortunately, no precise data for other children’s life-limiting and life-threatening diseases. In our society exists a lack of attention towards psycho-social needs of cancer patients and their families (psychological, social or spiritual needs) during the all phases of illness and especially in terminal phases. Problems are overlooked and rejected (patient’s rights especially). Death and dying belonged to the taboo. Patients mainly die in their home alone, depressed, in bad conditions, without dignity, suffering in pain and other symptoms. Traditional medical model with strong attitudinal barriers for psycho-social care for cancer patients and their families during the illness trajectory, is dominant in Serbian hospitals and throughout health care system, also. Communication



skills, breaking bad news, bereavemnt support were not included into medical curriculum. We haven`t basic or additional education in the fi eld of Psycho-Oncology or Palliative Care (in the school or at the academical level) There are fi ve specialized children’s hospitals in Serbia (three in Belgrade, in the cities of Novi Sad and Nis). There are no specialized department, hospice or home care teams for palliative care of children. All of us who work with children and teenagers with limited prognoses are faced with the suffering of children, families and we use isolated interventions in our work (cropping pain and psychological support). In situations when you need to decide whether to stop treatment or continue treatment although it will not lead to desired outcomes, in our environment it is almost always a decision to continue treatment, regardless of the quality of life of children and their families and without care for psycho/social aspects.

455

PSYCHOLOGICAL SUPPORT FOR PARENTS, TEENS AND

ADOLESCENTS DURING THE TREATMENT WHEN A CHILD OR

TEEN DIES AT THE ONCOLOGICAL DEPARTMENT

Tamara KlikovacNational Institut for Oncology and Radiology of Serbia, Paediatric Oncology Ward, Faculty of Philosophy, Department of Psychology, University of Belgrade

There are fi ve specialized children’s hospitals in Serbia (three in Belgrade, in the cities of Novi Sad and Nis). Children with malignant diseases are treated in fi ve departments of pediatric oncology. The largest division is the one at IORS (18 beds) treating children and teenagers with brain tumors, bone tumors, soft tissue tumors of various localization.

Children with leukemia and limfoma are treated at the other departments.

There are no specialized department, hospice or home care teams for pallia-tive care of children.

After losing a child, I work, occasionally, with the parents depending on its individual needs.

Psychological intervention conducted at a oncological department dealing with interventions that are associated with the processing of loss are:

1. Psychological workshops – psychological work group when a child or teen dies at the Department, which is a huge stress for other parents and other children at the department (especially teenagers and adolescents) and of course, for the staff. Psychology workshops with the theme of loss, are aimed at healing and ventilation of heavy feeling, interpretation of various facilities, the opening ritual of forgiveness from the deceased friend (which is better than not speaking or misleading – frequent prac-tice of parents and medical staff in our society).

Conclusions: How to help dying patients (adults and children) to relieve suffering? How to care for the WHOLE patient not just for disease or isolated symptoms? How to help dying patients to normalize situation, establish control, identity, relationships, sense of meaning, peace and purpose in their life? How to provide bereavement support for families after lost? And most important question is how to fi nd and implement a good enough model for the Psycho-oncology and Palliative care, taking into account the situation and obstacles in Serbian health care system today?

456

POPULATION SURVEY ON SWEDISH WOMEN’S ATTITUDES

TOWARDS TAILORED MAMMOGRAPHY SCREENING BASED ON

INDIVIDUAL RISK FOR BREAST CANCER

Marie Koitsalu1, Kamila Czene1, Mirjam Sprangers2, Yvonne Brandberg3

1. Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden2. Medical Psychology, University of Amsterdam, Amsterdam, Netherlands3. Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden

Background: The ongoing Karma study aims to identify risk factors for breast cancer, including genetic factors, to tailor prevention programs (www.karmas-tudien.se). However, little is known about the attitudes of women towards this approach. Thus, a web-based questionnaire was developed and pilot tested.

Material and methods: 200 randomly selected women in Sweden between 20 and 70 years of age were sent a letter including information about the study and a log in to the web-based questionnaire. The questionnaire assessed women’s interest in getting information about personal risk for breast cancer, reasons for wanting or not wanting to know, willingness to convey personal information including blood for genetic analysis to the health care system, preferred ways to get the information about individual risk, and willingness to participate in screening programs based on indi-vidual breast cancer risk.

Results: A total of 61 women responded. Most women (84%) reported that they were interested in getting knowledge about their breast cancer risk and listed ‘Avoid worrying’ as their major reason for wanting to know. A majority of them responded that they trust the healthcare system and feel comfortable in giving personal information, including blood for genetic testing (61% resp. 70%). Most women were not opposed to the idea of receiving their cancer risk information by a phone call or a letter, even though they preferred receiv-ing the information during a consultation. 98% of the women could see themselves having mammograms no matter how often, whereas 84% could also see themselves having mammograms less than every two years.

Conclusions: Women who consented to participate in this attitude study report a positive attitude towards breast cancer risk knowledge and are not opposed to the idea of personalized screening programs based on their individual risk profi le. Since selection bias may have infl uenced our results, a larger population-based study has been launched, which takes every effort to increase the response rate.

457

ARE CAREGIVERS OF CANCER PATIENTS DEPRESSED? – A

SINGLE CENTRE EXPERIENCE FROM SOUTH INDIA

Kirushna Kumar Kosanam Subramanian, Vijayabhaskar Ramakrishnan, Uma Jayaraman, Krishnakumar RathnamMeenakshi Mission Hospital and Reasearch centre, Madurai, Tamil, India

Aim: The aim of this study was to evaluate the prevalence of Depression among family caregivers of patients diagnosed with cancer and are on active treatment.

Materials and methods: We enrolled 324 caregivers of patients who were under treatment in Meenakshi Mission hospital and research centre, Madurai, with either radiotherapy and/or chemotherapy during the period from Dec-2011 to Apr-2012. We recorded demographic data for both patients and caregivers. Beck’s depression Inventory was applied for assess-ing the depression in family caregivers. The data collected was recorded, tabulated and analysed.

Results: Majority of caregivers were males (n = 192,59.3%). Fifty two (16%) out of 324 caregivers were illiterate, 128 (39.5%) were educated up to middle school, 68 (21%) completed Masters and the rest completed only secondary education.



Majority (n = 188, 58%) had a depression score of >13. Of 324 caregivers, 56 (17.3%) had borderline depression (BDI score 17–20). Sixty four (19.8%) caregivers were clinically depressed.(BDI of 21 and above). Two hundred and thirty two families were having fi nancial issues for getting treatment. Out of these, 92 caregivers (39.7%) had features of more than borderline depression (BDI > 17).

Conclusion: Depression was highly prevalent among family caregivers of cancer patients. Financial constraints were the major predictors of depres-sion in these subjects. Insurance cover, if existing would have reduced the fi nancial burden and in turn will reduce the psychological distress in these families.

458

FACTORS INFLUENCING THE TREATMENT CHOICES IN EARLY

STAGE NEWLY DIAGNOSED CARCINOMA CERVIX PATIENTS – A

SINGLE CENTRE EXPERIENCE FROM SOUTH INDIA

Kirushna Kumar Kosanam Subramanian, Vijayabhaskar Ramakrishnan, Uma Jayaraman, Krishnakumar Rathnam, Anandaselvakumar PandyMeenakshi Mission Hospital and Reasearch centre, Madurai, Tamil, India

Aim: Although cancer cervix at early stages are curable, a signifi cant amount of women refuse conventional treatment in spite of discussions with the patient and the caregivers. This study is to identify the reasons for denying the treatment.

Methods: Patients with a diagnosis of carcinoma cervix and stage less than stage II, who refused standard treatment during April 2011 and March 2012 were included in the study. A semi structured Questionnaire were given to 63 patients who were fi tting into the criteria and was analysed.

Results: Majority of the patients (n = 48, 76.2%) had only one factor as the reason for refusal and 15 patients (23.8%) had more than one factor as their refusal. Fear of side Effects was the major reason identifi ed for refusal of treatment. 30 patients (47.6%) quoted fear of side effects, 15 (23.8%) wanted an alternate treatment, 14 (22.2%) refused due to inadequate knowledge about the treatment and the disease, 13 (20.6%) said their rela-tives had a similar treatment and they had died, when enquiring their rela-tives had a higher stage of the disease and also cancer of a different site which carries poor prognosis. seven patients (11.1%) did not take treatment because of the possibility of recurrence and 3 (4.8%) gave reasons as spir-ituality will help.

Conclusion: Women opted for different treatment or no treatment despite physicians warnings that it could cost their lives. Their decision is due to fear of cancer, treatment side effects, experience of different patients, mis-information and also having fi xed ideas about the disease. Creating aware-ness in the public and having a caring and compassionate approach to these patients would make them take correct choices.

459

TARGETS FOR PSYCHOSOCIAL TREATMENT: FAMILY AND WORK

AFTER BREAST CANCER

Galina Kuznecova, Sergejs Kuznecovs, Ivans KuznecovsPreventive medicine center, Riga, Latvi, Latvia

Background: The breast cancer is a chronic disease that may often have a relapse. Patients’ survival rate depends on the frequency of relapses, which commonly is defi ned by the phase and the histology of tumor. Recent inves-tigations show that psychosocial factors are also has a great infl uence on development of metastasis and the survival rate of the patient.

Objectives: The aim of the present study was to identify priorities and targets for psychosocial support. In the focus were work and family in women with breast cancer.

Methods: Monitoring was spent from the 1997 to 2012. There were 1258 women in the age of 25–79 years old with breast cancer. The Occupational

Psychosocial Monitoring Questionnaire was used to detect the cause and level of victimization. The Social Support Questionnaire was used to examine functional support in family (affect, affi rmation, aid) and structural support (size of network, duration of relationships, frequency of contact).

Results: The results showed that more than 75% (48% in 1997) of the patients were still working after the diagnosis was defi ned, 12% (5% in 1997) during the course of chemotherapy and radiotherapy. The main reason to be employed was the absence of social guaranties and very low level of material security. Overall 82% (25% in 1997) of patients returned to their previous job. Leading factors promoting occurrence of relapses and reduction of a life were confl icts at work, overtime hours, shift work, work in a night shift. Findings reveal that 49% (32% in 1997) of women with relapse in cancer treatment and recurrence of the disease perceived them-selves as victims of the confl icts at work. The positive infl uence of returning to labor activity on life expectancy was established only in 6% of cases in patients with breast cancer. The marital status of women renders an essential infl uence on occurrence of the relapses of disease and life expectancy of women with breast cancer. The most vulnerable group are the single or divorced women in the age of 40–50 years. Married women felt negative infl uence of such factors, as ‘false sexual unattractiveness’ and ‘a complex of the invalid’. The maximal positive infl uence of family attitudes was established in the women who were married more than 20 years, having adult children and steady communication between members of the family and generations. In 26% of cases the obvious and latent uncooperative altitudes in family caused development of relapses of disease and reduction of life expectancy. Among these reasons – an alcoholism (25%), a narcotism (10%), matrimonial changes (17%), «biological incompatibility’ (9%).

Conclusions: The results of monitoring confi rm the assumption that leading psychosocial factors, such as emotional distress at work and in family attitudes which could be provoking in occurrence of breast cancer, continue to render essential infl uence on development of relapses of breast cancer and life expectancy of women.

460

COUPLES COPING WITH CANCER: A QUALITATIVE STUDY OF THE

VIEWS OF HEALTH CARE PROVIDERS

Tim Regan1, Sylvie Lambert2, Brian Kelly1

1. The University of Newcastle, Waratah, NSW, Australia2. Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia

Objectives: Recognition of the effi cacy of couple-based interventions in reducing psychological distress and improving QoL for couples facing cancer is increasing. The success of these interventions may be partially attributed to improvements in dyadic coping, a coping strategy that refl ects how couples manage stressors together, rather than as individuals. This has implications for how psycho-social interventions for patients with cancer and their partners are conceptualised and delivered. It is therefore timely to explore how health care professionals (HCPs) perceive the impact of cancer on couples, how they view couple-based interventions, and how health services can best meet couples’ needs.

Methods: Semi-structured face-to-face or telephone interviews, guided by a grounded theory framework, were conducted with HCPs (psychologists, social workers, cancer care coordinators, medical oncologists) from across NSW and QLD (n = 10, to date). Potential participants were contacted directly and invited to participate. Interviews were audio recorded and transcribed verbatim, then coded separately by two authors to enhance methodological rigor.

Results: HCPs had mixed opinions regarding the issues facing couples, and some differences were noted between disciplines. However, most HCPs believed the health system they worked in could improve how they managed of couples’ distress. Most HCPs also felt that couples that communicated openly with each other and with HCPs tended to cope better than couples that did not. Key differences emerged regarding the most pressing needs for couples following a cancer diagnosis (emotional vs. informational support),



the utility and feasibility of dyadic distress screening, and the perceived need for more training to manage couples’ issues.

Conclusions: Overall, HCPs were acutely aware of the issues faced by couples. Although some differences emerged between professional disci-plines regarding the most pertinent needs of couples facing cancer, com-monalities included an emphasis on improving communication within couples and towards HCPs, and providing tailored information for couples. Future research may consider the barriers and facilitators for improving services for couples facing cancer.

461

EXPLORATION OF THE EXPERIENCES AND DECISION MAKING OF

OLDER PEOPLE WITH CANCER

Heather Lane, Jennifer Philip, Sue-Anne McLachlanSt Vincent’s Hospital, Fitzroy, Vic, Australia

Australian society is aging and as cancer incidence increases with age, the care of older people with cancer is a growing concern. The majority of literature around cancer care, however, focuses on a younger population.

Aims: To explore the experiences, decision making and the impact of age on older people with cancer.

Methods: In this qualitative research, semi structured interviews were con-ducted with 10 older people with cancer. Interviews were audiotaped and transcribed. Consecutive interviews were continued until saturation of themes occurred. A thematic analysis was undertaken, which was reviewed by a second investigator with points of divergence compared, discussed and consensus reached.

Results: The interviewees simultaneously felt younger than their chrono-logical age and had an awareness of age bought on by physical symptoms and having encountered losses. They spontaneously brought up thoughts about their own mortality. Interviewees generally followed their doctors advice with little questioning. When the patients chose not to follow the doctor’s advice, they favoured an approach with goals of comfort over life prolongation, because they were aware of their limited life expectancy. When considering treatment options views and needs of family were central.

Conclusions: Healthcare professionals need to be mindful that older people tend to follow medical advice with little questioning and therefore initiate opportunities for discussion and negotiation of treatment goals. The impor-tance of the broader social network should be recognised and older people offered the opportunity to involve these people in healthcare discussions.

462

TRANSITION TO FOLLOW-UP CARE AFTER BREAST CANCER

TREATMENT IN RURAL AUSTRALIA: WOMEN’S EXPERIENCES OF

SERVICE PROVISION

Sheleigh Lawler1, Kym Spathonis1, Jane Masters1, Jon Adams2, Elizabeth Eakin1

1. University of Queensland, Herston Rd, QLD, Australia2. Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney, NSW, Australia

Aim: With ongoing improvements in breast cancer survival rates, there is a need for quality follow-up care for women after treatment, particularly for the 30% of women who reside outside of metropolitan areas where health services resources are limited. This qualitative study explored the experi-ences of follow-up care (medical and psychosocial) after breast cancer treatment among women living outside major Australian cities.

Methods: Twenty-fi ve women, recruited from the Breast Cancer Network Australia, took part in semi-structured telephone interviews addressing per-ceptions of follow-up care access and quality. Thematic saturation was reached at 22 interviews, whereby three more interviews were conducted to

ensure validity of our interpretation. Interviews were audio-recorded, tran-scribed, independently coded, and thematically analysed.

Results: Returning home after active treatment was described as a diffi cult time, exemplifi ed by feelings of isolation after having been in constant contact with health professionals. With limited access to local providers, many women travelled to regional centres for appointments with multiple health professionals for follow-up care. However, there was considerable overlap in consultation content, and a lack of co-ordination and communi-cation between treating physicians and rural general practitioners. A consist-ent theme of limited support and resources in rural areas emerged, along with a strong desire for access to other health professionals (dietitians, psychologists and physiotherapists) and support networks via the telephone or internet.

Conclusions: Breast cancer survivors living outside of major Australian cities have limited access to follow-up care and support programs. There is a need for greater co-ordination of care between health professionals, and for the provision of tailored information and accessible support services, which may help to reduce both patient and medical system burden.

463

A COGNITIVE BEHAVIOURAL INTERVENTION ON

BIOPSYCHOSOCIAL FACTORS IN PATIENTS WITH CANCER

FATIGUE – A COMPARATIVE, CORRELATIONAL STUDY

Isabel Leal1,2, Claudia Deep3, Ivone Patrão1

1. Research Unit in Psychology and Health, Lisbon, Portugal2. ISPA, Lisboa, Portugal3. Instituto Superior Dom Afonso III, Loulé, Portugal

Aims: Some studies suggest that patients undergoing radiotherapy present cancer fatigue (CF), and that an ICBSM cognitive-behavioural intervention on stress management (with muscle relaxation, cognitive restructuring, and coping strategies’ training) is effective in its reduction. However, not all research supports these data and, given the lack of agreement in this area, this study approaches CF and the impact of ICBSM on 26 biopsychosocial factors, divided in: emotional patterns; quality of life; resilience; and percep-tion and satisfaction with social support.

Methods: A longitudinal, comparative and correlational study was devel-oped using two samples (35 patients in the control group – only with conventional treatment by radiotherapy; 35 patients in the experimental group – with radiotherapy and ICBSM) that were evaluated before and after the treatments. Signifi cant differences between before and after the treat-ments, in each group, were considered for p <. 005, and particular attention was given to the most signifi cant correlations before and after radiotherapy treatments, with or without ICBSM.

Results: The results suggest ICBSM is effective on the biopsychosocial explores, and highlight the differences between the two evaluation moments in both samples, relating with different factors.

Conclusions: This study enabled a greater understanding of the nature and degree of the relation between different components of CF, as well as the biopsychosocial dynamics that characterize CF and the evolution from before to after radiotherapy, with or without cognitive-behavioural interven-tion in stress management. Furthermore, it contributed to the cognitive-behavioural intervention on CF cases.

464

QUALITY OF LIFE, POSTTRAUMATIC STRESS AND

POSTTRAUMATIC GROWTH IN BREAST CANCER SURVIVORS

Isabel Leal1, Daniela Paiva2, Ivone Patrão1, Catarina Ramos1

1. Research Unit in Psychology and Health, Lisbon, Portugal2. ISPA, Lisboa, Portugal

Objective: Previous research has focused on negative outcomes of breast cancer in several areas of women’s quality of life (QoL). Current scientifi c



evidence shows that breast cancer can have positive effects, referenced by the perception of posttraumatic growth (PTG). There is still a shortage of empirical studies concerning these two variables in breast cancer survivors. In this sense, the present study aims to evaluate the prevalence of posttrau-matic stress disorder (PTSD), PTG and QoL in breast cancer survivors.

Method: This is a cross-sectional study that encompasses a community-based sample of 61 Portuguese women (M = 59.33; SD = 13,813), who ended their treatments at least 6 months before. We measured the PTSD using the PTSD Checklist, PTG was assessed with PTGI and QoL was evaluated with WHOQOL-bref.

Results: Women with lower scores of PTSD had a higher QoL (r = −0.498; p = 0.000 for α = 0.01; CI 99%). The PTGI domain New Possibilities and Appreciation of Life has a positive relationship with the psychological QoL (r = 0.394; p = 0.002; α = 0.01; CI 99%) and social relationships QoL (r = 0.379; p = 0.003; α = 0.01; CI 99%) of the WHOQOL-bref. Women who underwent conservative surgery show a higher QoL than women who underwent mastectomy in the WHOQOL-bref total (U = 223.500; W = 1213.500; p = 0.015 < α = 0.05), physical QoL (U = 181.000; W = 1071.000; p = 0.001 < α = 0.05), and psychological QoL (U = 252.500; W = 1243, 500; p = 0.051 < α = 0.05).

Conclusions: QoL in breast cancer survivors is correlated with PTSD symp-toms, but perceived positive benefi ts – PTG, can also infl uence the women’s perception of QoL. Having a mastectomy represents an important factor for QoL. Other clinical and socio-demographic variables are important factors in these correlations, being recommended for detailed study in future investigations.

465

THE EPIDEMIOLOGY OF PSYCHIATRIC DISORDERS AMONG

WOMEN WITH BREAST CANCER IN SOUTH KOREA: ANALYSIS OF

THE NATIONAL REGISTRY DATA

Jee In Kang, Na Young Sung, Chong Gul Lee, Byung Ook Lee

Background: There are little population-based data on epidemiology of psychiatric disorders in breast cancer. Since the National Health Insurance (NHI) Program in South Korea covers the whole population living in the Korea as a compulsory social insurance system, NHI of Korea can be a good information source for epidemiological study. The present study examined the incidence of psychiatric disorders among women with breast cancer in Korean population using NHI database.

Methods: The present study used a Korea national database to examine the incidence of psychiatric disorders in breast cancer patients in Korea. We examined patients newly diagnosed with breast cancers using database from the National Health Insurance Corporation of Korea from September 2004 to August 2009 for psychiatric disorders, and September 2005 to August 2008 for breast cancer. Since the ‘F’ at the beginning of the code indicating ‘psychiatric disorder’, we selected women who had F codes as a registered principal or additional diagnosis among women diagnosed with breast cancer.

Results: We identifi ed 6,536 patients with psychiatric disorders among 42,190 women with breast cancer. The most prevalent condition of psychi-atric disorders was anxiety disorder (N = 2,518), followed by depressive disorders (N = 2,083). The incidence rates of anxiety disorder, depression, insomnia and adjustment disorder were 27.08, 22.41, 10.57 and 4.35 cases per 1000 person-year, respectively.

Conclusions: The incidence rates of psychiatric disorders were much lower than previous reports assessed by psychiatric interviews or screening tools. Psychiatric disorders including anxiety and depressive disorders tend to be underrecognized and undertreated among breast cancer patients. Special attention should be given for psychiatric comorbidity to women with breast cancer.

466

PRE & POST EFFECTS OF THE COMMUNITY SUPPORT SERVICES

ON THE QOL OF CANCER PATIENTS IN HONG KONG

Tammy Yuk Chun Leung1, Katherine Chow1. Hong Kong Cancer Fund, 32 Hollywood Road, Central, Hong Kong

Background: Quality of Life (QoL) is a signifi cant area in assessing cancer patient’s care. Since 2010, the Hong Kong Cancer Fund (HKCF) started to evaluate the quality of life of cancer patients and their care givers in Hong Kong. There are 3 Community Cancer Support Centers organized by HKCF, one of them is located in the heart of commercial activities of Hong Kong. In this study, we would like to learn about the quality of life of users reg-istered in the commercial center of Hong Kong so as to provide tailor-made services in meeting their psychosocial needs.

Method: Each user of the Community Cancer Support Service Centre is required to fi ll in a self-completed Quality of Life Questionnaire (EORTC QoL30). Social Workers will immediately follow up with those who indi-cated more intense problems in specifi c areas. Data would be stored and a post-test was carried out after half year of each user’s registration. From 2010 Oct to 2011 Sept, this study collected 246 users’ Quality of Life Questionnaires and demographic data. The response rate is 30% out of 800 total registered user of the center for the period of time.

Result: Among 246 questionnaires, 229 were valid for analysis. 34% of the patients are aged between 41 to 50. 34% are between 51 to 60. The average age is 51. Most of the patients are working class. 50% of the new users are breast cancer patients, 11% are lung cancer and 8% are gynecology cancer patients. The majority of them came to our support center while they are under treatment (47%). 21% of them are advance cancer patients. 30% of them learn about the center service from their family/friends. 25% are referred by public hospital. The score of service users’ pre and post test result indicated signifi cance difference (statistically) between pre and post QoL for Q13, 20, 21 and 28.

Implication: There is signifi cance difference (statistically) between pre and post QoL (domain score) for emotional functioning, social functioning. The higher the score implies the better the functioning. Also, fatigue, pain, appetite lost and global health status are signifi cance different between pre and post QoL. The lower the score implies the least the symptom patient suffer.

467

BENEFIT FINDING IN PARENTAL CANCER: PREVALENCE, TYPES

AND PREDICTORS

Janelle V Levesque1, Darryl Maybery2

1. School of Psychology, Charles Sturt University, Bathurst, NSW, Australia2. Monash University Department of Rural and Indigenous Health, Monash University, Moe, VIC, Australia

Aims: To investigate the prevalence and types of benefi ts reported by adult children of patients with cancer and the predictors of benefi t fi nding.

Methods: A convenience sample of adult children of patients with cancer (n = 319) completed a comprehensive on-line or pen and paper survey that included measures of benefi t fi nding and potential predictors of this outcome, including gender of parent, outcome and duration of illness, caregiving experience, and emotional experiences including reaction to diag-nosis and grief and loss.

Results: Between 95–98% of participants reported some degree of benefi -cial change with the most strongly reported benefi ts relating to improved relationships with the parent with cancer, and an enhanced valuing of family overall. The proposed model explained 15.3% of the variance in benefi t fi nding (p < 0.01). Greater benefi t fi nding was positively associated with stronger emotional experiences arising from parental cancer, and satisfac-tion with the caregiving role. Outcome of parental cancer was also a



signifi cant predictor of benefi t fi nding, and the relationship between these variables was further examined using moderator analysis, however no fi rm conclusions could be drawn.

Conclusions: Benefi t fi nding is a common outcome for adult children expe-riencing parental cancer, particularly in relation to familial relationships and valuing family. Higher emotional reactions and outcome of parental cancer as signifi cant predictors of parental cancer provide some support for the applicability of theories of post-traumatic growth to this experience.

468

POSTTRAUMATIC GROWTH LEVELS AND THEIR INFLUENCING

FACTORS AMONG CHINESE BREAST CANCER PATIENTS

Jun-E Liu1, Yi-Ying Li2

1. Capital Medical University, Fengtai, Beijing 100069, PK, China2. Beijing Neurosurgical Institute, Beijing Tiantian Hospital affi liated to Capital Medical University, Beijing, P.R. China

Objective: To describe posttraumatic growth (PTG) levels and their infl u-ence factors among breast cancer patients, and describe the dynamic changes of PTG and psychological distress hospitalized breast cancer patients over a 9 months span after diagnosis.

Methods: There were 468 breast cancer patients who were in the rehabilita-tion period were investigated in a cross-sectional study, and 155 breast cancer patients who were receiving therapy in hospital were selected in the longitudinal study at 3 time points spaced 6 months apart. The baseline data were collected at 3-month after diagnosis. Finally, 120 breast cancer patients completed the follow-up investigation.

Results: The total score of the PTGI was 73.98 in rehabilitative breast cancer patients, the educational level, religion, breast-conserving surgery and increasing exercise after the illness were positive factors, while the stage of cancer and the level of psychological distress were negative factors. Post-traumatic growth increased and psychological distress decreased continually from 3 months to 9 months after diagnosis.

Conclusions: Although the level of PTG is high among breast cancer patients in the rehabilitation period, there is still room for growth. The infl uence factors of the level of PTG are the educational level, religion, stage of cancer, breast-conserving surgery, and increasing exercise after illness and the level of psychological distress. Patients can produce a lower level of PTG while they are receiving therapy in hospital. In the treatment phase, the level of PTG shows an increasing tendency, while the degree of psychological distress has a downward trend.

469

COMPLEMENTARY AND ALTERNATIVE MEDICINE USE OF

WOMEN WITH BREAST CANCER: SELF-HELP CAM ATTRACTS

OTHER WOMEN THAN GUIDED CAM THERAPIES

Deborah NN Lo-Fo-Wong1, Adelita V Ranchor2, Hanneke CJM de Haes1, Mirjam AG Sprangers1, Inge Henselmans1

1. Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands2. Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

Aims: Examine 1) stability of use of complementary and alternative medi-cine (CAM) of breast cancer patients, 2) reasons for CAM use, and 3) socio-demographic, clinical, and psychological predictors of CAM use.

Methods: CAM use was assessed after adjuvant therapy and six months later. Following the CAM Healthcare Model, CAM use was divided into use of provider-directed (guided) and self-directed (self-help) CAM. Stability and reasons for CAM use were examined with McNemar’s tests and descriptive statistics. Cross-sectional and longitudinal associations between predictors and CAM use were examined with univariate and multivariate logistical analyses.

Results: Approximately 18% of the respondents used provider-directed CAM services, and 57% of the women used self-directed CAM, at each of the two assessments (N = 176). Use of provider-directed and self-directed CAM was stable over time.

Twenty-four percent of the women who used provider-directed CAM, used it to infl uence the course of cancer after adjuvant therapy, while 52% of the women who used self-directed CAM, used that for that purpose. Within six months these percentages rose to 47% and 65% respectively. At least 95% of the women used provider-directed respectively self-directed CAM to infl uence well-being, at both assessments.

Openness to experience predicted use of provider-directed CAM, after adjusting for other predictors (OR = 1.14, 95% CI 1.03–1.24, p < 0.01 after adjuvant therapy; OR = 1.10, 95% CI 1.00–1.20, p < 0.05 six months later). Clinical distress predicted use of self-directed CAM, after adjusting for other predictors (OR = 2.17, 95% CI 1.09–4.32, p < 0.05 after adjuvant therapy).

Conclusions: CAM use is stable over time. It is meaningful to distinguish provider-directed from self-directed CAM. Based on the results, providers are advised to plan a ‘CAM-talk’ before adjuvant therapy, and discuss patients’ expectations about infl uence of CAM on the course of cancer. Providers may address patients’ preferences for provider- or self-directed CAM. Distressed patients most likely need information about self-directed CAM.

470

ARTHRALGIA WITH AROMATASE INHIBITORS: ASSOCIATION

WITH QUALITY OF LIFE, EMOTIONAL STATE AND FEAR OF

RECURRENCE

Clementine Lopez1,2, Pascal Rouby2, Sarah Dauchy2

1. University of Bordeaux 2, Bordeaux, France2. Institut Gustave Roussy, villejuif, IDF, France

Purpose: Endocrine therapy (Tamoxifen and Aromatase Inhibitors (AI): Letrozole, Anastrozole and Exemestane) in breast cancer have reduced the risk of recurrence and improve survival. But they can cause more broken bones and more joint pain (approximately one in two women). These chronic pains can become disabling and could have a negative impact on the patients’ quality of life and emotional state. However the specifi c impact of arthralgia with AI was little studied. The present cross-sectional and quantitative study explored links between arthralgia, quality of life, adher-ence to AI, emotional state and particularly fear of recurrence which is frequent after treatment for breast cancer.

Methods: Participants treated for breast cancer and currently under AI were recruited at the French Cancer Center Gustave Roussy Institute (N = 71). They all signed written informed consent to participate to this prospective study. Patients responded to self-reported questionnaires about their pain (intensity with EVA and location) on psychological adjustment (STAI YA/YB, BDI-SF), quality of life (SF-36) and fear of recurrence of cancer (FCRI).

Results: Among the 71 women included, 70% reported having arthralgia. These women had a lower quality of life and poorer emotional state than women without pain. Only 48% of them reported taking analgesic medica-tion. Half of the 71 patients have fear of recurrence which was associated with depression and anxiety symptoms and particularly with anxiety trait. This confi rms its proximity with anxiety disorder. One third had thought to stop treatment because of side effects (particularly arthralgia).

Conclusion: Arthralgia is a frequent side effect of AI which needs a better management including mood and fear of recurrence evaluation. The fear of recurrence can be intense, pathological, and so can required a specifi c man-agement like cognitive behavioural therapy.



471

ANXIETY AND DEPRESSION DURING RADIOTHERAPY

TREATMENT: A COMPARISON OF TOUCHSCREEN COMPUTER

ADMINISTRATION OF THE HOSPITAL ANXIETY AND DEPRESSION

SCALE AND SINGLE-ITEM SELF-REPORT MEASURES

Lisa J Mackenzie1,2, Mariko L Carey2, Rob W Sanson-Fisher2, Chris L Paul2, Catherine A D’Este2,3,4

1. Graduate School of Medicine, Kyoto University, Kyoto, Japan2. Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia3. Priority Research Centre for Gender, Health and Ageing, The University of Newcastle [2], Newcastle, NSW, Australia4. Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle [3], Newcastle, NSW, Australia

The aims of this study were to assess agreement between Hospital Anxiety and Depression Scale (HADS) and patient self-reported levels of anxiety and depression; and to describe the proportion of patients who would like to be offered professional assistance for anxiety and/or depression. Patients waiting for radiation therapy treatment in one of four Australian metropoli-tan radiation oncology treatment centres completed a touch screen compu-ter survey. Respondents answered questions regarding socio-demographics, disease characteristics, the HADS, and two single-item questions about their perceptions of their level of anxiety and depression. Respondents’ prefer-ences for psychological support were also assessed. Weighted kappa was calculated in order to assess agreement between the HADS and patients’ perceived levels of anxiety and depression. The intended sample size was 300, and the survey was completed by 304 patients (71% of eligible patients). There was signifi cant agreement between the HADS and patients self-reported single-item responses regarding anxiety and depression when comparing across normal, mild, moderate and severe levels (weighted κ = 0.5, 95% CI: 0.4–0.6, p < 0.0001). Twenty-two per cent of patients (95% CI: 18–27%) indicated that they would like to be offered psychosocial support for their current levels of anxiety and/or depression. Of these patients, moderate to severe anxiety and/or depression levels were identifi ed in 27% (95% CI: 17–39%) according to HADS criteria, and 37% (95% CI: 26–50%) according to patient perceptions. The fi nding that over one fi fth of cancer patients receiving radiotherapy expressed a desire to be offered professional support for their current levels of anxiety and depres-sion suggests high need for psychosocial services for this patient group. Single item patient self-report screening questions may be useful for psycho-social screening in radiotherapy settings, however further examination of how patient self-reported levels of anxiety and depression compares to standardised clinical interview is warranted.

472

ESTABLISHING A MULTIDISCIPLINARY SERVICE, THE HUNTER &

NORTHERN NSW YOUTH CANCER SERVICE, AUSTRALIA

Karen A Matthews1, Kerrie A Clover1, Elizabeth Hesketh2, Lyndal Moore1, Julia Drake1, Gregory L Carter1

1. Calvary Mater Newcastle, WARATAH, NSW, Australia2. John Hunter Children’s Hospital, NEWCASTLE, NSW, Australia

Aims: To establish the psychosocial service requirements for the new Hunter & Northern NSW Youth Cancer Service (15–25 yrs) and to compare the frequency of cancer types with NSW data.

Methods: Data were obtained for the state from The Cancer Institute of NSW (2007) and from the Hunter New England & North Coast Clinical Cancer Registries (2008–2010). Descriptive and chi-square statistics were used to examine frequencies of cancer type and any use of psychosocial services.

Results: From 2003–2007 in Australia, for the 15–29 age group, there were 8,783 new cases of cancer (age-standardised rate of 419 cases per million), the most common melanoma1. In NSW for the 15–25 age group, the fi ve most common were cancers were: Melanoma, Lymphomas, Testicular,

Leukaemia and Thyroid. In the Northern zone of the new service, for the 15–25 age group, there were 29 new cases, the top fi ve: Testicular (20.7%), Lymphoma (20.7%), Colon (17.2%), Thyroid (10.3%) and Leukaemia/Breast (6.8%). In the Hunter zone there were 91 new cases, the top fi ve: Lymphoma (21.9%), Leukaemia (16.5%), Testicular (10.9%), Melanoma (7.7%) and Bone (6.6%). There was some access of psychosocial services in the Northern zone (20.8%) and greater access in the Hunter zone (54.9%). Males (26.5%) accessed psychosocial services more frequently than females (19.5%).

Conclusions: The development of new psychosocial services for adolescents and young adults should be informed by the frequency of cancers in their own populations. The Hunter and Northern NSW areas are similar to the state patterns, although the frequency of Colon cancer in the Northern zone and the reduced presentation of Melanoma in the Hunter zone is different to the state patterns. There is some access to psychosocial services, although the access is less for rural and female patients.

Reference

1. Australian Institute of Health & Welfare (2011). Cancer in adolescents and young adults in Australia.

473

ADOLESCENT AND YOUNG ADULT (AYA) TASK FORCE:

IDENTIFYING AND EVALUATING EDUCATIONAL AND

PSYCHOSOCIAL NEEDS OF AYA’S

Lina Mayorga1, Jeanelle Folbrecht1, Natalie Kelly, JoAnn Namm, Kayla Fulginiti, Marisol Trujillo, Toni Carreras-Irwin1. City of Hope Cancer Center, Rosemead, CA, United States

Methods: A multi-disciplinary AYA taskforce was developed in fall 2011. The taskforce pilot-tested LiveSTRONG’s ‘Cancer Transitions: Moving Beyond Treatment’ – a six week educational series amongst AYA’s. Although it is an evidence-based program, it has not yet been directly implemented with AYAs. Cancer TransitionsTM is designed to support, educate, and empower individuals with cancer. It is composed of a six week series that includes support groups, education, nutrition, physical exercise, medical management, psychosocial and quality of life issues. The group was offered two times during a fi ve month period. Patients between the ages of 18–39 who were up to two years post treatment were recruited and referred to the program.

Results: Preliminary data, acknowledged the benefi ts of engaging with others that have shared similar experiences at the same age, but indicated a frequent participant request for more time to talk with other participants. While they touted the benefi ts of an educational format and curriculum, a need for social support and contact also dominated their responses. It was also noted that patients that participated in the ‘Cancer Transitions’ program felt that attending a similar group while going through treatment would have been extremely benefi cial, not only to receive information and education, but also to connect with other AYAs in treatment and alleviate feelings of loneliness.

Conclusion: Based on our preliminary fi ndings from completing the ‘Cancer Transitions’ program combined with the unique psychosocial issues of AYAs, there is a need to further explore the development and evaluation of an age specifi c psychoeducational series to address the unique, complex and often challenging needs of City of Hope’s AYA population in active treat-ment. A group that will support and educate for AYAs and to improve their overall well-being. By developing tools and resources to assist AYAs with coping with daily challenges when affected by cancer, as well as providing them with a safe environment to meet and connect with others.

Research impact: The purpose of this study was to evaluate educational programs for AYA’s and assess their educational and psychosocial needs. The physical, emotional, and social challenges of the AYA patient popula-tion are a reality that, at times, has been overlooked.

Clinical impact: The timing of this intervention is optimal given that it will provide support and resources to participants to begin implementing the



tools before the challenges of returning to ‘normal’ become too overwhelming.

474

THE IMPORTANCE OF HEALTH LITERACY TO ADOLESCENT AND

YOUNG ADULT CANCER PATIENTS

Fiona EJ McDonald, Pandora PattersonCanTeen Australia, Sydney, NSW, Australia

Aim: Higher levels of health literacy (HL) have been shown to be infl uential in improving health outcomes including survival. Hence it is important to explore the role of HL in the context of adolescents and young adults (AYAs) who have or have had cancer. While prior research has focussed on the consequences more than the causes of HL, a population based study found that lower family socio-economic status is associated with lower HL in AYAs1. The aim of this study was to examine the impact of individual factors on HL.

Method: The HL of 101 AYA cancer patients (M = 18.6 years, SD = 3.2 years) was assessed using a self-report scale that measures three components of HL: functionality, communication and criticality. The impact of age, gender, psychological distress, education, and time since diagnosis on each HL component was assessed using stepwise linear regression.

Results: The analysis indicated that psychological distress was a predictor for functional literacy (R2 = 0.04, F[1,99] = 4.55, p = 0.035; β = −0.21, p = 0.035); while communicative literacy was predicted by age and psycho-logical distress (R2 = 0.11, F[2,99] = 7.17, p = 0.001; distress: β = −0.28, p = 0.005, age: β = 0.27, p = 0.007); and critical literacy was predicted by age only (R2 = 0.09, F[1,99] = 10.4, p = 0.002; β = 0.311, p = 0.002). Higher levels of psychological distress predicted poorer functional and com-municative HL, while critical and communicative HL were predicted by increasing age. Overall; the other variables had minimal effect on the HL of AYAs with cancer.

Conclusion: The results suggest that psychological distress and age have an impact on HL. It is interesting that time since diagnosis did not contribute to HL, as it is often seen as a proxy for level of exposure to the health system. Clearly, individual factors contribute to the HL of AYAs with cancer.

Reference

1. Chang, L. (2010). Health literacy, self-reported status and health promot-ing behaviours for adolescents in Taiwan. Journal of Clinical Nursing, 20, 190–196.

475

OVARIAN CANCER PATIENTS’ EXPECTATIONS OF PALLIATIVE

CHEMOTHERAPY: THE FINE LINE BETWEEN HOPE AND

MISUNDERSTANDING

Rebecca L Mercieca-Bebber1,2, Phyllis N Butow1,2,3, Michael Friedlander4,5,6, Madeleine T King1,2

1. University of Sydney, The University of Sydney, NSW, Australia2. Psycho-oncology Co-operative Research Group, University of Sydney, NSW, Australia3. Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia4. University of New South Wales, Kensington, NSW, Australia5. Prince of Wales Hospital, Randwick, NSW, Australia6. Royal Hospital for Women, Randwick, NSW, Australia

Aims: This qualitative study assessed expected benefi t from palliative chem-otherapy in women with resistant/refractory ovarian cancer, as part of Stage 1 of the Gynaecologic Cancer Inter-group Symptom Benefi t Study.

Methods: Eligible patients were symptomatic at baseline and had completed ≥3 cycles of chemotherapy. We sampled purposively to obtain a balanced mix of patients whose symptoms improved, persisted or worsened. Data

saturation was achieved at twenty telephone interviews. Three researchers coded transcribed interviews, and thematic analysis was conducted using NVivo.

Results: Three major themes emerged. The fi rst was ‘hope’ that the chemo-therapy would extend survival. Hope motivated patients to begin and remain on chemotherapy, despite knowing that their disease was incurable. Hope made treatment easier to bear and could only be maintained by con-tinued treatment. Any biological or symptomatic improvement infl ated this hope.

The second major theme, ‘perseverance and stoicism’, included three sub-themes: 1) prioritising life and independence; 2) avoidance; and 3) blind trust. Patients were prepared to endure severe treatment side-effects as long as their independence and physical QOL were maintained. Patients’ stoicism enabled them to avoid acknowledging their suffering or mortality. Patients also had blind trust that chemotherapy would extend their life, leading them to persevere with chemotherapy despite its side-effects.

‘Tipping point’, the third major theme, is the point at which the side-effects of chemotherapy will inevitably become unbearable for the patient, leading to the decision to end treatment. Patients admitted they would rather pass away than become a burden to their families.

Conclusions: Patients expected chemotherapy would prolong their survival rather than improve their symptoms and persisted with chemotherapy despite side-effects. Patients had diffi culty accepting the palliative intent of their treatment despite having been informed of this by their clinicians. The line between hope and misunderstanding can be hard to draw for both patients and clinicians.

476

THE LIVED EXPERIENCE OF BREAST CANCER SURVIVORS

PARTICIPATING IN CHALLENGE-BASED PEER SUPPORT

PROGRAMS: THE TRANSFORMATIVE EFFECT OF RIDING

MOTORCYCLES

Bronwyn A Morris1,2, Meredith Campbell3, Megan Dwyer3, Jeffrey Dunn1,2,4, Suzanne K Chambers1,2

1. Griffi th Health Institute, Gold Coast, Qld, Australia2. Cancer Council Queensland, Brisbane, Australia3. Amazon Heart, Brisbane, Australia4. School of Social Science, University of Queensland, Brisbane, Australia

Peer support programs can provide a unique perspective and understanding from other cancer survivors. The last decade has seen the emergence of peer groups based on exercise or physical challenges, and the benefi ts of such programs are yet to be fully examined. A mixed-method approach investi-gated participant experiences during Amazon Heart Thunder (AHT); a peer support program for breast cancer survivors based on riding motorcycles. Surveys were collected from all participants (N = 51) and interviews con-ducted with riders new to AHT (N = 37) prior and after two ten-day pro-grams (in Australia and US). Ratings (0–10) on six statements (e.g., ‘How stressed are you feeling now?’) and three words describing each participant’s day were also collected daily, providing a concise description of the experi-ence as the ride progressed. Repeated measures analyses for the Australian ride showed stress ratings decreased (p < 0.05) and their feeling of con-nectedness with the group increased (p < 0.01). Results for the US ride showed an increase in confi dence (p < 0.01). Content analysis of daily descriptor words revealed a distinct pattern, with words such as ‘loneliness’ and ‘overwhelming’ being commonly reported for the fi rst fi ve days, and superseded by words such as ‘alive’, ‘strength’, ‘achievement’, ‘pride’, and ‘empowered’ in the last days of the event. Words such as ‘challenging’, ‘free-spirited’, ‘emotional’, ‘soul searching’, and ‘me time’ were evident through the entire ride. The daily tallies contributed to survey and interview data to provide a rich understanding of the lived experience of breast cancer survivors during the AHT program. Challenge-based activities, such as AHT, provide women with a safe environment to explore self-identity and experience positive modelled behaviour. A model of service delivery can be created by identifying factors that promote posttraumatic growth and adjustment to being a breast cancer survivor.



477

NEED FOR PSYCHOSOCIAL CARE – EXPRESSED BY PATIENTS IN

PRIMARY TREATMENT

Fritz A MuthnyUniversity of Muenster, Muenster, NRW, Germany

Background: Although cancer patients and caregivers agree, that psychoso-cial care should be offered there are still limited data on the need for par-ticular interventions in primary therapy and on the question, which psychosocial services are really important.

Methods: 265 cancer patients were investigated during their primary care in two hospitals. The patients were on average 61 years old, 58% female, educational level of 54% primary, 22% secondary, and 17% high school. The cancer had been diagnosed on average 33 months ago. 36% were in primary care, 32% in after-care and 24% in relapse treatment. Main diag-noses were breast cancer (30%), colon cancer (13%), lymphoma/leukaemia (12%) and lung cancer (6%).

Results: As the most important interventions, the patients rated ‘psycho-logical individual counselling’ (50%), psychological pain therapy (49%), social counselling (45%) and relaxation training (37%). Patients expect from a psycho-oncology service, that it helps them ‘to recognize what is important in life’ (66%), ‘to see the good things in life’ (58%), to support coping and to help the patients to understand what cancer means for him or herself (53%).

Discussion: The fact that more than half of the patients stress the impor-tance of psychological as well as social counselling indicates that having a team of psychotherapists and social workers would be the best solution. Based on the fact that 61% of the patients would like a close cooperation between the psychosocial service and medical doctors, an integrational care model or a liaison service would best meet the needs of cancer patients.

478

ONCOLOGY NURSES’ RECOGNITION OF SUPPORTIVE CARE

NEEDS AND SYMPTOMS OF THEIR CANCER PATIENTS

UNDERGOING CHEMOTHERAPY

Tomohiro Nakaguchi1,2, Toru Okuyama1,2, Megumi Uchida1,2, Yoshinori Ito1,2, Hirokazu Komatsu3, Makoto Wada4, Tatsuo Akechi1,2

1. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan2. Division of psycho-oncology and palliative care, Nagoya City University Hospital, Nagoya, Japan3. Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan4. Division of psycho-oncology, Saitama Cancer Center, Kitaadachi-gun, Japan

Background: The aim of this study was to assess the accuracy of oncology nurses’ identifi cation of perceived needs and symptoms of their patients undergoing chemotherapy.

Methods: The participants included a sample of randomly selected cancer outpatients receiving systematic chemotherapy and eighteen oncology nurses. Written informed consent was obtained from each patient. The patients responded to validated self-administered questionnaires to assess their supportive care needs and symptoms. The oncology nurses completed a survey in which they indicated their perception of level of same set of needs or symptoms. The two datasets were compared statistically.

Results: Complete datasets were available for 439 patients. Most common primary cancer site was breast cancer (36%), followed by colorectal cancer (24%). The most prevalent domain of needs perceived by patients was psychological one (77%), of which prevalence perceived by nurses (61%) was lower than that of patients themselves. The sensitivity and specifi city for psychological need were the greatest and the lowest respectively among

the all domain of needs. About sexual needs, in particular, the proportion of patients for whom the oncology nurses indicated not knowing the status was the greatest (82%) among all investigated variables. The sensitivity and specifi city of the nurses’ assessment for all physical symptoms except fatigue, appetite loss and hair loss were <50% and >80% respectively, indicating the tendency that the nurses could not detect symptoms which are nonspe-cifi c for chemotherapy, but could rule out the possibility of those experi-enced by patients. None of patients classifi ed as clinically anxious and/or depressed were perceived as such by their nurses.

Conclusion: Oncology nurses’ recognition may not accurately refl ect their patients’ supportive care needs and symptoms in routine practice. Further interventions should be developed to heighten the nurses’ ability to detect their patients’ such problems, especially symptoms that could not be observ-able directly, involving psychological ones.

479

PREVALENCE OF ‘PROBLEM LIST’ SYMPTOMS AMONG

ONCOLOGY OUTPATIENTS AND RELATIONSHIP WITH DISTRESS

Kerrie Clover1,2,3, Louise Nelson1, Kerry Rogers1, Gregory L Carter1,2

1. Calvary Mater Newcastle, Hunter Region Mail Centre, NSW, Australia2. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia3. School of Psychology, University of Newcastle, Newcastle, NSW, Australia

Aims: Brevity of measures is an important consideration in the acceptance of programs which screen for distress. Ultrashort measures (<5 items) have been proposed and one of these is the single-item Distress Thermometer (DT). However, the Problem List which accompanies the DT contains 35 items, which considerably lengthens its administration time. We examined the prevalence of Problem List symptoms and their relationship to distress with a view to removing items.

Methods: Data were collected as part of the QUICATOUCH screening program at an Australian regional hospital. Oncology and Haematology outpatients completed the DT and the problem list among other measures. Frequency and chi-squared analyses were used to examine prevalence and relationship with distress.

Results: Preliminary data from 664 patients indicated that the four most commonly endorsed problems were fatigue (51%), worry (40%), sleep (35%) and pain (32%). All of these were signifi cantly related to distress. 14 of the 35 items were not signifi cantly related to distress. Of these, fi ve had a prevalence of <5% (spirituality, childcare, work or school, sexual & transport problems) and a further four were endorsed by fewer than 10% of respondents (appearance, mouth sores, indigestion, dry nose).

Conclusions: In clinical settings which require an emphasis on brief screen-ing, the removal of low prevalence problems which are not related to distress could be considered.

480

PSYCHOSOCIAL CONCERNS AND COPING STRATEGIES OF

PATIENTS WITH ADVANCED STAGE HEPATOBILIARY CANCER

Suthisa Temtaap1, Kittikorn Nilmanat1

1. Prince of Songkla University, Hat Yai, Songkhla, Thailand

Hepatobiliary cancer is the major cause of death among adult with cancer in Thailand. Being diagnosed with advanced stage hepatobiliary cancer may result in psycholosocial distress and functioning. Little is known about the psychosocial concerns and coping strategies among this group. The main aim of this study was to describe the concerns and coping strategies of patients with advanced stage hepatobiliary cancer.

This study was conducted in the tertiary hospital. Informants were 10 patients newly diagnosed with stage III or stage IV Hepatobiliary cancer.



Interviews were employed and recorded on audiotape. Informants were asked to describe their experiences with advanced stage hepatobiliary cancer. Qualitative content analysis was applied.

Informants identifi ed fi ve main areas of concern: 1) being suffered from distressful symptoms; 2) fear of death; 3) fi nancial constrain; and 4) feeling of being a burden to their family. Informants used several coping strategies to adjust themselves to illness experiences. Coping strategies were catego-rized in to 4 groups; using religious approaches, developing optimistic views, applying relaxation technique, and seeking health information and alterna-tive treatments.

The result of this study will be useful for health care providers to develop a holistic and culturally sensitive care program for persons with hepatobil-iary cancer.

481

THE EFFECT OF A SPECIFIC MUSIC THERAPY SONGWRITING

PROTOCOL ON ADULT CANCER PATIENTS MOOD – A MIXED

METHOD, MULTI-SITE, RANDOMIZED, WAIT-LIST CONTROLLED

TRIAL

Emma K O’Brien1, Jeff Szer1, David Westerman2

1. The Royal Melbourne Hospital, Parkville, VIC, Australia2. Haematology, Peter Macallum Cancer Institute, Melbourne, Victoria, Australia

Aims: The research study examined effect of the guided original lyrics and music (GOLM) songwriting on cancer patients’ mood, distress levels, quality of life, and satisfaction with hospital stay. GOLM is a specialised music therapy songwriting protocol to create an original song with the patient (O’Brien, 2005). The control was a Befriending Protocol (BP) which is a vali-dated non-directive interaction that controls for the therapist’s presence.

This RCT was open adult cancer patients undergoing treatment (curative and palliative) at two major hospitals. All participants were randomised to either the treatment post baseline. The protocol was three sessions over a maximum of two weeks, with a pre and posttest design.

Methods: Quantitative and Qualitative Analysis. The quantitative measures were McGill Quality of Life Scale, short form – Profi le of Moods States, Distress Thermometer, a Mood Rating Scale, and a basic hospital satisfac-tion rating. Qualitative data was gathered post session from interviews about the experience of GOLM.

Results: Following a effect sizes analysis on the MQOL to demonstrate a medium effect was N = 44 (Cohen & Mount, 2000). The total number was N = 50. Interviews were given to the fi rst 9 participants in the study.

For this paper the method of GOLM will be illustrated, results from the POMSf will be presented alongside interview quotes and audio examples of the songs.

Results from the POMSf measure – A change score analysis (95% confi -dence interval for all measures regarding the difference between the means) when the waiting list control (BP) was compared to the songwriting (GOLM) (4–72 hours post the intervention – after session 3) found that GOLM was signifi cantly more effective in reducing tension [p = 0.008, CI −3.40 (−5.86, −0.94)], depression [p = 0.038, CI −2.21 (−4.30, −0.13)], confusion [p = 0.017, CI −2.49 (−4.5, −0.47)] and overall mood disturbance [p = 0.027, CI −11.66 (−21.94, −1.37)] GOLM did not signifi cantly reduce anger (p = 0.21), fatigue (p = 0.10) and did not improve vigour (0.40).

Conclusion: GOLM is effective in reducing tension, depression and confu-sion resulting in a reduced overall mood disturbance for adult cancer patients as measured form baseline, after three music therapy sessions at 4–72 hours post intervention compared to a standard BP.

482

IDENTIFYING EMOTION IN TEXT GENERATED FROM ONLINE

INTERVENTIONS FOR PEOPLE WHO HAVE SURVIVED CANCER

Erin O’Carroll Bantum1, Jason E Owen2, Noemie Elhadad3, Mitch Golant4, Joanne Buzaglo5, Janine Giese-Davis6

1. Cancer Prevention and Control, University of Hawai’i Cancer Center, Honolulu, HI, USA2. Psychology, Loma Linda University, Loma Linda, CA, USA3. Department of Biomedical Informatics, Columbia University, New York, NY, USA4. Research & Training, Cancer Support Community, Los Angeles, CA, USA5. Research & Training, Cancer Support Community, Philadelphia, PA, USA6. Psychology, University of Calgary, Calgary, Alberta, Canada

Introduction: Emotional expression is a potential mechanism of action by which psychosocial interventions act to improve cancer-related distress and quality of life. However, most extant research on emotional expression has been limited to self-report. Giese-Davis (Specifi c Affect (SPAFF) for Breast Cancer; 2005) has developed an extensive coding system, based on the work of John Gottman, for identifying emotional expression and other interac-tions between cancer survivors in the context of supportive-expressive group therapy. Given the dramatic increase in the use of text-based exchanges between cancer survivors and the use of Internet-based interventions, the current study seeks to extend this work by developing a coding system for identifying and classifying emotional expression in transcripts of online cancer support groups.

Methods: The 24 codes in the original SPAFF system (which include non-verbal codes) were revised to include text identifi ers. All 24 codes are used in the current study, and outcome codes used in the training process were analyzed for frequency of each code.

Results: Preliminary data were available from 856 assigned emotion codes. The most frequent emotions expressed were prosocial emotions (i.e., inter-est, validation, affection), which represented 59.5% of all expressed emo-tions. Codes for excitement/joy/delight and humor represented 9.3% and 9.2% respectively, followed by tense humor (4.4%), sadness (3.0%), tension (2.7%), frustration (2.2%), and anger (2.0%). Excluding prosocial emo-tions, expressed emotions were slightly more positive (56.8%) than negative (43.2%).

Discussion: The eventual goal of this process is to create a computer program that can effectively identify emotional expression in text. A fi rst step in this process is to manually code emotional expression in a reliable fashion, also allowing us to identify the use of emotion in different methods of communication. Finding ways to objectively measure mechanisms of action, instead of relying on self-report measures is crucial to providing tailored and potent psychosocial interventions.

483

EARLY PALLIATIVE CARE IMPROVES THE PROGNOSIS OF CANCER

PATIENTS

Masatomo Otsuka1, Atsuko Koyama1, Hiromichi Matsuoka1, Minoru Niki, Chihiro Makimura, Ryo Sakamoto, Kiyohiro Sakai, Masahiro Fukuoka1. Sakai Hospital Kinki University Faculty of Medicine, Osaka, Japan

Purpose: Early palliative intervention is necessary in advanced cancer patients. Early palliative intervention in metastatic non-small cell lung cancer patients has been shown to improve their prognosis. Hence, it is possible that cooperation between active anti-cancer treatment and early palliative care improves patient prognosis. We performed a comparative study of inpatients and outpatients with advanced cancer to clarify the appropriate time for palliative intervention and to assess the improvement in prognosis.



Methods: Two hundred and one patients, all deceased, who had been treated in our department over a period of 4 years were divided into two groups of patients: inpatients who had experienced outpatient services for less than 7 days (inpatient group, 64 patients) and those who had experi-enced outpatient services for 7 days or more (outpatient group, 137 patients). Overall survival (OS), duration of chemotherapy and post-pro-gression survival (PPS) were retrospectively analyzed through examination of medical records.

Results: OS of the outpatient group was longer than that of the inpatient group in all cases (19.8 months vs. 7.3 months, P < 0.001). In advanced non-small cell lung cancer patients with anti-cancer treatment, OS (14.0 months vs. 3.5 months, P = 0.015), duration of chemotherapy (6.0 months vs. 1.9 months, P = 0.115), and PPS (2.7 months vs. 0.7 month, P = 0.018) in the outpatient group were longer than those in the inpatient group.

Conclusion: In advanced non-small cell lung cancer patients undergoing anti-cancer treatment, early palliative intervention at the outpatient stage improves their prognosis.

484

POSTTRAUMATIC STRESS SYMPTOMS AS AN IMPORTANT

REACTION IN CHILDREN WHO DONATE THEIR STEM CELL TO

THEIR SIBLINGS WITH CANCER

Miwa Ozawa, Asuka Higashi, Akiko Kobayashi, Disuke Hasegawa, Chitose Ogawa, Atsushi Manabe, Ryota HosoyaSt.Luke’s International hospital, Chuou-ku, Tokyo, Japan

Objective: The goal of this prospective study was to evaluate psychological reactions in children supposed to be a donor for their siblings with cancer.

Participants: Fifteen children whose siblings had cancer. They are donor candidates for stem cell transplantation during the period from 2005 to 2010. The median of their age was 10 years old (range 6–14). Their parents were also asked to participate in this study.

Methods: Investigators contacted them twice. Structured interviews were conducted face to face before the transplantation. And questionnaires were sent by mail over 6 months after the transplantation.

In structured interviews, 30 open- and close-ended questions, scale of social support, Posttraumatic Stress Disorder Reaction Index (PTSD-RI), Chil-dren’s Behavior Checklist (CBCL) evaluated by parents were used as a tool.

Mailed questionnaires consisted of 10 open- and closed-ended questions and the PTSD-RI.

Results: PTSD-RI showed mild to severe posttraumatic stress symptoms (PTSS) before donation in 14 of the 15 (93%) candidates of donors. Existing circumstances evaluated by themselves, score of social support and score of CBCL were not correlated with severity of PTSS. Nine of the siblings became HLA matched donors and cooperated in stem-cell transplantation. Five of the nine donors and seven siblings who were not candidates responded to the follow-up questioners. In 4 of 5 siblings who underwent donation (80%) and 2 of 7 siblings (29%) reported that PTSS was decreased.

Conclusion: The psychological problems of children who are supposed to be donate their stems cells to their siblings are easily understandable using the concept of PTSS.

485

POSTTRAUMATIC STRESS SYMPTOMS AMONG PARENTS OF

CHILDHOOD CANCER IN TRANSITION FROM INPATIENT TO

OUTPATIENT SETTINGS

Shuichi Ozono1, Hiroko Inada1, Koichiro Ueda1, Maiko Noguchi1, Tomoyuki Mantani2, Toshinari Saeki3, Shigeto Yamawaki2

1. Kurume University School of Medicine, Kurume, FUK, Japan2. Department of Psychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan3. Department of General Health, Hiroshima University, Hiroshima, Japan

Aims: To investigate the presence of severe Posttraumatic Stress Symptoms (PTSS) and their related factors among parents of childhood cancer who were in transition from inpatient to outpatient settings.

Methods: Mothers (N = 46) and fathers (N = 45) of 46 children diagnosed with cancer completed questionnaires. Disease status of patients were in remission at the time of investigation. The Impact of Event Scale-Revised (IES-R), the Family Assessment Device (FAD), the Zung Self-rating Depres-sion Scale (SDS), and the State-Trait Anxiety Inventory (STAI) were used to assess PTSS, family functioning, depression, and anxiety. We also assessed medical and demographic variables.

Results: Descriptive statistics, univariate analysis, and multivariate logistic regression analysis were performed to examine related factor of severe PTSS. Forty-eight percent (N = 22) of mothers and 34% (N = 15) of fathers had an IES-R score ≥ 25, indicating the presence of severe PTSS. Results of univariate analysis indicated that higher state (p < 0.01) and trait (p < 0.01) anxiety, and depression (p = 0.01) were signifi cant related factors of severe PTSS for mothers. And lower rating of ‘emotional involvement’ in family functioning (p = 0.10). For fathers, higher depression (p < 0.01), state anxiety (p < 0.01), trait anxiety (p < 0.01), and were detected. We found mothers’ state anxiety (p = 0.02) was related factors using multivariate logistic regression analysis.

Conclusion: Mothers and fathers who have learned that their child has cancer experience high rates of severe posttraumatic symptoms even the cancer is in remission. Although preliminary analysis, parents who are more generally anxious are more likely to experience severe PTSS than less anxious parents. Family functioning was important factor especially for mothers during transitional period from inpatient to outpatient settings.

486

COMPARISON OF QUALITY OF LIFE BETWEEN CANCER

SURVIVORS AND PEOPLE WITH CHRONIC STABLE DISEASES

Jose Pais-Ribeiro1, Isabel Silva2, Luisa Pedro3, Helena Cardoso4, Rute Meneses2, Ana Martins4, Antonio Martins-da-Silva4, Estela Vilhena4, Denisa Mendonça4

1. Porto University, Porto, Portugal2. Psychology, Fernando Pessoa University, Porto, Portugal3. Physiotherapy, ESTES, Lisboa, Portugal4. Medicine, ICBAS, Porto, Portugal

Aims: The objective of the present study is two-fold: to compare physical and mental components of quality of life between people that survive cancer and people with endocrine diseases (diabetes 1 and 2), neurologic diseases (epilepsy, multiple sclerosis and myasthenia gravis), and morbid obesity, with a stable illness and a diagnosis for longer than three years; and to compare cancer survivors with persons without disease.

Methods: The participants are 106 surviving cancer patients, with a mean age of 48 years (sd = 9.71), 79.2% female, with a diagnosis between three and 41 years, 117 endocrine, 199 neurologic, and 205 obese patients, with more than 18 years of age. All returned to normal daily life after diagnosis and treatment. They answered a demographic questionnaire and the SF-36 – a 36 item self report questionnaire about health perception, used as a quality of life questionnaire, which includes eight dimensions that can be grouped into two components, mental and physical. Data was collected in



a medical care setting and all participants fi lled the informed consent form according with the Helsinki declaration rules and the local law.

Results: Results show that for the physical component there are no statisti-cally signifi cant differences between the four disease groups and that regard-ing the mental component there are statistically signifi cant differences between the obesity group and the cancer group, with the cancer survivors reporting better mental health. Comparisons between cancer survivors and people from the community without disease, paired for gender and age, show that 35.8% of cancer survivors report better physical health than the community sample, and 50.5% better mental health.

Conclusions: Results suggest that cancer survivors do not differ from people with other chronic diseases except for morbid obesity and the mental com-ponent: comparison with people from the community shows no signifi cant differences regarding quality of life.

487

FROM A DISTANCE: THE INFLUENCE OF DISPOSITIONS AND SELF-

DISTANCED ANALYSES ON AFFECT AMONG PARENTS OF

PEDIATRIC CANCER PATIENTS

Louis Penner1, Ethan Kross2, Felicity Harper1, Amy Peterson1, Heatherlun Uphold1, Jeffrey Taub1, Terrance Albrecht1

1. Wayne State University, Detroit, MI, United States2. Psychology, University of Michigan, Ann Arbor, MI, USA

Aims: Pediatric cancer treatments elicit negative affect in parents. Prior research suggests that the tendency to analyze one’s negative experiences from a self-distanced, observer perspective is associated with less short-term negative affect (Adyuk & Kross, 2008). The present study expanded this research to parents of pediatric cancer patients. Specifi cally, we asked whether the tendency to adopt a distancing perspective might moderate the impact of trait anxiety on parents’ negative affect during their children’s treatments for cancer.

Methods: Participants were 95 parents of children between 3 and 12, cur-rently undergoing outpatient cancer treatments at two comprehensive cancer centers. At entry to the study, parents rated how they refl ected on their children’s past treatments (saw the memory as close (1) or as distant (7)); and later completed a measure of Trait Anxiety. Parents subsequently completed measures of state anxiety and personal distress immediately before three of their children’s treatments and of negative mood immediately after treatments. Affect was averaged across treatments.

Results: Trait anxiety and self-perspective were unrelated. Trait anxiety was positively associated with all negative affect measures (p’s ≤ 0.04); distanc-ing was negatively associated with personal distress and negative mood (p’s. < 05). Hay’s & Matthes (2009) MODPROBE was used to analyze trait anxiety by distancing interactions. R2s for all regressions were signifi cant (p’s < 0.01), as were the interactions (p’s < 0.03). If parents reported a distancing perspective on prior memories, differences in trait anxiety had little impact on negative affect before or after treatments; if they did not distance, higher trait anxiety was associated with more negative affect.

Conclusions: Parent affective reactions to pediatric cancer treatments are associated with subsequent PTSS. Self-perspectives that parents spontane-ously adopt when thinking about children’s treatment can impact affective reactions to treatments and mitigate the impact of dispositions on these reactions. Findings suggest the potential value of interventions that target parents’ self-perspectives.

488

WHAT HAPPENS ONLINE? PILOT EVALUATION OF HOW BREAST

CANCER SURVIVORS USE THE NON-GUIDED INTERNET-BASED

SELF-MANAGEMENT INTERVENTION BREATH

Sanne SW Van den Berg1, Esmee EJ Peters1, Marieke MFM Gielissen1, Nelleke PB Ottevanger2, Judith JB Prins1

1. Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands2. Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands

The BREAst cancer e-healTH [BREATH] intervention aims to facilitate post-treatment adjustment of all breast cancer patients. The effectiveness of BREATH compared to usual care is currently being evaluated in a multi-center randomized controlled trial. We conducted a pilot study to gain insight in the usage statistics and usability evaluation.

Methods: The non-guided Internet-based self-management intervention BREATH is based on cognitive behaviour therapy and guides patients chronologically through universal post-treatment survivorship topics. The intervention has a fi xed structure of four recovery phases after breast cancer. Intervention ingredients are Information (26 scripts), Assignments (48 tasks), Assessments (10 tests) and Videos (20 peer modeling clips). A con-secutive sample of the fi rst intervention-completers was obtained from the ongoing trial. All patients completed baseline measures, were randomly allocated to the intervention group, and had four-month access to the BREATH intervention. Baseline demographics, distress measures and usabil-ity evaluation were analyzed. Intervention use was analyzed with frequency of log-ins, duration of sessions and activity (defi ned as opened ingredients).

Results: Of the 41 non-metastatic breast cancer patients (mean age 49.6 years), 16 patients (39% [95% Cl: 26.66–45.27]) experienced psychological distress (HADS-total ≥ 11). Based on last login, 19 patients viewed all four phases resulting in an intervention adherence of 46.3% [95% CI: 32.06–61.25]. Seven patients (17.1%) were non-users. Two groups of users were classifi ed: low (n = 17, 41.5%) and high users (n = 17, 41.5%). High users logged in with a median of 19 times, had a median session duration of 30.4 minutes and opened all 104 ingredients. User groups did not differ signifi -cantly on age, education and psychological distress. Usability evaluation on a 10-point scale was signifi cantly higher in high users (median 8) compared to low users (median 7), U = 58.5, z = −2.07, p = 0.039, r = −0.38.

Conclusion: When analysing the effectiveness of the BREATH intervention, different user groups need to be considered.

489

MY CHANGED BODY: BREAST CANCER, BODY IMAGE, DISTRESS

AND SELF-COMPASSION

Astrid Przezdziecki1,2, Kerry Sherman1,3, Andrew Baillie1, Alan Taylor1, Elizabeth Foley4, Kellie Stalgis-Bilinski3

1. Department of Psychology, Macquarie University, Sydney, NSW, Australia2. Liverpool Cancer Therapy Centre, Liverpool BC, NSW, Australia3. Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia4. Mind Potential, Sydney, NSW, Australia

Aim: Adjustment to bodily changes after breast cancer treatment can lead to long term distress. Self-compassion, the ability to be kind to one self, is an internal resource that may enhance a woman’s ability to adjust to cancer-related bodily changes. The aim of the present study was to investigate the association of body image disturbance, self-compassion and psychological distress among breast cancer survivors.

Method: Members of a nationwide breast cancer consumer network were invited to participate. A total of 279 women who had completed active cancer treatment completed the online survey. Assessments included the



Body Image Scale (BIS), Self Compassion Scale (SCS) and the Depression, Anxiety and Stress scales (DASS). Possible mediating effects of self-compas-sion on the body image-distress relationship were assessed.

Results: Clinical levels of depression (28%), anxiety (20%) and stress (17%) were evident in a subset of women sampled. Pearson’s correlations indicated a positive association between body image disturbance and dis-tress, and negative associations between self-compassion and body image disturbance and self compassion and distress. Self-compassion was found to partially mediate the association between body image and depression and body image and anxiety, and to fully mediate the body image-stress association.

Conclusions: Body image disturbance and lower self-compassion were asso-ciated with increased psychological distress among these breast cancer sur-vivors. This study found preliminary evidence for a mediating role of self-compassion, between body image disturbance and psychological dis-tress, suggesting a potential buffering effect of higher levels of self compas-sion for women at risk of experiencing body image disturbance.

490

AVOIDANCE OF DISGUST’S ELICITORS IN COLORECTAL

CONTEXTS: MINDFULNESS PREDICTS AVOIDANCE WHEN

AVOIDANCE MAKES SENSE

Lisa M Reynolds, Sarah McCambridge, Ian P Bissett, Nathan S ConsedineUniversity of Auckland, Auckland, Auckl, New Zealand

Aims: The colorectal cancer (CRC) context contains numerous elicitors of disgust including screening tests requiring exposure to faeces, rectal exami-nations, invasive surgery and unpleasant bowel symptoms. Disgust has evolved to minimise contamination risk through avoidance and withdrawal and may have serious implications in the CRC context. Because aspects of mindfulness facilitate greater tolerance of unpleasant emotion and more considered decision-making, it may promote enhanced behavioural responses in CRC contexts.

Methods: 80 healthy volunteers completed measures of dispositional mind-fulness prior to visiting the laboratory. Participants were block randomised according to gender to either an olfactory disgust induction or a control condition before completing tasks assessing immediate avoidance of a disgust elicitor (stoma bag) and anticipated avoidance of a hypothetical CRC drug with disgusting side effects.

Results: Manipulation checks confi rmed the successful elicitation of disgust in the experimental condition (F(1,78) = 8.72, p = 0.004). As expected, participants with greater non-judging mindfulness were less disgusted than people with low mindfulness (more judging), (F(1,74) = 4.70, p = 0.03). When making decisions about medication side effects, non-reacting mindful-ness predicted less avoidance of a disgusting drug (Wald = 4.25, df = 1, p = 0.04) odds ratio 3.14 (95% CI 1.05–9.33). However when disgusted, individuals high in non-judging mindfulness required a prompt (F(1,74) = 5.51, p = 0.02) and took longer to touch a stoma bag (F(1,56) = 5.63, p = 0.02) suggesting more considered decision-making when experiencing unpleasant emotion.

Conclusions: The current report suggests that mindfulness may play a role in enhanced decision-making and avoidance of disgust elicitors in CRC contexts. Training in non-judging and non-reacting mindfulness may prove benefi cial in addressing problematic avoidance behaviours in the CRC context.

491

FACTORS INFLUENCING PRIMARY CARE PHYSICIANS’ DECISION

TO ORDER PROSTATE-SPECIFIC ANTIGEN (PSA) TEST FOR

HEALTHY MEN

Afsaneh Roshanai1, Karin Nordin, Gunilla Berglund1. Karolinska Institute, Stockholm, Sweden

Purpose: The aim of the current study was to investigate physician- and patient-related factors infl uence on primary care physicians’ decision to order a prostate specifi c antigen (PSA) test for asymptomatic men.

Methods: A total of 305 Swedish physicians fi lled out the study question-naire containing items about physicians’ attitudes towards PSA-test and the probability of screening of healthy men of varying ages.

Results: The majority of physicians reported positive attitude towards PSA-testing. However, the likelihood of offering PSA-testing to young men was low, but increased with age. Patient suffering from another disease (s) was the only variable which increased the likelihood of ordering screening test in all age groups. This was followed by the level of the patients’ worry which was an indicator in age groups above 40 years. Physicians’ opinion about using PSA-test as a screening tool was the most important physician-related variable affecting physicians’ decision regardless of patient age, followed by the physicians’ attitudes towards the test which was the second most infl u-ential factor in age groups above 40 years.

Conclusion: The decision to screen for prostate cancer using the PSA-test is infl uenced by several factors and not only those having direct clinical indication for prostate disease. This may lead to unnecessarily treatment of some patients.

492

THE EFFECTS OF RUMINATION ON ILLNESS-RELATED FUTURE

THINKING IN YOUNG PEOPLE: IMPLICATIONS FOR PROMOTING

RESILIENCE AFTER CANCER

Ursula M Sansom-Daly1,2, Claire E Wakefi eld1,3, Richard A Bryant2, Richard J Cohn1,3

1. Centre for Children’s Cancer & Blood Disorders, Sydney Children’s Hospital, Randwick, NSW, Australia2. School of Psychology, The University of New South Wales, Kensington, NSW, Australia3. School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW, Australia

Background: Due to their young age upon entering ‘survivorship’, address-ing adaptation to life after cancer is critical for adolescents and young adults (AYAs). Unfortunately, AYAs may experience more long-lasting distress than other age-groups. Little research has examined cognitive factors that account for individual differences in AYAs’ resilience after cancer. Research suggests that the ability to integrate the cancer experience into personal memory, and into an ongoing sense-of-self in the future, promotes good adaptation. Particularly important is the ability to recall specifi c instances of adaptive coping in the past, in order to be able to clearly envisage such adaptive coping in the future. One factor that may impede these processes is rumination – a maladaptive thinking style associated with depression. This study examined the role of rumination on autobiographical memory and illness-related future thinking.

Methods: A non-clinical sample of N = 60 high and low health-anxious undergraduate students was used as an analogue model for post-cancer illness concerns (e.g., fear of recurrence). The effects of maladaptive thinking were mimicked experimentally using a rumination induction. Participants also completed two illness-focused autobiographical memory and future imaginings tasks.

Results: Engaging in ruminative thinking led to more vivid illness-related memories, particularly amongst high health anxious participants (p = 0.015). However, rumination also predicted more general, avoidant health-related



future thinking (p = 0.000). Greater preoccupation with illness-related memories was associated with more negative, illness-related future thinking (p = 0.000). Participants with more illness-related future thinking were more likely to expect a serious illness (e.g., cancer) diagnosis, in the next fi ve years (p = 0.002).

Conclusions: The way young people remember illness-related events signifi -cantly alters how they picture their future. Engaging in ruminative thinking led to health-related future thinking that was more general and avoidant in nature. These fi ndings implicate rumination as a viable process to target in the treatment of post-cancer illness concerns in AYAs.

493

RESILIENCE IN CANCER SURVIVORS AFTER ALLOGENEIC

HEMATOPOIETIC STEM CELL TRANSPLANTATION

Andrea Schumacher1, Cristina Sauerland2, Annika Zeglarski1, Matthias Stelljes1, Wolfgang E Berdel1

1. Department Medicine A, University Hospital, Muenster, Germany2. Inst. Biostatistics and Clinical Research, University of Muenster, Muenster, Germany

Aims: In the wide spectrum of cancer therapies, allogeneic hematopoietic stem cell transplantation (HSCT) is a very taxing form of treatment. Accord-ingly, patients after HSCT are subjected to many physical and emotional stress-factors. Patients adapt in different ways to the situation, some patients almost seem to fail in this challenge. The concepts resilience and self-effi cacy may help to understand the individual differences in adaptation after HSCT.

Methods: The instruments Resilience-Scale (short form), Self-effi cacy-Scale (SWE), HADS and EORTC-QLQ were supplemented with a qualitative survey. Out of 89 HSCT-patients (leukemia, lymphoma, myeloma, aplastic anemia), 75 patients took part in the study. 44 patients (59%) were male, 31 female (41%), aged 20–76 years (median 46 years). Time since allo-HSCT ranged from 6 months to 8 years (median: 34 months).

Results: Resilience is positively correlated with quality of life (QL, Spear-man’s Rho: 0.587**) and social functioning (0.472**), negatively with anxiety (−0.491**) and depression (−0.577**). Correlations of resilience with emotional functioning (0.253*) and physical functioning (0.335**) are weak. Self-effi cacy is highly correlated with resilience (0.698**) and QL (0.453**).

** Sign. at the 0.01 level;* Sign. at the 0.05 level.

Patients with a high resilience score (median split at 144) scored higher in physical functioning (p = 0.041), emotional functioning (p = 0.032) and QL (p = 0.000) than patients with a low resilience score.

No effects were found for age, gender or disease entity. Preliminary analysis of the interviews indicates that patients defi ne resilience largely on the basis of self-perception and social environment and attribute themselves a rather strong resilience.

Conclusions: Further research is needed to understand long-time adaptation after HSCT and to defi ne potential benefi cial factors for a successful adapta-tion. In order to support long-term survivors with their special needs, resilience and self-effi cacy should be considered as important protective psychosocial factors.

494

CORRELATES OF POST-TRAUMATIC STRESS DISORDER (PTSD)

AND POST-TRAUMATIC GROWTH (PTG) IN ONCOLOGY

POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Lyndel K Shand1, Sean Cowlishaw2, Sue Burney3, Jane Fletcher3, Lina Ricciardelli1

1. Deakin University, Burwood, VIC, Australia2. School of Psychology & Psychiatry, Monash University, Clayton, VIC, Australia3. 3. Cabrini Monash Psycho-oncology Research Unit, Cabrini Institute, Malvern, VIC, Australia

Objectives: The diagnosis and treatment of cancer is commonly viewed as a potentially traumatic event. This is supported by evidence showing that some individuals experience cancer-related PTSD, while others experience positive changes such as PTG. Although studies have suggested various correlates of PTSD and PTG, these typically rely on small samples and produce fi ndings that are widely variable. This paper will present the results of a systematic review and meta-analysis of studies examining associations between such variables and symptoms of PTSD and PTG, respectively, in cancer patients.

Methods: A systematic review was conducted to identify eligible studies that used cross-sectional designs with samples of adult cancer patients, and reported associations between proposed correlates and symptoms of PTSD and PTG. Random effects meta-analyses were used to synthesise results.

Results: The systematic review identifi ed k = 62 studies that considered a range of correlates including age, gender, stage of disease, distress, perceived life threat, prior exposure to trauma, social support, optimism and physical quality of life. The current paper will present the best available estimate of association between each risk factor and PTSD and PTG, based on all studies. The degree of variability across studies will be examined, as will the clinical characteristics of studies that may explain any variation.

Conclusions: This review is the fi rst to systematically examine the correlates of PTSD symptoms and PTG in oncology populations, and provide the best available estimate of these associations based on all available data.

495

SUPPORTING MEN, SUPPORTING WOMEN: DEVELOPMENT OF A

WEB-BASED INFORMATION AND SUPPORT RESOURCE FOR

SUPPORT PARTNERS OF WOMEN UNDERGOING GENETIC

TESTING FOR BREAST CANCER RISK

Kerry A Sherman1, Nadine Kasparian2, Kathy Tucker3

1. Macquarie University, North Ryde, NSW, Australia2. School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Kingsford, NSW, Australia3. Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia

Aim: Undergoing genetic testing for breast cancer risk can be stressful and women who have testing frequently rely on their spouses for support. Unfortunately support partners often experience considerable distress them-selves, feeling under-informed about the genetic testing process and unsure about how best to support the woman concerned. In this study we describe the development of a theoretically-driven web-based information and support resource for male support partners of women undergoing genetic testing.

Method: Development of the Supporting Men, Supporting Women website entailed: 1) A needs analysis by interviewing genetics health professionals and male support partners; 2) Module and content development informed by theory, the needs analysis and expert consultation; 3) Video-recording and editing of interviews depicting experiences of male support partners and modelled stress management techniques; 4) Website ‘look-and-feel’ piloting; and, 5) Final website production.



Results: Interviews with health professionals and support partners high-lighted the need for a resource to provide men with information about the genetic testing process as well as guidance on managing their own and the woman’s distress, and improving communications with the tested woman. Website modules developed for this resource refl ect information about these topics, as well as descriptions of typical reactions of women and their spouses to the testing process, and guidance to enhance coping and com-munication. Additionally, videotaped interviews depicting the experiences of spouses who have supported women through genetic testing were included.

Conclusion: Supporting Men, Supporting Women is the fi rst resource to specifi cally target the support needs of partners of women undergoing genetic testing for breast cancer susceptibility. By providing an accessible web-based supportive resource for male partners, this resource is likely to provide benefi ts both to supportive spouses, as well as the tested women themselves. The effi cacy of this web-based resource will be assessed in a randomised controlled trial.

496

CLINICAL BIO-PSYCHO-SOCIAL RISK FACTORS FOR DEPRESSION

IN LUNG CANCER PATIENTS: A COMPREHENSIVE ANALYSIS

USING DATA FROM THE LUNG CANCER DATABASE PROJECT

Ken ShimizuNational Cancer Center Hospital, Japan, Tokyo, Japan

Background: Various risk factors for depression in lung cancer patients have been suggested but have been examined separately in studies with rela-tively small sample sizes. The present study examined the bio-psycho-social risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date.

Patients and methods: A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal char-acteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale.

Results: Among the recruited patients, 165 (12.4%) manifested depression. The results of a binary logistic regression analysis were signifi cant (overall R2, 36.5%), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fi ghting spirit, helplessness/hopelessness, and anxious pre-occupation). Although the contributions of cancer-related variables, per-sonal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated signifi cantly with depression.

Conclusion: Depression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.

Reference

1. Clinical biopsychosocial risk factors for depression in lung cancer patients: a comprehensive analysis using data from the Lung Cancer Database Project. Shimizu K, Nakaya N, Saito-Nakaya K, Akechi T, Yamada Y, Fujimori M, Ogawa A, Fujisawa D, Goto K.

497

COMPARISON BETWEEN PATIENTS WITH HEPATITIS C AND

HEPATOCELLULAR CARCINOMA IN QUALITY OF LIFE AND ITS

RELATED FACTORS DURING RECEIVING TREATMENT

Shiow-Ching Shun, Yeur-Hur Lai, Chen-Hua LiuNational Taiwan University, Taipei, Taiwan

Background: Hepatitis C virus (HCV) infection and hepatocellular carci-noma (HCC) are two major health problems in Taiwan. In order to prevent

from HCC, the current mainstay of treatment for patients with chronic HCV infection is the combination therapy of interferon plus ribavirin. However, those treatments generally cause physical and psychological dis-tress and decreased patient’s QOL. Until now, there is no study to compare the impact of treatment on quality of life between patients with HCV and HCC during receiving treatment.

Aim: The aim of this study was to compare the differences in quality of life and physical and psychological distress between patients with HCV and HCC during receiving treatments.

Methods: A cross-sectional design was used to recruit the participants. Eligible participants were hospitalized patients with HCC receiving non-surgical treatments; meanwhile, patients with HCV infection were outpa-tients receiving interferon combined ribavirin therapy. Disease information was collected from chart and a set of structured questionnaires was used to assess patients’ symptom distress, anxiety, depression and quality of life. The t test was used to examine the differences between the two groups.

Results: The participants with HCV infection (n = 161) and HCC (n = 122) all reported fatigue was the most distressed symptom during the treatment and there is no statistical differences between the two groups. Compared to the patients with HCC, those with HCV infection had lower level of depres-sion but worse QOL, especially in physical functioning, bodily pain, vitality, and mental health.

Conclusions: Fatigue was the most distress problem in the two populations. Patients with HCC had higher level of depression but those with HCV during the interferon therapy had a worse level of QOL. Therefore, health care providers should offer fatigue management program for both of them. However, more psychological management is needed for patients with HCC; whereas, symptom management is needed for those receiving interferon therapy in order to improve their QOL during therapy.

498

‘THERE IS NO INFORMATION FOR US’ – THE DEVELOPMENT OF

THE FIRST VICTORIAN GAY MEN’S PROSTATE CANCER SUPPORT

GROUP

Amanda Spillare1, Robyn Metcalfe1, Chris Thomas, Les Mather, Sam Gebert, David Rhodes1. Cancer Council Victoria, Carlton, Vic, Australia

Aims: Gay men with prostate cancer can face multiple additional challenges to those of heterosexual men, including isolation and fear ‘coming out’ to their treatment team. They may lack the support of a traditional family structure in addition to other social and economic factors.

Gaps have been identifi ed (both policy and service provision) that require consideration for this vulnerable group.

The fi rst Victorian prostate cancer support group for gay men was estab-lished to address these challenges, in a gay friendly environment. The group was launched in September 2011 by Cancer Council Victoria (CCV), in collaboration with Prostate Cancer Foundation of Australia (PCFA), a pros-tate care nurse and consumers.

Methods: The group used a collaborative, cross organisational approach with consumer and professional representation. Gay specifi c health services and media were targeted. Group meetings were held in gay-friendly space, and employed a psycho-educational model, including guest speakers and opportunities to share narratives. CCV mentored the group facilitator and provide ongoing support.

Results: 7 men attended the launch of the fi rst meeting. 6 out of the 7 men felt that the session met their needs, with the most valuable parts of the session named as ‘the understanding, compassion and direction’ now felt. It was decided the group should meet monthly, and now has 16 members (May 2012). A one-year evaluation will take place in September 2012. Topics/themes covered at the group meetings so far include erectile dysfunc-tion, relationships, identity, coming out to the treatment team, and medita-tion/relaxation.



Conclusions: Gay men with prostate cancer face multiple barriers to access-ing supportive care. Offering a gay specifi c space for men to meet without fear of judgement or prejudice is an essential step forward in offering serv-ices to all men affected by prostate cancer.

Reference

1. Davis Cornell MD A Gay Urologist’s Changing Views on Prostate Cancer. http://www.informaworld.com/smpp/title~content = t904385604.

499

THE USE OF A PERSONALITY/STRESS QUESTIONNAIRE IN THE

PREDICTION OF CANCER OR CHD IN HEALTHY PROBANDS

A Kizior1, J Spisz2

1. University of Lodz, Pro Ars Foundation, Lodz, WA, Poland2. Pro Ars Foundation, Lodz, WA, Poland

Objectives: There is a long standing theory, suggested that there are per-sonality traits, which in combination coping strategies and biomedical factors can predict cancer or coronary heart disease in healthy probands (Hansen, Floderus, Fredriksen, Johansen et. al, 2005).

The Multiple methods were used to develop suggestion authors this new Personality/Stress Questionnaire that there are personality traits, stress and coping strategies which in combination with physical variables can predict cancer or CHD in healthy probands in 81% accuracy (Grossarth-Maticek, Eysenck, Boyle, 1991, 1995).

This study examines the predictive accuracy of three different methods of administration of a questionnaire designed to predict and divided the popu-lation into four types: Type 1 as a cancer prone, Type 2 as a coronary heart disease CHD prone, Type 3 is alternating between behaviors characteristic of Type 1, 2, and 4 and this thereby protected to some extent, and Type 4 as a healthy, autonomous type hypothesized to survive best.

Methods: From the global healthy probands sample (n = 1 087 (both sexes), we were selected (N = 131) men and women aged 24–65 completed three methods: The Personality/Stress Questionnaire, Ipat Anxiety Scale and 37 Adjective Check List ACL. For these studies used statistical multiple package: The Classifi cation Trees Module with two algorithms CART (Clas-sifi cation and Regression Trees), Discriminant Analysis, Logistic Regression and Correlation R-Spearman. STATISTICA 8 PL was used for analysis.

Results: The largest share in the variation for all presented models showed the second Type, as CHD prone (characterized by an overarousal, open behavior pattern) in potentially healthy probands. Classifi cation of the TREE`S analysis demonstrated that in 83,19% can classify peoples in terms of belonging to one of four types correctly. In Discriminant analysis in 97,11% (R = 0.900, the value of Wilk`s Lambda statistics = 0.190, Chi square = 188,85, DF = 30). In the Linear Regression in 68,7% (p = 0.0001, R2 = 592,7, DF = 16, F = 156,8) can classify peoples in terms of belonging to one of four types correctly.

Conclusions: The fi ndings suggest that The Personality/Stress Questionnaire is an appropriate and effective method for eliciting peoples for one of four types` personality and coping strategies. But such studies should be carried out on a large number of peoples (longitudinal and follow-up study), having regard to the cultural differences and biomedical factors.

500

EXPERIENCE OF DEATH CONFERENCE AT GENERAL HOSPITAL

SETTING IN JAPAN

Koji Sugano1,2,3, Nasako Adachi1, Kazumi Koizumi1, Chiharu Hirose1, Yoshinori Ito3, Yosuke Kubota3, Tomohiro Nakaguchi3, Megumi Uchida3, Toru Okuyama3, Tatsuo Akechi3

1. Palliative supporting team, Koshigaya Municipal Hospital, Koshigaya, Saitama, Japan2. Division of Respiratory Medicine, Juntendo University Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan3. Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan

Background: Medical staffs often experience grief, helplessness after their patients’ death. To cope with the problem, we often have conferences, called ‘death conference’ in Japan, with attending physicians, nurses, palliative care team (PCT) members and other medical staffs.

Aim: To clarify the structure of death conferences and topics discussed in the conferences, and obtain implications for more useful death conferences, we reviewed our experiences.

Method: Koshigaya Municipal Hospital is a regional core hospital. No mental health practitioners such as psychiatrists or clinical psychologists are working in the hospital. Death conferences are hold by requests mainly from ward nurses. Records of death conferences from April in 2011 to March 2012 were retrospectively reviewed. Information regarding patients charac-teristics (e.g., cancer lesion), structures (e.g., days between patients’ death and having the conference) and topics discussed were investigated from the conference records. Comments and feedbacks from participants were obtained using self-administered questionnaires.

Result: Thirteen death conferences were held. About half of subjected patients (46.1%) had colon cancers. All death conferences were held within a month after patients’ death and between 30 minutes and 2 hours in time. The topic discussed in the conferences were care strategies of patients in delirium and their families (53.8%), issues with negative insuffi cient control of pain and other physical symptoms (38.4%), and burnout of unit nurses (7.6%). The participants reported that the conferences were met their need, and also were helpful to relief their distress. The most common feedback from participants to improve conferences more useful was requests of par-ticipations of mental health practitioners.

Conclusion: Reviewing the care for dying patients after their death by multidisciplinary members seems to be helpful to manage distress among the medical staffs, especially nurses. Mental health practitioners’ participa-tions are highly recommended.

502

EMOTIONAL EXPRESSION IN SPOKEN NARRATIVES AND

DIURNAL CORTISOL RHYTHMS AMONG WOMEN WITH

METASTATIC BREAST CANCER PARTICIPATING IN SUPPORTIVE

EXPRESSIVE GROUP THERAPY

Rie Tamagawa1,2, Yong Li1, Janine Giese-Davis1,2

1. Psychosocial resources, Alberta Health Services, Tom Baker Cancer Centre, Calgary, AB, Canada2. University of Calgary, Calgary, AB, Canada

Background: Aberrant diurnal cortisol rhythms are one of the biological risk factors for cancer progression. We have previously shown that greater expression of negative emotions during a fi rst session of supportive-expres-sive group therapy (SET) was associated with salutary, steep cortisol rhythms among women with metastatic breast cancer.

Objectives: We examined whether time spent storytelling shared in SET (personal storytelling vs. direct communication with other group members) are associated with cortisol rhythms, and whether expression of negative affect is associated with cortisol rhythms regardless of story types. We also



explored whether women who shared many stories and those who shared few stories exhibit differential relationships between their emotion expres-sion and cortisol rhythms.

Methods: Prior to the initial SET session, 29 women with metastatic breast cancer donated four saliva samples per day for three consecutive days. We coded emotional expression using Specifi c Affect Coding System-Cancer and story types from video-recorded SET. We collapsed the 23 emotion-catego-ries into defensive, hostile, primary negative, high arousal positive, con-strained anger, compassion, and neutral categories.

Results: The overall duration of storytelling was not associated with diurnal cortisol rhythms. However, greater expression of primary negative affect and defensiveness were associated with steep diurnal cortisol slopes only during direct conversation. Also, greater expression of hostility was associ-ated with aberrant slopes, while greater expression of positive affect was associated with steep slopes only among women who shared many stories throughout the year of SET.

Conclusions: While expressing primary negative affect through direct con-versation may be salutary, expressing hostility through personal narratives is not. Our results provide preliminary evidence for how emotional expres-sion in spoken narratives is associated with a disease-relevant physiological marker.

503

ASSOCIATIONS BETWEEN DEPRESSIVE MOOD, HEALTH

BEHAVIOUR, AND DIURNAL CORTISOL SLOPES AMONG WOMEN

WITH BREAST CANCER

Rie Tamagawa1,2, Michael Speca1,2, Janine Giese-Davis1,2, Richard Doll3, Joanne Stephen3, Linda E Carlson1,2

1. Psychosocial resources, Alberta Health Services, Tom Baker Cancer Centre, Calgary, AB, Canada2. University of Calgary, Calgary, AB, Canada3. BC Cancer Agency, Vancouver, BC, Canada

Background: Chronic experience of depressive mood has been associated with aberrant diurnal cortisol rhythms, which is one of the risk factors for early mortality among individuals with cancer. In contrast, some health behaviour, specifi cally, regular exercise has been shown to improve mood, and attenuate cortisol levels at certain times of a day. However, little is known about how these psychological and behavioural factors are associ-ated with diurnal cortisol rhythms, which are especially disease-relevant for cancer patients.

Objectives: This study examined the relationships between depressive mood, health behaviour, and diurnal cortisol rhythms.

Methods: A total of 277 breast cancer patients were recruited from tertiary cancer clinics in Calgary and Vancouver. Participants were asked to com-plete questionnaires assessing health behaviour including quality of sleep and diet, daily duration of exercise, and depressive mood, and to collect a saliva sample at awakening, noon, 5pm and bedtime for three consecutive days, which were used to calculate diurnal cortisol slopes. Hierarchical multiple regression analyses were conducted to examine the relative impor-tance of psychological and behavioural factors in their association with the cortisol slopes.

Results: A longer duration of daily exercise was associated with steep, healthier cortisol slopes. Unexpectedly, greater cancer severity was also associated with steep cortisol slopes. Depressive mood was more strongly associated with diurnal cortisol slopes over and above the medical and behavioural factors. High levels of depressive mood were associated with aberrant diurnal cortisol rhythms. Greater daily exercise contributed to higher morning cortisol levels, while greater depressive mood contributed to lower bedtime cortisol levels.

Conclusions: Psychological morbidity relative to the behavioural and medical factors was more strongly associated with physiological regulation of cortisol. Promoting regular exercise and alleviating depressive mood may be important to restore physiological regulation, particularly for individuals with high levels of depressive mood and a diffi culty engaging in exercise.

504

A SYSTEMATIC REVIEW OF THE RECENT QUALITY OF LIFE

STUDIES IN ADULT EXTREMITY SARCOMA SURVIVORS: NEED

FOR FURTHER RESEARCH TO ASSESS ROLE OF PSYCHOLOGICAL

DISTRESS IN INFLUENCING OVERALL OUTCOMES

Melissa Huiliang Tang1, Donald JW Pan, David Castle1, Peter Choong1

1. St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia

Background: The role of psychological distress and its impact on outcomes in extremity sarcoma patients (ES) has received little attention. Patients with ES face unique additional challenges compared to patients with other types of cancer. It is recognised that depression and anxiety during rehabilitation for other orthopaedic conditions has a negative impact on recovery and is associated with poor function and pain outcomes following joint arthro-plasty. Psychosocial interventions have been shown to improve the effective-ness of rehabilitation after orthopaedic injuries.

Purpose: To further explore the current literature regarding psychological distress in extremity sarcoma.

Methods: Systematic review of the literature on extremity sarcoma in adults from fi ve databases over the last ten years.

Results: Nine articles were selected. We divided studies into two groups. The fi rst group made conclusions regarding the mental health of ES patients using either the mental health subscale of a global Quality of life (QoL) assessment tool or self-reported prevalence of depression and/or anxiety (six studies). The second group utilised tools designed to detect symptoms of psychological distress (three studies). Studies that used global QoL assess-ment tools concluded that mental health subscales were comparable between ES survivors and a normal reference population. However, studies that used tools to specifi cally detect distress reported a signifi cant level of depression, anxiety, posttraumatic stress disorder as well as psychological distress.

Conclusion: The available literature regarding QoL in extremity sarcoma patients is heterogeneous in terms of aims and assessment tools. Psychologi-cal distress is an important but often overlooked aspect of care. There was a mismatch in fi ndings between studies that used global QoL assessment tools and those that used tools to assess psychological distress symptoms. Further research is required to assess the role of psychological distress in infl uencing overall outcomes following surgery for extremity sarcoma.

505

FEAR OF CANCER RECURRENCE IN YOUNG BREAST CANCER

SURVIVORS: THE ROLE OF META-COGNITIVE STYLE AND

DISEASE-RELATED FACTORS

Belinda Thewes1, Melanie L Bell2, Phyllis Butow1

1. School of Psychology, University of Sydney, Camperdown, NSW, Australia2. Psycho-Oncology Cooperative Research Group of Australia (PoCoG), University of Sydney, Sydney, NSW, Australia

Aims: Fear of cancer recurrence (FCR) is increasingly recognised as a preva-lent and debilitating challenge of cancer survivorship, particularly in younger survivors. Gaining a better understanding of the factors that con-tribute to high levels of FCR is an important step in the development of treatment approaches. Maladaptive metacognitions have been shown to be important to the development of a range of emotional disorders, but have not previously been explored in the context of fear of cancer recurrence.

Methods: This cross-sectional study included young women diagnosed with early stage breast cancer at least one year prior to study entry. Participants completed a web-based questionnaire which included the Fear of Cancer Recurrence Inventory (FCRI) and the Brief Metacognitions Questionnaire (MCQ-30).

Results: 218 women with a mean age of 39 years at diagnosis participated. All measures of metacognitive style were moderately correlated with FCRI scores (r = 0.31–0.49) and statistically signifi cantly associated with FCRI in



both unadjusted and adjusted models. Overall metacognitive style, in com-bination with disease and demographic factors explained 36% of the vari-ance in FCR scores. A change in the MCQ total score of 13 points (1 s.d.) would result in a clinically important change in FCR.

Conclusions: Metacognition appears to play an important role in FCR. Treatments which focus on changing unhelpful metacognitions may prove a useful approach for treating clinical FCR in cancer survivors.

506

INTRUSIVE THOUGHTS AFTER PROSTATE CANCER DIAGNOSIS

AND SURGERY

Thordis Thorsteinsdottir1, Maria Hedelin, Johan Stranne, Heiddis Valdimarsdottir, Ulrica Wilderang, Eva Haglind, Gunnar Steineck1

1. University of Gothenburg, Gothenburg, Sweden

Objective: Sudden, unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – could relate to how men assess their quality of life after prostate cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after surgery.

Method: During the fi rst year of the LAPPRO-trial, 971 men planned for radical prostatectomy were prospectively registered at 13 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specifi c questionnaires before and three months after surgery (participation rate 86%).

Results: Before surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months later. Comparing those report-ing intrusive thoughts at least weakly before surgery with those who did not, the prevalence ratio (95% confi dence interval) three months after surgery for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5).

Conclusions: The prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with impaired quality of life three months later. It could be valuable to design clinical interventions that dimin-ish the occurrence of negative intrusive thoughts in men with prostate cancer diagnosis.

507

THINKING ABOUT ONE’S OWN DEATH WHEN DIAGNOSED WITH

PROSTATE CANCER

Thordis Thorsteinsdottir1, Heiddis Valdimarsdottir2,3, Johan Stranne4, Ulrica Wilderang1, Eva Haglind5, Gunnar Steineck1,6

1. Sahlgrenska Academy of the University of Gothenburg, Gothenburg, SWE, Sweden2. Department of Oncological Sciences, Mount Sinai School of Medicine, New York, USA3. Department of Psychology, Reykjavik University, Reykjavik, Iceland4. Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden5. Sahlgrenska Academy of the University of Gothenburg, Gothenburg, SWE, Sweden6. Division of Clinical Cancer Epidemiology, Department of Oncologyâ ’Pathology, Karolinska Insitutet, Stockholm, Sweden

Objective: Being diagnosed with prostate cancer increases the risk of suicide. Among men with a diagnosis of clinically localized prostate cancer there could be an unmet need for psychiatric care signed by thoughts about one’s own death. Such thoughts constitute an indicator for depressive dis-order but we do not know if they appear commonly among men who are diagnosed with prostate cancer or if these thoughts could be critical for some individuals.

Participants and methods: In the prospective LAPPRO-trial 833 of the 971 (86%) men with localized prostate cancer undergoing radical prostatectomy during the fi rst study-year answered two study-specifi c questionnaires, before and three months after radical prostatectomy. Multivariable prog-nostic models explaining thoughts about one’s own death were built with the help of stepwise regression and Bayesian Model Averaging.

Results: Three months after surgery 18 percent of the men had thoughts about their own death at least once a week. Urban living [Adjusted Relative Risk (RR) 2.39, 95% Confi dence Interval (CI) 1.23 to 4.64], low control [RR 2.19, CI 1.35 to 3.57], uncertainty about the future [RR 3.37, CI 2.16 to 5.24] and crying [RR 1.95, CI 1.28 to 2.96] before surgery predicted thoughts about one’s own death after surgery.

Discussion: Men undergoing surgery for prostate cancer have thoughts about one’s own death simultaneously as symptoms of psychological dis-tress. When aiming at improving the situation for men diagnosed with prostate cancer it could be advantageous to screen for thoughts about their own death and, when apparent, consider psychological interventions.

508

CANCER PATIENTS’ REHABILITATION IN EUROPE: RESULTS FROM

THE EUROCHIP-3 PROJECT

Luzia Travado1, Elke Van Hoof, Josette Hoekstra-Weebers2, Paolo Baili, Hans H Bartsch, Miklos Garami, Piret Veerus1. Central Lisbon Hospital Centre-Hospital S. José, Lisbon, Portugal2. University Medical Center Groningen, The Netherlands

Background: There are about 20 million cancer patients in Europe, and the number is increasing. Cancer patients’ rehabilitation has been recognised as a part of integrated care to restore the patients’ physical and psychosocial status and quality of life as far as possible.

Methods: European Cancer Health Indicator Project EUROCHIP-3 collected data on cancer rehabilitation programmes across the European Union with the aim to map the present situation in the European Union and to provide equal opportunities for all citizens in the future. From 2009–2011, a two-step survey was performed, and altogether 35 experts from 27 countries were consulted.

Results: All 27 countries completed the survey. Most respondents provided a defi nition of rehabilitation similar to the WHO defi nition of rehabilitation, including physical, psychological and social domains in the defi nition. Cancer rehabilitation was reported to be included in the national cancer plans in 18 countries. Guidelines for cancer patient rehabilitation exist in fi ve countries. Training courses for professionals involved in rehabilitation are available in 15 countries, and counselling for cancer patients and their family members in 24 states. Rehabilitation services are offered in special-ised rehabilitation centres for cancer patients, in comprehensive cancer care centres, in general rehabilitation centres, in general, private and university clinics, in health centres, hospices, and resorts.

Conclusions: In many European countries, cancer patients’ rehabilitation services are fragmented with vast differences in availability and competence between countries. Cancer patients’ rehabilitation should be on the political and fi nancial agenda in all European countries to ensure that each cancer patient receives the care needed, and it should be included in national cancer plans. The development and implementation of uniform rehabilitation guidelines and quality assurance guidelines may help to increase the quality of rehabilitation.

509

BREAST CANCER MEANINGS: A COGNITIVE-DEVELOPMENTAL

STUDY

Luzia Travado1, Joaquim Reis1. Central Lisbon Hospital Centre-Hospital S. José, Lisbon, Portugal

Purpose: This study has focused upon the meaning women with breast cancer attach to their illness. According to the common-sense model of



health and illness there are fi ve domains of illness representation: causes, identity, timeline, consequences and controllability. From a developmental perspective based on the social and cognitive-developmental theory, health and disease processes experienced by adults may be represented as different levels of openness, fl exibility, inclusiveness and abstraction and can be ordered in a sequence from least to more mature. Within this framework we developed a study with two main objectives: (1) to assess in breast cancer patients the fi ve domains of their illness representation and, (2) to verify if those domains can be ordered developmentally from least to more mature.

Method: Fifty women treated for breast cancer as outpatients by the Breast Surgery Multidisciplinary Team at Hospital S. José, Lisbon, Portugal, were randomly selected and interviewed using a semi-structured method in order to obtain data on the signifi cance they attached to their illness.

Results: The qualitative data show that, for each domain of illness repre-sentation, it was possible to identify a typical breast cancer representation profi le; it was also possible to classify women’s illness meanings into differ-ent developmental levels. A developmental sequence of meanings for breast cancer is presented.

Conclusions: The implications of this approach to clinical intervention suggest that accessing the patients’ meanings about their illness helps under-standing the emotional reactions and coping processes they use with the stressful situation. Also it enables the clinician to match clinical methodolo-gies with the patient’s cognitive-developmental level, which would be of greater effi cacy and improve outcomes.

510

SENSE-OF-COHERENCE IN BREAST CANCER: IS IT PROTECTIVE OF

PSYCHOLOGICAL MORBIDITY?

Luzia Travado1, Cidalia Ventura, Cristina Martins1. Central Lisbon Hospital Centre-Hospital S. José, Lisbon, Portugal

Purpose: A diagnose of breast cancer (BC) is still considered for many a ‘death sentence’ in Portugal. Evidence shows that 25–50% of cancer patients will develop psychological morbidity as a consequence of having cancer. We conducted the present study with the purpose of characterizing the psycho-social consequences of BC in Portuguese patients after active treatment.

Methods: A convenience sample of BC treated outpatients from Multidis-ciplinary Breast Surgery Consultation at Hospital S. Jose, Lisbon were assessed to evaluate anxiety and depression (HADS), QoL (SEPOS-VAS), coping style (Mini-MAC), concerns (CWI) and Sense-of-Coherence (SOC). The protocol used was adapted from the SEPOStudy (Grassi et al, 2004).

Results: We assessed 110 women (mean age = 58.1 yrs; level of educa-tion = 5.8 yrs). Psychosocial morbidity was found in about ¼ of the women (16.1%–24.5%) with anxiety in 39.1% and depression in 29.1%. Predominant use of Fatalism, Avoidance and Fighting Spirit as coping styles; support from faith and from others as most relevant for our population. Concerns were low and mainly about emotional issues, the future and the illness. Meaningfulness is the highest SOC component. Concerns were signifi cantly correlated to psy-chosocial morbidity and maladaptive coping (Hopelessness, r = 0.48; Anxious Preoccupation r = 0.51), and negatively with QoL variables and SOC/meaning-fulness (r = −0.41). Faith is signifi cantly correlated with psychosocial morbidity (r = −0.26), Hopelessness (r = −0.27), Avoidance (r = −0.42) and support from others with depression (r = −0.21). SOC is negatively correlated with hopeless-ness, psychological morbidity and concerns.

Conclusions: Portuguese BC survivors’ psychosocial profi le allows us to better understand their needs and to develop psycho-oncology programs accordingly to address them at an early phase as part of standard patient care. Our study also emphasizes the patients’ need to fi nd meaning in their cancer experience and its important value in building resilience, which helps them facing stressful circumstances and maintain well-being. The interesting results with SOC components in this population suggests that the introduc-tion of a sense-of-coherence model in an early psychological intervention aimed at preventing psychological morbidity may have important value in providing patients complementary resources in dealing with the distressing episodes of their cancer journey.

511

EXPECTED FRIENDS REACTIONS TO CANCER DISCLOSURE:

AN EXPLORATORY VIGNETTES STUDY AMONG JAPANESE

CANCER SURVIVORS

Miyako TsuchiyaGraduate School of Nursing, Chiba University, Chiba, Japan

Aims: To explore expected reactions of friends and its reasons from cancer survivors’ perspectives.

Methods: Inclusion criteria were 1) Japanese cancer survivors aged twenty and over, and 2) those who were in both physically and psychologically stable. Potential participants were recruited by letter from several cancer self-help groups in Japan. Questionnaires were administered to 145 members, and 40 returned their completed questionnaires. Questionnaires include vignettes describing stories from the time of cancer diagnosis and the time of telling it to friends. Participants were asked to read vignettes, and then to response to open-ended questions. Additionally, demographics and cancer-related information was asked.

Analysis: Responses to vignettes were qualitatively analysed using a the-matic analysis. Demographics and cancer-related information was analysed by descriptive statistics.

Results: The mean age of participants was 67.4 years. The mean years since cancer diagnosis were 12.7 years. Regarding expected friends’ responses to cancer disclosure, four themes were extracted: 1) playing passive roles (sub-categories: look on me, listen to me, and accept me who develop cancer), 2) sharing my anxiety, 3) playing active roles (subcategories: encouragement, useful information provision about cancer, and advice on what I should do now), and 4) maintaining usual friendships. Regarding reasons for such expectations, fi ve themes were extracted: 1) no ideas about cancer yet, 2) do not want to feel alone, 3) already some decisions in mind, 4) want more information to fi ght my cancer, 5) importance of usual everyday life.

Conclusions: Participants, who expected their friends to play passive roles, tended not to understand what was going on yet or tended to already decide to undergo surgery as doctors suggested. Participants, who expected their friends to play active roles, tended to be ready to fi ght against cancer.

512

BUILDING A PSYCO-ONCOLOGY UNIT AT A CANCER CENTER.

IS THIS REALLY ONE OF THE WAYS TO BREAK THE STIGMA

RELATED TO PSYCHIATRIC CARE AMONG CANCER PATIENTS?

Ozen Onen Sertoz1, Aysel Avcı2, Ruchan Uslu3,4

1. Ege University School of Medicine Department of Psychiatry, Turkish Association of Psychiatry, Izmir, Turkey2. Ege University School of Medicine Department of Oncology, Tulay Aktas Oncology Hospital, Turkish Association of Oncology Nursing, Izmir, Turkey3. Ege University School of Medicine Department of Oncology, Tulay Aktas Oncology Hospital, Turkish Association of Oncology, Izmir, Turkey4. Turkish Association of Palliative Care, Izmir, Turkey

Background: Because of progress in cancer treatments survival rates have been increased in cancer. However approximately half of the patients still die from cancer today. Many cancer patients need supportive psychological care. Although psychological distress is high among cancer patients, most of the cancer patients do not receive a psychological care appropriately because of some reasons. May be the most important reason is the word psychiatric or to be seen by a mental health professional is a kind of stigma for most of them. In addition many cancer patients prefer treatment in the cancer center, they prefer talking treatments in order to take pills and coun-selors or cancer nurses are also popular preferences.

Aim: In this naturalistic observational study we aimed to investigate the characteristics of cancer patients, their adjustment to control visits, their satisfaction from this unit and to investigate the reasons for drop-outs.



Methods: All of the patients were undergone a psychodynamic oriented psychiatric evaluation, they were given psycho-education, for suitable patients cognitive behavioral techniques were applied, and patients who had clinically relevant depression or anxiety disorder according to DSM-IV were initiated psychiatric drugs. All of the patients were explained that they would be followed up periodically until their psychiatric treatment ends. All patients were screened with distress thermometer, Hospital Depression Anxiety Scale (HAD), EORTC-QLQ-C30 (3.0) at their initial visit and planned to repeat these scales at eighth week, sixth month and after one year. For statistical analysis descriptive statistics and analysis of variance for repeated measures were applied.

Results: Psycho-oncology unit was developed in February 2011 at Ege University Tulay Aktas Oncology Hospital, Izmir, Turkey. We reviewed all referrals from February 2011 to April 2012. Total of 222 patients (age: 49.6 ± 11.8, 15% men, 85% women) were referred to psycho-oncology unit. First all patients were evaluated by a psycho-oncology nurse and the ones who need further evaluation were seen by an experienced psychiatrist. Most of the patients were referred to us were breast cancer patients (58%), patients with colorectal tumors (10%), patients with gynecological cancers (9%) and patients with lung cancer (5%). Most of them were retired (85%). Most of the patients were satisfi ed with their social support (84%). After sixth month follow-up, among 222 patients, approximately 16 patients were still continuing their psychiatric care. Initial, 8th week and 6th month evalu-ations were revealed with repeated measures ANOVA. Only one patient was completed one year follow-up therefore fi rst year evaluations were not included in the analysis. Six months after fi rst evaluation patients’ distress (p < 0.001), depression (p = 0.001) and anxiety (p < 0.001) scores decreased signifi cantly, global health status (p = 0.03), emotional functioning (p = 0.001), cognitive functioning (p = 0.006), social functioning (p = 0.01) increased signifi cantly and insomnia score decreased signifi cantly (p = 0.03). Patients’ satisfaction from psycho-oncology unit was favorable for most of the patients. Despite this adherence to psychiatric care was very low.

Discussion: Routine psychiatric care at cancer center had positive impact on distress, anxiety, depression, global health status and emotionally related sub dimensions of quality of life questionnaire. This observational natural-istic study showed that beyond its psychosocial benefi ts still there are some problems to refer for psychiatric care and to continue follow up visits. Reasons for non-adherence will be discussed in detail.

513

RESEARCH INFORMING PRACTICE: HOW CAN WE TRANSLATE

HOPE IN THE PALLIATIVE CARE PRACTICE?

Josiane Roulez, Christine Goyette, Mélanie VachonUQAM, Montreal, Que, Canada

Context: End-of-life palliative care aims at healing physical, psychological, social and existential distress for patients with incurable illness. In the philosophy of palliative care, death is considered a natural process that shouldn’t be hastened or prolonged. In western societies, often regarded as ‘death-denying’, the palliative care movement tends to promote social matu-rity and the acceptance of fi niteness. Consequently, death denial is identifi ed as an obstacle to good palliative care in clinical practices as well as in research literature. Most importantly, the term ‘denial’ tends to be overused by professional caregivers and is often confused with the concept of hope, whether that hope is realistic or not.

Aims: This research has three objectives: 1) to review the literature on the concept of hope in palliative care; 2) to examine the use of the concept of hope in palliative care and its relationship with the concept of denial and; 3) to translate those fi ndings into clinical recommendations for palliative care practice.

Method: A MEDLINE search (2002–2012) was performed with the terms ‘hope’ and ‘palliative care’ in combination. The search was restricted to English-written articles and to adult palliative care. The 450 articles initially retrieved were screened based on their relevance, yielding 41 publications for analysis. Articles were summarised, elements of defi nitions of hope were extracted and a qualitative thematic analysis was conducted.

Results: Main fi ndings revealed that: 1) Hope appears to be a multidimen-sional concept often described either as a state of being or as a state of wanting. 2) Hope evolves during the illness trajectory. 3) Most studies describe hope in palliative care as a way to adapt to and to transcend suf-fering. 4) Hope tends to be confused with wish, denial and unrealistic hope.

Discussion: Clinical implications of the confusion between hope and denial are discussed and recommendations are provided for health care professionals.

514

FOLLOW-UP CONTACTS WITH THE PSYCHOSOCIAL CARE TEAM

AFTER SCREENING FOR DISTRESS IN NEWLY DIAGNOSED

CANCER PATIENTS

Ging-Long Wang1,2, An-Chen Feng3, Sheng-Hui Hsu2, Yi-Chen Hou2, Cheng Chih-Tao2,4

1. Psychiatry, National Yang-Ming University, College of Medicine, Taipei, Taiwan2. Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan3. Protocol, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan4. Psychology and Social Work, National Defense University, Taipei, Taiwan

Purpose: At KF-SYSCC, we have been screening all newly diagnosed cancer patients with the Distress Thermometer (DT) for psychosocial distress since 2007. The optimal cutoff was set at DT ≥ 4 (1). For the patients who are detected to be signifi cantly distressed and wish to be assisted by the psycho-social care team, our social workers will make telephone or personal con-tacts with them. If needed, they will also be referred for psychiatric evaluation.

The goal of this study was to retrospectively assess to what extent the dis-tressed patients had actually had contacts with the psychosocial care team.

Methods: All newly diagnosed cancer patients, who fi t the following criteria and received treatment at KF-SYSCC between 2007 and 2010, were included in this study:

1. Major cancer type, of which the total number of patients were more than 100 from this time period;

2. 2. Age 18 or older; and3. 3. DT screening done within 90 days after the diagnoses.4. Information of contacts with the psychosocial care team was retrieved

from the computerized data bases.

Results: Five thousand three hundred and thirty fi ve (5335) newly diag-nosed cancer patients of 12 major cancer types, seen between Jan. 1, 2007 and Dec. 31, 2010, were included in this study. Over all, 1771 (33.20%) were assessed to be signifi cantly distressed. Among these distressed patients, 628 (36%) had had contacts with the psychosocial care team: 422 (24%) with the social worker, 276 (16%) with the psychiatric staff, and 70 (4%) with both the social worker and the psychiatric staff.

Vast majority of these patients, up to 88%, had the contacts with the social worker within 30 days after the screening, as the social worker had made the initial contacts. The visits to the psychiatric staff were spread out to a year with only 52% within the fi rst three months.

Conclusion: Routine screening for psychosocial distress in newly diagnosed cancer patients has led to 36% of those identifi ed as distressed to have contacts with the psychosocial care team. Most of such patients were reached by the social workers within one month after the screening. However, only half of the fi rst psychiatric visits were made within the fi rst three months.

Clinical implications: Routine screening for psychosocial distress should be continued. Patient’s follow-up contacts with the psychosocial care team, especially with the psychiatric staff, should be closely monitored to facilitate timely intervention.

Research implcations: Further studies are needed to assess the outcome of the psychosocial intervention for these highly vulnerable patients.



Acknowlegement: None.

Reference

1. Wang GL, et al. The HADS and the DT for screening psychosocial dis-tress of cancer patients in Taiwan. Psych-Oncology 20: 639–646 (2011).

515

TESTING RECIPROCAL RELATIONSHIPS BETWEEN COPING AND

POST-TRAUMATIC GROWTH AMONG BREAST CANCER PATIENTS:

A CROSS-LAGGED STRUCTURAL EQUATION STUDY OF

APPROACH, EMOTIONAL, AND DISENGAGE COPING

Wei Ting Wang1, Cheng-Shyong Chang2, Shou-Tung Chen2, Dar-Ren Chen2, Wen-Yau Hsu1

1. Department of Psychology, National Chengchi University, Taipei, Taiwan2. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan

Aims: Studies has addressed the role of post-traumatic growth (PTG) as an outcome of adaptive coping according to the PTG models of Schaefer and Moos (1992) and Tedeschi and Calhoun (2004). However, Zoellner and Maercker (2006) argued that PTG might function as positive illusion or self-enhancing appraisal (Taylor, 1983). This argument implicates that PTG could predict the use of coping strategies. Moreover, according to Aspinwall (2001)’s upward spiral and downward spiral, PTG and different types of coping could have bidirectional associations. Little research has examined the latter two temporal relationships. The current study, adopting a longi-tudinal design, aims to explore the directional (i.e., temporal) relation between different types of coping and PTG among newly-diagnosed breast cancer patients.

Methods: A longitudinal study was conducted with 113 breast cancer patients at the third month after the cancer surgery (T1) and the sixth month after the surgery (T2). The Chinese version of the brief COPE (Carver, 1997) and the Post Traumatic Growth Inventory (PTGI) were assessed at both T1 and T2.

An autoregressive cross-lagged modeling strategy was applied to examine whether initial coping styles predicts subsequent PTG above and beyond PTG stability, or vice versa. Three models indicating three types of coping (approach, emotional, disengaged) were tested to examine whether different coping styles show different directions.

Results: Three models all fi t the data adequately (χ2/df = 1.90, 1.27, 2.37; CFI = 0.99, 0.96, 97; RMSEA = 0.064, 0.091, 0.092; for approach, emo-tional, disengaged coping respectively). Approach coping and PTG showed bidirectional associations (β = 0.39, 0.32; p < 0.05) and emotional coping predicted later PTG (β = 0.22, p < 0.05). Other cross-lagged relations were not signifi cant.

Conclusions: The results indicate that different coping styles show different temporal relationships with PTG. Approach coping and PTG showed upward spiral relations (Aspinwall, 2001). Emotional coping facilitates PTG, a fi nding consistent with the notion of Tedeschi and Calhoun (2004)’s model.

References

1. Tedeschi, R. G., & Calhoun, L. G. (2004). Post-traumatic growth: Con-ceptual foundations and empirical evidence. Psychological Inquiry, 15, 1−18.

2. Schaefer, J. A., & Moos, R. H. (1992). Life crises and personal growth. In B. N. Carpenter (Ed.), Personal coping: Theory, research and applica-tion (pp. 149−170). Westport, CT: Praeger.

3. Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology: A critical review and introduction of a two component model. Clinical Psychology Review, 26, 626–653.

4. Aspinwall, L. G. (2001). Dealing with adversity: self-regulation, coping, adaptation, and health. In A. Tesser & N. Schwarz (Eds), The Blackwell handbook of social psychology, vol 1. (Intraindividual processes) (pp. 591–614). Malden, MA: Blackwell.

517

SPIRITUAL WELLBEING IN CAREGIVERS OF GERIATRIC CANCER

SURVIVORS: THE ASSOCIATION OF PEACE, MEANING, AND FAITH

TO PSYCHOLOGICAL MORBIDITY AND RESILIENCE

Hayley S Whitford1,2, Simeon BW Jones2, Melissa J Bond2,3

1. Cancer Council Australia, Sydney, Surry Hills, NSW, Australia2. School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia3. Clinical Psychology Department, The Royal Adelaide Hospital Cancer Centre, Adelaide, South Australia, Australia

Aims: To assess caregivers’ psychological morbidity/resilience, and predic-tors of spiritual wellbeing dimensions; peace, meaning, and faith.

Methods: Of 100 anticipated respondents, 76 caregivers of geriatric cancer survivors aged ≥70 years completed a cross-sectional questionnaire; 72 clas-sifi ed as caring for curative (n = 30) or palliative (n = 42) survivors. Stand-ardised measures of depression, anxiety, stress, coping, subjective burden, mindfulness, quality of life, and spiritual wellbeing were assessed alongside study-specifi c questions of carer/survivor demographics and health characteristics.

Results: Caregivers of curative (compared to palliative) survivors evidenced higher spiritual wellbeing (p = 0.01, φ = 0.31), specifi cally higher peace and faith, and verging on signifi cance, they showed lower subjective burden (p = 0.07, φ = 0.23). Univariate correlations r ≥ 0.30 were included in linear regressions to predict spiritual wellbeing dimensions. Seven variables pre-dicted 64% (adjusted R2) of meaning’s variability (p = 0.001); individually signifi cant predictors included lower depression (β = −0.65), higher QOL (β = 0.45), and higher stress (β = 0.45) despite the opposite univariate asso-ciation between meaning and stress (r = −0.31, p = 0.001). Eight variables predicted 58% of peace’s variability (p = 0.000); three individually signifi -cant predictors included higher QOL (β = 0.56), lower burden (β = −0.37), and caring for a curative survivor (β = −0.34). A lower degree of variance (25%) including fi ve variables predicted faith.

Conclusions: Spiritual wellbeing and subjective caregiver burden appeared worse for caregivers of palliative geriatric cancer survivors. Caregivers higher in meaning and peace evidenced lower burden, lower depression, higher QOL, but perhaps meaning did not appear to buffer against stress. These and previous fi ndings on survivors suggest when spiritual wellbeing is poor, a signifi cant degree of QOL is threatened throughout the cancer journey, highlighting the recent ‘third-wave’ behavioural therapies that aid in existential concerns are of particular importance.

518

THE IMPACT OF CANCER ON DEVELOPMENT IN ADOLESCENT

AND YOUNG ADULTS: PERSPECTIVES FROM PATIENTS AND

HEALTH PROFESSIONALS

Helen Wilson, Vikki KnottUniversity of Canberra, Bruce, ACT, Australia

Adolescents and Young Adults (AYAs) face distinct developmental tasks which can be derailed by a cancer diagnosis. This study sought to identify the unmet needs of AYAs and investigate related factors in the supportive care services provided in different settings. It drew on the perspectives of both AYAs (n = 8) and health professionals with AYA experience (n = 6). Participants were recruited using opportunity sampling with in-depth inter-views continuing until data saturation was achieved (Grbich, 1999). Data were transcribed and analysed according to Braun and Clarke’s (2006) method of thematic analysis. Despite indications of distress in the AYA sample, and inadequate support from existing networks, there was limited uptake of established support and psychological care services. Reasons identifi ed included: a perceived lack of need, inappropriate timing, and the type of services offered. Many of the identifi ed issues faced by AYAs per-tained to a disruption of normal developmental processes, such as accepting responsibility for oneself, establishing an equal relationship with parents,



being fi nancially independent, and building social support networks. Poten-tial improvements to services for AYAs are identifi ed, as are areas of sup-portive care which should be targeted.

References

1. Grbich, C. (1999). Qualitative research in health: An introduction. Aus-tralia, SA: SAGE Publications.

2. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

519

DEATH ANXIETY REDUCTION AFTER ATTENDING THE

PSYCHOLOGICAL GROUP TACKLING SPIRITUAL CONCERNS

Kam Fung WongHong Kong Cancer Fund, Kowloon, HK, China

Background: Cancer is a life threatening disease that the patients are per-sistently troubled by the fear of relapse and death (Rowland, 1990). If the fear of death cannot be managed well, maladaptive consequences will occur affecting the life quality of survivors (Lehto & Stein, 2009). So a weekly 6-sessions psychological group aiming to promote an openness and acceptance to life and death was conducted. In order to measure the effec-tiveness of the intervention, the Death Anxiety Scale (Templer, 1970) was adopted.

Method: A pre and post-test design was adopted. The participants joining the psychological group tackling spiritual concerns were invited to fi ll in a set of questionnaires before and after the group. The time interval between pre and post-test was six weeks. Templer’s Death Anxiety Scale was trans-lated into Chinese and modifi ed to avoid response bias. Besides, basic demographic characteristics and disease history were collected. The data was transformed into SPSS and the variables were labeled and evaluated. 138 sets of pre and post-test data were collected and paired T test was employed.

Results: The fi ndings showed that there was a signifi cant decrease of death anxiety level of the participants after joining the group (mean −1.601, p ≤ 0.001). In order to check if any difference between the patients with different years of survival, sub group analysis was conducted. It was found that the level of decrease was similar between the group having cancer within 2 years and the group over two years.

Conclusion: The participants had a signifi cant decrease of death anxiety level after joining the group. Next stage a randomized controlled trial will be conducted to facilitate a better understanding to the effectiveness of the intervention. Video clips and contents of the group will be shown during the presentation.

520

MY CHOICE, MY VOICE: END OF LIFE PLANNING WITH

ADOLESCENTS AND YOUNG ADULTS

Sima Zadeh1, Lori Wiener1, Maryland Pao2

1. National Cancer Institute, Bethesda, MD, United States2. National Institute of Mental Health, Bethesda, MD, USA

Background: Each year, more than 11,000 adolescents and young adults (AYA), ages 15–34, die from cancer and other life-threatening conditions.1 To facilitate the transition from curative to end-of-life (EoL) care, it is recommended that EoL discussions be routine, begin close to the time of diagnosis and continue throughout the course of illness.2 3 4 The American Academy of Pediatrics, the Institute of Medicine and the World Health Organization recommend involving AYA in decisions regarding their care as much as they are developmentally ready.5 6 4 Allowing AYA involvement in EoL planning can help parents and healthcare agents make informed decisions, alleviate distress, avoid decisional regret, and improve the patient’s quality of life.7 8

Methods: Two studies were conducted to determine AYA interest in EoL planning and the specifi c aspects of EoL planning AYA want to participate in. In Study I, participants rated the helpfulness, stressfulness, and appro-priateness of concepts within Five Wishes® they believed to be important in EoL planning. A new document was then created. In Study II, participants were randomly presented pages from Five Wishes® and the newly created document, and asked to rank each item on several factors including how likely they would be to complete each statement and also on content, design, format and style.

Results: Results from both studies indicated that AYA were very interested being included in EoL planning and specifi c items to include within an advance care-planning guide. These fi ndings led to the development of My Choice, My Voice: An Advanced Care Planning Guide for AYA.

Conclusions: With the recent completion of this document, clinicians now have a tool with which they can engage AYA in EoL planning. This presenta-tion will review study fi ndings and introduce My Choice, My Voice, as well as provide guidance on how to incorporate it into care.

References

1. National Vital Statistics System, National Center for Health Statistics, CDC. 10 Leading Causes of Death by Age Group, United States. 2011. Available at: http://www.cdc.gov/injury/wisqars/leadingcauses.html.

2. Larson DG, Tobin DR. End-of-life conversations: evolving practice and theory. JAMA. 2000; 284: 1573–8.

3. Mack JW, Wolfe J. Early integration of pediatric palliative care: for some children, palliative care starts at diagnosis. Curr Opin Pediatr. 2006;18:10–4.

4. Field M, Behrman R, editors. When children die: improving palliative care and end of life care for children and their families. Washington, DC: National Academy Press; 2002.

5. American Academy of Pediatrics. Committee on Bioethics and Com-mittee on Hospital Care. Palliative care for children. Pediatrics. 2000;106(2):351–7.

6. McGrath PA. Development of the World Health Organization Guidelines on cancer pain relief and palliative care in children. Journal of Pain and Symptom Management. 1996;12(2):87–92.

7. Kane JR, Joselow M, Duncan J. Understanding the illness experience and providing anticipatory guidance. In Wolfe J, Hinds PS, Sourkes BM, eds. Textbook of Interdisciplinary Pediatric Palliative Care. Philadelphia, PA: Elsevier Incorporated; 2011: 30–40.

8. Barfi eld RC, Brandon D, Thompson J, Harris N, Schmidt M, Docherty S. Mind the child: Using interactive technology to improve child involve-ment in decision making about life-limiting illness. The American Journal of Bioethics. 2010;10(4):28–30.

521

DEPRESSION AND ANXIETY IN BREAST CANCER PATIENTS

UNDERGOING CHEMOTHERAPY

Nor Zuraida Zainal, Ong Hui Koh, Anita BustamUniversity of Malaya, Kuala Lumpur, WP, Malaysia

Depression and anxiety are common in breast cancer patients. Most cancer patients receiving chemotherapy experience psychological distress as a result of negative effects of the chemotherapeutic agents. The aims of the study were to determine the prevalence of depression and anxiety in patients with breast cancer undergoing chemotherapy and to investigate the associated factors related to depression and anxiety.

Methods: Patients diagnosed with breast cancer and attended oncology out-patient clinic for chemotherapy, were invited to participate in the study. They were assessed on socio-demographic profi les and clinical history. Hos-pital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression.

Results: Ninety-four breast cancer patients participated with mean age of 48.6 + 9.6 years. About 77% were married, 57% were Chinese, 25% Malays, 15% Indians and 3% others. Majority (87%) were newly diag-nosed breast cancer. They were on 6 cycles of chemotherapy regime.



Forty-two percent were on the 1st and 2nd cycle, 37% on the 3rd and 4th cycle and 21% were on the last two cycles of chemotherapy. The prevalence of depression and anxiety were 17.0% and 22.3% respectively. Depression was signifi cantly associated with ethnic (p = 0.019), diffi culty eating (p = 0.001), memory/concentration problems (p = 0.029), skin dry/itchiness (p = 0.035) and tingling sensations of hands/feet (p = 0.019). Anxiety was signifi cantly associated with age (r = −0.24, p = 0.018), appearance (p = 0.047), diffi culty breathing (p = 0.004), changes in urination (p = 0.018), constipation (p = 0.002), diffi culty eating (p = 0.038), indiges-tion (p = 0.005), memory/concentration problems (p = 0.052), dry/con-gested nose (p = 0.025), and tingling sensation of hands/feet (p = 0.007).

Conclusion: Breast cancer patients underwent chemotherapy experienced high level of depression and anxiety. These were mainly related to their physical problems.

522

EAT: A STEPPED WEDGE CLUSTER RANDOMISED TRIAL TO

IMPROVE NUTRITION IN HEAD AND NECK CANCER PATIENTS

UNDERGOING RADIOTHERAPY

Ben Britton1,2, Amanda Baker3, Judith Bauer4, Luke Wolfenden5, Chris Wratten5,6, Alison Beck3, Patrick McElduff7, Gregory Carter2,5

1. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia2. Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, NSW, Australia3. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia4. University of Queensland, Brisbane, QLD, Australia5. University of Newcastle, Newcastle, NSW, Australia6. Department Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia7. Clinical Trials Unit Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia

Background: Maintenance of adequate nutrition in Head and Neck Cancer (HNC) patients is challenging. The rigours of radiation treatment and the burden of the malignancy make it diffi cult to maintain suffi cient nutrition. However, health behaviour interventions designed to improve nutrition in HNC patients have not yet been evaluated.

Aims: The proposed trial builds on promising pilot data and evaluates the effectiveness of a dietitian delivered health behaviour intervention: Eating As Treatment (EAT) to reduce malnutrition in HNC patients undergoing radiotherapy.

Research design: A stepped wedge cluster randomised design will be used.

Each site will begin the study as a control hospital providing treatment as usual. Each site will receive two days of EAT training in a randomly gener-ated order and begin contributing to the intervention arm of the study.

Intervention: EAT is based on established behaviour change counselling methods, including motivational interviewing (MI), cognitive behaviour therapy (CBT) and systems change theory. EAT is designed to improve motivation to eat despite a range of barriers (pain, mucositis, nausea, reduced or no saliva, taste changes and appetite loss), and to provide patients with practical behaviour change strategies. The EAT intervention will be delivered by dietitians alongside their normal consultations.

Methods: 400 HNC patients, aged 18+ will be recruited from radiotherapy departments in fi ve Australian sites. Assessments will be conducted at fi ve time points by project offi cers blinded to the intervention allocation. Assess-ments include a nutrition assessment and self report depression screen. Treatment interruption and completion, number and length of hospital stays and dietetic contacts will be retrieved from medical records. Covariates will be documented, including mucositis; dysphagia; primary tumour site; stage; concurrent chemotherapy; surgical procedure, proposed radiotherapy dose; fractionation and overall treatment time; gender; age; live-in carer; smoking; alcohol consumption; and presence of a feeding tube.

523

A FEASIBILITY STUDY OF RELAXATION THERAPY PLUS

AUTOHYPNOTHERAPY TRAINING (HYPREL) FOR PATIENTS WITH

THORACIC CANCER UNDERGOING RADIOTHERAPY

Emma J Lewis1, Rachel Barton, Julie S Bateman, Andy Beavis, Fiona Braid, Mohammad Butt, Amulya Chaturvedi, Kay Duxbery, Andrew Greenhalgh, Claire Hebblewhite, Teresa A Hope, Claire Hutton, Michael G Lines, Mark J Stein, Martin Sykes, Lorcan O’Toole, Mary B Walker, Andrzej Wieczorek, Donald M Sharp, Leslie G Walker1. Hull and East yorkshire Hospitals NHS Trust, Cottingham, United Kingdom

As radiotherapy becomes more sophisticated, it is becoming increasingly important to minimise respiratory movement during radiotherapy planning (CT simulation) and treatment. Psychological factors such as procedure-related anxiety and pain may affect respiratory parameters2 4 6 5, resulting in sub-optimal planning and radiotherapy.

The aims of this study were to develop a psychological intervention that would minimise respiratory changes associated with procedure-related anxiety during planning and radiotherapy, and to carry out a preliminary evaluation of the effects of the intervention on respiration and quality of life during planning and radiotherapy.

The planned accrual target of 30 patients was reached with 31 patients randomised to the experimental intervention (HYPREL– relaxation, auto-hypnotherapy and exposure in vivo) or to the control group.

The primary outcome, respiratory amplitude during radiotherapy planning, was assessed objectively and repeatedly using the Varian RPM system. Secondary respiratory outcomes – amplitude variability, frequency, and frequency variability – were assessed during radiotherapy planning. Respira-tory parameters were assessed repeatedly during the course of radiotherapy, and quality of life was assessed on six occasions during the study1 3 9.

Compared to the control group, patients randomised to HYPREL had a lower mean amplitude of respiration during radiotherapy planning (ANOVA, F = 3.905, p = 0.059). There were no signifi cant differences in amplitude variability, respiration frequency, or frequency variability.

The two groups did not differ on any of the respiratory or quality of life parameters during the course of radiotherapy. This pilot study has demon-strated that HYPREL is an acceptable intervention for patients undergoing radiotherapy to the chest wall, and there is some evidence that HYPREL reduces the amplitude of respiration during radiotherapy planning, thereby potentially minimising unnecessary radiotherapy-induced damage to tissue surrounding the tumour.

In conclusion, the data from this preliminary study show that the interven-tion is feasible, and provides the justifi cation for a larger, adequately powered, randomised controlled trial.

References

1. Cella D. F., Tulsky D., Gray G., Sarafi an B., Linn E., Bonami A. et al. (1993). The Functional Assessment of Cancer Therapy Scale: develop-ment and validation of the general measure. J Clin Oncol, 11, 70–579.

2. Heap M., Aravind K. K. (2002). Hartland’s medical and dental hypnosis, 4th edition. Churchill Livingstone, London, UK. 2002.ISBN: 0443072175.

3. Marteau, T. M., Bekker, H. (1992). The development of a six item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol, 31, 301–6.

4. Walker, L. G., Walker, M. B., Ogston, K. et al. (1999). Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer, 80, 262–268.

5. Walker, L. G., Walker, M. B., Ogston, K. et al. (1999). Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer, 80, 262–268.

6. Walker, L. G. (1992). Hypnosis and cancer. Am J Prev Psychiat Neurol, 3, 42–49.



7. Walker, L. G., Dawson, A. A., Pollet, S. M., Ratcliffe, M. A., Hamilton, L. (1988). Hypnotherapy for chemotherapy side effects. Bri J Exp Clin Hypnosis, 5, 79–82.

8. Wilson, S. C., Barber, T. X., (1978). The Creative Imagination Scale as a measure of hypnotic responsiveness: applications into experimental and clinical hypnosis. Clin Hypnosis, 20, 235–249.

9. Zigmond, A. S., Snaith, R. P. (1983). The Hospital Anxiety and Depres-sion Scale. Acta Psychiatr Scand, 67, 361–37.

524

ACT IN ACTION: ACCEPTANCE AND COMMITMENT THERAPY

(ACT) PRESENTED IN A GROUP FORMAT TO CANCER PATIENTS

Sue McConagheyPsycho-oncology Service, Central Coast Local Health Network, NSW, Australia

Aim: this study considered the effi cacy of a group program of Acceptance and Commitment Therapy (ACT) in improving psychological fl exibility and decreasing psychological distress in cancer patients.

Method: 32 cancer patients with a range of cancers, recruited by advertising the program through multidisciplinary networks, participated in an ACT group for two hours a week for six weeks. Measures were the Depression Anxiety and Stress Scale (DASS), the Mental Adjustment to Cancer Scale (subscales are Fighting Spirit, Anxious Pre-occupation and Fatalism) and the Acceptance and Action Questionnaire, version 2 (AAQ-II). Data were collected at pre- and post-intervention and at 6-week follow-up. Participants also completed a group evaluation at the conclusion of the program.

Results: 26 (19 females, 7 males) of the 32 participants completed more than 5 of the 6 sessions. The fi ve groups ranged in size from 4 to 15 partici-pants. Signifi cant differences were found pre- and post-group for Depression (p = 0.0322), Stress (p = 0.0147), Fighting Spirit (p = 0.0364) and Anxious Pre-occupation (p = 0.0016). Signifi cant differences for Fatalism were found between pre- and follow-up measures (p = 0.0463). There were no signifi -cant differences between pre- and follow-up and post- and follow-up meas-ures. there were no signifi cant differences found for Anxiety (DASS) or Psychological Flexibility, nor between pre- and follow-up scores on either the DASS measures or the AAQ-II.

Conclusions: the reported changes in psychological distress support further research into the role of group programs. Further research is also needed to investigate what components of the therapy are alleviating psychological distress, given the lack of change in psychological fl exibility found in this study.

525

GROUP MEDICAL CONSULTATIONS AND IPADS FOR BREAST

CANCER SURVIVORS: FROM PILOT STUDY TO RCT

Annemiek Visser1, Hanneke van Laarhoven2,3, Margrethe Schlooz4, Thijs van Dalen5, Sandra Radema6, Judith Prins1

1. Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands2. Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands3. Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands4. Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands5. Surgery, Diakonessenhuis, Utrecht, Netherlands6. Medical Oncology, Gelre hospital, Apeldoorn, Netherlands

Background: During follow-up of breast cancer patients there is a high need for psychosocial support and information. Therefore, group medical con-sultations (GMCs) have been introduced. A GMC provides individual medical visits by the clinician conducted within a group, which is led by a behavioral health professional. This 90 minute group-visit with ~8 patients

gives patients the opportunity to spend more time with their clinician as well as to learn from other patients experiencing similar topics. However, it should be noted that group visits may also increase distress and anxiety.

Methods: In a multicenter pilot study 29 breast cancer survivors partici-pated once in a GMC instead of an individual visit.

Results: The mean patient satisfaction was 4.0 (sd 0.9) on a 5-point scale. 66% would choose a GMC in the future again. 86% experienced support from other patients. According to patients less topics were discussed during the GMC than reported by professionals.

Conclusions: GMCs are feasible and well-received. However, patients are selective in recalling medical information. Also, information needs are changing constantly. Therefore ‘My Home GMC’ is developed. Using this specially programmed iPad following the GMC, patients can join virtual group meetings or have email contact with other GMC-participants and a nurse at times and places they prefer. Additional information will be pro-vided via ‘My Home GMC’. This approach provides a unique combination of social support and professional education in an e-health environment. A future RCT will evaluate the effectiveness of GMCs combined with ‘My Home GMC’, in which the intervention group (n = 65) will participate in a GMC and ‘My Home GMC’, while the control group (n = 65) will receive care as usual. Outcome measures will be empowerment and psychological distress. In addition, the effects on cancer worry, information exchange, treatment compliance, patient satisfaction, quality of life and cost-effective-ness will be evaluated.

526

NURSE INTERVENTION PROJECT: A RANDOMIZED CONTROLLED

TRIAL TO ASSESS THE (COST) EFFECTIVENESS OF THE USE OF

THE DISTRESS THERMOMETER IN BREAST CANCER PATIENTS

Floor K Ploos van Amstel1, Judith B Prins2, Petronella B Ottevanger1

1. Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands2. Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

A guideline for screening distress in patients with cancer has been published in the Netherlands. Use of the distress thermometer (DT) is recommended. However, the effects of the use of the DT on the psychosocial wellbeing of the patient as well as the cost-effectiveness are unknown. A 2-arm rand-omized controlled trial is performed in patients treated for primary breast cancer to assess these effects of the nurse-led intervention (systematic use of the DT and its discussion by a nurse) compared to usual care provided to outpatients by their physicians. In the experimental arm the DT is collected from and discussed with patients by a trained nurse. If necessary, patients are referred to an expert professional depending on the problems encoun-tered. In the usual care arm, no DT is used and patients are referred to an expert professional if this is felt necessary by the treating physician. All patients diagnosed with primary breast cancer who will be treated with curative intent are eligible and invited. Recruitment takes place in the out-patient clinic of a university hospital. In total, 193 patients is needed. Primary outcome measure is quality of life measured with the EORTC QLQ C30. Questionnaires are obtained in both arms after completion of each treatment modality and during follow up (fi rst year every 3 months, second year every 6 months). Patients are followed from diagnosis until two years after fi nishing treatment. This study is currently recruiting participants. At this moment there are 143 participants in the study. We expect completion of accrual in November 2012. The preliminary results of the measurements during treatment will be presented. So far as we know, this is the fi rst ran-domized controlled longitudinal study about the effects of the DT as a nurse-led intervention.



527

EVALUATION OF THE EFFICACY OF TWO MODELS OF DELIVERING

INFORMATION ABOUT TREATMENT-FOCUSED GENETIC TESTING

AMONG YOUNG WOMEN NEWLY DIAGNOSED WITH BREAST

CANCER

Belinda Rahman1,2, Bettina Meiser1,2, Kaaren Watts1,2, Margaret Gleeson3, Christobel Saunders4, Gillian Mitchell5, Kristine Barlow-Stewart6, Judy Kirk7, Kathy Tucker1

1. Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia2. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia3. Hunter Genetics, Newcastle, NSW, Australia4. Department of Surgery, University of Western Australia, Perth, WA, Australia5. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia6. Centre for Genetics Education, Sydney, NSW, 20317. Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Sydney, NSW, Australia

Background: Increasingly, women newly diagnosed with breast cancer with a relevant cancer family history or other high risk features are being offered genetic testing to guide their treatment (Treatment-Focused Genetic Testing ‘TFGT’). In this randomised controlled trial, we evaluate two ways of offer-ing information about genetic testing to young women at diagnosis.

Methods: Women (<50 years) at diagnosis before defi nitive breast cancer surgery, with either suggestive cancer family history or other high risk fea-tures, are invited to participate by their surgeon. After completion of a baseline questionnaire, participants are randomised to receive information about TFGT either: a) in educational materials (Intervention) or, b) in a face-to-face genetic counselling consultation (Control). Free rapid genetic testing is offered; results are disclosed at a face-to-face genetic counselling consultation. Self-report questionnaires assess demographic information, decisional uncertainty about TFGT, surgical and psychosocial outcomes. The second questionnaire is administered after the intervention; the third questionnaire is completed 2 weeks after results disclosure, and the fourth questionnaire is completed 12 months from date of study enrolment.

Results: Preliminary results for change in decisional confl ict are reported for 62 women who completed the fi rst and second questionnaires, all of whom opted for TFGT. Decisional confl ict (DC) decreased following receipt of information about TFGT, with no difference in mean change between the two groups (Intervention N = 33, M = −13.8, SD = 20.7; Control N = 29, M = −17.6, SD = 25.8), t60 = 0.642, p = 0.523.

Conclusions: These early data suggest that both modes of delivering infor-mation about genetic testing to women at breast cancer diagnosis are equally effective.

528

A RANDOMISED CONTROLLED TRIAL OF A THEORY-BASED

SCHOOL INTERVENTION TO IMPROVE SUN-PROTECTIVE

BEHAVIOUR AMONG ADOLESCENTS

Katherine White1, Ross Young1, Anna Hawkes1,2, Kyra Hamilton3, Stuart Leske1, Louise Starfelt1

1. Queensland University of Technology, Kelvin Grove, QLD, Australia2. Cancer Council Queensland, Brisbane Queensland, Australia3. Griffi th University, Brisbane, Queensland, Australia

Aims: Melanoma of the skin is the third most commonly diagnosed cancer in Australia. Skin cancer is largely preventable by using consistent sun protection methods. Adolescents, in particular, have high levels of knowl-edge and awareness of the risks of skin cancer but exhibit signifi cantly lower sun-protective behaviours than adults. Research examining adolescents’ decision making about their sun safe actions and theory-based interventions to improve sun protection practices among this cohort are limited. Our aim

was to test a theory of planned behaviour-based school intervention to improve sun-protective behaviour among Queensland adolescents.

Methods: Approximately 400 adolescents (aged 12–17 years) were recruited from public and private schools in Queensland, Australia and randomized to the intervention or control group. The intervention focused on encourag-ing supportive sun-protective attitudes and beliefs, fostering perceptions of normative support for sun safety, and increasing perceptions of control for using sun protection. Specifi c attention was given to friendship group norms about sun protection. Intervention delivery occurred during three one-hour sessions over a three week period by trained facilitators during class time. Data were collected at one week pre-intervention (Time 1) and one week (Time 2) and four weeks (Time 3) post-intervention. Primary outcomes were sun-protective intentions and behaviour. Secondary outcomes were attitudes toward performing sun-protective behaviours, perceptions of normative support to sun protect and perceived control over performing sun-protective behaviours. The beliefs underlying these constructs were also examined.

Results: Preliminary results suggest support for the positive effect of the intervention in changing the cognitions underpinning students’ sun safe decisions, as well as evidence for a positive change in self-reported sun-protective behaviours.

Conclusions: Intensive, theory-based school interventions among adoles-cents may provide the impetus for enhancing positive sun protection beliefs and adopting effective sun safe habits in a cohort at risk for developing skin cancer in their lifetime.

529

IMPLEMENTING SURVIVORSHIP CARE PLANS IN A CANADIAN

ENVIRONMENT; UNDERSTANDING THE BARRIERS

Margaret Fitch1, Holly Bradley2, Geoff Eaton3, Janine Giese-Davis4, Jeff Sisler5, Jill Taylor-Brown5

1. Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada2. Wellspring, Toronto, Ontario, Canada3. Young Adult’s Cancer Association, St. John’s, Newfoundland, Canada4. Alberta Health Services, Calgary, Alberta, Canada5. Cancer Care Manitoba, Winnipeg, Manitoba, Canada

Background: Cancer survivorship does not come without cost. There are late and long-term effects cancer survivors experience which can compro-mise quality of life and increase suffering. Patients who are fi nishing their treatment ought to receive a survivorship care plan to assist in their coping with the after effect of treatment. The purpose of this work was to create and implement sustainable survivorship care plan approaches in our Cana-dian health care environment.

Methods: Four jurisdictions were selected through a competitive process to mount survivorship care plan projects. The jurisdictions refl ected a broad range of settings for the delivery of care plans and included a community-based agency, a cancer centre, a cancer-centre/community-based consortium (urban/rural), and a national volunteer based organization (on-line). Each designed a unique approach for using a survivorship care plan based on the template draft provided in the call for proposals. Evaluations included patient and staff satisfaction as well as program utilization.

Results: The project illustrated that use of survivorship care plans in Canada was feasible. Survivors reported that the plans helped them in understanding the next steps in their cancer journey. Each jurisdiction reported the following elements were important factors for successful imple-mentation of survivorship care plans: leadership, teamwork and collabora-tion, tailoring the care plan, education and training, communication and dissemination, and conceptualization of survivorship. Barriers identifi ed included infrastructure support (information technology in particular), process for developing the actual care plan, access to services, and engaging in robust evaluation.

Conclusions: The projects streamlined the transition from treatment to survivorship, and signifi cantly increased the capacity to address this gap in care. It is possible that the community, cancer centre, and on-line approaches could work as complementary systems to bridge gaps for survivors, offering



care plan services at various times and places to match needs along the survivorship trajectory.

530

PSYCHOSOCIAL SERVICES UTILIZED BY OLDER ADOLESCENTS

AND YOUNG ADULTS AT A COMPREHENSIVE CANCER CENTER

Jeanelle Folbrecht1, Lina Mayorga1, Christina Cabanillas, Amy Tafel, JoAnn Namm, Toni Carreras-Irwin, Marisol Trujillo1. City of Hope Cancer Center, Duarte, CA, United States

Background: To an adolescent or young adult (AYA), a diagnosis of cancer poses unique challenges to personal and social development: interrupting social relationships, halting the move towards independence, and postpon-ing achievement of educational and occupational goals. Isolation, side effects of treatment, dependence upon family members, and changes in body image lead to an interruption of identity development and often results in emotional symptoms including anxiety and depression. The goal of this research was to measure the psychosocial services utilized by AYAs in a pediatric program at a comprehensive cancer center.

Methods: The Pediatric Psychosocial Support team at a comprehensive cancer center in the United States collected data on services (emotional coping, family conference, social services, medical education, psychosocial screening, socialization, school, symptom management) rendered by the psychosocial team (psychiatry, psychology, clinical social work, child life, palliative care, chaplain) to all patients over a 2 month period. Quantity and types of services utilized were examined contrasting the Pediatric (0 to 15) and AYA (16+) age groups.

Results: A total of 1403 encounters were collected amongst 149 unique patients. Services were provided to 56 AYA patients with an average of 14 encounters per patient. Services were provided to 97 pediatric patients with 6 encounters on average. AYAs had a signifi cantly higher number of encoun-ters per patient than Pediatric patients. (p < 0.05). The top interventions provided to AYAs were emotional/coping support (44.7%), school (15.3%), socialization (15.1%), and social services (15%). The top interventions for pediatrics were emotional coping (57.3%), socialization/developmental activities (17.3%) and school (9.9). While AYAs required slightly less emo-tional/coping support, they needed more support in the area of social service (fi nancial assistance, accessing resources, and advocacy). Finally, AYAs received emotional/coping resources primary from Clinical Social Work professionals, while Pediatric patients received emotional and coping support primarily from Child Life Specialists.

Conclusion: The results suggest that AYA oncology patients continue to need outside support to address the needs that arise from a cancer diagnosis. AYA patients like pediatric patients, need support in the area of coping, socialization, and schooling. Unlike pediatric patients, however, they have many more concerns with regards to navigating fi nancial, resource, and advocacy concerns than pediatric patients and their families.

531

PSYCHOLOGICAL CORRELATES OF NOT UNDERGOING GENETIC

TESTING: A SYSTEMATIC REVIEW

Louise Heiniger, Phyllis Butow, Melanie Price, Margaret CharlesUniversity of Sydney, NSW, Australia

Background: Reviews on the psychosocial aspects of genetic testing for hereditary diseases typically focus on outcomes for carriers and non-carriers of genetic mutations. However, the majority of unaffected individuals from high-risk families do not undergo predictive testing. Recent empirical focus on these groups indicates a review of distress among these individuals is warranted.

Method: Medline, CINAHL, PsychINFO and PubMed were searched to identify studies investigating psychological distress in unaffected individuals who delay, decline or remain ineligible for predictive genetic testing.

Reference lists of eligible articles and relevant reviews were also searched to identify additional articles for review. After screening 1898 potentially eligible articles, 23 articles reporting on 19 different studies were systemati-cally reviewed and assessed for quality.

Results: Most studies were of a high quality (n = 19), with some of moder-ate (n = 2) and adequate quality (n = 2). Findings of this review suggest the defi nition of delaying and declining is not always clear cut and few studies have investigated psychological distress among individuals who remain ineligible for testing. Findings related to distress in delayers and decliners have been mixed, but more studies reported comparatively lower distress in decliners than studies reporting higher distress in this group. A number of psychological, personality and family history vulnerability factors were identifi ed for decliners and individuals who are ineligible for testing. Pro-spective studies suggest decliners and those who remain ineligible for testing may be at risk for poorer psychological outcomes, although the small number of studies and methodological limitations make it diffi cult to draw defi nitive conclusions.

Conclusion: Subgroups of those who remain untested appear to be at increased risk for psychological morbidity. As the majority of unaffected individuals do not undergo genetic testing, further research is needed to better understand the psychological impact of being denied the option of testing, declining and delaying testing.

532

A QUALITATIVE FOCUS GROUP STUDY TO IDENTIFY THE NEEDS

OF COLORECTAL CANCER SURVIVORS

Maria Y Ho1, Carolyn Gotay2, Eva Grunfeld3, Craig Earle4, Mary McBride5, Jon Sussman6, Sharon Relova5, Miranda Tsonis5, Winson Y Cheung1

1. BC Cancer Agency, Vancouver, BC, Canada2. Population Health, UBC, Vancouver, BC, Canada3. Family Community Medicine, University of Toronto, Toronto, ON, Canada4. Ontario Institute for Cancer Research, Toronto, ON, Canada5. Epidemiology, BC Cancer Research Centre, Vancouver, BC, Canada6. Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada

Aim: Most prior survivorship research has focused on issues faced by sur-vivors of childhood tumors, breast cancers, or hematologic malignancies. Little is known about the needs of other prevalent survivor groups. The purpose of this study is to identify the specifi c concerns of colorectal cancer (CRC) survivors in the key domains of physical functioning, psychological wellbeing, and social relationships.

Methods: We conducted 8 two-hour focus groups with CRC survivors in British Columbia, Canada who had completed their primary cancer treat-ment between 2009 and 2010. Patients were asked to describe the ways in which their diagnosis and treatment impacted their lives, to outline defi cien-cies in the care that they received, and to suggest ways of addressing any unmet needs. Discussions were audiotaped and transcribed verbatim. A content analysis was subsequently conducted to identify major themes.

Results: Twenty nine patients participated in the focus groups. The median age of the cohort was 60 and 52% were men. Many CRC survivors encoun-tered signifi cant diffi culties with caring for their colostomy and desired more direct guidance from healthcare providers in order to gain more independ-ence in this aspect of their health. Importantly, both men and women reported psychological distress with the change in lifestyle and self-image as a result of their diagnosis and treatment. Having survived CRC, many expressed an interest in advocacy and promotion of further research in the fi eld. Many participants also felt that it would be useful to have supportive measures and resources to connect with other CRC survivors who have had similar experiences.

Conclusion: CRC survivors face many challenges after their primary cancer treatment. Issues with colostomy are unique to this survivor group. Interven-tions to improve CRC survivorship care should also incorporate opportuni-ties for patient advocacy.



533

THE EFFECT OF CHEMOTHERAPY ON COGNITION IN PATIENTS

WITH COLORECTAL CANCER

Kristy Hodgson1, Carlene Wilson2, Ted Nettelbeck1, Amanda D Hutchinson2, Ganessan Kichenadasse3, Ian Zajac4

1. School of Psychology, University of Adelaide, Adelaide, South Australia, Australia2. School of Medicine, Flinders Centre for Innovation in Cancer, Adelaide, South Australia, Australia3. School of Medicine, Flinders University, Adelaide, South Australia, Australia4. CSIRO, Adelaide, South Australia, Australia

Aims: Chemotherapy-related cognitive impairment (CRCI) is commonly reported following the administration of chemotherapy in cancer patients. The aims were to assess whether CRCI is consistently observed in people treated for colorectal cancer and to identify the domains of cognition affected.

Method: This study comprises four sample groups, all who, except for the healthy controls, have been diagnosed with colorectal cancer; participants who have been treated with chemotherapy (n = 19), participants who received treatment with the anti-vascular drug Avastin (n = 12), participants who have received only surgery (n = 10), and a healthy control group (n = 20). Each participant undertook approximately 90 minutes of neu-ropsychological testing which assessed four cognitive domains, defi ned by Lezak, Howieson and Loring (2004): verbal functions and language skills, orientation and attention, construction, memory.

Results: A multivariate analysis of variance revealed a statistically signifi -cant difference between the groups in all four cognitive domains (F(12,143) = 1.58). Post-hoc tests revealed poorer performance for the surgery group compared to the healthy controls in verbal functions and language skills, and memory, and lower memory scores for the surgery group compared to the chemotherapy group. A univariate analysis of vari-ance showed no statistically signifi cant difference between the groups for the Everyday Problems Test. However, correlation analyses revealed statisti-cally signifi cant positive relationships between all four domains and EPT score (p < 0.01 for all correlations).

Conclusions: Results support previous reports that cognitive impairment may occur in patients treated for cancer. However, suggestions that chemo-therapy impacts cognition more than other forms of treatment are not supported by our results, with the surgery patients being the only group to be signifi cantly different in their cognitive performance from the healthy controls. The relationship between everyday problem solving and cognitive performance in cancer patients must be investigated in future research.

Reference

1. Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment (4th edn). Oxford University Press: New York, 2004.

534

FEATURES OF GENDER AND GRIEF REPORTED IN THE

EXPERIENCES OF FAMILY CARE-GIVERS SIX MONTHS AFTER A

FAMILY MEMBER’S DEATH FROM OVARIAN CANCER

EA Lobb1,2,3, PN Butow4,5, N McGowan4,5, J Mowll1, MA Price4,5

1. Calvary Health Care Sydney, Kogarah, NSW, Australia2. Cunningham Centre for Palliative Care, Darlinghurst, NSW, Australia3. School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW, Australia4. Centre for Medical Psychology & Evidence Based Decision-Making, The University of Sydney, NSW, Australia5. School of Psychology, The University of Sydney, NSW, Australia

Aims: This paper reports the grief experience of male and female family care-givers of women diagnosed with ovarian cancer, six months after the

death. Findings are drawn from a study seeking to identify predictors of poorer health outcomes in palliative care family care-givers and to identify those most at risk.

Methods: Thirty-two bereaved care-givers participating in the Australian Ovarian Cancer Study–Quality of Life (AOCS-QOL) completed the Inven-tory of Complicated Grief (ICG) and qualitative telephone interview at 6 months post bereavement, reaching data saturation. The interview explored the concept of ‘a good death’, exploring on the whole end of life period, the death itself and current grief and coping. Data were analysed using the constant comparison method based on Grounded Theory.

Results: Caregiver ICG scores indicate a trend towards high levels of car-egiver grief, particularly in male partners, although the sample was too small for formal statistical testing. Overall, the bereaved caregivers’ experience of grief indicated persistence of grief reactions, shock and distress, as well as acceptance for some. Qualitatively, grief was related to meanings attached to the death experience, including preparation for the death and the circum-stances of surrounding the death event. Participants’ responses indicated a perceived need to conform to expected grief patterns and anxieties about grief persisting in the future. Male partners in particular commonly talked of their emotional loneliness, their own physical health deterioration, as well as the use of strategies such as contemplating re-partnering, travelling and ‘keeping busy’ to counteract their grief, with varying reported success. Counselling was not widely accessed and was on the whole not felt as needed.

Conclusion: Given the intensity of grief related issues reported at six months post-bereavement, there is a need to further assess carers’ grief longitudinally and explore, sometimes pejoratively viewed, coping strategies such as re-partnering.

535

PERCEPTIONS OF PATIENT-CENTRED CANCER CARE DURING

RADIOTHERAPY TREATMENT: A CROSS SECTIONAL SURVEY

Lisa J Mackenzie1,2, Mariko L Carey2, Rob W Sanson-Fisher2, Catherine A D’Este2,3,4

1. Graduate School of Medicine, Kyoto University, Kyoto, Japan2. Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia3. Priority Research Centre for Gender, Health and Ageing, The University of Newcastle [2], Newcastle, NSW, Australia4. Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle [3], Newcastle, NSW, Australia

The aim of this study was to describe radiotherapy patients’ perceptions of patient-centred cancer care by assessing the proportion and characteristics of patients identifying the need for better care. Cancer patients receiving radiotherapy at four metropolitan treatment centres in Australia completed a touchscreen computer survey assessing their perception of whether their wellbeing would have been improved by better care. Demographic, disease and psychological characteristics were assessed. We aimed to recruit 450 patients. Of 508 eligible radiotherapy patients, 344 (68%) completed the survey. The proportion of respondents identifying that their wellbeing would have been greatly improved by better care across the eight domains of patient centred care was: information and communication (22%, 95% CI: 18–27%); emotional and spiritual support (22%, 95% CI: 18–27%); man-agement of physical symptoms (21%, 95% CI: 17–26%); support for friends and family (21%, 95% CI: 17–26%); practical concerns (20%, 95% CI: 16–25%); access to care (18%, 95% CI: 14–23%); relationship changes (16%, 95% CI: 13–21%), and staff approachability (12%, 95% CI: 8.9–16%). Thirty-one per cent of respondents (95% CI: 26–36%) endorsed two or more of these domains where better care would have greatly improved their wellbeing. Patients in younger age groups (p < 0.0001) and migrants to Australia (p = 0.02) had higher odds of endorsing multiple domains. Results of this study have indicated several areas where treatment centre quality improvement efforts should be directed. However, it is also impor-tant to consider how to improve quality of care at the level of the individual. Further investigation of why the identifi ed subgroups appear more likely to



identify that better care would be of benefi t to their wellbeing may assist in developing targeted interventions to improve patient-centred care and other outcomes for these groups.

536

WHICH TEST IS BEST? – A RCT TO EVALUATE FAMILY HISTORY

AS A TRIAGE TOOL IN SCREENING FOR COLORECTAL CANCER

Sundresan Naicker1, Bettina Meiser2, Annabel Goodwin3, Judy Kirk4, Kristine Barlow-Stewart5, Timothy Dobbins1, Brandi Baylock1, Danielle Mazza6, John Emery7, Marie Pirotta8, Lyndal Trevena1

1. School of Public Health, University of Sydney, Sydney, NSW, Australia2. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia3. Sydney South West Area Health Service, NSW Department of health, Sydney, NSW, Australia4. Westmead Clinical School, University of Sydney, Sydney, NSW, Australia5. Northern Clinical School, University of Sydney, Sydney, NSW, Australia6. Department of General Practice, Monash University, Melbourne, Victoria, Australia7. School of Primary, Aboriginal and Rural Health Care (SPARHC), University of Western Australia, Perth, Western Australia, Australia8. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia

There has been little effort to systematically screen individuals for colorectal cancer (CRC) according to their familial risk1, despite national guidelines in place2, resulting in a trend toward risk-inappropriate screening3. The study aims to evaluate the utility of an online CRC family history risk tool, in assisting GP triage to improve the uptake of risk appropriate referral for CRC screening. Phase one of this study piloted this risk tool4, which was modifi ed to improve usability for participants. This tool is now being imple-mented in a large clustered RCT with participants from general practices divided into the intervention (the online CRC familial risk tool plus 12 month follow-up) and control group (12 month follow-up, followed by the online CRC familial risk tool). The primary outcome of phase two (the RCT) is to measure whether the intervention group (who were able to access the family history website) has a higher proportion of risk appropriate screening after GP triage, when compared to individuals in the control group. Preliminary fi ndings from this RCT (n = 60), have shown that this online tool is valid in triaging individuals into an appropriate familial risk category, with fi ve participants at an high familial risk, two at moderate familial risk and 53 at average familial risk, of developing CRC. Online tracking data has shown that individuals successfully complete the tool within 24 hrs of logging into the website, while their GP’s receive a faxed copy of their risk report immediately after submission. Telephone feedback with participating general practices has confi rmed that these reports are being systematically fi led and are ready to be used as a triage tool by the GP. It is expected that this tool will signifi cantly increase the level of risk-appropriate screening in a primary care setting, while gathering epidemio-logical data about the familial penetrance rates of colorectal cancer in the complete study population (n = 7360), when this study concludes in 12 months’ time.

537

‘I’M NOT COMPLAINING BECAUSE I’M ALIVE’: CONSTRUCTING A

DISCOURSE OF CANCER-RELATED FATIGUE THAT CAN INFORM

CLINICAL PRACTICE

Maria M Pertl, David Hevey, Jean QuigleyTrinity College Dublin, Dublin, IRL, Ireland

Aims: Cancer-related fatigue (CRF) is widely acknowledged as one of the most common and distressing side-effects of cancer and treatment in the academic literature. However, this discourse of CRF is not mirrored in

the wider social context or in clinical practice where it is most meaningful to patients. The aim of this study was to construct an understanding of CRF based on the lived experiences of patients who suffer from fatigue related to cancer. Specifi cally, the factors that help to explain and sustain the absence of a discourse of CRF were explored.

Method: Thematic discourse analysis was used to analyse ‘additional com-ments’ left by 73 fatigued cancer patients and survivors (80% of whom were women) at the end of a questionnaire on CRF. Participants were recruited through cancer associations and support groups in Ireland and the United Kingdom. A constructionist approach, informed by Foucauldian discourse analysis, was used to identify latent themes.

Results: The fi ndings supported the absence of a discourse of CRF. Two explanatory themes were identifi ed: (1) a discourse of CRF is hindered because it falls outside the illness process; CRF is at odds with the schema of being a cancer survivor and it fails to fi t into the established discourse of falling ill, and (2) a discourse of CRF is actively obstructed because the enormity of cancer works to invalidate and overshadow patients’ post-cancer experiences and uses up patients’ ‘illness quota’.

Conclusion: The fi ndings suggest that beyond the lack of recognition, support, and interventions available for patients with CRF, broader dis-courses of health, illness and cancer are hampering communication regard-ing this side-effect. Alternative ways in which CRF might be handled in clinical practice, that reduce unnecessary distress and help to validate patients’ experiences while recognising the many potential contributing factors to fatigue in cancer survivors, are considered.

538

A PROSPECTIVE STUDY OF THE ROLE OF CLIENT VARIABLES IN

DISTRESS AND THERAPY OUTCOME WITHIN A COMMUNITY

CANCER COUNSELLING SERVICE

Patricia Rolls1, Sandy Hutchison1, Samantha Clutton1, Esben Strodl2, Suzanne Chambers3

1. Cancer Council Queensland, Fortitude Valley, QLD, Australia2. School of Psychology, Queensland University of Technology, Brisbane, QLD, Australia3. Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia

Background: Cancer Council Queensland provides both telephone and face to face counselling throughout Queensland via its Cancer Counselling Service. This paper will describe results of an analysis of data routinely collected from face to face clients, as well as provide a general description of the CCS and fi ndings obtained from telephone clients of the service. The study below describes the face to face clients and explores the relationship between their demographic, medical, and psychosocial variables, using cross-sectional and longitudinal data from a range of psychological measures.

Method: 452 face-to-face counselling service clients completed pre-therapy assessments (T1). 209 clients completed post therapy assessment (T2). Inde-pendent variables were demographic, medical and psycho-social factors. Dependent variables were general distress, mental health, traumatic impact, and positive affect. Analyses used were regression and structural equation modelling.

Results: Clinically reliable changes were found for most clients. A range of outcomes were seen to improve signifi cantly over the course of treatment including: general distress; traumatic stress; mental wellbeing; positive affect; life satisfaction; perceived social support and relationship satisfac-tion. Distress at T1 was strongest predictor of outcome at T2. Psychosocial factors played a moderating role at T1. Structural equation modelling dem-onstrated that T1 Distress moderated the effect of psychosocial factors on outcome at T2. Demographic and medical factors were not reliably predic-tive. Attrition reasons between T1 and T2 included ill health, death and single session-only clients.

Conclusion: This model is unique in Australia, with no other State offering comprehensive evidence based cancer-specifi c counselling delivered by



psychologists at no cost to clients. This research program has provided Level IV evidence that face-to-face and telephone therapy can have a positive effect on cancer related distress. Importantly, not only were a broad range of psychosocial problems addressed, but for most clients this can be achieved within fi ve intervention sessions.

539

SCREENING CHILDHOOD CANCER SURVIVORS WITH THE

PEDIATRIC QUALITY OF LIFE: CLINICAL UTILITY RELATIVE TO THE

YOUTH SELF REPORT

Soohyun Shin, Kyong-Mee Chung, Sul Ki Yang, Chull Joo Lyu, Jung Woo Han, Sun Hee KimYonsei University, Seoul, South Korea

Childhood cancer survivors are at an increased risk for developing psycho-logical problems, yet their problems are often under-diagnosed and under-treated. There is thus a need to identify additional ways to screen for and identify relevant psychological problems. The purpose of the present study was to evaluate the effectiveness of the Pediatric Quality of Life (PedsQL) measure as useful screening tool among childhood cancer survivors.

Participants were sixty-nine adolescent survivors of childhood cancer between ages 11 and 18, referred from the Yonsei Severance Hospital, located in Seoul, Korea. Participants completed the 120-item Korean-Youth Self Report (K-YSR) and the 23-item PedsQL. Receiver operating charac-teristic (ROC) analysis was applied to examine the assessment precision of the PedsQL with respect to being able to screen for total behavior problems and social competence relative to the K-YSR.

PedsQL Total score identifi ed general behavioral problems among childhood cancer survivors relative to the YSR Total Behavior Problem scale. Specifi -cally, the ROC Area Under the Curve (AUC) value was 0.848 – indicating good diagnostic utility. An optimal cut-off point on the PedsQL Total score was 69 which yielded sensitivity of 100% and specifi city of 80%. PedsQL School subscale was also found to be comparable relative to the YSR Social Competence scale. The ROC AUC value was 0.933 – suggesting excellent classifi cation utility. An optimal cut-off point on the PedsQL School subscale was 52.5 which yielded sensitivity of 100% and specifi city of 82.5%.

Both PedsQL subscales exceeded the recommended criteria of sensitivity ≥ 0.90 and specifi city ≥ 0.75 (Recklitis & Rodriguez, 2007), indicating that the PesQL can successfully identify adolescent cancer survivors identifi ed by the YSR as needing clinical attention. Scoring lower than 52.5 on the PesQL School scale and under 69 on the PedsQL Total score suggests clinical problems pertaining to social competence and behavioral problems, respectively.

Reference

1. Recklitis, C. J. & Rodriguez, P. (2007). Screening childhood cancer survivors with the brief symptom inventory-18: Classifi cation agreement with the symptom checklist-90-revised. Psycho-Oncology, 16(5), 429–436.

540

CLINICAL PRACTICE GUIDELINES FOR THE PSYCHOSOCIAL CARE

OF ADULTS WITH CANCER: UPDATING AND PRIORITIES FOR

AUSTRALIAN HEALTH PROFESSIONALS

Sue Sinclair1, Fleur Webster1, Trenna Morris1, Jane Turner2, Phyllis Butow3, Helen Zorbas1

1. Cancer Australia, Strawberry Hills, NSW, Australia2. The University of Queensland, Brisbane, Queensland, Australia3. University of Sydney, Sydney, NSW, Australia

Aim: The Clinical practice guidelines for the psychosocial care of adults with cancer (psychosocial CPGLs) developed in Australia and released in 2003, are widely regarded by health professionals, both nationally and

internationally. The aim was to review the guidelines to identify and priori-tise topics for updating to support ongoing evidence-based psychosocial care for people with cancer.

Methods: The psychosocial CPGLs were reviewed by Cancer Australia using a model based on engagement of key stakeholders including health professionals and consumers. A multidisciplinary Steering Committee undertook the review to identify and prioritise topics for updating, and consultation was also undertaken with a wider group of stakeholders. Topics were prioritised based on the criteria of whether there was new evidence that may change practice recommendations and clinical need.

Results: Review of the psychosocial CPGLs identifi ed two key topic areas for updating: (i) cancer suffering and spirituality issues and (ii) wellness including exercise, nutrition and fear of recurrence. Multidisciplinary working groups have been established for each topic to provide input to the systematic reviews being undertaken and to oversee the development of evidence-based topic-specifi c guidelines. The working groups are comprised of experts including health professionals, consumers, and representatives from professional colleges and endorsing bodies. This engagement model will assist in the promotion and uptake of the guidelines.

Conclusion: The 2003 psychosocial CPGLs have been reviewed for updat-ing using a model that effectively engages key stakeholders, including health professionals, consumers, professional colleges and endorsing bodies. Two key topics have been prioritised for development of evidence-based guide-lines: (i) cancer suffering and spirituality issues and (ii) wellness including exercise, nutrition and fear of recurrence. A clinical engagement model is essential to support the uptake of evidence-based practice, and thereby improve outcomes for people living with cancer.

541

DOES SOCIAL SUPPORT MEAN DIFFERENTLY FOR CANCER

PATIENTS AND THEIR FAMILY CAREGIVERS? A CROSS-

SECTIONAL STUDY IN A CHINESE COMMUNITY

Adrian HY Wan, Timothy HY Chan, Jessie SM Chan, Pamela PY Leung, Cecilia LW ChanThe University of Hong Kong, Hong Kong, China

Aim: Social support is often cited as a protective factor against stress for both cancer patients and their family caregivers, although existing literature focus on social support perceived either by patients or by caregivers alone. Little is known about the role of social support in a patient-caregiver dyad in mediating stress and mental health outcome. This study aimed to explore whether patient’s perceived social support is associated with caregiver’s mental well-being, and vice versa.

Method: 236 pairs of Chinese cancer patients and their family caregivers completed questionnaires on their perceived social support (Multidimen-sional Scale of Perceived Social Support), perceived stress (Perceived Stress Scale), mood (Hospital Anxiety and Depression Scale), and self-reported mental health (Short Form-12).

Results: Perceived social support reported by cancer patients correlated signifi cantly with that by their caregivers (support from friends: r = 0.474; support from family: r = 0.432). Regression analyses with caregiver’s and patient’s perceived social support entered as possible predictors showed that (a) patient’s own perceived support from family and friends were associated with patient’s mental health (betas = 0.160 and 0.267), mood (betas = −0.303 and −0.275), and perceived stress (betas = −0.364 and −0.148); (b) car-egiver’s own perceived family support was the only signifi cant association with mental health (beta = 0.192) and mood (beta = −0.254); and (c) car-egiver’s perceived stress was associated with perceived family support reported both by own and by patient (betas = −0.156 and −0.203).

Conclusion: The current fi ndings suggest that while Chinese cancer patients with support from either friends or family cope better, for caregivers it is family support that appears to have the protective effect. Patient-reported family support, presumably a proxy index of patient-caregiver relationship, appears to affect caregiver’s stress.



542

THE PREVALENCE AND RISK FACTORS OF PSYCHOSOCIAL

DISTRESS IN NEWLY DIAGNOSED CANCER PATIENTS

Ging-Long Wang1,2, An-Chen Feng2, Sheng-Hui Hsu2, Yi-Chen Hou2, Chih-Tao Cheng2,3

1. Psychiatry, National Yang-Ming University, College of Medicine, Taipei, Taiwan2. Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipwi, Taiwan3. Psychology and Social Work, National Defense University, Taipei, Taiwan

Purpose: Using Brief Symptom Inventory (BSI), a landmark study, with a sample size of 4496, reveals that 30 to 43% of newly diagnosed cancer patients have signifi cant levels of psychological distress (1). The Distress Thermometer (DT) has been recommended by the National Comprehensive Cancer Network for screening psychosocial distress (2). At KF-SYSCC, the DT has been used to screen distress in all new patients since 2007. The goal of this study was to assess the prevalence of psychosocial distress among different cancer types and its probable risk factors.

Method: All newly diagnosed cancer patients, who fi t the following criteria and received treatment at KF-SYSCC between 2007 and 2010, were included in this study:

1. Major cancer type, of which the total number of patients were more than 100 from this time period;

2. 2. Age 18 or older; and3. 3. DT screening done within 90 days after the diagnoses.4. The optimal cutoff was set at DT ≥ 4 (3). Rates of distress were analyzed

by cancer type, and by probable related factors such as gender, age, disease stage and pain score.

Results: Five thousand three hundred and thirty fi ve (5335) newly diag-nosed cancer patients of 12 major cancer types, seen between Jan. 1, 2007 and Dec. 31, 2010, were included in this study. Over all, 1771 (33.20%) were signifi cantly distressed. The prevalence rates varied from 22 to 36% among the cancer types. Esophageal, breast, nasopharyngeal, gastric, thyroid and lung cancers had the highest rate, while prostate and bladder cancer had the lowest. The differences were very moderate. Younger age, female gender and higher pain score, but not the stage of disease, were found correlated with higher rates of distress.

Conclusion: Between 22 and 36% of newly diagnosed cancer patients are signifi cantly distressed. The rate of signifi cant distress is positively correlated with younger age, female gender, higher pain score, but not the stage of disease. There are moderate differences in the prevalence rates by cancer type. The lack of correlation between disease stage and rate of distress may be partially related to the cultural factors in truth telling and family relation-ship (4, 5).

Clinical implications: A third of newly diagnosed cancer patients are dis-tressed and need to be referred for further assessment and intervention. The family members should be closely involved in this process in our patient population.

Research implications: Further studies are needed to evaluate the outcome of the routine screening of psychosocial distress, the follow-up assessment and intervention.

Acknowledgement: None.

References

1. Zabora J, et al. The prevalence of psychological distress by cancer site. Psycho-Oncology 10: 19–28 (2001).

2. National Comprehensive Cancer Network, Inc. NCCN Practice Guide-lines in Oncology – V.I. 2003, Distress Management, 2003.

3. Wang GL, et al. The HADS and the DT for screening psychosocial dis-tress of cancer patients in Taiwan. Psych-Oncology 20: 639–646 (2011).

4. Tang ST, et al. Cancer diagnosis and prognosis in Taiwan: patient prefer-ences versus experiences. Psycho-Oncology 13:1–13 (2004).

5. Juan Li, et al. Whether, when, and who to disclose bad news to patients with cancer: a survey in 150 pairs of hospitalized patients with cancer and family members in China. Psycho-Oncology (wileyonlinelibrary.com). DOI:10.1002/pon.1979 (2011).

543

INVESTIGATING THE USEFULNESS OF PEDIATRIC QUALITY OF

LIFE INVENTORY 4.0 AS A SCREENING TOOL FOR CHILDHOOD

CANCER SURVIVORS’ PSYCHOLOGICAL DIFFICULTIES: CLINICAL

UTILITY RELATIVE TO THE CHILDHOOD BEHAVIOR CHECKLIST

Sul Ki Yang1, Kyong-Mee Chung1, Soohyun Shin1, Chull Joo Lyu2, Jung Woo Han2, Sun Hee Kim2

1. Yonsei University, Shinchondong, Seoul, South Korea2. Yonsei Severance Hospital, Seoul, South Korea

Aims: Since some cancer survivors have been found to be at an increased risk for later psychological maladjustment [1], it is important to develop assessment tools to screen for such individuals. However, there remains a lack of screening tools available to screen for problems among youth samples. The purpose of study was to investigate the usefulness of the PedsQL in identifying youth in need of clinical attention.

Methods: Participants included mothers of childhood cancer survivors aged 8 to 18 from the Long-Term Follow-Up Clinic, Korea. 118 mothers com-pleted the 120-item Korean CBCL, a standardized parent-report tool that assesses youth behavioral and emotional problems. They also completed the 23-item PedsQL, a parent-report tool measuring youth health-related quality of life. Receiver operating characteristic (ROC) analysis is applied to examine the assessment precision of the PedsQL relative to the K-CBCL.

Results: AUC values associated with the PedsQL Total score were 0.810, 0.867, 0.898 with respect to identifying problem related to internalizing, externalizing, and overall problems, respectively. A PedsQL score of 70 yielded sensitivity of 78% and specifi city of 75% with respect to identifying internalizing problems, sensitivity of 100% and specifi city of 76% with respect to externalizing problems, and 75 yielded sensitivity of 100% and specifi city of 66% with respect to identifying youth with overall problems. These results demonstrate good diagnostic utility associated with the PedsQL relative to the CBCL with respect to identifying youth with internal-izing/externalizing problems.

Conclusion: Result suggests that PedsQL can be useful in identifying youth in need of further psychological services. The survivor whose mother reports lower than 70 point needs further psychological assessment. Particularly given the brevity of the PedsQL relative to the CBCL, the PedsQL may be useful in clinical settings to identify youth in need of more clinical attention in ways that minimize assessment burden on clients.

Reference

1. Schnoll, D.R.A.S, Knowles, J.C., & Harlow, D.L. (2002). Correlates of adjustment among cancer survivors. Journal of Psychosocial Oncology, 20(1), 37–59.

544

THE DATA OBTAINED IN THE FIRST ASSESSMENT OF DISTRESS

LEVEL CAN INDICATE FUTURE DATA: EVIDENCE INTO PRACTICE

Cristiane D Bergerot1,2, Tereza CCF Araujo2, Alexandre Nonino1, Marco M Buso1

1. CETTRO – Centro de Cancer de Brasi lia, Brasi lia, DF, Brazil2. Psicologia, Universidade de Brasi lia, Brasi lia, DF, Brazil

Distress is related to cancer diagnosis and treatment and is explicitly tied to a number of common practical, physical, and psychologic problems. Throughout cancer treatment different levels of distress can be expected and related to changes phases. Therefore, we sought to characterize the distribu-tion of distress level over three points of evaluation, considering the duration



of chemotherapy protocol (average range of two and a half months between each assessment). To compose the sample, a total of 261 patients of a Brazil-ian cancer center, completed all the phases of evaluation, through the Dis-tress Thermometer. They had a mean age of 53.3 years (SD = 15.5), 67% were women and 33% were men, most of them were married (63.2%), and 58.6% had at least college degree. The main forms of cancer were breast (27.6%), hematological (24.1%) and gastrointestinal (23.7%). In the begin-ning of the treatment (T1) 55.2% of patients were with signifi cant distress (DT ≥ 4). At the middle (T2) 21.8% of patients remained with high distress, 33.4% reduced distress level, 43.3% remained with low distress, and 1,5% increased distress level. At the last day of chemotherapy (T3) 8% remained with high distress, 15.3% reduced distress level, 71.3% remained with low distress, and 5.4% increased distress level. The demographic characteristic and the problems related distress, considering the distress level behavior over the points of evaluation will be presented at the meeting. Moreover, the present fi ndings shows a high incidence of distress, with a progressive decrease in reevaluation stages, not for all patients, which increased or persisted with high level of distress. We can observed that low distress in T1 is a good indicator for patients maintain low distress throughout the treatment.

545

STOP PAIN PROJECT: A COLLABORATIVE, INTERDISCIPLINARY

PROJECT TO IMPROVE THE PERSON-CENTREDNESS OF

ASSESSMENT AND MANAGEMENT OF CANCER PAIN

Josephine Clayton1,2, Patricia M Davidson3, Jane Phillips4,5, Tim Luckett3,6,7, Anna Green3, Meera Agar7,8,9, Andrew Broadbent1, Melanie Lovell1,2, On behalf of The STOP Pain Project Team ImPaCCT and HammondCare1. Greenwich Hospital Palliative and Supportive Care Service, Greenwich, NSW, Australia2. University of Sydney, Sydney, Australia3. Centre for Cardiovascular and Chronic Care, University of Technology Sydney (UTS), Sydney, NSW, Australia4. School of Nursing, University of Notre Dame Australia, Sydney, NSW, Australia5. Sacred Heart Palliative Care Service, St Vincents Hospital, Sydney, NSW, Australia6. Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia7. South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia8. Ingham Institute, Sydney, NSW, Australia9. Braeside Hospital, HammondCare, Sydney, NSW, Australia

Background: Cancer pain is a common, burdensome problem that is under-diagnosed and inadequately managed. Patient, provider and health system variables can either help or hinder effective pain assessment and manage-ment. Understanding these factors at a local level is critical to reduce barriers and drive improvements in clinical outcomes.

Aim: To develop methods for assessing barriers and facilitators to assess-ment and management of cancer pain at patient, provider and service levels.

Method: A sequential mixed method design is being undertaken at a single clinical service using a case study method. Environmental scanning and clinical process/patient journey mapping are being carried out by a collabo-rative involving researchers and local multidisciplinary clinical staff.

Findings: The team has developed strategies for increasing the quality and effi ciency of care for people with cancer pain. Communication with patients and coordination between different disciplines and settings have been par-ticular foci.

Conclusions: Improving cancer pain management requires an in-depth understanding of policies, systems and procedures at a local level. Clinical process mapping in particular enables a ‘patient-eye’ view of services that can be used to enhance the person-centredness of care.

546

CHARACTERISTICS OF COHORT AND BASELINE FINDINGS: A

COHORT STUDY TO EXPLORE RECOVERY OF HEALTH AND WELL-

BEING FOLLOWING PRIMARY TREATMENT OF COLO-RECTAL

CANCER (CREW (COLORECTAL WELLBEING) COHORT)

Debbie Fenlon1, Kim Chivers Seymour1, Alison Richardson1, Julia Addington-Hall1,2, Peter Smith1, Jessica Corner1, Jane Winter2, Claire Foster1

1. University of Southampton, Southampton, United Kingdom2. Southampton General Hospital, Southampton, United Kingdom

Background: Survival rates from colorectal cancer are rising. Studies suggest most people return to near pre-diagnosis status following surgery; however most have been small scale or narrowly focused e.g. physical recovery. There is a need for a large, longitudinal study exploring impact of cancer and treatment on everyday life and how this affects recovery of health and wellbeing of colorectal cancer patients.

Aims: To establish patterns of recovery of health and wellbeing; explore what infl uences this; determine who is most at risk of poor or protracted recovery; chart health service use; explore use of self-management techniques.

Methods: A prospective, longitudinal cohort study of adults from 30 cancer centres across Great Britain diagnosed with non-metastatic colorectal cancer (Dukes stage I-III) and undergoing surgery with curative intent. Question-naires are administered prior to surgery and 3, 9, 15 and 24 months later assessing health and wellbeing, symptoms, social support, health service use, self-effi cacy to self-manage.

Results: 1350 eligible people attended clinics in the 30 recruiting centres between November 2010–March 2012. 1051 (78%) consented; of which 67% gave full consent and 11% consented to medical details being collected but without completing questionnaires. 13% declined and 9% were missed. Baseline data are reported describing the characteristics of the cohort and association between outcome measures.

Conclusions: The fi ndings at baseline will inform health care providers about problems experienced prior to surgery and identify areas for sup-portive interventions. Follow-up data will identify what helps or hinders rapid and effective recovery and identify areas for intervention to support the growing number of cancer survivors.

Acknowledgement: Funded by Macmillan Cancer Support.

Contact: [email protected]

NB: We are in the process of analysing the baseline data. If this abstract is accepted, we would welcome the opportunity to update it in the next few months.

547

QUALITY OF CARE FOR BREAST CANCER PATIENTS: DISTRESS,

HEALTH CARE NEEDS AND USE

Deborah NN Lo-Fo-Wong1, Hanneke CJM de Haes1, Mirjam AG Sprangers1, on behalf of the PINK DIAMOND research group2

1. Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands2. AMC – azM – Erasmus MC – LUMC – Reinier de Graaf Gasthuis – St. Elisabeth Hospital – NKI-AVL – UMCG – UMCU, Netherlands

Aims: The primary objective is to investigate the association between the psychosocial distress levels of breast cancer patients and their concurrent and future health care needs, health care use, and health care costs, as determined at two points in time: 6 months, and 15 months after diagnosis.

There are three secondary objectives: (a) to document prevalence of and changes in distress levels, distress-related problems, health care needs, use,



and costs of breast cancer at the two points in time; (b) to determine the extent to which sociodemographic variables, psychological characteristics, enabling, clinical and psychosocial factors are associated with health care needs, use, and costs of breast cancer patients at the two points in time; and (c) to determine which health care services should be available to fulfi ll breast cancer patients’ needs at the two points in time.

Methods: In this prospective multicenter study 900 patients fi ll in a ques-tionnaire at 6 and 15 months after diagnosis. Clinical data are retrieved via medical record audits. Univariate regression analyses, hierarchical multiple regression analyses, and multilevel analyses will be used to relate the levels of distress and distress-related problems of patients (assessed 6 months after diagnosis) to their overall and domain-specifi c health care needs and use, and to their health care costs (assessed 6 months, and 15 months after diagnosis). A range of statistical methods (e.g., multiple regression analyses, structural equation modeling) will be used to attain the secondary objectives.

Expected results: We hypothesize that higher distress levels will be associ-ated signifi cantly with higher perceived need for and actual use of health care services, and with higher individual health care costs.

Expected implications: Results may be used to tailor psychosocial health care, which may reduce breast cancer patients’ health care needs, use, and costs.

548

ROUTINE SCREENING AND MANAGEMENT OF DISTRESS IN

PEOPLE WITH CANCER IN WA: A PILOT STUDY OF PEOPLE WITH

HAEMATOLOGICAL MALIGNANCIES TREATED IN AN OUTPATIENT

SETTING

Toni Musiello1, Claire Johnson2, Lisa Millar’3, David Joske4, Moira O’Connor5, Anna Petterson6, Deb Cook1

1. University of Western Australia, Crawley, WA, Australia2. University of Western Australia (UWA), CAPCREU, Perth, Western Australia, Australia3. Department of Psychiatry, Sir Charles Gardiner Hospital (SCGH), Perth, WA, Australia4. Haematology Care Centre, Sir Charles Gardiner Hospital, Perth, WA, Australia5. Curtin University, WA Centre for Cancer and Palliative Care, Perth, WA, Australia6. Sir Charles Gardiner Hospital, Solaris Care Foundation, Perth, WA, Australia

Aims: 1. To establish the prevalence of distress in patients with a haema-tological malignancy while receiving chemotherapy in a major outpatient clinic.2. To examine the feasibility of implementing the distress thermometer and

problem list in clinical practice in WA.3. To identify the services required for managing distress in haematology

oncology patients.

Method: Patients were recruited from a Haematology outpatient clinic. Each participant completed the Distress Thermometer (DT) and problem list (PL). These were then discussed with a nurse who arranged appropriate referrals. At follow up, participants completed a semi structured phone interview reporting their outcomes from the use of the DT and PL.

Outcomes: Data collection is still in process and will be reported at the full IPOS meeting, including the prevalence of distress in this population. To date, 40 individuals have been recruited; 49% are males. Ages ranged between 18 and 84 years (m = 52, sd 15.5). The majority of participants (90%) accepted referrals: 22 (55%) for nursing related information, 8 (20%) for fi nancial assistance and 3 (7.5%) for further psychological support. The mean time for the initial DT completion and PL interview between the patient and nurse was 47 minutes (sd 16.23).

In the follow up telephone interviews, participants stated that the DT and PL were easy to complete and the environment in which the initial assess-ment was carried out was suitable. Participants agreed that they would

benefi t from a distress assessment at regular intervals throughout their treatment.

Conclusions: The DT and PL are useful for identifying distress in people receiving chemotherapy for haematological malignancies in an outpatient setting. The majority of the distress can be dealt with by a nurse. However, the time required for the initial interview and follow up would produce an unrealistic time burden on the nurses working in a busy chemotherapy outpatient clinic.

549

AGREEMENT BETWEEN CANCER PATIENTS AND THEIR

RADIATION ONCOLOGIST REGARDING DIAGNOSIS AND

PROGNOSIS DISCLOSURE EXPERIENCES IN JAPAN

Lisa Mackenzie1,2, Eiji Suzuki3, Masakazu Ogura4, Mariko Carey2, Rob Sanson-Fisher2, Hiromi Asada4, Masakazu Toi3, Masahiro Hiraoka4, Kazue Tatsuno4, Catherine D’Este2,5,6

1. Graduate School of Medicine, Kyoto University, Kyoto, Japan2. Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia3. Breast Surgery, Kyoto University Hospital, Kyoto, Japan4. Radiation Oncology & Image-applied Therapy, Kyoto University Hospital [2], Kyoto, Japan5. Priority Research Centre for Gender, Health and Ageing, The University of Newcastle [2], Newcastle, NSW, Australia6. Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle [3], Newcastle, NSW, Australia

Retrospective clinician surveys are often used for assessing the content of consultations. However, concordance between clinician and patient reports of prognosis is reportedly quite poor [1]. The aim of this study was to establish agreement between Japanese radiotherapy patients’ perceived prognosis disclosure experiences, and the views of their radiation oncologist. Participants are currently being recruited from a large radiation therapy department in a single university hospital in Japan (intended sample to be recruited from April-August n = 200). Participants are asked to complete a touchscreen computer survey assessing demographic and disease factors, and their perceptions of psychosocial communication and care. In the fi rst month of the study, forty patients have given written informed consent to complete the touchscreen tablet survey and to have their survey responses compared to their clinicians’ survey responses. Preliminary analysis from 28 completed patient-clinician survey pairs suggests that agreement between patients and clinicians on whether treatment aim is palliative or not is cur-rently 96% (Cohen’s κ = 0.6, 95% CI: 0.02, 1). However, of 24 completed patient-clinician survey pairs, 21% (95% CI: 7.1–42%) of patients reported that they had discussed life expectancy discussions with their radiation oncologist, whilst radiation oncologists report that they have discussed this with 71% (95% CI: 49–87%) of patients. The observed agreement between patients and clinicians on whether life expectancy has been discussed is currently only 42% (Cohen’s κ = 0.1, 95% CI: −0.2, 0.3). Although agree-ment between Japanese cancer patients’ and clinicians on the aim of treat-ment is moderate, agreement about whether life expectancy has been discussed was found to be only slight. Clinical and research implications of this will be discussed.1. Goldstein NE, Concato J, Bradley EH, O’Leary JR, Fried TR. Doctor-

Patient Communication about Prognosis: The Infl uence of Race and Financial Status. Journal of Palliative Medicine 2005;8(5):998–1004.



550

IMPACT OF THE DIAGNOSIS OF A LIFE THREATENING ILLNESS

ON PURPOSE IN LIFE: IMPLICATION FOR PRACTICE

Elizabeth O Akin-Odanye, Chioma C AsuzuDepartment of Guidance and Counselling, University of Ibadan, Ibadan, Oyo State, Nigeria

Background: The diagnosis of a life threatening illness like cancer has psychosocial implications for patients which could affect their purpose in life. Purpose in life is very important as it gives one a reason to live and could help build a fi ghting spirit even against a life threatening illness. This study was designed to assess the difference in purpose in life between people diagnosed with cancer and otherwise healthy people.

Methods: This descriptive study involved 126 voluntary participants com-prising 62 people with confi rmed cancer diagnosis and 64 healthy controls. The cancer patients were recruited from the Radiotherapy Department of the Lagos University Teaching Hospital while the healthy participants were made up of different members of a university community. The twenty-items Purpose in Life Test (PIL) by Crumbaugh and Maholick, 1964 was validated for cultural suitability and used for data collection. Descriptive statistics, multiple regression and t-test statistics were used in data analysis.

Results: The mean age of patients with cancer and the control group was 50.16 (range 23–96) and 40.14 (range 19–81) respectively. In the cancer group, there were 6 (9.7%) men and 56 (90.3%) women while in the control group females were 41 (64.1%) and males were 23 (35.9%). A signifi cant mean difference was found in the PIL scores between the cancer patients group and the control (p < 0.05). Marital status predicted the PIL among the cancer patients, while age, gender and occupational status did not.

Conclusion: This study shows that cancer affects the purpose in life of cancer patients. This fi nding if further extended by future studies can provide the rationale for clinical psychologists, nurses and other stake holders to consider including purpose in life in the everyday assessments of cancer patients. Also psychological interventions geared towards fi nding a purpose in life can be developed to help patients experiencing existential void.

551

THE EFFECTIVENESS OF GROUP THERAPY FOR THE BEREAVED

WHO HAVE LOST THEIR PATIENT TO CANCER IN JAPAN

Kanako AmanoShiga Medical Center For Adults, Ashiya, Hyogo, Japan

Background: I held structured group therapy for the bereaved who have lost their patient to cancer using an original manual that is based on ‘the manual of group therapy for cancer patients (version 3)’ (Hosaka, 2008).

Aim: Aim of this study is to investigate mental health of the bereaved on pre-post group therapy.

Methods: Participants of group therapy: Bereaved family members who have lost their patients to cancer in the palliative care unit of my hospital within the past 6–11 months from the date of the group therapy. Schedule of group therapy: from 31/1/2008 to 26/12/2009. The number of partici-pants per group: from 4 to 9. The number of sessions and time of 1 session: Once, I held 5 sessions for 1 group (90 minutes per session) but I changed 5 sessions to 3 sessions for 1 group (180 minutes per session) because it was diffi cult to gather participants on 5 sessions. I held 3 sessions of group therapy thrice.

Facilitators: Clinical psychologist, palliative care doctor.

Contents of group therapy: Discussion, psycho-education and relaxation.

Questionnaire: Items of question about physical and mental health after bereavement, GRS (Grief Response Scale), GHQ28 (General Health Ques-tionnaire) and POMS (the Profi le of Mood States).

Results and conclusion: From GRS, GHQ and POMS scores, the effective-ness of group therapy is both promoting grief because scores of grief reac-tion, somatic symptoms, fatigue, anxiety and insomnia rose in some participants after recalling suppressed emotions and solving grief because the score of solving grief rose and group therapy reduced scores of anxiety, depression, fatigue and anger in some participants. Some widowers experi-enced diffi culties and stress in cooking so I suggested cooking books for males to them. Providing concrete information to the bereaved family is also necessary. From free comments, participants could share their feelings, relax and be encouraged.

552

PERSONAL MEANING AS ADAPTATION RESOURCE AND SPECIFIC

CONDITIONS OF SURVIVE (BREAST CANCER AND GYNECOLOGY

CANCER)

Eugenia Ananyeva1

1. Chelyabinsk Regional Oncology Centre, Chelyabinsk, Russia

We can talk about personal meaning as adaptation resource and specifi c conditions of survive for oncology patients. There are specialties of the world perception by the oncology patients in their personal meaning. If we know these specialties we can provide personal individual psychology care for the patients.

Personal meaning consists of different spheres of patients’ lives. These are religion, self-transcendence, self-acceptance, intimacy, achievement, rela-tionship, fair treatment. General personal meaning depends on the meaning of the past, present and future and this process is impressed by locus-control (internal or external). Motivation in different ways of the life expression takes part in the forming of the personal meaning. Emotional condition infl uences the attitude and the meaning sphere of the person.

Selected methods of investigation of psychological aspects of personal meaning and individual intervention strategy (for patients suffering from the Brest Cancer or Gynecology Cancer) provides studying the semantic sphere of the patients and build the individual strategy of psychological care for oncologic patients. The study is carried out in Chelyabinsk regional oncology Center for patients inpatient departments (mammary and gynecology).

Data analysis of the psychological testing of two groups of patients con-fi rmed the hypothesis that in both groups semantic spheres are alike, but the resources to enter the stable remission of mammary and gynecological patients are different because of the localization of tumor.

The psychological support recommendations based on the result of this investigation have individual character. They refl ect the specialties of per-sonal meaning sphere of the patients with different tumor localization.

553

RESEARCH ON PRIMARY SCHOOL PUPILS’ COGNITION ABILITIES

WITH ONCOLOGICAL DISEASES

Marina Aralova1, Karapet Aslanyan2, Lyudmila Goncharova2

1. Southern Federal University, Rostov-on-Don, South, Russia2. Center for Pediatric Oncology and Hematology, Regional Children’s Hospital of Rostov-on-Don, Rostov-on-Don, South, Russia

The aim of this research is the analysis of peculiarities in the cognition fi eld of primary school pupils’ with oncological diseases.

The following techniques have been used: perception span– ‘Figures recogni-tion’, ‘Words, numbers and images reproduction’; steadiness, switching, attention allocation and working effi ciency dynamics – ‘Shultz tables’; rote, mediated and notional memory – ‘10 words’, ‘Pictographs’, etc.; imagina-tion level – creative tasks as ‘Collect a picture’, ‘What does it look like?’, etc.; analysis and synthesis peculiarities – ‘Odd one out’, ‘Notions’ compari-son’; self-regulation and intention ability level – verbal instructions’ accom-plishment, etc.



Testees: 32 children of 6–9 years on the books at the Rostov regional hos-pital’s oncohematological department (acute lymphoblastic leukemia, medulloblastoma, Wilms tumor, T-lymphoid neoplasm). Average remission duration – 1.8 years. Control group – 64 people. The research has been conducted with each child individually.

The following peculiarities have been discovered among testees:

1. Memory characteristics. Rote (p = 0.045), mediate memory (p = 0.023) and development of semantic relations (p = 0.016) lag substantially.

2. Thinking peculiarities. Generalizing and abstracting processes’ weakness has been discovered in the following rates: ‘odd one out’ (p = 0.023), ‘notions’ comparison’ (p = 0.032).

3. Self-regulation level as a general studying ability’s component is lower: differences in ‘verbal instructions’ and ‘voluntary behaviour’ rates have been discovered (p = 0.046 and p = 0.016 respectively).

4. Perception span, descriptive materials’ recognition processes, attention stability, effi ciency, spatial orientation and imagination – rates are lower than in the control group, but the results are statistically insignifi cant.

5. Absence of interest, weak participation and emotional languor (at memo-rizing given words and solving refl ective problems), insuffi cient skills of subjecting actions to instructions, listening and accomplishing adults’ directions (while performing the tasks) have been noticed during the research, which infl uences the testees’ cognitive sphere retardation.

Given the found characteristics of primary school pupils’ with oncopatholo-gies, we recommend the elaboration of individual programs of their psycho-logical support in education.

554

PERCEPTIONS OF PSYCHOLOGICAL DISTRESS IN JAPANESE

CANCER PATIENTS UNDERGOING RADIOTHERAPY TREATMENT

Lisa Mackenzie1,2, Eiji Suzuki3, Masakazu Ogura4, Rob Sanson-Fisher2, Mariko Carey2, Hiromi Asada4, Masakazu Toi3, Masahiro Hiraoka4, Kazue Tatsuno4, Catherine D’Este2,5,6


The aims of this study are to establish in Japanese radiation oncology patients’: 1) The proportion of likely cases of anxiety, depression, and overall distress as identifi ed by the Hospital Anxiety and Depression Scale (HADS); and 2) the agreement between patients’ self-reported anxiety and depression levels and HADS classifi cations. Eligible participants are adult cancer patients attending radiation therapy appointments in a Japanese university hospital. Patients providing informed consent complete a touch-screen computer survey assessing demographic and disease characteristics; perceived anxiety and depression levels; and the HADS. Our accrual target is 200. After one month of recruitment, 40 patients have completed the survey. Preliminary fi ndings suggest that 20% (95% CI: 9.0–36%) of patients are likely cases of moderate-severe depression, and 13% (95% CI: 4.2–27%) are likely cases of moderate-severe anxiety. Thirty-three percent (95% CI: 19–49%) of patients are likely cases of general psychological distress (overall score ≥15). Ten percent of patients (95% CI: 2.8–24%) indicated that they would like to be offered some professional support for their current levels of anxiety and/or depression. Agreement between self-reported anxiety and HADS classifi ed likely anxiety is currently 79% (slight-moderate; Cohen’s κ = 0.2, 95% CI: 0.1, 0.6). For depression agreement between patient self-reported depression and HADS classifi ed likely depres-sion is 82% (none-substantial; κ = 0.3, 95% CI: −0.08, 0.7). Agreement between having a current desire to be offered support and HADS classifi ed likely anxiety is 89% (κ = 0.4, 95% CI: −0.01, 0.9) and depression 79% (κ = 0.2, 95% CI: −0.1, 0.6). Assessment of psychological distress using

touchscreen computers in Japanese radiotherapy treatment settings appears to be feasible. Patients’ perceptions of levels and/or desire for support for psychological distress may be a useful fi rst step in a staged approach for distress screening in this setting.

555

BODY AND SOUL TREATMENT: MUSIC THERAPY AND GUIDED

IMAGERY IN ONCOLOGY WARD

Arza Ashkenazi1, Irena Dankevich, Noam Asna1. sourasky medical center, tel-aviv, israe, Australia

Background: Cancer and its painful treatment is a period of crises for most patients. Research shows that cancer patients that were treated along side the conventional treatment, with music therapy, meditation and guided imagery, reported better overall feeling, improvement in functioning and in coping.

Aim: to provide music therapy and guided imagery in the oncology ward, in order to give the patients better tools for coping with cancer.

The patients were given questioners to evaluate the impact of the treatments.

Method: The project is being implemented for two years in the oncology ward. Music therapy is being provided in individual meetings, using many different music tools, like drums, strings and brass. The activity takes place by the patient’s bed in a jam session way, together with the therapist and it is related to the patient’s cultural and social background. The musical ele-ments are being used as a healing process.

The guided imagery is used both individually and in group therapy in a variety of ways and is adjusted to the patient’s personality. Through the process the patient goes into deep relaxation and he can experience feelings and emotions that blocks and causes pain. This process can create a change in his emotional state.

Results: The results of the questioners indicated that the treatments helped them coping better with their cancer and that they are dealing better with their anxiety and distress.

The treatments allow them to experience positive thinking that improved their quality of life.

Conclusions: All the patients were satisfi ed with the alternative treatments and requested to be part of the project whenever they are hospitalized so the team decided to continue with the project and include in it more patients.

556

KNOWLEDGE, ATTITUDE AND SCREENING BEHAVIOUR OF

SECONDARY SCHOOL MALE TEACHERS IN IBADAN NORTH

LOCAL GOVERNMENT AREA TOWARDS CANCER OF THE

PROSTATE

Chioma Asuzu, Onyinye OmeremmaUniversity of Ibadan, Ibadan, Oyo, Nigeria

Background: Prostate Cancer is the commonest cancer among the males in Nigeria. It manifests late and also has a very high mortality rate. There is need to plan programmes that will enhance the screening behaviour of the males. This study examined the knowledge, attitude and screening behav-iour of secondary school teachers in Ibadan North Local Government area (LGA).

Method: Using a multistage sampling, 200 male teachers were selected from nineteen different secondary schools in Ibadan North Local Government Area. The Instrument used for data collection was Prostrate Cancer Knowl-edge, Attitude and Behaviour scale, which is made up of fi ve subscales with reliability coeffi cient of 0.77. Of the 200 questionnaires 186 were retrieved and analysed, by descriptive statistics and Pearson product moment correla-tion as appropriate.



Result: The teachers were within the age range of 21–60 years, with a mean age of 38 years; 136 (73.1%) were married while 50 (26.9%) were single. The educational level of the participants ranged from senior secondary school certifi cate to masters degree. Some 79.0% have heard about prostate cancer, 7 1.0% know about prostate cancer screening, 56.6% of the respondents reported that they do not know where to go for prostate cancer screening; 35.5% have had any sort prostate cancer screening and among the 18.3% that had the specifi c marker antigen screening only 16.1% went back to collect the result. Of those, 91.4% did not go back to collect result because of fear of the diagnosis. A positive linear relationship was found between respondent’s prostate cancer related knowledge and perceived benefi t of screening for prostate cancer and prostate cancer screening behav-iour (p < 0.05).

Conclusion: It is recommended that prostate cancer related public health enlightenment should be organized for the public, especially for the males and their spouses in order to enable them make informed decisions about going for prostate cancer screening.

557

PATIENTS WITH SCHIZOPHRENIA AND CANCER

Joseph Barbuto1

1. Memorial Sloan-Kettering Cancer center, New York, NY, United States

The literature on the incidence of and mortality from cancer in patients with a schizophrenic disorder describes an on-going debate between those who show there is a lower incidence or that schizophrenics are immune to cancer, and those who believe the incidence is the same or greater than the normal population. Because of cognitive and perceptual defi cits among schizo-phrenic patients, their reaction to cancer may very well be distorted or unusual to the point of impairing their ability to tolerate symptoms, treat-ment, and outcome. This study presents a comparison of stage of cancer at time of diagnosis of cancer in a schizophrenic and normal population.

558

CANCER AS A LIFE-DEFINING EVENT

Joseph BarbutoMemorial Sloan-Kettering Cancer center, New York, NY, United States

There are 12 million people survivng cancer according to the NCI. Are there people affected by cancer who make sweeping life changes? A group of case reports is compiled from a clinician’s 29 year experience with cancer patients. As a result of having cancer, these patients or their signifi cant others experienced life-defi ning transition (or life change). General trends in this case population will be presented along with a few case vignettes which will amplify the trends.

559

PROGRAM DESIGN FOR STRESS MANAGEMENT IN A GROUP OF

ADMINISTRATIVE EMPLOYEES AT AN ONCOLOGY UNIT.

CARACAS–VENEZUELA

Gissell G Barreto1, Reina R Pardo, Ynirida Y Infante, Yadilka Y Marquez1. Avenida Baralt, Bucare a Maderero, Caracas, Venezuela

Background: the hospital service is an universal phenomenon that has taken importance over the last decades. Researches show that the oncology health-care personnel frequently work with users that suffer serious organic pathol-ogies and/or personal crisis; the emotional response to such circumstances is an aspect of their motivation to relief suffering and provide adequate attention, and may lead to a traumatic overburden as a consequence of repeatedly and painful confrontation with the human affl iction and death.

Method: prior to the program design, several semi-structured observations and interviews were conducted in an institution to 11 administrative

employees that have direct contact with patients and their families. The issues were addressed through the design of a behavior program for stress management in the service personnel. The program content was focused on improving communication skills by using assertiveness and organization techniques for work tasks through workshops and practical activities. The goals are improving work effi ciency, communication strategies, and reduce stressful situations among workers to achieve a harmonic work environment.

Results: results show that there are frequent irritability situations in the personnel, apathy, job confl icts, workplace absenteeism, low motivation in employees, lack of assertiveness in the relationships with patients and rela-tives, communication defi ciency among the personnel, and several other signs and symptoms that involve the presence of stress; thus disturbing the group’s effective psychosocial quality in the institution.

Conclusion: the developed program offers an important relevancy to the scientifi c community since the observed results might be applied to other areas, providing an useful experience to other administrative personnel groups that work with oncology patients or other chronic pathologies.

560

RELATION AMONG RESILIENCE, EMOTIONAL UNREST AND LIFE

QUALITY IN PATIENTS WITH CANCER ATTENDING THE

DEPARTMENT OF ONCOLOGY

Gissell Barreto1, Claudia Carbonell1. Avenida Baralt, Bucare a Maderero, Caracas, Venezuela

Background: In patients diagnosed with cancer the symptoms of the disease are related to pessimistic conditions before recovery. On the other hand, favorable emotional conditions increase life expectancy in oncological patients. Resilience refers to the individuals´ capacity to face diffi culties, to recover and manage to end up strengthen from a situation likely harmful for health. The diagnosis of cancer, the increase of symptoms of such disease pose an impact that may play against the patient should he not have an adequate response that may enable him to cope with the sickness. Emotional unrest encompasses psychological, social and existential preoccupations and interferes with his capacity to properly face his sickness and ensuing treat-ment. Its appearance occurs upon diagnosis of cancer, grieve for the current state of health, fear of death, preoccupation for loved-ones, the treatment effects or fear of relapse. Life quality is related to the degree of satisfaction the person has with regards to his physical condition, emotional state, family and social life, as well as the meaning he gives to his life. Psychological reactions before such sickness may decrease the life quality of a person who has been diagnosed with cancer and they may even unleash other disorders as anxiety or depression. This renders more diffi cult the process of under-standing and facing such sickness.

Methods: The relation between resilience, emotional unrest and quality of life is studied in cancer-diagnosed patients. A sample of 50 adults diagnosed with cancer was selected. Said patients are given chemotherapy and meas-urement instruments (using the Connor-Davidson Resilience Scale) were applied: the thermometer of emotional unrest and the Questionnaire of the European Organization for Research and treatment of Quality of Life in patients with cancer (EORTC QLQ-C30). Correlation coeffi cients were found between each pair of variables.

Results: A weak and positive correlation was found between resilience and functional scales QLC-C30, as well as between resilience and global life quality of QLC-C30 and a weak negative correlation between resilience and the scales of symptoms of QLQ-C30. All of the above seem to indicate that resilience has a rather slight relation with higher life quality and functioning level, and also with the absence of physical symptoms.

Research and clinical implications: Study of life quality and emotional unrest in patients with cancer is paramount mainly due to the threat to existence, fear of death and changes in life styles lead to by the diagnosis and treatment, as they also lead to physical, emotional, spiritual, social and occupational consequences. It is thus deemed important to assess the rela-tion existing between psychological variables as resilience in patients with



cancer, to the effect that, when intervening there may be a decrease on the emotional unrest and a positive impact in the quality of life of individuals who suffer from such disease.

Acknowledgement of funding: Instituto de Oncología y Hematología (IOH) [Institute of Oncology and Hematology in Spanish]. Universidad Central de Venezuela.

561

SCREENING FOR DISTRESS AND QUALITY OF LIFE: THE

RELATIONSHIP BETWEEN THEM AND THE SEVERITY OF THE

DISEASE

Cristiane D Bergerot1,2, Paulo G Bergerot1, Tereza CCF Araujo2, Marco M Buso1

1. CETTRO – Centro de Cancer de Brasilia, Brasi lia, DF, Brazil2. Psicologia, Universidade de Brasi lia, Brasilia, DF, Brazil

The quality of life (QoL) evaluation can better contextualize the psychoso-cial problems experienced by patients over the disease trajectory, as well as, monitor the quality of cancer care and the effi cacy of psychosocial interven-tion/treatment. Moreover, elevated level of distress have been linked with reduced health-related QoL. A longitudinal study was carried out to inves-tigate the relationship between high level of distress (DT ≥ 4) and QoL, throughout the chemotherapy. For this assessment was considered three points in the treatment protocol, with an average interval of two and a half months between them (fi rst day – T1; middle – T2; last day – T3). A sample of 161 patients, completed the Distress Thermometer and the Functional Assessment of Cancer Therapy – General. Of those, 29.8% were male and 70.2% female, with a mean age of 56 years (SD = 14.9; range 19–84 years). The main forms of cancer were gastrointestinal (33.4%), breast (29.8%) and hematological (21.7%). About 36.4% had early stage (I and II) disease and 63.6% late stage (III and IV). At T1 distress level was signifi cant related to QoL score (r = −0.73, p < 0.001) and QoL to disease stage (r = −0.16, p < 0.05). At T2 and T3 distress was related to QoL (r = −0.65, p < 0.001; r = −0.59, p < 0.001). Accordingly with this preliminary data distress was related to QoL over all treatment phases: fear of the unknown (T1), adapta-tion to side effects and the cancer reality (T2) and apprehension with the end of treatment (T3); and the disease stage just with QoL at T1. This results suggest the importance of distress and QoL screening routine, since this allows an in-depth look at the patient’s psychosocial health care needs, improving not only the psychosocial service as the quality of cancer care.

562

PSYCHOSOCIAL FACTORS INFLUENCE THE ADAPTATION OF

CANCER DIAGNOSIS/TREATMENT: ASSOCIATION BETWEEN

DISTRESS AND COPING STYLES

Cristiane D Bergerot1,2, Tereza CCF Araujo2, Marco M Buso1

1. CETTRO – Centro de Cancer de Brasi lia, Brasi lia, DF, Brazil2. Psicologia, Universidade de Brasilia, Brasi lia, DF, Brazil

Coping refers to the cognitive and behavioral activities by which a person attempts to manage a potentially stressful situation. This study aims to investigate the association between distress level and coping styles in 161 patients from a private cancer center, located in Brasília, the capital of Brazil. They were between 19 and 84 years of age (M = 56; SD = 14.9), of both gender (29.8% male and 70.2% female), most of them married (61.5%), 61.5% had at least the college degree, with several types of cancer (gastroin-testinal, breast and hematological were the main diagnosis). All patients answered the Distress Thermometer and the Ways of Coping Checklist 20 days after receive the diagnosis, on the day of the beginning of chemo-therapy treatment. A signifi cant proportion of patients (42.9%) reported high level of distress (DT ≥ 4), of these patients the main coping strategy used to deal with diagnosis/treatment was seeking social support (27.5%) and painful problem solving (27.5%), followed by escape-avoidance (13%), confrontive coping, distancing and self-control (8.7% for each one). Those

patients (57.1%) with low level of distress (DT ≤ 3) chose the social support (28.3%), problem solving (25%), distancing (23.9%), positive reappraisal (8.7%) and self-control (7.6%). There were similarities and differences between group of patients with high and low of distress level. For both social support and problem solving were the most strategy used. The third one could be considered a similar construct of avoidance/denial (escape-avoidance and distancing). This preliminary fi ndings suggest that individuals who appraise their cancer illness as a threat are likely to use more social support and planful problem solving coping strategies. We suggest future studies to evaluate the relationship between coping and demographic and disease characteristics.

563

SUFFERING IN CANCER – CONCEPTUALIZATION, ASSESSMENT

AND INTERVENTIONS. A SYSTEMATIC LITERATURE REVIEW

Megan Best1, Lynley Aldridge1, Phyllis Butow1, Melanie Price1, Helen Zorbas2, Fleur Webster2, Ian Olver3

1. PoCOG, University of Sydney, NSW, Australia2. Cancer Australia, Sydney, NSW, Australia3. Cancer Council, Sydney, NSW, Australia

Existential or spiritual suffering is one of the most debilitating conditions found in cancer patients and yet is a neglected area of care because of the lack of conceptual understanding and defi nition, few documented interven-tions, and the absence of appropriate training for healthcare providers. Failure to recognize suffering may result in treatment of the patient with cancer in such a way as to increase suffering. A literature search focusing on the conceptualization, assessment and management of suffering across all cancers was undertaken.

The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases. To ensure a suffi ciently broad range of conceptualizations of suffering in cancer were identifi ed, the search strategy was drafted using an iterative process, using results of preliminary searches to develop a list of concepts identifi ed as synonymous with suffering, or potentially measurable ‘symptoms’ of suffering in the literature. Following the development of a defi nition of suffering, validated instruments for measurement of this phe-nomena were identifi ed and specifi c interventions proven to effective allevi-ate suffering were sought.

Although there is no universally recognized defi nition of suffering, it is generally accepted to be experienced by the whole person. There is disagree-ment as to the benefi t of identifying the different domains where suffering is focused: social, physical, psychological or spiritual/existential. While this process may assist in identifying triggers and symptoms of suffering, it may impede an holistic approach to care. Suffering results from personalization of illness and the meaning attributed to symptoms by the individual patient must be understood before symptoms can be fully addressed.

Suffering in cancer patients is a signifi cant problem which needs to be diagnosed before treatment can proceed. The literature was reviewed in order to improve patient care by educating healthcare providers regarding how to understand the concept of suffering, how to identify it in patients, and what interventions may be of benefi t.

564

INVESTIGATING THE ENGAGEMENT OF CANCER PATIENTS AND

SURVIVORS INTO PSYCHOLOGICAL TREATMENT

Rachel Brebach, Phyllis Butow, Paul Rhodes, Louise SharpeSchool of Psychology, University of Sydney, Camperdown, NSW, Australia

Living with and beyond a diagnosis of cancer is associated with increased risk of psychological morbidity. Much research has highlighted the need to improve the identifi cation of cancer patients and survivors who may benefi t



from psychological assistance. Once barriers to the identifi cation of such patients are overcome, however, patient-centered barriers to accepting psy-chological help are also evident. Of those cancer patients who are identifi ed as being distressed, anxious or depressed, a referral to psychological services is only desired or acted upon in 25% to 36% of cases. There has been very little investigation into the large proportion of cancer patients who, once identifi ed as being distressed, anxious or depressed, opt not to pursue psy-chological treatment once it is offered. Our studies are examining barriers to cancer patients and survivors accepting psychological treatment when it is offered and factors infl uencing this decision, as well as investigating how engagement is maintained once treatment begins. The views and experiences of both cancer survivors and psychologists who treat cancer patients and survivors are being examined. Fear of Cancer Recurrence (FCR) is one of the most frequently reported concerns related to cancer survivorship, and is associated with anxiety, depression, and reduced quality of life. Cancer survivors who have clinical levels of FCR (assessed using the 42-item Fear of Cancer Recurrence Inventory) and have been offered psychological treat-ment, are being recruited for semi-structured interviews about engagement in treatment. Psychologists are being recruited to participate in an expert panel to create guidelines for best practice in engaging cancer patients and survivors into psychological treatment. It is hoped that these studies will identify potential strategies to better manage the psychological impact of cancer and cancer survivorship.

565

PSYCHO-EMOTIONAL EXPERIENCE AND THE CRITICAL FACTORS

IN 80 ELDERLY PATIENTS UNDERGOING TERMINAL CANCER

STAGE

Francesco Buda1, Emerenziana Basello1, Adriana Lugano1, Laura Pagani2

1. City of Udine Hospital, Udine, Italy2. Statistics Sciences, University of Udine, Italy, Udine, Italy

From January 2007 to December 2011, 80 terminal cancer pts have been assessed before hospital discharge in favor of a palliative care customized program in order to assess the psycho-emotional experience and the critical factors.

Method: The sample was represented by 52 males (65%, average age 67.6, range: 53–81) and 28 females (35%, average age 73.2, range: 58–83), who have been submitted to a semi-structured interview which track included: state of conscience, interactive skills, communication, awareness (diagnosis and/or prognosis), evaluation of the prevalence of neuropsychiatric disor-ders (anxiety/depression)

Results: 63.7% (51/80 pts) was vigilant in relation to mental status, 23.7% (19/80 pts) conscious, 12.9% (10/80 pts) confused or unconscious. Interac-tive skills were spontaneous in 61.2% (49/80 pts), mediated by the family in 19.7% (15/80 pts), under stimulation in 14.7% (11/88 pts), absent in 6.5% (5/80 pts). The communication has been convenient and truthful in 36.2% (29/80 pts), with awareness of the diagnosis in 25% (20/80 pts) and of the prognosis in 11, 2% (9/80 pts). Overall, in 20% of the cases (16/80 pts) neuropsychiatric disorders have been detected abnormal cogni-tive-behavioral and affective disorders) and in 36.2% (29/80) anxiety dis-orders (17/29 pts, 58.6%) and depression (12/29 pts, 41.3%).

Conclusions: Altogether our data indicate an intense psycho-emotional dis-tress at the time of hospital discharge, with a percentage of neuropsychiatric disorders in line with literature (10–20%) but with a higher prevalence of two symptoms: anxiety (58.6%) and depression (41.3%). The critical factors are as follows: awareness of illness (diagnosis and/or prognosis to terminality) and communication patient/caregiver/family. Even on the basis of these data, we believe that, within the relational process with patient and family, even at this stage of disease, it is necessary to implement the provi-sion of counseling to facilitate relationship with the person and to improve the performance of care giving assistance.

566

REDUCING SYMPTOMS WITH SPA THERAPY – A PILOT TRIAL TO

IMPROVE QUALITY OF LIFE IN PALLIATIVE CARE PATIENTS [THE

RESPAT PROJECT]

Tracey Bullen1, John Rosenberg2, Rachel Bilton-Simek3

1. Calvary Centre for Palliative Care Research Australian Catholic University, Barton, ACT, Australia2. Calvary Centre for Palliative Care Research Australian Catholic University, Barton, ACT, Australia3. Clare Holland House, Barton, ACT, Australia

Aims: Palliative care services are increasingly utilising complementary inter-ventions to improve symptom management and quality of life for patients with end-stage illnesses. However, the clinical evidence for complementary interventions in palliative care populations remains limited. Clinical studies evaluating spa therapy with other patient populations suggest this interven-tion reduces pain severity and anxiety. The aim of this research was to conduct a pilot study to evaluate the use of spa therapy in a palliative care setting with a group of palliative cancer patients to investigate the impact of spa sessions on their perceptions of pain and emotional distress.

Methods: The planned accrual target for this pilot study is 30 participants. To date, six patients with a palliative diagnosis admitted to hospice for symptom management consented to participate. These participants com-pleted 20 minute spa sessions once every two days over a period of two weeks utilising a therapeutic spa system. Participants’ perceptions of psy-chological distress and pain are assessed prior to and following each spa therapy session. Patients are followed up weekly to assess quality of life utilising the McGill QOL scale.

Results: Results will be analysed using a repeated measures analysis of variance. To detect differences in perceived levels of psychopathology and pain and minimise multiple comparisons the means from the post treatment sessions for each scale will be calculated to create a summary score. The signifi cance of the variability of changes will also be analysed.

Conclusions: It is hypothesised that spa therapy sessions decrease subjective reports of pain and distress and improve subjective perceptions of QOL. The prospective nature of this study will allow an assessment of perceptions of pain and distress following a non pharmacological intervention. Amelio-ration of psychological and physical symptoms is key to assist patients to improve quality of life during end-stage cancer. If therapeutic spas reduce pain and improve psychological well being, non pharmacological interven-tion has the potential to enhance the effectiveness of pharmacological treat-ments for pain and distress whilst easily being integrated into standard clinical palliative care practice. Consistently offering a non pharmacological intervention such as spa therapy may also improve the quality of the pallia-tive care experience for patients, carers and staff.

Acknowledgement of funding: Calvary Centre for Palliative Care Research.

567

THE EXPERIENCE OF CANCER AMONG INFORMED AND NON-

INFORMED INDIAN CANCER PATIENTS: A QUALITATIVE STUDY

Mahati Chittem1, Paul Norman2, Peter Harris2

1. Indian Institute of Technology Hyderabad, Yeddumailaram, AP, India2. Psychology, University of Sheffi eld, Sheffi eld, Yorkshire, UK

Aims: Nondisclosure of cancer diagnosis is found to be associated with poor patient quality of life and high levels of distress, thereby creating disparity in patient care. Although nondisclosure is common practice in India, little is known about the experience of nondisclosure (versus disclo-sure) among Indian cancer patients.

Methods: Using purposive sampling techniques, Indian cancer patients who had been disclosed (n = 6) or non-disclosed (n = 4) of their cancer diagnosis were recruited. Patients participated in semi-structured interviews exploring their experiences of their illness, how they were coping, and their attitudes



about truthful disclosure of a serious illness. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis.

Results: Disclosed patients reported reacting to the cancer diagnosis with either a matter-of-fact acceptance or shock. They also used a range of coping strategies including social comparisons to deal with their illness. Non-dis-closed patients reported feeling entrapped and desiring death as a conse-quence of the illness experience, and they remained passive and relied on their doctor for emotional support. Almost all the patients believed that truthful disclosure of a serious diagnosis was important and preferred.

Conclusion: Indian non-disclosed cancer patients’ intense negative experi-ence of their illness is both novel and an important fi nding. The fi ndings suggest that the overall experience of cancer for non-disclosed patients is worse than for disclosed patients, with disclosed patients using a range of coping styles while non-disclosed patients using only passive coping. This may be due to differences in the quality of patient care given to each group. In order to overcome these disparities, non-disclosed patients should be provided additional psychological support to cope with their situation. Interestingly, almost all patients preferred truthful disclosure of a serious illness, suggesting a need for a better understanding of what patients want in terms of cancer care.

568

GRIEF COUNSELING EXPERIENCES OF BEREAVED CHILDREN IN A

MEMORIAL SERVICE

Ching-Hui Chung1

1. Mackay Memorial Hospital, New Taipei City, Taiwan

Memorial services are important ceremony in bereavement care in hospice. There are different bereavement needs under different culture and social, economical. The best time to invite the bereaved to a memorial service was from three to six months after a patient died. Memorial services were designed for bereaved adults in hospitals, but not including their children. Most of bereaved adults don’t know how to talk about death with children, think children don’t understand the meaning of death and don’t hope them contact with hospitals. The bereaved children’s feelings and grief were ignored easily. This case report investigated bereaved children whose were from three to six months after their father or mother died and elementary school students between fourth and sixth grade participated an exclusive memorial service. In the process of grief counseling, the authors employed the fundamental communication skills with four principles ‘Ask-Tell-Ask’, ‘Tell me more’, ‘Respond to emotion’ and ‘Assess their coping style’ to induce them to recall their life and relationships in the family and school in the past few months and assess their grief reaction and adjustment in Sep-tember 2011. The authors also employed creative activities to express their emotions that may be diffi cult in just talking grief. Bereaved children try hard to learn correct understanding of death, build a new relationship with their surroundings and adapt themselves to the new life, so they need com-panionship and positive support. The authors hope to develop the memorial service of bereaved children in Oncology and hospice. This case may provide a reference for treating similar clinical cases in the future.

569

THE THEME OF DEATH IN THE TRANSCRIPTS OF ADULT

ATTACHMENT INTERVIEWS IN CANCER PATIENTS:

A PILOT STUDY

Cristina Civilotti, Valentina Furno, Giulia Di Fini, Martina Cussino, Fabio VegliaUniversiti degli Studi di Torino, Torino, Italy

The attachment theory recognizes the biologically-based need for protective proximity to a conspecifi c in the case of perceived vulnerability. The activa-tion of attachment is primed ‘from the cradle to grave’1, especially in the presence of events – intensive or prolonged – that involve pain, danger, fatigue or protracted vulnerability. It is hence apparent how cancer may

represent a threat to the patient’s life or physical integrity, which will acti-vate this system.

Previous research showed how complications in the activation and modula-tion of the attachment system are associated with a recursive thought of traumatic memories2 and a decreased ability of the working memory to function3–6.

The aim of this pilot project was to study the narrative Theme of Death in a group of oncological women (N = 15) compared to a sample of healthy women (N = 15), through the analysis of the Adult Attachment Interview (AAI) transcripts.

The AAIs were transcribed verbatim and coded according to the criteria of George, Kaplan and Main7. Transcripts were then analyzed at a lexical and a semantic level within the framework of the Grounded Theory8.

The Theme of Death was used ‘out of context’ in 60% of patient transcripts (N = 9), compared to only 26.7% (N = 4) of the control group. Three types of occurrences were identifi ed: 1. in reference to a loved one; 2. in the context of loss in general; 3. in co-occurrence with one’s own illness. The second and third types are found only in patients’ transcripts, as if the Theme of Death entered within the context of attachment, in a typical and possibly perturbing form. Preliminary results will be discussed with the use of transcript excerpts.

From a clinical perspective therefore, the importance of investigating the potentially disturbing effect of cancer on the thought processes assumes particular importance.

References

1. Bowlby, J. (1979). ‘The making and breaking of affectional bonds’. New York: Brunner-Routledge.

2. Hesse, E., Van Ijzendoorn, M.H. (1999). Propensities toward absorption are related to lapses in the monitoring of reasoning or discourse during the Adult Attachment Interview: A preliminary investigation, Attachment and Human Development, 1:67–91.

3. Hesse, E., & Main, M. (2006). Frightened, threatening, and dissociative (FR) parental behavior as related to infant D attachment in low-risk samples: Description, discussion, and interpretations. Development and Psychopathology, 18, 309–343.

4. Clark, C.R., McFarlane, A.C., Morris, P., Weber, D.L., Sonkkilla, C., Shaw, M., et al. (2003). Cerebral function in posttraumatic stress disor-der during verbal working memory updating: A positron emission tom-ography study. Biological Psychiatry, 53:474–4

5. Moores, K.A., Clark, C.R., McFarlane, A.C., Brown, G.C., Puce, A., & Taylor, D.J. (2008). Abnormal recruitment of working memory updating networks during maintenance of trauma-neutral information in post-traumatic stress disorder. Psychiatry Research: Neur.

6. Weber, D., Clark, C.R., McFarlane, A., Moores, K.A., Philip, M., & Egan, G.F. (2005). Abnormal frontal and parietal activity during working memory updating in posttraumatic stress disorder. Psychiatry Research: Neuroimaging, 140(1):27–44.

7. George, C., Kaplan, N., & Main, M. (1996). The Attachment Interview for Adults. Unpublished Manuscript, Department of Psychology, Univer-sity of California, Berkeley (3rd Edition).

8. Glaser, B.G. & Strauss, A.L. (1967). Discovery of grounded theory: Strategies for qualitative research. Hawthorne, NY: Aldine de Gruyter.

570

RELATIONSHIPS BETWEEN STRESSORS, DEPRESSION AND

SALIVARY PH IN OLDER PERSONS WHO CARE FOR SPOUSES

WITH CANCER

Rabia Khalaila1, Miri Cohen2, Jamal Zidan1. Zefat Academic College, Zefat, Israel2. University of Haifa, Haifa, Israel

Background: Caregiving for an older spouse with cancer is a stressful event which impacts negatively on health. Recently, studies have focused on iden-tifying physiological markers of stress. The pH in saliva, which has not been



studied in the past in the context of stress of care, is a potential biomarker, since the pH level is likely to decrease in stressful situations due to activation of the sympathetic nervous system. Decrease in the pH level indicates an increase in saliva acidity.

Aims: To examine the effects of the stress of caregiving appraisal on depres-sive symptoms and level of pH in saliva among spouses of cancer patients, and examine the sense of mastery and coping strategies as possible media-tors in the relation between the two.

Method: Cross-sectional data were collected in 2011 by a structured inter-view from 68 convenience sampled cancer patients’ spouses, and 42 age-matched individuals in the community. Linear regression analysis was used to examine the study objectives.

Results: The saliva pH level among cancer patients’ spouses was lower than in the matched group. Lower levels of pH were predicted by higher stress appraisal and greater depression; and lower sense of mastery. Depression was predicted by higher stress appraisal and emotion-focused coping, and by lower sense of mastery and problem-focused coping.

Conclusions: The analysis showed that the level of pH in the saliva indicates more acidity in case of continuous stressful events such as caregiving of cancer patients, particularly among the spouses. However, more studies are still needed to show if the saliva pH level could be the potential marker of stress level.

571

ACCULTURATION AND UNMET PRACTICAL, SUPPORTIVE AND

INFORMATIONAL NEEDS OF LATINO CANCER PATIENTS

Rosario Costas-Muniz, Francesca Gany, Julia Ramirez, Thelma McNish, Jennifer Leng, Abraham AragonesMemorial Sloan Kettering Cancer Center, New York, NY, United States

Background: There is limited research on the unmet needs of Latinos diag-nosed with cancer. The literature has focused on symptom assessment and psychological needs for predominantly Caucasian patients. Thus, we have little understanding of the specifi c needs of immigrant and minority patients.

Purpose: This study explores the practical, supportive and informational needs of Latino cancer patients and examines what acculturative variables are associated with these needs.

MethodS: A cross-sectional needs assessment was conducted with Latino cancer patients in cancer centers of New York City. The survey was provided in the patient’s preferred language and focus areas included support service, practical and informational needs. Descriptive statistics and logistic regres-sion was used for the analyses.

Results: Two hundred and ninety Latino patients participated with a mean age of 55 years (60% females). Twenty-nine per cent of the overall sample described themselves as monolingual in Spanish. Ninety-six per cent of patients reported having unmet needs, with unmet fi nancial (79.3%) need being most prevalent. Only 12% of the patients requested additional infor-mation about their diagnosis and treatment. After controlling for sociode-mographic characteristics, the acculturative factors that were independently associated with having unmet practical needs were: being an immigrant with limited English profi ciency (LEP) or monolingual, more recent immigration, and requesting interpretation for health care. The same acculturative vari-ables predicted lower informational needs. Support needs were not predicted by the acculturative factors.

Implications: The prevalence of unmet needs among Latino cancer patients is substantially high. More recent Latino immigrants with limited English profi ciency are in need of additional practical support. Further studies should focus on identifying why these patients do not express a need for informational services. Patients may benefi t from psychoeducational inter-ventions that aim to empower patients to take a more active role and request more information about their disease and treatment.

572

SELF-REPORTED COPING STRATEGIES AND PREDICTORS OF

DISTRESS FOR HOSPITALISED CANCER PATIENTS

Sue De Bono1, Lynda Katona, Stuart Lee1. The Alfred, Prahran, Vic, Australia

What are the factors that may increase the risk for hospitalised patients of experiencing psychological distress and what are the stratergies that are used by patients to help in coping with thier illness? To address this gap, the current cross sectional-study presented data that was collected as part of a 12 week trial of routine bedside screening for psychological distress in patients admitted to an Australian public hospital cancer service. A total of 115 patients completed screening using the Distress Theromometer and Problem Checklist and 18-item Brief Symptom Inventory (BSI-18). Only past psychiatric history and being newly diagnosed were signifi cantly cor-related with increases global distress and anxiety (all p < 0.01). Multiple regression analysis found that the current number of emotional and physical problems were signifi cant unique predictors of global distress. Patients reported an array of stratergies as being helpful in coping with their illness and these were clustered around four themes. For clinicians working with hospialised cancer patients, not only being aware of identifi ed risk factors for depression, anxiety and distress but also the strategies that patients use to cope with their illness, is important in ensuring the provision of holistic and effective care.

573

BENEFITS OF MINDFULNESS BASED GROUP THERAPY ON

CANCER DISTRESS AND QUALITY OF LIFE IN HOSPITALIZED

WOMEN WITH BREAST CANCER IN ROMANIA

Csaba Degi, Tunde SzilagyiBabes Bolyai University, Cluj-Napoca, Cluj, Romania

Background: Hospitalized cancer patients in Romania experience high level of cancer distress: 47.5% are clinically depressed, 46.7% suffer from anxiety disorders and 28.1% report critically low quality of life. Development of patient-focused psychosocial services in oncology in Romania is imperative.

Aims: In our project we investigate the impact of a mindfulness based group therapy on reduction of anxiety, depressive symptoms and on improvement of coping resources and quality of life in a sample of hospitalized breast cancer patients from Romania. Also we aim to inform professionals, espe-cially in Romania, about the benefi ts of the Mindfulness-Based Stress Reduc-tion (MBSR).

Methods: We will carry out our intervention with breast cancer in-patients at the Institute of Oncology ‘Prof. Dr. Ion Chiricuta’ in Cluj-Napoca. Instru-ments used in this clinical study: HADS scale, FACT-G 4.0 and the Ways of Coping Questionnaire. The intervention group will include in-patients with breast cancer, who receive regular chemo and/or radiotherapy treatment, and who will take part in six group meetings based mostly on Russ Harris’s mindfulness model.

Results and conclusions: Signifi cance of our work should be highlighted as this is the fi rst MBSR intervention in Romania. Data about our recently started project will be reported at the meeting.



574

PSYCHOLOGICAL CARE FOR PEOPLE AT HIGH RISK OF

MELANOMA: DEVELOPMENT AND PILOT TESTING OF

A PSYCHO-EDUCATIONAL INTERVENTION

Mbathio Dieng1, Jordana K McLoone2, Bettina Meiser3,4, Phyllis N Butow5, Kristine Barlow-Stewart6, Graham J Mann7,8, Scott Menzies9,10, Anne Cust1, Nadine A Kasparian2,4

1. Cancer Epidemiology and Services Research Group, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia2. School of Women’s & Children’s Health, Faculty of Medicine, University of NSW, Kensington, NSW, Australia3. Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia4. The Children’s Hospital at Westmead, Westmead, NSW, Australia5. Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, NSW, Australia6. Centre for Genetics Education, Royal North Shore Hospital, St Leonards, NSW, Australia7. Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead, NSW, Australia8. Melanoma Institute Australia, North Sydney, NSW, Australia9. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia10. Prince of Wales Clinical School, University of NSW, Kensington, NSW, Australia

Aim: The aim of this study was to develop and pilot test a psycho-educa-tional intervention to address the supportive care needs of people at very high risk of developing melanoma. The intervention aimed to improve patient understanding of melanoma risk, and promote healthy psychologi-cal, social and behavioural adjustment, as well as improve doctor-patient communication, following melanoma diagnosis.

Methods: The content of this intervention was developed using an iterative process based on: (a) extensive consultation with expert researchers and clinicians from a range of disciplines; (b) a 10-year history of work by our group with people at high risk of developing melanoma; and (c) the Trans-actional Model of Stress and Coping. The process of intervention develop-ment was undertaken in accordance with the NH&MRC guidelines on ‘How to present the evidence for consumers’, and the Medical Research Council guidelines on developing complex interventions.

Results: The intervention has been evaluated by 30 melanoma survivors (15 at high risk, and 15 at moderate risk, of developing melanoma) and 10 health care professionals (dermatologists, psychologists, nurses, GPs). All participants were asked to complete a questionnaire assessing the acceptabil-ity, relevance, and comprehensibility of the resource, as well as the quality, quantity and balance of information presented. In addition, melanoma patients were asked to complete measures of psychological distress, melanoma-related knowledge, perceived risk, and unmet supportive care needs. Data analyses are currently being undertaken and will be reported at the meeting.

Conclusion: This Phase II trial will provide preliminary data on intervention acceptance, feasibility, and psychological effi cacy in preparation for a larger randomised controlled trial to begin in 2013.

575

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 Tel, Metin Ozkan1. Erciyes University, Kayseri, Turkey

Study was conducted to determine the effect of relaxation exercise on fatigue, depression and level of quality of life in diagnosed with breast and

colorectal cancer within patients under chemotherapy. Study was conducted at Chemotherapy Unit of M. Kemal Dedeman Oncology Hospital at Erciyes University. Study sample was composed of 70 patients diagnosed with breast cancer and colorectal cancer, who were taking adjuvant chemotherapy for the fi rst time and who were being planned to take ambulatory adjuvant chemotherapy lasting at least 3 cures. Study group was applied relaxation exercise. Effect of the exercise was evaluated by measurement instruments prior to every chemotherapy cure and on the 7th day of ending cure being measured for 6 different times during 3 cures. Data were collected with questionnaire form, Piper Fatigue Scale, Beck Depression Scale and EORTC QLQ C-30 Quality of Life Scale. Data were statistically analyzed with Pearson correlation analysis, Independent Samples t Test, Pillai’s Trace Test which is one of the one-variable general linear models and with Bonferroni Test. Fatigue level of the study group patients was high compared with controls and by measurements and inter group comparisons it was found that fatigue scores in study group decreased while increased in control group. Depression scores were found to be lower in study group and higher in control group. Quality of life increased in study group patients who were applied relaxation exercise. Depression and fatigue scores were positively correlated and while depression increased, fatigue increased and quality of life effected as negative. Lactic acid level which is thought to be one of the physical parameters of fatigue was lower in study group patients who were applied relaxation exercise compared to controls. Consequently, it was recommended to regularly evaluate fatigue, depression and quality of life levels of subjects diagnosed with cancer within general care, to conduct further clinical trials to emerge the effi ciency of relaxation exercises, to use devices like I-pod for applying relaxation exercises during chemotherapy, to integrate relaxation exercises into routines at chemotherapy units.

576

PSYCHOLOGICAL OUTCOMES OF CANCER SUPPORT GROUP

PARTICIPATION AMONG WOMEN WITH BREAST CANCER IN

THE PHILIPPINES

Jo Anne R Dumalaon-CanariaDepartment of Psychology, Ateneo de Manila University, Quezon City, Philippines

This study explored the experience of cancer support group participation among women with breast cancer in the Philippines. Using the case study method, a total of eight women were interviewed. Yalom’s group therapeutic factors and Lepore’s social cognitive processing model guided the analysis. Results of the study showed that helpful factors found in a support group is sense of security, outlet for thoughts and feelings, guidance and informa-tion, hope, joy and respite. Outcomes gained from participation are sense of meaning and purpose. However diffi culties with regards to fears of recur-rence, metastasis, and death were also expressed. The challenge being posed by this study is how limitations of support groups be addressed and how psychologists could assist them in this domain.

References

1. Janoff-Bulman, R. (2006). Schema change perspectives on post-traumatic growth. In L. G. Calhoun, & R. G. Tedeschi (Eds). Handbook of post-traumatic growth: research and practice, 81–99. New Jersey: Lawrence Erlbaum Associates.

2. Lepore, S. J. (2001). A social-cognitive processing model of emotional adjustment to breast cancer. In A. Baum, & B. L. Andersen (Eds). Psy-chosocial Interventions for Cancer (1st ed, 99–118). Washington D.C.: American Psychological Association.

3. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed). New York: Basic Books.



577

THE STAGGERING INCREASE OF CANCER AND AIDS PATIENTS

SEEN AT ADVANCED STAGE IN YAOUNDE GENERAL HOSPITAL:

THE ONLY WAY OUT IS A PALLIATIVE CARE STRUCTURE

Anncommy B Ekortarh1, Brigitte M Takuefou, George Enow-orock1. Yaounde General Hospital, Yaounde, Cameroon

Aim: The increasing number of palliative care cases from cancer and AIDS patients is now considered to be a public health crisis and there is urgency for a palliative care services to be put in place.

Methods: Interview was conducted, questionnaires were fi lled and medical records were reviewed for cancer patients who were hospitalized to undergo chemotherapy. HIV/AIDS data was collected during consultations, medical fi les review at the hospital. Statistics from the NACC, NCCC and cancer registry provided evidence that the number of advanced cases are tripling yearly.

Results: There is a signifi cant increase in the number of cancer and AIDS patients who are in their advanced stages of their illness and are in need of palliative care services. With 15000 new cancer cases diagnosed yearly, 70% of these cases present at advanced stage. One million infected cases in Cameron, 39% of these cases are in the advanced stage and about 19% at the End of Life stage. One research indicates that each year close to 220.000 cancer and AIDS patients are in need of palliative care services in Cameroon. Approximately 70% of these cases are abandoned to their families who will in long run be abandoned to themselves to die painfully in shame and distress.

Conclusion: The investigation brought to light and awareness the actual number of cancer and AIDS patients who are in dying need of a structured palliative care service in the community or in a hospital setting. It is a crisis for the families, health professional and the government.

578

PSYCHOSOCIAL CORRELATES AND DEPRESSIVE

SYMPTOMATOLOGY AMONG ATTENDEES OF AN ONCOLOGY

CLINIC IN WEST AFRICA

Babatunde Fadipe, Andrew T Olagunju, Olatunji F AinaLagos University Teaching Hospital, Lagos, Nigeria

The prevalence of depressive symptomatology in persons suffering from cancer has been documented to varied degrees and may impact negatively on the course and outcome of cancer treatment. Our study set out to deter-mine the psychosocial correlates of depression among patients with cancer attending an oncology clinic. The study participants were two hundred subjects receiving cancer care at the oncology clinic of a university teaching hospital. They were recruited into the study having met inclusion criteria and after informed consent was obtained. The participants were subjected to designed questionnaires to elicit their socio-demographics/clinical profi le and the Centre for Epidemiological Studies Depression Scale Revised (CES-DR) to characterise depressive symptomatology in them. Data was analysed using the Statistical package for social sciences, version 16.

Depressive symptomatology based on CES-DR score ≥16 was present in 49% of the participants. Among cancer subjects in this study, depressive symptomatology was signifi cantly correlated with an individual’s marital status (Correlation co-effi cient [r] = −0.124, p- 0.013), educational status (r = 0.102, p- 0.041), social support (r = −0.128, p- 0.011), stage of cancer (r = −0.323, p < 0.01), family history of mental illness (r = 0.148, p- 0.003), presence of physical complications (r = 0.355, p- < 0.01), and the presence of pain (r = 0.277, p- <0.01). We found no signifi cant relationship between depressive symptomatology and age, employment status, illness duration and a past history of psychiatric illness.

Conclusion: It is recommended that a holistic approach with full inclusion of mental health services be employed in the care of individuals with cancer.

579

EFFECTS OF PALLIATIVE CARE ON TERMINALLY ILL BREAST

CANCER PATIENTS

Omolara O FagbenleUniversity College Hospital, Ibadan, Oyo, Nigeria

Aim: This study considers the general approach to palliative care by health professionals and response from the patient, family and society. It seeks to reduce client’s pain as much as possible and maximize available resources. It fi nds out how clients perceive their condition and observe the effects.

Method: A prospective case-series was conducted on the terminally ill breast cancer patients. Both primary and secondary sources of data were used to obtain substantial information for the study through personal obser-vation and interviews.

Result: A total of 10 patients were involved in the study. Nursing interven-tion reduced the psychosocial and physical pains drastically as observed from pain score of severe to mild. Clients and families got the right informa-tion, understood disease treatment and how to manage the situation. Fami-lies acquired knowledge and skills to care for the patient and themselves. Established nurse- client’s- relatives confi dence promoted good relationship for them to express their feelings and problems in a relaxed atmosphere.

Conclusion: Palliative care is a holistic approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness through prevention and relief of suffering by means of early identifi cation assessment and treatment of pain and other physical, psychosocial and spiritual problems.

580

RESTORE: DEVELOPMENT AND TRIAL PROTOCOL OF AN ONLINE

INTERVENTION TO ENHANCE SELF EFFICACY TO SELF MANAGE

CANCER RELATED FATIGUE FOLLOWING PRIMARY TREATMENT

Chloe Grimmett, Mathew Breckons, Lynn Calman, Jessica Corner, Debbie Fenlon, Alison Richardson, Peter Smith, Lucy Yardley, Claire FosterUniversity of Southampton, Southampton, Hants, United Kingdom

Background: The majority of cancer survivors will experience some adverse effects as a result of their cancer and its treatment. Lack of information and support can make managing these problems challenging for survivors, par-ticularly among those with low self-effi cacy. Here we describe the develop-ment and exploratory trial protocol of the RESTORE online intervention to enhance self-effi cacy to self manage cancer related fatigue.

Methods/design: Informed by the MRC guidance on developing and evalu-ating complex interventions, this intervention was developed in partnership with survivors, Macmillan partners, clinicians and academic experts. A prototype was created and underwent user testing. A two-armed ran-domised controlled trial will compare the RESTORE intervention with a ‘Coping with Fatigue’ leafl et. The intervention consists of fi ve weekly ses-sions with components and activities informed by self-effi cacy theory. The study population consists of cancer survivors within fi ve years of completion of treatment with curative intent (target sample size N = 125). An initial pilot phase will determine feasibility and acceptability of proposed methods. The primary aim is to test the value of the intervention (‘proof of concept’) to increase self-effi cacy to manage fatigue related problems. Secondary aims include impact on the perception and experience of fatigue and quality of life. Outcome measures will be collected at baseline, 6 weeks (completion of intervention) and 3 months. Process evaluation (including telephone interviews) will also be conducted.

Discussion: Data from this trial will be used to refi ne the intervention and conduct a full-scale RCT. We hope to roll out the intervention in clinical practice and expand it to address other cancer related problems important to survivors following primary cancer treatment.



581

CANCER SURVIVORS’ SELF-EFFICACY TO SELF-MANAGE

PROBLEMS ARISING FROM PRIMARY CANCER AND ITS

TREATMENT: RESULTS OF AN ONLINE SURVEY

Claire Foster, Phil Cotterell, Matthew Breckons, Deborah FenlonMacmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom

Background: Previous research suggests that higher levels of self-effi cacy in people affected by cancer can result in improved health care outcomes including self-care behaviours and decreased physical and psychological symptoms. The aim of this survey was to assess self-effi cacy in relation to self-management of problems associated with primary cancer treatment in the year following treatment.

Methods: The survey was carried out online and contained several validated questionnaires including the Chronic Disease Self-Effi cacy Scale, Brief COPE and the Quality of Life in Adult Cancer Survivors scale. 182 people were recruited over 4 months. Eligible participants were UK residents, aged over 18 and within 12 months of completing cancer treatment. Statistical analysis was performed to examine levels of self-effi cacy and its associations with self-management and other outcome measures.

Findings: 147 women and 35 men completed the survey representing 20 different cancer types. Respondents reported a range of self-effi cacy scores and these were associated with self-management activity and problems reported. Regression models indicated that several variables were predictive of a low self-effi cacy score including: having a more threatening perception of cancer, having a low subjective sense of well-being, experiencing a high level of fatigue/low amount of energy and having limited social support.

Discussion: Findings from this survey provide important baseline data and contribute to the understanding of the role of self-effi cacy in the self-man-agement of cancer/treatment related problems. Our analysis indicates who may be in need of support to self-manage cancer related problems. Screening for self-effi cacy across a number of areas should inform assessment to self-manage and interventions designed to increase self-effi cacy in specifi c domains may be helpful for cancer survivors.

Acknowledgement: Funded by Macmillan Cancer Support.

582

SUPPORTING ONCOLOGY NURSES: INTRODUCTION TO A NEW

PROGRAM BASED ON MEANING AND MINDFULNESS

Lise Fillion1, Melanie Vachon2,3, Christine Goyette2,3, Patricia Dobkin4

1. Nursing, Laval University, Quebec city, Qc, Canada2. UQAM, Montreal, Que, Canada3. CRISE, Montreal, Que, Canada4. Medicine, McGill University, Montreal, Quebec, Canada

Oncology and palliative care nurses are commonly faced with different emotional stressors such as: repeated grief, death confrontation or witness of patients and families’ suffering. Most importantly, those emotional stres-sors are embedded into organizational context in which the staff are exposed to organizational and professional stressors of various kinds. In order to support oncology and palliative care nurses, an existential group-interven-tion, based on meaning-making, has been developed and tested by Fillion et al. (2006). The fi rst objective of this presentation is to report the accu-mulated empirical evidence on this existential intervention (Fillion et al. 2006–2011). The strengths and limitations of the intervention will be dis-cussed. Based on our previous fi ndings, we suggest that a mindfulness approach, combined with the existential approach, would be helpful to support oncology and palliative nurses. Therefore, our second objective is to present the empirical and theoretical bases of a Mindfulness approach to supplement the existential intervention. To this end, scientifi c studies on stress reduction as well as humanistic and theoretical foundations of the concept of presence will be underpinned. We will also present our

participative research program that aims at implementing this new interven-tion on a specialised palliative care unit.

583

HUMOUR AND FOBT: TAKING THE FEAR OUT OF CANCER

SCREENING FOR THE UNDER AND NEVER SCREENED

Dionne Gesink1, Levni Yilmaz2, Brooke Filsinger3, Sarai Racey1, Alanna Mihic1, Joan Antal3, Susan Bondy1

1. University of Toronto, Toronto, Canada2. Tales of Mere Existence, San Francisco, USA3. Cancer Care Ontario, Toronto, ON, Canada

Aims: Colon cancer screening rates are lower than targeted in Ontario. Further investigation indicated that a large proportion of the under and never screened population is illiterate and that the written fecal occult blood test (FOBT) instructions are too complex and wordy for illiterate, low lit-eracy, and English as a second language populations. Our purpose was to develop a humourous FOBT instructional video to overcome this barrier.

Methods: The Ontario FOBT written instructions were used as the basis for the instructional video script. Artist sketches and group consensus was used to develop an appropriate character. An iterative process with focus group feedback was used to work towards a fi nal video.

Results: Various versions of the video were tested on the regional under/never screened project teams (physicians, nurses, outreach workers), rural community members (n = 7 groups), small town (n = 4), and suburban community members (n = 2 groups). Men had a strong and uniformly posi-tive reaction to the video, requesting that it be on TV and stating that it was ‘Superbowl brilliant’. Women’s reactions ranged from reserved positive to strongly positive. All felt confi dent and optimistic about performing the test after watching the video. Family health team clinicians indicated they wanted the animation on loop in their clinic waiting areas.

Conclusions: Providing an uncomplicated, humourous instructional video can increase awareness of cancer screening, alleviate test fear, increase confi dence in performing test, and change attitudes towards screening.

584

DEVELOPMENT OF A SEXUAL HEALTH CLINIC FOR GYNECOLOGIC

CANCER SURVIVORS

Margaret I Fitch, Lauran Adams, Cathy Doyle, Alison McAndrewSunnybrook Odette Cancer Centre, Toronto, Ontario, Canada

Introduction: Gynecologic cancer treatment can have a profound impact on women. In particular, cancer treatment can impact sexual function and sexuality and include issues such as pain, bodily changes, alternation in body image, shifts in relationships, and emotional distress. We created an innova-tive specialized clinic to address the concerns about sexual health, rehabilita-tion, and quality of life following cancer treatment for women with gynecologic cancer.

Methods: The initial clinic visit involves an in-depth assessment by the nurse using a customized tool, based on the Supportive Care Framework, with other standardized measures. The assessment helps to tailor interven-tion related to physical, psychosocial, informational and practical patient concerns. Brief counseling and education are provided by the nurse and individualized resource packages are provided. Subsequently the patient returns for a second appointment with the physician and nurse together. Referral is made to social work or psychology as required.

Results: Of the 168 women who attended the clinic, 95% had surgery, chemotherapy, and radiation. The most frequently identifi ed problems were fatigue (75.6%), depression (58.3%), anxiety (62.5%), fear (45.8%), pain (45.8%), appearance (44.6%) and weight change (44.0%). Feedback about the clinic is very positive with ratings being primarily ‘very satisfi ed’. In particular, women reported their information needs were met through the



interaction with the staff. Learning how to better manage the effects they were experiencing and learning more about community-based resources were cited as helpful and contributed to reducing their anxiety.

Conclusion: This presentation will describe the design of our sexual health clinic for women following gynecologic cancer. The nature of the practice will be described in terms of the issues women bring forward, the interven-tions offered, and the resulting impact on patient outcomes. Given the emerging survivor issues regarding sexuality, this clinic offers an effective model for providing care to this population.

585

MEASURING PSYCHOSOCIAL DISTRESS IN COMMUNITY-BASED

VOLUNTEER AGENCIES

Margaret I Fitch, Alison McAndrew, Kittie PangSunnybrook Odette Cancer Centre, Toronto, Ontario, Canada

Distress has been recognized as the 6th vital sign in cancer. Screening for distress has engendered attention in clinical settings as a strategy for iden-tifying, through self-report, what patients are most concerned about during a clinic visit and having a conversation about what interventions would be helpful. Recently, interest has been expressed from community–based cancer support organizations about the relevancy of screening for distress in their settings. The purpose of this project was to develop and fi eld-test a distress screening approach in community settings.

The project utilized a literature review to identify relevant screening tools for a community-based setting. Focus groups with patients/survivors, vol-unteers, and staff members of community-based agencies were held to explore the idea of distress screening in their setting. A new approach to distress screening was designed based on the feedback and implemented in three community organizations.

The literature contains many standardized tools to identify distress. During focus group discussions, participants were very clear about what would be suitable for application in the community-based setting, especially given their philosophy of creating an inviting, supportive and home-like environ-ment. The distress screening approach we designed is embedded in a con-versation rather than a paper-based or computer generated survey. Items cited for distress rating or measurement are crafted for the community-setting and include issues apt to be of concern to patients/survivors in that environment. Pilot sites were able to incorporate the screening measurement approach effectively in their member intake and follow-up procedures.

This presentation will highlight the literature and focus group fi ndings, describe the new approach to screening and outline the early experience with implementing the new distress screening approach.

586

CANCER PATIENT NAVIGATION: IMPLEMENTING PROGRAMMATIC

APPROACHES

Margaret I Fitch1, Sandra Cook2, Shaun Lorhan3

1. Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada2. Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada3. BC Cancer Agency, Victoria, British Columbia, Canada

Introduction: One of the main concerns expressed by cancer patients and their family members is uncertainty about the pathways of care. Many have indicated in needs assessment surveys that they do not understand the way their care will be organized or how they are to access services and supports. Navigation has been described as an intervention that can assist patients and families in understanding the cancer system and how to move through the various settings and providers.

Purpose: Our work was designed to understand the differences in profes-sional, peer/lay and self navigation approaches in cancer care and under-stand the competencies needed for each.

Methods: Through literature review, focus groups and implementation of demonstration programs, evidence was gathered regarding how to best implement cancer patient navigation approaches, navigator roles and responsibilities, and support the development of navigator competencies.

Results: Key lessons emerged from the implementation of patient naviga-tion projects: the importance of engaging leadership, the need for a clear vision and program elements, and the critical contribution of education and evaluation. Patient satisfaction with navigation was high although health care professionals struggled with clarity of roles and responsibilities as a new member of the cancer care team was introduced. Education ought to be developed in order to achieve the defi ned competencies for professional, peer and self navigation.

Conclusions: Cancer patient navigation can be an effective augmentation to the existing cancer care delivery system. It is critically important to select the correct type of navigation approach to fi ll the identifi ed gaps in care delivery in a jurisdiction.

587

CANCER REHABILITATION IN THE PRIVATE SECTOR:

ESTABLISHING A CANCER REHABILITATION PROGRAM FOR

WOMEN WITH EARLY STAGE BREAST CANCER

Jane Fletcher1,2, Sue Burney1,2, Michelle White3, Jenny Macindoe1, Joanne Brooker1,2, Sue Liersch4, Brian Anthonisz1, Anne-Marie Cassano1, Danielle Feil1, Jenny Glowrey1, Caroline McFarlane1, Natalie O’Connor1, Manasi Salvi1, Talya Samueil1, Penny Westgate1

1. Cabrini Health, Malvern, Vic, Australia2. School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia3. Medical Oncology, Southern Health, Melbourne, Vic, Australia4. Southern Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia

Breast cancer is the most common cancer in women living in Australia, accounting for 27% of all diagnoses in 2007. It was also the leading cause of burden of disease for females in 2010. Previous research has highlighted the utility of cancer rehabilitation programs for a range of tumour streams including breast cancer. The aim of cancer rehabilitation is to improve physical, social and psychological outcomes during and after treatment. Based on the end of treatment program for early stage breast cancer ‘Yes-terday, Today and Tomorrow’ conducted at Cabrini Health, a private hos-pital in Melbourne, a pilot breast cancer rehabilitation program has been developed to address the rehabilitation needs of women with early stage breast cancer. The program will function as an adjunct to the existing rehabilitation service and has a physical reconditioning and psycho-educa-tion component. In this paper the establishment of the program will be described and data on the outcomes of the fi rst three months presented.

588

FAMILY HISTORY OF BREAST CANCER: CLINICAL IMPLICATIONS

FOR RELATIONAL HEALTH PROMOTION DERIVED FROM A

SYSTEMATIC REVIEW

Liz Forbat1, Farhana Haseen1, Pamela Flynn1, Sandra Menzies1, Liz Reed2, Karen Scanlon2, Sally Adams1, Ian Thomas3, Gill Hubbard1

1. University of Stirling, Stirling, Stir, United Kingdom2. Breast Cancer Care, London, UK3. NHS Highland, Inverness, UK

Background: Managing the psychosocial impact of breast cancer in families affected by the disease is important in increasing access to timely screening, enhancing self-care and managing the impact of the diagnosis in oneself or in relatives.

Methods: A systematic review of the literature was conducted to explore the impact of breast cancer on families and identify psychosocial interven-tions that have been tested to support families affected by breast cancer.



Findings: Key factors in the relevant articles reported psychosocial out-comes (anxiety, depression, distress, and sexual functioning) and managing breast cancer risk and genetic testing. Interventions to support those with a family history prioritise psychological variable such as worry and risk per-ception, or promote self-care behaviours such as breast self-examination, mammography attendance and increasing physical activity.

Conclusions: Health services have the opportunity to use relational and familial networks to promote self-care and target interventions to manage psychosocial sequalae of enhanced risk. We propose a relational model of health promotion as being particularly salient for heritable conditions, where interventions can reduce risk and promote psychosocial adjustment.

589

HEALTH-PROMOTING COMMUNITIES FOR FAMILIES AFFECTED BY

CANCER: A QUALITATIVE STUDY

Julie Watson1, Michelle Hadjiconstantinou2, Gill Hubbard3, Liz Forbat3

1. University of Edinburgh, Edinburgh, UK2. University of Leicester, Leicester, UK3. University of Stirling, Stirling, Stir, United Kingdom

Background: Ensuring the information and support needs of people affected by cancer are met presents a considerable public health challenge. Informa-tion needs alter throughout the cancer journey, indicating the need for fl exible and ongoing access to information. Information needs are inextri-cably linked with emotions such as hope, fear, anxiety and depression.

Objective: To examine experiences of receiving information and support for people affected by cancer, as part of a larger formative evaluation of two community-based cancer information and support services.

Methods: Thirty service users and twenty professionals were purposefully sampled, and interviewed about their experiences and views of a cancer information and support service. Accounts were examined using thematic analysis.

Results: Participants perceived information and support as intersecting. Participants valued access to lay knowledge and peer support, which was seen as augmenting healthcare professional knowledge and support. People affected by cancer benefi tted from the development of community networks for the provision of information and support. Indeed, the co-location of information and support services in the community was felt to provide additional levels of support throughout people experiences of cancer.

Conclusion: Embedding support and information services in the community draws on health promotion principles, which privilege the creation of sup-portive environments, strengthening of community action and the reorienta-tion of health services away from individualistic clinical approaches. Thus, acknowledging the signifi cant role of community networks improves care since it impacts the context which shape people’s experiences of cancer from health-beliefs, through to diagnosis, survivorship and end-of-life care.

590

TRANSITION TO PALLIATIVE CARE FOR PEOPLE LIVING WITH

METASTATIC MELANOMA: PRELIMINARY FINDINGS FROM A

GROUNDED THEORY STUDY

Jennifer Fox, Patsy Yates, Carol Windsor, Shirley ConnellQueensland University of Technology, Kelvin Grove, Qld, Australia

Melanoma is the most aggressive form of skin cancer. Five-year survival rates for patients with metastatic melanoma are less than 10%, with a median survival of 6 to 9 months. Despite a number of clinical trials for metastatic melanoma, the treatment options for patients are limited. Pallia-tion is often the main goal of treatment.

This constructivist grounded theory study is seeking to examine how people with metastatic melanoma negotiate the transition to palliative care. The

method of sampling is purposive and data have been generated through semi-structured interviews with those with metastatic melanoma and part-ners. Open, focused and theoretical coding of data from 13 interviews conducted to date has produced analytical concepts that refl ect how the transition is negotiated. These concepts depict ways in which individuals interact with a fragmented health care system and how meanings are con-structed around the rapid progression of the disease and uncertain treatment decisions.

The preliminary fi ndings reported upon here are being further explored with a larger sample. The fi ndings to date highlight the need for improved coor-dination of services for those living with metastatic melanoma, and improved support for individuals dealing with uncertainty.

591

WHAT IS THE NATURE AND THE NEEDS OF PROSTATE CANCER

SUPPORT GROUPS IN AUSTRALIA?

John Friedsam1, Laura Kirsten2,3, Amanda OReilly4, Rachel Zordan3

1. Prostate Cancer Foundation of Australia, Lane cove, NSW, Australia2. Napean Cancer Care Centre, Penrith, NSW, Australia3. Centre for Medical Psychology and Evidence-based Decision Making, University of Sydney, Sydney, NSW, Australia4. Cancer Services, Northern Sydney, Royal North Shore Hospital, Sydney, NSW, Australia

Background: At the last federal election funding was allocated to improve the existing prostate cancer support group network through the Prostate Cancer Foundation of Australia (PCFA). Specifi cally, funding was allocated to provide training and support for prostate cancer support group leaders. In order to do this effectively, more information is needed about the nature of these groups and their leaders. As such, the aim of this study is to gain a comprehensive understanding of the highly diversifi ed community based prostate cancer support groups currently in existence in Australia and to examine the group leaders’ existing training and training needs.

Method: The study utilises a cross-sectional design and will be a nation-wide study including male and female leaders of prostate cancer support groups affi liated with the PCFA (currently 118 groups). A telephone inter-view will be conducted with the leader for each group, in order to assess each of the following factors: i) the organisational structure of the group, ii) practical features and modalities of the support group, iii) the aims of the group and the needs it sets out to address: e.g. social, psychological, practical, informational, advocacy, awareness, iv) degree of integration with the health system or with voluntary organisations, and any funding or support provided, v) existing levels of group leader training and vi) willing-ness to take part in future research or training for prostate cancer support groups affi liated with the PCFA. Interviews will be digitally recorded.

Results: to be presented at the conference.

Conclusion: Detailed mapping of the nature of the groups will be the fi rst step in the development of targeted resources and skills training provision. Results will also provide the framework to target and encourage the evi-dence based growth of new groups.



592

‘BRIGHTER IN THINKING, LIGHTER IN BODY AND STRONGER IN

MIND’ EXPLORING THE EXPERIENCES OF PATIENTS USING

COMPLEMENTARY THERAPIES

Bonnie J Furzer1,2, Anna Petterson2,3,4, Kemi Wright1, Timothy Ackland1, David Joske1,2,3, Karen Wallman1

1. University of Western Australia, Crawley, WA, Australia2. Collaborative Research Team, SolarisCare Foundation, Perth, Western Australia, Australia3. Sir Charles Gairdner Hospital, Perth, Western Australia, Australia4. Edith Cowan University, Joondalup, Western Australia, Australia

Objectives: The purpose of this study was to explore the experiences of cancer patients utilising SolarisCare’s four cancer support centres in Western Australia.

Methods: Across the four locations during the ‘snapshot’ week 191 patients attended a SolarisCare centre. Ninety-seven patients completed survey 1 and 65 of those (mean age = 61 SD ± 12; female n = 47; male n = 18) completed survey 2. The fi rst survey investigated patient demographics and disease variables, use of complementary therapies and support services, and patient rated outcomes (PROs) including quality of life, fatigue, exercise habits, and physical distress symptoms. The second survey patients completed consisted of open-ended questions designed to explore patients perceptions of com-plementary therapies offered whilst undergoing outpatient medical treat-ment and their general use of the cancer support centres services. Inductive and deductive content analyses using NVivo software were used to analyse responses.

Results: Five higher order themes were identifi ed, namely; coping, well-being, challenges, support and relaxation. Twenty-fi ve fi rst order themes were identifi ed, which were clustered into a framework of multifaceted views held by cancer patients in relation to their quality of life, the impor-tance of support, personal empowerment and well-being.

Conclusions: Cancer patients and those around them are faced with multi-ple challenges throughout and following medical treatment. In order to effectively target and enhance complementary support services in a hospital setting and improve patient outcomes, it is crucial to explore the experiences of patients in their own words.

Key words: Cancer Patients – Quality of Life – Complementary Therapies – Supportive Care – Patient Rated Outcomes

593

THE DEVELOPMENT AND INTEGRATION OF CANCER

SURVIVORSHIP STRATEGIES AT HALMSTAD HOSPITAL, SWEDEN,

THROUGH INTERACTION AND PARTICIPATION – A PILOT PROJECT

Patrik Göransson, E Börjesson, L WahlbeckHallands Hospital, Halmstad, Halland, Sweden

Background: In 2012 a government funded endeavor to create and integrate a strategy for addressing survivorship issues will be fi nalized and evaluated. The process consists of assessment, consultation, treatment, support for hospital staff, and survivorship care plans for cancer patients. This will be the fi rst hospital all-embracing survivorship strategy in Sweden.

Development through collaboration: Working together with patients, sig-nifi cant others and staff, using focus groups and social media, the project has developed:

• Network of psychosocial contact nurses.• Multidisciplinary support team.• Basic education for hospital staff (500 individuals).• Support system for hospital staff and for patients.• Individual survivorship plans.

Implications: The strategy shall be fully integrated within all cancer care processes. All cancer patients receiving care at Halmstad Hospital shall have

a personal survivorship plan including physical, psychological, social and existential needs.

Within Sweden adequate resources for addressing survivorship are frag-mented and unequally distributed. The result of this pilot project is of national interest as a step towards creating a model for an integrated and all-embracing survivorship plan. The inclusion of primary care, municipal-ity-level care and the social welfare system into the strategy will be the natural next step of development. While there´s a growing body of research on basic and advanced needs of cancer survivors globally and in Sweden, there´s a gap concerning knowledge on how to acknowledge and meet these needs within the Swedish healthcare system.

There’s a need for research from the multi-scientifi c approach of innova-tional sciences to draw forth organizational, social and technical innova-tions concerning cancer survivorship. Region Halland and Halmstad University has started this research program in collaboration.

This presentation will inspire on how to develop and integrate services. It will also suggest how to include patients, their signifi cant others and health-care professionals into the developmental process through the approach of open innovation.

594

THE SPECIALIST MENTAL HEALTH INITIATIVE IN PALLIATIVE

CARE (SMIP) PROJECT – DEVELOPMENT OF AN INTEGRATED

PSYCHOLOGICAL SERVICE WITHIN AN ESTABLISHED PALLIATIVE

CARE SERVICE

Andrea GregorySMIP Adelaide Northern Division of General Practice, Elizabeth North, South Australia, Australia

Purpose: Prevalent mental health problems such as anxiety and depression remain under-recognised in the palliative care setting. Mental illness and life-limiting physical health conditions often aggravate one another, and co-management of these requires specialist skills. This Level 6 Palliative Care Service is located within one of the most socially disadvantaged geo-graphical areas of Australia, and large gaps exist in the recognition and management of mental health problems at end-of-life. This project aimed to address these gaps.

Methodology: Collaborative care networks were developed to build service delivery capacity. Psychology services were sourced through a brokerage agreement with a local non-government agency. Thus specialist mental health skills were integrated into an established palliative care multidiscipli-nary team.

Following the introduction of pain and distress screening tools across the service, a pathway of care was developed to meet identifi ed mental health needs of patients and their families. Direct clinical work was provided by psychology and up-skilled members of the multidisciplinary team. Clinical services were designed to be applicable to all patients regardless of site of care.

Results: Previously mental health needs, when identifi ed, were met by a general psycho-social team or through referral to external agencies where wait-times were often in excess of 4 weeks and offi ce based. Following this re-orientation of service delivery, 137 referrals were made within the fi rst year, 87 receiving interventions within a week. All were able to choose the venue of appointment.

Education and Trainings sessions were held across 8 community palliative care teams (2 metropolitan and 6 rural).

SMIP was the winner of the 2011 S.A. Health Ministers Award for Innovation.

Conclusion: The development of this sustainable, integrated and collabora-tive service delivery model is a promising foundation for improving the mental health of families in receipt of palliative care. Future directions include extension to an early intervention focus.



595

THE EFFECT OF A UNIQUE CENTER FOR CANCER SURVIVORS ON

THEIR SUBJECTIVE WELLBEING – THE ‘EZER ME-ZION’

EXPERIENCE

Arza Ashkenazi1, Itzhak Gur, Bracha Zisser1. Sourasky Medical Center, Tel-Aviv, Israel

Background: Patients recovering from cancer may encounter medical and emotional diffi culties. A center named ‘New Beginning’ was opened in Israel in order to support cancer survivors.

Aims: To evaluate the effect of ‘New beginning’ cancer survivors center on these patients subjective wellbeing.

Subjects: Adults (aged 20 years or more) who were diagnosed with cancer and currently are not treated by any mean for their illness.

Methods: ‘New beginning’ is operating since 11/2011. Subjects are invited for 5 hours of counseling, support and gaudiness, delivered by 5 profession-als: general practitioner (who is familiar with medical long term effects of oncological treatments), social worker, onco-pshycologist, nutrition and onco-sexologist. By the end of the meeting participates fi ll a short drop-off survey concerning their experience.6 months later a phone-based survey of patients` satisfaction was made.

Results: 300 cancer survivors were consulted by ‘New Beginning’ cancer survivors center by the fi rst year of operation; of these, 150 cancer survivors answered the phone survey. Most of the cancer survivors were very pleased from the counseling day. They felt that the program focus on their recovery and promote their medical and emotional wellbeing. All of them said they would like to come again.

Conclusion: Our evaluation shows that centers of this kind may advance the subjective sense of wellbeing by cancer survivors. Future studies should evaluate primary care physicians` satisfaction, return to work rates and psychosocial and sexual improvement of cancer survivors attending this program in order to establish the objective benefi ts of the program.

596

CITATION ANALYSIS OF CANADIAN PSYCHOSOCIAL ONCOLOGY

RESEARCHERS

Thomas F Hack, Dauna Crooks, James Plohman, Emma KepronUniversity of Manitoba, Winnipeg, MB, Canada

Citation analysis can yield objective criteria for assessing the value of pub-lished research, and is becoming increasingly popular as an academic evalu-ation tool in universities around the world. Citation analysis is useful for examining the research performance of academic researchers and identifying leaders among them. The aim of this study was to analyze citations to publications in psychosocial oncology and supportive care in oncology and palliative care, and authored by Canadians. The journal publication records of 124 non-retired psychosocial oncology researchers were subject to cita-tion analysis using the Scopus database. This analysis was guided by a set of decision rules for article inclusion that were reviewed and modifi ed by fi ve Canadian experts representing four disciplines in psychosocial oncology and supportive care. The top 20 psychosocial oncology researchers for each of the following four citation categories were identifi ed: the number of career citations for all psychosocial oncology publications; the number of career citations for fi rst-authored publications; the h-index for all publica-tions; and the h-index for fi rst-authored publications. In addition, the 20 most cited publications in the fi eld of psychosocial oncology were calcu-lated. The individuals who hold the #1 position in each of the lists are Dr. Kerry Courneya (University of Alberta; #1 on three lists), Dr. Lesley Degner (University of Manitoba), and Dr. Harvey Chochinov (University of Manitoba).

597

DEVELOPMENT OF AN INTERACTIVE MULTIMEDIA PRODUCT TO

FACILITATE THE EXCHANGE OF EMOTIONAL STATE IN CHILDREN

WITH ACUTE LYMPHOBLASTIC LEUKEMIA

Jovita Hernández Arista1, José Méndez Venegas2

1. Universidad Autónoma Metropolitana Azcapotzalco/Servicio de Psicooncologia del Instituto Nacional de Pediatria, Delegación Azcapotzalco, D.F., Mexico2. Servicio de Psicooncologia, Instituto Nacional de Pediatria, México, Distrito Federal

Applying an Interactive Multimedia Product for therapeutic intervention to facilitate the children’s emotional shift and manipulation of biochemical indicators

Psycho-Oncology Services, Medical Oncology and Immunology have defi ned the priorities in cancer treatment, emphasizing auxiliary therapeutic in clinical treatment. This work implies the use of new technologies to give emotional support to patients, applying interactive multimedia emotional training, which facilitates emotional shift in children from fi ve to seven years of age with acute lymphoblastic leukemia. Application occurs during induc-tion and/or maintenance phase therapy, considering the relationship between nervous and immune systems.

The design is based on Psychooncology and Psychoneuroimmunology (PNI) therapeutic suggestions. It measures emotional and behavioral changes and signifi cant differences in immunoglobulin production, as well as the change in salivary cortisol levels after chemotherapy in patients who interact with the media, according to baseline and after-use levels.

The instruments to measure indicators are as follows:

1. Immunology laboratory test.2. Behavioral assessment.3. Symbolic Emotional Scale.

Results obtained will allow to observe trends of effectiveness in therapy. This work defi nes Interactive Multimedia as: a digital product which includes a variety of technologies that allow different ways to present infor-mation in a given environment allowing audience participation to achieve pre-established goals.

The proposal is to use these technologies to manage emotional training in patients. Research procedure consists of the following phases:

• Designing of an interactive multimedia product that comprises 12 ses-sions, one for each consecutive day of therapy.

• Structuring the product by learning objects, self-contained and sequenced.• Applying therapy in sessions of 15 minutes.

This work seeks to strengthen adaptation and adherence to cancer treat-ment, by making the recovery phase more tolerable for the patient.

598

EVALUATING PROGRAMMES FROM THE HAVEN’S BREAST

CANCER SUPPORT CENTRES: RESULTS AND CHALLENGES

Caroline J Hoffman, Barbara S Baker, Julia E HarringtonThe Haven Breast Cancer Support Centres, London, Lond, United Kingdom

The Haven is a unique registered UK charity with three beautiful day centres providing free programmes of psychological support and integrative thera-pies to help people diagnosed with breast cancer. The programmes of therapy provided over the last 12 years have been researched by various methods of evaluation including large randomised controlled trials including nested qualitative data, a small randomised controlled pilot study, self-evaluation, feedback questionnaires, telephone interviews and focus groups. When trying to evaluate cancer supportive care programmes in a not for profi t organisations, challenges including funding, recruitment, control groups, and generalisability of results to other settings.



In collaboration with other organisations, the Haven’s small research team have evaluated outcomes of the Haven’s therapeutic programmes providing preliminary data as a platform for future larger multicentre studies. Learn-ing about the experience of the Haven may help others take forward further research in this fi eld. Details of existing Haven research can be found at www.thehaven.org.uk/research.

599

UNMET PSYCHOSOCIAL NEEDS IN HAEMATOLOGICAL CANCER: A

SYSTEMATIC REVIEW OF THE LITERATURE

Brooke Swash, Nick Hulbert-Williams, Samantha Williams, Ros BramwellUniversity of Chester, Chester, United Kingdom

Aims: Haematological cancers are a complex group of diseases. The often intensive treatment can affect a person’s ability to function within their usual roles, with related unmet psychosocial needs subsequently impacting upon overall psychological and emotional wellbeing. In the UK, haematological cancer is less likely to be treated within the larger cancer centres but rather within smaller satellite units which may have fewer psychosocial supportive care resources available. The identifi cation of psychosocial needs most rel-evant to this patient group is necessary to effectively target and implement clinical services. We aimed to systematically review published literature on unmet psychosocial needs in patients with haematological cancer.

Method: A systematic search of online databases, and hand searching of three primary psychosocial oncology journals was conducted to identify all published research papers within this area. Papers were selected on the basis of pre-defi ned inclusion criteria and inclusion was verifi ed by an independ-ent reviewer. Of 14,547 titles identifi ed in searches, 17 were included in the fi nal review.

Results: Data synthesis is ongoing but preliminary fi ndings suggest that some of the most commonly expressed psychosocial needs within this patient group relate to: emotional support, support from healthcare profes-sionals, fear of recurrence, psychological distress and a need for informa-tion. Needs in these areas are perhaps unsurprising considering the general cancer literature, however, some differences between cancer type were iden-tifi ed with regard to specifi c sources of need, rather than general areas of need.

Conclusion: The preliminary fi ndings indicate similarities in the type of psychosocial need present in haematological cancer in comparison to more general cancer samples, however, this is perhaps refl ective of methodologies used as much as a true refl ection of actual need. These fi ndings build upon the current knowledge base of psychosocial needs in cancer patients and suggest important but unanswered questions that research needs to address.

600

LIVING LIFE AFTER CANCER TREATMENT: A SUPPORT GROUP

EVALUATION STUDY

Nick Hulbert-Williams1, Samantha Flynn1, Michelle Tytherleigh1, Sam Roberts1, Elizabeth Taylor2

1. University of Chester, Chester, United Kingdom2. Macmillan Information Support Offi ce, Countess of Chester NHS Foundation Trust, Chester, Cheshire, UK

Aim: There are over two million cancer survivors in the UK, many of whom report feeling under-supported, distressed and having poor quality of life. The transition from treatment to follow-up is particularly problematic. Adequate social support can buffer against negative consequences of stress, and cancer support groups have been shown to be effective in achieving this. The aim of this study is to evaluate the effectiveness of the ‘Living Life after Cancer Treatment’ Programme; this programme is open to all patients who have completed treatment at a local NHS funded hospital. Both patients and their spouses are invited to attend for fi ve weeks of structured psycho-educational and support sessions.

Methods: We are currently recruiting participants into this study. Three focus groups will be conducted: one with patients completing the current iteration of the programme, one with spouses completing the current itera-tion, and a third of mixed patients and spouses who completed the pro-gramme six months ago. Data will be transcribed and thematically analysed using Framework Analysis.

Results: Focus groups are being held in June 2012 and all data will be analysed by September 2012 in order to inform development of the next iteration of the programme. In analysing the data we will explore: motiva-tions for joining the programme; participant expectations form the pro-gramme; perceived strengths and weaknesses; suggested improvements; and, in the retrospective focus group, longer-term benefi ts of participation.

Discussion: The fi ndings will be used to inform development of this pro-gramme for both local implementation, and to make suggestions for roll-out of similar end of treatment interventions across other cancer centres.

601

PSYCHOLOGICAL DISTRESS OF THE BEREAVED SEEKING

MEDICAL COUNSELING AT CANCER CENTER

Mayumi Ishida1, Hideki Onishi1, Satoshi Kawada1, Yosuke Uchitomi2

1. Department of Psycho-Oncology, Saitama International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan2. Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Aims: The death of a loved one is one of the most stressful events in life and is related to the physical and psychological wellbeing of the bereaved. Some bereaved individuals seek medical counseling to alleviate their distress. However, no studies have focused on the bereaved who lost a loved one with cancer and asked for medical help at a cancer center as a result. The aim of this study was to investigate the distress of the bereaved who sought medical counseling, in order to obtain some basic information needed for the provision of effective medical help for these subjects.

Methods: We conducted a survey of people consulting outpatient services for bereaved families between April 2007 and September 2009. Data were obtained from medical records at initial consultation and qualitatively ana-lyzed by content analysis using all statements related to their distress.

Results: During the study period, fi fty-one patients (bereaved) consulted the outpatient service for bereaved families. And, according to inclusion/exclu-sion criteria, 21 bereaved were surveyed. Their statements were classifi ed into 11 categories, which were further classifi ed into 6 themes. The main categories of bereavement-related distress were as follows: (i) regret; (ii) anger; (iii) memories; (iv) loneliness; (v) anxiety; and (vi) hopelessness. ‘Regret’ was frequently recognized in their distress and it includes some points related to the cancer trajectory.

Conclusions: Psychological distresses of the bereaved who lost a loved one and asked for medical counseling are revealed. Their distresses are strongly related to cancer trajectory of a family member, and their perception of the death. Some of these distresses are related to medical misunderstanding about the course of cancer. These fi ndings might provide basic information for considering their appropriate treatment.

602

PARENTAL TRAUMA: CARING 3 CHILDREN WITH ADVANCED

CANCER

Sunita JadhavTata Memorial Hospital, Parel Mumbai, Mahar, India

Introduction: Palliative care and counseling is a vital task in Multi profes-sional approach of treatment in life threatening illness.

The very delicate issue of losing the child and no available allopathic treat-ment is a very diffi cult decision for the family to accept.



Case summary with personality traits of children: The P family constituted of 2 daughters and 2 sons.

Three children in their adolescence suffered from Xeroderma pigmentosa, a genetic disorder associated with cancer.

Children school drop outs, as concerned about physical appearance and peers acceptance.

The unaffected eldest sister a smart postgraduate, who understood sibling’s disease, but felt helpless whilst dealing with them.

S, 19/F the least affected daughter has mild pigmentation on face and hands with no skin lesions. She is sensitive to sunlight and has adjusted well by making lifestyle changes and doing housework and tailoring which she fi nds therapeutic in the stressful family environment.

J, 17/M our regular member of the clinic suffered a slow growing disease due to the positive regard he feels with us and the relief he experiences from the depressing environment in his home. He is optimistic and keen on life, and as he is fond of cricket and roaming with friends he often requests for skins/ointments/etc.

As a team we are attempting to initiate a small independent income generat-ing activity for him.

S, 14/M a severe case of the same condition, physically affected and emo-tionally scarred expired a few months ago, causing a scare in the family.

He was a loving, caring child especially attached to his mother, scared of his father and kept away from strangers; he was fond of drawing and clean-ing the house. The mental stress caused sleeplessness, crying spells and temper tantrums on smallest of issues.

About the parents:

Mr. P father suffered intense turmoil, since he loves them but unable to accept illness and reacts with anger questioning ‘Why me? Why Has God given me these ugly children?’

He is unable to accept the scientifi c explanation and believes in black magic done on his family. Added stressors include loss of job and anger towards his wife since he did not want any children after his second daughter S.

Mrs. P mother and sole primary care giver is a disillusioned and highly dis-tressed woman; she feels responsible for the family’s plight since was keen on a healthy male child and therefore insisted on having children against the husband’s wishes. She feels helpless and often cries in front of the children. The husband’s reaction of anger, hostility and avoidance in all areas of the house including children’s treatment and expenses is of great concern to her. In her despair, she has even attempted to end her life on one occasion.

Family concerns and trauma: The family concerns can be summarized under:

1. Childrens future:* The futu.re of the unaffected daughter, since she is not getting any

marriage proposals* Their independence, if they survive∗ Who will care for them after her demise?

2. Social issues:∗ Curiosity and fear of friends and relatives regarding the children’s

condition∗ Social isolation and withdrawal

Depression, confusion, hopelessness and guilt continuously haunt the family, especially after the death of the youngest son S.

Role of Palliative Care team: The case is a challenging one due to the enormity of problems from different fronts. The main methods used were:

Counseling:

∗ For the Mother with the purpose of venting, expression of feeling, focus on self, identifying needs and generating options to resolve those needs.

∗ For the father with the purpose of facilitating acceptance, and healthy expression of feeling, and generating employment options.

∗ For the children to help them cope, express themselves and develop a positive self image; also addressing certain needs such as providing a television set.

∗ As a family with the purpose of improving relationships and cohesiveness with a constructive expression of emotions; also to prioritize needs and therefore utilize existing resources most effectively.

Home care services extended to assist in care and support in times of need.

Issues for discussion:

∗ Other possible areas and means of intervention y the team, with specifi c focus on coping strategies, grief reactions keeping in mind the nature of the illness and extent of its effect on this family.

∗ Issues in genetic cancers that require exploration.

603

THE CANCER JOURNEY: PATIENTS’ PERSONAL EXPERIENCES

WITH AN ONGOING MULTIDISCIPLINARY APPROACH

Yoshiko Katayama1, Mariko Kitagawa2

1. Nagoya Memorial Hospital, Tempaku, Nagoya, Aichi, Japan2. Nagoya city University Scool of Nursing, Nagoya, Japan

Aims: This study was conducted to identify the nature of psychological suffering by patients with advanced cancer, from their subjective experiences.

Methods: We conducted participant observation and non-structured inter-views with middle aged to elderly cancer patients attending a general hos-pital for treatment. The collected data was subjected to qualitative and descriptive analyses.

Results: Data was obtained from 8 patients aged from the 40s to 70s, with a variety of malignancies. We defi ned ‘psychological suffering’ as ‘the state of psychological tension and emotional and behavioural problems arising from psychological tension’.

As a result, we identifi ed 38 subcategories and 26 main keywords related to the process moving from a ‘Prior to mental gear shifting’ to ‘Preparation for mental gear shifting’, and fi nally a ‘Mental gear shifting’ phase.

Conclusion: We confi rmed that patients with advanced cancer mentally shift gears, from a concept of life and death as opposites to a concept of life and death coexisting together.

604

PREDICTORS OF DEPRESSION IN KOREAN BREAST CANCER

PATIENTS: A ONE YEAR LONGITUDINAL STUDY

Seon-Young Kim1, Sung-Wan Kim2, Jae-Min Kim2, Il-Seon Shin2, Min-Ho Park3, Jung-Han Yoon3, Jin-Sang Yoon2

1. Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea2. Departments of Psychiatry, Chonnam National University Medical School, and Depression Clinical Research Center, Chonnam National University Hospital, Gwangju, Korea3. Breast and Endocrine Tumor Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea

Introduction: To investigate the prevalence, and 12-month persistence and incidence of depression following surgery for breast cancer; to determine factors associated with this in an East Asian setting.

Methods: All cases at a given hospital following surgery for breast cancer were approached and participants were interviewed 2–5 days after surgery. Depression (major and minor depressive disorders) was diagnosed by DSM-IV using the Mini International Neuropsychiatric Interview at baseline and 12 months after surgery. Socio-demographic and clinical characteristics investigated as covariates in logistic regression models.

Results: Of 335 breast cancer patients analysed at baseline, 80 (23.9%) had prevalent depression. Persistence in those with depression at baseline (60 analyzed) was 33.3%; incidence of depression in those without depression



at baseline (202 analyzed) was 13.4%. In adjusted logistic regression analy-ses, past and family histories of depression were signifi cantly associated with depression on baseline, and number of metastatic axillary lymph nodes was associated with persistence of depression at follow-up. No factors were associated with incident depression.

Discussion: Depression is common among Korean women with breast cancer, and predictive factors of depressions may differ according to the time after surgery.

605

FINDING A NEEDLE IN A HAYSTACK: POPULATION-BASED

APPROACHES TO RECRUITING RELATIVES OF CRC PATIENTS

INTO A BEHAVIORAL INTERVENTION TRIAL

Anita Y Kinney1, Rebecca G Simmons1, Yuan-Chin Amy Lee1, Antoinette Stroup2, Amy Rogers1, Sandie Edwards1, Jan Lowery3, Charles Wiggins4, Dierdre Hill4, Christopher Johnson5, Rosemary Cress6, Marc S Williams7, Kory W Jasperson1, Marc Schwartz8, Randall Burt1, Scott Walters9

1. University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States2. Internal Medicine, University of Utah, Salt Lake City, UT, USA3. Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA4. University of New Mexico, Albuquerque, NM, USA5. Epidemiology, Idaho Hospital Association, Boise, ID, USA6. California Cancer Registry, Sacramento, CA, USA7. Genomic Medicine Institute, Weis Center for Research, Danville, PA, USA8. Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA9. School of Public Health, University of North Texas Southwestern, Ft. Worth, TX, USA

Aims: Accessing relatives of cancer patients through population-based cancer registries has potential advantages for increasing the reach of behav-ioral interventions to educate family members about their risk and motivate screening adherence. We examined factors associated with case (proband) and relative recruitment to a multi-site behavioral intervention trial target-ing individuals at increased familial risk for colorectal cancer (CRC).

Methods: The Family CARE trial partnered with fi ve population-based cancer registries in the United States. Mode and intensity of registry contact varied widely. We attempted to contact 3893 eligible CRC probands to identify their relatives and invite them to participate in the trial. Multiple logistic regression models were utilized to determine predictors of proband participation and relative enrollment.

Results: 18.4% (n = 715) of probands who were asked to provide contact information on their relatives provided the information. Overall, 15.6 (range = 8–77) cancer cases were contacted for every one relative rand-omized. Factors signifi cantly (p values < 0.05) associated with probands’ willingness to provide contact information on their at-risk relatives include younger age at diagnosis, more recent cancer diagnosis, non-Latino White ethnicity/race, female sex, and registry source/contact intensity. 79% (n = 496) of eligible relatives enrolled and were randomized to one of the two intervention arms (targeted mailed intervention vs. individualized phone and mailed print intervention). The participation of another at-risk family member in the trial (OR = 1.67; 95% CI = 1.08–2.59; p = 0.001) and registry source (p < 0.01) emerged as independent predictors of rela-tives’ participation.

Conclusion: Participation rates varied widely across registries, which may in part be due to differences in contact intensity. Adequate resources are required to maximize family participation. Our fi ndings can guide the design of future family-based cancer prevention trials utilizing cancer registries to reach relatives of CRC probands with potentially life-saving health communications.

606

THE PREDICTION OF CANCER OR CORONARY HEART DISEASE

MORBIDITY BY MEANS OF THE PERSONALITY/STRESS

QUESTIONNAIRE

A Kizior1, J Spisz2

1. University of Lodz, Pro Ars Foundation, Lodz, WA, Poland2. Pro Ars Foundation, Lodz, WA, Poland

Objectives: There is a long standing theory, suggested that there are per-sonality traits, which in combination coping strategies and biomedical factors can predict cancer or coronary heart disease in healthy probands (Hansen, Floderus, Fredriksen, Johansen et. al, 2005). The authors of the Personality/Stress Questionnaire has suggested that can predict cancer or CHD in healthy probands in 81% accuracy (Grossarth-Maticek, Eysenck, Boyle, 1991, 1995). We tested the hypothesis that personality plays a role in cancer or CHD onset in a potentially healthy population.

Methods: From the global healthy probands sample (n = 1 087 (both sexes) we were selected (N = 131) men and women in polish population, aged 24–65 completed the ‘Personality/Stress’ Questionnaire. The Classifi cation Trees Module with two algorithms CART (Classifi cation and Regression Trees) the Discriminant Analysis and Logistic Regression (STATISTICA PL) was used for analysis.

Results: MULTIVARIATE ANALYSIS:

The CLASSIFICATION OF THE TREES ANALYSIS for the ‘PERSONAL-ITY/STRESS’ QUESTIONNAIRE, showed that in 80, 15%, we can classify people in terms of belonging to one from four types correctly (TYPE I – cancer prone; TYPE II – CHD prone; TYPE III – ambivalence and TYPE IV – autonomous, healthy). Based on the importance ranking of predictors TYPE II (open behavior pattern, CHD-prone) = 100 (was a most ranged predictors); TYPE I VARIABLE (withdrawing) = 93; Type III (ambiva-lent) = 77 Type IV (healthy, autonomous) = 95.

LOGISTIC REGRESSION for the ‘PERSONALITY/STRESS’ QUESTIONNAIRE:

Values of Chi-square statistics were signifi cant at: p = 0.00712; Constant value (BO) = −0.429; X2 (7) = 10.368; SD = 1.321; T = −0.325. The largest share of the variability have TYPE II (open behavior pattern, CHD prone) which informs us of the fact that the studied group of people, is determined to open behavior pattern in a stressful situation, but still prone to the inci-dence of cardiovascular disease. In this population based on the potentially healthy probands using with the ‘Personality/Stress’ Questionnaire can predict with 68.7% accuracy.

DISCRIMINANT ANALYSIS

In the current case, the hypothesis was rejected at a signifi cance level of p < 0.01, and its approximation using the F-statistic, is – 0.862955616. The values of the lambda Wilks’ statistics are L = 0.862945616; Chi 2 (square) = 18.49915123; DF = 0.00992455; level of signifi cance (p = 0.00992455). Based on standardized discriminatory coeffi cients for the ‘Personality/Stress’ Questionnaire found that the greatest power in the dis-criminant model has a variable – Type II (open pattern of behavior); for it the partial lambda L was smallest (Y(x) = −0.209). Discriminative power of the model can be described as a moderate; it can be expected given the personality type and reaction to stress factors in 97,11% predictive accuracy.

Conclusions: The fi ndings suggest that The Personality/Stress Questionnaire is an appropriate and effective method for eliciting peoples for one of four types` personality and coping strategies. But such studies should be carried out on a large number of peoples (longitudinal and follow-up study), having regard to the cultural differences and biomedical factors.



607

ISSUES IN END OF LIFE CARE AND PERSONS INVOLVED IN

DECISION MAKING – SINGLE INSTITUTIONAL EXPERIENCE FROM

SOUTH INDIA

Kirushna Kumar Kosanam Subramanian, Vijayabhaskar Ramakrishnan, Uma Jayaraman, Krishnakumar RathnamMeenakshi Mission Hospital and Reasearch centre, Madurai, Tamil, India

Aim: To identify the issues in End of life care with relation to Home care, Local Hospital care and also identifying the persons involved in decision making for patients along with the Physician.

Methods: Around 1400 new oncology cases are being referred to Meenakshi Mission Hospital and Research centre, Madurai, with 75% of the patients coming from a rural background. During the period from June 2011 to Febru-ary 2012, 68 patients/caregivers who refused End of Life care at local place were asked to fi ll up a semi structured Questionnaire to assess the reasons and also identify the persons involved in decision making on the same.

Results: On analysing 52 (76.5%) of them had single factor and 16 (23.5%) had more than one factor as the reason for refusal of home care. Out of the 68 respondents 30 (44.1%) felt that there was no motivated person at home, 22 (32.4%) felt that the facilities at home are insuffi cient, 18 (26.5%) felt inadequate medical facilities available nearby and round the clock for service, 12 (17.7%) of them were not willing to take care at home and 5 (7.4%) of them refused due to family issues. For Hospital care 50 (73.5%) refused due to local physician’s unwillingness and 18 (26.5%) didn’t have a local hospital for care as they hail from a very small village. Decision of 43 patients (63.2%) was made by the spouse and their children. In 11 (16.2%) it was village head and in 9 (13.2%) it was friends and relatives as they were illiterate.

Conclusion: Hospice if developed can cater the neighbouring rural areas. End of life training for local physician and nurses will help patients take home and hospital care. This will help in reducing the burden in these fami-lies to a larger extent both physically, fi nancially and mentally.

608

INDICATION FOR PSYCHOONCOLOGY CARE AMONG VOLUNTEER

PROGRAMME PARTICIPANTS

Veronika Koutná1, Marie Nosálková2

1. Masaryk University, Brno, Czech Republic2. Palacký University Olomouc, Olomouc, Czech Republic

Cancer and its treatment followed by hospitalization represent an important stress factor for a patient and psychosocial care is considered as a part of comprehensive oncology care. Civic association Amelie was founded to support the oncology patients and their relatives. The organization imple-ments group art sessions as a Volunteer programme at Oncology Clinic Faculty Hospital Olomouc. Although the motivation of volunteers is fre-quently discussed theme in the fi eld of actual researches at the time, a little is known about the motivation and expectations of the clients attending these volunteer programs. Our goal in this study is to analyze the profi le of a patient who is interested in aforementioned activities in terms of indication for psychooncology care and other relevant characteristics. The set of ques-tionnaires with Hornheide Questionnaire and the evaluation questionnaire was distributed among 45 respondents who attended the Volunteer pro-gramme during the period of 9 months. We emphasized low degree of the burden the questionnaires represent for the people undergoing cancer treat-ment. The Volunteer programme is the most often sought by women (χ2 = 33.8 > χ2

0.01(1) = 6.63) in average age 57 during their fi rst hospitaliza-tion due to cancer lasting for 5–9 weeks. Their attendance in the Programme is motivated by the possibility to learn something new and the distraction from the thoughts about cancer is considered as the Program’s main benefi t. Among other possible activities, the respondents are interested in talking with volunteers. The results suggest the connection of attendance in the Volunteer Programme with indication for psychooncology care (87% of the

respondents are indicated for the psychoncology care, χ2 = 24.2 > χ2

0.01(1) = 6.63). According to the results of actual researches this high percentage does not correspond with the normal distribution of the indica-tion for psychooncology care among cancer patients.

609

THE EFFECTS OF NARRATIVE THERAPY ON FAMILY MEMBERS OF

CANCER PATIENTS AT A SPECIFIC PSYCHO-ONCOLOGY

OUTPATIENT SERVICE

Atsuko Koyama1, Minoru Niki1, Ryo Sakamoto1, Kiyohiro Sakai1, Hiromichi Matsuoka2, Chihiro Makimura2

1. Psychosomatic Medicine, Sakai Hospital, Kinki University Faculty of Medicine, Sakai, Osaka, Japan2. Medical Oncology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan

Background: We started a special outpatient service for cancer patients in 2010. Not only cancer patients but also their family members have visited our outpatient service and the number of them is gradually increasing. However, little is known about the impact of cancer and the process of its treatment on the family members of cancer patients. The aim of this study is to clarify the symptoms and the recovering process of the family members through narrative therapy.

Methods: The data of family members of cancer patients who visited the specifi c outpatient service for psycho-oncology were collected. All the items assessed during narrative sessions were extracted from medical charts. Mul-tiple factors such as age, sex, economic and social status, the relation to the cancer patient, physical and psychological symptoms, psychiatric diagnosis, the duration until recovery and the infl uence of the family members’ condi-tion on the cancer patient were analyzed.

Results: Relations to cancer patients were divided into four patterns; parents, children, husband, and wife, and there were characteristic clinical manifestations related to the relation pattern. In addition, lack of other family members and a fragile economic background hampered the psycho-logical recovery of bereaved family members. The most common psychiatric disorders for family members, as well as cancer patients, were depression, anxiety disorders and adjustment disorders. Some family members also revealed outstanding symptoms of confusion and anger. In narrative therapy sessions, bereaved family members showed temporary exacerbation of psy-chological symptoms at around the fi rst anniversary of a patient’s death. Following that time, they gradually recovered and approximately two years were necessary to adjust themselves to a new life situation.

Conclusions: Supporting family members is an important aspect of cancer therapy and gives positive effects to cancer patients. Narrative therapy is one example of an effective approach for helping family members recover.

610

SELF COMPASSION IN THE FACE OF UNCERTAINTY: THE

POTENTIAL CONTRIBUTION OF A BUDDHIST CONCEPT TO THE

PSYCHOSOCIAL SUPPORT OF CANCER PATIENTS

Lisbeth G LaneCancer Care Centre, Wollongong, NSW, Australia

Western psychologists have begun to examine self compassion, a construct central to the 2,500 year old tradition of Buddhism. A consistent fi nding in the newly emerging research literature is that greater self compassion is linked to less anxiety and depression, with zero-order correlations in the range of −0.50 to −0.60 for depression, and −0.60 to −0.70 for anxiety. Self compassion has been defi ned as a multifaceted construct with three essential elements that are exhibited during times of challenge and uncertainty: (1) Self Kindness, extending kindness and understanding to oneself rather than harsh self criticism and judgment, (2) Common Humanity, seeing one’s experiences as part of the larger humanity rather than as separating and



isolating; and (3) Mindfulness, holding one’s painful thoughts and feelings in balanced awareness rather than over-identifying with them. There has been considerable attention given in recent years to clinical interventions that focus on the third element, for example, Mindfulness Based Stress Reduction (MBSR), Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) which have demonstrated benefi cial outcomes in multiple populations, including cancer populations. To date, the majority of these studies have considered mindfulness as an outcome measure along with other outcomes, rather than as a quality developed during a wider meditative practice. The recent fi ndings on the role of self compassion as a mechanism of change have prompted the author to explore a self compassion based intervention specifi c to a cancer popula-tion. It is proposed that therapy incorporating all of the three components of this construct may enhance our therapeutic approaches to working with patients facing the challenge of cancer.

611

FACILITATING DISCLOSURE OF COMPLEMENTARY THERAPY USE

VIA EFFECTIVE COMMUNICATION

McLaughlan M Laura, Vikki E KnottUniversity of Canberra, Bruce, ACT, Australia

Effective communication between health professional and patient regarding Complementary Therapy (CT) use in oncology is essential. However, there is an absence of research addressing the way in which health professionals facilitate patient disclosure of CT use. This study aimed to examine the methods health professionals implement to initiate and/or facilitate CT discourse with patients. Thirteen health professionals, previously or cur-rently working in oncology, were recruited using opportunistic sampling and snowballing until data saturation was reached (Grbich, 1999). Participants were aged between 29 and 58 years and had varying levels of experience working in the oncology setting. Data were transcribed and analysed using Braun and Clark’s (2006) six staged method of thematic analysis. The analysis revealed that health professionals used various communication strategies and models as ways to facilitate CT discourse with patients. Key factors such as attitudes, subjective norms and education in CTs were linked with facilitation of CT discourse. The results are summarized within three major themes including ‘facilitators of disclosure’, ‘barriers impeding dis-closure’, and ‘integrative issues’. Overall, the study identifi es particular communicative methods that facilitate CT disclosure with patients, as well as the potential barriers that impede this process. Recommendations pro-posed focus on the development and implementation of a ‘facilitating CT disclosure’ education model that aims to generate awareness around ways to achieve effective communication with patients in the area of CT use and non-disclosure. Future research would aim to assess the effi cacy of the model to improve the facilitation of discourse around CT use during oncology consultations.

References

1. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi: 10.1191/1478088706qp063oa.

2. Gribich, C. (1999). Qualitative research in health: An introduction. Australia, SA: Sage Publications.

612

WELL-BEING, STRESS, ANXIETY AND DEPRESSION AMONG

MIDDLE-AGED WOMEN WHO ARE CANCER SURVIVORS AND

WOMEN WITH NO CANCER HISTORY

Filipa Pimenta1,2, Isabel Leal1,2, João Maroco1,2, Sofi a Pereira2

1. Reserach Unit in Psychology and Health, Lisbon, Portugal2. ISPA, Lisboa, Portugal

Aims: There is evidence that cancer survivors present mood and psychologi-cal well-being impairment when compared with counterparts with no cancer

history (Costanzo, Ryff, & Singer, 2009). Therefore, the aim of this research is to explore if there are differences between women with and without cancer history, regarding well-being, stress, anxiety and depression.

Methods: A community sample of 66 Portuguese women (33 cancer survi-vors and 33 with no oncologic antecedents), aged between 42 and 60 years old, fi lled in a questionnaire to collect socio-demographic and health-related information. Validated instruments were applied to assess the psychological variables. Depression, anxiety and stress levels were measured with the Depression, Anxiety and Stress Scales (Pais-Ribeiro, Honrado, & Leal, 2004). Subjective well-being was assessed with the Subjective Well-Being Scale (Albuquerque & Tróccoli, 2004). To compare the means, a t-Student test was used.

Results: Most cancer survivors had breast cancer (n = 20) and had a related surgical intervention between 2 to 11 years prior to the present assessment. Regarding subjective well-being, there were no signifi cant differences in terms of positive affect (t(60) = 0.175; p = 0.862), life satisfaction (t(63) = 1.725; p = 0.089) and overall well-being (t(63) = −1.662; p = 0.101); however, there were differences among the two groups concern-ing negative affect (t(60) = −3.108; p = 0.003). Anxiety (t(39.537) = −2.899; p = 0.006), stress (t(62) = −2.053; p = 0.044) and depression (t(45.947) = −2.516; p = 0.015) also showed differences among cancer survivors and participants with no previous oncologic disease.

Conclusions: Cancers survivors presented higher levels of negative mood, including anxiety, stress and depression. This emphasizes that, although several years underwent since the diagnosis and related surgical interven-tions, an impaired mood might persist over the years.

613

CHANGE OF FATIGUE AND PHYSICAL FITNESS IN HOSPITALIZED

LEUKEMIA PATIENTS: A PRELIMINARY STUDY

Pei-Hsuan Lee1, Shiow-Ching Shun2

1. Nursing, National Taiwan University Hospital, Taipei, Taiwan2. Nursing, National Taiwan University, Taipei, Taiwan

Aims: To explore the change of fatigue and physical fi tness and their asso-ciations in hospitalized leukemia patients before and after chemotherapy.

Methods: Eligible participants were leukemia patients, who were going to receive chemotherapy and in hospital at least one week, in a teaching hos-pital in northern Taiwan. Data was collected twice at 48 hours after admis-sion (T1) and 48 hours before discharged (T2) by using Cancer Fatigue Scale and physical fi tness examination with 6-minutes walking test (6MWT), grip strength with both hands, and 30-sec chair stand test (30-sec CST). Spear-man *.rcorrelation were used to examine the association between fatigue and indicators of physical fi tness.

Results: A total of 18 patients were recruited and 16 patients completed the study procedures. The level of total fatigue, physical and cognition fatigue increased, but mental fatigue decrease. Besides, the distance of 6MWT, the grip strength of dominant hand, and times of 30-sec CST decreased. However, those changes did not show statistical signifi cances. There was only times of 30-sec CST was negatively correlated with total fatigue at T2.

Conclusions: The level of fatigue that patient experienced increased and their physical fi tness decreased after chemotherapy; therefore, they might need further education program in fatigue management and enhancing physical activity before discharged. Our preliminary fi nding revealed that 30-sec CST might be an indicator to predict fatigue for inpatients, but further studies with larger sample size are needed.



614

WOULD PSYCHOLOGICAL ASSISTANCE BE HELPFUL TO ME?

PREVALENCE AND PROFILE OF PATIENTS WHO CONSIDER

PSYCHOLOGICAL ASSISTANCE AS A RESOURCE

Concha Leon1, Tomas Blasco2, Esther Jovell3, Rosanna Mirapeix1, Gloria Arenas1, Remei Blanco1, Jordi Alfaro1, Luis Fernandez1, Angeles Arcusa1

1. Inst. Oncol. Valles (IOV) Consorci Sanitari de Terrassa. Hospital Parc Tauli Sabadell, Terrassa, Barna, Spain2. Psicologia Basica, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain3. Ofi cina Técnica de Recerca, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain

Aim: Although health professionals consider that psychological assistance (PA) is a useful tool to help cancer patients at the different phases of the disease, we do not know whether all patients share this opinion. Not all cancer patients ask for PA, but we do not know which reasons allow them to that decision. Availability of psychological resources and agreement about that PA would be helpful could explain this feature. The present study focuses on this second point of view and assesses the prevalence and profi le of patients who believe that PA would be useful for them.

Methods: A sample of 352 patients (186 women and 166 men) with differ-ent diagnoses receiving their fi rst visit in the Oncology Service were assessed using a structured questionnaire. Presence of Emotional distress (fear, anger), Effort to cope with cancer, and Belief in the helpfulness of PA, were evaluated as ‘High’ or ‘Low’. Previous diagnosis of anxiety or depression prior to oncological disease was also considered.

Results: Only 86 patiens (24’5%) considered that PA would be helpful to them. These patients did not differ from the other patients of the sample in age, gender, and previous diagnosis of anxiety or depression, but they had higher proportion of cases showing high fear (43% vs. 19% p = 0.00), high anger (44% vs. 18% p = 0.00) and high efforts to cope with the situation (44% vs. 18% p = 0.00).

Conclusions: A 75% of patients do not consider PA as helpful for them-selves, but we do not know whether they consider PA as unhelpful for other patients. Patients considering PA as helpful suffer emotional distress and must spent high levels of effort to cope with disease.

615

AN EXPERIENCE OF STRUCTURED SUPPORT GROUP FOR THE

SIBLINGS OF CHILDREN WITH CANCER

Clementine CL Lopez, Fresneau FB Brice, Sarah SD DauchyInstitut Gustave Roussy, villejuif, IDF, France

Purpose: Siblings of children treated for a cancer often experience psycho-logical diffi culties (anxiety, sadness, feeling of anger, of loneliness) some-times associated to behaviour disorders, school diffi culties and social/familial dysfunctioning.

Groups approach for siblings showed positive effects on mood, quality of life and understanding of the disease. However, presently there is no con-sensus about these group-functioning: number of session, opened or closed group and program of the sessions. Consequently, the evaluation and the replication of such groups are rather diffi cult. Qualitative data collected in 2011 at the cancer center Gustave Roussy Institute (IGR) concerning fami-lies’ expectations about the supportive care for siblings and data from the literature lead us to build a structured group program, based on cognitive and behavioural theories, which could be available for other teams.

Method: This closed group, of 2 sessions, is lead by a paediatrician and a psychiatrist for children. It concerns children from 6 to 12. This group is supposed to offer a psychological support, informations about cancer and its treatments, improve family communication and develop the social support by offering recreation activities. We created a booklet given to the

children which helps structuring the sessions and makes the emotional expression freer. Further quantitative and prospective study, with a control group, will evaluate the impact of such sessions on the emotional state of siblings, their quality of life and family communication.

Results: data analysis of fi rst two groups is underway.

Conclusion: Our project is innovative because it offers a cognitive and behavioural model of support of siblings by using a personal booklet which could be used by other teams.

616

CO-ORDINATION OF PSYCHO-ONCOLOGY CARE WITHIN THE

QUEENSLAND CHILDREN’S CANCER CENTRE

Cherie LoweRoyal Children’s Hospital, Herston, Qld, Australia

The Queensland Children’s Cancer Centre (QCCC) receives approximately 160 new diagnosis of cancer a year. The Psycho-Oncology care of these patients is provided by a multi-disciplinary team of health professionals including Social Workers, Occupational Therapists, Music Therapists and Mental Health Clinicians including Psychologists and Clinical Mental Health Social Workers.

Until 2010, the co-ordination of Allied Health Services within the QCCC including psycho-oncology care was performed by all team members without clear direction from a legitimate leader. In 2010, an Allied Health Clinical Leader was appointed to co-ordinate the Paediatric Oncology Allied Health Team and establish a co-ordinated program of psycho-oncology care provided by an identifi ed Psycho-Oncology Team.

The evaluation of the impact of the Allied Health Clinical Leader demon-strated improvements in referral co-ordination, a decrease in duplication of services and improved role clarifi cation between psycho-oncology oriented health professionals. This had a fl ow on effect to patient care including a clearer focus on mutual goal setting and family centred care.

This poster details the Paediatric Psycho-Oncology Model of Care including referral pathways, universal, targeted and clinical services offered to patients and families and the communication avenues to enhance multi-disciplinary care planning and intervention.

617

JAPANESE CANCER PATIENTS’ PREFERENCES FOR LIFE

EXPECTANCY DISCUSSIONS

Lisa Mackenzie1,2, Eiji Suzuki3, Masakazu Ogura4, Mariko Carey2, Rob Sanson-Fisher2, Hiromi Asada4, Maskazu Toi3, Masahiro Hiraoka4, Katsue Tatsuno4, Catherine D’Este2,5,6


This study aimed to describe Japanese cancer patients’ willingness to answer survey questions about life expectancy; and to describe patients’ preferences for life expectancy disclosure. Adult cancer patients (planned n = 200) undergoing radiotherapy treatment at a Japanese university hospital are being recruited during 2012. Patients are asked to complete a touch screen computer survey assessing their preferences for cancer communication and care. Respondents indicating that they are aware of their (cancer) diagnosis are asked if they were willing to answer questions about their life expectancy



[replication of 1]. These questions assess patients’ preferences for and expe-riences of life expectancy discussions. Forty patients completed the survey during April 2012. Preliminary fi ndings suggest that 83% of these respond-ents (95% CI: 67%, 94%) are willing to answer questions about their life expectancy. There was strong agreement from patients that their radiation oncologist should: ask them if they want to discuss life expectancy (17%; 95% CI: 5.6–35%); tell the patients’ partner or family the news and let them decide whether to tell the patient (17%; 95% CI: 5.6–35%); and just tell the patient the news that the radiation therapist thinks the patient can cope with (10%; 95% CI: 2.1–27%). There was strong disagreement with these statements by 10% (95% CI: 2.1–27%); 3.3% (95% CI: 2.1–27%); and 13% (95% CI: 3.8–31%) respectively. These fi nding suggest there is variation in Japanese cancer patients’ preferences for life expectancy disclo-sure. There is a need to investigate and consider individual patient charac-teristics associated with different preferences for life expectancy disclosure.

Reference

1. Mackenzie, L. Sanson-Fisher, R., Carey, M. Hall, A. II-2: Who should make disclosure decisions? Cancer patients’ preferences for life expect-ancy disclosure. IPOS 13th World Congress of Psycho-Oncology, 16–20 October 2011, Antalya, Turkey.

618

EVIDENCE-BASED PRACTICE OF ORAL CARE FOR HEAD AND

NECK CANCER PATIENTS IN JAPAN: A LITERATURE REVIEW

Reiko Makabe, Noriko NemotoSchool of Nursing, Fukushima Medical University, Fukushima, Japan

Purpose: The purpose of this study was to review and identify Japanese articles of evidence-based practice (EBP) related to oral care for head and neck cancer patients in Japan.

Methods: A literature search was conducted by using Igaku-Chuou Zasshi, a Japanese health literature data base. We performed ‘KEYWORD’ and ‘AND’ literature search methods by using three terms, ‘oral care,’ ‘head and neck cancer,’ and ‘original article.’

Results: The ‘KEYWORD’ search for ‘oral care’ resulted in 10,063 articles and the results for ‘head and neck cancer’ were 159,892 articles. Next, we combined these two terms, and selected 377 articles from the results. 41 articles using the term ‘original article’ were then selected. After reading and reviewing the 41 articles, 12 articles were fi nally selected and determined as relevant articles for this study (performed at the end of November, 2010). According to the EBP methods by Newhouse et al. (2007) and Poe et al. (2010), the 12 articles were reviewed and summarized with regards to studies, purposes, methods (i.e., research designs, study samples, data col-lection instruments and procedures, and data analyses), study results, and conclusions. Research designs of the 12 articles were quasi-experimental studies (n = 5) and case and descriptive studies (n = 7). The articles show effective assessments of their oral and intervention methods for these samples by caring from the pretreatment to the post treatment phase.

Conclusion: This literature review identifi ed the important issues of oral care for head and neck cancer patients receiving surgery, chemotherapy, radiotherapy, etc., and suggests that Japanese healthcare providers for head and neck cancer patients need to be more aware of EBP in cancer care. We propose further research studies on oral care for head and neck cancer patients.

619

PATIENT’S PREDICTION OF THEIR RECOVERY AFFECTS THEIR

PAIN THROUGHOUT TREATMENT

Hiromichi Matsuoka1, Atsuko Koyama1, Chihiro Makimura, Otsuka Masatomo1, Kiyohiro Sakai, Ryo Sakamoto, Minoru Niki, Kazuhiko Nakagawa1. Kinki University Faculty of Medicine, Osaka, Japan

Introduction: Pain is among the most common symptoms of cancer. It increases in prevalence and intensity as the disease progresses and it impacts multiple domains of a patient’s quality of life. Concerning pain as a result of cancer, there is much research about the patient’s amount of pain using the Numerical rating scale (NRS), or in respect to emotions, using the Hospital anxiety and depression scale (HADS). However, little is known about the infl uence of the patient’s individual cognition and individual view of pain. Therefore, the objective of this study is to investigate the effect of cancer patient’s individual cognition and individual view to pain on the reduction of the patient’s pain in the future.

Methods: We prospectively analyzed 48 patients (male 25) experiencing pain as a result of cancer. The subjects of this study were cancer patients who went to our hospital regularly or were hospitalized between September 2009 and January 2011. Morphine treatment was performed according to the standard method including titration (NCCN GuidelinesTM, Adult Cancer Pain). We investigated if the patient’s prediction of their recovery affects their pain throughout treatment.

Results: Patients who thought their pain would lessen on Day 1 had a chance of pain reduction on the NRS on Day 8 (P = 0.008). We also exam-ined the relation between ‘the mental condition before medical treatment’ and ‘a chance of their pain lessening’. There were moderately strong correla-tion coeffi cients (r = −0.407, P < 0.01) between ‘the recognition of getting better on Day1’ and ‘a high HADS-D score on Day 1’, and mild correlation coeffi cients (r = −0.333, P < 0.05) between ‘the recognition of getting better on Day1’ and ‘a high HADS-A score on Day 1’.

Conclusion: Our results suggest the patients who think their pain will lessen in the future could experience a reduction of pain.

620

AN INNOVATIVE APPROACH TO THE MANAGEMENT OF

CANCER-RELATED FATIGUE

Sue McConaghey, Shirley Benbow, Victoria Busch, Stephanie Foster, Jackie Gao, Kate Hudson, Natalie Louie, Alison Read, Colleen Stevens, Janet ThosebyCentral Coast Local Health District, Gosford, NSW, Australia

Cancer-related fatigue (CRF) is a common symptom reported by cancer patients. Management is diffi cult because CRF is thought to have a variety of causes and no single intervention is likely to benefi t all patients.

Aim: this study considered the effi cacy of a group program utilising behav-iour change strategies for increasing quality of life and reducing fatigue in cancer patients.

Method: 24 cancer patients with a range of cancers and at varying stages in their treatment pathways, were recruited by advertising the program through multidisciplinary networks. Three groups of patients completed the 6-week fatigue management program, developed by the psychosocial team to include both education and behaviour change components. 18 patients attended at least 4 of the 6 weeks of the program.

Outcome measures were the Quality of Life and Fatigue Scale (EORTC-C30, version 3), completed pre- and post-group, a group evalution, and a structured telephone interview 6 weeks after the completion of the group.

Results: 14 patients completed all pre- and post-measures. Signifi cant differ-ences were found for Quality of Life (p = 0.0034) and Fatigue (p = 0.0479). There were no signifi cant differences for Physical Functioning.



The group evaluations were very positive, with the majority indicating that they ‘Strongly Agreed’ and ‘Agreed’ that the group was well run, informative and relevant.

Thematic analysis of the telephone interviews and group evaluations indi-cated overall improvement in patients’ quality of life through the application of newly acquired skills and strategies to manage CRF. Patients also reported changes in their perception of fatigue as something which is manageable as opposed to insurmountable.

Conclusions: these preliminary fi ndings support continued research into the effi cacy of behaviour change strategies for the management of CRF.

621

/STREET-VIEW.COM/: REFERRAL PATTERNS AND PATIENT

EVALUATION OF CLINICAL PSYCHOLOGY SERVICES IN A

UROLOGY DEPARTMENT

Jessica C Medd, Daniel Kwok, Martin StocklerConcord Repatriation General Hospital, Concord, NSW, Australia

Background: The Clinical Practice Guidelines for the Psychosocial Care of Adults (2006) gave compelling evidence of the psychological sequelae fol-lowing a diagnosis of cancer and the effi cacy of clinical psychology (CP) interventions in addressing these. Steginga (2001) and Smith (2007) have also examined the supportive care needs of men and their partners when they face a diagnosis of prostate cancer and how CP interventions can address these needs.

Objectives: This paper aims to give the street view on referral to, and uptake of, CP services from referral and patient perspective.

Methods: Part 1 of this study asked 15 genito-urinary medical staff who attended the CRGH Uro-Oncology Multi-disciplinary Team Meeting (MDT) about their knowledge and use of CP services using 10-item cross-sectional survey.

Part 2 of the study used Change Questionnaire v2 by S Matthey (2007) mailed to 88 subjects who had been seen by the Urology CP during 2011. This 5-item questionnaire asked subjects to report if their symptoms were better than when they fi rst came to the service and how they were feeling now; compared with the time of their referral.

Results: For part 1 will present 2012 results, but a previous study in 2009 showed that adjustment to diagnosis, anxiety and depression were most common reasons for referral. Reason for non referral was – unawareness of service or referral process.

Part 2 will present 2012 data, but in 2009 a study showed that 85% of patients had an improvement in their presentation symptoms and 81% felt a lot better than when they presented to the service. Patients identifi ed themes of assistance as obtaining support; managing depression/anxiety etc and normalising of feelings.

Conclusion: This study will help promote the use and update of CP services in this population.

References

Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (2003). National Breast Cancer Centre and the National Cancer Control Initiative.

S Stegina, S Occhipinti et al (2000). Supportive Care needs of Men with Prostate Cancer. Psycho-oncology Vol 10, 66–75.

D Smith, R Suprmaniam et al (2007). Age, health and education determine supportive care needs of men younger than 70 with prostate cancer. Journal of Clinical Oncology Vol 25 (18), 2560–2556.

622

OCCURRENCE AND PREDICTORS OF SEARCH FOR PERSONAL

MEANING AND REATTRIBUTION IN PATIENTS WITH LUNG,

BREAST OR OVARIAN CANCER

Sigrun Vehling, Anja MehnertUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany

Aims: Recent research suggests an important role for personal meaning in the context of adaptation to cancer. However, specifi c meaning-focused coping processes have been little investigated so far. This longitudinal study examines the occurrence of (a) reattribution and (b) search for personal meaning as subtypes of (a) situational vs. (b) global meaning-focused coping processes according to the Park & Folkman model1.

Methods: A total of 275 patients were recruited during inpatient (lung cancer: 40%) or outpatient (breast/ovarian cancer: 60%) treatment (T1, participation rate: 50%) and after six months (T2, n = 169). The mean age was 59.0 (SD = 11.1), 70% were female, and 57% were in palliative treat-ment. Search for personal meaning was assessed by the Meaning in Life Questionnaire-Search (MLQ-S). Reattribution was assessed by a two-item-index tapping causal and selective incidence reattribution processes.

Results: 32% reported ‘often’ or ‘always’ for at least one reattribution item at T1. 22% reported ‘mostly’ or ‘absolutely true’ for at least one MLQ-S-item. While the mean reattribution score decreased between T1 (M = 5.0, SD = 2.0) and T2 (M = 4.6, SD = 2.2) (p < 0.01), search for personal meaning scores did not change (M = 16.4, SD = 8.3) vs. (M = 16.5, SD = 8.0). However, reattribution at T2 was signifi cantly predicted by older age and palliative treatment at T1 (p < 0.05), when gender, tumor site, time since diagnosis and baseline level of reattribution were controlled. Search for personal meaning at T2 was not related to any of these factors at T1.

Conclusions: Results show that both types of meaning-focused coping proc-esses were present in our sample, independent of tumor site and time since diagnosis. Limited associations with sociodemographic and medical factors suggest the need to focus on the individual cancer-global meaning system interaction in order to better understand the occurrence of global meaning-focused coping.

Reference

1. Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115–144. doi:10.1037/1089–2680.1.2.115

623

SELF ESTEEM IN HEMOPHILIC, THALLASSEMIC AND ACUTE

CANCER PATIENTS IN ESFAHAN

Gholamhossein MobarakyMedical university, Esfahan, Iran

Discussion: Self esteem formed in childhood and developed during growth of child, there are lot of factors infl uencing it; to have high or low self esteem during life depends on these factors. One of these factors is disease, espe-cially chronic and life threatening. In main essay I discuss about self esteem and its differences in three groups.

Object: Comparing self esteem in three groups of patients Hemophilic, Thallassemic and Acute cancer in Esfahanians patients.

Method: Filling kooper Smith Questioner by 100 (20 hemo. 30 thall, 50 canc.) patients referring to OPD in SAIED-AL–SHOHADA Hospital in Esfahan to fi nd scales of self esteem in three groups and compare them with normal standards.

Result: There were differences in self esteem in these three groups that will be discussed in main essay.



624

TELEPHONE SUPPORT FOR CANCER PATIENTS DURING

TREATMENT: CHEMOTHERAPY AND RADIATION

Arza Ashkenazi1, Irena Dinkevich, Asna Noam, Inbar Moshe1. Sourasky Medical Center, Tel-Aviv, Israel

Background: Cancer patients in the oncology unit are treated by multidis-ciplinary team: nurses, doctors and social workers. Most of the patients suffer from constant distress because of their life threatening illness. Most of them feel very isolated and lonely with their fears about cancer and while suffering from pain and the different side affects of the treatments. The stuff members are involved in medical and social aspects of the patients’ lives and help them cope and feel better. When the patient is discharged from the hospital, he suddenly fi nds himself cut off from this support. The patient is now all alone and fi nds himself in need to cope with various problems concerning his illness. This situation may increase the feelings of distress and anxiety.

The aim: The aim is to fi nd out if telephone support can help improve patients’ quality of life and reduce their feelings of anxiety, loneliness and distress.

Process: During one year the head nurse and the social-worker telephoned once a week, to 40 patients who received chemotherapy and radiation treat-ments at the oncology unit, while at home. The conversations were about their feelings, diffi culties concerning the illness and about their general condition.

Conclusion: The patients that were involve in the support phone project were asked, one month after the fi nal call, if they felt helped in any way to better cope with the illness. All of them answered that the phone contacts helped them fi nd solutions to problems they faced while at home. They stated that they felt protected by the staff and that they were given answers and ways to cope better with the illness. All wished to continue to take part in this project.

625

INTEGRATING SPIRITUALITY INTO A GROUP PSYCHOTHERAPY

PROGRAM BASE OF IRANIAN-ISLAMIC CULTURE IN INCREASING

THE GENERAL HEALTH AND QUALITY OF LIFE IN WOMEN WITH

BREAST CANCER

Seyed Mahdi Mousavi, Farah Lotfi Kashani, Shahram Vaziri, Mohamad Esmail AkbariCancer Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: The public health level and life quality in patient with cancer and their caregivers is very important. Considering to four dimensions of health including bio-psycho-social and spiritual aspects with united view-point that recommended by World Health Organization (WHO) is required for increasing the health level and improving the life quality of patients and their care providers. Among these, spiritual-psychical dimension has key role in decreasing the mental tensions and stresses and increasing the hope, pleasure and life satisfaction as well as coping with diseases and their com-plications in patients and their care givers. On the other side, providing the list of spiritual health skills and items according to culture of patients is a necessary task.

Methods: In this study, during two years we evaluated the major religious and cultural texts and articles of Iran population with Persian and Arabic language. Then we provided the list of spiritual skills and effective items in spiritual health according to Iranian-Islamic culture of Iran people that are: Praying, recourse to prophets, thanksgiving, patience, Trust on God, altru-ism, to go on religious places such as masques and pilgrimage and perform-ing the religious action and rituals. Then this study performed in 12 researches at two cities including Tehran and Zanjan on women aged 25–60 years with breast cancer including stage 3 and less, during six months after diagnosing by psycho-oncology group of Cancer Research Center of Shahid

Beheshti University of Medical Science. Also this study was done as group therapy in the form of Psycho-Education.

Result: With considering to performed study, there was not signifi cant deference between spiritual skills and religious items according to Iranian – Islamic culture (Shie) to other cultures and international provided proto-cols; however, recourse to celestial prophets such as messengers and Imams (according to Imamieh opinions that is the formal and prominence religious of Iran) and to going on pilgrimages which are the tombs of Imams is more signifi cant than other Islamic group. On the other hand, the level of general health and life qualifi cation in all 12 performed researches on women with breast cancer has increased signifi cantly.

Conclusion: With regard to Iran community that is a religious-spiritual society, considering the spiritual dimension for improving the public health of Iran population, especially patients with cancer is very important issue. The results of this 12 performed researches demonstrated that introduced items in study that were coincident to Iranian-Islamic culture of Iran popula-tion resulted in increasing the spiritual-psychic health level and life quality of women with breast cancer.

626

CONFUSION – FOR PATIENTS AND CLINICIANS. POTENTIAL

DIFFERENCES IN THE MANAGEMENT OF DELIRIUM IN THE

PSYCHO-ONCOLOGY SETTING ACCORDING TO SPECIALTY.

A CASE DISCUSSION AND REVIEW OF PALLIATIVE MEDICINE

AND PSYCHI

Michael Murphy1, Catherine Mason1

1. Westmead Cancer Care Centre, Westmead, NSW, Australia

Delirium, or acute confusional state, is a serious medical condition. Pallia-tive care physicians encounter acute confusional state frequently in their cancer patients with terminal illness (rates ranging from 25% to 85% study dependent). General consultation-liaison psychiatrists encounter delirious patients on a similar frequency within the general hospital population. The clinical presentation of the delirium, in conjunction with the patients’ current oncological diagnosis and prognosis, will infl uence the specialty involved in the patients care.

A case study of a 62 yo man who developed delirium whilst undergoing post-operative palliative chemo-radiotherapy for glioblastoma multiforme in a tertiary referral hospital is presented. It highlights some of the potential differences in treatment focus and modality from the different medical specialties of radiation oncology, medical oncology, psychiatry and palliative medicine. The case caused considerable distress for the patient, his family and clinicians and some ethical issues arose.

Much work has been published within the Palliative medicine community regarding delirium in end of life care. More advice comes from the Colleges of Psychiatry, while even more medical guidelines for delirium have recently emerged, such as those of the British National Institute for Clinical Excel-lence (NICE 2011). Therefore a psycho-oncology clinician could easily become overwhelmed. A review of the medication advice is presented.

This author proposes that further cooperation and alliance between the fi elds of psychiatry and palliative medicine could assist both sets of clinicians working in the fi eld of psycho-oncology. This could improve the outcome for patients, their families and the clinicians involved.



628

COUPLE DISTRESS FOLLOWING PROSTATE CANCER DIAGNOSIS

Suzanne K Chambers1, Lisa Nielsen2, Leslie Schover3, Kim Halford, Robert A Gardiner, Jeff Dunn2, Stefano Occhipinti1

1. Griffi th University, Southport, QLD, Australia2. Cancer Council Queensland, Spring Hill, Qld, Australia3. UT MD Anderson Cancer Center, Houston, TX, United States

Aims: The experience of a diagnosis of prostate cancer is distressing for both men with the disease and their partners. This presentation describes the prevalence of distress and marital functioning in men and their partners.

Methods: A cross-sectional survey of 189 (47% response) prostate cancer patients who had chosen or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables; anxiety/depression; cancer-specifi c distress; marital functioning.

Results: Levels of distress were higher in partners than patients, with 31% of partners and 21% of patients in the distressed range (≥4) on the Distress Thermometer. Hospital Anxiety and Depression Scale scores indicated that a greater number of partners exhibited mild-severe levels of anxiety than patients (36% versus 23%); 6% of patients displayed mild to severe levels of depression compared to 8.5% of partners displaying mild to moderate levels. Partner and patient distress was signifi cantly correlated. Marital functioning was high for 87% of patients and 81% of partners.

Conclusions: A signifi cant subgroup of men and their partners experienced high levels of distress. Interventions that target both the patient and partner are warranted.

629

VOICE OF SUFFERING AMONG PATIENTS WITH TERMINAL

CANCER: CASE STUDIES FROM THAILAND

Kittikorn Nilmanat1, Pachariya Chailungka1, Temsak Phungrassami2, Chantra Promnoi1, Kandawasri Tulathamkit2, Prachuap Noo-urai2, Sasiwimon Phattaranavig2

1. Faculty of Nursing, Prince of Songkla university, Hat Yai, Songkhla, Thailand2. Radiation Therapy Division, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, THAILAND

Suffering is a common phenomenon experienced by patients with cancer, particularly advanced cancer. This qualitative study aims to describe the experiences of patients with terminal advanced cancer. Series interviews and participant observation were conducted on 15 patients with terminal advanced cancer. Thematic analysis was applied. The fi ndings reveal that living with suffering was the dominant theme. The causes of suffering include physical symptom distress, feeling of alienation, sense of worthless-ness, sense of burden to others and desire for hastened death. The study also highlights the importance of psycho-spiritual interventions to alleviate suffering among the dying patients with advanced cancer.

630

EFFECTS OF PSYCHO-ONCOLOGICAL SYSTEMATIC

CONSULTATION ON THE DISTRESS AND ADAPTATION OF

PATIENTS WITH BREAST CANCER

David Ogez1, Céline Brison2, Philippe de Timary1, Martine Berlière1, Jean-pascal Machiels1, Emmanuelle Zech2

1. Cliniques Universitaires St Luc, Brussels, Belgium2. UCL, Louvain-la-neuve, Belgium

Background: The Belgian state has recognized the value and provided means to develop Psycho-Oncology through the national cancer plan

(Onckelinx, 2008). Therefore, it is important new models to organize this discipline. Transdisciplinary work is organized around the care coordinator who fi rst to assesses the psychosocial needs of patients. Beyond this initial evaluation, we modeled a systematic psycho-oncological semi-structured interview by psychologists, which allows him to refer the patient to appro-priate cares.

Method: The systematic consultation should allow the psychologist to iden-tify the psychological needs, the psychopathological comorbidities, as well as the personal and social resources of patients.

Our study aimed to assess the effectiveness of this intervention: 1 – We fi rst conducted a survey to identify the psychological needs of patients with breast cancer; 2 – The items collected were used to develop a structured intervention; 3 – We then tested its relevance on cancer in patients at time of surgery with needs, psychological distress and coping questionnaires.

Results: Nearly 90% of breast cancer patients reported to be satisfi ed with the intervention. 30% of patients decided to consult a psychologist after the systematic consultation.

Patients not requiring psychologist signifi cantly decreased their anxiety (p < 0.01) after the intervention. The patient who consulted a psycho-oncologist were signifi cantly more depressed and had more physical and psycho-social needs (p < 0.01) than the others. They also required more medical information.

Conclusion: The interest of systematic consultation is to orient the patient towards appropriate support. Patients who were referred to the psychologist had more psychological distress. The aim of further clinical interventions is to allow the patients to develop better coping strategies to overcome this psychological distress.

631

PERSPECTIVES ON COMPLEMENTARY AND ALTERNATIVE

MEDICINES (CAM)

Ian OlverCancer Council Australia, Sydney, NSW, Australia

Aim: To gain a perspective on the scope and meaning of CAM.

Method: 24 authors including traditional and CAM practitioners, research-ers, educators, regulators and consumers were recruited to write about CAM from their perspectives.

Results: The defi nitions of CAM were problematic. The same therapy could complement traditional therapy, be used as an alternative or if assessed by randomised clinical trials, become a mainstream treatment. Whether a therapy is classifi ed as a CAM may be culturally based (e.g. Chinese vs. Western). Classifi cation by mechanism of action may be unhelpful since this can be unknown for both traditional therapies and CAM, or explanations such as external energy forces in CAM may have no counterpart in Western medicine. Distinctions between ‘natural’ therapies and pharmaceuticals blur when vitamins are used in high dose like pharmaceuticals, or antioxidants in foods are extracted and prescribed as supplements. Studies on CAM usage can depend on classifi cation, e.g. whether a widespread practice such as prayer is counted as a CAM or not. Perspectives on research differ. The Western approach isolates the active agent and trials it, whereas Chinese medicine relies on interactions of multiple natural products. A literature analysis prior to us performing a triple-blind randomised trial of interces-sory prayer showed a resistance to investigating CAM where the mechanism is opaque to scientifi c investigation. Finally, consumers who were found to be polarised in their views on CAM in a qualitative study often wanted to speak to their clinicians about CAM but would not do so if they sensed disapproval. Their doctors should, at least, be able to advise on interactions of drugs with CAM.

Conclusions: A broadly based expert group on CAM had diverse views. Integrative clinics may bridge the gap between CAM and traditional medi-cine and make it easier for consumers to understand what is being offered.



632

SOMATIC VULNERABILITY AND DEPRESSION IN ONCOLOGICAL

PATIENTS

Luisina Onganía1, Paula Climentzos2, Marina Bramajo2, Oscar Osores1, Marcelo Blanco Villalba2

1. LALCEC – Centro Médico Austral OMI, Ushuaia, TDF, Argentina2. Psychooncology, Centro Médico Austral Omi, Buenos Aires, Argentina

Introduction: Making a complete psychosocial diagnosis in oncological patients, at the beginning of medical treatment enriches the approach of interdisciplinary teams. It gives important information that may be used to decide future interventions. The prevalence rates for major depression dis-order in cancer patients are between 0% and 38% and 0%–58% for depres-sion spectrum syndromes (Massie, MJ; 2004). Somatic vulnerability is a theoretical concept that shows some dimensions of the personality and environment that may put the patient in risk. Some of them are alexitimia (diffi culty to express emotions), operatory thinking, over-adaptation, depression, anxiety, stress and supportive environment. Doctors are fairly used to detect some depressive symptoms, but no so familiarized with the detection of the other kind of dimensions that are also risky for the patient evolution or quality of life.

Objectives: Observe the relationship between depressive symptoms and somatic vulnerability in cancer patients.

Material and methods: Descriptive, transversal and randomized study. Sample: 103 cancer patients that attend to a private cancer center between April and June of 2011. Instruments: Beck Depression Inventory (BDI), Somatic Vulnerability Scale (EVS-25) and specifi cally designed questionnaire.

Results: 50 of 103 patients show somatic vulnerability. The 54% of the vulnerable ones, doesn’t evidence any depressive disorder. Only 15% of the vulnerable patients are in psychological treatment. Most of them give high results for the other dimensions that involve somatic vulnerability (alexiti-mia, operatory thinking, over-adaptation, anxiety, stress or unsupportive environment in different percentages).

Conclusion: This study shows that a high percentage of the patients have somatic vulnerability. The somatic vulnerability seems to be hard to be detected by doctors because it involves many specifi c mental dimensions. In fact, only 15% of the patients in risk are in psychological treatment. The intervention of a trained professional seems to be relevant to make an earlier diagnosis of the patients in risk, affecting directly in the evolution and quality of life of them and their families.

634

LONG-TERM CANCER SURVIVORSHIP: THE IMPACT OF

RECURRENT DISEASE ON PSYCHOSOCIAL OUTCOMES

Errol J Philip1, Thomas V Merluzzi2

1. Memorial Sloan Kettering Cancer Center, New York, NY, United States2. Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA

Introduction: Survivors of cancer are at an increased risk of recurrence and secondary cancers, as well as comorbid disease and late and long term effects of treatment. Fear of recurrence is a routinely noted stressor by survivors; however little is known of the impact of recurrent disease on psychosocial outcomes (Koch et al., 2012; Vivar et al., 2008). The current study examines the psychosocial outcomes and quality of life of long-term survivors with and without recurrent disease.

Method: A sample of 327 cancer survivors (N (Recurrence) = 85, M age = 62.8 years, female = 70%, M years since treatment = 10), completed demographic and health history information forms, as well as measures of depression, anxiety, distress and quality of life, by mail as part of a larger study.

Results: There were no signifi cant differences across demographic variables between the two groups. Long-term survivors who were currently under treatment for disease recurrence reported signifi cantly higher rates of depres-sion (p < 0.05) and greater impairment in quality of life (p < 0.01). Impair-ments in quality of life were most notable in domains of physical, emotional and functional well-being (p’s < 0.01). There were no differences between the groups on measures of anxiety or acute distress.

Discussion: Fear of recurrence is a tangible stressor for many cancer patients and survivors. In a group of long-term survivors, an episode of recurrent disease was associated with signifi cant impairments in quality of life and heightened depression. Care providers should be vigilant in monitor-ing possible depressive symptoms and quality of life concerns in survivors who experience a recurrence.

635

CANCER RECURRENCE AND LONG-TERM SURVIVORSHIP:

SYMPTOM BURDEN AND DESIRE FOR SUPPORT REFERRAL

Errol J Philip1, Thomas V Merluzzi2

1. Memorial Sloan Kettering Cancer Center, New York, NY, United States2. Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA

Introduction: Post-treatment cancer survivors routinely endorse fear of recurrence as a salient and ongoing stressor (Koch et al., 2012). Despite this, there is a paucity of information regarding the impact of recurrent disease on psychosocial outcomes (Vivar et al., 2008), and the most appropriate manner by which to provide support. The current study examines the psy-chosocial outcomes and support preferences of long-term survivors with and without recurrent disease.

Method: A sample of 327 cancer survivors (N (Recurrence) = 85, M age = 62.8 years, female = 70%, M years since initial treatment = 10), com-pleted demographic and health history information forms by mail as part of a larger study. Participants reported symptom burden, psychosocial stres-sors and whether they would like to follow-up with a health professional, in addition to psychosocial outcomes.

Results: There were no signifi cant differences across demographic variables between those with and without recurrence. Long-term survivors under treat-ment for disease recurrence reported signifi cantly higher rates of symptom burden (p < 0.01), but not higher rates of psychosocial stressors (p = 0.16) or desire for referral (p = 0.27). ROC analysis suggested that for survivors, regardless of recurrent disease status, the number of psychosocial stressors endorsed remained the most accurate predictor of desiring support referral, beyond screening measures of depression, anxiety and acute distress.

Discussion: Fear of recurrence can be a salient and ongoing concern for many cancer survivors. As expected, those who were receiving treatment for recurrence endorsed higher rates of symptomatology; yet recurrence was not associated with a greater number of psychosocial stressors or need for support compared to those who were not coping with recurrence. These preliminary results indicate that psychosocial stress may be critical in dis-cerning need for supportive services.

636

SEX – LET’S TALK

Janine Porter-Steele, Leonie YoungKim Walters Choices Program, Toowong, QLD, Australia

Background: Whilst research indicates a signifi cant number of women diag-nosed with breast cancer suffer body image, intimacy and sexuality issues such as loss of libido or reduced sexual activity it also demonstrates sexual-ity remains a taboo subject. These sexuality problems are often an unex-pected side effect of their cancer treatment. Women report they not only want to fi nd solutions for themselves but also for their partners for whom they often experience enormous guilt about the impact this has on them.



Method: Through a team effort presenting multiple dimensions the Sexual-ity Workshop offers a safe environment where women can openly share and discuss their concerns. Breaking down barriers to discussion, these work-shops are interactive and fun, explore sexuality and body image and share strategies and solutions through a range of media.

They are facilitated by a specialist breast care nurse drawing on her experi-ences in supporting women diagnosed with breast cancer and reinforcement by evidence based strategies together with a breast cancer survivor whose anecdotes and survivor experience add another perspective to help the audi-ence gain insight and fi nd solutions. This sensitive topic is addressed with the use of humour and compassion to create a sense of ease in the audience.

Results: Through quality assurance strategies and verbal feedback these workshops have demonstrated they encourage increased emotional resil-ience, strengthened relationships and reduced anxiety.

Conclusion: By offering women something practical that may improve this part of their lives, these workshops are in a sense investing in the hopeful side of their surviving a serious disease like cancer.

637

THE CHARACTERISTICS OF PERSONAL SOCIAL NETWORKS

OF BREAST CANCER PATIENTS IN SOUTHERN THAILAND:

A QUALITATIVE CASE STUDY

Shutiwan Purinthrapibal1, Julie Boddy1, Lesley Batten2, Kittikorn Nilmanat3

1. School of Health and Social Services, Massey University, Palmerston North, none, New Zealand2. Research Centre for Maori Health and Development, Massey University, Palmerston North, none, New Zealand3. Faculty of Nursing, Prince of Songkla University, Songkhla, none, Thailand

Social networks are identifi ed in theory and policies as ways to support women and their relatives during breast cancer journeys. In southern Thai-land, there are unique health care circumstances, population demographics, ways of life, and traditional beliefs related to health. Therefore women with breast cancer in southern Thailand may have unique personal social networks.

In this paper I will present preliminary fi ndings of a qualitative case study related to the characteristics of personal social networks of breast cancer patients. Five women agreed to participate. Data collection activities included conversations, interviews, observations, document analysis and social network mapping. Individuals identifi ed by the women as their sig-nifi cant network members were also involved through individual or group conversations and interviews.

Analysis demonstrated that the women’s personal social networks were predominantly family-based, and family and work place-based, with some overlap. Most relationships between network members formed pre breast cancer diagnosis and were maintained during the cancer journey. Some women identifi ed health professionals in their social networks; however, these relationships were of a temporary nature. Network relationships formed with other breast cancer patients usually developed during treatment phases and some continued post treatment. The structures and characteris-tics of the networks were dynamic. A particular feature identifi ed was the contraction of broader community links during treatment phases related to cultural beliefs about serious illness. Personal social networks functioned in different ways with some controlled by the women, some coordinated by network members, and some demonstrating a team approach. Network characteristics were infl uenced by the prior personal health and illness experiences of the women with breast cancer and their network members.

These preliminary fi ndings illustrate the importance of personal social net-works during women’s journeys with breast cancer and provide health professionals with some understandings of the ways in which network characteristics can differ between individual women.

638

QUALITY OF LIFE IN PATIENTS TREATED WITH ADVANCED

LARYNGEAL AND HYPOPHARYNGEAL CANCERS – A SINGLE

INSTITUTION EXPERIENCE FROM SOUTHERN INDIA

Vijayabhaskar Ramakrishnan1, KS Kirushnakumar2, Krishnakumar Rathinam3, Anand selvakumar P2

1. Department of surgical oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India2. Department of radiation oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India3. Department of medical oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India

Objective: To study quality of life in patients treated for advanced hypopha-ryngeal or laryngeal cancer, with laryngeal conservation or laryngectomy.

Patients and methods: Ours is a retrospective study which included 85 patients in remission from squamous cell carcinoma, treated between 2003 and 2011. Thirty patients (10 hypopharynx, 20 larynx) were treated by total (pharyngo-) laryngectomy followed by external radiation therapy, and 55 (37 hypopharynx, 18 larynx) underwent an organ-conservation protocol with concurrent radiochemotherapy or with induction chemotherapy using platin-5FU followed by radiation therapy. All patients responded to the quality of life questionnaires (EORTC QLQ-C30 and QLQ-H&N35) applied to them on their followup visit during Oct–Dec 2011.

Results: Advanced tumor stages IVa and IVb were signifi cantly more fre-quent in the surgery groups (hypopharynx: 67.8% vs. 32.3%, p = 0.01; larynx: 62.4% vs. 47.5%, p < 0.01). Sensory perception to smell and taste was signifi cantly better in the laryngeal conservation group compared to surgery group (p < 0.01). In laryngeal cancer, the only signifi cant difference was for ‘dry mouth’, which was signifi cantly less incapacitating with surgical treatment (p < 0.001). The impairment of the other quality of life items did not differ between surgical and conservative treatment.

Conclusions: Quality of life is impaired in all patients treated for pharyn-geal or laryngeal cancer. The type of treatment, surgical or conservative, affects differently various aspects of quality of life.

639

FACTORS AFFECTING TREATMENT OPTIONS IN PATIENTS WITH

ADVANCED CANCER OF ORAL CAVITY – A SINGLE INSTITUTION

PROSPECTIVE STUDY FROM SOUTHERN INDIA

Vijayabhaskar Ramakrishnan1, KS Kirushnakumar2, Krishnakumar Rathinam3, Anand selvakumar P2

1. Department of surgical oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India2. Department of radiation oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India3. Department of medical oncology, Meenashi Mission Hospital and Research Centre, Madurai, TN, India

Aim: Cancer of the oral cavity is one of the commonest cancers encountered in our patient population. Most of the patients present in advanced stage ignoring early symptoms, despite easy accessibility for examination and early symptoms. A signifi cant number of these patients refuse further treat-ment after initial diagnosis and staging. This study aims to identify the reasons for Initial refusal of treatment.

Methods: This is a single institution prospective study conducted at Meen-akshi Mission Hospital and Research Centre. All patients attending the oncology outpatient department between Jun–Dec 2011, with either T3/4 and/or N2c/3 oral cavity squamous cell carcinomas were included in this study. The basic demographic details and tumor details were collected. All patients who refused the treatment were given a semi structured question-naire to fi ll in details for refusing treatment. The data were tabulated and analysed.



Results: During the study period, 126 patients of advanced oral cavity cancers attended the OPD. Cancer of the tongue was the common subsite (50%) followed by buccal mucosa (15.8%), Alveolus (15.8%), Retromolar trigone (12.6%) and Hard palate (5.5%).

Of these, 70 patients (55.5%) refused further treatment. Not able to afford the treatment costs were the commonest reason given by over 50% of patients. Twenty fi ve patients (35%) cited disfi gurement as the reason for refusing radical surgery. Ten patients were of the opinion that cancer recurs faster after surgery and this misconception was the reason for refusal of treatment. Other factors cited were the self assessment by the patient and relatives that they were too weak and old to tolerate any major procedure. Overall, 48 patients (68.5%) cited a single factor as the reason for refusing treatment, 15 patients (21%) cited 2 factors and 7 patients cited more than 2 factors. After initial refusal, 34 of the 70 patients consented for further treatment, after active counselling by the treating physician.

Conclusion: Cost of the treatment is the major hindrance in the decision making of the patient and caregivers, in choosing optimal health care. Making health insurance mandatory and providing free insurance cover for the lower socioeconomic strata people will help them make early and wise decisions. Active counselling by the treating physicians is helpful in allaying the unfounded fears and misconceptions and help them in taking treatment decisions.

640

PHYSICAL ACTIVITY AND DIETARY INTERVENTIONS IN BREAST

CANCER SURVIVORS: A SYSTEMATIC REVIEW OF THE

MAINTENANCE OF BEHAVIOUR CHANGE OUTCOMES

Lauren Spark, Marina Reeves, Brianna Fjeldsoe, Elizabeth EakinCancer Prevention Research Centre, The University of Queensland, Brisbane, Queensland, Australia

Introduction: The effi cacy of physical activity and dietary interventions in producing short-term (end-of-intervention) behaviour change among breast cancer survivors is supported by a large evidence base. However, no review to date has systematically evaluated the extent to which such outcomes can be maintained post-intervention. This review aimed to determine: (1) the proportion of physical activity and dietary interventions in breast cancer survivors that reported on and achieved successful post-intervention main-tenance outcomes; and (2) the sample, intervention, and methodological characteristics common among trials that reported successful maintenance outcomes.

Methods: A structured search of PubMed, CINAHL, Medline via Ovid, Web of Science, CENTRAL, and PsycInfo was conducted for articles pub-lished until March 2012. Included studies had to: evaluate a randomised controlled trial of a physical activity and/or dietary behaviour change inter-vention that included breast cancer survivors (inclusively or exclusively; during or post-treatment); and report on between-group differences of behavioural outcomes at end-of-intervention and at least three months post-intervention.

Results: The initial search resulted in 1298 publications. Of 63 identifi ed studies that reported on intervention outcomes, 11 (17%) also reported on maintenance outcomes. Five of these 11 studies reported successful mainte-nance of behaviour change (four physical activity and one combined physi-cal activity and dietary intervention). Due to the limited number and heterogeneity of the fi ve studies, few commonalities were identifi ed.

Conclusions: This systematic review of physical activity and dietary inter-ventions targeting breast cancer survivors indicates that reporting on main-tenance of behaviour change is rare. There is thus a pressing need to direct more attention to reporting on post-intervention outcomes. Doing so will be important in informing the development of interventions to improve longer-term health and well-being outcomes for the growing numbers of breast cancer survivors, and to identify intervention strategies that success-fully promote the maintenance of health behaviour change.

641

INVESTIGATING RESILIENCE IN BREAST CANCER: A MIXED-

METHODS APPROACH

Natalie Stefanic, Peter Caputi, Don Iverson, Lisbeth Lane, Lindsay OadesUniversity of Wollongong, Gwynneville, NSW, Australia

Background: Psychological resilience has recently emerged as a topic of interest among psycho-oncology researchers and clinicians. Although this concept has been discussed with increasing frequency, the investigation and application of resilience in the cancer context is still in its infancy. Resilience has been conceptualised as a contextual phenomenon that manifests as maintenance or recovery of well-being amidst adversity, with adaptive goal-based coping processes proposed to underpin this phenomenon. This study aimed to apply a goal-based model of resilience to women with early-stage breast cancer and to determine whether adaptive goal processes of assimila-tion and accommodation underpin the maintenance or recovery of psycho-logical well-being in the six months following diagnosis.

Methods: The study utilised a longitudinal mixed-methods design. Self-report questionnaires were administered at four time-points post-surgery, in conjunction with semi-structured phone interviews. To date, complete data has been collected from 14 women; the fi nal sample size will be approxi-mately 50 women.

Results: Preliminary data analysis reveals that women with early-stage breast cancer hold important goals in life and that these goals are differen-tially impacted by cancer-related circumstances. Women who make adjust-ments to their goals or situation when encountering goal interference seem to be better able to continue goal pursuit and maintain a general sense of well-being and control. Longitudinal data will be further analysed with latent growth modelling and logistic regression. Cross-sectional and longi-tudinal interview data will be analysed for themes indicative of adaptive goal-based coping.

Conclusions: Preliminary fi ndings indicate that a goal-based model of resil-ience has utility for understanding how resilience can be manifested in the context of breast cancer. This model has the potential to inform the psycho-social care of patients by enabling clinicians to better identify factors that may support or detract from the manifestation of resilience in the context of breast cancer diagnosis, surgery and adjuvant treatment.

642

WORRYING ABOUT THE CHILDREN AFTER BREAST CANCER: THE

ASSOCIATION BETWEEN AGE OF THE YOUNGEST CHILD AND

MOM’S NEED TO TALK

Karin Stinesen-Kollberg, Thordis Thorsteinsdottir, Ulrica Wilderäng, Gunnar Steineck1. University of Gothenburg, Gothenburg, Sweden

Objective: This study investigated the association between worrying about own children and low psychological well-being during the year that follows breast cancer.

Method: In an observational population-based study, we collected data from 313 women operated for breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden.

Results: Worrying about own children (3–7 on a 1–7 visual digital scale) was, among other variables, most signifi cantly associated with low psycho-logical well-being one year after breast cancer surgery (relative risk (RR) 2.63; 95% CI 1.77–3.90; Posterior probability value 98.8%).

Conclusions: In this group of women operated for breast cancer we found an association between worrying about one’s own children and low psycho-logical well-being.

Keywords: cancer; children; parenting; psychological well-being



643

GROUP PEER SUPPORT IN A RESEARCH SETTING: TRAINING AND

CHALLENGES

Anna Stiller1, Brigid Hanley1, Sylvia Burns1, Tracey Saxton1, Lisa Nielsen1, Suzanne Chambers1,2

1. Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia2. Griffi th University, Brisbane, QLD, Australia

Aims: Peer support has relatively high uptake amongst men with prostate cancer, with men reporting that peer discussions provide information, emo-tional support, and reduce feelings of social isolation. However, the effi cacy of group peer support as a method of psychosocial intervention is compara-tively untested. We developed a multimodal supportive care intervention combining group peer support and self-management to target unmet sup-portive care needs and improve overall health in men with prostate cancer. This presentation describes the design and implementation of the peer support volunteer training program, and the challenges of using peer support within a research design.

Methods: Over twenty peer support volunteers underwent extensive train-ing to support their role. Training included: group facilitation skills, group dynamics, coping with diagnosis and treatment side-effects of localised prostate cancer, working within a research protocol, role description and boundaries. The training aimed to assist peer support volunteers in creating a cohesive and constructive group environment for participants to share their experiences and reduce participant’s unmet supportive care needs.

Results: Important areas of consideration for the training included: identi-fi cation of appropriate peers; challenges of peers in facilitating group discus-sion; and establishing an effective debriefi ng and supervision process.

Conclusions: Working with peer support volunteers is a valuable yet time-intensive process that requires ongoing monitoring. Peers often report some diffi culties in adjusting to the challenges of group facilitation, and the fl ex-ibility of approach that this requires. To assist with the transition of peers into this unique research role, comprehensive training and providing regular opportunities for peers to meet and discuss these challenges is essential.

644

FACING THE FEAR OF DEATH: 35 YEARS AS A PSYCHO

ONCOLOGIST, A PSYCHOANALYST’S PERSPECTIVE

Norman L StrakerSloan Kettering Cancer, New York City, NY, United States

The unoffi cial beginning of Psycho-oncology dates back to the hiring of Dr Jimmie Holland at Sloan Kettering Cancer Center in 1976. This paper will focus on the evolution of the psychological treatment of cancer patients facing death, from the perspective of a psychoanalyst who was a member of that founding group of mental health professionals that worked with Jimmie 35 years ago. I will emphasize the importance of the fear of death and its avoidance by oncologists, patients, psychiatrists and psychoanalysts.

645

ACCEPTABILITY OF TOUCH SCREEN COMPUTER PSYCHOSOCIAL

SURVEY TO JAPANESE RADIATION THERAPY PATIENTS

Eiji Suzuki1, Lisa Mackenzie2,3, Masakazu Ogura4, Rob Sanson-Fisher3, Mariko Carey3, Hiromi Asada4, Masakazu Toi1, Masahiro Hiraoka4, Kazue Tatsuno4, Catherine D’Este3,5,6

1. Breast Surgery, Kyoto University Hospital, Kyoto, Japan2. Graduate School of Medicine, Kyoto University, Kyoto, Japan3. Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia4. Radiation Oncology & Image-applied Therapy, Kyoto University Hospital [2], Kyoto, Japan5. Priority Research Centre for Gender, Health and Ageing, The University of Newcastle [2], Newcastle, NSW, Australia6. Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle [3], Newcastle, NSW, Australia

The aim of this study is to examine the acceptability of a touchscreen tablet cancer care survey amongst Japanese radiotherapy patients’ views. We will assess the proportion of patients completing the touchscreen survey unas-sisted, as well as patient self-reported acceptability. Eligible patients attend-ing a university hospital radiation therapy department in Japan are being invited to complete a touchscreen tablet survey about psychosocial com-munication and care. The planned accrual target is 200. Of the 40 respond-ents recruited during April 2012, the median age was 69.5 (Q1, Q3: 56.5, 74.5). The touchscreen survey was completed without assistance by 40% (95% CI: 25–57%) of respondents, while 60% (95% CI: 43–75%) required some or full assistance with survey completion from the research assistant or an accompanying person. Preliminary fi ndings suggest that 69% (95% CI: 52%, 83%) of respondents would be willing to complete such a survey more than once while waiting for their radiotherapy treatment. Of the respondents, 92% (95% CI: 79%, 98%) agreed of strongly agreed that they comfortable answering the questions and had enough privacy; 87% (95% CI: 73%, 96%) felt that the electronic touchscreen survey was easy to use and that the instructions were easy to follow; and 77% (95% CI: 61%, 89%) felt that the questions were easy to understand. This work indicated that this style of patient survey is somewhat feasible in a Japanese radiation oncology setting. However, although over two thirds of patients indicated that they would be willing to complete the survey on multiple occasions; under half of the respondents completed the touchscreen tablet survey unas-sisted. This suggests that touchscreen technology may not be entirely appro-priate for this patient group. Socio-demographic characteristics of patients completing the touchscreen survey unassisted will be reported.

646

EVALUATION OF THE INITIAL ASSESSMENT PSYCHOSOCIAL

CLINIC – PALLIATIVE CARE

Kate M SwetenhamRepatriation General Hospital, Daw Park, SA, Australia

Introduction: The evaluation of the Initial Assessment Psychosocial Clinic Palliative Care is a model that has been introduced as a quality improvement exercise after the palliative care service underwent a process of self assess-ment against the National Standards Assessment Program (NSAP). The palliative care service was unable to demonstrate a systematic way in which patients and caregivers receive an interdisciplinary assessment focusing on all the domains of ‘total’ care. The palliative care service is very strong in attending to physical issues and signs of obvious distress, however a process that enables early identifi cation can now be delivered through this new model of care.

Inclusion for the clinic: New referrals to palliative care which are triaged as ‘clinic only’ will be eligible for this service. This triage criteria means that the patient has a high functional score and is well enough to attend a clinic setting for a duration of approximately 90 minutes. The focus of service delivery is based on initial assessment, education and health promotion especially for the primary caregiver.



Methodology: Patient and caregiver satisfaction surveys were developed based on existing tools from the Palliative Care Outcomes Collaborative, and the Palliative Care National Standards Assessment Program. These questionnaires were posted out with a reply paid envelope to patients and their caregivers.

Results: 41 patients attended the GP Plus clinic between September 2011 and February 2012. Of those 41 patients that attended 4 attended alone without a caregiver. Of a possible 78 questionnaires sent out to both patient and caregiver we had 36 returned which gave us a 50% return rate.

24 questionnaires were from both patient and caregiver, 4 questionnaires were from carers only, 6 were from patients only, and 2 were from bereaved caregivers.

6 patients died within the study time, and 2 patients died within 3 weeks of attending the clinic.

Outcomes: Overall there were very positive responses to the nature of the clinic. Patients provided a satisfaction rate of 82% – 89% for time with the Nurse Practitioner, 82%–94% for time with the Social Worker and 80%–94% for time with the Psycho-Oncology Nurse. With the exception of the Social Work Clinic caregiver satisfaction scores were generally a little lower with 79%–83% satisfaction with the Nurse Practitioner, 82%–93% satisfaction with the Social Worker and 83%–87% satisfaction with the Caregiver Network Facilitator. Patients appreciated the opportunity for privacy to discuss their own fears and concerns related to the illness in 94% of responses which compared to 83% of caregivers. Qualitative comments support the structure and value of the clinic however further evaluation is proposed to assess the benefi t to the referring health care providers.

647

POSTTRAUMATIC GROWTH AND ITS CORRELATES

Shweta Tandonsafdarjung hospital, ghaziabad, U.P, India

The present study aimed at exploring the extent and nature of self reported posttraumatic growth (PTG) as well as the association of posttraumatic growth with psychosocial resources, meaning making, coping & psychologi-cal outcomes following cancer diagnosis in a heterogeneous sample of thirty Indians undergoing treatment at two points. Results indicated that post traumatic growth (PTG) was reported by almost all study participants. Patients in the early stage of the disease reported more positive changes in the aftermath of the diagnosis than those with advanced disease. Among the psychosocial resources, self effi cacy, social support and emotional processing and adaptive coping strategies namely information seeking and support seeking were positively related with PTG. Patients with positive and fate illness appraisals also reported higher PTG as did those with lower depression and higher quality of life.

648

BARRIERS TO EFFECTIVE DECISION MAKING IN CANCER PATIENT

Lili TangPeking University Cancer Hospital, Beijing, China

Objective: To describe and provide understanding of the attribution factors infl uencing effective decision-making in cancer patients.

Methods: Selective literature review was undertaken, to explore the effects and the barriers on effective decision-making in cancer patients from Chinese culture, law, system and other aspects. The articles were analysed for themes.

Results: The literature review contributed to information describing the Key factors which might affect effective decision making:

1. Family-related factors: In China, Most family members try to withhold information from patients, and some of them are in charge of the fi nance in their families.

2. Hospital-related factors: Doctors and hospitals occupied dominated posi-tion in the medical seeking process, especially in the famous special cancer centers or local authoritative cancer centers. And the doctor–patient relationship also have some problems.

3. Patient-related factors: The diagnosis of cancer brought the patient a psychological shock, scared them out of their wits, and make them not able to fi nd solutions rationally.

4. Medical System: The medical insurance system is defective for now. Whether a patient could get timely and effective treatment is largely depend on the choice of the family.

5. Culture: Different from the patient-centered decision-making process in western countries, in the oriental countries decision-making process are more likely to be family-centered decision-making.

6. The Demographics, cancer stage and other factors of cancer patients can also affect their decision-making.

Conclusions: Cancer Patients’ expectation to participate in decision making become stronger and stronger. How to build effective decision-making mechanism and methods fi tting Chinese national condition pose a challenge task for medical staff, which need more meticulous studies.

649

EXISTENTIAL PSYCHOTHERAPY FOR TOTAL SUFFERING: RESULTS

OF A MULTIPLE-CASE-STUDY RESEARCH AND

RECOMMENDATIONS FOR PRACTICE

Mélanie Vachon1,2

1. UQAM, Montreal, Que, Canada2. CRISE, Montreal, Que, Canada

In patients with advanced cancer (ACP), total suffering results from the interdependent physical, psychological, existential and sociocultural dimen-sions of illness. Whereas medicine treated the physical symptoms, the social, psychological and existential dimensions of suffering are usually tackled by psychologists. However, very few in-deep clinical data address the existential aspects of total suffering amongst ACP. Based on clinical case studies, this presentations aims at (1) better understanding when and how existential psychotherapy may be appropriate to help relieving total suffering in ACP; and at (2) formulating clinical recommendations for practicing existential psychotherapy with ACP. Main source of data arise from in-deep analysis of 5 clinical and longitudinal case studies. Patients were referred to the psychologist by their treating physician. They completed from 5 to 30 ses-sions of existential psychotherapy to address the psychological and existen-tial aspects of their suffering. They agreed their clinical data to be used for research purposes. For all therapy sessions, detailed clinical records on the content and therapeutic process were kept and transcribed. Codifi cation, analysis and interpretation of material followed Jonathan Smith’s interpreta-tive phenomenological analysis. Two patients out of fi ve didn’t experience existential psychotherapy as being helpful. Those patients fi nally requested palliative sedation to relieve their total suffering. Analysis of all 5 cases revealed meaningful variations of the following themes: (1) meaning of death, (2) temporality, (3) corporeality, (4) relationship with self and (5) relationship with others. The qualitative variations on those themes shed light on ACP’s existential experience of suffering and precise the possible benefi ts of existential psychotherapy. Results are discussed in the current debate surrounding the use of palliative sedation for total suffering. Based on the results, we suggest clinical guidelines in assessing and treating the existential aspects of total suffering. The heuristic and clinical values, and the methodological limitations of our results are discussed.



650

PSYCHIATRIC SERVICES PROVIDED BY A NEW DEPARTMENT OF

PSYCHO-ONCOLOGY ESTABLISHED IN A PUBLIC CANCER CENTER

IN JAPAN: A 2-YEAR REVIEW

Makoto Wada1, Tomomi Wada1. Saitama Cancer Center, Kita-Adachi-gun, Saitama-ken, Japan

Aim: To describe in detail the psychiatric services provided by a new Department of Psycho-oncology established in a public cancer center in Japan.

Methods: Psychiatric services provided over a period of 2 years by a new Department of Psycho-oncology established in a public cancer center in Japan (Saitama Cancer Center, 400 beds) are described in detail. Statistics on the number of psychiatric consults, departments requesting a consult, the primary site of the cancer, cancer treatment strategies, the existence or absence of metastasis and recurrence, previous cancer treatments (e.g. surgery, chemotherapy, or radiation), and performance status during that 2-year period are also reported.

Results: The Department of Psycho-oncology has a staff psychiatrist who is assisted by a consulting psychiatrist (who visits twice a week). Different departments in the Cancer Center request consults by the Department’s psychiatrists with regard to inpatients and outpatients with psychological problems, and the Department’s psychiatrists provide psychiatric services to those patients. Over a period of 2 years, the Department of Psycho-oncology has had 485 consults in total (357 inpatients, 128 outpatients), and the Department has effi ciently initiated and maintained psychiatric services. Details on outcomes will be reported later.

Conclusion: A new Department of Psycho-oncology was established in the Saitama Cancer Center, a public cancer center in Japan. Almost all the departments have consulted the Department of Psycho-oncology in the 2 years since its founding, and the Department has effi ciently initiated and maintained psychiatric services for both inpatients and outpatients.

652

THE CLASSIFICATION OF MOBILE (CELL) PHONE USE AS A

POSSIBLE CARCINOGEN: INVESTIGATING READINESS FOR

POSITIVE BEHAVIOURAL CHANGE IN YOUNG PEOPLE

Hayley S Whitford1,2, Linley A Denson2, Melissa J Bond2,3, Kathryn L Collins2,3

1. Cancer Council Australia, Sydney, Surry Hills, NSW, Australia2. School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia3. Clinical Psychology Department, The Royal Adelaide Hospital Cancer Centre, Adelaide, South Australia, Australia

Aims: To assess young peoples’ readiness for positive behavioural change to mobile phone use, following a reading-based intervention of the Inter-phone Study; the largest, international case-control study investigating the link between mobile phones and brain cancer.

Methods: The intervention was exposure to the Interphone Study abstract, interpretations by well-known organisations, and expert and community opinions in national newspapers, before assessment of readiness for change. For adequate power, 100 participants were required, and 242 completed a cross-sectional, online questionnaire including standardised pre-assessment of risk-attitude, optimistic bias, illness worry, and time preference. Study-specifi c questions included those on demographics, health and lifestyle.

Results: High exposure (≥30 minutes of calls per day) and low exposure groups evidenced similar readiness for change (p = 0.17, φ = 0.09); some indicating pre-study changes to mobile use. Risk-aversion in the health/safety (p = 0.003, φ = 0.20) and ethical (p = 0.02, φ = 0.16) domains was associated with greater readiness for change. Higher illness worry (p = 0.07, φ = 0.12) and lower optimistic bias (p = 0.13, φ = 0.10) showed non-signif-icant, small effects on change, however, time preference (p = 0.96, φ = 0.02)

showed no effect. A signifi cant (p = 0.000) logistic regression including comprehension, illness worry, and risk-attitude to health/safety and ethical domains accounted for between 9.6% (Cox & Snell R2) and 12.8% (Nagelkerke R2) variability with one individually signifi cant predictor; com-prehension (p = 0.002, 95% CI 1.16–1.90).

Conclusions: Recent information about possible carcinogenicity of mobile phone use appeared to permeate these students’ behaviour before com-mencement of this study. High exposure to risk (mobile phone calls) did not impact readiness for change, but risk-aversion in health and ethical domains did. Comprehension of the Interphone Study evidence was the most promi-nent predictor of change, supporting education as paramount to establishing health-enhancing behaviours.

653

THE USEFULNESS OF THE DISTRESS THERMOMETER IN THE

DISTRESS MANAGEMENT OF CANCER PATIENTS – A

QUANTITATIVE AND QUALITATIVE STUDY

Arlene Dr Walker1, Melinda Ms Williams2

1. Psychology, Deakin University, Geelong, Victoria, Australia2. Barwon Health, Geelong, Vic, Australia

Objective: It has been demonstrated that cancer patients experience a high level of psychological distress and psychosocial concerns across the cancer trajectory and that unresolved psychological distress can lead to problematic psychological disorders. A tool called the Distress Thermometer has been recommended to screen cancer patients to identify psychological distress and psychosocial concerns early in the cancer trajectory. However, there has been limited qualitative research investigating the perceptions of cancer patients about the usefulness of The Distress Thermometer in distress management. The aim of this study was to investigate the usefulness of the Distress Ther-mometer in identifying distress levels and psychosocial concerns over the cancer trajectory using a combined qualitative and quantitative approach.

Method: Twenty three cancer patients from a regional cancer centre in the Barwon region of Victoria participated in this study by completing the Distress Thermometer over three time periods. Three case studies were also conducted to add a qualitative dimension.

Results: Hypotheses were supported in that the Distress Thermometer was found to be useful in identifying psychological distress and psychosocial concerns to enable referral to supportive care services early in the cancer journey. Cancer patient’s narrative accounts supported the usefulness of The Distress Thermometer as a screening tool.

Conclusions: Findings are discussed with reference to implications for psy-chological/emotional support of cancer patients, the provision of supportive care services and directions for future research.

654

HANDLING NEGATIVE EMOTIONS BY SOMATIC APPROACH – A

BODY WORK EXPERIENCE

Kam Fung KF WongHong Kong Cancer Fund, Kowloon, HK, China

Background: A Hong Kong’s study showed that the prevalence of mood disorder among cancer patients was 1.5 times higher than that of the general public (Hong Kong Cancer Fund, 2005). So a psychological group using Somatic Experiencing approach to manage anxiety and depression for cancer patients has been implemented since 2010. Somatic Experiencing (Levin, 1997) is an approach that facilitates the participants to use their own body sensation and instinct ability to restore to normal from the over-whelming experience. The present study aimed to evaluate the effectiveness of the psychological group using Somatic Experiencing approach in reducing anxiety and distress measured by the Hospital Anxiety and Depression Scales (HADS) and the General Health Questionnaires (GHQ12).



Method: From 2010 to 2012, the groups of handling negative emotion by somatic work were conducted. The participants were invited to fi ll in the GHQ12 questionnaire for measuring the distress level and the HADS ques-tionnaires to measure the anxiety and depression level before and after the group. Basic demographic characteristics and disease history were collected simultaneously. The data was transformed into SPSS and the variables were labeled and evaluated. 37 subjects were measured and paired T test was employed in analyzing the pre and post-test data.

Results: The fi ndings showed that there was a signifi cant decrease of dis-tress, anxiety and depression level of the participants after joining the group (GHQ12: mean −7.324, p = 0.000; HADS: mean −3.270, p = 0.001; HADS-A: mean −1.757, p = 0.001; HADS-D: mean −1.784, p = 0.000).

Conclusion: The participants had a signifi cant decrease of distress, anxiety and depression level after joining the group. In order to prove if body work can really help to regulate the negative emotion, a randomized controlled trial will be conducted in next stage. Video clips and contents of the group will be shown during the presentation.

655

A RANDOMIZED PILOT STUDY COMPARING ACCESS TO THE

ALLOGRAFT INFORMATION EXCHANGE (ALLINEX) WEBSITE PLUS

STANDARD CARE VERSUS STANDARD CARE FOR SUPPORTING

ALLOGENEIC HAEMOPOIETIC STEM CELL TRANSPLANT (HSCT)

PATIENTS POST TRANSPLANT

Penny Wright1, Beverly Horne1, Suzanne Liebersbach, Marianne Pearce, Maria Gilleece1. University of Leeds, Leeds, Yorks, United Kingdom

Allogeneic Haemopoietic Stem Cell Transplant (HSCT) carries signifi cant and persistent psychosocial burden. Use of supportive care services is limited. A website (Allograft Information Exchange ALLINEX) was devel-oped with the aim to improve information exchange, service access and encourage self-management.

Aims: To assess the acceptability and feasibility of introducing ALLINEX as an adjunct to post HSCT standard care (SC) by investigating:

• patient acceptance and use;• impact on

� patient behaviour� process of care

• patient opinion concerning content, layout and function;

and estimating effect size of this intervention on patient well-being for future studies.

Methods: The study is a randomised pilot study involving HSCT patients post transplant who are likely to return to clinic on two occasions within twelve weeks following consent. The study employs stratifi ed randomisation (with/without Graft versus Host Disease) to allocate consenting patients to ALLINEX plus SC or SC. Recommendations for estimating effect sizes for larger trials were followed resulting in a sample size of n = 40 required to complete the study. Patient reported outcomes including HADS, SDI-21, EORTC QLQ-C30 and high dose module are collected at baseline and twelve weeks post consent. Patients in the intervention arm complete ques-tionnaires on Patient Acceptance and Use of Technology at six weeks and ALLINEX feedback and system usability scale at twelve weeks, and have their website activity tracked. All clinician-patients consultations are audio-recorded and subjected to simple content analysis. Patient contacts with the clinical team between hospital visits are collated.

Results: To date 42/58 (72%) patients have consented and 2 have com-pleted the study (median age 52 years: range 20–66). One participant has died. Process of care and other outcomes will be reported in full.

Conclusions: The study is due to close by August 2012. Results will inform the next stage of the project.

656

A PARTNERSHIP PROVIDING SUSTAINABLE HEALTH CARE AND

SUPPORT: THE BREAST CARE NURSE AND EXPERT PEER

SUPPORT

Leonie Young, Janine Porter-SteeleKim Walters Choices Program, Toowong, QLD, Australia

The philosophy of the Kim Walters Choices Program (Choices) is to provide appropriate support and information to all women, men and their families affected by breast and gynaecological cancers with respect for their emo-tional, social and intellectual needs.

Utilising research evidence the goal of Choices is to reduce the impact of unmet psychosocial and psychological needs by providing optimum care with a holistic focus. The full spectrum of information relating to surgery and treatments is covered with due consideration of those issues.

Choices recognizes that whilst clinical support and appropriate information are essential to the patient, so is the benefi t of hearing about the lived experience when it is provided in an empathetic and experienced manner. One of the strengths of Choices which distinguishes it from other support programs is its strong commitment to the value of expert peer support as part of the clinical team and deliberate strategies have been put in place acknowledging this and thus ensuring Choices offers a holistic model of care.

Choices employs a Nurse Manager who is a specialist breast care nurse and women’s health nurse alongside a Peer Support Coordinator who has had a personal experience of cancer who work together in the development of all the support initiatives offered. Its success exists around this partnership which has ensured Choices remains sustainable and client focused.

This support is particularly pertinent at the time of diagnosis and accord-ingly a key aspect of the program is the ability of patients and their families to access immediate information, clinical nursing and peer support and this crucial time. Importantly, this support is accessible throughout the cancer journey with no time limits on when support is provided, sometimes from diagnosis to end of life.

Choices is not only unique in the Australian context but also worldwide. There are few, if any, similar programs offering at the same level a combina-tion of clinical expertise, alongside peer support and varying holistic meas-ures to improve well-being. Integral to the program’s success has been the continual development and improvement of the services using total quality management and leadership principles. The development of Choices has been based on and refl ects the philosophy of providing a therapeutic envi-ronment that respects the needs of patients and signifi cant others.

657

A RANDOMIZED CONTROLLED TRIAL OF STRESS MANAGEMENT

PROGRAM FOR BREAST CANCER PATIENTS UNDER TREATMENT

Eun-Seung Yu, Byung-Soo Kim, Jae-Hon Lee, Jong-Heun KimMental Health Clinic, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea

Aims: The purpose of this study was to develop a stress management program for Korean breast cancer patients and to examine its effectiveness.

Methods: We had developed a ‘National Cancer Center-Stress Management Program (NCC-SMP)’ based on cognitive-behavioral and problem solving approach through article reviews and expert consultations. The NCC-SMP was a group-psychotherapy, consisted of 10 sessions, twice a week, and conducted by 2 clinical psychologists. In each session, participants dealt with agenda related to breast cancer. To examine the effectiveness of the NCC-SMP, we conducted a randomized controlled trial. 128 women newly diagnosed with breast cancer (stage 0-IIIc) undergoing radiation therapy were randomized to either an intervention group or a treatment as usual



(TAU) control group. All patients completed self-reports including Symptom Check List-90-Revision (SCL-90-R), EORTC-QLQ-BR23, Mini-Mental Adjustment to Cancer (Mini-MAC), K-ATQN (Korean Automatic Thought Questionnaire), and Post-traumatic Growth Inventory (PTGI) at pre-, post-, and 3 months follow-up intervention. Data of 64 participants (intervention group: 32 patients, control group: 32 patients) were fi nally analyzed.

Results: By mixed repeated-measures ANCOVA (group × time), interaction effect was signifi cant in somatization (p = 0.021), anxiety (p = 0.034), depression (p = 0.010) in SCL-90-R, sexual function (p = 0.003) and general functioning (p = 0.028) in EORTC-QLQ-BR23, anxious preoccupa-tion (p = 0.049) and fatalism (p = 0.49) in Mini-MAC. Also, group main effect was signifi cant in automatic negative thoughts (p < 0.001) in K-ATQN, posttraumatic growth (p = 0.004) in PTGI, and body image (p = 0.017) and symptoms caused by cancer treatment (p = 0.002) in EORTC-QLQ-BR23.

Conclusions: The NCC-SMP was effective on reducing breast cancer patients’ psychological distress, improving their daily functioning, and enhancing their posttraumatic growth.

Acknowledgment: This work was supported by the National Cancer Center Grant (NCC 1010073–1).

701

SAFETY OF TELE-ONCOLOGY AND CHEMOTHERAPY DELIVERY IN

RURAL CENTRES

Bryan A Chan, Sabe SabesanDepartment of Medical Oncology, Townsville Cancer Centre, Townsville, Douglas, QLD, Australia

Background: Access to equitable and timely oncology care is a challenge faced by many rural Australian communities. To overcome these issues, The Townsville Cancer Centre (Queensland, Australia) utilises shared care (Townsville tele-oncology model) to deliver oncology services to rural com-munities. The Mount Isa Hospital is the largest of these remote sites and has used tele-oncology since 2006.

Aim: Assess the safety of remotely supervised chemotherapy delivery at Mount Isa Hospital using the Townsville tele-oncology model.

Methods: A retrospective review was conducted on all referrals to the Mount Isa oncology unit between September 2006 and May 2012. Patients not receiving chemotherapy or those supervised by other units were excluded.

Results: A total of 83 patients received 1076 cycles of chemotherapy. Treat-ment intent was either adjuvant (37%) or palliative (63%). The median age was 57 years (range 33–79) and 26% of patients were Indigenous. The most common malignancies were breast (26%), lung (24%) and colorectal (19%). Adverse effects (AE) of any grade were recorded in 90 cycles (8%). Of these, half were grade 3 or 4 and included: haematological (61%), neuropathic (7%) and gastrointestinal (5%). There was one death, two months after completion of gemcitabine for metastatic pancreatic cancer. There were 41 hospitalisations (4%). Reasons included: febrile neutropenia (25%), progression or palliation (22%) and grade 3 or 4 AE (18%). The median dose intensity achieved for adjuvant treatment was 100% for breast, 93% for colorectal and 89% for other malignancies. The full intended dose was delivered in 87% of cycles (n = 940).

Conclusions: The rate of AE and dose intensities achieved in this cohort was similar to that seen in the literature. These fi ndings suggest that the Townsville tele-oncology model is a safe and effective way to provide oncol-ogy services to rural Australian communities.

702

RAPID REGRESSION OF LIFE THREATENING ALK POSITIVE

EPITHELIOID INFLAMMATORY MYOFIBROBLASTIC SARCOMA

FOLLOWING SINGLE AGENT CRIZOTINIB THERAPY

Karen Gomes1, Ella Sugo2, Draga Barbaric1, Toby Trahair1

1. Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia2. Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia

Infl ammatory myofi broblastic tumours (IMT) are rare. Complete resection is the therapy of choice but there is no standard treatment for inoperable or recurrent disease. An aggressive subtype, epithelioid infl ammatory myofi -broblastic sarcoma (IMS), characterized by nuclear or perinuclear ALK staining and an epithelioid morphology has been described. Conventional therapies have been ineffective with most patients dying from progressive disease.

We describe a rapid, early response of an aggressive epithelioid IMS to Crizotinib (PF-02341066). A 14-year old boy presented with weight loss, lethargy, unexplained fever, increasing abdominal discomfort, a microcytic anaemia, thrombocytosis and raised C-reactive protein (CRP). Examination and imaging demonstrated a large localized pelvic mass (6.1 x 4.3 cm) and ascites. Immunohistochemical and cytogenetic studies were consistent with an epithelioid IMS. Prednisolone and celecoxib were ineffective and a com-plete macroscopic resection was performed. Celecoxib was continued, but a life-threatening multifocal abdominal relapse was detected within one month of resection. There was a rapid clinical deterioration due to tumour progression and respiratory impairment from ascites and pleural effusions, requiring ICU admission. Crizotinib, an inhibitor of the anaplastic lym-phoma kinase (ALK) tyrosine kinase, was commenced within 48 hours with evidence of response within 72 hours. Over the next 2 weeks a dramatic clinical improvement occurred with resolution of pleural effusions and ascites, 50% tumour shrinkage, normalization of the CRP and improved thrombocytosis. Three months after commencing Crizotinib, progress scans show remarkable reduction in intra-abdominal disease.

Crizotinib has been well tolerated with mild side effects (transaminitis, leukopaenia, neutropaenia). This case confi rms that Crizotinib is effective and can induce a rapid response in patients with life threatening symptoms. We suggest that Crizotinib may be considered as initial therapy for aggres-sive or inoperable ALK+ve epithelioid IMS however further studies would be warranted in this indication.

We would like to acknowledge Pfi zer Oncology, Australia who provided Crizotinib on a compassionate use basis.

703

CORRELATING KI67 AND OTHER PROGNOSTIC MARKERS WITH

ONCOTYPE DX RECURRENCE SCORE IN EARLY BREAST CANCER

Bob T Li1, Suzanne Danieletto2, Eva S Fong2, Angela E Li3, Trevor Currer4, Andrew Parasyn4, Philip Middleton4, Heidi Wong4, Denis Smart4, Michael Hughes4,5, Josie J Rutovitz1, Gavin M Marx1,5

1. Medical Oncology, Sydney Adventist Hospital, Wahroonga, NSW, Australia2. Anatomical Pathology, Sydney Adventist Hospital, Wahroonga, NSW, Australia3. Royal Prince Alfred Hospital, Camperdown, NSW, Australia4. Surgical Oncology, Sydney Adventist Hospital, Wahroonga, NSW, Australia5. University of Sydney, Sydney, NSW, Australia

Background: Breast cancer is a common problem. Decisions regarding adju-vant chemotherapy are complex. Ki67 is increasingly used, in conjunction with conventional prognostic markers, to help decide the use of adjuvant chemotherapy for early breast cancer. Ki67 may be an economical



alternative to Oncotype DX recurrence score (RS), which is a validated prognostic marker for disease recurrence[1] and predictive marker for response to chemotherapy[2].

Methods: All known cases (n = 33) of Oncotype DX performed for early breast cancer (T1–2, N0–1mi, M0, ER positive, HER2 negative) at an Australian tertiary private hospital from 14th December 2006 to 30th May 2012 were analysed. RS was correlated with Ki67, along with other con-ventional prognostic markers including tumour size, grade, mitotic rate and lymphovascular invasion. Spearman’s rank order correlation coeffi cient and Pearson product-moment correlation coeffi cient (r) were used for ordinal and continuous variables respectively.

Results: The median Ki67 was 12 (range 2–50), the median RS was 19 (range 3–65). There was no positive correlation between Ki67 and RS (r = −0.17, P = 0.344). No single conventional prognostic marker was shown to signifi cantly correlate with RS, including tumour size (r = −0.218, P = 0.222), grade (r = 0.253, P = 0.155), mitotic rate (r = −0.18, P = 0.921) and lymphovascular invasion (r = −0.147, P = 0.415).

Conclusion: Ki67 and conventional prognostic markers do not correlate with Oncotype DX recurrence score. In the setting where conventional prognostic markers do not show a clear indication for adjuvant chemo-therapy, Ki67 is not a substitute for Oncotype DX testing.

References

[1] Paik S, et al, A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004;351(27):2817.

[2] Paik S, et al, Gene expression and benefi t of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24(23):3726.

704

ADJUVANT CHEMORADIOTHERAPY IN CARCINOMA OF

GALLBLADDER: A SINGLE INSTITUTION STUDY WITH 10-YEAR

FOLLOW UP

Neeraj Rastogi, VK KapoorSanjay Gandhi P G I, Lucknow, U.P., India

Background and purpose: Carcinoma of gallbladder is diffi cult disease to control due to advanced disease at presention, poor resectability and high loco-regional recurrence even after radical surgery. As role of adjuvant therapy is not well defi ned, an attempt has been made to evaluate the role of adjuvant chemoradiotherapy following simple/radical cholecystectomy in the management of gallbladder carcinoma.

Materials and methods: One hundred sixteen patients of carcinoma of the gallbladder were inducted into the prospective non-randomized study. Age ranged from 28–75 years (median = 50 years; females – 90, males – 26). Ninety four underwent simple cholecystectomy and 22 underwent radical cholecystectomy. The patients were staged according to AJCC/TNM staging (I = 18, II = 62, III = 36). All received postoperative external beam radio-therapy (45–50Gy/20–25 fractions/4–5 weeks). Patients with transmural infi ltration or positive drainage lymph nodes on histology, were given chem-otherapy (5-Fluorouracil 350 mg/m2 IV weekly × 12 cycles or D1–5 monthly x6 cycle) during and after radiation therapy.

Results: Follow up ranged from 2–10 (median = 5) years. At the time of evaluation 28/116 (24%) patients were alive with no evidence of disease. Median survival was 18 months. Overall survival rate at 5-years was 28%. 5-year survival rate in stages I, II, and III were 50%, 26.7% and 18.7% respectively. Among 83 patients who succumbed to death, 57.8% had loco-regional recurrence and 37.2% had distant metastases including liver, neck node and peritoneal (ascitis) deposits, 5% lost to follow-up were also con-sidered dead for analysis. In multivariate analysis T stage was found to be the only factor of prognostic signifi cance for overall survival.

Conclusions: Adjuvant chemoradiotherapy following cholecystectomy is feasible, effective and can provide an improvement in the loco-regional control and prolong overall survival in carcinoma of the gallbladder. Large prospective randomized trial needed for defi nitive conclusions.

705

AGGRESSIVE BEHAVIOUR OF CUTANEOUS SQUAMOUS CELL

CARCINOMA IN PATIENTS WITH CHRONIC LYMPHOCYTIC

LEUKEMIA

Jonathan M Tomaszewski1, Haim Gavriel2,3, Emma Link1, Sholeh Boodhun4, Andrew Sizeland1, June Corry1,5

1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia2. Assaf Harofeh Medical Center, Tel Aviv, Israel3. Tel Aviv University, Tel Aviv, Israel4. Alfred Hospital, Melbourne, Australia5. University of Melbourne, Melbourne, Australia

Aim: To describe the clinico-pathological features and prognosis of cutane-ous squamous cell carcinoma (SCC) in patients with chronic lymphocytic leukemia (CLL).

Methods: Consecutive patients with CLL who were treated with curative intent for cutaneous SCC between July 2000 and July 2010 were identifi ed through the institutional database. Chart review and telephone follow-up was undertaken to obtain clinical features and outcomes.

Results: Thirty-three patients (32 male, 1 female; median age 74) were identifi ed. Primary tumour stage (AJCC 7th edition) at presentation was T1 27%, T2 52%, T3 0%, T4 3%, TX 15% and T0 3%. Six patients (18%) presented with nodal involvement, and two patients (6%) had in-transit metastases. The majority of patients were treated with surgery (91%), and 27% received adjuvant radiotherapy (median 50.4 Gy). Three node-nega-tive patients (9%) were treated with defi nitive radiotherapy. Surviving patients were followed for a median of 5.6 years following the completion of treatment. Three-year overall survival and recurrence-free survival was 41% (95% CI: 27–63%) and 25% (CI: 14–47%), respectively. Local recur-rence occurred in 10 patients (30%), and regional recurrence in 16 patients (48%). Six patients (18%) developed distant metastatic disease. The three-year overall survival in the subgroup of patients with nodal metastases treated with curative intent (n = 14) was 12% (95% CI: 2–69%).

Conclusion: Cutaneous SCC demonstrates aggressive behaviour in patients with underlying CLL. Outcomes with current standard treatment regimens are poor, highlighting the need for studies utilising novel management strategies.

706

ORGANISATIONAL AND INDIVIDUAL FACTORS CONTRIBUTING TO

JOB SATISFACTION, DISSATISFACTION AND BURNOUT FOR

ONCOLOGY AND PALLIATIVE CARE NURSES

Eliza Birtles, Anne SwinbournePsychology, James Cook University, Townsville, Qld, Australia

Background: Occupational stress research has demonstrated that employ-ees’ personal resources infl uence their experience of the work environment. In particular, research has discussed how personal resources are utilised to respond to job characteristics.

Aims: The current study aimed to explore the role of individual and organi-sational factors and the relationship between these factors, on the experience of occupational stress, burnout and job satisfaction for nurses working in a hospital context. It was hypothesised that individuals high in optimism and hardiness would perceive more job resources and fewer job demands in their working environment, and consequently experience lower stress and burnout and higher job satisfaction. Palliative care and oncology specialities were identifi ed as being characterised by unique stressors, such as frequent exposure to patient death and dying, which may contribute to higher levels of stress and burnout among nurses. Specifi cally, oncology nurses were predicted to experience more stress relating to patient death and dying than palliative care nurses, as a result of the different goals and perceptions of death held by nurses working in these specialities.

Method: A sample of 237 nurses was recruited from palliative care and oncology specialities. Nurses completed an online self-report questionnaire



assessing their perceived job demands, job resources and personal resources, relating to dispositional optimism and hardiness, and their experience of job satisfaction, stress and burnout.

Results: Employees’ personal resources were found to infl uence the percep-tion of job characteristics and consequent experience of stress, burnout and job satisfaction. Signifi cant differences found between the two nursing spe-cialities were explored.

Conclusions: These fi ndings suggest, that while job characteristics infl uence the experience of nursing in the hospital environment, nurses’ individual resources play a signifi cant role in their perception of the work environment and their consequent experience. These fi ndings have implications for under-standing the role of personal resources and job characteristics on key out-comes, and subsequently strategies for their development in the individual, professional bodies and the organisation.

708

DISCUSSING EXPENSIVE ANTICANCER DRUGS – A SURVEY OF

THE OPINIONS OF PATIENTS WITH ADVANCED CANCER

Linda Mileshkin1,2, Edward Livshin2, Mark Voskoboynik2, Emilia Agalianos2, Penelope Schofi eld1,3, Alan Herschtal4, Ian Collins2, Aparna Rao2, Damien Urban2, Damien Kee2, George Au-Yeung2, Sandra Harvey2, John Zalcberg1,2

1. Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia2. Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia3. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia4. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

Background: Novel cancer treatments are increasingly available but not subsidized, and come at considerable fi nancial cost. We have previously reported that although the general public want to be informed about these expensive anticancer drugs (EACDs), Australian medical oncologists com-monly do not discuss them because of concern about causing distress. We aim to evaluate the views of patients with cancer about this issue.

Methods: Eligible patients with incurable cancer completed a questionnaire regarding their views about four hypothetical scenarios involving an EACD (out-of-pocket cost A$30,000). The four scenarios described EACDs associ-ated with either improved overall survival of 4–6 months (OS), encouraging response rate (RR) in a treatment-refractory situation, improved treatment tolerability/quality of life (QOL), or an improvement in progression-free survival of 4 months (PFS). An interim analysis is presented.

Results: Fifty-nine patients (response rate: 97%) completed the survey. Median age of 61 (range 37–83) with 35 (59%) female. 55 patients (93%) wanted their oncologist to discuss a relevant EACD with them but only 6 (10%) have had such a discussion. The majority wanted their oncologist to discuss the 4 EACDs: improved OS = 75%, encouraging RR = 88%, better QOL = 92%, improved PFS = 93%. However, a smaller percentage wanted to actually receive the EACDs (49–64%), or consider paying for them (25–37%). Those not wanting discussion were mostly concerned about themselves or family being distressed about not being able to afford the treatment. Thirty-four (58%) patients reported out-of-pocket expenses asso-ciated with their cancer care, with 9/59 (15%) reporting a moderate-signif-icant fi nancial burden.

Conclusion: Most patients would like the opportunity to discuss relevant EACDs with their oncologists and a signifi cant minority would be prepared to pay for such treatments. Such discussions need to be handled sensitively given that some patients are already facing signifi cant fi nancial burden.

709

TIMELINES IN LUNG CANCER DIAGNOSIS AND TREATMENT IN

SOUTH WEST SYDNEY

James Kelly, Shalini Vinod, Jesmin Shafi qUniversity of NSW, Sydney, NSW, Australia

Background: Early detection of cancer has been a longstanding goal. It has been postulated that delay from diagnosis to treatment may impact on treatment outcomes. For lung cancer, screening is still only in its rudimen-tary stages; current literature on the topic has had mixed fi ndings. This study was undertaken to quantify the timelines in the diagnosis and management of lung cancer in South West Sydney and to compare these timelines to best practice guidelines.

Methods: A retrospective audit of all newly diagnosed primary lung cancer patients treated at the Liverpool/Macarthur Cancer Therapy Centres from 1/1/2009–31/12/2009 was carried out. Patient demographics, dates of refer-rals, dates of consultation and treatment were retrieved from the oncology database of the Centre. Patients included were those that received radical or palliative radiotherapy and chemotherapy or supportive care; patients treated only surgically were excluded due to missing information.

Results: A total of 228 patients were identifi ed; 73% of patients had Non-Small Cell Lung Cancer (NSCLC) and 19% had Small Cell Lung Cancer (SCLC). The average duration from the fi rst diagnostic procedure to treat-ment was 54 days (range 1–520 days); duration varied signifi cantly (p < 0.05) according to the histology, stage, age and choice of fi rst treat-ment. Patients who were referred to an oncologist prior to a tissue diagnosis being obtained were more likely to receive timely care (p = 0.084). For 34%–50% of patients, the average time interval from referral to treatment commencement complied with the guidelines (British Thoracic Society) recommendations.

Conclusion: Heterogeneity in the pathway from diagnosis to treatment in lung cancer makes examining intervals diffi cult to compare. This audit of the selected lung cancer population allows future comparisons of the time-lines to explore the reasons behind the delay, to ensure the intervals exam-ined do not increase and unnecessary causes of delays be rectifi ed. One possible method of reducing delay could be through hastier referral of patients highly suspicious of lung cancer from respiratory physicians to oncologists.

710

IMPACT OF PREVENTION ON FUTURE CANCER INCIDENCE IN

AUSTRALIA

Peter D Baade1, Philippa H Youl1, Xingqiong Meng1, Craig Sinclair2

1. Cancer Council Queensland, Fortitude Valley, QLD, Australia2. Cancer Council Victoria, Melbourne, Victoria, Australia

Background: Cancer, along with other chronic diseases such as cardiovas-cular disease, is recognised as one of the most common public health threats in Australia. This burden and fi nancial cost to the community will continue to increase given Australia’s increasing and aging population.

Method: We estimated the total number of cancers that would be diagnosed in Australia in 2025 by applying published age- and sex-specifi c population projections to current incidence rates, and applied published attributable fraction estimates to calculate the number of preventable cancers in future years.

Results: These calculations suggested that there will be about 170,000 new cancers diagnosed in 2025 in Australia, representing more than a 50% increase in the number of cancers diagnosed in 2008. Given only about 5–10% of cancers are caused by generic or inherited disorders, there is obvious potential for the role of prevention in reducing this burden. It was estimated that about 10,050 colorectal cancers, 7,250 female breast cancers and 5,700 lung cancers could be prevented in 2025 alone by changes in nutrition and physical activity. Further prevention is possible through



reducing the prevalence of other known risk factors such as tobacco smoking, alcohol, harmful occupation and sun exposure. Combined this equates to preventing about 57,000 cancer diagnosed in 2025 alone.

Conclusions: While we have witnessed signifi cant declines in the prevalence of tobacco smoking, there is little evidence that there have been any signifi -cant reductions in the prevalence of other known behavioural risk factors such as sedentary behaviour, obesity and poor diet. Clearly, the need for large-scale and long-term preventive strategies mean that it is imperative that governments at all levels, along with clinicians and researchers, act now with vigour if we are going to have any impact on reducing the signifi cant human and fi nancial burden of cancer in to the future.

711

FOUR-YEAR SURVIVAL UPDATE FOR METASTATIC MELANOMA

(MM) PATIENTS (PTS) TREATED WITH IPILIMUMAB

(IPI) + DACARBAZINE (DTIC) ON PHASE 3 STUDY CA184–024

Michele Maio1, Igor Bondarenko2, Caroline Robert3, Luc Thomas4, Claus Garbe5, Alessandro Testori6, Stephen Francis7, Kevin Chin8, Jedd Wolchok9

1. University Hospital of Siena, Siena, Italy2. Dnepropetrovsk State Medical Center, Dnepropetrovsk, Ukraine3. Institute Gustave Roussy, Villejuif, France4. Lyon 1 University, Centre Hospitalier Lyon Sud, Pierre Bénite, France5. University Medical Center, Tuebingen, Germany6. Istituto Europeo di Oncologia, Milan, Italy7. Bristol-Myers Squibb, Braine-I’Alleud, Belgium8. Bristol-Myers Squibb, Wallingford, CT, United States9. Memorial Sloan-Kettering Cancer Center, New York, NY, United States

Aims: An analysis of 177 pts from 3 phase I/II IPI studies conducted at NCI demonstrated 5-yr survival rates of 13–25%. In other phase II trials, IPI monotherapy was associated with long-term survival of 4+ yrs in some pts with MM. IPI in combination with DTIC in previously untreated MM patients signifi cantly improved OS in phase III study CA184–024. Safety data from study 024 has been previously published. Here we report 4-yr survival data from study 024, the longest IPI survival follow-up from a phase III study.

Methods: Pts with treatment-naive MM were randomized to receive either IPI (10 mg/kg) + DTIC (850 mg/m2) or placebo + DTIC (850 mg/m2) given at Wks 1, 4, 7, 10 followed by DTIC q 3 wks through Wk 22. Pts with stable disease or better then received IPI or placebo q 12 wks as mainte-nance. This analysis reports OS with updated last known alive date or death date based on data collected through April 2012.

Results: Median OS for was 11.2 m [95% CI, 9.4–13.6] for IPI + DTIC (N = 250) and 9.1 m [95% CI, 7.8–10.5] for placebo + DTIC (N = 252). The 4-yr overall survival rates in the current analyses were 19.0% [95% CI, 14.2–24.2] for IPI + DTIC and 9.6% [95% CI, 6.1–13.5] for placebo + DTIC.

Conclusions: The 4-yr survival rates observed in an extended follow-up of a completed phase III trial suggests that IPI 10 mg/kg in combination with DTIC continues to demonstrate a survival benefi t compared to the control arm. The continued survival of some patients at 4 yrs suggests that pro-longed survival may indeed be obtained in some pts with treatment-naive MM. This observation of long-term survival benefi t in a phase III RCT is consistent with observations from phase I/II studies of IPI in patients with advanced melanoma.

712

IS THERE A SURVIVAL BENEFIT IN THE RECEIPT OF GUIDELINE

RECOMMENDED THERAPY IN NON METASTATIC NON SMALL

CELL LUNG CANCER?

Kirsten J Duggan1, Shalini K Vinod2,3, Joseph Descallar4

1. SLHD & SWSLHD Clinical Cancer Registry, Liverpool Hospital, Liverpool, NSW, Australia2. Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Liverpool Hospital, Liverpool, NSW, Australia3. South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia4. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

Background: Lung cancer presents a considerable disease burden for South Western Sydney (SWS) residents, representing over 10% of all diagnoses, and over 21% of all cancer mortality. Guideline recommended therapy (GRT) can facilitate sound clinical decision making in the management of Lung cancer patients. The potential survival benefi t that can be gained from GRT is most likely seen in patients without distant metastases at diagnosis. The study aim is to evaluate whether survival benefi t was associated with the receipt of GRT in this sub group of patients.

Method: Patients residing in SWS, with a new diagnosis of Lung cancer in 2006–2008, were identifi ed from the SWS&SLHD Clinical Cancer Registry (CCR). Tumour details, stage, treatment, performance status (ECOG) and outcome were investigated. Treatment received was compared against Aus-tralian clinical practice guidelines. Patients in whom GRT could be assessed (documented stage and ECOG) were included for analysis. Multivariate analysis by Cox proportional hazards model was used to determine survival differences between patients receiving GRT and those who did not. Univari-ate analysis was conducted to investigate survival differences between GRT therapeutic modalities.

Results: 214 Stage I-III non-small cell lung cancers (NSCLC) identifi ed. 62% were male and the median age was 70. 25% had Stage I&II, 33% Stage IIIA, and 42% had Stage IIIB NSCLC. Pathology distribution was 28% adenocarcinoma, 31% large cell, and 31% squamous cell. 57% of Stage I&II, 58% of Stage IIIA, and 25% of Stage IIIB NSCLC received GRT. GRT was not associated with improved survival in any group. For those who received GRT, surgery in Stage I&II NSCLC and radiotherapy in Stage IIIA & IIIB NSCLC was associated with a survival benefi t when compared with other GRT for each group.

Conclusion: The receipt of GRT in non-metastatic NSCLC was not associ-ated with a survival benefi t. This may be due to the wide defi nition of GRT used in this study. Specifi c types of GRT were associated with improved survival per stage of NSCLC.

The authors declare no confl icts of interest.

713

βIII-TUBULIN AND GLIOBLASTOMA: ROLE IN DRUG RESISTANCE

AND TUMOURIGENESIS

Gorjana Mitic1, Maria Tsoli1, David S Ziegler1, Maria Kavallaris1,2

1. Children’s Cancer Institute Australia, Lowy Cancer Research Centre, Randwick, NSW, Australia2. Australian Centre for Nanomedicine, UNSW, Randwick, NSW, Australia

Background: Glioblastoma is an aggressive malignant brain tumour with a dismal prognosis. Current treatments are ineffective and offer no realistic chance of cure. ßIII-tubulin is a neuronal specifi c β-tubulin isotype, a struc-tural component of microtubules, that is not expressed in glial cells. Its aberrant expression in various cancers is associated with drug resistance and poor clinical outcomes (1). In gliomas, high ßIII-tubulin expression corre-lates with higher tumour grade, however its role in the biology of gliomas



is unknown. The aim of this study was to investigate the role of ßIII-tubulin in glioblastoma drug resistance and tumourigenesis.

Results: Two glioblastoma cell lines, U87 and U87vIII, were selected for functional studies. To examine the role of βIII-tubulin in glioblastoma chemo-sensitivity and tumourigenesis, siRNA gene silencing was used. Potent and specifi c knockdown achieved a 94% reduction in ßIII-tubulin levels compared to non-targeting control siRNA. Drug-treated clonogenic assays using βIII-tubulin knock-down cells resulted in a signifi cant increase in sensitivity to DNA-damaging agent temozolomide and tubulin-binding agents epothilone B and paclitaxel, in U87vIII cells (p < 0.01) compared to control siRNA transfected cells. Additionally, knockdown of βIII-tubulin led to increased apoptosis after temozolomide treatment compared to control siRNA. To examine the potential role of ßIII-tubulin in glioblastoma tumourigenicity, anchorage-independent growth (soft agar assay) was used. A signifi cant decrease (p < 0.01) in anchorage-independent growth in U87vIII cells was observed following βIII-tubulin knock-down. Further studies are currently ongoing to examine the effects of βIII-tubulin knock-down in U87 cells and on primary glioblastoma neurosphere formation.

Conclusion: βIII-tubulin is expressed in glioblastoma cell lines and its expression contributes to intrinsic drug resistance to two different classes of drugs: DNA-damaging and tubulin-binding agents. Our data suggests that expression of βIII-tubulin may also be contributing to tumourigenic phenotype of this devastating disease.

Reference

1. Kavallaris M. Microtubules and resistance to tubulin-binding agents. Nat Rev Cancer 2010; 10: 194–204.

714

MECHANISM OF IGF INDUCED EPITHELIAL-TO-MESENCHYMAL

TRANSITION (EMT) IN MELANOMA PROGRESSION

Prashanth Prithviraj, Aparna Jayachandran, Matthew Anaka, Jonathon CebonLudwig Institute for Cancer research, Heidelberg Heights, VIC, Australia

Background: Melanoma is a common and highly aggressive form of skin cancer with a high propensity to metastasise. Despite recent improvements in treatment, metastatic melanoma is nearly always fatal. The role of EMT in facilitating cancer metastasis, progression and recurrence in various cancers has been demonstrated1,2. Growing evidence supports the role of EMT in melanoma progression3,4. However, detailed mechanistic insights into how EMT impacts metastasis in melanoma are currently lacking.

Rationale: Since IGF signalling is elevated in invasive melanoma cells and has been implicated in promoting EMT in other cancers, it is conceivable that IGF may contribute to EMT in melanoma. The aim of this study is to identify and target key components of the IGF signaling pathway to inhibit or reverse the EMT process in melanoma cells.

Methods & results: Microarray analysis identifi ed components of IGF sig-nalling pathway that are differentially expressed. Using qPCR, we confi rmed differential expression of various components of IGF signalling pathway in invasive melanoma cell lines. We tested the infl uence of IGF ligands on the proliferative abilities of melanoma cells by MTS assay. Furthermore, we tested the invasive and migratory behaviour of melanoma cells post IGF treatment by subjecting them to Matrigel coated or uncoated Boyden cham-bers. We studied the effect of IGF treatment on the expression of classical EMT markers.

Conclusion: Our results demonstrate that IGF signalling plays a critical role in melanoma progression by facilitating EMT. We suggest targeting IGF signalling as a promising strategy to limit melanoma progression.

References

1. Walsh, L. A. and S. Damjanovski (2011). ‘IGF-1 increases invasive poten-tial of MCF 7 breast cancer cells and induces activation of latent TGF-beta1 resulting in epithelial to mesenchymal transition.’ Cell Commun Signal 9(1): 10.

2. Graham, T. R., H. E. Zhau, et al. (2008). ‘Insulin-like growth factor-I-dependent up-regulation of ZEB1 drives epithelial-to-mesenchymal tran-sition in human prostate cancer cells.’ Cancer Res 68(7): 2479–2488.

3. Mikesh LM, Kumar M, Erdag G, Hogan KT, Molhoek KR, May MW, Slingluff CL Jr. (2010). ‘Evaluation of molecular markers of mesenchy-mal phenotype in melanoma.’ Melanoma Res 20(6): 485–95

4. Kudo-Saito C, Shirako H, Takeuchi T, Kawakami Y. (2009). ‘Cancer metastasis is accelerated through immunosuppression during Snail-induced EMT of cancer cells.’ Cancer Cell 15(3): 195–206

715

BREAST CANCER DIAGNOSIS AND PATTERNS OF TREATMENT:

DOES BEING INDIGENOUS MAKE A DIFFERENCE?

Suzanne P Moore1, Adèle C Green1, Gail Garvey2, Michael Coory3, Jennifer Martin4, Patricia C Valery2

1. Queensland Institute of Medical Research, Brisbane, Queensland, Australia2. Menzies School of Health Research, Brisbane, Qld, Australia3. Cancer Council Victoria, Melbourne, Victoria, Australia4. School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Background: Indigenous Australians with cancer in general receive less cancer treatment, take longer to receive their treatment, and have poorer cancer outcomes than non-Indigenous Australians; however, the compara-tive outcomes for Indigenous women with breast cancer are largely unknown. We have therefore compared diagnosis, treatment, and presence of comorbidity in Indigenous and non-Indigenous Australian women diag-nosed with breast cancer.

Methods: Through a matched cohort design we compared all Indigenous women (n = 110) treated in Queensland public hospitals (1998–2004) to a frequency-matched (age, place of residence) random sample of non-Indige-nous women (n = 105). Clinical data were abstracted from records at public hospitals to a standard form.

Results: At diagnosis, Indigenous women had an average age of 54 years, were more likely to be highly socioeconomically disadvantaged (43% vs. 20% for non-Indigenous women; p < 0.01), to have serious comorbidity (diabetes, cardiovascular disease; p < 0.01), and more advanced disease than non-Indigenous women (regional/metastatic spread 51% vs. 36%, respectively; p = 0.03). There was no difference in the histological types of tumours (p = 0.46), the proportions of oestrogen and progesterone receptor positive tumours (approximately 80%; P = 0.92 and 70%; p = 0.76 respec-tively), in time from diagnosis to treatment (p = 0.26), treatment completion rates (p > 0.05), mode of treatment (lumpectomy vs. mastectomy; p = 0.17), or rates of tamoxifen use (p = 0.17) between groups.

Conclusions: In Queensland, Indigenous women with breast cancer gener-ally received comparable treatment to their non-Indigenous counterparts. Differences in comorbidity and stage at diagnosis between the two groups reinforce the need for early detection and improved management of co-existing disease in Indigenous women with breast cancer.

716

A MULTI-DISCIPLINARY PRACTICAL SUPPORT TEAM FOR

PATIENTS AND FAMILIES

Louisa Fitz-Gerald, Paula Vallentine, Sarah PenmanCancer Council NSW, Woolloomooloo, NSW, Australia

Background: In 2009, Cancer Council NSW commissioned research to investigate the legal and fi nancial needs of patients and carers. The study revealed a high level of unmet need, particularly in relation to insurance, superannuation, consumer credit, welfare rights and employment issues. A program was established in March 2010 to provide legal and fi nancial plan-ning assistance through a series of partnerships with the corporate sector.



In 2012, human resources, recruitment and small business consulting serv-ices were added to the suite of pro bono professional support programs. A multi-disciplinary team of professional service providers is now available to assist patients and carers to resolve unmet practical support needs.

Objectives: The primary objective of the pro bono programs is to assist patients and carers to receive assistance with pressing practical issues, if they cannot pay for advice. In so doing, the programs aim to improve psycho-social outcomes for patients and families.

Methods: Partnerships were established with a range of law fi rms, fi nancial planners, human resources consultants, recruitment advisers and account-ants. Partner organisations register to provide pro bono services to patients and carers in defi ned areas of expertise and up to an agreed frequency. Cancer Council staff and volunteers assess the eligibility of potential clients and take detailed instructions on matters, which are then referred to panel members on a pro bono basis.

Results: Since the establishment of the programs, 280 law fi rms, 358 fi nancial planning practices and several HR and recruitment professionals and account-ants have registered to provide pro bono services, and over 2600 families have received assistance. A comprehensive evaluation of the legal and fi nancial planning components revealed high levels of satisfaction amongst clients, referring social workers and participating professional service providers.

Conclusion: The partnerships developed between Cancer Council and the cor-porate sector have been invaluable in delivering practical support to patients and carers across Australia. By engaging a multi-disciplinary professional serv-ices team, Cancer Council has gained enormous leverage in terms of the number of patients assisted and the geographic reach of the programs.

717

AN ACUTE ONCOLOGY MALNUTRITION STRATEGY: SUSTAINING

POSITIVE RESULTS 12 MONTHS POST-IMPLEMENTATION

Belinda Steer, Jenelle Loeliger, Amber KelaartPeter MacCallum Cancer Centre, East Melbourne, Vic, Australia

Aims: Malnutrition is highly prevalent in the oncology population, resulting in many adverse clinical outcomes for patients and health services. An evidence based malnutrition screening, assessment and treatment strategy has been successfully piloted in an acute oncology setting, proving to be an effi cient and effective model of care achieving signifi cant positive clinical and fi nancial outcomes. This study aimed to determine if the positive out-comes achieved during the pilot project were sustained 12 months post-implementation.

Methods: Comparisons of clinical outcomes from the pilot of a new model of nutritional care completed in 2010 were made to audit data collected over a 12 month period post-implementation.

Results: Malnutrition screening rates on admission of patients admitted for >1 day remained high 12 months post-implementation (95% during the pilot compared to 93% 12 months post), and positive improvements were seen in weekly rescreen rates (66% during the pilot compared to 94% 12 months post). The percentage of patients under the care of the dietitian who maintained/improved their nutritional status during their admission remained stable (85% in both pilot and 12 months post). Median length of stay of malnourished patients continued to decrease over time (8.0 days in pilot compared to 7.3 days 12 months post). The number of patients coded for malnutrition increased (average 75 patients/month in pilot compared to average 83 patients/month 12 months post) resulting in increased reimburse-ments directly attributable to malnutrition coding (average A$51,000/month in pilot compared to average A$61,000/month 12 months post).

Conclusions: This study demonstrates the positive clinical and fi nancial outcomes that were sustained 12 months following the implementation of a structured malnutrition strategy in the acute oncology setting. This work provides valuable insight into effective methods for treating malnutrition, sustaining nutrition care practice and producing positive health outcomes in an acute oncology setting.

Contact email – [email protected]

718

A REGIONAL COMMUNICATION SKILLS INITIATIVE

Heather Davis1, Tracey Tobias1

1. Southern Melbourne Integrated Cancer Service, East Bentleigh, Vic, Australia

Aims: There is substantial evidence that effective communication in cancer care can positively impact on a number of patient outcomes, including their quality of life, satisfaction with care, decision making and psychosocial distress.

The aim of the project is to enhance the communication skills of the cancer workforce within southern Melbourne.

Method: An initiative by the Southern Melbourne Integrated Cancer Service (SMICS), the Cancer Council Victoria (CCV) and three SMICS health serv-ices, Alfred Health, Peninsula Health and Southern Health resulted in the development, adaptation and accreditation of a set of communication skills workshops encompassing discussing bad news, relaying a new diagnosis, how to stop active treatment, how to discuss end of life care and how to conduct a family meeting. Facilitators were trained to deliver the workshops utilising trained actors. A group mentoring program was trialled at Southern Health and an online registration and survey system was developed.

Results: Nine facilitators were trained by the CCV to conduct the work-shops and eighteen workshops are planned for 2012. To date eleven work-shops and one mentoring session have been held, with 96 clinicians attending from the following disciplines:

• nursing 25• allied health 28• medical 39

An additional 7 workshops will be completed by October 2012. Interim results from surveys administered prior to, upon completion of and 3 months post workshop, indicate that the participants level of confi dence in having diffi cult discussions has increased. Those who have completed a survey administered 3 months after attending workshops have indicated that they are utilising the skills learned in the workshop.

Conclusions: The workshop development, facilitator training and the roll out of the workshops across the SMICS region has been successful in equip-ping participants with the skills necessary to effectively communicate with cancer patients. The impact on patients is yet to be measured.

719

TENSIONS AND CONTRADICTIONS – A QUALITATIVE STUDY

EXPLORING THE EXPERIENCE OF HEALTH PROFESSIONALS

CARING FOR PATIENTS WITH ADVANCED CANCER IN THE

EMERGENCY DEPARTMENT

Jennifer Weil1, Jennifer Philip1,2, Heather Lane1,2, Tracey Weiland3, Claudia Marck3, Mark Boughey1,2, George Jelinek3

1. St Vincent’s Hospital Melbourne, Fitzroy, Vic, Australia2. Centre for Palliative Care, St Vincent’s Hospital and University of Melbourne, Fitzroy, Vic, Australia3. Emergency Practice and Innovation Centre, St Vincent’s Hospital, Fitzroy, Vic, Australia

Aims: People with advanced cancer often present to hospital emergency departments (ED’s).

This study sought to understand the views of emergency, palliative care and oncology clinicians regarding the care of advanced cancer patients present-ing to the ED.

Methods: Semi-structured focus groups were conducted with emergency, oncology and palliative care service providers until data saturation and supplemented with purposively sampled telephone interviews with emer-gency professionals from interstate and across a variety of health services.



Results: Eight focus groups were held with a total of 82 health professionals (45 ED, 8 oncology, 29 palliative care), and 11 telephone interviews were conducted. The main theme emerging from the data was of tensions and con-tradictions. The ED was ‘not the right place’ with various environmental issues cited and concerns expressed about an approach to care that was inconsistent with the perceived needs of patients with advanced cancer; yet many ED staff spoke of the rewards of caring for this patient group and alluded to their particular skills in doing so. Tensions were identifi ed within interdisciplinary relationships, particularly around the responsibility for decision-making and communication. The value of palliative care was acknowledged, yet was viewed as limited to end of life care, and exclusive of anti-cancer treatments. Concerns were expressed that labelling patients as ‘palliative’ may lead to inappropriate limiting of treatment options, yet simultaneously earlier involvement of pallia-tive care services was considered desirable. ED presentations were viewed by participants as failures of the system and in some cases the legitimacy of pres-entations was questioned, yet there was consensus that there will always be a cohort of advanced cancer patients who appropriately present to the ED.

Conclusions: A richer understanding of perceptions, barriers and facilita-tors to care provides opportunities for the development of interventions to improve care for patients with advanced cancer at these times of crisis.

720

THE PREVALENCE AND PREDICTORS OF THRESHOLD AND SUB-

THRESHOLD PROLONGED GRIEF DISORDER (PGD) AMONGST

BEREAVED CANCER CAREGIVERS: IMPLICATIONS FOR

BEREAVEMENT SERVICES

Rachel D Zordan1, Cheryl Remedios1, Melanie Price2, Melanie Bell2, Elizabeth Lobb3,4, Tom Trauer5,6,7, Chris Hall8, Peter Hudson1

1. Centre for Palliative Care, Melbourne, VIC, Australia2. Psycho-Oncology Co-operative Research Group, Sydney, NSW, Australia3. Calvary Health Care, Sydney, Australia4. Cunningham Centre for Palliative Care, Darlinghurst, Australia5. Department of Psychiatry, The University of Melbourne, Melbourne, Australia6. School of Psychology and Psychiatry, Monash University, Melbourne, Australia7. St Vincent’s Hospital Mental Health Service, Melbourne, Australia8. Australian Centre for Grief and Bereavement, Clayton, Australia

Introduction: Poor psychological health has been documented in the bereaved, with approximately 10% to 20% experiencing PGD. Early iden-tifi cation of caregivers with sub-clinical PGD is required to ameliorate the associated distress and potentially prevent diffi cult to treat PGD. Utilising a large population-based cohort of bereaved caregivers, the aim of this study is to report the prevalence of, and explore the predictors of, clinical and sub-clinical levels of PGD.

Method: Participants were caregivers of cancer patients admitted to three Victorian palliative care (PC) services who were subsequently bereaved. Baseline data were collected upon patient admission (T1), then six (T2), 13 (T3) and 37 (T4) months post-bereavement. Validated self-report measures, including the Prolonged Grief Disorder Scale (PG-13), were administered at each time point. Caregivers were identifi ed as having sub-threshold PGD if they met three of the four criteria required for a PGD diagnosis.

Results: Of 301 caregivers completing the PG-13 at T1, 15% met criteria for PGD, 7% at T2, 11% at T3, and 5% at T4. Sub-threshold PGD was more common, 29% at T2, 20% at T3, and 14% at T4. Using the PG-13 summary score, multiple linear regression analysis including family func-tioning, social support, dependency, death circumstances, pre-loss anticipa-tory grief, and self-rated coping at T2, found that pre-loss anticipatory grief (p < 0.0001) and self-rated coping at T2 (p = 0.0004) signifi cantly predicted PGD at T4.

Conclusions: The prevalence of PGD was low, however the number of car-egivers with sub-threshold PGD was high. Caregiver pre-loss PG at T1 and caregiver self-assessment at T2 were predictive of PGD in the longer-term, suggesting value to screening at these times. Simply asking caregivers how

they are coping at six months post-bereavement may be effective in identifying those at high risk of PGD. PC bereavement services are potentially well placed to conduct such screening and institute early intervention.

721

PROGRESSION FREE SURVIVAL VS OVERALL SURVIVAL: AN

EXAMPLE FROM RANDOMISED PHASE III TRIAL WITH AXITINIB

(AXIS) IN METASTATIC RENAL CELL CARCINOMA

Mahmood Alam1, Philippa Delahoy1, Simon H Park2

1. Pfi zer Australia Pty Ltd, West Ryde, NSW, Australia2. Oncology Business Unit, Pfi zer Korea, Seoul, Korea

Background: Although improvements in overall survival (OS) remain the Oncologist’s treatment goal, because effective post-trial therapy exists, true OS gains are increasingly diffi cult to quantify. This raises concerns as payers, unlike regulatory agencies, may be less accepting of progression-free survival (PFS) in the absence of validated relationship. Payers quantify life years gained (LYG) to determine cost per LYG; a metric used to establish cost-effectiveness. The AXIS study provides an example of this challenge.

Method: AXIS study randomised 723 patients (361, axitinib; 362 soraf-enib) with metastatic renal cell carcinoma following failure of 1 prior sys-temic treatment. The primary endpoint was PFS with OS as a secondary endpoint. Study treatment was continued until evidence of disease progres-sion, intolerability or withdrawal of consent. Patients who discontinued randomised treatment could receive subsequent treatment based on investi-gator-opinion. Patients were followed-up until death.

Results: From AXIS, median PFS for axitinib was 6.7 months versus 4.7 months with sorafenib (HR = 0.665, 95% CI 0.544–0.812; P < 0.0001). Median PFS reported for axitinib-treated cytokine refractory patients was 12.1 months and median PFS 4.8 months for axitinib-treated sunitinib refractory patients. Median OS was not reached at the time of analysis as 30% of patients had died, however estimated survival probability at 12 months was similar (66% for axitinib, 67.8% for sorafenib).

Axitinib phase II trials reported 16 months median PFS for axitinib-treated cytokine refractory patients and 7 months median PFS for axitinib-treated sunitinib refractory patients. Median OS reported for axitinib-treated cytokine refractory patients was 30 months and 14 months for axitinib-treated sunitinib refractory patients.

Discussion: With demonstrated PFS but diluted OS gains, post-progression survival (PPS) is scrutinised. PPS is infl uenced by factors like crossover and non-randomised post-progression treatments that introduce unmeasurable bias. This requires complex statistical analysis using patient level data. Further research is required in this area.

Conclusion: An OS gain is diluted in clinical trials due to heterogeneity in SPP. In studies with PFS as the primary endpoint a conservative estimate of OS gain can be estimated, however this is subject to bias if SPP estimations are likely based on nonrandomised, single arm studies.

722

A PERSONALISED APPROACH TO TREATING CANCER; A CROSS-

SECTIONAL REVIEW TO UNDERSTAND PUBLIC PERCEPTION AND

ITS CAPACITY TO INFLUENCE CLINICAL OUTCOMES

Mahmood Alam, Victoria Civils-Wood, Shams ArifeenPfi zer Australia Pty Ltd, West Ryde, NSW, Australia

Background: The more we understand the cancer genome, better we get at identifying niche driver mutations and our ability to target those with effec-tive therapies. Personalised cancer medicine (PCM) on one hand provides hope for delivering right treatment for the right patient, on the other it raises several questions about the cost of delivering such care, its impact on health budgets and its sustainability. Patient preferences play an important role in treatment decisions and an understanding of personalised approach to cancer may heavily impact these decisions.



Method: This is designed as a cross sectional observational study, designed to capture public understanding of terms like, individualised, personalised and targeted approaches to treating cancer. Respondents will be asked how this understanding helped them in their decision making process to receive a particular treatment. 2 different cohorts of patients, those with and without cancer diagnosis will be asked to complete the questionnaires. Those willing to participate will be provided with information to either complete the survey online or request a paper copy that can be fi lled and mailed back. Additional questions in the survey will address the issue of identifying the ‘target’ population for such specifi c therapies and willingness of respondents to fund such therapies or diagnostic tests if they are not reimbursed by the Government.

Results: All responses will be collated, summarised and univariate and multivariate analyses will be performed using regression modelling to iden-tify the relationship between different groups understanding of a personal-ised approach to cancer. The results will provide insights into the public’s understanding of personalised medicine, its value and its future role in cancer treatment. It will also inform future dialogue between governments, the medicines industry and healthcare consumer organisations regarding the ethical and fi nancial implications.

Conclusion: This study will address an important gap in our knowledge to understand public perceptions towards individualised cancer care with implications to the community of providing high cost, targeted cancer treat-ments to smaller groups of patients suffering from rare sub-types of cancer.

723

TGF-B1 MEDIATED APOPTOSIS IS ASSOCIATED TO

MITOCHONDRIAL BCL-2 EXPRESSION IN LYMPHOMA CELL

Masoomeh Bakhshayesh1, Farhad Zaker2, Merdad Heshemi3, Majid Katebi4, Mansooreh Soleimani5, Mohsen Marzban6, Mahmood Barati7

1. Cellular & Molecular Research Center, Tehran University of Medical Sciences, Tehran, Iran2. Tehran Cellular & Molecular Research Centre, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran3. Department of Genetic, Azad University Tehran, Medical branch., Tehran, Iran4. Dept. of Anatomy, Hormozgan University of Medical Sciences, School of Medicine, Bandar Abbas, Iran5. Department of Anatomy, Tehran University, School of Medicine, Tehran, Iran6. Department of Anatomy, Tehran University, School of Medicine, Tehran, Iran7. Dept. of Pharmacology, Shahid Beheshti University, Tehran, Iran

TGF-b1 can elicit various cellular responses including inhibition of cell growth, migration, differentiation and apoptosis. In addition, TGF-β1 is able to induce apoptosis in certain lymphomas. In the present study the role of Smads, Bax, Bcl-xl and Bcl2 was characterized in two B-lymphoma cell lines, Burkitt´s and pre B-cell. Apoptosis was detected after exposure of TGF-β on Raji and Nalm 6 cell lines and evaluated by fl ow cytometry using Annexin V, RT–PCR, and Western blot analysis. FACS analysis showed that apoptosis could be observed after 24 h of TGF-β treatment and was con-tinued after 48 h. TGF-β down regulated the BCL-xl and Bcl-2 while the Bax was unregulated. Furthermore, mRNA of Smads 6 and 7 showed the signifi cant upregulation. The results indicated that alteration in gene expres-sion and protein level may determine the induction of apoptosis pathway in these lymphoma cell lines exposed to TGF-β.

724

MELANOMA SHARED CARE, A TRIPARTITE APPROACH FOR

SURVIVAL. THE PATIENT, THEIR GP AND THEIR SPECIALIST – A

SURVIVORSHIP PROJECT

Colleen Berryman1, Martin Haskett2, Sarah Hannam2, Geraldine Largey1

1. Southern Melbourne Integrated Cancer Service, East Bentleigh, Vic, Australia2. Victorian Melanoma Service, The Alfred, Melbourne, Victoria, Australia

This project is a collaboration between Victorian Melanoma Service (Alfred Health), Melanoma Patients Australia, SMICS, GRICS and funded by the Victorian Department of Health.

Aim: To develop a model for long-term care of survivors of malignant melanoma including patient self-management, GPs/specialist shared care, supportive care screening, patient and family centred care planning and an electronic call back mechanism.

Method: a) Map current service models and consumer perception of these models.

b) Undertake a literature search to determine best practice models of care.c) Development of a risk stratifi ed follow-up protocols and care pathways

including:• patient self-examination• GP examination• specialist examination• dermoscopy and digital total body photography and digital serial

monitoringd) GP and primary care engagement into model delivery with education

modules and seminars and fast track access to specialist care ensured.e) Development of continuous supportive care through a patient held record

including a supportive care screening tool and pathways for addressing revealed supportive care needs.

f) Development of an electronic means for the implementation of a patient reminder system to prompt follow-up care, whether to perform a self-assessment, attend GP assessment or specialist appointment.

g) Recruitment of patients to participate in the shared care model of care.h) Evaluation including patient, GP’s/primary care and specialist care pro-

viders surveys, interviews and assessment of identifi ed health outcome measures. Operational outcomes such as follow-up compliance will also be measured.

Results: Chaired by a Melanoma Patients Australia consumer representa-tive, a multidisciplinary Survivorship Steering Group has been established to provide leadership and direction. The literature review and identifi cation of models of care have been completed and are currently being considered by the Group. The risk stratifi cation tool, patient information and consent, patient self assessed support screening and patient held treatment record and data collection tools have been drafted and will be reviewed continu-ously as users trial them in practice.

Conclusion: There is strong consumer, specialist and GP commitment to collaborate to improve the long term care and management of melanoma survivors using innovative approaches.

725

A CASE OF DELAYED METHOTREXATE CLEARANCE FOLLOWING

ADMINISTRATION OF A COMPLEMENTARY MEDICATION

CONTAINING CHLOROPHYLL

Sally L Brooks1, Julie Sanders1, John F Seymour2, James D Mellor1

1. Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia2. Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

We report a case of delayed methotrexate (MTX) clearance following administration of a complementary medicine containing chlorophyll. A 54



year-old male with relapsed primary cerebral lymphoma and normal renal function (CrCl 126 mL/min) was treated with methotrexate 3 g/m2 intrave-nously monthly. Throughout treatment the patient self-administered a com-plementary medicine (Jason Winter’s chlorophyll®) which he was advised to cease during methotrexate treatment due to unknown potential interac-tions. For the fi rst 4 cycles (pre-MTX CrCl 112–143 mL/min), chlorophyll was ceased 2 days prior to commencement of methotrexate and withheld until methotrexate clearance. These cycles were administered without com-plication, with the methotrexate level reduced to ≤0.05 μmol/L within 3 days. Prior to cycle 5 (pre-MTX CrCl 110 mL/min), the patient did not cease chlorophyll but there were no other changes to concomitant medica-tions. A literature search found no specifi c interactions between methotrex-ate and chlorophyll. The chemotherapy was administered without delay or evidence of change in renal function but the methotrexate level 3 days post-administration was 1.20 μmol/L and did not reduce to ≤0.05 μmol/L until day 10. Consequently, from cycle 6–12, (pre-MTX CrCl 87–97 mL/min) the methotrexate dose was halved, and the patient ceased chlorophyll 48 hours prior to methotrexate administration and until clearance. There were no further episodes of delayed methotrexate clearance. A sample of Jason Winter’s chlorophyll® was analysed for impurities, specifi cally salicylates, which could have caused impaired methotrexate clearance. A high perform-ance liquid chromatography (HPLC) assay was developed to separate and quantitate the stated ingredients in addition to acetylsalicylic acid and sali-cylic acid, and any other unknown impurities. No impurities were detected. It is therefore likely the patient’s delayed methotrexate clearance was due to an interaction with chlorophyll. The case we have described is a novel association between the ingestion of chlorophyll and delayed methotrexate clearance.

726

APPLICATION OF THE REPERTORY GRID TECHNIQUE TO EXPLORE

MEDICATION UNDERSTANDING IN PATIENTS RECEIVING CANCER

THERAPY FOR BREAST CANCER

Christine V Carrington1, Neil Cottrell2, Carl Kirkpatrick3

1. Department of Pharmacy and Division of Cancer, Princess Alexandra Hospital, Brisbane, Queensland, Australia2. School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia3. Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia

Background: Patient adherence to medication is critical to treatment success and is infl uenced by the patient’s perception about what the medication is for and when it should be taken (1). The repertory grid technique (RGT) was originally developed from personal construct theory by George Kelly (2) and identifi es a person’s own perceptions and understanding of a topic. The technique has the potential to elicit how an individual patient perceives and conceptualises their medication.

Aims: To explore patient’s characterisation of their chemotherapy and sup-portive therapy for breast cancer using a modifi ed RGT.

Methodology: Day therapy patients receiving chemotherapy for breast cancer were interviewed utilising the RGT. Study participants were asked to describe similarities and differences (the constructs) between their medi-cines (the elements) and were then required to rate each of their medicines against their own constructs on a Likert scale of 1–10, with 10 being rele-vant and 1 being not relevant. Generated constructs from all groups were combined into themes and analysed for commonality and frequency of themes. Principal components analysis (PCA) was performed on the grid data using Idiogrid software® to produce visual representations of the data.

Results: Forty-three participants participated in the study generating 144 constructs. Common elicited themes included ‘recognise the drug’ n = 44 (18%), ‘chemotherapy’ n = 40 (16%) and ‘prevents nausea and vomiting’ n = 39 (16%). PCA produced graphical representation for each interview, mapping patient descriptions to the medicines. Patients frequently charac-terised chemotherapy and supportive therapy into distinct areas and tended to characterise medicines according to what they were for, what their side effects were and if they knew the name.

Conclusions: The RGT allows the patient to defi ne and describe how they characterise each medicine in their own words and provides a useful tech-nique to elicit how an individual patient conceptualises their medication. The results of this study warrant further use of the repertory grid technique to explore how patients with cancer characterise medication and what may infl uence their medication taking decisions and behaviour.

References

1. Osterberg L et al. N Engl J Med. 2005;353(5):487.2. Kelly G A. New York: WW Norton & Company; 1955.

727

NICOTINAMIDE FOR SKIN CANCER CHEMOPREVENTION

Andrew C Chen1, Andrew J Martin2, Gary M Halliday3, Devita Surjana1, Diona Damian1

1. Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia2. NHMRC Clinical Trials Centre, Camperdown, NSW, Australia3. Dermatology, The University Sydney, Camperdown, NSW, Australia

Nicotinamide, the amide form of vitamin B3, prevents photocarcinogenesis in mice and protects from the immunosuppressive effects of UVB and UVA radiation in humans. As an NAD+ precursor, nicotinamide is centrally involved in ATP production and cellular energy metabolism, which in turn regulates the highly energy-dependent process of DNA repair. Nicotinamide replenishes the ATP depleted in keratinocytes by UV exposure, and enhances repair of direct and oxidative DNA photolesions in cultured keratinocytes and in ex vivo human skin. In order to assess the in vivo effects of nicoit-namide on skin carcinogenesis, heavily sun damaged individuals were ran-domised to receive oral nicotinamide (500 mg) or placebo twice daily for 4 months. Actinic keratoses (AKs) were counted by a blinded observer at baseline, 2 and 4 months. We found that participants receiving nicotinamide had reductions in AKs of 35% relative to placebo at 2 and 4 months (p < 0.001). Similar relative reductions were observed in a second group receiving nicotinamide (500 mg) or placebo once daily for 4 months. In total, 37 patients in these trials received nicotinamide and 37 received placebo. While 30% of the placebo group developed a new skin cancer during the study period (20 cancers in total), only 5% of those taking nicotinamide developed new skin cancers (4 cancers in total; p = 0.019 for Logistic regression and p = 0.010 for Poisson regression). A phase III dou-bled-blinded randomised controlled trial (ONTRAC; Oral Nicotinamide To Reduce Actinic Cancer) with an accrual target of 386 subjects is now underway. Otherwise healthy participants with at least 2 previous non-melanoma skin cancers in the past 5 years receive nicotinamide 500 mg or placebo twice daily for 12 months. AKs and new skin cancers are counted at baseline and 3 monthly. As a convenient tablet formulation, nicotinamide has the potential to provide a nontoxic, accessible and inexpensive (~$10/month) approach to skin cancer chemoprevention.



728

FIVE-YEAR SURVIVAL RATES FOR PATIENTS (PTS) WITH

METASTATIC MELANOMA (MM) TREATED WITH IPILIMUMAB (IPI)

IN PHASE II TRIALS

Celeste Lebbe1, Jeff Weber2, Michele Maio3, Bart Neyns4, Kaan Harmankaya5, Kevin Chin6, Diane McDowell7, Lori Cykowski6, Brent McHenry6, Jedd Wolchok8

1. APHP University Paris 7, Diderot Saint-Louis Hospital, Paris, France2. Moffi tt Cancer Center, Tampa, FL, United States3. University Hospital of Siena, Siena, Italy4. UZ Brussel, Brussels, Belgium5. Medical University of Vienna, Vienna, Austria6. Bristol-Myers Squibb, Wallingford, CT, United States7. Bristol-Myers Squibb, Lawrenceville, NJ, United States8. Memorial Sloan-Kettering Cancer Center, New York, NY, United States

Aims: Three phase I/II studies conducted at NCI demonstrated 5-yr survival rates of 13–25%. Evaluation of the long-term survival benefi t of IPI for MM pts from 3 additional completed phase II studies continues. Here we report 5-yr survival data.

Methods: Trials included: (1) CA184–008, a single-arm study of IPI at 10 mg/kg in pretreated pts; (2) CA184–022, a dose-ranging study of IPI at 0.3, 3, or 10 mg/kg in pretreated pts with crossover from lower doses to 10 mg/kg allowed upon disease progression; and (3) CA184–007, a study of IPI at 10 mg/kg ± prophylactic budesonide in treatment-naive and pre-treated pts. IPI was given q 3 wks × 4 (induction); eligible pts could receive reinduction or maintenance IPI q 12 wks from Week 24. The analysis reports OS with updated last known alive date or death based on data col-lected through March 2012. Safety data for these trials have been previously published.

Results: Survival rates at 5 yrs appeared similar to those at 4 yrs and ranged from 12–28% in pretreated pts and 38–50% in treatment-naive pts. In trial 008, median OS was 10.2 m. In trial 022, median OS was 8.6 m, 8.7 m and 11.4 m for IPI at 0.3 mg/kg, 3 mg/kg and 10 mg/kg, respectively. In trial 007, median OS in the IPI + placebo arm was 30.5 m and 14.8 m for treatment-naive pts and pretreated pts, respectively, and 45.0 m and 8.5 m for treatment-naive and pretreated pts, respectively in the IPI + budesonide arm.

Conclusions: Across studies, 5 yr OS rates appear similar to those at 4 years, suggesting that IPI monotherapy may result in prolonged survival in some pts with MM. Further research and analyses are needed to identify the pt population with MM most likely to achieve long term survival benefi t from IPI therapy.

729

SAFETY OF IPILIMUMAB IN PATIENTS (PTS) WITH UNTREATED,

ADVANCED MELANOMA ALIVE BEYOND 2 YEARS: RESULTS

FROM A PHASE III STUDY

Luc Thomas1, Jedd Wolchok2, Claus Garbe3, Celeste Lebbe4, Igor Bondarenko5, Kristen Rodrigues6, Cyril Konto6, Kevin Chin6, Stephen Francis7, Caroline Robert8

1. Lyon 1 University, Centre Hospitalier, Lyon Sud Pierre Bénite, France2. Memorial Sloan-Kettering Cancer Center, New York, NY, United States3. University Medical Center, Tuebingen, Germany4. Saint-Louis Hospital, Paris, France5. Dnepropetrovsk State Medical Center, Dnepropetrovsk, Ukraine6. Bristol-Myers Squibb, Wallingford, CT, United States7. Bristol-Myers Squibb, Braine-I’Alleud, Belgium8. Institute Gustave Roussy, Villejuif, France

Background: In a phase 3 study (CA184–024) of previously untreated pts with stage III or IV melanoma, IPI + dacarbazine (DTIC) signifi cantly improved overall survival (OS) vs. DTIC alone (Robert et al. NEJM 2011). We now report safety data of IPI in pts from this study alive >2 yrs from study initiation.

Methods: Pts with untreated advanced melanoma, were randomized to IPI (10 mg/kg) + DTIC (850 mg/m2) or placebo + DTIC (850 mg/m2) given at Wks 1, 4, 7, 10 followed by DTIC q 3 wks through Wk 22. Eligible pts (stable disease or better) received IPI or placebo q 12 wks as maintenance. Immune-related adverse events (irAEs) occurring after 2 yrs were evaluated as was safety in subjects receiving IPI dosing after 2 yrs.

Results: In the IPI + DTIC group 68 (28%) pts survived >2 yrs compared with 44 (18%) in the DTIC alone group. In the IPI + DTIC group, 7.4% of pts (5/68) experienced irAEs including grade 3/4 rash/pruritus (n = 1), low-grade rash (n = 3), pruritus (n = 2), skin hypopigmentation, and ele-vated ALT/AST (n = 1). Of 11 pts receiving IPI dosing for ≥2 yrs, 3 expe-rienced irAEs: grade 3/4 rash/pruritus (n = 1); low-grade events included rash/pruritus (n = 2) and elevated ALT/AST (n = 1). No gastrointestinal or endocrine events (any grade) were observed.

Conclusions: In Study 024, IPI + DTIC treatment improved OS in pts with untreated, advanced melanoma with higher survival rates in the IPI + DTIC group at 1 yr, 2 yrs and 3 yrs (HR 0.72, p < 0.001). The IPI safety profi le beyond 2 yrs survival suggests that treatment with IPI + DTIC is associated with low rates of irAEs in these pts. For patients receiving active IPI treat-ment ≥2 yrs, the safety profi le appears to be consistent with the known safety profi le of IPI.

730

AN AUSTRALIAN TRANSLATIONAL STUDY TO EVALUATE THE

PROGNOSTIC ROLE OF INFLAMMATORY MARKERS IN PATIENTS

WITH METASTATIC COLORECTAL CANCER TREATED WITH

BEVACIZUMAB (AVASTINTM) [ASCENT]

Stephen Clarke1, Matt Burge2, Cassandra Cordwell3, Peter Gibbs4, William Reece5, Niall Tebbutt6

1. Royal North Shore Hospital, St Leonards, NSW, Australia2. Royal Brisbane and Women Hospital, Butterfi eld, QLD, Australia3. Roche Products, Pty Limited, Dee Why, NSW, Australia4. Royal Melbourne Hospital, Parkville, VIC, Australia5. Covance Pty Ltd, Sydney, NSW, Australia6. Austin Health, Heidelberg, VIC, Australia

Background: Bevacizumab in combination with fl uoropyrimidine-containing chemotherapy is a well-established fi rst-line and second-line treatment for patients with metastatic colorectal cancer (mCRC). However, there remains a need for reproducible, validated, inexpensive and accessible prognostic markers to aid in treatment selection. The optimal treatment duration and the role of bevacizumab in certain patient subgroups, considered at particular risk of bevacizumab-mediated toxicity, also require further investigation. The aim of the ASCENT study, which is currently in progress across a number of centres in Australia, is to evaluate the relationship between the host infl am-matory response as measured by neutrophil/lymphocyte ratio (NLR) and treatment outcomes in patients with previously untreated mCRC receiving bevacizumab-based fi rst- and second-line treatment.

Design: ASCENT is an open-label, prospective, single arm, phase-IV, multi-centre study. The planned 150 patients will be recruited from 17 centres around Australia. Patients will receive trial treatments in two phases: Phase A: XELOX or mFOLFOX6 plus bevacizumab administered from study start until 1st disease progression; and Phase B: FOLFIRI plus bevacizumab administered from 1st disease progression until 2nd disease progression. The primary analysis will test the association between NLR (<5 versus >5) and progression free survival using a proportional Hazards Model. Secondary analyses will investigate whether the relationship can be improved upon with other prognostic biomarkers, and further characterise the safety of bevacizumab following treatment initiation, and when continued after pro-gression in combination with standard chemotherapy regimens (presented through summary statistics and Kaplan Meier curves). Recruitment started in June 2012 and will end after 24 months or when 150 patients are recruited, whichever occurs fi rst.

Discussion: Quantifying the relationship between NLR and PFS will inform decision making on the extent to which this simple metric may be applied clinically.



Trial registration: This trial is registered with Clinicaltrials.gov, registration number NCT01588990 (ML25753).

731

A RANDOMISED CONTROLLED TRIAL EVALUATING INSIGHT, A

WEB-BASED COGNITIVE REHABILITATION PROGRAMME, IN

CANCER SURVIVORS WITH SELF-REPORTED COGNITIVE

IMPAIRMENT

Victoria Bray1, Haryana Dhillon2,3, Melanie Bell4, Michael Kabourakis2, Melanie Price4, Janette Vardy1,2

1. Sydney Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia2. Centre for Medical Psychology and Evidence-based Decision-Making, The University of Sydney, NSW, Australia3. Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia4. Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Background: Up to 70% of cancer survivors self report cognitive impair-ment after chemotherapy and 30% have impairment on neuropsychological testing. Survivors consistently report that this has a major impact on their quality of life and functional abilities. The mechanisms are unknown and there are no proven treatments.

Insight, a home and web-based cognitive rehabilitation programme has been successful in the management of cognitive symptoms in non-cancer popula-tions with similar cognitive defi cits, and in a pilot study in breast cancer survivors.

Our randomised controlled trial evaluates the effi cacy of Insight in cancer survivors who self-report cognitive impairment following completion of potentially curative chemotherapy for solid primary tumours (excluding central nervous system malignancies).

Our primary hypothesis is that Insight will improve self reported cognitive function. Secondary hypotheses are that Insight will improve objective neu-ropsychological performance and will lead to: (i) improved quality of life; (ii) reduced depression and anxiety; (iii) reduced stress; (iv) reduced fatigue.

Methods: We are recruiting cancer survivors with self reported cognitive impairment, as indicated by changes in concentration and memory on the 2-item screening test from the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire–C30 Cognitive Func-tioning scale. Participants must be aged 18 years and above, have completed potentially curative chemotherapy within the last 6–60 months and have no evidence of cancer recurrence.

The intervention arm receives the 40 hour Insight programme and the control arm receives standard care. Both groups participate in a 30-minute, structured telephone consultation teaching compensatory cognitive training strategies.

Participants complete neuropsychological tests and questionnaires evaluat-ing patient reported outcomes at baseline, post intervention and 6 months post intervention.

This is a home-based study allowing cancer survivors with access to com-puter and internet facilities from any location in Australia to participate. Sample size is 214, with 124 patients randomised to date.

732

MERKEL CELL CARCINOMA IN SOUTH WESTERN SYDNEY AND

SYDNEY LOCAL HEALTH DISTRICTS: A SIX YEAR RETROSPECTIVE

REVIEW

Mahbuba Sharmin1, Joyiti K Prakash1, Nathaya Muadjienga1, Kirsten J Duggan1, Dion Forstner2, Allan Fowler2

1. SWSLHD and SLHD Clinical Cancer Registry, Liverpool Hospital, Liverpool, NSW, Australia2. Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool and Campbelltown, NSW, Australia

Merkel Cell Carcinoma (MCC) is a relatively rare neuroendocrine cancer, accounting for less than 1% of cutaneous malignancies. The disease is characterised by rapid growth, with a high likelihood for lymphatic spread and recurrence. MCC is a highly radiosensitive tumour and radiotherapy (RT) has an important role in the defi nitive management of these tumours. This investigation aims to identify local treatment patterns for this uncom-mon and potentially aggressive tumour.

A retrospective review of MCC patients with a new diagnosis between July 2005–June 2011 from the South Western Sydney and Sydney Local Health Districts (SWS&SLHD) Clinical Cancer Registry was performed. Additional clinical data was identifi ed from patient record review. 64 cases of MCC were identifi ed. Of these, 65% were male, 82% were diagnosed at 70 years or over and only 22% were born overseas. MCC occurred more frequently on the head, neck and face region (37%) as well as the upper and lower extremity areas (35%). 11% of cases were of unknown primary site. 25% had no stage documented at diagnosis. Most patients were found to be stage I (23%) or stage III (23%) at diagnosis. 94% of patients had documented treatment provided for their MCC. 77% of patients received surgical resec-tion and 81% received RT. The most common reason for no RT was poor performance status or progressive disease (52%). 28% of patients had a recurrence within 12 months of initial diagnosis. One year crude survival was 54%.

Patterns of incidence, treatment and outcomes identifi ed are similar to other studies conducted locally and internationally, but also hold unique local characteristics. Further research into treatment patterns, referral rates and patient outcomes will enhance clinical practice and service provision.

The authors indicated no potential confl icts of interest.

733

STUDY PROTOCOL: OPTIMISING MEN’S UPTAKE OF FAECAL

OCCULT BLOOD TEST SCREENING FOR BOWEL CANCER: A

POPULATION BASED RANDOMISED CONTROLLED TRIAL

Amy Duncan1, Ian Zajac2, Carlene Wilson3,4, Ingrid Flight2, Graeme P Young3,5, Stephen R Cole5, Deborah Turnbull1

1. School of Psychology, The University of Adelaide, Adelaide, SA, Australia2. Preventive Health Flagship, CSIRO, Adelaide, SA, Australia3. Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, SA, Australia4. Cancer Council, Adelaide, SA, Australia5. Bowel Health Service, Repatriation General Hospital, Adelaide, SA, Australia

Background: Participation in faecal occult blood test (FOBT) screening in Australia is signifi cantly lower amongst men than women. This is problem-atic as men are at a signifi cantly increased risk of being diagnosed with, and dying from, colorectal cancer (CRC). Unpublished analyses of our existing data have consistently found differences in several psychosocial constructs (e.g., self-effi cacy, perceived barriers) between male non participants and participants in FOBT screening. Moreover these constructs are differentially associated with readiness to screen amongst men relative to women, thus suggesting a gender specifi c approach to offering screening may improve male participation.



Objective: To compare the effi cacy of three male-targeted recruitment tech-niques for improving participation in FOBT screening.

Design: The study will be a multi-armed randomised controlled trial. Names and addresses of N = 9,200 men aged 50–74 will be randomly selected from the Australian Electoral Roll. The sample will be stratifi ed based on population density for the fi ve most populous Australian states. Participants will be randomised to either a control condition or one of three intervention arms. The control condition will mimic the recruitment proto-col of the Australian National Bowel Cancer Screening Program, which includes an advance notifi cation letter and a free, mail-delivered FOBT and invitation letter. The intervention arms will vary in terms of whether they receive customised advance notifi cation letters, customised invitation letters or both. Customised letters will be designed to target relevant psychosocial variables identifi ed in previous analyses. The study will be powered to detect group differences in FOBT participation of at least six percent. Sub samples from each group will complete a baseline and endpoint questionnaire to determine the psychological impact of the intervention.

Discussion: This project will identify whether new strategies are effective for encouraging men to participate in screening for CRC and will provide insights into how messages might be framed and delivered in order to maximise participation.

734

THE DIAGNOSTIC ACCURACY OF THE 7-POINT CHECKLIST TO

ASSESS PIGMENTED SKIN LESIONS IN PRIMARY CARE

Fiona M Walter1, A Toby Prevost2, Joana Vasconcelos2, Per Hall3, Nigel Burrows3, Helen Morris1, Ann-Louise Kinmonth1, Jon Emery4

1. Department of Primary Care, University of Cambridge, Cambridge, UK2. Department of Primary Care and Public Health Sciences, Kings College, London, UK3. Addenbrookes Hospital, Cambridge, UK4. University of Western Australia, Crawley, WA, Australia

Background: The seven-point checklist (7PCL) has been recommended internationally for routine use in general practice to identify possible melanomas. We report the fi rst formal validation in primary care of the 7PCL.

Methods: Data were obtained from the Molemate Trial (1) on patients present-ing with a pigmented lesion in general practice. Data including the 7PCL items were collected on all lesions in the trial. Reference standard diagnoses were as follows: for referred lesions, histology or dermatology expert opinion; for non-referred lesions, clinical history, digital photograph, and SIAscopic image where available. 7PCL scores were calculated blinded to the reference diagnosis, and a case was defi ned as (1) a clinically signifi cant lesion; (2) melanoma.

Results: 1436 lesions were included in the analyses: 225 clinically signifi cant cases including 36 melanomas and 1211 benign. For diagnosing clinically signifi cant lesions there was a statistically signifi cant difference between the performance of the Original and Weighted 7PCLs area under curve (AUC): 0.66 (0.62 to 0.70), 0.69 (95% CI 0.65 to 0.73), difference = 0.03 (0.01 to 0.05, p < 0.001). For the identifi cation of melanoma, similar differences were found. Increasing the Weighted 7PCL’s cut-off score from recom-mended 3 to 4 improved detection of clinically signifi cant lesions in primary care (sensitivity 73.3%, 67.1% to 79.0%; specifi city 57.1%, 54.2% to 59.9%; PPV 24.1% (20.9% to 27.5%)), NPV 92.0% (89.8% to 93.9%)) while maintaining high sensitivity (91.7%, 77.5% to 98.3%) and moderate specifi city (53.4%, 50.8% to 56.1%) for melanoma.

Interpretation: The Original and Weighted 7PCL both performed well in a primary care setting to identify clinically signifi cant lesions as well as melanoma. The Weighted 7PCL, with a revised cut-off score of 4 from 3, performs slightly better than both the previous checklists and could be applied in general practice to support the recognition of clinically signifi cant lesions and therefore the early identifi cation of melanoma.1

Reference1. Walter F M, Morris H C, Humphrys E, Hall P N, Prevost A T, Burrows

N, Bradshaw L, Wilson E C F, Norris P, Walls J, Johnson M, Kinmonth

A L, Emery J D. Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised con-trolled trial. BMJ 2012;344:e4110 doi: 10.1136/bmj.e4110.

735

A RANDOMIZED, PHASE IB/II TRIAL OF RILOTUMUMAB (AMG 102;

RIL) OR GANITUMAB (AMG 479; GAN) WITH PANITUMUMAB

(PMAB) VS PMAB ALONE IN PATIENTS WITH WILD-TYPE (WT)

KRAS METASTATIC COLORECTAL CANCER (MCRC): PRIMARY AND

BIOMARKER ANALYSES

Niall C Tebbutt1, Eric Van Cutsem2, Cathy Eng3, Elzbieta Nowara4, Anna wieboda-Sadle5, Edith Mitchell6, Irina Davidenko7, Kelly S Oliner8, Lisa Chen8, Jing Huang9, Elwyn Loh9, Eduard Gasal10, Josep Tabernero11

1. Austin Hospital, Heidelberg, VIC, Australia2. University Hospital Gasthuisberg, Leuven, Belgium3. The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA4. Instytut im. M. Sklodowskiej-Curie, Gliwice, Poland5. Warszawski Uniwersytet Medyczny, Warszawa, Poland6. Thomas Jefferson University, Philadelphia, PA, USA7. Krasnodar City Oncology Center, Krasnodar, Russia8. Amgen Inc., Thousand Oaks, CA, USA9. Amgen Inc., South San Francisco, CA, USA10. Amgen (Europe) GmbH, Zug, Switzerland11. Vall d’Hebron University Hospital, Barcelona, Spain

Aim: Pmab, ril, and gan are fully human monoclonal antibodies against epidermal growth factor receptor, hepatocyte growth factor, and insulin-like growth factor receptor 1, respectively. The safety and effi cacy of ril or gan with pmab in patients with WT KRAS mCRC is presented.

Methods: Part 2 of this 3-part study was a phase II, randomized, double-blinded, placebo-controlled trial of 3 arms: pmab (6 mg/kg)/placebo (Arm 1), pmab/ril (6/10 mg/kg, Arm 2, and pmab/gan (6/12 mg/kg, Arm 3). Administration was Q2W until disease progression or intolerance. Patients were ≥18 yrs old, had ECOG PS 0/1, and had prior irinotecan and/or oxaliplatin. The primary endpoint was objective response rate (ORR). The primary analysis of ORR used a Bayesian method. Secondary endpoints included progression-free survival (PFS) and safety. Biomarker analyses including c-Met expression by immunohistochemistry on archival tumor samples were completed.

Results: Of the 142 patients enrolled, 58% were men, mean age was 59.7 yrs, and ECOG PS of 0/1 was 40%/59%, respectively. The ORRs were 21%, 31%, and 22% and the median PFS (95% CI) were 3.7 (2.5–5.3), 5.2 (3.6–5.4), and 5.3 (2.7–5.7) months for Arms 1, 2, and 3, respectively. The posterior probability of OR >1 relative to Arm 1 for ORR were 0.93 for pmab/ril and 0.63 for pmab/gan. The most common adverse event of grade ≥ 3 in the pmab/ril arm was rash, and in the pmab/gan arm was hypomag-nesemia. Immunohistochemistry results were obtained for 94% of the patients (134/142).

Conclusions: Pmab/ril met the prespecifi ed criterion for improvement in ORR (greater than Arm 1). Pmab/gan was indeterminate. Pmab in combina-tion with ril or gan was well tolerated. There were no strong correlations demonstrated between the expression of tumor c-MET protein and clinical outcomes. (© 2012 Amgen Inc.)



736

TO ANALYSE THE TOXICITY AND EFFICACY OF CONCOMITTANT

CHEMOTHERAPY OR CETUXIMAB AND RADIOTHERAPY

(CHEMORADIATION) AMONGST PATIENTS OF HEAD AND NECK

CANCERS AT THE ALAN WALKER CANCER CENTRE, NORTHERN

TERRITORY FROM 2010–2012

Ajay Gupta, Siddartha Baxi, Meena Okera, Narayan KaranthRoyal Darwin Hospital, Tiwi, NT, Australia

Background: In advanced head and neck malignancies – CCRT (concurrent chemo radiotherapy), is the current standard as defi nitive or adjuvant treat-ment. It is administered in the setting of 1) unresectable disease, 2) organ preservation in laryngeal and hypopharyngeal cancers and 3) high risk features post surgical resection-positive margins, residual disease, extracap-sular spread, multiple nodes and perineural or lymphovascular spread.

This modality has only been recently introduced in the NT with the estab-lishment of the Alan Walker Cancer Center since 2010. The clinical setting in the NT is unique in that more patients are from remote areas, climate is primarily tropical: and about 30% of the patients are indigenous. It is important to analyse the toxicity and effi cacy of this treatment modality in this clinical setting in order to identify any unique problems relevant to our patient population.

Methods: All adult patients (aged 18 years or above) suffering from histo-logically proven Head and Neck Cancer who have received defi nitive or adjuvant chemoradiation (with either platinum compunds or cetuximab) since the establishment of Alan Walker Cancer Center (2010 till August 2012) will be taken up for the study. Expected sample size is 60–70 patients. Toxicity will be graded according to COMMON TOXICITY CRITERIA FOR ADVERSE EVENTS VERSION 3 and the RADIATION THERAPY ONCOLOGY GROUP (RTOG) criteria. A sincere attempt will be made to understand if the toxicities encountered by indigenous patients are any dif-ferent from those faced by other patients in order to address them more effectively.

Results: Results are being collated and will be presented in full at the meeting.

Conclusions: This study will provide improved understanding of supportive care needs amongst patients of head and neck cancer including indigenous patients in the Northern Territory. Indigenous Australians are likely to experience increased treatment related toxicities and compliance issues. This study will help in assessing safety and effi cacy of chemoradiotherapy in our patients and identify areas of improvement.

737

IMPROVING THE MANAGEMENT OF CHEMOTHERAPY TOXICITIES

IN HAEMATOLOGICAL CANCER PATIENTS: A PHASE II

RANDOMISED CONTROLLED TRIAL OF THE PATIENT REMOTE

INTERVENTION AND SYMPTOM MANAGEMENT SYSTEM

(PRISMS)

Sibilah Breen1, Sanchia Aranda2,3, David Ritchie4, Penelope Schofi eld1, Rose Kamateros1, Roma Maguire5, Nora Kearney5

1. Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia2. Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia3. Division of Cancer Services and Information, Cancer Institute NSW, Sydney, NSW, Australia4. Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia5. Department of Nursing and Midwifery, University of Dundee, Dundee, UK

Background: Patients with haematological malignancies are at increased risk of serious/life-threatening chemotherapy toxicities. We have previously developed a highly acceptable system to remotely monitor/manage

chemotherapy toxicities of haematological cancer patients in the community setting. This phase II trial combines the remote monitoring system with a novel nurse-led intervention (PRISMS).

Aims: To pilot the intervention to: estimate potential effect sizes/coeffi cients of variation to form the basis of power calculations; calculate patient recruitment/retention rates; assess intervention compliance rates.

Methods/design: Thirty patients are being recruited from two Melbourne hospitals. Eligibility criteria include: diagnosis of Chronic Lymphocytic leu-kaemia/Hodgkin’s/Non-Hodgkin’s lymphoma; aged 18 years. Patients are randomized 1:1 to either the control or intervention arm. Patients allocated to the control arm receive ‘Usual Care’ whilst those allocated to the interven-tion will receive the PRISMS intervention in addition to ‘Usual Care’. Randomization is stratifi ed by site/diagnosis/Chemotherapy toxicity. Inter-vention patients will be provided with a computer tablet and software prompting twice-daily completion of physical/emotional indicators (eg tem-perature/depression/distress) and side-effects (eg vomiting) for four treat-ment cycles. Should patient data exceed pre-determined limits an email alert is delivered to the treatment team with nurses logging-in to view historical data/provide clinical intervention. In addition 6 scheduled nursing interven-tions support patients in device usage/self care. Trial outcomes assess: symptom severity, psychological distress/anxiety/depression, quality-of-life (pen-and-paper questionnaires); health service useage/costs (medical record audit/interview); intervention compliance (system logs).

Discussion: This trial is the fi rst in the world to both develop a remote monitoring system for haematological cancer patients receiving chemo-therapy and to combine the system with a nurse-led intervention. Findings from this trial are essential so that a future phase III trial is not undermined by poor compliance, recruitment/retention rates and smaller than expected effect sizes. The future use of such monitoring systems have the potential to improve patient outcomes and reduce health care costs.

738

EXPLORATORY LANDMARK ANALYSIS OF METASTATIC

MELANOMA PATIENTS TREATED WITH IPILIMUMAB

Hansoo Kim1, Victor Barzey2, Greg Cook1

1. Bristol-Myers Squibb, Noble Park North, VIC, Australia2. IMS Health, London, United Kingdom

Ipilimumab is a fully human monoclonal antibody registered in Australia for the treatment of patients with unresectable or metastatic melanoma who have failed or are intolerant to prior therapy. Delayed response kinetics, while a hallmark of this immunotherapy, complicates the early assessment of ipilimumab’s anti-tumor effect. A double-blind multicenter parallel phase III clinical trial (MDX010–020) comparing ipilimumab to an active placebo with overall survival as primary endpoint reported a hazard ratio (HR) of 0.66 (95% CI: 0.51, 0.87)1. The treatment regimen for ipilimumab in MDX010–020 consisted of four infusions over a 9 week period with re-staging at 12 weeks. In the event of a prolonged delay or multiple delays in treatment, the treatment regimen could be extended up to week 16. Eighteen percent of the patients in the trial were withdrawn, censored or died prior to the 12 week time point, with this fi gure increasing to 21% by week 16. A post-hoc analysis was performed exploring the survival of those patients who survived beyond the treatment regimen timeframe of weeks 12 or weeks 16. Kaplan-Meier estimates were calculated with a resulting HR = 0.57 (95% CI: 0.43, 0.77) for patients surviving beyond the week 12 landmark time point and a HR = 0.58 (95% CI: 0.42, 0.79) for patients surviving beyond the week 16 landmark time point. This study demonstrates that ipilimumab treated patients surviving beyond 3–4 months in study MDX010–020 demonstrated enhanced overall survival when compared to the overall patient population (HR = 0.66).

Reference1. Hodi FS, O’Day SJ, McDermott DF et al. Improved survival with ipili-

mumab in patients with metastatic melanoma. N Engl J Med. 2010 Sep 23;363(13):1290.



739

PROJECTING LONG TERM OVERALL SURVIVAL BENEFIT IN

METASTATIC MELANOMA PATIENTS TREATED WITH IPILIMUMAB

USING EXTRAPOLATION METHODS

Hansoo Kim1, Greg Cook1, Philip McCloud2

1. Bristol-Myers Squibb, Noble Park North, VIC, Australia2. McCloud Consulting Group, Sydney, Australia

Ipilimumab is an immuno-oncological medicine registered in Australia for the treatment of patients with metastatic melanoma who have failed or are intolerant to prior therapy. Ipilimumab specifi cally blocks the inhibitory signal of CTLA-4, resulting in T-cell activation, proliferation, and lym-phocyte infi ltration into tumours, leading to tumour cell death. Treatment consists of a regimen of four infusions of ipilimumab at a dose of 3 mg/kg every three weeks. As a proportion of patients treated with ipilimumab have previously been demonstrated to experience long term overall survival benefi t, this study sought to project overall survival of patients beyond the 2 year study period of the pivotal ipilimumab phase III study (MDX010–020). Additionally, we sought to validate the extrapolation method selected by comparing to the observed survival rates from two phase II ipilimumab studies where long term survival data is available for patients with 4 and 5 years follow-up. Traditional parametric curves such as Weibull, exponential and log-normal produced a poor fi t to the Kaplan-Meier survival curve. Investigation of the hazard function revealed that the survival curve could be characterized as a mixture of two different curves – as the magnitude of the hazards changed approximately 2 years (turning point) after treatment initiation. A Weibull curve was fi tted to the survival curve after the turning point and projections were derived. The projected overall survival rate at 5 years was 16.1%. This method projected the overall survival rates at 4 and 5-years to within a margin of less than 1% difference when compared to the observed rates from two phase II ipilimumab trials. This comparison confi rms the hypothesis that overall survival for ipilimumab does not follow traditional parametric curves but rather a mixture of distributions. Applying this extrapolation approach allows one to project the long term effect of ipilimumab on overall survival with increased certainty.

742

PERCEIVED BARRIERS TO OPTIMAL LUNG CANCER CARE IN

NORTH QUEENSLAND: A QUALITATIVE STUDY

Shivanshan Pathmanathan1, Jillian Matthiesson2, Dilanka De Silva2, Sabe Sabesan1,2

1. School of Medicine, James Cook University, Townsville, Australia2. Department of Medical Oncology, Townsville Cancer Centre, Townsville, Australia

Aim: The mortality of cancer patients living in rural areas is higher, the greater distance they live away from a tertiary centre due to many factors and barriers. The aim of this study is to evaluate patient’s views on barriers to lung cancer diagnosis, and management, in particular of rural patients in North Queensland.

Methods: As part of a patterns of care lung cancer study, Patients’ view on barriers were explored in a qualitative study using semi-structured inter-views lasting up to 30 minutes. Patients from urban and rural areas were recruited from Townsville, Cairns, Mackay and Mt Isa hospitals after informed consent. Transcripts of the interviews were coded and summarised under several themes. Rurality was defi ned as per standard guidelines.

Results: Of the 250 patients approached, a total of 230 patients consented to interviews; 86 from Townsville and Cairns, and 144 from rural areas. Main themes relating to patients’ perceived barriers/factors included the following: they delayed their presentations to general practitioners or their referral to the appropriate specialists was delayed, responsibilities (work, family, carer), fi nancial diffi culty, delay in investigation and staging, patient refusing investigations, lack of social support, communication barrier (lan-guage), environmental hazards (fl oods, cyclones) and other medical condi-tions. Rural patients perceived fi nancial diffi culty, diffi culty travelling to

tertiary centres for management, and responsibilities such as work or family, as being key barriers to receiving management. In the urban group, pre-dominant themes included: patient not opting for management, other medical conditions delaying management, and responsibilities such as work.

Conclusions: Signifi cant modifi able barriers to lung cancer diagnosis and management remains in both urban and rural communities. Rural cancer patient have additional barriers of fi nancial diffi culty and diffi culty travel-ling to tertiary centres, in comparison to urban patients. New models of care are needed to address rural barriers.

743

IS THERE A NEED FOR ROUTINE CARDIAC EVALUATIONPRE-

ANTHRACYCLINE CHEMOTHERAPY IN BREAST CANCER

Dagmara M Poprawski, Sudarsha Selva-Nayagam, Anne Taylor, Nicholas MurrayRoyal Adelaide Hospital, Adelaide, SA, Australia

Systemic chemotherapy in breast cancer often includes anthracyclines, with associated risk of inducing cardiomyopathy. In many units cardiac function is routinely evaluated with measurement of left ventricular ejection fraction by cardiac gated pool (MUGA) scan or echocardiogram. The intent of such evaluations is to identify those who may be more at risk of clinically signifi -cant anthracycline induced cardiotoxicity due to poor pre-existing function. The utility and cost effectiveness of this approach in younger patients with no risk factors for cardiac disease has been questioned, and we sought to audit this in our practice.

A retrospective clinical audit of 3 years of breast cancer patients was done and identifi ed 477 patients between January 2008 and December 2010, who were discussed at Breast Multidisciplinary Meetings at Royal Adelaide Hos-pital. 173 (36.3%) patients received chemotherapy, with 139 (29.1%) having received anthracycline regimen. All patients had cardiac gated pool scans performed, and the results were obtained using computerised results from Nuclear Medicine Department or casenotes. All scans gave a normal results of above 50% ejection fraction, with 87.6% of patients having EF > 60%.

This results challenge current practice, and raise the possibility of an alterna-tive approach – to only scan those with known cardiac problems or identifi -able risk factors for cardiac disease.

References

1. Jeyakumar A, et al. Routine Cardiac Evaluation in Patients With Early-Stage Breast Cancer Before Adjuvant Chemotherapy. Clinical Breast Cancer, 2011; 12(1): 4–9.

2. Anthracycline Induced Cardiomyopathy. UptoDate Website. Available at www.uptodate.com.au Accessed: May 2012.

3. Anthracycline Induced Cardiotoxicity. Clinical Guidelines in Oncology. National Comprehensive Cancer Network website. www.nccn.org Accessed: May 2012.



744

FINAL RESULTS OF AUSTRALASIAN GASTRO-INTESTINAL TRIALS

GROUP (AGITG) ARCTIC STUDY – AN INTERNATIONAL AUDIT OF

RALTITREXED FOR PATIENTS WITH CARDIAC TOXICITY (CT)

INDUCED BY FLUOROPYRIMIDINES (FP)

David Ransom1, Kate Wilson2, John Simes2, Desmond Yip3, Niall Tebbutt4, Chris Karapetis5, Marion Fournier2, David Ferry6, Tim Price7

1. Royal Perth Hospital, Perth, WA, Australia2. NHMRC Trials Centre, Sydney, Australia3. Canberra Hospital, Canberra, Australia4. Austin Health, Melbourne, Australia5. Flinders Medical Centre, Adelaide, Australia6. Russells Hall Hospital, Dudley, United Kingdom7. Queen Elizabeth Hospital, Adelaide, Australia

Background: CT is an uncommon but potentially fatal side effect of FP. The incidence of further CT if the same chemotherapy is continued is reported to be 20%*. Management of these patients remains poorly defi ned and options include continuing same dose/schedule of FP, adding a nitrate and calcium antagonist, switching administration schedule of FP, or substituting with raltitrexed, the later based primarily on case reports.

Methods: AGITG & OCTO (Oncology Clinical Trials Offi ce – Oxford) members identifi ed patients who had CT from FP, and were subsequently switched to raltitrexed. CT included angina, myocardial infarct (MI) or arrhythmia. A coronary angiogram was not mandatory.

Results: 42 patients were included in this clinical audit. Cancer diagnoses included colorectal (39 pts), oesophageal (2) and ampullary carcinoma (1). Median age – 62 years (range 36–81). 27 patients (64%) were male. Median number of cycles prior to switching to raltitrexed was 2 (range 1–11). FP regimens included FOLFOX, CAPOX, continuous infusion 5FU, ECF, capecitabine alone. 40 patients had angina, 5 MI, and 2 arrhythmia with some patients experiencing >1 event at that time. 8 patients experienced two separate CT events, and 2 had 3 events prior to switching to raltitrexed. Following CT, 9 patients received raltitrexed alone, 32 received raltitrexed in combination with other agents or radiotherapy and one received ralti-trexed alone followed by combination. Median number of raltitrexed cycles was 6 (range 1–21). One patient (CT rate 2.4%, 95% CI: 0.1–12.3) expe-rienced a possibly related cardiac event (acute arrhythmia 5 mths into therapy) after switching to raltitrexed, signifi cantly lower than the reported rate of CT when continuing FP of 20% (p = 0.004).

Conclusion: The rate of recurrent CT after switching from FP to raltitrexed was low. The strategy of switching to raltitrexed may represent an accept-able option for patients that are deriving a benefi t from FP based chemo-therapy but in whom cardiac toxicity is a concern. (* Jensen SA et al. Cancer Chemotherapy & Pharm. 58:487–93, 2006)

745

CHANGES IN ADIPOSITY, GASTRO-OESOPHAGEAL REFLUX AND

OBESITY-RELATED HORMONES FOLLOWING A 24-WEEK

EXERCISE INTERVENTION IN MEN WITH BARRETT’S

OESOPHAGUS

Brooke M Winzer1, Marina M Reeves1, Jennifer Paratz1, Jon Whitehead2, David C Whiteman3

1. The University of Queensland, Herston, QLD, Australia2. Mater Medical Research Institute, Brisbane, Australia3. Queensland Institute of Medical Research, Brisbane, Australia

People diagnosed with Barrett’s oesophagus are approximately 30–40 times more likely to develop oesophageal adenocarcinoma than the healthy popu-lation. Gastro-oesophageal refl ux disease and obesity are widely recognized risk factors for oesophageal adenocarcinoma. At present there is a lack of evidenced-based interventions aimed at reducing cancer risk in individuals with Barrett’s oesophagus. This study examined the effect of exercise on

adiposity, gastro-oesophageal refl ux and obesity-related hormones in over-weight and obese males with Barrett’s oesophagus. Inactive males with Barrett’s oesophagus (n = 33), aged 18 to 70 years, who were overweight or obese (BMI 25.0–34.9 kg/m2) were recruited and randomised to receive either a 24-week, moderate-intensity aerobic and resistance exercise inter-vention (60 minutes, 5 days/week) or stretching (45 minutes, 5 days/week). Body composition, waist circumference, gastro-oesophageal refl ux symp-toms and circulating concentrations of leptin, adiponectin, C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), insulin and glucose were measured at baseline, 12-weeks and 24-weeks. Insulin resistance was determined using HOMA. Intervention effects were analysed using generalised linear models adjusting for baseline values. At 24-weeks (n = 32), the exercise group signifi cantly reduced waist circumfer-ence (intervention effect −4.5 [95% CI −7.5, −1.4] cm; p < 0.01) and leptin concentration (intervention effect −3.0 [95% CI −6.4, 0.5] ng/mL; p = 0.09) compared to the control group. A non-signifi cant reduction in fat mass was also observed (intervention effect −1.7 [95% CI −4.9, 1.7] kg; p = 0.32). Changes in gastro-oesophageal refl ux symptoms, HOMA, IL-6, TNF-α and adiponectin levels did not differ between groups. Insulin, CRP and total adiponectin signifi cantly decreased within both groups (p < 0.05). These data suggest that regular moderate-intensity aerobic and resistance exercise may improve risk profi les associated with cancer risk in inactive, overweight and obese males with Barrett’s oesophagus. Larger trials are required to confi rm these fi ndings.

746

VEMURAFENIB AND PHOTOTOXICITY IN MELANOMA

Carol A Rice, Julie S LongPeter MacCallum Cancer Centre, East Melbourne, VIC, Australia

Aim: To investigate the incidence of phototoxicity and the possible correla-tion between phototoxicity reactions and effi cacy of response in Melanoma patients treated with Vemurafenib at Peter MacCallum Cancer Centre.

Method: The patient records of all patients treated with Vemurafenib for metastatic Melanoma between December 2008 and June 2012 were reviewed to identify the documented incidence of phototoxicity and the recorded severity of the phototoxic reaction. The time to progression was recorded and a correlation between phototoxic reactions and time to pro-gression was investigated.

Results: Of a total of 82 patients treated with Vemurafenib 39 patients (47.6%) were documented as having suffered a phototoxic reaction. 4 (10.5%) of these patients had a Grade 3 reaction, 9 (21%) patients a Grade 2 reaction and the remaining 26 patients a Grade 1 reaction. The mean time to progression for patients suffering a phototoxic reaction of any grade was 11.18 months. Patients with no documented phototoxicity had a mean time to progression of 5.25 months which was a statistically signifi cant difference (P = 0.003)

Conclusion: Vemurafenib is a new small molecule oral therapy which targets BRAF V600E mutations. Approximately 60% of melanoma patients have tumours with BRAF mutations and the response rate of these patients is 53% although the duration of response varies signifi cantly. A common toxicity of Vemurafenib is phototoxicity. This project investigated whether the occurrence of phototoxicity could predict patients who may have a longer duration of response when treated with Vemurafenib. There did appear to be a correlation between a phototoxic reaction and a longer dura-tion of response however the sample size is small. Also the timing of the treatment could have infl uenced the results as phototoxic reactions were more likely to be recorded in the summer months. A phototoxic reaction was most likely to be documented earlier in a patient’s treatment period and this may be an early indicator of duration of response. This also however may indicate the patient’s awareness of this toxicity and their ability to implement coping strategies.



747

SQID – TESTING THE PERFORMANCE OF A SINGLE QUESTION IN

DELIRIUM CASE FINDING FOR CLINICAL ONCOLOGY

Megan B Sands1, Clare Zachluski2, Swapnil Sharma3, Lindsay Carpenter3, Manish Anand4, Janette Vardy5

1. Palliative Medicine, The Prince of Wales Hospital, Sydney, NSW, Australia2. Palliative Medicine, Westmead Hospital, Sydney, NSW, Australia3. Liaison Psychiatry, The Prince of Wales Hospital, Sydney, NSW, Australia4. Liaison Psychiatry, Westmead Hospital, Sydney, NSW, Australia5. Sydney Cancer Centre, University of Sydney, Sydney, NSW, Australia

Aims: Delirium may affect patients with any cancer diagnosis and has signifi cant, negative impacts on patients, staff and carers. Delirium is common in hospitalised oncology patients and associated with increased mortality, morbidity, distress and prolonged hospital stay. Delirium diagno-sis is frequently missed. Diagnosis can be improved with screening tools but existing tools require signifi cant training, can be time consuming, and are rarely used in inpatient oncology settings.

In this study we address the research question; How sensitive is a single question in delirium screening?

Methods: Institutional Health and Research Ethics Committee approval has been gained at both sites. The study involves administration of 3 tools to test for delirium. The study instrument is the Single Question in Delirium screen (SQiD). The patient’s friend or relative are asked: ‘Do you feel [patient’s name] has been more confused lately?’ Responses are compared with a psychiatrist’s clinical diagnosis of delirium and a validated multi-item tool; the Confusion Assessment Method. Consecutive weekday oncology/palliative care admissions will be approached (sample size = 195) at Prince of Wales and Westmead Hospitals in Sydney, Australia. The SQID has been piloted and results appear promising.1

Current status: Of consecutive 283 admissions at site one. Of these 52 were inpatient admissions of less than 2 days for chemotherapy and not included. Of the remainder 35 have completed all 3 tests of delirium. Site two will commence recruitment in September 2012.

Reference

1. Sands et al. Single Question in Delirium (SQiD): testing its effi cacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Palliative medicine (2010) vol. 24 (6) pp. 561–5.

748

FAMILY CONNECT: A RANDOMISED CONTROLLED TRIAL TO

IMPROVE PSYCHOSOCIAL OUTCOMES FOR CANCER CARERS

Joanne Shaw1,2, Jane Young1,2, Phyllis Butow1,3, Patricia Davidson4, James Harrison1,2,5, Michael Solomon1,5

1. Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia2. School of Public Health, University Of Sydney, Sydney, NSW, Australia3. Psycho-oncology Co-operative Research Group, University Of Sydney, Sydney, NSW, Australia4. Faculty of Nursing Midwifery and Health, University of Technology, Sydney, NSW, Australia5. Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia

Background: Patients with upper gastrointestinal, Dukes D colorectal and metastatic liver cancers have a poor prognosis. As a result, patients and their family caregivers have signifi cant levels of unmet supportive care need, psychological distress and poor quality of life. Family members are also at high risk of signifi cant carer burden.

Aim: The study aims to ascertain the effectiveness of a structured telephone intervention to reduce carer’ unmet supportive care needs and psychological distress and to improve quality of life of family caregivers of people with poor prognosis gastrointestinal cancer in the fi rst three months after starting treatment. The study will also investigate whether a carer focused interven-tion can improve patient outcomes.

Methods: This multicentre-RCT will recruit 160 family caregivers and patients starting treatment (surgical or non-surgical) after a surgical review for a newly diagnosed or recurrent primary upper gastrointestinal cancer or Dukes D colorectal cancer or newly diagnosed or recurrent metastatic liver disease. Participants are randomised to receive four telephone intervention calls in the 10 weeks following the patient’s discharge, or standard care. Six Sydney hospitals are currently recruiting to the study. Total recruitment to date is 97 participants. Study retention rate is 82%. Most common reason for withdrawal is patient death (n = 9). Current rate of questionnaire return is 88% for carers and 91% for patients at 3 months and 89% and 86% at 6 months.

Conclusions: This trial will determine the effectiveness of a telephone-based intervention to improve psychosocial outcomes for family caregivers of patients with poor prognosis gastrointestinal cancer. Based on current study participation, recruitment is due to be completed December 2012.

749

ACHIEVING INCREASED AND WIDE SPREAD PARTICIPATION IN

CLINICAL TRIALS

Victoria Steel1, Elizabeth Paton1, Enmoore Lin1, Alan Lucas1, Gerald B Fogarty2,3

1. Australia and New Zealand Melanoma Trials Group, North Sydney, NSW, Australia2. Melanoma Institute Australia, Sydney, Australia3. Mater Sydney Radiation Oncology, Sydney, Australia

Introduction: The Australia and New Zealand Melanoma Trials Group (ANZMTG) develops and supports melanoma studies of clinical relevance. Success depends upon engagement with potential Investigators and timely recruitment of patients.

Method: We developed a number of strategies to these ends. They included:

I. Increase in the size and diversity of ANZMTG membership II. Establishing an Annual Scientifi c Meeting and Annual General Meetings,

a website, newsletters, consumer forums and other presentations III. Increasing ANZMTG involvement with consumer groups IV. Development of a protocol synopsis form allowing greater ease in

submission of research proposals V. Approving a larger number of proposals, providing more opportunities

for Investigators to become involved with a study of interest VI. Collaborating with international research groups to enhance participa-

tion nationally in other clinically relevant collaborative trialsVII. Publishing results in peer reviewed journals

Results: Data will be presented proving our strategies have worked:

I. Membership has increased in number and diversity II. Increased patient accrual, having used novel ways to achieve this for

the ANZMTG 01.07 WBRT Mel study III. A relevant number of publications and press activity IV. Increased number of ANZMTG trials V. Links have been established with consumer groups and national and

international collaboratorsVI. Annual Scientifi c Meeting well attended by key melanoma researchers

Conclusion: Innovative ways of increasing engagement with researchers has led to an acceleration of trials being opened and patients being accrued. ANZMTG is the only melanoma specifi c trials group in the World; it is vibrant, is growing and thereby helping to making this cancer history.



750

PERI-OPERATIVE CHEMOTHERAPY IMPROVES RELAPSE-FREE

SURVIVAL FOR UROTHELIAL CARCINOMA OF THE BLADDER

TREATED BY RADICAL CYSTECTOMY, BUT REMAINS UNDER-

UTILISED IN AN AUSTRALIAN TERTIARY REFERRAL INSTITUTION

Ali Tafreshi1, Mun Sem Liew2, Renu Eapen3, Ian D Davis1,4, Shomik Sengupta3

1. Joint Austin-Ludwig Oncology Unit, Austin health, Melbourne, VIC, Australia2. Joint Austin-Ludwig Oncology Unit, Austin health, Heidelberg, VIC, Australia3. Department of Urology, Austin health, Heidelberg, VIC, Australia4. Monash university, Melbourne, Australia

Background: Radical cystectomy (RC) for curative treatment of invasive urothelial cancer (UC) of the bladder is associated with high relapse rates, especially in patients with extravesical (pT3) and node positive (N+) disease. The aim of this study was to review the peri-operative use of chemotherapy, shown to improve survival after RC, and its impact on oncological outcomes.

Methods: Using health information system coding, 88 patients undergoing RC between 2004 and 2011 were identifi ed. Clinical & pathological data, recurrence and death were assessed by retrospective chart review. Survival analysis was carried out using Cox proportional hazard models.

Results: The median (range) age of the patients was 65 y (37–84), and 66 (75%) were males. Pathologic features included 84 (95%) UC (pure or mixed), 81 (92%) high grade tumours, pT-stage ≥T3 in 34 (38.6%) and pN+ in 10 (11.4%) of patients. Twenty-fi ve (28.4%) patients underwent peri-operative chemotherapy, including 8 (9%) neoadjuvant and 21 (24%) adjuvant. There was a signifi cant trend over the study period in the use of neoadjuvant but not adjuvant chemotherapy. Patients undergoing chemo-therapy were more likely to be node positive (p < 0.05) and had a trend toward higher T-stage (p = 0.06). Twenty-four (27%) patients relapsed at a median interval (range) of 11 (1–83) months and 29 (33%) patients died, at a median interval (range) of 17 (0–84) months. Relapse free survival (RFS) and overall survival (OS) were comparable between chemotherapy and non-chemotherapy patients, but on multivariate analysis after adjusting for age, pT-stage and pN-stage, chemotherapy signifi cantly impacted RFS (RR 0.34, p < 0.05) but just failed to reach statistical signifi cance for OS (RR 0.39, p = 0.057).

Conclusions: There was a trend over the study period in increased use of neoadjuvant chemotherapy, but overall, peri-operative chemotherapy remains under-utilized. Patients who received chemotherapy had poorer prognostic features, but had better RFS after adjusting for other factors.

751

A RETROSPECTIVE CLINICAL AUDIT COMPARING NEUROPATHY

ASSOCIATED WITH TWO DIFFERENT SCHEDULES OF

OXALIPLATIN IN THE TREATMENT OF METASTATIC COLORECTAL

CARCINOMA

Thomas Vien1, Desmond Yip2

1. Australian National University, Canberra, ACT, Australia2. Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia

Aims: This study compares various aspects of peripheral neuropathy associ-ated with two regimens for metastatic colorectal cancer: XELOX (oxalipla-tin and capecitabine) and FOLFOX (oxaliplatin, fl uorouracil and folinic acid).

Methods: Patients on treatment between January 2009 and December 2011 were identifi ed via the oncology pharmacy at three hospitals in the ACT: The Canberra Hospital, Calvary Hospital and National Capital Private Hospital. Initially, 80 patients were collected and 30 patients included after exclusion criteria were applied (13 XELOX and 17 FOLFOX). A retrospec-tive chart review was conducted on oncology medical records at the three

hospitals. XELOX was compared to FOLFOX in terms of neuropathy incidence and severity, seasonal variation in the onset of worst neuropathy, time to worst neuropathy, effectiveness of various neuropathy management methods, and arm pain incidence. Neuropathy severity was assessed using an Oxaliplatin Specifi c Neurotoxicity Scale (OSNS).

Main results: Demographics were similar between the arms. Comparing XELOX to FOLFOX, no signifi cant difference was found in neuropathy incidence (84.62% versus 82.35%, p = 1.00), neuropathy severity (p = 1.00 overall comparing all grades of severity) and season of worst neuropathy (p = 0.999 overall comparing summer, autumn, winter and spring) between the arms. A non-signifi cant trend towards an earlier time to worst neuropa-thy (11.73 weeks versus 15.00 weeks, p = 0.240) was found. A signifi cant difference in arm pain incidence was found (42% versus 0%, p = 0.003). For the management of neuropathy, non-signifi cant trends towards a higher incidence of dose reduction to address neuropathy in the XELOX arm (36.4% versus 21.4%, p = 0.656), and a larger decrease in neuropathy severity after dose reduction (−1.00 versus −0.33 in OSNS scores, p = 0.440), was found.

Conclusion: This study provides preliminary evidence of XELOX non-inferiority to FOLFOX at the study location, which supports its use in the place of FOLFOX in metastatic colorectal cancer. The signifi cant difference in arm pain incidence, and other non-signifi cant trends, should be explored further with a larger sample size.

752

A PHASE 1B STUDY OF TREBANANIB (AMG 386) IN COMBINATION

WITH PEGYLATED LIPOSOMAL DOXORUBICIN (PLD) OR

TOPOTECAN (T) IN WOMEN WITH RECURRENT OVARIAN CANCER

Shirley S Wong1, Sumitra Ananda2, Ignace B Vergote3, Russell J Schilder4, Charles H Pippitt5, Sidney Scudder6, Nuwan Nanayakkara7, Henry Adewoye8, Rebeca Melara8, Robert M Wenham9

1. Western Hospital, Footscray, VIC, Australia2. Royal Women’s Hospital, Melbourne, Australia3. University Hospitals Leuven, Leuven, Belgium4. Fox Chase Cancer Center, Philadelphia, USA5. Piedmont Hematology-Oncology Associates, Winston-Salem, USA6. UC Davis Medical, Davis, USA7. Quintiles, San Diego, USA8. Amgen Inc., Thousand Oaks, USA9. H. Lee Moffi tt Cancer Center, Tampa, USA

Aims: Trebananib (formerly AMG 386), an investigational peptibody, inhibits tumor angiogenesis by blocking angiopoietin-1/-2 and Tie2 receptor interactions. This interim analysis evaluated the tolerability and effi cacy of trebananib plus PLD or T in recurrent ovarian cancer.

Methods: The study included four cohorts: trebananib 10 mg/kg plus PLD (A1) and 15 mg/kg plus PLD (A3); trebananib 10 mg/kg plus T (B1) and 15 mg/kg plus T (B3). Cohorts received PLD 50 mg/m2 IV Q4W or T 4 mg/m2 IV QW (3 on/1 off). Dose-limiting toxicities (DLTs) in <33% of 6 or 9 initial patients triggered cohort expansion to n = 25. Endpoints included DLT incidence (primary); and adverse events (AEs), pharmacokinetics, and tumor response (secondary).

Results: 72 of 73 enrolled patients received ≥1 dose of trebananib (A1, A3, B1, B3; n = 25, 12, 25, 10). One patient in A1 and none in A3 had DLTs; three patients in B1 and none in B3 experienced DLTs. For A1 + A3, AEs ≥50% were fatigue, nausea, and peripheral edema; AEs grade ≥3 in more than three patients were ascites (n = 5), abdominal pain (n = 5), neutropenia (n = 5), decreased appetite (n = 4), and fatigue (n = 4). For B1 + B3, AEs ≥50% were fatigue, nausea, peripheral edema, and thrombocytopenia; AEs grade ≥3 in more than three patients were neutropenia (n = 5) and ascites (n = 4). Trebananib pharmacokinetics increased dose-proportionally; pre-liminary results suggest that trebananib did not alter PLD or T exposure. Tumor responses for A1, A3, B1, and B3 were 36%, 18%, 17%, and 0% (objective response rate); and n = 10, 3, 8, and 2 (CA-125 responders). Median progression-free survival was 8.1 months for A1 + A3 and 3.5 months for B1 + B3.



Conclusions: In this phase 1b study of women with recurrent ovarian cancer, no DLTs occurred in the trebananib (AMG 386) 15 mg/kg cohorts. The results of this study suggest evidence of antitumor activity, supporting additional studies in this setting.

Funding: This study was funded by Amgen Inc.© 2012 Amgen Inc.

753

OUTLINING THE PROTOCOL FOR AN INNOVATIVE COMBINED

NUTRITION AND PHYSICAL ACTIVITY INTERVENTION FOR

CANCER SURVIVORS

Stephanie Zrim1, Michelle Miller2, Lynette Jones3, Sharon Lawn4, James Dollman5, Richard Woodman6, Chris Karapetis7, Ganessan Kichenadasse7, Shawgi Sukumaran7, Sue Booth2, Bogda Koczwara1,7

1. Medical Oncology, Flinders University, Adelaide, SA, Australia2. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia3. School of Physical Education, University of Otago, Dunedin, New Zealand4. Department of Psychiatry, Flinders University, Adelaide, SA, Australia5. School of Health Sciences, University of South Australia, Adelaide, SA, Australia6. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA7. Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

Background: Weight gain and inactivity have been associated with worse cancer outcomes, functional impairment and cardiovascular morbidity among cancer survivors. The optimal model for improving nutrition and activity levels of cancer survivors has not been established and many inter-ventions focus on either nutrition or exercise but not both. Research sug-gests superior outcomes when incorporating self-management models into health care delivery.

Aims: To evaluate the feasibility, acceptability and impact of a combined nutrition and physical activity intervention in cancer survivors within a self-management framework.

Methodology: A single centre prospective study will recruit 60 participants aged ≥ 18 years, treated for solid tumours with curative intent. The study involves 2 patient cohorts: 1) those currently receiving chemotherapy, and 2) patients following completion of active treatment. The Flinders Living Well Self-Management Program will be utilised to establish patient led nutrition and physical activity SMART goals (specifi c, measureable, achiev-able, realistic and timely). Subsequently, healthcare professionals will work with participants to develop a tailored nutrition and physical activity inter-vention of their choice, supported by access to one-on-one dietary counsel-ling, nutrition group education, supermarket tours, home exercise programs and supervised exercise classes over the 12 week period. Reviews of progress will occur fortnightly, with assessments at baseline, 6 and 12 weeks. The primary outcome for the pilot trial is feasibility. Feasibility measures include recruitment rate, completion rate, optimal intervention points, preferred intervention choices and adherence to interventions, measured by subjective physical activity diaries and dietary recalls.

Discussion: The NAPA trial is the fi rst of its kind to deliver a combined nutrition and physical activity intervention within a self-management model to patients treated with curative intent. The assessment of feasibility will inform future randomised control trials on an optimal nutrition and physical activity intervention and its timing in cancer survivors.

754

NATIONAL APPROACH TO DATA, INFORMATION AND

KNOWLEDGE TRANSFER

Cleola Anderiesz, Simeon Jones, David Roder, Christine Giles, Helen ZorbasCancer Australia, Strawberry Hills, NSW, Australia

Aims: Cancer Australia’s Cancer Clinical Data Set Specifi cation sets data standards for the national collection of general clinical cancer data. However, this data set does not include tumour or population group specifi c information. To address this an extension data set specifi cations (DSS) for lung cancer and cancers in Adolescents and Young Adults (AYA) has been developed and tested.

Methods: DSSs were drafted by expert working groups, prior to being piloted using prospective data collection at the point of clinical care.

Pilot sites provided an initial scoping report outlining data items that were being collected prior to piloting. The active data collection phase spanned 3–6 months and sites reported on data item capture, time required for data collection, and barriers or facilitators to data collection.

Results:

Lung Cancer DSS

Four sites across Australia piloted tested the 35 draft Lung Cancer DSS data items. At the commencement of the pilot, sites were collecting between 10–20 of the proposed data items. Six of the proposed data items were not fully available for collection due to the length of the pilot period and three items were unable to be collected.

AYADSS

Three sites across Australia pilot tested 31 draft AYA data items. At the commencement of the pilot, two sites were collecting 22 of the proposed data items. Six of the proposed data items were not applicable for collection during the pilot period and three were unable to be collected.

Conclusions: The pilot testing of DSSs at the point of clinical care is an effective mechanism for determining data items for inclusion in a national DSS. The DSSs promote consistency in the collection of clinical cancer data and piloting suggests that DSS items are generally available for collection at cancer treatment centres.

756

GEOGRAPHIC REMOTENESS, AREA-LEVEL SOCIOECONOMIC

DISADVANTAGE AND COLORECTAL CANCER: A CROSS-SECTION

MULTILEVEL STUDY

Peter D Baade1,2,3, Paramita Dasgupta1, Gavin Turrell2, Joanne F Aitken1,2,3

1. Cancer Council Queensland, Fortitude Valley, QLD, Australia2. Queensland University of Technology, Brisbane, QLD, Australia3. Griffi th University, Gold Coast, Queensland, Australia

Aims: The independent contribution that area and individual-level factors have on observed geographical variations in stage at diagnosis and survival for colorectal cancer in Australia have not been analysed. We explored the association between area disadvantage and geographic remoteness with stage at diagnosis and survival after invasive colorectal cancer while control-ling for individual-level characteristics.

Methods: Multilevel models were used to analyze variations in stage at diag-nosis for all 18,561 patients aged 20–79 years diagnosed with colorectal cancer in Queensland from 1996 to 2007, and notifi ed to the population-based Queensland Cancer Registry. Survival was examined using multilevel logistic regression and Markov chain Monte Carlo simulations for 17,065 surgically treated cases diagnosed from 1996–2006 and followed up through 2008.

Results: Independently of individual-level variables, patients living in inner (OR 1.09, 95% CI 1.01–1.19) and outer regional areas (OR 1.11, 95% CI



1.01–1.22) were more likely to be diagnosed with advanced disease (p = 0.045) although no variations with area disadvantage (p = 0.885) were evident. After multivariate adjustment those from more disadvantaged areas had signifi cantly (p = 0.002) worse survival (Mortality odds Ratio (MOR) = 1.14, 1.16, 1.21, 1.18 for Quintiles 4, 3, 2 and 1 respectively) than least disadvantaged area. Patients from outer regional (MOR = 1.24, 95% CI 1.11–1.38) or remote areas (MOR 1.32, 95% CI 1.12–1.56) also had poorer survival (p < 0.001). Important individual-level predictors of both advanced disease and poorer survival were being Indigenous, female, unmarried or in blue-collar occupations. Patients having less differentiated tumors, advanced disease, comorbidities (except diabetes) or treatment in public hospitals had poorer survival.

Conclusions: Both the risk of being diagnosed with advanced disease and survival after a diagnosis of invasive colorectal cancer depends on where a patient lives, independently of their individual characteristics. The underly-ing reasons for these inequalities need to be identifi ed.

757

ASSOCIATION BETWEEN BREAST CANCER INCIDENCE AND

LATITUDE IN MAINLAND AUSTRALIAN WOMEN

Kellie Bilinski1,2, John Boyages2,3, Karen Byth4

1. Westmead Hospital, Westmead, NSW, Australia2. Westmead Breast Cancer Institute, Westmead, NSW, Australia3. Australian School of Advanced Medicine, Macquarie University Hospital, Macquarie University, NSW, Australia4. University of Sydney, Sydney, NSW, Australia

Aim: Higher rates of breast cancer at latitudes further from the equator in comparison to latitudes close to the equator have been shown in several international ecologic studies. Our aim was to investigate the association between breast cancer and latitude in Australia.

Methods: Female breast cancer incidence by fi ve-year age group between 2002 and 2006 were obtained for all mainland Australian Local Govern-ment Areas (LGA). Latitude, Accessibility/Remoteness Index of Australia (ARIA) and Index of Relative Socioeconomic Disadvantage (IRSD) were assigned to each LGA. Data were aggregated into fi ve latitude bands (≤27; >27–30; >30–33; >33–36; >36°S). We estimated the Odds of breast cancer by fi tting univariate, bivariable and multivariable logistic regression models with breast cancer as the response variable adjusting for latitude, age-group, IRSD and ARIA. The analysis was replicated with melanoma as the response variable to support the hypothesis that increasing latitude is associated with decreasing sun exposure.

Results: In women aged 20–89 years, the Odds of breast cancer at latitude south of 27°S was 2.1 to 2.4 times higher than at latitude ≤27°S (univariate model, p < 0.001). In bivariable analysis, age adjusted Odds of breast cancer also increased with increasing latitude for each category of IRSD and remoteness (OR 1.1–2.9, p ≤ 0.001). In multivariable analysis, the Odds of breast cancer was 1.22 (1.17–1.26) at latitudes >27–30 and 2.12 (2.04–2.2) to 2.37 (2.28–2.47) at latitudes >30 (all p < 0.001). Conversely, in the same population, after adjusting for age-group, IRSD and ARIA the Odds of melanoma was 0.62 (0.58–0.63, p < 0.001) at latitudes >36°S compared to latitude ≤27°S (p < 0.001)

Conclusions: We report a signifi cant relationship between latitude and breast cancer incidence in Australian women which supports international fi ndings showing an ecological gradient for breast cancer. Although we are cannot infer causality, these fi ndings support suggestions that higher vitamin D concentrations associated with increased sunlight exposure is associated with reduced risk of breast cancer.

758

INCIDENCE, MORTALITY AND SURVIVAL OF RARER HEAD AND

NECK CANCERS IN NEW SOUTH WALES

Ingrid Boehm, Deborah Baker, Sally Smith, Stephen MorrellCancer Institute NSW, Eveleigh, NSW, Australia

Survival from head and neck cancers is infl uenced by age at diagnosis, sex, stage at diagnosis, histological features and Human Papillomavirus (HPV) infection status. The incidence of HPV-associated squamous cell carcinomas in males is reported to be increasing globally, and higher nasopharyngeal cancers incidences have been reported in Asian countries.

The NSW Central Cancer Registry was used to calculate age-standardised incidence and mortality rates and unadjusted Kaplan-Meier survival curves for the rarer head and neck cancers – nasopharyngeal, hypopharyngeal, nose and sinuses, salivary gland and oral cavity/other pharynx – between 1990 and 2008.

Incidence per 100,000 for all cancer sites was stable or declined, (mean 1.08 males, 0.41 females), and mortality decreased (mean 0.68) over time. Five-year survival from salivary gland cancer was signifi cantly higher in females than males (81% versus 74%), refl ecting less advanced disease at diagnosis (37% localised in females versus 52% in males). No survival differences by sex were observed for the remaining sites studied, but 5-year survival did vary signifi cantly by cancer site. The incidence of nasopharyngeal cancers of all histologies was higher in Asian-born than Australian-born people (SIR 10.02 males and 10.34 females). Squamous cell carcinomas were the most common histology, and in males the incidence of this histology at HPV-associated sites increased over time.

The higher incidence of nasopharyngeal cancer in Asian-born people indi-cates a probable emerging public health burden for Asian NSW residents. Increasing HPV-associated cancers of the head and neck in males gives further impetus to the vaccination of boys against HPV.

759

ONCOLOGY PATIENTS PRESENTED TO EMERGENCY

DEPARTMENT, BEFORE AND AFTER THE ESTABLISHMENT OF

RESIDENT ONCOLOGY SERVICE: EXPERIENCE IN GOULBURN

VALLEY HEALTH

Yu En YE Chia, Mohd Azlan MA Mohd Hashim, Nur Hayati NH Mohd Alias, Manny M Geaboc, Linley L Smith, Zee Wan ZW Wong, Mahesh M IddawelaGoulburn Valley Health, Shepparton, Vic, Australia

Aim: Cancer patients in regional Victoria is increasing in number and a Resident Oncology Service (ROS) was set up to provide an easily accessible service. The aim of this study was to gain information about solid tumour patients presenting to regional hospitals following chemotherapy.

Methods: The ROS was set up in January 2012. Retrospective review of all oncology patients managed in the Emergency Department (ED) from July 2011 to September 2011 and January 2012 to March 2012 was performed.

Results: 161 solid cancer patients visited the ED during the six months period, 70 before ROS and 91 after, with a cancer type break down of 34.7% gastrointestinal, 23.6% breast, 11.2% lungs, 2.5% hepatobiliary, and 26.1% others. Of those, 97 (60.25%) were metastatic and 106 (65.8%) were on adjuvant therapy. Diagnosis was grouped into four categories; cancer related problems 38.5%, treatment related problems 19.9%, infec-tion 14.3% and non-cancer related problem 27.3%. Treatments include antibiotic administration 25.5%, pain management 18.6%, anti-coagula-tion 6.8%, surgical procedures including drainage 6.8% and others 42.2%. Of the 161 patients, 29.2% were admitted, 3.1% died during the stay, 3.7% were referred to hospice and 5.0% were transferred to other hospitals. Median length of stay before and after ROS were 3 (range, 1–14 days) and 4 (range 1–22 days).



Conclusion: Resident Oncology Service plays an important role in manag-ing oncology patients in regional areas. However, more data is required as the service is in its infancy stage. Improving the protocols in the ED and in the oncology service would lead to improvements in service.

760

USING ROUTINELY COLLECTED CANCER DATA TO INFER RISK

FACTOR PATTERNS

Susanna M Cramb1,2, Kerrie L Mengersen2, Peter D Baade1,3,4

1. Cancer Council Queensland, Fortitude Valley, Qld, Australia2. School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia3. School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia4. Griffi th Health Institute, Griffi th University, Southport, Queensland, Australia

Cancer Registries collect reliable and detailed population-based data on cancer incidence and mortality, providing the foundation for effective cancer control at both the global and local level. In contrast, cancer risk factor information is often based on self-reported survey data, which has known limitations, such as the potential to introduce bias. The typically limited sample sizes also preclude examining small-area patterns. Recent attempts to overcome these restrictions have involved applying statistical shared component models to cancer data to obtain estimates for the cancers of interest and also the underlying, unmeasured risk factors.

The goal of this study was to use routinely collected, population-based lung cancer incidence data to estimate the spatio-temporal patterns in the under-lying risk factors, of which tobacco smoking is a major component.

Using data from the Queensland Cancer Registry, male and female lung cancer incidence rates were jointly modelled using a Bayesian spatio-tem-poral shared component model across 477 small areas and 13 years (1997 to 2009). The spatial pattern and temporal trends in the shared component were identifi ed, and were consistent with available data on tobacco smoking. Females had a higher risk than males in the south-east corner, but a reduced risk in some regional areas to the north of Brisbane, which may indicate differences in the smoking pattern. Known infl uences on smoking, such as socioeconomic status, remoteness and Indigenous population, were also included at the area level to investigate their impact on the patterns.

These results enable areas with higher underlying risk factors to be identifi ed with greater precision and confi dence. The methodology can also be applied to other groups of cancers to estimate spatio-temporal patterns for other risk factors of interest. Further work is required to isolate the effects of lag time and other risk factors so as to better quantify the area-level smoking prevalence.

761

GEOGRAPHIC REMOTENESS, AREA-LEVEL SOCIOECONOMIC

DISADVANTAGE AND BREAST CANCER: A MULTILEVEL STUDY

Peter D Baade1,2,3, Paramita Dasgupta1, Gavin Turrell2, Joanne F Aitken1,2,3

1. Cancer Council Queensland, Fortitude Valley, QLD, Australia2. Queensland University of Technology, Brisbane, QLD, Australia3. Griffi th University, Gold Coast, Queensland, Australia

Aims: Although signifi cant geographical variations in both breast cancer stage and survival have been reported, few studies have analysed the inde-pendent contribution of area- and individual-level factors to these varia-tions. Here we describe the relationship that geographic remoteness and area disadvantage have on stage at diagnosis and survival after diagnosis with invasive breast cancer while controlling for individual-level characteristics.

Methods: Multilevel logistic regression and Markov chain Monte Carlo simulations were used to analyze 18,568 breast cancer cases extracted from

the Queensland Cancer Registry for women aged 30 to 70 years diagnosed between 1997 and 2006 from 478 Statistical Local Areas. Maximum follow-up was to 31 December, 2007.

Results: Independently of individual-level factors, women living in the most disadvantaged areas had an increased risk of being diagnosed with advanced disease (OR 1.21, 95% CI 1.07–1.37, p = 0.002) and poorer survival (OR 1.23, 1.27, 1.30, 1.37 for Quintiles 4, 3, 2 and 1 respectively, p = 0.032) compared to women from least disadvantaged area (Quintile 5). After full adjustment, women from outer regional (OR 1.13, 95% CI 1.02–1.24) or most disadvantaged areas (OR 1.16, 95% CI 1.02–1.32) had signifi cantly higher (p < 0.001) risks of advanced disease. However geographic remote-ness was not associated with lower survival (p = 0.366) after multivariate adjustment. There was also no evidence that the impact of area-level disad-vantage varied by geographic remoteness. At the individual level, being Indigenous and having blue collar occupations were important predictors of advanced disease and poorer survival.

Conclusions: Both a woman’s risk of being diagnosed with advanced disease and her survival after invasive breast cancer depend on where she lives, independently of her individual characteristics. The underlying reasons for these inequalities must be identifi ed and barriers to early diagnosis of breast cancer addressed to reduce existing inequalities in breast cancer survival.

762

PATIENTS’ AND HEALTH PROFESSIONALS’ PERSPECTIVES ON

THE OUTCOMES AND CONDUCT OF MULTIDISCIPLINARY CANCER

MEETINGS (MDMS)

Bianca Devitt1, Jennifer Philip1, Madhu Singh2, Linda Mileshkin3, Sue-Anne McLachlan1

1. St Vincent’s Hosptial, Fitzroy, Vic, Australia2. Andrew Love Cancer Centre, Geelong, Victoria, Australia3. Peter MacCallum Cancer Centre, East Melbourne, Australia

Background: Multidisciplinary cancer meetings (MDMs) are a fundamental component of multidisciplinary cancer care. Guidelines relating to their conduct are largely based on expert opinion rather than empirical evidence. We examined patients and health professionals’ (HPs) attitudes to the out-comes and conduct of MDMs.

Methods: Two study-specifi c questionnaires were developed based on quali-tative research, published literature and guidelines, for health professionals who attend MDMs and patients with a current or previous diagnosis of cancer. The questionnaires were administered at 5 health services encom-passing tertiary and regional centres in Victoria, Australia.

Results: 179 HPs (response rate 64%) and 152 patients (response rate 90%) completed the questionnaire. 92% of patients want their case discussed at an MDM. HPs believe the focus of MDMs is to consider different treatment modalities (99%) and ensure patients receive evidence-based care (83%) rather than address psychosocial issues (52%). Similarly, patients allocated 71% of MDM discussion time to discussing possible treatment options, 15% to relevant social issues and 14% to psychological issues. More than 70% of patients and HPs thought no formal patient consent was required prior to MDM discussion. 93% of HPs thought MDM discussions should result in a consensus on the proposed management plan. Patients would prefer to discuss the outcomes of the MDM personally with their treating doctor (81%) and 75% also desired written documentation.

Conclusions: Patients and HPs agree the focus of MDMs is predominately treatment planning rather than focusing on the psychosocial needs of patients. Both groups believe MDM discussion forms part of standard care and formal consent is not required. HPs aim to develop an individualized, evidence-based management plan, agreed to by consensus. Strategies to improve communication of this plan to patients should be developed. This is the fi rst empirical evidence on MDMs’ conduct and should help inform the development of future guidelines.



763

THE DEVELOPMENT OF EVIDENCE BASED GUIDELINES ON THE

CONDUCT OF MULTIDISCIPLINARY CANCER MEETINGS (MDMS).

A MODIFIED DELPHI STUDY

Bianca Devitt, Jennifer Philip, Sue-Anne McLachlanSt Vincent’s Hospital, Fitzroy, Vic, Australia

Background: Australian guidelines on the conduct of multidisciplinary cancer meetings (MDMs) are largely based on expert opinion. We developed evi-dence based guidelines on the conduct of MDMs based on a literature review and results of a questionnaire survey administered to health professionals and patients across 5 Victorian centres. A Delphi study was performed to validate and refi ne these guidelines and ensure they are nationally relevant.

Methods: Opinion leaders in the fi elds of cancer care, health policy and ethics were invited to join an expert panel. Two consecutive multiple choice and short answer questionnaires pertaining to each guideline were admin-istered according to Delphi methodology. A summary of the evidence rele-vant to each guideline accompanied the questionnaire. Consensus regarding agreement was defi ned a priori as 75% of respondents scoring ≥7 (using a 9-point likert scale) and disagreement being a score in 75% of ≤3.

Results: 23 experts agreed to participate, 19 responses were received in round 1 (83% response rate). Results from round 2 will be available at the time of presentation. The panel reached consensus on the following pro-posed guidelines: 1) Discussion at MDM should result in an individualised, evidence based treatment plan agreed to by consensus. 2) Where divergent views or equivalent treatments exist, each option should be discussed with the patient. 3) The treatment plan should be documented in the medical record using a proforma and disseminated to treating clinicians outside the institution. 4) Documentation should be detailed enough for a clinician who did not attend the MDM, to be able to discuss and institute the treatment plan. After round one, consensus has not been achieved surrounding 1) the role of MDMs in addressing the supportive care needs of patients, 2) the need for patient consent and 3) patient attendance at MDM.

Conclusions: These are the fi rst Australian guidelines based on empirical evidence informing the conduct of MDMs. Innovative strategies to improve documentation and dissemination of the MDM treatment plan are needed as are novel methods of incorporating the supportive care needs of patients into the MDM plan.

764

ARE RADIATION ONCOLOGISTS AWARE OF HEALTH LITERACY

AMONGST PEOPLE WITH CANCER TREATED WITH

RADIOTHERAPY?

Sian Smith1, Lisa-Marie Petrak2, Jennifer Taylor2, Chris Milross2,3, Haryana M Dhillon2,4

1. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia2. University of Sydney, Sydney, NSW, Australia3. Sydney Cancer Centre, Dept Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia4. Psycho-Oncology Cooperative Research Group, University of Sydney, NSW, Australia

Background: Patients with cancer are exposed to complex information as part of treatment decision-making. There has been little research with cancer patients who have lower education and literacy, or the clinicians caring for them and their awareness of health literacy. This study aims to gain insight into radiation oncologist’s (RO) awareness of health literacy amongst their patients, and its effect on communication and decision-making.

Methods: This qualitative study used semi-structured interviews with ROs conducted in person or via telephone. Interviews were audio-recorded and transcribed verbatim. Framework analysis was used to develop a coding schema of themes identifi ed from the interviews. The coding schema was

then used to code, chart and analyse the data and compare and contrast how ROs experiences differ.

Findings: Twenty-six ROs, aged 35–65 years and who had worked in oncol-ogy for 9 to 30 years, were interviewed. Nineteen were male, 17 Australian and 18 native English speakers.

Main themes identifi ed included: recognition of need to screen patients for characteristics indicating lower literacy levels; using verbal and visual infor-mation is important to effective communication; using the multi-disciplinary team to communicate with and support patients; tailoring consultations to meet expectations, needs and preferences of patients; confi rming patient understanding.

ROs described strategies to help them form judgments about patients lit-eracy level. These included; monitoring questions asked, vocabulary used, non-verbal behaviour and demographic information. Only a few ROs indi-cated they would screen patient literacy levels and one reported using a screening tool in practice. Most identifi ed concepts they perceived patients had diffi culty understanding, including: disease and treatment information; risk information; side-effects of treatment; the healthcare system. ROs reported diffi culties discussing subtleties of cancer treatments with patients they thought had lower literacy.

Discussion: RO recognised health literacy as important in patient decision-making, adherence and self-care in radiotherapy. There are opportunities to improve communication between RO and patients, including: improved literacy screening tools, improved information materials about cancer and radiotherapy, and increasing communication skills of health professionals in dealing with patients of limited literacy.

765

WHAT ARE PEOPLE WITH CANCER ARE TOLD ABOUT

RADIOTHERAPY AND HOW DO THEY PERCEIVE IT?

Haryana M Dhillon1, Sian Smith2, Django Nathan1, Jennifer Taylor1, Chris Milross1,3

1. University of Sydney, Sydney, NSW, Australia2. Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia3. Sydney Cancer Centre, Dept Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Background: Patients with cancer are exposed to complex information as part of treatment and follow-up decision-making. There has been little research with cancer patients who have lower education and literacy, or the clinicians who care for them and their awareness of health literacy. This study aims to identify strategies to improve patient understanding and involvement in consultations regarding radiotherapy treatment for cancer, particularly among people with low literacy.

Methods: This qualitative study used semi-structured interviews with patients receiving radiotherapy treatment at Royal Prince Alfred Hospital were conducted in person or via telephone. Interviews were audio-recorded and transcribed verbatim. Framework analysis was used to develop a coding schema of themes identifi ed from the interviews. The coding schema was then used to code, chart and analyse the data and compare and contrast how patient experiences differ.

Results: Twenty-one patients were interviewed, all were receiving radio-therapy treatment at the time they were interviewed. Participants had mean age of 63 (40–83) years, 65% had a partner, 32% did not complete high school, and were from a range of tumour types: breast 21%, prostate and gynaecological 15% each, rectal cancer 9%, and 39% other. The main themes identifi ed included: access to information; decision-making; under-standing treatment; and, personnel. Strategies identifi ed included: making existing information more easily accessible outside the hospital, patient mentoring system, treatment centre tours, and seeing same staff at each visit.

Conclusions: Information about radiotherapy is understood to varying degrees by patients receiving this treatment. Improvement in information accessibility, familiarity with the treatment centre and continuity of staff



involved in care may facilitate patient knowledge about treatment and its side-effects.

766

INDIGENOUS WOMEN WITH GYNAECOLOGICAL CANCERS HAVE

POORER SURVIVAL THAN NON-INDIGENOUS WOMEN:

EXPLAINED BY STAGE, COMORBIDITY AND TREATMENT UPTAKE

Suzanne P Moore1, Abbey Diaz2, Adele C Green1, Gail Garvey2, Michael Coory3, Jennifer Martin4, Patricia C Valery2

1. Population Health, Queensland Institute of Medical Research, Brisbane, Queensland, Australia2. Menzies School of Health Research, Brisbane Adelaide Street, QLD, Australia3. Murdoch Children’s Research Institute, Cancer Council Victoria, Melbourne, Victoria, Australia4. School of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia

Background: Australian Aboriginal and Torres Strait Islander women have both higher incidence and mortality from gynaecological cancers than non Indigenous women but little is known about how survival compares between the two groups. We therefore aimed to compare survival of Indigenous and non-Indigenous gynaecological patients in Queensland and identify factors that may explain potential discrepancies.

Methods: All Indigenous women diagnosed with a gynaecological cancer, including uterine, cervical, ovarian and others, between 1998 and 2004 and treated in a Queensland public hospital (n = 137) were compared to a random sample of non-Indigenous gynaecological cancers patients, matched on age, remoteness of residence and cancer type (n = 120). Data was abstracted from public hospital records and the National Death Index. Time to event analysis was conducted using Cox Regression models to describe survival differences between Indigenous and non-Indigenous women, unad-justed and adjusted for key factors.

Results: Indigenous women were more likely to have regional or metastatic spread of disease at diagnosis (52% v. 35%, p = 0.02), more likely to have a comorbidity at diagnosis (51% v. 21%, p < 0.001), and less likely to undergo cancer treatment (91% v. 98%, p = 0.01) compared to non-Indig-enous women. When considering only cancer-related deaths, Indigenous women were 50% more likely to die during the study period (HR 1.5, 95% CI 1.0–2.3); however the ratio decreased when adjusted for stage, comor-bidities, and treatment (HR 1.1, 95% CI 0.7–1.7). Results were similar when considering all-cause deaths (unadjusted HR 1.7, 95% CI 1.1–2.5 and adjusted HR 1.2, 95% CI 0.7–1.8).

Conclusions: Indigenous women diagnosed with gynaecological cancer have poorer survival rates than their non-Indigenous counterparts. This was explained by differences in stage of disease, comorbidities and uptake of cancer treatment.

767

WHEN AGE REALLY DOES MATTER

Julia Drake1, Lyndal Moore1, Karen Matthews1, Elizabeth Hesketh2

1. Calvary Mater Newcastle, Waratah, NSW, Australia2. Paediatric oncology, John Hunter Childrens Hospital, Newcastle, NSW, Australia

The Hunter and Northern NSW Youth Cancer Service commenced in December 2011 as part of the Youth Cancer Networks Project. The primary focus of the service is to address the psychosocial needs of 15–25 year old patients with a cancer diagnosis and their family members. The team con-sists of a Paediatric/Adolescent Oncologist, Clinical Nurse Consultant, Clinical Psychologist and Social Worker who work closely together to provide an age appropriate multidisciplinary service.

It has been identifi ed that this age group needs more attention at diagnosis due to different age related; complex developmental needs which need to be addressed sensitively. Young people with cancer have often gone under the radar, so this service hopes to link patients with relevant referrals, improve accessibility to timely treatments and reviews and improve psycho-social supports.

The team has actively worked to establish the service, provide relevant information and educate key health workers about the physical, psychoso-cial and practical needs of this age group. The team conducts comprehensive psychosocial assessments and addresses the complexities of the issues that are identifi ed. The team is accessible, free and located in a regional oncology hospital, and is promoted to multiple cancer streams and health sites across the Hunter and Northern region of New South Wales.

The service has been positively received by both health professionals and patients and their families. The team has been increasingly consulted and referred patients at time of diagnosis. Interventions have been multi-layered and been linked to increased treatment compliance, health literacy and patient ownership regarding their treatment. The positive feedback high-lights the need for an ongoing specifi c adolescent and young adult team.

768

LOCALISED VERSUS CENTRALISED NURSE DELIVERED

TELEPHONE SERVICES FOR PEOPLE IN FOLLOW UP FOR CANCER:

OPINIONS OF CANCER CLINICIANS

James Harrison1, Ivana Durcinoska1, Phyllis Butow1,2, Kate White3, Michael Solomon1,4, Jane Young1,5

1. Surgical Outcomes Research Centre (SOuRCe), School of Public Health, University of Sydney & Sydney Local Health District, Camperdown, NSW, Australia2. Centre for Medical Psychology and Evidence-based Decision Making (CeMPED), University of Sydney, Camperdown, NSW, Australia3. Sydney Cancer Centre, Royal Prince Alfred Hospital & Sydney School of Nursing, University of Sydney, Camperdown, NSW, Australia4. Discipline of Surgery, University of Sydney, Camperdown, NSW, Australia5. Cancer Epidemiology and Services Research (CESR), School of Public Health, Univeristy of Sydney, Camperdown, NSW, Australia

Aims: Nurse-delivered telephone services to improve care coordination, clinical and supportive care are methods to supplement traditional clinical follow-up. Telephone services could be implemented locally or from a cen-tralised location. This study explores cancer clinicians’ views about the role of additional telephone services, preferences for localised or centralised models of service delivery and implementation in practice.

Methods: Interviews were conducted with 16 surgeons and cancer nurses across NSW. Content analysis was conducted independently by two review-ers. Data were analysed inductively, responses were organised into catego-ries and then higher order themes.

Results: All clinicians valued the role of additional telephone follow-up as it would allow patients to ask questions, receive reassurance and reinforce information. Clinicians believed these services could reduce emergency department presentations and provide equity and standardised care, particu-larly to those living outside metropolitan centres.

Although all clinicians accepted a centralised model of delivery would be cost-effective, all indicated a preference for local delivery. This preference was based on the perception that local nurses would have superior knowl-edge of the local context. Despite the premise of delivering telephone serv-ices, clinician’s felt some face-to-face contact with patients was essential.

All clinicians stated that new funding was required given such services did not exist or current staff were overstretched. Key at risk groups where limited resources could be targeted included the elderly, those at high risk of recurrence and culturally and linguistically diverse populations. The timing and intensity of support would depend on tumour type and treatment pathways. Clinicians acknowledged there could be overlap with cancer nurses locally requiring local decisions about implementation.



Conclusion: There was clear endorsement of the benefi ts of additional tel-ephone support for patients, with a greater preference for a local model of service delivery. The opinions ascertained in this study can be used to trans-late services into practice.

769

DIAGNOSING CANCER IN THE BUSH: A MIXED METHODS STUDY

OF DIAGNOSTIC INTERVALS IN PEOPLE WITH CANCER FROM

RURAL WESTERN AUSTRALIA

Jon Emery1, Fiona M Walter2, Vicky Gray1, Craig Sinclair1, Caroline Bulsara1, Max Bulsara3, Kirsten Auret1, Anna Nowak1, Christobel Saunders1, D’Arcy Holman1

1. University of Western Australia, Crawley, WA, Australia2. Department of Primary Care, University of Cambridge, Cambridge, UK3. Notre Dame University, Fremantle, WA, Australia

Objectives: To compare and explore diagnostic intervals in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA).

Design, setting and participants: Mixed methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from the Gold-fi elds and Great Southern Regions of WA. Recruitment occurred from March 2009 to April 2010 through rural cancer nurse coordinators and the WA Cancer Registry.

Main outcome measures: Total Diagnostic Interval and its sub-components. Qualitative interviews exploring factors underlying differences observed in these intervals.

Results: 66 participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancers). There were signifi cant differences between cancers in time from: symptom onset to deciding to seek help (p = 0.006); presentation in general practice to referral (p = 0.045), referral to seeing a specialist (p = 0.010) and fi rst specialist appointment to diagnosis (p ≤ 0.001). There was a signifi cant overall difference in mean Total Diagnostic Interval (p = 0.046): breast cancer was signifi cantly shorter than colorectal or pros-tate cancer (mean difference (95% CI): 266.3 days (45.9–486.8) p = 0.019; 277.0 days (32.1–521.9) p = 0.027 respectively). Differences in symptom appraisal and help-seeking by patients were explained by several factors including the nature and personal interpretation of symptoms, fear, embar-rassment, competing demands and the core rural Australian characteristics of optimism, stoicism and machismo. Breast cancer was diagnosed more quickly because its symptoms are often more specifi c and better recognised by consumers, and due to good access to diagnostic tests and specialist one-stop clinics.

Conclusions: This study could inform the development of targeted interven-tions in rural Australia to promote earlier presentation and investigation of symptoms suggestive of cancer, particularly for colorectal and prostate cancer.

770

A FORMATIVE EVALUATION OF NURSE CANCER CARE

COORDINATORS: BUILDING A PLATFORM FOR ONGOING

EVALUATION AND DEVELOPMENT

Louise M FreijserThe University of Melbourne, Parkville, VIC, Australia

Background: Continuity of care is integral to the quality of care provided to people with cancer and their carer(s). The need to address fragmented cancer care has been addressed in part by the development of the Nurse Cancer Care Coordinator (NCCC) roles. It is imperative to provide evidence of the contribution these roles make in improving the continuity of cancer care.

Aim: The aim of the project was to clarify the theory underpinning the role of NCCCs and provide a tool for ongoing evaluation of these roles. This

included theory underpinning how the role works including activities per-formed; resources required; expected outcomes; within a given context.

Methods: The project was a qualitative study comprising of a literature review and exploring the views of experts (semi-structured interviews/email questionnaire), to develop a program logic. The participants were purposely selected to represent a range of perspectives including policy-makers, prac-titioners, patient advocates, and researchers.

Results: The diversity of NCCC roles and theory was refl ected in both the literature and practice. NCCC roles and activities were identifi ed at the individual, organisational and systems level.

Discussion: A range of theories were discussed that may inform the con-ceptualisation of NCCC roles including Complex Adaptive Systems, Bound-ary Spanning Theory and Relational Coordination; and the implication for roles focusing at different levels of the system were explored.

Conclusion: The increasing complexity and demand for better coordinated care highlights the need to further research how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research policy and practice, and makes explicit existing the theory (based on both the literature and in practice) to provide a plat-form for further evaluation for development of these roles.

771

SHARED FOLLOW-UP CARE FOR EARLY BREAST CANCER –

RESULTS FROM A NATIONAL DEMONSTRATION PROJECT

Christine Giles, Trenna Morris, Helen Zorbas1

Cancer Australia, Strawberry Hills, NSW, Australia

Aims: Follow-up care after breast cancer treatment is important to monitor side effects of treatment and provide patient-centred support. As breast cancer incidence increases and survival improves, new models for follow-up care are needed. The Shared care demonstration project aimed to implement and evaluate a model of follow-up care for early breast cancer, shared between specialists and GPs, that supports best practice follow-up care.

Methods: Four demonstration sites across Australia recruited 1,214 patients to participate who had completed treatment for early breast cancer. An evaluation was undertaken to test the feasibility of the new model, in terms of acceptability, cost and best practice delivery of care.

Results: Shared follow-up care was acceptable to the majority of patients, with 78% of patients approached, agreeing to participate. Specialists and GPs at the demonstration sites are committed to providing shared care as the standard model of follow-up care.

Results to date indicate that shared follow-up care is being provided in line with best practice recommendations. Surveys showed that 78% of the special-ist team members and 64% of GPs agreed that the Shared Care Plan helped them to provide best practice follow-up care. 91% of patients received a schedule for follow up in line with best-practice recommendations.

Preliminary fi ndings show that providing shared follow-up care was not more expensive compared to specialist-led follow-up care, with cost savings reported for some patients.

A further result of the project was the identifi cation of critical success factors for the sustainability of the shared care including; clinical leadership, women having a regular GP, electronic patient and medical records and coordina-tion of care.

Conclusions: The fi ndings will inform the national delivery of shared fol-low-up care for early breast cancer patients. The proven feasibility of the model indicates that the shared follow-up care may be applicable across other cancer groups.



772

VARIATION IN THE SURGICAL MANAGEMENT OF OESOPHAGEAL

CARCINOMA IN NSW, 2001–2007

Jason P Bentley1,2, David Goldsbury1, Guy D Eslick3, Michael R Cox3, Dianne L O’Connell1,4,5,6

1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia2. Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, NSW, Australia3. Whiteley-Martin Research Centre, Nepean Clinical School, The University of Sydney, Penrith, NSW, Australia4. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia5. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia6. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

Background: With oesophagectomy the predominant curative option for oesophageal cancer, access to health services is vital. This study aimed to investigate variation in the defi nitive surgical management and mortality of oesophageal carcinoma by urban/rural place of residence and disadvantage in urban-dwelling patients, in New South Wales (NSW), Australia.

Methods: The study was a population-based retrospective cohort of patients diagnosed with primary oesophageal carcinoma between 1 January 2001 and 31 December 2007, using data from the NSW Central Cancer Registry, probabilistically linked with hospital and death data. Logistic regression and Cox-regression were used to identify factors associated with surgery and mortality respectively. Factors investigated included age at diagnosis, sex, country of birth, year of diagnosis, disease stage, diagnostic group and co-morbidities.

Results: Among 1,412 patients with loco-regional oesophageal carcinoma, 24% (n = 339) received defi nitive surgery. Of these, 3.5% died within 30 days after surgery, the median length of stay for surgery was 17 days, and 27% of patients experienced a respiratory complication. Median survival was 10 months, and 5 year survival was 19.1% (95% Confi dence Interval [CI]: 16.5–21.9%). Reduced uptake of defi nitive surgery was associated with living in a rural location (adjusted Odds Ratio: 0.40; 95% CI: 0.23–0.70) or a more disadvantaged urban area (P-trend: <0.001). Patients who had defi nitive surg+ery had a lower risk of dying (adjusted Hazard Ratio [aHR]: 0.33; 95% CI: 0.27–0.40), as did patients living in rural areas (aHR: 0.70; 95% CI: 0.55–0.89).

Conclusions: Patterns of surgical management differ for patients living in rural and more disadvantaged urban areas. While this may be offset partly by treatment with chemotherapy or radiotherapy, it is important to conduct further research to fully understand the role of patient access to health services, referral and clinical assessment practices, and patient choice in the curative treatment of oesophageal carcinoma in NSW and Australia.

773

ABORIGINAL CANCER CARE AT PETER MAC: CONNECTING AND

RESPONDING (ACCAP)

Alison Hocking1, Leanne Bird1, Rosie Longo1, Fiona Watson1, Lynette Joubert1,2

1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia2. School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia

Background: Prior to 2011 Peter MacCallum Cancer Centre was unable to demonstrate many initiatives that supported our existing Aboriginal & Torres Strait Islander patient population or encouraged earlier presentation of new patients for diagnosis and treatment. This paper will report on many changes that this health service has implemented over the last 12 months to improve service delivery to this under-served cancer patient population.

Methodology: Under the auspices of the Aboriginal Cancer Care at Peter Mac: Connecting and Responding Project, the health service has undertaken two key research methods: 1) to understand more about this patient popula-tion and explore opportunities to better identify patients of Aboriginal and Torres Strait Islander origin and 2) to examine staff requirement for educa-tion and training in this area. Coupled with this we have strengthened working relationships with key external stakeholders, implemented several system changes and enhanced our aesthetics to be more encompassing of Aboriginal patients.

Results: An extensive data mining analysis was undertaken to defi ne the current population of Aboriginal patients receiving treatment at Peter Mac including range of diagnoses and patient demographics.

A staff survey of 265 participants indicated that 84% were interested in learning more about Aboriginal health to enhance their capacity to provide culturally sensitive care.

A toolkit for staff focussing on the needs of Aboriginal patients and resources to support them was launched on the hospital intranet.

Whilst it is too early to determine whether this project will have an overall positive effect on the Aboriginal patient numbers attending Peter Mac for treatment we have demonstrated a 37% increase in inpatient activity.

Conclusions: Informal feedback from current patients has indicated that the changes implemented have made Peter Mac a more culturally welcoming and safe environment. The project has also demonstrated that staff acknowl-edge the importance of understanding how to provide the best care for this disadvantaged patient group.

774

IS GINGER SUPPLEMENTATION EFFECTIVE IN AMELIORATING

CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING?

Wolfgang M Marx1, Laisa Teleni2, Alexandra L McCarthy3, Luis Vittetta4, Dan McKavanagh5, Damien Thomson6, Elisabeth Isenring1,7

1. University of Queensland, St Lucia, QLD, Australia2. Centre for Integrative Clinical and Molecular Medicine, Princess Alexandra Hospital, Brisbane, Australia3. School of Nursing, Queensland University of Technology and Cancer Services Southern Clinical Network, Brisbane, Australia4. Centre for Integrative Clinical and Molecular Medicine, Princess Alexandra Hospital, Brisbane, Australia5. Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia6. The Cancer Collaborative Group, Princess Alexandra Hospital, Brisbane, Australia7. Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland Health, Brisbane, Queensland, Australia

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment. It continues to affect a signifi cant proportion of patients despite the widespread use of anti-emetic medication. In folk-medicine, ginger (Zingiber offi cinale) has been used to prevent and treat nausea in many cultures for thousands of years. However, its use has not been validated in the chemotherapy context. To determine the potential use of ginger as a prophylactic or treatment of chemotherapy-related nausea and vomiting, a systematic literature review was conducted. The review comprised randomised controlled trials or cross-over trials that investigated the anti-CINV effect of ginger as the sole independent variable in chemo-therapy patients. Seven studies met the inclusion criteria. All studies were assessed on methodological quality and their limitations were identifi ed. Of the seven RCTs published to date; fi ve reported favourable results while two were unfavourable.1 2 Three favourable studies found ginger improved some measure of CINV when combined with the standard anti-CINV treatment, either acute nausea only or a reduction in both acute and delayed nausea and vomiting.3 4 5 The two other favourable studies found ginger reduced some measure of CINV equal to the anti-emetic medication, metoclopra-mide but due to the lack of a placebo group in both studies, it is diffi cult to determine the clinical signifi cance of these results.6 7 Other limitations



were identifi ed within the literature such as the use of unstandardized ginger extracts and the lack of control for anticipatory nausea. This article also highlights the potentially negative effects of high-dose ginger on CINV and provides possible explanations for these results. In conclusion, the current literature is mixed in its support for ginger as a treatment for ginger. This review discusses the current level of evidence for this treatment and provides recommendations for future research.

References

1. Zick S, Ruffi n M, Lee J, et al. Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Supportive Care in Cancer. 2009;17(5):563–572.

2. Fahimi F, Khodadad K, Amini S, et al. Evaluating the Effect of Zingiber Offi cinalis on Nausea and Vomiting in Patients Receiving Cisplatin Based Regimens. Iranian Journal of Pharmaceutical Research. 2010;10(2):379–384.

3. Pillai AK, Sharma KK, Gupta YK, Bakhshi S. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer. Feb 2011;56(2):234–238.

4. Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, Abol-hasani E. Effect of Ginger on Acute and Delayed Chemotherapy-Induced Nausea and Vomiting: A Pilot, Randomized, Open-Label Clinical Trial. Integr Cancer Ther. Feb 7 2012.

5. Ryan JL, Heckler CE, Roscoe JA, et al. Ginger (Zingiber offi cinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. Aug 5 2011.

6. Manusirivithaya S, Sripramote M, Tangjitgamol S, et al. Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecol Cancer. Nov–Dec 2004;14(6):1063–1069.

7. Sontakke, S., ThawanI, V., Naik, S. M. Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: A randomized, cross-over, double blind study. Vol 35. Pondicherry, INDE: Indian Pharmacological Society; 2003.

775

AUSTRALIAN GENERAL PRACTITIONERS’ PREFERENCES FOR

INTER-PROFESSIONAL COMMUNICATION AND A COLLABORATIVE

APPROACH WHEN CARING FOR PEOPLE DIAGNOSED WITH

CANCER

Claire Johnson1, Natalia Lizama2, Christobel Saunders1

1. School of Surgery, The University of Western Australia, Perth, Western Australia, Australia2. WA Cancer and Palliative Care Network, Deaprtment of Health, WA, Perth, Western Australia, Australia

Aims: To explore general practitioners’ (GPs’) experiences and perceptions about communication when caring for people diagnosed with cancer.

Methods: A self-report survey, which included an open response section, was mailed to a random sample of 1969 eligible Australian GPs. We will present results of a qualitative (thematic) analysis of open comments about communication – a key theme which emerged in the data. Comments per-taining to communication were coded into four non-mutually exclusive categories of general communication, positive experiences, negative experi-ences, and feeling undervalued by specialists.

Results: Half of the 648 eligible GPs who participated in the survey included open response comments, of which 21% (68) pertained to communication. GPs were particularly concerned about inter-professional communication. They noted the importance of receiving detailed and timely communication from specialists and hospitals, especially in relation to patients’ treatment regimes and follow-up care. GPs valued a collaborative approach and good inter-professional relationships.

GPs who described positive experiences with communication were signifi -cantly more likely to have a higher overall interest in being involved in cancer care (p < 0.001), as measured by other items in the questionnaire. Although female GPs were more likely to comment on communication

generally (p < 0.001), male GPs were more likely than female GPs to describe negative communication experiences (p = 0.050). Male GPs were more likely to feel undervalued or unappreciated (p = 0.004), as were GPs who had undertaken previous cancer-specifi c training (p = 0.037).

Conclusions: While many GPs are currently involved in some aspects of cancer management, detailed and timely communication between specialists and GPs is imperative to support shared care and ensure optimal patient outcomes. This research highlights the need for established channels of communication between specialist and primary care medicine to support greater involvement by GPs in cancer care.

776

A MATTER OF OPINION: AGE DIFFERENCES IN COLORECTAL

CANCER PATIENTS’ AND PHYSICIANS’ VIEWS ON

CHEMOTHERAPY TREATMENT DECISIONS

Mikaela Jorgensen1, Jane Young1, Michael Solomon2

1. Cancer Epidemiology and Services Research Group, University of Sydney, Sydney, Australia2. Discipline of Surgery, University of Sydney, Sydney, Australia

Older patients with colorectal cancer are signifi cantly less likely than younger patients to receive stage-appropriate adjuvant therapy. This study comprised separate surveys of colorectal cancer patients and colorectal surgeons to compare barriers to adjuvant chemotherapy use.

In the patient survey, a self-administered questionnaire was completed by patients who had undergone colorectal cancer surgery at a single tertiary referral hospital within the previous 24 months. Patients rated the impor-tance of various factors in chemotherapy decision-making using a 10 cm visual analogue scale. Factors were ranked in order of importance and results compared between older and younger patients. In the surgeon survey, a questionnaire was sent to all colorectal surgeons in Australia and New Zealand (n = 146) to elicit opinions and self-reported practices. Likelihood of referring an older and a younger patient for adjuvant chemotherapy was compared in eight scenarios.

68 patients completed the survey (91% of those consenting). Factors that were signifi cantly more important to older patients than younger patients were fear of dying (p < 0.0001), health status before treatment (p = 0.0003), and maintaining a good quality of life during treatment (p = 0.005). Reduc-ing the risk of cancer returning (mean 9.3; SD 0.5) and physician trust (mean 9.2; SD 0.5) were factors of highest importance for older patients. Travelling for treatment (mean 3.8; SD 2.8), cost (mean 5.5; SD 3.6), treatment dura-tion (mean 5.8; SD 3.3) and family opinion (mean 6.7; SD 3.6) were rated lowest. Surgeons (n = 102, 70% response rate) were signifi cantly less likely to refer an older patient than a younger patient in all scenarios (all p < 0.001). Distance to treatment, health status, and family support were factors that produced greatest differences in chemotherapy referral recommendations.

Surgeons’ and patients’ perceived barriers to treatment differ. Practical bar-riers such as distance to treatment were important to surgeons but not to older patients. Understanding barriers and individual patient preferences may help reduce care disparities among older people.

777

THE SOCIAL ENVIRONMENT AND CANCER SURVIVORSHIP:

CRITICAL FACTORS CONTRIBUTING TO RECOVERY

Lynette Joubert1, S Oldfi eld2, L Whatmore2, S Petrevski2, B Dickinson2, T Nichols2

1. University of Melbourne, Carlton , Vic, Australia2. Austin Hospital, Melbourne, Vic, Australia

The environment can simultaneously be the source of the greatest distress and the greatest support to an individual. This is a challenging proposition for cancer service delivery as it emphasises the signifi cance of the social context on



recovery. We would like to report on the results of a retrospective audit of the contribution of social capital and social networks to survivorship outcomes in 100 patients receiving treatment for a diagnosis of cancer at the Austin Hospi-tal, Melbourne Australia. We used the National Coalition defi nition for Cancer Survivorship as ‘Individuals with cancer from the time of diagnosis and for the balance of life including family, friends and caregivers’.

Methodology: A retrospective study of N = 100 consecutively referred patients to Social Work were analysed using Clinical Data Mining Method-ology (Epstein 2004).

An audit tool was developed and data analysed in relation to demographic variables, the supportive care screening tool and domains of social capital (carers, fi nance, family and interpersonal relationships) The quantitative data was descriptively and inferentially analysed while all qualitative content was coded using a thematic networks framework (Atrride-Stirling 2001)

Results: A signifi cant relationship was found between scores of emotional distress (depression, anxiety, worry) and fi nancial issues, lack of carer support and poor interpersonal relationships (P = 0.02) Financial issues represented the highest level of social stress (including the inability to par-ticipate in paid employment, infl exible work arrangements, pre-morbid fi nancial stress, complexities and delays in accessing income maintenance, and the need to provide for dependants. (Interpersonal and family relation-ships provided the highest level of support while carer issues were predomi-nantly stressful with support experienced where there were deeply meaningful relationships.

This results of this study suggest key social network and social context interventions that support the importance of including broader social vari-ables as part of the clinical service offered in cancer care as key components of the patient experience.

778

PRICING OF ANTI-CANCER DRUGS APPROVED FOR USE IN

AUSTRALIA SINCE 2000

Deme J Karikios, Martin R StocklerNHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

Background: Expensive new anti-cancer drugs, often with modest clinical benefi ts, are contributing to the rising costs of treating patients with cancer. The purpose of this study was to determine recent trends in prices of new anti-cancer drugs.

Methods: Schedule of pharmaceutical benefi ts documents were searched for new listings of anti-cancer drugs and their prices that had been approved for PBS funding between 2000 and 2010. Drugs to treat haematological malignancies and non-melanoma skin cancers, vaccines, and drugs used for supportive care were excluded. Standard treatment protocols were used to calculate doses and prices for 28 days treatment for each new drug approved. Prices were infl ated to 2010 dollars and plotted over time. Average price of prescriptions of all anti-cancer drugs was also determined from PBS pricing authority annual reports and compared with average prescription prices of other drug classes, rates of infl ation and change in GDP per capita.

Results: The total number of new drugs approved for use over this time period was 18, of which 33% (6) were cytotoxic and 50% (9) were targeted. All but one drug (cetuximab) was approved for treatment of advanced (incurable) disease. Cetuximab was fi rst listed in 2007 and was also the drug with the highest price per month – $7484 (unadjusted for infl ation). The average prescription price for all anti-cancer drugs has increased by an average of 10.4% per year over the 10 year period, which increases to 14.5% if drugs with an endocrine mechanism of action are excluded. In comparison, the average health prices infl ation rate, overall infl ation rate and increase in GDP per capita per year was 5.5%, 3.1% and 5.6% respectively.

Conclusions: Prices of new anticancer drugs have increased signifi cantly over the last 10 years. If this trend continues Australian patients may have restricted access to effective new therapies.

779

CHANGES IN ONCOLOGY INPATIENT CARE OVER A NINE YEAR

PERIOD AT A MAJOR AUSTRALIAN CENTRE

Richard C Khor1, Mathias Bressel2, Keen Hun Tai1, Linda Mileshkin3, David Ball1, William Rose4, Suki Gill1, Farshad Foroudi1

1. Department of Radiation Oncology and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia2. Centre for Biostatistics and Clinical Trials, Melbourne, Victoria3. Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia4. Peter MacCallum Cancer Centre, East Melbourne, Australia

Introduction: Many factors may infl uence patterns of care delivery in terms of hospital admission rates. We present data over a nine year period refl ect-ing admissions activity across a large cancer centre.

Methods: Hospital administrative records were examined between 2002 and 2011. Patient demographics, as well as admitting unit, length of stay, treatment received, and admission complexity were examined.

Results: A total of 198202 admissions were examined over the nine year period. Admission numbers increased over time, from 15732 patients admit-ted in 2002 to 20799 patients in 2011. The proportion of Radiation Oncol-ogy admissions fell from 14.5% in 2002 to 5.5% in 2011. Surgical Oncology admissions increased from 20.9% to 24.9%, and Medical Oncology admis-sions increased from 64.5% to 69.6%. The total number of Radiation Oncology admissions per annum fell in both single and multi-day admission numbers (1106 to 609, and 1178 to 542, respectively), with a decrease in number of multi-day admissions during radiotherapy (1106 to 521). Surgi-cal annual admissions increased in both single and multi-day admissions (2611 to 3989, and 683 to 1190, respectively), accompanied by an overall increase in inpatient surgical procedures. Yearly Medical Oncology single day admissions increased, while multi-day admissions decreased (8224 to 12831 and 1930 to 1638 respectively). Single day admissions for chemo-therapy increased by 212% (4610 to 9782 patients).

Conclusions: Overall, admission rates are rising. In contrast to Surgical and Medical Oncology streams, we observed a decrease in Radiation Oncology admissions over time. This could be attributed to a decrease in the practice of delivering radiotherapy as part of a multi-day admission. The growth in Medical Oncology admissions was driven largely by an increase in single day admissions, refl ecting an increased utilisation of outpatient chemo-therapy regimens. This data can help inform planning of future health service requirements.

780

EXPLORING OPPORTUNITIES FOR SERVICE IMPROVEMENT TO

OPTIMISE OUTCOMES FOR OLDER PEOPLE WITH CANCER

Belinda Lambros, Meinir KrishnasamyPeter MacCallum Cancer Centre, East Melbourne, VIC, Australia

Background: Over 57% of all new cancer diagnoses in Australia occur in people aged over 65 years. During 2010–2011, 40% of the patient popula-tion at Peter MacCallum Cancer Centre (Peter Mac) was aged over 65 years.

Aim: To identify opportunities for service improvement from multidiscipli-nary and consumer perspectives to promote optimal outcomes for older people with cancer.

Method: An exploratory, semi-structured interview study. Sample. Thirty four health professionals, 15 patients and their carers/family members took part in audio taped interviews to explore perceptions of current service provision to identify opportunities to improve patient experiences and out-comes. Data analysis: Interview data were transcribed and coded into key themes.

Results: Five key categories were identifi ed as barriers to enabling optimal outcomes for older cancer patients: 1) Lack of a coordinated approach to screening and geriatric assessment at point of referral; 2) Lack of a



coordinated approach to assessment and management of poly-pharmacy; 3) Lack of timely access to ACAS assessments; 4) Lack of specialist geriatric knowledge to promote optimal outcomes; and 5) Limited knowledge of essential cancer care in residential care facilities and home like care settings. Recommendations: Four key recommendations emerged: 1) Implementation of a sensitive screening tool to promptly identify frail patients 2) Implemen-tation of a standardised approach to identify and assess co-morbid condi-tions likely to be exacerbated related to treatment; 3) Timely referral and access to ACAS assessments; 4) Implementation of protocols and pathways to support care of elderly cancer patients at Peter Mac and in residential aged care or homelike settings.

Conclusion: This study has provided targeted recommendations to inform service improvements for care of older cancer patients at Peter Mac. Optimal models of care provision for older people with cancer are being explored and will be implemented and evaluated over the next two years.

781

FEASIBILITY AND UTILITY OF A COMPREHENSIVE CANCER

SURVIVORS DATABASE

Marleesa Ly1, Amanda Robertson1, David Roder2, Bogda Koczwara1,3

1. Department of Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia2. Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia3. Flinders University, Bedford Park, SA, Australia

Aim: The delivery of follow-up and clinical care for cancer survivors requires access to relevant information across many sites of service delivery including acute specialist and primary care setting. We investigated the potential utility and feasibility of a comprehensive cancer survivors database to facilitate the provision of services to survivors and support research into this area.

Method: A literature review was performed to identify current needs related to the cancer survivor care delivery and existing cancer survivor databases. Focus groups and individual interviews were held with service providers and survivors to identify needs, preferences and concerns surrounding the imple-mentation of comprehensive survivors database.

Results: The literature review identifi ed a number of existing cancer survi-vor databases designed as longitudinal questionnaire studies. Survivors were encouraged to complete patient reported outcome questionnaires through a secure web portal. Responses to these questionnaires are linked with cancer registries and other clinical datasets to allow for complex analysis.

Twelve service providers and four cancer survivors participated in small focus groups or individual interviews. All participants agreed that there was a need for more research into the needs, long term quality of life and late effects of cancer survivors and that a comprehensive cancer survivors data-base had the potential to facilitate this research. However concerns were raised over privacy, data security and the resources required to collect the necessary data. Cancer survivors were agreeable for data collected about them to be used for other research purposes.

Conclusions: A comprehensive cancer survivors database should merge cur-rently separate data sources into a single accessible record to facilitate the provision of clinical services as an individual moves from one provider to another. Incorporating patient reported outcomes at regular intervals may increase survivor engagement with the database and provide valuable lon-gitudinal data on late effects and health outcomes of this population.

782

USING HEPATITIS B REGISTRY DATA TO IMPROVE LIVER CANCER

PREVENTION AT PRIMARY CARE LEVEL

Annie Fraser1, Ximena Masgoret1, Monica Robotin1, Mamta Porwal1

1. Cancer Council NSW, Woolloomooloo, NSW, Australia

Aims: Identify and review risk stratifi cation and referral processes in the management of hepatitis B in general practice based on Chronic Hepatitis B (CHB) disease Registry data.

Background: In Australia hepatocellular cancer incidence is rising fastest of all internal cancers, largely due to rising rates of CHB infection in migrants born in countries where the disease is endemic. Regular monitoring and timely antiviral treatment initiation can reduce the risk of malignant trans-formation and is being trialled in the B Positive program.

Methods: We analysed initial screening data collected by the B Positive Registry from participating General Practices and ascertained if patient management and referral were consistent with Gastroenterological Society Australia (GESA) guidelines, which stratifi es patients by risk level according to alanine aminotransferase (ALT) and viral load levels.

Results: Among the fi rst 219 participants enrolled in B-Positive project 14% lacked documentation of ALT or viral load levels required to evaluate the stage of CHB disease. Approximately 67% had normal ALT and viral load levels and did not require referral but continued 6 monthly monitoring by primary health care provider. Fewer than 3% of patients had elevated ALT levels and viral loads. 1% of patients were not referred to the specialist as recommended by GESA. 18% of participants were referred to the specialist despite normal ALT and viral loads.

Conclusions: We anticipate that HCC risk factors such as family history and diabetes may be the reason for the 18% of patients referred who had normal ALT and viral loads.

Overall the present fi ndings suggested that the general practitioners were following the recommended GESA criteria. The identifi cation of knowledge gaps found in procedures and referral process will be vital to conduct further educational need in order to achieve successful and correct management of CHB and HCC risk.

783

IMPROVING THE CANCER PATIENT EXPERIENCE

Clare McGinness, Kirsten Seletto, Amanda Proposch, Monica WallaceCabrini Health, Malvern, Vic, Australia

Problem: No one but the patient experiences their health system journey and yet health services and processes are built primarily on the health profes-sional’s view of what is needed, rather than the customer’s experience and knowledge of system requirements.

In 2011, 27 Cancer health professionals developed a big picture map of the current state of the Cancer Service at Cabrini Health. The picture served as a tool to exemplify the complexity of the cancer system from the patients’ perspective. Using the metaphor of a stream, it was evident that the patients’ fl ow of care was complicated by system issues.

Goals: The goal was to understand how value could be created in the cancer patient’s journey.

Current state: Using demand analysis, extended value stream mapping across the health system and understanding patient value, the current state was mapped and found to be multifaceted, complex and diffi cult to navi-gate. It was validated there is much waste at a time when patients have little time and energy to waste.

Future state: Data revealed four high volume/high impact cancer tumour streams with deeply entrenched issues. Teams based around the patient journey and system level improvement perspective commenced a program of improvement to create value with agreed targets and quality outcomes.



Outcome and learnings: The team have worked with cancer patients to redesign the model of care to achieve a person centered plan of care, whereby the patient feels in control. The national benchmark patient satis-faction survey (Press Ganey) indicates that satisfaction scores for Cancer patients at Cabrini have improved remarkably due to this work.

784

MODERATE-TO-SEVERE SYMPTOMS ARE PREVALENT AMONG

PATIENTS ATTENDING A BREAST CANCER SURVIVORSHIP CLINIC

Carolyn Behrendt, Joanne MortimerCity of Hope, Duarte, CA, United States

The majority of women who are treated for early stage breast cancer die of causes other than breast cancer but experience longterm sequelae from treat-ment. 73 women who had completed treatment for stage I-III breast cancer were enrolled in a survivorship protocol which included quality of life (QoL) questionnaires, bloodwork, bone density, and cardiac function. We report the QoL fi ndings. Of 73 enrollees, 59 (68.5%) completed questionnaires. The median age was 55.4 (± 9.1) years with 25.8 (14.2–64.3) months from diag-nosis; 14 (28%) were stage I, 29 (58%) stage II, 7 (14%) stage III; 10 (20%) received adjuvant chemotherapy, 14 (28%) endocrine therapy and 23 (46%) both. Within the past week, 50 experienced the following symptoms ‘quite a bit’ or ‘very much:’ hot fl ashes – 21, weight gain – 16, low libido – 16, pain in the joints – 15, upper body swelling – 14, vaginal dryness – 13, and night sweats – 13. Hot fl ashes were positively correlated with night sweats (p < 0.001), pain in joints (p < 0.001), age (p < 0.05), and irritability (p < 0.05), negatively correlated with breast sensitivity/tenderness (p < 0.001) and no correlation with time since diagnosis, stage, systemic therapy, or fatigue. Within the prior month, participants ‘accomplished less than they would have liked’ due to physical health 21 (42%) and emotional problems 19 (38%). Sleep quality was ‘fairly poor to bad’ in 36% and correlated with bodily pain (p < 0.001) and night sweats (p < 0.05) but not pain in joints, hot fl ashes, systemic therapy, endocrine therapy, or time since diagnosis. Health limited vigorous physical activity in 34% and correlated with age (p < 0.0005), worsening sleep quality (p < 0.01), pain in joints (p < 0.05), but not stage or time since diagnosis. Breast cancer survivors continue to have symptoms which compromise QoL long after their initial cancer diagnosis and treatment. We have undertaken a prospective trial to determine the role of individual therapeutic interventions on QoL.

785

TOWARDS A SMART CANCER REGISTRY

Anthony Nguyen1, Julie Moore2, Guido Zuccon1, Shoni Colquist2

1. The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia2. Queensland Cancer Control Analysis Team, Queensland Health, Brisbane, QLD, Australia

Aims: Pathology notifi cation for a Cancer Registry is regarded as the most valid information for the confi rmation of a diagnosis of cancer. In view of the importance of pathology data, an automatic medical text analysis system (Medtex) is being developed to perform electronic Cancer Registry data extraction and coding of important clinical information embedded within pathology reports.

Methods: The system automatically scans HL7 messages received from a Queensland pathology information system and analyses the reports for terms and concepts relevant to a cancer notifi cation. A multitude of data items for cancer notifi cation such as primary site, histological type, stage, and other synoptic data are classifi ed by the system. The underlying extrac-tion and classifi cation technology is based on SNOMED CT1 2. The Queens-land Cancer Registry business rules3 and International Classifi cation of Diseases – Oncology – Version 34 have been incorporated.

Results: The cancer notifi cation services show that the classifi cation of notifi able reports can be achieved with sensitivities of 98% and specifi cities

of 96%5, while the coding of cancer notifi cation items such as basis of diagnosis, histological type and grade, primary site and laterality can be extracted with an overall accuracy of 80%6. In the case of lung cancer staging, the automated stages produced were accurate enough for the pur-poses of population level research and indicative staging prior to multi-disciplinary team meetings2 7. Medtex also allows for detailed tumour stream synoptic reporting8.

Conclusions: Medtex demonstrates how medical free-text processing could enable the automation of some Cancer Registry processes. Over 70% of Cancer Registry coding resources are devoted to information acquisition. The development of a clinical decision support system to unlock information from medical free-text could signifi cantly reduce costs arising from dupli-cated processes and enable improved decision support, enhancing effi ciency and timeliness of cancer information for Cancer Registries.

References

1. A. Nguyen, M. Lawley, D. Hansen, S. Colquist, ‘A Simple Pipeline Application for Identifying and Negating SNOMED Clinical Terminol-ogy in Free-text,’ Health Informatics Conference, pp. 188–193, Can-berra, Australia, 2009.

2. A. Nguyen, M. Lawley, D. Hansen, R. Bowman, B. Clarke, E. Duhig, S. Colquist, ‘Symbolic rule-based classifi cation of lung cancer stages from free-text pathology reports,’ J Am Med Inform Assoc, 17(4): 440–445, 2010.

3. Queensland Cancer Registry ‘Clinical Coding Manual v3.’4. International classifi cation of diseases for oncology 3rd Edition, WHO

2000.5. A. Nguyen, J. Moore, G. Zuccon, M. Lawley, S. Colquist, ‘Classifi cation

of pathology reports for Cancer Registry notifi cations,’ Health Informat-ics Conference, pp. 150–156, Sydney, Australia, 2012.

6. A. Nguyen, J. Moore, M. Lawley, D. Hansen, S. Colquist, ‘Automatic Extraction of Cancer Characteristics from Free-Text Pathology Reports for Cancer Notifi cations,’ Health Informatics Conference, pp. 117–124, Brisbane, Australia, 2011.

7. I. McCowan, D. Moore, A. Nguyen, R. Bowman, B. Clarke, E. Duhig, M. Fry, ‘Collection of Cancer Stage Data by Classifying Free-text Medical Reports,’ J Am Med Inform Assoc, 14(6): 736–745, 2007.

8. A. Nguyen, M. Lawley, D. Hansen, S. Colquist, ‘Structured Pathology Reporting for Cancer from Free-text: Lung Cancer Case Study,’ eJHI, 7(1): e8, 2012.

786

CANCER REPORTING FROM OCR FREE-TEXT PATHOLOGY

REPORTS

Guido Zuccon1, Anthony Nguyen1, Anton Bergheim2, Narelle Grayson2

1. The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia2. Cancer Institute NSW, Sydney, NSW, Australia

Aims: To evaluate the effects of Optical Character Recognition (OCR) accuracy on automatic cancer classifi cation of pathology reports.

Methods: 228 scanned images of pathology reports obtained from an Aus-tralian state-based Cancer Registry were converted to free-text using a commercial OCR system. A state-of-the-art rule-based cancer classifi cation system, Medical Text Extraction (Medtex)1, was employed to classify the OCR-ed reports. A post-processing pipeline2 was implemented to recover part of the formatting loss during the OCR process. Ground truth judge-ment for cancer classifi cation was provided by two clinical coders. Classifi -cation effectiveness using OCR-ed reports was compared with that obtained on human corrected reports.

Results: Free-text was recognised by the OCR tool with high word accuracy (98.8%); however, some words that may affect the correct classifi cation of reports in terms of histologies (e.g. keratinising) and sites (e.g. anterior, posterior) were misrecognised. Pathology reports were classifi ed into notifi -able and not-notifi able with an F-measure of 91.6%, regardless of OCR errors. Lower effectiveness was witnessed when extracting fi ner-grained



synoptic factors, e.g., primary site and histological type. OCR errors were found to lower the performance of the system when compared to those obtained using reports that had OCR errors rectifi ed.

Conclusions: A commercial OCR tool appeared suited to convert image-based pathology reports into electronic free-text with high accuracy. However, words key to the identifi cation of affected body structures and histological types were misrecognised by the OCR tool. Medtex was used to assess the impact of OCR errors when automatically coding pathology reports. Experimental results suggest that OCR errors are negligible for classifying notifi able cancer reports. However, OCR errors do affect the classifi cation of synoptic reporting items, as lower performances were achieved by the automatic system. Future work will consider incorporating OCR error correction within Medtex to improve synoptic reporting.

References

1. A. Nguyen, J. Moore, M. Lawley, D. Hansen, S. Colquist, ‘Automatic Extraction of Cancer Characteristics from Free-Text Pathology Reports for Cancer Notifi cations’, Health Informatics Conference, pp. 117–124, Brisbane, 2011.

2. G. Zuccon, A. Nguyen, A. Bergheim, S. Wickman, N. Grayson, ‘The impact of OCR accuracy on automated cancer classifi cation of pathology reports’, Health Informatics Conference, pp. 250–256, Sydney, 2012.

787

LIVING WITH DYSPHAGIA: INSIGHTS AND IMPLICATIONS FOR

SPEECH PATHOLOGY SERVICES FOR PATIENTS IN THE

SURVIVORSHIP PHASE OF HEAD AND NECK CANCER

Rebecca Nund1,2, Elizabeth Ward1,2, Nerina Scarinci1, Bena Cartmill2,3, Pim Kuipers2,4, Sandro Porceddu5,6

1. Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia2. Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia3. Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia4. Griffi th Health Institute, Griffi th University, Brisbane, Australia5. Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia6. School of Medicine, The University of Queensland, Brisbane, Australia

Aims: The current study adopted a patient-centred, qualitative approach to examine the patients’ perspective on speech pathology services during and in the months following treatment for head and neck cancer. Despite numer-ous studies conducted into the prevalence and nature of dysphagia in the survivorship phase of treatment, the full impact remains poorly understood. This is a time when patients are coping with side effects of treatment and the challenges of adjusting to temporary or permanent changes to their ability to eat, and thus the need for speech pathology services requires elucidation.

Methods: Purposeful, maximum variation sampling was utilised to recruit 26 participants who had undergone radiotherapy as part of their curative treatment for a mucosal head and neck cancer in the past 5 years. All par-ticipants had access to speech pathology services during their treatment. Each participated in an in-depth interview, detailing the full impact of dysphagia and experiences with speech pathology services. Data collection and analysis were conducted simultaneously and recruitment continued until data saturation was reached. Thematic analysis was utilised to catego-rise themes and identify common concerns and key phrases from the transcripts.

Results: The main themes identifi ed were: 1) Patients generally underesti-mated the extent of side effects and associated recovery time; 2) Differences in perspectives between patients and clinicians; and 3) Patients perceived a lack of follow up from speech pathology services post-treatment. Patients expressed a desire for changing models of healthcare to include follow-up services in the survivorship phase of care.

Conclusions: These data confi rm the clinical belief that dysphagia has a negative and multi-faceted impact on the patient in the survivorship phase of care. The fi ndings outline the dimensions of that impact, and highlight the need for new models of long term support to help individuals adjust to changing physical states and enhance psycho-social adjustment.

788

FAST TRACKING PHARMACY

Carol A Rice, Julie Long, Senthil Lingaratnam, Jill Davison, Heike Raunow, Karena HanlonPeter MacCallum Cancer Centre, East Melbourne, VIC, Australia

Aim: To introduce a system by which clinical trial prescriptions are dis-pensed in advance of the patient’s medical appointment in order to reduce pharmacy waiting times.

Method: Four pharmacists and 4 research nurses formed a working party and mapped the processes around prescription writing and dispensing in order to identify areas which cause delays. A system was implemented in which research nurses obtain prescriptions for selected patients at least 2 days prior to their appointment. The trial pharmacist then dispenses the prescription and places it on hold. After the patient’s medical consultation a fax is sent to the pharmacy confi rming whether or not the prescription is required. Following confi rmation a fi nal check is performed before the prescription is released to the patient. Waiting times for trial prescriptions were recorded and patients were surveyed as to their satisfaction of the pharmacy service before and after the new system was implemented.

Results: Median waiting times for trial prescriptions improved by a mean of 21.5% (13.7%–29.4%) in the 5 months after the implementation of the new system. Of the 35 patients surveyed whose prescriptions were not prepared in advance 20 reported waiting 1 to 2 hours and 7 over 2 hours. None of the 15 patients surveyed whose prescriptions were advanced waited over an hour and 4 reported waiting 10 minutes or less. The average satis-faction score (7.8 of a 10 maximum) was the same for both groups.

Conclusions: Clinical trials prescriptions take longer to dispense than stand-ard prescriptions because of trial specifi c documentation and recording requirements. Implementing a system which allowed many of these proc-esses to be completed ahead of the patient’s appointment expedited dispens-ing the prescription and vastly reduced the patient waiting times. Patient satisfaction remained high possibly because patients value the counselling and care of pharmacists.

789

TREATMENT AND SURVIVAL OUTCOMES FOR PROSTATE

CANCER FOR ABORIGINAL MEN IN NEW SOUTH WALES (NSW)

AUSTRALIA

Jenny Rodger1, Rajah Supramaniam1, Alison Gibberd1, Veronica Saunders1, Dianne O’Connell1,2,3,4

1. Cancer Council NSW, Kings Cross, NSW, Australia2. University of Sydney, Sydney, NSW, Australia3. University of NSW, Sydney, NSW, Australia4. University of Newcastle, Newcastle, NSW, Australia

Background: Prostate cancer is the most frequently diagnosed cancer for Australian men. Previous studies have shown lower survival rates for Abo-riginal men compared to non-Aboriginal men.

Aims: This study investigates the infl uences on radical prostatectomy and survival rates for Aboriginal and non-Aboriginal men in NSW.

Methods: NSW Central Cancer Registry data for 35,214 men diagnosed with prostate cancer in 2001–2007, of whom 259 identifi ed as Aboriginal, was linked with all inpatient episodes in all NSW hospitals. More detailed diagnostic and treatment information was extracted from NSW hospital records for 91 Aboriginal men diagnosed between 2000 and 2011.



Results: Aboriginal and non-Aboriginal men had similar age and spread of disease at diagnosis. The fi ve-year crude prostate cancer-specifi c survival was 7% lower for Aboriginal men (81%, 95% CI: 75–87) than non-Aboriginal men (88%, 95% CI: 87–88). The risk of death from prostate cancer was higher for Aboriginal men than non-Aboriginal men after adjusting for age at diagnosis, year of diagnosis and spread of disease (hazard ratio 1.74, 95% CI: 1.26–2.33). After also adjusting for having a prostatectomy, socio-economic disadvantage, comorbidities and place of residence the increased risk was lower (1.48, 95% CI: 1.08–2.01). For the Aboriginal men with more detailed treatment information 53/91 had localised disease at diagno-sis, of whom 20/53 had surgery as their primary treatment, 15/53 had radiotherapy and 18/53 had active surveillance.

Conclusions: Aboriginal men had similar spread of disease, but were less likely to receive radical prostatectomy for localised disease and had lower prostate-cancer specifi c survival compared to non-Aboriginal men.

Controlling comorbidities and addressing treatment barriers associated with place of residence and socioeconomic disadvantage may increase prostate cancer survival rates for Aboriginal men.

790

SOCIO-DEMOGRAPHIC FACTORS AND THEIR IMPACT ON THE

NUMBER OF RESECTIONS FOR PATIENTS WITH RECURRENT

GLIOBLASTOMA

Yi Sia, Kathryn Field, Mark Rosenthal, Kate DrummondRoyal Melbourne Hospital, Melbourne, Vic, Australia

Background: Glioblastoma (GBM) is the most aggressive malignant brain tumour. Having a second or subsequent operation at recurrence may be a positive prognostic factor for survival. Recent studies suggest that socio-demographic variables may infl uence survival; raising the question whether surgical care differs based on these variables.

Methods: We examined the relationship between selected socio-demo-graphic variables and the number of repeat operations undergone by patients with recurrent GBM. Data from all patients diagnosed with GBM between 2001 and 2011 was obtained from a clinical database at two institutions. The clinical and socio-demographic factors for patients who received one operation were compared to those who had two or more (≥2) operations, using chi-square analyses to determine statistical differences between groups. Socio-economic status was measured using the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) scores.

Results: Of 553 patients, 449 (81%) had one operation and 104 (19%) had ≥2 operations. Patients who had ≥2 operations were signifi cantly younger (median 55 years versus 64 years, p < 0.001), less likely to have multifocal (p = 0.043) or bilateral (p = 0.037) disease and more likely to have initial macroscopic resection (p = 0.006), than those who had only one operation. Socioeconomic status did not signifi cantly differ between the groups (p = 0.31). Similarly, there was no signifi cant difference between the number of operations in patients from regional versus city residence and public versus private hospital.

Conclusion: There were no signifi cant differences between the socio-demo-graphic status of patients who had multiple resections for recurrent GBM and those who had only one operation. This is reassuring in that it suggests that similar surgical management options are available for patients regard-less of their socio-demographic background.

791

SUPPORTING BEST PRACTICE LUNG CANCER CARE

Sue Sinclair, Elizabeth King, Helen ZorbasCancer Australia, Strawberry Hills, NSW, Australia

Background: Lung cancer is the leading cause of cancer death in Australia, accounting for 21% of all cancer death in males and 17% in females. [1] Survival rates remain poor and have improved little over the previous 26

years. Only 13 out of 100 people with lung cancer survive fi ve years beyond their diagnosis.

Cancer Australia is leading a portfolio of work which aims to improve outcomes for people with lung cancer, including reducing variations in care and building a knowledge base to inform the future provision of care.

Methods: A systematic review of evidence was undertaken, followed by qualitative and quantitative analysis. An Advisory Group, comprising con-sumers, experts and health professionals, was established to inform the directions and priorities of the work.

Results: Informed by the evidence, and expert advice and input, a two-year program of work was commenced.

The current activities include:

• Evidence-based information and resources to support general practition-ers in the assessment of symptoms of suspected lung cancer and rapid referral to multidisciplinary specialist care

• Report on risk factors for lung cancer• Clinical practice guidelines about treatment of lung cancer for health

professionals• Study and report on the impact of stigma and nihilism on lung cancer

outcomes• A literature review on patterns and models of care and ongoing consulta-

tion with cancer services on service delivery.

Conclusions: This body of work provides the foundation building blocks in the provision of evidence-based best practice care in lung cancer. These activities, ranging from awareness and risk reduction, to primary care and specialist treatment support and improved service delivery, will support improved outcomes for Australians diagnosed with lung cancer, and the health professionals who manage their care.

Reference

1. Australian Institute of Health & Welfare & Cancer Australia 2011. Lung cancer in Australia: an overview. Cat. No. CAN 58. Canberra: AIHW.

792

DEVELOPING AN ALLIED HEALTH SERVICE IN A NEW

RADIOTHERAPY CENTRE IN MELBOURNE’S WEST

Nadine Alexander, Hollie Bevans, Sarah Davies, Karen Kessner, Hunter Mulcare, Laurelle Stalker, Ande Szendroe, Emma WallaceWestern Health, St. Albans, Vic, Australia

Introduction: Development of a new radiotherapy centre in Melbourne’s West allowed for the establishment of an integrated allied health service.

Background: The Western region of Melbourne is one of the fastest growing corridors in Australia comprising a culturally and linguistically diverse com-munity. The centre is a collaboration between Peter MacCallum Cancer Centre and Western Health. The allied health team comprises social workers, dietitian, physiotherapist, occupational therapist, speech therapist and psychologist.

Discussion: Initial challenges were making patient appointments, docu-menting interventions, establishing patient referral pathways, identifi cation of multidisciplinary team processes such as allocation of space for clinical consultations, hot desks etc. The patient cohort has changed over eighteen months with patients receiving radiotherapy initially diagnosed with breast, prostate and lung cancer. Diagnosis diversity has now increased to include colorectal, upper gastrointestinal and head and neck cancers requiring more extensive allied health intervention. An education programme comprising all members of the treating team was established. Medical staff delivered disease/treatment specifi c sessions to up-skill allied health staff and each allied health discipline presented their role/functions and referral criteria maximising the patient experience and support. A multi-disciplinary case conference was established to identify new patients requiring allied health input. Allied health referrals are received from a range of staff. Interventions are documented electronically and accessible to all members of the treating team. Allied health team members meet regularly to discuss issues



encountered in service provision, develop interdisciplinary relationships and establish team goals. Monthly data collection monitors referrals to various allied health disciplines and subsequent cancer diagnosis.

Conclusion: Many factors have contributed to the establishment of a spe-cialised, well functioning allied health team in the radiotherapy centre. Interventions are timely, in line with evidence and practice and designed to meet patients’ needs. Data collection, research and patient experience will continue to inform the development of the multidisciplinary team.

793

CONSUMERS’ AND HEALTH PROFESSIONALS’ PERCEPTIONS OF

RADIOTHERAPY AND THE INCONVENIENCE ASSOCIATED WITH

ITS ACCESS AND UTILIZATION

Puma Sundaresan1,2, Christopher Milross1,2, Andrea Smith1,3, Alison Evans3, Martin Stockler1,2, Madeleine King1

1. The University of Sydney, Sydney, NSW, Australia2. Sydney Cancer Centre, Sydney, NSW, Australia3. Zest Health Strategies, Sydney, NSW, Australia

Background: Radiotherapy (RT) is an essential and cost-effective compo-nent of curative and palliative cancer treatments, but is currently underuti-lised in Australia. Perceptions of RT-related inconvenience may infl uence consumers’ (patients and carers) treatment decisions and treating doctors’ referral practices. This study explored perceptions of consumers and health professionals (HPs) regarding RT and its practicalities.

Methods: Semi-structured focus groups (FGs) and interviews were con-ducted between December 2011 and March 2012 with consumers and HPs in metropolitan and regional/rural NSW. FG and interview transcripts were analysed thematically.

Results: Interviews and FGs were conducted with 26 consumers and 30 HPs from metropolitan (6 consumers, 13 HPs) and regional NSW (20 consum-ers, 17 HPs). Multiple logistical, fi nancial and psychosocial issues with accessing and utilising RT were identifi ed. These appeared pronounced in non-metropolitan NSW. Final decisions regarding RT appeared to be driven primarily by perceived treatment benefi ts. Those who declined RT felt the potential benefi t was not worth the inconvenience to them/their family. The role of HPs in infl uencing RT decisions was apparent from consumer and HP perspectives. HPs felt the opportunity to consult with a radiation oncol-ogist (RO) was crucial for consumers to be informed about the role, benefi ts and toxicities of RT. Referring doctors’ knowledge and perceptions of RT and RO services appeared to be important factors in treatment decisions and referral. For some referrers, bias towards their own treatment speciality was a potential barrier to discussing RT. Inadequate knowledge or diffi cul-ties with referral pathways were also perceived as possible referral barriers.

Conclusions: Perceived RT-related inconvenience was multifaceted. Many consumers were prepared to endure considerable RT-related inconvenience to gain a treatment benefi t. Referrer recommendation was an important infl uence on a patient’s decision. Underutilisation of RT may be due to inadequate patient information provision as well as multiple barriers at the referral level.

794

UTILISATION AND ACCEPTABILITY OF AN E-HEALTH STRATEGY

TO FACILITATE CARE OF BREAST CANCER SURVIVORS

Siaw Sze Tiong1, Geoffrey Delaney1,2,3,4,5, Annie Lau2, Eng-Siew Koh1,3,4, Diana Adams1, Vicki Bell1, Pharmila Sapkota1, Therese Harris1, Afaf Girgis5,6, Astrid Przezdziecki1,7, Denise Lonergan1, Jenny Treloar1, Enrico Coiera2

1. Cancer Therapy Center, Liverpool and Campbelltown Hospitals, NSW, Australia2. Centre for Health Informatics Australian Institute of Health Innovations, UNSW, Sydney, Australia3. University of New South Wales (UNSW), Sydney, Australia4. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia5. University of Western Sydney, Sydney, Australia6. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Sydney, Australia7. Department of Psychology, Macquarie University, Sydney, Australia

Aim: The exponential number of breast cancer survivors (BCS) provides opportunity to develop novel e-health systems that facilitate effi cient follow-up care. A pilot study aimed to test the utilisation and acceptability of an on-line programme designed for BCS called Healthy Me (HM).

Methods: HM design included registration data input (patient demograph-ics, pathology results), tailored information (‘journeys’) regarding common survivorship issues (hot fl ushes, sexual health etc.); moderated forums, modifi able medication lists and on-line diaries; and email/scheduling func-tions with their healthcare team.

From November 2011 to June 2012, fi fty female English-speaking early BCS, aged 18–70 years with internet access were prospectively recruited from Liverpool and Macarthur Cancer Therapy Centres after cancer treat-ment completion. BC Nurses aided registration and instructed on HM use/functionalities. Participants completed an on-line baseline Profi le Question-naire (PQ1), Usability Questionnaire (UQ1) via telephone at one month, then PQ2 and UQ2 at 4 months. PQ and UQ results were analysed quali-tatively, as was face-to-face feedback from 7 patients.

Results: PQ1 and UQ1 completion rates were 68% and 95% respectively; for PQ2–50% and UQ2–90%. HM usage declined from 32/50 (64%) at 1 month to 16/46 (30%) at 4 months. 44% at 1 month and 37% at 4 months found HM useful in their survivorship care, particularly peer forums, sched-uling and email functions to access healthcare professionals. All active users at 4 months would recommend HM to other BCS. Barriers to HM use included lack of time (52%) and technical factors (20%). User feedback included preference for earlier introduction of HM at initial diagnosis, continued content updates and development of a HM phone application.

Conclusions: Pilot data in BCS supports Healthy Me’s potential to facilitate tailored on-line information, peer support and improved connectivity to healthcare teams. Ongoing feedback will assist with refi nement of the system. This is a preliminary step to developing a robust personally control-led health management system for any given population of cancer survivors.



795

AUSTRALIAN MESOTHELIOMA REGISTRY

Nico van Zandwijk1, Malcolm Sim2, Bruce Armstrong3, Bill Musk4, Julie Hill5, Anita Anderson6, Ewan MacFarlane2, Grace Kwaan7, Aisling Raftery7, Paula Laws7

1. Asbestos Diseases Research Institute, Sydney, NSW, Australia2. Centre for Occupational and Environmental Health, Monash University, Melbourne, Vic, Australia3. Cancer Epidemiology and Health Services Research Group, University of Sydney, Sydney, NSW, Australia4. Western Australian Mesothelioma Registry, Perth, WA, Australia5. Safe Work Australia, Canberra, ACT, Australia6. Workers’ Compensation Dust Diseases Board, Sydney, NSW, Australia7. Cancer Institute NSW, Sydney, NSW, Australia

Aims: The Australian Mesothelioma Registry (AMR) was established to collect information on all new cases of mesothelioma in Australia, including detailed information on asbestos exposure.

Methods: The AMR is funded by Safe Work Australia and managed by the Cancer Institute NSW, which coordinates notifi cations from state/territory cancer registries. Participants are assessed for their past asbestos exposure using tools developed by The Monash Centre for Occupational and Envi-ronmental Health. Hunter Valley Research Foundation conducts computer assisted telephone interviews with patients. An expert management commit-tee provide oversight.

Participants complete a job and residential history postal questionnaire and are assessed for their past asbestos exposure by telephone interview using OccIDEAS, an online exposure assessment tool. Clinicians are required to advise if their patient is suitable for recruitment to the asbestos exposure component. Detailed information on occupational and environmental asbes-tos exposure can only be obtained if clinicians promptly review and respond to AMR requests.

Results: The AMR became operational in 2011. More than 600 cases of mesothelioma were notifi ed to the Registry in the fi rst year. This number will further increase when supplementary notifi cation processes, including from clinicians, are implemented.

The long latency between fi rst exposure to asbestos and onset of mesothe-lioma is a major reason why incidence is expected to peak over the coming decade. Exposure assessments collected within the AMR framework provide information not previously available, for both occupational and non-occu-pational asbestos exposure. Data will be presented for patients diagnosed in 2011, the fi rst calendar year of data collection.

Conclusions: AMR information will aid federal and state governments to more accurately defi ne the relationship between work and environmental asbestos exposure sources and the development of mesothelioma. It provides a national resource for researchers to identify preventable risk factors and will assist in preventing mesothelioma in the future.

Confl ict of interest: None.

796

DEVELOPMENT OF AN ELECTRONIC PLATFORM FOR PATIENT

SELF-REPORTING OF ADVERSE-EVENTS DURING CANCER

TREATMENT. INVOLVEMENT OF PATIENTS AND PROFESSIONALS

Galina Velikova1, Lucy Ziegler1, Patricia Holch1, Clare Harley2, Ada Keding1, Leon Bamforth1, Kate Absolom1, Lorraine Warrington1, Ceri Hector1

1. Psychosocial Oncology and Clinical Practice Research Group, Leeds, United Kingdom2. School of Healthcare, University of Leeds, Leeds, UK

Background: Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) is a programme aiming to develop and evaluate an online system for cancer patients to self-report treatment adverse

events (AE). The system will allow AE reporting from home/hospital, be integrated into electronic patient records (EPR), generate clinicians’ alerts and provide patient self-management advice.

The development programme aimed to deliver the electronic platform and to review care pathways to explore how eRAPID can be integrated into practice.

Methods: 1. A web-based questionnaire system (QTool) was developed. QTool was integrated into the EPR achieving secure and confi dential data linkage. Usability tests were performed with 9 patient Research Advisory Group members.2. To describe existing care-pathways we performed: interviews with health

professionals (n = 12), chemotherapy patients (n = 20), patients acutely admitted with AEs (n = 27) and an audit of emergency telephone calls triage-forms (n = 180).

Results: 1. Ten-to-fi fteen toxicity items were uploaded on QTool (see www.erapid.leeds.ac.uk), with automated immediate patient advice. Modifi ca-tions were made to content/design following usability tests. A secure ano-nymised interface between QTool and the Leeds-Cancer-Centre EPR (800,000 patients; 2500 users) was developed. The interface underwent 3 iterations of testing to identify errors/usability issues.2. Interviews with oncology professionals mapped the chemotherapy man-

agement/admission pathway and identifi ed training requirements. The audit of patient calls found 40% were 1–7 days post-treatment; common symptoms were pain, nausea/vomiting, temperature/infection, diarrhoea, breathlessness; 48% patients had Grade-1 AE, 14%-Grade-2, 18%-Grade-3; 83% of patients with Grade-3 AE were admitted, whereas 68% with Grade-1 received advice. If half of calls were for Grade-1 AE, and 2/3 didn’t need admission, eRAPID monitoring/advice could reduce this workload and increase the proportion of appropriate calls.

Conclusion: The system is undergoing usability tests in breast cancer patients on chemotherapy. A pilot study in systemic treatment is planned followed by a Randomised-Controlled-Trial to evaluate effi cacy and cost-effi ciency.

797

OPTIMISING CANCER CARE IN VICTORIA: VIEWS AND OPINIONS

FROM CANCER CLINICIANS

Philippa Niven, Victoria WhiteCancer Council Victoria, Melbourne, VIC, Australia

Aim: To investigate cancer clinicians’ opinions regarding the strategies Vic-toria needs to implement to facilitate the delivery of optimal cancer care.

Method: Victorian clinicians treating cancer patients in the previous two years identifi ed through membership lists of the Victorian Clinical Oncology Group, Medical Oncology Group Australia and the Royal Australian and New Zealand College of Radiologists and Victorian Cancer Registry noti-fi cations. Clinicians were approached via email and invited to complete an online survey. The survey assessed views regarding the most important strategies to improve cancer care, and the barriers and enablers to develop-ing/implementing the strategies identifi ed. Clinicians indicated the stage of care when barriers were commonly encountered during their clinical practice.

Results: 196 clinicians completed the survey. Most participants were sur-geons (33%) and medical oncologists (20%) and 11% were radiation oncologists. The strategies considered most important to improve patient care were: ‘IT systems that are compatible across organisations’ (57%), ‘resources to manage volume and direct clinical care demands’ (39%) and ‘access to multidisciplinary team care’ (35%). Most important strategies did not differ by discipline. The main barriers to implementing the different strategies were lack of funding and resources (42%) and staffi ng shortages (29%). 77% of clinicians encountered a signifi cant barrier to care in the week before the survey with 26% reporting a barrier for a few patients and 23% for many patients. Barriers were most commonly encountered in continuity of care/care co-ordination (48%), planning treatment/manage-ment (42%), and preparing to start chemotherapy/radiotherapy (34%).



Conclusion: Clinicians have a clear picture of strategies to improve the care they provide to cancer patients. Future planning efforts should continue to consult clinicians and other medical staff to develop strategies that optimise workloads and improve service delivery to patients. The fi ndings will be used to inform Cancer Council Victoria’s advocacy efforts in improving cancer care.

798

STOP THE SMOKES FOR A HEALTHY BUB: ADDRESSING

SMOKING IN PREGNANT ABORIGINAL AND TORRES STRAIT

ISLANDER WOMEN

Doris Ahmat, Nicole Huxley, Pip YoulCancer Council Queensland, Fortitude Valley, QLD, Australia

Aims: The harm caused by tobacco smoking during pregnancy is well established. Smoking prevalence is three times higher among pregnant Abo-riginal and Torres Strait Islander women compared to non-Indigenous Aus-tralian women (52% v 16%). The project aims to deliver a culturally appropriate, intensive smoking cessation support program to pregnant Abo-riginal and Torres Strait Islander women through Aboriginal Medical Serv-ices (AMS).

Methods: A multi-phased approach is adopted to equip health professionals with the knowledge, confi dence and skills to deliver the program within their communities. Phase one provides a broad overview for AMS staff and community members, including content on nicotine addiction and smoking cessation approaches. Phase two includes additional training in an intensive smoking cessation support program, available to health professionals working directly with pregnant women. Phase three involves the health professionals implementing a culturally appropriate intensive smoking ces-sation support program which will be tailored to their clients and families. Qualitative and quantitative data will capture both process and outcome measures and provide practical recommendations for other working within this sector.

Results: To date, phase one is nearing completion and phase 2 has begun for participating AMS in North and South East Queensland. Ongoing engagement and consultation within these communities continues to identify varying needs and feedback is guiding and informing further development and refi nement of the project.

Conclusions: Building on principles of self-determination, this intensive smoking cessation program aims to empower and build resilience among pregnant Aboriginal and Torres Strait Islander women to overcome tobacco addiction and elicit sustainable health outcomes for these mothers and their babies.

799

FACTORS ASSOCIATED WITH DIAGNOSTIC AND TREATMENT

INTERVALS AND THE TREATMENT RECEIVED BY PROSTATE

CANCER PATIENTS IN QUEENSLAND

Peter D Baade1, Danny R Youlden1, Robert A Gardiner2, Megan Ferguson1, Joanne F Aitken1, John Yaxley3, Suzanne K Chambers4

1. Cancer Council Queensland, Fortitude Valley, QLD, Australia2. University of Queensland Centre for Clinical Research, Royal Brisbane Hospital, Brisbane, Queensland, Australia3. Brisbane Private Hospital, Brisbane, Queensland, Australia4. Griffi th Health Institute, Griffi th University, Brisbane, Queensland, Australia

Aim: To determine the demographic, clinical and quality of life factors that infl uence the time to diagnosis and treatment for men with prostate cancer and the type of treatment that they receive.

Methods: Data were obtained by telephone interviews and self-adminis-tered questionnaires from a prospective sample of 1,064 men (response rate = 82%) who were diagnosed with prostate cancer in Queensland

between 2005 and 2007. Stepwise processes were used to build multivariate models and results were presented in terms of either odds ratios (logistic regression) or adjusted predicted probabilities (multinomial regression).

Results: Men were more likely to wait longer for a defi nitive diagnosis when they initially presented with symptoms or if they did not have private health insurance. The time between diagnosis and treatment was greater for those without private health insurance, who had less advanced cancer at diagno-sis, or who were treated with radiotherapy alone. Patients who had a radical prostatectomy were younger, lived closer to tertiary treatment centres, had lower grade cancers and assessed their physical health as being above average, while androgen deprivation therapy was administered for more advanced disease. Watchful waiting was more common among those who were older, were symptomatic at presentation and who had a Gleason score of 6 or less. Two-thirds of the study cohort made their own decision regard-ing treatment.

Conclusions: Our results demonstrate that some of the disparity in the timeliness of a defi nitive diagnosis and the commencement of treatment for prostate cancer patients is related to clinical factors and access to private health care. Furthermore, health status, proximity to services and tumour characteristics are among the factors that infl uence treatment choices. The fi ndings also highlight the importance of making information regarding the benefi ts and risks of treatment options readily available to guide the deci-sion-making process.

800

GEOGRAPHICAL VARIATION IN SURVIVAL FROM PROSTATE

CANCER IN RELATION TO DISEASE STAGE AT DIAGNOSIS: AN

ANALYSIS OF DATA FROM THE NSW CENTRAL CANCER

REGISTRY

Xue Qin Yu1,2, Qingwei Luo1,3, David P Smith1, Dianne L O’Connell1,2,4,5

1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia2. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia3. PhD candidate, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia4. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia5. School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia

Aims: We reported previously (Jong et al, MJA 2004) that men in rural and remote NSW had lower survival from prostate cancer compared to their metropolitan counterparts. In this study, we used recent data to examine geographical differences in survival from prostate cancer by stage of disease at diagnosis to identify perceived disparities in access to diagnostic and treatment services between geographical areas.

Methods: We obtained data from the NSW Central Cancer Registry for all fi rst primary prostate cancer cases diagnosed in 1999–2007. Stage was clas-sifi ed as localised, non-localised or ‘unknown’. Place of residence at diag-nosis was categorised as major cities, inner regional, rural (including outer regional, remote and very remote) using ARIA+. We estimated cause-specifi c survival and used Cox proportional hazards models to adjust for other factors.

Results: Over 90% of prostate cancer patients were diagnosed with local-ised (48.5%) or ‘unknown’ (41.8%) stage disease. Compared with men in major cities, those living in inner regional and rural areas had poorer overall 8-year survival (83.5%, 79.6%, and 79.4% respectively), a higher propor-tion with ‘unknown’ stage (40.0%, 45.2%, and 45.3% respectively) and a lower proportion with localised stage disease (50.2%, 45.4%, and 44.3% respectively). After adjusting for age and year of diagnosis, and stage of disease, the risk of dying from prostate cancer was signifi cantly higher for cases in inner regional (Hazard Ratio = 1.24, 95% CI: 1.15–1.33) and rural areas (1.17, 1.04–1.31).

Conclusions: Recent data indicate that geographical inequities in prostate cancer survival still persist in NSW: those living in areas outside major cites



had poorer survival. This fi nding in combination with a larger proportion having ‘unknown’ stage recorded in the Cancer Registry suggests that pros-tate cancer patients living in inner regional and rural NSW may have poorer access to specialist healthcare services compared with their counterparts living in major cities.

801

MELANOMA RATES CONTINUE TO INCREASE IN THE ELDERLY:

AN ANALYSIS OF QUEENSLAND MELANOMA INCIDENCE RATES

UP TO 2009

Dannie Zarate, Hazel Harden, Shoni ColquistQueensland Cancer Control Analysis Team, Queensland Health, Brisbane, Queensland, Australia

Background: Queensland has the highest rate of melanoma in the world with nearly 70 cases diagnosed in every 100,000 people each year. While the overall rate has not changed appreciably in recent years, the trends vary considerably by age.

Methods: We used joinpoint regression to analyse trends in the age-specifi c incidence rate of melanoma notifi ed to the Queensland cancer registry from 1990 to 2009.

Results: Three distinct age-related patterns are apparent in the Queensland melanoma rate over the past two decades. In young people below 35 years of age, the rate rose to a peak in the late 1990s but declined steadily since then by 4% per annum to levels similar to those from twenty years ago. In 35–64 year olds, the rate peaked at the end of the 1990s then remained largely unchanged over the following decade. In people aged 65 and over, the rate increased linearly by 2% per annum over the entire period, from 152 per 100,000 in 1990 to 231 per 100,000 in 2009. The patterns are similar for males and females.

Conclusion: Melanoma is becoming less common in young people in Queensland, but this reduction is offset by the increase in melanoma rate in the elderly. Further study is needed to determine if the latter refl ects continuing recalcitrance to sun protection measures in this age group.

802

EFFECTIVE ONLINE DIRECTORY OF AUSTRALIAN CANCER CARE

RESOURCES

Janette Gay1, Gillian Batt1, Katie Armstrong, Laura Wuellner1

1. Cancer Council NSW, Wooloomooloo, NSW, Australia

Background aims: In 2010, Cancer Institute NSW commissioned Cancer Council NSW to undertake a National Cancer Care Directory Project to address concerns raised by health professionals, organisations and the com-munity regarding the quality of Australian cancer resources.

The main purposes were to:

• collect information about Australian cancer resources produced since 2000

• make the data available publicly at www.cancerdirectory.com.au• promote the website as a comprehensive directory that has been popu-

lated by trusted health organisations• undertake an audit (Gap Analysis Report) to analyse gaps and

duplication.

Methods: Cancer Council NSW collected data from more than 80 cancer care organisations, including Cancer Councils, health services, not-for-profi t and government agencies. The publications had to meet strict criteria to ensure only current, quality resources were included. More than 1,400 resources are on the Cancer Directory.

The directory is searchable by variables such as cancer type, audience, format and language. The Gap Analysis compares the extent to which the current publications target:

• the most prevalent cancers• different population groups, and• a variety of formats.

Results: The Gap Analysis Report showed that there are limited resources targeted to men, children and adolescents, and for people with cancer of unknown primary, myeloid, kidney, pancreatic, uterine and endocrine cancers. It also showed that with the exception of breast cancer, resources focusing on treatment management for specifi c cancer types are limited. An extensive number of publications focus on breast and cervical cancers, and some of these resources have a similar target audience, content and format.

Conclusions: The Report recommends sector-wide consultation and col-laboration with stakeholders developing cancer care resources. It also rec-ommends further qualitative research into content needs and the quality of resources to ensure that health professionals and the public have access to the most current, credible resources through the Cancer Directory.

803

EPITHELIAL MESENCHYMAL TRANSITION (EMT) IS INVOLVED IN

THE PROSTATE CANCER RADIATION RESISTANCE

Lei Chang1,2, Peter Graham1,2, Jingli Hao1,2, Jie Ni1,2, Joseph Bucci1,2, Paul Cozzi2,3, John Kearsley1,2, Yong Li1,2

1. Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia2. St George Clinical School, Faculty of Medicine, UNSW, Kensington, NSW, Australia3. Department of Surgery, St George Hospital, Kogarah, NSW, Australia

Aim: Radiation therapy (RT) continues to be one of the most popular treat-ment options for localized prostate cancer (CaP). Understanding the mecha-nisms and signalling pathways of radioresistance will help to overcome recurrence after RT in CaP patients. Our objectives in this study were to developradiation resistant CaP cell lines with RT treatment, investigate whether these radiation resistant cancer cell lines are related with epithelial mesenchymal transition (EMT) and fi nd the mechanisms and signalling pathways involved in redioresistance for future CaP treatment.

Methods: Three CaP cell lines (PC-3, DU145 and LNCaP) were treated by irradiation at a 2 Gy dose each day for 5 consecutive days and the morpho-logical changes of the RT-treated cells were recorded daily with an inverted microscope. The growth of RT-treated and untreated CaP cells were com-pared by a proliferation assay and the expression of EMT markers including E-cadherin, Vimentin, OCT3/4, OCT4 and SOX2 was examined by immu-nocytochemistry and immunofl uorescence, and further confi rmed by Western blotting.

Results: We have developed three radiation resistant CaP cell lines with the morphological changes including loss of glandular pattern, vacuolated cell plasma, pleomorphic nuclei and enlarged size. We found that after 2 Gy/per day for 5 days, the proliferation rate in RT-treated CaP cells was obviously reduced compared to those without RT treatment. The expression of Vimen-tin was increased in RT-treated CaP cells compared to those without RT treatment while the expression of E-cadherin, OCT3/4, OCT4 and SOX2 in RT-treated CaP cells were reduced in RT-treated CaP cells compared to un-treated CaP cells. These results are consistent with previous reports for EMT characteristic in cancer treatment.

Conclusion: With 2 Gy RT, we have developed three radiation resistant CaP cell lines with EMT characteristic which can be used for future in vitro and in vivo studies for CaP diagnosis and treatment.



804

DOCETAXEL BLOOD MANAGEMENT: ANALYTICAL VALIDATION

OF A RAPID AUTOMATED IMMUNOASSAY

Patrick I Cook, Daniel J Cline, Hongxia Zhang, Gregory D Lundell, Rebecca L Harney, Hadia K Riaz, Yunying Li, Jodi B Courtney, Irina Baburina, Salvatore J SalamoneSaladax Biomedical Inc, Bethlehem, PA, United States

Aim: This study was undertaken to validate the fi rst immunoassay for docetaxel (DTX) as a tool for therapeutic dose management. DTX is used in the treatment of many solid tumors and presents a high risk of dose-limiting toxicity. Both pharmacokinetic variability and the association of total exposure with major toxicity have been reported, suggesting therapeu-tic DTX dose management could benefi t patients. The current physical methods for measuring DTX have limited application due to cost, availabil-ity and required operator expertise.

Methods: The DTX immunoassay (MyDocetaxel™) developed by Saladax uses a nanoparticle method with a highly selective antibody and can be run on a wide array of clinical chemistry analyzers. The Beckman AU400 and Roche COBAS c111 were used in this study. Performance was evaluated according to CLSI protocols in our laboratory. Precision, accuracy and linearity were validated at 3 external laboratories using the same protocols. Method comparison was performed versus a validated LC-MS/MS method using patient samples (n = 89) collected in accordance with IRB approved protocols. These samples, taken at the end of infusion and/or 1 hour post-infusion, may be used to calculate drug exposure.

Results: Linearity was validated from 30 ng/mL to 1000 ng/mL. Internal studies established the lower limits of detection and quantitation as 21 ng/mL and 29 ng/mL, respectively. There was no clinically signifi cant bias from co-administered drugs, related compounds or major metabolite. A Deming regression for the method comparison between the immunoassay and LC-MS/MS generated a slope of 0.978 with a y intercept of −1.18 ng/mL and a correlation coeffi cient of 0.9980. For all control concentrations and three patient pools, repeatability was <4% and within-laboratory impreci-sion was <6%.

Conclusion: With the validation of an immunoassay method, docetaxel testing could gain wider acceptance for individualizing patient dosing with the goal of controlling toxic side effects associated with treatment.

805

THE CONSUMER ROLE IN INNOVATION IN CANCER TREATMENT

AND CARE

Kathy Smith, Sally Crossing AMCancer Voices NSW, Sydney, NSW, Australia

Cancer Voices’ action relates to policy and service innovation or improve-ment, and also to ‘on the ground’ issues experienced by our members and others – their carers, friends and families.

Cancer Voices NSW (CVN), the peak independent organisation for people affected by cancer in NSW, works closely decision-making organisations makers which are able to make a difference for those we represent. This is to ensure that the informed consumer voice is heard, especially when advo-cating for innovative improvements in cancer treatment and care. Examples being:

• Linking consumers through the CVN rural and remote Area Cancer Services Program, now LHDs, to facilitate attention to their local service and support issues.

• Advocating for and participating in the development of a consumer initi-ated directory to fi nd cancer specialists associated with multidisciplinary teams, CanRefer

• Successfully advocating for funding of regional cancer centres and par-ticipation in their planning and development – eg Central Coast

• Gaining commitment by the NSW Minister for Health through a public campaign, to review, reform and refund palliative care services in NSW

• Developing (with the Cancer Council NSW) a Consumer Advocacy Train-ing program to enable meaningful engagement in the fi ght to improve cancer rates of survival, treatment, care and systems.

• Developing (also with the Cancer Council NSW) a Consumers in Research Training Program. CVN ensures graduates have the opportunity to apply their expertise by developing a ‘matchmaking’ service for institutions/committees seeking valuable consumer input to their projects. This service has been very successful; to date there are 83 research projects within 21 organisations for which CVN provides consumer input.

806

‘KNOWLEDGE IS POWER’: COPING WITH THE RISK AND

UNCERTAINTY OF FAMILIAL BREAST CANCER

Louise E Heiniger, Melanie A Price, Margaret Charles, Phyllis N ButowUniversity of Sydney, NSW, Australia

Background: Studies of how individuals living with increased risk for disease cope with being ‘at risk’ regard optimal psychosocial functioning as evidence of adaptation, yet the strategies and processes that precede adapta-tion have been predominantly unexplored. This study investigated social, cognitive and behavioural efforts to adapt to familial risk of breast cancer in a sample of unaffected women.

Method: Adopting a Grounded Theory approach to data collection and analysis, semi-structured interviews with 27 women enrolled in the Kathleen Cuningham Consortium for Research into Familial breast cancer (kConFab) psychosocial study explored women’s understanding of their risk and their experiences in adapting to familial risk. Participants were sampled to include a range of genetic testing statuses (tested, eligible untested and ineli-gible for testing) and patterns of distress (identifi ed from existing quantita-tive data).

Results: Two themes – risk identity and managing uncertainty and risk – illustrated the approaches adopted by women in attempts to cope with being at risk, and a number of personal, family and healthcare characteristics that facilitated and challenged adaptation were identifi ed. Knowledge of familial risk was seen as an opportunity to engage proactive strategies, while sub-conscious use of social comparisons, intuition and desensitisation facilitated the integration of ‘being at risk’ into self concept. The impact and experi-ences related to familial breast cancer shaped women’s perceptions of risk and their ability to adapt, as did confi dence in healthcare. Most regarded personal satisfaction with risk management efforts, acceptance and a ‘day-by-day’ attitude as crucial to maintaining a positive outlook. A range of views on the value of genetic testing emerged and adaptation was facilitated through preservation of autonomy and provision of information in a manner appropriate to the individual’s needs.

Conclusion: At-risk women adopt strategies for coping with increased risk to match their personal and social resources. These fi ndings will be used to guide the development of interventions for and communication with indi-viduals at increased risk who experience diffi culty adapting to this knowledge.

807

SURVEILLANCE OF STAGE III COLON CANCER IN SOUTH

WEST SYDNEY

Florian HoneyballSydney South West LHD – Campbelltown Hospital, Campbelltown, NSW, Australia

Aims: The investigators aim is to determine whether there is a difference in SWS between current patterns of care and NHMRC recommendations. Secondary outcomes will include whether there is any difference between recurrence rates or death rates in those who had follow up according to guidelines and those who did not, and whether distance from hospital, age or CALD status impacted on pattern of care.



Method: Patients with stage III colon cancer who were treated in a large, multiple surgeon run clinic rooms were identifi ed from those discussed at a large tertiary referral centre Colorectal Cancer Multidisciplinary Meeting between Jan 2007 and Dec 2009. In the immediate 5 year postoperative surveillance period, CEA measurements, colonoscopies and CT scans for each of these patients were obtained both from private clinic records, outside pathology and hospital records for the 24 patients identifi ed who met the inclusion criteria. This project is ongoing, and we aim to identify approximately 50 patients by November. The frequency of each was then compared to NHMRC guidelines to assess whether current patterns of care refl ect current recommendations. Language spoken, home suburb, recur-rences and deaths were also noted.

Results: Following a median follow up period of 4.5 years, 20 from 24 (86%) patients were followed up for history and examination in the appro-priate timeframes. However, only 8 (33%) of the cohort had CEA measure-ment every 6 months or less as suggested by NHMRC guidelines (this does increase to 14 (58%) allowing for one late or missed measurement). As could be expected in such a population, at the time of analysis 10 of the 24 (42%) had evidence of a recurrence, and 2 of these had died from their colon cancer. There is a correlation between CEA measurement and rate of recurrence (chi-square 10.4, p = 0.001), however our numbers are too small to determine whether this translates to a reduction in death rate. There was no difference in rates of surveillance based on the patient factors analysed.

808

THE DEVELOPMENT OF AN INTERNATIONALLY-VALID CANCER-

SPECIFIC MULTI-ATTRIBUTE UTILITY INSTRUMENT (MAUI) FROM

THE EORTC CORE HEALTH-RELATED QUALITY OF LIFE (HRQOL)

QUESTIONNAIRE, QLQ-C30

Madeleine T King1, Daniel SJ Costa1, Neil K Aaronson2, John E Brazier3, David Cella4, Peter M Fayers5, Julie F Pallant6, Stuart Peacock7, Simon Pickard8, Donna Rowen3, Galina Velikova9, Tracey Young3, on behalf of the MAUCa Consortium1

1. University of Sydney, NSW, Australia2. Netherlands Cancer Institute, Amsterdam, Netherlands3. University of Sheffi eld, Sheffi eld, UK4. Northwestern University, Chicago, USA5. University of Aberdeen, Aberdeen, UK6. University of Melbourne, Melbourne, Australia7. Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada8. University of Illinois at Chicago, Chicago, USA9. University of Leeds, Leeds, UK

Objectives: Preference-based measures have been derived from various descriptive HRQOL measures. A general 2-stage method has evolved: 1) an item from each domain of the HRQOL measure is selected to form a health state classifi cation system (HSCS); 2) a sample of health states is valued and an algorithm derived for estimating the utility of all possible health states. The outputs of these two stages represent a MAUI. Our aim was to adapt the fi rst stage for the widely-used cancer-specifi c QLQ-C30, and apply it to a large, heterogeneous, international dataset as the fi rst step in developing an internationally-valid cancer-specifi c MAUI.

Methods: Secondary analyses were conducted on a pooled dataset compris-ing QLQ-C30 responses plus demographic and clinical data from 2616 patients from eight countries, over 14 cancer sites, all stages, and all common cancer treatments. The established domain structure of the QLQ-C30 (physical, role, emotional, social and cognitive functioning, plus several symptoms) formed the underlying conceptual model for the MAUI. Generalisability of the conceptual model across cancer sites was tested with multi-group CFA. Items within each domain were then subjected to statisti-cal scrutiny, including Rasch analysis for domains with suffi cient items.

Results: CFA results supported the proposed conceptual model and its generalisability across cancer sites. Two items exhibited fl oor effects (>75% observations at lowest score), none exhibited misfi t to the Rasch model, one

exhibited disordered item response thresholds, and two exhibited differen-tial item function by cancer site. These results, along with results for responsiveness and qualitative patient input (analyses underway) will be presented.

Conclusions: The next stage of this research will obtain valuations for a range of health states defi ned by the HSCS from general population samples in various countries. The ability to determine a preference-based utility score from QLQ-C30 responses will facilitate cost-utility analysis in cancer trials which use the QLQ-C30.

809

CORRELATION OF GRADE & HORMONE-RECEPTOR STATUS WITH

STAGE IN NODE-POSITIVE, NON-METASTATIC BREAST CANCER

Stephanie Lim1, Joseph Descallar2,3, Phan Sayaloune1, Geoff Delaney1,2,3,4,5, George Papadatos1,4, Paul de Souza1,2,3,4,5

1. Department of Medical Oncology, Liverpool and Campbelltown Hospitals, NSW, Australia2. Sydney South West Clinical School, University of NSW, Liverpool, Australia3. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia4. Cancer Services, South Western Sydney Local Health District, Liverpool, Australia5. University of Western Sydney, School of Medicine, Molecular Medicine Research Group, Liverpool, Australia

Background: Features that infl uence treatment in non-metastatic breast cancer include tumour size, positive nodes, age, grade, hormone-receptor and Her-2 status. Larger cancers, positive nodes, higher grade and receptor negativity lead to worse outcome. TNM staging takes into account the fi rst two variables. Correlation of grade and receptor status with stage is not well-documented. Studies suggest grade to correlate with stage and Her-2, however correlation of hormone-receptor status and stage is less clear. The aims of this study were to explore how grade and hormone-receptor status correlate with stage in node-positive non-metastatic breast cancer.

Methods: A retrospective review of patients referred to Liverpool and Macarthur Cancer Centres with node-positive non-metastatic breast cancer, diagnosed from January 2003 to November 2006. Variables examined included tumour size, number of positive nodes, grade, hormone-receptor status, age and race. We examined correlation of grade and receptor status with stage II and III cancers using the Chi-squared test and performed a multivariate analysis of variables for disease-free survival.

Results: Total number of patients was 644, median follow-up 6.1 years, age 52.5 years, disease-free survival 148 months and overall survival 177 months. Grade 1, 2, 3 tumours comprised 20%, 40% and 40%. Receptor positive, stage II, stage III tumours were 79%, 66% and 34%. Grade cor-related with stage (χ2 p-value 0.004), with 35% grade 3 and 24% grade 1 tumours in stage II; and 42% grade 3 and 13% grade 1 in stage III. Hor-mone-receptor status correlated with stage (χ2 p-value 0.014), with 16% receptor negative tumours in stage II and 24% in stage III. Multivariate analysis revealed larger size, more positive nodes, higher grade and negative hormone-receptor status to be associated with lower disease-free survival.

Conclusion: Disease-free survival factors and outcomes are consistent with published literature. Tumour grade and hormone-receptor status correlated with stage, with larger proportion of higher grade and receptor negative tumours in stage III than II. Future studies would validate these fi ndings in a larger cohort and explore correlation with Her-2.



810

ARGININE DEPRIVATION UNVEILS SPECIFIC SURFACE MARKERS

OF APOPTOTIC LEUKEMIC CELLS

Liliana Lyniv, Marina Barska, Oleh StasykInstitute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Lviv, Ukraine

Recombinant arginine-degrading enzymes, as a basis of metabolic enzymo-therapy, embrace a good capacity to be translated in an suffi cient anticancer treatment. Among types of tumors auxotrophic for arginine, fully dependent on its exogenous supply and sensitive to arginine starvation are many those, for which currently no effi cient cure exists, such as melanomas, hepatocar-cinomas, mesotheliomas, renal and prostate carcinomas. Nevertheless, there are no literature data concerning the effect of arginine starvation on exposi-tion of carbohydrate moieties of tumor cell surface.

We demonstrated that human leukemic Jurkat cells are auxotrophic for arginine as its precursors, ornithine and citrulline, are unable to support their proliferation under arginine withdrawal. Jurkat cells appeared to be very sensitive to arginine deprivation and were unable to restore their pro-liferation when shifted to fresh complete medium already after 24 hours of arginine starvation. When starved for arginine in a defi ned medium, viability of Jurkat cells progressively decreased, and early signs of apoptosis were evident.

Prolonged arginine limitation in humans may lead to hart disorder, vaso-constriction and thrombosis due to the defi cit of NO as vasodilator and disaggregant. In our opinion, application of exogenous NO donor, as sodium nitroprusside (SNP), in vivo could diminish some side-effects of arginine deprivation. We also demonstrated that SNP at very low concentra-tions negatively affects Jurkat cells viability and arginine deprivation ele-vates its cytotoxicity. At 24, 48, and 72 h of incubation, the estimated SNP IC50 in CM were 3.0, 0.5 and 0.1 mM respectively. In AFM, the SNP IC50 for Jurkat cells was signifi cantly lower relative to IC50 in arginine-rich medium: 0.7, 0.1 and 0.02 mM, corresponding to 24, 48, and 72 h of incubation.

Decreased viability of Jurkat cells under arginine deprivation was accompa-nied by decreased binding of SNA lectin complemented to N-acetyl-neuraminic acid on the surface of Jurkat cells. The alteration refl ected the situation observed for UV-induced apoptotic. Thus, arginine starvation effi -ciently induced demasking of specifi c apoptotic cells surface markers of leukemic cells, thereby potentially triggering the host immune response.

811

DEVELOPMENT OF A SURVIVORSHIP PROJECT – ‘POSITIVE

CHANGE FOR LIFE’

Helen Mclauchlan1, Sara Andrews1, Sue Liersch2, Sharon Avery3

1. Leukaemia Foundation, Melbourne, Australia2. Southern Melbourne Integrated Cancer Service, East Bentleigh, Vic, Australia3. Alfred Health, Melbourne, Australia

Aim: Lifestyle modifi cation is an increasingly important component of cancer survivorship to ameliorate the effects of treatment, minimise co-morbidities and promote long-term wellness. Although curative for many people with blood cancer, stem cell transplant (SCT) survivors often carry a burden of associated morbidity. Within an established Late Effects Clinic, a high prevalence of obesity (60%), hypertension (51%), elevated triglycer-ides (55%) and smoking (14%) has been identifi ed. Survivors are also at risk of osteoporosis with 59% having low bone mineral density and increased fracture risk. Lifestyle modifi cation focusing on nutrition and physical activity has the potential to impact substantially on these cardio-vascular and bone health risk factors.

The aim of this project is to provide a range of community-based physical activities, support and education opportunities to enable survivors, at any

fi tness level, to develop lifelong healthy eating and physical activity patterns to benefi t health, wellbeing and quality of life.

Method: Autologous or allogeneic SCT survivors (≥2 years in ongoing remission) attending the Late Effects Clinic are offered the opportunity to participate in the ‘Positive Change for Life’ project. Each participant enters a 12 month program integrating the key components of dietary advice, tailored individual and group physical activity, motivational strategies and GP support.

Results: Recruitment and data collection has commenced. Changes from baseline over time for dimensions of interest relating to anthropometric measurements, laboratory parameters and questionnaire items relating to quality of life, barriers to physical activity, leisure time exercise habits, dietary intake and fatigue will be assessed.

Conclusion: The completion of cancer treatment can represent an opportu-nity to make changes to improve health and wellbeing. A critical need for SCT survivors to address lifestyle has been identifi ed. Regular exercise, good nutrition and maintaining a healthy weight are all strategies that may improve health, wellbeing and quality of life for long-term survivors of curative SCT.

812

ENGAGING YOUTH IN REDUCING THE BURDEN OF LIVER CANCER

IN CULTURALLY AND LINGUISTICALLY DIVERSE (CALD)

COMMUNITIES

Mamta Porwal1, Barbara Hillman2, Matthew Russel2, Monica Robotin1

1. Cancer Council NSW, Woolloomooloo, NSW, Australia2. Cabramatta Community Centre, Sydney, NSW, Australia

Background: In NSW hepatocellular cancer (HCC) incidence is rising faster than any other cancer, particularly among migrants born in countries of high hepatitis B (HBV) prevalence. As chronic hepatitis B (CHB) treatment can effectively prevent HCC, low community awareness and stigma related to these diagnoses represent missed opportunities for cancer control. Earlier this year we conducted a CHB awareness survey among participants at the ‘Bring It on’ Youth Festival, which identifi ed common misconceptions about CHB disease causation. As youth were more knowledgeable about HBV than the older population, we propose to collaborate with community organisations in Fairfi eld City to make CALD youth (people aged between 14–24 years old) aware and committed to raising community awareness of HBV and HCC, while providing them with opportunities to attain skills in digital media.

Methods: Youth will be identifi ed through community networks and offered opportunities for training in developing short-fi lms. They will be coached on HBV and develop community messages about HBV and HCC, which will be incorporated into developing short fi lms addressing HBV related stigma, myths and misconceptions about cancer in CALD communi-ties. The short fi lms will be entered into the popular ‘SHORTCUTS Film Festival’ hosted by Fairfi eld City in 2013 and screened at the Bring It on Festival in 2013

Results: The publicity surrounding both events will be used to foster com-munity dialogue about HBV and cancer prevention and discussions around CHB and HCC and a repeat knowledge survey will be distributed following the screening of the fi lms, to ascertain changes from baseline.

Conclusion: Engaging youth via digital media will cultivate a dialogue on stigmatising disease and address gaps in liver cancer information in CALD communities.



813

DIFFERENTIAL EFFECTIVENESS OF FAMILY AND FRIENDS IN THE

PROMOTION OF HEALTHY LIFESTYLE BEHAVIOURS AMONG

ADOLESCENTS

Ivanka Prichard1,2, Amanda D Hutchinson1,2, Carlene Wilson1,2

1. Flinders University, Adelaide, SA, Australia2. Cancer Council SA, Adelaide, SA, Australia

Aims: The study assessed the differential infl uences of social support from family and friends on the physical activity and fruit and vegetable consump-tion of adolescent boys and girls. Both lifestyle choices have implications for health and play a role in the prevention of obesity and cancers.

Methods: Participants (313 12–14 year old boys and girls, Mage = 12.87 years) recruited from 4 secondary schools in metropolitan South Australia completed a questionnaire measuring physical activity, diet and social support. The planned accrual target was 400.

Results: Boys participated in signifi cantly more exercise each week than girls (M = 634.19, SD = 666.68; M = 433.21, SD = 351.13 mins respec-tively), t(155) = 2.30, p = 0.023. Girls reported a greater amount of social support for exercising than boys, t(155) = 1.99, p = 0.048. There were no other signifi cant differences between genders on measures of social support from friends and family or types of food consumed (all t’s < 1.79, p > 0.079). For boys, there was a signifi cant relationship between social support from family and amount of exercise, r(117) = 0.22, p < 0.05, but not for social support from friends and amount of exercise r(117) = 0.09, p > 0.05. Boys also ate signifi cantly more fruit/vegetables when they felt supported in this behaviour by their families, r(117) = 0.26, p < 0.01. For girls, there were no signifi cant relationships between social support from friends/family and exercise or fruit/vegetable consumption (all r’s < 0.13, p > 0.10). For both genders, actual consumption of snack/fast food was signifi cantly related to perceptions of their best friend’s consumption (boys: r = 0.77, p = 0.000, girls: r = 0.67, p = 0.000).

Conclusion: Adolescent boys increase their exercise and healthy eating behaviour when they feel support from their families but not their friends, whereas girls are infl uenced by neither. All adolescents reported an associa-tion between their and their friend’s consumption of unhealthy foods. This suggests that, in this age group, modelling may be a better strategy to improve healthy food consumption than social support, especially for girls.

814

RADIOEMBOLIZATION WITH YTTRIUM-90 MICROSPHERES IS

ASSOCIATED WITH A SIGNIFICANTLY IMPROVED SURVIVAL

COMPARED TO CONSERVATIVE THERAPY AFTER TREATMENT OF

HEPATIC TUMORS: A LARGE SINGLE CENTER EXPERIENCE OF 537

PATIENTS

Akshat Saxena1, Baerbel Meteling, Lourens Bester1. UNSW Department of Surgery, Kogarah, NSW, Australia

Introduction: Several studies have demonstrated the effi cacy of yttrium-90 radioembolization in the treatment of both primary and secondary hepatic malignancies. There is, however, a paucity of literature comparing the out-comes of patients who, after initial evaluation, proceeded with yttrium-90 radioembolization and those who were managed more conservatively.

Methods: Five-hundred and thirty-seven patients underwent initial evalua-tion for 90Y radioembolization; of these, 422 patients were suitable for treatment with 90Y radioembolization (Group 1) and the remaining 115 were not (Group 2). The most frequent pathological diagnosis was colorec-tal cancer (n = 287). Patient, pathological and treatment characteristics were compared between the two groups using t-test and chi-square analysis, where appropriate. Survival outcomes were evaluated using the Kaplan-Meier method and compared using the log-rank test.

Results: The median length of follow-up for all patients after initial evalu-ation was 11.5 months (range, 2 to 59). Median survival of patients who

received 90Y therapy was 10.5 months with a 1- and 3-year survival of 44% and 20%, respectively. Median survival of patients not treated with 90Y radioembolization was 4.0 months with a 1- and 3-year survival of 29% and 15%, respectively. This was statistically signifi cant (p < 0.001). In patients with colorectal cancer, median survival in patients treated with and without 90Y radioembolization was 11.4 and 6.7 months, respectively (p = 0.003). In patients with non-colorectal cancer, median survival in patients treated with and without 90Y radioembolization was 9.1 months and 2.5 months, respectively (p < 0.001).

Conclusion: These data suggest that 90Y radioembolization is associated with a signifi cantly improved survival in patients’ referred for an initial evaluation. Whilst confounding factors may play a role, offering this treat-ment may confer the best prognosis.

815

INCIDENCE OF ACUTE PHASE REACTIONS (APRS) IN PATIENTS

WITH ADVANCED CANCER OR MULTIPLE MYELOMA (MM) AND

BONE METASTASES/LESIONS FOLLOWING TREATMENT WITH

DENOSUMAB OR ZOLEDRONIC ACID (ZA)

Nina Singh1, Cynthia Campbell-Baird RN2, Hans Polderdijk3, Stacey Harrelson4, Judith Buechel5, Tap Maniar6

1. Sydney Haematology and Oncology Clinics Clinical Trials Unit, Sydney Adventist Hospital, Wahroonga, NSW, Australia2. Penn State Milton S. Hershey Medical Center, Hershey, PA, USA3. HagaZiekenhuis-Leyenburg, Den Haag, Netherlands4. Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA5. Haematology and Oncology, Innsbruck University Hospital, Inssbruck, Austria6. Amgen Inc., Thousand Oaks, CA, USA

Background/aim: Patients with advanced solid tumours and bone metas-tases frequently develop skeletal-related events (SREs). Results from a pre-planned, integrated analysis of 3 identically-designed, randomised phase 3 trials showed that denosumab is superior to ZA in preventing SREs in patients with advanced cancer and bone metastases. Furthermore, APRs – a fl u-like syndrome – are potentially distressing adverse events (AEs) com-monly associated with intravenous ZA therapy.1 Here we compare the subject incidence of AEs relating to APRs with either denosumab or ZA during the fi rst 3 days after initial treatment.

Methodology: Patients with advanced solid tumours and bone metastases were randomised 1:1 to receive subcutaneous denosumab 120 mg or intra-venous ZA 4 mg (adjusted for renal function) every 4 weeks in double-blind fashion. Daily calcium and vitamin D supplementation was recommended. The safety analysis was conducted in patients receiving ≥1 dose of deno-sumab (n = 2841) or ZA (n = 2836). Investigator-reported AEs potentially relating to APRs were aggregated using 37 pre-specifi ed MedDRA 12.1 preferred terms.

Results: Incidence of APRs was 8.7% (n = 246) with denosumab and 20.2% (n = 572) with ZA, a 57% relative reduction. APR-related AEs were generally reported less frequently with denosumab than ZA (pyrexia [0.6% denosumab, 7.2% ZA], fatigue [1.7% denosumab, 2.5% ZA], bone pain [1.1% denosumab, 2.4% ZA], arthralgia [1.1% denosumab, 2.2% ZA], and chills [0.1% denosumab, 2.0% ZA]). Incidence of serious AEs associ-ated with APRs was <0.1% (n = 2) for denosumab and 0.6% (n = 17) for ZA.

Conclusion: Denosumab was associated with signifi cantly fewer APRs com-pared with ZA (p < 0.0001) in patients with advanced cancer and bone metastases. Fewer APRs may result in a better patient experience and improved compliance.

Study and writing supported by Amgen.

Reference

1. Diel et al. J Support Oncol 2007.



816

AFTER TREATMENT: PROFILE AND PREDICTORS OF LONG-TERM

MORBIDITY IN BREAST CANCER SURVIVORS

Yuan Tian1, Penelope Schofi eld2, Karla Gough2, Gregory B Mann1,3

1. University of Melbourne, Parkville, VIC, Australia2. Nursing & Supportive Care, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia3. Breast Service, Royal Melbourne & Women’s Hospitals, Parkville, VIC, Australia

In light of the rapid evolvements in breast cancer treatment in recent decades, doctors and patients need to weigh the potential risks against the likely benefi ts when making treatment decisions. There is evidence of a substantial amount of underappreciated medium- and long-term morbidity associated with breast cancer treatment. A cross-sectional cohort study was conducted to determine the prevalence and severity of persistent functional decrements and symptoms experienced by breast cancer survivors and in doing so, identify variables associated with poorer health-related quality of life (HRQoL) outcomes. 400 English-speaking women treated for DCIS or stage I-III breast cancer between 1999 and 2009, at least 12 months after surgery and currently disease free were randomly selected and invited to complete 1) the Breast Cancer Treatment Outcome Scale (BCTOS) and 2) European Organization for Research and Treatment of Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30). The response rate was 85.60%. Moderate to severe decrements in HRQoL domains including functional wellbeing (15%), cosmetic status (32%) and overall quality of life (21%) were found. There were strong associations (all p < 0.05) between younger age and poorer HRQoL. There were no signifi cant associa-tions between time since surgery and morbidity (all p > 0.05). Those with higher stage disease had poorer scores in both cosmetic status and breast specifi c pain. Different treatments were associated with different impacts on the participants’ HRQoL. Patients who had undergone axillary dissection reported poorer functional status when compared to those who had sentinel node biopsy or no axillary surgery (p < 0.05). Adjuvant radiotherapy was a signifi cant predictor of breast specifi c pain (p < 0.05). Apart from poorer perceptions of body image (p < 0.05), patients who had undergone mastec-tomy reported a similar level of HRQoL compared to those who had breast conserving surgery. Overall, a signifi cant proportion of breast cancer survi-vors have long-term physical morbidity. Signifi cant association between locoregional therapies and poorer HRQoL outcomes stress the importance of tailoring locoregional therapy.

817

‘90 MINUTES’ INFORMATION SESSIONS SUPPORTING CARERS OF

PEOPLE WITH LIFE THREATENING ILLNESSES – A PILOT STUDY

Marion Innes, Gini AdcockYarra Ranges Health, Lilydale, Vic, Australia

Introduction: The needs of carers of people with life threatening illnesses are largely unexplored in the health system. This pilot program aimed to determine the potential impact of ‘90 minutes’ sessions to provide support to carers. ‘90 Minutes’ sessions were based upon an intervention for carers of people attending palliative care services in London.

Methods: 13 carers of patients with life threatening illnesses were recruited from the Palliative Care Outpatient Clinic and Day Oncology Centre. Six closed group sessions of ‘90 Minutes’ were conducted over consecutive weeks, facilitated by a social worker and occupational therapist. Emphasis was placed on developing group cohesion through discussion, ownership, mutual support, and opportunities for socialisation. The education sessions were presented by expert speakers, designed to legitimise participants’ reasons for leaving their care recipient. Group outcomes were assessed using a survey completed by participants on completion of the program, and observations of the group facilitators.

Results: Participants comprised 9 partners, 1 ex-wife, 2 parents and 1 daughter-in-law. One participant did not complete the program. Participants

reported a range of benefi ts including: speaking with health professionals without the patients, validation of their feelings, reduced isolation and sharing strategies and experiences with others in a non-judgemental environ-ment. The end of life discussion was reported to be the most valuable by participants. Participants chose to continue meeting and formed an ongoing support group over 2 months. Health professionals facilitating the group also gained a clearer understanding of patients’ needs through contact with their carers.

Conclusions: The ‘90 minutes’ program confi rmed that the six psychosocial and educational sessions were an effective intervention in providing benefi ts to carers of people with life threatening conditions. The informal group structure enabled carers to identify with each other and validate their feel-ings. Further research to formally evaluate this intervention is warranted.

818

THE ‘BRIDGE OF SUPPORT’, AN INNOVATIVE PROGRAM

BRINGING PEER SUPPORT TO THE HOSPITAL SETTING

A Amos1, H Shepherd1, F McRae1, J Rigby1, B Flanagan2, K Shanahan2, GB Mann2, D Missen1

1. Women’s Health Victoria, Melbourne, VIC, Australia2. The Royal Melbourne Hospital, Parkville, Victoria, Australia

The Bridge of Support pilot aimed to explore the feasibility, acceptability and effectiveness of providing peer support in the acute setting for women with breast cancer. The pilot operated from April 2010 to December 2011 and was delivered by trained BreaCan peer support volunteers, all with a personal experience of breast cancer and a minimum of three years experience at BreaCan supported by a BreaCan staff member. A weekly peer support session was provided to the breast service of the Royal Melbourne and Royal Women’s Hospitals. 427 contacts were recorded with 191 individuals includ-ing 146 women with breast cancer and 45 other people, primarily partners and family members. This represents an estimated reach of 46% of individual women seen by the breast service in the same period. An equitable, accessible service was refl ected by 48% of Bridge of Support contacts being with women from non-Main English speaking countries (compared with 17% in Victoria overall). A successful bridge to community-based information and support was demonstrated through 79% of women having further contact with BreaCan including 410 individual contacts (peer support and foot refl exology) and 119 group contacts (information and exercise sessions). Evaluation of the pilot project indicated a high level of satisfaction with the service of women, the peer support volunteers, staff of the breast service and BreaCan staff. Key themes identifi ed were the importance of peer support in normalising experi-ences; having someone who’s walked a similar path – an understanding, listen-ing ear; providing hope and confi dence to commence or continue with treatment. This highly successful acute-community sector partnership demon-strates how the medical and social models of health can work in harmony to provide a connected and high quality service for women. The successful partnership continues and BreaCan is developing a strategy to expand the service to other hospitals in Victoria.

819

AN INDIVIDUALISED GROUP BASED EXERCISE INTERVENTION IS

ASSOCIATED WITH IMPROVEMENTS IN FUNCTIONAL

PERFORMANCE, QUALITY OF LIFE, AND FATIGUE IN ADULTS

WITH CANCER

Morgan Atkinson1, Michael Osborn2,3

1. Centre for Physical Activity in Ageing, Hampstead Rehabilitation Centre, Royal Adelaide Hospital, Northfi eld, Australia2. Youth Cancer Service SA/NT, Adelaide, Australia3. Department of Clinical Haematology and Oncology, Women’s and Children’s Hospital, North Adelaide, Australia

Cancer and its treatment are frequently associated with impaired physical fi tness which often persists into survivorship. Physical impairments



including muscle atrophy, excessive weight gain or weight loss, reduced joint range of motion and cancer-related fatigue are commonly reported side effects of cancer therapy. These symptoms often impact considerably on activities of daily living and quality of life. We evaluated the effectiveness of a group based exercise intervention on functional capacity, quality of life and fatigue in cancer patients.

We developed a group based exercise intervention for cancer patients who were either undergoing or had recently completed therapy for cancer. Participants were encouraged to attend 2–3 sessions per week at our hospital based gym-nasium under close supervision by an Exercise Physiologist. Exercise programs were goal orientated and tailored to the needs of each individual. Outcome measures included Ferran’s and Power’s Quality of Life Assessment, Revised Piper Fatigue Scale, the Australian Functional Fitness Norms and Fullarton’s Functional Assessment for Older Adults. Paired t-tests were used to compare results prior to commencing and after completing the programme.

296 cancer patients were enrolled between 2008 and 2012. 153 were male and 143 female with a range of cancer diagnoses. The median age was 57 years. 186 (63%) completed the 10 wk intervention. Highly signifi cant improvements were observed in quality of life scores (Mean (± SD) = 20.5 (± 4.2) pre-intervention vs 22.8 (± 3.7) post-intervention, p < 0.0001), Piper fatigue scores (5.0 (± 1.9) pre-intervention vs 3.2 (± 2.0) post-intervention; p < 0.0001), and in 14 of the 15 functional assessment measures.

In conclusion, the improvement in functional assessment measures indicates that the programme improves functional capacity, at least in the short-term. Furthermore, the improvements in fatigue levels and quality of life suggest that the benefi ts of an exercise programme extend beyond just physical fi tness for cancer patients.

820

A PILOT STUDY OF THE EFFECTIVENESS OF A PRE-OPERATIVE

SUPPORTIVE CARE EDUCATION AND COUNSELLING

INTERVENTION FOR PATIENTS UNDERGOING MAJOR HEAD AND

NECK CANCER SURGERY

Penny Chapman, Sarah McDonald, Laurelle Stalker, Andrew Badcoe, Carrie Lethborg, John Santamaria, Bernard LyonsSt Vincent’s Hospital, Fitzroy, Vic, Australia

Background: Surgical treatment of head and neck cancer is complex, and recovery involves signifi cant physiological, functional, social and psycho-logical challenges. Patient education, information and counselling are criti-cal components of supportive care during the recovery period.1 Anecdotal evidence suggests that patients may adjust better to these challenges when education and counselling is initiated pre-operatively by a multidisciplinary team.

Aim: To assess the effectiveness of a semi-structured, multidisciplinary Pre-operative Supportive Care Education and Counselling Intervention (PSC-ECI) for patients undergoing major head and neck cancer.

Methods: 60 eligible surgical patients were recruited and randomly assigned to a control (n = 30) or intervention (n = 30) group. The intervention group received the PSC-ECI via a tandem meeting with a speech pathologist, nurse coordinator or social worker. The control group received standard care. For both, pre- and post-measures of psychosocial distress were obtained using a Distress Thermometer2. Qualitative feedback was obtained via a 6 week post surgery questionnaire.

Results: 40 complete data sets were obtained – 20 from control and 20 from the intervention group. Post-operative distress scores were 1 point lower in the intervention group compared to the control. A majority of the intervention group valued the PSC-ECI. The semi-structured, multidiscipli-nary approach was highly valued overall. 19% of the control and 24% of the intervention group reported not being prepared for surgery. A diversity of post-operative adjustment issues and supports were reported across both groups.

Signifi cance: Despite ambiguity in the results, semi-structured pre-operative education and counselling appears to somewhat reduce adjustment issues encountered post surgery. Findings have confi rmed the value of the PSC-ECI

in preparing patients for recovery challenges and optimising longer term adjustment. They have substantially informed clinical practice and prompted ongoing multidisciplinary pre-operative interventions following the pilot. A larger study involving the PSC-ECI is likely to help clarify ambiguous fi nd-ings, identify its benefi cial components for specifi c patient sub-groups of head and neck cancer patients, and further target its delivery.

References

1. Ziegler L, Newell R, Stafford N & Lewin R. (1998) A literature review of head and neck cancer patients information needs, experiences and views regarding decision-making. European Journal of Cancer Care 13, 119–126.

2. Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher H & Holland JC (1998) Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82, 1904–1908.

821

A SMOKING INTERVENTION AMONG PEOPLE WITH PSYCHOTIC

DISORDERS – PRELIMINARY RESULTS FROM A RANDOMIZED

CONTROLLED TRIAL

Amanda Baker1, Robyn Richmond2, Frances Kay-Lambkin3, Sacha Filia4, David Castle5, Jill Williams6, Vanessa Clark1, Terry Lewin7

1. Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia2. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia3. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia4. Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne, NSW, Australia5. Department of Psychiatry, University of Melbourne, Melbourne, NSW, Australia6. UMDNJ, Robert Wood Johnsons Medical School, New Brunswick, New Jersey, USA7. Hunter New England Mental Health, Newcastle, NSW, Australia

Aims: People with severe mental disorders have much higher rates of smoking and other cancer risk factors compared to the general community. To our knowledge, this is the fi rst randomised controlled trial to evaluate the effectiveness of a multi-component intervention addressing smoking as well as multiple health behaviours among people with a severe mental disorder. The Healthy Lifestyles Project was a randomized control trial aimed at addressing multiple behavioural health risk factors and this paper reports smoking outcomes.

Methods: Participants diagnosed with psychotic disorders residing in the community who were smoking 15 or more cigarettes per day (CPD) were randomly assigned to either a multi-component face-to-face intervention addressing multiple health risk behaviours or to a telephone intervention addressing smoking only. There were 8 weekly, 3 fortnightly and 6 monthly sessions scheduled, of approximately 60 minutes duration in the face-to-face condition and 10 minutes in the telephone condition. Nicotine replacement therapy was provided.

Preliminary results: At baseline, participants (N = 236, Mean age = 41.68, 59% male) were smoking on average 28.2 (SD = 14.65) CPD. Point preva-lence abstinence (last 28 days) was 11% at 15 weeks and 12% at 12-months for the face-to-face condition and 12% and 9% respectively for the tele-phone condition. At 15 weeks and 12-months, participants signifi cantly reduced their CPD for both the face-to-face (M = 13.72, SD = 12.38; M = 18.87, SD = 14.93) and brief telephone interventions (M = 14.26, SD = 11.67; M = 17.32, SD = 14.93), p < 0.001.

Conclusions: Face-to-face (focused on multiple health risk behaviours) and telephone-delivered interventions (focused on smoking) are feasible among people with severe mental disorders.



822

ALCOHOL, TOBACCO USE AND READINESS TO CHANGE IN AN

AUSTRALIAN SAMPLE OF HEAD AND NECK CANCER PATIENTS

UNDERGOING RADIOTHERAPY

Amanda L Baker1, Alison Beck1, Ben Britton1,2, Gregory Carter2,3, Judith Bauer4, Chris Wratten5, Luke Wolfenden3, Patrick McElduff6, Louise Thornton1

1. Priority Research Centre for Translational Neuroscience & Mental Health, University of Newcastle, Newcastle, NSW, Australia2. Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, NSW, Australia3. University of Newcastle, Newcastle, NSW, Australia4. University of Queensland, Brisbane, QLD, Australia5. Dept Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia6. Clinical Trials Unit Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia

Maintaining adequate nutrition in Head and Neck Cancer (HNC) patients is challenging. The rigours of radiation and the burden of the malignancy make it diffi cult to maintain suffi cient nutrition. Poor nutrition has been linked to impaired outcome and treatment complications. HNC patients also demonstrate elevated levels of problematic alcohol use and tobacco smoking. Alcohol misuse and tobacco smoking represent key risk factors in the development of HNC, and both can undermine the effi cacy of treatment. Continued use during/post radiotherapy has been linked to cancer recur-rence and reduced survival time. Tobacco smoking and hazardous alcohol consumption have also been linked to depression, poor quality of life and have the capacity to exacerbate a range of complications arising from radio-therapy. Given the prevalence, co-occurrence and consequences of poor nutrition, smoking and problematic drinking, assisting patients to improve nutrition, quit smoking and reduce alcohol use represents an important avenue for improving treatment outcomes. In the current study, we will assess a) the pattern of alcohol and tobacco use demonstrated by HNC patients undergoing radiotherapy and b) interest/readiness to quit smoking and/or reduce alcohol. This study is embedded within an existing stepped wedge randomised controlled trial. 400 HNC patients undergoing radio-therapy will be recruited from fi ve Australian hospital sites. Assessments will be conducted during week one of radiotherapy, four and 12 weeks post radiotherapy. Quantity and type of alcohol will be measured using the AUDIT consumption. The FTND will be used to measure self-reported nico-tine dependence. Smoking status will be verifi ed using expired CO or sali-vary cotinine. Alcohol dependence will be measured at time one using the AUDIT. Recruitment is due to begin November 2012. This study will be used to inform the development of an intervention to assist HNC patients improve their nutrition, quit smoking and/or reduce alcohol consumption.

823

THERAPEUTIC ALLIANCE BETWEEN DIETITIANS AND PATIENTS

WITH HEAD AND NECK CANCER: RELATIONSHIP TO QUALITY OF

LIFE AND NUTRITIONAL STATUS FOLLOWING A DIETITIAN

DELIVERED HEALTH BEHAVIOUR INTERVENTION

Alison K Beck1, Amanda L Baker1, Ben Britton1, Gregory Carter2,3, Judith Bauer4, Chris Wratten3,5, Luke Wolfenden3, Patrick McElduff6, Louise Thornton1

1. Priority Research Centre for Translational Neuroscience & Mental Health, University of Newcastle, Newcastle, NSW, Australia2. Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, NSW, Australia3. University of Newcastle, Newcastle, NSW, Australia4. University of Queensland, Brisbane, QLD, Australia5. Dept Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia6. Clinical Trials Unit Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia

Maintaining adequate nutritional status in Head and Neck Cancer (HNC) patients is challenging. Dietetic intervention can improve clinical outcomes. However, many HNC patients are non-compliant with dietary advice when it is provided. Engagement of HNC patients in dietary intervention is com-plicated by a range of factors including tumour site, radiotherapy side effects and elevated rates of depression and hazardous alcohol use. Behaviour Change Counselling (BCC) is an empirically supported approach for pro-moting behaviour change. BCC is a collaborative, patient centred approach that incorporates motivational interviewing and behavioural strategies. Assisting dietitians to integrate BCC into standard dietetic consultations represents one mechanism for enhancing compliance with dietetic interven-tions. Within psychology, positive therapeutic alliance consistently emerges as an important mediator of treatment outcome. The importance of a sound patient-clinician relationship is also beginning to emerge within cancer care. However, little is known about the therapeutic alliance between dietitians and HNC patients. In the current study, we will explore whether a) sup-porting dietitians to implement BCC as part of standard practice infl uences therapeutic alliance and b) whether HNC patient outcome is mediated by therapeutic alliance. This study is embedded within an existing stepped wedge randomised controlled trial. 400 HNC patients undergoing radio-therapy will be recruited from fi ve Australian hospital sites. Patients and dietitians will complete the fi ve item version of the Agnew Relationship Measure during week one of radiotherapy and again four and 12 weeks post radiotherapy. Nutritional Status and Quality of Life will be assessed during the fi rst and fi nal week of radiotherapy and again four and 12 weeks post radiotherapy using the PG-SGA and EORTC QLQ-C30. Recruitment is due to begin November 2012. Improved understanding of the impact of relational factors on treatment outcome in HNC patients represents an important step in improving the quality of care available to this challenging patient group.

824

BIAS DUE TO DIFFERENTIAL ATTRITION: WHAT MATTERS AND

WHAT DOESN’T

Melanie L Bell1

University of Sydney, NSW, Australia

Background: Attrition in longitudinal randomized trials is common, and threatens validity of results, particularly in patient reported outcomes like quality of life. When attrition rates differ between treatment arms it is sometimes called differential attrition. The implications of differential attri-tion are often misunderstood: some believe that if attrition rates are similar between study arms estimated treatment effects will be unbiased. Or, if dif-ferential attrition occurs, results are biased. This study demonstrates that these beliefs are false.

Methods: Quality of life data were simulated for a randomised 2 arm trial of 3 time points which were complete, missing completely at random, at



random, and not at random (MNAR). Missingness was 30% in the equal case, and 40% and 20% for unequal missingness. Data were analysed with a t-test and simple approaches to missing data; and a mixed model contrast.

Results: The simple approaches yielded biased estimates of the treatment effect, for nearly every type of attrition and missing data type. Mixed models yielded unbiased estimates for all scenarios except when data were MNAR.

825

THE MANAGEMENT OF RADIATION-INDUCED SKIN TOXICITIES IN

WOMEN WITH BREAST CANCER: THE IMPACT OF A SYSTEMATIC

IN-PATIENT CONTROLLED CLINICAL TRIAL ON PATIENT

WELL-BEING

Noelle C Bennett, Annie SutherlandSouthern Blood and Cancer Service, Dunedin, New Zealand

Breast cancer is the most common malignancy for women in New Zealand. The majority will receive radiation therapy as part of their treatment regime, and radiation-induced skin toxicities (erythema, dry desquamation, moist desquamation) will occur in 80–90% of patients by treatment completion. Skin toxicities can seriously impact on a patient’s mental and physical well-being and yet currently there is no standard treatment with practice being based on historical and anecdotal evidence alone.

An initial single centre stage II randomised controlled trial comparing the effi cacy of a silicon foam dressing with the (then) current standard treatment of aqueous cream (the control) was followed by a similar multi-centre trial. A total of 104 patients were enrolled across both trials; all received 50 Gy in 25 fractions and patients doubled as their own controls to eliminate confounding patient and treatment-related factors. The trial endpoint was moist desquamation (MD). Toxicities were measured using the Radiation-Induced Skin Reaction Scale (RISRAS) which includes participant as well as the researcher components. As each participant’s experience is unique, this scale adds valuable depth to the data since the level of reaction observed does not always refl ect the degree of discomfort and distress experienced by the patient.

The statistical analysis used ANOVA design of repeated measurement of paired patches for the ‘combined’ and researcher scores and the non-para-metric Wilcoxon signed rank test for patient scores. The analysis clearly demonstrated a signifi cant (42%) toxicity decrease (p < 0.001).

An intriguing incongruity became apparent when the percentage of our patients progressing to MD (16% control area v 0% trial area) was com-pared with the patient cohort from other centres (56% control area v 30% trial area). Hypothesizing about this disparity resulted in our current research examining the correlation between the level of holistic care afforded to patients and the intensity of reactions experienced/observed.

826

CONSUMER ENGAGEMENT AND SATISFACTION WITH A SPEECH

PATHOLOGY TELEHEALTH SERVICE SUPPORTING PATIENTS WITH

HEAD AND NECK CANCER

Clare Burns1, Professor Liz Ward2, Dr Anne Hill3, Karen Malcolm4, Lynell Bassett1, Franca Del Rosso5, Dr Liz Kenny6, Phillip Greenup7

1. Speech Pathology Department, Royal Brisbane and Women’s Hospital, Queensland Health, Brisbane, QLD, Australia2. Centre for Functioning and Health Research, Queensland Health, Brisbane, QLD, Australia3. School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia4. Speech Pathology Department, Nambour General Hospital, Queensland Health, Nambour, QLD, Australia5. Offi ce of CEO, Metro North, Queensland Health, Brisbane, QLD, Australia6. Central Integrated Regional Cancer Services, Queensland Health, Brisbane, QLD, Australia7. Statewide Telehealth Services, Queensland Health, Brisbane, QLD, Australia

Purpose: In head and neck (H&N) cancer, the majority of services are delivered at metropolitan centres where Speech Pathologists provide special-ist management of swallowing and communication diffi culties. For patients living in non-metropolitan areas, there can be signifi cant fi nancial and emotional costs with ongoing access to these specialist services and chal-lenges for the local clinician in supporting this complex clinical population. Following on from prior research, demonstrating the potential for telehealth in speech pathology management (Ward et al, 2007, 2009, 2011, 2012), the current project evaluates the consumer engagement of 6 month pilot tele-health service providing specialist speech pathology support for H&N cancer management within Queensland Health.

Methodology: A dedicated weekly telehealth clinic was established for patients with H&N cancer between the speech pathology departments of a metropolitan health service (RBWH) and a regional health service (Nambour General Hospital). A range of services were provided including pre-treat-ment counselling, early intervention and post treatment follow up. Along with service data, questionnaires were completed by patients, their carers and the participating clinicians to evaluate satisfaction with the telehealth service and any workforce training benefi ts achieved.

Results: Fifty telehealth sessions were conducted. Overall patients were satisfi ed with the service, stating a preference for attending the telehealth session, that the telehealth session was equal to a face to face session and reporting fi nancial and time benefi ts. Carers also reported the telehealth service assisted and reassured them in their caring role. Clinicians reported the telehealth system supported the clinical assessment and for the majority of patients assessed, telehealth would be a more effi cient means of service. Signifi cant workforce training benefi ts were also achieved.

Conclusions: A coordinated telehealth service improves patient access to specialist speech pathology services, enhances patient and carer satisfaction and provides strategic staff training. These outcomes will support the expan-sion of telehealth services for allied health cancer management.

827

ANTIDEPRESSANT PREFERENCES FOR WOMEN TAKING

TAMOXIFEN: A SURVEY OF AUSTRALIAN ONCOLOGISTS

Jane G Cass-Verco1, Catherine Mason2, Nicholas Wilcken2

1. Westmead Cancer Care Centre, Sydney, Australia2. Westmead Cancer Care Centre, Sydney, Australia

Background: Antidepressants are co-prescribed with tamoxifen at rates up to 30%, to manage depression, anxiety and menopausal symptoms that are commonly encountered in breast cancer. CYP2D6 converts tamoxifen to its most active metabolite, endoxifen. Some antidepressants inhibit CYP2D6,



raising concerns that they may reduce tamoxifen’s effi cacy, increasing breast cancer recurrence and mortality. However, research to date has yielded confl icting results and remains inconclusive.

Methods: A cross-sectional survey with quantitative and qualitative com-ponents was designed and pilot-tested. The survey was distributed electroni-cally via COSA and MOGA to 482 oncologists of various disciplines. Survey Monkey collected responses between September 2011 and January 2012. Data was analyzed by descriptive statistics, with two researchers independ-ently coding qualitative information.

Results: 80 clinicians participated: 77.5% (62) were medical oncologists, 10% (8) surgical, and 6.3% (5) radiation oncologists. Depression was the leading indication for co-prescribing antidepressants and tamoxifen, fol-lowed by menopausal symptoms, then anxiety. 87.3% (69) of subjects reported being aware of potential interactions between tamoxifen and certain antidepressants, while 12.7% (10) were not aware. 87.3% (62) cited venlafaxine as their preferred antidepressant with tamoxifen; while citalo-pram, mirtazapine, desvenlafaxine, and escitalopram were mentioned less frequently. Regarding antidepressants to avoid with tamoxifen: 42.5% (31) listed paroxetine, 38.4% (28) fl uoxetine, 13.7% (10) ‘SSRIs’, 11% (8) sertraline, and 4.1% (3) ‘CYP2D6 inhibitors’. 23.3% (17) of respondents reported they would not avoid any antidepressants due to concerns about interactions with tamoxifen.

Discussion: Most participants were concerned about potential interactions and observed cautions to avoid using strong CYP2D6 inhibitors, particu-larly paroxetine and fl uoxetine, with tamoxifen. However, awareness was suboptimal and further research is required, particularly regarding newer antidepressants like duloxetine and bupropion, which were rarely men-tioned by clinicians despite being moderate and strong CYP2D6 inhibitors, respectively. For postmenopausal women, aromatase inhibitors may be pref-erable to tamoxifen if CYP2D6-inhibiting antidepressants are considered essential.

No disclosures.

828

FOUR YEARS OF SCREENING FOR PAIN AND DISTRESS WITH

QUICATOUCH

Kerrie Clover1,2,3, Gregory L Carter1,2, Kerry Rogers1

1. Calvary Mater Newcastle, Hunter Region Mail Centre, NSW, Australia2. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia3. School of Psychology, University of Newcastle, Newcastle, NSW, Australia

Purpose: Routine screening combined with appropriate management has been recommended to increase the detection and management of distress among cancer patients. However, few centres have implemented screening on a large scale. We propose to describe the QUICATOUCH program of routine screening for pain and distress at Calvary Mater Newcastle.

Methods: Over four years (2007–2011) a paid Screening Assistant assisted oncology outpatients to complete a brief, computerized assessment of their pain and distress prior to their outpatient appointment. A Clinician Alert was generated if patients were over threshold for pain (scoring one or more out of 10) or over threshold for distress (scoring four or more out of 10), and this was printed in time for the consultation with their oncologist. Cancer Care Coordinators have electronic access to screening results and can conduct screening over the phone. A screening module for caregivers was developed.

Results: Preliminary results indicate that over 27,000 occasions of screening were undertaken in four years. The percentage of patients reporting pain and distress above threshold levels decreased from 32% to 12% and 28% to 9% respectively in that time. Detailed analysis of data from 4755 indi-vidual patients screened in the fi rst 24 months indicated that the decreased prevalence was not explained by sample differences in gender, age, clinic type or treatment status. Use of QUICATOUCH has expanded to other locations both within and outside our health service area.

Conclusion: QUICATOUCH is an acceptable model for screening for pain and distress. Pain and distress levels among oncology outpatients at our hospital signifi cantly reduced, consistent with a positive effect of routine screening.

829

THE IMPACT OF PHYSICAL ACTIVITY ON FATIGUE AND QUALITY

OF LIFE IN LUNG CANCER PATIENTS (PAL STUDY): A

QUALITATIVE EXPLORATION OF PARTICIPANT EXPERIENCE

Haryana M Dhillon1, Jane Turner1, Michael Kabourakis1, Hidde P van der Ploeg2, Janette L Vardy1,3

1. University of Sydney, Sydney, NSW, Australia2. Department of Public and Occupational Health, VU University Medical Center Amsterdam, Amsterdam, The Netherlands3. Sydney Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia

Background: The impact of physical activity on function, quality of life and progression free survival of people with incurable lung cancer is unknown. PAL is a randomised controlled trial of a 2-month physical activity interven-tion in this population, 71 people have been recruited to date.

Aim: To explore people with advanced lung cancers’ experience of the PA program and their perception of its benefi ts and harms.

Methods: This qualitative study used semi-structured interviews with PAL participants from one of four hospitals. Interviews were conducted in person or via telephone. Interviews were audio-recorded and transcribed verbatim. Framework analysis was used to develop a coding schema of themes identi-fi ed from interviews. The coding schema was used to code, chart and analyse the data and compare and contrast how patient experiences differ.

Results: Twelve people who had consented to be randomised into the PAL study were interviewed during the 2 (n = 7), 4 (n = 5) or 6 (n = 4) month follow-up visits. All 12 had a diagnosis of advanced, incurable lung cancer, six were male, aged from 48–77 years. Seven received the PA intervention and fi ve the control group. Sixteen interviews were completed; four people were interviewed twice (three at 4 and 6 months, one at 2 and 4 months). Walking was the most common PA reports, some participants did a range of activities.

The main themes identifi ed included: empowerment; confi dence; independ-ence; physical and mental well-being; and hope. Most important parts of the PA program: support from PA consultants to start exercising; learning how to manage PA and side effects, particularly dyspnoea. Participants reported benefi ts derived from active anti-cancer treatments as well as PA and it is diffi cult to disentangle the impact of one intervention from the other.

Conclusions: People with advanced lung cancer are willing to participate in PA and some perceive it enhances physical and mental well-being. They describe feeling hopeful but not expectant about the future. Support from a trained PA consultant was s important to start and maintain PA. Recruit-ment and follow-up for the PAL study continue.



830

IMPROVING CANCER RISK UNDERSTANDING: A SYSTEMATIC

REVIEW OF EDUCATIONAL INTERVENTIONS FOR PEOPLE WITH,

OR AT HIGH RISK OF, CANCER

Mbathio Dieng1, Nadine A Kasparian2,3, Caroline Watts1, Rachael Morton4, Graham J Mann5, Anne Cust1

1. Cancer Epidemiology and Services Research, University of Sydney, Sydney, NSW, Australia2. School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia3. Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia4. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia5. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

Introduction: Understanding of cancer risk has been found to be theoreti-cally and empirically relevant in motivating cancer screening and risk reduc-tion behaviours. Risk perceptions have also been found to be associated with health-related quality of life, including psychological stress, psychologi-cal adjustment and health behaviours. Despite its importance, subjective perceptions of personal cancer risk have been shown to be sometimes rela-tively resistant to change.

Objective: To assess the effectiveness and quality of educational interven-tions specifi cally developed to improve participants’ understanding of cancer risk, we conducted a systematic review of published educational interven-tions with a focus on risk perception.

Methods: Randomised and non-randomised trials and prospective studies were identifi ed via Medline, PsycINFO, Embase, Amed and CINAHL data-bases from 1806 to April 2012, and evaluated according to predetermined criteria. A total of 2,701 articles were identifi ed after the removal of dupli-cates, with 2,508 articles excluded after title and abstract screening by two reviewers. A total of 181 articles were fully reviewed to assess eligibility. The methodological quality of the included Studies was assessed using two tools: the Quality Assessment Scoring for prospective studies and the Cochrane collaboration tool for assessing risk of bias for randomised con-trolled trial.

Results: A total of 35 studies met inclusion criteria, including six RCTs and 29 prospective studies. Most of the interventions (n = 20) examined risk perceptions in the context of genetic counselling for breast, ovarian or colorectal cancer. Most interventions reported only modest increases in the accuracy of perceived risk. I will also present the strengths and weaknesses of the interventions.

Conclusions: There are few interventions aiming to improve cancer risk perception in cancers other than breast and ovarian. I will discuss the useful-ness of these educational interventions for different clinical and research contexts, and the challenges for future research.

831

CANCER PATIENTS AND THOSE SUPPORTING THEM HAVE

UNIQUE ILLNESS PERCEPTION PROFILES AND SUPPORT NEEDS

Rosie Dobson1, Claire O’Donovan1, Alexandra Leggat1, Olivia Anstis1, Lisa Reynolds2

1. Cancer Society Auckland Division, Auckland, New Zealand2. Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

Introduction: It is considered that a person’s perceptions of cancer including their illness and emotional representations play an important role in deter-mining their quality of life, level of disability, and treatment adherence.

Aims: To assess the illness perceptions of cancer patients and individuals supporting someone with cancer (supporters); specifi cally their cognitive representations of the cancer including the dimensions of cause, conse-quences, timeline, control, identity and their emotional representations.

Methods: The sample includes a total of 159 individuals (18–86 years of age) presenting at the Cancer Society Counselling and Psychology Service for initial assessments over a 20 week period (March to August, 2012). Participants completed the Brief Illness Perceptions Questionnaire (Brief-IPQ) as well as other measures prior to their assessment with the psycholo-gist. The mean illness perception scores from the Brief IPQ are presented and differences between patients (n = 106) and supporters (n = 53) are assessed using non-nonparametric (Mann-Whitney’s U) tests as the depend-ent variables were not normally distributed.

Results: The results indicate that, as expected, patients and their support people presenting for psychological support perceive the cancer to have high consequence on their lives. However, compared to supporters, patients were found to have signifi cantly higher perceptions of treatment control (U = 1455.5, z = −3.88, p < 0.001) and personal control (U = 1501.0, z = −2.94, p < 0.01). Conversely, supporters were found to have signifi -cantly higher levels of concern for the cancer (U = 1913.5, z = −2.65, p < 0.01) than patients.

Conclusions: Whilst the results show overall similarities in illness percep-tions between patients and those supporting them, the fact that supporters perceive less control yet higher concern suggests that supporters have par-ticular needs and would benefi t from tailored interventions distinct from support aimed at cancer patients. This study has highlighted the necessity for supportive care services to address the unique cancer representations of both patients and those supporting them.

832

YOU MATTER TOO: DEVELOPING A CARER INFORMATION PACK

AND PSYCHOEDUCATION SESSION IN THE CANCER SETTING

Linda Drvodelic, Pauley Kessel, Carrie LethborgSt Vincent’s Hospital, Fitzroy, Vic, Australia

Background: Carers are central to the adjustment process of cancer patients, yet the demands on them are signifi cant. The Carer Needs Scoping Project, undertaken by the Cancer Social Work Team (CSWT) in 2009, provided six recommendations to enhance carer well being. Two recommendations were identifi ed to progress further.

Aim: To develop a carer information pack & psycho-education session for carers of cancer patients at St Vincent’s.

Methods: Following a review of current literature, carer resources were benchmarked from cancer and carer organisations along with a consumer survey & consultation with the CSWT to inform the content & structure of the information pack & session.

Results: Consumers (n = 9) & CSWT (n = 6) agreed carers needed targeted information to perform their role & identifi ed clear components required for the information packs. Versions of the packs were developed & reviewed with changes being made at each point. The psycho-education session was linked to the pack using the same feedback obtained from the literature and clinician/consumer feedback.

Conclusions: The fi nal pack offers a unique, targeted source of support for carers in the cancer setting that will be provided by the CSWT to carers. The psycho-education session will be used as part of the standard support offered by the Cancer Centre.

Relevance/signifi cance to the fi eld: This translation of research responds to the need for targeted interventions for carers of cancer patients in their own right.



833

BONE HEALTH AND ITS MANAGEMENT IN EARLY STAGE BREAST

CANCER PATIENTS COMMENCING ADJUVANT HORMONAL

TREATMENT

Divyanshu Dua1, Bogda Koczwara2

1. Royal Adelaide Hospital, Adelaide, SA, Australia2. South Adelaide Health Service, Bedford Park, SA, Australia

Background: As chemotherapy and hormonal treatment with aromatase inhibitors (AI) are associated with the risk of bone loss, in particular in women with underlying osteopenia and osteoporosis, the prescription of hormonal therapy in early stage breast cancer needs to take into account the current status of patient’s bone health and include a consideration of additional investigations and therapies to manage this risk (J Clin Oncol 28:3784–3796)

We have reviewed our clinical practice to determine prevalence of underlying bone loss and its management in patients about to receive hormonal treat-ment for early breast cancer.

Methods: A retrospective audit was conducted of patients with early stage breast cancer referred for the DEXA (Dual X-Ray Absorptiometry) scan prior to commencing of hormonal treatment between June 2007 and December 2011. This was cross-referenced with the Cancer Registry to identify the breast cancer patients. The medical records was accessed to collect information regarding demographic status, tumour staging, chemo-therapy and hormonal treatment, history and risk factors for underlying bone disease and management of any DEXA abnormality.

Results: The preliminary analysis of fi rst 31 patients out of the total of 55 revealed 19 postmenopausal, 7 premenopausal & 5 perimenopausal patients with hormone responsive cancer were identifi ed. 17 post-menopausal patients commenced AI; 1 declined. 6 pre, 5 peri & 1 postmenopausal patients were treated with tamoxifen. 11 post-menopausal patients, 4 peri-menopausal and 1 premenopausal patient were osteopenic. 1 post-meno-pausal woman had osteoporosis. 8 patients had endocrine review because of osteopenia (n = 6) osteoporosis (n = 2). 6 were Vitamin D defi cient (defi ned as less than 60 nmol/dL). The secondary causes of bone loss identi-fi ed included dietary defi ciency of calcium and premature menopause. 2 received Zoledronic acid 4 mg 6 monthly schedules. Final data will be provided at the time of presentation.

Conclusions: Osteoporosis and osteopenia are common among women commencing hormonal treatment for breast cancer. Management patterns in these patients vary. There is a greater need for adherence to practice guidelines in this patient cohort.

834

‘TOMORROW, AND TOMORROW, AND TOMORROW’ – WHAT

CANCER SURVIVORS WANT TO KNOW, AND HOW THEY WANT

TO KNOW IT

Jacinta Elks, Katrina WestCancer Care, Sunshine Coast HHS, Nambour, QLD, Australia

Cancer survivors and their carers experience a range of health and support needs. Limited research is available to guide supportive care interventions to address these needs. A review of a multidisciplinary patient education program designed to facilitate the transition for individuals with cancer completing treatment was undertaken. This clinical research was designed to examine survivor perspectives towards the program specifi cally and issues of survivorship more generally.

Four separate data tools were utilised to methodologically triangulate the evaluation, providing both a qualitative and quantitative analysis of the benefi ts of and barriers to a supported transition.

75% of the cancer survivors invited to attend the transition program declined to do so. Those that did attend reported a qualitative benefi t, but

this benefi t was not refl ected in the quantitative analysis. Patients expressed clear preferences in terms of their self identifi ed needs as cancer survivors.

Cancer survivors have voiced their preference for a supported transition that empowers them to understand and manage the implications of survivorship in a personally relevant manner. The predominant barriers to such a sup-ported transition to cancer survivorship are both organisational and patient based in origin. The utilisation of the proposed Survivorship Care Frame-work may assist in the development of policy and procedure that offers lasting benefi ts for travellers on the cancer journey.

835

PUSHING THE POSSIBILITIES: CONSUMERS AND HEALTH

PROFESSIONALS CO-DESIGN WEB VIDEOS ON BREAST CANCER

Chris Walsh1, Rowena Mortimer2, Sue Ellis1

1. Breast Cancer Aotearoa Coalition, Levin, New Zealand2. Breast Cancer Aotearoa Coalition, Auckland, New Zealand

Purpose: This paper describes the collaborative approach between consumers and health professionals to produce web-based videos designed to support those affected by breast cancer. This project demonstrates the success of using the combined talents and experience of consumers and health professionals to co-design appropriate supportive information and resources.

Data sources: Narratives from fourteen women, one man, four family members and fi ve health professionals form the basis of these videos. Initial drafts of the videos were reviewed by health professionals for accuracy. This review was critical to the quality of the web videos because balance was needed between the evidence based practice of health professionals and the experiences of those with breast cancer.

Findings: The professionally produced and edited web videos feature a range of identifi ed themes. Specifi cally, the psychosocial impact of breast cancer is explored in the themes; family supports, relationship with partners, help getting through and life after breast cancer. Whilst consumers acknowl-edge the key role health professionals have in guiding them through their breast cancer journey they also value highly the support from family, friends and others who have been down the same path.

Conclusion: The practice of health professionals is interwoven with experi-ences of breast cancer patients. The possibilities aspired to have achieved a ‘fi rst’ in cancer supportive care in New Zealand. To date, feedback from the web videos supports the ideology of a consumer/professional interface in the provision of supportive cancer care.

836

DECISION MAKING, DECISION REGRET AND PATIENT

PREFERENCES IN PRE-MENOPAUSAL WOMEN WITH LOW-RISK

EARLY BREAST CANCER

Laura Emery, Christobel M SaundersUniversity of Western Australia, NEDLANDS, WA, Australia

Introduction: While treatment advances mean many breast cancer patients can expect to be long term survivors, quality of life after treatment is important including potential loss of fertility.[1] Premenopausal women, particularly those with hormone dependent cancer thus a variety of treatment options, need to weigh up potential survival benefi ts against treatment side effects.[2]

To date no studies have evaluated a comprehensive set of factors around the treatment of young women with low risk early breast cancer which includes decision making, decision regret, patient preferences, side effects and disease outcomes.

Methods: This is a prospective study looking at treatment preferences, decision making, decision regret, patient preferences, side effects and disease outcome in pre-menopausal women under 47 years with low-risk early breast cancer.



Recruitment is across multiple sites in Australia and eligible patients are invited to participate after they have chosen their treatment (including endocrine therapy alone or with chemotherapy).

Results: With 6 participants lost to follow-up or declining to participate further, this paper focuses on the decision making, decision regret and patient preferences of 28 participants (15 chemotherapy; 13 Goserelin). One of the validated tools used measured decision confl ict with 10 respondents preferring chemotherapy; 11 goserelin and 4 suggesting they were unsure at the time of undertaking treatment. Nearly half (47%) of the respondents were strongly aware of the benefi ts of their chosen treatment, with less respondents strongly agreeing about their knowledge of the risks and side effects (44%). Two (7%) respondents strongly disagreed about this ‘being an easy decision to make’. Overall, only 38% strongly agreed they were satisfi ed with their decision.

Conclusion & recommendations: This research will provide relevant data to assist younger women to make informed evidence based decisions regard-ing treatments taking into consideration quality of life, side effects, survival and the impact of treatments on subsequent fertility.

References

1. Petrek J, et al. Incidence, Time Course, and Determinants of Menstrual Bleeding After Breast Cancer Treatment: A Prospective Study. Journal of Clinical Oncology, 2006. 24(7):1045–1051.

2. Thewes B, et al. What survival benefi ts do premenopausal patients with early breast cancer need to make endocrine therapy worthwhile? The Lancet Oncology, 2005. 6(8):581–588.

837

CHARACTERISTICS OF PATIENTS PRESENTING TO WESTERN

AUSTRALIAN CANCER SUPPORT CENTRES: PATIENT RATED

OUTCOMES AND USE OF COMPLEMENTARY THERAPY

Bonnie Furzer1,2, Kemi Wright1, Anna Petterson2,3,4, David Joske1,2,3, Timothy Ackland1, Karen Wallman1

1. University of Western Australia, Crawley, WA, Australia2. Collaborative Research Team, SolarisCare Foundation, Perth, Western Australia, Australia3. Sir Charles Gairdner Hospital, Perth, Western Australia, Australia4. Edith Cowan University, Joondalup, Western Australia, Australia

Objectives: To determine the medical and demographic characteristics, in addition to patient rated outcomes of individuals presenting to SolarisCare cancer support centres.

Methods: A cohort with a current or previous cancer diagnosis aged 18–87 years presenting to SolarisCare centres with the intent to receive services completed a written questionnaire bundle incorporating medical and demo-graphic variables together with patient rated outcomes including health related quality of life (HRQoL). The four SolarisCare centres participated in the trial over a 5-day period and included two regional and two metro-politan locations throughout Western Australia.

Results: Of the 95 participants who completed the questionnaires (70.3%) the mean age was 60.5 years with 62% currently receiving treatment. Eighty per cent of the sample had at least 1 other comorbid condition and the most popular complementary modality being relaxation massage. Of the PROs, HRQoL was signifi cantly poorer that the Australian general population and other mixed cancer populations. No notable differences were seen between genders, however signifi cantly poorer patient rated outcomes were seen for the younger age group. Fifty per cent of the population did not meet physical activity recommendations, and musculoskeletal symptoms explained the variance of 25–27% in HRQoL.

Conclusions: To effectively target and tailor support strategies it is crucial to have a comprehensive picture of the individuals presenting for services. The increasing uptake of complementary and alternative medicine by patients with high levels of distress or dysfunction makes it imperative to work collaboratively and ensure communication between patient, physician and cancer support services. This will help ensure the safety of practices

pursued by patients outside of mainstream medical care and foster optimal clinical outcomes.

838

THE IMPACT OF PHYSICAL ACTIVITY ON DISEASE-FREE SURVIVAL

IN PATIENTS WITH HIGH-RISK STAGE II OR III COLON CANCER:

ONE MONTH SCREENING RESULTS

Emma M Goddard1, Haryana M Dhillon1, Jane Turner1, Michael Kabourakis1, Philip J Beale2, Annabel Goodwin2, David Goldstein3, Stephen J Clarke1,4, Myra Ouriques4, Stephen P Ackland5,6, Fiona Abell5, Antonio Bonaventura5, G Mallesara5, Clare Fischer5, Laurence Kreiger7, Marie Lashbrook7, Janette L Vardy1,2

1. University of Sydney, Sydney, NSW, Australia2. Sydney Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia3. Dept of Clinical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia4. Dept of Clinical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia5. Medical Oncology, Newcastle Private Hospital, New Lambton, NSW, Australia6. Faculty of Medicine, University of Newcastle, Newcastle, NSW, Australia7. Riverina Cancer Care Centre, Wagga Wagga, NSW, Australia

Background: Although there is compelling observational evidence that physical activity (PA) is strongly and inversely associated with colon cancer incidence, recurrence, and disease-specifi c and overall survival, this has not been tested in a randomised, controlled setting and the mechanisms are unknown. CHALLENGE is a randomised controlled trial of a 3-year physi-cal activity intervention in people who have completed adjuvant chemo-therapy for colon cancer.

Aim: To determine the proportion of colon cancer patients suitable for the CHALLENGE study, and reasons for non-participation.

Methods: Evaluation of colon cancer patients seen at six participating hos-pitals over one month, reasons for ineligibility or non-participation in CHALLENGE.

Results: During July 2012, 76 people with colon cancer were screened. Three of these went on to be registered into the study and one was ran-domised. Of the two not randomised, one was excluded due to elevated blood pressure and the other elevated liver function tests.

Of 76 non-participants, 53 (70%) were not eligible. Eleven (14%) were eligible and are considering study participation in the future. Main reasons for ineligibility were: 38 (50%) with metastatic disease, 6 (8%) had com-pleted adjuvant chemotherapy more than 180 days previously, 2 (3%) already met the current recommended physical activity guidelines, 2 (3%) had comorbidities preventing exercise, 2 (3%) were of non-English speaking background, 3 (4%) did not meet criteria for high risk Stage II disease, 1 (1%) history of other malignancies. A further 9 did not participate due to: 6 (8%) patient choice, 2 (3%) logistics or 1 (1%) clinician decision. A further 33 patients seen in clinic had rectal cancer and were ineligible.

Conclusions: The majority of colon cancer patients seen in clinics are not eli-gible for the study. Main reason for ineligibility was the presence of metastatic disease. Only 2% were meeting recommended physical activity guidelines.



839

PANCREATIC CANCER AND SUPPORTIVE CARE – FACED WITH

DEATH, IT IS THE SMALL THINGS THAT POSITIVELY IMPACT ON

QUALITY OF LIFE

Helen Gooden1, Kate White2

1. University of Sydney, Camperdown, NSW, Australia2. Sydney Cancer Centre, Cancer Institute of New South Wales, Camperdown, NSW, Australia

Purpose: The purpose of this study was twofold; to identify the psychoso-cial and supportive care needs of people affected by pancreatic cancer and to identify the areas of unmet need. Given the short survival time for people with pancreatic cancer, effective supportive care is imperative to enable best quality of life. The study revealed that dietary issues are an area of unmet need that severely impacted on quality of life and increased carer burden in people affected by pancreatic cancer.

Methods: A qualitative inquiry framework was used to explore partici-pants’ perspectives and experience. Three groups of participants (N = 35) were recruited from people accessing the Cancer Council Helpline across Australia or by direct referral from clinicians and cancer nurses: patients diagnosed with pancreatic cancer (N = 12), carers/primary (N = 18) and family/not primary carer (N = 5). The carer/family group included a sub-group of bereaved participants (N = 14). Sampling continued until satura-tion. Thematic content analysis was conducted utilizing NVivo9®.

Results: The fi ndings revealed the major theme across all groups under quality of life was ‘managing complex and rapid physical changes’, espe-cially relating to dietary issues. Issues related to ongoing and unresolved gastro-intestinal symptoms and lack of information about symptoms of exocrine insuffi ciency and malabsorption. This was compounded by a lack of routine dietary consultation; a perceived reluctance of clinician’s to pre-scribe enzyme supplements and poor understanding of dose guidelines.

Conclusion: Participants in all groups expressed distress relating to the effects of exocrine insuffi ciency. Pancreatic enzyme supplements associated with clear dosage guidelines and dietary advice resolved symptoms of mal-absorption and markedly improved quality of life. For people affected by pancreatic cancer this is essential supportive care.

841

WHEN YOU LOOK IN THE MIRROR AND DON’T RECOGNISE THE

PERSON LOOKING BACK AT YOU . . . WHERE DO YOU TURN FOR

HELP?

Sally Harrold, Tarnya HotchkinLook Good . . . Feel Better, Scarborough, QLD, Australia

Background: Look Good . . . Feel Better (LGFB) is a free national com-munity service program dedicated to teaching cancer patients, through hands on experience, techniques to help them restore their appearance and self image during their treatment. The program was established in 1990.

Method: Look Good . . . Feel Better hosts workshops in 24 countries, and in 184 centres throughout Australia. The duration of a workshop is two and half hours, teaching participants how to manage the appearance the appearance related side effects. These steps are taught by our 1600 industry trained volunteers who dedicate their time to assist at the workshops. There are twelve basic steps of skin care and make up that is demonstrated in workshop. This allows an easy format for the participants to follow and recreate the look at home. A patient can attend a workshop only once at convenient location.

Results: Since our inception in Sydney in 1990 we have helped over 100,000 women. In 2011 we helped 9000, through the participation in our workshops.

Referrals can come from a variety of sources; of the 1,822 workshop par-ticipants surveyed during 2011, 1,079 learnt about the program from health

professionals and 932 were registered for a workshop by their health a health professional.

The above post workshop qualitative survey assessments indicated the posi-tive impact of the LGFB program. These surveys also provided some insight into the reasons for participant non attendance.

Clinical Implications: The LGFB workshops are conducted in a supportive non threatening environment by fully trained professional volunteers. Thus allowing each participant to adjust to the temporary appearance related side effects of their treatment, and explore the different avenues to manage them. Every woman undergoing treatment for cancer should have access to the program and afforded the opportunity to attend.

Acknowledgement of funding: The cosmetic industry founded and contin-ues to generously fund and support LGFB.

Conclusion: Our aim is to help cancer patients face the mirror with confi -dence; with our long term goal to be assisting 15,000 cancer patients per year by 2015. We need the continuing support of those working directly with the patient, to promote the benefi ts of attending a LGFB workshop.

The presentation will include participant feedback following their attend-ance at a LGFB workshop. It will illustrate the referral process for health professionals, enabling them to help us to reach our goal of 15,000 partici-pants in 2015.

842

‘MEASURING EMOTIONAL DISTRESS IN NEWLY DIAGNOSED

CANCER PATIENTS WITH RESPECT TO THEIR AWARENESS

REGARDING CANCER AND TAKING MEASURES TO MINIMIZE

THEIR DISTRESS LEVEL IN INDIAN SETTING’

Kavita Hazare, Ajinkya Mehta, Suchitra Mehta, Geeta MathurSadhana Charitable Trust, Nagpur, MS, India

A diagnosis of cancer often entails a feeling of disbelief and dread leading to feelings of anxiety, panic and distress. In India, most of the general population lacks proper awareness regarding Cancer. This study measures emotional distress level in newly diagnosed cancer patients who are totally unaware about cancer and intends to take corrective measures to minimize it.

Methods: Emotional distress thermometer was used to measure distress level in 98 newly diagnosed patients of all types of cancer over a period of 1 year. Their awareness regarding cancer was obtained by asking simple questions in their local language. Those who had absolute no knowledge regarding cancer were referred for more intensive counseling improving their knowledge.

Results: This study showed distress level of ≥8 in almost all 98 patients.

Conclusion: Main aim of this study was to identify most vulnerable group of patients who were totally unaware of the disease and referring them for more aggressive counseling. Emotional distress was directly pro-portional to their ignorance regarding the disease. Modifi cations in coun-seling techniques were needed for these patients where more importance was given to impart knowledge regarding cancer and explaining its myths and facts.

843

MOVING FORWARD WITH CONFIDENCE: A REPORT ON WORK IN

PROGRESS TO INCREASE THE CAPACITY FOR SELF-

MANAGEMENT IN CANCER SURVIVORS

Paula Howell1, Katherine Simons1, Melissa Shand1, Patsy Yates2

1. NEMICS (North Eastern Melbourne Integrated Cancer Service), Heidelberg, Vic, Australia2. School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia

Introduction: Numbers of cancer survivors are increasing in Australia. Sur-vivors report physical, psycho-social and practical concerns that are not



routinely addressed by health services. Specifi cally, reduced self-effi cacy in recognising new symptoms and fully engaging in life after cancer, are com-monly reported (1). Whilst survivorship care plans are increasingly being provided to assist medical care coordination, there is a need to trial care plans that incorporate a self-management approach; targeting self-effi cacy and utilising individualised wellbeing goals (2).

Aims: 1. Resource cancer survivors to more independently manage their post-treatment health and optimise their sense of wellbeing.2. Build health professional awareness of common issues facing survivors.3. Educate cancer professionals to promote increased self-management

abilities in their patients.

Method: 130 participants will be recruited from four tumour groups across three health services. Participants will develop a ‘Health and Wellbeing Plan’ with support from a health professional. The plan includes: a short cancer treatment summary, distress thermometer screening, identifi cation of con-cerns, and a wellbeing goal setting component.

Copies of the plan are shared with participants, GPs and a Nurse HEL-PLINE service. The HELPLINE nurses provide telephone support 4 weeks, 4 months and 8 months following initial plan development.

Participating health professionals are educated in techniques to promote patient self-management.

Using pre and post implementation measures this project will evaluate:

• acceptability, usability and sustainability of the intervention• impact on participants’ ability to self-manage their health• effectiveness of the training provided to health professionals.

Results: Recruitment for this project has commenced. This poster will provide an overview of the study design, process for designing the interven-tion and progress to date.

References

1 M Jeffard, E Karahalios, A Pollard, C Baravelli, et al., ‘Survivorship issues following treatment completion-results from focus groups with Austral-ian cancer survivors and health professionals’, J Cancer Survivorship, Vol 2, 2008, pp. 20–32.

2 Self-Management Workstream, National Cancer Survivorship Initiative, Self-management support for cancer survivors: guidance for developing interventions, Macmillan Cancer Support, 2010.

844

‘THERE’S NOTHING OF ME LEFT.’ THE EXPERIENCE OF ALOPECIA

FOR AUSTRALIAN WOMEN WITH OVARIAN CANCER

Victoria Jayde1, Maureen Boughton1, Penny Blomfi eld2

1. The University of Sydney, Camperdown, NSW, Australia2. Dept of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Australia

Aim: The primary aim of the study was to explore the experience of ovarian cancer for women, partners and children. The intent of this presentation is to report one of the fi ndings – alopecia – and the signifi cant impact this has on the experience of Australian women with a primary diagnosis of ovarian cancer.

Method: This research was informed by phenomenological philosophy. Fifteen Australian women with a primary diagnosis of ovarian cancer con-tributed to this component of the study via digitally recorded unstructured interviews. Data collection continued until themes became repetitive indicat-ing that data saturation was reached. The interviews were transcribed verbatim and analysed utilising van Manen’s (1990) method of data interpretation.

Findings: In this study, alopecia signifi cantly affected the women’s embod-ied sense of self. It was described as the worst corporeal feature of the ovarian cancer experience – they were ‘devastated’ by the loss of their hair. A number of factors contributed to the overall distress caused by hair loss: altered body image; it was a reminder of their illness; it was a public

statement about their private lives; and the practical issues associated with dealing with the loss.

Conclusions: Alopecia had a major impact upon the lives of women already battling with a diagnosis of ovarian cancer. This presentation explores ways in which alopecia can be conceptualised for this group of women. By enhancing understanding of the traumatic impact of alopecia, fi ndings from this study may help health care workers provide appropriate care for women in relation to this aspect of their ovarian cancer experience.

845

ANCHORS OF HOPE – THE CENTRALITY OF THE RELATIONSHIP

BETWEEN HEALTH CARE PROFESSIONALS AND AUSTRALIAN

WOMEN WITH OVARIAN CANCER

Victoria Jayde, Maureen BoughtonThe University of Sydney, Camperdown, NSW, Australia

Aim: This paper reports one aspect of a larger study, which aimed to explore the experience of ovarian cancer for women, partners and children. In this presentation the impact of relationships with health care profession-als (HCPs) upon the experience of Australian women with a primary diag-nosis of ovarian cancer will be described and interpreted.

Method: This research was informed by phenomenological philosophy. Data were collected via digitally recorded unstructured interviews with 15 Australian women with a primary diagnosis of ovarian cancer. Data collec-tion ceased once themes became repetitive and saturation was reached. The analysis of the transcribed interviews was based upon van Manen’s (1990) method of data interpretation.

Findings: The women’s experience was explored around the themes of embodiment, relationality, spatiality, temporality and mortality. Results of the study indicate that relationships with HCPs can be viewed as critical foundations of the experience. Specifi cally, person-centered care, which refl ected caring as an affect (caring about, as well as for women), provided stability and an ‘anchor of hope’ for many of these women experiencing uncertainty within a changing world.

Conclusions: This study presents evidence that relationships with HCPs form a strong foundation for the overall experience of ovarian cancer and were central to women’s experience of the disease. Results from this study have important implications for, and can be directly applied to, professional practice. An understanding of the importance women place upon their interactions with HCPs will support and encourage those HCPs already practicing in an engaged, person-centered manner. The information pre-sented in this paper will be useful to researchers interested in optimising the provision of psychological support to women with ovarian cancer. It sug-gests that the impact of HCP relationships upon the experience of women with ovarian cancer is an area, which warrants further investigation in all cultures and countries.



846

SYSTEMATIC REVIEW OF QUALITY-IMPROVEMENT

INTERVENTIONS AIMED AT CANCER SPECIALISTS

Michael Coory1, Victoria White2, Kristin Johnson2, David J Hill2,3, Michael Jefford2,3,4, Simon Harrison5,6, Ingrid Winship3,7, Jeremy Millar8,9, Graham Giles2

1. Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia2. Cancer Council Victoria, Melbourne, VIC, Australia3. Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, VIC, Australia4. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia5. Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia7. The Royal Melbourne Hospital, Melbourne, VIC, Australia8. Radiation Oncology, Alfred Health, Melbourne, VIC, Australia9. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Background: Despite the recent emphasis on reducing practice and outcome variation through more effective teamwork, quality improvement interven-tions (QIIs) aimed at cancer specialists are needed because there are some processes over which only cancer specialists have control (e.g. surgical technique, optimisation of chemotherapy regimen). There is a need to iden-tify which, if any, QIIs are effective with cancer specialists.

Methods: Medline, PsycINFO, CINAHL and EMBASE searches were con-ducted for studies of QIIs aimed at cancer specialists, published between January 1990 and April 2012. Papers were excluded if they focused on fi nancial interventions, multidisciplinary care or did not involve direct care of patients (e.g., pathology reporting). All study designs were included.

Findings: A total of 5781 unique English-language papers were identifi ed and of these 13 meet the study’s eligibility criteria. Three papers reported results from cluster-randomised controlled trials (cRCT), seven reported on uncontrolled before and after studies and three reported results from cross-sectional studies. No cRCTs showed a benefi t of the QIIs they tested. While some of the uncontrolled before and after and cross-sectional studies reported benefi ts of QII, these studies are diffi cult to interpret because they are prone to publication bias. Interventions in all studies were multifaceted, but descriptions of different components were limited and only one study examined their separate impact using a multi-arm trial design.

Interpretation: Although there is demonstrable need to reduce variation in the care provided to cancer patients, the published evidence regarding how to do this is thin. The evidence that has been published is diffi cult to inter-pret because of the potential for publication bias and lack of documentation about the components of the intervention. More investment in research to develop and assess QIIs for cancer specialists is needed to ensure consistent adoption of new clinical knowledge into everyday clinical practice.

847

THE EFFECT OF DIETARY COUNSELLING AND/OR ORAL

SUPPLEMENTS IN LUNG CANCER PATIENTS UNDERGOING

CHEMOTHERAPY AND/OR RADIOTHERAPY: A SYSTEMATIC

REVIEW

Nicole Kiss1,2, Meinir Krishnasamy2, Elisabeth Isenring3,4

1. School of Health Sciences, Univesity of Melbourne, Parkville, Victoria, Australia2. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia3. Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia4. School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia

Aim: The prevalence of malnutrition in lung cancer patients at various stages of disease and treatment ranges from 45 to 69%, with a median weight loss of 6.5% reported compared to usual weight. This systematic review examined if dietary counselling (DC) and/or oral supplements (OS) during chemotherapy and/or radiotherapy in patients with lung cancer affect nutritional status, functional status, quality of life (QoL) or treatment outcomes.

Methods: Relevant studies up to March 2012 were identifi ed from the fol-lowing databases: Medline, PubMed, CINAHL, Web of Science and the Cochrane Library. Search terms included: ‘lung neoplasms’ OR ‘lung cancer’ AND ‘nutrition’ OR ‘nutrition support’ OR ‘dietary counselling’ OR ‘diet therapy’ OR ‘nutrition therapy.’ Articles meeting pre-determined inclusion/exclusion criteria were critically appraised and included in the review.

Results: Five studies were identifi ed including three randomised controlled trials (RCT’s), one historical cohort and one case series. DC consistently improved dietary energy and protein intake during chemotherapy and radio-therapy. Some low level evidence suggests DC or OS may reduce weight loss and maintain nutritional status during radiotherapy treatment. Evidence of an effect on QoL and functional status is limited, and no evidence was located for treatment response or survival during radiotherapy. DC or OS during chemotherapy had no effect on weight changes, nutritional status, QoL, treatment response or survival, with no evidence located for an effect on functional status.

Conclusion: Dietary counselling improves energy and protein intake during chemotherapy and radiotherapy in patients with lung cancer. Current evi-dence suggests no benefi t to other outcomes during chemotherapy. There is insuffi cient evidence regarding the effect on other outcomes during radio-therapy. All studies were conducted in multiple tumour groups and only two studies analysed data from lung cancer patients separately. Randomised controlled trials examining the effect of DC in patients with lung cancer during radiotherapy treatment are required.

848

REVIEW OF CLINICAL PRACTICE GUIDELINES OF CHEMOTHERAPY

INDUCED ORAL MUCOSITIS IN AN AUSTRALIAN HAEMATOLOGY

ONCOLOGY PRACTICE

Maria A Larizza, Cheree MastersonAlfred Health, Melbourne, VIC, Australia

Aim: Mucositis is a potentially serious side effect of chemotherapy used for severe malignancies. Concerns about potential barriers to the use of oral cryo-therapy has lead to diffi culties when providing patients with information. The aim was to identify those chemotherapies which benefi t from the prior admin-istration of oral cryotherapy in order to reduce the incidence of mucositis. In addition best practice guidelines will be used to implement a uniform approach to cryotherapy management targeting patient compliance.

Methods: A literature review of the following databases were comprehen-sively searched via Monash University Databases: EMBASE (OVID), CINAHL, Austhealth, Clinical Evidence, Cochrane Database, EBM Reviews,



Current Contents, PubMed. A search from 1980 through 2012 was per-formed, linking the subject search headings ‘oral cryotherapy’, ‘ice chips’, and ‘oral mucositis’ with each of the following headings: ‘chemotherapy’, ‘haematology’, ‘antineoplastic agents’, ‘guidelines’, and ‘oncology’. The search was restricted to studies of chemotherapy induced oral mucositis in which clinical practice guidelines was a major focus.

Results: The search identifi ed a number of studies that examined oral cryo-therapy on the development of chemotherapy induced oral mucositis. Studies suggest fl uorouracil and melphalan are implicated in oral related complications more so than anthracycline based treatments. Practice guide-lines recommend the use of cryotherapy for the following chemotherapies; fl uorouracil, cycloposphamide, melphalan, methotrexate (IV), etoposide, cisplatin, mitomycin, and vinblastine. In addition patient compliance has been reported to improve with the concurrent use of sensitive toothpaste and salt and sodium bicarbonate mouthwashes. Reported limitations of oral cryotherapy include sensitive teeth, continuous infusions, cold, headaches and unwillingness to continue the cryotherapy through the entire infusion. Contraindications to the use of oral cryotherapy is existing mucositis and oxaliplatin based regimens.

Conclusion: A unit based protocol for the administration of oral cryo-therapy for the purpose of reducing the incidence of mucositis was imple-mented as a result of this review. Furthermore, a uniform approach to cryotherapy management, targeting patient compliance, had improved con-fi dence amongst staff.

References

1. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis (p 2026–2046) Edward B. Rubenstein, Douglas E. Peterson, Mark Schubert, Dorothy Keefe, Deborah McGuire, Joel Epstein, Linda S. Elting, Philip C. Fox, Catherine Cooksley, Stephen T. Sonis Published Online: 19 Apr 2004

2. Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Little-wood A, McCabe MG, Meyer S, Khalid T. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD000978. Review. PubMed PMID: 21491378.

3. Katrancý N, Ovayolu N, Ovayolu O, Sevinc A. Evaluation of the effect of cryotherapy in preventing oral mucositis associated with chemother-apy – A randomized controlled trial. Eur J Oncol Nurs. 2011 Sep 10. [Epub ahead of print]PubMed PMID: 21911313.

4. Chemotherapy: the effect of oral cryotherapy on the development of mucositis. J Clin Nurs. 2005, vol 14, issue 6

5. Oral complications of chemotherapy & Head and neck radiation. National cancer institute. www.cancer.gov.au.

6. Boissenvain-Chan et al. 2008. ‘Best practise for chemotherapy induced oral mucositis.’ www.nurseweb.ucsf.edu/conf/cripc/ebpabstract/boissenvain.

7. Baydar et al. ‘Prevention of oral mucositis due to 5FU treatment with oral cryotherapy’. J Natl Med Ass, Aug 2005, page 1161–1164.

849

EVALUATION OF A PSYCHO-EDUCATION BASED GROUP

PROGRAM FOR CANCER PATIENTS AND SUPPORTERS

Alexandra Leggat, Rosie Dobson, Claire O’Donovan, Olivia AnstisCounselling and Psychology Service, Cancer Society Auckland, Auckland, New Zealand

Background: Research indicates that psycho-educational based support helps cancer patients and people supporting someone with cancer (support-ers) adjust to and cope with cancer. Psycho-Education based interventions provide information allowing patients and supporters to learn ways to effectively manage and cope during cancer. The Cancer Society Auckland Provides Psycho-education sessions (‘Tips and Tools’) which are currently delivered by psychologists. The sessions are one hour in duration and are free to attend. There are four sessions on communication, sleep, emotional distress management and stress management.

Aim: This study aimed to evaluate the utility and also understand the demographics of people attending the psycho-education sessions.

Methods: A total of 64 participants completed evaluation forms following attending a session over a 16 week period asking them to rate the overall session, the relevancy of the session, and likelihood of using the information presented on a scale from 1–5. It also included qualitative questions looking at what was helpful, unhelpful, could be improved, and how they heard about the sessions. Demographic information was also collected.

Results: A mean of four people attended each session (range 0–11). Females represented 75% of the sample population with 53.4% and 46.6% of the sample being cancer patients and were cancer supporters respectively. Mean results show participants rated all four psycho-education sessions (com-munication, sleep, emotional distress management and stress management) above four out of fi ve for overall usefulness, relevance of the session and likelihood to use the information. Attendees reported wanting more time spent on relaxation exercises and increased group interaction.

Conclusion: This study indicates that psycho-education based support is a helpful tool for both cancer patients and cancer supporters and that it should be regarded as a valuable intervention in psycho-oncology settings.

850

CAPTURING THE MULTI-CULTURAL EXPERIENCE OF CANCER – A

STUDY INVOLVING NARRATIVES IN WORDS AND PHOTOGRAPHIC

IMAGES

Carrie Lethborg, Pauley Kessel, Andrew Badcoe, Linda DrvodelicSocial Work, St. Vincent’s, Melbourne, Victoria, Australia

St Vincent’s has been noted for its culturally diverse cancer patient popula-tion yet research with these diverse groups is particularly challenging. The use of photography as a research method can enable experience to be cap-tured regardless of a grasp of the English language.

Aims: To raise awareness of the experience of cancer in a multi-cultural cohort using photography and narrative methods.

Methods: Participants (n = 4) were given a digital camera to take home to photograph their experience of cancer. Interviews about their images involved an interpreter present and themes from descriptions were analysed for commonality.

Results: The most common theme was the focus on doing what one could to help oneself in the face of cancer but themes of celebrating life, suffering and determination were also present. Images illustrated a sense of pride in the things that health care professionals often don’t see, their homes, family, commitment to a faith and culture.

Conclusion: Interspersed amongst images that showed the actions under-taken to increase their chances of living, these photographs are an illustra-tion of a universal preciousness of life.

Signifi cance: If you are a refugee from Sudan, a proud Aboriginal man, a Chinese mother or a French immigrant you will be drawn to similar things in the face of cancer – family, faith and helping yourself to have the best chance at survival. The depth of focus on a personal role in survival offers opportunities for specifi c interventions.

851

‘I WAS MISSING OUT ON RITES OF PASSAGE’: SUPPORTIVE CARE

OF YOUNG PEOPLE WITH CANCER AND THEIR PEERS

Peter Lewis, Christopher FC JordensUniversity of Sydney, Camperdown, NSW, Australia

Background: Growing up during adolescence means, among other things, moving through life with one’s peer group. A cancer diagnosis has the potential to disrupt this normal social process.

Aim: The Growing Up With Cancer project aimed to describe the impact of cancer illness and treatment on the process of growing up. This paper has two aims. One is to describe the impact of missing out on rites of passage



on young people’s relationships with their peers. The other is to discuss how health professionals can support young people’s peer relationships.

Method: We conducted forty-nine interviews with 27 young people aged 16–29 years (diagnosed between 10 and 22 years). Participants were chosen using quota sampling. We analysed interview data from a symbolic interac-tionist perspective.

Findings: Participants missed out on both the accrual of day to day experi-ences and the rites of passage they would normally have shared with their peers because of their cancer treatment.

They managed this in two ways. First, they tried to recapture the day to day experiences they had missed out on during their cancer illness and treatment. However, the day to day experiences cannot be recaptured. Participants had a set of day to day experiences that shaped their own process of growing up.

Second, some participants attended social events that marked different rites of passage, but their experience of those events was unsatisfying because they did not share them with their peers.

Conclusion: ‘Missing out’ denies young people access to the experiences that form the ‘currency’ of social interactions in later life. Some topics of conversation and the memories and feelings they evoke are therefore una-vailable to young cancer survivors. Every effort should therefore be made to facilitate the patient’s attendance at social events whether the events themselves seem important or not.

852

PILOTING A MULTIDISCIPLINARY PARENTERAL NUTRITION TEAM

IN AN ONCOLOGY SETTING

Fiona Rezannah, Jenelle LoeligerPeter MacCallum Cancer Centre, Victoria, VIC, Australia

Aims: A multidisciplinary team for the management of parenteral nutrition (PN) improves patient outcomes and provides cost-savings for health serv-ices. This study aimed to (1) pilot a multidisciplinary PN team; examining appropriateness of PN prescription/monitoring, line management, complica-tions, nutritional provision and cost implications; (2) provide recommenda-tions regarding potential improvements to PN provision and service practices.

Methods: Prospective data was collected pre and post implementation of a PN team on all patients commencing PN. Patient demographics, length of PN usage, appropriate monitoring of clinical parameters, metabolic and line complications, nutritional adequacy, cost of PN and length of stay (LOS) were recorded. PN management was compared to the hospital PN policy and best-practice guidelines and an evaluation survey of staff was conducted.

Results: Twenty patients commenced PN pre-implementation and 28 post-implementation (45% haematology patients). Both periods had equal median length of PN delivery at 7.5 days and PN hang times at 24 hours. Post-implementation improvements were observed in the adherence to monitoring parameters as specifi ed by the PN policy and positive blood cultures (likely secondary to line complications) reduced from 25% to 21% of patients. Thirty fi ve percent of both groups failed to meet >80% of their nutritional requirements whilst on PN. The median patient cost of PN was A$581 and A$537 respectively and median LOS for patients was recorded as 22 days for both cohorts. The staff survey revealed improved knowledge surrounding PN prescription, PN processes, monitoring and highlighted practice improvements and a reduction in clinical risk. Support for imple-mentation of the PN team into usual care was high at 85%.

Conclusions: This study identifi ed inconsistencies in the prescription and monitoring of PN, however it demonstrates improved patient management and reductions in complication rates and costs with operation of a PN team. This work supports implementation of the PN team into usual care, high-lighting clinical and organisational benefi t.

853

CARERS OF PATIENTS WITH HGG ARE MORE DISTRESSED THAN

THE PATIENTS: UNDERSTANDING THE EXPERIENCE OF

CAREGIVERS

Georgia Halkett1, Elizabeth Lobb2, Anne Long3, Celine Fournier1, Anna Nowak3

1. Western Australia Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute Curtin University, Perth, WA, Australia2. Calvary Health Care Sydney and Cunningham Centre for Palliative Care, Calvary Health Care, Sydney, NSW, Australia3. Sir Charles Gairdner Hospital, Nedlands, WA, Australia

Background: Our previous qualitative study showed that family caregivers of people with HGG experience rapid role changes, new daunting respon-sibilities, and altered relationships with their loved one1. There have been few studies looking at unmet needs of caregivers of people with HGG.

Methods: Consenting caregivers and patients with HGG planned for com-bined chemoradiotherapy were recruited to this prospective longitudinal cohort study. All participants completed the validated Supportive Care Needs Survey (SCNS) including the Access to Services subscale, Brain Tumour Specifi c Supportive Care Needs Survey (BTSSCNS), and Distress Thermometer (DT). Caregivers also completed the General Health Ques-tionnaire (GHQ) examining self-reported anxiety and depression, social dysfunction, and loss of confi dence. Questionnaires were administered during patient chemoradiotherapy and three and six months later; here we present baseline caregiver results. Analysis used SPSS v20.

Results: 115 caregivers/114 patients were recruited. Caregiver demographics: female (72%); mean age 53 years; caring for spouse (82%). 72% of caregivers reported fi nancial impact and 51% of those previously working full-time had taken leave or reduced working hours. Regarding caregiving, 37% felt they had learnt new skills; 5% felt non-confi dent; and 14% felt unprepared. 31% of caregivers reported moderate distress (DT score 5–6) and 31% reported extreme distress (score 7–10). Distress scores were moderately correlated within dyads (r = 0.4, p < 0.001) but caregivers reported signifi cantly more distress than patients (mean 5.1 vs 4.1; paired t test p = 0.01). Caregiver distress was associated with high GHQ scores, (r = 0.61, p < 0.001). The top 5 moderate/high unmet needs were: accessing prognostic information; access-ing fi nancial support and government benefi ts; accessible hospital parking; impact of caring on usual life; reducing stress in the patients’ life.

Conclusion: Carers were more distressed than patients and high distress levels were associated with more mental health concerns in carers. Develop-ment of a caregiver-specifi c intervention is underway.

854

A REGIONAL MODEL FOR SUSTAINABLE CHANGE THROUGH

REDESIGNING CANCER CARE

Melissa Loorham, Heather Davis, Lisa Brady, Sue Liersch, Tracey TobiasSouthern Melbourne Integrated Cancer Service, East Bentleigh, Vic, Australia

Aim: To develop a sustainable and transferable change model utilising redesigning care methodology by:

• increasing the capacity of the Southern Melbourne Integrated Cancer service (SMICS) to lead others in process redesign methodology

• providing professional development for dietitians to carry out projects across the SMICS region

• establishing a regional network of dietitians to foster ownership to imple-ment sustainable change.

Method: A consultant was engaged to upskill the SMICS staff in the reVIEW redesigning care program and coach them to deliver the program to dietitians representing four SMICS member health services. Health service executives identifi ed dietitians working in oncology to participate in the program.



Participants undertook redesigning care projects within their respective health services, utilising the following reVIEW methods:

• value stream mapping the patient pathway• A3 problem solving• stakeholder engagement• presentations to colleagues, managers and multidisciplinary teams

Results: Three SMICS staff co-facilitated eight sessions under the guidance of a coach. Nine dietitians participated in the program, carrying out process redesign work on four discrete projects and highlighting additional areas for future redesign.

The four projects focused on tumour streams in which patients were at high risk for malnutrition i.e. Upper Gastro-intestinal and another, a service interface issue.

The evaluation fi ndings of the program were positive, indicating benefi ts in:

• regional networking• stakeholders engagement• sustainable change• enhanced transferable skill sets• whole of systems approach• increased leadership capacity

A strong regional dietetic network has been established, SMICS will support this group to meet regularly to share progress of their ongoing redesigning care projects.

Conclusion: SMICS has been successful in implementing a regional, sustain-able and transferable model of interdisciplinary networking and redesigning care.

855

STRATEGIC PLANNING OF BREAST CANCER AWARENESS AND

PREVENTION TECHNIQUES INCLUDING OLD INDIAN TRADITIONS

IN REGULARLY PRACTICED PROGRAMS

Geeta Mathur1, Suchitra Mehta2, Kavita Hazare1, Sneha Valaparla2, Arjun Mehta2, Ajinkya Mehta1, Ajay Mehta2

1. Sadhana CharitablE TrusT, Nagpur, MH, India2. Oncology, Central India Cancer Research Institute, Nagpur, MS, INDIA

The alarming rise in the incidence of breast cancer cases in India has been attributed to certain extent to westernization and changing life styles. It is already a known fact that old Indian Traditions like early marriages, early child birth, prolonged breast feeding, simple vegetarian diet and lot of physi-cal work had a major role to play in reducing the risk of Breast Cancer in the past.

A qualitative study was done to evaluate effectiveness of Cancer awareness programs advocating importance of old Indian Traditions for cancer prevention.

Methods: Around 24 cancer prevention awareness programs were con-ducted over a period of 12 months at various places near Nagpur by trained counselors and health workers. Pre and post program feedback was col-lected to evaluate effectiveness of programs, which propagated especially old Indian traditions of cancer prevention. Around 960 women were edu-cated and old Indian traditions were explained to them. As few of the tradi-tions are not possible to practice, e.g early marriages and early child birth, modifi cations were made to explain their importance.

Result: Feedback in local languages was taken pre and post programs in 952 cases. 95% of cases showed positive response and accepted the impor-tance of modifi cation in life style of their own as well as their families and friends.

Conclusion: Modifi ed Cancer awareness programs advocating old Indian traditions of cancer prevention proved to be acceptable to the general women population.

856

CHANGES IN SOCIAL RELATIONS AS A RESULT OF

PARTICIPATION ON GROUP THERAPY IN CANCER PATIENTS

Tomoko Matsui1, Kei Hirai1, Masako Shokoji2, Naoshi Ito3, Madoka Tokuyama2

1. Osaka university, Suita-City, Osaka, Japan2. Toyonaka Municipal Hospital, Toyonaka-City, Osaka, Japan3. Kuwansei Gakuin University, Nishinomiya-City, Hyogo, Japan

Aim: Studies on group interventions that deal with social relations in cancer patients have shown that such interventions could increase patients’ social support and help build social support networks. Therefore, group interven-tions are expected to have benefi cial effects on cancer patients’ social rela-tions. However, previous studies have examined only certain social relations. In addition, the results of group intervention studies covering loneliness in cancer patients, which arises from cognitive discrepancy of social relations, have little consistency, possibly because of cultural differences. Against this background, this study extracted factors that contribute to changes in the social relations of Japanese cancer patients after being affected with cancer and after taking part in a group intervention, and explored the potential of group interventions as a means of improving social relations in this population.

Method: Four cancer patients (mean age = 63.3; SD = 11.8) who partici-pated in group therapy were interviewed. Participants were asked about changes in their social relations after being affected with cancer and after taking part in group therapy.

Result: After analyzing the fi ndings, the researchers identifi ed seven elements related to changes in social relations after experiencing cancer: cognitive changes, decreased network size, decreased social support, reversal of receipt and provision of social support, disruption due to excess social support, absence of support network size, and absence and decreasing quantity of companionship. Following that, six elements were identifi ed about changes in social relations after taking part in group therapy: increased network size, receipt of social support, provision of social support, companionship, cogni-tive changes, and interactions with facilitators and medical staff.

Conclusion: The fi ndings suggest that participation in group therapy leads to the perception that one’s social relations have changed in several ways. In particular, participants felt companionship that they lose after being affected with cancer, which have not been referred.

857

ACUPUNCTURE SERVICE FOR SUPPORTIVE CARE IN A DAY

ONCOLOGY UNIT

Chris McKeonMater Health Services, South Brisbane, Queensland, Australia

This presentation is about the acupuncture service in the Mater Adults Hospital Brisbane and the evaluation of the service. The service has have been operating for 2 years at the time of this presentation. I will be present-ing the data collected for the last 12 months which has included changes to the survey tool identifi ed after the fi rst 6 month review. This will include uptake and usage of the service and the data obtained from research of the evaluation of the service. The evaluation of the service consists of a survey completed by the patients after one month of treatment, covering symptom/s treated, benefi ts, adverse events, should the service continue, use of other complementary medicine and qualitative data. The changes were to data collected on adverse events, medications and treatments used for the symp-toms and changes in usage after acupuncture and the inclusion of MYCaW (Measure Your Concerns and Wellbeing) (1) a tool designed for evaluating complementary therapies in cancer support care.

Reference

1. Paterson C, Thomas K, Manasse A, Cooke H, Peace G. Measure Yourself Concerns and Wellbeing (MYCaW): An individualised questionnaire for



evaluating outcome in cancer support care that includes complementary therapies. Complementary Therapies in Medicine. 2007;15(1):38–45.1.

858

ELECTROACUPUNCTURE VS SHAM ELECTROACUPUNCTURE VS

STANDARD CARE FOR CHEMOTHERAPY INDUCED NAUSEA AND

VOMITING – A PILOT STUDY

Chris McKeon, Janet Hardy, Helen AndersonMater Health Services, South Brisbane, Queensland, Australia

Introduction: Despite improvements in antiemetic therapy, chemotherapy induced nausea and vomiting (CINV) continues to be a common side effect impacting on quality of life for cancer patients. A Cochrane review (1) has shown that acupuncture reduces the incidence of acute vomiting but not acute or delayed nausea. Electroacupuncture (EA) reduced acute vomiting, but delayed symptoms were not reported and standard antiemetics were not used. To prepare for a high quality controlled study to determine whether EA gives better control of delayed CINV than standard antiemetic treatment alone, we undertook a pilot study.

Methods: Patients having their fi rst cycle of moderately or highly eme-togenic chemotherapy were approached. Patients were randomised to one of three arms; EA, sham EA or standard care. EA was given for 30 minutes on day 1 of chemo and on day 3 using standard acupuncture points bilater-ally. Sham EA was given to points adjacent to true EA points. All patients received antiemetics according to hospital guidelines. A daily diary rating nausea and vomiting for 7 days and the Functional Living Index Emesis (FLIE) was captured on Days 1, 4 and 7.

Results: Sixty patients were recruited from April 2009 to May 2011. The FLIE was completed by 49 of 60 patients, on days 4 and 7. Adverse events were generally mild and infrequent (needle pain, bruising). There was no difference in nausea scores between arms but scores were low in all 3 arms.

Discussion: Our pilot study confi rmed the feasibility of a defi nitive study and improvements in design. As few patients experienced nausea with their 1st cycle of chemotherapy, we will recruit at their 2nd or 3rd cycle using an enriched enrolment design (only if they experienced CINV in their 1st course). As QoL aspects of the FLIE could dilute the objective nausea scores, a NRS scoring nausea as the primary end-point will be used with the FLIE as a secondary outcome measure. As participants come back for a second course, acupuncture will be delivered on days 1 and 3 as standard.

Reference

1. Ezzo J, Richardson M, Vickers A, Allen C, Dibble S, Issell B, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev. 2006(2):CD002285.

859

WORKSHOPS TO IMPROVE COMMUNICATION IN CANCER CARE

Vicki Mcleod1, Ranjana Srivastava1, Heather Davis2

1. Southern Health, Melbourne, Victoria, Australia2. Southern Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia

Background: One of the major causes of dissatisfaction amongst cancer patients is defi cient communication with health personnel, which increases psychological distress.

Aims: To train a wide variety of professionals involved in cancer care to effectively communicate with cancer patients.

Method: Southern Health and Southern Melbourne Integrated Cancer Service (SMICS) collaborated to develop a series of interactive multidisci-plinary communication skills training workshops. Professional actors were used for each workshop.

Modules developed included:

• Discussing Bad News• Relaying A New Diagnosis• Stopping Active Treatment• How To Discuss End Of Life Care• How To Conduct A Family Meeting

Results: The communication skills modules delivered over the course of this year have so far been attended by 68 clinicians comprising of 19 nurses, 22 allied health staff and 27 doctors. 61 evaluations have been completed.

Participants were surveyed prior to, on completion of, and 3 months post each workshop. Utilising a Likert scale, the participants indicated the degree to which they use certain communication strategies and their level of con-fi dence in having diffi cult discussions with patients and families. All partici-pants agreed that they would recommend the workshops to others. When asked whether their level of confi dence in having diffi cult discussions had increased, 54% of participants strongly agreed, 44% agreed and 2% were not sure. Those participants surveyed three months after the workshops indicated that they are utilising the skills learned.

Conclusions: The program has been successful in attracting participants and equipping them with simple yet effective skills to improve communica-tion. The use of professional actors creates more realistic experiences for participants. The confi dence gained allows these skills to become incorpo-rated into routine practice. The interactive style of these workshops has proven popular and feasible. With organisational support, they can be expanded to a larger audience.

860

COMPARATIVE ANALYSIS OF POST-TREATMENT QUALITY OF LIFE

IN BREAST CANCER PATIENTS IN CENTRAL INDIA AFTER

COUNSELING THEM WITH FAMILY MEMBERS AGAINST

COUNSELING THEM ALONE

Suchitra Mehta1, Arjun Mehta2, Geeta Mathur1, Suresh Ughade3, Ajinkya Mehta1, Ajay Mehta2

1. Psycho Oncology, Sadhana Charitable Trust, Nagpur, Maharashtra, India2. Central India Cancer Research Institute, Nagpur, Mahar, India3. PSM, Govt Medical College, Nagpur, Maharashtra, India

Introduction: A substantial number of breast cancer patients of all stages of Cancer are regularly counseled at Central India Cancer Research Insti-tute, Nagpur India by trained counselors. In India majority of the patients belong to large joint families where family members play major role offering great support and motivation to the patient throughout their treatment.

Objective: To compare quality of life (QOL) of breast cancer patients after undergoing 10 days post-treatment counseling sessions with family or alone.

Methods: A consecutive sample of 120 cancer patients seeking treatment (in the form of surgery – MRM or BCT/Radiation/Chemotherapy) at the tertiary care setting was recruited after obtaining informed consent. This sample was randomly divided in to 2 groups. Group 1 patients were coun-seled alone on one to one basis while Group 2 patients were offered addi-tional family counseling for equal number of (i.e. 10) days. Counseling was done in person by trained counselors. Quality of life instrument-Breast cancer patient version with 46 items developed by City of Hope, National Medical Center and Beckman Research Institute was used to assess QOL.

Results: Age and family background of two groups was comparable. But, education (p < 0.014) and socio-economic status (p < 0.016) of Group 2 subjects were signifi cantly better than those in Group 1. Mean (± SD) score of QOL in Group 2 patients (209.8 ± 18.6) who additionally received family counseling was signifi cantly (p < 0.0001) higher than the mean score (173.4 ± 16.9) of Group 1 patients who were counseled alone. The study fi ndings justify the need of counseling family members for improving the post-treatment quality of life of the breast cancer patients in India.



861

WHAT ABOUT ME? IDENTIFYING NEEDS OF, AND RESOURCES

FOR, YOUNG ADULT CANCER SURVIVORS (25–40 YEARS)

Angela Pearce1, Annie Miller2, Gill Batt2

1. Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia2. Cancer Council NSW, Woolloomooloo, NSW, Australia

Aim: To conduct a literature review of survivorship issues and programs in young adult cancer survivors aged 25–40 years; and to identify gaps in service provision.

Method: A literature search using various databases was conducted to iden-tify needs research and program evaluative studies targeting survivors in the identifi ed age group. Search terms included: young adult; childhood; adoles-cent; survivor; psychosocial needs; health needs; intervention; program.

Results: A number of studies assessing the needs of young adult cancer survivors were found. These included both personal needs (information, managing emotions, communication strategies, self concept issues and worldview) and social needs (workplace discrimination, fi nancial planning, legal issues, patient rights and altruistic motivations). Poorer outcomes were noted in this age group compared to both age matched controls and older cancer survivors. Overall, survivors reported a need for age-appropriate interventions targeting the psychosocial needs outlined above. Delivery of these interventions should also cover as many modalities as possible to cater for variance in service delivery preferences. Interventions addressing these needs and outcomes were scant, indicating a gap in survivorship service provision for those aged 25–40 years.

Conclusions and recommendations: The literature showed a need for age-appropriate resources and supports. In addition, interventions targeted at this population are lacking, representing a gap in current service provision. Cancer Council NSW has a range of current services that could be either modifi ed to meet the needs of this population, are age-restricted in some incarnations, and/or are promoted in a way that will reach the target audi-ence. The current pilots include Living Well After Cancer program, ENRICH – exercise and nutrition routine and a half day Art Therapy workshop based on The Creative Journey developed at New York’s Memo-rial Sloan Kettering Cancer Centre.

863

CANCER EDUCATION & RESOURCE CENTER (CARE): CARING

BEYOND

Mazanah Muhamad, Othman Omar, Nurfaizah SaibulUniversiti Putra Malaysia, Serdang, Selangor, Malaysia

Cancer survival is a challenging journey. Medical intervention alone might not be adequate for cancer survivors to live with, through and beyond cancer. Evidences suggested that cancer survivorship needs social support, cancer information, healthy lifestyle, spiritual and psychological compo-nents (Jabson et al., 2010; Radhakrishnan et al., 2010). Cancer Education & Resource Center (CaRE) was developed to provide evidence based cancer information, education and support to those affected by cancer. CaRE, a Center of Excellence for Universiti Putra Malaysia, was set up in 2003 in collaboration with Cornell University, USA. CaRE provides cancer informa-tion through education materials, education and awareness program, peer support, professional counselling, help line, portal and website, and resource center. This paper highlights on CaRE’s supportive role through education, peer support, and production of education material programs. The delibera-tion is based on data in form of records and documents. CaRE’s monthly face to face education program is based on survivors’ needs and recom-mendation from specialists. This program covers components including; 1) cancer treatment, 2) lifestyle, 3) stress management, 4) spiritual, 5) social, and 6) volunteer development. 7,795 people affected by cancer participated through the monthly education program. Customers expressed satisfaction to the program as evidenced by mean score of 4.3/5.0. A total 22 group peer support sessions have been conducted and facilitated by professional counsellors and trained nurses/volunteers. As for the educational material,

30 booklet titles in Malay and Mandarin languages have been published. A total of 23,749 copies have been disseminated through cancer resource centers, hospitals, and NGOs. The continuous participation and demand from customers suggest that CaRE’s supportive role is relevant. CaRE’s model may benefi t other institutions/organizations.

864

A SNAPSHOT OF DISTRESS AND PROBLEMS IDENTIFIED BY

THOSE ACCESSING A CANCER SUPPORTIVE CARE SERVICE

Claire O’Donovan, Alexandra Leggat, Rosie Dobson, Olivia AnstisCancer Society Auckland, Auckland, New Zealand

Background: There is evidence to show that up to 50% of patients and those supporting them (supporters) experience clinically signifi cant levels of distress following a cancer diagnosis. The National Comprehensive Cancer Network’s (NCCN) Distress Thermometer and Problem List can be used as a way of identifying levels of distress and problems in a clinical setting. The Counselling and Psychology Service (CPS), Cancer Society Auckland provides various forms of support including individual based interventions (utilising CBT, ACT, Supportive Psychotherapy and Problem Solving Therapy), group psy-cho-education sessions (Tips and Tools) (stress, sleep, emotional distress, and communication) and specialist group programmes (relaxation and stress man-agement, moving forward after cancer and support for supporters).

Aim: This observational study aimed to assess distress levels and problems reported by individuals presenting at the CPS, in order to determine whether this service provides appropriate support.

Method: All patients (n = 281) and supporters (n = 117) presenting to the CPS for an initial assessment between October 2010 and December 2011 were given psychometric measures prior to seeing a psychologist. This included the NCCN Distress Thermometer and Problem List.

Results: The average distress score for patients presenting for their assess-ment was 4.58 (SD = 2.28) and for supporters 5.31 (SD = 2.16) (range 0–10). The following list indicate the most common problems reported by patients and supporters: ‘dealing with partner’ (25.4%); ‘depression’ (28.6%); ‘fears’ (38.9%); ‘anxiety’ (51.2%); ‘sadness’ (47.5%); ‘worry’ (57.3%); ‘loss of interest’ (26.4%); ‘fatigue’ (46.2%); ‘memory/concentra-tion’ (34.4%); and ‘sleep’ (42%).

Conclusion: The most common problems identifi ed by this study are areas targeted by the different levels of care provided by the CPS. Firstly Tips and Tools provide psycho-education around four pertinent topics in psycho-oncology and secondly individual and group therapy is available for more comprehensive psychological support.

865

SELF-MANAGEMENT SUPPORT IN CANCER CARE PILOT STUDY:

AN INTEGRATED MODEL-OF-CARE AND INTERVENTION

PROTOCOL

Inga OBrien, Diana Sarfati, Louise SignalUniveristy of Otago, Wellington, New Zealand

Due to improvements in cancer screening and treatment, the cancer journey often lasts many years for survivors who routinely manage cancer-related side-effects and sometimes complex medication regimes. Cancer manage-ment occurs within person-specifi c and system complexity requiring indi-viduals to often self-manage and cope with cancer and comorbidities at home. An integrated model of care may address the reality of patient com-plexity and comorbidity in the context of cancer as a chronic condition. This model of care incorporates self-management support and care planning into supportive care delivered during outpatient cancer treatment.

Most self-management support and care planning studies have shown improvement in chronic care outcomes and evidence is needed for the acceptability, feasibility and utility of this approach in the context of cancer care. This mixed method study utilised descriptive interviews and focus



groups to explore the acceptability, feasibility and timing of integrating self-management and care planning support into outpatient cancer treat-ment. A longitudinal outcomes pilot transplanted The Flinders Program from primary care into the secondary care setting to support self-manage-ment, care planning and care coordination.

An integrated model of cancer care is presented that incorporates self-management support and care planning into outpatient cancer treatment. An intervention protocol was developed and implemented to support color-ectal cancer survivors receiving outpatient treatment in Wellington, New Zealand. Process and outcome evaluations are expected to indicate the value of a large-scale trial of The Flinders Program for improving the experience of cancer survivorship across New Zealand.

866

CABAZITAXEL FOR PATIENTS WITH METASTATIC CASTRATION-

RESISTANT PROSTATE CANCER (MCRPC): INTERIM RESULTS

FROM THE AUSTRALIAN EARLY ACCESS PROGRAM

[NCT01254279]

Phillip Parente1, Siobhan Ng2, Francis Parnis3, Alexander Guminski4, Mark Rosenthal5, Stanley Gauden6, George Kannourakis7, Howard Gurney8

1. Medical Oncology, Box Hill Hospital, Boxhill, VIC, Australia2. Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia3. Adelaide Cancer Centre, Adelaide, SA, Australia4. Medical Oncologist, Royal North Shore Hospital, St Leonards, NSW, Australia5. Medical Oncology, Royal Melbourne Hospital, Parkville, VIC, Australia6. Medical Oncology, Launceston General Hospital, Launceston, TAS, Australia7. Director, Ballarat Cancer Research Centre, Ballarat, VIC, Australia8. Medical Oncology, Westmead Hospital, Sydney, NSW, Australia

Background: Despite the survival benefi t with docetaxel in mCRPC,1,2 patients inevitably progress. Cabazitaxel, a novel taxane, improved survival in the TROPIC trial.3 A single-arm multicenter, open label trial has been established to provide early access to cabazitaxel.

Methods: Patients received intravenous cabazitaxel (25 mg/m2) every 3 weeks and oral prednisone 10 mg daily. Safety assessments were undertaken following each cabazitaxel cycle.

Results: Baseline characteristics – median age 70 years, 34% aged ≥ 75 years, 93% had ECOG PS of 0 or 1, 93% had bone metastases and 48% had disease progression during/within 3 months of their last docetaxel dose. Of the 86 patients enrolled: >50% have received at least 4 cycles of cabazitaxel, 50 are still undergoing treatment and 36 discontinued treatment predominantly due to disease progression (22 patients). G-CSF was administered at cycle one of cabazitaxel in 36 (41.9%) patients. Treatment-emergent adverse events (TEAE) considered related to the study drug were experienced by 77 (89.5%) patients. The table shows the frequency of TEAEs occurring in ≥5% of the safety population. There were 2 (2.3%) treatment-related deaths (acute renal failure, neutropenic colitis); 11 (12.8%) patients experienced a TEAE result-ing in permanent, premature discontinuation of treatment.

Frequency of selected toxicities:

TROPIC cabazitaxel arm (n = 378)

Australian EAP (n = 86)

All grades Grade ≥3 All grades Grade ≥3

Neutropenia 347 (94%) 303 (82%) 20 (23%) 17 (20%)Febrile neutropenia – 28 (8%) – 9 (11%)Anaemia 361 (97%) 39 (11%) 26 (30%) 7 (8%)Diarrhoea 173 (47%) 23 (6%) 49 (57%) 7 (8%)Fatigue 136 (37%) 18 (5%) 47 (52%) 4 (5%)

Conclusions: Rapid accrual is suggestive of a high unmet treatment need in this patient population. The toxicity profi le of cabazitaxel appears to be similar to that observed in the TROPIC study. Funding: Sanofi Australia Pty Ltd.

References

1. Tannock IF, et al. NEJM 2004;351(15):1502–12.2. Petrylak DP, et al. NEJM 2004;351(15):1513–20.3. de Bono JS, et al. Lancet 2010;376(9747):1147–54.

867

HEALTH RESOURCE UTILISATION (HRU) AND PATIENT BURDEN

ASSOCIATED WITH SKELETAL-RELATED EVENTS (SRES) IN A

RANDOMISED CONTROLLED TRIAL SETTING

Gary Richardson1, Jean-Jacques Body2, Roger von Moos3, Fred Saad4, Janet Brown5, Allan Lipton6, Karim Fizazi7, Wendy Ying8, Carsten Goessl8, Akshara Richhariya8

1. Cabrini Hospital Malvern, Malvern, Melbourne, Australia2. Brugman University Hospital, ULB, Brussels, Belgium3. Kantonsspital Graubunden Medizin, Chur, Switzerland4. University of Montreal Hospital Center, Montreal, QC, Canada5. Cancer Research UK Clinical Centre, St James’s University Hospital, Leeds, UK6. Penn State Hershey Medical Center, Hershey, PA, USA7. Institut Gustave Roussy, University of Paris Sud, Villejuif, France8. Amgen Inc., Thousand Oaks, CA, USA

Background: Bone metastases (BM) are common in patients with solid tumours and may result in SREs such as spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB) or radiation to bone (RB). SREs result in signifi cant morbidity, debilitating pain, decreased health-related quality of life and increased HRU. An integrated analysis of data from three phase 3 trials demonstrated superiority of denosumab over zoledronic acid in patients with solid tumours and BM was used to assess HRU associated by SRE type.

Methods: Data through 41 weeks for patients with solid tumours and ≥1 BM were included in this post-hoc analysis. HRU data were estimated and compared between patients with ≥1 on-study SRE (by SRE type) and those not experiencing an on-study SRE. The index date was defi ned as the date that the fi rst SRE was reported. Median time from randomisation to inci-dence of fi rst SRE for each SRE type was used to establish an index date for the control (no SRE) group. The HRU window encompassed a 3-month period (i.e. 1 month before and 2 months after the index date) and was assessed by mean number of types of medical visits (outpatient clinical visits, emergency room visits and hospitalisations) during this window.

Results: Data from 5,543 patients were included in the analysis. PF was the most common type of fi rst SRE (n = 1,017), followed by RB (n = 940), SCC (n = 156), and SB (n = 74). 3,618 patients did not have an SRE. For all types of medical visits HRU was higher for patients with an on-study SRE than those without.

Conclusions: SREs are associated with increased HRU, refl ecting an increased burden for patients with solid tumours and BMs.




868

MODIFYING CONVENTIONAL PROGRAM LOGIC APPROACHES TO

INCORPORATE LONGITUDINAL EVALUATION OF RURAL CANCER

SERVICE IMPROVEMENT PROGRAMS: THE GIPPSLAND

CHEMOTHERAPY NURSE PRECEPTOR PROGRAM

Kerrie Missen1, Louise Cristofaro1, Kylie Halsall1, Anne Johnson2, Kiona Smith2, Elmer Villanueva3

1. Gippsland Regional Integrated Cancer Services, Latrobe Regional Hospital, Traralgon, Victoria, Australia2. Latrobe Regional Hospital, Traralgon, VIC, Australia3. Gippsland Medical School, Monash University, Churchill, Victoria, Australia

Background: Programmatic co-modifi cations are rarely captured by tradi-tional program logic models. Especially in the context of a rapidly develop-ing and maturing health program, conventional program logic approaches provide limited guidance and inadequate opportunity to track the dynamic changes that occur over time.

Methods: Using a current rural cancer service improvement program, we have developed and tested a longitudinal approach to program logic that provides insight into the longitudinal components of a program. The Gipps-land Chemotherapy Nurse Preceptor Program (GCNPP) was initiated by Gippsland Regional Integrated Cancer Services in 2007 in response to wide variations in the level of training and experience of chemotherapy nurses within Gippsland and to provide an opportunity for non-chemotherapy nurses to gain practical experience with PICCS and ports and to manage chemotherapy patients within the region.

Results: Now in its sixth year, the GCNPP has incorporated major develop-ments in its approach and delivery to address the service needs of the Gippsland region. Using the modifi ed program logic approach, we can trace the development of different delivery models of the GCNPP as they accrued over time; track modifi cations to the evaluation of clinical competence, knowledge, skills, learning goals and impact on the patient and health services outcomes; and demonstrate the utility of the longitudinal program logic approach in the management and evaluation of a complex health program.

Conclusions: Our suggested use of program logic allows health program managers and stakeholders to gain greater insight into the implementation and evaluation of a complex health program. By explicitly incorporating longitudinal developments, the relationship between the initial program conditions can be more directly linked to anticipated cause-and-effect rela-tionships between program activities and outputs.

869

QUALITY OF LIFE AND COPING IN OVARIAN CANCER: THE LAST

YEAR OF LIFE

Dirkje W Sommeijer1, Melanie A Price2,3, Melanie Bell2, Michael Friedlander1, Martin Stockler1, Anna deFazio4, Penelope M Webb5, The Australian Ovarian Cancer Study Group4,5,6, The Australian Ovarian Cancer Study – Quality of Life Study Investigators, Phyllis N Butow2,3

1. ANZGOG, NHMRC Clinical Trials Centre, Sydney, NSW, Australia2. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia3. Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, NSW, Australia4. Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, University of Sydney at the Westmead Millenium Institute, Westmead, NSW, Australia5. Gynaecological Cancers Group, Queensland Institute of Medical Research, Brisbane, QLD, Australia6. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: The major treatment goal at the end of life of patients with recurrent ovarian cancer is palliation and improving quality of life (QoL). The aim of this study was to determine important symptoms and changes in QoL during the last 12 months of patients’ lives, and the possible effects of preferred coping strategies.

Patients and methods: QoL, specifi c symptoms and coping strategies (opti-mism, minimisation, hopelessness/helplessness) were assessed at three monthly intervals in 217 women recruited into the Australian Ovarian Cancer Study-QoL sub-study between 2002–2007 and who completed at least one follow-up assessment during their last year of life.

Results: The 217 women completed a total of 502 assessments during their last year of life. Overall QoL as well as the functional, physical and emo-tional sub-scales signifi cantly worsened over time, with a more rapid decline commencing 6–8 months before death. Lack of energy (78%) was the most prevalent and severe symptom 4–6 months before death. Other major symp-toms included abdominal swelling (46%), pain (43%), nausea (38%) and loss of appetite (37%), all increasing in prevalence and severity towards the end of life. Forty eight percent of patients were receiving chemotherapy at 4–6 months before death, decreasing to 39% within 0–3 months before death. QoL was positively predicted by optimism (β 0.6 (0.2, 1.1); p = 0.009) and minimisation (β 1.1 (0.4, 1.8); p = 0.003) and negatively predicted by helplessness/hopelessness (β −0.8 (−1.5, −0.1); p = 0.03).

Conclusion: Fatigue, abdominal distension, pain, nausea and anorexia are the major symptoms reported by patients in the last year of life. Many of these could potentially be improved by early referral to palliative care. This is the fi rst study in patients with ovarian cancer showing that coping strate-gies are strongly associated with QoL at the end of life. Whether interven-tions targeting coping strategies might improve QoL in patients with advanced cancer needs further study.

870

UNIQUE ROLES TO SUPPORT OUTREACH CANCER CARE

Lynn Steenhuis1, Lyn Brebner2, Judy Cornick3, Marie Clowes4, Maree Bransdon5

1. Bundaberg Hospital, Bundaberg, QLD, Australia2. Hervey Bay Hospital, Hervey Bay, QLD, Australia3. Rockhampton Hospital, Rockhampton, QLD, Australia4. Gladstone Hospital, Gladstone, QLD, Australia5. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

To achieve quality, safe cancer care close to home it was identifi ed that a pivotal role was required at the sites oncologists visited. The central regional outreach service covers 561,824 Sq Km, 1.6 million people (2008), and



involves twelve oncology staff specialists. In 2005 it was identifi ed that the increasing complexity and frequency of treatment required a specialist role to support and educate patients to facilitate the patient’s journey. The regional Cancer Care Coordinator (CCC) works with the patient and their family to identify solutions to overcome barriers to access treatment.

Positions commenced in 2007, it was quickly identifi ed that the expectations of a CCC role varied between metropolitan and outreach services. ‘Fly in, fl y out’ staff specialists face unique challenges with airlines: fog, fl oods, mechanical breakdowns, baggage handlers, ‘bird strike’ and fl ight delays. Any form of delay requires explanations, negotiations, and diffusing stressed and anxious patients and families, many of whom have travelled and lost income to attend their appointment.

To manage the impact of events outside of anyone’s control the CCC roles require a lateral approach to provide the patient with alternative solutions to their specialist care. Mostly commonly the next available clinic for appointments is on average a month away, however patient shuffl e board impacts on all staff and subsequent clinics. The one clinic of forty patients can impact on up to 120 patients that the CCC role triages and oversees.

The roles are now viewed as pivotal to the success of cancer care service delivery in central regional outreach. Staff specialists, general practitioners, allied health and nursing colleagues identify this role as integral to the delivery of cancer care.

871

MY TIME; YOUR TIME; THE TIME OF LIVING WITH MYELOMA

Moira Stephens1, Christopher F Jordens2, Ian Kerridge2, Stacy Carter2, Heather McKenzie3, Tracy King3

1. University of Wollongong, Wollongong, NSW, Australia2. Centre for values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia3. Sydney Nursing School, Cancer Nursing Research Unit, University of Sydney, Sydney, NSW, Australia

Introduction: Improvements in treatment of myeloma have led to a signifi -cant increase in the median duration of survival Management of the disease often requires onerous and complex regimens involving multi-disciplinary support and treatment from a number of different modalities. This requires signifi cant input of effort from both health care professionals and from patients and their carers.

Methods: Ten patients, with myeloma and attending one of three hospitals, were recruited together with a lay carer. Participants were interviewed on three occasions over 14 months. A total of 47 interviews were generated. These data have been analysed using the constant comparative method of Grounded Theory. Interviews were digitally recorded and transcribed ver-batim. Data were managed using NVIVO software.

Results: Living with myeloma requires effort, planning and organisation and thus, is work. Participants also put effort into managing complications and side effects of myeloma and its treatment and into integrating them into how they live with myeloma. Living with myeloma requires organisational skills, physical and emotional effort and is undertaken by both patients and signifi cant others.

Conclusion: The constellation of activities that require toil and effort by those living with myeloma have been conceptualised as work as it takes effort to live day to day with myeloma. Understanding this notion is impor-tant for healthcare professionals in working with people with myeloma and other cancers. Understanding commonalities and differences between the kinds of work patients and healthcare professionals undertake may assist with working together with patients in their own work and thus enhancing supportive care.

872

DISTRESS AND QUALITY OF LIFE OF DISEASE FREE CERVICAL

CANCER SURVIVORS IN TAMILNADU, INDIA

Surendran Veeraiah, Vidhubala Elangovan, Selvaluxmi GanesanCancer Institute(WIA), Chennai, TN, India

Background: Incidence of cervical cancer in India accounts for 26% of the global burden. Advancements in treatment have increased survival rates, however the quality of life of these patients are under reported in India. The current objective is to determine the quality of life of cervical cancer survi-vors in Tamilnadu – India.

Method: Three year or more DFS Cervical cancer survivors (N = 103) from January 2011 to March 2012 (average years of survival = 3.85, age range = 27 to 70 years, Mean age = 49.68 years) were administered Cancer Institute Quality of Life Questionnaire (CI-QOL), EORTC QLQ CX24 and Distress Thermometer with their consent. Disease stage (Stage I & II N = 77, and stage III N = 26), type of treatment (received only radiation therapy (N = 55) and combined modality (N = 47)) and year of survival were con-sidered for analysis.

Results: Analysis revealed that 33.9% of the cervical cancer survivors were found to have better QOL whereas 66.1% reported poor QOL. While 90.3% of the survivors reported being inactive sexually, 17.1% of them worried about their sexual life. In contrast, majority (79.6%) of them reported better body image, no peripheral neuropathy (81.6) and no meno-pausal symptoms (96.1%). The disease stage (t = 0.303; p < 0.762) and treatment (t = 0.551; p < 0.583) did not alter the QOL. Similarly, these survivors did not differ signifi cantly in body image, symptom experience scale and sexual/vaginal functioning. The level of reported distress (M = 3.88) was found to be less among most of the survivors. QOL and distress was found to be signifi cantly related (r = −0.297, p = 0.002).

Conclusion: Though majority of the DFS cervical cancer survivors did not report good quality of life, and have inactive sexual lives they are free from distress. Disease stage and the type of treatment received did not infl uence QOL functional scales.

873

CURRENT CARE AND NEEDS OF ADULT CANCER SURVIVORS – A

CROSS-SECTIONAL SURVEY

Kate Webber1, Afaf Girgis2, Barbara K Bennett1, Tony Bonaventura3, Fran Boyle4,5, Eng-Siew Koh6, Michael Friedlander7, Eva Segelov8, David Goldstein1,9

1. NSW Cancer Survivors Centre, University of New South Wales, Sydney, NSW, Australia2. Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia3. Department of Medical Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia4. Poche Centre, North Sydney, NSW, Australia5. University of Sydney, Sydney, NSW, Australia6. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Liverpool, NSW, Australia7. Royal Hospital for Women, Randwick, NSW, Australia8. St Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia9. Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

Aims: Meeting the needs of the large and growing population of cancer survivors requires innovative models of care. This study explores survivors’ perceptions on adequacy of their current care, perceived areas of importance and met and unmet survivorship care needs.

Methods: A cross-sectional survey was mailed to adult cancer survivors from 5 NSW oncology units. Eligible survivors were diagnosed in 2008 with no evidence of recurrence in the past 6 months, had adequate English language



and were physically and mentally capable of completing the questionnaire. Self-report data were obtained regarding current care (provider and frequency of visits); ranking of physical, psychological and practical areas of importance to survivors; and how well their needs were met in each of these areas.

Results: 182 surveys were returned (ongoing, response rate 48.7% to date). Respondents had a mean age of 59.8 years (range 32–87), 78% were female, with most common primary cancers being breast (65.9%), colorectal (14.8%), prostate (4.9%) and ovarian (2.7%). More than 90% indicated the importance of follow-up was to check for recurrence, reassurance or to learn about late effects. The majority attended regular follow-up with a cancer specialist (98.3%), every 3–6 months (78%). Two thirds (68.7%) reported follow-up with a GP, with 31% not having seen a GP at all. Sur-vivors felt it was important that they were offered information about check-ups (96.5%) and late effects (91.9%), reassurance (89.6%), help with pain and other symptoms (86.2%) and a written follow-up plan (85.9%). The most commonly reported unmet needs were information about late effects (49.7%), managing fatigue (41.2%), genetic risk to family (34.9%), reas-surance (32.9%) and psychological support (32.0%).

Conclusions: Cancer survivors report signifi cant unmet survivorship care needs despite intensive specialist-led care. This survey will inform service development to better meet the needs of this large and growing population.

874

ASSESSMENT OF A SHORT SUBJECTIVE BURDEN MEASURE AS

A SCREENING TOOL FOR AT-RISK CARERS OF GERIATRIC

ONCOLOGY SURVIVORS

Simeon BW Jones1, Hayley S Whitford1,2, Melissa J Bond1,3

1. School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia2. Cancer Council Australia, Sydney, Surry Hills, NSW, Australia3. Clinical Psychology Department, The Royal Adelaide Hospital Cancer Centre, Adelaide, South Australia, Australia

Aims: To identify the characteristics of carers and their recipients (geriatric cancer survivors), carer psychological morbidity/resilience, and psychological variables and carer/survivor characteristics predictive of subjective carer burden.

Methods: Of 100 anticipated respondents, 76 carers of geriatric cancer survivors aged ≥ 70 years completed a cross-sectional questionnaire includ-ing study-specifi c questions on carer/survivor demographics and health characteristics alongside standardised measures of depression, anxiety, stress, coping, quality of life, mindfulness, and subjective burden.

Results: Carers were mainly female, elderly (M = 65 years) spouses, not working, sole care-giving 35+ hours per week. Survivors were on average 76 years old, 53.9% male, on average 3.3 years since diagnosis, mainly reporting no or limited symptoms. According to the DASS21, 19.1% and 23.6% of carers reported moderate-to-extremely severe anxiety and depres-sion, respectively. Daughters compared to spouses showed higher degrees of psychological morbidity, as did those caring for survivors > 5 years post-diagnosis. Given that all psychological variables assessed in the current study were signifi cantly associated (p < 0.02) with subjective carer burden, all variables with moderate univariate associations r ≥ 0.30 were included in a linear regression. A signifi cant model (p = 0.000) accounted for 59% of subjective carer burden variability (adjusted R2). Of individual predictors, higher depression (β = 0.34), use of emotion-focused coping (β = 0.30), and greater years since diagnosis (β = 0.25) were signifi cant. Other predictors (stress, quality of life, problem-focused, and dysfunctional coping) were not signifi cant.

Conclusions: The Brief Assessment Scale for Caregivers of the Medically Ill (BASC), a 14-item measure of subjective carer burden appears to be a short and easy-to-administer scale and thus could be successfully employed as a screening tool for psychological morbidity (or resilience) in carers of geri-atric cancer survivors. Future research should trial the BASC for identifying at-risk individuals who may require further psychological intervention.

875

EVALUATING PAIN AND ANALGESIC USE IN PATIENTS WITH

SOLID TUMOURS AND BONE METASTASES RECEIVING

DENOSUMAB OR ZOLEDRONIC ACID (ZA) FROM 3 IDENTICALLY-

DESIGNED, RANDOMISED, DOUBLE-BLIND, TRIALS

Sally Woodhead1, Gisela Mayer2, Gail Fitzpatrick3, Georgette Frey4, Hannah Wigginton5, Charles Cleeland6, Ada Braun7, Yi Qian7, Karen Chung7

1. Sydney Adventist Hospital, Wahroonga, Sydney, Australia2. Kantonsspital Graubunden Medizin, Chur, Switzerland3. Urology Associates/Urologic Medical Research, Kitchener, ON, Canada4. Pitt Pavillion, The University of Arizona Cancer Center, Tucson, AZ, USA5. Cancer Research UK Clinical Centre, St James’s University Hospital, Leeds, UK6. MD Anderson Cancer Center, University of Texas, Houston, TX, USA7. Amgen Inc., Thousand Oaks, CA, USA

Introduction: Clinical research nursing focuses on the care and education of research participants, and this is particularly important for patients with solid tumours and bone metastases (BMs), who may experience complications such as skeletal-related events (SREs), pain, impaired mobility, or increased anal-gesic use. In three phase 3 trials, denosumab was superior to ZA in preventing SREs in patients with solid tumours and BMs. In this analysis, pain and analgesic use were evaluated in an integrated analysis of these trials.

Methods: Patients randomly received double blind subcutaneous deno-sumab 120 mg or IV ZA 4 mg (adjusted for renal function) Q4W. Pain severity and analgesic use were assessed at baseline and before each monthly dose. Worst-pain severity ratings were classifi ed as no/mild (0–4) and moder-ate/severe (5–10). Analyses included all randomised patients (N = 5544). To assess pain progression, patients with no/mild pain at baseline were evalu-ated for time to moderate/severe pain.

Results: Denosumab reduced risk of progression from no/mild pain at base-line to moderate/severe pain by 17% (HR 0•83; p < 0•001). Furthermore, the proportion of patients who progressed was less with denosumab versus ZA (average 13.5% less), statistically signifi cant at the majority of visits (p < 0.05). Patients (%) shifting from baseline no/low analgesic use (AQA score 0–2) to strong opioid use (AQA score >2) was less (average 13.4% less) with denosumab versus ZA.

Conclusion: These fi ndings indicate bone-targeted agents play an important role in pain control in these patients, with denosumab preventing pain worsening more effectively than ZA in patients with solid tumours and BMs, and with fewer patients on denosumab shifting from no/low analgesia to strong opioid analgesia compared with ZA.


876

RETURNING TO WORK FOLLOWING CURATIVE CHEMOTHERAPY:

A QUALITATIVE STUDY

Stephanie Zrim1, Vikki Knott2, Sharon Lawn3, Michael Shanahan4, Bogda Koczwara5,6

1. Medical Oncology, Flinders University, Adelaide, SA, Australia2. Department of Psychology, University of Canberra, Canberra, ACT, Australia3. Department of Psychiatry, Flinders University, Adelaide, SA, Australia4. Department of Rheumatology, Repatriation General Hospital, Adelaide, SA, Australia5. Medical Oncology, Flinders University, Adelaide, SA, Australia6. Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

Background: Many cancer survivors identify limitations in work capacity and experience altered relationships within their workplace, hindering their return to work (RTW). At present there is no standardised approach to



occupational rehabilitation of cancer survivors and little is known about barriers to return or preferences regarding intervention from the perspective of Australian survivors and health care providers.

Aims: To explore the impact of cancer diagnosis, perceived and experienced barriers and preferred intervention and support regarding RTW for cancer patients treated with curative intent.

Methods: Focus groups and semi-structured interviews were held with i) providers: multidisciplinary team (MDT) members including medical oncol-ogist, radiation oncologists, psychologist, nurse practitioners, allied health, rehabilitation and occupational physicians (N = 15) and general practition-ers (N = 3), and ii) consumers: cancer survivors (N = 16) and a carer (N = 1). Topics explored included: impact of cancer diagnosis and treat-ment; barriers; healthcare staff best able to address barriers; and, preferences for intervention or supports regarding RTW. Audio fi les were transcribed verbatim and thematic analysis was used to analyse the data to identify themes.

Results: Several themes pertaining to the successful return to work were identifi ed. Survivors indicated that a supportive and fl exible work environ-ment was integral in facilitating RTW and/or continuing work whereas the lack of appropriate referral pathways was identifi ed as a potential barrier. Provider focus groups highlighted the need for MDT approaches incorporat-ing the provision of individualised care plans. Potential candidates to deliver the RTW service included practice nurse staff and general practitioners.

Discussion: This study supports the need for a MDT approach to occupa-tional rehabilitation of cancer survivors. This involves a standardised return to work care plan to ensure equitable provision of services, barriers are addressed and continuity care from the tertiary to primary setting. Further research is required to delineate the precise role of healthcare providers in facilitating successful RTW outcomes.

877

DEVELOPING PATIENT RESOURCES FOR WEIGHT MANAGEMENT

IN PATIENTS UNDERGOING CURATIVE CHEMOTHERAPY

Genevieve James-Martin1, Emma Smith2, Michelle Miller1, Stephanie Zrim3, Bogda Koczwara3,4

1. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia2. Department of Dietetics and Nutrition, Flinders Medical Centre, Adelaide, SA, Australia3. Medical Oncology, Flinders University, Adelaide, SA, Australia4. Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

Background: While advanced cancer is often associated with weight loss, curative cancer treatment is often associated with weight gain (Demark-Wahnefried et al, 1997). Weight gain during treatment is associated with greater risk of cancer recurrence and development of lifestyle diseases. Cur-rently, there are no resources available to patients and survivors focussed on weight control.

Aim: To assess the information needs of patients undergoing curative chem-otherapy regarding diet, exercise and weight management for the purpose of developing weight management resources.

Methods: Semi structured focus groups were held with oncology practition-ers, patients and survivors to determine current information provision and information needs.

Results: Focus groups highlighted that information provision regarding diet, exercise and weight management is perceived as insuffi cient and no routine assessment of weight occurs during chemotherapy. Practitioners described barriers to information provision including lack of resources and

time, and practitioners’ uncertainty regarding appropriate messages to provide. Patients wanted more information regarding diet, exercise and weight, and for information to be provided during treatment time and preferably by nursing staff.

Conclusions: The fi ndings of this study suggest that there needs to be an increase in provision of diet, exercise and weight management information that is evidence-based and delivered at an appropriate time by the preferred health care professional. It would also be benefi cial to implement protocols regarding assessment of weight during treatment.

878

THE FEASIBILITY OF AN INNOVATIVE COMBINED NUTRITION AND

PHYSICAL ACTIVITY INTERVENTION FOR CANCER SURVIVORS

– PRELIMINARY RESULTS

Stephanie Zrim1, Stephanie Leggett2, Michelle Miller2, James Dollman3, Lynette Jones4, Sharon Lawn5, Richard Woodman6, Chris Karapetis7, Ganessan Kichenadasse7, Shawgi Sukumaran7, Sue Booth2, Bogda Koczwara1,7

1. Medical Oncology, Flinders University, Adelaide, SA, Australia2. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia3. School of Health Sciences, University of South Australia, Adelaide, SA, Australia4. School of Physical Education, University of Otago, Dunedin, New Zealand5. Department of Psychiatry, Flinders University, Adelaide, SA, Australia6. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA7. Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia

Background: Weight gain and inactivity amongst cancer survivors have been associated with poorer cancer outcomes, functional impairment and cardiovascular morbidity. The optimal model for improving nutrition and activity levels in cancer survivors has not been established. Research indi-cates superior outcomes when incorporating self-management models into health care delivery.

Aim: To evaluate the feasibility of a combined nutrition and physical activ-ity intervention in cancer survivors within a self-management framework.

Methodology: A single centre prospective study of participants with solid tumours aged ≥18 years, treated with curative intent within one of 2 cohorts: 1) those currently receiving chemotherapy, and 2) within 8 weeks of completion of active treatment. The intervention includes the Flinders Living Well Self-Management Program where participants develop nutrition and physical activity SMART goals (specifi c, measureable, achievable, real-istic and timely) followed by the development of a tailored 12 week nutrition and physical activity intervention in consultation with the health care pro-fessional. Feasibility outcomes include recruitment rate, completion rate, progress towards nutrition and physical activity goals, and acceptability.

Results: Preliminary results indicate a high level of interest in the study with 7 of 9 patients (78%) approached consenting to participate. Of these 3 were in cohort 1 and 4 in cohort 2. Most research participants already actively attempt to eat a healthy diet and exercise and are highly motivated, espe-cially those at completion of treatment. Participants undergoing chemo-therapy face additional challenges requiring further support outside the intervention including psychosocial support. Updated feasibility and compli-ance data will be provided at time of presentation.

Discussion: A combined nutrition and physical activity intervention within a self-management framework is of great interest to cancer survivors. Those undergoing chemotherapy face additional challenges requiring further support.

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